Written By: Tania Tarafdar | Published : October 11, 2014 12:39 PM IST
Better toilets may not always mean better health of the citizens of India. Is the programme of building toilets really effective? New evidence has raised troubling questions about India's 25-year strategy of pushing people to use toilets as a way to improve health. The world's largest sanitation initiative which provided access to toilets to over 25,000 individuals in rural India did not seem to have changed the scenario.
In a paper published on Friday morning in the medical journal Lancet,researchers led by Thomas Clasen of the U.S.-based Emory University found that increased toilet coverage did not lead to any significant improvements in the occurrence of child diarrhoea, prevalence of parasitic worm infections, child stunting or child mortality. For their study, Dr. Clasen and his team looked at 50 villages in Odisha's Puri district between May 2010 and December 2013, where the then Total Sanitation Campaign to build toilets was in effect, and 50 otherwise similar villages where the campaign had not yet started.
The programme is effective, but not all households use the toilets. Thecontinued exposure from poor hygiene, contaminated water, and unsafe disposal of child feces, may explain the lack of a health impact This could be key possible explanation for the increase of fecal pathogens in the environment affecting one's health. The researchers said, at the end of the study period, just 63 percent of households in the villages where the scheme ran had any toilet, and two-thirds of this group reported a family member using the toilet. Usage was substantially lower among men than among women.
If everyone with a toilet were to use it, would India then see the positive health impacts of its sanitation scheme?
Dr. Clasen told The Hindu that his research could not conclusively answer that question, given that the study compared all households, whether compliant or not, in the 50 'treatment' villages with the 50 'control' villages.
According to Hindu, Dr. Clasen said, 'India should be proud of the efforts that have been made to improve sanitation and eliminate open defecation. It is an exceptionally large challenge and the new government should be applauded for the commitment it is making'. He recommended two changes, however. 'First, it must target latrine use, not latrine coverage,' he said. Secondly, the sanitation programme should be combined with other environmental health schemes, including safe drinking water and hand-washing, that will limit other forms of exposure.
Other studies, like the one by economists Jeffrey Hammer and Dean Spears in rural Maharashtra, showed an increase in child height following the implementation of the TSC. 'It [Dr. Clasen's] is an important study because it shows that even a very careful effort to improve sanitation might not actually reduce open defecation, because sanitation behaviour is very hard to change,' Dr. Spears toldThe Hindu.
Image source: Getty Images
With Inputs from IANS
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