Abstract
Wide disparity exists in access to drinking water across social groups in rural and urban India. This article shows that the economically weaker sections or the lower quintile class does not have access to water within the premises both in rural and urban areas. This indicates that low income or wealth would mean poor access to basic amenities for households. Similarly, access to toilets and incidence of open defaecation reflect social disparities. The regression results show that an increase in the household income increases the predicted probability of maintaining an exclusive latrine. Further, compared to the ‘General Category’, the ‘Scheduled Castes’ and ‘Other Backward Classes’ have a lower probability of constructing an exclusive latrine facility, in the rural and urban areas.
Introduction
Water supply and sanitation facilities are essential for human development. They result in various health and nutritional benefits which in turn have a positive impact on child mortality and morbidity. Bartram and Cairncross (2010) found that adequate sanitation and safe drinking water could avoid 2.4 million deaths (4.2% of all deaths) every year globally. Children from developing countries account for the majority of these deaths mainly due to diarrhoea and subsequent malnutrition. The key to controlling diarrhoea deaths is to focus on three interdependent core issues: water, sanitation and hygiene (WASH). WASH is one of the strategic programmes of the United Nations Children’s Fund (UNICEF) to achieve ‘sustainable water, sanitation services, and the promotion of hygiene, with a focus on reducing inequalities especially for the most vulnerable children’ (UNICEF, 2016). The present article focuses on the first two aspects and tries to review the progress in India.
The water and sanitation studies conducted in India can be broadly classified into two categories. First, some studies used the census data, the Central Pollution Control Board data, the National Sample Survey data, the National Family Health Survey data and the data accessed from international agencies like the WHO and the World Bank to present the macro picture of the existing situation (Kumar, 2019; Kumar & Managi, 2010; McKenzie & Ray, 2009; Murty & Kumar, 2011; Reddy, 2001). The near-consensus in these studies is that the management of basic amenities plays a crucial role in improving the health of the people in urban and rural areas. The second category of studies has used the primary data collected through small sample surveys in various parts of the country to depict the seriousness of the problem. A large majority of these studies has used randomised or non-randomised controlled experiments to emphasise the need for better sanitation facilities for improving the health status of the country. The studies by Clasen et al. (2014), Hammer and Spears (2016) and Augsburg and Rodríguez-Lesmes (2018) fall under this category. The broader focus of these studies was to analyse the impact of the increased disease environment due to poor sanitation on the growth trajectory of children. They contended that various interventions such as the ownership of basic amenities and awareness have a positive correlation with child health. However, inadequate sanitation coverage can lead to stunting. Using a household survey conducted in Gwalior, Madhya Pradesh, Hammer and Spears (2016) showed that overpopulated or crowded conditions may lead to sanitation externalities with worse access to the services, a point highlighted in the first category of studies. The study further reports that ‘a 10-percentage point increase in sanitation coverage translates into an approximately 0.7 centimetres increase in height at age 4’. Most studies argued that girl children would get more benefits than boys from the improved sanitation environment. However, Caruso et al. (2018) pointed out the effects of sanitation on the mental health of women in a cross-sectional study conducted in rural Odisha. The study identifies a positive correlation between access to sanitation and sanitation experiences and their impact on selected mental health outcomes, which includes mental well-being, depression, distress and various forms of anxiety.
A majority of the studies reviewed here focus on the impact of inadequate drinking water and sanitation facilities on health, whereas the present study examines the existing drinking water and sanitation situation and its determinants at the household level. The studies discussed here raise questions that deal with the probable impact of sanitation on health. They help in understanding a wide range of issues associated with drinking water and sanitation in India, but the progress achieved in this area is relatively bleak. To understand this gap, there is a need to review the existing status using the available data and that is the focus of the present study.
The present study has used the National Sample Survey data (NSS) and the WHO/UNICEF database to examine the various aspects of drinking water and sanitation facilities in the country. The rest of the article has been divided into three sections. The first section discusses various problems associated with drinking water, while the second section analyses different aspects regarding sanitation and the determinants of latrine facilities in the households in rural and urban India. The last section provides a concluding evaluation based on the results obtained in the previous sections.
A Review of India’s Approach to Water and Sanitation
Water and sanitation were given due importance in post-independent India, but the progress achieved in both fronts was dismal. The situation changed for the better in the 1990s with the implementation of the Total Sanitation Programme. It was at this time that the country saw tremendous progress in various fields including water development and infrastructure, food grain production, urbanisation and industrialisation. However, it occurred at the cost of various aspects linked to water such as depletion of groundwater level, waterlogging, pollution and increased use of natural resources. The Twelfth Five-Year Plan had pointed out that rural areas would be adversely affected by these changes, which in turn would have an impact on the quality of water. To a great extent, our development strategies have focused more on the benefits rather than the cost which in turn resulted in further environmental degradation.
However, after evaluating the progress achieved in the various sectors, Indian planners modified their approach to development, which was inclusive in nature. This was incorporated in the planning process from the 10th plan onwards, and it aimed at being pro-poor. The new approach widened the debate on development where a large majority argued that the redistribution of resources would reduce economic inequality thereby ensuring high economic growth. However, inclusiveness is not restricted to the mere redistribution of resources. It has a wider implication. ‘Clean water is a key factor for economic growth. Deteriorating water quality is stalling economic growth, worsening health conditions, reducing food production and exacerbating poverty in many countries’. This further strengthens the need to achieve the Sustainable Development Goal (SDG) 6, which is about ensuring adequate water supply and sanitation for all by the year 2030.
Since Independence, India has always followed a top-down approach in managing its water resources and sanitation facilities. However, the 73rd and 74th constitutional amendments entrusted the Panchayati Raj institutions and Urban Local Bodies (ULBs) with more responsibilities. Given this, the state governments had to design, plan and execute programmes on water and sanitation through the respective ministry. However, the institutional framework to provide these services varies from state to state. In some states, the services are delivered by the ministry and ‘State Public Health Engineering Departments’, while in other states, certain specialised departments such as ‘Water Supply and Sewerage Boards’ (WSSB), grama panchayats, municipal corporations and ULBs carry out the work.
The central government, however, took the lead in coordinating various programmes and allocating funds to harmonise the standards across the country. It also devised strategies through various Five-Year Plans to further help the state governments in streamlining their investments to achieve the desired objectives. Additionally, several central institutions have also been involved in planning and monitoring water supply and sanitation either directly or indirectly. For instance, the ‘Central Water Commission’ (CWC) has the responsibility of regulating surface water for drinking, irrigation and industrial purposes. Similarly, the ‘Central Ground Water Board’ (CGWB) monitors the groundwater level and the rate of depletion as well as the production of water resource inventories in the country. Both the agencies are under the Ministry of Jal Shakti, Government of India. There are various other agencies, including research organisations, that are functioning in the areas of water and sanitation to set standards and provide technical assistance to the central as well as the state governments.
The Question of Quality of Water in India: A Survey
According to the United Nations (UN), globally, the progress in providing safely-managed drinking water has improved significantly in the last two decades. It is reported that the growth rate has increased from 61% to 71% between 2001 and 2017. The UN has estimated that around 785 million people in the world do not have access to even basic drinking water. However, in India, the NSS survey has considered ‘improved sources of drinking water’ 1 as a criterion instead of ‘safely-managed drinking water’ as set by the UN. Moreover, comparing different NSS survey data is challenging owing to the different methodologies adopted in the process of data collection. For example, the 69th round of the survey used 13 principal sources which increased to 17 in the 76th round survey. Figure 1 shows that in 2012, 88.5% of households in rural India had improved sources of drinking water, while it was 95.3% in urban India. It increased to 94.6% and 97.4%, respectively, in rural and urban India in 2018. However, ensuring the quality of water has remained a great challenge for the country and so has the issue of sanitation and hygiene. A total of 91.2% of households in the urban areas have access to toilets whereas the figure stands at 56.6% in the rural areas. The results further show that the improved source of drinking water has been primarily due to piped water supply, which is estimated at 65% in 2018. Similarly, non-piped drinking water services have increased in both the survey years. The Twelfth Five-Year Plan aimed to providing at least 55% of rural households with a piped water connection at the end of the plan period, but the actual figure stood at 32.9%. This signifies an improvement in our efforts on the various aspects of providing improved drinking water at all times to households in the rural areas of the country.
Despite the country achieving almost 100% improved drinking water supply in rural and urban areas, its availability within the premises of a household remains a major challenge. In several instances, people must travel 200 m to 1.5 km to collect water. Such households account for 34.1% of total households in 2018 (see Figure 2). It may seem worrisome, but the country has made tremendous progress in this regard over the last few years. Rural India performs poorly in this respect as 54% of the households in 2012 did not have access to water within their premises, and the figure remained high at 41.8% in 2018. However, the situation is different in urban India where 56% of the households in 2018 had access to drinking water within the premises. The survey results show that piped drinking water and water from hand pumps accounts for more than 40% of the share in providing water within the dwellings in urban and rural areas. The other major sources include bottled water, public taps, tube wells and protected wells. In most cases, these sources are far away from the dwellings and people must travel a long distance to collect water. This has its impact on human development as women and children are the ones who are worst-affected.
Unequal Distribution and the Availability of Water
Many studies have observed that the availability of freshwater is unevenly distributed across the country, and a huge disparity exists from region to region, state to state and in many cases, within the state as well. However, different survey results show that a majority of households in rural and urban areas have sufficient drinking water available throughout the year, but the distribution is skewed. The WHO prescribes 25 L of water per person per day to meet basic hygiene and other requirements, including food. In general, the NSS surveys do not collect information on the per capita availability of water, but the results given in Table 1 can be used to illustrate the problem in a different way. It explains the wide differences in the availability of drinking water within the premises of different social groups and income classes. The economically-weaker sections such as the scheduled tribes (ST) and scheduled castes (SC) have poor water availability within the premises, which is far below the national average of 25.8%. Table 1 shows that only 2.8% ST and 11.5% of SC households have access to water within the premises.
The widening disparity in access to drinking water could be understood by analysing income inequalities in the country. The results point to three major aspects. First, the economically-weaker sections or the lower quintile class does not have access to water within the premises of their houses in rural and urban India. This indicates that low income or wealth means a poor access to basic amenities. Second, there exists a wide disparity in the availability of water in the rural and urban areas and our results show this trend. The social groups that belong to the OBC community have more access to water in rural areas (49.5%) than their urban counterparts (34.9%). Further, 52.6% of those belonging to other groups (general category) have water available within their premises in the urban areas, as compared to their rural counterparts, which was only 33.9% in 2012. Third, when it comes to the quintile class, a systematic pattern can be observed where the availability of water, to a large extent, depends on the income of a family. A worrisome fact is that even for the top 20% households with access to water, the availability of water is only 21.4% in rural and 56.8% in urban areas. It shows that income is not a major determinant of access to water in India. Therefore, we need an inclusive approach in achieving various goals of safe drinking water and sanitation in the country.
The results presented in Table 1 indicate structural barriers that exist in India against access to basic amenities. Evidence from across the world suggests that people’s participation in the development process could make a significant change in how we access the resources, which in turn would help in improving our living standards. Further, it has been observed that for a healthy life, water rights should be available and affordable for all without discrimination.
Availability of Principal Source of Drinking Water within Premises by Social Group and Income Class in 2012 (in %)
Sanitation in India
Sanitation is considered one of the important aspects of improved health standards. However, it was not given due importance in the initial decades of Indian development planning. Though many initiatives were taken in various Five-Year Plans, most of them failed to yield the desired results owing to lack of health education, lack of awareness and poor community participation. The available data shows that only 0.1% of the rural population in India had access to sanitation facilities in the 1970s, which marginally increased to 2.45% in the 1990s. However, the 1991 census provided a clear picture. It reported that 9.5% of rural households and 63.9% of urban families had toilet facilities. It certainly shows an improvement, but there is a lot left to be desired when it comes to achieving a 100% sanitation coverage in rural India. The changes in basic sanitation facilities in rural and urban India since 2000 are given in Figure 3. It uses results from various data sets adopted from the WHO and UNICEF database, and shows an improvement in basic sanitation facilities over the years. It is not only the result of various government initiatives, but also of community-led and people-centred awareness programmes undertaken as part of those initiatives. 2 The approach of the Tenth Five-Year plan is noteworthy in this regard. It made an effort to provide toilet facilities in all primary and upper primary schools and facilitated integrated sanitary complexes for women. Similarly, the Tenth Finance Commission also recommended sanitation facilities in higher secondary schools. The School Sanitation and Hygiene Education (SSHE) was one of the components of the Total Sanitation Campaign (TSC) that aimed at providing sanitation facilities in all schools across the country. All these programmes helped in promoting a behavioural change in the society through community participation. It led to an improvement in the basic sanitation facilities and a decline in open defaecation that the country witnessed (Figures 3 and 4).
However, the Swachh Bharath mission proved to be a shot in the arm for the government initiatives. It helped India achieve almost a 100% basic sanitation coverage by the end of 2019 (Figure 3). According to the Ministry of Drinking Water and Sanitation, India witnessed a significant increase in the construction of toilets, about 9 crores since 2014, and saw a substantial reduction in open defaecation during this period (Figure 4). The WHO, in 2019, reported that the global open defaecation trend has been halved from 1.3 billion in 2001 to 673 million. In 2012, the organisation had noted that about 626 million people defaecate openly in India, which is more than twice the figure of the next 18 countries combined. However, since 2014, India, in association with the UNICEF, has made remarkable progress in achieving open defaecation-free targets and in January 2020, the country achieved the goal. Nonetheless, about 7.6% of people in the rural areas and 2% in the urban areas continue to practice open defaecation as their personal preference (Figure 5). This classification done by the NSSO (2010) seems problematic because, if people have access to a latrine facility in their houses, they would prefer not to defaecate in the open. It implies that there may be problems associated with the latrine facility and hence the open-defaecation ‘preference’ is forced upon them. If so, it means that we have not achieved the goal of open defaecation-free India. This calls for an integrated approach to improve the sanitation situation in India, as it has a direct impact on the development of human capital. The WHO, in 2013, reported that over 760,000 children die every year due to diarrhoea, where 88% of the cases are linked to unsafe water, poor sanitation, or insufficient hygiene.
Figure 5 explains that there is wide variation in the distribution of households with no latrine facilities across different states in India. It shows that certain states such as Odisha (45.1%), Uttar Pradesh (37.7%), Jharkhand (33.6%) and Bihar (32.8%) are at the top in the distribution. These are considered poor states in India, which require immediate attention from the government. However, as part of the Swachh Bharat Mission, since 2014, the government has constructed a total of 10.28 crore toilets in the country. However, Figure 6 suggests that having access to latrine facilities does not always translate into its use. There may be several reasons for not using the latrine facilities, and a few among them are malfunctioning due to construction failures, insufficient water and lack of superstructure.
Determinants of Sanitation
The previous section provided the details of the status of drinking water and sanitation in India using different data sources. This section attempts to understand the determinants of access to latrine in rural and urban areas. I have used a binary model to this end and the details of the variables used in the model are given in Table 2. The logic behind using a binary probit model is derived from the descriptive results given in the previous section, which shows that sanitation facilities have improved in India over the years. This improvement is brought about by certain factors that must be identified as the prime motives behind the modelling exercise. Hence, the dependent variable used in the model takes the value of 1 if the households have access to latrine exclusively for their use, and 0 otherwise. The explanatory variables have been grouped into five categories.
Description of the Variables Used in the Model
First, we assume that income is a major determinant of having a good latrine in the households. Hence, we expect a positive sign of the coefficient. However, a major drawback in the NSS survey is the lack of variables representing income while collecting the socio-economic data. Therefore, we have used the monthly consumption expenditure of a household as a proxy for income. Second, more members in the family require exclusive latrine facilities in households, and hence, we expect a positive sign for the variable household size. The third aspect is related to access to water, which is a dummy variable. We assume that the exclusive availability of water is positively associated with the latrine facility and hence, we expect a positive sign of the coefficient. The fourth groupings include the incorporation of a social group into our model. This is also a dummy classification where the general category of households is taken as the base against which the others are compared. The general category is commonly known as the upper caste, whose standard of living is comparatively better than the other social classes. Therefore, a positive sign for the comparison group would indicate an improvement in sanitation and hygiene. The last categorisation of variables consists of the awareness level of the households, which is captured through the extent of education. This is also a dummy variable where we expect a positive sign of the coefficient. The mean and standard deviation (SD) of the variables used in the model are given in Table 3.
Summary Statistics of the Model
The Impact of Income, Size of the Households and Access to Water on Latrine
The probit model results given in Table 4 shows that income is one of the major determinants of having basic amenities in a household. As we expected, the income of a family has a positive sign for the coefficient, which indicates that an increase in the household income increases the predicted probability of maintaining an exclusive latrine. However, the result shows that there are substantial differences in maintaining the basic amenities in rural and urban households, which is evident in the marginal effects presented in the model. About 31% of the households in rural areas and 26% of the families in urban areas are likely to maintain exclusive latrine facilities as their income increases. This indicates that households with the highest per capita income 3 have a high probability of maintaining exclusive latrine facilities. Similarly, exclusive access to water in the households would also increase the probability of setting up sanitation and latrine amenities. In the previous paragraph, we assumed a positive relationship for the variable household size as well, but the model estimated a negative relation for the coefficient. It shows that maintaining exclusive amenities for the households is expensive in both rural and urban areas and hence they may resort to common latrine facilities. India being a patriarchal society, women are the ones who suffer the most in the absence of sufficient drinking water and sanitation facilities.
Determinants of Access to Latrine Facility in Rural and Urban India in 2012
The Social Group and Education
The Indian society is not only patriarchal but is caste-centred. The incorporation of the dummy variable such as a social group helps us in comparing the amenities available to different groups of people. However, before explaining the social hierarchy and the question of sanitation, a brief insight into the caste system will help in explaining the results. Historically, scheduled tribes (ST) and scheduled castes (SC) are the most backward and downtrodden sections in the society. After Independence, a series of measures taken by the government helped them improve their social status. The other backward classes (OBCs) also have similar social stratification, but they are comparatively better than the STs and SCs. Therefore, the model has taken the general category, which is popularly known as the upper caste, as the base against which the rest of the social groups are compared. As mentioned earlier, a change would indicate an improvement in the standard of living of the compared groups. The result shows that when compared to the base category, the OBCs and SCs have a lower probability of constructing an exclusive latrine facility in rural as well as urban areas. The STs, on the other hand, have a higher predicted probability of maintaining a latrine facility exclusively for a household in rural and urban India. This can be attributed to the success of the special programmes and policies meant for the upliftment of STs in India. However, in various other development indicators, they are yet to show progress and that casts serious doubts over the results. Therefore, we need further investigation to validate this argument.
The last aspect is related to awareness about the usefulness of better sanitation and hygiene in households. The model presented in Table 4 has used education as a proxy for awareness and it predicts well, yielding the expected sign of the coefficient in both the models. It indicates that the probability of setting up a latrine increases with more members in the households being aware of its benefits. In general, it is the awareness among women that brings about an improvement in sanitation and hygiene, as its lack may make their life miserable.
Conclusion
The study found that India has made tremendous progress in terms of providing drinking water to its citizens and improving sanitation facilities. However, its quality is still a major concern. Despite the central and the state governments launching various initiatives, wide disparities exist in the availability of drinking water within the premises of different social groups in rural and urban India. It proves to be a serious concern as unequal access to basic amenities retards inclusive development. The recent announcement of country’s open defaecation-free status might be an outcome of a combined effort by the government as well as various stakeholders. However, our results show that a large majority in India does not utilise latrine facilities owing to their malfunctioning and insufficient water supply. In this case, the study suggests a correction within the system to improve the functioning of the administrative mechanism in the country. Moreover, the effort requires more public expenditure to provide basic amenities to all citizens.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author received no financial support for the research, authorship and/or publication of this article.