India, with the second largest population in the world, is staring at a major health hazard due to lack of poor drinking water and hygiene facilities. According to a report by Water Aid (2016), India has the highest number of people in the globe without access to safe drinking water.
In urban areas, the problem of poor drinking water and hygiene is only going to increase due to fast urbanisation and pollution. Substantiating this, Arvind Panagariya, the vice chairman of NITI Aayog has said that the country's urban population is expected to rise by 22 crores by 2031-32 to 60 crores, as against 37.7 crores in 2011.
The delinking of safe drinking water from public health policy, thus, has led to the state's failed response in making potable water available for all.
In rural areas, with the huge geographical diversity, water resources and their availability greatly vary. Rajasthan, the biggest state in India is dominated by arid landscape. Here, the problem of water scarcity is further aggravated by the potassium contamination in the meagre drinking water that is available. In states like Maharashtra and Chhattisgarh, the tradition of "water brides" exists. In some parts, it is a common practice for men to have more than one wife, so that the wives can carry drinking water from far off places! Further, in north Indian states like Uttar Pradesh, Bihar, though the rivers are perennial, they are greatly polluted with toxic chemicals, making the water non-potable. In the Yamuna belt, there has been an increase in the metal content in the ground water. In states like Haryana and Punjab, the ground water has become saline due to excessive use of chemical fertilisers in agriculture. Thus, water contamination is prevalent across regions due to varied reasons, making the already scarce drinking water scarcer.
Also, lack of safe drinking water has serious implications on the economy. People in rural India are non-voluntarily spending a minimum of ₹100 per annum for the treatment of water/ sanitation-related diseases. In a monetary sense, this amount adds up to ₹6,700 crore annually. This is ₹52 crore less than the annual budget of the Union Health Ministry and more than the annual budget of the Education Ministry.
State's ineffective response
The ineffective response of the state to deal with the problems of non-availability of clean drinking water has its origin in the policy decisions taken soon after independence, when the Indian health administration and governance was going through a transition.
In 1949, the Bhor committee, for the first time, highlighted the provisions for clean drinking with 40 years as a time limit. In 1969, the National Rural Drinking Water Supply Programme was launched with the support of UNICEF. Later, the programme was renamed as the Accelerated Rural Water Supply Programme (ARWSP) in 1972, the National Drinking Water Mission (NDWM) in 1986 and the Rajiv Gandhi National Drinking Water Mission (RGNDWM) in 1991. In 2009, the National Rural Drinking Water Programme was re-launched which subsumed the earlier ARWSP and the sub-missions, miscellaneous schemes, mainstreaming the Swajaldhara principles. Subsequently, the National Water Policies of 1987, 2002 and 2012 highlighted the concerns of clean drinking water. However, these recommendations were never taken seriously enough to evolve them into implementable programmes.
We need to have a mission mode programme on drinking water in place. For this, adequate data about the drinking water infrastructure, water quality etc. is of great importance.
Despite the several programmes, access to safe drinking water did not improve. Many of the above mentioned programmes failed because of the lack of adequate budget, periodical intervention, redesign and call back of schemes. Further, these programmes were implemented by the Department of Drinking Water Supply under the Ministry of Rural Development. There was no separate Ministry of Drinking Water and Sanitation until 2011. Also, the Health Ministry was completely disassociated with all these programmes. This highlights an important issue of the lack of understanding of safe drinking water as a vital component of public health.
Safe drinking water as a public health component
Drinking water and sanitation form a major component of population-wide preventive services. In public health discourse, there are three sets of health systems services: population-wide preventive services, clinical preventive services and medical services.
In India, clinical preventive services (piggybacked on medical services) garnered the major focus in public health policy making. The Millennium Development Goals along with several vertical programmes gave credence to this. As a result, population-wide preventive services were sidelined in public health policy. Further, drinking water, then, was not considered as an issue directly affecting health. Instead, water was mostly understood through the framework of irrigation and agriculture, leading to the sanctioning of large dams in India.
In the late 1990s, sanitation was promoted through schemes such as the Total Sanitation Campaign and Nirmal Bharat Abhiyan. However, clean drinking water, again, did not receive much attention as a public health concern.
This delinking of safe drinking water from public health policy, thus, has led to the state's failed response in making potable water available for all. The WHO has documented 37 diseases as the major causes of death in developing countries, of which 21 are associated with water and sanitation. Around 1,40,000 children in India die from diarrheal diseases every year because of drinking dirty water. Thus, it is high time for safe drinking water to be prioritised in public health policy.
Safe drinking water and sanitation are the two vital components of population-wide preventive services in public health systems. After 67 years of independence, in 2014, India launched its first mission mode programme to address the issue of sanitation. Drinking water, the other component is yet to receive the deserved attention, and as elucidated above this neglect is responsible for far too many deaths.
More than ever, we need to have a mission mode programme on drinking water in place. For this, adequate data about the drinking water infrastructure, water quality etc. is of great importance. Without quality data, accurate and effective policy decisions are not possible. Thus, standardised data on drinking water should be collected and compiled at the earliest.
For implementing all these measures, it is first imperative to view lack of safe drinking water as a public health concern. Perceiving drinking water as only a basic service and not a vital public health component downgrades its significance in the growth and development of India.