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KEY TRENDS

• India accounts for 59 per cent of the 1.1 billion people in the world who practice open defecation$

• India has 97 million people without access to improved sources of drinking water, second only to China$

• The population in India without access to water is 147.3 million##

• Indian Government spent 0.57 percent of GDP on water and sanitation in 2008, which fell to 0.54 percent in 2009 and further to 0.45 percent in 2010##

• India provided over 200 million people with access to sanitation between 1995 and 2008##

• Some 1.6 million children die each year from diarrhea and other gastrointestinal diseases for which contaminated drinking water is a leading cause@

• Nearly 65 per cent of rural households had no latrine facility#

• Nearly 18 per cent of rural households had all three facilities (drinking water within premises, latrine and electricity)#

• About 66 million population is at risk due to excess fluoride in 200 districts of 17 States* 

• Arsenic contamination is widespread in West Bengal and it is now seen in Bihar, eastern UP, and Assam*

$ WHO/ UNICEF Joint monitoring report 2012: Progress on drinking water and sanitation, http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf

## Off-track, off-target-Why investment in water, sanitation and hygiene is not reaching those who need it most (2011), Water Aid, http://www.wateraid.org/documents/Off-track-off-target.pdf   

@ Providing Safe Water: Evidence from Randomized Evaluations by Amrita Ahuja, Michael Kremer and Alix Peterson Zwane, April, 2010

# Housing Condition and Amenities in India, 2008-09, National Sample Survey

* 11th Five Year Plan, Planning Commission, Government of India

**page**

Key findings of the WHO/UNICEF joint monitoring report 2012: Progress on drinking water and sanitation, http://www.who.int/water_sanitation_health/publications/2012/jmp2012.pdf, are as follows: 

• India with 626 million people who practice open defecation, has more than twice the number of the next 18 countries combined;

• India accounts for 90 per cent of the 692 million people in South Asia who practice open defecation;

• India accounts for 59 per cent of the 1.1 billion people in the world who practice open defecation;

• India has 97 million people without access to improved sources of drinking water, second only to China.

• 593 million in China and 251 million in India gained access to improved sanitation since 1990.

• China and India account for just under half the global progress on sanitation.

Water

• In 2010, 89 per cent of the world’s population, or 6.1 billion people, used improved drinking water sources, exceeding the MDG target (88 per cent); 92 per cent are expected to have access in 2015.

• Between 1990 and 2010, two billion people gained access to improved drinking water sources.

• Eleven per cent of the global population, or 783 million people, are still without access.

• In 2015 the WHO/UNICEF JMP projects that 605 million will still not have access.

Sanitation

• 63 per cent of the global population use toilets and other improved sanitation facilities.

• By 2015, 67 per cent will have access to improved sanitation facilities (the MDG target is 75 per cent).

• Since 1990 1.8 billion people gained access to improved sanitation.

• 2.5 billion people lack improved sanitation, projected be 2.4 billion by 2015.

• 1.1 billion people (15 per cent of the global population) practice open defecation.

• 949 million open defecators live in rural areas.

Countries that account for almost three-quarters of the people who practice open defecation:

India (626 million)

Indonesia (63 million)

Pakistan (40 million)

Ethiopia (38 million)

Nigeria (34 million)

Sudan (19 million)

Nepal (15 million)

China (14 million)

Niger (12 million)

Burkina Faso (9.7 million)

Mozambique (9.5 million)

Cambodia (8.6 million)

**page**  

According to the policy report titled Off-track, off-target-Why investment in water, sanitation and hygiene is not reaching those who need it most (2011), Water Aid, http://www.wateraid.org/documents/Off-track-off-target.pdf: 

• India has made a political commitment of reaching universal access to clean water by 2012. It has made the political commitment of reaching universal access to urban sanitation by 2012 and rural sanitation by 2017.

• The population in India without access to water is 147.3 million. The population in India without access to sanitation is 818.4 million (WHO/UNICEF Joint Monitoring Programme, 2010). 

• Indian Government spent 0.57 percent of GDP on water and sanitation in 2008, which fell to 0.54 percent in 2009 and further to 0.45 percent in 2010.

• India provided over 200 million people with access to sanitation between 1995 and 2008; however, the progress has been highly inequitable, with the poorest households barely benefiting. Only five million from the poorest section benefited compared with 43 million and 93 million from the richest sections.

• The five countries with the largest absolute numbers of people without sanitation–India, China, Indonesia, Nigeria and Pakistan–are all middle income and account for over 1.7 billion people without sanitation.

• WaterAid research in India illustrates how scheduled castes are denied access to water facilities and how scheduled caste children are not allowed to drink water from common sources at school.

• India and China were top 10 recipients for clean drinking water, sanitation and hygiene (WASH) aid for nine and eight years respectively, which is consistent with the fact that these two countries are home to the greatest number of people without water and sanitation facilities.

• Diarrhoea, 88 percent of which is caused due to lack of access to clean drinking water, sanitation and hygiene (WASH), is now the biggest killer of children in Africa and the second biggest killer of children worldwide. It is responsible for 2.2 million deaths each year.

• Lack of access to water and sanitation is a major drag on economic growth, and costs African and Asian countries up to 6% of their Gross Domestic Product (GDP) each year.

• Poor people in South Asia are over 13 times less likely to have access to sanitation than the rich; and poor people in Sub-Saharan Africa are over 15 times more likely to practice open defecation.

• There is a rural-urban divide in access to clean water and sanitation. 94% of the urban population in developing countries has access to clean water, compared to 76%  in rural areas, and 68% of the urban population has access to improved sanitation, compared with only 40% in rural areas.

• For families without a drinking-water source at home, it is usually women and girls who go to collect drinking water. Surveys from 45 developing countries show that this is the case in almost three-quarters of households.

• Historically, local natural monopolies have been in public ownership, and about 90% of the world’s piped water is delivered by publicly-owned bodies, at both national and municipal levels.

• Increasing overall WASH spending to 3.5% of GDP and sanitation to 1% are very large changes from current levels—but this is the scale of change that is needed if the MDG targets are to be achieved in all regions and LDCs are to get on course for universal access by 2020.

According to Providing Safe Water: Evidence from Randomized Evaluations by Amrita Ahuja, Michael Kremer and Alix Peterson Zwane, April, 2010
http://www.economics.harvard.edu/files/faculty/36_ARRE_CLEAN_2010_04_14.pdf: 

• Some 1.6 million children die each year from diarrhea and other gastrointestinal diseases for which contaminated drinking water is a leading cause.

• Young children are most at risk of death from unsafe water, and women and children are typically responsible for most water collection.

• Multiple randomized trials show that water treatment can cost-effectively reduce reported diarrhea. However, many consumers have low willingness to pay for cleaner water, with less than 10% of households purchasing household water treatment under existing retail models.

• Provision of information on water quality can increase demand, but only modestly. Free point of collection water treatment systems designed to make water treatment convenient, salient, and public, combined with a local promoter, can generate take up of more than 60 percent. The projected cost is as low as $20 per year of life saved, comparable to vaccines. In contrast, the limited existing evidence suggests many consumers are willing to pay for better access to water, but it does not yet demonstrate that this improves health.

• Providing dilute chlorine solution free at the point of water collection, together with a local promoter, can increase take up of water treatment from less than 10 percent to more than 60 percent.

• Evidence available from randomized studies suggests that consumers realize substantial non-health benefits from convenient access to water and are willing to pay for this.

• Separately identifying how water quantity and quality affect health is important because different water interventions affect water quality and quantity asymmetrically. For example, adding chlorine to water affects quality but not quantity. On the other hand, providing household connections to municipal water supplies to households that currently use standpipes is likely to have a bigger effect on the convenience of obtaining water, and thus on the quantity of water consumed, than on water quality.

• Increased availability and convenience of water facilitates more frequent washing of hands, dishes, bodies and clothes, thus reducing disease transmission. There is indeed strong evidence that hand washing is important for health.

• Frequent collection of self-reported diarrhea data through repeated interviews leads to health protective behavior change in addition to respondent fatigue and social desirability bias.

• Frequent data collection leads to lower reports of child diarrhea by mothers relative to infrequent surveying and also to higher rates of chlorination verified by tests for chlorine in water.

• In rural areas, septic tank/flush latrine was used by 18 per cent households as compared to 77 per cent households in urban areas.

Electricity Facility

• At the all-India level, nearly 75 per cent of the households had electricity for domestic use. While 66 per cent households in rural areas had this facility, 96 per cent in urban areas had the facility.

Households With Three Basic Facilities: Drinking Water Within Premises, Latrine and Electricity

• Nearly 18 per cent of rural households had all three facilities (drinking water within premises, latrine and electricity) whereas in urban areas, all three facilities were available to 68 per cent households.

Micro Environmental Elements Surrounding the House

• Nearly 19 per cent of the households in rural areas and 6 per cent in urban areas had open katcha drainage. Nearly 57 per cent of the households in rural areas and 15 per cent in urban areas had no drainage arrangement.

• Garbage disposal arrangement was available to only 24 per cent of rural households and 79 per cent of the urban households.

• Nearly 18 per cent of the rural households and 6 per cent of the urban households had no direct opening to road.

 

According to Progress on Sanitation and Drinking-Water: 2010 Update (WHO and UNICEF), http://www.unicef.org/media/files/JMP-2010Final.pdf:

• Use of improved sanitation facilities is low in Sub-Saharan Africa and South Asia.

• Among the 2.6 billion people in the world who do not use improved sanitation facilities, by far the greatest number are in Southern Asia, but there are also large numbers in Eastern Asia and Sub-Saharan Africa.

• 61% of global population uses improved sanitation facilities

• Unless huge efforts are made, the proportion of people without access to basic sanitation will not be halved by 2015. Even if we meet the MDG target, there will still be 1.7 billion people without access to basic sanitation. If the trend remains as currently projected, an additional billion people who should have benefited from MDG progress will miss out, and by 2015, there will be 2.7 billion people without access to basic sanitation.

• 672 million people will still lack access to improved drinking-water sources in 2015.

• Sub-Saharan Africa faces the greatest challenge in increasing the use of improved drinking-water. 884 million people – 37% of whom live in Sub–Saharan Africa – still use unimproved sources for drinking-water

• In China, 89% of the population of 1.3 billion uses drinking-water from improved sources, up from 67% in 1990. In India, 88% of the population of 1.2 billion uses drinking-water from such sources, as compared to 72% in 1990. China and India together account for a 47% share, of the 1.8 billion people that gained access to improved drinking-water sources between 1990 and 2008.

• For sanitation, even with the increase between 1990 and 2008 in the proportion of the population using improved sanitation facilities in China (from 41% to 55%) and India (from 18% to 31%), the world is not on track to meet the sanitation target. This is despite the fact that 475 million people gained access to improved sanitation in these two countries alone, a 38% share of the 1.3 billion people that gained access globally.

• Of the approximately 1.3 billion people who gained access to improved sanitation during the period 1990-2008, 64% live in urban areas.

• Worldwide, 87% of the population gets their drinking-water from improved sources, and the corresponding figure for developing regions is also high at 84%. While 94% of the urban population of developing regions uses improved sources, it is only 76% of rural populations.

• The rural population without access to an improved drinking-water source is over five times greater than that in urban areas. Of almost 1.8 billion people gaining access to improved drinking-water in the period 1990-2008, 59% live in urban areas. The urban-rural disparities are particularly striking in Sub-Saharan Africa, but are also visible in Asia and Latin America.

• The proportion of the world population that practises open defecation declined by almost one third from 25% in 1990 to 17% in 2008. A decline in open defecation rates was recorded in all regions. In Sub-Saharan Africa, open defecation rates fell by 25 per cent. In absolute numbers, the population practising open defecation increased, however, from 188 million in 1990 to 224 million in 2008. In Southern Asia, home to 64% of the world population that defecate in the open, the practice decreased the most – from 66% in 1990 to 44% in 2008.

• Between 1990 and 2008, more than 1.2 billion people worldwide gained access to a piped connection on premises.

• In developing regions, while 73% of the urban population uses piped water from a household connection, only 31% of rural inhabitants have access to household piped water supplies.

• For families without a drinking-water source on the premises, it is usually women who go to the source to collect drinking-water. Surveys from 45 developing countries show that this is the case in almost two thirds of households, while in almost a quarter of households it is men who usually collect the water. In 12% of households, however, children carry the main responsibility for collecting water, with girls under 15 years of age being twice as likely to carry this responsibility as boys under the age of 15 years.

**page**

According to the study titled Combating Waterborne Disease at the Household Level (2007), prepared by The International Network to Promote Household Water Treatment and Safe Storage and WHO, http://www.who.int/household_water/advocacy/combating_disease.pdf:  

•    Globally, 1.1 billion lack access to an “improved” drinking water supply; many more drink water that is grossly contaminated.

•    4 billion cases of diarrhoea occur annually, of which 88% is attributable to unsafe water, and inadequate sanitation and hygiene.

•    1.8 million people die every year from diarrhoeal diseases, the vast majority children under 5. 90% of diarrhoeal deaths are borne by children under five, mostly in developing countries.

•    Lack of safe water perpetuates a cycle whereby poor populations become further disadvantaged, and poverty becomes entrenched.

•    WHO estimates that 94% of diarrhoeal cases are preventable through modifications to the environment, including through interventions to increase the availability of clean water, and to improve sanitation and hygiene.

•    A 2005 systematic review concluded that diarrhoeal episodes are reduced by 25% through improving water supply, 32% by improving sanitation, 45% through hand washing, and by 39% via household water treatment and safe storage.

•    A growing body of research suggests household water treatment and safe storage (HWTS):a. dramatically improves microbial water quality; b. significantly reduces diarrhoea; c. is among the most effective of water, sanitation and health interventions; d. is highly cost-effective; and e. can be rapidly deployed and taken up by vulnerable populations.

•    Existing low-cost technologies for safe drinking water are: a. Chlorination – adding chlorine in liquid or tablet form to drinking water stored in a protected container; b. Solar disinfection – exposing water in disposable clear plastic bottles to sunlight for a day, typically on the roof of a house; c. Filtration; d. Combined flocculation /disinfection systems–adding powders or tablets to coagulate and flocculate sediments in water followed by a timed release of disinfectant; e. boiling; f. Safe storage

•    Many low-cost HWTS technologies do not come with clear labels and reliable accreditations attesting to their ability to provide “safe” water. This has led to uncertainty and confusion among consumers and other stakeholders.

 

According to the 11th Five Year Plan
http://planningcommission.gov.in/plans/planrel/fiveyr/11th/11_v2/11v2_ch5.pdf:

 The status of provision of water and sanitation has improved slowly. According to Census 1991, 55.54% of the rural population had access to an improved water source. As on 1 April 2007, the Department of Drinking Water Supply’s figures show that out of a total of 1,50,7349 rural habitations in the country, 74.39% (11,21,366 habitations) are fully covered and 14.64% (2,20,165 habitations) are partially covered.

 Present estimates shows that out of the 2.17 lakh water quality affected habitation as on 1.4.05, about 70,000 habitations have since been addressed for providing safe drinking water.

 The access to toilets is even poorer. As per the latest Census data (2001), only 36.4% of the total population has latrines within or attached to their houses. However in rural areas, only 21.9% of population has latrines within or attached to their houses. An estimate based on the number of individual household toilets constructed under the TSC programme (a demand-driven programme implemented since 1999) puts the sanitation coverage in the country at about 49% (as on November 2007).

 An evaluation study on the programme conducted in 2002 shows 80% of toilets constructed were put to use. This use is expected to be much higher as awareness has improved much since 2002.

 The GoI’s major intervention in water sector started in 1972–73 through Accelerated Rural Water Supply Programme (ARWSP) for assisting States/Uts to accelerate the coverage of drinking water supply. In 1986, the entire programme was given a mission approach with the launch of the Technology Mission on Drinking Water and Related Water Management. This Technology Mission was later renamed as Rajiv Gandhi National Drinking Water Mission (RGNDWM) in 1991–92.

 In 1999, Department of Drinking Water Supply (DDWS) was formed under the MoRD to give emphasis to rural water supply as well as on sanitation. In the same year, new initiatives in water sector had been initiated through Sector Reform Project, later it was scaled up as Swajaldhara in 2002. With sustained interventions, DDWS remains an important institution to support the States/UTs in serving the rural population with water and sanitation related services all across India.

 There are about 2.17 lakh quality-affected habitations in the country with more than half of the habitations affected with excess iron (118088). This is followed by fluoride (31306), salinity (23495), nitrate (13958), arsenic (5029) in that order. There are about 25000 habitations affected with multiple problems.

 About 66 million population is at risk due to excess fluoride in 200 districts of 17 States. Arsenic contamination is widespread in West Bengal and it is now seen in Bihar, eastern UP, and Assam. The hand pump attached de-fluoridation and iron removal plants have failed due to in appropriate technology unsuited to community perceptions and their involvement. Desalination plants have also met a similar fate due to lapses at various levels starting with planning to post implementation maintenance.

 To ‘provide clean drinking water for all by 2009 and ensure that there are no slip-backs by the end of the Eleventh Plan’ is one of the monitorable targets of the Eleventh Five Year Plan. The first part of the goal coincides with the terminal year of Bharat Nirman Programme under which it is proposed to provide safe drinking water to all habitations. Under the Bharat Nirman Programme 55,067 not covered habitations, 2.8 lakh slipped back habitations, and 2.17 lakh quality-affected habitations are proposed to be covered.

According to the Water, Sanitation and Hygiene Links to Health FACTS AND FIGURES  *updated November 2004:

• 1.8 million people die every year from diarrhoeal diseases (including cholera); 90% are children under 5, mostly in developing countries.

• 88% of diarrhoeal disease is attributed to unsafe water supply, inadequate sanitation and hygiene. Improved water supply reduces diarrhoea morbidity by between 6% to 25%, if severe outcomes are included.

• Improved sanitation reduces diarrhoea morbidity by 32%. Hygiene interventions including hygiene education and promotion of hand washing can lead to a reduction of diarrhoeal cases by up to 45%.

• Improvements in drinking-water quality through household water treatment, such as chlorination at point of use, can lead to a reduction of diarrhoea episodes by between 35% and 39%.

• 1.3 million people die of malaria each year, 90% of whom are children under 5. There are 396 million episodes of malaria every year, most of the disease burden is in Africa south of the Sahara.

• Intensified irrigation, dams and other water related projects contribute importantly to this disease burden. Better management of water resources reduces transmission of malaria and other vector-borne diseases.

• In 2002, 1.1 billion people lacked access to improved water sources, which represented 17% of the global population. Over half of the world’s population has access to improved water through household connections or yard tap.

• Of the 1.1 billion without improved water sources, nearly two third live in Asia. In sub-Saharan Africa, 42% of the population is still without improved water. In order to meet the water supply MDG target, an additional 260 000 people per day up to 2015 should gain access to improved water sources.

• Between 2002 and 2015, the world ís population is expected to increase every year by 74.8 million people.

• In 2002, 1.1 billion people lacked access to improved water sources, which represented 17% of the global population. Over half of the world’s population has access to improved water through household connections or yard tap. Of the 1.1 billion without improved water sources, nearly two third live in Asia. In sub-Saharan Africa, 42% of the population is still without improved water.

• In order to meet the water supply MDG target, an additional 260 000 people per day up to 2015 should gain access to improved water sources.

• Between 2002 and 2015, the world’s population is expected to increase every year by 74.8 million people.

• The development of water resources continues in an accelerated pace to meet the food, fibre and energy needs of a world population of 8 billion by 2025.

• Lack of capacity for health impact assessment transfers hidden costs to the health sector and increases the disease burden on local communities. Environmental management approaches for health need to be incorporated into strategies for integrated water resources management.