World's largest sanitation drive does not improve health due to people's reluctance to use latrines and lack of good hand washing habits, study finds
By Magda Mis
LONDON, Oct 10 (Thomson Reuters Foundation) - The world's largest sanitation drive to provide toilets for all of India's population has not improved health standards due to people's reluctance to use the latrines and the lack of good hand washing habits, said a study.
Almost half of India's 1.2 billion people defecate in the open - a practice that puts them at risk from cholera, diarrhoea, dysentery, hepatitis A and typhoid fever.
Despite India's launch of the Total Sanitation Campaign over a decade ago, which built millions of latrines aimed at improving sanitation in rural areas, only a quarter of India's rural population has access to toilets. And those who do often decline to use them, researchers found.
"The fundamental problem is that this programme doesn't put enough resources to behaviour change. It is harder to change behaviour than to build latrines," Thomas Clasen, lead author of the study published in The Lancet Global Health, told the Thomson Reuters Foundation.
Although access to toilets in villages in India's Odisha state increased from 9 to 63 percent during the course of the study, the researchers found no evidence that the intervention improved villagers' health.
The reason, said Clasen, was not only an insufficient number of toilets available, but also people's reluctance to use them, lack of hand washing practices, and contact with faeces from children and animals.
"If a family boils its drinking water it's probably protecting itself from pathogens that are transmitted through water. If a family sleeps under a bed net it might protect itself from malaria.
"But in sanitation it's a community issue and the fact that you have a latrine and you use a latrine doesn't mean that you're going to be protected, because there's still a lot of potential sources of exposure in your community," Clasen said.
Clasen applauded India's recent commitment to provide toilets for every household by 2019. But apart from toilet construction, the Indian government needs to make sure that people actually use them in order to succeed in its sanitation drive and in improving health, he said.
HABITS OFTEN DISCOURAGE LATRINE USE
"I don't think building latrines by itself is going to end open defecation. If we're serious about ending open defecation we need to complement this commitment to latrine construction by an equal commitment to latrine use," he said.
Habits such as using open spaces to defecate, not understanding the need to do so in an enclosed space, and often a negative first experience with a dirty toilet might be some of the reasons that put people off using latrines, Erik Harvey, head of Programme Support Unit at WaterAid, told the Thomson Reuters Foundation.
Some people, however, use a newly built lavatory as storage space or even as a temple, as it often is the nicest-looking room in their house.
"In order to achieve the health benefits we need a whole set of conditions together. One is that everybody must have access to toilets and must be using the toilets, and everybody must be practicing hygienic behaviour and (have) access to clean water all at the same time," Harvey said. (Reporting by Magdalena Mis,; Editing by Lisa Anderson)
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