The Modi government has made implementation of schemes at population scale one of its key signatures.
The building of around 11 crore individual household latrines under the Swachh Bharat Mission (SBM) has averted 60,000-70,000 infant deaths annually, according to a recent study published in the prestigious science journal Nature. That shouldn’t come as a surprise. Open defecation is a known source of water and food contamination, besides disease transmission through the fecal-oral route. Repeated infections, in turn, lead to dehydration and malabsorption of nutrients. NFHS data shows the percentage of Indian households with no toilet facility falling from 55 to 39 between 2005-06 and 2015-16. The decline was sharper and within a shorter period to 19 per cent in the 2019-21 survey, enabled by subsidised provision of toilets at scale under SBM launched in October 2014 by the Narendra Modi government. There may be questions over official claims of India becoming open defecation-free. But reduction in infant and child mortality consequent to improved sanitation access is consistent with international experience — and India, as the Nature study has established.
Moreover, it isn’t just early child mortality rates that need to come down. Equally important are stunting (low height-for-age) and wasting (low weight-for-height). These are, again, a result of both inadequate nutrition and poor absorption from recurrent diarrhea, cholera and typhoid attacks caused by contaminated food and water. That’s where a national sanitation programme like SBM could have a transformative role along with the Jal Jeevan Mission. The latter, which envisions providing safe drinking water through tap connections to all rural households by 2024, is also being taken up at-scale. The Nature study has demonstrated district-level toilet access of 30 per cent and above corresponding with substantial lowering of infant and under-five mortality rates. Similar critical thresholds are possible when SBM’s effects are combined with that of universal piped drinking water availability.
The Modi government has made implementation of schemes at population scale one of its key signatures. Some — notably SBM and Jan Dhan — have been successes. Universal access to bank accounts has not only allowed subsidy and welfare payments to be directly transferred to beneficiaries, but also facilitated digital transactions through UPI and other mobile-based protocols. Toilets for all are, likewise, not just about ensuring dignity; they address a major pathway through which millions of Indians are repeatedly exposed to enteric pathogens. But there are, equally, schemes that have been not-so-successful (Soil Health Card) or whose effects aren’t yet visible (Jal Jeevan). Ultimately, it’s a matter of sustained intervention and schemes going beyond meeting their initial numerical targets.
