Using community support to battle fluoride contamination

Anita Sharma and Anil Gautam of Peoples Science Institute, Dehradun talk about their work with fluoride affected communities in Madhya Pradesh.
Several young children in Jhabua suffer from skeletal fluorosis (Source: INREM Foundation)
Several young children in Jhabua suffer from skeletal fluorosis (Source: INREM Foundation)

What is the exact problem as regards fluoride contamination in Madhya Pradesh, particularly in Dhar district?

A continuous level of 1.5 mg/l and above of fluoride in drinking water is considered hazardous for the health of bones and teeth. In Madhya Pradesh 27 districts are affected with fluoride contamination.

Dhar, a drought prone district in the southern tribal belt of Madhya Pradesh has high levels of fluoride in its groundwater. People are dependent on groundwater which they traditionally withdrew from open wells. Now handpumps and tube wells are commonly being used for domestic purposes. With the increase of irrigated agriculture, the groundwater level has started depleting, requiring people to go deeper. Deeper sources of water are more prone to fluoride contamination as they allow for more contact with rocks. The effects of high concentration of fluoride have been investigated by various researchers. A study conducted in 2011 by People’s Science Institute (PSI), Dehradun detected endemic fluorosis in 31 villages of Dhar. Skeletal fluorosis and an increased risk of bone fracture occurs as a result of long-term excessive exposure to fluoride. Open defecation is a common practice here leading to fecal contamination of drinking water.

According to the Public Health Engineering Department (Government of Madhya Pradesh) data, out of 3763 water sources monitored by them in 13 blocks of Dhar, 1683 sources have been found to be contaminated with fluoride. The fluoride concentration in water was found to be as high as 17 mg/l in some areas, which is significantly higher than the Bureau of Indian Standards (BIS) norms of 1.0 to 1.5 mg/l for drinking water.

What is the status of surface water in the area? Can it not reduce dependence on groundwater? Or are people forced to drink from fluoride contaminated groundwater aquifers?

Low rainfall of less than 1000 mm has been responsible for drought-like situations. This has implications on the availability of drinking water in a major way. With seven major rivers flowing through Madhya Pradesh, it is a paradox of sorts that the drinking water needs are almost entirely (about 99 percent) being met through groundwater extraction. An increasing use of handpumps and tubewells clearly points to the over-exploitation of groundwater in many parts of the state.

Over the last three census decades, the proportion of rural households depending upon handpumps and tubewells as the primary and dominant source of drinking water has risen sharply, from above one-third in 1991 to over half in 2001 and about two-thirds by 2011.

Please tell us about the work of People’s Science Institute in fluorosis mitigation in Dhar. What approach do you follow to control the spread of fluorosis?

PSI has successfully implemented community based safe drinking water supply system in three villages--Kaalapani, Badichetri and Daheriya--in Dhar district by advocating that groundwater is a common pool resource and that safe drinking water is a necessity. Village level institutions were developed after strong community mobilisation which resulted in the preparation of operation and maintenance plans, monthly contributions and sharing of groundwater by the communities. The interventions were based on local hydrogeological studies, groundwater quality and urinary analysis.

As per PSI’s hydrogeological studies in this area, geogenic contamination is proportional to the depth of the water source, as deeper sources allow for more contact with the rocks. That is why most of the tube wells and hand pumps here have higher concentration of fluoride (>1.5 mg/L) as compared to wells. But unsafe sources viz., handpumps and tubewells are being used for domestic purposes because of their easy accessibility whereas safer sources, which are the wells in this area, are mostly being used for irrigation. The programme is based on the principles of Participatory Groundwater Management (PGWM) which includes recognising groundwater as a common pool resource, studying the local hydrogeology in assessing the extent of geogenic contamination, and working towards its sustenance and equitable use by involving local communities. The uniqueness of our approach is that we used the science of hydrogeology to correlate the depth of fluoride mineral bearing rocks and water contamination. An agreement was signed by the villagers that the source well water will not be used for gardening, irrigation or construction purpose. We have used urinary fluoride as a tool to look at the impact of the program on the health of the people.

We insisted on the use of well water rather than defluoridation units or rainwater harvesting. The reason was simple--change is hard. The closer things are to what the people are accustomed to, the more likely it is that people will adopt them and people’s routines are also not changed in anyway.

This kind of participatory and scientific approach is safe, sustainable and less expensive than the installation of defluoridation units attached to hand pumps. The results of an impact study conducted recently are encouraging.

How different is it from the Public Health Engineering Department’s handpump based defluoridation units?

PHED’s interventions so far have not been able to achieve the desired level of success perhaps because their programme design does not have much scope for community involvement or for proper operation and maintenance of the installed units which results in their becoming dysfunctional after some time. Since the PHED is primarily a works department, it does not have a cadre of extension workers to work with the communities. In this context, if community driven initiatives for fluoride mitigation are taken up involving the local CBOs, then chances of success increases many fold.

How does PSI train the villagers to operate and manage the community based safe drinking water systems?

PSI involves the communities from the planning stage (pre-implementation) phase itself after collecting the baseline village data and water quality data. Through various means of community mobilisation the collected information is shared with the people. A logical reason behind the existing water quality problems and demonstration of simple water quality tests helps in demystifying certain complex issues to them in a simple manner. Once they clearly understand the problem, they come up with the possible solutions themselves. Based on the feasibility of the suggested solutions and the most agreeable solution to the majority, a plan to implement the solution is prepared. This is also done by the communities under our guidance and finally it is prepared in the form of a consent document on a stamp paper duly signed by the villagers.

A Water User Committee (WUC) is also formed which has both male and female volunteers to take up responsibilities to operate and maintain the water supply system they have thought of for their village. Rules, responsibilities and per household monthly contribution to operate and manage the water supply system are decided by the WUC members in consultation with the rest of the villagers. A final O&M plan is prepared by them on stamp paper which is signed by all the members of the WUC. A bank account is opened which has two signatories from the newly formed WUC.

Thereafter, the proposed water supply system is implemented in which the village community also contributes through shramdan. In this way the people develop a sense of ownership and feel responsible for the water supply system. After the structure has been set up, the WUC members are supervised in cleaning the tanks, operating the motor pump, checking the pipes for any leakages and replacing the worn off tap washer. They are also trained in carrying out bleaching of the source well.

The monthly collected contribution deposited by them in their bank account helps them to bear the expenses for operation and maintenance. They are also trained in depositing and withdrawing money from the bank and maintain the bank pass book.

Do they have a community based water quality monitoring and management system in place in these villages?

Once they are able to carry out the above mentioned tasks to begin with, they are provided with a set of stationery items and a small water testing kit having some basic parameters for assessing water quality (pH, fluoride, fecal coliform). They are trained in conducting these tests and in recording the values, minutes of the monthly meetings and monthly contribution details in the register.

What are your plans for scaling up? Can PSI’s approach be replicated elsewhere and under what conditions?

We are currently extending our work in four new villages of Dhar with financial support of Frank Water, UK. There is an urgent need to rapidly promote safe sources of drinking water in fluorosis affected regions. Our approach can certainly be replicated in other areas provided we get some support (through convergence) from the government department and a good local partner organisation to monitor the work for a certain period of time till the communities get used to maintaining the systems set in their villages.