The residents of Bankpura village in Dhar district in Madhya Pradesh, Dilip Bundela (19), Seema Kalu (20) and Naval Singh (35), have one thing in common. All three of them suffer from skeletal fluorosis. Skeletal fluorosis is a bone disease that is caused by the accumulation of fluoride in the bones. In advanced cases, it could cause severe pain and damage to the bones. They are not, however, alone in this village. Many are suffering from this ailment, due to the high fluoride content in the water. 

Today, fluorosis is prevalent in more than 200 districts of 20 states and Union Territories of India and Dhar district is one of them. There is no treatment for fluorosis. The disease, however, is easily preventable if diagnosed early and steps are taken to prevent the intake of excess fluoride. This is possible by making safe drinking water available and through adequate diet. 

Source of water

Dhar, a drought-prone area, lies in the southern tribal belt of Madhya Pradesh. The groundwater level in the district is low and at many locations, it is highly contaminated with fluoride. But unfortunately, in these villages, people are dependent on ground water which they traditionally draw from open wells. With the increase in irrigation for agriculture and the use of motor pumps, the ground-water level has started depleting, forcing people to draw water from deeper aquifers using hand pumps and tube wells. 

Due to the lack of awareness about fluorosis, people use hand-pump and tube-well water for domestic purposes because of easy accessibility. Pipe-water supply from the government wells is also available at some places in these villages but the supply is mostly irregular. Moreover, the wells are not cleaned periodically, resulting in water-borne diseases like typhoid and diarrhoea. 

Access to water is fundamental to human dignity and health. However, it is a struggle for many in Dhar as 50 percent of the population in this district belongs to marginalised tribal communities. Within rural Dhar, disability is a significant issue with many people experiencing impairments of all natures due to increased fluoride content in the water, poor healthcare, old age and other factors. Most people in these vulnerable groups have no access to the facilities available for basic necessities like water because these are not often designed or positioned with the needs of such people in mind. They often rely on others for assistance. This affects their dignity and self-esteem.

A new solution

In order to help such people live with dignity and also to mitigate fluorosis, a Dehradun-based research organisation People’s Science Institute (PSI) initiated community-based safe drinking water supply system in these villages with the financial support of Frank Water, United Kingdom. Their interventions were based on local hydrogeological studies, groundwater quality monitoring and strong community mobilisation. This resulted in the preparation of operation and maintenance plans, monthly contributions and sharing of groundwater by the communities. 

As per hydrogeological and water quality monitoring studies conducted by PSI, most of the tube wells and hand pumps here have higher concentration of fluoride (>1.5 mg/L) as compared to wells. This is because deeper sources allow for more contact of water with the rocks containing fluoride-bearing mineral. Based on these findings, PSI insisted on the use of well water for drinking and cooking purposes. Initially, people were reluctant to accept change but gradually, with village meetings and door-to-door campaigns, the message that consumption of fluoride-free water is the key to prevent fluorosis went across the community. Hand-washing exercises were also carried out to spread awareness about the importance of hygiene. 

In each village, Water User Groups (WUGs) have been formed and the water tanks have been constructed. These are built at places easily accessible to the majority of people. The villagers too helped during the construction of water supply setup. The tanks are now filled up with water from the fluoride-safe well. The waterman, appointed by the villagers, runs the motor pump to fill these tanks twice a day. Most villagers have tap-water connection from this tank. The WUGs collect a monthly contribution -- in the range of Rs 30-50 (as decided by the villagers) -- from the villagers, which is then deposited in the WUGs’ bank account for repair works and also to pay a monthly honorarium to the waterman. The disabled and those who cannot afford to pay are exempted from contributing. In this way, the system is being operated and managed by the communities themselves. The villagers have been trained to clean the source and the water supply tanks well.   

The result shows 

Growing up as a girl child with four siblings in a poor family is difficult but growing up with a disability in such a family is worse.  It was a joyous moment for Seema when fluoride-free water became available just outside her house. Affected by skeletal fluorosis, the most difficult task for her was to walk up to the hand pump or the government tank around 150 m away from home to collect water and carry it back home. At times, she would avoid taking bath or would ask someone to get water for her. But now with a water tank installed just outside her house, she is perhaps the happiest person in her locality. She has to walk very little to get water and doesn’t have to depend on others to fetch her water. With improved access to water, she has ample time to engage in household chores and take care of her personnel hygiene as well.

As Seema’s story elucidates, things have changed for the better now. Water has brought respite to not only the marginalised communities in these villages but also the physically-challenged. Prem Kumar (20), who resides in Banjari village, has an impaired hand due to polio. All these years he had been getting water by manually operating a hand pump but now he gets water easily by just opening the tap. He even stores some water at home so that he can use it at his convenience. The villagers believe the safe drinking water now available will eventually help in fluorosis mitigation as well.

This initiative has set a successful example of decentralised management of groundwater resource. Earlier, a pilot programme on community-based safe drinking water supply was successfully developed by PSI and Frank Water in Kaalapani, Badichetri and Daheriya villages of Dhar. This kind of participatory and scientific approach is safe and less expensive than the installation of defluoridation units attached to the hand pumps which become dysfunctional after sometime. To make this effort sustainable, there is also a need to promote operation and maintenance of these water supply systems by the local communities. The differently-abled people should also be involved in the decision making.

The author, Anita Sharma, is with People's Science Institute, Dehradun. This write up is a collation of the ongoing work by the PSI team that includes Anil Gautam, Puja Singh, Dalpat and Heena.The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of India Water Portal.