Dirty drains 'drain' health

Dirty drainages, harbingers of illhealth. Image for representation only (Image Source: SuSanA Secretariat via Wikimedia Commons)
Dirty drainages, harbingers of illhealth. Image for representation only (Image Source: SuSanA Secretariat via Wikimedia Commons)

Poor access to adequate and good quality sanitation and hygiene facilities can give rise to a number of water borne diseases in populations. Infact, poor sanitation and hygiene are known to lead to diarrhoeal diseases that lead to deaths of 2,195 children every day with maximum deaths being among under five children in South Asia and SubSaharan Africa.

Poor drainage infrastructure, a neglected issue

This paper titled 'Drain on your health: Sanitation externalities from dirty drains in India' published in the journal Review of Development Economics argues that programs and policies in South Asia over the last two decades have focused on toilet construction and personal hygiene to combat diarrhoeal diseases and such programs and policies have resulted in a steady decline in open defecation rates over the past two decades in India.

However, while toilet coverage is important to prevent diarrhoeal diseases, the role of drain infrastructure in causing diarrhoeal diseases continues to be given less attention in developing countries such as India.

For example, household surveys in India do not systematically collect data on drain availability and quality. The Rural Economic and Demographic Survey in India contains only two questions on sewers. Similarly, India's latest National Family Health Survey, conducted in 2019–2020, contains only two questions on drains.

While India adopted the Central Rural Sanitation Program in 1986, sanitation was overtaken by the need for provision of safe drinking water and disease treatment. The Indian government adopted a supply-driven approach, under Indira Awaas Yojna, that focused on providing subsidies for housing and toilet construction. This was followed by the Total Sanitation Campaign and Nirmal Gram Puraskar where the focus shifted to sanitation through community involvement.

In recent years, such programs supported by popular media campaigns have greatly helped in destigmatising sanitation and hygiene discussions. However, despite these positive developments, village drainage infrastructure has received little attention from policymakers and researchers in rural India.

Drains, carriers of water and sometimes, diseases

A drain passing through houses in any rural village in India is critical for disposing of water from the nearby kitchens and bathroom sinks. Drains passing through neighbourhood are often decentralised networks maintained by a cluster of households for disposal of dirty water from their domestic kitchens and bathrooms.

The sanitary quality of a neighbourhood drain depends on the collective effort of the residents, and can vary within a village and can affect the health and well-being of the households. The study highlights the role of neighbourhood drain quality, in rural Uttarakhand where only 22 percent of the households have roadside drain networks, most of which are open. Poor quality drains, along with open defecation and poor neighbourhood sanitation practices, can be a dangerous vector of bacteriological transmission. The study is based on the findings of survey of 1,530 households in rural Uttarakhand.

The study finds that:

Many of the households dispose off their wastewater into open drains

Twenty-nine percent of the households dispose off their domestic wastewater into soak pits and house gardens, which is generally considered safe . Approximately 24 percent of the households divert their wastewater into the roadside open drain and directly into the stream.

Almost half (47 percent) of the households have no drain and the wastewater from their homes freely flows outside.

Water shortages, water borne diseases are common in the villages

The hilly and densely forested terrain of the state makes it difficult to be covered by water supply schemes. Only about half of the state is covered by functioning water supply schemes. Moreover, about 30 percent of the schemes suffer from water shortage, especially during the summer months. As a result, some villagers spend 1 to 3 hours a day in collecting water for domestic use. Water-related diseases are a significant health problem, particularly for infants and children.

Most of the toilets in Uttarakhand are pour-flush-type toilets. About 21.1 percent households have had ill-health incidences related to waterborne diseases in the 12 months preceding the survey. Alternatively, 4.1 percent of the household members have had illhealth incidences associated with waterborne diseases.

A high number of households have dirty neighbourhood drains

Approximately 51 percent of the households have a toilet inside their house, and 41 percent have access to drinking water inside their house. About 7.5 percent of the households report that their neighborhood drains are clean, and 20.5 percent of the households have toilets constructed with the support of the government's toilet subsidies scheme. About 38 percent of the villages are located on plain terrain, and almost 30 percent of the villages are part of the Swajal program.

As high as 52 percent of the households have dirty or very dirty neighborhood drains.

There is a significant variation in the sanitary quality of drains across the districts. As high as 57 percent of the households in Pauri district have dirty drains followed by 41 percent in Nainital. The districts of Almora, Bageshwar, and Uttarkashi have relatively cleaner neighborhood drains.

Households having clean drains have lower incidences of ill-health

Around 17 percent of the households with “very dirty” neighborhood drains have ill-health incidences, whereas only about 10 percent of the household with “clean” neighbourhood drains have episodes of ill-health.

Households having clean neighbourhood drains have significantly lower ill-health incidences. The households living in the network of a clean neighbourhood drain have 0.33 times lower ill-health incidence.

The study thus finds that the sanitary quality of neighbourhood drains, in addition to toilets, are associated with household ill-health incidences signifying that dirty neighbourhood drains are key vectors of pathogen transfer. Households having clean drains in their neighbourhood have about one-third the incidence rate of waterborne diseases compared to those having dirty drains near their house.

The study directs attention at the need to consider the sanitary quality of village drains in India and other developing countries and argues that improving drain quality along with improved access to sanitation facilities, could address sanitation externalities in rural health in India.

The paper argues that toilet construction alone is unlikely to eradicate open defecation and improve health outcomes and while multi-pronged strategies, including information campaigns are important, investment in improving neighborhood drains could be a more effective strategy since it contributes directly to household ill-health incidence and has the potential to mitigate the disease burden of open defecation.