India's sanitation economy is booming, but basic data on water and hygiene still missing

Although the sanitation economy of India is estimated to grow to $63 billion by 2022, the country has failed to gather data on basic water, sanitation and hygiene (WASH) services in hospitals and households.

The Joint Monitoring Programme (JMP) report by World Health Organization (WHO) and UNICEF released on Wednesday has indicated that while developing neighbour China has national data available but India has no available numbers on these basic services.

The global public health agencies in the report said that since the first global report on WASH in health care facilities was published in 2019, many countries have strengthened their national monitoring systems and included WASH indicators in health care facility assessments as well as in routine monitoring information systems (MIS).

In 2022, for the first time, there were sufficient data from 40 countries representing 35 per cent of the global population, to make a global estimate for hand hygiene services in health care facilities.

“The increase in data coverage was in sub-Saharan Africa and in Northern Africa and Western Asia, both of which had enough data to produce regional estimates of basic hygiene for the first time. The only national data available from China covered basic water and basic hygiene services (from a 2018 survey on WASH in primary health care facilities), while no national data were available from India for any of the basic WASH services,” said the JMP report.

India has heavily invested in its sanitation schemes, such as the Swachh Bharat Mission. The finance minister Nirmala Sitharaman recently said that the Swachh Bharat Mission (Urban) 2.0 would be implemented over five years – 2021 till 2026 – with an outlay of Rs 1.41 lakh crore. According to the government figures, Swachh Bharat (Gramin) expenditure has seen an increase from 2014-15 (Rs 2,841 crore) to 2017-18 (Rs 16,888 crore) and a decrease in the subsequent years. However, each year since 2018-19, there has been some under-utilisation of the allocated budget.

The WHO report noted that, however, India has made assessments in hospitals data coverage by population higher for hospitals (24 per cent) than for non-hospitals (10 per cent).  The data is only available from the ‘Kayakalp Award Scheme’ that was launched by the Union Health and Family Welfare Ministry in 2015 as an extension of 'Swachh Bharat Mission'.

The initiative was aimed at improving and promoting the cleanliness, hygiene, waste management and infection control practices in public health care facilities and incentivize the exemplary performing facilities. The scheme is intended to encourage and incentivize Public Health Facilities (PHFs) in the country to demonstrate their commitment for cleanliness, hygiene and infection control practices. Initiated from District hospitals in 2015, the scheme expanded to PHC level (2016) and then covered all Urban Health Facilities by 2017.

As far as the global situation is concerned, the WHO report has said that half of healthcare facilities worldwide lack basic hygiene services with water and soap or alcohol-based hand rub where patients receive care and at toilets in these facilities.

The newly established global estimate revealed a clearer and more alarming picture of the state of hygiene in health care facilities. Though 68 per cent of health care facilities had hygiene facilities at points of care, and 65 per cent had handwashing facilities with water and soap at toilets, only 51 per cent had both and therefore met the criteria for basic hygiene services. Furthermore, 1 in 11 (9 per cent) of health care facilities globally have neither.

“Hygiene facilities and practices in health care settings are non-negotiable. Their improvement is essential to pandemic recovery, prevention and preparedness. Hygiene in health care facilities cannot be secured without increasing investments in basic measures, which include safe water, clean toilets, and safely managed health care waste,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health.

The report further said that out of the the countries with available data, 1 in 10 healthcare facilities globally had no sanitation service. The proportion of health care facilities with no sanitation services ranged from 3 per cent in Latin America and the Caribbean and in eastern and south-eastern Asia to 22 per cent in sub-Saharan Africa. In the Least Developed Countries, just 1 in 5 (21 per cent) had basic sanitation services in health care facilities.

"India through Swachh Bharat Mission has made noticeable progress on WASH in the last four-five years, need to be considered while applying the findings of the report in Indian context.  Having said that overall scenario, while has considerably improved, still needs further strengthening. Hospital acquired infection (HAI) rates still remain high in many parts of the health ecosystem and needs concentrated efforts  in coming years," said Himanshu Sikka, Chief Strategy and Diversification Officer and Lead - Health, Nutrition and WASH, IPE Global, an international development consulting company.

"Further improvements in WASH at health facility level will not only lower the pressure on already stretched health systems but also lead to improved productivity by reducing the economic losses that result from unnecessary prolonged illness due to HAIs," he said.