The economics of sanitation
Primary amongst the 17 goals geared to make the world a better place by 2030, is sanitation and the access to safe and clean water. Globally, one in three people still live without sanitation, making it a key metric of disparity, inequality and lack of access to a path to a better life. But more crucial is the link between a lack of sanitation and ill-health. India still ranks high when it comes to open defecation – a grave national issue that we have been trying to combat for decades now. According to UNICEF, more than 564 million people in India still practice open defecation.
Sanitation is the third crucial leg of the health and nutrition triad. The three aspects are linked in more ways than one may immediately realise. In India alone, the lethal effects of the link between inadequate sanitation and ill-health is visible in some very dismal numbers. One in five children under the age of two is believed to suffer from severe diarrhoea, caused by exposure to contaminated water, every year. The specific culprit is Rotavirus – a kind of diarrhoeal infection that is commonly seen in infants exposed to unclean living conditions without access to sanitation and safe and clean water. Rotavirus kills approximately 98,000 toddlers annually. It is a double edged sword because in cases where the viral infection is caught in time, treated and cured, the child becomes highly susceptible to rapid dehydration. And in the absence of clean water, this is equally lethal. It is alarming to note that India accounts for 20% of the 500,000+ children under five years of age, who lose their lives annually due to severe dehydration caused by diarrhoea.
The most alarming feature of sanitation coverage is the prevalent inequity. The disparity between the greater access granted to the richer, well-off segments of society, versus the greater majority of disadvantaged segments of society do not even have access to a toilet, let alone sanitation and clean water.
Much has been said about how the quest to abolish open defecation cannot be won by providing toilets alone. Yes, ensuring access to toilets is crucial, however it is imperative to think of sanitation in a broader sense so we also take into account the allied aspects like health care, disease management, management and disposal of solid and liquid waste, and most of all the environmental impact of all of this. With population rising exponentially even as we roll some of these policies out, we have a huge task on hand just keeping up with the numbers and ensuring that we reach the remotest people and populations.
India’s Prime Minister Narendra Modi took the issue head-on, with the launch of the Swachh Bharat Mission – a policy-driven mission that promised improved sanitation and public health. It is one of this government’s most lauded, widely publicised and praised campaigns, with ambitious goals to eliminate open defecation entirely, eradicate manual scavenging of sanitation lines as well as pumping the system with modern and scientific methods of solid waste management. Alongside this is a campaign to broaden the reach of awareness around the need for sanitation and its link to good health. The accent is clearly on building effectiveness through knowledge-building, spreading information through activities and other modes of engagement.
However, there is a glimmer of hope and some signs of an upward spike. The WHO, in a report released in late 2018, lauded India’s Swacch Bharat Mission for the increased focus on providing improved sanitation. In the event that the mission achieves its goal of 100% coverage by October 2019, it will ensure that 300,000 deaths caused by diarrhoea-related diseases and protein-energy malnutrition (PEM) will be averted. In the report it is also said that, “According to calculations, if all sanitation services are used, the initiative could result in over 14 million more years of healthy life in the period measured, with the benefits accruing yearly thereafter.”
The math is promising: the more the disadvantaged factions of society gain access to improved water and sanitation services, the more their health improves. And the more their health improves, the more health care costs are saved. That’s not all, healthier citizens also means more able and willing working citizens. According to a 2014 UN report, every dollar invested in providing access to clean water and better sanitation brings a four-fold return in the form of slashed health-care costs.
It is therefore in our country’s best interests to power on and keep the momentum we have gathered in this respect, going full steam ahead. Poor sanitation results in greater disease spread. The Water and Sanitation Program (WSP) launched an Economics of Sanitation Initiative (ESI) in 2007 to deem precisely what the cost of inadequate sanitation is. Lack of sanitation costs the world USD 260 billion, annually.
In an older time and day, the economic value of a resource such as water or sanitation would be measured by its market price. According to Sustainable Sanitation and Water Management report, “Even economists sometimes make this statement: “In a market system, economic values of water, defined by its price, serve as a guide to allocate water among alternative uses, potentially directing water and its complementary resources into uses in which they yield the greatest economic return.” However, it is also seen that it is the poorest of poor, the most backward sects of our society that pay the heftiest price for this lack of access. Their already low incomes are siphoned off towards healthcare due to diseases caused by contaminated water and exposure to pathogenic living conditions. This further greatly hampers their capacity to provide their families with basic living requirements like three square meals, a roof over their heads, health care and education. Ultimately, the cumulative effects of this result in costs borne by the government.
In 2015, the acute lack of access to sanitation slashed USD 106.7 billion from India’s GDP. This is the immense economic burden of this issue that ails India. However, in the years between 2016 and 2018, a renewed focus, greater resource allocation, better management and goal-based policy has ensured a commitment and new drive to topple these numbers. These efforts have manifested a growth in household sanitation coverage going up from an estimated 2% per year in the time pre-Swacch Bharat Mission to more than 13% annually today.
While it may be inaccurate and near impossible to specifically quantify the exact costs saved by providing access to clean water and sanitation, the benefits are far more visible and measurable. These estimates definitely show and prove that the gains far outweigh the costs of investments towards sanitation.