Adequate sanitation, together with good hygiene and safe water, are fundamental to good health and to social and economic development. India has already made remarkable strides in the eradication of polio and the elimination of neonatal tetanus. Further, the progress on key health indicators such as infant and maternal mortality rates, as well as the reduction in the incidence of HIV, TB and malaria, helped India meet the Millennium Development Goals on health (MDGs 4, 5 and 6).
Life expectancy at birth has doubled since independence, from 33 years in 1947 to 68 years in 2011. The issues of health and well-being are closely related to that of an adequate water supply and functional sanitation systems. India is focused on ensuring access to water and sanitation services to all. Since the launch of Government of India’s flagship scheme, the Swachh Bharat Abhiyan (Clean India Mission), more than 12 million toilets have been constructed in rural areas.
Still, despite the headway made in the last 15 years, several challenges remain. There are significant inequalities in access to quality and affordable health services, and a disproportionate burden of communicable and non-communicable disease. Low budgetary allocations for health are a key reason. The government’s health expenditure has remained at around 1% of GDP over the past decade, which puts India significantly behind than the global average. These funds are also not efficiently utilised due to fragmented planning and vertical disease programmes.
The private sector, which provides care to about 70% of the population, is unregulated and poorly integrated into health service delivery systems, despite the lack of infrastructure and human resources in the public sector. Access to life-saving drugs remains a challenge despite India’s role as a global pharmacy.
India also faces significant challenges in the provision of quality water, sanitation, solid waste management and drainage. Inequality in access is acute, with more than 90% of urban residents accessing sanitation facilities compared to only 39% in rural India. Additionally, 44% of the population continues to defecate in the open.
The Government of India has demonstrated its commitment to the overall well-being of its citizens. Back in 2005, the central government established the National Health Mission and introduced structural reforms to strengthen health care and sanitation. The National Health Policy 2017 clearly articulates the government’s commitment to reforming the health sector and achieving universal health coverage, not least by proposing an increase in the health budget to 2.5% of GDP. The policy also sets bound targets for disease elimination, reduction of premature and preventable mortality, systems strengthening, as well as improving health services.
The government launched Mission Indradhanush in 2015 to rapidly increase immunisation coverage. It is also investing significant resources towards ending open defecation by 2019 through the Swachh Bharat programme.
Strategic Pathway of SRU for next 11 years (DISHA 2019-30); prioritises ‘Hygiene and Sanitation’ a one of its development agenda. It extends hygiene up to the level of personal hygiene of individuals.