New Delhi: It has been more than 70 years since India became independent but many of our indices on health, hygiene, literacy and women empowerment continue to be areas of concern. There are fresh doubts over whether all our villagers have access to a toilet despite government’s claims to the contrary. The government has promoted the Swachh Bharat Mission (SBM) vigorously but latest data indicates not every village may be open defecation free (ODF).
Other concerns remain too: nearly every fourth Indian over seven years of age remains illiterate – more women than men, since every third woman in this age group in villages still cannot read or write. Almost half of our rural households continue to use firewood or dung cake for cooking instead of the healthier LPG despite government’s harping over success of the Ujjwala Mission – it has claimed in the past that LPG penetration has crossed well over 90 per cent. And not only is India’s overall spend on healthcare pretty dismal as a percentage of GDP, a majority of Indians seem to be bearing the cost of medical treatment from their savings since not even one in five has any health insurance coverage.
Claims of Cleanliness
There is no gainsaying that India has taken giant strides in making its cities and villages ODF in recent years. But have all of our villages shunned the habit of defecating in the open? Prime Minister Narendra Modi made this claim on Mahatma Gandhi’s birth anniversary on October 2 this year. But latest government data shows there are discrepancies between what SBM data and the reports by the NSO.
More than one in four rural households did not have access to a toilet till October 2018, according to NSO, when the government was citing SBM data to say 95 per cent rural households had access to a toilet. The 76th round of NSO survey on “Drinking Water, Sanitation, Hygiene and Housing Condition in India” shows 29 per cent of rural households (or at least one in four) and 4 per cent of urban households did not have access to toilets till October last year.
How Good Hygiene Habits Helped Villagers Save Money
The discrepancy in ODF is followed by some more data points of concern. Every third rural Indian still does not wash hands with soap and water after defecation, while in cities, nearly two in 10 do not. Nearly all those who do not use soap while washing after defecation in cities just wash hands with plain water, while in villages, more than 15 per cent rely on just water to wash away fecal matter from hands.
While Indians overwhelmingly prefer to use their hands rather than cutlery for eating their meals, only about every fourth villager remembers to wash hands with soap and water before her meal. Two in three wash hands only with water. In Indian cities, nearly every second person uses soap and water to wash hands before eating but almost all the remaining people think washing hands with just water before eating is all right.
There can be no argument over the fact that washing hands with soap and water after defecation, before eating a meal and even before cooking a meal are essential habits if a nation wants to reduce its disease burden. Global research has shown that cases of diarrhea halve on use of soap and water but globally too, getting people to wash hands after defecation is a tough call - only about one in five people ever wash hands with soap and water after defecation globally. The Economic Survey for 2018-19 quotes a recent study by UNICEF which assessed the economic impacts of SBM. The study found that on an average, every household in an ODF-free village saved about Rs 50,000 per year or almost Rs 137 daily due to lower likelihood of disease from using a toilet and practicing hand washing and the value of time saved due to a closer toilet.
So is the reluctance to use soap after defecation due to cultural, economical or other reasons and has the government done enough to promote hygiene across India’s hinterland?
Cost of Healthcare
Another NSO Survey shows the delicate state of healthcare in the country. About 59 per cent (nearly one in two) Indian children up to five years of age have been fully immunised. This means roughly four in 10 children have not been inoculated against deadly diseases. Also, there is wide disparity among Indian states on percentage of children up to five years of age who have been fully immunised. While in Nagaland, less than 13 per cent such kids have taken their vaccines, in Manipur three in four children have been fully immunised. In Bihar and Assam, not even one in two such children have received all their shots and in all, 13 states figure in the list of those states where the percentage of all children aged up to five years have been fully immunised.
How expensive is healthcare in India? If hospitalisation becomes unavoidable for a patient, the average spend she will have to bear varies widely on the choice of hospital. The NSO data shows the average spend for a trip to a public hospital was Rs 4,290 in rural areas but jumped by almost seven times if the patient landed up in a private hospital at Rs 27,347. Also, only 14 per cent of our villagers and about one in five (19 per cent) in cities have any health coverage!
Now let us look at literacy levels across the country. The NSO data showed nearly every fourth Indian over seven years of age is still illiterate, with illiteracy in rural women of this age far higher. Every third woman aged seven or more in our villages still cannot read and write. If we take the age group of 15 years and above, nearly every fifth urban woman has remained illiterate and the highest number of educated people comprise the urban male category since 24.6 per cent of urban males in this age group are at least graduates. Not even 4 in a 100 rural women above 15 years are graduates, over 40 per cent of them remain illiterate.
Nearly every third woman in India’s villages between 3 to 35 years of age cannot pursue education as she is engaged in “domestic activities” while another third of those enrolled were either not interested in education or were unable to fund further education. Among rural men, nearly every third dropped out of school/college because he was engaged in “economic activity”; every fifth rural male was not interested in studies and every fourth cited financial constraints for quitting studies. And yes, more than 12 per cent rural girls cited marriage as a reason to stop studying.
Women’s ability to pursue education improved somewhat in an urban setting, but 15 per cent still said they dropped out because of marriage, which is more than the percentage of rural women. Nearly one in four said they couldn’t study further because of “domestic activities” while over 28 per cent were either not interested in education or had financial constraints due to which they had to opt out of further studies.