India Lags Sub-Saharan Africa in Public Hygiene

[Riaz Haq]

India's rivers have been turned into open sewers by 638 million Indians without access to toilets, according to rural development minister Jairam Ramesh. He was reacting a UNICEF report that says Indians make up 58% of the world population which still practices open defection, and the sense of public hygiene in India is the worst in South Asia and the world.



India(638m) is followed by Indonesia (58m), China (50m), Ethiopia (49m), Pakistan (48m), Nigeria (33m) and Sudan (17m). In terms of percentage of each country's population resorting to the unhygienic practice, Ethiopia tops the list with 60%, followed by India 54%, Nepal 50%, Pakistan 28%, Indonesia 26%, and China 4%.

18 percent of urban India still defecates in open while the percentage of rural India is as high as 69 percent of the population. It is the key reason why India carries among the highest infectious disease burdens in the world.

The number of open defecators in rural India alone is more than twice those in the whole of sub-Saharan Africa, according to a report by DFID, the UK's Department for International Development.

The World Bank has estimated that open defecation costs India $54 billion per year or $48 per head. This is more than the Government of India’s entire budget for health.

The UNICEF report says that with only four more years to go until 2015, a major leap in efforts and investments in sanitation is needed to reach the targets of Millennium Development Goals.

After the embarrassing headlines, it appears that Minister Ramesh is ready to step up the efforts to improve sanitation. He is quoted by Times of India as saying that "we are going to focus now on `nirmal gram abhiyan' -- today 25,000 nirmal grams are a tiny fraction of 6 lakh villages. These nirmal grams are in Maharashtra and Haryana. Maharashtra is a success of social movements while Haryana an example of determined state government action."

Here's a video clip of Indian environment minister Jairam Ramesh saying "if there was a Nobel Prize for dirt and filth, India would win it hands down":



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Food, Clothing and Shelter in India and Pakistan

Heavy Disease Burdens in South Asia

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Poverty Across India 2011

India and Pakistan Contrasted

[Riaz Haq]

#Pakistan improving sanitation way faster than #India: Study - The Economic Times http://ecoti.ms/7idC2a 

NEW YORK: Pakistan has left India far behind in terms of improving water and sanitation access for their citizens, reveals a new performance index released on Friday. 

While Pakistan was ranked five in the new index developed by The Water Institute at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health in the US, India occupied an unenviable 92nd position. 

High performers also included China, El Salvador, Niger, Egypt, and Maldives. Russia, the Philippines and Brazil on the other hand, were low performers.


The index compares countries regardless of size and income level. By use this method the report deduced that a country’s gross domestic product does not determine performance in improving water and sanitation access for its citizens.

“This means that even countries with limited resources can make great strides if they have the right programmes in place,” said co-author of the report Jamie Bartram, director of The Water Institute at UNC.

“National governments, NGOs, and aid agencies can direct their resources toward building systems and capacity for action in countries that are lagging, and toward implementation where those capacities are in place and performing,” Bartram noted.

Read more at:
http://economictimes.indiatimes.com/articleshow/47212815.cms 

[Riaz Haq]

http://waterinstitute.unc.edu/wash-performance-index-report/

The WaSH Performance Index is the sum of country performance values in the following components: water access, water equity, sanitation access, and sanitation equity. Each of the components ranges from -1 to 1 meaning the overall WaSH index value can range from -4 to 4.

Figure 19 summarizes the values. The WaSH Performance Index was calculated for 117 countries (i.e. 117 countries had values for all four index components). Tables 6 and 7 list the countries with the top ten and bottom ten values. Values range from -1.34 to 2.6, which is much smaller than the range of possible values (-4 to 4).

Figure 19. WaSH Performance Index values by country

Top and bottom performing countries
The top ten and bottom ten countries are a surprising group. Low levels of coverage are often clustered in certain regions – for example, water access is low in sub-Saharan Africa while sanitation access is low in South and Southeast Asia. In contrast, performance values appear to be spread widely within regions. This suggests that country-specific factors, such as the enabling environment, may be driving performance and regions as a whole are not constrained to perform poorly.

Among countries with top ten values, two are low income, five are lower middle income and three are upper middle income. Among countries with bottom ten values, three are low income, five are lower middle income, and two are upper middle income. Top performing countries are located in all world regions with the most from South Asia (n = 4) and Sub-Saharan Africa (n = 2). Among bottom ten countries, three are from East Asia and the Pacific, and four are from Sub-Saharan Africa. A few countries are under-represented in the JMP data sets that we used, notably highly industrialized countries with very high coverage rates (as data may not be collected) and small island developing nations (as few have nationally representative household surveys).

Table 6. Top ten countries in the 2015 WaSH Performance Index

Table 7. Bottom ten countries in the 2015 WaSH Performance Index

Among the most populated countries in the world, Pakistan, China, and Nigeria were top performers (ranked 5, 11, and 18 respectively). Russia, the Philippines and India were bottom performers (ranked 72, 83, and 92 respectively).

Trends in performance
Tables 8 and 9 show the trend of components for the top ten and bottom ten countries. Six of the top ten have improving trends over time for all components. Conversely, seven of the bottom ten have an unchanged or deteriorating trend for all components. Tables 6 through 9 show that among most top performing countries, neither water nor sanitation components dominated the overall Index value, suggesting improvements in water and sanitation do not necessarily come at the expense of the other.

Table 8. Trend in performance among the top ten countries

Table 9. Trend in performance among the bottom ten countries

[Riaz Haq]

#India: inherently unhygienic? #Indian writer touches third rail http://reut.rs/1pa6d7h via @Reuters

My Indian friends and I joke around a lot about me as the typical white American guy visiting India. Cows! Con men! Colors! Most people I’ve met in India have restricted their reactions to my westerner-in-the-east experiences to gentle teasing. When I stuck a picture of a man urinating in public on my Facebook page, calling it one more picture of what you see everywhere you go in India, people weren’t as patient. What was I doing? Insulting the nation? Focusing on the ugly because it’s what all the westerners do when they visit India? Why does India provoke such visceral reactions in visitors?

Public urination, public defecation, dirt, garbage, filth, the poor living on the street — talking about these things, even acknowledging that they’re in front of your face, risks making your hosts unhappy, and possibly angry. It’s the third rail of India, and the voltage can be lethal. That’s why I was surprised when B.S. Raghavan decided to touch it with all 10 fingers.

Raghavan’s column in The Hindu Business Line newspaper begins with this headline: Are Indians by nature unhygienic?

Consider these excerpts:

From time to time, in their unguarded moments, highly placed persons in advanced industrial countries have burst out against Indians for being filthy and dirty in their ways of life. A majority of visitors to India from those countries complain of “Delhi belly” within a few hours of arrival, and some fall seriously ill.

There is no point in getting infuriated or defensive about this. The general lack of cleanliness and hygiene hits the eye wherever one goes in India — hotels, hospitals, households, work places, railway trains, airplanes and, yes, temples. Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits. … 

Open defecation has become so rooted in India that even when toilet facilities are provided, the spaces round temple complexes, temple tanks, beaches, parks, pavements, and indeed, any open area are covered with faecal matter. … 

Even as Indians, we are forced to recoil with horror at the infinite tolerance of fellow Indians to pile-ups of garbage, overflowing sewage, open drains and generally foul-smelling environs.

There’s plenty more that you can read in that story, but I’ll direct you to the article. I’ll also ask you some questions:

Some people say you shouldn’t point out these problems, and that every country has problems. Do you agree with this statement? Why?
Does anyone disagree with Raghavan’s descriptions of these sights and smells?
Is this even a problem? Or should people get used to it?
Should visitors, especially ones from countries where people are generally wealthier, say nothing, and pretend that they don’t see unpleasant things?
As for me, I can say this: I got used to it, but I would be lying if I said I didn’t notice it. Indians notice it too. Otherwise, people wouldn’t suggest public shaming campaigns against people urinating in public, they wouldn’t threaten fines for doing it, and they wouldn’t respond with relief to plans to finally make sure that toilets on India’s trains don’t open directly onto the tracks. Of course, these are people in India. It’s a family, taking care of business the family way.

As for me, the message usually seems to be: “If you don’t love it, leave it.” It would be nice if there were some other answer. Acknowledging problems, even ones that are almost impossible to solve, makes them easier to confront.

[Riaz Haq]

A Timeline of Food Safety in #India. High levels of worms, bacteria, insecticdes, pesticides, lead. http://on.wsj.com/1ct7OUQ via @WSJIndia
As public debate turns to food safety, we recap other recent allegations of food contamination in India.

Pesticides and cola: CocaCola Co. and PepsiCo Inc. found themselves in a media storm in 2003 after a New Delhi-based nonprofit alleged their soft drinks contained pesticide and insecticides at levels between 11 times and 70 times the maximum set by the European Union for drinking water. Coke’s sales plummeted by as much as 40% in the aftermath of the scare. Both companies disputed the claims, and spearheaded aggressive ad campaigns to contain damage.
Worm-infested Cadbury bars: The same year, chocolate lovers in the western state of Maharashtra discovered worms in Cadbury’s Dairy Milk bars, the country’s best-selling candy. Cadbury India Ltd., now Mondelez India Foods Pvt., said the infestation was likely because of poor storage conditions in India’s mom-and-pop shops. Much like Pepsi and Coke, the company responded with celebrity endorsements, including from Bollywood superstar Amitabh Bachchan. They also added a plastic coating to their chocolate wrappers. The issue resurfaced in 2006 after a local court ordered the company to pay 15,000 rupees (now $235) as compensation to a man who gifted a worm-infested chocolate to a friend.

Poisoned school lunch: At least 23 children died and two dozen others fell sick after eating rice, beans and potato curry at a school lunch in the eastern state of Bihar in 2013. The lunch, part of a government program to feed tens of millions of malnourished children, was contaminated with pesticides.

KFC worm allegations: A businessman in the state of Tamil Nadu said he found a worm in a piece of KFC chicken last year. The allegations follow similar claims in 2012, when authorities shut down an outlet in the neighboring state of Kerala after customers reported worms in their chicken. KFC denied their food was contaminated in both instances.

Tainted country liquor: A batch of tainted country liquor killed 18 people and left another four dozen hospitalized in the northern state of Uttar Pradesh earlier this year. Inexpensive, homemade alcohol is common in rural areas, and often spiked with chemicals to enhance its flavor or potency.

[Riaz Haq]

Holding Your Breath in #India #pollution http://nyti.ms/1eCMCxj by Gardiner Harris in New Delhi fir NY Times

We gradually learned that Delhi’s true menace came from its air, water, food and flies. These perils sicken, disable and kill millions in India annually, making for one of the worst public health disasters in the world. Delhi, we discovered, is quietly suffering from a dire pediatric respiratory crisis, with a recent study showing that nearly half of the city’s 4.4 million schoolchildren have irreversible lung damage from the poisonous air.
------------
And children are by no means the only ones harmed. Many adults suffer near-constant headaches, sore throats, coughs and fatigue. Arvind Kejriwal, Delhi’s chief minister, had to leave the city for 10 days in March to cure a chronic cough.

It’s not just the air that inflicts harm. At least 600 million Indians, half the total population, defecate outdoors, and most of the effluent, even from toilets, is dumped untreated into rivers and streams. Still, I never thought this would come home to my family quite as dramatically as it did.

We live in a four-year-old, five-story apartment building that my wife chose because its relatively new windows could help shut out Delhi’s appalling nighttime air. Its cookie-cutter design — by the same developer who built dozens of others in the neighborhood — gave us confidence that things would function, by no means assured for new construction here.

About six months after we moved in, one of our neighbors reported that her tap water suddenly smelled like sewage. Then the smell hit another neighbor and another. It turned out that the developer had dug open channels for sewage that had gradually seeped into each apartment’s buried water tank. When we pulled up the floor tiles on the ground floor, brown sludge seemed to be everywhere.

I was in the shower when this sewage mixture arrived in our apartment. Sounds horrible, but I shrugged and toweled off because that smell is such a frequent presence here.

For much of the year, the Yamuna River would have almost no flow through Delhi if not for raw sewage. Add in the packs of stray dogs, monkeys and cattle even in urban areas, and fresh excretions are nearly ubiquitous. Insects alight on these excretions and then on people or their food, sickening them.

Most piped water here is contaminated. Poor sanitation may be a crucial reason nearly half of India’s children are stunted.

The list of health threats sounds harrowing when considered together, but life goes on and can be quite nice here. Our apartment building eventually installed aboveground water tanks. My children’s school and travel in the region are terrific, and many expats are far more influential here than they would be in their home countries.

Yet one afternoon this spring, someone in our neighborhood burned something toxic, and an astringent cloud spread around our block. My wife was out walking with a friend, and their eyes became teary and their throats began to close. They bolted back inside our apartment where they found Bram gasping again, for the first time in two years. In some places in Delhi, the levels of fine particles that cause the most lung damage, called PM2.5, routinely exceed 1,000 in winter in part because small trash and other fires are so common, according to scientists. In Beijing, PM2.5 levels that exceed 500 make international headlines; here, levels twice that high are largely ignored.

http://www.nytimes.com/2015/05/31/opinion/sunday/holding-your-breat...

[Riaz Haq]

• By
•  
• CORINNE ABRAMS

The Wall Street Journal made with Datawrapper

Indian Prime Minister Narendra Modi has made sanitation a priority for his country, saying he would rather build toilets than temples and setting a goal for every home in the country to have a place to go to the bathroom by 2019.

But new data show India is lagging behind its neighbors in providing access to adequate sanitation.

“Progress on Sanitation and Drinking Water,” a report published by the United Nations Children’s Fund and the World Health Organization this week, says that advancements in meeting Millennium Development Goals, or MDGs, by 2015 in relation to sanitation have faltered worldwide. The report says 2.4 billion people still don’t have access to improved sanitation.

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Mr. Modi launched his Clean India, or Swachh Bharat, campaign last year for good reason. Research shows that the practice of open defecation is linked to a higher risk of stunting in children and the spread of disease. A World Health Organization report said in 2014 that 597 million people in India still relieved themselves outdoors.  And the new WHO/Unicef report says that the Southern Asia region has the highest number of people who defecate in the open.

The new data show that despite recent efforts, over the past 25 years, India has been losing the regional race to improve sanitation.

Its neighbors, Nepal, Bangladesh and Pakistan led the way with the greatest percentage-point change in the proportion of the population with access to improved sanitation facilities between 1990 and 2015.

Pakistan’s percentage point change was 40–64% of people have use an improved sanitation facility. In Nepal, a country in which just 4% of people had access to improved sanitation facilities in 1990, access rose by 42 percentage points to 46%. Bangladesh improved its score by 27 percentage points — 61% now have access to improved sanitation facilities.

India meanwhile, had a lower 23 percentage point increase in the same period – bringing the number of people with access to improved sanitation facilities to 40%.

And Sri Lanka is way ahead, with 95% of people having access to improved sanitation.

The report defines an improved sanitation facility as one that hygienically separates excreta from human contact and the target was for 50% or more of those with inadequate water or sanitation in 1990 to have adequate sanitary services in 2015.

Likewise, rates of open defecation have reduced, but India still has the highest percentage of the population defecating in the open–with 44% of people going outside in 2015—down from 75% in 1990, compared with a 13% figure for Pakistan in 2015, 32% for Nepal and only 1% for Bangladesh.

But, the report says: “The 31 per cent reduction in open defecation in India alone represents 394 million people, and significantly influences regional and global estimates.”

http://blogs.wsj.com/indiarealtime/2015/07/01/india-lags-behind-pak...

[Riaz Haq]

Jharkhand, #India: Girl commits suicide after parents refuse toilet in home

http://www.hindustantimes.com/india-news/girl-kills-self-in-jharkha... via @htTweets

A class 12 student allegedly committed suicide on Friday in Jharkhand’s Dumka district after her parents turned down her repeated pleas to construct a toilet at home as they wanted to save money for the 17-year-old’s marriage, police said.

Khushbu Kumari, a resident of Dudhani colony in the town, was found hanging from the ceiling of her room by family members, the police added.

The tragedy underlined a growing awareness on hygiene among the younger generation in the state which has country’s highest rate of open defecation.

The 2011 census had said that 92.4% people in Jharkhand’s rural areas do not have toilets.

In recent times, there have been several instances of women refusing to marry into families who don’t have toilets in their homes, which officials attribute to growing public awareness about the health hazards of open defecation.

Dumka police, quoting Khushbu’s family-members, said that she was pressurising her parents for a toilet in her home as she was fed up and ashamed of defecating in open fields.

“Girl’s parents told her that they couldn’t afford a toilet as they were saving money for her marriage,” said investigating officer Manoj Mishra.

Her father Shripati Yadav is a driver.

“For us marriage was more important. She was demanding a toilet and on Friday we had a heated argument. She was stubborn and ended her life,” said a tearful Sanju Devi, Khushbu’s mother.

Police said that the girl ended her life when her parents were not at home.

“It is a tragic incident as girl’s parents were unaware of the importance of toilets,” said Dumka SP Bipul Shukla.

A government official said that under a government scheme, individuals are provided Rs 4,600 for household toilet construction.

“The parents seemed uninformed,” said a senior sanitation officer requesting anonymity.

A study by the Unicef earlier had identified poor sanitation as a major cause for diseases and deaths among children in the state and also showed how open defecation had a strong correlation with malnutrition (55%) and stunting (47%) among children of the state.

[Riaz Haq]

Reddy- one of #India's largest drugmakers is crashing after the #US #FDA warning on quality http://read.bi/1Prz0Ua via @bi_contributors

Dr Reddy's Laboratories Ltd, India's second-largest drugmaker, has received a "warning letter" from US regulators over inadequate quality controls at three manufacturing plants producing drugs for cancer and other diseases.

The warning is the latest in a string of incidents that have hurt the industry's reputation and slowed its growth in the world's largest drug market, where India supplies more than 40% of the generic and over-the-counter medicines.

Dr Reddy's said the FDA warning meant it would not receive US approvals for drugs made at the plants until it fixed the problems, a blow for business at a company that relies on the US for a majority of its sales.

The affected plants account for more than 10% of the company's sales.

Dr Reddy's said a production halt may not be required, but the news caught investors by surprise, sending shares to their lowest level in four months.

"We are probably looking at flat to declining earnings in FY 2017, while earlier we were expecting growth," said analyst Nimish Mehta, founder of Research Delta Advisors.

Analysts warned the move by the US Food and Drug Administration would hit US sales for at least the next two years, as the launch of key products may be delayed.

"There is no indication in the warning letter that we need to stop manufacturing, but we will be examining the contents and deciding our strategy," Dr Reddy's CFO Saumen Chakraborty told the Indian television news channel ET Now.

The FDA inspected the company's Srikakulam, Miryalaguda, and Duvvada drug-manufacturing sites in November, January, and February, and it almost immediately issued initial notices asking the group to rectify some problems.

But the company was unable to fix the issues to the satisfaction of the FDA, and it was hit with a warning letter. Such letters are issued by the agency when it finds a manufacturer has "significantly violated" its regulations.

"We had absolutely no idea it could escalate to this level," Siddhanth Khandekar of ICICI Securities said.

Dr Reddy's said the agency's concerns with the plants related to quality-control procedures and how data was recorded. It did not provide details.

The FDA has already banned plants of other Indian firms, such as Wockhardt Ltd and Ranbaxy Laboratories Ltd, a unit of the country's largest drugmaker Sun Pharmaceutical Industries Ltd, after finding faulty, fudged, or incomplete data records in recent years.

Both companies have been unable to get their plants cleared by the agency, more than two years after the bans.

But analysts say the FDA considers data integrity issues to be the most serious, typically requiring at least two years to be remedied to its satisfaction.

Dr Reddy's CEO G V Prasad said the group was revamping its quality systems as a result.

The FDA has increased the number of inspections of foreign plants supplying to the US over the past year, exposing quality-control issues at several Indian drugmakers. India plants of multinational drugmakers, such as Novartis and Mylan, have also come under fire.

Industry executives say they have been improving their manufacturing and systems, but sanctions continue.

Dr Reddy's makes drug ingredients at the Srikakulam and Miryalaguda plants, and cancer medicines at the Duvvada plant.

[Riaz Haq]

It's no joke. WaterAid says #India has 60.4% people without access to toilet. 36% in #Pakistan #opendefecation https://shar.es/1c08Z4 

Noting that the resulting health crisis is a serious matter, the report said that more than 140,000 children younger than five years die each year in India due to diarrhea.
“Nearly 40 per cent of India’s children are stunted; this will affect both their life chances and the future prosperity of India. India also has high rates of maternal and newborn mortality linked to sepsis,” the report said.
The equipment necessary to prevent infection during and after child birth is simple and inexpensive, but requires clean water and soap along with clean surroundings, which are difficult to achieve in an environment contaminated by open defecation and without good hygiene practices such as handwashing with soap by clinic staff and midwives, it said.
Prime Minister Narendra Modi has given the sanitation issue a top political priority, and last year launched Swachh Bharat (Clean India) Mission.
Commenting on Swachh Bharat, which aims to ensure a toilet for every household by 2019 and to educate people about the long-term health and economic benefits of using a a proper sanitation system, the report said that “by simply building the toilets won’t be enough.”
“What will be absolutely crucial is getting local, state and national government to make this a priority, and creating the cultural shift that will ensure that once the toilets are built, they are used by everyone,” it added.

http://www.wateraid.org/what-we-do/our-approach/research-and-public...

[Riaz Haq]

From WaterAid 2015 Report "It's No Joke: State of the World's Toilets 2015":

India, the world’s second most populous nation, has a well-known problem with sanitation. Cities growing at an incredible pace with unofficial, unserviced slums, combined with cultural preferences for open defecation in fields rather than enclosed spaces, mean India has the World’s Longest Queues for Toilets. If you stretched all 774 million people in India now waiting for household toilets, the queue would stretch from Earth to the moon – and beyond! That queue would take 5,892 years to work through,assuming each person needs about four minutes in the toilet. The resulting health crisis is a serious matter. More than 140,000 children younger than five years die each year in India from diarrhoea. Nearly 40% of India’s children are stunted; this will affect both their life chances and the future prosperity of India. India also has high rates of maternal and newborn mortality linked to sepsis. The equipment necessary to prevent infection during and after childbirth is simple and inexpensive, but requiresclean water and soap, and clean surroundings, which are difficult to achieve in an environment contaminated by open defecation, and without good hygiene practices such as handwashing with soap by clinic staff and midwives. Work is underway in India to end the crisis. Prime Minister Narendra Modi has given the issue high political priority, and in autumn 2014 announced the Swachh Bharat (Clean India) Mission. Swachh Bharat aims to ensure every household has a toiletby 2019 and to educate people about the long-term health and economic benefits of using a toilet. This is an important and long-overdue initiative, and is bringing change to India’s communities. But simply building the toilets won’t be enough. What will be absolutely crucial is getting local, state and national government to make this a priority, and creating the cultural shift that will ensure that once the toilets are built they are used – by everyone. 

http://www.wateraid.org/what-we-do/our-approach/research-and-public...