Health gains from the Swachh Bharat initiative

At a dissemination workshop organised by WHO Country for India, the Ministry of Drinking Water and Sanitation and the Ministry of Health & Family Welfare, key findings of an assessment undertaken by WHO to study the health gains from the progress made under the Government of India’s Swachh Bharat (Clean India) Mission were presented.

The study presents initial estimates of the expected health gains from reduced diarrhoeal disease and malnutrition due to increased sanitation coverage following the Swachh Bharat initiative and was undertaken at the request of the Ministry of Drinking Water and Sanitation.

Key findings

  • It is estimated that Swachh Bharat Mission (SBM) - Grameen will result in averting more than 300 000 deaths (diarrhoea and protein-energy malnutrition) between 2014 and October 2019.
  • Unsafe sanitation caused an estimated 199 million cases of diarrhoea annually before the start of the SBM in 2014. These have been gradually reducing, and will almost be eliminated when universal use of safe sanitation facilities is achieved by October 2019.
  • More than 14 million DALYs (Disability-Adjusted Life Years) are estimated to be avoided (diarrhoea and protein-energy malnutrition) between 2014 and October 2019.

Methodology and data sources

The estimation of health impacts is based on comparative risk assessment (CRA) methods, which are used extensively in burden of disease assessments and the report uses the updated Global Burden of Disease model applying country-specific data on sanitation in India. CRA requires as input data: i) the proportion of the population exposed to the conditions of interest, ii) the exposure-response relationship linking exposure and disease, and iii) the total number of deaths and disease burden by disease, country and year, which are combined through an estimated population-attributable fraction).

The data sources for the study comprises two large nationally representative surveys: the Rapid Survey on Children, which was made shortly before the launch of the SBM in 2014, and the National Family Health Survey from 2015/2016. This modelling study uses data from third party surveys as well as Swacch Bharat Mission - Grameen administrative reporting and its targets up to October 2019.

The exposure-response relationship for diarrhoea is based on the most recent systematic review of sanitation intervention studies and impacts on diarrhoea. Burden of total disease from diarrhoea for India is based on WHO cause-specific mortality and disease burden by country, 2000-2015.

Dr Richard P Johnston, Technical Officer for water, sanitation and hygiene at WHO, presented the key findings in the presence of Mr Parameswaran Iyer, Secretary, Ministry of Drinking Water and Sanitation; Ms Preeti Sudan, Secretary, Ministry of Health & Family Welfare, and Dr Henk Bekedam, WHO Representative to India. Experts from India and abroad, representatives from several partner organisations, government officials and members of the press attended the event.

To accelerate the efforts to achieve universal sanitation coverage and to put focus on sanitation, the Swachh Bharat Mission was launched in 2014 with the principal aim of eliminating open defecation by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi.