Sub-Theme-II

Health, Hygiene and Sanitation

 Health, Hygiene and Sanitation

2.1. Background
Health is the level of functional and metabolic
efficiency of a living organism. The World Health
Organization (WHO-2006) defined human health
in its broader sense as “a state of complete
physical, mental, and social well-being and not
merely the absence of disease or infirmity”. (http:/
/www.who.int/governance/eb/who_constitution_en.pdf)
Health, or health and well-being, are also includes
a supportive environment, personal security,
freedom of choice, social relationships, adequate
employment and income, access to educational
resources, and cultural identity (Diaz et al., 2006;
Millennium Assessment 2005).

Over the last decade, health promotion practitioners have increasingly been asked to think
about the relationships between humans and the environment in terms of ecosystems (Brown,
1994) and to adopt an ‘ecological’ approach to health promotion (Kickbusch, 1989) with the
environment an integral part of human development (Hancock, 1993a).

Hygiene is a set of practices performed to preserve

health. According to the World Health Organization
(WHO), “Hygiene refers to conditions and practices that
help to maintain health and prevent the spread of
diseases. Hygiene is a concept related to cleanliness,
health and medicine. It is as well related to personal
and professional care practices. In medicine and
everyday life settings, hygiene practices are employed
as preventative measures to reduce the incidence and
spreading of disease. Hygiene practices vary, and what
is considered acceptable in one culture might not be
acceptable in another. In the manufacturing of food,
pharmaceutical, cosmetic and other products, good
hygiene is a critical component of quality assurance.

The terms cleanliness and hygiene are often used

interchangeably, which can cause confusion. In general,
hygiene refers to practices that prevent spread of

45
disease-causing organisms. Cleaning processes (e.g., hand
washing) remove infectious microbes as well as dirt and soil,
and are thus often the means to achieve hygiene.

Sanitation generally refers to the provision of facilities and

services for the safe disposal of human urine and feces. The
word ‘sanitation’ also refers to the maintenance of hygienic
conditions, through services such as garbage collection and
wastewater disposal.(WHO).

Environmental sanitation envisages promotion of health of the

community by providing clean environment and breaking the
cycle of disease. It depends on various factors that include hygiene, status of the people,
types of resources available, innovative and appropriate technologies according to the
requirement of the community, socioeconomic development of the country, cultural factors
related to environmental sanitation, political commitment, capacity building of the concerned
sectors, social factors including behavioral pattern of the community, legislative measures
adopted, and others. India is still lagging far behind many countries in the field of
environmental sanitation.(Pandve, 2008).

Ecological sanitation, which is commonly abbreviated to ecosan, is an approach, rather

than a technology or a device which is characterized by a desire to “close the loop” (mainly
for the nutrients and organic matter) between sanitation and agriculture in a safe manner.
Put in other words: “Ecosan systems safely recycle excreta resources (plant nutrients and
organic matter) to crop production in such a way that the use of non-renewable resources is
minimized”. When properly designed and operated, ecosan systems provide a hygienically
safe, economical, and closed-loop system to convert human excreta into nutrients to be
returned to the soil, and water to be returned to the land. Ecosan is also called resource-
oriented sanitation

Sustainable sanitation considers the entire “sanitation value chain”, from the experience of
the user, excreta and wastewater collection methods, transportation or conveyance of waste,
treatment, and reuse or disposal. The term is widely used since about 2009. In 2007
the Sustainable Sanitation Alliance defined five sustainability criteria to compare the
sustainability of sanitation systems. In order to be sustainable, a sanitation system has to be
economically viable, socially acceptable, technically and institutionally appropriate, and it
should also protect the environment and the natural resource

Sustainable Development – the core concept for the Post-2015 Development Agenda –
provides an integrated response to the complex environmental, societal, economic and
governance challenges that directly and disproportionately affect children. With appropriate
focus, investment and innovation, the Post-2015 Development Agenda presents an
unprecedented opportunity to create a World Fit for All Children.

46
The relationship between children and sustainable development is symbiotic. Progress in
sustainable development underpins child rights and well-being, and conversely, child rights
and well-being underpin lasting and equitable development progress. Finding the balance
to achieve progress for all in today’s world and for future generations depends upon three
key propositions:
1. Sustainable development starts with safe, healthy and well-educated children;
2. Safe and sustainable societies are, in turn, essential for sensitive groups such as children,
women and elderly; and
3. Children’s voices, choices and participation are critical for the sustainable future we want.

2.2. Focus of the Sub theme

The primary objective of this sub theme is to explore, document and analyze the role of
health, hygiene and sanitation on the health of not only humans but of the entire ecosystem
and thus its impact on sustainable development in terms of use of science, technology and
innovative approaches and ideas. The brief objectives are could be :
i. Identifying the status of prevailing sanitary and hygiene conditions which affect the health
and wellbeing of living beings. This may in turn have major impact on economic productivity,
since inadequate sanitation impacts individuals, households, eco systems, communities
and nations as a whole.
ii. Addressing mental health problems amongst children and adolescents which include
depression, anxiety, eating and sleeping disorders that can be attributed to several reasons
such as decrease in physical activities, spending too much time in the virtual world which
put such children at risk of delayed emotional and social development.
iii. Improving health conditions of the urban/peri-urban and rural citizens, especially children,
women and elderly through providing access to safe drinking water, sanitation and
introducing preventive interventions in domestic places, workplaces and outdoors.

2.3. Logical Frame work

Natural & Man-made Systems

Hygiene & Sanitation Preventive & Safety

(Domestic/Workplace/Outdoors) Interventions

Curative Interventions

Well-being

Social
(Physical & Mental State) Environmental Economical

Fig.-2.3. Flow chart showing relationship of health, hygiene and sanitation with sustainable development

47
2.4. Scope
The strong synergies between health and nutrition (World Bank 2013) are well-documented;
good health is not possible without good nutrition. Malnutrition remains one of the main
determinants of the global burden of disease, with 45% of child mortality attributable to under
nutrition (Black et. al. 2013).

The major challenges faced by the sanitation sector are the lack of proper sanitation for the majority,
ill effects owing to poor sanitation, water shortage and pollution, food insecurity and unplanned
urban growth. The population un-served by sanitation facility is about 40% of the world population.
Approximately 6000 children die every day from diarrheal diseases related to inadequate sanitation
and hygiene. About 1 billion people worldwide-mostly children - are infested with intestinal worms
and as a result suffer from nutritional deficiency and poor growth. Both these groups of diseases
are mostly transmitted through unhygienic conditions. Sewage discharges are a major component
of water pollution all over the world. Only a small portion of the polluted water is treated before it is
discharged into open water channels or bodies. Pollutants Components of SDG 6: Availibility
also leak into ground water from sewers, septic tanks, and Sustainable Management of
Water and Satition for All
soak pit toilets and cesspools. By 2030, more than half of
world population will face shortage of water. 6.1
DRINKING
WATER
The sanitation practices promoted today are either based 6.5 6.2
ECO- SANITATION
on hiding the human excreta in deep pits (drop-and- SYSTEM SDG 6 AND
CLEAN HYGINE
store) or on flushing them away and diluting them in WATER AND
SANITATION
rivers, lakes and the sea (flush-and–discharge). Whereas
6.5 6.3
ecological sanitation is based on three fundamental WATER WATER
principles which are preventing pollution rather than MANAGE- QUALITY
MENT
6.4
attempting to control it after we pollute; sanitizing the urine WATER-USE
and faeces; and using the safe products for agricultural EFFIENCY

purposes (sanitize – and –recycle).

48
Spurred on by Agenda Goals, along with changing national realities, many low and middle-
income countries will need to invest heavily in sanitation in the next decade. The decisions
they make and the approaches they take today will have far-reaching consequences for
sustainability and for the well-being of their citizens.

Sanitation is an integral piece of the sustainable development puzzle. The right sanitation
systems can not only minimize health and environmental risks associated with open
defecation and poorly managed waste disposal, but also, in many cases, yield multiple
benefits in areas from health to food security, resilient livelihoods, business growth, energy,
and ecosystem services. The Initiative focus on “productive” sanitation approaches.

Hygiene - specifically hand-washing with soap - is one of the most

important interventions for human health and development and is a
universal necessity. Fundamental to fighting under nutrition, reducing
child mortality, overcoming antibiotic resistance, and advancing access
to education, hygiene underpins the delivery of several other SDGs
and ultimately advances gender equity, dignity, and human rights.

Promotion and demonstration of safe hygiene practices – i.e., hand-washing with soap,
food hygiene, menstrual hygiene management, safe stool disposal, and solid waste
management – at the household, community and institutional level needs to be carried out
collaboratively with the health, education, community development and business development
sectors . The success of these programs involves ensuring that schools and health facilities
enable the practice of safe hygiene behaviors and those health workers and educators are
trained on appropriate behavior change Communication. Developing educational and
communication materials for WASH, and strengthening school health club programs, are
also instrumental to reinforcing hygiene promotion in schools.

The concept of WASH, groups together water, sanitation, and hygiene because the impact of
deficiencies in each area overlap strongly. Addressing these deficiencies together can achieve a
strong positive impact on public health.
The UN’s Millennium Development Goals included improvement of WASH services in Target 7.C:
“Halve, by 2015, the proportion of the population without sustainable access to safe drinking water
and basic sanitation. This has been replaced by the Sustainable Development Goals, where Target
6 aims to “ensure availability and sustainable management of water and sanitation for all”.
Access to WASH, in particular safe water, adequate sanitation, and proper hygiene education,
can reduce illness and death, and also affect poverty reduction and socio-economic development.
Lack of sanitation contributes to approximately 700,000 child deaths every year due to diarrhea.
Chronic diarrhea can have a negative effect on child development (both physical and cognitive) In
addition, lack of WASH facilities can prevent students from attending school, impose a burden on
women and diminish productivity.
Although access to sanitation has been improving over the past decades, the World Health
Organization (WHO) estimates that still “2.5 billion people – more than one third of the global
population – live without basic sanitation facilities”. In 2015, 750 million people lacked access to
safe, clean drinking water and approximately 2,300 people die every day from diarrhoea

49
Policies made in all sectors can have a profound effect on population health and health
equity. The health of people is not solely a health sector responsibility; it is also impacted by
issues such as transport,
agriculture, housing, trade and
foreign policy. To address the
multi-sectoral nature of health
determinants requires the political
will to engage the whole of
government in health. The health
sector should promote “Health for
All” policy across sectors that
systematically takes into account
the health implications on
decisions, seeks synergies and
avoids harmful health impacts in
order to improve population
health and health equity and address the social determinants of health.

In short;
l Today more than 1 billion people are chronically undernourished and food insecure.

l Undernourishment compromises immune systems, which leads to a higher incidence of

illness and disease that in turn contribute to lower productivity and life expectancies.
l Poor nutrition undermines economic growth. According to UNICEF, billions of children

younger than 5 are chronically malnourished. Chronic undernourishment in children

creates a vicious cycle of compromised physical and cognitive development that reduces
their economic productivity when they become adults, miring people in poverty that, in
turn, leads to chronic undernourishment and poor health in the next generation.
l A massive disease burden is associated with deficient hygiene, sanitation, and water
supply and is largely preventable with proven, cost-effective interventions.
l The total benefits of these interventions are greater than the health benefits alone and

can be valued at more than the costs of the interventions.

l Hygiene, sanitation, and water supply are development priorities, yet the ambition of

international policy on drinking water and sanitation is inadequate.

l Hygiene, sanitation, and water supply continue to have health implications in the developed
world.
l The active involvement of health professionals in hygiene, sanitation, and water supply

is crucial to accelerating and consolidating progress for health.

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2.5. Project Ideas

Project – 1:
Bio-filtration/bio-remediation processes
to improve water quality for reuse

Introduction
About 30% of the drinking quality of water is used everyday to flush the toilets, Grey water
(from kitchen, bath and wash) generated in a household if treated can be reused for flushing
toilets and gardening purposes using reed-bed (a channel filled with pebbles with aquatic
plants growing on it), it would be possible to improve the quality of water for reuse.

Objective
1) To assess the quality and quantity of water required for different household uses
2) To understand the influence of growing microbial and plant communities on the quality of
water passing through it
3) To understand the influence of residence time on the emergent water quality

51
Methodology
1) Collect samples of Grey water (Kitchen, Bath, Wash)
and check for its quality (bacterial and physical)
2) Construct a reed bed in a plastic drum by filling it with
clean pebbles and planting wetland plants (plants
growing on the submerged edges of ponds)
3) Pass the grey water from the bottom to emerge from
the top
4) Monitor the water quality difference between the
incoming and outgoing water
5) Increase the residence time of grey water in the reed
bed and record its influence on emergent water quality
6) Determine the optimum size of a reedbed required by a
household

Expected outcome
1. Understanding the way in which wetlands purify water
2. Understanding designing and sizing of a reedbed to suit family needs
3. Appreciation of simple, economical ways of reusing & conserving water at household
level

Project – 2:
Study of plant and animal diversity in a pond as
an indicator of water quality

Introduction
Aquatic biota are very sensitive to
water quality. As the water quality
deteriorates the plant and animal
communities also change. Studying
the presenceof flora and faunain
ponds of different water quality will
help in understanding the tolerance
of biota to pollution.

Objective
1. Understanding the influence of
water quality on the aquatic biota
2. To relate the presence or
absence of aquatic fauna and flora
to pollution levels

52
Methodology
1. Identify ponds of different pollution status in your locality
2. Study the presence of macro fauna and flora, and identify them
3. Collect the water samples from the ponds and test their quality (physico-chemical and
biological including bacteriological)
4. Relate the water quality to the presence of the aquatic biota

Expected outcome
1. To appreciate the sensitivity of the aquatic biota to changing water quality
2. To understand the influence of pollution level on the aquatic ecosystem
3. To be able to use the presence or absence of the aquatic biota to predict water quality

Project – 3:
Personal hygiene – for not missing out on studies

Objective:
To establish role between personal hygiene and
health in everyday life, particularly for students

Methodology
1. Design and develop a questionnaire with key
questions related to personal hygiene (hand-
washing, bathing, using soap, cleanliness – hair,
nail, frequency of keeping oneself clean, and the
likes)
2. Record number of children absent for a definite
period (may be for a month)
3. Assess reasons behind the absence, and identify
number absent due to illness
4. Correlate type of illness with parameters of personal hygiene (a common factor among
children)
5. Record number of classes, chapters in different subjects missed out by the absentees
6. Record level of personal hygiene followed by the others who has been present all through
the study period
7. Create awareness about personal hygiene measures to be taken and the manner in
which these are to be adopted

Expected Results
Establish the role of personal hygiene with the missed out studies, signifying importance
attached to personal hygiene on day-to-day basis.

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Project- 4:
Improving quality of potable water

Objective
Assess quality of potable water in school / community and
make it fit for consumption (if not consumable) using suitable
mechanisms / process

Methodology
1. Collect 100 ml of water sample in a dry and clean (free
from any kind of chemicals) bottle or container from the
source
2. Analyze the sample collected for physical (color, smell,
turbidity, etc.), chemical (pH, metals, etc.), and microbial
(algae, bacteria, etc.) properties, at school / college /
research institute / laboratory
3. Establish whether the sample water, based on properties analyzed, fit for consumption
4. If found unfit for consumption, use suitable mechanism / process, like bio-filtration (filtration
through specific type of plant and the likes)
5. After processing, reanalyze for properties

Expected Results
Establish the efficacy of the bio-filtration

Project – 5:
Perform studies to understand the cognitive development in kids due
to extended exposure to electronic media

Objectives
1) To develop an understanding of changing lifestyle amongst children
2) To explore and understand the overall psychological problems of children.
3) To develop a comparative understanding of lifestyles of rural children and urban children
with respect to the impact of exposure to electronic media day to day activities
4) Finding out if there is any relationship between children who are engaged in excessive
exposure to Internet/cell phones with behaviours such as parent conflict/difficulty in making
friends/other social changes in behaviour

Background
Changing lifestyles: lack of physical activities, excessive uncontrolled use of digital gadgets
and online social media, decreasing social communication, competitiveness, diversified
backgrounds and many such reasons attributing to growing stress, anxiety and other disorders
amongst children.

54
Methodology
1) Base line surveys of children living in rural areas as well as urban areas
2) Surveys should act as an instrument to understand children’s engagement with Digital
Gadgets and Online Social Media/Apps eg. (Facebook, Twitter, Instagram, WhatsApp)
and understanding their response, activity and behavioral patterns of the students etc.
3) Key information interviews/questionnaires – children, parents and teachers from both
rural and urban communities

Expected Results
1) Change in Rural & Urban lifestyle Map with respect to exposure to digital Media and its
Impacts.
2) Analysis of current trends in use of electronic media for a given set of demographic
conditions
3) Report on relationship between children who are engaged in excessive exposure to
Internet/cell phones with deviant social behaviours

Case Study-1

Aging is a critical societal concern in developed countries and many high class families in
developing countries like ours as well. Especially, the elderly living alone may face various
health problems in their daily lives. Social welfare organizations or people themselves hire
social caregivers to help the senior citizens who live alone; however, there often is a shortage
of professional caregivers due to steep increase in elderly population and insufficient budget.
You would like to address this problem by developing a cheap technology-driven solution to
monitor and help the elderly on a daily basis.

55
Case Study-2

What causes sustainable changes in hygiene behaviour? A cross-sectional study from

Kerala, India (Cairncross et al., 2005)

This study was designed and the field

work carried out by a non-governmental
organization (NGO) responsible for
implementing hygiene promotion. The
sustainability of changed hygiene
behaviour was studied at various
periods up to nine years after the
conclusion of a multifaceted hygiene
promotion intervention in Kerala, India.
Various methods including a
questionnaire to assess knowledge,
spot observation, demonstration of
skills on request, and household pocket
voting were used and compared for the
measurement of the hygiene outcome.
Pocket voting gave the lowest
prevalence of good practice, which we
infer to be the more accurate. Good
hand washing practice was reported by
more than half the adults in intervention
areas, but < 10% in a control area.
Hand washing prevalence showed no
association with the elapsed time since
the interventions, indicating that
behaviour change had occurred and
persisted. Recall of participation in
health education classes was
significantly associated with good
hygiene as indicated by women’s hand
washing practice (OR 2.04, CI 1.05–
3.96) and by several other outcomes, suggesting that the classes were an effective component
of the intervention. The evidence for a specific impact on behaviour from home visits and an
awareness campaign is less strong, although the home visits had influenced knowledge. The
finding of an association between interventions and male hand washing, in ecological analysis
(comparing administrative areas i.e. panchayats) but not at individual level, suggests that the
effect of the interventions on men may have been indirect, via women or neighbours, underlining
the need to direct interventions at men as well as women. The finding that hygiene behaviour
persisted for years implies that hygiene promotion is a more cost-effective health intervention
than previously supposed.

56
Problem: Unobtrusive Fall Monitoring
Lots of elderly people fall unexpectedly at home due to their weakened muscles and motor
ability. Also, internal health problems like stroke could cause sudden falls. Fall is one of the
biggest threats to the elderly, especially for those who live alone, since they cannot get
immediate help from their family. You would like to design an accurate and robust sensor-
driven system to monitor if an elderly falls. Upon the detection of fall, your system will
automatically call an ambulance and notify a nearby hospital.

Objectives
You have the following four objectives for the design of your system: (1) high coverage (the
whole apartment unit needs to be covered), (2) low cost (the cost of sensors should be less
than 15,000INR per house), and (3) low false negative rate (ideally, all falls need to be
detected while you can have a few false positives), (4) passive monitoring (the elderly does
not want to wear or hold any types of devices).

Methodology
A key part of this system is to monitor the occurrence of falls. The requirements for its first
version are:1) to detect ‘catastrophic falls’ where the elderly person falls and unconscious or
immobile for more than 30 seconds, and 2) to cover a one-bedroom apartment unit (with 1
main door, 1 living room, 1 bedroom, 1 kitchen and 1 bathroom) where one elderly person
lives alone. You don’t have to consider scenarios where the elderly falls and gets up within
30 seconds or there are visitors at home who can provide in-situ help.

2.6. Additional Project Ideas

1. Metals / heavy metals in potable water and its management

2. Water quality assessment
3. Biofilteration / bioremediation processes to make water available for recycling
4. Hygiene at personal / familial / community level and its impact on community health
5. Assessment of hygiene maintained at regular basis
6. Level of hygienic conditions during different seasons
7. Occurrence of diseases due to breakdown in hygienic conditions and its management
8. Waste management (eg.Diapers)
9. Diseases (microbial / parasitic) and their impact of social / economical / environmental
parameters
10. Impact and management of zoonotic diseases
11. Impact and management of conditions arising out of vital nutrient deficiency /
malnutrition
12. Comparison of sanitation before and after Swachch Bharat campaign, in terms of
behavioral change
13. Impact of cookware used to cook on health
14. Effect of Indoor Air Pollution on health
15. Maternal health and hygiene during pre and post-partum stages
16. Gender specific health and hygiene and its control / management

57
17. Safe use of anthropogenic waste in agriculture.
18. Impact of use of public transport on community health.
19. Improving occupational health.
20. Promoting city health through sensing technologies
21. Unobtrusive fall monitoring of the elderly.

Swachh Bharat Abhiyan

“A clean India would be the best tribute India could pay to
Mahatma Gandhi on his 150 birth anniversary in 2019,” said
Shri Narendra Modi as he launched the Swachh Bharat
Mission at Rajpath in New Delhi. On 2nd October 2014,
Swachh Bharat Mission was launched throughout length and
breadth of the country as a national movement. The
campaign aims to achieve the vision of a ‘Clean India’ by
2nd October 2019.

Swachh Bharat Abhiyan has become a ‘Jan Andolan’

receiving tremendous support from the people. Citizens too
have turned out in large numbers and pledged for a neat
and cleaner India. Taking the broom to sweep the streets,
cleaning up the garbage, focussing on sanitation and
maintaining a hygienic environment have become a practice
after the launch of the Swachh Bharat Abhiyan. People have
started to take part and are helping spread the message of
‘Cleanliness is next to Godliness.’

Full immunization against preventable childhood diseases is the right of every child. With a
view to provide this right to every child, the Government of India launched the Universal
Immunization Program (UIP) in 1985, one of the largest health programs of its kind in the
world.

Despite being operational for over 30 years, UIP has been able to fully immunize only 65%
children in the first year of their life and the increase in coverage has stagnated in the past 5
years to an average of 1% every year.

To strengthen and invigorate the program and achieve full immunization coverage for all children
at a rapid pace, the Government of India launched Mission Indradhanush in December 2014.

Mission Indradhanush will ensure that all children under the age of two years and pregnant
women are fully immunized with all available vaccines.

58
 National Deworming Day
The National Deworming Day is an initiative of Ministry of Health and Family Welfare, Government
of India to make every child in the country worm free. This is one of the largest public health
programs reaching large number of children during a short period.
More than 836 million children are at risk of parasitic worm infections worldwide. According to
World Health Organization 241 million children between the ages of 1 and 14 years are at risk of
parasitic intestinal worms in India, also known as Soil-Transmitted Helminths (STH).
About STH:
Helminths (worms) which are transmitted through soil contaminated with faecal matter are called
soil-transmitted helminths (Intestinal parasitic worms). Roundworm (Ascarislumbricoides), whipworm
(Trichuristrichiura) and hookworms (Necatoramericanus and Ancylostomaduodenale) are worms
that infect people.
STH transmission:
s Adult worms live in human intestines for food and survival and produce thousands of eggs each
day.
s Eggs are passed in the faeces of infected person.
s Infected people who defecate outdoors spread worm eggs in the soil.
s Eggs contaminate the soil and spread infection in several ways: ?
s Ingested through vegetables that are not carefully cooked, washed or peeled;
s ingested from contaminated water sources;
s ingested by children who play in soil and then put their hands in their mouths without washing
them.
s STH infectionscan lead to anemia, malnutrition, impaired mental and physical & cognitive
development, and reduced school participation.
STH Infections can be prevented by:
s Using sanitary toilets, not defecating outside
s Hand-washing, particularly before eating and after using toilets
s Wearing slippers and shoes
s Washing fruits and vegetables in safe and clean water
s Eating properly cooked food
Objective of National Deworming Day:
The objective of National Deworming Day is to deworm all preschool and school-age children
(enrolled and non-enrolled) between the ages of 1-19 years through the platform of schools and
AnganwadiCenters in order to improve their overall health, nutritional status, access to education
and quality of life.

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