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Combating diarrhoeal disease in India through safe drinking water

Justin DeNormandie and Janette Sunita, Population Services International (PSI) Delhi, India

November 2002
All images are free to download and use, with the mention: copyright: WHO/P. Virot

While access to drinking water in India has increased over the past decade, the tremendous adverse impact of unsafe water on health continues. The World Bank estimates 21% of communicable diseases in India are water related. Of these diseases, diarrhoea alone killed over 700,000 Indians in 1999 (estimated) – over 1,600 deaths each day. The highest mortality from diarrhoea is in children under the age of five, highlighting an urgent need for focused interventions to prevent diarrhoeal disease in this age group.

Despite investments in water and sanitation infrastructure, many low-income communities in India and other developing countries continue to lack access to safe drinking water. Regardless of the initial water quality, widespread unhygienic practices during water collection and storage, poor hand washing and limited access to sanitation facilities perpetuate the transmission of diarrhoea-causing germs through the faecal-oral route.

In view of this tremendous public health problem, the World Health Organization (WHO) and Population Services International (PSI) have partnered to develop and test a safe drinking water strategy to reduce the incidence of diarrhoeal diseases in India via a demonstration project in West Delhi slums. The strategy for Delhi includes the social marketing of a Safe Water System supported by messages about safe drinking water and sanitation.

The Safe Water System (SWS) is a water quality intervention that uses simple, inexpensive, and robust technologies appropriate for the developing world to prevent mortality and morbidity associated with diarrhoeal diseases. Developed by the World Health Organization (WHO), the Pan American Health Organization (PAHO) and the Centers for Disease Control and Prevention (CDC), the SWS reduces the number of diarrhoeal episodes by around 50%. It consists of a bottle of 0.5 to 1% sodium hypo chlorite (chlorine) solution to disinfect water at the point-of-use, the household level, along with a home water storage vessel to prevent water recontamination.

Improved hygiene and sanitation also play an important role in reducing diarrhoeal and other water-borne diseases. To motivate the behavioral changes necessary for improved hygiene and sanitation, PSI enlisted the help of volunteers from the Delhi slums.

Volunteers, or change agents, were trained to use the SWS, to raise awareness about hygiene related issues and to motivate the consumption of safe drinking water in their community. Apart from participating at local events conducted by PSI, change agents make door to door visits conducting SWS demonstrations and promoting proper hygiene and sanitation. Being from the project community, these change agents have both an understanding of local health issues, and an established relationship based on trust within the community.

Educational materials and posters linking simple hygienic behavior to clean water and food were designed for low-literacy populations with the input of PSI’s change agents. These materials focus on a simple message: the adoption of hygienic practices that impact on water and food safety, and the consistent and exclusive consumption of safe drinking water by regularly using the Safe Water System to treat water and store it safely.

The next step in PSI’s approach to improving hygiene and sanitation conditions focuses on mobilizing the community. One of the essential techniques PSI has identified to increase community involvement is making improvements to common areas in the slums. By providing covered garbage bins and undertaking minor repairs to key water sources, PSI transforms highly visible and highly frequented sites into opportunities to promote behavior change. These improvements are linked to hygiene and sanitation messages to bring about a sense of shared responsibility in the community to keep these areas clean.

Technical support and funding from the WHO Regional Office for South-East Asia provides an excellent opportunity for PSI to develop a safe drinking water strategy for an urban slum setting. Lessons from this project will assist PSI to replicate a successful model in communities through out India and in other countries where PSI operates.

PSI currently social markets Safe Water Systems in Bolivia, India, Madagascar, Malawi, Rwanda, Tanzania, and Zambia.