Impact assessment of India's Swachh Bharat Mission – Clean India Campaign on acute diarrheal disease outbreaks: Yes, there is a positive change

Abstract

Background: Enough evidence exists to attribute the occurrence of diarrheal disease outbreaks due to open defecation practice and unsafe sanitation methods. Open defecation enables pathogens such as virus, bacteria, and protozoa to infect humans by means of fecal–oral transmission methods through contaminated fluids, water, and fomites. To curb the malefic effects of open defecation, the Indian government had initiated pro sanitation program namely Swachh Bharat Mission (SBM) in 2014. SBM became the world's largest toilet-building initiative. More than 95 million toilets have been built across rural and urban India since the launch of this mission. This articulation summarizes the trend analysis of acute diarrheal disease (ADD) outbreaks over a 9-year period with emphasis on changes due to the building of toilets under the clean India campaign. Methods: Weekly ADD outbreaks data from national-level Integrated Disease Surveillance Program between 2010 and 2018 were used for trend analysis along with the number of toilets constructed in rural areas under SBM from the year 2014. Results: ADD outbreaks were analyzed from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season. Conclusion: The recent pattern of ADD outbreaks exhibits a declining rate.

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

“…We recognize there is no one-size-fits-all for delivering these essential services [ 63], but governments should explore immediately delivering water trucks, sanitizing stations, and portable toilets. Communities should be consulted, along with local officials, and municipal and national policies should be prepared to develop plans that provide clean water and safe, hygienic, and dignified toilets on a large scale, such as that of India's Swachh Bharat Abhiyan (SBA) or Clean India Mission [64]. (6) Immediate food assistance.…”

Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries

“…Sub-optimal increases in coverage may limit the health benefits of sanitation programs [5][6][7][8]. While there is some consensus on the overall principles needed to achieve and sustain universal sanitation coverage [9], there is little rigorous evidence of successful programs at scale [10]. Context plays an important role in determining the implementation approach, so evidence of success and challenges of cross-country programs could support the rural sanitation and hygiene sector in achieving universal coverage.…”

Reprioritizing Research-cum-intervention Strategies on Gastrointestinal Infections Considering Swachh Bharat Abhiyan

“…Since 1986, the Government of India has taken several initiatives to improve the sanitation in the country. 10 It initiated the Central Rural Sanitation Programme in 1986, which is considered as a failure because the reality on the ground did not match the requirements for success. This was followed by the total sanitation campaign (TSC) launched in the year 1999, which was supposed to have been modified based on key lessons that were learned from previous program.…”

“…• The Indian Space Research Organization (ISRO) center at Jodhpur in partnership with others from Hyderabad and other places has carried out an in-depth country-wide study on the impact of SBM using Integrated Disease Surveillance Project (IDSP) data from 2010 to 2018. 10 The year-wise count of acute diarrheal disease (ADD) outbreaks, summer and July season peaks, the total number of toilets constructed under SBM, and the total villages that gained the status of open defecation free were analyzed. It was observed that the years 2017 and 2018 recorded the lowest number of total ADD outbreaks.…”

“…Economic significance of SBM/SBA has been rightly highlighted as the decrease in ADD outbreaks can significantly strengthen the gross domestic product. 10 • A study carried out in the two blocks, viz., Bhandra in Lohardaga and Gola in Ramgarh district of Jharkhand, on the impact of SBA has also shown interesting results. 6 In this study, which was carried out by Aarogya Foundation India (Jharkhand Chapter), qualitative survey research methodology was utilized to estimate the impact of the program on the community.…”