Over the last five years, central and state governments have invested in improving access to sanitation across rural and urban India. The next five years are dedicated to increasing in-house water connections. Despite such laudable efforts and significant investments, informal settlements continue to fall outside the ambit of these programmes, owing to tenurial roadblocks and inadequacy of space.
These circumstances, emerging from past policy failures, make mitigation of Covid-19 risks through age-old public health measures of improved hand hygiene and social distancing in dense underprovided informal settlements near impractical, and need our urgent attention.
While over five dozen drug makers and universities across the globe, such as Sanofi, Johnson & Johnson and Moderna Inc., are racing to develop a vaccine for long-term resilience, most experts agree that it would take between 12–18 months before it is available for emergency use. Given this timeframe, the Narendra Modi government must contemplate giving emergency water and sanitation assistance in slums by expanding the application of the Disaster Management Act, 2005. The government must exercise collaboration and flexibility to avoid a “notified disaster” turning into a “multi-dimensional public health emergency” beyond the nation’s current management capacities.
Give immediate water and sanitation relief
Indian governments have substantial experience in providing emergency water and sanitation in both post-disaster situations and for mega-events. After the floods in Kerala in 2018, the government provided massive water and sanitation assistance to the affected communities through new water and mobile sewage treatment units along with family hygiene kits. Rapid delivery of infrastructure has taken place even during mega-events, such as the 2019 Kumbh Mela in Uttar Pradesh’s Prayagraj, when an additional 120,000 toilet blocks and water kiosks were set up. A similar approach should be adopted for highly vulnerable slum settlements through:
- Maintaining an adequate supply and encouraging the use of personal protective equipment (PPE) among providers of essential services, including sanitation workers living in slums, to prevent any further outbreaks and mass contraction of the corona.
- Distributing soaps and hand sanitisers, recognising that for many urban poor households, use of soap and frequent hand washing is a luxury.
- Providing rapid installation and maintenance of innovative and portable pre-fabricated toilet blocks — such as Pune’s Washroom on Wheels — in highly dense urban slum areas, to reduce the congestion faced when a large number of people are forced to use the undersupplied public water and sanitation infrastructure, undermining the social distancing norm.
- Ensuring all toilet blocks (portable or existing public/community blocks) have functioning water points and vending machines for menstrual products and soaps.
- Installing additional water points throughout the informal settlements for hand washing and ensuring that these receive an adequate quantity and quality of water. With the onset of summer, governments should work hard to ensure continuity of water supply in these settlements.
Recovery phase measures
- The urban poor bear a significant financial load for accessing both water supply and sanitation, often higher than that experienced by middle and higher-income residents. Considering the strong economic impact of Covid-19, it is recommended that the government ensures sustained and free basic access to water, sanitation, and hygiene (WASH) facilities in the informal settlements, in the immediate term, and offer more equitable options in the future.
- Establish slum water and sanitation management institutions with community support. Keeping sanitation facilities in working condition would require well-maintained plumbing, such as sealed bathroom drains, backflow valves on sprayers and faucets to prevent aerosolised faecal matter from entering the plumbing or ventilation system, together with standard wastewater treatment.
- Maintaining hygiene at the water and sanitation facilities is also critical. WHO recommends cleaning of shared toilet blocks at least twice a day with ethyl alcohol and sodium hypochlorite at specific concentrations. The government needs to invest in raising awareness among sanitation workers engaged in cleaning of public and community toilet blocks about the usage of stipulated cleaning agents, while also ensuring their supply.
Build resilience in slums
- Prioritise social protection for sanitation workers in tandem with that of the health workers. While states like Delhi and Punjab have announced specific measures for the frontline sanitation workers, government of India’s health insurance scheme has thus far overlooked them.
- Ensure that social protection programs are spatially targeted towards urban slums to meet supply-side issues of access to basic services such as public health and its infrastructure.
Safely managed WASH services not only form an essential part of preventing and protecting human health from the Covid-19 pandemic, but will remain critical during the recovery phase to mitigate secondary impacts on community livelihoods and well-being.
As currently being witnessed in Singapore, with the recent rise in the number of positive Covid-19 cases in worker dormitories and past epidemic outbreaks like Ebola, low-income settlements can serve as grounds for emerging and re-emerging communicable diseases. Thus, for India, it would be critical to incorporate intra-urban spatial and water and sanitation infrastructure disparities, while designing a comprehensive mitigation strategy.
The opportunity in this crisis is to correct WASH inequalities in the cities. This will not only protect against immediate vulnerabilities but also act as a long-lasting urban public health strategy against any future epidemics.
Shubhagato Dasgupta is a senior fellow, Anindita Mukherjee is a senior researcher, and Neha Agarwal is a research associate at the Centre for Policy Research, New Delhi. Views are personal.