PrintFriendlyLaunched by the Ministry of Jal Shakti in 2019, the Jal Jeevan Mission (henceforth JJM), is envisioned to provide safe and adequate drinking water through individual household tap connections by 2024 to all households in rural India. The programme will also implement source sustainability measures as mandatory elements, such as recharge and reuse through grey water management, water conservation, rain water harvesting. It will be based on a community approach to water and will include extensive Information, Education and communication as a key component of the mission. It aims to create a jan andolan (people’s revolution) for water, thereby making it everyone’s priority. This mission has received endorsement from the global scientific community as well as leading water experts, notably Nobel Laureate and renowned development economist, Prof. Michael Robert Kremer.
Prof. Kremer is a Professor in Economics and Public Policy at the University of Chicago. He is the founding director of the Development Innovation Lab at the Becker Friedman Institute for Economics. He has also served as the Gates Professor of Developing Societies at Harvard University until 2020. He visited India in July 2022. During his visit, Prof. Kremer interacted with Vini Mahajan, Secretary and senior officers from Department of Drinking Water and Sanitation, Ministry of Health & Family Welfare, UNICEF and other sector partners at Antyodaya Bhawan in New Delhi. He was happy to learn that the JJM was not just making water available in rural household, but it also ensured that water supplied was of prescribed quality. In this regard, regular testing of water sources and end points was carried out through water testing laboratory and community surveillance using Field Test Kits (FTKs).
Prof. Kremer’s Research
A significant study-led by Prof. Kremer and his team has found that the JJM can save 1.36 lakh lives of children under five every year. This implies that efforts to reach as many people as possible with safe water are likely to have very large net benefits. In a paper titled ‘Potential Reduction in Child Mortality through Expanding Access to Safe Drinking Water in India’ economists Michael Kremer, Akanksha Saletore, Witold Więcek and Arthur Baker suggested that if JJM succeeds in this mission, it will prevent around 1,36,000 under-5 deaths per year. However, this will require that water delivered through JJM is free from microbiological contamination. The researchers noted that in 2019, at the inception of JJM, more than 50 per cent of the population did not have access to safe drinking water. They were of the view that although geogenic pollutants such as arsenic, fluoride and nitrate are widespread in certain regions of India, the most pervasive type of contamination is microbial, which must be avoided.
Diarrhoea is the third leading cause of mortality among children under five in India. Each year, around 500,000 children under 5 years of age die from diarrhoea, making it the third leading cause of death in this age group. More than 80 percent of these deaths can be attributed to unsafe drinking water. Each year over two billion people consume drinking water contaminated with faeces and over 1.5 million people die from diarrheal diseases. Climate change and aquifer depletion threaten existing sources of clean water. Yet relatively basic measures to contain disease spread from faecally-contaminated water remain unimplemented in large parts of the world.
Chlorination has been found to be effective in reducing the concentration of diarrhoeal pathogens like E. coli in controlled laboratory settings and in reducing caregiver-reporter diarrhoea. A variety of low-cost delivery systems for water chlorination exist, in addition to municipal water systems. Drinking water thus can be made safe through dilute chlorine solution, but take-up of this technology has been low. The meta-analysis conducted by Prof Kremer and his team also suggests that water treatment is one of the most cost-effective ways to reduce infant mortality. Providing tap water is an important step in improving water quality. However, it is important that it is free from microbial contamination. Even where water is treated at a central point, negative pressure in the pipes can lead to contamination,” the authors warn. The study further suggests working with the Ministry and assisting the effort by testing possible solutions to water quality treatment to reduce child deaths in India.
In rural areas of low-income countries with dispersed populations, piped water is likely to be too costly to adopt for some time. Prof. Kremer has also presented a study on different methods of treating drinking-water in the absence of centralized services, the more efficient method being the provision of free coupons to mothers after childbirth to access dilute chlorine solution. These coupons are sufficient to cover water supplies for the 12 months until children reach approximately age two. Mothers are told how and where to redeem coupons and are urged to treat water for their children during this vulnerable stage of their life.
Prof. Kremer in one of his researches also examined the free provision of dilute chlorine via a point-of-collection system, which included a container to dispense the product placed at the water source, a local promoter to encourage the product’s use, and free provision of a supply of chlorine solution packed in bulk. This bulk supply dramatically reduced delivery costs relative to the retail approach, which required packaging chlorine in small bottles, and relative for door-to door distribution, which in addition significantly raised marketing costs. Hence, bulk distribution to water sources made free provision more realistic. Additionally, this delivery method makes chlorine use very convenient. Users can treat drinking water when they collect it. The source-based dilute chlorine disinfection approach to water treatment makes this act salient and public, in addition to making it cheaper and more convenient. The dispenser provides a daily visual reminder to households to treat their water at the moment when it is most salient—as water is collected—and maximizes the potential for learning, norm formation, and social network effects by making the dispenser public. Potential users can see others who use the dispenser, and they have the opportunity to ask questions; they will also know that others will see whether they use the dispenser.
Prof. Kremer also spoke of the long-term economic benefits of deworming children regularly, Professor Kremer presented a study showing that 2-3 years of deworming results in 13% gains in earning and consumption expenditures, dewormed children have a higher rate of shifting from agricultural to non-agricultural activities and are able to obtain better wages. More than 25% of the world’s population are affected by soil-transmitted helminth infections, largely due to lack of access to sanitation and contamination of soil with human faeces. A study had found that deworming treatment of mothers during pregnancy reduced by 14% the risk of their child dying within the first 4 weeks after birth; treating pregnant women with anthelminthic medicines can also avoid low birthweight.
Many water interventions require significant investments in infrastructure. This is particularly true of water quantity investments, whether bundled with water quality improvements or not. Whereas some water quality investments (for example, leaving out water in the sun or adding chlorine) require virtually no investment in infrastructure, others (for example, spring protection) require hardware. Along with infrastructure investments comes the challenge of maintenance, which has historically been a major problem in developing countries. The rural water sector in particular has a poor track record of maintaining infrastructure investments. For instance, a quarter of India’s water infrastructure is believed to be in need of repair. According to World Bank Reports, more than a third of rural water infrastructure in South Asia is not functional. Difficulties with maintaining water infrastructure, particularly in rural areas, reduce the cost-effectiveness of these interventions relative to other measures that prevent diarrhoea. Two options frequently mentioned as potential elements of a solution to this infrastructure challenge are (a) empowering women to manage water resources and (b) including communities in participatory management schemes.
Significance
On 30 September 2021, the World Health Organization (WHO) hosted Prof. Kremer at their headquarters in Geneva. During his visit, Professor Kremer gave two virtual presentations: one on the ‘relationship between water, sanitation and hygiene (WASH) improvements and child mortality; the other on meta-analysis and public policy: the case of mass drug administration for helminths.’ He spoke of the correlation between water quality, access to water and child survival in developing countries. He said that there is strong evidence to suggest that access to improved water quality is critical to reducing communicable diseases and that young children stand to benefit most from access to clean water.
The extensive study conducted by Prof. Kremer and his team can certainly help in resolving problems arising out of water borne diseases in rural India. The study also suggests working with the Ministry of Jal Shakti and assisting the effort by testing possible solutions to water quality treatment to reduce child deaths in India. In a way, the legitimacy provided to the Jal Jeewan Mission by one of the topmost experts in the field of science is indeed very significant. With the progress of JJM, India has become a shining example on a global platform for its impactful WASH policies that are being driven on such a large scale. Upon having received global endorsement, India is now certainly in a position to transfer/make available the knowledge/experience to other countries, especially in South Asia and Africa.
Reference:
- https://jaljeevanmission.gov.in/
- https://pib.gov.in/PressReleasePage.aspx?PRID=1841315
- Ibid.
- https://www.sarkaritel.com/jal-jeevan-mission-will-prevent-around-1-36-lakh-under-5-deaths-per-year/
- https://newswaali.com/research-led-by-nobel-laureate-kremer-shows-indias-jal-jeevan-mission-could-save-1-36-lakh-lives-of-under-5s-the-tribune-india-news-waali/
- https://news24online.com/india/jal-jeevan-mission-can-save-lives-of-1-36-lakh-under-5-children-every-year-finds-nobel-laureate-kremer/44201/
- https://www.annualreviews.org/doi/pdf/10.1146/annurev.resource.012809.103919
- ttps://newswaali.com/research-led-by-nobel-laureate-kremer-shows-indias-jal-jeevan-mission-could-save-1-36-lakh-lives-of-under-5s-the-tribune-india-news-waali/
- https://www.annualreviews.org/doi/pdf/10.1146/annurev.resource.012809.10391
- Kremer, E. Miguel, S. Mullainathan S, C. Null, A. Zwane, Making water safe: Price, persuasion, peers, promoters, or product design? Work. Pap., 2009 Harv. Univ., Cambridge, MA
- Deworming (sometimes known as worming, drenching or dehelmintization) is the giving of an anthelmintic drug (a wormer, dewormer, or drench) to a human or animals to rid them of helminths parasites, such as roundworm, flukes and tapeworm
- https://www.who.int/news/item/06-10-2021-2019-nobel-laureate-michael-kremer-emphasizes-wash-and-deworming-benefits
- Ray. Water for all? Peri-urban and rural water delivery options: the case of India. Int. Conf. Eng. Sustainable World, 2004, Stanford
- https://www.who.int/news/item/06-10-2021-2019-nobel-laureate-michael-kremer-emphasizes-wash-and-deworming-benefits