Published in IIPS Mumbai, ENVIS center, Volume 1, No. 4, December 2004

 

ACCESS TO SAFE DRINKING WATER : EFFECTS ON HEALTH AND TIME MANAGEMENT IN ANDHRA PRADESH, INDIA

by G. Rama Rao1, G. Rohini Devi2 and MNV Prasad3

Introduction:

Importance of providing safe drinking water was fully recognized in the Fifth Five Year Plan and included in the Minimum Need Programme. In India, in1986, the National Drinking Water Mission was launched. The main motto of this Programme was to provide water free from contamination especially of Iron and fluoride.

 

Safe drinking water is vital for human health and efficiency. More than one billion people in the world lack access to an adequate supply of safe water for household use and growing water scarcity, which makes it difficult to meet increasing demands (WHO 1998). Diarrhoea caused by unsafe drinking water is among the World’s greatest killers contributing to deaths of 3 million children annually and also causing about 900 million persons episodes of illness each year (Panda 1997). Recent studies(Health For the Millions,1997, Sachchidananda,1999) have indicated that diarrhoea death rates are 60 percent higher among those without safe drinking water. Hence providing access to safe water yields direct economic benefits.

 

The present research paper focuses on access to safe drinking water and effect on health in Anantapur District, Andhra Pradesh.  About 850 villages in Andhra Pradesh have been drinking water (Ramachandraiah 2001), Anantapur district is one such area where the majority of villages are drought prone. Sri Sathya Sai Baba Central Trust, a public charitable trust had undertaken a major infrastructure project namely Sri Sathya Sai Water Supply Project (SSWP)(see box.1)

 

Objectives:

The main objectives of this paper are:

  • To evaluate direct and indirect effects on time management before and after the implementation of the Sri Sathya Sai Water of the Sri Sathya Sai Water Supply Project(SSWP).

  • To examine the changes in morbidity pattern with particular referenceto waterborne and NSP Villages and SP villages under Sri Sathya Water Supply Project (See Box.2).

 

 

Results and Discussions:

The main sources of water supply for different purposes such as drinking, washing, bathing and for other domestic purposes are being compared in this study between SP and NSP villages. This would give a clear picture whether there exists any difference between these two groups of villages in terms of accessibility to water sources. It is observed that prior to installation of the scheme two thirds of the households in both SP and NSP villages used to depend entirely on public hand pumps for acquiring water, and nearly one fourth of household in both groups of villages were found using public taps laid down by rural water supply department. This clearly shows that before the completion of the project the SP and NSP villages depended on both public hand pumps and Rural Water Scheme(RWS) public taps.

 

1.Professor, 3. Research Officer, IIPS, Deonar, Mumbai-400 088,

2.Professor & Head Department of Sociology, S.K. Somaiya College of Arts Commerce & Science, Mumbai

 

 

 

 

 

 

It is interesting to note that there are notable changes in the SP villages after implementation of SSWP.  It was found that 9 out of 10 households who used to draw water from public hand pumps prior to the implementation of the scheme have now shifted to public taps laid down by SSWP (Table 1).

 

A similar trend was observed in those households who used to draw water from RWS public taps. On the whole, around 85 percent of the households in SP villages have shifted from their earlier water sources. The number of households that are continuing with the prior sources of water has consequently been reduced greatly.

 

 

Box.2:Sampling Design:

Sri Sathya Sai Water Supply Project( SSWP) covered 731 villages. Out of these, 15 villages were selected by Simple Random Sampling (SP villages). Seven adjacent but identical villages having the same socio-economic characteristics, which were not covered under the same scheme (NSP villages) were also selected for the purpose of comparison. From each sample village 50 households were identified by Systematic Circular  Sampling. Altogether 1105 households were selected. The structured questionnaires were canvassed to collect detailed information relating to a household, particularly water sources and utilization, morbidity among individuals of the household. In addition, community  leader’s opinions about the functioning and utilization  of SSWP schemes were obtained from medical officers the perception of morbidity pattern were determined. The investigators were trained to minute observations in detail regarding the opinion and problems in  utilization of Rural Water Supply (RWS) schemes as  well as SSWP schemes. The survey was conducted during the year 1999-2000.

 

 

T able.1: H household distribution of water and utilization and time management in  study villages

Characteristics

 Not  Covered Villages

Covered Villages

 

 

Before the Scheme

After the scheme

Source for Bathing, Washing & Drinking

 

 

 

Residence tap by PW S

1. 4( 5)

2. 1( 16)

1. 9( 14)

Public tap by RWS

( 77)

23. 1( 172)

3. 4( 25)

Public tap by SSWP

 

 

8 7 . 8 ( 654)

Public Hand Pump

( 242)

66. 2( 493)

6. 2( 46)

Other source like Agr. Borewells

 (4 )

(9 )

(1 )

Public Wells

( 32)

 7. 4( 55)

0. 7( 5)

Distance  (in meters)

 

 

 

< 50

21. 7( 78)

22. 4( 167)

64. 2( 478)

50-100

28. 9( 104)

25. 5( 190)

25. 2( 188)

100-200

28. 1( 101)

27. 0( 201)

  8 . 6( 64)

> 200

21. 4( 77)

25. 1( 187)

2. 0( 15)

Median

 100

120

50

Time (in minutes)

 

 

 

< 10

9. 4( 34)

10. 6( 79)

33. 2( 247)

10-20

26. 7( 96)

28. 6( 213)

50. 3( 375)

20-30

15. 6( 56)

28. 3( 211)

11. 3( 84)

> 30

48. 3( 174)

25. 1( 187)

5. 2( 39)

Average

  31.8

27.9

16.4

Number of Trips

 

 

 

< 2

 31. 1( 112)

55. 8( 416)

15. 8( 118)

3-4

58. 9( 212)

39. 3( 293)

73. 3( 546)

> 4

10. 0( 174)

  4 . 8( 36)

10. 9( 81)

Average

 3.1

 2.6

 3.3

Using same source for Drinking water

 

 

 

Yes

 96. 7( 348)

100. 0( 745)

85. 4( 636)

No

  3 . 3( 12)

 ( 0 )

14. 6( 109)

Reasons for not Drinking Water

 

 

 

Salty water

3. 3( 12)

 ( 0 )

45. 8( 50)

Muddy/colored water

 (0 )

(0 )

2 4 . 7 ( 2 7 )

High chlorid etaste water

0. 0( 0)

 0. 0( 0)

29. 3( 32)

Collection of water

 

 

 

House Head (male )

9. 4( 34)

17. 4( 130)

 5. 0( 37)

House wives

68. 6( 24. 7)

75. 6( 563)

40. 4( 301)

Children

 21. 9( 79)

6. 9( 52)

55. 0( 407)

 

Note : parenthesis is indicates the frequency of the household.

 

Distance: Prior to the implementation of the scheme, respondents on an average used to walk around 100 to 120 meters from their residence in both the SP and NSP villages (Table 1).  The planner of SSWP, in order to give benefit to the maximum number of people, laid the public taps where the houses are clustered. After the implementation of SSWP project it was found that this distance has been reduced to 50 meters. At the same time households from the NSP villagers are still traveling a median distance of 100 meters to collect water.  It is pertinent to observe that around one fourth of the respondents are traveling more than 200meters to fetch water now in NSP villages whereas the corresponding figure for SP villages is less than 2 percent.

 

 

 

 

 

 

 

 

Time: Another important factor for the shift to public taps was reduction in time spent for fetching water.  Prior to the implementation of the scheme is approximately 25 percent of the cases the time spent to fetch water was more of than half an hour.  But interestingly after the SSWP implementation, it has been reduced to ten minutes. Prior to implementation of SSWP project both the groups of villages used to spend on an average about ½ hour for fetching water.   After implementation SSWP in the SP villages it has been drastically reduced to 16 minutes. . But even now, in the NSP villages, people are spending half an hour for fetching water.

 

It was mentioned before, 15 percent of the people are still depending on public hand pumps for their main source of water.   When questioned as to the reasons for the continuation of the same source of water even after the implementation of SSWP the respondents reported that they are used to that taste. They also complained that the water from SSWP is salty, muddy and giving chlorine smell (taste). This suggests that village people are very rigid about their drinking water habits.

 

Regular supply of water : Regarding regularity in supply of water it was found that only 62% of the household in NSP villages reported receiving water supply regularly whereas 90% of people from SP villages are beneficiaries of regular supply of water, due to the implementation of the project. It is pertinent to note that 30 percent of households from NSP villages depended on power for regularity of water supply whereas the corresponding percentage in SP villages are only 7 percent.

 

This clearly indicates that SP villages are enjoying more regular water supply compared to NSP villages. Usually sufficient water is available in winter and in rainy seasons. The situation worsens in summer, but the SP respondents never felt the inadequacy of water even in summer.

 

Around 80 percent of the households in SP villages are receiving sufficient water in summer compared to only 25 % households in case of NSP villages.  Around 86% of the respondents in NSP villages complained that they have to make extra efforts to fetch water in summer, and this had been reduced to only 30% in the SP villages. In the drought prone area like Anantapur district, special efforts have  to be made to procure water, especially in summer season.

 

The main advantages for household members in SP villages due to implementation of the scheme are (1) reduction in distance travelled to fetch water from source to residence (2) considerable time saved in fetching water due to reduction of distance and (3) regularity of water supply particularly in summer season has been ensured with less extra effort after the introduction of the project.

 

Impact of availability of water on social attitudes and hygiene habits

 

The links between water and health are complex, influenced by a series of interacting factors and heavily dependent on social attitude and hygiene habits. In this section an attempts has been made to study the changes in social attitude, hygiene habits due to availability of water.

 

Around 56 percent of the respondents in SP villages indicated that they have saved a significant amount of time after implementation of the project (Table 2). Male members are going to their fields earlier than before and female members are doing extra work in their households which they could not do prior to the scheme as housewives used to spend majority of their time in water collection before the project. Due to the project there has been a considerable reduction in time spent for water collection, which allowed them  to engage in diverse activities. Prior to the implementation of the project, collection of water was thus a time consuming activity.

 

Table.2: Household distribution of water utilization according to seasons between SP and NSP villages.

 

Characteristics

 NSP

SP

 

Saving Time

 

Yes

 ----

  6.4(420)

No

 ----

  3.6(325)

Time utilizing in

 

Going early to field work

 ----

18.1(76)

Any other house work

 ----

77.4(325)

Going early to school

 

  4.5(19)

Regularity of water supply

 

Yes

 61.4(221)

88.9(662)

No

 8.6(31)

  4.0(30)

Depend upon power

30.0(108)

  7.1(53)

No.of days to store

 

 

One day

57.9(84)

92.8(311)

Two days

42.1(61)

  7.2(24)

During rainy season

 

Sufficient for Drinking

96.4(347)

 98.3(732)

water and washing

 

 

Sufficient for Drinking

  3.6(13)

  1.7(13)

water but not washing

 

 

During summer season

 

Sufficient for Drinking

14.7(53)

 49.0(365)

water and washing

 

 

Sufficient for Drinking

11.7(42)

 30.6(228)

water but not washing

 

 

Scarce supply

73.6(265)

20.4(152)

During winter season

 

Sufficient for Drinking

91.9(331)

 92.1(686)

water and washing

 

 

Sufficient for Drinking

 5.6(20)

  6.9(52)

water but not washing

 

 

Scarce supply

 2.5(9)

 (7)

Extra efforts in summer

 

Yes

 (308)

 (224)

No

 (52)

 (521)

Note: parenthesis indicates the frequency of the households.

 

 

 

 

 

 

Regarding morbidity prior to the scheme, sixty six percent of women in SP villages have reported that they suffered from severe body pains or felt fatigue as they used to carry heavy pots on their shoulders. After the implementation of the project this problem has been reduced drastically. In NSP villages 94 percent of the women mentioned that they were suffering either body pain or fatigue. Hence, it is evident that children’s help in fetching water has tremendously reduced the burden of woman's work, and the Distance traveled and time spent in fetching water has been reduced significantly after the project.

 

There is a significant reduction in long queues for water in SP villages after the implementation of the scheme whereas even now people have to spend time in long queues for water in NSP villages (Table 3).In the villages there used to be frequent quarrels for water particularly when it was scarce. Fifty two percent of the respondents reported that there used to be frequent quarrels in SP villages prior to the scheme. This friction have been reduced after the project.

 

Table.3: Differentials in social attitude hygienic Habits  and daily routine activities in SP & NSP villages.

 

Characteristics

NSP Villages

SP Villages

 

 

Before the scheme

After the scheme

Pains

More body pains

37.5(135)

 19.1(142)

 14.6(109)

Tiredness

 27.5(99)

30.2(225)

24.8(185)

More body

29.2(105)

 13.8(103)

 11.3(84)

No pains

  5.8(21)

36.9(275)

49.3(367)

Queue System

Follow a long Rarely we follow queue

56.9(205) 32.5(117)

46.3(345)  22.4(167)

30.1(224)  14.1(105)

Not nec.to follow queue

10.6(38)

 31.3(233)

(416)

Quarrels occurred

Frequently

65.3(235)

 51.8(386)

 31.9(238)

Rarely

 22.2(80)

33.8(252)

26.6(198)

No quarrels

12.5(45)

14.4(107)

41.5(309)

Bath

Twice in a day

0.0(0)

0.0(0)

12.6(94)

Daily

 15.3(55)

24.9(186)

34.2(255)

6 times in a week

22.5(81)

30.2(225)

32.6(243)

5 times in a week

20.0(72)

15.0(112)

11.8(88)

4 times in a week

13.1(47)

14.4(115)

8.7(65)

Thrice in a week

29.2(10

15.4(115)

0.0(0)

 

 

 

 

 

 

Note: parenthesis indicates the frequency of the   households.

 

 

It is pertinent to note that two third of the respondents reported that frequent quarrels are occurring even now in NSP villages for water.

 

 

 

 

 

 

It is pertinent to note that the consumption of water has increased considerably in SP villages after the implementation of the scheme. This increase in the consumption of water after implementation of the scheme has made a significant change in hygienic habits among the household members in the SP villages.  There was hardly any difference noticed in bathing pattern between the NSP villages and SP villages before the scheme. As a result of the scheme, the “frequency of number days” when bath is taken has significantly improved in the SP villages with a large proportion taking bath daily.

 

Impact of safe drinking water on health

Diarrhea is most closely associated with water supply and sanitation. Nearly 37.1 million new cases of diarrhoea among children aged 0 to 4 years occur in Andhra Pradesh annually. This results in an estimated 49,000 deaths per year. Outbreaks of cholera, dysentery, typhoid, hepatitis and E.coli are attributed to the exposure to water borne pathogens. In order to find the relation between safe drinking water and health, data has been collected regarding recent morbidity pattern.

 

The ratio of prevalence of sickness in the SP and NSP villages is 159: 231 (Table 4).  This clearly proves that safe drinking water plays an important role on health. As the safe drinking water is provided to them, the prevalence of arthritis has come down drastically to 29 in SP villages whereas in NSP villages the respondents are still suffering from arthritis (91) due to contaminated water.  The prevalence of water related sickness has also been analyzed by age wise. The age specific prevalence rates for both SP and NSP villages showed ‘j’ shaped curve with a minimum prevalence rate in the age group 5-9 years* and maximum in the age group 60 years and above. Irrespective of the age groups, the prevalence rates in NSP village is more as compared to SP villages.  The gap in the prevalence rates between the two groups of villages is particularly found in the age groups of 50-59 and 60 years and above.

 

Table 4: Prevalence rates of diseases with in 3 months prior to survey by background characteristics in SP and NSP villages.

Characteristics

 NSP Villages

SP village

Sex

Male

 215

149

Female

 249

171

Age

<5

 148

126

5-14

121

103

15-29

176

115

30-49

273

199

50-64

485

279

65+

 593

242

Education

Illiterates

292

205

Literates, Middle completed

208

139

Metric and above

162

114

Occupation

Labours

271

201

Landlords

236

160

Skilled Workers

301

166

House wife

337

193

Others

 141

98

Diseases

Seasonal Diseases1

 65

77

Waterborne Diseases2

 19

13

Skin Diseases

14

9

Dental Problems

36

14

Arthritis

91

29

Loss of hair

0

14

Others3

 6

3

Total

 231

159

 

 

 

 

 

Note:       1. Seasonal diseases are cough/cold and  High Fever

                 2. Waterborne diseases are diarrhea, jaundice, worms gastroenteritis and typhoid
                  3. Other diseases are breathing problem, measles, chicken-fox and stomachache.

 The prevalence rates in NSP villages are significantly high as compared to SP villages irrespective of the levels of education.

 

Among the diseases prevalent in SP villages, the seasonal diseases such as cough/cold, high fever and malaria ranked first with the prevalence rate of 77 followed by arthritis with 29. On the other hand, arthritis ranked first in NSP villages with 91 followed by seasonal diseases with a prevalence rate of 65. It is observed that the prevalence rates of all the specific diseases are reported to be high in the NSP villages as compared to SP villages with the exception of seasonal diseases.

 

 

 

 

 

 

The prevalence rates referred earlier are crude as they are affected by age distribution. It cannot be said with confidence that NSP villages are having higher prevalence than the SP villages. The standardized prevalence rates are computed by taking Andhra Pradesh age distribution as a standard population. A significant reduction was observed in crude prevalence rate (CPR) and

 

in crude prevalence rate (CPR) and standardized morbidity prevalence rates (SPR) in SP villages (CPR 159 and SPR 155) as compared to NSP villages’ (CPR 231 and SPR 232). The CPR of SP and NSP villages can’t be compared strictly as these rates were influenced by the socio­economic and demographic variables prevailed in both the groups of villages.(table.5)

 

Table 5: Crude Prevalencerates by diseases in SP and NSP Villages of SSWP, Andhra Pradesh
 

Diseases

 SP Village

NSP Village

Seasonal

 65

77

Water borne

 19

13

Skindiseases

14

 9

Dental problems

36

 14

Arthrit is

 91

29

Loss of hair

 0

14

Others

 6

3

Total

 23 1

15 9

 

The logistic regression analysis has been applied to find the probability of person falling sick in SP villages as compared to NSP villages controlling the socio-economic and demographic variables (age, education, occupation and housing condition). The result revealed that the chance of sickness in the NSP villages under the scheme were 1.6 times more as compared to SP villages after controlling the socio-economic and demographic variable.

 

Summary: Water is essential for human life. The impact of SSWP as brought out by a comparison of SP villages to NSP villages could be seen in change in morbidity pattern in both villages. Implementation of SSWP scheme, with an objective of providing water facility to loarge number of water deficient villages in Ananthapur district in Andhra Pradesh has resulted in positive change. Men could start their work early and

this is important since most of them were involved in agricultural work. Due to availability of water from nearby public tap, children also share the chore of water collection.

 

To above sum up, the SP project (SSWP) has helped  the people in the following manner.

 

1.Male members are going early to their work.

2.Children are able to help the family by drawing water from the public taps.

3.Women now are able to use their time in other activities.

4.Women are greatly relieved from body pains and fatigue.

5.Fights for collection of water have reduced.
6.People are helping each other incase there is need for extra water.
7.The respondents are able to take bath more frequently there is no shortage of water.

Water and Health

1.Number of people suffering from sickness in the past 3 months was more in NSP compared to SP villages

2.An inverse relationship is observed between the levels of education and prevalence rates in both SP and NSP villages.

3.Incidence of Water borne diseases were reduced in SP compared to NSP villages.

4.Number of people suffering from arthritis is   less in SP compared  to NSP villages. Thus there is a significant improvement in health in SP villages due to the safe drinking water.

 

Reference:

 

‘Effects of safe drinking water and sanitation on Diarrhoeal diseases among children in rural Orissa’, Pradeep Kumar Panda- Thiruvanathapuram, CDS, 1997.

 

‘Social dimensions of water supply and sanitation in rural areas: A case study of Bihar’, Sachchidananda- New Delhi, 1999.

 

‘Safe drinking water and Primary Health Services’, Mishra, Sweta- Kurukhetra, Vol. XLV, October-November, 1996.

 

‘Drinking Water as a Fundamental Right’, Ramachandraiah, C-Centre for Economic and Social Studies, Hyderabad, 2001.

 

Guidelines for drinking water quality: Vol.1- Addendum to Vol. 1 Recommendations’, World Health Organization , 2nd Edition- Geneva, WHO, 1998.

 

‘Environment and health: environmental sanitation and community water supply’, HEALTH FOR THE MILLIONS, Sep-Dec; 23(5-6): 26-8, 1997.

 

[This paper is the revised version of the Paper presented in PAA Conference held at  Boston, Massachusetts, (USA) during April 1-3, 2004]