Water

NFHS-5: Why figures on improved sanitation shouldn’t be taken on face value

The latest NHFS-5 figures on improved sanitation are restricted to a select number of households and individuals and have been taken from a survey conducted in only 14 states and Union territories

 
By Shivangi Aggarwal
Published: Friday 03 December 2021

The Fifth Edition of the National Family Health Survey (NHFS-5) recently came out with its figures on people having access to improved sanitation facilities in India. The figures may be heartening at first glance but should not be taken at face value.

The main reason for this is the sample size as well as certain criteria used in the exercise. 

The number of people having access to improved sanitation facilities increased to 70 per cent according to NFHS-5, from 49 per cent in NHFS-4. The NFHS-5 figures were released November 24, 2021.

Some 65 per cent of rural Indians and 82 per cent urban Indians have access to improved sanitation facilities, according to NFHS-5.

These figures were arrived at after a rapid survey was conducted by the International Institute for Population Sciences, Mumbai, the nodal agency for the project designated by the Union Ministry of Housing and Family Welfare.

The survey consisted of multiple rounds and was conducted on a large-scale in a representative sample of households throughout India.

NHFS-5 was conducted in two phases due to the novel coronavirus disease (COVID-19) pandemic. Phase one was from June 17, 2019-January 30, 2020. Phase two was conducted from January 2, 2020-April 30, 2021.

The data was collected by 17 field agencies, which gathered information from 636,699 households, 724,115 women and 101,839 men.

Four survey questionnaires — for households, women, men and biomarkers — were used to collect information in 19 languages, using Computer Assisted Personal Interviewing.

The survey, the results of which were likely to be released by 2020, got delayed due to the COVID-19 pandemic and only covered 14 states and Union territories of India.

NFHS-5 also provides information on socio-economic characteristics of households, water sanitation and hygiene (WASH).

The data for NFHS-5 has been collected on the following, according to the survey:

  • Flush to piped sewer system
  • Flush to septic tank
  • Flush to pit latrine
  • Flush to don’t know where
  • Ventilated improved pit / biogas latrine
  • Pit latrine with slab
  • Twin pit / composting toilet

The NHFS-5 survey does not denote actual access to toilet facilities but only the percentage increase in improved sanitation. The percentage of households practicing open defecation or existence of unimproved latrines is still unclear from the datasheet.

Source: Union Ministry of Health and Family Welfare

Note: Due to Covid-19 pandemic, the survey data in NHFS-5 is collected only from 14 states and Union territories across India

The survey suggests that populations living in households with an improved drinking-water source have increased to 96 per cent in NHFS-5, from 94 per cent in NHFS-4. This figure is 95 per cent for rural areas and 99 per cent for urban ones.

Here, ‘improved drinking water source’ denotes:

  • Piped water into dwelling / yard / plot
  • Piped water to neighbour
  • Public tap / standpipe
  • Tube well or borehole
  • Protected dug well
  • Protected spring
  • Rainwater
  • Tanker truck
  • Cart with small tank
  • Bottled water
  • Community RO plant

The survey doesn’t give a clear understanding on the number of households having access to safe drinking water supply or sustainable source of water.

Source: Union Ministry of Health and Family Welfare

Note: Due to Covid-19 pandemic, the survey data in NHFS-5 is collected only from 14 states and union territories across India

The survey reported an increase in the percentage of children under five years who are stunted to 38.4 per cent in NHFS-5, from 35.5 per cent in NHFS-4.

Many studies have found that stunting is linked to poor sanitation and hygiene practices.

On the other hand, the percentage of children who received oral dehydration salts increased to 60.6 per cent in NHFS-5, from 50.6 per cent in NHFS-4.

Thus, there was a reduction in the percentage of children below five years with prevalence of diarrhoea to 7.3 per cent in NHFS-5, from 9.2 per cent in NHFS-4.

Benefits of having access to improved sanitation facilities can only be realised when there is access of improved drinking water source, with adherence to good hygiene practices.

Poor access to water, sanitation and hygiene — collectively known as WASH — can have intense socio-economic and various health impacts, particularly for women, girls and children.

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