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The World Bank's Handwashing Initiative is based on the conviction that the simple practice of washing hands with soap could reduce deaths from diarrhoea by half. But its intentions are being questioned in Kerala, where people say they need safe drinking water, not multinational soap
Kerala
is learning many lessons from global development agencies
these days. And it will soon get a few in hygiene. The people
of the most literate state in India are to be taught the art
of washing their hands with 'good' soap in the coming months.
Courtesy the World Bank, scientists from the London School
of Hygiene and Tropical Medicine (LSHTM) have designed a handwashing
initiative "to reduce the incidence of sanitation-related
death amongst children". But the choice of a state that
has the lowest incidence of childhood diarrhoea and water-related
epidemics could indicate that the project is more about paving
the way for the MNCs into the informal personal care market
than bringing down the diarrhoeal death rates in the country.
The World
Bank-Netherlands Water Partnership, the funding arm of the
initiative, inaugurated the ambitious project to promote handwashing
at the World Summit on Sustainable Development in Johannesburg
recently. Called the Handwashing Initiative, the public-private
partnership project aims at promoting the use of soap manufactured
by multinational companies to reduce the incidence of diarrhoeal
diseases in poor communities. For reasons best known to the
project managers, the initiative is being implemented simultaneously
in Kerala and Ghana.
It appears
that UN agencies will perform their pro-poor obligation of
making the communities aware of the virtues of handwashing,
but private soap companies will harvest the gains. The project
document, prepared by LSHTM and discussed at various fora
in Washington DC, New Delhi and Thiruvananthapuram, with no
public participation, makes its intentions clear. It offers
a win-win approach: whilst governments and development agencies
want to combat disease and poverty, industry is interested
in expanding its market. But the big question is: should development
money be invested in generating profits for the corporate
sector?
The Global
Initiative for Public-Private Partnerships (PPP) in Handwashing
was launched with the aim of meeting "a huge unmet need
for handwashing with soap in poor communities in developing
countries". The World Bank and the Water and Sanitation
Program (WSP) which collaborate with the LSHTM and other partners,
have identified multinational soapmakers like Unilever and
Colgate Palmolive as partners in this initiative. According
to official sources, a meeting in Washington DC on May 7,
2001, attended by representatives from the LSHTM, the governments
of Kerala and Ghana and the WSP, decided the specifications
of the initiative. Among the 20 participants, Kerala was represented
by Elias George of the Kerala Water Authority and James Varghese
of the Kerala Rural Water Supply and Sanitation Agency (KRWSA).
Vidur Behal of Hindustan Lever India and Diana K Grina of
Colgate-Palmolive were also present.
The WSP
is an international partnership of the world's leading development
agencies "concerned with water and sanitation services
for the poor". It receives support from multilateral
and bilateral organisations for national, regional, and global
activities, including the Asian Development Bank, Australian
Agency for International Development, Belgium Agency for Development
Cooperation, Canadian International Development Agency, Danish
Agency for International Development and the Directorate General
for International Cooperation, Netherlands. Its goal is to
alleviate poverty by helping the poor gain sustained access
to improved water and sanitation services.
The
mission statement of the Handwashing Initiative will tell
you it aims to bring down diarrhoeal deaths in the world from
the present 6,000 deaths every day, to less than 40 per cent.
It says lack of sanitation alone is the cause of more than
three-quarters of diseases worldwide, and cholera and dysentery,
to name a few, account for the death of seven million children
every year. The project partners are convinced that handwashing
with soap is the most feasible and sustainable option to improve
health in the developing countries. A draft report titled
Sanitation and Hygiene: Unleashing the Power of the Market
prepared by the World Bank and other partners says: "Diarrhoeal
diseases kill 2 to 4 million children in developing countries
every year. Handwashing with soap alone could cut deaths in
half and handwashing with soap combined with adequate sanitation
could almost eradicate diarrhoeal diseases." The report
also discovers that in developing nations hands are washed
with soap on less than 10 per cent of the occasions when they
should be!
But some
questions remain unanswered: Has there been a serious problem
of diarrhoeal deaths in Kerala to merit its being handpicked
as one of the two hotspots in the world? Does lack of handwashing
really cause outbreaks of water-related epidemics in waterlogged
areas such as Kuttanad? Have the people of the state ever
been consulted on the washing of their hands with 'good' soap
five times a day? Niether Parameswaran Iyer at the Water and
Sanitation Program, who co-authored the programme or the Kerala
Health Minister P Sankaran provide any answers. "Why
should we give up such a chance for a health campaign when
the entire amount is met by them?" argues P Sankaran,
a lawyer-turned-politician. Officials at the KRWSA in Thiruvananthapuram,
the nodal agency for the campaign, are also tight-lipped about
the programme.
Nobody
in Thiruvananthapuram knows on what basis Kerala was selected
for the programme along with Ghana. Some time ago, a survey
had been carried out in Thrikkunnappuzha, Alappad and Panmana
panchayats along the backwaters in South Kerala on the sustainability
of changes in hygiene behaviour. Compiled by Eveline Bolt,
IRC International Water and Sanitation Centre, the study concluded
that whereas Kerala shows a low mortality rate, it has a high
morbidity rate, and the frequently occurring water and sanitation-related
diseases point to neglect of hygiene. This report is the only
document that the government has to justify Kerala's selection
for the campaign.
The villagers
in the backwater islets of Kuttanad, however, believe that
shortage of safe drinking water and not lack of handwashing
is the cause of diarrhoeal outbreaks in Kuttanad. According
to Kerala State Pollution Control Board statistics, the coliform
bacteria count in 100 millilitres (ml) of water in parts of
Kuttanad, is above 48,700 against a permissible 200 in water
for human use. No wonder then that outbreaks of epidemics
like rat fever and diarrhoea have seen an increase. According
to statistics available with the district medical officer,
Alappuzha, 18 persons died of wheel's disease in 2002 till
October. The count for 2001 was 23. The total number of those
suffering from diarrhoea in 2001 was 19,570. Statistics at
the Alappuzha Medical College show an increase in filariasis,
schistosomiasis, typhoid, jaundice, intestinal cancer, gastroenteritis
and cholera. "Give us drinking water first, instead of
Palmolive soap," says R Visakhan, the president of the
Kainakari Panchayat.
Many in
Kerala doubt the intentions of the initiative. "Why preach
handwashing when people in Kerala are traditionally conscious
about cleanliness and hygiene?'' questions development activist
K R Balan. A wide variety of local products are used for personal
hygiene in Kerala and an informal market for these products
exists in rural areas. There are more than 200 soap manufacturing
units in rural Kerala. The award-winning poverty alleviation
programme, Kudumbasree, also employs more than 2,500 women
in small-scale soap manufacturing units. "This handwashing
initiative is a ploy to eat into the existing informal market
for these swadeshi soaps,'' says Manoj Arukandathil, General
Secretary of the Kerala Small Scale Soap Manufacturers Association.
For Unilever,
Colgate Palmolive and Procter & Gamble, it is free promotion.
Under the patronage of the UN agencies and governments, these
multinational personal care companies stand to make inroads
into a hitherto unexplored market segment. The Handwashing
Initiative, it is claimed, will open the unexplored global
soap market segment of an estimated US $ 20 billion annually.
Multinational giants are upbeat about the new window of opportunity.
"It is about increasing the market," remarked Uri
Jain, General Manager of Hindustan Lever, one of the prime
beneficiaries. Though pushing products amongst the socially
disadvantaged isn't new, social investments by the government
and UN agencies in the process provides a much-desired legitimacy
and a tag of social responsibility to the corporations.
(The
Quest Features & Footage)
InfoChange
News & Features, November 2002
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