From Victim to Change Agents—Children as Social Change Agents for Cleanliness and Hygiene

  • Padma Kant JhaEmail author
  • Yogesh Kumar SinghEmail author
Conference paper


‘Sanitation and Hygiene’ has been one of the biggest problems for developing and underdeveloped countries. The absence of sanitation and hygiene among the masses leads to different kind of diseases which brings more financial burden to poor families and loss to the countries. The children have been the biggest sufferer as absence of sanitation and hygiene lead to severe health complications. Using education as a tool for behavioural change of children and developing a positive outlook towards hygiene and sanitation of children will result in healthy children as well as clean and hygienic environment.


Children Sanitation and hygiene Open defecation Clean country Rural India Education for sanitation and hygiene 

1 Introduction

Today’s children will lay the foundation of world’s future. It is vital that the national governments focus and invest more in children’s health and education to build a prosperous future. The children with poor health and low-quality education will become a liability to the nation. It is the responsibility of today’s leaders and existing governments to turn the fertility rate of the world into an asset.

663 million people in the world do not have access to improved water sources, and 1.8 billion people are using fecally contaminated drinking water sources. Nearly 1000 children die due to preventable water and sanitation-related diarrhoeal diseases each day. The given facts are the reasons that Sustainable Development Goal 6 is dedicated to clean water and sanitation that aims to ensure availability and sustainable management of water and sanitation for all by 2030.1

2 Overview

Using unimproved sanitation facilities lead to contamination in ground water, and pathogen contamination leads to diarrhoeal diseases. Each episode of diarrhoea leads to loss of nutrients from the body which is connected to malnutrition, stunting and sometimes death.2 Access to clean water and sanitation reduces exposure to pathogens and transmission to pathogens which further results in the reduction in diarrhoea, improvements in anthropometric indexes of children and reductions in total mortality.3

9% of all deaths among children under age five happen due to diarrhoea.4 WHO acknowledges diarrhoea to be the leading cause of child mortality and morbidity in the world, killing an estimated 760,000 children every year.5 In countries with high child mortality rates, diarrhoea accounts for more deaths in children under five years of age than any other cause of death—more than pneumonia and more than malaria and HIV/AIDS combined.6 Diarrhoea is the third leading cause of childhood mortality in India and is responsible for 13% (around 1.50 lakh) of all deaths/year in children under five years of age.7

The probability of infection during pregnancy, premature delivery and low birth weight increases if the mother does not have access to safe water and improved sanitation. Stunting starts from preconception when an adolescent girl, and who later becomes mother, is undernourished and anaemic; it worsens when infants’ diets are poor, and when sanitation and hygiene is inadequate.8

3 Results and Discussion

As per National Family Health Survey 2015–2016 conducted by Ministry of Health and Family Welfare, Government of India, 38.4% children under the age of five are stunted and under-five mortality rates is 50 per 1000 live births at national level. The situation is much worse in rural India where 41.2% children under the age of five are stunted and under-five mortality rate is 56 per 1000 live births.

The data of rural households without toilets, under-five mortality rate and children under five years who are stunted in rural India in 2015–2016 is tabled to find the impact of non-availability of toilets on other two (Fig. 1 and Table 1).
Fig. 1

Graphical presentation of households without toilet, under-five mortality rate and per cent children stunted under 5 years in rural India, 2014

Table 1

Status of households without toilet, under-five mortality rate and per cent children stunted under five years in rural India, 2014


% of rural households without toileta

Under-five mortality rate/1000 live births ruralb

Percentage children stunted under 5 ruralb

Andhra Pradesh




Arunachal Pradesh



























Himachal Pradesh




Jammu and Kashmir
















Madhya Pradesh








































Tamil Nadu












Uttar Pradesh








West Bengal




aMinistry of Drinking Water and Sanitation—2015–16

bNational Family Health Survey 4—2015–16

Above graph clearly shows that the number of households without toilets has direct correlation with under-five mortality rate and stunting rate among children under five years.

Under Swachh Bharat Mission, launched on 2 October 2014 to achieve open defecation status by 2 October 2019; India has shown tremendous progress in terms of construction of toilets. The coverage of households with toilets in rural India which was 38% at the time of launch of the mission has reached to more than 80%. But the construction of toilets alone will not solve the health problems caused due to the absence of sanitation facilities. While rural India has shown progress in numbers of toilets constructed, the usage of toilets is still a major concern of the government. It is also necessary to monitor the kinds of toilets being constructed under the Mission. In this regard, the definition by WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) may be adopted which defines an improved sanitation facility as a facility that hygienically separates human excreta from human contact, such as a flush toilet, piped sewer system, septic tank, flush/pour flush to pit latrine, ventilated improved pit latrine, pit latrine with slab or composting toilet.

Following the cooperative federalism approach, the Government of India formed a Sub-Group of Chief Ministers on Swachh Bharat Abhiyaan in 2015. The group came up to the consensus to use education as a tool to bring the positive change in the mindset of society with regard to sanitation. But this time, the education was given broader perspective which included awareness related to sanitation should be spread out by teams of students, and introducing sanitation as a stream at graduate, postgraduate and postdoctoral levels. The group also suggested that training should also be given to officials of local bodies and other government officials.9 In the line of Swachh Bharat Mission, Ministry of Human Resource Development also launched a programme Swachh Bharat Swachh Vidyalaya which aims to construct separate functional toilets for girls and boys, and imparting education on water, sanitation and hygiene in all government schools (Fig. 2).10
Fig. 2

Influence of safe water and improved sanitation on child health through decreased exposure to pathogens

Developing the habit of using safe water and sanitation facilities in children may work as stepping stone to motivate their families as well as society. Schooling and education can be used as powerful tools to bring behaviour change in the society. Being adaptive by nature, it is not difficult to make children use the sanitation facilities and developing hygienic approach in them.

The teachers should try to know the socio-economic background of the students with regard to sanitation and hygiene. On the basis of collected information from the students, the teachers should intervene. The schools should teach the children about the diseases caused due to contaminated water and by not using sanitation facilities, which can be easily preventable.

A school must have accessibility to appropriate toilets for boys and girls, hand-washing facilities and potable drinking water facility. It has been observed that the girls drop out from schools if the schools do not have separate sanitation facilities for girls. There should be proper cleanliness and maintenance for teachers’ toilets and students’ toilets. A school must have an onsite solid waste management system and must also teach children the appropriate hygiene practices.11 Not providing running water facility may be an obstacle to motivate the children to use the toilets. The schools must ensure running water facility in the toilets. The schools must also teach the students about the scarcity of water and its conservation.

In India, the society is not much open to talk about menstruation. In absence of education on dealing with menstruation and using wrong absorbents may lead to health hazards to adolescent girls. The teachers should sensitize the girls as well as boys on this issue. Sensitizing the boys will create a positive outlook towards the girls going through menstruation cycle which will bring further support from the boys to the girls. The schools should have facility of providing sanitary napkins at the same time, they should guide on safe disposal of absorbents used for menstruation. Providing the toilets suitable for disabled children is also an issue which should be addressed.

In India, there is a problem of waste segregation12 which results in difficulties in processing of the waste, generating the electricity from waste, composting of waste, reuse and recycle of waste. Using different kinds of bins for different kinds of waste at school will impart the habit of segregation of waste in the students. Burning waste is often considered an easy way to get away with the waste but particle pollution, carbon monoxide and dioxins lead to health hazards which make the situation worse. The concept of refuse, reduce, reuse, recycle and rot should be taught to children to develop their attitude towards the green environment. Children should also be made aware of how littering harms the animals and birds.

The students should also be taught about the technical aspects of sanitation facilities like which kind of superstructure of toilets should be constructed in which kind of situation. Not defecating in open cannot resolve all the problems related to sanitation as using unimproved sanitation facilities cause other harmful impacts on human health. The education as a tool should also cover aspect of safe disposal of excreta.

To introduce sanitation and hygiene, only as a theoretical part of the course curriculum, will not bring the desired results. The practical on washing hands and involvement of students in cleanliness in and around the school are of utmost importance to drive the students towards sanitation. The teachers should also keep an eye on the students’ behaviour towards sanitation and their cleanliness.

An attitude towards hygiene may also be developed through education and teachers. The teachers can list out activities related to maintaining personal hygiene for the students. The teachers could also involve the parents in these activities. Activities related to personal hygiene can be added as part of the mark sheet. The activities which may be incorporated are:
  1. 1.

    Using toilet regularly: To provide the toilets is an aspect of sanitation mission, but usage of toilets is also an issue of utmost importance. Regular bowel movements keep the human body free from waste generated inside.

  2. 2.

    Washing hands: A single gram of human excrement can contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts and 100 worm eggs.13 The faecal-oral transmission can be avoided by hand washing after the toilet usage. The students should also be motivated to wash their hands before eating. The students should also encourage their mothers to wash their hands before preparing for the meals. After meeting an infected individual or sneezing, the hands must be washed. The students should also be taught about right way to wash the hands which involves wetting hands with clean water followed by applying soap, lather hands by rubbing them with soap. The hands should be rubbed in a way that lather reaches to the back side of hands, between fingers and under the nails.

  3. 3.

    Brushing teeth: The students should be made into the habit of brushing their teeth twice a day, once in morning and second before going to bed. The residual food particles between teeth can cause the germs which may lead to oral infection.

  4. 4.

    Bathing everyday: Bathing everyday helps in removing the dirt from the body and keeps human body free from body lice and germs.

  5. 5.

    Wearing clean clothes: The undergarments cover the private parts of the body where moisture and sweat generate. Cleaning of these parts with clean water is necessary, but covering these parts with clean clothes is also an important issue.

  6. 6.

    Avoiding picking nose: As the hands are source of the bacteria for human body. Picking nose can lead to transfer of the bacteria to nose. On the other hand, the finger nails can cause abrasions which might lead to bleeding inside nose.

  7. 7.

    Nail Clipping: There is a possibility for germs to grow in long nails. The students should be taught to clip their nails weekly and maintain the hygiene.

  8. 8.

    Coughing and Spitting: The students need to be taught about coughing and spitting etiquettes. Covering the mouth while coughing and sneezing with handkerchief or tissue is important. In absence of handkerchief or tissue paper, the mouth should be covered with upper sleeve or elbow instead of hands.

  9. 9.

    Abstaining from habit-forming substances: The students should also be taught about the mal-effects of smoking and alcohol.

  10. 10.

    Community Hygiene: The students should be taught about harms of untidy surroundings and its bad impact on health.


In the state of Kerala, an activity-oriented workbook related to sanitation titled ‘Thelima’ was developed and used in course curriculum to motivate children on school sanitation, health and hygiene.14 The content of this workbook was developed in such a way that it could fit with various chapters in course curriculum of classes V–IX. The same workbook could also be used by the teachers as a handbook for preparing a calendar of activities for students. The workbook was also oriented to imparting some skills related to sanitation among children. The help of external agencies like Non-Governmental Organizations (NGOs) and the concerned government departments may be taken by the schools for providing, generating awareness on sanitation aspect among students as well as in society.

While using education as a tool for spreading the concept of sanitation and hygiene, it is essential that the teachers should take ownership of such initiatives and must be motivated. The help from concerned government departments and local NGOs can be taken for motivating teachers.

4 Conclusion

Developing an attitude towards sanitation, cleanliness and hygiene in early childhood will turn the children in adults with positive habits in respect of sanitation, cleanliness and hygiene. The children with positive attitude towards sanitation, cleanliness and hygiene will become social agent for their families as well as society which will further lead to healthy and clean country (Fig. 3).
Fig. 3

Using education as a tool for bringing change in sanitation and hygiene scenario among school children


  1. 1.
  2. 2.
  3. 3.

    Burger and Esrey (1995).

  4. 4.

    WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates 2015.

  5. 5.

    WHO, 2013.

  6. 6.
  7. 7.

    Diarrheal diseases among children in India: Current scenario and future perspectives ( accessed on July 10, 2017).

  8. 8.
  9. 9.

    Report of the Sub-Group of Chief Ministers on Swachh Bharat Abhiyaan, October 2015.

  10. 10.

    Ministry of Human resource Development, Government of India.

  11. 11.

    Water, Sanitation and Hygiene (WASH) in Schools, UNICEF (

  12. 12.

    Kumar and Pandit (2013).

  13. 13.
  14. 14.

    Water and Sanitation Programme—Compendium of Best Practices in Rural Sanitation in India.


  1. Burger, S., & Esrey, S. (1995). Water and sanitation: Health and nutrition benefits to children. New York: Cornell University Press.Google Scholar
  2. Kumar, V., & Pandit, R. K. (2013). Problems of solid waste management in Indian cities. International Journal of Scientific and Research Publications, 3(3), 1–9.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.NITI Aayog, Government of IndiaNew DelhiIndia

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