Fluoride hotspots of Tamil Nadu: Why quick action on the ground is needed

The well-begun story of TN’s fight against fluoride contamination can have a resounding finale as in the case of several other social sector programmes.
Fluoride hotspots of Tamil Nadu: Why quick action on the ground is needed
Fluoride hotspots of Tamil Nadu: Why quick action on the ground is needed
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Read Part 1 and Part 2 of the series here.


Two major reports about India’s water scenario provide us with the context in which Tamil Nadu’s failure in ensuring safe drinking water for its fluoride affected population is to be seen. According to the reports published by the Ministry of Drinking Water and Sanitation (MDWS), out of the total 17,13,303 habitations in India, 1,76,177 were found to be contaminated, as per lab tests conducted during FY 2015-16. This accounts for 10.28% of all habitations being affected by poor water quality.

The major chemical parameters of concern are fluoride and arsenic. Iron is also emerging as a major problem, with many habitations showing excess iron in the water samples. It is estimated that 66 million people in 20 states are at risk due to excess fluoride and 10 million due to excess arsenic in the groundwater. About 62 million people are suffering from various levels of fluorosis, of which 6 million are children below 14 years, suffering from dental, skeletal and non-skeletal fluorosis. And Tamil Nadu is home to thousands of these victims.

The Composite Water Index (CWI) released by NITI Aayog in June 2018 minces no words over the fact that India’s water supply is limited and the quality is poor. Here are the highlights. India is currently ranked 120 among 122 countries in the water quality index. By 2030, the country’s water demand is projected to be twice the available supply, implying severe water scarcity for hundreds of millions of people and an eventual 6% loss in the country’s GDP. 600 million people face high-to-extreme water stress and 75% of households do not have drinking water on the premises. 84% rural households do not have piped water access. When water is available, it is likely to be contaminated (up to 70% of our water supply is contaminated), resulting in nearly 2,00,000 deaths each year. About 70% of India’s population, approximately 800 million people, live in rural areas, making this one of the largest service delivery challenges in the world in terms of scale. While access has improved markedly in recent years, with almost 87% of rural households having access to basic water, the provision of safe water remains a huge challenge. Currently, only half of the rural population has access to safely-managed water, far behind even our neighbours such as China and Bangladesh—resulting in one of the highest disease burdens due to water-borne diseases in the developing world.

How Tamil Nadu fares

NITI Aayog’s CWI scores vary widely across states, with most states below 50% and needing significant improvement in their water resource management practices. Tamil Nadu has managed to get an overall score of 51% - one point above the median score and with a dismal to moderate score in most of the 10 key CWI indicators of water management. Although listed among the medium performing states (Gujarat is top performer, closely followed by Madhya Pradesh and Andhra Pradesh), Tamil Nadu has performed poorly on many indicators. On positive change in overall score across 10 indicators between FY 2015-16 and FY 2016-17, Tamil Nadu has gone down steeply to minus 3.3 points from the base year performance. In source augmentation of groundwater, the state has a score of 9 points, as compared to Andhra’s 12. This is 3.8 points above median score which puts the state in the third position and Andhra in first among Indian states.

Under Major and Medium Irrigation (Supply side management), Tamil Nadu has a minus 6 score in FY 2016-17 and 3 in FY 2015-16. Most of the states have scored less than 50%. In Watershed development (Supply side management) the state has done excellently, second only to Punjab with a score of 8.9 points. But in participatory irrigation management, it is just above the median score with 6.1 points. In Rural Water supply, TN ranks fifth among Indian states with a median score of 4.1 points. In policy and governance, it ranks 6th, with a score of 10.5 points. In Sustainable on-farm water-use practices (Demand side management), TN ranks last among the 17 non-Himalayan states with a dismal score.

TN’s not-so-encouraging median level CWI score is loaded with significant implications for the water stressed habitations of the state and the fluoride hit areas in particular. It has to improve on vital indicators like sustainable farm use practices, which on the ground translate into indiscriminate and abusive groundwater exploitation depleting the natural source. As groundwater level goes down deeper and deeper, the water in the depths are in contact with fluoride and other deadly minerals like arsenic for a longer period and hence more contaminated. For 45% of irrigated land, source of water is tube well drawing groundwater resources. In comparison, canals irrigate just 26% of irrigated lands and tanks and wells only 22%. Competing industrial and domestic demand for groundwater will increase much faster than agricultural demand, although agriculture will remain the largest overall user. These competing demands for water, if not managed equitably would, exacerbate shortage of groundwater for poor communities.

Median ranking in rural water supply is a wakeup call to ramp up supplies so that unsafe groundwater dependent communities are brought into the safe net of Combined Water Supply Schemes (CWSS) soon and the socio-economic burden of waterborne diseases may be brought down.

Need to close gaps

The well begun story of TN’s fight against fluoride contamination can have a resounding finale as in the case of Family Planning, Noon Meal Scheme, AIDS Control and the ongoing effective thrust to end open defecation (ODF). The stakes are high, requiring immediate turn of the trend as India has the highest number of people who lack access to clean water, imposing a huge financial burden for some of the country’s poorest population, warns Quality of Drinking Water in India 2017, a report released by WaterAid. The alarming condition of water quality is based on the fact that the lack of clean drinking water has put over 11.5 million people of India at a high risk of the bone crippling disease, fluorosis. The World Bank estimates of 2015 show that in India, 28.1% of the deaths took place due to communicable diseases. Evidently, these were linked to unsafe water and the lack of hygiene practices.

If access to water and sanitation equip people to get themselves out of poverty and to contribute to national prosperity (Human Development Index Report 2006), the lack of it traps children from poor backgrounds in a vicious cycle, preventing them from improving their standard of life.

Younger people with early signs of the disease degenerate slowly towards permanent, full-blown skeletal fluorosis or non-skeletal fluorosis as they near their fifties, meeting the fate suffered by their parents, who would otherwise be productive and contribute to the well-being of their families and the village community.

Experts call for a paradigm shift in India's water governance. This may require a thorough revamp of the colonial era Water Supply and Drainage Boards. Inadequately equipped, corrupt local bodies with communal hegemonies and money power calling the shots cannot deliver. An autonomously administered council/board needs to be constituted with decentralised responsibility for source tapping and system delivery. It must have modernised systems to minimise, detect and fix leaks, thefts, be transparent and also have efficient information systems and space for community participation in asset maintenance, regulation and in decision-making. The voice of the water insecure marginalized communities must be heard. The new system must educate and engage communities of low income and other marginalised communities to advocate against environmental injustices impacting their health and well-being.

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