As India takes small but concrete steps towards revitalising its economy, recreating the lost jobs, and boosting its manufacturing and services sectors, it is important that these processes are both safe and sustainable. We are still in the midst of the Covid-19 pandemic and cases in India are rising daily. Regions that house among the highest industrial activity in the country and contribute most to economic growth are also the areas with very high incidences of Covid-19 positive cases. A few notable areas are Andhra Pradesh, Gujarat, Haryana, Hyderabad, Karnataka, Maharashtra, NCR Delhi, Tamil Nadu and Uttar Pradesh.
Both medical professionals and policymakers across the world have been stressing on adoption of two key practices as containment measures to reduce the incidences of Covid-19 infections: (i) improved hygiene and (ii) safer sanitation. As offices are beginning to work with full strength, factories are resuming more and more production, and commuting again becomes a part of the daily life, it is important to ensure that each and every individual adopts safe and secure sanitation and hygiene practices. It is also critical that systems are created and followed to enable and encourage each person to adopt habits and behaviour that ensure safety for all. The Ministry of Health and Family Welfare has issued several guidelines and advisories for office and factory managers, and for individuals to follow at workplace and at home; an important publication being “ An Illustrative Guide on COVID Appropriate Behaviours “.
What is a shared toilet? A toilet at home is a shared toilet, unless one is living alone and does not have any visitors. Any toilet in office, shop, factory, storage facilities, etc. is a shared toilet. So are toilets in public places such as those in markets, bus and train stations, airports, parks, courts and government offices. All community toilets will be classified as shared toilets. Simply put, any toilet used by more than one person is a shared toilet; such a shared facility is a part of our regular life. About 80 million persons in cities/towns and over 100 million in rural India people are still dependent on “shared” toilets . Additionally, tens of millions more daily use “shared” toilets (during commute and travel, public parks, government and private offices, clinics and hospitals, markets, educational institutions, etc.). Any initiative to make sure that shared toilets do not lead to transmission of diseases has to address at all levels: households, communities, workplaces and public spaces.
One can carry food and water from home to the workplace but not the toilet. Using a toilet is a critical and necessary biological need. But it need not become a source of spreading infections, whether Covid-19 or any other disease. By itself, not washing hands regularly with soap leads to higher incidences of diseases. However, data shows that handwashing with soap (Table 1). In these times of the Covid-19 pandemic, regular washing of hands with soap is not only important but can be life-saving too. Not to mention the positive impact enhanced handwashing will have ton keeping families and workforce health, leading to a stronger and more sustainable economic recovery. Higher incidences of Covid-19 cases in any company is not only bad for business but for its reputation.
Table 1: A large number of people in India do not wash hands with soap ( Reproduced from: Report on Drinking Water, Sanitation, Hygiene and Housing Conditions in India, NSS 76th Round Survey, GoI. Page 39)
While unwanted behaviour is a key reason for anyone to not wash hands with soap as and when needed, shortage or lack of both water and soap are also important reasons. Further, the poorer you are, the lesser the chances of having regular access to adequate water and soap for handwashing (Figure 1). Thus, it seems that the poor are at more risk of the Covid-19 contagion, given inadequate or lack of access to soap and/or water. But India cannot afford to leave behind the poor as higher incidences of Covid-19 infections among the poor are bound to lead higher number of infections among all socio-economic segments of the society, including the private sector offices and factories.
Figure 1: The poorer you are, the lesser the accessibility to water and soap for handwashing ( Reproduced from: World Bank. 2020. “Public Banks” South Asia Economic Focus (April), World Bank, Washington, DC. Doi: 10.1596/978–1–4648–1566–9. License: Creative Commons Attribution CC BY 3.0 IGO. Page 20)
Keeping safe and healthy
It is entirely possible to share a toilet but not transfer any diseases, if good hygiene and sanitation practices are followed. By its very nature, such a toilet is both a shared facility as well as a very personal space. Thus, utmost caution, good hygiene and adequate safety have to be adopted while using a shared toilet and follow protocols for handwashing. For the corporate sector in India, it has to address the issue of at three levels to ensure both sustainability of its business.
Table 2: Key responsibilities of management and each employee
Workplace: It is the joint responsibility of management and each employee (Table 2) to ensure that good hygiene practices and safe sanitation protocols are followed at all times: while at home or office, during commute, and when in any public place. Special attention has to be paid to the needs of women employees. Each company or office has to put in place a strong internal communication process whereby all employees are visitors are informed, motivated and encouraged to follow good hygiene and safe sanitation practices. This communication has to be based on science and facts, be continuous and updated, and reward good practices and behaviour. A feedback system has to be in place to attend to concerns and problems at the earliest as well as enable employees to make useful suggestions to improve the system.
Community level: It is important for the private sector to invest in improving hygiene and sanitation facilities for the underprivileged groups and communities. Key focus has to be provision of clean water for drinking and other uses (including hand washing) and access to hygiene products such as soap and sanitisers. Another key focus has to be on cleanliness and maintenance of community toilets along with availability of water and soap at these facilities.
Marketplace: Toilets at shopping complexes and in markets are used not only by visitors but also by the shop owners, their employees, and their supplier of goods and services. Incidence of Covid-19 cases can lead to closure of business and/or drop in sales. Shoppers are less likely to visit a shop or market where Covid-19 infections are found. It is important for the Market Associations to adopt a good and safe framework as has been outlined in Table 2.
Figure 2: When to wash hands with soap ( with input from UNICEF’s protocols)
For the government, it is important to focus on provision of clean and usable toilets, at all public spaces including those used during travel and commute, in its offices and in courts. Further, it needs to speed up the process of providing adequate water to all households, offices and commercial places to enable each person to follow good hygiene and safe sanitation practices. A viable approach would be to develop a comprehensive policy on public toilets covering design, accessibility, operation and maintenance, training of cleaning and maintenance staff, location, inclusivity (women, men, third gender), safety and signage. It would have to be supported by a strong public communications campaign on how to use a shared or public toilet, so as be safe and healthy, and good practices to keep the toilet clean and usable.
An inclusive, comprehensive and multi-stakeholder approach to hygiene and sanitation will ensure and build confidence among all that while toilets may be shared, they will not result in aggravating the Covid-19 contagion (disease).