Tag Archives: India

Eight Million Toilets and Counting

By Alice Carter

world toilet day 2015Normally, we don’t like to talk about bathrooms. That is a private space that most of us would largely like to avoid thinking about. But on World Toilet Day, we give thanks for our sanitary facilities and celebrate the invention of the toilet, which has saved countless lives as a disease control mechanism, and gives us privacy to, you know, go.

There is a Sesame Street song, a global “urgent run,” and an art show in New York. All of these types of events are celebrations for the often overlooked efficiency of the mundane technology that is a toilet, but also are opportunities to spread awareness of just how precious our access to toilets really is. One in three people around the globe don’t have access to adequate sanitary infrastructure, leaving them at increased risk for neglected tropical diseases (NTDs) that are spread through contact with fecally-contaminated soil. Half of the people who practice open defecation globally live in India, where 1.1 million liters of human excrement enter the Ganges River every minute. Recognizing the toll that open defecation takes on health, education and economic output, the government of India is trying to increase access to sanitation infrastructure and put an end to open defecation.

Prime Minister Modi has pledged that India will be open defecation free by 2019, and under his leadership the government has set up incentives for toilet construction and usage. Swachh Bharat Abhiyan — the Clean India Mission — is a sanitation campaign run by the Indian government, with the joint objectives of reducing open defecation and changing behavior to increase the use of sanitary facilities. Prime Minister Modi launched Swachh Bharat on Mahatma Gandhi’s birthday in 2014. The government also plans to raise Rs 3,800 crore (approximately 550 million USD) from the public to support this initiative, which gives subsidies for toilet construction and helps villages become certified as open defecation free. As of August 2015, 8 million toilets have been constructed as part of the campaign.

Unfortunately, it is tricky to measure the prevalence of open defecation and people’s toilet usage. Simply constructing a toilet in every home and school won’t make people start exclusively using toilets, especially if they don’t know the benefits of sanitation infrastructure and the risks of open defecation. For this, public awareness campaigns are also needed, and people need to be given plenty of reasons to use the toilet exclusively. One motivating factor for people to switch from open defecation to toilet use is awareness of the health risks of open defecation.

In communities that continue to practice open defecation, children playing outside or walking to school with no shoes can be exposed to contaminated soil, putting them at risk for infection by soil-transmitted helminths (STH). Similarly, clean drinking water sources and uncooked fruits and vegetables can be contaminated, increasing the risk of infection.

On the other hand, access to a household latrine has been found to reduce the risk of infection with STH by 40%. Nadia, a district in West Bengal, India, was the first district to be certified as open defecation free, and has since noted a decreased incidence of diarrhea and malnutrition. Reduced NTD infection is a strong indicator of the success of the Swachh Bharat campaign. Including an NTD indicator in Swachh Bharat would give the mission concrete targets to measure exclusive toilet use in communities where the campaign has built toilets, and it would help spread awareness of the negative health impacts of open defecation.

Perhaps on Gandhi’s 150th birthday, in 2019, India will have achieved its goal of ending open defecation. He would be proud, as he often stressed that a society’s approach to private and public sanitation reflects its commitment to true freedom and dignity.


Celebrating NTD Success Stories: India’s Historic NTD Progress

A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

During the month of October, END7 student supporters are celebrating NTD Success Stories from Haiti, India, Sierra Leone and the Philippines. Each country we are spotlighting has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive NTD treatment and progress towards disease control and elimination. The examples of these four diverse countries help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good. Last week, we celebrated Haiti’s inspiring progress towards the elimination of lymphatic filariasis, and this week we’re looking across the globe to India, a historic leader against that and many other NTDs.

India’s diverse population has experienced rapid economic growth over the past two decades, but the country still faces significant health challenges due to its size and high burden of disease. Almost half of the 1.2 billion people at risk of lymphatic filariasis (LF) infection globally live in India. Additionally, NTDs such as soil-transmitted helminths (STH) negatively impact hundreds of millions of children in the country, causing delays in cognitive and physical development. These NTDs take a heavy toll on economic productivity and chronic infections perpetuate the cycle of poverty. However, the Indian government has one of the largest and most successful NTD programs in the world, and treatment scale-up is paving the way towards the elimination of LF and the control of STH infections on the subcontinent.

The Indian government first launched a pilot program to tackle LF in 1949. Over the next four decades, the government supported important research and demonstration studies that became the technical backbone of the World Health Organization’s Global Programme to Eliminate LF, launched in 2000. India’s experience with LF provided the evidence for the operational and technical feasibility of mass drug administration (MDA) to eliminate LF — a strategy that has since been adopted in countries around the world.

Today, India leads the world’s largest MDA program, reaching more than 400 million people with an annual dose of preventative medicine for LF. To date, India is one of only two countries who have achieved MDA coverage at a national level, and the population at risk of LF in the country has been reduced from 600 million to 460 million as a result. The country has also successfully scaled up efforts to control STH infections at the state level, particularly through school-based deworming programs, and recently launched a National Deworming Day to coordinate multiple platforms for deworming into one cohesive push to tackle STH in children under 19. This initiative will encourage coordinated efforts, budgeting, and monitoring to improve the efficacy and reach of deworming programs.

Several districts in India are in the process of undergoing Transmission Assessment Surveys, evaluations designed to register whether LF transmission has been interrupted and annual MDA can cease. Moving forward, bi-annual MDAs will continue in districts with a high burden of LF. Continued efforts aimed at interrupting transmission of diseases, disease surveillance, early diagnosis and response, as well as continued community mobilization and education to change risk behaviors will be critical to reducing the LF burden in India. Managing the disease among existing patients, particularly those disabled by LF with elephantiasis or hydrocele, is also a high priority.

India’s Ministry of Health and Family Welfare worked with the Global Network for Neglected Tropical Diseases in November 2014 to produce a mass media campaign, Hathipaon Mukt Bharat (Filaria Free India) to raise awareness of LF and encourage people to participate in MDAs. The video created for the campaign, entitled Giant Footprints!, won silver at the Cannes Festival of Creativity in 2015. Bollywood star Abhishek Bachchan is also supporting India’s effort against NTDs as the END7 campaign’s first official ambassador in India.

These ongoing social mobilization efforts will be critical to achieving national, regional and global NTD control and elimination goals by 2020. If India’s current NTD efforts can be maintained and expanded, those at risk for NTDs can live free of these diseases of poverty and their devastating effects. And as the leader of one of the oldest and largest programs to tackle NTDs, India can be a leader in assisting other endemic countries hoping to replicate their success around the world.

There’s ample reason to hope that history will repeat itself in India as the country celebrates the elimination of polio and looks towards new goals, like the elimination of LF. The country’s example shows that directing the expertise of different agencies and organizations towards a common goal can be successful even in a country with a large and diverse population. END7 supporters are eagerly following the good news from India — the second success story we’re spreading in a month that’s already offered many reasons to celebrate — and hoping to see it replicated worldwide.

Following the Footprints to an India Free of Lymphatic Filariasis


India is embarking on the largest mass drug administration in history against lymphatic filariasis (LF), also called elephantiasis or filaria, a painful, disabling and disfiguring neglected tropical disease (NTD).

A shocking 500 million people are at risk of infection in India. But if the government expands its efforts to treat every community at risk, it could eliminate LF from the country as early as next year.

To support this ambitious effort, India’s Ministry of Health and Family Welfare launched a campaign titled Hathipaon Mukt Bharat (Filaria Free India).

Giant Footprints!, a video created by the Global Network, Ogilvy and Little Lamb Productions, is raising awareness of this campaign and encouraging all Indians at risk to take the preventive medicine.

India is on the verge of success. Be a part of the story by sharing the video today.

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Achieving Global Health Impact through Strategic Communications



(L to R) Richard Hatzfeld, Sabin Vaccine Institute; David Harris, independent creative consultant; Elizabeth Bass, Alan Alda Center for Communicating Science

In a world where politics, ideology and values sometimes outweigh evidence, how can global health professionals better communicate what they do in order to achieve impact?  Global Network’s Managing Director, Dr. Neeraj Mistry, addressed this question at last week’s American Society for Tropical Medicine and Hygiene (ASTMH) Annual Meeting. His panel discussion, titled “Using Communications to Elevate Neglected Tropical Diseases as a Policy Priority,” featured insights from Richard Hatzfeld, communications director for the Sabin Vaccine Institute; David Harris, an independent creative consultant who helped develop the ideas behind the END7 campaign; and Elizabeth Bass, director of the Alan Alda Center for Communicating Science.

ARK_8895Elizabeth began by stressing the importance of knowing your audience and goals. While some stakeholders, including policy makers, may be familiar with your issue, it is important to understand where they are coming from so messaging can be adjusted accordingly. She also emphasized the importance of connecting with people. Each and every one of us has a unique background – whether we’re a cancer survivor, an animal lover, a mother or an athlete. If your audience knows more about who you are as a person, they are more likely to trust you and take what you say seriously, she said. Lastly, Elizabeth clued the audience in on what she sees as the “wonder drug” of communications: storytelling. While statistics can cause an audience’s eyes to glaze over, stories have the power to grab an audience’s interest, evoke emotion and make people care.

Further emphasizing the importance of storytelling, David Harris discussed creative communication campaigns that have worked. Every day, our brains are inundated with hundreds of advertising messages – so an engaging and creative story is necessary to stand out and cut through the noise. He first used the example of the Wise Child Trust – a largely unknown charity (at the time) that is working to end child trafficking. Through David’s innovative marketing campaign, happy and healthy school children in the UK were encouraged to write their own story about love, hope or friendship. These stories stood in stark contrast to the terrible stories of trafficked children. The stories of the school children were compiled into a book and were then sold to parents and the community –with all proceeds going towards Wise Child Trust. This campaign was hugely successful and used the power of storytelling to raise an unprecedented amount of awareness and funds for Wise Child Trust.


David also discussed the Global Network’s END7 campaign and its “How to Shock a Celebrity” video which has gained more than 600,000 views. The concept of “END7” has been effective, explained David, because of its specific and time-bound goal: End 7 neglected tropical diseases by 2020. The campaign’s tagline, “together we can see the end,” is inclusive and encourages everyone to be a part of the solution. In addition, he said, the campaign has a strong call to action – donate just 50 cents to treat and protect one child. was hugely successful and used the power of storytelling to raise an unprecedented amount of awareness and funds for Wise Child Trust.

ARK_8914Next, Richard provided an overview of a communications campaign in India which will raise awareness of an upcoming mass drug administration for lymphatic filariasis (LF). He discussed the unique challenges of the campaign, which include messaging to diverse audiences, encouraging compliance and reaching media dark areas without access to television or radio. Richard emphasized that an effective communications campaign can overcome these issues and support the Indian government in their effort to eliminate LF by 2015.

The remarks provided by Neeraj, Elizabeth, David and Richard drew needed attention to the importance of communications and storytelling in the field of global health. Through effective and smart communications, the global health community can have an even bigger impact on the world’s most vulnerable communities.