Sanitation, immunisation and disease control

Two of the cheapest ways to save lives are also the oldest public health tools: clean surroundings and vaccines. Sanitation prevents the faecal contamination that spreads diarrhoea, worms and other infections, which in turn cause malnutrition and child deaths. Immunisation protects against diseases such as measles, diphtheria, tetanus and polio before children ever fall ill. Both require the state to reach every household, repeatedly, which is why they are good tests of state capacity.

The Swachh Bharat Mission, launched on 2 October 2014, made toilet construction and open defecation free status its central goals, with a large behaviour-change campaign alongside construction. In October 2019 the government declared rural India open defecation free, though independent surveys found continued open defecation in many areas and raised questions about toilet usage, water availability and maintenance. The mission's second phase shifted focus to solid and liquid waste management and to sustaining usage — an admission that building a toilet and using it are different achievements.

On immunisation, India's Universal Immunisation Programme provides free vaccines against a schedule of childhood diseases, and Mission Indradhanush, launched in December 2014, targeted districts and children missed by routine rounds. The most celebrated success is polio: India was certified polio-free by the World Health Organization in March 2014, after the last wild poliovirus case in January 2011, achieved through repeated national immunisation days reaching hundreds of millions of children. Routine immunisation coverage has risen, but gaps remain in remote, migrant and urban slum populations.

The common lesson is that coverage figures hide usage and quality. A toilet counted as built may not be used; a vaccine dose recorded may not complete the schedule; and disease control depends on cold chains, trained workers and community trust as much as on budgets. Sanitation and immunisation are also equity issues: the households missed by both are usually the poorest, the most remote, and the least served by the health system in general.