A market model owned by communities achieves more sustainable health seeking behaviour than one that relies on donations for free, safe water by third parties.
Ten years ago, while working with farmers, Vrutti Livelihood Resource Centre noticed something odd about the people. Many of them looked aged beyond their years, seemingly malnourished. Farming couples were hunched over from pain, going to local clinics for analgesics to be able to work extra hours on the fields. Concerned, Vrutti invited Swasti, it’s sister outfit to come to Chikkaballapur and intervene.
Chikkaballapur, a district in Karnataka, India is a drought-prone region. Its only source of water is groundwater, contaminated with toxic levels of fluoride. The people it turned out, were suffering from fluorosis and in some places were even poisoned by trace arsenic.
A detailed needs assessment revealed that as much as people were aware about water causing these health problems, they did not know that it could be reversed. The study also revealed that men were willing to spend on alcohol but not on potable water. The study also showed that women wanted healthy water for their children and for their families if they were ill, but not for cooking because they believed that boiling water removed harmful toxins.
In addition, the study revealed that all previous health interventions that were grant-based (where communities accessed programmes, services and products for free) were popular but not sustained.
The team understood that in order for people to use healthy water and avoid water from their wells, a well-thought out market model, with strong behaviour change interventions was needed.
It also had to be owned and governed by the community. Thus emerged a market model where initial grant capital and technical support were catalysed externally (in this case through Swasti) and the community managed the operations and governance completely. A reasonable price point was set at 2 rupees per 20 litres.
Ten years later, the National Programme for Prevention and Control of Fluorosis (NPPCF) still did not address the provision of safe water, but politi- cally it seemed like a good bet. Both political leaders and private companies used this opportunity to provide safe water.
An extensive study by two Water Fellows from Arghyam in 2018, revealed that most of the water plants established by political leaders or companies are non-functional or have been shut down, but the eleven community-led water plants, co-established by the community, continue to thrive. Thimammpalli, where the first community water plant was inaugurated back in 2013, still functions to full capacity.
Dr. Mahima from the local health center says,
Earlier, during summer, the clinic was overloaded with patients complaining of gastro-intestinal issues and water-related problems. Today, patients coming to the clinic have no water related diseases
Health interventions need a new kind of leadership: people from within the community who value both the business potential and social capital of the project. They are the ones who can keep it moving forward.
Swasti worked with Gram Panchayats in Chikkaballapur to create a community-owned solution through investment in 10 water defluoridation plants and a tanker operating across two taluks of the district. Since 2017, Swasti only visits the water plants to meet old friends and enjoy a cold drink of water.
In Mamidikayalapalli, the medical costs have reduced by 100 per-cent, according to Vijay Kumar, the Gram Panchayat bill collector.