Although India has achieved unprecedented development in many sectors, similar progress has yet to be made in the sanitation sector: Over 50% of the population still resorts to open defecation (Chambers, Medeazza, 2013). Approximately 70% of the wastewater generated in India is released without any treatment, leading to various adverse environmental and health consequences (Mallapur, 2016).

As of today, 15% of India’s population are undernourished, and the country’s overall food security is classified as ‘serious’. An estimated 43% of children under the age of 5 years are malnourished (Chambers, Medeazza, 2013), and in the same age group, 38.7% of India’s children are shorter than normal for their age, a phenomenon called “stunting” (IFPRI, 2016). In 2016, India was ranked 97th out of 118 countries in the Global Hunger Index (Kaul, 2016).

The public health implications of inadequate nutrition and poor sanitation are similar, such as (1) stunting/malformation among children (2) impaired cognitive development, and (3) weakened immune system. Inadequate nutrition and poor sanitation often go hand in hand and they reinforce one another, yet they are often conceived and practised as two unrelated topics. In fact, research indicates that poor sanitation plays an even more important role for malnutrition than lack of food (Chambers, Medeazza, 2013).

For an overview on how poor sanitation impacts human health, please refer to this video produced by Generation Nutrition: The Government of India has for decades tried to combat malnutrition by distributing vast amounts of subsidized food. But more and better food has largely failed to reverse early stunting, which is at least partly due to the lacking sanitation infrastructure (Worley, 2014).

In order to tackle the issue of malnourishment, one also has to consider the environmental and agricultural framework necessary to grow nutritious foods in a sustainable manner. According to the World Population Prospects (2015 Revision) published by the United Nations' Department of Economic and Social Affairs, Population Division, India’s population in the year 2050 is projected at 1.7 billion (UN, 2015). Already today, the country is facing serious problems and conflicts borne from shortages in freshwater. But not only water, also important plant nutrients such as phosphorus are becoming increasingly scarce and expensive (Adavikolanu, 2014). Worldwide, unsustainable farming techniques and inputs are leading to soil erosion, nutrient imbalances in soils and produce, and soil salinisation, creating various risks for human health and the environment . At the same time, untreated wastewater and faecal sludge, both rich in essential plant nutrients, are directly released into natural ecosystems, where they cause eutrophication, disturb natural nutrient cycles , and often lead to a loss in biodiversity. This in turn diminishes the availability and quality of environmental services (see info box) otherwise supplied by these systems.

The Nexus Project addresses the links between sanitation, agriculture and health. At our pilot sites, with our Information and Education Campaigns (IEC) as well as through our workshops for practitioners, we make visible and understandable the great synergetic potential between these three different domains. As a project of CDD Society, and a number of well-established implementing partners, Nexus can draw on an extensive body of expertise concerning decentralized, low-cost, low-maintenance, biological (i.e. non-chemical) wastewater and faecal sludge treatment options. Together, we work on improving the sanitation situation to create a favourable environment for food production and digestion, and to close the nutrient loop from “poo to plate".


Adavikolanu, 2014: Peak phosphorus and implications for India. Retrieved from
Chambers, Medeazza (2013): Sanitation and Stunting in India - Undernutrition’s Blind Spot
Kaul, 2016: India hunger levels ranked as “Serious” in 2016: Global Hunger Index
Mallapur, 2016: 70% Of Urban India’s Sewage Is Untreated
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2015 Revision.
Worley, 2014: Water, Sanitation, Hygiene, and Malnutrition in India

Environmental services refer to qualitative functions of natural non -produced assets of land, water and air (including related ecosystem) and their biota. There are three basic types of environmental services:
(a) disposal services which reflect the functions of the natural environment as an absorptive sink for residuals,
(b) productive services which reflect the economic functions of providing natural resource inputs and space for production and consumption, and (c) consumer or consumption services which provide for physiological as well as recreational and related needs of human beings.” (OECD, 2005).