While India continues to remain one of the fastest-growing major economies in the world, it is also a country where more than 750 million people live without that most basic of amenities that some of us take for granted: a toilet.

Sahida Khan is a Class IX student living in the small hamlet of Bidarka in Alwar district, Rajasthan. The bright 16-year-old cycles six km to the secondary school at Baghoda as her village does not have a secondary school. Her school has just one teacher for Classes VI to X for all subjects. While this constitutes a big problem for Sahida, who nurses an ambition to become an engineer, she is confronted with an everyday problem that could also undermine her health. There is no toilet for the children, no drinking water at school. So Sahida waits eight hours till she gets home and can go to the toilet. There is no bathroom at home either but at least there is the privacy of the fields around her house. This is the reality in Alwar district, which is less than 200 km from the national capital.

India is indeed a country of stark contrasts. It is rightly known as the Mecca of medical tourism, where cutting-edge medical technology can provide a cure for all kinds of even malignant diseases. Despite the economic downturn, the number of high net-worth individuals in the country grew 22.2 per cent in 2012, according to the World Wealth Report 2013. Only Hong Kong, at 35.7 per cent, grew faster than India. The number of millionaires in the country is expected to jump over 66 per cent at 3.02 lakh by 2018, even as 94 per cent of India's population has wealth below $10,000. India continues to remain one of the fastest-growing major economies in the world.

Yet, it is also a country where more than 750 million people live without that most basic of amenities that some of us take for granted: a toilet. Another 96 million do not have access to safe drinking water. In rural areas, seven in ten people still practiced open defecation in 2010.

As we observe yet another World Health Day, India continues to have the highest number of children under five — 1.5 million — dying every year. The majority are dying not from incurable diseases but because of totally preventable and curable diseases like diarrhoea and pneumonia. Lack of clean, safe drinking water, poor hygiene and sanitation is an underlying cause in most of these preventable deaths. Despite technological advancements, India has not been able to put an end to this silent epidemic in our backyard that is wiping out generations of our children.

On the flip side, India has fought and won a major battle against the scourge of polio through a massive vaccination effort. The eradication of polio is no small public health victory. But the war is not won yet. Polio cases could still resurface as the poliomyletis virus thrives in the absence of safe water and sanitation.

The sanitation crisis has a huge impact on health and poverty, with the country home to half of all the world’s malnourished and underweight children. A recent UNICEF report showed that poor sanitation is responsible for stunting the growth of 62 million children under the age of five in India. There is an economic cost to this staggering figure stemming from lost productivity and missed work and school days due to recurring illness or time spent searching for water or a safe place to defecate.

If the moral case has not triggered us to act then perhaps economic common sense will inspire us. A World Bank report says inadequate sanitation causes India considerable economic losses, equivalent to 6.4 per cent of India’s GDP in 2006 at $53.8 billion (Rs. 2.4 trillion).

Policymakers and politicians are waking up to this reality. The recent past has seen political parties spelling out the need for safe sanitation. The momentum is also building worldwide to making access to safe water and sanitation basic rights. U.N. Secretary-General Ban Ki-moon has called the need for access to safe drinking water, sanitation and hygiene “a matter of justice and opportunity”.

A key Millennium Development Goal (MDG) is the elimination of extreme poverty. India will miss this target in 2015 having not met its obligation to providing safe water and sanitation to all its citizens, particularly the most marginalised and vulnerable in society. It is not the lack of resources that prevents India from addressing the sanitation crisis but political will to ensure that the schemes in place reach those that need them the most. In addition, a recent report by WaterAid shows that just $0.55 has been received in water and sanitation aid for each person in India on average for the years 2010-2012.

This report, Bridging the Divide, argues that international water and sanitation aid is failing to reach those in greatest need, exacerbating global inequalities rather than reducing them. Overall, India has received on average $683.31 million per year in water and sanitation aid for the years 2010-2012. The stated aim of international aid is to help the world’s poor break out of poverty and to live healthy and productive lives — and to positively address our fundamentally unequal world. With over 1.5 million children under the age of five dying every year in India because of a lack of access to clean drinking water, basic sanitation and hygiene, why is not more water and sanitation aid being targeted at those who are desperately waiting for these essential services in our country?

This should be on the agenda when Ministers from India and other developing and donor country Ministers meet in Washington on April 10 to discuss the water and sanitation crisis at the World Bank hosted third high-level meeting of the Sanitation and Water for All partnership.

When the MDGs end in 2015, a new set of ‘sustainable’ development goals and targets will replace them. It is critical that sanitation, along with safe water and hygiene, is at the forefront of this new framework. Mere public pronouncements are not enough. The fight has to move beyond the sphere of debates and policy forums and translate into the reality of everyone, everywhere having access to safe water and toilets no later than 2030.

Neeraj Jain is CEO, WaterAid, India.

Email: neerajjain@wateraid.org.