Corporate Responsibility in Public Health, Sanitation, and WASH: Addressing India's Social Infrastructure Deficit

Author: Utsa Basu Das

I. Introduction 

Healthcare, sanitation, and access to safe drinking water represent a critical dimension of India’s mandatory CSR landscape, codified under Schedule VII of the Companies Act, 2013. Investment in this domain directly supports the achievement of crucial global objectives, notably Sustainable Development Goal (SDG) 3 (Good Health and Well-being) and SDG 6 (Clean Water and Sanitation). 

Sectoral Priority Shifts Post-Pandemic 

During the height of the COVID-19 crisis, health infrastructure and support received an unprecedented allocation of CSR funds. However, in the subsequent fiscal years, there has been a notable re-prioritization. Current data indicates a shift away from high health spending toward other sectors, with Healthcare and WASH collectively seeing a significantly lower focus (12%) in FY 2023-24 compared to long-term favorites like Education and Skill Development. This trend reflects a normalization or potential underestimation of the continuing structural challenges within India’s public health system following the immediate crisis response. 

II. Policy Intersections and Government Missions 

The deployment of CSR capital in this sector is highly influenced by, and aims to complement, major government missions, ensuring private resources enhance public infrastructure. 

Supporting the National Health Policy (NHP) 2017 

The National Health Policy (NHP) 2017 outlines ambitious goals, including the progressive achievement of Universal Health Coverage (UHC), ensuring improved access and affordability of quality secondary and tertiary care, and crucially, achieving a significant reduction in catastrophic out-of-pocket (OOP) expenditure for citizens. 

CSR funds offer a strategic mechanism to bolster the public health system. They can be utilized to finance preventive and promotive services, build the capacity of essential healthcare workers (such as through UNICEF-supported training programs for nurses and midwives), and strategically fill infrastructure deficits in underserved areas, often by

working with not-for-profit private providers. Successful interventions focus on delivering health and nutrition education campaigns to address root causes of poor health, particularly in rural settings where malnutrition rates remain high. 

The Swachh Bharat Mission (SBM) and Corporate Response 

The launch of the Swachh Bharat Mission (SBM) in 2014 provided a clear call to action that corporate India embraced enthusiastically, successfully bringing the national conversation on sanitation into corporate boardrooms. 

CSR initiatives under WASH (Water, Sanitation, and Hygiene) have focused primarily on large-scale infrastructure and awareness campaigns. Typical interventions include providing safe drinking water, constructing household and pre-fabricated toilets (such as those funded in railway stations), and promoting sanitation awareness programs (e.g., the Swachh Aadat Swachh Bharat Program). These corporate efforts align with the national movement, recognizing that improved sanitation is a fundamental requirement for broader economic development and public health improvement. 

III. Evaluating Impact, Discrepancies, and Equity 

While CSR has driven significant funding into the WASH sector, an analysis of reported progress against ground reality reveals systemic contradictions, particularly concerning accountability and geographical equity. 

The Input-Output Fallacy in WASH 

The SBM, which has received substantial corporate backing, initially claimed great success, with official figures reporting that over 98% of households achieved access to toilets. However, subsequent national statistical surveys suggested a much lower level of household coverage, closer to 71%. 

This discrepancy highlights a critical challenge for CSR policy: the corporate investment model in sanitation often focuses on the most visible and easily reportable metric, which is infrastructure construction (input). While companies are successful in meeting their targets for building toilets and clean water facilities, the divergence in official numbers suggests a critical failure in measuring sustained usage and the resulting behavior change (outcome/impact). Consequently, corporate investment risks being highly successful in terms of regulatory compliance, yet structurally ineffective in achieving the ultimate goal of eliminating open defecation due to a lack of funding directed toward long-term maintenance, awareness, and behavioral transformation.

Measurable Health Outcomes and Systemic Deficits 

Targeted CSR health interventions have demonstrated clear, localized impact. For instance, sophisticated mobile dispensary programs focused on low-income communities have yielded quantifiable results, including a 30% reduction in waterborne diseases and successful early detection and management of non-communicable diseases (NCDs) such as hypertension and diabetes. Such projects show the immense potential of targeted, preventive care initiatives to alleviate the burden on local healthcare systems and reduce treatment delays. 

Despite these localized successes, national health indicators show persistent systemic weaknesses. For example, while general health attendance rates have improved, the prevalence of anemia among children aged 6–59 months worsened in recent years, rising from 58.5% in 2015/16 to 68.1% in 2019/21. This suggests that current CSR efforts, while important, are not yet sufficient or coordinated enough to reverse deeply entrenched, large-scale public health crises. 

Geographic Exclusion of High-Need Regions 

A review of CSR investment patterns in WASH indicates a pronounced geographical concentration bias. Funding tends to gravitate toward states that already have a significant industrial or corporate presence, such as Maharashtra, Uttar Pradesh, Rajasthan, Gujarat, and Tamil Nadu. This clustering suggests that CSR spending is often tied to the company's operational footprint or perceived ease of project implementation, rather than strictly prioritizing need. 

This localized preference leads to the systemic neglect of high-need geographic areas, such as states in the North-East, which were observed to see low levels of corporate interest despite high reported rates of open defecation. This concentration bias significantly undermines the national goal of equitable development inherent in the CSR mandate, indicating that the current decentralized model fails to direct resources efficiently to India’s most vulnerable regions. 

IV. Implementation Challenges and Future Monitoring 

Implementation challenges mirror those seen in the education sector, involving difficulties in aligning CSR initiatives with core business goals and constraints on budgets that limit project scope. Companies also frequently cite struggles in identifying suitable, effective implementation agencies, leading to delayed or unspent CSR funds. 

To improve overall accountability, policy focus is shifting toward rigorous external monitoring. Legal and policy recommendations include the establishment of a dedicated

ESG oversight body within the Ministry of Corporate Affairs and the transparent tracking of all unspent CSR funds. Such measures are crucial to ensuring that corporate resources are utilized as intended and achieve maximum social value. 

V. Conclusion and Policy Recommendations 

The CSR mandate has injected critical capital into India’s public health and sanitation infrastructure, demonstrating clear success in establishing localized preventive care systems and catalyzing the national sanitation movement. However, the system is characterized by structural weaknesses: a post-crisis decline in health priority, data contradictions indicating a failure to measure long-term behavioral change in WASH, and a stark geographical inequality in funding distribution. 

To maximize the social return on investment, CSR funding must transition strategically from constructing discrete facilities to facilitating sustainable, systemic health interventions. The focus should shift toward addressing persistent, chronic health indicators and ensuring resource equity across the nation. 

Policy Recommendations for Sustainable Public Health Impact: 

1. Prioritizing Preventive Care and NCDs: Given the proven efficacy of technology-enabled, localized mobile health units in disease reduction and early detection, companies should be strongly incentivized to direct their funds toward expanding preventative health campaigns and NCD screening programs. This strategy directly supports the NHP 2017 goal of reducing massive out-of-pocket expenditure on catastrophic illnesses. 

2. Addressing Geographical Neglect through Pooled Funding: To ensure equitable resource distribution and counter the current concentration bias, the MCA or NITI Aayog should develop transparent mechanisms, such as mandatory pooled funds, specifically designated to direct CSR expenditure into states and regions (like the North-East) that are currently marginalized due to a lack of significant corporate operational presence. 

3. Mandatory Outcome-Based WASH Reporting: To overcome the input-output fallacy inherent in sanitation projects, companies funding WASH initiatives should be required to move beyond reporting construction metrics. Instead, reporting should focus on verifiable, long-term sustainability metrics, including toilet usage rates, water quality maintenance standards, and quantifiable reductions in the incidence of waterborne diseases. 

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