This document provides a summary of a case study on water and fluoride levels in Nalgonda District, India. It finds that over 30% of water sources in the district have fluoride levels exceeding 1.5 mg/L, potentially impacting 10 lakh people. An estimated 3 lakh people show dental or skeletal fluorosis symptoms. The district administration has formed a District Fluoride Monitoring Centre to coordinate mitigation efforts across departments. A key focus is providing safe drinking water to the over 1,100 habitations affected by high fluoride levels in groundwater.

1. [Type text] [Type text] [Type text]
REPORT FOR INREM FOUNDATION, ANAND, GUJARAT
2015
Water scenario in
Fluoride Affected Region
A case study of Nalgonda District
KIRAN KUMAR SEN
M.Sc in Water Policy and
Governance
School of Habitat Studies
T A T A I N S T I T U T E O F S O C I A L S C I E N C E S , M U M B A I

2. Acknowledgments
I would like to thank Sunderrajan Krishnan, Rajnarayan Indu and Vikas Ratanjee at INREM
foundation for their constant guidance in every way possible during the study period. For
supporting throughout my stay in Nalgonda with language and travelling, I thank Srinivas
Cherkuri, Sadguru Prasad and K Subhash. In matters of the dealing with the government
departments, I would like to thank all the members associated with the District Fluoride
Monitoring Center, Rural water supply department, Nalgonda for their support for my study.
I thank the members of the Fluoride Knowledge and Action Network for their valuable
knowledge, especially Ayan Biswas, Dr Arjun Khandare, Safa Fanian, Avinash Krishnamurthy,
Samuel Rajkumar at various points in my study period.
I would like to thank Hari Krishna and his friend for helping with the language and guiding me to
the villages. I thank the waterman, Panchayat, teachers, Angaanwadi centres of all the selected
villages for extending cooperation.
I thank Nirmalya Choudhury for getting me in touch with INREM foundation.

3. Section 1
Introduction
Fluorosis is a condition caused by excessive ingestion of fluoride, a highly reactive ion of
element Fluorine through water, food or both. The upper limit of optimum fluoride level in
drinking water for a tropical country like India is 1.5 ppm. The upper limit of safe total intake of
fluoride from food and water per day for an adult is 5 milligrams (WHO-2002).
The total daily intake through water and food determines the development of Fluorosis. First
ever cases of endemic skeletal Fluorosis and its neurological manifestations in the world were
recorded from Podili, Darsi and Kanigiri areas of Andhra Pradesh in 1937. Subsequently cases
of Fluorosis were recorded from Nalgonda and other areas of the Andhra Pradesh state and
other parts of India. It is now estimated that 60 million people are living in these endemic area
are at risk of being affected by the disease and 2 million people are crippled because of it.
States like Assam, Bihar, Delhi, Gujarat, Haryana, Jammu and Kashmir, Karnataka, Kerala,
Maharashtra, Madhya Pradesh, Odisha, Tamil Nadu, Rajasthan, Uttar Pradesh, and West Bengal
have been affected by Fluorosis. It can be clearly seen as a growing and major public health
issue.
Moderate amounts of fluoride lead to dental effects, but long-term ingestion of large amounts
can lead to potentially severe skeletal problems. But, it is interesting to note that Fluoride in
low levels is vital for important for tooth development in the body.
The factors, which govern the development of Fluorosis, are the following:
 High levels of fluoride in drinking water supplies and in the foodstuffs grown in these
endemic areas.
 Tropical weather and hard manual labor by affecting more intake of water.
 Poor nutrition and diets deficient in their content of calcium, magnesium and vitamin C
aggravate fluoride toxicity. High intake of calcium reduces the amount of absorbed into
the bones.
These factors play a dominant role especially in places like Nalgonda, Prakasam,Chittoor
etc and other fluoride endemic areas.

4.  Renal disease aggravates Fluorosis by increased deposition of fluoride in the bones. A
diseased kidney cannot handle fluoride excretion from the body and hence it’s
increased deposition in the bones.
Fluorosis can manifest in these following conditions. Below are pictures of these
manifestations.

5. Figure 1: Cases of Fluorosis in study villages
1) Dental- It is characterized by mottling of dental enamel, which has been reported at levels above 1.5
mg/L intake.
2) Genu valgum - These are the deformities of limb bones, which are notably seen in weight bearing
lower limbs in children in endemic areas of Fluorosis.
3) Skeletal- Exposure to very high fluoride over a prolonged period of time results in acute to chronic
skeletal Fluorosis. Early stages of skeletal fluorosis start with pain in bones and joints, muscle weakness,
sporadic pain, stiffness of joints and chronic fatigue. During later stages, calcification of the bones takes
place, osteoporosis in long bones, and symptoms of osteosclerosis where the bones become denser and
develop abnormal crystalline structure.
4) Neurological Fluorosis - This is a late stage of skeletal fluorosis where in spinal nerves and spinal cord,
are compressed causing paralysis. This is a crippling stage and some of them can only be help them by
surgery.

6. Section 2
OVERVIEW: THE NALGONDA DISTGRICT AND FLUOROSIS
Figure 2: Nalgonda - Field Study Area
The Nalgonda gets its name from the geography around. In Telugu language, it literally translates into
“Black hills”. The geographical area of the district is 14,322 Sq Km. The population of the district is 34.88
lakhs, of which Scheduled Castes (SC) constitute 17.73% and Scheduled Tribe (ST) accounts for
10.55%. About 81% of the population lives in rural areas with agriculture as main occupation.
Total area is 14,22,000 ha of which only 5.88% is under forests. The annual normal rain fall is
752.60 mm. The climate is very hot (as high as 43-48 C) in summer and moderate in other seasons.
Main occupation of the people is agriculture and agricultural labourers represent 42% of the
population while cultivators represent 25.5%. Percentage of workers engaged in non-
agricultural activities is 32.4. River Krishna and Musi flows through this district. Ground water is
the main source for drinking water and irrigation in the district having 5 Lakh plus
borewells.The fluoride in ground water is as high as 14.75mg/Lit as against the maximum
permitted WHO guideline level of 1.5 mg/Lit.
The fluoride content of granite rocks in Nalgonda varies between 325 to 3200 PPM with a mean
of 1440 PPM. The fluoride content of soils in this district varies between 28 to1780 PPM. The

7. fluoride content of ground waters in Nalgonda ranges between 0.4 to 20 PPM. The reasons
adduced for this high level of fluoride in ground waters of this district are the low calcium
content of rocks and soils and the presence of high levels of bicarbonate in soils and waters.
There are 59 mandals with 1159 Gram panchayats and about 3312 habitations in the district.
1108 habitations are affected by fluoride in Nalgonda. Around 30% of water sources in
Nalgonda are fluoride affected (>1.5 mg/l) impacting an estimated 10 lakh people. An
estimated 3 lakh people are having dental / skeletal fluorosis symptoms.
1108 habitations spread over in 59 mandals are affected by the fluoride which is categorized as
follows.
Figure 3: Nalgonda District Fluoride map
Category A Covering 484 habitations in 17 severely affected mandals (Above 2.5 ppm)
Category B Covering 561 habitations in 31 moderately affected mandals (1.5 ppm to
2.5ppm)

8. 2.1 THE DISTRICT ADMINISTRATION & ITS INITIATIVES
Andhra Pradesh Legislative Assembly (APLA) high powered all party delegation of over 20
legislators have visited Nalgonda District during 6-7 July 2012. The visit was led by Speaker of
APLA and leaders from all political parties, ministers, and secretaries of the line departments
included. The purpose of the visit was to assess the impact of Fluoride on the communities and
decide on the immediate and long term measures to address the problem. Of the various steps
decided, formation of a body called the District Fluoride Monitoring Centre (DFMC), which
would help in monitoring the activities related to Fluorosis Mitigation, was a key initiative under
the District Administration.
The DFMC has been specially constituted with the District Collector as head to monitor, share
information, point out gaps, and help coordinate efforts across 17 line departments
carrying out various efforts in tackling the fluorosis problem. This center will involve in
preparation of Perspective Plan, Monitoring and Evaluation of the initiatives being initiated by
these departments concerned in convergence mode for at least for five years.
The DFMC is supported by 1) District Fluoride Monitoring Officer who is the Executive
Engineer of the Rural Water Supply Department, 2) Project Coordinator and 3) Computer
Operator. While the Monitoring Officer and Computer Operator are deputed by the
government, the Project Coordinator is recruited by DFMC to work to coordinate and monitor
the activities of DFMC on full time basis.
UNICEF earlier guided and supported the DFMC in its activities, but as of now UNICEF has
withdrawn its technical support and continues to be financial stakeholder as per the time frame
set by the agreement with the Nalgonda District Administration. DFMC primary responsibility
is to work with key line departments, review and monitor their performance. It holds
Bimonthly review meetings to assess the action taken and the outcomes with the heads of the
all related line departments with the District Collector presiding the meeting.
DFMC is a commendable step, which is initiated within the governmental setup. Hence it would
be very important to nurture the plans for mitigation of any public health issue (here it is
Fluorosis) along with it. In that way, it is much easier to implement strategies initiated by a
technical competent group.

9. Section 3
Rural water supply study: a case study of Nalgonda district
After getting familiarized with the issue of Fluorosis through readings, informed discussions,
media and earlier experience, it became pretty clear to me that providing safe drinking water to
fluoride affected habitations will play pivotal role in mitigating Fluorosis. This became focus of
my study in villages of Nalgonda district, Telangana, where groundwater fluoride was above
WHO standard of 1.5 ppm for drinking water.
I decided to conduct a detailed study of rural water supply scheme (May 2015) in the fluoride
affected villages of Nalgonda district where the scheme is implemented with reference to its
effectiveness. The rural water supply is run by various schemes and names from Rural Water
Supply department have Krishna river water as the major source of drinking water.
Villages were sampled randomly based on the present data available, according to the severity
of the Fluorosis where Category A are Severely Affected villages (above 2.5 ppm), B are
moderately affected villages (1.5- 2.5 ppm Fluoride)See the map above. I had surveyed 16
villages/habitations with eight each in both the category. In each village, five households were
randomly questioned based on the proximity to the water tanks/taps.
The views gathered here are from the people at this time of the year i.e summer, where water
scarcity problems peak up in a tropical country like ours, where rainfall is both spatial and
temporal in nature. The views may be different, subject to seasons and water availability.
Below is the list of the sampled villages/habitations for the study.

10. Sl.No Mandal Grampanchyat Habitation
1 Marriguda Kondur Thoorpathanda
2 Chinthapally Vinjamoor Kistyampally
3 Marriguda Attampeta Attampeta
4 Narayanapur Chillapur Lacchanagudem
5 Narayanapur Vailipally Vailipally
6 Chandur Gattupal Gattupal
7 Nalgonda Anneparthy Anneparthy
8 Nalgonda Gundlapally Gundlapally
9 Kattangur Cheruvannaram Cheruvannaram
10 Kattangur Ramachandrapuram Ramachandrapuram
11 Nakirekal Chandampalle Chandampalle
12 Nakrekal Nellibanda Adavi Bollaram
13 Kanagal Kanagal Kanagal
14 Kanagal
Gaddamvari
yadavally
Gaddamvari
yadavally
15 Chityal Shivanenigudem Shivanenigudem
16 Chityal Peddakaparthy Arigudem
Starting the survey, I reached Shivanagudem early morning to join my guide Mr. Subash, the
convener of the Floride Vimukti Porata Samiti, an activist group working to provide relief to the
affected from the government. We started towards our sample villages; the first village we
visited was Thoorpathanda in Marriguda Mandal. It was pretty long mud road more than a km,
which connected it with the main road.
On reaching the village, I asked for the waterman, the villager said there is no one like that. So I
started interviewing households on the water scenario, especially about the Krishna water, but
hearing from the first household, had kept me thinking. Because this village started receiving
Krishna Water for the last three days itself after repeated agitations with many concerned
officials, so the point of my evaluation of KWSS seemed pointless. But the water scenario in the
village is what aggravates the case of Fluorosis.

11. There is one tank from which Krishna water is supplied usually in the morning for about two
hours. For approx 80 households, the water supplied isn’t sufficient for drinking and cooking. As
a result, they resort to drinking groundwater without any basic filtering, very often throughout
the year.
Groundwater though not for drinking or cooking, is a major source used for other household
purposes across villages in Nalgonda district. Most of the households have a groundwater pipe
connection ending in a water sump, maintained through the waterman and administered by
Panchayat. The village had a number of bore wells dug (some which went defunct in recent
years) according to the needs of the population. When it comes to drinking and cooking, people
depend upon Krishna water and filter water. Below are the pictures showing different, but
major source of water consumption in Nalgonda district.

12. Figure 4- Different source of water consumption in Nalgonda District
In villages in Category A, nearly three-fourth of the respondents said that Sagar water (Krishna
water) is not sufficient. There were issues with the supply that of being irregular and
contaminated water. These are prime reasons for Fluorosis cases to increase as there is greater
chance for people to drink groundwater. However, most of the respondents depended upon
alternatives water source like RO water, thanks to increased awareness to not drink fluorine
water (that is what most Villagers had to say/refer about groundwater). In fact, 6 villages had
RO water plants which catered the demand for filter water, some being run by trust,
organizations and private entrepreneurs selling RO water in the range of 3-12 rupees for 20
liters. While others got filter water by delivered by autowalas. In couple of villages, the school
didn’t even have a water tank meant for drinking; this in a way puts children at greater risk to
their health, which includes Fluorosis.
There were issues of groundwater mixing with the Krishna water and hence people would use
Krishna water only for cooking and not drinking. The frequency of water in villages near
Nalgonda town were much better i.e 12 hours daily than other villages were it was just half the
days with no specific timings. I did find cases of Fluorosis in these villages, from dental, genu
valgum to severe skeletal Fluorosis. The extreme cases of Fluorosis were seen in more elderly
population, while the young showed cases of dental Fluorosis. See the pictures above.
With the villages in the moderately affected category where I had Mr Sadguru Prasad as my
translator/guide, the water supply was more predictable, with water supply being more regular
with appropriate time. However, still half the respondents depended upon alternative source
(RO water) to meet their drinking water needs. It was seen wherever there were issues with
Krishna water i.e mixing with groundwater, contaminated, dusty, colored water, people

13. hesitated to drink that water. In some cases, people drank groundwater because the tank was
far away from their house. Scenes of people drawing Krishna water through pipes to their
house were seen, while most of them walked and fetched water from the tank/public taps.
Below are few pictures depicting the common scenario of water in selected villages.
Figure 5: Water collection and structures scenario

14. There were no community level water conservation efforts seen in the villages, as Krishna
water and RO water quenched their thirsts, there seemed no incentive amongst people to do
water conservation. The rainwater harvesting structures provided by the government are
defunct, now a store for garbage collection. Even the tanks in dilapidated conditions, with
broken taps are common sight (see pic above). The waterman, most of them had asked me if
their salary can be increased, were in no condition to do O & M all by themselves.
It is interesting to note that people spend a considerable amount, in some cases 300-360
rupees per month to meet their drinking water needs. Even though the water supply was much
better with no water charge, they spend on other source due to quality issues. Even after huge
spending by Government to provide safe water through various schemes and names, people
resorting to alternatives questions the credibility and points towards the failure of maximizing
the benefits. People in many cases attributed the line breaks for the water being contaminated,
these incidences occurring every 2-3 months, keeps one wondering if contractors do a good
job, while laying these pipes. Another striking finding from the study is that most of the
respondents, who depended upon alternatives, were willing to pay for the reliable and clean
Krishna water supply. It gives us many directions on how a rural water supply can be made
more effective for all the stakeholders involved. More importantly, a better effective rural
water supply will ensure just enough fluoride for the development of the body and not to arrest
it.

15. Section 4
Data Analysis for the study
Prerequisite for the study was the presence of the rural water supply. Among the responses received
nearly 71% it is quite clear, that rural water scheme is functional for more than 4-5 years. Good
enough to carry out a study for its effectiveness.
14%
15%
33%
38%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Don’t Know 0-2 years 3-5 years Above 5 years
Presence of Krishna water supply
Total respondents= 79

16. The above figure shows that more than 3/4th
of the respondents use the small water sumps to get
Krishna water. The other response also hints at the Krishna water not being in use, clearly an
indication that other sources like bore wells, filter water etc are used for drinking and cooking.
The above figure shows that nearly half the respondents when asked about the time when Krishna
water is supplied replied with no specific answer. They were unaware of the timings and hence they
had to be ready, when water supplied started. The Krishna water with the above responses seemed to
unreliable to many respondents, when it comes for its time for supply.
1%
87%
12%
Access to Small water
sump/standpost/public taps
N/A
Yes
No
Don’t know Morning Afternoon Evening No specific
time
5%
37%
5%
13%
41%
Time for water supply
Total Respondents = 79

17. 0
5
10
15
20
25
30
35
Don’t Know 1-7 days 8-14 days 15-21 days Entire month
Category A Category B
Frequency of Water Supply
18%
15%
28%
18%
23%
8%
3%
13%
26%
51%
0%
10%
20%
30%
40%
50%
60%
Don’t Know 1-7 days 8-14 days 15-21 days Entire month
Category A villages Category B villages
Frequency of Water Supply

18. The above figure consists of representation of responses from category A villages (Fluoride levels
above 2.5 ppm/severely affected villages) and category B villages (Fluoride levels 1.5-2.5
ppm/moderately affected villages). The frequency in the severely affected is very low against
moderately affected villages. For example, among 15 % reported frequency in the range of 1-7 days in
severely affected villages as against 3 % in moderately affected villages. Again in the case of the 8-14
days range, it is 28 % for Category A and 13 % for Category B. It is to be noted that these Category A
villages require Krishna water on a regular basis, to be effective for Fluorosis mitigation, but from the
above data, the trend shows otherwise.
It is clear from the above representation that summer is inevitably the most water scarce season.
However, few respondents also confirmed that water supply is not a summer problem alone, but
throughout the year. It is during these seasons, the water problems are at their peak and hence the
probability for resorting to groundwater to meet their water needs. This eventually adds to the
Fluorosis problem.
5%
87%
8%
Water supply dwindles most
No answer
Summer
All seasons
total respondents=79

19. This graph explains the how accessible is the source of Drinking and cooking from the house. Most of
the responded that there house was at commutable distance to fetch Krishna water. Few of the
respondents, whose house was more than ½ km, more than often depended upon other alternatives
for drinking and cooking. This is the other issue cited by the respondents.
From the above figure, it is clear that nearly sixty percent of the respondents confirmed that the
present Krishna water supply doesn’t meet their Drinking and Cooking water requirements.
3%
42%
47%
9%
0% 10% 20% 30% 40% 50%
No Answer
Just outside
Within 1/2 Km
More than 1/2 Km
Distance of the water tanks/taps from the
house
Total respondents= 79
1%
38%
61%
Krishna Water for drinking and
cooking
N/A
Sufficient
Not Sufficient
Total Respondents= 79

20. This graph shows the dependence of nearly 70 % of the interviewed on the alternatives. Due to the
high temperature and farming profession among people in Nalgonda, they resort to alternative source
for drinking and cooking, when the regular water supply dwindles. It is to be noted that the study was
carried out during summer (May 2015), where usually the water supply dwindles due to high
temperature.
The above graph shows representation of most preferred alternative for drinking and cooking. Among
the respondents who depended upon the alternatives, the highest number depended upon filter/RO
68%
32%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Yes No
Depend on alternative sources for for
drinking and cooking
Total Respondents = 79
0%
10%
20%
30%
40%
50%
60%
70%
Borewell water Commercial RO water Both
Totalrespondents=54
Alternatives for drinking and cooking
Total

21. water for meeting their drinking water needs. There are few cases, where bore well water is
exclusively used for cooking and cases where both the alternatives are used.
About more than half the people, who depend upon alternatives to cope up with the issues of the
regular water supply spend more than 200 rupees per month. It is very surprising to note that villagers
seem to spend more than 300 rupees per month to meet their drinking water needs. The villagers
don’t spend this amount at once, but spend in little amount a day and which may vary according to
the requirements of the family and season.
25% 25%
43%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1-100 101-200 201-300 >301
Amount spent per month on Alternatives
Total respondents = 40

22. Among the issues with the Krishna water supply, there were some major issues that were more often
confirmed by respondents. They are irregular supply, frequent line breaks and contaminated water.
Infact, due to these issues the villagers hesitate to depend upon Krishna water to meet their drinking
and cooking water needs. The other issue cited is the distance of the water sump from the house
being far and defunct water sumps.
54%
5%
32%
9%
Issues with Krishna water supply
Irregular Supply and frequent Line breaks
Malfunctioning of taps
Contaminated Water
Other issues
Total Respondents= 79

23. From the graph above, it is clear due to the various issues associated with the Krishna water supply;
about 65 % of the respondents were not satisfied with the supply. Only when the supply was regular
with known timings, did the villagers felt satisfied. Clearly, pointing out to the solution that the
people demand and need.
35%
65%
0%
10%
20%
30%
40%
50%
60%
70%
Satisified with the current supply Not satisfied
Krishna water supply
Series1
Total Respondents= 79

24. When asked to the respondents who were not satisfied with the current water supply, due to its
irregularity, contaminated water issues. Most of them on being asked, replied that they are willing to
pay for regular and clean Krishna water. This was because people understood that they are spending
a lot of money on alternatives for their drinking water. They supported the view of a government led
supply system which would be the best option of providing drinking water to them. This gives a route
map of step in mitigating Fluorosis.
67%
19%
14%
Willing to pay for regular, clean Krishna
Water
Yes
No
Cant say
Total respondents= 51

25. Section 5
Reverse Osmosis (RO)/ filtered WATER IN NALGONDA
While studying the regional water supply scheme i.e the Krishna water supply scheme in fluoride
affected Mandals/Taluks of Nalgonda district, the major alternative to drinking water turned out to be
RO/filter water. The villagers admitted that due to the various issues with the surface water supply, they
resort to drinking filter water. This rise in the demand for the RO water had me surprised and curious.
The sale was observed both in villages and in Nalgonda town. Surprised that the water is sold by delivery
near homes similar to items delivered by the online business giants like Amazon, flipkart, snapdeal etc.
this trend is more prevalent in the villages, while in the town, RO water is available in any kirana store
nearby. It becomes easier for people to buy it, not the case in other circumstances.
An important reason for people to opt RO water in Villages is because the surface water supply is
erratic. People spend nearly about rs 90/month (in Vailipalli village), through an established supply with
cards that are marked each time a consumer goes for a can of water. People are spending as high as rs
300-360/month. I guess people don’t realize that they are spending a lot of money on drinking water to
cope up with the issues. More than half than respondents in severely affected mandals depended upon
RO water as a drinking water alternative. This shows the weakness of the existing system not being able
to cater drinking water, even after huge financial and technological investments. The price for 20 litres is
ranged 3-12 rs.
In some cases, people use Krishna water only for cooking (even though the supply is much better) and
buy RO as they feel that Krishna is contaminated, colored, tastes awkward. I think here, which people
also confirmed is the perception that Krishna water isn’t filtered and RO water being filtered is good for
health. The reason holds true for the town dwellers as well.
After having interviewed a few RO plants in Nalgonda town, it can be inferred that the system of RO
water is more business oriented in the town. At every level in the chain of business, till the water finally
reaches the customers, all involved in the sale has their own margin for sustenance. Having heard of an
informal association from a few respondents, which also included the Auto-delivery persons, who
commute across the town to supply RO water to the customers like Kirana shops, small hotels, hostels,
offices, houses etc. the probable no of RO plants working in Nalgonda town is between 30-40. All those
interviewed told they had bore well for the source of water, which had no issues with the water supply.
The return/waste water was sent out to the storm water drain. Most of these RO plant owners have
invested their own money, even buying the autos for water delivery for better sale each day.
It is quite unclear at this moment; whether all the RO plants need legal license of a particular type to
start their business. Most of the respondents had no license of any sort. Enquiring about the authority
which gives license, I was told it was Dept of Small industries. Some other officials in the RWS dept, told
it is the Municipality. The respondents kept talking about labour and food inspectors. It remains
ambiguous, when it came to legality of RO plants, atleast for now.

26. The RO water can reach the customers through various means and people involved.
Mode of RO water sale in Nalgonda Town, May 2015
Pricing scenario of RO water in Nalgonda town, May 2015
Step in Business chain Price per 20 litre (in
rupees)
Price per litre
RO water plant 8-10 to customers directly 0.40-0.50 paisa
From RO water to Auto-
delivers
5-6 0.25-0.30 paisa
From Auto-delivers to
Shops
10 to customers directly 0.50 paisa
From Shops to
customers
 15-20
 With cooler
 0.75- 1.00 rupees
 4 rupees
See the pictures below of the RO water business in Nalgonda town
RO water plant Auto-RO water delivers CustomersShops(Kirana Stores)

29. Figure 6: RO water business in rural and town areas in Nalgonda

30. Section 6
6.1 Conclusion
The fluorosis condition in Nalgonda is evident, with some extreme cases seen during the period
of the study. The severely affected villages have erratic supply of rural water supply than the
others group of villages. Thanks to increased awareness now among people, they depend more
on safer alternative sources like RO water, when it comes to drinking water. In moderately
affected villages and villages closer to the Nalgonda seem to have a better, reliable supply of
Krishna water with little or no quality issues. This gives direction to the government and other
stakeholders, to extend the services in a similar manner. They have to do pretty good job in
making the service dependable, because the market (RO water business) might just give them a
tough competition.
6.2 Recommendations
According to me, Nalgonda presents a great example for Fluorosis mitigation initiatives.
However, they are still not the best and solutions to the problem are still evolving. Here are few
suggestions/recommendations to make the effort more focused is vital.
 It is seen that villages in the severely affected category had erratic water supply. All
these villages were about 100 km from the Nalgonda town, where water is pumped
from. Hence, to augment the supply, there is a need to create reservoirs of
considerable capacity at specified distance at regular intervals from the Nalgonda
town. So these reservoirs need not depend altogether on the main reservoir stations at
Nalgonda rural water treatment facility.
 At policy level there is the Nakkalagandi project and its implementation will ensure
Krishna water to the western part of the district where the prevalence of Fluoride is
high when compared to the command area which is situated under NSP left canal in the
district.
 The pipes used in the distribution network (must be thoroughly maintained by the RWS
dept by regular inspection) and the water sump has to be ensured is of good quality

31. and its charge of maintenance should be entrusted to the villages, with guidelines to
protect or lose the water connection. Villagers can be capacitated with skills for O & M.
 All these villages receive good/moderate amount of rainfall, therefore to augment water
levels, village level water conservation activities must be promoted by watershed
programs. Like Ground water recharge management and rainwater harvesting:
Strategizing district water conservation plan in collaboration with the District
Administration and facilitating in implementation of the same.
 There were issues with Krishna water quality; hence there should be a simultaneous
primary/basic treatment facility along with the reservoirs, which would cater the
needs of a dozen GPs.
 Most of the villages surveyed, didn’t pay any water charge. From the study, it was found
that many are willing to pay for a better supply. Hence, a proper calculated charge, to
cover the O & M of the villages must be applied.
 If RO water turns out to be a better alternative in all aspects, then the Government
must look to invest in it, especially for tail end habitations facing water issues.
 For the RO in town, the government may look to formalize the business by regularizing
it and extending the benefits to market to grow.
 DFMC is a commendable step, which is initiated within the governmental setup. To
improve it functioning, following steps can be undertaken
 The DFMC lacks clears strategy and technical expertise on how it would ensure a
fluoride free district. Hence a clear, defined strategy from experts must be laid
and implemented. Activities are charted on paper; implementation of these
would be helpful.
 Departments like Social, Tribal, Backward, Horticulture and Animal Husbandry
have very little/negligible focus on Fluorosis mitigation. While RWS, Health,
DWMA, Groundwater, Civil Supplies have major focus. There is a need to relook
at the departments are should be involved with the DFMC. For e.g., Activities of
watershed can be taken by the DWMA, instead of distributing plants.
 DFMC must ensure to bring in an educational institution, which would help in
promoting Fluoride awareness and transfer of knowledge from lab to field.
 Regular inspection by the staff to ensure accountability of the steps taken by
various departments involved.

32. Section 7
References
 Understanding the Disease of endemic Skeletal Fluorosis and Ways to Contain It, Dr Raja
Reddy, Telangana Jagruti
 PROGRESS REPORT ON STRATEGIC ENGAGEMENT WITH FLUORIDE MITIGATION IN
NALGONDA DISTRICT, TELANGANA (July 2012 –Aug 2014)
 Issues in regional rural Water Supply Scheme: Ensuring Safe Drinking Water Supply in
Lathi-Liliya Region.
 Strategy Frame work for strengthening District Fluoride Monitoring Center,
District Administration.
 Strategy to eradicate Fluorosis in Nalgonda District, District Collector, Nalgonda
 Action taken reports, Feb and April 2015, DFMC