As regard to the major human development indicators for Kerala, the birth rate is at 18.2 per 1000 population during 1998 compared to an all India average of 26.4 and the death rate for the same period is 6.4 per 1000 against the all India level of 9. Kerala's infant mortality rate in 1998 is 12, which is the lowest among Indian states. The life expectancy (1996-2000) at birth in Kerala is 68.23 years for men and 73.62 years for women. Although the morality is low, there are high levels of morbidity rates especially contributed by water and sanitation related diseases.
The total sanitation programmes in Kerala has been on a low key compared to the progress recorded in the human and social development. According to national sample survey (1991), out of 5.5 million households in Kerala, 2.9 million households are without individual sanitary latrines. The overall sanitary coverage for the State is slightly over 50%. About 2.9 million households in the rural areas also have no safe latrines, out of which 2.5 million are families below poverty line. Considering the current progress in providing individual sanitary latrines, many of the poor and vulnerable will still remain with out individual sanitary latrines for many years. The state is having a higher incidence of water quality related diseases. A large majority of rural households especially belonging to the poor and the vulnerable are with out latrines and pose environmental and health threats. Yet another problem is that of leach pit latrines located in the vicinity of open wells. This contamination of the groundwater poses a very serious environmental problem since methods of restoration are extremely difficult. The coastal areas characterised by high population density and higher water table cause special problems in providing sanitary facilities.
In Kerala, the organised governmental sanitation sector intervention was through PHED, the forerunner to KWA in 1957, when WHO sponsored ESP was implemented. Currently a multiplicity of organisations including Rural Development Department, local bodies, Fisheries Department, Sodo-Economic Unit Foundation, SC/ ST Development Coperation etc, are involved in the sanitation sector. DANIDA (1983-89) also implemented a project for the construction of sanitary latrines. A sanitation project 'Ninmal 2000' is being implemented in the district of Kottayam targeting to become the first district in Kerala with full sanitation coverage. Yet another district level project named Clean Kerala is also on the anvil. Realising the vulnerability of the public health system, owing to poor environmental sanitation, the GOK appointed a task force to study and report on the comprehensive environmental sanitation needs of the slate. The task force recommended setting up of a technical mission for total sanitation to implement Clean Kerala Project with emphasis on IEC.
The GOK set up Kerala state Total Sanitation and Health Mission in line with the recommendations in 1999.