Promoting Rural Sanitation Key Challenges Background:

Open defecation is a traditional behavior in rural India. This along with the relative neglect of sanitation in terms of development priorities, was reflected in the countrys low sanitation coverage at the close of the 1990s when it was found that only one in five rural households had access to a toilet !ensus "001#. This fact, combined with low awareness of improved hygiene behavior, made the achievement of the goal of total sanitation a pressing challenge in rural India. Individual health and hygiene is largely dependent on ade$uate availability of drin%ing water and proper sanitation. There is, thereof, a direct relationship between water, sanitation and health. !onsumption of unsafe drin%ing water, improper disposal of human e&creta, improper environmental sanitation and lac% of personal and food hygiene have been ma'or causes of many diseases in developing countires. India is no e&ception to this. (revailing )igh Infant *ortality rate is also largely attributed to poor sanitation. It was in this conte&t that the !entral +ural ,anitation (rogramme !+,(# was launched in 19-. primarily with the ob'ective of improving the $uality of life of the rural people and also to provide privacy and dignity to women. The concept of sanitation was earlier limited to disposal of human e&creta by cesspools, open ditches, pit latrines, buc%et systems, septic tan%s etc. today it connotes a comprehensive concept, which includes li$uid and solid waste disposal, food hygiene, and personal, domestic as well as environmental hygiene. (roper sanitation is important not only from general health point of view but it has a vital play in our individual and social life too. ,anitation is one of the basic determinants of $uality of life and human development inde&. /ood sanitary practices prevent contamination of water and soil and thereby prevent diseases. The concept of sanitation was, therefore, e&panded to include personal hygiene, home sanitation, safe water, garbage disposal, e&creta disposal and waste water disposal. The responsibility for provision of sanitation facilities in the country primarily rests with local government bodies 0 /ram (anchayat in rural areas. The state and !entral /overnments act as facilitators, through enabling policies, budgetary support and capacity development. In the !entral government, the planning !ommission, through the 1ive 2ear (lans, guides investment in the sector by allocating funds for strategic priorities. Global Scenerio and Joint Monitoring Programme (JMP !"#!: 3*( is 3oint *onitoring of 4ater and ,anitation (rogramme initiated 'ointly by 4)O and 56I!71. This is being done every two years. (rogress in !hina and India is highlighted, since these two countries represent such a large proportion of their regional populations. 4hile !hina has contributed to more than 98 per cent of the progress in 7astern 9sia, the same is not true for India in ,outhern 9sia. Together, !hina and India contributed 'ust under half of the global progress towards the *:/ target in sanitation. There are 11 countries those ma%e up more than three $uarters ;. per cent# of the global population without improved sanitation facilities. One third of the ".8 billion people without improved sanitation live in India. The ma'ority of those practising open defecation globally 9<9 million# live in rural areas. Open defecation in rural areas persists in every region of the developing world, even among those who have otherwise reached high levels of improved sanitation use. 1or instance, the

proportion of rural dwellers still practising open defecation is 9 per cent in 6orthern 9frica and 1; per cent in =atin 9merica and the !aribbean. Open defecation is highest in rural areas of ,outhern 9sia, where it is practised by 88 per cent of the population. The disparities in rural and urban sanitation are even more pronounced than those in drin%ing water supply. /lobally, ;9 per cent of the urban population uses an improved sanitation facility, compared to <; per cent of the rural population. In rural areas, 1.- billion people lac% access to improved sanitation, representing ;" per cent of the global total of those unserved. )owever, a great deal of progress has been made in rural areas since 1990> ;"< million rural dwellers have gained access to improved sanitation while the number of people unserved in urban areas has grown by 1-? million.

Go$ernment %nitiati$es:
In 19-., the +ural :evelopment :epartment initiated Indias first nation@wide program, the !entral +ural ,anitation (rogram !+,(#. !+,( focused on provision of household pour flush toilets with little accent on communication mechanism for behaviour change. It did not envisage ade$uate attention to Atotal sanitation which includes improved hygiene behaviour, school and institutional sanitation, solidBli$uid waste management and environmental sanitation. This approach did little to motivate and sustain high levels of sanitation coverage. :espite an investment of more than +s. . billion, rural sanitation grew at 'ust 1 per cent annually throughout the 1990s and the !ensus of "001 found that only "" per cent of rural households had access to a toilet. 4ith a less than satisfactory performance of the !+,(, /overnment of India restructured the program with the launch of the Total ,anitation !ampaign T,!# in 1999. T,! advocates a participatory and demand driven approach, ta%ing a district as a unit with significant involvement of /ram (anchayats and local communities. It moves away from the infrastructure focused approach of the earlier programs and concentrates on promoting behaviour change. ,ome %ey features of the T,! include> 9 community led approach with focus on collective achievement of total sanitation 1ocus on Information, 7ducation and !ommunication I7!# to mobiliCe and motivate communities towards safe sanitation *inimum incentives only for D(= householdsBpoorBdisabled, post construction and usage 1le&ible menu of technology options :evelopment of supply chain to meet the demand stimulated at the community level 1iscal incentive in the form of a cash priCe 0 6irmal /ram (uras%ar 6/(# 0 to accelerate achievement of total sanitation outcomes. T,! is being implemented at scale in .0; districts of ?0 statesB5nion Territories 5Ts#. 9gainst an ob'ective of 1".8; crore Individual )ousehold =atrines I))=#, the sanitation facilities for individual households reported to be achieved is about -.?- crore as of :ecember "011. In addition, about 10.?" la%h school toilets, 19,80" sanitary comple&es for women, and ?.<. la%h anganwadi preschool# toilets have been constructed.

The above figure shows Individual household latrine coverage has more than tripled, from around "" per cent in "001 to .; per cent in ,eptember "01". 4hile the coverage reflected above appear to be very impressive, there are issues lin%ed li%e The figures above only reflect the number of householdsBschoolsBanganwadis that have a toilet and do not ta%e into account sanitary conditions of the toilet or its usage. They do not consider sanitation more broadly e.g. by considering improved hygiene behaviours such as hand@washing with soap. Initial indications of an evaluation study shows that around a $uarter of household latrines are not being used planning !ommission, 7leventh (lan :ocument, page 1;?#. 1ield studies have pointed to lower levels of latrine usage because of inade$uate awareness of the importance of sanitation, water scarcity, poor construction standards and the past emphasis on e&pensive standardiCed latrine designs. Integrating sanitation programs with initiatives to improve water availability and health care would increase the li%elihood of achieving public health outcomes such as reduction in diarrheal and other water borne E infectious diseases. T,!s, convergence with the rural water supply programs and the 6ational +ural )ealth *ission 6)+*# program is of utmost importance. ,ince school sanitation and hygiene education is an integral part of T,!, convergence is established with :epartment of ,chool 7ducation and =iteracy :,7=# and the ,arva ,hi%sha 9bhiyan ,,9#, the flagship program of /oI to achieve universal elementary education. The emphasis is on providing a school environment e$uipped with necessary inclusive sanitary facilities as well as ensuring these facilities are safe and well maintained and help to inculcate improved hygiene behavior in children. 7ncouraged by the success of 6/(, the T,! is being renamed as F6irmal Dharat 9bhiyanG 6D9#. The ob'ective is to accelerate the sanitation coverage in the rural areas so as to comprehensively cover the rural community through renewed strategies and saturation approach. The main ob'ectives of the 6D9 are as under>

1. Dring about an improvement in the general $uality of life in the rural areas. ". 9ccelerate sanitation coverage in rural areas to achieve the vision of 6irmal Dharat by "0"" with all gram (anchayats in the country attaining 6irmal status. ?. *otivate communities and (anchayati +a' Institutions promoting sustainable sanitation facilities through awareness creation and health education. <. To cover the remaining schools not covered under ,arva ,hi%sha 9bhiyan ,,9# and 9ganwadi !entres in the rural areas with proper sanitation facilities and underta%e proactive promotion of hygiene education and sanitary habits among students. 8. 7ncourage cost effective and appropriate technologies for ecologically safe and sustainable sanitation. .. :evelop community managed environmental sanitation systems focusing on solid E li$uid waste management for overall cleanliness in the rural areas.

There are some conse$uences due to lac% of sewerage system or improper functioning of sewerage system. The untreated and partially treated municipal waste water could find its way into water sources such as rivers, la%es and ground water, causing water pollution. The organic matter and bacterial population of fecal origin continue to dominate the water pollution problem@ mean levels of biological o&ygen demand have increased in si& of the 1- ma'or rivers accounting for <.H of the total river length nationally. /round water is also polluted due to discharge of untreated sewage. To achieve sustainable sanitation, more area should be covered under well maintained piped sewerage system. Dut there are some constraints in achieving the piped sewerage system. ,ome of them are discussed here li%e lac% of funds, lac% of %nowledge about nonconventional sanitation technologies, wea% institutions with trained personnel, water ,hortage and lac% of operation and maintenance. 4ater shortage is one of main constraint in installing and for proper functioning of the sewerage system. =arge number of class@I cities in India do not have minimum per capita water supply to sustain the sewerage system. *inimum 1?0 lpcd (er !apita 4ater ,upply# is re$uired to sustain the sewer system in the area. 9hmedabad, Iadodara, +aipur, +ohta%, )isar, /urgaon, Dangalore, *ysore, Indore, 6avi *umbai, Imphal, ,hilong, Dathinda, !oimbatore, *athura, *eerut do not have minimum per capita water supply to sustain the sewer system. 9fter the installation of sewerage system the proper operation and maintenance is also a big challenge. The e&isting treatment capacity is also not effectively utiliCed due to operation and maintenance problem. ,ome treatment plants are underutiliCed and some are overloaded. 9ctual sewerage treatment due to inade$uacy of the sewerage collection system shall be low compare to capacity. 9s nearly most of the treatment plants are not conforming to the general standards prescribed under the 7nvironmental (rotection# +ules for discharge into streams. ,T(s are usually run by personals that do not have ade$uate %nowledge of running the ,T(s and %now only operation of pumps and motors. 9ccording to census "011, only 11.9H of total households are covered under piped sewer system. To cover whole country in sewerage system a huge investment of money will be re$uired. /eneral estimates based on 19;- per capita costs indicate that up to J.0 billion would be re$uired to provide water supply for everyone, and from J ?00 to J.00 billion would be needed for sewage. (er capita investment costs for the latter range from J180 to J .80, an amount totally beyond the ability of the

beneficiaries to pay. 9ny technology whose total financial cost is more than 10@"0 percent of user income probably should be e&cluded as financially unaffordable. 1irst priority of e&creta disposal programs in developing countries must be human health, that is, the reduction and eventual elimination of the transmission of e&creta related diseases. This health ob'ectives can be fully achieved by nonconventional sanitation technologies that are much cheaper than sewage. =ac% of interest in sanitation technologies other than sewerage is in part because of the standardiCed education of most planners and engineers in developing countries. (eople do not %now more about the nonconventional sanitation technologies. The cost for e&cavation and pipe will be more in roc%y area for conventional technologies as comparison to nonconventional technologies. 9ll these above mention problems show that to cover whole country under the sewerage system is not possible in near future. To achieve sustainable sanitation it is necessary for our country to go for the nonconventional technologies. 9s these technologies re$uires less money, less water, less space and do not re$uire s%illed labour for operation and maintenance. The technologies which are maintained by the beneficiaries should be promoted because as and when the system collapse they could able to fi& the problem by themselves.

%ssues in &chie$ing the Sustainable Sanitation co$erage: &ccess:

(rovision of sanitation and a clean environment are vital to improve the health of our people, to reduce incidence of diseases and deaths. To address this challenge the international community has pledged to halve the proportion of people without access to safe drin%ing water and basic sanitation facilities by "018 as part of the *illennium :evelopment /oals. The 3oint *onitoring (rogramme 3*(# for 4ater ,upply and ,anitation published by 4)OB56I!71 describes the status and trends with respect to the use of safe drin%ing@water and basic sanitation, and progress made towards the *:/ drin%ing@water and sanitation target. 9s the world approaches "018, it becomes increasingly important to identify who are being left behind and to focus on the challenges of addressing their needs. This report presents some stri%ing disparities> the gap between progress in providing access to drin%ing@ water versus sanitationK the divide between urban and rural populations in terms of the services providedK differences in the way different regions are performing, bearing in mind that they started from different baselinesK and disparities between different socio@economic strata in society. The census "011 shows the coverage of sanitation and water supply. The census report shows that <9.-H of total 1"".9 million households in India practice open defecation. 4hile in rural India the situation is still worse. .;.?H i.e. 11? million households practice open defecation.

Po$erty and dis'arities>

5nder *:4, proggramme, an incentive is provided only to Delow (overty =ine households under the scheme. 4hile the incentive for I))=s has been revised from time to time and stands at +s ?"00B@ +s. ?;00B@ for hilly and difficult areas# per I))= constructed and used by D(= household, including ,tate share of +s 1<00(), the D(= households are e&pected to find resources for the remaining cost. *ost assessments have calculated I))= cost at about +s -000B@ with the substructure alone costing about +s 8000 ()* Those who are 9bove (overty =ine 9(=# are e&pected to be motivated through I7! to construct toilets on their own or through availing of credit facilities.

9part from this incentives, it has now been decided that sanitation programme activities can be underta%en under */6+7/9 in accordance with these guidelines> a# !onstruction of Individual )ousehold =atrines I))=# as per instructionsBguidelines of FTotal ,anitation !ampaignG administered by *inistry of :rin%ing 4ater and ,anitation *:4,#. b# !onstruction of 9nganwadi Toilet unit and ,chool Toilet 5nit as Institutional (ro'ects. c# ,olid and =i$uid 4aste *anagement ,=4*# wor%s in proposed or completed 6irmal /rams. L5ns%illed labour up to "0 person days# and s%illed labour up to . person days, under material component under *ahatma /andhi 6+7/,# on construction of Individual )ousehold =atrine. The total amount to be boo%ed under */6+7/9 will however not e&ceed +s. <,800 per I))=.M 4hile the policy of /overnment of India under T,! has been to disburse incentives to the D(= households, considered the poorest in the rural areas, poverty continues to be a curse and a barrier for accelerating rural sanitation coverage. This gives an indication of continuing with the practice of incentives to the poor in recognition of their achievement to construct and use sanitation facilities with corrections as may be re$uired to get the intended results. In a study done by !entre for *edia ,tudies !*,#, engaged by the *inistry of +ural :evelopment in the year !"#", +#, of the respondents cited poverty as the reason for non@ construction of toilets.

Community a''roach -or sanitation and health bene-its:

The current allocations are restrictive towards adoption of a community approach to sanitation. 9n assessment underta%en by 4,(@4orld Dan% in )imachal (radesh in "008 revealed that in villages with appro&imately ?0H sanitation coverage, the incidence of diarrhea was reported by appro&imately ?-H households. 7ven in villages with 98 per cent sanitation coverage, the diarrheal incidences were reported by around ".H households. Only open defection free O:1# villages with 100 per cent sanitation coverage reported significantly lower incidences of diarrhea by appro&imately ;H households. In effect, even if a few individual households switch to using toilets, the overall ris% of bacteriological contamination and incidence of disease continues to be high. .o achie$e the -ull goals osanitation/ community saturation a''roach cutting across the &P0(BP0 barrier is suggested -or creation o- 1irmal Grams*

The community is sensitiCed by creating awareness about the impact of open defecation and lac% of sanitation on health, dignity and security especially of women and children. In rural sanitation, Fencouraging cost@effective and appropriate technologies for ecologically safe and sustainable sanitationG has been one of the main ob'ectives of the approach.

Beha$iour change:
In addition to hardware issues, large scale efforts are still needed to create and sustain community demand for hygiene and sanitation. The capacity for behaviour change programming, which is decentraliCed under T,!, is also limited at the state and local levels. Though the country has come a long way to brea% the traditional barrier and taboo associated with toilets, open defecation in rural areas continues to be a socially and culturally accepted traditional behaviour at large, by both rich and poor. There is thus a need to systematically understand factors around effective behavior change and to support a comprehensive behavior change program with consistent strategy and messages at the program level through detailed communication strategies coupled with sufficient funding for Information, 7ducation and !ommunication I7!# activities. 9t present, u' to #2, o- Pro3ect outlay is reserved for I7! activities. 9 limitation noted while achieving sanitation coverage is that various field studies have pointed to various levels of latrine usage depending upon the community awareness and also slippage in the status of 6/( villages that shows a variable trend. 1or e&ample, in one such study undertaken by UNICEF in 2008, it was found that out of the 81% of the popu ation ha!in" access to sanitation in N#$ panchayats, on y %&% were usin" the faci ities'

Se'tic .ank:
,eptic tan%s are also big problem in achieving sustainable sanitation target. *a'ority of the septic tan%s had openings into open drains, which drained the li$uid effluents from the septic tan%s. This also leads to a high probability of ground water contamination, as in many cases, the habitation drains are not concrete structures, and low soa%age of the contaminated water in the soil. ,eptic tan% re$uires more space. The construction needs regular technical assistance and supervision. This needs ventilation, which adds to cost. :esludging of ,eptic tan% is needed on regular basis. The sludge and effluent from a septic tan% can not be used as a fertiliCer straight away without causing health haCards. In some areas septic tan% toilets are within 10 meters distance from water sources. )owever, people do demand for septic tan%s, as most of masons available in the rural areas have got some %nowledge about constructing a septic tan% rather than any other safer designs. These people motivate villagers to go far these. :isadvantages of ,eptic tan%> The leaching system is often not constructed and common practice is to discharge effluent directly into an open drain. ,eptic tan%s often receive too much wastewater. 9s a result, the retention time in the septic tan% is insufficient and the soa% away becomes hydraulically overloaded. *ainly householder bypasses the soa% away and connects the overflow directly to a surface water drain. ,hoc% loadings and disturbance of settling Cones caused by large inflows typically from sullage discharges# can affect the efficiency of the septic tan% and causes e&cess solids to flow into the soa% away. (erformance monitoring of septic tan%s is rarely underta%en and regulation to control private desludging operators is problematic. This creates pollution as well as a potential health haCard.

Caste based distribution o- toilets:

!onstruction of household toilets has got significant lin%age with caste educational bac%ground, economic factor and concept of cleanliness amongst households. Iarious studies have highlighted these issues. In one such study conducted by O+/ !entre for ,ocial +esearch shows that more households of the general caste own toilets, and there is a significantly lower proportion of ,! and OD! households which was found to own household toilets. The survey was conducted in year "009 under (+4,, 4orld Dan% (ro'ect in all the districts of (un'ab with a sample siCe of "0 households in each village. 90 percent general category households, .9.8 percent households in OD! category and 8; percent households in ,cheduled caste category had this facility.

4ys-unctional toilets and 5 6 M:

+eport of the 6ational 4ater ,upply and ,anitation !ommittee 19.0@.1#, *inistry of )ealth, /overnment of India it was written that the district !entre would be the pivot of future activity for implementing the rural programme in future. It is desirable that the !entre is so developed that it has a manufacturing yard for casting, curing and storage of different siCes of concrete pipes, specials, latrine pans, s$uatting slabs, traps etc. re$uired for rural water supply and sanitation wor%s. 9 mechanical section under ade$uate supervision of the district !entre should be entrusted with the production, stoc%ing, supply and distribution of all materials re$uired for the programme. 7ach centre could, in addition, train the re$uired number of masons, carpenters, mechanics, mistries and other artisans in their respective wor%s so that they may handle the field wor% in rural areas to better advantage. The district !entre could, in addition, arrange for the necessary orientation, refresher and training courses for the subordinate technical personnel employed in the rural areas to better advantage. Though important suggestions for implementation, O;* of rural sanitation were made as early as 19.0@.1, not much actions have been initiated in last 8 decades for ta%ing up these important issues of the programme seriously in the districts. ,tudies have shown e&istence of many incompleteBpoorly constructed toilets due mainly to lesser availability of funds that are now dysfunctional as a reason for non@usage. 9ttainment of 6irmal /ram ob'ective re$uires policy interventions to ensure that these may be made functional and appropriate *aintenance and Operation mechanism evolved especially for !ommunity and Institutional toilets. One of the important factors as emerging from various studies show lag between coverage and usages has been poor $uality construction of sanitation facilities and dysfunctional toilets for reasons li%e pitBseptic tan% full, choc%ed panBpipes, wrong location, filled with debris and used as storage space among others. The issue of water availability is one of the ma'or concerns while dealing with water@seal toilets. In the !*, study, respondents gave poor or unfinished installations as a ma'or reason for dysfunctional toilets.

%nstitutional -rame7ork 7ith 'artici'ation o- 1G5s:

9s per T,! /uidelines, 6/Os have an important role in the implementation of T,! in the rural areas. They have to be actively involved in I7! software# activities as well as in hardware activities. Their services are re$uired to be utiliCed not only for bringing about awareness among the rural people for the need of rural sanitation but also ensuring that they actually ma%e use of the sanitary latrines. 6/Os can also open and operate (roduction !enters and +ural ,anitary *arts. 6/Os may also be engaged to conduct base line surveys and (+9s specifically to determine %ey behaviours and perceptions regarding sanitation, hygiene, water use, OE*, etc. It is now recogniCed that programmes impacting social practices re$uire greater involvement of civil society and its organiCations. =ocal Sel- 8el' Grou's, womens organiCations, youth associations and 6/Os of repute can play a ma'or role in programme implementation. 1G5s can contribute immensely in ensuring sustainability o- 549 status and monitoring a'art -rom demand generation/ resource mobilisation and ca'acity building o- stakeholders* &''ro'riate mechanisms need to be built -or them to be encouraged to engage in the sanitation sector*