Sustainable Sanitation

Goutam Sadhu Associate Dean (Rural Management) IIHMR, Jaipur

TSC OBJECTIVES
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Improvement in the general quality of life. Accelerate sanitation coverage in rural areas. It is a demand driven programme. People centered & community lead programme Promote hygiene education & sanitary habits among students. Encourage cost effective & appropriate technologies in sanitation. Eliminate open defecation. Minimize risk of contamination of water & Food.

Seven components of sanitation

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Free from open defecations Disposal of waste water Disposal of households garbage Personnel Hygiene (Head to toe) Hand washing

CONSTRAINTS
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Large geographical area. Dense population. Defecation open Not having mindset to built toilets. Many more people not having finance for construction Some were not having land Technological awareness.

Increasing Coverage in toilet construction..

60% 50% 40% 30% 20% 10% 0% 53% 31% 22% 1% 9% 38% 44%

1981 1991 2001 2005 2006 2007 2008

But is usage also increasing?

Construction Programmes
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Maharashtra (1997-2000): 16.61 lakh toilets built BUT usage is 43% -57% (concurrent evaluation) Andhra Pradesh (2001-2005 ): 29 lakh toilets built BUT usage is 30% - 60% concurrent evaluation) Himachal Pradesh (1993-1998): 3 lakh toilets built BUT usage is approx. 30% (evaluation in 2003)

NGP Awards 2005: a slow beginning

TRIPURA K ERA L A G UJA RA T W ES T B ENG A L TA MIL NA DU MA HA RA S HTRA 0 5 10 1 1 1 11 13 13 15

Source: Govt. of India, Dept. of Drinking Water Supply <http://ddws.nic.in/TSC/crsp/TSCPhy_st.asp?Form=ALL> Accessed 6 May 2007. Note: Does not include institutional households.

Why Sanitation?
Why are we interested in promoting sanitation? Is it just to implement TSC and achieve a target of construction of latrines? Is it provide dignity and status to the people? Is it to provide facility to some sections of the society?
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OR
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Is it to achieve the objective of universal public health?

Performance vs toilet Subsidy

P erform anc (s ored: 0 0 e c -2 ) 0 Pla B n la e n a g d sh W st B n a T C e egl S Ah e n g r T C mdaa S G m la T ra a ya SC N O F ru G o m R ja a a rh t L PP A d ra P d sh nh ra e 0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 Pe rm n rfo a ce Su sid b y 2 4 6 8 1 0 1 2

H ardware s bs (U per ho eh ) u idy S$ us old

So, What to focus?

Focus on

OUTCOME

which is stopping open defecation and educating the entire community of safe and hygienic sanitation behavior

Construction of toilets

ODF Community

Challenges
Slippage Focus on hard ware/ Out puts Weak institutions Weak M&E Lack of capacities

Focus on Outcomes for the Entire Community

Focus on outcomes and not on hardware inputs, Mobilise the community rather than establishing household contacts alone Empower and strengthen the PRIs Reward the collective community action & outcomes Strengthen the M&E systems Technology options to sit local situation

Incentives/reward for achievement

creative use of subsidy
Village becomes Open Defecation Free Village becomes Nirmal
Subsidy given as incentive to

Community / Individuals

Nirmal Gram Puraskar

Village strives for Nirmal ++

State Reward Scheme

State Sanitation Rewards Program: A Tool to Scale-up and Sustain Sanitation

What is a state sanitation rewards program?

Annual competition between different PRI levels Gram Panchayat, block, district to be recognized as the cleanest Motivates PRIs to go beyond ODF and address total sanitation Rewards achievement of collective outcomes Government is a facilitator and monitor at all levels but community plays the main role

How does a State Rewards Program differ from NGP?

Both NGP and state rewards program are an incentive to accelerate TSC by motivating Gram Panchayats However, there are some differences: NGP is given by Govt. of India but state rewards are given by respective state governments NGP is one-time reward but state rewards program is an annual competition NGP monitoring is by external third-party organizations. State rewards program teams are constituted from within the state at different levels but each block/district is verified by another block/district NGP incentive amount is population based but state sanitation rewards program incentive is based on level of competition

What are the advantages of a state sanitation rewards program?

Annual competition motivates PRIs to sustain and improve sanitation outcomes Tremendous IEC success, raises the profile of both sanitation and winners Generates stiff competition at all levels Creates peer pressure on neighboring Panchayats, blocks, districts within a state Strengthens the capacity of local institutions

Which states have introduced such a rewards program?

State Maharashtra Himachal Pradesh Andhra Pradesh Madhya Pradesh Karnataka Year of Launch 2001 2005 2007 2008 2009 Name of Rewards Program Sant Gadge Baba Gram Swachata Abhiyaan Maharishi Valmiki Sampoorna Swachata Puraskar Shubhram Ujwal Puraskar Nairmalaya

What are the main elements of a state rewards program?

Competition is held at different levels block, district, division, state Winners at each level are eligible to participate in next higher level e.g. block winners participate in district competition, district winners at state level Verification is based on same criteria at all levels Verification at each level is undertaken by a team from outside the area i.e. each block/district is assessed by a team from another block/district on non-reciprocal basis Winners are recognized by senior dignitaries and receive a cash prize

SUSTAINABLE SANITATION & HYGIENE EDUCATION FOR BETTER HEALTH

(INTER SECTORAL CONVERGENCE OF TSC WITH NHRM)

Areas of NRHM have shared NRHM TSC and Convergence withgoals Integration of health, sanitation and hygiene education through effective intersectoral convergence is key to achieving MDGs by both TSC and NRHM Strengthen Village Health and Sanitation Committees in preparing and implementing village health and sanitation pIans.

Areas of Convergence

Convergence meetings held under the Joint chairpersonship of Secretaries of both the Departments including Empowered Committee meeting of National Rural Health Mission to strategies the areas of convergence between the programmes of the two Departments. Joint Letters issued by Secretaries of both Depts to States to strengthen intersectoral convergence initiatives These include Integration of activities of State Water Sanitation Mission (SWSM), District Water Sanitation Committees (DWSC), under TSC with State Health Society and District Health Society, under NRHM. Identify Functions, mechanisms of pooling of financial and human resources of staff under TSC and NRHM

Convergence ASHA for Health and ASHA Village level health activist & Role Model for awareness in the community on health Sanitation , hygiene, nutrition, sanitation, safe drinking water

Inclusion and active involvement of ASHA workers in VHSC Incentive to ASHA workers by provision of toilets through TSC funds for their role in Community mobilization on demand creation for sanitation facilities and health and hygiene education programmes particularly in school and anganwadis. Total Sanitation Campaign (TSC) guidelines has a provision of giving incentives to motivators which includes ASHA workers at earmarked for IEC. The amount of incentives is fixed by State Governments and varies for eg in Bihar it is Rs. 75

Access to toilet in the household an essential criteria for selection of Asha Workers Inputs given on inclusion of messages on good personal hygiene, importance of use of toilets, water and sanitation related illnesses and their prevention in training curriculum for

Areas of Convergence
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Inclusion of Vector Borne Diseases Control Programme (VBDCP) activities by the Village and Sanitation Committees (VHSC) for prevention of vector borne disease at the village level out of annual untied grants of Rs. 10, 000 to each VHSC. Prevention of vector mosquito breeding by filling up of unused /unwanted wells/ditches disposal of solid waste. Joint Information Education Communication (IEC) action plans on preventive and curative aspects of water , sanitation, health and hygiene Joint Meeting of officials under TSC and NRHM of high Polio risk Districts of UP and Bihar was convened by Secretary DWS to assess the extent of prevalence and undertake coordinated actions to eradicate Polio by combining immunization with provision of sanitation facilities and improving health and hygiene practices in the Polio endemic areas. Inputs were given on the mechanism for integrating the Nirmal Gram Puruskar Awardees as Model Village and Training Centres also for Health Programmes.

Areas of Convergence
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Comments were given on Guidelines for Training Programme under RCH I Programme of Ministry of Health and Family Welfare for inclusion of messages on importance of personal and food hygiene practices by women, menstrual health and hygiene amongst adolescent women. Inputs were given to NRHM regarding integrated web based Management Information System of the Department of Drinking water Supply for online monitoring of progress made in programme implementation. Includes baseline data, updated data on sanitation coverage for all TSC components, viewed on the website- www. ddws.nic.in.

Intersectoral Convergence by States (Some Examples)

Manipur Utilization of services of the ASHA workers, District media experts and social mobilization under NRHM for coordination on IEC and HRD activities under TSC Uttaranchal Doctors being involved in TSC programme. Use of Rubber stamp messages on health and hygiene by doctors Assam- TSC mobilization entrusted to existing VHC/VH & SC rather than forming a new VHWSC. Inclusion of WATSAN messages in ASHA Radio programme sponsored by NRHM

Intersectoral Convergence Road Ahead Priority Areas

Strengthen Intersectoral convergence initiatives in the areas of Institutional structures and mechanisms, Planning and Operational strategies, Field teams implementation, Reporting and Monitoring Strengthen formation / integration of VHSC in states. Define roles, responsibilities , mechanism for pooling of human and financial resources from both programmes. Regular review and monitoring of of progress made by States on intersectoral convergence initiatives like provision of toilets/incentives to Asha workers Strengthen Capacity building programmes for ASHA workers, ANMs , MPHW and other officials under TSC and NRHM with a synergy on WATSAN. Link Communication and Capacity development Units and Key resource Centres under TSC with the Regional Resource Centres and other training institutions under NRHM for developing common curriculum.

Intersectoral Convergence Road Ahead Priority Areas

Joint IEC and Media Campaign and documentation of best practices and case studies on models on integration of sanitation and health hygiene Education Strengthen Convergence of School Health Hygiene Education Programme( SSHE) with the School Health programme which would include the provision of safe drinking water, construction of toilets for both boys and girls, proper use of toilets, in schools, personal health and hygiene, menstrual hygiene education programmes. Common coding standards for intersectoral convergence at database level and mechanism for information sharing on water supply programmes in states, water quality, waste water and poor sanitation related diseases, impact of provision of sanitation and health and hygiene on improvement of health indictors like MMR, IMR may be worked out between the two Ministries through a common MIS. Common information and monitoring mechanism system for identification of endemic areas of water quality affected areas and tracking of water and sanitation related diseases polio, cholera, typhoid , hepatitis, developing response system for to outbreaks within the institutional mechanism

Intersectoral Convergence Road Ahead Priority Areas

Joint Monitoring mechanisms on both health programmes and water and sanitation facilities in the village Research and development activities on sustainable, low cost, locally appropriate technologies on water and sanitation and prevention and cure of most prevalent illnesses in the village, emergency joint action plans for management of outbreak of communicable diseases, impact of sanitation on health indicators of a region. Follow up Workshop of officials of TSC and NRHM on Polio Eradication and management in high polio risk districts of Bihar and UP. National Workshop on Sustainable Sanitation for improved Health- Convergence of programmes of TSC and Dept. of Health in partnership with NRHM, and NHSRC to review of progress made, identify gaps and building synergies on intgersecotral convergence at Central , State and Village level

Sustainable Sanitation for Better Health

We shall not finally defeat AIDS, tuberculosis, malaria, or any of the other infectious diseases that plague the developing world until we have also won the battle for safe drinking water, sanitation and basic health care. -- Kofi Annan, Former Secretary-General, United Nations

Sustainable Sanitation for Better Health INTERSECTORAL CONVERGENCE

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TSC and NRHM has shared goals & outcomes, strategies and plan of action Intersectoral Convergence can be effective if synergies are built at all levelsInstitutional structures / mechanisms Planning and Operational strategies Field teams / implementation Reporting / Monitoring COMING TOGETHER IS BEGINNING WORKING TOGEHER IS PROGRESS REACHING TOGETHER IS SUCCESS

Thank you for your attention

sadhugoutam@gmail.com Contact: 8107777867