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 country’s 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 (Census 2001). 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 adequate availability of drinking water and proper sanitation. There is, thereof, a direct relationship between water, sanitation and health. Consumption of unsafe drinking water, improper disposal of human excreta, improper environmental sanitation and lack of personal and food hygiene have been major causes of many diseases in developing countires. India is no exception to this. Prevailing High Infant Mortality rate is also largely attributed to poor sanitation. It was in this context that the Central Rural Sanitation Programme (CRSP) was launched in 1986 primarily with the objective of improving the quality 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 excreta by cesspools, open ditches, pit latrines, bucket systems, septic tanks etc. today it connotes a comprehensive concept, which includes liquid and solid waste disposal, food hygiene, and personal, domestic as well as environmental hygiene. Proper sanitation is important not only from general health point of view but it has a vital play in our individual and social life too. Sanitation is one of the basic determinants of quality of life and human development index. Good sanitary practices prevent contamination of water and soil and thereby prevent diseases. The concept of sanitation was, therefore, expanded to include personal hygiene, home sanitation, safe water, garbage disposal, excreta disposal and waste water disposal.

The responsibility for provision of sanitation facilities in the country primarily rests with local government bodies – Gram Panchayat in rural areas. The state and Central Governments act as facilitators, through enabling policies, budgetary support and capacity development. In the Central government, the planning Commission, through the Five Year Plans, guides investment in the sector by allocating funds for strategic priorities.

Global Scenerio and Joint Monitoring Programme (JMP) 2012:

JMP is Joint Monitoring of Water and Sanitation Programme initiated jointly by WHO and UNICEF. This is being done every two years.

Progress in China and India is highlighted, since these two countries represent such a large proportion of their regional populations. While China has contributed to more than 95 per cent of the progress in Eastern Asia, the same is not true for India in Southern Asia. Together, China and India contributed just under half of the global progress towards the MDG target in sanitation.

There are 11 countries those make up more than three quarters (76 per cent) of the global population without improved sanitation facilities. One third of the 2.5 billion people without improved sanitation live in India.

The majority of those practising open defecation globally (949 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. For instance, the proportion of rural

dwellers still practising open defecation is 9 per cent in Northern Africa and 17 per cent in Latin America and the Caribbean. Open defecation is highest in rural areas of Southern Asia, where it is practised by 55 per cent of the population.

The disparities in rural and urban sanitation are even more pronounced than those in drinking water supply. Globally, 79 per cent of the urban population uses an improved sanitation facility, compared to 47 per cent of the rural population. In rural areas, 1.8 billion people lack access to improved sanitation, representing 72 per cent of the global total of those unserved. However, a great deal of progress has been made in rural areas since 1990: 724 million rural dwellers have gained access to improved sanitation while the number of people unserved in urban areas has grown by 183 million.

Government Initiatives:

In 1986, the Rural Development Department initiated India’s first nation-wide program, the Central Rural Sanitation Program (CRSP). CRSP focused on provision of household pour flush toilets with little accent on communication mechanism for behaviour change. It did not envisage adequate attention to ‘total’ sanitation which includes improved hygiene behaviour, school and institutional sanitation, solid/liquid waste management and environmental sanitation. This approach did little to motivate and sustain high levels of sanitation coverage. Despite an investment of more than Rs. 6 billion, rural sanitation grew at just 1 per cent annually throughout the 1990s and the Census of 2001 found that only 22 per cent of rural households had access to a toilet.

With a less than satisfactory performance of the CRSP, Government of India restructured the program with the launch of the Total Sanitation Campaign (TSC) in 1999. TSC advocates a participatory and demand driven approach, taking a district as a unit with significant involvement of Gram Panchayats and local communities. It moves away from the infrastructure focused approach of the earlier programs and concentrates on promoting behaviour change. Some key features of the TSC include:

A community led approach with focus on collective achievement of total sanitation

Focus on Information, Education and Communication (IEC) to mobilize and motivate communities towards safe sanitation

Minimum incentives only for BPL households/poor/disabled, post construction and usage

Flexible menu of technology options

Development of supply chain to meet the demand stimulated at the community level

Fiscal incentive in the form of a cash prize – Nirmal Gram Puraskar (NGP) – to accelerate achievement of total sanitation outcomes.

TSC is being implemented at scale in 607 districts of 30 states/Union Territories (UTs). Against an objective of 12.57 crore Individual Household Latrines (IHHL), the sanitation facilities for individual households reported to be achieved is about 8.38 crore as of December 2011. In addition, about 10.32 lakh school toilets, 19,502 sanitary complexes for women, and 3.46 lakh anganwadi (preschool) toilets have been constructed.

The above figure shows Individual household latrine coverage has more than tripled, from around 22 per cent in 2001 to 67 per cent in September 2012.

While the coverage reflected above appear to be very impressive, there are issues linked like

The figures above only reflect the number of households/schools/anganwadis that have a toilet and do not take 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 quarter of household latrines are not being used (planning Commission, Eleventh Plan Document, page 173).

Field studies have pointed to lower levels of latrine usage because of inadequate awareness of the importance of sanitation, water scarcity, poor construction standards and the past emphasis on expensive standardized latrine designs.

Integrating sanitation programs with initiatives to improve water availability and health care would increase the likelihood of achieving public health outcomes such as reduction in diarrheal and other water borne & infectious diseases. TSCs, convergence with the rural water supply programs and the National Rural Health Mission (NHRM) program is of utmost importance.

Since school sanitation and hygiene education is an integral part of TSC, convergence is established with Department of School Education and Literacy (DSEL) and the Sarva Shiksha Abhiyan (SSA), the flagship program of GoI to achieve universal elementary education. The emphasis is on providing a school environment equipped 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.

Encouraged by the success of NGP, the TSC is being renamed as “Nirmal Bharat Abhiyan” (NBA). The objective 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 objectives of the NBA are as under:

1. Bring about an improvement in the general quality of life in the rural areas.

2. Accelerate sanitation coverage in rural areas to achieve the vision of Nirmal Bharat by 2022 with all gram Panchayats in the country attaining Nirmal status.

3. Motivate communities and Panchayati Raj Institutions promoting sustainable sanitation facilities through awareness creation and health education.

4. To cover the remaining schools not covered under Sarva Shiksha Abhiyan (SSA) and Aganwadi Centres in the rural areas with proper sanitation facilities and undertake proactive promotion of hygiene education and sanitary habits among students.

5. Encourage cost effective and appropriate technologies for ecologically safe and sustainable sanitation.

6. Develop community managed environmental sanitation systems focusing on solid & liquid waste management for overall cleanliness in the rural areas.

There are some consequences due to lack 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, lakes 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 oxygen demand have increased in six of the 18 major rivers accounting for 46% of the total river length nationally. Ground 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. But there are some constraints in achieving the piped sewerage system. Some of them are discussed here like lack of funds, lack of knowledge about nonconventional sanitation technologies, weak institutions with trained personnel, water Shortage and lack of operation and maintenance.

Water shortage is one of main constraint in installing and for proper functioning of the sewerage system. Large number of class-I cities in India do not have minimum per capita water supply to sustain the sewerage system. Minimum 130 lpcd (Per Capita Water Supply) is required to sustain the sewer system in the area. Ahmedabad, Vadodara, Raipur, Rohtak, Hisar, Gurgaon, Bangalore, Mysore, Indore, Navi Mumbai, Imphal, Shilong, Bathinda, Coimbatore, Mathura, Meerut do not have minimum per capita water supply to sustain the sewer system.

After the installation of sewerage system the proper operation and maintenance is also a big challenge. The existing treatment capacity is also not effectively utilized due to operation and maintenance problem. Some treatment plants are underutilized and some are overloaded. Actual sewerage treatment due to inadequacy of the sewerage collection system shall be low compare to capacity. As nearly most of the treatment plants are not conforming to the general standards prescribed under the Environmental (Protection) Rules for discharge into streams. STPs are usually run by personals that do not have adequate knowledge of running the STPs and know only operation of pumps and motors.

According to census 2011, only 11.9% of total households are covered under piped sewer system. To cover whole country in sewerage system a huge investment of money will be required. General estimates based on 1978 per capita costs indicate that up to $60 billion would be required to provide water supply for everyone, and from $ 300 to $600 billion would be needed for sewage. Per capita investment costs for the latter range from $150 to $ 650, an amount totally beyond the ability of the beneficiaries to pay. Any technology whose total financial cost is more than 10-20 percent of user income probably should be excluded as financially unaffordable.

First priority of excreta disposal programs in developing countries must be human health, that is, the reduction and eventual elimination of the transmission of excreta related diseases. This health objectives can be fully achieved by nonconventional sanitation technologies that are much cheaper than sewage. Lack of interest in sanitation technologies other than sewerage is in part because of the standardized education of most planners and engineers in developing countries. People do not know more about the nonconventional sanitation technologies. The cost for excavation and pipe will be more in rocky area for conventional technologies as comparison to nonconventional technologies.

All 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. As these technologies requires less money, less water, less space and do not require skilled 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 fix the problem by themselves.

Issues in Achieving the Sustainable Sanitation coverage:

Access:Provision 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 drinking water and basic sanitation facilities by 2015 as part of the Millennium Development Goals.

The Joint Monitoring Programme (JMP) for Water Supply and Sanitation published by WHO/UNICEF describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. As the world approaches 2015, 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 striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socio-economic strata in society.

The census 2011 shows the coverage of sanitation and water supply. The census report shows that 49.8% of total 122.9 million households in India practice open defecation. While in rural India the situation is still worse. 67.3% i.e. 113 million households practice open defecation.

Poverty and disparities:

Under MDWS proggramme, an incentive is provided only to Below Poverty Line households under the scheme. While the incentive for IHHLs has been revised from time to time and stands at Rs 3200/-(Rs. 3700/- for hilly and difficult areas) per IHHL constructed and used by BPL household, including State share of Rs 1400/-, the BPL households are expected to find resources for the remaining cost. Most assessments have calculated IHHL cost at about Rs 8000/- with the substructure alone costing about Rs 5000/-. Those who are Above Poverty Line (APL) are expected to be motivated through IEC to construct toilets on their own or through availing of credit facilities.

Apart from this incentives, it has now been decided that sanitation programme activities can be undertaken under MGNREGA in accordance with these guidelines:

a) Construction of Individual Household Latrines (IHHL) as per instructions/guidelines of “Total Sanitation Campaign” administered by Ministry of Drinking Water and Sanitation (MDWS).

b) Construction of Anganwadi Toilet unit and School Toilet Unit as Institutional Projects.

c) Solid and Liquid Waste Management (SLWM) works in proposed or completed Nirmal Grams.

{Unskilled labour (up to 20 person days) and skilled labour (up to 6 person days, under material component under Mahatma Gandhi NREGS) on construction of Individual Household Latrine. The total amount to be booked under MGNREGA will however not exceed Rs. 4,500 per IHHL.}

While the policy of Government of India under TSC has been to disburse incentives to the BPL 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 required to get the intended results.

In a study done by Centre for Media Studies (CMS), engaged by the Ministry of Rural Development in the year 2010, 41% of the respondents cited poverty as the reason for non-construction of toilets.

Community approach for sanitation and health benefits:The current allocations are restrictive towards adoption of a community approach to sanitation. An assessment undertaken by WSP-World Bank in Himachal Pradesh in 2005 revealed that in villages with approximately 30% sanitation coverage, the incidence of diarrhea was reported by approximately 38% households. Even in villages with 95 per cent sanitation coverage, the diarrheal incidences were reported by around 26% households. Only open defection free (ODF) villages with 100 per cent sanitation coverage reported significantly lower incidences of diarrhea by approximately 7% households. In effect, even if a few individual households switch to using toilets, the overall risk of bacteriological contamination and incidence of disease continues to be high. To achieve the full goals of sanitation, community saturation approach cutting across the APL/BPL barrier is suggested for creation of Nirmal Grams.

The community is sensitized by creating awareness about the impact of open defecation and lack of sanitation on health, dignity and security especially of women and children. In rural sanitation, “encouraging cost-effective and appropriate technologies for ecologically safe and sustainable sanitation” has been one of the main objectives of the approach.

Behaviour 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 decentralized under TSC, is also limited at the state and local levels. Though the country has come a long way to break 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, Education and Communication (IEC) activities. At present, up to 15% of Project outlay is reserved for IEC activities.

A 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 NGP villages that shows a variable trend. For example, in one such study undertaken by UNICEF in 2008, it was found that out of the 81% of the population having access to sanitation in NGP panchayats, only 63% were using the facilities.

Septic Tank:Septic tanks are also big problem in achieving sustainable sanitation target. Majority of the septic tanks had openings into open drains, which drained the liquid effluents from the septic tanks. This also leads to a high probability of ground water contamination, as in many cases, the habitation drains are not concrete structures, and low soakage of the contaminated water in the soil. Septic tank requires more space. The construction needs regular technical assistance and supervision. This needs ventilation, which adds to cost. Desludging of Septic tank is needed on regular basis. The sludge and effluent from a septic tank can not be used as a fertilizer straight away without causing health hazards. In some areas septic tank toilets are within 10 meters distance from water sources.

However, people do demand for septic tanks, as most of masons available in the rural areas have got some knowledge about constructing a septic tank rather than any other safer designs. These people motivate villagers to go far these.

Disadvantages of Septic tank:

The leaching system is often not constructed and common practice is to discharge effluent directly into an open drain.

Septic tanks often receive too much wastewater. As a result, the retention time in the septic tank is insufficient and the soak away becomes hydraulically overloaded. Mainly householder bypasses the soak away and connects the overflow directly to a surface water drain.

Shock loadings and disturbance of settling zones caused by large inflows (typically from sullage discharges) can affect the efficiency of the septic tank and causes excess solids to flow into the soak away.

Performance monitoring of septic tanks is rarely undertaken and regulation to control private desludging operators is problematic. This creates pollution as well as a potential health hazard.

Caste based distribution of toilets:Construction of household toilets has got significant linkage with caste educational background, economic factor and concept of cleanliness amongst households. Various studies have highlighted

these issues. In one such study conducted by ORG Centre for Social Research shows that more households of the general caste own toilets, and there is a significantly lower proportion of SC and OBC households which was found to own household toilets. The survey was conducted in year 2009 under PRWSS World Bank Project in all the districts of Punjab with a sample size of 20 households in each village.

90 percent general category households, 69.5 percent households in OBC category and 57 percent households in Scheduled caste category had this facility.

Dysfunctional toilets and O & M:Report of the National Water Supply and Sanitation Committee (1960-61), Ministry of Health, Government of India it was written that the district Centre would be the pivot of future activity for implementing the rural programme in future. It is desirable that the Centre is so developed that it has a manufacturing yard for casting, curing and storage of different sizes of concrete pipes, specials, latrine pans, squatting slabs, traps etc. required for rural water supply and sanitation works. A mechanical section under adequate supervision of the district Centre should be entrusted with the production, stocking, supply and distribution of all materials required for the programme. Each centre could, in addition, train the required number of masons, carpenters, mechanics, mistries and other artisans in their respective works so that they may handle the field work in rural areas to better advantage. The district Centre 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, O7M of rural sanitation were made as early as 1960-61, not much actions have been initiated in last 5 decades for taking up these important issues of the programme seriously in the districts.

Studies have shown existence of many incomplete/poorly constructed toilets due mainly to lesser availability of funds that are now dysfunctional as a reason for non-usage. Attainment of Nirmal Gram objective requires policy interventions to ensure that these may be made functional and appropriate Maintenance and Operation mechanism evolved especially for Community and Institutional toilets.

One of the important factors as emerging from various studies show lag between coverage and usages has been poor quality construction of sanitation facilities and dysfunctional toilets for reasons like pit/septic tank full, chocked pan/pipes, wrong location, filled with debris and used as storage space among others. The issue of water availability is one of the major concerns while dealing with water-seal toilets.

In the CMS study, respondents gave poor or unfinished installations as a major reason for dysfunctional toilets.

Institutional framework with participation of NGOs:As per TSC Guidelines, NGOs have an important role in the implementation of TSC in the rural areas. They have to be actively involved in IEC (software) activities as well as in hardware activities. Their services are required to be utilized not only for bringing about awareness among the rural people for the need of rural sanitation but also ensuring that they actually make use of the sanitary latrines. NGOs can also open and operate Production Centers and Rural Sanitary Marts. NGOs may also be engaged to conduct base line surveys and PRAs specifically to determine key behaviours and perceptions regarding sanitation, hygiene, water use, O&M, etc.

It is now recognized that programmes impacting social practices require greater involvement of civil society and its organizations. Local Self Help Groups, women’s organizations, youth associations and NGOs of repute can play a major role in programme implementation. NGOs can contribute immensely in ensuring sustainability of ODF status and monitoring apart from demand generation, resource mobilisation and capacity building of stakeholders. Appropriate mechanisms need to be built for them to be encouraged to engage in the sanitation sector.