WHO Relief Mission to the Gujarat Earthquake

ASSESSMENT OF THE WATER SUPPLY, SANITATION AND ENVIRONMENTAL HEALTH

ASSISTANCE

OF THE

WORLD HEALTH ORGANIZATION TO THE GUJARAT EARTHQUAKE

26 JANUARY – 30 JUNE 2001

by

Dr Dennis B. WarnerConsultant

Bhuj, Gujarat, India30 June 2001

Contents

1. Introduction

2. Purpose of the Assessment

3. Overview of WHO Water Supply and Sanitation Assistance, 26 January – 30 June 2001

4. Sources of Financial Support Director-General’s Fund Donor Funds

o US Office of Foreign Disaster Assistance (OFDA)o UK Department for International Development (DFID)o US Agency for International Development (USAID)

5. WHO Water Supply, Sanitation and Environmental Health Activities General Technical Assistance Equipment and Supplies

o Chloroscopeso WHO office equipmento Bhuj District Water Quality Laboratoryo Water quality laboratories in other districtso Aquachlor chlorine generator

Training Coordination

6. Cooperative Agreements Gujarat Water Supply and Sewerage Board (GWSSB)

o WHO office accommodationso Laboratory equipmento Water quality surveillance

Dindayal Development and Charitable Trust German Federal Agency for Technical Relief (THW)

7. Progress in Implementing Recommendations of Consultant Mission of 16 February - 6 April 2001

8. Conclusions OFDA Support DFID Support USAID Support WHO’s Role in Water Supply, Sanitation and Environmental Health

9. Recommendations

AnnexesA. Officials InterviewedB. DFID Proposal: Project DescriptionC. USAID Proposal: Project DescriptionD. Water Supply Services in Kachchh District

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1. Introduction

On 26 January 2001 at 08:45 am, the State of Gujarat was rocked by a massive earthquake measuring 6.9 on the Richter scale. The epicenter of the quake occurred near Ludia Village, about 20 km north of Bhuj, the capital of Kachchh District. The resulting destruction and loss of life was enormous and widespread. Nearly 20,000 people died and 166,000 were injured. The casualty toll would have been even higher except for the fact that many people were out of their homes that morning to celebrate India’s Republic Day. The most severely-affected areas were in the District of Kachchh, especially the sub-districts (talucas) of Bhuj, Bhachau, Anjar and Rapar.

Destruction was widespread in all sectors. For the first several days, almost all public services were unable to function. In water supply and sanitation, pump houses collapsed and boreholes stopped operating, storage tanks, especially ground-level tanks, either collapsed or experienced serious cracking, and pipelines were severed. The impact of the earthquake was universal; it affected all people and all services in the severely-affected areas. Although Kachchh District with population of two million people bore the brunt of the earthquake, the Government of Gujarat states that over 15 million people in the state were directly affected by the event.

Response to the earthquake was relatively rapid and effective, considering the relative remoteness of Kachchh District. The Indian Army and international rescue services were the first to arrive on the scene for search and rescue operations. Within days, however, local and international NGOs, United Nations agencies and bilateral assessment teams began to appear and begin urgently-needed relief operations. Medical attention, shelter, drinking water supplies and communications were initial priorities. Slowly, but progressively over the first couple of weeks, public services came back on line. Government offices with their depleted staffs operated under canvas and in sheet metal shelters. External organizations generally set up their own tented camps to house their personnel. By the second week in February, the relief effort was beginning to take coherent shape through cooperation between local and state government agencies, UN organizations, local and international NGOs and bilateral donor agencies.

WHO was, and continues to be, part of this massive relief effort. From the first days following the earthquake, WHO personnel have been in the affected areas of Gujarat providing technical assistance and material support in the areas of water quality, disease surveillance and health coordination. These efforts have continued through the mid-point of 2001 and have evolved to meet the changing needs of the relief effort.

This report is an assessment of the WHO response to the Gujarat earthquake. The focus here is on water supply, sanitation and environmental health and how WHO contributed to relief measures in these areas over the period 26 January – 30 June 2001. The assessment also will describe the overall role WHO played and continues to play as part of a worldwide effort to assist the people of Gujarat. It concludes with observations on the WHO’s role in emergency responses and with several specific recommendations for future WHO water supply and sanitation activities in Gujarat.

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2. Purpose of the Assessment

This assessment constitutes a review of the water supply, sanitation and environmental health activities in Gujarat State carried out by WHO in response to the earthquake of 26 January 2001. These activities were initiated, implemented and supervised by a variety of personnel within WHO, including epidemiologists, engineers, public health physicians and other health sector experts. The period of review is 26 January to 30 June 2001.

Although the environmental health activities of the WHO team included a range of health activities, such as health promotion, hygiene education and intersectoral coordination, the main focus of this assessment is on water supply and sanitation, with particular emphasis upon drinking water quality, human excreta disposal and solid wastes management. Where other significant activities of the team are clearly related to environmental health, they are described as needed.

The terms of reference for the assessment were approved by WHO/India and SEARO on 11 June 2001. They contained the following four specific points:

Assess progress in implementing water supply and sanitation activities with financial support provided by USAID/OFDA.

Review the status of proposals to DFID (UK) for a programme of water quality surveillance in Kachchh District and to USAID for a project to strengthen environmental sanitation facilities and sanitation promotion activities at rural health centres in Kachchh District.

Assess the general role and relevance of WHO in providing water supply, sanitation and environmental health assistance to the earthquake-affected areas of Gujarat State. This should include both activities undertaken and relationships established with local and state governmental authorities, international development agencies and NGOs.

Provide appropriate recommendations for future WHO programmes, proposals and technical assistance in water supply, sanitation and environmental health.

Thus, this assessment is a retrospective review of events and responses, culminating in suggestions for both future actions in Gujarat State and in emergencies in general.

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3. Overview of WHO Water Supply and Sanitation Assistance, 26 January – 30 June 2001

The earthquake of 26 January 2001 caused a complete cessation of all public services in the most severely-affected areas of Gujarat. Electricity, telephone, water supply, hospitals and health facilities, schools, public administration and local government were all disrupted and ceased to function for periods ranging from a few days to several months. In the water supply and sanitation sector, most water systems in the worst hit areas of Kachchh District stopped functioning because of physical damage and interruptions in the electricity supply. Particularly hard hit were pumphouses and ground-level water storage tanks which were not built to earthquake-resistant standards.

Throughout Gujarat State as a whole, 274 boreholes, 336 pumps and 954 civil structures were damaged and 1614 km of pipelines were damaged and out of service. The worst-hit district, Kachchh, had serious water supply disruptions in ten urban areas, with another eight towns severely affected in the districts of Rajkot, Jamnagar, Ahmedabad and Surendranagar. A total of 1340 rural villages wereaffected in these five districts, with 884 found in Kachchh District alone. The Government of Gujarat estimated the damage to the water supply systems at INR 2.9 billion (US$ 63 million).

WHO reacted quickly to the catastrophe. Dr Eigil Sorensen from SEARO/New Delhi arrived in Ahmedhabab on 27 January, the day after the earthquake, and Dr Bipin Verma from WHO/India arrived in Bhuj shortly thereafter. Dr Verma participated in the assessment of the United Nations Disaster Management Team (UNDMT), which completed its report on the affects of the earthquake on 8 February. The UNDMT report designated WHO as focal agency for the health sector and a cooperating agency for water and sanitation and for food and nutrition. Dr Verma also became team leader of the WHO health team and the coordinator of the overall WHO response to the earthquake.

Within the water and sanitation sector, international and national organizations rapidly mobilized to assist in the relief effort. The first water supply and sanitation (watsan) coordination meeting was held in Ahmedabad on 2 February and was attended by Oxfam (convener), Concern, USAID, SDC (Switzerland), DMI, WHO, MSF/Holland, ECHO, IFRC and Sadvichar Parivar. WHO was represented by Dr Luis Jorge Perez, an emergency expert from PAHO in Washington DC. This meeting and the frequent watsan meetings that followed in Bhuj were devoted to information sharing between organizations in order to better coordinate overall activities.

During the first weeks following the earthquake, WHO was represented in the Bhuj watsan meetings by Dr David Bradt, WHO Epidemiological Consultant, Mr M.M. Datta, WHO/India Sanitary Engineer and Dr Perez. WHO concerns during this period were focused on water quality, the chlorination of emergency water supplies and the distribution of chloroscopes for the testing of chlorine residuals. Several hundred chloroscopes were distributed to district health officials, NGOs and the GWSSB.

On 19 February, Dr Dennis B. Warner, WHO Consultant and former head of water supply and sanitation at WHO/Geneva, arrived in Bhuj to strengthen WHO’s assistance in the areas of water supply, sanitation and environmental health. That same day he was joined by Dr Jagdish M. Barot, former Chief Engineer with the GWSSB and formerly head of the Gujarat Jalseva Training Institute, who was hired by WHO as a National Professional Officer. Together, they formed the WHO watsan team until 4 April when Dr Warner left Bhuj. Dr Barot has remained in Bhuj throughout the emergency period and continues to direct WHO water and sanitation activities associated with the earthquake.

The initial efforts of the WHO watsan team were directed at issues of water quality. Additional chloroscopes were provided to the GWSSB for use by water quality personnel in the field, and over the following months efforts were made to systemize and compile the testing and reporting of chlorine

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residuals by health, water and municipal officials. Field visits were made to identify problems in the outlying municipalities and rural areas, and contacts were established with the GWSSB, the Kachchh District water quality laboratory, offices of the Relief Commissioner Kachchh, Relief Commissioner Bhuj, Collector for Kachchh District Development Office, Bhuj Municipality, UN agencies (UNICEF, UNDMT, UNDP), bilateral agencies (THW, DFID, JICA) and NGOs (Oxfam, IFRC, MSF, Dindayal, Abhiyan and Swaminarayan Trust).

These initial investigations revealed that existing water quality surveillance capabilities in the field were not adequate to monitor the safety of drinking waters in the affected areas and that the Kachchh District water quality laboratory in Bhuj did not have sufficient equipment and personnel to support the necessary programme of surveillance. On 1 March, a proposal was submitted to DFID (UK) for a total of US$ 125,700 to support the establishment of a programme of water quality surveillance in all earthquake-affected areas of Kachchh District. The programme included new staff, personnel training, field equipment, water sampling and a system of reporting results to the GWSSB. At the same time, the WHO watsan team submitted a request to WHO/India for laboratory equipment for the Kachchh District water quality laboratory in Bhuj. (This equipment was delivered to the laboratory in May.)

The growing cooperation between the WHO watsan team and the GWSSB was highlighted in early March when the GWSSB allocated WHO an office in the district laboratory. WHO furnished the office with computer equipment, office furniture and supplies.

Another concern of the WHO watsan team was with the sanitary conditions in campsites, urban areas and rural villages. Many people had taken refuge in open, tented campsites in Bhuj, but few locations had adequate facilities for excreta disposal, trash collection and insect control. On 10 March, the WHO watsan team proposed that WHO contract with a local NGO, the Dindayal Development and Charitable Trust, to provide emergency sanitation services in 13 campsites within Bhuj Municipality. This proposal was supported by a letter from the President and Chief Officer of the municipality.

Sanitation conditions in the rural areas were found to be very poor, but most problems pre-dated the earthquake. Village sanitation systems were limited, as few households even had a latrine. In rural areas, government health facilities are primarily responsible for preventive health, but few rural centres had proper sanitary facilities for excreta disposal, bathing, handwashing or drainage. The sanitation conditions were further aggravated by the earthquake, which damaged 40% of the rural health centres (primary health centres, sub-centres and anganwadis) in Kachchh District and perhaps 80% of the centres in the most severely-affected talucas of Bhuj, Bhachau, Anjar and Rapar. Because of the poor environmental sanitation conditions found in many rural areas, it was feared that the coming monsoon rains would pose great risks to public health through the spread of gastro-intestinal illnesses, worm infections, skin and eye infections and vector-borne diseases.

To address these problems, WHO on 30 March submitted to USAID/India a proposal to strengthen environmental sanitation facilities and sanitation promotion activities at rural health centres in Bhuj, Bhachau, Anjar and Rapar talucas of Kachchh District. Totaling US$ 444,700 and extending over a period of 18 months, the project is designed to provide sanitation facilities and training for health staff at PHCs, sub-centres and anganwadis and resources for the promotion of sanitation and healthy sanitation behaviours in the surrounding villages.

Beginning in late-March, there were increasing reports of jaundice (hepatitis) linked to water supplies. Over the next several weeks, Dr Barot organized teams of officials from the GWSSB, Department of Health and the affected municipalities to investigate the quality of water supplies in Bhuj, Gandhidham, Adiphur, Anjar and Rapar. It was concluded that water provided by the GWSSB was properly chlorinated, but chlorine residuals in the systems often fell to zero because of contamination in hotels, restaurants and underground storage tanks. Moreover, it was noted that chlorination was not generally practiced at private boreholes and by private tankers.

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Over 21-27 March, Dr Warner traveled to New Delhi to make a presentation on the watsan situation in Gujarat and to have discussions with the World Bank, USAID, JICA and The Netherlands Embassy. By the beginning of April, WHO had approved the project to provide sanitation services in Bhuj Municipality campsites. An agreement for INR 686,500 (US$ 14,900) was signed with the Dindayal Development and Charitable Trust to implement the project. In addition, WHO was approached at this time by CESVI, an Italian NGO, for assistance in identifying water supply and sanitation projects in Mundra Taluca. Over the next three months, Dr Barot helped CESVI to select appropriate villages and provided follow on technical guidance for the installation of reverse osmosis treatment systems in six villages serving 15,000 people.

Dr Warner departed Bhuj on 4 April, leaving Dr Barot in charge of WHO watsan activities in Gujarat. During April and May, Dr Barot gave a series of short training courses for field personnel of the Department of Health and the GWSSB in the practical aspects of water chlorination, water quality, solid wastes management, and the interaction of water and health. Over 400 participants, including linemen, pump operators, tanker drivers, sanitary inspectors, health supervisors, paramedical staff and medical officers, attended 13 courses in various locations in Kachchh District.

April/May also was a period marked by numerous examples of WHO technical assistance to the local agencies, municipalities, villages and external organizations. In April, for example, technical advice on sanitation was given to the District hospital in Bhuj, on water quality to the district laboratory in Bhuj, on building construction to the Community Health Centre in Bhachau, on chlorination equipment to Bachau Municipality, on solid wastes management to Rapar Municipality, and on water storage and health surveys to Ludia Village in Bhuj Taluca. In May, technical assistance on chlorination and pipeline repairs was given to Gandhidham Municipality.

WHO cooperation with THW, the German technical works agency, illustrates well the interaction WHO developed during this period with various organizations. In February, THW assisted WHO in identifying laboratory equipment suitable for the Gujarat emergency. In March, WHO called upon the assistance of THW to provide water tanks, distribution taps and tanker water to Mahendi Colony, a temporary campsite in Bhuj. In April, Bhachau Municipality requested chlorination equipment from WHO, which in turn approached THW for the necessary equipment, installation and operational support. In May, THW requested WHO technical assistance in installing chlorination equipment in villages lacking water disinfection. This has resulted in an on-going programme that will install chlorination units in up to 55 small villages by the end of August. The WHO watsan team helps to identify the villages and provides continuing technical advice during installation of the units by THW.

On 21 May, the WHO watsan team was strengthened with the addition of Mr Vinod M. Shah, a former deputy executive engineer with the GWSSB. Mr Shah’s contributions to date have included assisting THW with its village chlorination programme, testing for residual chlorine in rural water water systems, representing WHO at the numerous health and watsan meetings held throughout the district and organizing the WHO watsan files.

Field observations and discussions with local officials over April-May suggested to the WHO watsan team a number of new interventions warranting WHO support. On 25 May, Dr Barot submitted proposals for six projects requiring a total of US$ 185,000 in support funds. The six projects (in order of priority) were (1) training courses for health and water field staff, (2) laboratory equipment for districts other than Kachchh, (3) provision of sanitation facilities at urban health centres, (4) provision of chlorine solution for village-owned rural water supply schemes, (5) supplemental solid wastes management assistance in four municipalities, and (6) provision of utility vehicles for repair and maintenance of rural water supply schemes. All projects were designed for implementation through government agencies or national NGOs.

Throughout the period of the emergency, the WHO watsan team participated in sectoral coordination meetings for water and sanitation and for health. Starting in May, team members also began to attend weekly health coordination meetings at the taluka level in order to respond to the many water and

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sanitation issues that were reported at these meetings. During May – June, the WHO watsan team prepared health messages for publication in a leading Gujarati-language daily newspaper (Kutch Mitra).

In early April, Oxfam and WHO agreed informally that WHO would take over some of the responsibility for convening and chairing the bi-weekly watsan sector meetings. Although Oxfam remains the official coordinator of the watsan sector, the WHO watsan team, because of its close support to the GWSSB and location in Bhuj, has taken on an increasingly central role in the coordination of the water supply and sanitation sector.

On 12 May, Dr Barot participated in a conference on sustainable recovery and vulnerability reduction which was organized by the Government of Gujarat at Ahmedabad. At about the same time, he was included in the interagency core team charged with formulating a health promotion strategy for the health sector. During the first week in June, Dr Barot traveled to Bali, Indonesia to participate in a WHO regional consultation on emergency response. On returning to India, he was met by Dr Warner, who returned to Bhuj for the period 12-27 June to carry out an assessment of WHO water supply, sanitation and environmental health activities associated with the Gujarat earthquake.

It should be noted that throughout the period of the emergency, there was a constant improvement in the service levels of urban and rural water supplies in Kachchh District as a result of the efforts of municipalities, GWSSB and external organizations. Annex D shows the status of water supply services in the district as of 10 June. By the end of the month, the superintending engineer of the GWSSB for Kachchh said that the water supply services were at 95% of pre-earthquake levels.

The review of on-going watsan activities and proposals at the end of June revealed that the laboratory equipment provided by WHO to the Kachchh District water quality laboratory was only partially in service because of a shortage of GWSSB laboratory technicians. In addition, the review showed that Dindayal was providing sanitation services to Bhuj Municipality campsites, but some sites had closed and there were indications that most of the other sites would remain in operation for an indefinite period. Moreover, the proposal to DFID had been approved (but not yet funded), and WHO had requested the GWSSB to begin recruitment of the necessary personnel for the water quality surveillance programme. Regarding the proposal to USAID on rural sanitation, WHO had not yet received any word from USAID. Finally, in late-June, WHO agreed to fund three of the six proposals submitted by the WHO watsan team in May. These were (1) training courses, (2) laboratory equipment for districts other than Kachchh, and (3) chlorine solution for village-owned rural water supply schemes.

Despite some difficulties in mobilizing external resources, the WHO watsan team remained fully engaged over the entire period with numerous requests for technical assistance, training presentations and future cooperation. The cooperation with THW on village chlorination is on going and has led to preliminary inquiries regarding possible continuation of the activities by WHO with support of the German Government after THW withdraws in August. Similarly, CESVI is pleased with the technical assistance it has received from WHO for water supply projects in Mundra and has inquired if WHO would be interested in becoming involved in future long-term development projects in Kachchh.

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4. Sources of Financial Support

Director-General’s Fund

The WHO Gujarat relief effort was provided a total of US$ 100,000 from the Director-General’s Fund at WHO headquarters and US$ 50,000 from the Regional Director’s Fund. Although none of these funds were designated for support of water supply and sanitation, some of the Director General’s funds were used on a temporary basis to support the costs of the international consultant (sanitary engineer). When the OFDA funds became available (see below), these charges were transferred to the OFDA account.

Donor Funds

US Office of Foreign Disaster Assistance (OFDA)

WHO and the US Office of Foreign Disaster Assistance (OFDA) were in communication with each other immediately after the earthquake on 26 January 2001. On 6 February WHO submitted a revised proposal to OFDA on “Disease Surveillance and Water Quality Control in Gujarat – Aftermath of Earthquake”, requesting US$ 232,000 for (1) disease surveillance, (2) water, sanitation and environmental health, (3) monitoring and evaluation and (4) project support costs.

The water, sanitation and environmental health component of the proposal requested US$ 75,000 for the re-establishment of water quality testing (laboratory supplies, training and personnel support) and US$ 60,000 for 6 months of a sanitary engineer to supervise, train and manage all water quality control activities.

On 7 February, the US Agency for International Development (USAID), the parent institution of OFDA, awarded WHO US$ 232,000 to support disease surveillance and water quality control in the aftermath of the Gujarat earthquake (Grant No. FDA-G-00-01-00022). The effective period of the grant was 6 February through 31 July 2001. According to USAID standard provisions, any funds not legally obligated by WHO at the time of expiration of the grant are to be refunded to USAID.

The programme description of the OFDA grant was taken from the WHO proposal, whereby US$ 135,000 was requested for water quality testing and sanitary engineering services.

UK Department for International Development (DFID)

On 1 March a proposal was submitted to DFID requesting support for a programme of water quality surveillance in Kachchh District. The proposal requested US$ 125,700 to establish water quality surveillance activities in all earthquake-affected talucas (administrative sub-districts) of Kachchh District, to train personnel at the field, supervisory and district laboratory levels to carry out sanitary surveys, water sampling and water analyses, to establish a system of reporting water quality results to the GWSSB, and to provide laboratory equipment, supplies and transport to support the project. A more complete project description is given in Annex B.

The period of the project was to be one year, and the implementing agency was the GWSSB with assistance from WHO, THW, OXFAM, UNICEF and Abhiyan. Overall coordination was to be provided by WHO.

In mid-May, DFID approved the proposal and the WHO watsan team began the process of implementing it with the GWSSB. WHO and senior officers of the GWSSB met at Gandhinagar on 17 May to discuss the implementation of the project and agreed upon operational responsibilities.

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WHO also requested the GWSSB to initiate recruitment of six sanitary inspectors for the project and to provide equipment and vehicle specifications for the preparation of an Agreement for Performance of Work (APW). By the end of June, WHO was still waiting for release of the DFID funds and for the information requested of GWSSB

US Agency for International Development (USAID)

On 30 March WHO submitted a proposal to USAID in New Delhi to support the strengthening of environmental sanitation facilities and sanitation promotion activities at rural health centres in Kachchh District. This proposal was in response to a USAID Request for Applications (RFA) under the Gujarat Earthquake Recovery Initiative (GERI). The amount requested in the proposal was US$ 444,700 for a project duration of 18 months.

The proposal included several major activities, including: A survey of all rural health centres in the four talucas (Bhuj, Bhachau, Anjar and Rapar) to

determine their needs for sanitation facilities and staff training. Construction of sanitation facilities at the health centres as determined by the survey. Development of training materials on sanitation and hygiene. Training of the staff of the health centres in sanitation and hygiene. Promotion of sanitation in the surrounding villages by health centre staff.

A fuller description of the project is given in Annex C.

The closing date for the receipt of proposals was 30 March, and USAID announced that it expected to make its selections within 30 days. However, WHO has not yet received any official word from USAID regarding proposal selections. On 12 June, the WHO Representative to India, Dr Robert Kim-Farley, wrote to USAID in New Delhi requesting a response to the WHO submission. As of 30 June, WHO was still awaiting the USAID reply.

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5. WHO Water Supply, Sanitation and Environmental Health Activities

General Technical Assistance

The primary strength of WHO water supply and sanitation assistance to the Gujarat relief effort is the provision of rapid, reliable and unbiased technical assistance. WHO health personnel were in the affected area within days of the earthquake providing advice and support on water quality and the safety of drinking water supplies. This assistance was strengthened with the addition of two water and sanitation experts in mid-February and the recruitment of a third expert in late-May. Over the period of the emergency, the WHO watsan team worked closely with the GWSSB, Department of Health and NGOs on a variety of water supply, sanitation and environmental health issues. This interaction and support to other organizations can be summarized in four general categories: GWSSB, Department of Health, municipalities, and NGOs and other international agencies.

Gujarat Water Supply and Sewerage Board (GWSSB)

The WHO watsan team has developed a very close working relationship with the GWSSB at all levels, ranging from the Water Board headquarters in Gandhinagar to the field offices at the taluka level. Part of this is attributed to the fact that the two WHO national staff, Dr Jagdish M. Barot, a former Chief Engineer of the GWSSB, and Mr Vinod M. Shah, a former Deputy Executive Engineer, have many personal and professional colleagues in the GWSSB. More importantly, they have used their contacts to develop a sense of trust and reliance between GWSSB officials and WHO. There is much evidence to show that the GWSSB looks to the WHO watsan team for technical advice, trouble-shooting in the field, links to external donors and coordination of external organizations. To support and maintain this cooperation, the GWSSB provided the WHO watsan team office space in the District Water Quality Laboratory building.

Dr Barot has been called upon to assist in organizing and facilitating meetings between GWSSB officials and delegations from external organizations. This has included assistance on visits of JICA (Japan), CESVI (Italy) and the Centers for Disease Control (USA). More often, he reviews problems and participates in internal technical discussions with GWSSB staff.

In April, WHO began holding short training courses for operational personnel of the GWSSB and the Department of Health on issues of chlorination, water quality, health impacts and solid wastes management. To date, more than 400 participants have attended these courses in Bhuj, Bhachau, Anjar, Rapar and Gandhidham talucas.

One of the first WHO activities with the GWSSB was to strengthen the district water quality laboratory in Bhuj. Technical advice was given to the laboratory personnel and new equipment was provided to help the laboratory take on the increased load of water testing and analyses. The equipment arrived in April, and the technical advice continues on an as needed basis.

Department of Health

Because of the strong WHO health team and WHO’s role as health sector coordinator, there has been from the beginning of the emergency good cooperation between the Department of Health in Kachchh District and WHO. This cooperation has continued with the WHO watsan team in the areas of field assistance and training.

In April, WHO assisted several PHCs in Bhuj, Bhachau and Rapar talucas in obtaining water storage tanks and tap stands from the GWSSB. The following month, WHO responded to requests for sanitation assistance from the district hospital in Bhuj by providing guidance on the disposal of wastewater and the installation of temporary latrine cabins. A somewhat different request was

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received from the Bhachau Community Health Centre (CHC) in May. The CHC needed assistance in the development of an X-ray room. The WHO watsan engineer (Dr Barot) assisted on the design of the room, identified a contractor, provided WHO funds of INR 15,600 and supervised the construction of the works.

Most of the short training courses given by the WHO watsan team have been oriented towards health staff, including medical officers, health supervisors and paramedical staff. Since the beginning of April, seven training courses on chlorination and on water and health have been held in cooperation with the Department of Health and various PHCs.

Municipalities

Increasingly, municipalities are turning to WHO for assistance with their water supply and sanitation problems. In late-April, Bhachau Municipality requested help from WHO for chlorination equipment at four pumping stations. The WHO watsan team approached THW, which promptly responded by installing and operating the needed equipment. A similar request came from Gandhidham Municipality in May. WHO assisted by contacting the Department of Health, which provided bleaching powder for the municipal system, and by contacting the GWSSB, which repaired a main pipeline coming into the town. WHO also provided overall technical advice on chlorination procedures and on various sanitation matters in the municipality.

In April, jaundice (unspecified hepatitis) was reported in several municipalities. Dr Barot organized joint visits with officials from the GWSSB, Department of Health and the municipalities of Bhuj, Anjar and Rapar to check the water quality at hotels and restaurants of the towns. That same month, WHO provided technical advice to sanitary inspectors in Rapar Municipality on problems of solid wastes management and sources of NGO support.

NGOs and Agencies

WHO has had a great amount of interaction with NGOs and other external organizations. Chloroscopes, technical instructions on chlorine testing and information on sanitation promotion were given to several NGOs (Swaminarayan Trust, World Vision, Merlin) to assist their efforts to maintain safe drinking water services. In March, WHO helped improve water services in Mahendi Colony, a temporary campsite in Bhuj, by requesting THW assistance in providing water storage tanks, distribution standposts and a regular supply of water by tanker truck. In April, CESVI, an Italian NGO, contacted WHO for assistance in formulating water projects in Mundra Taluca. The WHO watsan engineer helped to identify appropriate villages and provided guidance in the selection of treatment options, water storage facilities and the interpretation of water quality tests.

Also in April, reports of tuberculosis in Ludia village of Bhuj Taluca prompted WHO to arrange for water storage tanks to be installed by the GWSSB. At the request of Manav Sadhana Trust, the WHO watsan engineer also arranged for the WHO health team to do a disease survey in the village. The following month, WHO assisted the Red Crescent Hospital at Anjar in obtaining water storage tanks and tanker truck water supply from the municipality.

In May, THW approached WHO for assistance in installing direct-injection chlorination equipment in villages without water disinfection. The WHO watsan team, in consultation with the GWSSB and the Department of Health, identified 25 suitable villages in the talucas of Bhuj, Bhachau, Anjar, Rapar, Mundra and Mandvi and is providing continuing technical advice during the installation of the equipment. THW now expects to have sufficient funds to install an additional 30 chlorination devices with WHO assistance before it departs India in August.

Initially, Oxfam was designated as the coordinating agency in the water and sanitation sector. However, in early April, WHO was requested by Oxfam to assist in the coordination of the watsan

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sector meetings. Since then, WHO has taken on an increasing role in the coordination of external organizations in the sector.

Equipment and Supplies

Chloroscopes

The immediate aftermath of the earthquake was marked by concern for the safety of drinking water supplies, especially in those areas where water systems were damaged and services were disrupted. The earthquake disrupted the chlorination of water supplies, and most systems at first could not maintain proper disinfection of their deliveries. The problem became aggravated by the emergency delivery of unchlorinated water by tanker trucks. The GWSSB and various cooperating NGOs attempted to introduce chlorine solutions directly into the tankers at the filling stations, but the problem was complicated by the difficulties of controlling operations at the stations and by the large number of government and private tankers involved in the relief effort.

As a means of testing the safety of drinking waters, WHO distributed numerous chloroscopes to governmental and private organizations to measure the levels of chlorine in the water. These chloroscopes are simple hand-held devices in which a few drops of orthotolodine reagent are mixed with a sample of water to show the residual chlorine in the water supply. If the reading for chlorine residual is positive (preferably between 0.5 and 2.0 mg/l), the water is considered safe to drink. In addition, the residual chlorine provides a measure of protection against subsequent microbiological contamination.

During the first week of February, WHO handed out approximately 100 chloroscopes to district health officials and another 60 to NGOs. By the end of the month, a total of 700 chloroscopes had been distributed to the government for distribution to all (450) health mobile teams, primary health centres(PHCs) and health supervisors. In addition, 50 chloroscopes were given to the GWSSB and 200 were retained for use by the WHO Disease Surveillance teams. Unfortunately, most chloroscopes were distributed without proper instructions regarding their use for the routine checking of water quality and no organized efforts were made to compile test results from the field. As a result, few health officials used the chloroscopes, and water quality in the field generally remained untested and subject to numerous rumours.

Realizing that accurate water quality information was not coming from the field, the WHO watsan team in early March began to organize the distribution and use of chloroscopes. Test kits were given only to individuals or organizations that gave assurances of proper use. Receipients of chloroscopes were given personal instruction in the use of the kit by a member of the watsan team or attended a watsan training programme on chlorination. Attempts also were made to compile test information from the field. Organizations were urged to send in their chlorine residual readings to the WHO watsan office. Additional information was collected by the WHO disease surveillance team and was obtained from weekly health coordination meetings at the taluka level. When field data showed insufficient chlorination in water samples, a member of the WHO watsan team went to the site to determine the appropriate course of action.

Since the beginning of March, the distribution of chloroscopes by the WHO watsan team was as follows:

Table 5.1 Distribution of Chloroscopes by the WHO Watsan Team.

Date Agency/Organization No. of Chloroscopes

04/03/01 Bhuj Municipality 10

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05/03/01 Swaminarayan Temple, Bhuj 220/03/01 GWSSB, Rambag 1322/03/01 Anjar Municipality 530/03/01 Merlin (NGO) 210/04/01 Bhachau Municipality 310/04/01 CHC, Bhachau 612/04/01 World Vision (NGO) 711/04/01 GWSSB, Rapar 616/04/01 GWSSB 2917/04/01 GWSSB 1218/04/01 Gandhidham Municipality 220/04/01 GWSSB Laboratory, Bhuj 524/04/01 PHC, Adhoi 4024/04/01 PHC, Manfara 2526/04/01 GWSSB, Anjar 2026/04/01 GWSSB, Bhachau 2004/05/01 PHC, Bhimasar 1030/05/01 Govt. of Gujarat, Bhachau Control Room 331/05/01 GWSSB, Gandhinagar 5007/06/01 Village panchayats, Anjar Taluca 414/06/01 PHC, Dhaneti 322/06/01 GWSSB, Saurahtra Region 13

Total 290

The WHO watsan office continues to provide additional orthotolodine reagent to PHCs and other organizations, as needed.

WHO Office Equipment

As a mark of the close cooperation between the GWSSB and WHO, the GWSSB on 3 March allocated to WHO a room in the Bhuj Water Quality Laboratory building to use as an office to support water supply and sanitation activities in the emergency. On 4 March, the WHO watsan team requested WHO to provide office furniture, computer equipment and supplies for the office for a period of approximately one year, after which the office and its equipment would be turned over to the GWSSB.

By end-March, furniture and equipment had been procured and installed in the office, as shown in Table 5.2

Table 5.2 Furniture and Equipment Procured for the WHO watsan Office.

Item No. Procured

Steel desk 1Revolving chairs 2Steel cupboards 2Visitors’ chairs 4Computer tables 2Telephone rack 1Ceiling fans 4Air conditioner with voltage stabilizer 1Telephone 1Fax machine 1

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Computer with monitor, laserjet printer and modem

1

The cost of furnishing and equipping the WHO watsan office was approximately US$ 6,000.

From the beginning of April, the WHO watsan office became the operational base for all WHO water supply and sanitation activities.

Bhuj District Water Quality Laboratory Equipment

One of the immediate needs in restoring safe water supply services to the people of Kachchh District was to ensure that water quality analyses could be carried out as part of the overall relief and rehabilitation effort. The GWSSB has a water quality laboratory in most districts. In Kacchchh District, the laboratory in Bhuj was functioning, but the building was damaged, operations were severely disrupted and the available equipment was inadequate for the needs of the emergency.

After a review of the laboratory needs in Bhuj, the WHO watsan team on 8 March requested WHO to provide a number of key items of equipment for the Bhuj laboratory. SEARO placed a purchase order for the equipment and associated supplies on 5 April and the equipment was received in Bhuj and accepted by the GWSSB on 18 May. (The Turbiquant turbidity meter was expected the beginning of July.) Table 5.3 is the listing of equipment provided to the Bhuj Water Quality Laboratory.

Table 5.3 Laboratory Equipment Provided to the District Water Quality Laboratory at Bhuj.

Item No. Procured

pH pocket meter (Orion Model 106 Quikchek TN)

2

TDS-2 Pocket Meter (Orion Model 114 Quikchek TM)

2

Turbidity test kits (Orion Aquafast II) 2Benchtop pH concentration meter (Orion Model 720A)

1

Fluoride, nitrate and lead electrodes 1 eachBenchtop pH meter (Orion Model 420A) 1Turbidity meter (Merck Turbiquant 3000T) 1Spectrophotometer (UNICAM Model Helios Epsilon)

2

Miscellaneous reagents -

The cost of the above items for the Bhuj water quality laboratory was US$ 11,524.

A visit to the laboratory on 20 June showed that some of the equipment is installed and in use, but a number of items are awaiting recruitment of new laboratory and field staff by the GWSSB.

Water quality laboratories in other districts

In mid-March, discussions between WHO and the GWSSB indicated that water quality testing equipment might also be needed in the earthquake-affected districts of Gujarat State other than Kachchh District. This prompted a request on 27 March from the Director of the Gujarat Jalseva Training Institute in Gandhinagar for laboratory equipment for the districts of Rajkot, Surendranagar and Banaskantha. Following further discussions with the laboratory officials of the GWSSB, the WHO watsan office on 25 May requested that WHO provide equipment for the three laboratories, as shown in Table 5.4.

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Table 5.4 Equipment Provided for District Water Quality Laboratories in Rajkot, Surendranagar and Banaskantha.

Item No. Requested

Quickcheck pH meter 6Quick check TDS (total dissolved solids) meter 6Portable turbidity meter 6Spectrophotometer 3Ion selective meter with electrodes for fluoride, nitrate, iron and lead

3

Desk type turbidity meter 3Potable microbiological field test kits 6Refrigerators for samples and reagents 3Chlorine measurement kits with reagent 100

The cost of the above items was estimated at INR 1,260,000 (US$ 27,400). On 15 June, WHO placed a purchase order for the equipment.

Aquachlor chlorine generator

In March, SEARO sent to the WHO watsan office an Aquachlor1 chlorine generator for use in the relief effort. This device uses electrolysis, powered by either municipal alternating current or solar-generated direct current, to produce a sodium hypochlorite solution from ordinary salt (NaCl). The unit is reported to have a capacity of disinfecting (at 2 ppm of chlorine) up to 50,000 litres of water per day under AC power and 24,000 litres under solar operation. These generators have been successfully used in emergency situations in several Latin American countries. The Regional Office intended that the device be tested in the field to determine if its use in the Gujarat earthquake, as well as in as future emergencies, was warranted.

Unfortunately, the instructions for assembling and operating the Aquachlor kit were in Spanish. English language instructions were subsequently received from the manufacturer in April, but difficulties in identifying a suitable test site either with the GWSSB, municipalities or NGOs delayed the testing process. In late-June THW agreed to test the unit and to determine its characteristics for application in the field. The testing occurred at the THW camp over 23-27 June, with the equipment performing satisfactorily on both municipal electric current and solar power. The WHO watsan team is now looking for a suitable operational site to install the unit.

Training

The initial problems in using chloroscopes highlighted the need for training as well as distribution of testing devices. To assist in this training, instructional guidelines were prepared (in Gujarati) on the subjects of how to chlorinate water in storage tanks and how to use a chloroscope to test the water. These guidelines were widely distributed by the WHO watsan team during their visits to the field.

It also was apparent to the WHO watsan team that field personnel often carried out aspects of their jobs poorly because they did not understand the technical or health issues underlying the tasks. Therefore, a series of short (one-half to one day) courses were held to instruct field personnel of the Health Department and GWSSB in the practical elements of water chlorination, water quality, solid

1 Manufactured by Equipment & Systems Engineering, Inc., Miami, Florida, USA.

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wastes management and the interaction of water and health. The target audiences for these courses included pump operators, linemen, sanitary inspectors, water tanker drivers, medical officers, health supervisors and paramedical staff. The courses were held with the cooperation of the District Health Department, GWSSB, municipalities and PHCs. Starting in April, twelve courses attended by 330 participants were held in Kachchh District. Dr Jagdish Barot designed and conducted the courses,which are listed in Table 5.5.

Table 5.5 Water Supply, Sanitation and Health Courses Held in Kachchh District.

Date Organization Location Subject Participants No. of Participants

10/04/01 Bhachau Municipality and Community Health Centre

Bhachau Chlorination Pump operators and Paramedical staff

24

11/04/01 Rapar Municipality and GWSSB

Rapar Chlorination Pump operators and Linemen

44

11/04/01 Rapar Municipality

Rapar Solid Waste Management

Sanitary inspectors

10

18/04/01 GWSSB and Gandhidham

Rambag Chlorination Pump operators and Supervisors

32

19/04/01 PHCs of Adhoi and Juna-Kataria

Adhoi Water and health, Chlorination

Paramedical staff 30

19/04/01 PHC at Manfara Manfara Water and health, Chlorination

Paramedical staff 13

20/04/01 GWSSB Bhuj Chlorination Water tanker drivers

16

23/04/01 District Health Department

Bhuj Water and health, Chlorination

Health supervisors

20

24/04/01 GWSSB Bhachau Water quality and chlorination

Pump operators and Supervisors

31

24/0401 GWSSB Bhachau Chlorination Water tanker drivers

16

27/04/01 PHC staff of Anjar Taluca

Anjar Water and health, Chlorination

Paramedical staff 38

07/05/01 PHCs of Rapar Taluca

Rapar Water and health, Chlorination

Paramedical staff 56

14/05/01 District Health Department

Bhuj Water and health

Medical officers 37

25/06/01 PHCs of Rapar Taluca

Rapar Water and health, Chlorination

Medical officers and Paramedical staff

40

The general reaction of the participants to these courses has been very enthusiastic. The WHO watsan team intends to conduct more of these courses and to include additional subjects and locations in the coming months.

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Coordination

The water supply and sanitation sector of the overall Gujarat earthquake relief effort has been officially coordinated, since the beginning of February, by Oxfam. This mainly consisted of chairing the frequent water and sanitation meetings that took place in the weeks following the earthquake. Because of its remote campsite in Lakadia (Bhachau Taluka), located 75 km from Bhuj, Oxfam has had difficulties in communicating with the other relief organizations and, recently, in attending and chairing the bi-weekly Watsan Sectoral Meetings. Since early April, WHO has been the de facto coordinator of these meetings.

Since the GWSSB has found it difficult to take on the task of coordinating the various organizations working in the water and sanitation sector during the emergency, WHO has offered to assist in this role. WHO is centrally located and works very closely with the GWSSB, District Health Department and the municipalities. The issue is not yet decided, but will depend on consensus by the other organizations (Oxfam, CARE, MERLIN, IFRC, THW, GWSSB, UNICEF) active in the sector.

A more influential coordinating role is played by WHO through its close relationships with Government (Collector’s office, GWSSB, Department of Health, municipalities) at both the district and state levels and with external agencies and NGOs (THW, UNICEF, UNDP, Oxfam, CARE, MERLIN, IFRC, Abhiyan, etc.). The WHO watsan team has ready access to many government offices and to the relevant NGOs in the watsan sector. In many instances this has allowed WHO to act as an intermediary in bringing organizations together and in assisting them in field activities. For example, CESVI, an Italian NGO contacted WHO in March requesting suggestions for water supply interventions in the field. The WHO watsan team put the CESVI representatives in contact with the GWSSB, assisted them in selecting a field site in Mundra Taluca and is currently providing technical advice to CESVI in the construction of a village water treatment plant.

Another example of WHO’s coordination role occurred in early April when an outbreak of jaundice was reported in Nandasar Village in Rapar Taluca. WHO watsan organized a visit of officials from the district health department and the GWSSB to inspect the status of water chlorination and the general cleanliness of the area. A third example is the cooperation that has developed between THW and WHO in the installation of direct injection chlorine feeders in village water systems not served by the GWSSB. WHO, in consultation with the GWSSB, helps to identify the villages and the village leaders and then TWH carries out the installation and handing over of the completed installation.

Thus, a major strength of the WHO watsan presence in Bhuj is the close working relationships it has developed with government and non-government organizations in the sector. In particular, Dr Barot has established good rapport with local officials and especially with his former colleagues in the GWSSB. These relationships have built upon and further strengthened the climate of trust and confidence established by the WHO Health team in the earliest days of the emergency.

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6. Cooperative Agreements

Gujarat Water Supply and Sewerage Board (GWSSB)

WHO office accommodations

On 3 March, Mr S.C. Patel, Superintending Engineer for GWSSB in Kachchh District, allocated an office to WHO in the building used by the Kachchh District water quality laboratory. The office was provided on a temporary basis for an initial period of six months. On 4 March, Dr Warner requested WHO to supply computer equipment, furniture and supplies for the office. He noted in the letter that WHO technical assistance would be needed for one year, after which the office and its equipment would be turned over to the GWSSB.

Laboratory equipment

In a letter dated 8 March, the WHO watsan team requested WHO to provide a list of laboratory equipment for the GWSSB water quality laboratory in Bhuj. This equipment was received and accepted by the GWSSB on 18 May.

It is noted elsewhere in this report (chapter 3) that as of 30 June the equipment in the district laboratory in Bhuj was not being fully utilized. The problem seems to be a shortage of laboratory technicians in the Bhuj area. Since the earthquake, the GWSSB has been rotating laboratory staff to Bhuj on a temporary basis from other district laboratories in Gujarat State. During May-June, the laboratory was understaffed and the number of analyses of water samples accordingly declined. New staff for the laboratory are expected to be funded under the water quality surveillance programme approved by DFID. The GWSSB has been requested to begin recruitment of these personnel.

Water quality surveillance

In March, WHO submitted a proposal to DFID for US$ 125,700 to support a programme of water quality surveillance in Kachchh District. This proposal was approved by DFID in May, and WHO is now awaiting the release of funds by DFID for use in the field. WHO expects to sign a number of Agreements for Performance of Work (APWs) with the GWSSB for the implementation of various components of the programme.

Dindayal Charitable and Development Trust

On 10 March, the WHO watsan team requested WHO provide INR 686,500 for the improvement of sanitation in Bhuj Municipality campsites. WHO/India approved the request, and on 21 March, WHO and Dindayal signed an agreement for the implementation of the project. Dindayal is currently implementing the project.

Several changes have occurred in the field since the agreement with Dindayal was signed. It was initially anticipated that Dindayal would rent a tractor for the removal of trash from some 13 campsites. During implementation of the project, it was found that trash removal was being supported by the IFRC and thus a tractor was not required. Moreover, only nine of 13 campsites currently remain open in the project, but most are likely to remain in place indefinitely instead of being closed by the Municipality of Bhuj at the start of the monsoon season. Because some anticipated expenditures have not occurred and the Dindayal contract will expire by 15 July, it is necessary to review the agreement with Dindayal to determine how the remaining funds can be used for the benefit of the camp residents.

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German Federal Agency for Technical Relief (THW)

In May, THW requested WHO assistance in the installation of direct-feed chlorination equipment in villages without adequate water disinfection. WHO agreed to assist with the identification of villages, to act as a liaison with the Government of Gujarat and to highlight the contribution of THW and the German Government wherever feasible. THW, in turn, agreed to finance and install at least 25 chlorine units in towns and villages identified by WHO. A Memorandum of Understanding formalizing these agreements will be signed on 25 June by the Mission Director of THW and by Dr Barot of WHO.

As noted in chapter 3, THW is hoping to install as many as 55 of the chlorine units by end-August when it will depart India. The WHO watsan team expects to continue to assist THW in this cooperative activity until their departure. Moreover, informal discussions have been held on the possibility of WHO receiving support from the German Government to continue the installation of chlorination units after August. Dr Barot is following up on these discussions.

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7. Progress in Implementing Recommendations of Consultant Mission of 16 February – 6 April 2001

In the final report of his mission to Gujarat of 16 February – 6 April 2001, Dr Warner set out a series of technical and administrative recommendations to WHO. The following is the status of these recommendations as of 30 June 2001.

Technical Recommendations

Continue to support the strengthening of water quality monitoring throughout Gujarat State

Water quality monitoring has remained a priority issue throughout the emergency. The WHO watsan team continues to promote chlorine residual testing in the field, and it has provided analytical equipment for the Kachchh District water quality laboratory. In addition, the proposal to DFID for a programme of water quality surveillance throughout Kachchh District has been approved and WHO is now waiting for the funds to implement the programme.

Only minimal assistance, however, has been given to water quality monitoring in the other districts of Gujarat State. There is a request for WHO provision of laboratory equipment for the water quality laboratories of Rajkot, Surendranagar and Banaskantha districts, which has been approved by WHO/India.

Establish a programme of rural sanitation based on rural health centres

WHO has been actively cooperating with the health promotion subgroup in Bhuj in order to become more closely involved in hygiene and sanitation promotion in the rural areas. At present, there are no funds to support anything but technical assistance. In March, WHO submitted a proposal to USAID, requesting US$ 444,700 for an 18-month programme of improving sanitation facilities and sanitation promotion activities at rural health centres in the talucas of Bhuj, Bhachau, Anjar and Rapar. WHO is currently awaiting word from USAID on the outcome of this proposal.

Continue to provide general technical advisory services to all environmental health organizations in Gujarat State

WHO is providing an increasing amount of technical advisory assistance to the GWSSB, Department of Health, NGOs and international agencies located in Kachchh District. The WHO watsan team has become a credible source of technical information and liaison with other organizations to many of the institutions working in the areas of water, sanitation and health in Gujarat. The addition of a United Nations Volunteer, Mr Vinod Shah, has allowed WHO to expand the amount of time devoted to such services.

Provide training to improve the technical skills of water system operators

Since the beginning of April, Dr Barot has conducted a series of short courses on issues of water chlorination, solid wastes management and health impact to technical field staff, paramedical personnel and medical officers. To date, over 400 participants have attended 13 short courses held in various locations throughout Kachchh District. It is the intention of the WHO watsan team to hold many more of these courses in the future.

Provide training and technical advice on the sanitary protection of water supply sources

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Although this issue has been mentioned in the short courses given to date, no specific training course or field programme is currently addressing the subject. It will be a part of the water quality surveillance programme funded by DFID and it also is included in the proposal on rural sanitation currently before USAID. The WHO watsan team has had some preliminary discussions regarding the provision of training on sanitary surveys for village water committee members.

Administrative Recommendations

Ensure that Dr Jagdish M. Barot, WHO National Professional Officer (Sanitary Engineer), has a contract for at least one year

Dr Barot began his work with WHO in mid-February under a Special Services Agreement (SSA). In mid-April he was given a three-month contract as a National Professional Officer. The WHO Representative to India, Dr Robert Kim-Farley has indicated that there will be no difficulties in extending Dr Barot’s contract to one year. This is good news for the WHO water and sanitation activities in Gujarat. Dr Barot, because of his technical knowledge, professional contacts and dedicated service, continues to be the best guarantee for successful WHO watsan programmes in the area.

Further strengthen WHO water supply and sanitation activities in Gujarat with the appointment of a United Nations Volunteer (UNV) to work under the direction of Dr Barot

In mid-May, Mr Vinod Shah was appointed as a UN Volunteer and assigned to work with Dr Barot in Bhuj. Mr Shah is a recently-retired deputy executive engineer with the GWSSB. He brings long experience and knowledge of the GWSSB and the water supply and sanitation problems of Gujarat State. In the few weeks he has been working on the WHO watsan team, he has taken responsibility for field liaison with THW, participation in the taluca-level health meetings and organization of the technical information in the WHO watsan office.

Consider having Dr Warner return to Gujarat for a short period to review progress on WHO programmes

WHO/India and SEARO requested a follow up visit even before Dr Warner completed his first mission in April. The return mission was for the period 8-30 June 2001, and the purpose of the visit was to assess overall WHO progress to date in water supply, sanitation and environmental health in the earthquake-affected areas of Gujarat. As in the first mission, the terms of reference, contract and funds were handled by WHO/EHA in Geneva.

Improve WHO administrative and logistical response times when support is requested

There continues to be some delays when equipment and supplies are ordered or when approvals for action are requested. For example, equipment for the Kachchh District water quality laboratory was first requested on 8 March but was not delivered until mid-May. Some of the delay can be explained by the need to clarify product specifications and by normal administrative processing. However, too often the status of requests directed to WHO/India and SEARO is unknown, forcing field staff to seek up-dated information by telephone. It would be very helpful if WHO/India kept the WHO Bhuj office fully informed of the approval status and likely response dates for requests from the field.

A related administrative issue is the payment of salaries and allowances to WHO national field staff. The WHO national professional officers do not receive their salaries on a prompt and regular schedule, thus causing numerous personal difficulties in paying bills and maintaining their households.

Require safety belts on all seats in WHO vehicles

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WHO has purchased eight new vehicles for the Gujarat operations in the past three months. All are equipped with safety belts for the front seats, but not for the middle row of seats nor for the side-facing seats in the back of the vehicles. It is to be regretted that no one uses the safety belts, even when they are available.

Establish a WHO Rest and Recuperation (R & R) Policy for all staff working in designated emergency areas

On 11 May 2001, the United Nations organizations in Bhuj (UNDP, WHO, UNICEF, WFP) agreed upon a common R&R policy for staff working on the Gujarat earthquake. This policy contains provisions for international staff recruited outside India, for national staff and for Special Services Agreement (SSA) holders. In general, international staff are provided travel costs plus DSA for a four-day weekend once a month in Mumbai, while national staff are provided only travel costs for a four-day weekend once a month at their home or duty station. No provisions were made for UNVs, but the issue is still under consideration.

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8. Conclusions

This chapter presents the conclusions of this assessment of WHO efforts to provide water supply, sanitation and environmental health support to the earthquake-affected areas of Gujarat State over the period 26 January – 30 June 2001. It should be remembered that the activities described in this report were part of a larger WHO relief mission to the Gujarat earthquake that also included health sector coordination, disease surveillance and general health promotion. The water and sanitation activities in this report, therefore, should be seen as part of the overall WHO relief effort in Gujarat.

In line with the terms of reference for this assessment set out by WHO, the following comments are addressed first to the actual and potential sources of funds for WHO, namely, OFDA, DFID and USAID, and second to the general role and relevance of WHO in providing water supply, sanitation and environmental health assistance to the earthquake-affected areas of Gujarat.

Office of Foreign Disaster Assistance (OFDA) Support

OFDA support was a crucial element in the WHO response to the Gujarat emergency. OFDA responded rapidly to a WHO proposal for funds to carry out disease surveillance and water, sanitation and environmental health activities in Gujarat. An agreement to provide US$ 232,000 allowed WHO to quickly mobilize a field team that had ten persons by mid-February and 18 persons by the end of the month.

In water and sanitation, the OFDA funds provided the basis for recruiting an international consultant (Dr Dennis Warner) for seven weeks (16 February – 10 April) and a national professional officer (Dr Jagdish Barot), who began working on 19 February. These funds also assisted in the hiring of vehicles for the field and in the procurement of chloroscopes and analytical equipment for the district water quality laboratory in Bhuj. Because of the rapid deployment in the field of Drs Warner and Barot, coupled with the availability of OFDA funds to address immediate needs, WHO was able to take a much more activist role in providing assistance to the government and people of Gujarat than it could have done in the absence of OFDA support. In the Gujarat emergency, the WHO watsan team was able both to serve as trusted advisors to the GWSSB and the Department of Health and to seek out additional activities for WHO assistance. Thus, the preparation of a proposal to DFID on water quality surveillance and the provision of direct sanitation support to Bhuj Municipality campsites were possible because of OFDA funding for water supply and sanitation.

As time passed and the immediate emergency needs diminished, OFDA funds continued to provide WHO with the resources to expand water and sanitation activities. This included the preparation of a proposal on rural sanitation to USAID, the expansion of technical assistance activities represented by WHO advisory services and training courses, and the recruitment of a second national staff member (Mr Vinod Shah) to work with the WHO watsan team. And finally, the OFDA grant was used to bring Dr Warner back to Gujarat in June to conduct an assessment of WHO’s water and sanitation efforts and to finance three new WHO activities: training courses for health and water field staff, (2) laboratory equipment for districts other than Kachchh District, and (3) provision of chlorine solution for village-owned rural water supply schemes.

In short, the OFDA grant was used by WHO to rapidly respond in strength to the Gujarat emergency. It allowed WHO to take an activist role in water and sanitation and served as a lever to accessing additional resources.2 While commodity procurement and the funding of field activities with OFDA

2 At an OFDA-sponsored workshop on “India Earthquake After-Action”, held in Washington DC on 7 June, representatives of cooperating organizations were asked to provide their comments on the OFDA role in the Gujarat emergency. Speaking on behalf of WHO, Dr Warner mentioned the following: OFDA was quick to provide funds to partner organizations.

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funds did not occur as quickly as would be desired, the intent and willingness of WHO watsan staff to take on critical issues is well appreciated by government and NGO officials in Gujarat.

Department for International Development (DFID) Support

The proposal to DFID for support for a programme of water quality surveillance throughout Kachchh District was first submitted on 1 March but was not approved until mid-May. By 30 June, WHO was still awaiting release of the US$ 125,700 in the DFID grant. Earlier, on 31 May, Dr Barot informed the GWSSB that WHO had approved a water quality surveillance project to be implemented in cooperation with the GWSSB. He requested that the GWSSB provide information on contracting procedures and begin the recruitment of field personnel for the project.

Thus, DFID funds were not available during the period under review, but the favourable prospects of receiving the grant allowed WHO to play an integral role in planning and strengthening water quality monitoring in Kachchh District. GWSSB officials are eagerly looking forward to the implementation of the water quality surveillance project. In addition, the DFID grant will allow WHO to retain the services of Dr Barot for at least one year, six months longer than is possible with OFDA funds.

US Agency for International Development (USAID) Support

Except for the grant from OFDA, which is a part of USAID, no general USAID funds have yet been provided to WHO for the emergency. The current link to USAID is the proposal for rural sanitation, which was submitted by WHO on 30 March. Totaling US$ 444,700, this proposal seeks support for WHO technical and material assistance to rural health facilities throughout the four Kachchh talukas of Bhuj, Bhachau, Anjar and Rapar. If funded, WHO will have an active programme of sanitation facility construction, health staff training and sanitation promotion in the most severely-affected areas of Gujarat. This programme will involve interaction between the Department of Health, Department of Rural Development, local and international NGOs and UNICEF.

USAID has not yet responded to the proposal, which was prepared in response to a USAID solicitation under the Gujarat Earthquake Recovery Initiative. Nevertheless, it is assumed that the proposal is still under consideration.

WHO’s Role in Water Supply, Sanitation and Environmental Health

In the immediate weeks following a catastrophic disaster, water supply and sanitation are two of the most urgently needed services. Without water, none of the relief efforts can be sustained, and without sanitation, emergency health services are quickly overwhelmed by infectious diseases of human faecal origin.

There is no question that WHO should make water supply and sanitation integral components of its emergency health responses. The Gujarat earthquake clearly showed the importance of the central roles WHO played in health sector coordination, disease surveillance and water quality monitoring. All organizations in the affected areas looked to WHO for leadership in these sub-sectors. After the first chaotic weeks passed and relief efforts became established, WHO began to take on the additional issues of health and sanitation promotion, water supply coordination and rehabilitation of water and

OFDA funds gave WHO the opportunity to play an active role in coordinating the health sector, monitoring disease outbreaks and providing water and sanitation assistance.

OFDA funds assisted WHO to become strong supporters of government health and water/sanitation relief efforts.

OFDA should consider supporting WHO in future emergencies because of the strong liaison role WHO traditionally maintains with governments in the field.

24

sanitation infrastructure. WHO was able to play this role because it had a strong watsan team in place early in the emergency and it encouraged its field staff to seek out areas of opportunity in which to provide WHO assistance.

By operating with a relatively free hand, the WHO watsan team was able to establish good working relationships with local government, international organizations and NGOs. In the process, the traditional lines separating the health sector from the water and sanitation sector became blurred as government health staff took on water quality monitoring roles and government water staff eagerly learned about environmental health issues.

As a result of this freedom of action in seeking out areas of need, WHO was able to undertake a wide variety of activities in cooperation with many organizations over the course of the past five months. The most effective areas of WHO watsan involvement during the emergency were as follows: GWSSB – water quality monitoring, strengthening of laboratory capabilities, general technical

advisory services, staff training. Department of Health – water chlorination, chlorine residual testing, investigations into water-

related disease outbreaks, sanitation and drainage at health facilities, staff training. Municipalities – sanitation for temporary campsites, chlorination of municipal water supplies,

urban solid wastes management, staff training. Rural communities – chlorination of village water supplies. NGOs and international agencies – liaison with government agencies, coordination of water and

sanitation activities, general technical advisory services.

It is anticipated that there will be a continuing need for WHO support and involvement in most of these areas for the foreseeable future.

The main lesson of the Gujarat earthquake is that WHO can play an effective role in future disasters and emergencies as long as it responds rapidly with an integrated team of epidemiological and environmental health experts. By doing so, it will automatically play a central role in coordinating and guiding the overall health activities of organizations responding to the crisis. This was done in Gujarat. It should be done in future emergencies.

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9. Recommendations

1. Continue to provide WHO technical assistance in water supply, sanitation and environmental health to the earthquake-affected areas of Gujarat State.

The main institutions for WHO assistance are the GWSSB, district departments of health and municipalities. At the same time, there is need for continued cooperation with NGOs and international agencies operating in Gujarat. WHO assistance is especially useful on issues of water quality, staff training, promotion of sanitation, coordination and liaison between organizations.

2. Improve the monitoring of chlorine levels of water supplies in both urban and rural systems.

Chlorine residual testing is currently carried out by GWSSB staff as well as staff from health departments, municipalities, NGOs and village organizations. The process of sampling, testing and reporting should be put on a more systematic basis, with all test results, including any corrective actions, reported back to WHO for follow up with the appropriate authorities.

3. Strengthen and put on a formal basis the training courses being developed for field staff.

The current short courses on chlorination, water quality, solid wastes management and health impacts have been well received by pump operators, linemen, sanitary inspectors, health supervisors, paramedical staff and medical officers. Because of the growing demand for more courses of this practical nature, the number and type of courses should be expanded and formalized, i.e. course schedules announced in advance and course materials prepared for the participants.

4. Continue to provide coordination to the water and sanitation sector, as needed.

Although sector coordination is properly the function of government, the GWSSB has been overloaded with work and has had difficulties taking the lead role in Kachchh District. Moreover, Oxfam, which was initially designated at the sector coordinator for the emergency, has not been able to fully carry out this function. WHO has played an increasingly influential role as coordinator of sector activities and as liaison between government agencies and external organizations. It should continue to provide coordination assistance to the GWSSB, other government agencies and NGOs, as needed.

5. Recruit another United Nations Volunteer (UNV) to assist the WHO watsan team with sanitation promotion.

An area of growing concern is the difficulty of encouraging change when sanitary environments are highly polluted. Providing sanitation facilities (latrines, bath houses, rubbish bins, etc.) does not guarantee they will be properly used. A UNV should be recruited for the Watsan team to promote sanitation improvements, hygiene education and behaviour changes in both urban and rural environments.

6. Continue the cooperation with THW on the installation of chlorine injection units in village water supply systems.

This cooperative activity, in which WHO identifies appropriate village water systems and THW installs the chlorination units, has proven to be very successful and should be continued, at least until THW leaves India at the end of August. Moreover, if the German Government wishes to continue the provision of chlorination equipment to Gujarat villages after August, WHO should consider taking on this activity with German Government support.

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7. Convene a consultation on vulnerability reduction in natural disasters in Gujarat, with special emphasis on water supply and sanitation services.

Now is the appropriate time to look at the issues of risk and vulnerability from natural disasters in Gujarat, such as earthquakes and cyclones. The memory of the January earthquake is fresh in people’s minds, and there is still time to incorporate structural and non-structural measures to mitigate risk into the rehabilitation of water and sanitation systems in Gujarat. WHO should convene such a consultation in Gujarat with the participation of the GWSSB, departments of health, municipalities, NGOs and relevant international agencies.

8. Consider supporting the establishment of village water and sanitation committees as part of an effort to strengthen local responsibility for rural services.

The key to the future sustainability of rural water supply and sanitation services will be found in developing an attitude of responsibility for and ownership of village systems within the rural communities. The Government of Gujarat has taken some steps to encourage the formation of village water and sanitation committees. WHO should review this issue and consider ways to support the establishment of these village-level committees as a means of promoting sanitation improvements and overall environmental health.

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Annex A: Officials Interviewed

Name and Organization

Position Contact numbers

Gujarat Water Supply and Sewerage BoardS.C. Patel Superintending Engineer, Kachchh District tel 98252-76195, 028332-50655 (O),

02832-50601 (R)K.K. Jadeja Chief Engineer (Maintenance and Planning) Gandhinagar

Kachchh DistrictH.N. Chibber Collector & District Magistrate tel 02832-50020Dr D.P. Solanki Chief District Health Officer tel 98250-15282

UNICEF

Peter Medway Emergency Coordinator tel 98240-57270Arun Mudgerikar Watsan Project Officer Gandhinagar, tel 98240-52068Jean Marc Baudot Emergency Logistics Officer tel 98240-16831

OXFAMGareth Owen Humanitarian Programme Coordinator tel 079-744-2674

Save the ChildrenDr Santa Tamang Health Manager tel 98250-85811

THWHenning Koth Head of Mission tel 02832-42595Peter Bytomski Project Manager tel +49-228-940-1822

WHODr Robert J. Kim-Farley

WHO Representative to India New Delhi, tel 98100-11999, 011-3018955, fax 011-3012450, email KimFarley@compuserve.com

Dr Eigil Sorensen Emergency & Humanitarian Action New Delhi, tel 98240-82647, 011-3317804 (x26443), fax 011-3318607,email sorensene@whosea.org

Terrence Thompson Regional Advisor, Environmental Health New Delhi, tel 011-33178004 (O), fax 011-3318607, email thompsont@whosea.org

Dr Lin Aung Emergency & Humanitarian Action New Delhi, tel 98103-92702, 011-3317804 (x26464), fax 011-3328438, email linaung@whosea.org

M.M. Datta National Professional Officer (Sanitary Engineer)

New Delhi, tel 011-301-8955, email dattamm@whoindia.org

R.M. Bhalla Administrative Officer New Delhi, tel 011-337-0804, ext 26474, email bhallar@whosea.org

Dr Jagdish M. Barot National Professional Officer (Sanitary Engineer)

tel 98240-23123, email barotj@whosea.org

Vinod M. Shah United Nations Volunteer (Sanitary Engineer)

tel 02832-26322, email vms811@reddif.com

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Dr Bipin Verma Team Leader, WHO Relief Mission tel 98252-28531, email vermab@whosea.org

Dr Nilesh Buddha Head, Health Surveillance Team Tel 98250-28531

Din Dayal Development and Charitable TrustNarendra Singh Jadeja President

CESVIAndrea Tamburini Project Manager Mundra, tel 02838-23684, email:

cesvi_india@satyam.net.inValeria Fabbroni tel +39-347-646-1621Francesca Petrecca tel +39-347-819-3263

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Annex B: Project Description (DFID Grant): Strengthening Water Quality Surveillance Capabilities in Kachchh District

This project is intended to establish a water quality surveillance programme for Kachchh to meet the needs of the current emergency in the earthquake-affected areas. It also is intended to strengthen the capability of the Kachchh District Water Quality Laboratory to carry out the surveillance programme both during the emergency and in the future after normal operations have resumed.

The surveillance programme will be based upon information collection at the water system level, both in municipalities and in villages. Sanitary surveys will be conducted on water sources and distribution systems, as described in the WHO document “Guide to Simple Sanitary Measures for the Control of Enteric Diseases” (S. Rajagoplan and M.A. Shiffman, WHO, 1974). These surveys will be performed to identify problems in design or operation which may endanger the health of the people.

Water quality will be assessed by taking water samples in the field from the existing water supply systems. Samples requiring full physical and chemical analyses will be sent to the District Water Quality Laboratory in Bhuj. Because samples taken for microbiological purposes need to be examined within 6 hours, most will be tested in portable field test kits at the taluca level. Only those taken from water systems near Bhuj will be sent to the central laboratory. The results of all tests carried out in the field will be sent to the laboratory in Bhuj.

In addition to sampling, field personnel will carry out numerous spot checks of chlorine residual of supplies at water sources, tanker trucks, storage tanks and final distribution taps. Again, all data from the chlorine tests will be promptly forwarded to the central laboratory.

The District Water Quality Laboratory in Bhuj will compile all test results and forward these data along with appropriate recommendations for action to the office of the GWSSB Superintending Engineer for Kachchh District. The GWSSB will have responsibility for corrective actions to maintain adequate water quality

The planning and scheduling of sanitary surveys and water sampling will be directed by the District Water Quality Laboratory. Overall responsibility for surveillance activities will go from the Chief Scientific Officer at the central laboratory to Sanitary Inspectors at the taluca level and then to field personnel at the water systems. At the field level, sampling and chlorine residual testing will be carried out by on-site personnel. For GWSSB water schemes, the Lineman, who is responsible for the operation of a system, will be given this task. The Lineman will forward water samples and other information to the taluca level, where the information will be compiled by a Sanitary Inspector and then forwarded to the District Water Quality Laboratory. For group supply villages that are not operated by the GWSSB, the village water committee will designate an individual, such as the committee secretary, to carry out the water sampling and chlorine residual tests. All information will be forwarded to the Sanitary Inspector at the taluca level. When necessary, sanitary surveys will be conducted by the Sanitary Inspector.

A total of six Sanitary Inspectors will be posted to the talucas. Some will oversee surveillance activities in two talucas while other will work in a single taluca. The final assignment of Sanitary Inspectors will be made by the central laboratory.

All personnel involved in the project will require training. This will include a review of laboratory procedures for staff at the central laboratory, training for sanitary surveys and on the use of portable field test kits for the Sanitary Inspectors and instructions on water sampling and chlorine residual testing for on-site field personnel. Training will be provided by the project through the use of experienced trainers available in Gujarat State. The training efforts will be supplemented by WHO and by cooperating organizations involved in water supply services in Kachchh District. Training

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activities supported by the project will be supplemented by other training activities provided through on-going WHO assistance to the GWSSB.

The project will provide equipment, transport and some salary support to the overall surveillance programme. Equipment will include a total of six portable field test kits (example: DelAgua kit available from the Robens Institute, UK) for the Sanitary Inspectors as well as miscellaneous chemicals and glassware for the central laboratory. A total of four jeep-type vehicles will be supplied – one for use of the central laboratory and three for use by the Sanitary Inspectors. Salaries will be provided for the six Sanitary Inspectors and for drivers of the vehicles. In addition, the necessary subsistence per diems for field personnel will also be provided.

Because the existing laboratory building is unsafe, the project will provide temporary facilities for all laboratory operations in Bhuj. This will consist of two rooms, each 20 ft by 20 ft, separated by a 10 ft wide covered areaway. The structure is fabricated of fiber walls, with a cement tile floor and AC roofing sheets. The complete installation will include electricity, water and sanitation.

This surveillance project is intended to be a cooperative effort among the main organizations providing water supply services during the emergency. Assistance in training will be provided by the following organizations: THW (German Federal Agency for Technical Relief and WHO will assist with the training of central laboratory personnel and the Sanitary Inspectors; MSF (Medecines Sans Frontiers), OXFAM, UNICEF and WHO will assist with training at the field level for both GWSSB Linemen and staff of village committees. Efforts also will be made to involve local NGOs in the project to assist in the training activities.

Throughout the duration of the project, WHO will act as the Project Coordinator and will provide general oversight and technical assistance to all aspects of the project. In addition, WHO will serve as the link between the GWSSB and the participating organizations. WHO technical assistance will include project planning, training, technical quality control and field-level trouble shooting. To ensure that full WHO technical support remains available for the full duration of the project, the project will fund the salary of the WHO Water Quality Expert (Dr Jagdish Barot, former Director of Training, HRD and Water Quality Monitoring of the GWSSB) for the final six months of the project. (At present, WHO has financial resources to maintain Dr Barot on the project only for the first six months. DFID support is requested to continue Dr Barot for the final six months of the project.)

It is recognized that the problems of water quality surveillance will continue for some time, even after the immediate emergency needs diminish. In order to ensure that the GWSSB capabilities are adequately strengthened to continue the surveillance activities on a sustainable basis, the project will have a duration of one year – 1 March 2001 to 28 February 2002. At the end of this period, project support will cease and all activities and support needs will become the responsibility of the GWSSB.

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Annex C: Project Description (USAID Proposal): Strengthening Environmental Sanitation Facilities and Sanitation Promotion Activities at Rural Health Centres in Kachchh District

This project is intended to strengthen the rural health facilities in four earthquake-affected talucas of Kachchh District to become effective demonstrators and promoters of good environmental sanitation. This will reduce the risk of sanitation-related diseases and improve the overall quality of life for all people. The project will accomplish these goals by supporting the construction of sanitation facilities at PHCs, sub-centres and anganwadis and by training rural health staff to be effective promoters and educators of healthy sanitation behaviours.

The talucas included in this project are Bhuj, Bhachau, Anjar and Rapar. They were suggested to WHO by the Chief District Health Officer (CDHO) for Kachchh District as the talucas having experienced the greatest damages to their rural health infrastructure and, therefore, in need of priority attention. These talucas represent a starting point for a campaign to improve rural sanitation. Once the project becomes established and has demonstrated an effective approach to promoting sanitation, it can be expanded to other talucas in the future.

It is expected that most of the health centres included in these four talucas will require replacement of their main clinic building as well as other physical works. A total of 17 of 19 PHCs and 116 of 148 sub-centres in these talucas are currently using tents for their clinical operations. The construction of either temporary or permanent buildings at the health centres will be carried out by other organizations and is not part of this project.

It is not possible at this point to specify the type and amount of sanitation improvements that will be needed in the rural health centres included in the project. As indicated above, there is no detailed damage assessment of the health centres, official standards for center reconstruction have not been published, and the sanitation plans of the organizations rebuilding the centres have not been developed. Available indications are, however, that sanitation facilities will not be given much attention in the design and construction phases of reconstruction. Unfortunately, restoring sanitation facilities to the levels that existed before the earthquake will not meet the needs of either the health centres or the people they serve. The project will work with each health centre to ensure that the resulting sanitation facilities are appropriate to the preventive health mission of the center.

It is assumed that all PHCs and sub-centres will require some form of supplemental sanitation from the project and that perhaps one-half of them will need a complete range of sanitation facilities. In addition, there are around 600 angawadi centres within the four talucas, of which it is estimated that approximately one–quarter, or 150 angawadis, will require some supplemental sanitation facilities. The types of sanitation improvements needed will be determined in the course of a survey of all rural health centres and a review of the implementation plans of organizations participating in the reconstruction effort.

The project will include several major components with the following interventions:

A survey of all rural health centres in the four talucas to determine their needs for sanitation facilities and staff training. This will include a review of government plans and designs for both temporary and permanent buildings and their sanitation facilities. It also will include a review of the implementation programmes of the agencies re-building the health centres. Field visits will be made to all rural sites to verify the sanitation needs.

Construction of sanitation facilities at the centres as determined by the survey. Based on the needs identified by the survey, sanitation facilities will be constructed at the centres, as appropriate. These facilities could include latrines/toilets, bathrooms, safe water storage, public drinking water points, handwashing basins, wastewater drainage, refuse disposal and

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medical wastes incineration. To avoid duplication, only those facilities that are needed will be constructed.

Development of training materials on sanitation and hygiene. Training materials on the following subjects will be assembled (or developed):

components of sanitation safe water and water quality low cost options for water and sanitation basic principles of communication role of sanitary facilities in preventing communicable diseases community participation and management of facilities

All materials (pamphlets, posters, videos, slides, puppet shows, etc) will be made available in the appropriate local language.

Training of the staff of the health centres in the subjects of sanitation and hygiene. Training of senior health staff (medical officers, sanitary inspectors, MPWs, ANMs) will be provided on a training-of-trainers (TOT) basis. These staff members will, in turn, give training and demonstrations on sanitation and hygiene to junior health staff, visitors to the health centres and rural villagers. TOT training of senior health staff will take place in Ahmedabad, while training of junior health staff will take place either at the District Health Training Centre in Bhuj or at the PHCs.

Promotion of sanitation in the surrounding villages by health centre staff. All health center staff, both senior and junior, will be involved in the promotion of sanitation and healthy sanitation behaviours. Promotional activities will take place at the health centres for patients and visitors and in the villages for the general public. A mobile publicity van, termed “Sanitation on Wheels”, will support the field work of the health staff. The scheduling and implementation of sanitation promotional activities will be coordinated with the field activities of other organizations having rural sanitation programmes.

It should be noted that training, hygiene education and the promotion of sanitation constitute the essential core of the project. It is upon these “software” elements that the sustainability of sanitation improvements will succeed or fail. The NGO responsible for implementing the project is the Environmental Sanitation Institute (ESI) in Ahmedabab , which has been developing and implementing programmes of low-cost sanitation and sanitation promotion in Gujarat State for over 40 years. The training of senior health staff will take place at the ESI campus in Ahmedabad, while junior staff training will be given at the PHCs by ESI staff or at the District Health Training Centre in Bhuj by government staff. In addition, the newly-trained senior health staff will participate as trainers of the junior health staff. Health staff, in turn, will carry out sanitation promotion and hygiene education activities in the villages. Sanitation promotion will be supplemented by a mobile publicity van operated by the ESI which will tour the health centres and villages bringing information and educational experiences to the people through television, videos and slide shows, as well as through models, exhibitions, puppet shows, competitions, games and workshops.

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Annex D: Water Supply Services in Kachchh District

Rural Water Supply Services in Kachchh District as of 10 June 2001

Taluca No. of Villages Supplied by Pipeline Supplied by Tanker Supplied by Local Sources

No. of GWSSB Tankers

No. ofPrivate Tankers

Regional Schemes

Individual Schemes

Regional Schemes

Individual Schemes

Bhuj 144 87 26 24 4 3 22 12Nakhtrana 123 65 40 6 5 7 4 2Mandvi 89 32 43 10 3 1 6 4Abdasa 150 81 13 36 9 11 5 5Lakhpat 85 45 3 31 1 5 10 1Mundra 59 16 31 8 1 3 4 2Anjar & Gandhidham

72 37 2 31 2 0 7 6

Bhachau 69 35 5 29 0 0 23 19Rapar 97 48 6 35 8 0 13 9

Totals 888 446 169 210 33 30 94 60

Urban Water Supply Services in Kachchh District as of 10 June 2001

Taluca City Population(Year 2000)

Supplied by Pipeline

(%)

Supplied by Tanker

(%)

No. of GWSSB Tankers

No. of Private Tankers

Quantity Supplied(million

litres/day)Bhuj Bhuj 140,000 90 10 10 4 11.5Bhuj Madhpar 20,047 100 0 0 0 1.5Mandvi Mandvi 43,000 100 0 0 0 3.5Anjar Anjar 77,800 80 20 5 5 5.5Gandhidham GandhidhamGandhidham Adipur 170,470 95 5 15 15 18.5Gandhidham KandlaBhachau Bhachau 26,000 65 35 11 0 1.4Rapar Rapar 19,759 90 10 1 8 1.2Abdasa Naliya 9,726 100 0 0 0 0.6Mundra Mundra 13,982 100 0 0 0 0.7

Totals 520,784 42 32 44.4Source: GWSSB data

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