WSH: Addressing sanitation needs of marginalized communities

CFAR has been working on WSH as part of both Mission Convergence and the Urban Poor program. The focus of this project, which commenced in 2012 as a component of CFAR’s Urban Poor Project is on strengthening partnerships between government and community organizations to address the sanitation needs of marginal communities living in unauthorized and under-served settlements.

Water, sanitation and hygiene are key elements in ensuring the health, development and welfare of women and children. Inadequate access to safe water and sanitation services, coupled with poor hygiene practices, is the cause of at least one quarter of all child deaths and one fifth of the total childhood disease burden globally.

Water, sanitation and hygiene are also linked to school attendance and performance (particularly among girls), safety and security of women and girls, and the economic and social development of communities and nations. Women and girls in developing countries spend most of their days gathering water for their families, walking 3.5 miles on average each day to collect water. Girls often drop out of primary school because their schools lack separate toilets and easy access to safe water.

This program is being taken forward in partnership with the Municipality, Government departments and community structures that have been officially mandated under the project such as the Gender resource Centres set up by Mission Convergence in Delhi, the District Water Sanitation Committees set up by the State Water and Sanitation Mission in Jaipur, the community Development Society and Urban Development Network set up under SJSRY program in Kolkata and the user groups of Women’s Forums and self help groups in each settlement.

Outcomes

  • Across the 3 cities a total of 26 health camps reached out to approximately 2658 persons. Another 18,918 were reached out to in the 3 cities through street plays, celebrations of important days such as Global Hand Washing Day, Environment Day, International Women’s Day, and Menstrual Hygiene Day etc.
  • 19 forums have been created:  (Delhi -9, Kolkata- 6 and Jaipur-4) with 353 members (Delhi-130, Jaipur 70 and Kolkata153). In addition 8 forums created for adolescent girls (Delhi-1, Jaipur -3 Kolkata-4) with 134 members (Delhi- 22, Jaipur-70, Kolkata- 42) and 6 forums, 3 each in Jaipur and Kolkata for youth with 67 members (Jaipur 51 and Kolkata -16).
  • We have witnessed collective action by forums for improving sanitation services. In Delhi the forums have filed 18 petitions for repair and maintenance of community toilet complexes, repair of drains, provision of mobile toilet vans and dustbins and irregular supply of water. Resulted in10% increase in the provisioning of water to households since there is a 20 -26% increase in the number of houses with their own toilets. Shared toilets have increased by 2-3% so 60-55%decrease in use of community toilets and decrease in open defecation from 18-16%.

Areas of intervention

In Delhi, we are working across 27 slum settlements and collaborating with 16 GRC clusters to reach out tapproximately 25289 households in three phases. In Kolkata we are working intensively in two wards: Ward No 27 since August 2012 and Ward No 15 from January 2013; comprising of 11 clusters and a population size of 14700 and 19672 respectively; and in Jaipur our intervention is spread across 7 slum settlements, reaching out to 2220 households.

 

Initiatives-July 2012 to March 2015

Through health camps we have been instilling a sense of linkages between health and poor sanitation behavior in communities. In Delhi we have organized two health camps in partnership with the Gender Resource Centres in two settlements of South district. We also made the Hakim Abdul Hameed Centenary Hospital (HAHC), which is the nodal institution for Mission Convergence into this initiative. A total of 488 persons were reached through these health camps and 94 were sent to HAHC for follow up referral services.

In Kolkata, a RTI screening camp was organized, which was attended by 72 women, of whom 30 were diagnosed with RTI and UTI problems. Each of them have been followed up and when necessary, patients are also referred to the nearest government hospital.

In Jaipur, 504 persons attended a general health camp that we had organized.

Creating community health champions

In Delhi we have created 6 voluntary associations or platforms across 4 settlements with 92 members. Of them, 31 are women and adolescent girls were capacitated as health champions on personal and household hygiene.

In Kolkata we capacitated 61 community women across 5 clusters on issues of personal, household, environmental and menstrual hygiene. Of them, 30 are emerging as strong community champions and 2 have even been appointed as outreach workers for the project.

In Jaipur, a total of 84 adolescents across 4 areas were specifically capacitated on life skills, menstrual health and nutrition. Twenty of them are emerging as strong health champions.

In Delhi, we have also been working with 16 GRCs spread across 27 clusters. Using this provision, we have already created 6 user forums/ WATSAN groups and trained them and handed them over to Mission Convergence. These 6 groups with 92 members have reached out to approximately 3300 persons, individually across 16 GRCs. Similarly, the WATSAN groups with 227 members will reach out to 6780 persons individually over a one month period with messages on safe sanitation practices and behavior.

In Kolkata we organized 10 capacity building workshop[s with the Municipality on personal, household and environmental sanitation, where 341 resident community volunteers, under the urban livelihood program were trained. They in turn will impact sanitation related behavior of 20460 households.

Evaluation by the Institute of Human Development identified defining shifts in behavior:

In Delhi

  • 22% households purifying water, not doing so earlier
  • Open defecation done from 18-16%
  • In intensive clusters proportion of households that consulted a doctor  was 92% compared to extensive cluster 72%
  • Proportion of women who disposed menstrual cloth after one us up from 32% to 72%

 In Jaipur

  • Of the 780 women surveyed the numbers using sanitary napkins up from 15% to 38%. Of those using cloth245 were following hygienic methods.
  • Hand washing /personal hygiene: Of the 2,355 households surveyed in August 2012 55% revealed they did not wash their hands. Post intervention there was a change and by end of the year 17.2% were regularly washing their hands.
  • 72% of these households did not maintain proper garbage disposal methods not even a dustbin. End of two years 34% of these households reported that they had dustbins and of the 2,355 households 24% had dustbins.
  •  Of the 2,355 families 1,154 did not have access to any toilet so defecated in the open. By end of year two 69 or 3% of families had toilets in their homes.

 Kolkata

  • In September 2012 58% of women and girls used dirty pond for bathing in 6 clusters resulting in RTI/UTIs and skin diseases. By June 2013 this had gone down to 33% and by May 2014 to 29%.
  • In September 2012 695 of households threw their waste outside. Down to 55% in June 2013 and 35% in May 2014
  • In September 2012 18% reported using soap for washing hands after eating or after defecating. By June 2013 it has gone up to 35% and by May 2014  to 59%.
  • Napkin usage among women and girls up from 45% in September 012  to 71% in May 2014.