The Gujarat Environmental Health Improvement Programme implemented by the Aga Khan Planning and Building Service, India (AKPBS,I) over seven years (2001-2007) sought to improve the health and well being of over 230,000 beneficiaries living in the three districts of Junagadh, Patan and Jamnagar.
The Gujarat Environmental Health Improvement Programme looked to the community, once informed and organised, to: take the lead in supporting water and sanitation infrastructure that ensures adequate village coverage; and practise water management and hygiene behaviour that contributes to improved health and well-being, especially of women and children under the age of five. Physical interventions take place both at the individual and the community level. Toilets, bathrooms, soak pits, water connections and drainage connections are constructed for private homes. Cattle water troughs, extension of drainage and water distribution networks, construction of rain water harvesting structures are built by and for the community.
A review of the results of the last ten years of rural water supply and sanitation provision in Gujarat indicates that while there has been improvement in terms water and sanitation coverage, provision of sustained physical benefits to communities, especially the poor, leaves room for improvement. Raising health and quality of life conditions through improved hygiene behaviours and practices also needs improvement. The principal methodology applied in the past has been largely based on the “target approach”, with minimum involvement of the community.
Regional and Environmental Issues
Poor sanitation and water supply services in parts of rural Gujarat have adversely affected the quality of the rural environment. The availability, quality and sustainability of drinking water systems, and the accessibility and use of sanitation structures remain a serious concern. It is widely acknowledged that in large parts of Gujarat access to potable water is often restricted to less than an hour per day. Rainfall is limited and over-pumping for agricultural purposes has reduced the supply of drinking water at critical times of the year. These factors contribute to high human costs through a negative impact on human health and morbidity.
The poor, particularly women, suffer the most. Girls, for example are often forced to drop out of school for lack of toilet facilities, and instead, are burdened with the daily task of fetching water. Even at home, women rarely have access to sanitation facilities and travel long distances to fetch water for domestic use. The time taken in their search has adverse affects on their quality of life as it reduces their income generation capacity, affects their health and cuts into time they can spend with families.
Besides availability, water quality is another issue. Excessive fluoride is a major threat to human health in over 2800 villages. Excess nitrate in drinking water constitutes a threat to blue-baby disease. Near the coast, sea water intrusion as a result of excessive withdrawal of groundwater poses a perpetual threat. Dental and skeletal fluorosis, kidney and gall bladder stones, gastro-intestinal problems and skin disease are common aliments that afflict the young and old alike. Women of reproductive age and children are particularly vulnerable. Diarrhoea is the most prevalent water-borne disease, responsible for a high percentage of deaths among children below five years of age. Infectious hepatitis, malaria, malnutrition food poisoning are also common.
An overwhelming 79 percent of Gujarat’s population does not have access to latrines and therefore have to make do with open grounds. In sparsely populated, arid and semi-arid areas, this causes little environmental damage but has an impact on their health. In more densely populated villages, the absence of household or communal sanitation systems creates significant environmental and health consequences. Women are especially disadvantaged by the absence of adequate household sanitation. Usually the time chosen by women to relieve themselves is before dawn or after dusk. When women are consulted, the demand for safe water and adequate sanitation (toilets and bathrooms) is vehemently expressed.
To meet this growing demand for clean water supply and to rectify the low coverage rates for rural sanitation, the Government of India and the Government of Gujarat have issued guidelines and proposed reforms to allow a community based demand-driven implementation of water supply and sanitation coverage.
Creating Demand by Highlighting Benefits
The Village-Coverage Approach is a markedly different approach from the centralised, supply driven and subsidised approach that does not respond to community demand and puts service sustainability in doubt. The implementation strategy adopted in these villages allows for a bottom-up, facilitator approach (as opposed to the traditional top-down provider and target-based approach) and makes interventions more responsive to community needs.
For community owned infrastructure, villagers contribute up to 10 percent of the total cost of construction. For private structures, community contribution goes up to 70 percent. In order to effectively manage their water and sanitation systems and engage in safe hygiene practises, there are five inter-linked activities that the beneficiaries need to be organised and involved in: water supply, excreta disposal, environmental sanitation, hygiene promotion and community management. Hygiene promotion activities include door-to-door campaigns, spot home visits, peer education/motivation, child to adult education and group meetings. A quarterly health survey of children in the age group of less than three years is assessing the impact of various information, education and communication activities on the health of these children.
Demand from Women
One of the outcomes of sensitising the community to potential benefits (health and non-health) of sanitation infrastructure was that women were quick to demand that interventions be introduced to their village. Surprisingly, reasons cited for installation of latrines and bathrooms had more to do with issues such as old age, menstruation and pregnancy that pertained to convenience and access rather than perceived and subsequent health benefits. Consequently, in addition to health benefits, non-health benefits of owning sanitation infrastructure are promoted as well. Some of these benefits are:
Community participation begins with the formation of a Village Development Committee (VDC) that represents all sections of the village community including women and marginalised sections (a VDC must comprise of a minimum of 30 percent women). Fifteen percent of the VDC are Panchayat (a grassroots government body) members as well. On an average there are 12 to 14 communities (religious/ethnic) in a village.
Separate meetings are held with women and the under-privileged to elicit their involvement to enable gender equity and a pro-poor bias.
Communities are then mobilised within the selected villages to prepare a Village Action Plan (VAP): a document that outlines work to be done and terms and conditions of executing it. The Village Coverage Approach promotes decentralised decision-making and ensures the involvement and representation of the village population in the process of developing, financing and managing rural water supply and sanitation systems. It also requires that 70-80 percent of households in the community be adequately covered with appropriate water supply and sanitation coverage to maximise health benefits accrued to the community at large.
Village Technical Advisory Groups comprising local technicians, masons and others have also been formed in some villages. The group is provided with technical guidelines required to monitor work progress, especially the quality of the materials and workmanship. It also serves as a platform for villagers with technical know-how to share their ideas for improving water and sanitation infrastructure.
Working Closely with Government
The Programme is in line with the Government of Gujarat’s interest in collaborating with non-governmental organisations to promote sustained development at the grass-roots. Implementation of the Village Action Plan also incorporates strategies to network with stakeholders, such as state and local bodies, which reflect current policy and programming directions of the Government. In line with Government policy, the Programme supports the development of strong local institutions located at the village level. Fifteen percent of the village committees comprises Panchayat (a village level Government body) members. This ensures that the grassroots representatives are involved in interventions being planned and implemented in their village. Governmental authorities responsible for rural water supply and environmental sanitation interventions are also involved, from the planning stage itself.
Initial Lessons Learned
Many lessons have been learned over the last ten years, including:
Sustainable Community-Based Approaches to Livelihood Enhancement (SCALE)
(Brief - English, 655KB, PDF)
Please also see:
Early Childhood Development (ECD) Programme (Brief - English, 1MB, PDF)
Community-based Savings Groups (CBSGs) (Brief - English, 1MB, PDF)
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