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WATSAN woes
JUN 09 -
Stories have been surfacing in the media yet again about the spread of a diarrhoea epidemic in the Mid and Far West regions of Nepal, with cases already reported numbering more than 441 in Jajarkot, Bajura, Dailekh and neighbouring districts as per the Epidemiology and Disease Control Division (EDCD) data. The situation may worsen after the onset of the monsoon, which is likely to hit the country early next week.
According to the EDCD, 26 districts are at risk of a diarrhoea outbreak, most of which are already bearing the brunt of food insecurity along with limited access to clean drinking water and basic health services with very few doctors or health assistants to be found at local health posts.
Working on an ad hoc basis to stop the outbreak does not help in the long run to minimise health risks like diarrhoea that are closely associated with water and sanitation (WATSAN). Rather, the government needs to invest more on potable water supplies, medicines, paramedics and awareness raising campaigns on basic hygiene and sanitation practices to curb the perennial outbreaks.
In the mid-90s, while on a mission to evaluate the impact of the Community Health and Development Project (CHDP) in remote communities of Sankhuwasabha district, I was delighted to report a few success stories. But after seeing these projects were not sustainable, I chose not to recommend their replication in other feasible areas. The question in the back of my mind was: What would happen to these communities’ sanitation practices once the project concludes? Though exit strategies were beautifully written in spiral-bound project documents, I was not convinced that they wouldn’t ultimately end up gathering dust on the shelf.
During this evaluation process, I also had the opportunity to observe the sanitary behaviours of some beneficiary households. It was frustrating to see that many of these families maintained hygiene only to please the project staff. Obviously, the next thing on my to-do list was to uncover why they were finding it difficult to follow the hygiene and sanitation behaviours espoused by the project. After individual sittings with each of the families, almost all women revealed that they find it impractical to wash their hands with soap every time they clean animal sheds, feed or milk animals, wash utensils, feed babies, or nurture plants. They argued that they have been undertaking these chores without soap-washed hands since they were children and the project-taught idea (of washing hands every time) would only add an extra burden on them without any tangible benefits. This incidence reiterated the fact of how difficult it is to induce behavioural change in rural communities!
While visiting eight villages of the Mid and Far Western regions to monitor WATSAN projects as an external consultant, I was pleased to find many villages had been declared as No Open Defecation (NOD) areas and villagers claimed to be practicing basic sanitation and hygiene. My cheering, however, subsided during a focus group discussion the following day after seeing a woman in tears carrying her 2-year-old daughter who had just recovered from diarrhoea. The woman later invited me to visit her village to see what had been done under a WATSAN project. Early the next morning, I headed to her village along with a project staff. We reached there after four-hour-long trek along the slippery ups-and-downs of narrow trails.
Completely exhausted and without a proper meal or sleep for days, I was quite perplexed after seeing the state of the so-called WATSAN project. There were large holes dug in the backyards of almost every household that had been left unattended for eight months. The story behind the holes was upsetting. These families were asked to contribute their physical labour as a part of the WATSAN project and were assured that they would be given the necessary hardware to construct the latrines. Upon inquiring with the project staff, they were told that there was not adequate funding to continue with the project, and as a result villagers were back to open defecation practices showcasing the potholes as testaments to their contribution to WATSAN practices.
Access to improved sanitation and hygiene is critical not only because it helps reduce the burden of disease and death, but because it also guarantees an economic return on investment. It is estimated that investment equivalent to one US dollar in WATSAN infrastructure will create an economic return of nine dollars in the context of developing countries.
More importantly, improved WATSAN practices contribute towards maintaining human dignity, as it is considered vital for women to keep their privacy, particularly in patriarchal societies. Sanitation practices like open defecation and walking long distances to collect water make women and young girls more vulnerable to physical assaults and sexual abuse. In Nepal alone, 1.7 million people practicing open defecation face indignity everyday and are exposed to the risk of diseases. Various reports indicate that the number of deaths of children under five to diarrhoea is 10,500 annually and there is no sign of improvement despite much effort to keeping this killer at bay.
Development actors need to internalise the fact that implementation of WATSAN projects must come along with an acceptable level of participation from various groups and strata of the community, especially women and young girls. One question that must be answered is whether the level of community participation is consistent with the objectives and strategies stipulated in the policy and programme documents or is it merely a token representation to please the donors they work with? A study of 9,000 water points in rural districts of Nepal conducted by WaterAid in collaboration with its local partners revealed that women’s representation in WATSAN user committees was only 25 percent, and representation from marginalised groups wasn’t any better.
My fellow counterparts working in the WATSAN field argue that the concept of community participation is often driven by the donors’ interest rather than defined by WATSAN projects working in close coordination with beneficiary communities. To further hamper the success of the intervention, there exists a lack of proper advocacy and campaign components, which are integral parts of WATSAN projects.
WATSAN projects based on the Community Led Total Sanitation (CLTS) approach have shown that improved sanitation is not achieved merely by counting the number of latrines built over a certain period, as their intended use is not guaranteed. Success stories from South Asian countries have revealed that adoption of the CLTS approach has helped achieve total sanitation. CLTS, pioneered by Kamal Kar together with the Village Education Resource Centre (VERC) in 2000 in Bangladesh, focuses on realising the behavioural change needed to ensure sustainable improvements in WATSAN practices. Rather than focusing on toilet construction for individual households, CLTS focuses on having NOD villages. Considering our struggle with recurrent diarrhoea outbreaks and the visible shortcomings in our approaches in improving WATSAN standards, incorporating the essence of CLTS into our WATSAN interventions could be the best bet.
Upadhyay_b@yahoo.com
Posted on: 2010-06-10 08:23
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