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Improving Sanitation in India: A Herculean Task [Part 1]

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By Dr. Amrit Patel:

Planning for human development in India is now more important than before, and it should aim at policy interventions that focus sharply on all its manifestations. It must ensure an improvement in the standard of living of the people through provision of Minimum Needs, more importantly of rural households by empowering the poor and marginalized. The Twelfth Five Year Plan (2012-17) should accord top priority for planning and implementation of human development programs and emphasize on a clean living environment and a more equitable distribution of development resources, opportunities and benefits. The development process should be made inclusive and should address challenges to formulate policies and programs to effectively and sustainably bridge regional, social and economic disparities. In this endeavour, rural women, in particular need to be adequately empowered so as to facilitate them to act as catalysts for change in country side.

Sanitation: In India, since time immemorial cleanliness has been considered as important as praying to God. And by tradition, the Indian society and culture values personal hygiene, but gives little importance to a clean and healthy community environment. Sanitation is an integral component of public hygiene and health care. In India, 736 million (71.7%) people out of total population of 1027 million lack basic sanitation facilities, thus resulting in high mortality and morbidity rates. Sanitation, in broad terms refers to the disposal and management of solid wastes, wastewater, human and cattle excreta etc. in such a way that it does not affect adversely domestic personal hygiene. Sanitation is a sine qua non for human health. It contributes to clean and improved environment, social development and generates significant economic benefits.

Human excreta, among all forms of wastes, are the principal sources of many enteric diseases and almost cause 80% of the diseases in developing countries. Studies reveal that over 50 types of infections can be transmitted from diseased persons to healthy ones by various direct and indirect routes from human excreta. Human excreta are the most hated object and anything connected with the latrine is considered so defiling that in India in past one was expected to take a bath immediately after coming out of the toilet and before entering into the kitchen due to religious taboos. Sanitation has, however, been seen as a matter of individual understanding and initiative rather than a collective responsibility of the community. Investment to promote environmental sanitation in this fast changing socio-cultural background is accorded the low priority.

Studies: According to a World Bank study, lack of toilets and other proper sanitation facilities costs India nearly $54 billion a year through hygiene-related illnesses, lost productivity and other factors stemming from poor sanitation. The problem is especially acute in rural areas where women suffer the most due to lack of proper sanitation facilities. A UN study in 2010 observed more people in India having access to a mobile phone than to a toilet. India’s mobile subscribers totalled around 894 million at the last count, enough to serve more than half of the country’s 1.2 billion people. But just 366 million people (30.5%) had access to proper sanitation. A recent UNICEF report says 638 million people (54%) defecate in the open in India as against just 7% each in Brazil and Bangladesh. Only 6% rural children below five years in India used toilets and about 50% of all Indians regularly wash their hands with soap after contact with excreta. Union Minister for Rural Development Shree Jairam Ramesh once said “It was shameful that India accounted for almost 60% of open defecations in the world”. He has recently made the commitment for making India “an open defecation-free” country by 2017.

Finance: Experts have observed that Government spending on sanitation and drinking water is grossly inadequate. According to the Center for Budget and Government Accountability, Government spending under these heads has declined from 0.59% of GDP in 2008-09 to 0.54% in 2009-10 and further to 0.42% in 2010-11. Union Minister for rural development Shree Jairam Ramesh has acknowledged that “Investment in sanitation and drinking water is as important as investment in defence”. He further adds “You can invest in missiles and tanks, in aircrafts, but if you don’t have clean drinking water, if you don’t have sanitation then the population is not going to be healthy. More investment in these sectors will result into better health of the people”. The Budget for 2012-13 has increased  allocation by 27% for rural sanitation and drinking water from Rs.11,000 crore in 2011-12 to Rs.14,000 crore.  A major initiative would be to strengthen Panchayats across the country through the Gram Panchayat Sashaktikaran Abhiyan and the capacity building of Panchayats.

Total sanitation campaign: The total sanitation campaign (TSC) launched in 2003-04 has been one of the flagship programs of the Government. The annual budgetary support has been gradually increased from Rs.202 crore in 2003-04 to Rs.1500 crore in 2011-12. The approved central outlay for the TSC in the Eleventh plan (2007-12) was of Rs.7816 crore. As of 28 December 2011, TSC projects approved with a total outlay of Rs.22, 022 crore (with a 65.5% Central Government share of Rs.14, 425 crore) are being implemented in 607 rural districts.

The TSC is implemented as a community-led and people-centric approach to generate effective demand for sanitation facilities by creating awareness among village communities, educating them and providing all required information that can help them avail Government’s subsidy and technical services under the TSC program. From June 1, 2011, to motivate the community towards creating sustainable sanitation facilities and their continued usage, the financial incentive in the form of subsidy for individual household latrines for BPL families has been raised from Rs.2200 to Rs.3200 and for hilly and difficult areas from Rs.2700 to Rs.3700.

TSC is an inclusive program and seeks active participation of all sections of society including women, SCs and STs. TSC has special components to encourage women and adolescent girls to actively participate in the sanitation program.  The Nirmal Gram Puraskar incentive scheme has been launched to encourage Panchayati Raj Institutions to attain a 100% open defecation-free environment. Under the scheme a total of 25,145 Gram Panchayats, 166 intermediate Panchayats and 10 district Panchayats have received the award in the last six years. Sikkim has become the first State to receive the award. Within a decade all 2.5 lakh Gram Panchayats are proposed to be converted into Nirmal Gram Panchayats. The thrust is not just to construct toilets, but to ensure their continued use keeping clean and maintaining properly which, of course, calls for behavioural change.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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