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“Sanitation Is Not All About Toilets” And Things You Should Know About Urban Sanitation

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Diksha Nawany, Analyst, Urban Sanitation

Safe sanitation is imperative to ensure that we meet the UN sustainable development goals (SDGs), particularly SDG 6, which aims at ensuring availability and sustainable management of sanitation for all. Urban India has made significant strides for sanitation with the government’s flagship Swachh Bharat Mission-Urban. However, as one thinks about the sanitation sector and its evolution over the last few years, there are millions of people still lacking the basic knowledge around sanitation and hygiene.

Let’s unfold some insights and interlinkages, which often remain only with sanitation experts. Here are a few things everyone should know about urban sanitation.

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Sanitation Is Not All About Toilets

Providing access to toilets or a sewer connection is only a part of the solution and not ‘the solution.’ Of the 4000+ cities in India, less than 10% have a sewerage system; and more than 45% of households rely on on-site sanitation, including septic tanks (MoUD 2017). This means most human waste generated in toilets flows untreated in open fields and water bodies, exposing using serious health and environmental hazards.

Poor Sanitation Can Have Significant Public Health Consequences

Sanitation linked diseases put a huge strain on the Indian healthcare sector. 1 out of 10 deaths in India is due to poor sanitation. Untreated faecal sludge and septage from cities is the single biggest source of water pollution in India[1]. This disposal poses a substantial public health threat as citizens can become victims of diseases. For instance, 1 truck of faecal sludge and septage carelessly dumped in the environment is equivalent to approximately 5,000 individuals defecating in the open[2]. Given the huge strain on our drinking water resources, ignoring the importance of faecal waste treatment can worsen the water crisis.

Lack Of Sanitation Disproportionately Impacts Women And Marginalized Groups

Women, differently-abled individuals, transgender communities, migrants, and the urban poor and marginalized groups are often left out of urban planning and safe sanitation service delivery. Women and girls are exposed to safety and health risks as they have few options to maintain privacy and manage menstrual health in restricted circumstances.

Urban poor communities also lack basic amenities and adequate housing, including toilets, and have higher exposure to untreated waste due to lack of proper sanitation infrastructure in informal settlements. It is important to take the specific needs of marginalized groups into account during planning, design, and pricing. For instance, Mobile She Toilets consider gender intentional infrastructure and design and have been introduced in Hyderabad to increase access for women in public spaces.

Sanitation Is A Public Service Delivered By Local Governments

Urban Local Bodies (ULBs) have been recognized as the independent third tier of governments (74th Constitutional Amendment Act, 1992). Local governments have been entrusted with the responsibility to provide basic essential services to citizens, including sanitation.

While there has been significant investment in sanitation infrastructure over the last few years, service delivery to citizens requires additional attention, planning, and resources. Municipal governments need to be functionally and fiscally empowered through reforms to be in a position to deliver safe, inclusive, and equitable sanitation services to the most vulnerable. Thus, to reach sanitation outcomes, it is important to also look into the larger municipal governance sector and strengthen local governments to be able to deliver on their sanitation-related functions.

Innovation And Technology Plays A Vital Role In Solving Key SanitationIssues

The last decade has seen significant investment in technology solutions and tools towards safe, affordable, and inclusive sanitation infrastructure, from making latrine designs gender intentional to FSM treatment technology for safe disposal/ reuse of wastewater.

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Innovation & technology in this space has been instrumental in reaching the most vulnerable. For instance, GIS mapping to plan and increase toilet coverage in urban slums or innovation in desludging trucks and pipes to reach remote, narrow lanes in urban areas. These ensure that exposure to faecal matter in the poorest communities is reduced and waste is safely treated.

Another area where technology plays a huge role in the occupational health and safety of sanitation workers. India sees at least one accident per week, resulting in loss of life for sanitation workers. Innovation in design and mainstreaming technologies for personal protective gear is crucial to reduce the risk of hazards during service provisions such as desludging of septic tanks, cleaning of sewers, or treatment of faecal waste.

Sanitation Plays A Key Role In Building Resilient Cities

COVID-19 is only one kind of disaster, and the threat of another public health outbreak is exacerbated by poor sanitation and hygiene. For instance, during the COVID-19, poorly maintained public and community toilets in urban slums have become hotspots and increased the risks of spread of the virus, making the need for universal access to individual household toilets even more urgent.

According to UNICEF, “Unless adequate water and sanitation services are quickly provided to emergency-affected children and their families, disease and death will follow. And unless good hygiene is consistently practised, the danger of diarrhoea, cholera and other disease outbreaks will persist.” In the absence of disaster-resilient infrastructure and services, the number of people affected due to disasters increases beyond directly affected victims. Further, the vast investment in sanitation can be reversed due to disasters if Disaster Risk Reduction (DRR) measures are not considered upfront.

This includes interventions such as designing sanitation infrastructure up to DRR codes, ensuring provisions of sanitation services during disasters, especially to vulnerable groups, building the capacity of officials and first responders on safe and inclusive sanitation, and raising awareness in communities on hygiene practices for mitigation and preparedness.

Image provided by the author.

Funding For Sanitation Must Increase To Meet The SDG Goals

According to the Water and Sanitation Program (World Bank Group), the funding requirement for Urban Sanitation in India is estimated at INR 5,193 billion for the capital requirement and an additional INR 2,647 billion for operating expenditure requirement over the 2012-32 period. To meet the promising vision of SDG 6, investment in Urban Sanitation is critical from the government, CSR, philanthropy, and social impact investors, keeping in mind that every one dollar invested in sanitation has a global economic return of $5.5[5] (World Health Organization 2012).

Lastly, even though the responsibility for service delivery sits with local governments, for effective systems change, multiple stakeholders in the sanitation ecosystem need to be activated, including practitioners, nonprofits, private sector players, citizens, funders, and of course, government stakeholders at national, state and local levels.

The user is an Analyst at Dasra.

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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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