Innovative strategies for promoting cleanliness and enhancement of health -An analysis in India

Dr S M Dason

Introduction

We need to understand the reasons in many angles that why does not India a healthy and clean country. Some of the points I can say that human habitats are mostly not clean and many habitants do not have safe drinking water, and garbage collects and putrefies causing noxious insects, vector born diseases and pathogens. When see the velocity of diseases , India has a high rate of water –borne, gastro-enteric and vector –borne diseases and now are facing lethal diseases like Diabetic, Cancer, Ebola etc. It is necessary to take simple steps through the primary health centres across the country. Though we have heath care system but its functions in many ways felt not up to the mark and burdened with inadequate infrastructure, funding, resources, personnel etc. It is necessary to devise a suitable strategies to make investment in preventive care such as focus on proper sanitation, safe drinking water, environmental health and nutrition.

Sanitation covers, storage, treatment , disposal of human excreta, management of solid waste, drainage , disposing of household waste water, drainage of storm water. Poor sanitation leads to medical cost for training illnesses ,lose of income through reduction or lost productivity and cost of providing health care services. Sanitation also includes air quality, safe food, safe products and of working conditions. The present prime minister said, according the World Health Organisation an average of Rs. 6500 was lost in India due to lack of cleanliness and hygiene

Sanitation is the hygiene, means of promoting health through the prevention of human contact with the hazards of wastes as well as the treatment and proper disposal of sewage or waste water. Hazards can be either physical , micro biological or chemical agents of disease .Waste that can cause health problems include human and animal excreta, solid waste , domestic waste water, industrial wastes and agricultural waste.( Health Action,Vol 27- No12 , Dec 2014)

The inadequate sanitation and health facilities are being witnessed in urban area due to various reasons. The causes of urban poverty and many urban problems can be traced to policy failure and government neglect as reflected in macroeconomic and sect oral policies. Mostly these policies have favoured large scale , capital intensive and metropolis industrialisation( Ernesto M.Pernia 1994)

Different aspects of sanitation

Sanitaion includes all four of the engineering structure items

Excreta Management System Waste water management systems Solid waste management System Drainage system for rain water

Centralised Treatment

National Capital Territory Delhi alone produces 8000 metric tons of municipal waste daily. In developed countries treatment of municipal waste water is now widespread but not yet universal. In developing countries , most water is till discharged untreated to the environment . For e.g in Latin America only about 15% of collected sewerage is being treated.

On- Site Treatment and Decentralised Treatment

In Many suburban and rural areas households are not connected to sewers. They discharge their waste water into sceptic tanks and other types of on-site sanitation. On site system s includes drain field which require significant area of land and this makes septic systems unsuitable for most cities. ( Health Acton Vol 27 –N012)

Priminister said, “sanitation should not be seen as a political tool but only be connected to patriotism and commitment to public health “

Hygiene mostly means practices that prevent the spread of disease –causing organism. Since cleaning process e.g. hand washing removes infectious microbes as well as dirt and soil, they are often means to achieve to achieve hygiene and other uses of hygiene such as body hygiene, personal hygiene, dental hygiene, occupational hygiene etc. Hygienic cleaning can be done by using soap, or detergent or rinsing under running water for removing from germs from the surface.

Culture and hygiene

In some cultures , the removable of body hair is considered proper hygiene. Otherwise practices that are generally considered proper hygiene include bathing regularly, washing hands regularly, washing scalp hair, keeping hair short, wearing clean clothing, brushing ones teeth, cutting finger nails etc. In some cultures, do not kiss, or shake hands to reduce transmission of bacteria by contact.

Prime Minister repeatedly emphasised that the work of cleaning India can not be done by one person or by the government functionaries alone – it has to be done by 125 crore people who are sons and daughters of Mother India.

The importance of isolation of excreta and waste lies in an efforts to prevent diseases which can be transmitted through the waste , which afflict both developed countries as well as developing countries to differing degrees . It is estimated that up to five million people die each year from preventable waterborne diseases as a result of inadequate sanitation .and promote hygiene practices.

Total Sanitation Campaign

In order to insure sanitation facilities in rural areas with the broader goal to eradicate the practice of open defecation a comprehensive programme called “Total Sanitation Campaign” was launched by Rajiv Ghandhi National Drinking Water Mission , Government of India to cover all the households with water and sanitation facilities and promote hygiene behaviour for overall improvement of health and sanitation in rural areas. The key intervention programme have been identified as individual house hold latrines, school sanitation , hygiene education , community sanitary complex and ankanwadi toilets. The scheme also laid strong emphasis on Information, Education and communication, capacity building , hygiene education for effective behaviour change with the involvement of PRI, community based organisation(CBOs) , NGOs etc.

The total Sanitation Campaign which was introduced in Cuddalore and Coimbatore districts initially in 1999 was extended in phases to all other districts in TamilNadu by 2004. This scheme is now renamed as Nirmal Bharat Abiyan and revised guidelines have been issued by Government of India with the salient features. These guidelines should be followed strictly so that gap which we presume will be identified and these will be eliminated by envisioning suitable and feasible strategies.

Sanitation messengers

Nirmal Bharat Abiyan has made provisions for the engagement of sanitation messengers who will motivate the village community through interpersonal communication and door to door contact to attain the programme goals. The sanitation messengers will be in a good position to exert the peer group pressure that is required to inculcate good sanitary practices among rural folk. It is observed that still many schools especially these are run by government do not have proper toilets . In the absence of toilets especially girls students are suffering a lot . When I visited dujana village in jajjahar District of Haryana State a week aso, girl children who are studying in this school say that they do not have proper toilets for them.

India’s Global Status

India is home to the largest number of poor with one third of the world’s 1.2 billion extreme Poor living here. It also had the highest number of under five- deaths in the world in 2012, with 1.4 million children dying before reaching their 5th birthday, according to the UN Millennium development goals report 2014.

Poverty rates in southern Asia fell from 51% in 1990 to 30% to decades later with China leading the way. According to the report almost 60% of people who defecate in open reside in India which also account for 17%of global maternal death. UN resident coordinator Lise Grande said the Millennium development goals cannot be met if they are not reached in India. 70% of India’s population have no health insurance and the countries short by 2 million beds compare with the global benchmark. This has been revealed in a white paper released by leading health sector body NATHEALTH on 20th Jannuary 2015.

Basic amenities should be provided to the people. “Deprivation and vulnerability are integral to the lives of many poor in India. For many severe deprivation is not a matter of unfortunate fall from previously more comfortable position but chronic state arising, for example absence of any asset and resources that can ensure adequate livelihood.”(Amartya Sen 1991) . The absence of basic amenities will also affect living condition of the people.

3 months after the launch of Swatch Bharat Mission government has made an allocation of Rs 1700 crore for this fiscal for complete sanitation in urban areas. SBM has two components – urban and rural. Central government expect the state government for submission of their plan and schemes.

Revised Guidelines of Nirmal Bharat Abiyan

Some of the revised guidelines in NBA are quite imperative such as NBA is proposed with village panchayat is a base unit and acceleration of sanitation coverage in rural areas. Here the panchayat is given importance and priority but in reality, in many of the panchayat, the peoples participation is minimum due to lack of education, awareness and of leadership qualities . Moreover, on the overage of sanitation part, neither the NGOs nor the government have taken full efforts and interests in achieving this. The efforts taken by the government and NGOs in eradication of polio had been much appreciated by WHO and other related organisations but this has not happened in achieving the sanitation. India presently even helping the Pakistan in eradication of polio. One of the ten cores theme of Honble Chief Minister TamilNadu aims at providing best infrastructures in India in terms of universal access to water &Sanitation. Further, the revised guidelines mention that the schools which are not covered under SSA and Ankanwadi centres will be provided with proper sanitation facilities and provocative promotion of hygiene education and sanitary habits among the students will be undertaken. The guidelines help a lot in protecting the interest and children of people.

Constraints of rural people

In India, the people from urban area can come together and show their solidarity on the Swatch Bharat Programme but the people from rural area which cover more than 6, 00,000 villages do not come due to various reasons . They may come once but attending the programmes of this nature continuously is the difficult task for them. These people need lot of awareness and inducement for brining necessary change in the community and society as well the programme assigned and meant for them. It is witnessed that NGOs working in different parts of country in rural area have built the people into various groups and involved them successfully in the development intervention. In country like India having more population, the efforts of government alone are not sufficient, other players support especially NGOs support is important and the NGOs personnel have got remarkable contact with local people across each region. I provide here some of the example from across the country on Swatch Bharat Abiyan.

The paper intends to brought out possible methodology and strategies especially in rural and semi –urban areas for the effective implementation of this programme across the country by involving and conducting in block level ,federation level and district level monitoring and evaluation of programmes. All of us know that Voluntary organisations in India have more contact with these areas and people. Already there are lakhs of organised groups with peoples leaders and their leadership could be used for the realisation of vision of Mahatma Ganthiji.Chetanalaya one of the NGOs from Delhi has been doing yeomen service in various field of developments in the states of Delhi and Haryana. In these two states Chetanalaya has 16 centres for promoting welfare and development works.

Chetanalaya Jahangirpuri joined hands enthusiastically and conducted a cleanliness drive in all its centres on Gandhi Jayanti, 2nd October 2014, and it was an effort towards fulfilling the dream of Gandhiji. Mr. Himanshu Rai, the project coordinator initiated the campaign by giving a brief introduction on the relevance of Clean India Campaign to the community. He applauded and appreciated the Cleanliness drive being started by our Prime Minister who repeatedly emphasized that the work of cleaning India cannot be done by one person alone, it should be done by each and every individual – who are the sons and the daughters of Mother India. He exhorted that each and every individual should change their habit for throwing waste here and there and in this way entire India will turn to Clean India.

Community people are being explained on the need and importance of Clean India Mission.

(Sources – Documentation from JahangirPuri Unit of Chetanalya)

NGOs personal is taking the lead together with community people on Clean India Mission

After cleaning the lane, a nukad naatak on cleanliness was enacted by the staff members. The idea behind performing the nukad naatak was to attract people of the community to understand the message on cleanliness in a fun loving way. Through the naatak, the staff members conveyed to the community that they should first bring a change in themselves then in the family followed by the change in the community.

A Nukat Nattak was organised on the theme of Clean India Mission

A slogan writing competition was conducted for the neighbourhood children parliament (NCP) students. The competition brought out some spirited writers who emphasized on the attitudinal change towards cleanliness. It was surprising to see small children with lot of deep thoughts.

Here the NGO established the contact for years and made the people aware of the situation in which they are living. The way NGOs create an environment in the community , may not be possible for other structures that are constitutionally existed in the area e.g local governance. It is evident that local governance should make the way for organised community to involve in the developmental intervention. Local governance should understand the efforts made by the NGOs for bringing people together for the right cause. Local governance also should make use of innovative methodology of NGOs for the accomplish the task assigned to the community people. Local governance and NGOs in the particular village/area should work shoulder to shoulder for the achievements of expected results. The suggestion provided by the community people should be taken into consideration and can be done positively and this give more confidence to the community people for involving to a further programme/activity.

NCP Children in the community area were given awareness on Clean India Mission. This shows , a committed NGO in the country can supplement a lot on such a campaign

(Sources – Documentation from JahangirPuri Unit)

Sustaining Model on Swatch Bharat at Bawana , Delhi

In Bhawana area in Delhi , Chetanalaya has been involved in development activities in eight blocks. Here also Chetanalaya organised Swatch Bharat Abiyan programme. From all the blocks community people were motivated for bringing broom for participating in the programme. The community people of Bawana area very enthusiastically participated in the programme. Prior to the programme ,community people were informed of the events and strategies supposed to be adopted for this programme. Mr. Gugan Singh , MLA of the area was invited and he gave a speech on Clean India Campaign.

Community people involved awareness campaign in Bawana area

In this area various committee have been involved in sustaining the programme and the names of the committee are given below.

Awareness Committee Women committee Parents committee Water &Sanitation committee Steering committee Volunteers etc.

All the above mentioned committees are assigned with specific purpose and responsibilities. In Water &sanitation Committee, there are 19 members and the committee members are taking the responsibilities for addressing the concerned issues. This committee is also doing the supervisory work of waste collection.

Earlier, the people of the area used to put the waste on the road side and in drainage. As a result of Swatch Abiyan Programme, water and sanitation committee took up the responsibility for the collection of waste. For this a number of four rickshaws have been hired and these four rickshaws are collecting the waste and put the same in the MCD centre. For meeting the hiring of rickshaw expenses, Rs. 10 from each family is collected and from this amount , hiring charges of rickshaws is being met . Per rickshaw is provided Rs. 6000 as

wage per month. The rest of the money is kept and this money is used for other related expenses.

The picture depict that Rickshaw pullers collect the waste from the houses on a specified time. (Sources – Documentation from Bawana Unit of Chetanalaya.)

Collection of waste from the respective area

(Sources – Documentation from Bawana Unit)

These kind of initiatives sustain the programme even in the absence of government programme.

Women Committee

In each area women committee was informed and respective project personnel informed of the importance of programme . Therefore it was easy for them to take participation. As women committee has already involved in community developmental activity, members did not find many difficulties in participating in the programme.

Women committee is involved in this programme and members are given orientation

Picture depicts Parents Teachers meeting & this group has also involved in Swatch Abhiyan programme in Bawana’ (Sources- Documentation from Bawana Unit of Chetnalaya.)

Steering committee- which consist of members from all the committee supervise the activities of entire programme.

Here , NGO gives an example , how this has built the community at different levels for making them to take appropriate action on each issue and problem. All over India NGOs presence is there and their interventions need to be looked into for the successful implementation of swatch Bharat Abiyan and related activities. As Prime Minister said , mere government will not be in a position to keep the country clean . It could be the collective responsibility and the same should be encouraged.

Unit level, Federation level &Block level action plan &monitoring

NGOs are involved development activities at unit level, federation level and block levels. When NGOs make such intervention , respective area of swatch Abyan programme could also be integrated . NGOs could very well contribute in terms of plan and monitoring of the

programme. I am sure, there will be good result if the government plan of action is done with the support of NGOs. In this way government need not look for a separate entity for the formation and promotion of any group. NGO can form and handle such a group very easily. NGOs can also be integrated with government district administration for the periodical review and monitoring.

Swatch Bharat programme in Jajjarh District of Haryana

Here also NGOs are involved in promoting people’s organisation . Chetnalaya has been involved in promoting developmental activities over 33 panchayats in this districts. Self-Help Groups , women groups , neighbourhood children’s parliament , farmers groups are being promoted. Bi-monthly meetings and monthly meetings are conducted for the organised groups. In this way Swatch Bharat programme will also be promoted with support of the same people’s groups. It is easy for the government administration to bring desired results through these groups. It is difficult to get such an organised groups so that these groups can be made use of in the particular village and area.

Swatch Bharat Abiyan in Jajjarh ( Awarenss Campaign)

Sources – Documentation from Jajjarh Unit

Swatch Bharat programme in Jhansi(UP)

Organization Jhansi Social Service Society , took part in the campaign and organized Swatch Bharat Abiyan in the village patakarka with the help of Farmer’s club members . The chief guest ADO Panchayat Mr. A.K Bhaskar was present in the campaign. The school teacher, Pradhan of the village, Director of JCSS, Project Coordinator, Project staff and other staff were also present in the programme. Director of the organization briefed the importance being clean and hygienic in each and every place. After that every one explained the importance of hygiene. After the speech everyone including Director of JCSS, teacher, Farmer’s club members took the broom and swept the road and this encouraged the villagers. ( Documentation report of Jhansi Catholic Sava Samaj)

Change of behavioral pattern is important among community members for carry forward Swatch Bharat Abiyan .

Community mobilization will be a greater task for the success of swatch Abiyan progamme

The government decided to provide Rs. 20 Lakh each to 247000 panchayats in the country for Clean India Misson . What needs to be looked into is connectivity of people and panchayat personnel for the better implementation. Community management Sustainable part of the programme is important for realizing the results in the long run.

Suggestion for the effective implementation of the programme.

Awareness programme should be organised for the students in all the schools for understanding the importance of cleanness and hygiene at the time of assembly and other related programme of the school

Still 8th std or even beyond this, students should be taught on cleanliness & Hygiene with practical knowledge and exposure if possible for generating future leaders in this field for drawing the subsequent action plan.

School can have health &hygiene committee and it should have the review meeting and this should be reported to the district level coordination committee of the government for updating the status.

Local governance and NGOs working in the area should have joint action plan as the NGOs can do better job at the gross root level through community mobilisation.

Installation of dustbin in the villages, schools, colleges and other institutional areas must be done.

NGOs should have tie up with karmacharis in connivance with local governance administration of the area.

NGOs should be provided opportunity as one of the members in Evaluation team at the block level/district level.

Innovation should be encouraged to have more community participation for the sustenance of the programme. At least district level , competition should be conducted and the best strategies should be recognised and given prizes

Government should have single window operation district level to sort out such issues and for bringing speedy progress.

Strengthen the VHNSC committee and train them to monitor the activity related to cleanness and hygiene .

Safai Diwas or Cleanliness Day should be organized in every village /area /region and given prizes for best motivation and performances.

Install toilets and community toilets and encourage them to use it and toilets to be constructed should of convenient and likeness of the people. In the absence of this , the people will again prefer open defecation.

Liquid and solid waste management units should be promoted through small-scale industries so that the area people could get an employment and in the mean time transmission of disease will be prevented.

The social works departments in the college and universities should be given greater responsibilities for the successful implementation of the programme. Some of the projects and programmes should be given for the direct implementation as the students and teachers are specialised in community development programmes and people’s organisation.

The people who are to be selected at panjayat level, block level and district level should be trained and they become resource team for the area /village/region

In each panchayat /block / district maintenance committee should be set up and NGOs representation and the representation from nearby educational institution are must for providing faster services and avoidance of negligence.

Local expertise and technician related to sanitation, health & hygiene should be given preference in the maintenance committee as to avoid unnecessary delay.

Revised guideliness of Nirmal Bharat Abiyan should be deeply looked to prior to the launch of present programme.

Good practices from India and other countries should be replicated in different states and regions for the accomplishment of task successfully.

State level seminars should be conducted for getting the sufficient and comprehensive feedback and suggestion recommended must be looked into on priority.

Envision of community managed sustainability programme is important for the realisation of results in the long run

Independent evaluation team ( mid-tem /annual )should be appointed for the assessment on the implementation of programme /projects and gaps identified in this should be addressed through the district level and state level coordination committee immediately.

References

Amartya Sen (1986 ): Poverty and Famines –An Essay on Entitlement and Deprivation, printed in India by RamPrintograph(India),New Delhi-110020

Amarta Sen(1991): Social Securities in Developing Countries ,Oxford University Press Nora Engel(2012) : Economic and Political weekly, Jan28,2012, Vol XLVII No 4, A

Sameeksha Trust Publication, Mumbai- 400013 Chai (2014) Health Action,Vol 27- No12 Times News Network : January 2015,Tmes of india, New Delhi Craig M.Watson(2001): Dynamics of Leadership, Jaico Publishing House ,

Mumbai.400023 Ernesto M.Pernia(1994): Urban Poverty in Asia- A Survey of critical issues, Oxford

University Press Documentation of Bawana Unit of Chetanalay Documentation of jajjar Unit of Chetanalaya Documentation of Jhansi Catholic Seva SamaJ

Dr. S.M Dason , Ph.D.Head of Programme (SSDNR)A Social work wing of Caritas India, New Delhi-110001