Water Justice, Gender and Disability - CBM Australia€¦ · The 2012 National Census identified 1.62 million people with disabilities in Sri Lanka, aged 5 years and over (8.7% of

SpecialIssue,Volume5,Issue4June2017

WaterJustice,GenderandDisability

©TomVanCakenberghe/IWMI

GuestEditors

Dr.FlorianeClementSeniorresearcherandIWMIGenderFocalPoint,InternationalWaterManagementInstitute,Nepal

SylvieCordierDisabilityandDevelopmentSpecialist,UnitedKingdom

Dr.AlanNicolStrategicProgramLeader-PromotingSustainableGrowth,InternationalWaterManagementInstitute,EastAfrica

ChiefEditor

Dr.AnjalPrakashProgrammeCoordinator–HI-AWARE,InternationalCenterforIntegratedMountainDevelopment,Nepal

ManagingEditor

MonicaPriyaResearchAssociate,SouthAsiaConsortiumforInterdisciplinaryWaterResourcesStudies,India

Introduction

In 2010 the UN Human Rights Council declared

accesstowaterandsanitationasabasichumanright.

Thiswasstrengthenedin2015,whentheUNGeneral

Assemblyfurtherrecognisedthedistinctionbetween

the human right to water and the human right to

sanitation. In Sri Lanka the rates of access to

improved drinking water and sanitation are well

above the regional average, with 96% and 95%

accesstoimprovedwaterandsanitationrespectively

(WHOandUNICEF,2015).However,thesestatistics

maskinequalitiesinaccessbetweenurbanandrural

areas,andacrossgeographicregions,withpeoplein

Planningforinclusion:exploringaccesstoWASHforwomenandmenwithdisabilitiesinJaffnaDistrict,SriLanka

ClareHanleyDisabilityInclusionAdvisor–CBMAustraliaEmail:[email protected]

TarrynBrownDisabilityInclusionAdvisor-CBMAustralia

NaomiNiroshinieNayagamIndependentConsultant,Australia

VellayanSubramaniamPresident-NorthernProvinceConsortiumofOrganizationsforDifferentlyAbled(NPCODA),SriLanka

SamanthaDeMelProtection&DisabilitySpecialist-WorldVisionLanka,SriLanka

ArunasalamSureshkumarMonitoringandEvaluationSpecialist-WorldVisionLanka,SriLanka

03

Abstract

WhileSriLankahasmadesignificantprogressoverthelastdecadeinimprovingratesofaccesstoWater,SanitationandHygiene(WASH),thisimprovementhasnotbeenuniformacrossthecountry.Peoplelivingintheconflict-affectedJaffnaDistricthavesubstantiallylowerrateofaccesstoWASHservicesthanthenationalaverage.Hence,effortsarebeingmadetoimproveWASHcoverageinthisregion.WorldVisionisonesuchorganisationworkingtoimproveaccesstosafedrinkingwaterandsanitationinJaffnaDistrict,withfundingfromtheAustralianGovernment.Thisprogramincludesaspecificfocusonreachingthemostvulnerablegroupsinthecommunity,includingpeoplewithdisabilities.In2015,WorldVisioncompletedabaselineassessment to informproject implementation,andestablishanevidencebase formeasuringchange.Giventhefocusondisabilityinclusion,akeypartofthiswastoidentifytheextenttowhichpeoplewithdisabilitieshadaccesstoWASHinprojectareas.Tosupplementthisbaseline,inearly2016,WorldVisionfundedanin-depthassessmentofdisability,tofurtherexploretheexperiencesandperceptionsofpeople with disabilities in accessing WASH. Findings from both these studies are presented, whichhighlight the complex and interacting barriers faced by people with disabilities in accessing WASHfacilities and the impact this has on their lives. The different experiences of women and men withdisabilitiesarealsoexplored,andrecommendationstostrengtheninclusiveWASHpracticeinSriLankaareprovided.

©2017SAWAS

Keywords:Disability,Gender,SriLanka,WASH,Inclusion

Hanleyetal./SAWAS5(4),2017

http://[email protected]

04

the conflict-affected Jaffna district experiencing

substantially lowerratesofaccess.This isduetoa

combination of factors: (i) damaged sanitation

facilitiesandlackofaccesstowater;(ii)weakwater

resource coordination and planning, and lack of

essentialpoliciesformanagingwaterresources;(iii)

poor institutional capacity ofwater and sanitation

authorities; and (iv) inadequate awareness about

water conservation, environmental protection, and

hygieneamongusers(WHOandUNICEF,2015).

Withinparticulargeographicareas,improvementsinaccesstoWater,SanitationandHygiene(WASH)havealso been inequitable. In South Asia, studies haveshownthatbetteraccesstosanitationhasprimarilybeenenjoyedbythewealthiestinsociety,whilethepoor and marginalised (such as people withdisabilities)areoftenleftbehind(Narayananetal.,

2012). Environmental barriers limit the extent to

which people with disabilities can benefit from

effortstoincreasecommunityaccesstoWASH.These

includeattitudinalbarriersthatcreatestigma,shame

and discrimination; physical barriers such as

inaccess ib le in frastructure des igns ; and

communication barriers (Narayanan et al., 2012).

Institutional barriers including a lack of specific

policiesandstrategiestoincreaseaccessibility(such

as a specific commitment to accessible design in

public infrastructure)can furtherperpetuate these

issues.

The 2012 National Census identified 1.62 millionpeoplewithdisabilitiesinSriLanka,aged5yearsandover(8.7%ofthepopulation)(DepartmentofCensusandStatistics,2012). Thisincluded43%malesand57% females. The most common impairmentreported was vision (5.4%), followed by mobility(3.9%), hearing (2.1%) and cognition (1.8%). InJaffnaDistrict,disabilityprevalencewasfoundtobehigherthanthenationalaverageat9.6%.Anecdotalevidence suggests disability rates in Jaffna aresubstantiallyhigherthanrecordedintheCensus,asaresultoftheextendedconflict.

Peoplewithdisabilitiesareamongstthepoorestof

the poor in Sri Lanka (Ministry of Social Welfare,

2003).TheNationalPolicyonDisabilityforSriLanka

reports that the employment rate for people with

disabilities is low (estimated at 16%), resulting in

many peoplewith disabilities being dependent on

othersforthedurationoftheirlife(MinistryofSocial

Welfare, 2003). Social exclusion and negative

attitudes towards people with disabilities are

widespread,resultingintheirexclusionfromfamilyoutings and social celebrations such as weddings,communityactivitiesandfestivals(MinistryofSocialWelfare,2003).Culturalbeliefsassociatingdisabilityandindividualswhohavedisabilitywithmisfortune,and perceiving them as omens of bad luck alsocontributetoexclusion.Womenwithdisabilitiesareoftenfurtherdisadvantagedcomparedtomenwithdisabilities – education and employment rates arelowerandpovertyratesarehigher(MinistryofSocialWelfare, 2003). Women with disabilities alsoencounter stronger negative attitudes, leading tofamiliesbecomingprotectiveandinmanycasesover-protective, thus further limiting their inclusion insociety.

Policycontext

The Government of Sri Lanka acknowledges thepotential discrimination faced by people withdisabilitiesandhasenactedarangeoflaws,policies,andregulationstohelpovercomethis.TheseincludetheProtectionoftheRightsofPersonswithDisabilityAct,No28in1996,theNationalPolicyonDisabilityforSriLankain2003,andtheNationalActionPlanforDisabilityinSriLankain2013.InFebruary2016,SriLankaalsoratifiedtheUnitedNationsConventiononthe Rights of Persons with Disabilities (CRPD).Article28oftheCRPDfocusesontherightofpeoplewithdisabilitiestoanadequatestandardoflivingforthemselves and their families; including access tocleanwaterservices(UnitedNations,2006).Whilethenationaldisabilitylawandpolicyincludeabroadcommitment to accessibility, there are no specificcommitmentsinrelationtoWASH.

With regards tophysical accessibility, theDisabled

Persons(Accessibility)RegulationNo.1(Ministryof

Social Welfare, 2006) stipulates that all public

buildingsandplacesbemadeaccessiblewithinthreeyears of the operation of the regulations. Thisincludes designs for accessible toilets. However,implementationofthisregulationhasbeenlimited,particularlyinrelationtoimprovingaccessibilityofexisting buildings. In 2013, theMinistry of HealthalsoreleasedDesignConsiderationsonAccessibilityforPersonswithDisabilitiestoaddresssomegapsinimplementation(MinistryofHealth,2013).

Whiletherearearangeoflawsandpoliciesinplaceto

protectdisabilityrights,implementationhasbeenan

issue. UNDP Resident Representative in Sri Lanka,

Subinay Nandy (2015) notes that the absence of

©2017SAWAS


05

institutional mechanisms to coordinate policy

implementation, and absence of institutional

monitoringprocessesarekeycontributingfactors.

WithintheWASHsector,theNationalPolicyforRuralWater Supply and Sanitation (RWSS) and theNationalDrinkingWaterPolicybothrecognisethataccesstosafedrinkingwaterandsanitationarebasichuman rights and commit to supporting activitiesthatleadtoaccessforallcitizens(MinistryofUrbanDevelopment, Construction and Public Utilities,2001). Whilenotspecificallyreferringtodisability,thesepolicycommitmentsprovideagoodbasisforinclusiveandaccessibledesign.TheNationalActionPlan for the Protection and Promotion of HumanRights 2011-2016 (which focuses primarily oninternallydisplacedpeople)alsoacknowledgesthatthe environment, including water and sanitation,

should be accessible to all, including people with

disabilities(GovernmentofSriLanka,2011).

WorldVisionRuralIntegratedWASH3Project

World Vision is a Christian developmentorganisation, with a long history of communityempowerment and development in Sri Lankaincluding supporting large-scale rural WASH

programs.WorldVisionhasastrongcommitmentto

social inclusion and seeks to ensure integration of

marginalised and neglected members of the

communityintodevelopmentprograms.

ItsapproachtoWASHistoworkinpartnershipwithlocal authorities and community organisations tosupport implementation of the RWSS policy. Thisincludes providing capacity building support todistrict and local governments, theNationalWaterSupply and Drainage Board, Disabled People'sOrganisations (DPOs), schools, and communitybasedorganisations.Thesupportprovidedtotheseorganisations includes resources, training,infrastructure,influencing,andadvocacytoimproveaccessofpoorandvulnerablecommunitiestowaterpoints,toiletsandhygieneinformation.

TheRuralIntegratedWASH3(RIWASH3)projectis

beingimplementedinJaffnaDistrict,intheNorthern

Province, funded by the Australian Government's

Civil Society WASH Fund 2. The five year project

commenced in 2014, and aims to improve the

performance of WASH actors to sustain services,

increaseadoptionofimprovedhygienepractices,and

increase equitable use of water and sanitation

facilities of target communities from 11 Grama

Niladari Divisions (GNDs) in Jaffna District in the

Divisional Secretariats of Chankanai (CHK) and

Chavakachcheri (CHV). The project focuses on the

most vulnerable groups, including female-headed

householdsandpeoplewithdisabilities,toaddress

inclusion issues in WASH design, implementation

andmanagement.

©2017SAWAS

Figure1:MapofRIWASH3ProjectLocation

Source:Nagayam,N.2013.RuralIntegratedWater,SanitationandHygiene3(RI-WASH3)BaselineAssessmentReport,WorldVision


06

To support disability inclusion within the project,

WorldVisionhaspartneredwithCBMAustralia,an

international Christian development organisation

committedtoimprovingthequalityoflifeofpeople

withdisabilitiesinthepoorestcountriesoftheworld.

Within the project, CBM Australia has focused on

building capacities of partners for disability

inclusion,fosteringconnectionswithlocalDPOs,and

providingtechnicalguidanceondisabilityinclusion

within planned activities. World Vision is also

partneringwiththeNorthernProvinceConsortium

ofOrganizationsforDifferentlyAbled(NPCODA)for

disabilityassessment,technicalsupportandcapacity

buildingoninclusionofpeoplewithdisabilitiesintheproject.

Theprojectconceptualisesdisabilityusingarightsbasedapproach,guidedbytheCRPD.Article3ofthe

CRPD states that people with disabilities include

'those who have long-term physical, mental,

intellectual or sensory impairments which in

interactionwith various barriersmay hinder their

fullandeffectiveparticipationinsocietyonanequal

basis with others' (United Nations, 2006). The

project recognises thatpeoplewithdisabilitiesare

citizensandrightsholders,whomusthavethesame

opportunity to participate in society as others.

Therefore, the society needs to change in order to

eliminate physical, communication, attitudinal and

institutionalbarriers.

Contextintheprojectarea

JaffnaPeninsulaisover1100km2inareaandhasa

coastline of 160 km. The district's economy is

predominantlybasedonagriculture.Groundwateris

the main water source and is used for domestic,

agriculturalandindustrialpurposes.Although70%

ofhouseholdsintheprojectareahavetoilets,upto

50% of them are not used due to lack of water,

maintenanceandhabits.Opendefecationistherefore

common, however this poses privacy and security

concerns, particularly for women at night (World

Vision,2013).

Thesocialfabricofthedistrictisenrichedbyculturalvalues,religiousbeliefsandtraditions.Casteandtherelateddividesinthesocialstructureplayakeyrolein influencing the community relationshipswithinthis district. This research did not set out tounderstand the barriers related to caste and howtheyintersectwithotherinequalities,althoughitisacknowledged that this is an area where further

researchwouldbebeneficial.

AgenderanalysisconductedbyWorldVisionin2014

in CHK Division found that women are commonly

responsiblefordomesticworkandchildcare,while

men are primarily responsible for economic

activities. Although the onus of fetching water

generally falls on women, in some families this

responsibilityissharedbymen(WorldVision,2014).

Peopleoftenneedtowalk1-2kmtoreachawater

source, sometimes further. During rainy season,

watersourcesaremuchmoredifficulttoaccessdue

tomuddyroads.

There are a large number of female-headedhouseholds in the north of Sri Lanka as aconsequence of the recent civil war. In thesehouseholds women are responsible for botheconomic and domestic activities, placing them atincreased risk of poverty (World Vision, 2014).Decisionmakers in families tend tobe fathersandmale children.Males also tend to dominate villagecommittees, although the introduction of separatewomen's development committees has increasedwomen's participation and has supported theirempowerment. However, these measures are notwithoutrisksasgenderbasedviolenceiscommon.Some incidents have been reported of husbandsassaulting their wives for participating in villagecommittees as this takes them away from otherdomesticoreconomicwork(WorldVision,2014).

A baseline assessment was completed by World

Vision in March 2015 to inform project

implementationandestablishanevidencebasefor

measuring change. Given the project's focus on

disabilityinclusion,akeypartofitwastoassessthe

policy context, and identify the extent to which

people with disabilities had access to WASH in

projectareasandwhether this requiredassistancefromfamilyorspecialarrangementstobemade. Tosupplementthisbaseline,inearly2016,WorldVisionfunded an additional in-depth assessment ofdisability, which was completed by NPCODA. Thisaimed to explore the opinions and experiences ofpeople with disabilities, communitymembers andgovernmentofficersinrelationtoaccesstoWASHforpeoplewithdisabilities.Thisarticlereportson theresultsofboththesestudiesinrelationtopeoplewithdisabilities and draws some conclusions andrecommendations to inform inclusive WASHpracticesinSriLanka.

©2017SAWAS


07

Methodology

Baselineassessment

TheRIWASH3baselineassessmentadoptedamixed

methods approach, collecting both qualitative and

quantitative data from primary and secondary

sources.Thissoughtto:identifycurrentpracticesfor

WASHcoordination,managementandgovernancein

the project areas (supply); identify current

communityparticipation,capacityandownershipin

theWASHsector(demand);andconductananalysis

of social inclusion, environmental factors and

knowledge management. Table 1 provides an

overviewofthedatacollectionmethodsandsample

size.

The household questionnaire was administered inTamilusingmobiletechnology.Questionnaireswere

©2017SAWAS

Description Type Samplesize

Literaturereview Qualitative -

Keyinformantinterviewswithchangeagents(individuals

identifiedbytheprojectwhoarecommittedtoprovidehands -on

supportforhealth,sanitationandhygienepromotionintheir

communities)representingthesupplysideaspectsofWASH

Qualitative 14

Workshopswithchangeagentsandcommunityrepresentatives

(oneeachinJaffna,CHKandCHV) Qualitative 3

Face-to-facehouseholdquestionnairewithhouseholdsinthe

projecttargetlocations –ruralandurbanpopulations Quantitative 810

Face-to-facehouseholdquestionnairesinnon -projectlocations

representingbothruralandurbanpopulations(controlgroup) Quantitative 165

Table1:Baselineassessmentdatacollectionmethoddescription,typeandsamplesize

designed, field tested and fine-tuned prior to use.Purposive quota sampling was adopted for theprojectlocations(11GNDs)basedonlistsobtainedfrom Government of Sri Lanka officials. Randomsampling was used for the control group. Datacollection was conducted by 25 enumerators(includingsixenumeratorswithdisabilities)and16researchassistants,whocompletedcomprehensivetraining prior to field work. Field work wasundertakenfromJanuary–March2015.

The questionnaire included questions related to

household demographics, access to water and

sanitation,andhygienebehaviour.TheWashington1

Group Short Set of Questions onDisability, which

focusesondifficultyinperformingsixbasicfunctions

such as seeing, hearing and walking, was used to

identify people with disabilities within the

household. An additional question regarding

difficultywithusinghandswasaddedtothestandardShortSet,giventherelevanceofthistoWASHaccess.Questions were then asked as to whether eachperson identified as havingdifficulty performing abasic function was able to access the water andsanitation facilities used by other householdmembers and if yes, whether they requiredassistance to do so. Key informant interviews andworkshops also included questions on disability –specifically regarding awareness of the NationalDisabilityPolicy,levelofacceptanceofdisabilityandlevelofawarenessaboutdisabilityinWASHdesign,implementation, and management. Only resultsrelatedtodisabilityarereportedhere.

¹Seehttp://www.washingtongroup-disability.com/formoreinformation

Source:CompiledfromNagayam,N.2013.RuralIntegratedWater,SanitationandHygiene3(RI-WASH3)BaselineAssessmentReport,WorldVisionAustralia


http://www.washingtongroup-disability.com/

Workshop GramaNiladari

Divisions Womenwithdisabilities

Womenwithout

disabilities

Menwithdisabilities

Menwithoutdisabilities

Total

1Karampaikurichchi Navatkadhu VaraniIyattalai

3 15 10 2 30

2 Thanankilappu 5 10 4 2 21

3MattuvilEast Sarasalai North

3 9 9 7 28

4Ponnalai ChulipuramEast

6 13 8 3 30

5Moolai VattuWest AraliWest

11 4 5 12 32

Total 28 51 36 26 141

08

Limitations

Field work was not entirely independent asenumeratorswere recruited,managed and qualitycheckedbyWorldVisionandwere fromthe targetGNDs.TheWashingtonGroupShortSetofQuestionsonDisability andotherquestions related toWASHaccess were answered by one household member(the survey respondent) on behalf of otherhousehold members. This may have affected theresultsassubsequentstudies(DanquahandWilbur,2016)haveshownthatquestionsaskedalonetothehousehold head in a household survey may notprovide an accurate reflection of the needs ofvulnerablemembersof thehousehold. Inaddition,the structure of the survey was such that not allsurvey questions could be disaggregated bydisabilitystatus,whichlimitedtheextentofanalysis

possible.

In-depthdisabilityassessment

The in-depth assessment was carried out from

January – May 2016. Its goal was to explore the

opinions of people with disabilities and other

community members on inclusion of people with

disabilities within WASH activities and the

accessibilityofWASHfacilities.Thishelpedincrease

understanding of current levels of accessibility to

WASH services by peoplewith disabilities and the

barriers and enablers for this. Five workshop

discussions were conducted in Tamil, involving

peoplefromthe11GNDofCHKandCHVwherethe

projectwillbeimplemented.Thisincludedatotalof

141people(seeTable1), including63peoplewith

disabilities and 78 people without disabilities,

including both males and females, and parents of

peoplewithintellectualorpsychosocialdisabilities.

Theworkshopswerefacilitatedbybothpeoplewith

and without disabilities. Ten government officers

©2017SAWAS

Table2:Demographicsofsampleforin-depthassessmentworkshops

workingonissuesrelatedtoWASHanddisabilityin

theprojectareaswerealsopurposivelyselectedfor

key informant interviews. These key informant

interviews were conducted by a person with

disability.

Aquestionnaireinvolving48questionswasusedto

guidetheworkshops.ThiswasdevelopedinEnglish

Source:NorthernProvinceConsortiumforDifferentlyAbled(NPCODA).2016.In-depthassessmentondisability.Unpublishedreport.


09

(withtechnicalinputfromCBMAustralia)andthen

translated into Tamil. An interview guide was

prepared with 11 questions to guide the key

informantinterviews.Qualitativedataanalysiswas

ledbyNPCODA,whichinvolvedanalysingthemost

common opinions and alternative opinions of the

workshopparticipantsinrelationtoeachquestion.

CBMAustraliafacilitatedasupplementarythematic

analysiswithNPCODArepresentativesinNovember

2016,toassist indrawingkeyfindingsandthemes

fromtheresearch,and inexploringgender-related

findingsinmoredetail.

Limitations

Theworkshopswerelargeinsize,andnodiscussions

were split into gender-specific groups, whichmay

haveaffectedwhatwomenandmenwerewillingto

share. In addition, gender-specific questions were

not directly askedduringworkshops,which led to

limitedinformationongenderbeingrecordedinthe

assessment. Reflection on the gendered nature offindings was therefore, primarily done throughdiscussions between CBM Australia and NPCODAduringthethematicanalysis.

Results

Baselineassessment

Householdsurvey

810householdsparticipatedinthesurveyinproject

areas. Surveyed households (with and without

peoplewithdisabilities)reportedveryhighlevelsof

accesstosecure/cleanwater(91%inCHKand78%

in CHV). The extent to which water accessed is

“secureorclean”needsfurtherinvestigationasthe

most common source of drinking water was an

unprotectedcommonwell,whichwasclassifiedby

the WHO/UNICEF Joint Monitoring Programme

(JMP)forWaterSupplyandSanitation(2015)asan

unimproved water source and 52% report not

treatingdrinkingwaterbeforeconsumption.

Amajorityofthesurveyedhouseholds(75%)claimto have flush/pour-flush toilets. Nevertheless,discussionsrevealedthatinmosthouses,theexistingtoilets do not meet acceptable toilet standards asreflected in national and international regulations.These toilets are not maintained in terms ofcleanliness and the solid waste generated is notmanaged properly. Rates of open defecation werereported to be quite low at 4.81%, howeverdiscussionsrevealedthatpeoplemightbehesitanttoreport this due to potential impact on caste orcommunityrejection.

Therewere 388 peoplewith disabilities identified

among the households surveyed, including 174 in

CHKand214 inCHV,andsomeof thosewhowere

identified had multiple difficulties. Of those2

reporting difficulties, the most common type of

difficulty reported was walking or climbing steps

©2017SAWAS

Figure2:Numberofpeoplewithdisabilitiesidenti�iedwithinthe11GramaNiladariDivisions

²Note:peoplewereclassi�iedashavingadisabilityiftheyreported“yes–verydif�icult”or“cannotdoatall”toatleastoneoftheWashingtonGroupShortSetquestions.



10

©2017SAWAS

(22.35%), using hands (22.35%), followedby self-

care (18.8%), seeing (13.22%), remembering and

concentrating(10.8%),communicating(8.94%)and

hearing(7.26%)(SeeFigure2).Rateofdifficultyalso

increasedwith age,with 290 people (75%) out of

thoseidentifiedwithdisabilitiesovertheageof55

years.

In relation to access to WASH, many people withdisabilities required family members to provideassistanceinordertofacilitatetheiraccess.Insomecasesspecialprovisionsweremadetoenableaccess

(more so in CHK than CHV) however this was

uncommon(seeTable3).

Amemberofthefamily

helps

Specialarrangementsaremadeforeasyaccess

Nodifference,accesssameas

others3Other Total

Accesstowater 40.7%(158) 3.1%(12) 54.4%(211) 1.8%(7) 388

Accesstosanitation

23.7%(92) 4.1%(16) 69.8%(271) 2.3%(9) 388

Accesstohygiene(handwashing)

27.1%(105) 1.8%(7) 70.9%(275) 0.3%(1) 388

Table3:MethodofaccessingWASHforpeoplewithdisabilities

KeyinformantinterviewsandworkshopsKeyinformantinterviewsandworkshopswereheldwith government representatives, school officials,community based organisations and community

representatives. These covered a broad range oftopicsrelevanttothesupplyanddemandofWASH.Arangeofissuesrelevanttogenderanddisabilitywerehighlightedduringthesediscussions.ThoseofmostrelevanceareoutlinedinTable4.

³Note:thisdoesnotnecessarilymeanaccesstosafewater,sanitationorhygieneasinmanycases,thehouseholdmaystillpracticeopendefecationoraccessfromanunimprovedsource.

Topic Perceptions

Women’srole

Theroleofwomenincludesfamilycare,involvementinincomegeneratingactivities and water collection. Most women work, and this is notrestrictedtofemale –headedhouseholds.Therearealsoafewwhohavetoworkasthe husbandhasadisabilityorisunabletowork.

Collectingwater

Sometimes people need towalk for longer distances in order to collectpotablewater,whichissometimesevencollectedfromtheagrowell.Thiswasreportedtobedifficultforpeoplewithdisabilities.Standinginqueuesat the water source was also reported to be diffi cult for people withdisabilities. Inaddition itwasfelt that it isnotsafe forwomentogofarfromtheirhomestocollectwater.

Table4:PerceptionsofpeoplewithdisabilitiesandissuesrelatedtoWASHaccess



Topic Perceptions

Sanitation–lackofaccessiblelatrines

A case study was provided where both husband and wife had mobilityimpairments and were provided an inaccessible toilet by an externalproject.Thewifeusesthattoiletwithgreatdifficultyandthehusbandoptsforopendefecation.

With regards to school latrines, according to the government policy, allnew school buildings are designed to be accessible for people withdisabilitiesbutmanytoiletsstillremaininaccessible.Insomecasesitwasreported that teachers help students where accessible facili ties are notavailable.

Sanitation–genderdifferences

Culturally, it is not acceptable for women and girls to practice opendefecation, and therefore those with disabilities try to manage withinaccessibletoilets.

Menwithdisabilitiestendtomanage(opendefecation)alone,butwomenfind it difficult to go to the forest, as theyneed support from the familymembers.Due to these reasons there are incidentswherewomen avoidfood.

Hygiene–impactonfamily

Attimes,membersofthefamilyhavetocareforthosewithdisabilitiesbyattending toall theirhygieneneeds.Forruralcommunities, thishashadan impact on their income, as everyone in the household is required toworktosustainthefamily.

Knowledgeofhygienepractices

Self-care knowledge is lacking in most instances. A lack of trainingprograms in this area is a gap in the system of social and medicalrehabilitation.

Trainingprograms for childrenareavailable,which includeuseof soap,handwashingandtoi letuse,howeveritisunclearwhetherchildrenwithdisabilities are included in these.Caregivers require trainingonhow tosupportpeoplewithdisabilities.

Attitudetowardspeoplewithdisabilities

Peoplewithdisabilities shouldbe included inalldevelopmentactivities:notonlythosewhoacquireddisabilityduringthewar,butalsothosewhoare born with disabilities. It was stated that the former have a higherstatusandgainmoreattention.

There is rejection of people with disabilities at many levels, includingwithin their own families. For example, itwas noted that amotherwillsupportachildbornwithadisability,butnooneelseinthefamilywoulddothesame.

11

©2017SAWAS

In-depthdisabilityassessment

Throughconductingathematicanalysisofthedata

from the in-depth disability assessment report,

NPCODAarrivedatthefollowingkeyfindings:

1.Almostallwomenexperiencechallengesinaccessing WASH facilities and services,howeverwomenwith disabilities experienceincreasedandadditionalbarriersinenjoying

theirWASHrights.

Womenwith disabilities are at an increased

riskofmockery,sexualharassmentandsexual

abusewhileaccessingWASHfacilitiesthatare

locatedoutsidetheirhouseholdpremises.2. People with disabilities experience manychallenges accessing WASH facilities. It isparticularlydifficulttoaccessWASHfacilitiesin public places, but difficulties at home inaccessing WASH facilities are still very

Source:CompiledfromNorthernProvinceConsortiumforDifferentlyAbled(NPCODA).2016.In-depthassessmentondisability.Unpublishedreport.


12

©2017SAWAS

significant.Peoplewithdisabilitieshavelittleornoaccessto WASH facilities when out in public. Inaddition,mostpeoplewithdisabilitiesdonothaveaccessibletoiletsathome.Therearesomecases where people with disabilities havemadesmallmodificationstotheirtoilets,butwherethisisnotpossible,theydefecateintheopen. DuetoanincreasedriskoffallingoveronthewaytotheWASHfacility,itiscommonforsomepeoplewithdisabilitiestobeescortedbyothers.

It was reported that only some people with

disabilities have good hand washing habits.

The assessment also found that peoplewith

disabilities had difficulties accessing hygiene

information. In some cases, family and

communitymembersblockinformationfrom

reachingthem.

3.ProvidinginclusiveWASHenvironmentsisacollectiveresponsibility.

ItistheviewofGovernmentandpeoplewith

d i s a b i l i t i e s t h a t Non Gove rnmen t

Organisations (NGOs), Community Based

Organisations (CBOs),Health SectorOfficers,

teachers (both preschool and school) and

families all have a role to play in supporting

disabilityinclusiveWASH.

4. There are institutional gaps relating todisability inclusion, in particular thepromotion of inclusive WASH at the Grama

NiladariDivision,DistrictSecretariatDivision

andprovinciallevel.

The assessment found that there are no

disabilityinclusionpolicies,strategicplansoractionplansatGNandDSdivisions,districtsorprovincial levels. Similarly, there are nopoliciesondisabilityinclusiveWASH.

5.Peoplewithdisabilitieshavelessaccessto

theirrightsandtoopportunities.Inparticular,

they are not involved in decision-making

processes.

The assessment found that people withdisabilities found it hard to participate indecision-makingactivitiesrelatedtoWASHatthe family and community level. In addition,people with d isabi l i t ies exper ience

discrimination due to the perception of thecommunitythattheyhavelowerphysicalandintellectual abilities than others in thecommunity.

6. People with disabilities experience

challengestomeaningfulparticipationintheir

community. In particular, women with

disabilitiesexperiencemorebarrierstosocial

inclusionthanmenwithdisabilities.

While some community members felt thatpeople with disabilities should be activeparticipants in community events, therewasstillaculturalstigmaaccordingtowhichtheywereconsideredinauspicious.Asaresult,theyareoftenridiculedatpublicevents.Itwasalsonotedthatwomenwithdisabilities

face increased barriers to participating in

communityevents.Thisisduetolackofself-

confidence, not being invited frequently, the

distanceandtransportationrequiredtoattend

the event, and the presence of very few

accessiblepublictoilets.

Discussion

The findings from the studies have helped indeveloping an understanding of the complexinteraction of factors preventing people withdisabilities from accessing WASH in northern SriLanka,anditsimpactontheirlives.Byunderstandingand addressing these barriers, policy-makers andWASHprogramscanhavearealimpactonimprovingthelivesofpeoplewithdisabilities.

TheimpactofnothavingaccesstoWASHfacilities

While some people with disabilities requireassistanceduetothenatureoftheirimpairments,thebaseline study reported that these high rates offamilyassistancecouldbeadirectresultofthelowrates of modifications to WASH infrastructureenablingeasyaccess.Thisreducestheautonomyanddignity of peoplewithdisabilities andperpetuatestheperceptionsoffamilymembersthatpeoplewithdisabilities have low capacity. Itwas also reportedthatassistanceandcaringresponsibilities restrictsfamilymembersfromengagingineconomicactivitiesorothertasks.

TheimpactsofnothavingaccesstoWASHfacilities

werefoundtobedifferentformenandwomen,and

appeared to bemore pronounced forwomen. The


©2017SAWAS

studies revealed that in some cases where people

withdisabilitiesareunabletoaccessthehousehold

latrine theyare forced topracticeopendefecation,

whichwasdeemedtobeparticularlyinappropriate

andunsafeforwomen.Insomeinstances,thishasled

to women using inaccessible latrines despite the

difficulties encountered, and in one case not

consuming food in order to prevent the need to

defecate. When people with disabilities ventured

outside the household to undertakeWASH related

tasks, they reported being subject to teasing and

ridicule.Whilethiswasreportedforbothwomenand

men with disabilities, women were more often

subjectedtosexualharassmentorabuse.

The studies also reported low communityparticipationandinadequateinvolvementofpeoplewithdisabilitiesindecision-makingprocesseswhich

is consistent with what has been reported in the

National Policy on Disability. Lack of accessible

public toilets and negative community attitudes

resulted in people with disabilities staying within

their homes thus contributing to their low

community involvement. This further results in

peoplewithdisabilitiesnotbeingabletosharetheir

needs with the community or contributing to

decision-making with regard to the location and

designofWASHfacilities.Thisisamajorinstitutional

barrier, which needs to be addressed in order to

strengthen accessibility. Lack of accessible WASH

facilities within schoolswas also reported to be a

significant factor in children with disabilities not

attendingschool.

Inrelationtohygiene,lackofinformationsharingbyfamilies on hygiene issues with people withdisabilities along with their lack of communityparticipation suggests that they are likely to bemissing out on important health promotionmessages.ThissuggeststhatWASHprogramsneedtospecificallytargetpeoplewithdisabilitiesforhygienepromotionactivitiestoensuretheyareincluded.

RIWASH3interventions

Through World Vision's partnership with CBMAustraliaandNPCODA,theprojecthasbeenabletoimplementadisabilityinclusiveapproach.ThishasfocussedonstrengtheningthecapacityofNPCODA,advocating about the importance of disabilityinclusiveWASHindivisional,districtandprovinciallevelgovernments,creatingawarenessofdisabilityrights with stakeholders, and supporting theprovisionofpublicandhouseholdaccessibletoilets

toselectedpeoplewithdisabilities.

RepresentativesfromNPCODAhavebeenincludedin

district and local government steering committees

and WASH civil society organisation committees,

wheretheyareabletodrawattentiontotheneedsof

peoplewithdisabilitiesandsharetheirperspectives.

WorldVisionhasalsocommittedtoensuringhygiene

promotionmaterialisavailableinaccessibleformats

(such as audio, large print etc), and recently

partneredwithDeaflinktoproduceahandwashing

videothatfeaturessignlanguage.

Todate, 22 accessiblehousehold toiletshavebeenbuiltforpeoplewithmobilityimpairments,withanadditional 16 toilets built for people with non-mobility related impairments. In addition, threeaccessible public toilets have been built in thedistricts.RIWASHaimstobuild65toiletsforpeoplewith disabilities by the end of the project period.RIWASH 3 will continue to seek opportunities forfurther inclusion of people with disabilities inresponse to these studies and monitor theirinvolvementintheproject.

Recommendations

Whilethefindingsfromthesetwostudiesarespecificto a local area in Sri Lanka and were designedprimarily as a baseline for the RIWASH 3 project,manyoftheactionsneededtorespondtothebarriersidentified require involvement and commitmentfrom multiple stakeholders at local, district andnationallevels.FindingsfromthesestudiescanalsobeusedtoinformthedesignofotherWASHprogramsin Sri Lanka and more broadly in other under-resourcedsettings.

In order to address the barriers identified,

governments, WASH programs, DPOs and other

community organisation need to work together.

Priorities include improving the physical WASH

infrastructure, challenging negative community

attitudesandensuringthatpeoplewithdisabilities

are targeted forhygienepromotionmessagingand

thatmessagesarepresentedinaccessibleformats.Governmentpolicymakersandinstitutions

Ÿ There is already broad policy level

commitmenttoinclusiveWASHinSriLanka

through statements that highlight the

importance of access to all citizens. This

should be strengthened by explicitly

acknowledging the difficulties faced by

13


14

©2017SAWAS

peoplewithdisabilitiesinaccessingWASH

facilities,andshouldbeaccompaniedbya

commitment touniversaldesignofpublic

WASH infrastructure. This would also

benefit othermembers in the community

such as the elderly, pregnantwomen and

children.

Ÿ Thereisaneedtoreviseexisting'guidanceonrequirementsforaccessibledesign'inSriLanka and differentiate between therequired approach for public WASHfacilities (which should adopt universaldesign principles) and private facilities(where a more targeted design isappropriate) . This should includeconsideringthecost-effectivenessofdesignoptions, as the cost of current approved

accessible designs are sometimes

prohibitiveforhouseholds.

Ÿ Specificbudgetallocationshouldbemadeatsub-national/districtlevelstocoverthecostsofuniversaldesignfeaturesinpublicWASH facilities, to provide support forconstruction of accessible householdlatrines (designed in consultation withfamilies) and to ensure public-fundedhygieneawarenessactivitiesareaccessibleforpeoplewithdisabilities.

Ÿ In line with the CRPD, DPOs should be

consultedandinvolvedinthedevelopment

ofpoliciesandgovernmentactionplansto

ensurethattheirperspectivesareincluded.

This should include representation in

WASHplanningorsteeringcommitteesat

division, district, provincial and national

levels.

Ÿ Existingdata collectionprocessesused tomonitor access and use of WASH at ahousehold level shouldbeadapted topayparticular attention to intra-householddifferences in access to WASH and bed i saggrega ted by d i sab i l i t y. The WashingtonGroupShortSetofquestionsondisabilitycanbeusedforthispurposebuttheyideallyshouldbeaskedtoindividualswithin households rather than heads ofhouseholds.

WASHprogramimplementers

Ÿ Community-basedWASHprogramsshouldbe designedwith the goal of reaching allpeoplewithinacommunity,acknowledgingthatsomewillhavespecificrequirementsinordertoenabletheiraccesstoWASH,whichneed to be identified and addressed. ThisshouldincludeacommitmenttouniversaldesignofpublicWASHinfrastructure.

Ÿ WASHprogramsshouldspecificallyseekto

identify people with disabilities in

communitiessothat targetedsupportcan

beprovidedthroughouttheprogram.This

can be achieved through partnering with

DPOs, using baseline surveys to identify

people with disabilities (see discussion

above on use of the Washington Group

ShortSet)andthroughsnowballsampling.

Ÿ Once identif ied, programs shouldspecificallyinvitepeoplewithdisabilitiestopa r t i c ipa te i n WASH commun i ty consultations and planning processes,whichcanalsobeusedtoraiseawarenessoftheimportanceofensuringallpeopleinthecommunity benefit from the program. Inaddition,giventhatpeoplewithdisabilitiesoften do not participate in communityevents,budgetandtimeshouldbeallocatedforstafftotraveltotheirhomestoseektheirinvolvementandtodistributeinformation.Thiscanalsobeusedasanopportunitytorefer people to relevant health orrehabilitationservices,ifneeded.

Ÿ Wherever possible, people with disabilitiesshould be encouraged and supported toa c t i v e l y c o n t r i b u t e t o p r o g r am

implementation. This could include forexample,participatinginWASHmanagement

committees,asenumeratorsforbaselineandendline surveys, and in hygiene promotionactivities. This not only ensures their

perspectives are considered, but alsodemonstrates the capacity of people with

disabilities,whichcanbeapowerfulwayof4

challengingnegativeattitudes.

Ÿ The additional needs of women with

disabilities should be considered and

⁴PeoplewithdisabilitieswereengagedasenumeratorsinthebaselineassessmentfortheRIWASH3Project.Theyreportedthatthisincreasedtheirself-con�idenceandhelpedtochallengeattitudesthatpeoplewithdisabilitieswerenotcapable.


©2017SAWAS

prioritised throughout WASH programs.

Ensuring active consultationwithwomen

withdisabilitiesonthedesignandlocation

ofWASHfacilitieswillensurethattheyare

not forced to undertake unsafe sanitation

andhygienepractices.Conclusion

Thesestudieshavehighlightedthecomplexrangeofbarriers faced by people with disabilities, andparticularlywomen, inaccessingWASHfacilitiesinnorthern Sri Lanka and the impact it is having ontheirlives.By investigating these challenges and partnering

with people with disabilities to develop culturally

appropriateandcosteffectivesolutions,theRIWASH

3 Project isworking hard to ensure no one is left

behindinbenefitingfromincreasedaccesstoWASH

intheprojectareas.However,themajorityofpeople

with disabilities in Sri Lanka are not living in the

RIWASH3project targetareasandbroadsystemic

changeisneededtoaddresstheseissuesatanational

level. While broad policy commitment exists to

ensure that all people in Sri Lanka have access to

WASH, government institutions and community

programs must work together to ensure these

commitmentsbecomearealityacrossSriLanka.

References

Danquah,LandWilbur,J.2016.Intra-householdaccess

toWASHinUgandaandZambia–Dovariationsexist?Paperpresentedat39thWEDCInternationalConference,Kumasi,Ghana,11-15July2016.

DepartmentofCensusandStatistics.2012.Censusof

populationandhousing2012–Keyfindings.Colombo,SriLanka:DepartmentofCensusandStatistics

GovernmentofSriLanka.2011.Nationalactionplanfor

theprotectionandpromotionofhumanrights2011-

2016.

MinistryofHealth.2013.DesignConsiderationsonAccessibilityforPersonswithDisabilities.Colombo,SriLanka:MinistryofHealth

MinistryofSocialServicesandMinistryofHealth.2013.

SriLanka:NationalActionPlanforDisability.Colombo,SriLanka:MinistryofSocialServicesandMinistryofHealth

MinistryofSocialWelfare.2003.NationalPolicyon

DisabilityforSriLanka.Battaramulla,SriLanka:Ministry

ofSocialWelfare

MinistryofSocialWelfare.2006.DisabledPersons(Accessibility)Regulations,No.1of2006.SriLanka:

DepartmentofGovernmentPrinting.

MinistryofUrbanDevelopment,ConstructionandPublicUtilities2001.Nationalpolicyforruralwatersupplyandsanitation.Battaramulla,SriLanka:MinistryofUrban

Development,ConstructionandPublicUtilities.

Nandy,S.2015.SriLankalacksimplementationofpolicies,ColomboGazette,http://colombogazette.com/2015/12/06/sri-lanka-lacks-implementation-of-policies/(accessed19April

2017)

Narayanan,R.;vanNorden,H.,Gosling,L.andPatkar,A.2012.EquityandinclusioninsanitationandhygieneinSouthAsia:Aregionalsynthesis.IDSBulletin43(2):101-111

UnitedNations.2006.ConventionontheRightsof

PersonswithDisabilities.TreatySeries,2515.

UnitedNationsNewsCentre,2015,PropersanitationbecomesseparateUNhumanrightinenhancedfight

againstdeadlyinfections.

http://www.un.org/apps/news/story.asp?NewsID=52924#.WPa0h2e1uM9(accessed19April2017).

WHO(WorldHealthOrganisation)andUNICEF(UnitedNationsChildren'sFund).2015.Progressonsanitation

anddrinkingwater2015updateandMillennium

DevelopmentGoalassessments.https://www.unicef.pt/progressos-saneamento-agua-potavel/files/progress-on-sanitation-drinking-

water2015.pdf(accessed11November2016).

WorldVision.2013.CivilSocietyWaterSanitisationand

HygieneIIOperationalplan.Unpublishedprojectdocument

WorldVision.2014.Reportongenderanalysisof

Chankanaidivision.Unpublishedprojectdocument.

15


SaciWATERs

B-87,3rdAvenue,Sainikpuri,Secunderabad-500094,Telangana,India

www.sawasjournal.org

DesignedbyRajuKakkerla

Documents

Water Justice, Gender and Disability - CBM Australia€¦ · The 2012 National Census identified 1.62 million people with disabilities in Sri Lanka, aged 5 years and over (8.7% of