SCOSAN VI Proceedings

Bangabandhu Sheikh Mujibur Rahman
Father of the Nation
Md. Abdul Hamid Sheikh Hasina

Hon’ble President Hon’ble Prime Minister
People’s Republic of Bangladesh Government of the People’s Republic of Bangladesh
6th South Asian Conference on Sanitation (SACOSAN-VI) 3
TABLE OF CONTENTS
1 Executive Summery……………………………………………..……………………………………………………………………………6
2 Background & Introduction of SACOSAN VI………………………………………………………………………………………7
2.1 Introduction………….………………….………………………………………………………………………………………….7
2.2 Conference Programme……….………………………………………………………………………………………………9
2.3 Press Briefing…………..............................………………………………………………………………………………13
3 The Dhaka Declaration……………………………………………………………………………………………………………………14
4 Inaugural Ceremony…………………………………………………………………………………………………………………….…15
5 Key Note Speech………..……………………………………………………………………………………………………………………35
6 Country Presentations………………………………………………………………………………………………………………….…36
7 Review of SACOSAN V Commitments……………………………………………………………………………..………………45
8 Plenary Sessions
Plenary session 1 (Community Approaches to Sanitation & Hygiene)…………….………………….………46
Plenary session 2 (Innovation on Sanitation & Hygiene)……………………………………………………………47
Plenary session 3: ‘Voices’…………………………………………………………………………………………………………48
Plenary session 4: The SACOSAN Journey: 2003-2015……….………………………………………………………49
Plenary session 5: The Sustainable Goals - Opportunities for Sanitation & Hygiene in SA............50
Plenary session 6: Role of Media to Improved Sanitation and Personal Hygiene Behavior…………51
Plenary session 7: Monitoring Sanitation & Hygiene beyond MDGs………………………….………………52
9 Technical Sessions
TFS 1: Hygiene Promotion (Afghanistan)……………………………………………………………………………………53
- CLTS as Best Practice in Afghanistan………………………………………………………………….………53
-The Journey of Menstrual Hygiene Management in the Afghan………………………………....63
-Changing WASH Practices in Southwest Bangladesh
One Small Doable Action at a Time…………………………………………………….………………………68
-Principles and challenges in scaling up CLTS
Experiences from Madhya Pradesh, India………………………………………….…………………………79
TFS 2: Urban Sanitation (Bangladesh) ………………………………………………………………………………………88
-Innovative On-site Toilet Technology in Slum: The Biofil Toilet, Bangladesh………………88
-Fecal Sludge Management (FSM) Scenario in Urban Areas of Bangladesh…………..……103
-Model estimation of reducing Combined Sewer Overflow in Drainage areas
consists of Infiltration facilities, Sri Lanka………………………………………………………………….
-A novel wastewater treatment eco-technology
applied to improve environmental sanitation in Khulna slum, Bangladesh……………………
TFS 3: Gender, Equity & Right (Bhutan)……………………………………………………………………………………118
-Gender Mainstreaming in Sanitation Programme for Social Transformation and
Empowerment, Bangladesh………………………………………………………………………………………118
-Sanitation Budget tracking: A basic need for dignity count, Bangladesh……………………131
-“Role of rural women in sanitation and hygiene”- A Gender Study from Bhutan………138
-The Question of Attitude or Access: Sanitation through a Gender Lens, India……………153
TFS 4: R&D Innovation (India)………………………………………………………………………………………………….166
-Fostering disruptive design innovations in sanitation marketing in Bangladesh………..166
-Faecal Sludge Management in small towns: BRAC WASH Initiative, Bangladesh……….176
-Innovation in Sanitation sector: e-Catalogue for Individual Household Toilet (IHHL),
India…………………………………………………………………………………………………………………………190
-Reducing costs and improving quality in rural sanitation options through innovation and
research, Bangladesh………………………………………………………………………………………………..
TFS 5: Financing for Sanitation & International Cooperation (Maldives) …………………………………195
-Financing of Sanitation an essential component of Sanitation Marketing,
a Case Study of Rajasthan, India………………………………………………………………………………
-Sustainable and equitable Financing of Sanitation Services, WaterAid & FANSA……….195
-Achieving Sustainable and Universal Access to Sanitation and Hygiene in South Asia:
Cost and Financing Assessment, World Bank……………………………………………………………206
-Financing Sanitation: Indian Experience and Lessons for SAARC Countries, India………
TFS 6: WASH in Institutions & Public Places (Nepal) ……………………………………………………………….214
-Inequalities in sanitation and handwashing facilities among Bangladeshi schools;
implications on hygiene practices, Bangladesh…………………………………………………………214
-Non-Utilization of Sanitary Infrastructure (NUSI) tool to operationalize defunct toilets,
India………………………………………………………………………………………………………………………….223
-WASH in Institutions and Public Places for transforming lives – Sanitation Matters!
Nepal…………………………………………………………………………………………………………………………230
-Water, sanitation and hygiene in health care facilities in South Asia, Nepal……………..243
TFS 7: Climate Change & Sanitation ……………………………………………………………………………….………252
-Sanitation strategies: Enhancing resilience to climate change, India…………………………
-The impact of climate change on sanitation, Afghanistan…………………………………………
-Water is life and sanitation is the way of life, Bangladesh…………………………………………
TFS 8: Sanitation for Hard to Reach Areas (Sri Lanka)……………………………….………………………….…253
-Ensuring water safety applying sustainable sanitation and hygiene promotion
programmes for marginalized communities-Sri Lankan Experience-
Gampola Water Supply Scheme and Paradeka River Catchment, Sri Lanka………………253
-Best Practices in Promoting Hygiene in Post Conflict Areas; A Case study of NEP WASH
Project, Sri Lanka………………………………………………………………………………………………………265
-A Triple-A approach for promoting sustainable school sanitation – Lessons learnt from
Central Province, Sri Lanka………………………………………………………………………………………..271
10 Other Events………………………………………………………………………………………………………………………………….280
10.1 Exhibition……………………………………………………………………………………………………………………280
10.2 Side Events…………………………………………………………………………………………………………………281
10.3 Ministerial Meeting……………………………………………………………………………………………………286
10.4 Poster Presentation……………………………………………………………………………………………………288
10.5 VVIPs Visit to Bangabandhu Museum………………………………………………………………………..289
10.6 Cultural Programme…………………………………………………………………………………………………..290
10.7 Field Visits………………………………………………………………………………………………………………….291
10.8 Focal Persons……………………………………………………………………………………………………………..292
11 Dhaka Declaration…………………………………………………………………………………………………………………………293
12 Acknowledgement………………………………………………………………………………………………………………………..295
13 Closing Ceremony…………………………………………………………………………………………………………………………296
14 Annexes…………………………………………………………………………………………………………………………………………307
MESSAGE
I am very much delighted to welcome you to the SACOSAN-VI conference in Dhaka. The Local Government
Division and the SACOSAN-VI organizing committee is pleased to provide this platform for our regional
partners to engage in deliberations on Sanitation.
Building on previous conferences, SACOSAN-VI aims to foster regional collaboration in pursuit of facing
sanitation challenge. This is an excellent opportunity for water and sanitation professionals including
policy makers, officials, development partners, NGO professionals and media professionals to engage in a
constructive dialogue, exchange experiences and make decisions on future action to meet the sanitation
challenges in the South Asian Region.
I thank all those who supported us in many ways to make this event a success. A special word of thanks
for the international organizations namely UNICEF, Water Sanitation Program-World Bank, New Venture
Fund (NVF), Water Supply & Sanitation Collaborative Council (WSSCC), Water Aid, SNV-Netherlands
Development Organization and many others for providing essential support in organizing this international
event. The Government of Bangladesh is providing financial contribution to organize this event.
On behalf of the organizing committee I thank all our delegates, sector partners, and international and
national delegates for their participation and valuable contribution in the Conference.
Abdul Malek
Secretary, Local Government Division
Ministry of Local Government, Rural Development and Co-operatives
Government of Bangladesh
and Chairman, SACOSAN-VI Organizing Committee
EXECUTIVE SUMMERY
The sixth South Asia Conference on Sanitation (SACOSAN-VI) was hosted by the Local Government
Division, Ministry of LGRD& Co-operatives from January 11th to 15th, 2016 in Bangabandhu International
Conference Centre (BICC) in Dhaka, Bangladesh. The conference was inaugurated by the Md. Abdul Hamid
Hon’ble President, People's Republic of Bangladesh with a motto of “Better Sanitation Better Life”.
The SACOSAN is a government led biennial convention on sanitation in South Asia held on a rotational
basis in each SAARC country to develop a regional agenda on sanitation, enabling learning from the past
experiences and setting actions for the future in order to accelerate the progress in sanitation and hygiene
promotion in South Asia and to enhance quality of people’s life. The objectives of this conference is to
achieve an open defecation free South Asia by 2023 through improvement of policy frameworks,
increased financing, strengthening implementation and monitoring strategies for sanitation and hygiene
with a special focus on marginalized groups. It aims at contributing to increased knowledge, in-depth
learning and practical solutions to address the common challenges in South Asia especially on universal
access to and use of sanitation and hygiene with an emphasis on behavior change across whole
communities, especially the hard-to-reach people, institutions and public places.
The conference was attended by more than 500 delegates from South Asian countries: Afghanistan,
Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The delegates included hon’ble
ministers, parliamentarians, senior government officials, donors and representatives of the civil society
organizations including unilateral & bilateral organizations, local and international non-government
organizations, research institutions, academicians, media, private sector and community members
actively engaged in the promotion of sanitation and hygiene services in their respective countries.
The conference included three days of deliberations by the policy makers and practitioners in the context
of national, regional and global priorities in the post 2015 context and developing a strategic direction for
the future. It included various plenary sessions and side events sharing wide range of information including
country specific experiences and knowledge. This was followed by two days field visits to successful
initiatives of the development partners and Government of Bangladesh. The conference also had an
exhibition area with stalls with informative materials from the participating countries and various
development sector partners. Visit to the Bangabandhu Museum and other cultural sites was arranged for
the dignitaries.
By the end of the conference, a declaration on the commitments was drafted and signed by the
participating countries in South Asia to ensure the future course of action in making a healthy, hygiene,
peaceful and prosperous South Asia. The conference closed with the presentation of the memento to the
heads of the delegations of the participating countries by the Hon’ble Minister, Engr. Khandker Mosharraf
Hossain, MP, Ministry of LGRD & Co, Government of People’s Republic of Bangladesh.
2 BACKGROUND & INTRODUCTION

2.1 Introduction
Background
The South Asian Conference on Sanitation (SACOSAN) is organized with the overall goal to accelerate the
progress of sanitation and hygiene practices in South Asia. SACOSAN has a glorious history of being a truly
regional event and has been instrumental in generating a political will towards better sanitation in the
region over the past one decade. South Asian countries namely Afghanistan, Bangladesh, Bhutan, India
Maldives, Nepal, Pakistan and Sri Lanka are the participating countries. The first conference was held in
Bangladesh in 2003, the second in Pakistan in 2006, the third in India in 2008 the fourth in Sri Lanka in
2011 and the fifth in Kathmandu in 2013. Bangladesh is proud to be hosting SACOSAN second time on its
soil.
As the millennium development goals draw to a close, the conference provides a platform to review the
accomplishments of the sector as a region. The proportion of people using improved sanitation in South
Asia has increased remarkably in the last fifteen years compared to global progress. The era of sustainable
development goals offers much more broader framework to tackle challenges exacerbated by climate
change, wider socio economic changes and increasing inequality which were addressed in the conference.
Objectives of SACOSAN VI
The key objectives of SACOSAN VI is to:
 Achieve open defecation free South Asia by 2023 through improvement in policy frameworks,
increase financing, strengthening implementation and monitoring strategies for sanitation and
hygiene with the special focus on marginalized groups;
 Contribute to increased knowledge, deepen learning and practical solutions to address the
common challenges in South Asia especially on universal access to and use of sanitation and
hygiene with an emphasis on behavior change across whole communities , especially the
unreached at home, in institutions and public places;
 Develop the strategic direction for future SACOSANs through review of the achievements and
learning of the past SACOSANs;
 Conduct the deliberations in the context of national, regional and global priorities in the post
2015 context.
Expected Outcome
The conference was expected to bring together policy makers, practitioners and civil society members
over three days followed by two days field visits, where wide range of information including country
specific experiences and knowledge was shared through technical paper presentations. By the end of the
conference, a declaration on the commitments (Dhaka Declaration) made by the participating countries
in South Asia was drafhted through this platform. The MDGs achievement was reviewed and SDG
challenges were identified through discussions and deliberations. A regional plan was discussed,
formulating policy and strategy to overcome those loggings and challenges. The key areas of outcomes
focused on the following:
 SDG challenges and the way forward

 Task of MDGs lagged behind
 Technology for heard to reach areas
 School sanitation
 Hygiene promotion for poor communities
 Urban sanitation
 Collaboration and alliances at national, regional and international level
 Monitoring mechanism for hygiene and sanitation at the national and regional level
Conference Structure
The conference programme was designed to engage the policy makers and practitioners into three days
of interactive discussions and deliberations on the global priorities and challenges in the post 2015
planning processes and developing a strategic direction for the future. It included country presentations,
various plenary sessions, technical focus sessions and side events sharing regional learning and
experiences.
This was followed by a two-day field visits to successful initiatives of the development partners and
Government of Bangladesh. The conference also had an exhibition area with stalls with informative
materials from the participating countries and various development sector partners. Visit to the
Bangabandhu Museum and other cultural sites was arranged for the dignitaries.
CONFERENCE PROGRAMME
Pre SACOSAN-VI Day (Sunday) 10 January, 2016

15:00 Press Briefing and Orientation with the Media at DPHE Auditorium (2nd floor),
14, Shahid Capt. Monsur Ali Sarani, Kakrail, Dhaka-1000)
(Country focal persons to participate in the press briefing)
15:00-19:00 Registration of Participants from Bangladesh only at the Reception desk of DPHE Bhaban
(Ground Floor).
Day 1 (Monday) 11 January, 2016

08:30 -10:00 Arrival of Delegates and Participants at Venue
Inaugural Ceremony (Hall of Fame)
10:00-10:30 Guests to be seated
11:00 Arrival of the Hon’ble President and National Anthem
11:01 Recitation from the Holy Books
11:11 Address by: H.E. Arjun Bahadur Thapa
Secretary General, SAARC Secretariat, Kathmandu, Nepal
11:16 SACOSAN-VI Theme Song with Live Performance
11:21 Video Presentation on “Bangladesh: Towards Sustainable Sanitation”
11:26 Address by the Head of Delegates:
Afghanistan, Bhutan, India , Maldives, Nepal, Pakistan and Sri Lanka
11:49 Speech of the Chair: Khandker Mosharraf Hossain, MP
Hon’ble Minister, Ministry of LGRD & Cooperatives,
Government of the People's Republic of Bangladesh
11:58 Memento to be presented to the Chief Guest by the Chair
12:00 Speech of the Hon’ble Chief Guest and Inauguration of the Conference
H. E. Mr. Md. Abdul Hamid
Hon’ble President, People's Republic of Bangladesh
12:10 National Anthem
12:12 Inauguration of the Exhibition
12:15 Departure of the Hon’ble President
12:30-14:00 Lunch Break (Celebrity, 1st F)
12:30-17:00 Registration of Delegates and Participants
Country Presentations (Hall of Fame)
14:00–14:10 Key Note Speech: Prof. Dr. Feroze Ahmed
Vice Chancellor, Stamford University, Dhaka, Bangladesh
14:10-15:30 Country Paper Presentations:
Afghanistan, Bangladesh, Bhutan, India, Pakistan, Maldives, Nepal and Sri Lanka (10 minutes
each)
15:30-16:00 Q & A Session
16:00-16:40 Tea Break
Side Events (8 parallel events)
16:40-17:40 Evidence to Swachh *a.Journey Raising Public *a. Faecal
improve Bharat to Zero: voices of Private Waste
lives- How Mission Sanitation Children/ Partnership Management in
evaluation Movement Youth for s in FSM in Urban areas
can help (Clean India in sanitation the SAARC with a focus on
decision- Mission) Bangladesh improveme Region Small Towns:
makers nt in their Getting right the
improve their *b. Disaster communiti policy and
policy and and es/schools. practice
program Sanitation – *b. Health &
impacts ` Learning Safety Along the
from Nepal Sanitation Value
Hall of Chain
Fame Media Carnival-GF Executive
Green View- Bazar-GF Lounge-GF
1st FL
Windy Town
1stFL
Note: The hall doors will be closed by 10:30 for the inaugural ceremony (30 minutes before the arrival of the
chief guest)
*Each session will be for 45 minutes only.
Day 2 (Tuesday) 12 January, 2016

Plenary Sessions
08:30-10:00 Plenary Session: 1 (Harmony, GF)
Community Approaches to Sanitation & Hygiene (Experience of Different Countries)
Innovation on Sanitation and Hygiene
VIPS visit to Bangabandhu Museum
11:00-11:30 Tea Break
Technical Session: 1 (4 Parallel Sessions)
11:30-13:30 Hygiene Urban Sanitation Gender, Equity & R&D Innovation
Promotion (Bangladesh) Right (GER) (India)
(Afghanistan) – (Bhutan)
Carnival-GF Media bazar Windy Town
Harmony-GF
Technical Session: 2 (4 Parallel Sessions)
14:30-16:30 Financing for WASH in Climate Change & Sanitation for Hard
Sanitation & Institutions & Sanitation to Reach Areas
International Public places (Pakistan) (Sri Lanka)
Cooperation (Nepal) - Media bazar
(Maldives) Carnival-GF Windy Town
Harmony-GF
16:30-17:00 Tea Break
Side Events (6 parallel events)
Appropria Payment Data for New WHO Fecal MDG Progress /
17:00-18:00 te by decision Initiatives on Sludge Achievement of
Communit Results: making- Sanitation and Managem Sanitation target in
y an Costs and Health: A new WHO ent Pakistan with PATS
Sanitation effective services of Global Strategy on & Challenges Ahead
Approach program WASH to accelerate
es for impleme WASH in and sustain progress

sustainabl ntation schools on Neglected
e approach Tropical diseases;
developm Ex. and Sanitation Green Harmony-GF
ents Windy Lounge- Safety Planning. View-GF
Town 1st GF
Media FL Carnival GF
Bazar-GF
Day 3 (Wednesday) 13 January, 2016

Plenary Sessions
09:00-10:00 Plenary Session: 3 (Hall of fame)
`Voices’ Elderly People, Women, Adolescent, Differently Able Children and Sanitation Workers.
Sideline: Sharing of draft Dhaka declaration
10:00-10:30 Plenary Session: 4 (Hall of Fame)
The SACOSAN Journey: 2003-2015 (Achievement & Lessons to Move Forward)
10:30-11:00 Tea Break
The Sustainable Goals: Opportunities for Sanitation & Hygiene in South Asia
Role of Media to Improved Sanitation and Personal Hygiene Behavior
Monitoring Sanitation & Hygiene Beyond MDG through JMP, GEMI and GLAAS
Sideline: Meeting of the Working Group on Declaration (Board room, GF)
Ministerial Meeting
14:00-15:00 Ministerial Meeting to Finalize SACOSAN-VI Declaration (Board room, GF)
14:00-15:00 Poster Presentation (Open Space at Milky way)
15:00-15:30 Tea Break
Closing Ceremony (Hall of Fame)
15:30 Arrival of the Chief Guest: Mr. Khandker Mosharraf Hossain, MP
Honorable Minister, Ministry of LGRD & Co-operatives
15:31-15:40 Declaration of the Conference: Country Focal Person, Bangladesh
15:40-15:45 Speech of the UN Representative: Mr. Edouard Beigbeder
Representative, UNICEF
15:45-15.50 Speech of the World Bank Representative: Mr. Parameswaran Lyer
Practice Manager, Water GP, World Bank
15:50-16:25 Speeches of the Head of Delegations: Afghanistan, Bhutan, India, Maldives, Nepal Pakistan and
Sri Lanka
16:25-16:30 Memento to be presented to Country Focal Persons by the Chief Guest
16:30-16:35 Memento to be presented to the Head of Delegations by the Chief Guest
16:35-16:38 Memento to be presented to the Chief Guest by the Chair
16:38-16:40 Flag Handover to SACOSAN-VII Host Country by the Chief Guest
16:40-16:50 Speech of the Chief Guest and Closing of the Conference:
Mr. Khandker Mosharraf Hossain, MP
Honorable Minister, Ministry of LGRD & Co-operatives
16:50-16:55 Speech of the Chair: Mr. Abdul Malek
Secretary, Local Government Division and
Chairman, SACOSAN-VI Organizing Committee
16:55-17:00 Vote of Thanks : Coordinator, SACOSAN VI Secretariat
17:30-18:30 Cultural Programme (Hall of Fame)
18:30 Closing Dinner (Celebrity, 1st F)
Day 4 & 5 (Thursday & Friday), 14and 15January, 2016
Field Visits (Optional)
Sirajganj/ Dhaka/Narayanganj/Gazipur/Sylhet/ Khustia/Cox’s Bazar
PRESS BRIEFING
6th South Asian Conference on Sanitation launched with a Motto “Better Sanitation Better Life”
A press briefing was held by the SACOSAN-VI Secretariat on January 10th, 2016 to formally announce the
opening of the 6th South Asian Conference on Sanitation (SACOSAN-VI) to be held on January 11—13,
2016 at Bangabandhu International Conference Centre (BICC). The press briefing was chaired by Mr.
Khairul Islam, Deputy Secretary, Ministry of LGRD & Co-operatives, Government of the People’s Republic
of Bangladesh and participated by the SACOSAN focal persons of the participating South Asian Countries.
The press briefing was widely attended by the representatives of electronic and print media along with
the senior government officials of the eight participating countries and international & regional
development partners.
The Government of Bangladesh announced that the conference was being inaugurated by Mr. Abdul
Hamid, Hon’ble President of the People’s Republic of Bangladesh. It will provide a platform to the
governments and civil society of SAARC countries to develop a regional agenda on sanitation, enable
learning from past experiences, and agree on future actions to accelerate the progress in sanitation and
hygiene promotion in South Asia, especially in the context of the SDGs.
The media was briefed that the conference aims to achieve improved policy frameworks, increased
financing, and strengthened implementation and monitoring strategies for sanitation and hygiene to
support the achievement of an open defecation free South Asia by 2023. As the Millennium Development
Goals (MDG) draw to a close, the conference provides a platform to review the accomplishments of the
sector as a region. The proportion of people using improved sanitation in South Asia has increased
remarkably in the last fifteen years compared to global progress. The era of the SDG offers much broader
framework to tackle challenges exacerbated by climate change, wider socio-economic changes and
increasing inequality which will be addressed in this government-led biennial convention.
It was announced that the conference is bringing together over 500 delegates, policy makers,
practitioners, media and civil society members across the SAARC countries in three day deliberations
including various plenary sessions, technical focus sessions, side events sharing wide range of information
including country specific experiences and knowledge. By the end of the conference, a declaration on the
commitments (Dhaka Declaration) will be signed by the participating countries.
DRAFTING OF DHAKA DECLARATION
The SACOSAN declaration is the key outcome of the

ministerial conference on sanitation. Drafting of the
declaration commitments and its endorsement by the
members states is a critical process. It requires intense
participation of the country focal persons of all the
participating countries and regional and global experts
on sanitation and hygiene. The process is steered by the
SACOSAN Secretariat.
For SACOSAN-VI, efforts were made to make the process highly participatory and inclusive. A working
group comprising of country focal persons and regional & global experts was formulated by the SACOSAN
VI Secretariat a month in advance. Input was sought from each member bringing in diversity and rich
contributions. The consolidated input was shared with the focal persons and experts to share with their
respective country delegations and organizations for wider consensus and feedback.
Round of meetings were held throughout the three days of the conference deliberating on the key
commitments for SACOSAN VI, keeping in line the challenges of the SDGs and the SAARC mandate. Input
from the sector experts participating in various technical sessions and plenaries was incorporated in the
declaration draft. The draft declaration was shared with the country delegations and organizations for
consensus before its presentation in the ministerial meeting.
INAUGURAL CEREMONY
The conference was inaugurated by the Hon’ble Md. Abdul Hamid,

the President of the People’s Republic of Bangladesh at the
Bangabandhu International Conference Center (BICC).
The conference inaugural ceremony was attended by the ministers

and heads of country delegations, government dignitaries &
officials, representatives of UN agencies and unilateral/multilateral
organizations, CSO members, private & corporate sector and media
representatives.
The conference was inaugurated with the national

anthem of the host country and recitation from the holy
books. The Secretary General SAARC Secretariat, H.E.
Arjun Bahadur Thapa gave the welcome address. He
congratulated the government of Bangladesh for hosting
this conference and appreciated the constructive role of
Bangladesh in SAARC since its inception. He highlighted
the role of SAARC in providing a platform for the Member
States to share experiences and learn collectively from
the best practices and accelerate progress towards achieving clean and safe sanitation in the region. He
stressed on the importance of the South Asia Regional Action Framework for Sanitation which recognizes
SACOSAN as a key regional process for the promotion of sanitation in South Asia. He urged the South Asia
governments to recall the commitments made through SAARC and SACOSAN and review the progress
made towards their implementation.
SACOSAN-VI theme song with live performance by Shilpakala

Academy was held highlighting the rich culture of Bangladesh.
This was followed by brief video presentation on Bangladesh
moving towards sustainable sanitation. The evolution and the
progress made by Bangladesh till date and the challenges faced
towards attaining sustainable sanitation was highlighted. The
video presentation also showed high commitment of the
government of Bangladesh and the dynamic role of the civil
society organizations in addressing the sanitation issues in the country.
The ministers and the heads of delegates of all the participating countries gave brief address on the
continued commitment and support towards the advancement of the sanitation and hygiene sector. They
appreciated and thanked the Government of Bangladesh for hosting the conference second time round.
The key milestones achieved by their respective countries on sanitation and hygiene in the last two years
post SACOSAN-V in Nepal were shared. The challenge of moving from the MDG to the SDG phase by the
member states was highlighted.
Mr. Khandker Mosharraf Hossain, MP Hon’ble Minister,
Ministry of LGRD & Cooperatives, Government of the
People's Republic of Bangladesh and the chair of the
conference addressed the audience. He thanked the Hon’ble
President for his kind and gracious presence to inaugurate
the conference. He express his profound appreciation to the
Government and People of Afghanistan, Bhutan, India,
Maldives, Nepal, Pakistan and Sri Lanka as well as regional
and global experts, development partners, academicians,
th
professionals, media for their active participation in this 6 SACOSAN. At the end, a memento was
presented to the Chief Guest by the Chair to express gratitude for his kind presence in the inaugural
session of the conference.
The Hon’ble Chief Guest addressed the conference delegates. He welcomed the honorable dignitaries and
members of academia and civil society to the sixth South Asian Conference on Sanitation and thanked
everyone for making the journey to come to Dhaka and be part of this auspicious event and benefit greatly
from the activities that will be undertaken in the conference. He formally announced the opening of the
conference and thanked the organisers of the conference for their dedication in putting together this event.
Address by His Excellency Mr. Arjun B. Thapa,

Secretary General of SAARC
The Hon’ble Md. Abdul Hamid, President of the People’s Republic of Bangladesh,
The Hon’ble Khandker Mosharraf Hossain,
Minister for Local Government, Rural Development and Cooperatives of Bangladesh,
Hon. Ministers, Excellencies, Distinguished Delegates, Ladies and Gentlemen,
It is a great honor and a privilege for me to address the Inaugural Session of the Sixth South Asian
Conference on Sanitation (SACOSAN-VI) being held today in this beautiful city of Dhaka. It is all the more
a pleasure for me as this event brings together representatives of all the Member States of SAARC. Their
collective presence here demonstrates their eagerness to strengthen collaboration in sanitation measures
to ensure a better life of our peoples across the region.
I acknowledge the eminent presence of the Hon’ble Md. Abdul Hamid, President of the People’s Republic
of Bangladesh as Chief Guest of this Inaugural Session. The Hon’ble President’s presence this morning not
only signifies the importance of this event, but also is testimony of the importance that Bangladesh
attaches to the issues of sanitation and safe hygiene.
I would also like to congratulate the Government of Bangladesh for hosting this Conference, and on a very
topical theme as “Better Sanitation, Better Life”. I also wish to thank the esteemed Government for the
warm reception and gracious hospitality extended to me and my delegation since our arrival in Dhaka. As
the incumbent Secretary-General of SAARC, it is always a pleasure for me to be in Dhaka for several
reasons. As we all know, Bangladeshis one of the founding members of SAARC, and Dhaka was the venue
of the First SAARC Summit in 1985. Dhaka was also the host of the Seventh SAARC Summit and Bangladesh
has continued to play a very constructive role in SAARC since its inception and have spearheaded several
important initiatives of SAARC.
In recent years, South Asia has seen gradual improvements in sanitation and the proportion of people
using improved sanitation measures has increased significantly. With the commitment of the governments
of the region to improve sanitation and hygiene in their respective countries, open defecation has been
reduced significantly and access to clean toilets has increased considerably. Moreover, comprehensive
national policies have been adopted by the countries in the region with sanitation as a priority and
increased community initiatives have set great examples for tackling the issue.
However, much remains to be done to address the issue of sanitation in the South Asian region. I say this
for a number of reasons. In spite of major strides made and significant headway achieved over the past
decades, in many parts of South Asia, diarrhoea, intestinal worms and environmental enteric dysfunction
caused by poor sanitation and hygiene practices, and unsafe drinking water are still major causes of child
malnutrition, disease and death. Millions of rural women and girls suffer even more in the absence of
proper sanitation and hygiene measures which is vital for a woman’s privacy, dignity, safety, and for her
health.
SAARC provides a platform for the Member States to share experiences and learn collectively from the
best practices, to accelerate progress towards achieving clean and safe sanitation in the region. In 2014,
with the support of UNICEF, SAARC developed the “South Asia Regional Action Framework for Sanitation”
in line with the directives of the SAARC Health Ministers. The Framework launched during the Eighteenth
SAARC Summit held in Kathmandu in November 2014 presents an overview of the sanitation status and
trends in the region, and also highlights the international and regional commitments made by the SAARC
Member States, to improve the sanitary conditions of the people of South Asia, including the MDGs and
the SACOSAN-4 Declaration. I am glad to mention that it also recognizes SACOSAN as a key regional
process for the promotion of sanitation in South Asia.
As we meet in Dhaka to renew our commitment and recommend a way forward, we must take due note
of the facts that a staggering 40 percent or more of the population in the region has no access to toilet;
over 610 million people defecate in the open; and more than a third of the schools in the region do not
have toilets. Therefore, today, let us recall the United Nations’ Global Agenda of Sustainable Development
Goals (SDGs), which, among others, aims for universal coverage of safely managed sanitation services
under SDG Target 6.2 and increase in the safe treatment of wastewater under SDG target 6.3. Let us also
recall the commitments we have made through SAARC and SACOSAN and review the progress we have
made towards their implementation. I believe that this event today, is a fitting occasion for us to commend
the excellent work we have done so far as well as to single out our lapses in the process for redress in the
future.
Against this backdrop, this Conference, is a very timely and praiseworthy initiative, thanks to the
Government of Bangladesh and its partners. I do hope that the outcome document of this Conference,
the Dhaka Declaration, will pave the way for new initiatives towards ending open defecation, increasing
access to clean toilets and increasing investment in sound sanitation policies and interventions across the
region.
I wish the Conference every success.

Speech by Mr. Atiqullah Khawasi, Hon’ble Deputy

Minister, Ministry of Rural Rehabilitation and
Development, Government of Islamic Republic of
Afghanistan
I thank the government of Bangladesh for hosting the conference for the second time and welcome the
opportunity to speak at the 6th South Asian conference on sanitation, a hugely important regional platform
for exchanging experiences on sanitation and hygiene situation of the people in South Asia. Since the first
SACOSAN conference in 2003, Afghanistan has made great progress in improving the access to improve
water source and we have seen that open defecation prevalence has decreased significantly.
Unfortunately, access to improved sanitation in Afghanistan is still lagging behind. According to our latest
household survey, one fifth of Afghan population still practice open defecation. In rural areas traditionally
latrine use in Afghanistan is high but many of the facilities do not meet the minimum hygiene standards
of WHO and UNICEF.
Improved sanitation coverage in Afghanistan according to the latest household survey is estimated to be
only 39 percent. Our latest nutrition survey show that only 12 percent of Afghan children under 5 years of
age are stunted, which is a manifestation of under nutrition so closely linked to poor hygiene and
sanitation. Our under 5 mortality rate has decreased significantly but is still on a higher side i.e. 91/1000
by births. Pneumonia and diarrhea are still the main killers of children. Ending open defecation and
increase in access to safe and sustainable sanitation is critical in preventing child deaths in Afghanistan.
In line with the new citizen’s charter that our government recently developed to deliver a comprehensive
package of services to the remote and urban population of Afghanistan. The Ministry of Rehabilitation &
Development in close coordination with the Ministry of Public Health, sector NGOs and UNICEF recently
developed a strategy to end open defecation by 2025, which is in line with the call of the Deputy Secretary
General of the United Nations two years ago. We intend to scale up the Afghan context of community led
total sanitation approach which was successfully introduced in Afghanistan in 2009 and was aided by 100
million USD. USAID is funding an integrated hygiene, sanitation and nutrition programme which would
start in the first quarter of 2016.
Afghanistan will be one of the two representatives of SAARC countries on the steering committee of the
global Sanitation and Water for All initiative. We are honored to represent South Asia at this forum and
will work hard with the international partners in ensuring sanitation, hygiene and drinking water receives
the political support and funding that deserves to be an ambition but also critical for the newly adopted
sustainable development goal 6 on water and sanitation to ensure availability and sustainable
management of water and sanitation for all.
Concluding, i would like to convey Afghanistan’s sincere thanks once again to the Government of
Bangladesh for hosting SACOSAN conference for the second time and for the warm hospitality.
Speech by Dr. Pandup Tshering, Officiating Hon’ble
Health Minister, Government of Kingdom of Bhutan
It is indeed a great honor for me to be addressing this distinguish gathering of the sixth South Asian
conference on sanitation. On behalf of the people of Bhutan, he extended a heartfelt gratitude and sincere
thanks to the organizing committee and the government of Bangladesh for extending the hospitality and
in hosting the south Asian conference on sanitation for the second time.
Bhutan was able to host the Inter Country Working Group (ICWG) in 2015. It was attended by the
representative of all the member countries, the UN agencies and International CSOs. The meeting fulfilled
the objectives of Kathmandu conference and deliberated on the objectives of the present conference.
Today we are all assembled here to share key progresses made and challenges confronted against the
commitments made by our member states at the 5th SACOSAN conference in Kathmandu two years ago.
From the ICWG meeting in Bhutan, it was very encouraging to know that the member countries have made
significant progress in the last two years in improving sustainable sanitation and hygiene facilities. It is
very important that we share along the best practices with each other and take it back to our own
countries.
In Bhutan, despite the commendable progress made in improving the sanitation and hygiene coverage,
the challenges remains high. To improve the sanitation coverage, we are embarked on upscaling a subsidy
free rural sanitation and hygiene programme nationally. The programme specifically focus on community
led sanitation demand creation, market place supply chain, hygiene behavior change communication and
most importantly to develop sustainable delivery model with due consideration of people living in
severity, elderly, gender and socially inclusive approach. The government’s emphasis is imminent to
improve sanitation coverage through evidence based learning.
With these few words, lets look forward to a very productive sessions during the three day conference to
strengthen our common goal towards improved sanitation facilities and hygiene practices for better
health and better life.
Speech of Shri Birender Singh,

Hon’ble Minister of Rural Development, Panchayati Raj &
Drinking Water and Sanitation, Government of Republic of
India
His Excellency, Mohammad Abdul Hamid, Hon’ble President, People’s Republic of Bangladesh, Ministerial
colleagues from South Asian countries, distinguished officials from various countries, eminent delegates,
representatives of International agencies, ladies and gentlemen.
Representing India, as the head of the Ministry of Drinking Water and Sanitation, it is my privilege to
participate in the sixth South Asian Conference on Sanitation (SACOSAN) in Dhaka. I would like to express
my greetings and congratulations to the Government of Bangladesh for hosting the sixth SACOSAN. I also
extend my greetings to the Country heads and delegates of Pakistan, Afghanistan, Bangladesh, Bhutan,
Maldives, Nepal and Sri Lanka present here, and other invited delegates. We are gathered here together
to deliberate on the various policies and implementation strategies, to share and cross-learn best
practices, and to prepare a common and constructive roadmap, to tackle the menace of open defecation
and take other measures which will lead to improved sanitation and hygiene.
It was a turning point in the sanitation history of India, when the Prime Minister of India, Shri Narendra
Modi, mentioned from the ramparts of the Red Fort, on 15th August, 2014, the occasion of India’s 68th
Independence Day:
“The poor need respect and it begins with cleanliness. I, therefore, have to launch a ‘Clean India’ campaign
from 2nd October this year and carry it forward in four years.”
Many were surprised. Prime Minister of a country, that is emerging as one of the fastest growing
economies in the world, a country that houses one- sixth of the world’s population, taking up the issue of
cleanliness as a priority for his Government! Friends, the Prime Minister had to take up this agenda
personally, in order to kick-start the process of achieving Swatch Bharat (Clean India) in a short time-frame
of five years - by 2nd October, 2019, as a befitting tribute on the occasion of his 150th birth anniversary
to the Father of the Nation, Mahatma Gandhi, who considered sanitation as next to Godliness. Our Prime
Minister realized that poor sanitation was closely linked with poor health, low education status,
malnutrition and poverty. How can a country, that has accomplished many feats that astonish the world
at large today, continue to bear this stigma of poor sanitation and hygiene status? He also recognized that
the work of sanitation cannot be the responsibility of Government alone; it has to be evolved as a citizen’s
movement, with involvement of people, and all sects of the society.
In response to Prime Minister’s call, my Government launched Swatch Bharat Mission (Clean India
Mission) on 2nd October, 2014 to accelerate efforts to achieve universal sanitation coverage, improve
cleanliness and eliminate open defecation in India by 201 9.The program is considered India’s biggest drive
to improve sanitation, hygiene and cleanliness in the country. The effectiveness of the programme is
predicated upon generating demand for toilets leading to their construction and sustained use by all the
household members. It also aims to promote better hygiene behaviour amongst the population and
improve cleanliness by initiating Solid and Liquid Waste
Management projects in the villages, towns and cities of the country. This is to be bolstered with adequate
implementation capacities in terms of trained personnel, financial incentives and systems and procedures
for planning and monitoring. There is stronger focus on behaviour change intervention including,
interpersonal communication; strengthening implementation and delivery mechanisms down to the
village level; and giving States flexibility to design delivery mechanisms that take into account local
cultures, practices, sensibilities and demands.
The progress in sanitation has witnessed a spurt, since the launch of the Swatch Bharat Mission. In the
first year of the Mission itself i.e. from 2nd October 2014 to 2nd October, 2015, 8.8 million toilets were
constructed, against an expected outcome of 6 million. Since the launch of Swatch Bharat Mission, more
than 11.5 million toilets have already been constructed in the rural areas and around 0.6 million in the
urban areas. The sanitation coverage, which stood at 40.60% as per the National Sample Survey
Organization Report of 2012, has increased to around 48.3%.
The focus of the Swachh Bharat Mission is on behavior change and usage of toilets. While individual toilets
continue to be provided on demand, there is a focus on village saturation and achievement of open
defecation free (ODF) communities. This involves collective behavioral change of the entire community
through intensive triggering and follow-up. This change of mindset involving changing of age-old habits is
a very challenging task; however, we understand its importance for the health benefits, as well as for
sustainability of the programme. The uniform parameters of ODF have been defined, so that there is a
common understanding of the term across the country. Guidelines for ODF verification have also been
issued to ensure capturing of right outcomes.
A key thrust of the Swachh Bharat Mission programme is the flexibility provided to the States in
implementation. The States can now, depending on their socio-economic-cultural milieu, adopt strategies
considered most appropriate by them. The Centre is trying to focus on evaluating the actual outcomes
and promoting cross-sharing of best practices between the States. The typical outcome parameters
include reduction in open defecation, achievement of Open Defecation Free villages and improvement in
solid and liquid waste management. Many States are utilizing this flexibility to implement the programme
in a manner best suited to them and encouraging innovations.
The programme has a strong thrust on equity, and focuses on the marginalized sections. The emphasis of
the programme on community approach ensures that all sections of the community - especially the poor
and the marginalized — participate in the deliberations and decisions in the community, towards adopting
safer sanitation practices. The programme also incentivizes toilet construction and usage by the poor and
marginalised households. An incentive of Rs 12000 is available for individual latrines. The States have a
flexibility to give this incentive amount either to the individual household, or to the community as a whole,
in cases where community approach is adopted, after the entire village becomes ODE.
India is acutely aware of the impact of India’s sanitation status on the overall progress of sanitation in the
region and the world. Brothers and sisters, I assure you, that India will not be found wanting on any of the
parameters of sanitation. India is committed to meeting the Sustainable Development Goal 6, that calls
for ensuring availability and sustainable management of water and sanitation for all.
Several important initiatives have been taken to expedite the programme. The focus on capacity building
has been increased, especially in skills pertaining to community processes and triggering for collective
behavior change. A 360 degree behavior change communication strategy is being deployed.
State/Regional level workshops involving all the key stakeholders such as Collectors, CEO, ZillaPanchayáts,
Chairmen Zilla Panchayats etc. are being held. Since sanitation is a State subject, and States/districts are
the actual implementing units of the programme, the Centre-State coordination has been increased. Social
media —Twitter, Facebook, HIKE and WhatsApp are being extensively used for sharing innovative ideas
and cross-learning. A National Rapid Action and Learning Unit has been constituted to institutionalize
learning from the field and provide quick feedback. The technology aspect is also being focused and an
Expert Committee under the chairmanship of Dr R.A. Mashelkar has been constituted to examine new
innovations; and quarterly exhibitions are organized to spread these technologies amongst the States and
other stakeholders. The collaboration with various sector professionals, experts, development partners,
international agencies and multilateral organizations has been increased.
The Swachh-Bharat Swachh-Vidyalaya campaign, a component of the Swachh Bharat Mission, which
aimed to provide separate toilets for girls and boys in all remaining schools of the country within one year
achieved remarkable success, and the targets were fully achieved with 4,17,796 toilets added to 2,61,400
government elementary and secondary schools during 15th August, 2014 to 15th August, 2015. This was
achieved by a combination of efforts from Government, public and corporate sectors and private
contributions.
As the Swachh Bharat Mission has entered the second year of its launch, there are renewed efforts in not
only sustaining the momentum achieved in the first year, but also multiplying the efforts towards a
deepened understanding and deployment of community processes, strengthening of implementation
capacities, promoting innovations in addressing various social and technical challenges and continuing the
focus on sustainability of outcomes.
I look forward to enriching deliberations on various sanitation related issues over the next three days.
Thank you.
Speech by Mr. Abdullah Ziyad, Hon’ble Minister,
Ministry of Environment and Energy, Government
of Republic of Maldives
His excellency, President of People’s Republic of Bangladesh, Hon’ble Ministers, Heads of country
delegates sanitation experts, civil society groups, sanitation workers, community groups, media
representatives, Ladies & Gentleman, AsslamaAlaiukum.
On behalf of the Government of Maldives and on my own behalf, I would like to express my warm wishes
and appreciation to the Government of Bangladesh for the excellent arrangements and for the generous
hospitality accorded to all the delegates. It is an indeed honor for me to address the Sixth South Asian
Conference on Sanitation. Being located in this beautiful and vital city of Dhaka, I congratulate the
government of Bangladesh for organizing and hosting this important gathering for the second time in the
history of South Asia.
Excellencies, since 2003, the need to strengthen and intensify the regional cooperation, improving access
to sanitation and to make the region free from open defecation, including the need to address the
challenge have been raised in several meetings by SAARC member states. Today again, we are all gathered
here to renew our assurance and make new commitments for improving sanitation across South Asia
region. Improved sanitation plays an important role of survival and it is an essential element to ensure
better health and comfort.
Sanitation has been once a neglected topic government by federal system and federal policies. The South
Asia region is part of the most populous of world’s continent, located in both the north and east
hemispheres, South Asia region comprises of 3.4% of world’s land area but the 1/5th of the world’s current
population and about 9.5% of the area’s population. It is also the largest concentration of under privilege
people. The task of providing improved sanitation has been a challenge in the region. Due to limited
resources, limited funds and diversity of technology options, regardless by the limitations, the passion
and interest expressed and efforts made by SACOSAN member countries for improving access to safer
water, sanitation and hygiene to its people are to be commended. The commitments being made by
member states since 2003 have been strong and the results are being seen.
Excellencies, ladies and gentlemen, in 2015 an estimated 2.4 billion people globally did not have access to
improved sanitation facilities. Of them, about 950 million defecated out in the open. In South Asia region,
more than 953 million people are still without access to sanitation, with highest number of open
defecators. We are gathered here to share progress, made against joint commitments that we made in
fifth SACOSAN in Kathmandu in 2013. The theme better sanitation – better life for the sixth Sacosan is to
be seen in the coming days, it will not only reflect better sanitation better life but also reflect better health,
better future.
Excellencies, Ladies & gentlemen, Maldives is the smallest country in this region and the only low lying
nation amongst the SAARC member states. It has a total population of only 350,000 people spread in the
988 islands, of the total 2200 Islands. 1.5 metres above sea level.
Maldives people defecate openly in the bush and on the beach. Successful child excreta disposal systems
and various types of sanitation systems are practiced. The introduction of on-site septic tank systems have
been the bench mark for the modern sanitation systems being implemented across Maldives.
Efforts are being made in securing and increasing finance for increasing the coverage of improved water
and sanitation coverage. By end of 2015 alone, over 100 million USD and 25.7 million USD from the
development budget have been secured to improve water and sanitation infrastructure. By 2014, about
2/3 of Island would have developed improved modern sewerage systems.
Excellencies, we have graduated from the UN Millennium development goals to sustainable development
goals target. We are here to make new commitments for ensuring sustainable management of water and
sanitation for all. With top policy makers and sanitation experts, we renew our commitments and
strengthen our networks and necessary knowledge and skills to ensure that we provide adequate
sanitation for all the people in the region for better sanitation and better life
Excellencies, provision of improved sanitation is a complex and controversial issue which means we need
creative thinking and cooperation amongst all the sectors of the society. It means. Good governance, good
science and good management. It means solid regulatory framework, it means well managed utilities to
generate adequate revenues for improving the services.
Concluding, I hope that this conference will further strengthen and contribute in improving access to
sanitation across South Asia region.
Speech by Mr. Suresh Prakash Acharya, Secretary
Ministry of Water Supply and Sanitation, Government
of Federal Democratic Republic of Nepal
Hon’ble President, distinguished country delegates, representatives of media and civil societies, Ladies &
gentlemen, i’m highly privileged and honored to lead the country delegation to the SACOSAN 6 here in
Dhaka as the first Secretary of the recently established Ministry of Water Supply and Sanitation in Nepal.
The government of Bangladesh deserves high appreciation for hosting this conference for the second time
as its commitment for uplifting the abject living condition of the people in South Asia.
The prevailing sanitary condition where every other citizen in our region has to hide their faces every
morning as they attain to their basic call of the nature is not only a call for dignity but also a reason as to
why our children or other vulnerable groups die or become seriously sick. Improper management of
human faeces is costing us not only millions of rupees or takkas every year in terms of medical expenses
and productive human days but millions of lives, that have been contributing towards our prosperity, have
been lost as well. I strongly believe that SACOSANs have now transformed into a movement in an effort
to sensitize, give awareness, promote networking and enhanced partnership among our people and
countries towards overcoming this single barrier towards our prosperity. It has become a process to build
political will for sanitation in South Asia.
In this context, i appeal to this galaxy of learning people to think beyond targets which may probably. be
achieved by pumping large resources but it will not answer the issue of effectiveness of outcomes. What
we require is sustainable change in hygiene behavior and practices, quality of services and traditional self
prevailing movement in sanitation.
The incentives of the past SACOSANs have been instrumental towards bringing marked changes in the
sanitation situation in our countries by promoting partnership, shared innovations and enhanced
government commitments. While moving towards achieving universal coverage of basic sanitation
services by 2017, Nepal by having struck with massive earthquake last year causing colossal loss of lives
and assets. Despite the current situation in Nepal, we are striving towards achieving open defecation free
Nepal by 2017. Around 81 percent people have now access have now access to toilets and 32 out of 75
districts have been declared open defecation free areas till date. Formation of a dedicated ministry for
water and sanitation shows that our government is giving high priority to WATSAN sector. We are
continually involved in the sector reforms process, amendments in our sector policies and acts are
underway and will be enforced very soon.
Lastly I would once again take this opportunity on behalf of my country and fellow delegates to
congratulate the hon’ble President of Bangladesh, thanks to the government of Bangladesh and people of
Bangaldesh and the organizer in hosting this grand event. Thank you very much.
Speech by H.E. Mr. Shuja Alam, High Commissioner,

Government of Islamic Republic of Pakistan in Dhaka,
Bangladesh
Hon’ble President of the People’s Republic of Bangladesh, Hon’ble Ministers, Secretary General SAARC,
distinguished country representatives, ladies and gentle-man. Assalam Alaikum and a very good morning!
Let me start by bringing the greetings of people of Pakistan on the occasion of the sixth meeting of
SACOSAN and commend the efforts of SACOSAN over the last decade towards strategic direction to the
countries of the region. It has in a great deal been addressing the predicament of sanitation which has a
huge bearing on health and economy of our respective countries. We look forward with keen interest the
outcome of this conference and how the recommendations and deliberations that can be taken back and
applied in Pakistan’s context.
Since the launch of the millennium development goals and their end in 2015, Pakistan has made
substantive progress in increasing the rate of improved sanitation. Even though we are still short of the
regional MDG target, but we believe if we are on the right trajectory and if continue with collaborative
efforts at the current pace, we will move forward to achieving our objectives in the near future. In the
past few years, Pakistan has achieved few milestones. The President of Pakistan inaugurated the second
PACOSAN meeting which brought together all major stakeholders in water and sanitation sector to discuss
the implications and recommendations of SACOSAN V.
Pakistan also participated in the Sanitation and Water for All meeting and pledged to increase sector
funding. One of the major development is the growing political commitment for the sector and increased
awareness for the policy makers and planners for the need to invest in the water, sanitation and hygiene.
One of key lessons that we have learnt in the last ten years is the increasing importance of the multi
sectoral planning and joint implementation for water and sanitation programmes. For instance, adequate
sanitation and drinking water facilities at schools play a key role in both school health and education while
linking up with health and nutrition programme contributes towards lowering child mortality and
morbidity rates. These developments would not have been possible without the continues support of UN
agencies, bi-lateral and multi lateral assistance and international organizations and civil society to whom
we are very grateful.
With the launch of the sustainable development goals, Pakistan looks forward with great optimism to
meeting the sanitation challenges. While we have covered much ground but still there are challenges that
need to be addressed with reduced inequities and enhanced coverage and access to improved sanitation.
The establishment of local government bodies in Pakistan has brought opportunities for addressing grass
roots participation and dissemination of rural sanitation programmes.
On behalf of Pakistan, we look forward to learning from the many distinguished leaders from the South
Asian countries. I wish this conference every success. Thank you.
Speech by the Secretary, Ministry of City Planning &

Water Supply, Government of Democratic Socialist
Republic of Sri Lanka
His excellency, Mr. Md Abdul Hamid, the President of the People’s Republic of Bangladesh, Hon’ble
Ministers representing SAARC countries, representatives of the SAARC Secretariat, United Nations and the
World Bank, heads of the delegation and focal person of SACOSAN VI, SACOSAN VI Secretariat officials, it
is an honor to be here today and a great privilege for me to address the 6th South Asian conference on
sanitation. I deliver this speech on behalf of the Minister City Planning & Water Supply in Sri Lanka who
will be joining us in the coming days. I congratulate the Government of Bangladesh for hosting SACOSAN
6 and extend an attractive arrangement made for all of us here in Dhaka.
We are proud that Bangladesh is the only South Asian country that has hosted two such high level
conferences on water and sanitation. These are two basic services which all of us need today. These are
services the developed world takes it for granted but in the developing world, it’s often lacking. The water
and sanitation deserves the attention of the highest policy makers of the South Asian region. The theme
for SACOSAN VI, better sanitation better life is very important theme for the future generation. We have
with us the top policy makers as well as the experts gathered here. Together all of us should make full use
of these few days of the conference and develop strategies of sustainable development for improving
sanitation coverage to ensure that we provide adequate sanitation to all the people of the South Asian
region. With regional coordination, it is widely important to achieve our targets.
Today, as member of SACOSAN, we have great commitment to achieve the targets of SACOSAN in our
country. Sri Lanka government has taken many actions to improve sanitation especially the commitments
made in the Colombo declaration in SACOSAN IV. As a result, in Sri Lanka we now have a dedicated budget
allocation for sanitation. I’m proud to announce that Sri Lanka has achieved 93 percent improved
sanitation coverage and 98.6 percent of total sanitation coverage. During SACOSAN V Conference in
Kathmandu in 2013, Sri Lanka proposed to mainstream child participation at policy and knowledge for
sanitation at the World Assembly. Sri Lanka committed to initiate such forum before the SACOSAN VI. I’m
proud to tell you all that we have set up a regional centre for sanitation in our country and were the first
to organized a student conference last year in Sri Lanka. The regional centre for sanitation should be
strengthened and continues regional activities to be done, in natural disasters especially providing
sanitation facilities. The South Asian student conference to be developed and strengthened to carry our
regional activities on sanitation.
There is so much that remains to be done but if we try the results can be attained even in the most
challenging situation. We hope that SACOSAN VI will give us great opportunities for regional development
and cooperation. Thank you.
Speech of the Chair: Khandker Mosharraf Hossain, MP,
Hon’ble Minister, Ministry of LGRD & Co-operatives,
Government of People’s Republic of Bangladesh
Hon’ble President of the People’s Republic of Bangladesh, Mr Md. Abdul Hamid

Respected heads of delegation from Afghanistan, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka
Ministers, Members of the Parliament
Distinguished participants from SAARC member countries
Representatives of UN Agencies, Development Partners, NGOs, Civil Society, Academia
Ladies and Gentlemen
Assalamualaikum and very good morning.

th
It is our pleasure to be the host of 6 South Asian Conference on Sanitation in Dhaka on this beautiful
winter morning. We are honoured and happy to have our Hon’ble President amongst us today. I, on behalf
of my Ministry and all delegates participating in this conference, thank Hon’ble President for his kind and
gracious presence to inaugurate the conference. This manifests the commitment of Bangladesh towards
attaining full sanitation coverage in shortest possible time.
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The theme of this 6 Conference is ‘Better Sanitation Better Life’ which has rightly pointed out the need
of sanitation for a healthy environment. I expect that the conference will be able to highlight this fact
among all participating countries through discussions, consultations and knowledge sharing.
All of you know that SACOSAN is a government-led biennial convention held on a rotational basis in each
SAARC member countries that provide an interactive platform for improving sanitation in South Asia.
st
Bangladesh was the organizer of the 1 SACOSAN that was held in 2003. SACOASN has returned to the
origin country after a round trip to other member countries. It has brought together high level policy
makers from every country in South Asia with representatives of community leaders to discuss regional,
national and local sanitation and hygiene actions, to set future actions and to share ideas. Around four
hundred country delegates and fifty experts from regional and global agencies are participating in this
conference. We wish to extend our warmest hospitality to all our guests and local participants. I hope, you
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will enjoy your time in Dhaka and actively participate in the 6 SACOSAN proceedings.
In 1971, Bangladesh attained its independence under the dynamic leadership of our ‘Father of the Nation’
Bangabandhu Sheikh Mujibur Rahman. He started reconstruction of the newly born country and put
emphasis on restoration of water and sanitation facilities. The daughter of Bangabandhu, our Prime
Minister Shaikh Hasina is also keen to ensure safe water and better sanitation for all citizens in Bangladesh.
The present Government has set target in its ‘Vision 2021’ to have universal coverage of safe water and
sanitation for all within that stipulated time frame. Government has increased budgetary allocations for
sanitation in its Annual Development Program. The NGOs and development partners are also contributing
to enhance sanitation converge. Ministry of Local Government, Rural Development and

Co-operatives is tirelessly working to ensure safe water and sanitation for all in Bangladesh.
Today, over 2.4 billion people do not have access to proper sanitation services, and over 1.1 billion people
defecate in the open worldwide. In rural areas, 7 out of 10 people are without improved sanitation
facilities, and 9 out of 10 people still practice open defecation globally. These figures suppress our sheer
achievements in the sanitation sector. In the world around half a million children die every year of diarrhea
caused because of unsafe water and poor sanitation. Open defecation is the prime cause of unsafe and
contaminated waters that takes away so many budding lives.
Improvement of sanitation coverage and reduction of open defecation is not possible in isolation.
Combined efforts are needed to combat this giant problem. SACOSAN Conference has triggered the pace
of sanitation coverage in SAARC region. Open defecation has been reduced remarkably in this region. It
has been reduced extraordinarily in Bangladesh. To be exact the rate of open defecation was 42% in 2003,
while it is only 1% in 2015. Asserting this piece of information, I would like to alert that there is no scope
for complacence and this 1% open defecation is unacceptable as this can still risk the lives of our
population as a whole. In 2013, United Nations has launched a ‘Call for Action on Sanitation’ aiming at
elimination of open defecation by 2025 and strengthening the partnerships that can make this happen.
United Nations has strongly emphasized the importance of sanitation and hygiene as key to reducing
inequalities and achieving human development. It has clearly articulated sanitation and hygiene within
the post-2015 ‘Sustainable Development Goals’.
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Dear delegates, all of you know, the head of the delegates of participating countries in 5 SACOSAN
unanimously agreed and committed to an ‘open defecation’ free South Asia by 2023 and to a
progressive move towards sustainable environmental sanitation. I am happy to announce that under the
dynamic leadership of Prime Minister Sheikh Hasina, Ministry of Local Government, Rural Development
and Co-operatives in collaboration with development partners and NGOs, Bangladesh is progressing
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towards eliminating open defecation much earlier than the deadline set by 5 SACOSAN.
The Local Government Division, Government of Bangladesh provided due importance to sanitation and
hygiene. The Policy Support Unit of the Local Government Division has devised enormous number of
policies and strategies for the sector program development. 15% of the development budget of the local
government bodies is now year marked for providing improved sanitation facilities in rural areas. The
Government had identified nearly 1200 Unions (almost one fourth) of Bangladesh as hard to reach areas
and had taken special program to provide sanitation services to the people living in those areas. Different
development projects were taken to increase sanitation coverage.
Despite having success in sanitation, we still have few challenges in Bangladesh as well as in other SAARC
countries. Faecal sludge management is one of them. Around 98% latrines in Bangladesh are based on
either septic tank, or pit. Faecal sludge of these pits or septic tanks requires emptying after filling up. In
practice, people are not disposing faecal sludge in a sanitary fashion, which is causing contamination of
open water bodies. Local Government Division is aware of this problem and has formed a National
Working Group that has already submitted the draft institutional and regulatory framework for faecal
sludge management.
Menstrual hygiene remains a challenge for all of us. National Hygiene Base Line Survey 2014 has revealed
that, in Bangladesh average 85% of adolescent girls and women use dirty cloths during menstruation. As
a result, they are suffering from different diseases. 40% of the surveyed adolescent girls reported that
they miss school during menstruation for 3 days in a month. 38% adolescent girls and 48% of adult women
were forbidden from religious activities during menstruation. Only 1% schools have menstrual pad
disposable facilities. Menstrual hygiene management situation in SAARC countries are almost similar to
Bangladesh. We have to take necessary action to improve menstrual hygiene practices. We should
encourage private sector to come forward to produce and supply low cost sanitary napkins to the users.
Financing for sanitation is crucial for achieving water, sanitation and hygiene targets. Investment in
sanitation is a worthy investment. We have to ensure sustainable financing for sanitation. We have to
encourage private entrepreneurs to promote sanitation. Micro-finance institutions, banks, other financial
institutions should come forward to promote sanitation entrepreneurship. I sincerely hope that SAARC
will support the SACOSAN process by adopting the ‘SAARC Regional Action Framework for Sanitation’ to
address the challenge of sanitation and hygiene in the region.
I express my profound appreciation to the Government and People of Afghanistan, Bhutan, India,
Maldives, Nepal, Pakistan and Sri Lanka as well as regional and global experts, development partners,
th
academicians, professionals, media for their active participation in this 6 SACOSAN.
At the end, I would once again, like to extend our gratitude and thanks to the President of Bangladesh for
his kind presence in the inaugural session of this Conference. His presence is inspiring us to have a better
knowledge sharing and exchange of views which will lead to better cooperation amongst us. I thank my
colleagues and friends. Thank you all. Allah Hafez. Joy Bangla, Joy Bangabandhu Long Live Bangladesh!
Speech of the Chief Guest,

H.E. Mr. Md. Abdul Hamid
Honorable President, People’s Republic of
Bangladesh
Honorable dignitaries, respected members of academia and civil society, our friends from the media and
distinguished guests – it gives me immense pleasure to welcome you to the sixth South Asian Conference
on Sanitation, once again hosted on Bangladesh’s soil.
SACOSAN has a glorious history of being a truly regional event. It has been our experience and I am sure
yours as well, that this is a forum where a spirit of sincere regional cooperation and progress drive the
discussions, and every conference brings us closer to achieving total sanitation for all our citizens.
As the age of the Millennium Development Goals draw to a close, we look back on our accomplishments
as a region. The proportion of people using improved sanitation in South Asia has increased by remarkably
from 1990 to 2015, compared to globally. Our friends in Maldives, Pakistan and Sri Lanka are to be heartily
commended for their success in meeting the MDG sanitation target. Alongside, the proportion of people
who practice open defecation has dropped by a faster reduction rate than any region. These achievements
owe a great deal to our commitment and pioneering stance in acting as a region in water, sanitation and
hygiene.
Bangladesh is proud to be a part of this journey. Despite its manifold challenges, Bangladesh has achieved
the MDG water target, and made good progress on reducing the sanitation gap. This is due in large part
to the government’s focused commitment to the country’s development, water and sanitation
particularly, along with the efforts of an active civil society, development partners, and the hard work of
local government institutions and the communities themselves at large. We have already met several
other MDG targets including reducing headcount poverty and poverty gap ratio, attaining gender parity
at primary and secondary education, and reducing under-5 mortality rate. We have also made
mentionable progress in reducing the prevalence of underweight children, lowering maternal mortality,
increasing enrolment at primary schools, and reducing the incidence of communicable diseases. Each of
these achievements owes something to the improvements in water, sanitation and hygiene that have
taken place across the country, which have greatly reduced the prevalence of disease in infants and
children, and improved the services and environment in schools and health facilities.
However, we are aware there is still a long way to go before we achieve universal WASH. We face immense
pressures from rapid urbanisation, climate change, and second generation sanitation challenges including
faecal sludge management. For our region as a whole, there are overarching challenges that also need to
be taken into account. A key concern is the rising trend of inequity we can see in South Asia, where there
is a difference between use of improved sanitation facilities in rural and urban areas.
Even as we reflect on existing hurdles, changes in the spheres of society, economics, climate and global
development are forging new opportunities and generating new threats. As we saw in the climate
conference knows as COP21 held in the last December in Paris, emerging global challenges will require
commitment and coordinated action where we act as global citizens, not in the self-interest of any one
nation. I would suggest that SACOSAN in a way set the precedent, and perhaps even the standard, for joint
learning, action and commitment on cross-country issues, and it is my belief we will become even
stronger, even more critical in the post-MDG context.
As we go forward into the era of the Sustainable Development Goals, WASH will come into the forefront,
not as a subsidiary or a contributor, but as a key set of issues in its own right: with complex, inter-related
impact on individuals, communities and the environment. From the comparatively straightforward MDG
perspective of improving access, we are now in a much broader framework where issues such as integrated
water resource management, water use efficiency, protecting ecosystems and preventing pollution will
become equally important. This means we must tackle even more demanding and complicated problems, it
also means WASH is finally being acknowledged for the critical area of work that it is essential to human
health, well-being and dignity.
Against this backdrop, we are very aware that we cannot afford to become complacent or lose pace. We
have already started to address many of the SDG issues in our comprehensive conceptualisation of WASH
components in the newly formulated 7th Five Year Plan for Bangladesh. We believe that ensuring access to
safe drinking water and sanitation is part and parcel of pro-poor, inclusive growth. However, the Plan has
also identified several areas of work, beyond access, which align with the spirit of SDGs: water resource
management, including reducing groundwater dependence and industrial water footprint; reducing
environmental risk to health from poor sanitation, hygiene and pollution; nationwide hygiene promotion;
and linking WASH with health, nutrition and education. It also explicitly acknowledges the need to tackle
underlying threats including climate change, which brings with it serious implications for resource
constraints; and wider socioeconomic changes including the afore mentioned trend towards increasing
inequality.
These are our very initial steps towards achieving better WASH in Bangladesh. However, our focus should
be on the realisation of this Plan, and other sector strategies that will support its implementation. In this
question of implementation, we have a tremendous opportunity here to hear from our neighbours, from
their successes. At the same time, I hope we will be able to offer something that will be useful for our guests,
including the significant reduction in open defecation seen in Bangladesh amongst all strata of society.
It is a forum for sharing experiences and ideas, that makes SACOSAN a unique event. I wish all of you a very
successful, productive and inspiring conference; and I hope, in the same spirit of mutual cooperation and
friendship that binds our vision of WASH and cleaner, healthier future, we can look towards a peaceful,
prosperous region.
I would like to conclude by thanking all of you for making the journey to come here and be part of this
auspicious event with us. As the pioneering SACOSAN nation, it is an honour to have you once again with us.
I would also like to thank those who have organised the conference for their dedication putting together this
event. I am certain every one of us will benefit greatly from the activities these will be undertaken in the
conference.
Finally, ladies and gentlemen, I emphasize once again that WASH is taking center stage. Now is the time to
give our best work, our best efforts to generating innovative, sustainable solutions that will ensure our future
generations to live in a healthy, hygienic and prosperous South Asia. Thank you.
KEY NOTE SPEECH
A keynote speech was made by Professor M. Feroze Ahmed, Vice

Chancellor, Stamford University Bangladesh. He emphasized on the
great significance of SACOSAN VI as it was being held at the end of
MDG and beginning of SDG period and provided an opportunity to
revisit the progress during MDG period and develop strategy to
achieve SDG based on the experience gained during 12 years of
SACOSAN movement.
He briefed that the access to improved sanitation for the global population increased from 54% to 68%
during 1990-2015, and the global MDG target has been missed by 9%. Although 2.1 billion people got
access to improved sanitation facilities globally during this period, the people lacking access to improved
sanitation facilities in 2015 remained at 2.4 billion, exactly the same number estimated in 1990.
The progress at a glance on sanitation facilities in SACOSAN countries during 1990-2015 was discussed.
The population coverage by improved sanitation has increased from 20% in 1990 to 45% in 2015, shared
sanitation facilities have increased from 6% to 12 % and unimproved facilities from 7% to 8%. At the same
time open defecation has decreased from 67% to 35%. The MDG sanitation target for SACOSAN countries
has been missed by 15%. Although the SACOSAN countries made a very good progress in population
coverage by improved sanitation and reduction of open defecation as compared to global progress in
respect of the two important sanitation indicators. Maldives, Pakistan and Sri Lanka have met the MDG
target, Bangladesh, Bhutan and Nepal marginally missed the target, while Afghanistan and India lag far
behind MDG target. In spite of very good progress, the combined achievement in coverage by improved
sanitation is behind the MDG target because of very low baseline coverage in 1990.
He informed that the SDG target of achieving 100% sanitation coverage by 2030 will be achieved by
Maldives and Sri Lanka. The other SACOSAN countries need to accelerate their rate of population coverage
during MDG period by 1.5 to 4.75 times to achieve SDG target, which may be difficult for some countries
but not impossible if backed by strong political commitment. Bangladesh, Bhutan, Maldives and Sri Lanka
have achieved or nearly achieved the status of zero open defecation. Afghanistan, Pakistan and Nepal, by
maintaining the present rate of reduction, are likely to eliminate open defecation within the SDG period.
India needs to increase the rate of reduction to eliminate open defecation by 2030.
He emphasized that SACOSAN needs to develop a

strategy to accelerate coverage by improved
sanitation, elimination of open defecation, reach
the unreached places and population, improve
hygiene practices and safe disposal of fecal sludge.
SACOSAN needs special attention to equity in
access to sanitation, the needs of the girls and
women and those in vulnerable situation.
COUNTRY PRESENTATIONS
The country presentation session was
chaired by Mr. Junaid Ahmed of the World
Bank. He emphasized on the importance of
sanitation in the economic development of
the country. He referred to a perspective
that sanitation happens over time as
economy develops and sanitation happens
only after water is delivered but stated
that empirically it is now recognized that
unless sanitation is addressed, the
problems of stunting, ill health, job loss
and most incredibility that of dignity will remain unresolved. He emphasized that countries can bend the
trajectory of history and deliver sanitation before economic developments in countries from low income
to middle income and above. He believed that the gathering of SACOSAN is indeed a confirmation that
countries can indeed shift the trajectory of sanitation delivery.
He termed SACOSAN VI as a historical meeting as the sector has shifted from the world of MDGs to the
world of SDGs which is not a trivial shift. He highlighted that it is a shift in which there are two very
important commitments that are being made i.e. commitment of inclusion which means that when the
services are delivered, its delivered universally to everyone and no one is left out. Secondly, it is the
commitment to create the right institutions that will ensure that
sanitation is delivered. In some countries, it will be local governments and
in other countries, it will be utilities. Without any doubt across countries,
involvement of citizens and communities as they engage local
governments and utilities, it is going to be extremely important in
ensuring the shift into the SDGs.
He emphasized that the SACOSAN statement has got to be a statement in which the South Asian countries
step forward and highlight what they are going to do to shift from the MDG into an SDG world. To shift
from the world of targeted delivery to universal access which is completely inclusive, and the one that has
institutions that can deliver and that in itself is a tall order and a historical moment for us to be able to
achieve that. Another reason for his conference to be historical was that we have all come home.
SACOSAN started here in Bangladesh and it has now come back to Bangladesh. It is important that as we
move away from Bangladesh, the countries that have come together from the cycle of delivery of
SACOSAN over a decade now make a commitment in the Dhaka declaration which will bring notice to the
rest of the world that South Asia has made a commitment in sanitation for the future of their citizens.
He informed that a glimpse of these commitments will be seen in the presentations by each country and
seen as the beginning of a conversation that would end up as a summery of Dhaka declaration and a door
step as to how South Asia would move from the MDG focus to the SDG focus. The representatives of
participating countries were invited to present their country paper.
Afghanistan Country Paper
In Afghanistan, overall access to improved sanitation facilities are

lower in rural in comparison to urban areas across the country,
though differences exist in the types of sanitation facilities used.
As per the JMP, Afghanistan’s coverage has only increased slightly
over the past decade and could hardly meet MDG on sanitation.
The latest national household survey from 2014, found that
almost one-fifth of the population of Afghanistan still practices
open defecation. MRU5 is estimated 91/1000, which is
unacceptable, and the highest in the region and 23% of the mortality is accounted for the poor sanitation
practices.
Despite investments of over US $ 200 million and construction of approximately 100,000 water points
since 2002, sanitation component can hardly experience up scaling. While 68 % of households make use
of some form of a traditional latrine facility, only 13% of the national population has access to safe and
hygienic latrines. The Central Statistics Office estimates that coverage with improved sanitation in
Afghanistan is around 39 per cent.
An analysis of the funding stream shows that far most investment into sanitation comes from the
households themselves. With very low government revenues, Afghanistan relies almost exclusively on
donor support for its development activities, including the promotion of sanitation and hygiene. Such high
dependence on donor funding brings insecurity for long-term development and often undermines the
continuity of the programming.
Low capacity at the sub-national level, donor fatigues, weak political commitment and public unawareness
about the link between sanitation and health as well as security that results in inability to monitor seems
to be the main barriers in front of marching towards universal sanitation coverage. To overcome the
narrated challenges, focused efforts &inter-sectoral collaboration between different line-ministries are
required in different aspects from strategic issues down to the process.
Afghanistan has most of the policies in place for both urban and rural areas to address WASH. Most
recently we developed a strategy for ending open defecation by 2025. There is a strong commitment from
the development partners to scale up the Afghan context CLTS which includes a hygiene behavioral change
component as well as upgrading of existing facilities to
improved facilities.
Most recently the government has introduced the Citizen’s

Charter a new approach to decentralized and integrated rural
development that focusses on delivering basic services from
health, education and infrastructure to agriculture, irrigation,
electrification and of course water supply and sanitation.
Bangladesh Country Paper
The political commitment of the government and a multi-

stakeholder approach and the sanitation movement in the South
Asian countries, triggered by first South Asian Conference on
Sanitation (SACOSAN-I) held in Bangladesh in 2003, has made a
remarkable change in sanitation practice in Bangladesh. The
coverage by improved sanitation increased from 34% in 1990 to
61% in 2015 bringing 35 million people under hygienic sanitation
coverage. At the same time open defecation decreased from 34%
to 1%, a milestone change in sanitation practice. The coverage by improved sanitation marginally misses
the MDG, but if the shared latrines promoted in densely populated urban areas are taken into account,
the coverage would exceed the MDG.
The improvement in sanitation has directly and indirectly contributed to achievement of some MDGs by
Bangladesh. The political commitment of the government to sanitation and multi-stakeholder approach
were the driving forces towards attainment of success. This collaborative effort by government and non-
government and community-based organizations, development partners, Local Government Institutions
supported by policies, plans and strategies adopted from time to time, increased financial allocation for
sanitation, intensive campaign in sanitation month, technological innovation and marketing approaches
led to remarkable success.
Bangladesh has made a change of social and cultural behavior of the people in respect of sanitation, by
changing the behavior of open defecation to defecation in fixed latrine. Now is the time to reach the
unreached, floating and isolated population and hard-core poor in rural and urban areas, make all
sanitation facilities into hygienic, resilient in all environmental conditions and sustainable for use and
motivation for hygienic practices. Attention beyond MDG will be concentrated on technological
innovation, sustainability in disaster prone areas, fecal sludge management, public toilets, service
coverage and improving service level, sanitation facilities in launch, steamer and trains and mainstreaming
school sanitation and hygiene promotion. Bangladesh is committed to achieve SDG 6 by ensuring access
to safe water and sanitation for all well ahead of its target of 2030.
Bangladesh has evolved some good practice to share with the

SACOSAN countries. These include building market for rural
sanitation, empowering women toward 100% sanitation,
sanitation for hard-to-reach area people, SANIMART run by
adolescent girls, etc. Bangladesh will continue refining these
good practices to bring sustainable solutions to sanitation. At
the same time Bangladesh is open to share and implement
ideas and good practices adopted in other SACOSAN
countries.
Bhutan Country Paper
The Royal Government of Bhutan’s (RGoBs) 11th Five Year Plan for
2013-18 has prioritized sanitation and hygiene as a key sector result
area. Local government is responsible for setting targets, developing
initiatives, and identifying and monitoring progress indicators aligns
with the decentralisation process outlined in the Local Government
Act 2009 and as specified in the national FYP.A key strategy to
achieve the national target of universal access to improved
sanitation is for each District and Block to set sanitation and hygiene targets in their FYPs. To achieve local
sanitation and hygiene targets, each District and Block need to include in their FYP the activities, the
resources (budget and time) required, support required from other agencies, and a timeline for
implementation.  
With other developmental priorities for the government, sanitation and hygiene often gets minimal or no
funding at all. Currently sanitation and hygiene program is supported by ADB, WB, GoI, UNICEF and other
donor agencies subjecting the program vulnerable to future sustainability. Governmental support is
crucial for the long term sustainability of the program.
With the current open defecation rates at 5% nationally, and the governmental stance of zero subsidy for
sanitation, it will remain a challenge for sometime to come. Further, nomadic communities will need
proper sanitation facilities as their lifestyles demand that they keep moving places. These factors will
undermine the national coverage on improved sanitation year on. The informal settlements in urban areas
do not get urban amenities and will need special attention, if all the people are to have improved
sanitation.
While the rural sanitation coverage is expected to improve by 2018, achieving 100 % improved sanitation
is seen to be unachievable. This could be due to changing peoples need and constant rural urban
migration. Poor households still need some governmental support and availability of quality sanitation
materials is still a concern in rural communities.
Despite the commendable progress made in sanitation and

hygiene coverage, diarrhoeal incidences still remains high year on. To
accrue the benefits of sanitation coverage, PHED and WSD has
embarked on improving the behavior of the people in hygienic toilet
usage and hand washing with soap. Proper monitoring on hygiene
behavior of people will ensure that diarrheal diseases reduces
gradually over time. Provision of adequate water supply at all times is
also crucial to sustain good hygiene behavior.
India Country Paper
The Prime Minister of India has taken up the agenda of sanitation personally in order to kick start the
process of achieving Swachh Bharat (clean India) by 2019. Poor sanitation is proven closely linked with
poor health, low education status, malnutrition and poverty. Although India has made some progress over
the past few decades, the challenge before India remained huge. Despite progress, India missed the
achievement of Millennium Development Goal of halving the proportion of people with sustainable access
to basic sanitation by 2015. 
The Government launched Swachh Bharat Mission (SBM) (Clean India Mission) on 2nd October, 2014 to
accelerate efforts to achieve universal sanitation coverage, improve cleanliness and eliminate open
defecation in India by 2019. The program is considered India’s biggest drive to improve sanitation, hygiene
and cleanliness in the country. The effectiveness of the Programme is predicated upon generating demand
for toilets leading to their construction and sustained use by all the household members. It also aims to
promote better hygiene behaviour amongst the population and improve cleanliness by initiating Solid and
Liquid Waste Management (SLWM) projects in the villages, towns and cities of the country. This is to be
bolstered with adequate implementation capacities in terms of trained personnel, financial incentives and
systems and procedures for planning and monitoring. The emphasis is on stronger focus on behaviour
change intervention including interpersonal communication; strengthening implementation and delivery
mechanisms down to the GP level; and giving States flexibility to design delivery mechanisms that take
into account local cultures, practices, sensibilities and demands.  
The progress in sanitation has witnessed a spurt, since the launch of

the Swachh Bharat Mission. In the first year of the Mission i.e. from
Oct 2014-15, 8.8 million toilets were constructed, against an expected
outcome of 6 million. Since the launch of Swachh Bharat Mission, more
than 11.5 million toilets have already been constructed in the rural areas.
The sanitation coverage, which stood at 40.60% as per the National
Sample Survey Organization (NSSO) has increased to around 48.3%. The programme has a strong thrust
on equity, and focuses on the marginalized sections. The programme also incentivizes toilet construction
and usage by the poor - BPL (below poverty line) households and marginalised APL (Above Poverty Line)
households. An incentive of Rs. 12000 is available for individual latrines.  
In order to get a quick feedback on innovations in addressing various implementation challenges, Rapid
Action and Learning Unit (RALU) has been constituted at the National level and similar RALUs are being
constituted at the State levels.
Maldives Country Paper
The government of Maldives attaches a high priority to the Health

and well-being of all Maldivians. The Government is committed
to improving access to safe drinking water and sanitation to all
Maldivians. The provision of safe drinking water supply and
sanitation is regarded as a basic right for all Maldivians in the new
constitution of the country that came into force in 2008.
Provision of appropriate water supply and sewerage services is

one of the top priorities for the Government with the main task being to protect the island aquifers from
fecal contamination and thus improve health and well-being of the people. Over the years the increased
groundwater pollution and salinization, along with the socio-economic development, raised the need for
action to improve sanitation services in the atolls and higher levels of services.
The water less sanitation systems such as defecation on beach, bush (Athirimathi) and pits at house
backyard (Gifili) practiced by Maldivians until early 70’s have gradually changed into water based onsite
sanitation practices. The 2004 Asia tsunami that was hit on part of Maldives has been the bench mark that
shifted into the modern sewerage infrastructure in Maldives. Island wide sewerage systems that began
with per capita capital cost USD 85- 150 in early 1990’s is now over USD 900. Absence of a stable
institutional setup, lack of technical people and comprehensive mechanism for sustainable operation and
management of water supply and sewerage systems in islands are some of the key challenge. The 46%
population who are using septic tanks and infiltration wells for sewage disposal also happens to pollute
the freshwater lens due to direct discharge of effluent into groundwater
Efforts have been made by the Government in increasing financial assistance in providing more islands
with improved water and sanitation services. Presently throughout the country, 31 islands have improved
sewerage systems and 6 islands have desalinated piped water supply system with household connections.
More water and sanitation projects are underway across the country for the development of the sector.
Over $100 Million loan has been secured for the provision of adequate water supply and sanitation
facilities to all Maldivians. Under the loan aid, 18 islands have been proposed for adequate sewerage
facilities. Whilst 21 islands have ongoing projects for the provision of safe water supply facilities under the
loan and grant aid. In addition, around USD 27.5 million is budgeted under 2015 Public Sector Investment
Program (PSIP) Government Budget, 49 islands are targeted for adequate sewerage facilities and 21
islands are targeted for safe water supply facilities.
The Government seeks out to involve the private sector in developing,

managing as well as providing the services in a sustainable manner.
Efforts are being made to improve the sector governance and to provide
more opportunities for the private sector. Creating an investor friendly
environment is a key priority and the government policy is to take on
the role of a facilitator and regulator rather than the service provider of
these services.
Nepal Country Paper
The Government of Nepal has set a target to achieve universal

coverage of water supply and sanitation by 2017. Nepal has
already achieved the Millennium Development Goal (MDG) in
sanitation (53% by 2015). The concept of the coverage on
sanitation got new outlook after the enforcement of the Master
Plan 2011 which has institutionalized ODF as the bottom line of all
sanitation and hygiene interventions. The government, through
enforcement of the Sanitation and Hygiene Master Plan 2011, is
firmly dedicated to promote the nationwide Open Defecation Free (ODF) and total sanitation campaigns
in collaboration with stakeholders.
Country’s sanitation coverage has increased notably within the period of five years (2011-2015) after the
enforcement of the Master Plan and massive expansion of ODF campaign in the form a national sanitation
movement. Sanitation has become a priority agenda of the national development as the government has
initiated a separate budget head for sanitation and the country has adopted massive ODF and total
sanitation initiatives. Similarly, issues like human right, gender sensitivity, inclusion and menstrual hygiene
management have achieved considerable attention in policies, plans and programs. The devastating
earthquake of April 2015 aggravated challenges to achieving the national sanitation targets within the
given timeframe. Hence the accelerating progress and investments are inevitable. The WASH Sector
Development Plan is in the preparation phase and is expected to build on the work achieved through the
Master Plan and meet new demands for ensuring Environment, Children, Gender, Disabled and Aged
People friendly sanitation facilities.
For sanitation promotion, the government allocates budget through stand alone sanitation program for
water supply and sanitation projects. The water supply and sanitation sector policies have made provision
to allocate 20% budget of the sector for sanitation and hygiene promotion. Apart from it, the government
has allocated resources for WASH in school, health institutions and
public places. In addition, the DPs and I/NGOs collaborate with the
government and mobilize their resources to accelerate pace for
achieving the sectoral target. Community's self-help contribution
occupies significant share in the WASH sector financing.
After enforcement of the Master Plan, National Sanitation and Hygiene

Steering Committee (NSHSC), National Sanitation and Hygiene
Coordination Committee (NSHCC) and
Regional/District/Municipality/Village Development Committee (VDC) level WASH Coordination
Committees (R/D/M/V-WASH-CCs) have led formulation and execution of the strategic plan/plan of action
in respective levels. The sector actors work under this unified plan with common target, principles and
approaches. Due to continuous and collaborative efforts by the government, DPs, CSOs and I/NGOs over
years, the recently promulgated Constitution of Nepal 2015 has recognized access to safe water and
sanitation as citizen's fundamental right.
Pakistan Country Paper
Pakistan has made steady progress towards achieving an open

defecation free environment evident from recent surveys,
although it still has a long way to go for improved sanitation.
According to the Joint Monitoring Programme (JMP) Report 2015,

Pakistan has achieved the MDG target of improved sanitation i.e.
65% in 2015, but still an estimated 70 million people in Pakistan
live without improved sanitation. Further, Pakistan has made
significant progress of reducing open defecation from 49% in 1990 to 13% in 2015 with an average 3.9%
annual rate of decline. In numerical terms, about 25 million people practice open defecation.
The significance of sanitation has been recognized in the Vision 2025 document of the Ministry of Planning,
Development and Reforms, Government of Pakistan that was launched in August 2014 by the Prime
Minster of Pakistan, which is the roadmap of the Government of Pakistan. The document lays emphasis
on provision of safe drinking water and improved sanitation through an integrated development strategy.
Presently, the Ministry of Planning, Development and Reforms is in the process of finalizing its
implementation and monitoring framework, in which one of the key indicators agreed in the document is
“Increase of proportion of population with access to improved sanitation from 48% to 90%” by 2025 which
is in-line to the SDGs to which Pakistan is a signatory.
Pakistan continues to face the challenge of appropriate solid waste collection and its safe disposal.
Presently, 23 % of HHs in Pakistan reported to have a garbage collection system. Compared to urban areas
where 57%, only 6% rural HHs have any garbage collection system. The Government of Punjab started
Lahore Waste Management Company and has now been replicated in five major cities of Punjab and plans
are underway to extend this coverage to all other major cities under “litter free’ Punjab initiative.
The share of expenditures made on water and sanitation are about 0.219% of GDP during 2014-2015
compared to about 0.17% of GDP during the 2012-2013 fiscal year. Moreover, there is a visible increase
in the investment made by the provinces on the social mobilization programme for ODF either through
public private partnerships with civil society partners’ organisations or even specific allocations under
Annual Development Programmes.
The formation of new local governments under Local Government Acts 2013
in respective provinces is an opportunity to build strong leadership and
governance to WASH especially hygiene and sanitation. This will be
complemented by newly developed WASH sector plans and provincial
integrated development strategies. The sector will need to focus on adding
the capacities of these newly formed local governments for effective
execution and implementation of sanitation initiatives and also enhance
voices and participation of local communities to ensure ownership and
accountability
Srilanka Country Paper
Sri Lanka has moved up the sanitation ladder in the past 50 years
and has already achieved the MDGs target. In Sri Lanka over 90%
of the people have access to improved sanitation and the national
goal is set for bridging the gap of less than 10% of the unreached
population.
Provision of water and sanitation has been one of the highest

social service priorities of the government and current
achievements are due mainly to this thrust based on the clear roles assigned to the main actors and
promotion of the commitment of the users. The institutional framework evolved over the past few
decades to meet the challenges and to achieve the set targets for the sector.
Establishment of a separate ministry for water and sanitation viz the then Ministry of Water Supply &
Drainage (My of WS&D) and the National Coordination Forum on WATSAN under Government leadership
with the Secretary My of WS&D as the Chair, provided the platform since 2007 for all stakeholders in the
sector for effective coordination.
Sri Lanka has a national goal to achieve universal coverage in Sanitation by 2020. Apart from difficulties in
mobilizing large scale financing for achieving national targets there are no cultural or social barriers to
bridge the gap in sanitation coverage.
Sanitation service improvement is a continuous process in Sri Lanka as it requires climbing the sanitation
ladder and provides next higher level facility in terms of technology and quality of service. Sri Lanka’s
challenges are mainly on the improvement of environmental sanitation. The safe disposal of human
excreta is the essence of the sanitation challenge. Complete removal of direct pit latrines and improve
technology in water logged areas, proper disposal of excreta along the coastal belt and high water table
areas posing a challenge at present and solutions are being implemented.
Sri Lanka’s impressive achievements in the sanitation sector is mainly due to the considerations matted
out to provide subsidies for low income families throughout the country to build their own toilet. Rural
water supply sector development included sanitation revolving fund at district level to reap benefits by
the poor household to meet an affordable solution for their household sanitation. Sanitations have been
considered as a right in the sanitation policy which is in line with the response o Sri Lanka to monitor SDGs
beyond MDGs. Men and women have equal rights in Sri Lanka in terms of gender equality and equal
opportunities to advance and pursue individual goals in life.
Sri Lanka has already responded positively to join the global efforts
in mobilizing efforts in meeting SDGs and the Goal 6 and its sub
targets are mainly taken up by the Ministry of Water Supply &
Drainage through the NWSDB.
REVIEW OF SACOSAN-V COMMITMENTS (TLP)
Signing of the Ministerial declaration with specific commitments has been an

important convention of the SACOSANs since inception. Such a declaration is
also seen as an important end product of different streams of discussion that
happens during each SACOSAN. The commitments reflect a direction for
actions that are intended to achieve long term and specific short term goals
committed by the eight National Governments to progress towards universal
access to sanitation in South Asia.
The progress against the ten commitments signed at SACOSAN V, using an

indicators' framework developed through consultation process within Inter
Country Working Group (ICWG) was presented. The progress review
complemented the country reports shared by the National Governments at SACOSAN VI even as it takes
a step forward to more objective and precise measuring system that can record the progress made on
each of the ten commitments.
The review of SACOSAN V commitments highlighted encouraging positive movement overall with
considerable progress in most of the commitments made. It is for the fourth consecutive SACOSAN that
FANSA and WaterAid have jointly conducted this review along with other civil society groups with the
cooperation and support from the National Governments and other Regional partners. The learning over
the past eight years has contributed to make significant improvements in the methodology and
presentation of the findings that emerged from the assessment process. During the presentation, it was
stressed that SACOSAN VI and follow up meetings of ICWG should integrate indicators based measuring
of progress into each country's reporting process. (See attached presentation for details)
PLENARY SESSIONS
A total of seven plenary sessions were held with support from the development partners.
Plenary Session 1: Community Approaches to Sanitation & Hygiene
Chair: Mr. Jyotirmay Dutta, Additional Secretary

(Urban Development), Local Government Division,
Ministry of LGRD & Co., Bangladesh
Co-Chair: Dr. Chris Williams, ED WSSCC
Moderator: Dr. Kamal Kar, Chairman, CLTS

Foundation
Presenters:
-Mr. Nipun Vinayak, IAS, Director MDWS, India
-Mr. Ghulam Muqtadir, DPHE, Bangladesh
-Sacosan focal person, Bhutan
-Ms. Tanya Khan, WSSCC, Pakistan
-Representative of Govt of Nepal
-Representative of Govt of Afghanistan
This session was chaired by Mr. Jyotirmay Dutta, Additional Secretary (Urban Development), Local
Government Division, Ministry of LGRD & Co., Bangladesh and moderated by Dr. Kamal Kar. The session
was initiated by appreciating the various community approaches being implemented by the countries of
South Asia and Africa. The best practices on community approaches in six countries of South Asia were
presented. The enabling environment, political support, innovations and synergies between the
government and vibrant civil society were the key factors of success. The respective governments taking
the leading role in implementing behavior change programmes was applauded and seen as a great
achievement. The presenters highlighted that the states and sub national governments have begun to
speak the language of behavior change focusing on involving the community which was earlier not seen.
Inter-sectoral approach and the role of the health workers was highlighted as critical.
Mr. Chris Williams emphasized on the learning on the key determinants and the obstacles faced such as
struggle to sustain and the innovations across the countries in South Asia as a common factor in all the
presentations. The role of the local governments and importance of documentation and constant learning
were highlighted as critical for accelerating the scale up of the programmes.
Plenary Session 2: Innovation on Sanitation & Hygiene
Chair: Mr. SaurendraNath Chakrabhartty, Additional

Secretary (Admin), LGD, MoLGRD&C
Moderator: Mr. Parameswaranlyer , Practice

Manager, World Bank Water GP
Presenters:
-Mr. AKM Ibrahim, Project Director, BWSSP, DPHE
Bangladesh
-Ms. Nitya Jacob, WaterAid India, TiffinBox
-Ms. Archana Patkar and Saskia Castle, WSSCC
-Arif Abdullah Khan, Programme Manager- Climate
Change, WaterAid Bangladesh
This session was chaired by Mr. Sourandra Nath Chakrabarti, Additional Secretary of LGD, Bangladesh and
moderated by Parameswaran Iyer, the World Bank Water GP Practice Manager. Innovative ideas for media
campaigning, inclusiveness, local governance and climate resilient technologies were presented in the
innovations session. The session provided a view on the various sides of sanitation: latest technologies
that are replicable also in environmentally vulnerable areas, changing the mindset of the community,
inclusiveness of those whose voices are not heard and finally effective implementation in local
government level.
The climate resilient sanitation technologies for flood prone areas of Bangladesh were presented. Water
Aid India presented a poster campaign called Break the Taboo: Let’s talk menstrual hygiene. Menstruation
is still a taboo in India and to break the taboo WaterAid India’s communications team developed a series
of Menstrual Hygiene related posters. The posters were also used by other country programmes like
Pakistan and Nigeria. The campaign was very successful in social media networks. The participants were
informed that in Madhya Pardesh, the Government is using these posters as a tool in more than 5000
Aanganwadi Centers. It was highlighted that this form of media is easily consumed, transfers information
quickly, requires less time, and can share a great deal of information efficiently leading to behaviour
change.
Plenary Session 3: ‘Voices’ elderly people, women, adolescent, differently abled children
Chair: Mr. Rauf Hakeem, Hon’ble Minister Sri Lanka
Moderator: Mr. Murali Ramisetty, Regional

Convenor, FANSA and Archana Patkar, Programme
Manager, WSSCC
Presenters:
-Afghanistan – Ms. Abida
Day 3 pictures missing -Bangladesh – JoyaShikdar (TG)
-Bhutan – Ms. Ugyen Tshomo
-Maldives – Ms AisathNaizath (PwD)
-Nepal – Lakshmi Devkota (PwD)
-Sri Lanka – SaravanamuttuJeyam. (plantation
worker)
-India – Adolescent
This session was chaired by Mr. Rauf Hakeem, Hon’ble Minister from Sri Lanka and moderated by Mr.
Murali Ramisetty, Regional Convenor, FANSA and Archana Patkar, Programme Manager, WSSCC. In this
session, space was given to hear voices of diverse, marginalised stakeholders directly, including women,
adolescent girls, people with disability, sanitation workforce and trans-gendered communities from
around the region, ensuring governments met their commitments. Though certain constituencies, such
as the elderly, were still missing, but overall the opportunity to raise the voices of vulnerable and
marginalised groups was an exciting experience and was well received by the governments and the civil
society members.
This session was an outcome of 55 consultations organized across eight member states of South Asia by
WSSCC, in collaboration with FANSA, to listen to demands, concerns and suggestions of the people who
are most affected by poor sanitation. This campaign was about putting into practice the Kathmandu
Declaration – and the commitment of SACOSAN to hearing the direct voices of those most affected, giving
them a platform, listening to them and taking action together. The outcomes were presented in the report
‘Leave No One Behind: Voices of Women, Adolescent Girls, Elderly, persons with Disability, and Sanitation
Workforce’. It is hoped that this initiative will lead to more active engagement of other marginalised
groups in WASH which will be a great achievement in the region.
Plenary Session 4: The SACOSAN Journey: 2003-2015
Chair: Mr. Md. Mahbub Hossain, Joint Secretary

(WS), Local Government Division, Ministry of LGRD
& Co.
Moderator: GO of Bhutan/Sri Lanka

Day 3 pictures missing
Session purpose: Dr. Dibalok Singha, DSK/FANSA
Presenter: Mr. Ravi Narayanan, Lead Author of the

Review Team, FANSA
Closing: Murali Ramisetty, Convener FANSA
This session was chaired by Mr. Md. Mahbub Hossain, Joint Secretary (WS), Local Government Division,
Ministry of LGRD & Co. Bangladesh and moderated by representative of Bhutan & Sri Lanka. One of the
areas of wide agreement was that the SACOSANs had raised the profile and importance of the sanitation
issue in the region. These were the only forums where the focus was solely on sanitation. What could
safely be stated was that SACOSANs contributed to keeping the issue of sanitation live and increased the
political will even if all the national governments' actions could not be attributed to these conferences. It
was also widely appreciated that the SACOSANs were ‘owned’ and seen as initiative proactively driven by
the National Governments of the region with required support from the regional partners. The setting up
of the ICWG was seen as a decisive step in this direction.
It was highlighted that SACOSANs could be further mainstreamed in the political processes in South Asia
such as in SAARCs. Suggestions to make SACOSAN more productive include broader selection of national
delegates (these must include more number of women, civil society and community representatives). The
country reports must include progress made on previous SACOSAN’s commitments and a follow-up
mechanism to ensure the incorporation of the final declaration is made at country level action plans must
be put in place. It was stressed that the SACOSAN process will have no relevance if the countries do not
report back with their progress on the commitments made during the intervening periods of the
SACOSANs and the gaps that still need to be addressed.
A small permanent establishment was advocated to note the outcomes of each SACOSAN and try to
provide a bridge to the subsequent SACOSAN by following up commitments made and agreements
reached.
Plenary Session 5: The Sustainable Goals – Opportunities for Sanitation & Hygiene in SA
Chair: Mr. Henk van Norden, Regional WASH

Adviser, UNICEF ROSA
Presenter: Mr. Rolf Luyendijk, Chief WASH

Afghanistan, UNICEF
This session was chaired by Mr. Henk van Norden, Regional WASH Advisor, UNICEF ROSA and a
presentation on SDGs was made by the Mr. Rolf Luyendijk, Chief WASH UNICEF Afghanistan. The
discussion focused on explaining the SDG pertaining to water and sanitation and how it was different from
the MDGs and what we need to do differently in order to achieve them. It was emphasized that the SDGs
demand focus on the most vulnerable population. The richest 20 percent have much higher access than
other wealth groups and the gap is increasing.
The participants were explained that the in order to achieve the SDGs, the member states need to address
systems and not symptoms which means that they need to (a) lead and enable i.e. identifying bottlenecks,
plan and allocate resources transparently and set policies and standards to address inequalities (b)
coordinate and manage i.e. streamline institutional roles & responsibilities, coordinating partners around
a single plan, and holding people accountable for results (c) and support and maintain i.e. monitoring
progress and taking corrective action, financing and supporting the front line staff and investment in
capacity for operation and maintenance. The role of the different constituencies i.e. government,
businesses, civil society and academia was highlighted as critical in achieving the SDGs which is also in line
with the mandate of Sanitation and Water for All, a global partnership for universal access.
Plenary Session 6: Role of Media to Improved Sanitation and Personal Hygiene Behaviour
Chair: Mr. Md. Shah Kamal, Secretary, Ministry of

Disaster Management and Relief
Moderator & Global Expert:

Mr. Richard Lace, BBC Media Action
Day 3 pictures missing Presenters (Journalist):
- Mr. Jagdish Kharel , Nepal Journalists Association
- Mr. V. Ganapathy, Special Correspondent, The
Hindu India
- Mr. Shamol Datta, Sr. Reporter, The Daily
BhorerKagoj, Bangladesh
- Video message by Dr. Val Curtis, LSHTD
This session was chaired by Mr. Md. Shah Kamal, Secretary, Ministry of Disaster Management and Relief
and moderated by Mr. Richard Lace. The panelist discussed what kind of a story drives behavior change
and how to utilize the power of social media. It was pointed out that sanitation can easily be an interesting
story for media to report because it touches everyone’s life. The important factor is to try to find a
surprising angle in the communications about sanitation. News about money always matter so putting a
price tag on insufficient sanitation would help the media coverage. The chair highlighted that it is
important to state that intended behavior change requires an approach which utilizes various channels:
from newspapers to social media, interpersonal communication and cultural and traditional media. It is
important and crucial to strengthen media utilization to increase the coverage on sanitation and hygiene
in households and within communities.
Plenary Session 7: Monitoring Sanitation & Hygiene beyond MDG through JMP, GEMI, GLAAS
Chair: Mr. Sk. Abu Jafar Shamsuddin, Sector

Expert, Bangladesh
Moderator: Ms. Payden, WHO Regional Adviser,

WASH
Opening Remarks: Mr. Sanjay Wijesekera,
Associate Director UNICEF WASH HQ
Presenter: Mr. Bruce Gordon, WHO WASH

Coordinator HQ
This session was chaired by Mr. Sk. Abu Jafar Shamsuddin Sector Expert, Bangladesh and moderated by
Ms. Payden, WHO Regional Adviser, WASH. The progress of South Asian countries on MDG sanitation
target was discussed. Comparison was shown of the development aid for water & sanitation relative to
other sectors, South East Asia Region (GLAAS/OECD). It was highlighted that the external aid development
for water & sanitation comprised over 6 percent of total aid to the region in 2013. Shift from the MDGs to
SDGs was explained highlighting ten indicators for monitoring goal 6. The coordination across goal 6 and
other SDGs was emphasized along with the critical role of member states. The session concluded by
sharing mechanism for monitoring WASH in institutions.
TECHNICAL FOCUS SESSIONS
There were eight technical focus sessions held on day ii of the conference. Each technical focus session
was supported by a member state of the SACOSAN. Each session had four presenters followed by question
answer session and discussion.
Technical Focus Session 1: Hygiene Promotion (Afghanistan)
Chair: Head of Afghan delegation
Moderator: Ms. Therese Mahon, Head of South Asia

Region, Water Aid UK
Presenters:
- Mr. Mohammad Javed, Hygiene Section Head,
RuWatSIP/MRRD, Afghanistan
- Mr. Nasratullah Rasa MoE, Afghanistan
- Ms. Julia Rosenbaum, Bangladesh
- Ms. Binu Arickal, WaterAid, India
Supporting Partners: WSSCC
The session focused on the following presentations:
 CLTS as Best Practice in Afghanistan

 The Journey of Menstrual Hygiene Management in the Afghan
 Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time
 Principles and challenges in scaling up CLTS – Experiences from Madhya Pradesh, India
CLTS as Best Practice in Afghanistan

RuWatSIP/Ministry of Rural Rehabilitation and Development (MRRD)
ABSTRACT:
15% of Afghans defecate in the open1 but the majority of the existing latrines cannot be categorized as
improved. The common types of latrine in the country are the traditional vault- and the pit latrines as
used by 75%2 of the population and often do not meet all the criteria of an improved latrine. Based on the
survey3, the coverage of improved sanitation does not go beyond 2.4% in the rural areas. Part of the
unsanitary condition of these traditional latrines is the poor excreta management which is another
1
National Risk & Vulnerability Assessment (NRVA) 2011/12

Traditional vault latrines are in general unimproved latrines which are constructed on top of the soil (often with
elevated access) that have an open squatting hole, absence of a ventilation pipe, no prevention against flies, and
often excreta is freely and openly flowing out of the vault as there is no cover or door of the vault.
2
NRVA 2011/12
3
NRVA 2011/12
challenge. Over the last two decades, WASH sector partners have been using different methodologies
(subsidy based latrine constructions, demonstration latrines, house to house visits, focus group
discussions, campaigns, trainings…) in order to promote toilet construction and use, good hygienic
behaviors and improve the household sanitation status. However, limited improvements were achieved
particularly with regards to construction of new latrines for/by those who don’t have a latrine and/or need
to improve their existing unimproved latrines. Another part of the lack of behavior change, which still
results in high incidences of diarrhea and stunting of up to 25.4% and 60.5%4 respectively of the children
in Afghanistan. Community-Led Total Sanitation (CLTS) was piloted in 2010, and despite a number of
challenges including the security situation, the approach has proved to be successful and the replication
of CLTS activities is ongoing with support of UNICEF. Family Health Action Groups (FHAGs) and the training
of natural leaders, who emerge during the triggering stage, are the keys to the Afghan Context CLTS which
is in essence sustained hygienic behavioral change.
Background
Lack of access to safe potable water, sanitation facilities and absence of hygienic behavior has exacerbated
the psychological and economical burden on the shoulders of families, particularly the poorest. Under 5
child mortality has been reported 97/1,000 live birth (23% of these deaths are directly attributable to
unsafe drinking water, poor sanitation and hygienic practices)5
Access to improved water sources in Afghanistan is 46% and improved sanitation facility is 8.3% in
Afghanistan6. Significant improvement has been made in the provision of improved water supply from
27% in 2007/8 to 45% in 2011/12, but very little improvement has been made with regards to sanitation,
5% in 2007/8 and 8.3% in 2011/147. In spite of good progress in water supply, we are too slow in sanitation
part. Open Defecation (OD) practice still stands on 15%. The traditional latrines are mostly unimproved
latrines which can in general be regarded as a type of open defecation so, the 15% OD is in fact much
higher. The big gap between progress on water supply but lacking sanitation is a challenge for achieving
the expected health benefits from improved WASH services. Noteworthy is the fact that in principle the
coverage level of water supply and access to sanitation should increase simultaneously, since the two
issues are both related to heath and are complementary, however that is clearly not the case.
Though the struggles for eradication of OD and construction of improved latrines had started more than
a decade before by using the traditional project approach of building demonstration latrines in villages
and spreading messages, this approach did not result in bringing the desired results. The latrines are often
emptied prematurely and under unprotected circumstances and the feces is being used without being
fully detoxified and composted as fertilizers.
CLTS, as a successful regionally tested approach, was introduced in Afghanistan in 2010 through the USAID
supported Afghan Sustainable Waters Supply & Sanitation (SWSS) project in cooperation with the Ministry
of Rural Rehabilitation and Development (MRRD), which piloted this approach in six provinces. The CLTS
approach is based on the use of triggering which persuades and sometimes even shames people into the
realization that they have to take care of their own sanitation situation without incentives or subsidy. After
piloting the USAID’s SWSS project in 2010, promising results with regards to OD eradication and using
4
National Nutrition Survey (NNS) 2013
5
Mortality Report 2011
6
NRVA 2011/12
7
NRVA 2007/8 and 2011/12
improved latrines were reported. MRRD with financial support from UNICEF adapted the
Community Led Total Sanitation (CLTS) in Afghanistan Context and began implementation
in 4 provinces in 2013 and later expanded to 6 provinces.
Afghan Context CLTS in action
The Afghan Context CLTS is a combination of CLTS based on the examples from Bangladesh by Dr. Kamal
Kar as started around 2000, and its application in these 15 years all over the world, and additional hygiene
interventions to change behavior in a sustainable way. Due to the highly traditional and cultural
determined family and village structure in Afghanistan the inclusion of the elders and traditional groups
often divided in specific groups for women and men, is essential. Through training and support natural
leaders could be identified and they became the CLTS leaders. These leaders support the establishment
and training of mothers’ groups called the Family Health Action Groups (FHAGs), who are not only practice
good hygiene and sanitation, but also encourage 10 to 15 neighboring families, use of Information
Education Communication (IEC) materials and distribution of notebooks and leaflets in schools as well as
village cleaning campaigns. Since 75% of the people use traditional latrines, AC-CLTS also focuses on
improving the existing latrines in order to make them safe.
Focus of Afghan CLTS

This approach focuses on ensuring behavior change rather than traditional approaches of conveying
pathogen-health messages and depending only on hardware components. Likewise during the triggering
phase people appraise their own sanitation practices, realize their short comings and take action to move
away from the undesired situation. Majority of Afghans have traditional unimproved latrines, but many
males go for OD not using household latrine. As a result of triggering and peer pressure, even poor people
somehow manage to build/improve their latrine and start using it, and in some cases with the support of
rich people the building latrines have also been accompliced.
Selection of Villages
In the Afghan Context of CLTS implementation, the districts and villages were selected by the provincial
team consisting of the Directorate of Provincial Rural Rehabilitation & Development (PRRD of MRRD), and
thePublic Health Department(DoPH of MoPH). In the provinces there was consultation with the National
Environmental Protection Agency (NEPA) and the UNICEF zonal offices. The main criteria for selection of
villages wereoccurrence of high Open Defecation (OD), unsightly environmental conditions and high
incidence of diarrheal diseases. The initial 4 provinces of this program selected for implementation of
Afghan Context CLTS were in different regions of the country, Bamyan & Daikundi in Central Region,
Helmand in the South and Samangan in the North. Per province, two districts were chosen and in each
district at least 15 villages covered as per the criteria mentioned above. The provinces have been
highlighted in blue color in the map hereunder.
Baseline and Triggering in the villages
After selection of the district and favorable villages in coordination with the provincial line departments,
the first visit with the village leaders takes place. After the introduction, the CLTS team asks for an
appointment for the next visit where the maximum number of villagers (of all ages) is requested to be
present in a convenient place. Date and time is determined by the village leaders. Most of the people in
the country are not interested to listen to you talking about hygiene and sanitation, so the purpose of visit
is generally told learning from the villagers regarding causes of illnesses in the village, or types of diseases
in the village...
Two male and two female facilitators accompanied by a supervisor tackle the triggering separately for
men and women. Triggering starts with introduction, purpose of the visit, followed with rapport building.
The typical Participatory Rural Appraisal (PRA) tools are implemented where the facilitators are looking
for triggers that create shame, shock or/and disgust amongst the people during the PRA implementation
from their existing practices and behaviors. Starting from community/social mapping in an open area and
followed with identification of places of defecation, transect walk also called walk of shame, spread of
diseases/flow diagram, calculation of feces, medical expenses and finally the realization of negative
hygienic and sanitation related behaviors. The villagers realize they have to change so, they decide to take
action towards abandonment of open defecation. Different triggers cause different people to change and
decide. The facilitator is always looking for what make people ignite and change. They draft plan of action
and paste it is somewhere visible so, that the villagers easily see it. During the triggering some interested
and active villagers are recognized. The CLTS committee is formed from these people also called the
natural leaders who take the follow up responsibility of their village in order to become Open Defecation
Free (ODF).
Women group during introduction step of triggering in Bamyan province
Women group drawing social map during triggering
Women decided to stop open defecation

Follow-up after Triggering
The routine follow up is tackled by the CLTS committee from their own village. During the triggering it is
discussed that if one person defecates in the open, the harm will not be limited to that family, it can harm
others too. The committee therefore, tries to convince others and help them stop OD. The CLTS team
makes visit not very frequently, but as per their plan and the plan is made as per the villagers’ promises
of stopping OD and building/improving latrine. Normally once to twice in a month. During the follow up,
the CLTS team visits the sites of open defecation they had observed during the triggering, see latrines
under construction and under improvements, observe whether or not the villagers have taken the hand
washing facility into consideration. The activities of the FHAG is also observed if any positive changed has
occurred to their own homes and children and neighboring families as well.
Training activities as part of CLTS

Afghan Context CLTS has integrated hygiene trainings for male and female. The project master trainers
conduct initial hygiene training and train the provincial CLTS facilitator teams and provide them with
required guidelines and IEC materials. After triggering the target villages, the influential leaders mostly
from the Community Development Councils (CDCs), religious leaders, teachers and CLTS committee also
called the natural leaders are invited for a 2 to 3 days hygiene training at the district or provincial level to
attend the training and share the information with others. These trainings have proven to be very effective
in converting a village into ODF status and its sustainability. Apart from that, the knowledge of the people
in regards to hygiene and sanitation builds on. The FAHGs has the responsibility of 10 to 15 neighboring
families to work with and make their homes clean and hygienic. Men do the same with other men and
children helping to keep their village clean.
Monitoring of CLTS activities

The team from the ministry visits the villages. During the visit, they meet with the CLTS committee and
other influential personalities to see their reflection on the program and learn what made them changing
their decision of stopping OD. Meanwhile some houses as sample are checked to see their hygienic status,
the latrine and hand washing facility and practices from the signs of being used. The ministry team mostly
goes for monitoring once a month. During the visit from the houses, the village leaders are part of the
monitoring process. Whereas, the CLTS team see each and every house and collect the data for compiling
it into their monthly reports.
The monthly reports are sent from the field for each village by the provincial officer to hygiene section
head with the following information:
 # of villages triggered per district with triggering date
 # of verified villages
 # of certified villages
 # of newly constructed latrines
 # of improved latrines
 # of Family Health Action Group (FHAG) established
 # of FHAG trained
 # of villagers trained in hygiene
Verification and Certification of ODF Villages

A time comes, when the CLTS committee of the village claims their village is ODF and appeal for
announcing their village as ODF. A team consisting of representatives of line departments, national and
international NGOs, CLTS team and the villagers fix the time with the villagers and check
the entire village if it is really ODF. The team sees:
- Previous OD sites are clean
- Places which are susceptible for OD are clean
- Check all the houses of the village to see if they have built/improved their latrine and its being
used
- Hand washing facility and it’s being used
- No human feces visible on the ground, neither in the house, nor in the village
This way the committee fills the pre-developed form and signs it. This takes the process to the next step
of ODF certification. When a village is verified as ODF, it means there is no OD practice, each house and
all family members have access to latrine and use it, hand washing facility exist and being used and the
latrine excreta is safely disposed. ODF certification is the confirmation of the ODF status. Depending on
the length of the project, the certification team same as the verification team check the above mentioned
criteria and confirm the village is ODF.
Afghan Context CLTS Results
During the SWSS project in Afghanistan, 2010-2012, 6 provinces 14 districts were chosen for
implementation of CLTS. As a result of those interventions a total number of 611villages achieved the ODF
status.
Ministry of Rural Rehabilitation & Development (MRRD) initiated working in 4 provinces following the AC-
CLTS in 4 provinces in mid 2013.The results of the CLTS activities between 2013 – 2014 have been listed
in the table 18:
N Provinc District # of # of # of # of # of # of houses

o e village traditiona traditiona latrines houses built new
s l latrines l latrines improved without improvedlatr
achiev before before after latrine ine
ed ODF interventi interventi interventi before
status on on on interventi
on
1 Helman Lashkarg 10 ?? 610 610 390 400
d ah 610+400
Nad Ali 7 588 588 252 252
2 Bamyan Center 24 1080 1080 720 720
Yakawla 8 572 572 308 308
ng
3 Daikund Nili 14 1540 1540 539 541
i Shahrist 14 1410 1410 520 520
an
4 Samang Khoram 9 1425 1425 475 487
an Aybak 9 1479 1479 450 451
8
RuWatSIP CLTS monthly reports
Total 95 8704 8704 3654 3679
Between 2013 -2014 the CLTS team in Afghanistan was able to motivate 95 villages in 4 provinces in
achieving ODF. All traditional latrines, which were not hygienic, were improved and all houses that did not
have a latrine before now installed an improved one on their premises. As a result, all families in the village
now have access to an improved latrine.
The process is still ongoing at present in Helmand province, restarted in Bamyan and Daikundi (just a
month ago) and initiated in 3 provinces in 2015. It is expected to achieve 100 ODF Villages at the beginning
of the year 2016, in the mentioned provinces, where twodistricts in each province have been targeted. It
is expected that by the end of 2015 Afghanistan will have 200 villages declared ODF by MRRD plus 611 of
the SWSS project (2010-2012) and about 50 under other organizations initiated CLTS.
Table2: Open Defecation before and after intervention, between 2013-2014 in 4 provinces9
70
60
50
% of people practicing OD
40
before intervention
30 % of people practicing OD
after intervention
20
10
0
Helmand Bamyan Daikundi Samangan
Source of data: CLTS/RuWatSIP field reports 2014
In Afghan Context CLTS the tradition unimproved latrines are rehabilitated and made safer, likewise a
place for hand washing has also been identified with water and soap beside latrine. During the verification,
the availability and use of latrine and hand washing facility has also been one of the criteria for verifying
the village as ODF, not only availability of latrines.
Depending on the geographical location, there are families who do not have latrine at all. During the
implementation period of Afghan Context CLTS, people are triggered and their mind sets are changed to
build safe latrines with hand washing facility (water and soap) and use it. Below chart shows the
construction of new latrines for the ones who did not have latrine before.
9
RuWatSIP CLTS monthly reports
Table3: Latrine construction before and after intervention, between 2013-2014 in 4 provinces
1200
1000
800
# of houses without latrine
600
# of houses built latrine after
400 intervention
200
0
Helmand Bamyan Daikundi Samangan
Source of data: CLTS/RuWatSIP field reports 2014
In the 95 villages which reach ODF between 1-2 years, work was done by the community to rehabilitate
their unimproved toilets (71%) and the remainder of the houses constructed new toilets (29%). During the
verification of ODF, 2 to 3.2% OD exists in the target villages. However, this was corrected and during
certification the whole village reached 100% ODF.
Based on these data it can be concluded that the building of toilets has been already part of the tradition,
but to make them safe and hygienic needed this CLTS intervention. All was done by the community
members using their own resources and 100% coverage was reached, even though Afghanistan is and has
been in crises for over 30 years.
Lessons Learned, Challenges and the Way Forward
Lessons Learned
Improvement of existing traditional latrines and construction of new latrines with the support of the
mothers’ group called the Family Health Action Groups (FHAGs) and the training of natural leaders who
emerge during the triggering stage, are the keys to the success in Afghanistan. Improving the sanitation
and hygiene status of target beneficiaries without provision of any subsidies to the people,shows
encouraging results even under stressful circumstances.The field results reveal that the CLTS in Afghan
context proves to be an appropriate approach towards converting villages into Open Defecation Free
(ODF) status and promoting good hygiene practice which in turn result in reduced diarrheal cases among
the target population. As a result of these CLTS activities and the involvement of the natural leaders, there
is a significant improvement of traditional latrines, construction of new latrines, use of latrines by all family
members, absence of OD, safe disposal of human feces, establishment of Family Health Action Groups
(FHAGs) and improved hygienic behavior like hand washing with water and soap after using toilet.
Based on this field evidence the Afghan WASH policy, which is in the process of revision, therefore insists
on including the CLTS approach in the Afghan context as a successful tool for not only eradicating OD but
even more promoting improved sanitation and behavioral change through appropriate hygiene measures.
One of the most important challenges is still the safe disposal of human excreta. This aspect has been
taken up as part of the CLTS approach, whereby the community is informed on ways to safely dispose of
the excreta during training workshops and follow up visits after the triggering. Usage of excreta as fertilizer
is a common practice, but the emphasis needs to be the safe handling of feces and the composting. After
a composting period, depending on the climate and soil conditions of the area, the excreta are ready and
safe for use on the land.
Challenges
 While contextualized CLTS helped eradication of OD and construction of new sanitary latrines and
upgrading of traditional latrines, excreta management is still a big challenge
 To reach out to all villages so all will reach ODF in their own time based on their own means.
 While the intervention improved the innermost circle of the environment that is the household
living environment, utilization of fresh excreta in the fields as fertilizers causes health hazards to
the farming communities.
 For activities which are part of CLTS it is hard to go beyond construction of new latrines and
upgrading of traditional latrines and safe disposal of excreta, excreta management, composting
process and using environmentally fully detoxified compost in the field still remaining to be
thought of.
Way forward
Regular monitoring and refreshing of the health and hygiene information will keep people informed and
will avoid slippage. The MoPH together with the CDCs are best positioned to continue this support to
sustain the behavioral change attained.
MRRD together with MoPH and MOE aim to scale-up the CLTS activities in order to achieve all villages ODF
free, including the public spaces, by 2030. The National WASH Policy will support this objective, and all
ministries in their own way will contribute to achieving this sustainable goal.
People need to adapt their traditional way of safe removal and use the human waste. Using feces and
extending their knowledge about the use of composition the fields is beneficiary and is in fact part of the
Sustainable Development Goals (SDG). The economic burden and environmental implication of chemical
fertilizers is also known, therefore CLTS should include composting issues in its implementation and build
on people experience
.
The use feces for compost is not the only positive and economic behavior, separating their waste and
including organic waste and even urine as natural fertilizer on their fields and should be coached in
improving the process
Author:
Mohammad Javed
Hygiene Sanitation Expert with RuWatSIP/MRRD, Afghanistan
[email protected]
Co-author:
Eng. Mohammad Afzal Safi
National Program Advisor, RuWatSIP/MRRD, Afghanistan
[email protected]
The Journey of Menstrual Hygiene Management in the Afghan schools

Authors: Nasratullah Rasa, Mohammad Daud Mukhlis, Pam Minnigh
Abstract
Menstruation is a very important stage in the development of maturity of girls. The onset of menstruation
is a significant milestone in the transition to adulthood, and it can present some challenges and concerns
among adolescent. Ignorance and inadequate or lacking facilities for proper Menstrual Hygiene
Management (MHM) for young girls leads to missing school days and can lead to girls completely
dropping-out of school. In addition to being a hygiene and health issue, menstrual hygiene management
is linked to the general health condition of girls, educational attainment, and social related issues like
dignity, cleanliness and even early marriage of girls. The magnitude, extent and the need for menstrual
hygiene management has not been fully understood in many societies. Nevertheless, Afghanistan has
already taken a number of great steps to identify the issues related to MHM in schools as well as the way
to address them.
Afghanistan has been working to incorporate MHM into the Water, Sanitation and Hygiene (WASH) in
school program. The country began the MHM in school journey by conducting a KAP study. In 2010, the
Ministry of Education and UNICEF conducted a Knowledge, Attitude, and Practice (KAP) study in two
provinces of Afghanistan (Kabul and Parwan). The initial KAP study showed low awareness of girls about
menstruation and lack of MHM facilities in schools for girls On the basis of this study MoE with support
from UNICEF developed an information package for teachers and girls on MHM and included MHM
facilities such as washing rooms and disposal units for napkins or pads in latrine designs for schools.
An evaluation of MHM program was conducted in 2013 to assess functionality and use of the MHM
facilities in 16 schools of two provinces (Kabul and Nangarhar). This evaluation found, as in many parts of
the world, latrines are locked by teachers, or many of them were not clean, and very few students used
the washrooms built for MHM.
At the end of 2015, research will be conducted by MoE and UNICEF Afghanistan, to further explore the
issues around MHM and school attendance of girls. This formative research will be conducted in 12 schools
of 6 provinces to identify main barriers adolescent girls face during menstruation at school. This will
include facts about the type of facilities and information needed to keep girls in school and for the school
to become an inclusive environment where girls can develop their capacity and create opportunities for
their future. This study will use rigorous qualitative research methods with strong support from the Emory
University in the US.
Introduction
Clean drinking water, proper sanitation and hygiene behavior at school make school a better place for
boys and girls and improve education and health outcomes for children. Improved Water, Sanitation, and
Hygiene (WASH) in school enhances attendance of students, improves the learning environment and
reinforces the dignity for students particularly the girls. WASH in schools reduces diarrheal diseases and
stunting among students and thus it improves growth and development of children which eventually leads
to improved attendance by students and better educational attainments.
In particular, the availability of proper information and adequate WASH facilities in schools for girls help
them manage their menstruation appropriately which improves their attendance at school and reduces
drop-out and possibly early marriage.
Access to water, sanitation and hygiene at schools in Afghanistan is very limited. Children in Afghanistan
study in very poor environment as, according to the Ministry of Education, more than half of schools do
not have buildings and student study in open space. About fifty five percent of schools in the country do
not have water supply facilities and only forty percent of schools have separate latrines for boys and girls.
Moreover, only 9% of schools have hand washing stations available. Nevertheless, the Ministry of
Education in collaboration with its key partners, including UNICEF, have been struggling to provide an
optimal learning environment to the Afghan students through enhancing access to clean water, adequate
sanitation and proper hygiene.
Call to Action to Water, Sanitation and Hygiene in schools

In line with the global realization of the importance of WASH in school and the launching of call to action
for WASH in school, the Afghan government and its key partners, including UNICEF, launched the “Call to
action for WASH in School” in 2010. The call to action brought multiple partners including the Ministry of
Education, Ministry of Public Health, Ministry of Rural Rehabilitation and Development together to express
their commitments for Water, Sanitation and Hygiene at schools around the country. During the Call to
Action, the partners signed six commitments as follows: Increasing investment in WASH in school,
engaging policy makers, involving multiple partners, demonstrating quality WASH projects in schools,
monitoring WASH in school programs and contributing evidence on WASH in school. The target of the call
to action was to provide WASH facilities in 80% of schools by 2015. The call to action also produced an
implementation guideline to WASH in school. Most specifically, the call to action also surfaced the
significant of tackling WASH needs of girls particularly during the menstrual period. The call to action
included promotion of menstrual hygiene and health under the school hygiene program.
Introduction of MHM in schools

With the call to action and the commitments made by the government and development partners the
importance of addressing menstrual hygiene surfaced. The first step was to find out the knowledge,
attitude and practice of girls around menstrual health and hygiene as well as the responsiveness of the
school sanitation system to the matters around menstruation. The plan was to develop communication
and teaching material based on the findings of the KAP study for girls and teachers.
Knowledge, Attitude and Practice Study on Menstrual Hygiene

As mentioned the first step to tackle the menstrual hygiene and health issues in the country was to
conduct a study therefore, the first Knowledge, Attitude, and Practice (KAP) study on menstrual hygiene
in schools was conducted in 2010 in nine schools of two provinces (Kabul and Parwan).
The main objectives of the study were as follows:
 To find out the beliefs and conceptions regarding menstruation among the study population.
 To find out the level of knowledge, information and practice of grown up girls during the
menstruation.
 To know about the available facilities in the school and hygiene education class room teaching.
 To provide input for design menstruation health and hygiene education training for teachers and
mothers.
The study population involved one hundred and sixty teenage girls, 25 teachers, 50 Mothers from the
secondary and high schools selected in Kabul and Parwan provinces. The study, conducted by a joint team
from the Ministry of Education and UNICEF and was completed in one month during August 2010. The
study used a semi-structured interview questionnaire. Interviews were conducted with students,
teachers, and mothers. Beside the individual interviews and group discussions with study population the
study team carried out observation of the surrounding of the school, toilet, and water system at schools.
The main findings of the study are reflected here. Both girls and teachers through their interviews and
discussions depicted that Menstruation is not incorporated into school curriculum. Furthermore, only
teacher of religious subject (Denyat) talked to girls about menstruation in grade eight. The main findings
of the study from interviews with girls included the following:
 Knowledge about menstruation process among girls was quite low as about 51% of the girls were
unaware of menstrual process. Some 42% of girls believed that menstruation is a disease.
 Main source of information related to menstruation for girls was friends and peers (71%).
Source of Information on
Menstruation for girls
29%
71%
Friends Sisters and relatives
Graph 1: Source of information among girls about menstruation
 Girls in Afghanistan do not wash their genitalia during menstruation as according to the study
about 84% of the girls said that they never washed their genital area during menstruation and the
remaining 16% washed once a day.
 When it comes to using soap after changing napkins or cloths about 80% of the girls never washed
their hands with soap.
 Girls usually reuse old clothes for menstruation and many of them do not dry the used cloths
under sunlight as about 84% and 69% of girls, according to the study, used old clothes and dried
their napkins under shade respectively.
 According to the study girls faced different types of restrictions during menstruation which
included not allowed to play sports and not to eat certain food items (71%).
 The study found out that about 29% of girls did not attend school during the menstrual period
due to heavy bleeding and lack of changing facilities at schools.
To summarize, the study concluded that girls had limited information about menstruation and
menstruation and menstrual hygiene was not part of school curriculum. Girls have misconceptions about
menstruation and how to manage it. Furthermore, girls are at risk of negative consequences of unhygienic
management of menstruation as they have poor hygiene practices during menstruation. Moreover, the
study found out that girls miss school days during menstruation.
Recommendations of the study included incorporating MHM in school curriculum and building capacity
of teachers and girls, development of guidelines for teachers on MHM, incorporating MHM facilities (e.g.
Washrooms) into school latrine designs as well as increasing availability of soap and healthy napkins for
girls.
Development and distribution of MHM material

On the basis of the recommendations of the MHM KAP study and the call to action on Water, Sanitation,
and Hygiene at schools, the MoE and UNICEF developed material on menstrual hygiene management
which included a guideline for young girls, guideline on Menstrual Hygiene Promotion for teachers and
supervisors, and picture cards for school girls. The mentioned material were translated into local
languages and were distributed to girls at schools in Kabul and provinces and MoE trained teachers on
MHM. Moreover, the hardware of MHM was also incorporated in the school latrine designs. The design
included a washroom for girls where they can change their napkins and wash the genitalia as well as an
incinerator attached to the washroom where the girls would throw the used napkins which would be
burned later. The designs were developed and approved by Ministry of Education in 2011. The above
designs were demonstrated as prototypes in 15 schools in Jalalabad and in one school in Kabul in 2011.
Later between 2012 and 2014 additional MHM facilities were constructed in more schools throughout the
country and teachers were trained on MHM from across the country.
Evaluation of the Menstrual Hygiene Management (MHM) Facilities

In 2013 UNICEF and the Afghan MoE decided to evaluate the functionality and use of MHM facilities at
schools. The main objectives of the evaluation were twofold; to assess the functionality and use of the
newly constructed MHM facilities by school girls and female teachers, and to know the extent that
teachers have communicated, or initiated dialogues with the student girls to share with them information
about menstruation, and about appropriate and hygienic use of the facilities.
A local NGO, the Womanity, was selected to carry out the evaluation of menstrual hygiene management
program. This evaluation was conducted in two provinces of Kabul and Nangarhar. During this evaluation
both qualitative and quantitative methods were used which included school observation, in-depth
interviews with students and teachers, and focused group discussions with both teachers and school girls.
A total of 30 students and 10 teachers per school from 16 schools were included in the sample for this
study. Fifteen schools were selected from urban and rural Nangarhar and one school from urban Kabul
where UNICEF supported construction of MHM facilities. Quantitative data was collected through school
observation and was entered into excel for further analysis. In the observation a
Structured Checklist was used and Data collectors observed use and functionality of
latrines, water points and hand washing stations and menstruation facilities.
Moreover, the qualitative data was collected through the tools mentioned earlier. The qualitative data
included in-depth interview with school girls. The In-depth interviews were conducted on a randomly
select sample of students in each school. Information was collected on the use of menstrual hygiene
management /disposal facilities recently installed in the schools, from girls above the age of 9 who had
reached menarche. Furthermore, Focus group discussions were used to gain a deeper understanding of
MHM practices, access and knowledge, attitudes and practices. 3 different groups were targeted:
teachers, younger students and older girls.
Findings of the MHM evaluation were not very promising and encouraging as many of the facilities were
either locked or unused. Majority of latrines in the school were vault latrines (12 out of 16) and, the
latrines in only 4 out of 16 schools were clean. According to the evaluation 14 out of 16 schools had hand
washing facilities but only 10 were functional. The evaluation found out that 15 out of the 16 target schools
had MHM facilities but most of the MHM facilities (12 out of 15) were locked during the evaluation as they
were used by teachers for ablution. Water was available in all MHM facilities visited.
Only 6.6% of students used the MHM washrooms and majority thought they were made for teachers as
the reason MHM facilities were constructed was not communicated well. Another important and shocking
fact of the evaluation was that 97% of the girls interviewed did not like the location of MHM facility
(Washroom). Two wash rooms were located close to the school guard room and the rest were located in
isolated areas which is intimidating for children to use since it is far and secluded from the main building
structure. A significant factor associated with lack of use was that girls were not consulted prior to
construction of the MHM facilities. Moreover, about 80% of students have not used the incinerators (the
reason was not mentioned). About 87% of respondents (girls and teachers) were not clear who is
responsible to burn the used napkins in the incinerators.
In regards to the classroom discussion about MHM and menstruation, only 13% of the students had
discussions with teachers in the class on MHM. The main reason was that teachers did not receive training
on MHM so they could not discuss MHM confidently. Only 10% of teachers in the target schools were
trained on Hygiene.
When students were asked about how to improve situation of latrines and MHM facilities in schools the
girls suggested that latrines need to be upgraded, cleaned, the number of latrines increased and water
supplied in the latrines.
Although the results of the MHM evaluation were not so positive and encouraging, they provided some
important lessons in program implementation. The evaluation suggested that we need to involve end-
users (here girls) in the design of the program. It shows that girls were not consulted when washrooms
and incinerators were being constructed at schools. Therefore, it is very important to consult girls even
on where the facilities should be built. Moreover, it is critical to communicate the purpose of any
intervention for all the users clearly. Teachers and principals must be informed that the washrooms are
built for the girls and need to be left open so that girls use them anytime they need to do so. Additionally,
training on MHM should be integrated with the construction of WASH facilities. A management system
should always be part of the WASH programs as WASH facilities need regular operation and maintenance.
Schools need to come up with local solutions to maintain the MHM facilities and keep them functional.
The upcoming MHM formative research

As part of the global evidence generation on MHM, UNICEF through support from Canada is going to
conduct a formative research on MHM in 10 countries including Afghanistan. This research is going to be
conducted in 12 schools of six provinces and will carry out a more in-depth analysis of the MHM issues in
the country as well as beliefs, perceptions, practices and behaviours of girls and those around them
including teachers, mothers and school administrators. The new study will also provide insight on the
future programming for MHM as well as corrective measures need to be taken in the designs of MHM
facilities in the schools. The new research will also provide input into the current advocacy efforts on MHM
as well as the training and information package for students and teachers.
Conclusion
Afghanistan shares some great lessons in regards to menstrual hygiene management of young school girls.
Starting the MHM programming with a KAP study was a good step to find out knowledge, perception and
behaviour of students on menstruation as well as how the behaviour was shaped by various factors
including the information they receive from mothers and peers. Despite many methodological issues in
the study it provided some initial insight to program planers around MHM.
Incorporation of MHM facilities including washroom and incinerator, as changing
Changing WASH Practices in Southwest Bangladesh–

One Small Doable Action at a Time
Authors: Julia Rosenbaum, Muhammad Faruqe Hussain, Selina Ferdous, Khairul Islam
Abstract
The global USAID WASHplus Project successfully increased access to water, sanitation and hygiene by
applying a comprehensive and innovative approach in hard-to-reach areas of southwest Bangladesh.
Rather than promoting ideal water, sanitation and hygiene (WASH) infrastructure and behavioral
improvements, households were encouraged to take ‘small doable actions’ – feasible yet effective
improvements – that moved toward the ideal practice. Through taking this approach, the project met and
surpassed all project targets before the end of the project period. Project implementers worked with
community members to develop age-specific behaviors for safely disposing infant and child feces and also
for patching leaky latrines that dump feces back into the environment.
Introduction WASHplus/Bangladesh is a USAID-sponsored project led by the INGO FHI 360 with
WaterAid/Bangladesh as lead implementation partner in collaboration with local government, partner
NGOs and communities. The four-year program (2010- 2014) seeks to establish sustainable provision of
safe water, improved sanitation, and hygiene (WASH) for just over a quarter million marginalized people
living in Southwestern Bangladesh. In addition to stimulating increased access to water and sanitation,
and strengthening local government and community management of WASH, the project seeks to integrate
WASH into child nutrition programs to strengthen evidence-based integrated programming and support
improved child growth. The targeted sub-districts were selected where access to water
and sanitation is low, poverty is high, and WASH-related diseases such as diarrhea are
widespread.
To achieve project goals, WASHplus applies comprehensive and innovative behavior change approaches
described in this paper that aim to improve consistent and correct WASH practice, and thus not only
improve WASH coverage but health, social and economic outcomes requiring consistent and correct
WASH practice.
Background
Millions of poor and marginalized people in hard-to-reach areas 1in rural Bangladesh are still deprived of
their basic rights to safe drinking water and improved sanitation facilities. Despite the fact that access to
WASH services has received global acceptance as a basichuman right, equitable and pro-poor WASH
services are yet to be achieved in Bangladesh. The problem is exacerbated by resource limitations,
disproportionate investment by government and donor communities in urban areas, extreme geographic
and technological challenges, and institutional and capacity gaps, such as poor local governance. The gap
between national policy and implementation at the local level has posed a challenge to successful WASH
service delivery, particularly in the hard-to-reach Southwest region.
The project areas coincide with USAID target areas for improved nutrition programs, with the intent of
integrating WASH and nutrition programming. Given that gastro-intestinal infection and diarrhea thwart
the uptake of nutrients and perpetuate the cycle of under-nutrition and morbidity, access to WASH
services will bolster ongoing efforts to reduce under-nutrition in the targeted subdistricts or upazilas. To
address the great challenges found in the four upazilas, the project seeks to:
1. Reach poor and marginalized communities to increase and sustain access to safe water, sanitation and
hygiene using locally appropriate technologies;
2. Build community and local government capacity to operate and maintain water and sanitation facilities,
demand increased allocation and pro-poor targeting of national and local government funds, and
community contributions to ensure sustainability of project interventions and impact;
3. Strengthen coordinated WASH-nutrition programming in Bangladesh; and
4. Strengthen collaboration between government, the private sector and civil society in the WASH sector.
National WASH Context

According to the World Bank Environmental Country Assistance Strategy (2006), the cost of the current
water and sanitation challenges in Bangladesh is an estimated USD $800 million per year including both
direct and indirect health costs. The Water and Sanitation Program (WSP) of the World Bank found the
annual economic impact of inadequate sanitation in Bangladesh is estimated at BDT 295,500 million,
equivalent to USD $4,230 million or 6.3 % of the GDP. (Bakarat 2010) At the same time, the World Health
Organization (WHO) reports the return on investment in Bangladesh WASH programs is 5:1, implying a
significant economic benefit to investing in WASH programming.
Current WASH and Nutrition Situation in Project Area

The project conducted a rigorous baseline evaluation (WASHplus 2014), using a cross-sectional, pre-post
design, where quantitative and qualitative approaches are combined. Various data collection methods
were employed in the study to gather information on different variables and themes. The quantitative
sample was randomly selected from the target villages, with a total sample size just under 1500. The
following highlights of baseline findings provide an overview of the intervention area:
Access to improved water is almost universal
use surface water in this regard.
required 15 to 30 minutes. On average about 14 minutes are required to fetch water from the nearest
improved source to the household.
Despite almost universal access, households choose to use other inferior sources for household use other
than drinking, including highly polluted pond and canal water for cooking, bathing and washing.
Sanitation
water sealed pit latrine.
lowing pit latrine without slab

(4.5%) and remaining 4% defecate in open place or bushes.
feces into household latrine’ (16.8%) or ‘throwing into a specific hole’ (17.9%). However, one third of them
(33.1%) report that they do not use a specific place disposal. Only 59% can be classified as safe disposal as
defined by international standards.
Handwashing after defecation

ilities inside or near to latrine (within 5 yards)
Handwashing before food preparation and feeding/eating

at or near the area/ kitchen for preparing
complementary foods for children undergoing weaning, while two thirds do not have.
Child Health, WASH and Nutrition

Under-nutrition is prevalent in Bangladesh, causing poor development and severe stunting in children
(41% of children under are stunted nationally, 42% in project area [WASHplus 2014]). About 10 percent
overall are wasted (<-2SD), 30 percent of them are malnourished or underweight (<-2SD) in baseline area
measures, not notably different from national averages; and almost equal for girls and boys (30.6-30.3%).
Under-nutrition is a result of not only lack of access to food but also poor hygiene practices and inadequate
access to and use of quality water and sanitation. The baseline statistics documenting poor handwashing
and sanitation highlight the toll of this vicious cycle on young infants and children. This environment can
also lead to the inability to fightinfections, leading to increased risk of acute respiratory infections (ARI),
the number one cause of mortality among children under 5. By improving WASH practices, WASHplus aims
to combat both diarrhea and ARI, contributing to decreasing rates of under 5 morbidity
and mortality.
While limited access to nutrient-rich foods is one challenge to ensuring proper nutrition in mothers and
children, poor quality of sanitation facilities and other means of fecal contamination contribute to the
burden of under-nutrition in these regions. Poor hygiene practices create a cycle where children are more
susceptible to diarrhea when exposed to fecal matter; feces are easily spread by caretakers do not wash
their hands with soap prior to cooking and feeding the child. Children in these environments are more
prone to diarrhea, which negatively affects their ability to eat and absorb necessary nutrients. Prevalence
of diarrhea among children 0-59 months of the survey area during two weeks prior to the survey found
19.0%; there is no difference between boys and girls in this regard. The growth stunting affecting children
under 2 is largely irreversible and affects not only physical growth, but also emotional and intellectual
development. (Victora 2008) Therefore, WASHplus aims to integrate WASH into nutrition programs to
break the cycle promote child growth and health, as well as family resiliency.
The WASHplus Project underlying theoretical framework

In order to see improvements in health, social and economic well-being of families in the project districts,
the WASHplus activity aims to increase the consistent and correct practice of a suite of WASH behaviors
including:
preparation and feeding/eating,
Our strategy for increasing the practice of WASH

behaviors is both theory-based and grounded in
established best practice. Rather than embracing one
particular theory of behavior change, the WASHplus
strategy is constructed around the USAID WASH
Improvement Framework (EHP 2004), which posits
that in order to realize sustained behavior change or
WASH improvement, three key domains must be
engaged:
1. Access to hardware and services, such as water
supply, soap, sanitation products, and financial
‘products’ like loans
2. An ‘enabled environment’, that includes a supportive policy environment, institutions with the needed
capacities, coordinated government and non-governmental organizational planning and
3. Hygiene promotion and demand creation, that includes social mobilization, community participation,
CLTS, social marketing and behavior change communication.
Therefore, the WASHplus strategy addresses increased access to necessary products and services, a
supportive ‘enabling environment’ with key policies, government and civil society with the essential skills
to plan, manage and support WASH; and finally promotion and demand creation through CLTS social
mobilization, sanitation marketing, and promotion. This directly corresponds to our project objectives.
To improve WASH practices, increasing knowledge and awareness is necessary, but not sufficient. A host
of other factors are also critical to the performance or non-performance of our focal WASH practices. The
design of the overall WASHplus activity in Southwest Bangladesh aims to increase access to water, hygienic
sanitation, and hygiene behavior; to strengthen local government capacity to plan, manage, implement
and evaluate WASH hardware and software activities; to stimulate formal and informal community
institutions like mosque and civil society to reinforce social norms that are supportive of WASH. These
social norms are the unwritten rules that guide individuals to ‘do’ or ‘not do’ certain behaviors; they
remind us what is ‘expected’, what people import to us think that we‘should do’. In general, the cross
cutting factors most influential in WASH behaviors include: perception of risk (of fecal contamination, of
NOT washing hands), skills, access to key “enabling” products, self-efficacy (the sense that individuals
and/or communities can do something to make things better), key knowledge, and social norms.
Improving WASH practices… one small doable action at a time

The WASHplus behavior change strategy also is built around the evidence that people canrarely go from
current practice to ideal practice, for example, from sedentary lifestyle tofive aerobic exercise sessions a
week, or from open defecation to consistent use of a VIPlatrine. Based on this understanding, WASHplus
incorporates what we’ve named a ‘smalldoable action’ approach to changing WASH practices. Rather
than setting the behavioralobjectives of WASHplus as the ideal WASH practices (e.g. put children in
diapers; washhands of all family members at all 7 critical junctions with running water and soap),
weidentify a continuum of behaviors that leads from unacceptable to ideal. Small doableactions are
behaviors that are deemed ‘feasible’ to perform in resource constrainedsettings, from the householder
point of view; and effective at the individual and publichealth levels. Behaviors that meet these two
criteria – feasible and effective – areconsidered ‘small doable actions’ and including in the ‘menu of
options’ for WASHbehavioral improvement.
These small doable actions are then ‘negotiated’ with householders, rather than focusing on educating
households to adopt ideal practices or ‘promoting’ without dialogue. The process of ‘negotiation’ involves
a community agent such as an ‘outreach worker’ assessing current practice, and problem solving with
householders to commit to trying an improved WASH practice. This approach contrasts with predominant
hygiene promotion that assumes households aren’t practicing ideal practices because they are unaware,
and that through awareness raising and education, ideal practices will be catalyzed. In the Bangladesh
program, these behaviors are ‘negotiated’ in group sessions in courtyards, in tea stalls, at households and
other venues.
Below is a pictorial representation from a Ugandan job aid of small doable actions related to safe water
handling. The first picture is an‘unacceptable’ currentpractice of uncovered water with animals and flies
accessing the container, followed by the “menu of options” that move toward an ideal practice (in this
context) of a covered jerry can with a spi got raised off the floor.
Applying the SDA approach to hardware and infrastructure

WASHplus works globally with local government and communities to increase access toWASH through
rehabilitation and installation of water and sanitation infrastructure. However, there are often
improvements for improving existing infrastructure solid lying the ‘domain’ of households, communities
or schools, such as re-hanging doors, stabilizing or raising sanitation platforms, patching leaky latrines,
hanging tippy tap handwashing stations,etc. These small improvements also fall into the category of
‘small doable actions’ that can improve WASH and address the environmental or ‘supply’ factors
influencing improved WASH. Therefore, while WASHplus works with local governments and communities
on major water and sanitation infrastructure, we will also been couraging ‘small do able’ improvements
in hardware as they influence WASH practice.
Small Do able Actions Address Unique Behavioural Challenges

While WASHplus aims to improve the entire ‘suite’ of WASH behaviors in our activities in South west
Bangladesh, particular focus is placed on the following behaviors based on an assessment of current
practice, available baseline and other epidemiologic data, environmental and social factors.
Safe and hygienic disposal of human feces

As demonstrated in baseline measures, many South west villages have high levels of latrine coverage and
use, but these latrines either intentionally or inadvertently leak into the surrounding ponds, canals or
other parts of the surrounding environment. As with many sanitation activities, WASHplus incorporated
CLTS-like ‘triggering’ to engage communities in the process of examining their current situation and
engaging them commit to ending UNHYGIENIC defecation practices and engage in hygiene practices. In
the case of our intervention areas, very little open defecation takes place, rather fixed point defecation
in latrines that leak feces into the environment. Seephoto example. Our challenge is to trigger actions
that end unsafe fixed point defecation, either fixing leaky latrines—by patching leaky rings, upgrading
systems, or arrange of small do able actions that we are in the process of developing with local
communities.
Pictured: At left, an off set pit latrine discharging into the household pond. At right, a ‘hanging latrine
empties directly into the canal below.
To promote small do able actions to improve leaky latrines, a ‘catalogue’of safe, hygienic and feasible
improvements was developed, to clear show arrange of options, including costs, and common ‘pros
and cons’ of each option to guide decision making. The catalogue is used by out reach workers as a
visual aid during household visits and at focused outreach to men at tea stalls. The catalogue includes
different designs of latrine that provide solution to the geo-physical characteristics of the South
western coastal parts. The designs include raised plinth and sand envelopment around the pit to
confine feces within the pit and to reduce pathogen transmission to the environment. The
improvements are retro fitted in the traditional single and twin off set pit latrine design. Sanitation
marketing, now often ‘twinned’ with CLTS under the ‘total sanitation’ or CLTS plus umbrella, is a part
of the WASHplus project model.
Local entrepreneurs are being trained in marketing appropriate sanitation products (many in the
‘catalogue’), and coordinating with local triggering efforts to ensure a smooth supply-chain of
necessary materials, allowing marketers to reach out to householders with sanitation options and
financing they desire.This coordination of supply, demand, coordinated planning and training to
address sustainable WASH improvement illustrates the use of the WASH Improvement Framework as
an innovative and comprehensive behavior change tool.
Using Small Doable Actions to Address Nutrition and WASH Integration

To integrate WASH and nutrition programming,WASHplus works to site water and sanitation
infrastructure in areas where we overlap with USAID nutrition projects, areas of high under nutrition and
vulnerability. At the same time, we work to integrate a very defined behavioural focus on hand washing
before food preparation and infant feeding, and safe disposal of infant faeces to specifically address faecal
contamination of under two year olds as complementary foods are being introduced. The most rapid
decline in growth (yielding the highest rates of growth stunting) are documented in this window of
vulnerability, indicating high rates of contaminated food and water. (K K Saha et al 2009).
Use of tippy taps as a small doable action increasing handwashing with soap, emphasizing handwashing
before food preparation and feeding
To reduce food contamination, a range of nutrition and WASHpartners have honed in on promoting
handwashing before food preparation and child feeding. Handwashing literature now shows that presence
of a fixed handwashing station increases the likelihood of handwashing (Luby et al 2009), therefore
WASHplus and other USAID nutrition actors include a focus on introducing tippy tap
handwashing stations near to food preparation areas as one small doable action negotiated
with households. This implies introduction of a second tippy tap into the household, one by the latrine and
another near the food area, a behavior that has not explicitly been promoted in many WASH interventions.
This is done through and along side house hold and group outreach to improve handwashing skills and
strengthen social norms around handwashing at this particular junction. Placement of a tippy tap facilitates
hand washing when flowing water is not readily available, and also serves as a reminder to wash, which has
been shown in other health areas to be a key determinant of practice. (Neal 2012) In Bangladesh, though
water is hardly scarce, its convenient presence facilitates hand washing, particularly with running water and
soap.
Small doable actions to increases a fedisposal of child feces

Although the impact of poor sanitation on children under five is often measured, little is known about
what happens to the feces of under 5s. Most sanitation interventions target adults and school-aged
children, ignoring the role that infant feces plays as a disease vector.
A reanalysis of Bangladesh DHS/MICS data by UNICEF and World Bank Water & Sanitation Program shows
only 22% of care givers reported safely disposing of infant feces, and only 11% into an improved sanitation
facility. Poor, rural and younger children are most at risk for unsafe disposal and its associated impacts.
(Rand et al 2015) To pioneer programming that aims at changing caretaker perception of ‘harmless child
poo’ and most importantly the related infant and child feces disposal practices, WASHplus worked with
district government counterparts and other development partners in South west Bangladesh to closely
examine current feces disposal practices by age cohort– the lap child (newborn to six month), the 6-12
month crawling child, 12 month – 3 year ‘toddlers” and 3-5 year old “young children”; considering toilet
training as well as caretaker practices. Bearing in mind current practice, WASHplus developed a menu of
‘small doable actions’, feasible yet effective feces management practices by age cohort to promote to
caretakers as alternatives to current practice. Enabling technologies such as child potties (commodes), use
of household tools like agricultural hoes and modifications to latrines to make them ‘child-friendly’, are an
essential element of SDAs to improve the safe disposal of infant and young child feces, along with other
‘doable behaviors’ around safe disposal of child feces when defecation happens out of the latrine. These
SDAs are then ‘negotiated’ during household visits and group sessions, also addressing skills and social
norms needed to improve these specific WASH practices. Again, the elements of the WASH Improvement
Framework (products, enabling environment and promotion) a really coordinated to yield improved
practice and outcome.
ILLUSTRATIVE SMALL DOABLE ACTIONS FOR SAFE DISPOSAL OF CHILD FECES
The various small doable actions are all tied together by a unifying theme, Poo’s Final Address, to
reinforce that where an infant or young child may defecate, it is the caretakers’ responsibility to get the
feces into the latrine (using the hoe, potty, etc.).
Results
The WASH behavior change approach described above yielded positive results beyond project targets.
Through the combination of social mobilization through CLTS-like approaches twinned with sanitation
marketing and assistance to the hard-core poor, a total of 154,729 people gained access to improved
sanitation facilities, 175% of the project target. Six hundred fifty three communities were certified open
defecation free, surpassing project targets as well.
WATER, SANITATION & HANDWASHINGSTATIONS
RESULTINGFROM PROJECT ACTIVITIES
Activities Project Achievement Target
target to date achieved
as %
Number of open defecation free 512 653 127
communities
Number of improved latrines 20,266 30,929 152
constructed
Number of peoplegaining accessto improved 88,358 154,729 175
sanitation facilities
Number of hand washing 39,726 41,114 103
devicesinstalledbyproject
Number of new deep hand tube wellsinstalled 670 670 100
Number of improved/ rehabilitated tube wells 19 19 100
Number of people gaining access to improved 65,771 94,200 143

drinking water source
Not only did households install ‘do it yourself’ handwashing stations fashioned from cast off PVC water
bottles, some innovated to make their own rudimentary running water supply, as pictured below, running
tubing from raised clay pots to facilitate anal cleansing and handwashing within the latrines.
Disposing child feces in a house hold latrine Rudimentary running water supply
Targets were surpassed, despite political and geographic challenges, in part because of project investment in
capacity building as a sustainability strategy.
NUMBERS TRAINED AT HOUSEHOLD AND COMMUNITY LEVEL
Activities Project Achievement Target achieved as %

target to date
Number of leadership and advocacy training 1,206 1,206 100
conducted with community members
Number of people trained on 1,450 1,450 100

O&M of water facilities
Number of community 386 386 100

volunteers trained
Number of hygiene cycles(4 total sessions) 1,683 1,683 100

conducted with mother groups
Conclusions and Lessons Learned

The comprehensive behavior change approaches outlined in this paper that take into account both the complexities
of human behavior and the unique geographic challenges offer promising strategies for meeting the immense WASH
challenges of South west rural Bangladesh precisely because they allow for local creativity and innovation, and
address hardware as well as promotion.
Our lessons are just emerging, and already we have seen that the small doable action approach resonates with
both outreach workers and communities, who willingly try to make small but significant change in their WASH
practices. The approach resulted in meeting all project targets, achieving significant gains in previously hard-to-
reach areas, and supported an atmosphere of innovation and independence in an area previously wrought with
dependence on NGO give aways.
Twinning of social mobilization with small scale sanitation entrepreneurship successfully addressed the geographic
and economic challenges of the area, particularly when focused project inputs built both government and private
capacity to deliver and sustain services. The small doable action approach reoriented communities from expecting
donations from NGOs, to looking for solutions that were within their means. The small doable action focus on safe
disposal of infant and child feces moved households towards truly open defecation free- status.
WASHplus approaches to integrate WASH into nutrition programming through a focus on young child feces and
handwashing before cooking and feeding strengthens best practice programming, and offers new tools and
approaches for adaptation throughout the region.
Acknowledgements
The author/s would like to extend thanks to Amina Mahbub, Iqbal Azad, Irfan Ahmed Khan and Raju Basak from
WaterAid Bangladesh, Orlando Hernandez/WASHplus and AKM Mustafa Sikdir, formerly WASHplus, Saydur
Rahman Siddique from the USAID/SHIKHA Project (FHI360), local government representatives and of course the
communitiesin South west Bangladesh for their enduring and innovative spirit to address their ongoing
challenges.
References
Barkat, Abul. Economic Impacts of Inadequate Sanitation in Bangladesh (draft),Water and
Sanitation Program, World Bank, July 2010.
EHP, The Hygiene Improvement Framework: A Comprehensive Approach for Preventing
Childhood Diarrhea, Environmental Health Project, Joint Publication 8, May 2004.
Luby, S.P., A.K. Halder, C.Tronchet, S.Akhter, A.Bhuiya and R.B.Johnston, Household characteristics associated
with handwashing with so apin rural Bangladesh, American Journal of Tropical Medicine and Hygiene, 81(5):882-
887, 2009.
Neal, DT, W Wood, JS Labrecque P, Lally, How do habits guide behaviour? Perceived and
Actual triggers of habits in daily life, Journal of Experimental Social Psychology 48(2), 492-
498, 2012.
Rand, Emily Christensen, Libbet Loughan, and Louise, Reese, Heather Maule. 2015. Management of Child Feces:
Current Disposal Practices. Washington, DC: World Bank Water Practice Water and Sanitation Program and
United Nations Children’s Fund (UNICEF).
Saha, Kuntal K.; Frongillo, Edward A.; Alam, Use of the new World Health Organization child growth standards to
describe longitudinal growth of breast fed rural Bangladeshi infants and young children,Food and Nutrition
Bulletin,Volume 30,Number 2,pp.137-144(8),June 2009
Victora CG, L Adair, C Fall, PC Hallal, R Martorell, L Richter, HS Sachdev, Maternal and child
under nutrition:Consequences for adult health and human capital. Lancet 371,No.9609:
340–357.doi.org/10.1016/S0140-6736(07)61692-4,2008.
WASHplus, Baseline EvaluationReport,WASHplus Project, WashingtonDC, February2014.
Contactdetails
Name of Principal Author Julia Rosenbaum
WASHplus/FHI360
1825Connecticut Ave NW
Washington,DC20009
Tel: 2028848838
Fax: 202884
Email:[email protected]
www.washplus.org
Name 2nd Author: Muhammad Faruqe Hussain

Address: WASHplus/FHI360
Dhaka, Bangladesh
Tel: +8801711437326
Email:[email protected]
www.washplus.org, www.fhi360.org
Principles and challenges in scaling up CLTS – Experiences from Madhya Pradesh (India)
(Binu Arickal)
Abstract
India is the largest contributor in pulling down the MDG targets around sanitation. Within India, Madhya Pradesh
is one of the poorer performing states in terms of sanitation coverage. With the MDG targets on sanitation heavily
pointing towards India’s poor performance, the government has been looking for sustainable and quick solutions
to end this crisis. The scale is huge and the government is trying out several approaches to meet this challenge. The
success of CLTS in Bangladesh has led different state governments to attempt CLTS at scale in India. In India we
have a model where terms like CLTS, triggering, post triggering etc. is mentioned in several government guidelines
along with clear mention of subsidies, standard approved designs, behaviour change, IEC and so forth. A
combination of all these has resulted in an ineffective implementation of an otherwise effective approach like CLTS
in India. The most critical part of the CLTS approach is identifying the right kind of trigger. However when CLTS is
implemented as the government sponsored scheme, triggers are often predetermined in the guidelines. Triggering
in CLTS is very context specific and it needs exceptional facilitation skills to identify the right kind of trigger in a
community. This paper discusses the challenge being faced in adopting CLTS in parts and how it contravenes some
of the principles of this approach. It also discusses some effective mechanisms the state has followed which were
people led and people centric that has remained sustainable. In the pressure to meet the huge target of making the
country ODF by 2019, there is a risk that CLTS approach would be loosely used and an empowering and effective
process would stand to lose in this. The paper recommends strengthening existing mechanisms to meet the huge
sanitation challenge. This would help the state in effectively engage communities in planning, implementing and
sustaining sanitation services in the villages and making it truly community led.
Introduction
The journey of making India Open Defecation Free (ODF) started with the launch of Central Rural Sanitation
Programme (CRSP) in 1986. Since then a range of approaches and models have been implemented with varying
elements of subsidisation, incentivisation, and behaviour change communication, yet the successes from these
approaches have been well below the targets with more than 130 m households lacking toilets and 72% of the rural
population relieving themselves in open in 2015. The present Government of India has sought to re-package the
avowed aim of Open Defecation Free country by 2019 as Swach Bharat Mission. Sanitation has become the buzz
word, though the meaning assigned to it varies considerably even among policy makers and practitioners.
In the year 2000, Community Led Total Sanitation (CLTS) was pioneered as an approach for total sanitation in
Bangladesh. The basic premise of the approach is that sustainable sanitation can be achieved only if it is led and
implemented by communities themselves. This can be achieved only if there is a collective understanding of the issues
of open defecation and the problems associated with it – particularly the impact it has on health and wellbeing of the
community. The process of CLTS entails lot of preparatory work with the community. Unless there is absolute trust
of the community members, the process does not work and the results are definitely not sustainable. The process
creates space for the communities to take collective resolve to stop the practice of Open Defecation and start
constructing latrines based on affordability of the household - gradually moving up the sanitation ladder finally
reaching to access of safe and sustainable latrine for each household. The premise being that people will not revert
to open defecation if behaviour change has effectively happened. The realization that hygiene behaviour change will
benefit individuals only if the entire community adopts them, motivates the community to monitor closely to ensure
that the whole community is ODF. Therefore sustainability is built into the very design of the CLTS. Since this is a
participatory and collective process, the communities collectively decide on recognising as well as reprimanding
members from the community who continue the practice of defecating in the open.
With the MDG targets on sanitation heavily pointing towards India’s poor performance, the government has been
looking for sustainable and quick solutions to end this crisis. The success of CLTS in the neighbouring Bangladesh
became a good reason for attempting this in India as well. However while implementing, some of the basic principles
on which the approach rests have been ignored. This has made it difficult to adopt CLTS at scale in government run
sanitation programmes in India. The success of CLTS in terms of its demonstrated effectiveness in demand creation
tempted policy makers to include parts of the approach in the sanitation scheme – without looking at the principles
or the process comprehensively. As a result, in India we have a model where terms like CLTS, triggering, post triggering
etc. is mentioned in several government guidelines along with clear mention of subsidies (which has increased more
than 20 times), standard approved designs (giving little scope for need based alteration), behaviour change (without
adequate human resource at the block and sub block levels), IEC (with more focus on information sharing than
changing behaviour) and so forth. A combination of all these has resulted in an ineffective implementation of an
otherwise effective approach like CLTS in India.
The following section describes the learnings in terms of challenges in adopting CLTS in the state of Madhya Pradesh,
alternative approaches experimented and how things can be developed further to meet the sanitation challenge in
the state.
Lessons Learnt
Identifying the right trigger

The most critical part of the CLTS approach is identifying the right kind of trigger. This happens naturally as the
facilitator engages with the community. Different communities respond to different triggers that work. However
when CLTS is implemented as the government sponsored scheme, triggers are often predetermined in the guidelines.
The sanitation scheme ofGovernment of Madhya Pradesh heavily relies on the issue of dignity of women as the trigger
for adoption of toilets and factor of behaviour change. Other triggers suggested in the guidelines are focused on
naming and shaming people defecating in the open. Similar triggers have been adopted as in several other states and
also in recent advertisement campaigns of the Swach Bharat Abhiyan. Triggering in CLTS is very context specific and
it needs exceptional facilitation skills to identify the right kind of trigger in a community.
There are several examples of positive triggers which have not been highlighted enough. For example, Anita Narre –
a newly married woman from Jeetudhana village of Betul district refused to go to her husband’s home until a toilet
was constructed there. In Dedakhedi panchayat of Sehore district, the awareness that excreta was carried by flies to
the offerings given in the temple triggered the entire village to construct and use toilets. Such positive triggers
empower the community. The changes may be gradual but are surely sustainable as compared to some of the
coercive measures as mentioned in the following sections.
When contents are put in a government document or guidelines, in a way they get legitimised. The facilitators
following the guidelines often do not go beyond the prescribed examples and accepts these as the only possible
trigger. In Madhya Pradesh, the state government came out with guidelines for sanitation scheme which had stated
examples of triggering the community to change behaviour. Some of these were also attempted in parts of the state.
However the methods suggested directly contravenes the existing laws of the land to protect the marginalised and
are in conflict with the CLTS principles.
Photographing or video graphing people defecating in the open

The guidelines suggests photographing or video graphing people defecating in the open and threatening them of
displaying it to public if they do not stop this practice. This contravenes the following legal provisions in India
 In case of women, this can be treated as a case of voyeurism as per the amended Criminal Law Amendment Act
2013 – Section 354C (refer notes) which was formulated for ensuring safety of women.
The Act says says ‘Any man who watches, or captures image of a woman engaging in private act in circumstances
where she would usually have the expectation of not being observed either by the perpetrator or by any other person
at the behest of the perpetrator or disseminated such image’. For the purpose of this section, ‘private act’ includes
an act of watching carried out in a place which, in circumstances, would reasonably be expected to provide privacy
and where the victims genitals, posterior or breast are exposed or covered only in underwear; or the victim is using a
lavatory; or the victim is doing a sexual act that is not of a kind ordinarily done in public.
 This also contravenes the Section 292-A of Indian Penal Code (refer notes), which is meant for penalising anyone
who ‘Prints or causes to be printed in any newspaper, periodical or circular, or exhibits or causes to be exhibited, to
public view or distributes or causes to be distributed or in any manner puts into circulation any picture or any printed
or written document which is grossly indecent, or in scurrilous or intended for blackmail’
As reported in The Hindustan Times on 13th January 2015 the Sarpanch Khusli Bai of Chauthiya village of Betul
district says “We tried our best to get them to use the toilets. First we started taking photographs of offenders on
mobile phones and made them public, but it didn’t work….” This clearly show that such methods does not work to
promote behaviour change.
Use of offending pictures for triggering

The state government's guidelines has a particular section which has a sketch of a girl (shown with bare buttocks)
being watched by men while reliving herself. This picture in a government guideline is against The
IndecentRepresentation of Women (Prohibition) Act, 1986- Section 4 which prohibits “publication or sending by post
of books, pamphlets, etc.; containing indecent representation of women.- No person shall produce or cause to be
produced, sell, let to hire, distribute, circulate or send by post any book, pamphlet, paper, slide, film, writing, drawing,
painting, photograph, representation or figure which contains indecent representation of women in any form” (refer
notes).
While there is a legislation which prevents indecent representation of women, even men have found some IEC
initiatives of the government scheme offending. In May 2014, the Zilla Panchayat of Harda district, Madhya Pradesh
put up a poster in the Zilla Panchayat office showing a man defecating in the open and adjacent to this image was an
image of a dog pooping. The poster compared people (defecating in the open) to a dog – which cannot use a toilet.
In India, it is abusive to compare a people with a dog. There was an immediate reaction and the Hindustan Times
reported that the poster was torn up by ‘unknown elements who found itoffending and embarrassing’. There is a
need to adopt a more sensitive way in approaching the issue.
Suggestions for reprimanding open defecators

 The guideline suggests following and whistling at open defecators as a measure to discourage open defecation. If
this is done in case of women, then this can be seen as ‘Stalking’ as per the Criminal Law Amendment Act 2013 -
Section 354 D, which reads as ‘Any man who attempts to follow a woman and contact, or attempt to contact such
woman to foster personal interaction repeatedly despite a clear indication of disinterest by such woman; or monitor
the use by a woman of the internet, email or any other form of electronic communication commits the offence of
stalking’.
 It is not practical to implement the reprimanding methods suggested in the government guidelines such as writing
names of open defecators on the walls, flagging the shit of the person, garlanding open defecators etc. in a multi-
caste society without the risk of this being misused. It is not possible that any ‘upper caste’ person would be
subjected to such humiliation to bring about change their behaviour. This invariably implies that such measures
would be implemented mostly on the lower caste (often SC and ST) communities. In such cases, it clearly leads to
a violation the SC, ST (Prevention of Atrocities) Act 1989 Section- 3 (refer notes) which reads as, ‘Anyone who... (x)
intentionally insults or intimidates with intent to humiliate a member of a Scheduled Caste or a Scheduled Tribe in
any place within public view; (xi) assaults or uses force to any woman belonging to a Scheduled Caste or a Scheduled
Tribe with intent to dishonour or outrage her modesty will be punishable by imprisonment from 6 months to 5
years’.
There have been instances where the local government have used such measures – in a way legitimising criminal acts
as good practice for achieving ODF. For example in Chauthiya village (Betul District, Madhya Pradesh) naming and
shaming was used as a deterrent to open defecation. As published in a national newspaper - a villager, Kachroo
Barange, said “Not only are the names of offenders announced but a running commentary is done on their
movements. This truly embarrasses them and most of them have stopped the practice”. Even though some members
might have changed their behaviour, but sustainability remains a question as such coercive measures may not lead
to a change in mindset. Also such measures are not changing the behaviour of the entire community, so the element
of communities taking decision on the issue is missing.
In contrast to this, a positive trigger was used in Taj village of Sehore district where WaterAid had installed a piped
water supply system. The water users committee decided that water connections will be given only to those
households which would construct toilets and start using it regularly. This helped in attaining ODF status in the village
of around 300 families within 1 month of completion of the piped water supply scheme.
Engaging children for behaviour change

The government guidelines recommend that when names of open defecators are put up on the walls so that their
children feel ashamed and they persuade their parents to construct and use toilets. It is unfair to make children feel
ashamed for decisions that are not in their hands. In Sehore district of Madhya Pradesh, a government official (who
wished not to be named) working in the scheme shared that they (the officials and facilitators) are forming child
brigades – whom they call vaanar sena (monkey army). These children would get up early in the morning and would
follow people going out to defecate in the open and chase them away by whistling at the open defecators. This flouts
the meaning of child participation and is certainly not in the best interest of the child. This is against the UN
Convention on Rights of the Child (UNCRC) – particularly Article 2.2, Article 3 and Article 19 (refer notes). These
Articles are to ensure that the State takes appropriate measures to protect children against discrimination, violence
(including mental and emotional) and to ensure that best interest of children remains the primary concern of adults.
India being a signatory to the convention and having ratified it on 11th December 1992 is bound to be committed to
the clauses laid out in UNCRC. The above example violates the articles meant for safeguarding and protecting the
rights of the children.
In contrast to this, in a Child Rights and WASH project implemented by WaterAid and partners, children’s rights to a
safe environment led the community members to ensure adequate WASH facilities in schools as well as in households
in Lasudia Parihaar Panchayat of Sehore district. Similarly interventions around WASH rights of children were effective
when youth were involved as support groups for advocating the issues faced by the children. Alternative mediums
(like child newspapers and notice boards) were used to ensure meaningful participation of children. These examples
show how children can be engaged in a dignified manner (Arickal 2014).
Scale and institutional challenge

It is true that in a country like India, where there are more than 60% population defecating in the open, the concern
is to scale up and accelerate sanitation coverage. The sector is struggling on making sustainable change at scale.
However adopting CLTS for scale needs to be looked at from the point of view of two essential elements for the
facilitators and the implementing agency
 The attitude and behaviour of facilitators: The government led CLTS is based on the cascading model of capacity
building for developing CLTS facilitators. The transmission loss in any cascading models of training is quite high.
The challenge is greater if the issue is as sensitive as ones defecation practice. While chasing the huge targets to
construct toilets, the quality of facilitators that are identified and developed as CLTS facilitators fall short on their
skills, attitudes and behaviours. As a result, the programme is led in the field by facilitators who are tempted to
take short cuts to generate demands from the communities for meeting targets thus compromising the principles
of community taking the lead.
 The flexibility of institutions supporting the process. CLTS can be applied by institutions which are flexible in terms
of their approach towards sanitation, which can invest in time and which does not push disbursement driven
approach towards reaching the goal. Government scheme and the departments implementing the scheme are
exactly the opposite of this. The government schemes have very limited flexibility and their implementation is
regimented – to the extent that there is no scope of approving alternative technologies for sanitation other than
the prescribed ones. Even the IEC/ BCC content is quite directive with very little scope of alteration.
Conclusions
The experience from the part adaptation of CLTS show that there is a need for the state to invest on developing
understanding of the principles in this approach. In the hurriedness to meet targets and to achieve numbers there
are distortion to the true version of CLTS. This is doing more harm to the approach than to strengthen its base. It is
important that any organisation – government or civil society- which claims to use CLTS adopts it in totality. The
experience very clearly show how part use of CLTS leads to disempowerment of the community and non-achievement
of the outcomes. Whereas, CLTS in true sense is an empowering tool which helps in communities to collectively
analyse situation, take decisions and be responsive to the needs of the community. The need of the hour for a country
like India which has a massive challenge in meeting the sanitation target should revolve around alternatives which
would be more effective and sustainable. In order to be able to do that it is essential to look at the existing
constitutional provisions by meaningfully engaging the Panchayats and Gram Sabhas. It is also important to take up
large scale behaviour change communication with more investment on human resource – preferably local and
building their capacities. There is a need to understand the importance of having a gestation period before
construction with clear indicators to measuring progress. This is a must so that communities realise the importance
and start taking corrective measures on their own. Also in the context of India where sanitation scheme is pushing
the construction of toilet in a big way, post construction behaviour change would be an essential component in the
coming years.
Recommendations
Madhya Pradesh has been one of the pioneer states in establishing and strengthening the Panchayati Raj
Institutions after the 73rd constitutional amendment passed in 1992. The state has undertaken several innovative
steps in empowering the Panchayats and Gram Sabhas (village councils) by devolving powers to the grassroots
governance structures. The scale of sanitation challenge can be effectively mitigated if the role of Panchayats in
WASH governance is effectively developed.
As of now, their involvement has remained constrained to that of an implementing body – as an extended arm of
the government and not as a governance institution. Effective devolution of funds, functions and most importantly
functionaries to the three tiers of Panchayats could become a critical intervention for scaling up and meeting the
huge challenge of sanitation in the state.
Constitutionally Gram Sabhas, are the most important decision making body for any development work in the village.
This body is mandated to take collective decisions on different aspects of economic and social development in the
village. The Gram Panchayat is also accountable to the Gram Sabhas. It would be worthwhile to let the Gram Sabhas
start take decisions even with regard to sanitation. The CLTS approach also emphasises on the need for the
community to take collective decisions. Village level Gram Sabhas are best positioned in taking collective decisions
for universal access to sanitation in the village. This calls for efforts to generate awareness and strengthen Gram
Sabhas on the issue. WaterAid partners LSS has been successful to use this approach to bring ODF status in 36 villages
in Rajnandgaon district of Chhattisgarh.
Since 2009, the Madhya Pradesh government has been undertaking extensive exercise of decentralised planning. This
involves development plans for different sectors like Health, Education, Livelihood, etc. Under this initiative a
Technical Support Group constituted of officials from different departments work very closely with the Panchayats
and the Gram Sabhas for development of village level plans. Experience from the previous schemes (like Total
Sanitation Campaign, Nirmal Bharat Abhiyan etc) show that construction alone will not ensure sustainable use of
sanitation infrastructure. It is essential to have communities involved in developing effective sanitation (or WASH)
plans. This can be integrated in the state’s decentralised planning process. This will ensure adequate convergence
with other departments and schemes as well. In 2012, WaterAid and its partner Samarthan ensured that WASH micro
plans get integrated in the decentralised plans of 23 villages in 15 panchayats of Sehore district. This helped in
converging resources for WASH from other schemes as well (for eg Watershed work, untied funds from the
panchayat, school education etc). This helped in many aspects of sanitation beyond construction of household toilets.
The sanitation scheme in the state, focuses extensively on meeting the mammoth target - 9.5 million household
toilets in the next 4 years. The risk in this approach is that new toilets would most certainly get constructed, however,
the defunct toilets from the previous schemes or the missing toilets (the over reported cases) would not be
constructed. It is essential for the government scheme to shift its focus from construction of individual toilets to
ensuring ODF villages in the state.
This shift in approach will serve two purposes – a) it is ensure that all households will become a priority (including the
defunct and missing toilets) and b) it will ensure greater thrust on village level planning (an element which CLTS
emphasises on).
CLTS has been more successful in places where there were no government subsidies for toilets. In Indian context, the
subsidies have actually worked as a perverse incentive. With the IEC specifically mentioning the amount that a
household would get for constructing toilets, and removing the clause of community contribution totally, people have
become entirely dependent on the money from the scheme for construction of toilets. The Swach Bharat Mission
provides opportunity for the states to bring in flexibility in how they want to implement the scheme. It would be
worthwhile for the state to move away from household subsidy to village incentives. The village incentive can be
based on ODF states, effective Solid and Liquid Waste Management and adequate water management. The amount
for individual subsidies can be given to the Gram Kosh (bank account of the village council) and the Gram Sabha can
take decisions on how to use this money. This money can also be used for taking care of any O&M of WASH
infrastructure or even to provide soft loans for families which cannot afford to construct toilets.
The success of sanitation scheme will also rely heavily on the cadre at the field level. It would be essential to invest a
lot on identifying the right kind and capacitating a large cadre of field level facilitators. This could be the swachata
doots or other volunteers and CSOs working at the village level. The state would need to invest in building the
capacities of this cadre in each of the 51 district and 313 blocks of the state. This will help the state in accelerating the
speed to achieve universal sanitation coverage.
The state of Madhya Pradesh has also been a pioneer in bringing about effective accountability systems like the Public
Service Guarantee Act 2010. This gives citizens an opportunity to make complaints for accessing public services and
these complaints are redressed within a stipulated time making the government departments more accountable. It
would be worthwhile either to include sanitation scheme also in this or build in other provisions for accountability by
introducing tools like Social Audit (as in NREGS) or Community Based Monitoring (as in NRHM) in the implementation
of the scheme to make it more transparent and effective.
References
Kamal Kar with Robert Chambers (2008) Handbook on Community Led Total Sanitation.
Government of Madhya Pradesh: Maryada Abhiyan Guidelines
Mukesh Pandey (5th May 2014) Hindustan Times article ‘Offending’ poster on open defecation torn up by citizen,
page 4.
Government of India (1989): The Scheduled Caste and Scheduled Tribes (Prevention of Atrocities) Act 1989
WaterAid (2013): Institutional gaps and major challenges in achieving improved WASH access and coverage in rural
Madhya Pradesh with focus on Nirmal Bharat (Maryada) programme
Government of India (1986): The Indecent Representation of Women (Prohibition) Act, 1986
Government of India (2013): Criminal Law Amendment Act 2013
Government of India: India Penal Code 1860
Note/s
i. Criminal Law Amendment Act 2013 – (Section 354 C) of Indian Penal Code – Punishable by imprisonment not less
than 1-3 years on first count and 3-7 years for repeat offences
ii. Indian Penal Code Section 292 (A) - shall be punished with imprisonment of either description for a term which may
extend to two years, or with fine, or with both. Provided that for a second or any subsequent offence under this
section, he shall be punished with imprisonment of either description for a term which shall not be less than six
months ** [and not more than two years].
iii. The Indecent Representation of Women (Prohibition) Act, 1986 (Section 4) - Punishable by imprisonment up to 2
years and fine of Rs 2000 on first count and on repeat offences punishable by imprisonment up to 5 years and fine up
to Rs 1lakh
iv SC ST Atrocities (Prevention of Atrocities) Act 1989 – (Section 3), clause x and xii – Punishable by imprisonment
from 6 months to 5 years
v. Article 2.2 of UNCRC: States Parties shall take all appropriate measures to ensure that the child is protected against
all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the
child's parents, legal guardians, or family members.
Article 19 of UNCRC: Protection from all forms of violence – physical, mental and emotional
Article 3 of UNCRC: The best interests of children must be the primary concern in making decisions that may affect
them. All adults should do what is best for children. When adults make decisions, they should think about how their
decisions will affect children. This particularly applies to budget, policy and law makers.
Contact details
Binu Arickal
WaterAid in India, E7/698Arera Colony,
Bhopal, Madhya Pradesh, India
Tel: +91 7554294724
Email: [email protected]
www.wateraid.org
Technical Focus Session2: Urban Sanitation (Bangladesh)
Chair: Mr. Taqsem A. Khan, Managing Director,

DWASA
Co-chair: Mr. Roshan Raj Shrestha, Senior Program
Officer, BMGF
Moderator: Dr. Dibalok Singha, DSK/FANSA
Presenters:
- Ms. Heleen van der Beek, ICCO Cooperation,
Bangladesh
- Dr. Mahbuboor Rahman, BUET, Bangladesh
- Mr. H.K.P.K. Jinadasa, NWSDB, Sri Lanka
- Mr. Abdullah Al-Muyeed, WaterAid, Bangladesh
Supporting Partners: WHO, BMGF
 Innovative On-site Toilet Technology in Slum: The Biofil Toilet, Bangladesh

 Fecal Sludge Management (FSM) Scenario in Urban Areas of Bangladesh
 Model estimation of reducing Combined Sewer Overflow in Drainage areas consists of Infiltration
facilities, Sri Lanka
 A novel wastewater treatment eco-technology applied to improve environmental sanitation in Khulna
slum, Bangladesh
Innovative On-site Toilet Technology in Slum: The Biofil Toilet
Abstract
Dhaka is one of the fasted growing megacities of the world and only 20% of the population of this city is served by
highly expensive sewerage network. The rest of the country relies on on-site sanitation systems, e.g. pit latrines and
septic tank systems. However, on-site sanitation systems have been developed without much attention to the
management of fecal sludge that accumulates in pits and septic tanks. There are limited choices regarding types of
on-site sanitation facilities, particularly in slums and low-income communities. In crowded communities of Dhaka,
where average population density is 115,000 per square mile, as reported in the latest edition of ‘Demographia
World Urban Areas’, sufficient space is not available for re-setting of pit latrines when the pits fill up. Besides,
multistoried apartment dwellers in rich neighborhoods often connect their toilets to storm water drains and thus
polluting open water bodies and rivers surrounding Dhaka. In the absence of organized fecal sludge management
services, pit contents are often drained to low-lying areas or pit emptying is carried out in unhygienic manner,
posing significant risks to environment and public health, and endangering the sustainability of on-site sanitation
services. This paper presents the experience of piloting The Biofil® toilet through the project titled ‘SanMark-CITY’,
which is being implemented in urban slum areas of Dhaka jointly by ICCO Cooperation, iDE and DSK since January
2014. The initiative is supported by Bill and Melinda Gates Foundation and ITN-BUET is evaluating the toilet
technologies. The Biofil toilet developed in Ghana by BIOFILCOM, rely on tiger worms (Eiseniafetida) for
digestion/decomposition of fecal matter. The Biofil digester is set in a tank made of ferro-cement or brick, which
could be laid above or below ground level depending on flood/groundwater level of the location. In the digester of
a Biofil toilet, the fecal solids are converted into vermicompost, which builds up slowly over regular usage and is
safe to handle. According to technology provider, BIOFILCOM, removal of vermicompost is not necessary within
minimum 5 years after installation. The water used for cleansing and regular operation and maintenance of the
toilet drains into a soakage pit for infiltration into the subsurface. According to the preliminary technical evaluation,
the Biofil toilets appear to fulfill all criteria of a ‘hygienic latrine’. The digesters of Biofil toilet have been able to
significantly reduce accumulation of fecal matter in the digesters. The technology is also well accepted by the users.
The Biofil toilet has demonstrated the potential to serve as a sustainable sanitation option for low-income
households in urban slum communities, which are currently being served by pit/pour-flush toilets. Besides, the Biofil
toilet appears to be a very suitable option for implementation and further testing in the rural areas, where lack of
FSM services is also threatening environment, public health and sustainability of sanitation facilities.
Key words: On-site sanitation; Fecal Sludge Management (FSM); sustainability of on-site sanitation; The Biofil®
Toilet
Introduction
In recent years, Bangladesh has achieved commendable success in increasing basic sanitation coverage throughout
the country. According to the Joint Monitoring Program (JMP) of the World Health Organization (WHO) and the
UNICEF, Bangladesh’s sanitation coverage (improved and shared) rose from 50 percent in 1990 to 75 percent in
2012; open defecation has gone down from 34 percent in 1990 to 3 percent in 2012 (WHO-Unicef, 2014). While
these figures represent a remarkable success story, these also indicate significant scope for improvement,
especially with regard to improved sanitation coverage.
The entire sanitation interventions in Bangladesh have been based on on-site sanitation systems (e.g. pit latrines
and septic tanks), without much attention to the management of fecal sludge that accumulates in pits and septic
tanks. Lack of proper management of wastewater and fecal sludge is causing severe environmental pollution and
health problems, which is endangering the sustainability of on-site sanitation services. Therefore, progress towards
total sanitation coverage must be aligned to delivering access to quality services. This is particularly true in the
urban slums of Bangladesh where environmental and physical constraints place significant barriers on the
development of quality sanitation solutions.
There appears to be limited choice regarding types of on-site sanitation facilities, particularly in slums and low-
income communities. In crowded communities, sufficient space is not available for re-setting of pit latrines when
the pits fill up. In the absence of organized fecal sludge management (FSM) services, pit contents are often drained
to low-lying areas or pit emptying is carried out in unhygienic manner, posing significant risks to environment and
public health. It is well recognized that technology and business driven solutions have a major role to play in helping
to deliver better sanitation for the poor in Bangladesh.
In the backdrop of these circumstances, the “Sanitation Marketing for Urban Onsite Sanitation in Bangladesh”, or
“SanMark-CITY” project was initiated with the aims to explore the potential of four toilet technologies including
The Biofil Toilet to overcome some of the challenges faced in delivering a sustainable sanitation solution. ICCO
Cooperation along with two other implementing partners – International Development Enterprises (iDE) and
Dushtha Shasthya Kendra (DSK) – are implementing the project, which will be ended in December 2015. The project
takes a market-led approach, and focuses on the role of the private sector to develop commercial ventures that
are sustainable and scalable as the implementation vehicles. The Bill & Melinda Gates Foundation (BMGF) is
providing financial and technical support to the project. ITN-BUET is involved in independent verification of the
toilet technologies.
Overview of Biofil Toilet Technology

Technology description:
The Biofil toilets (first developed in Ghana) rely on the Tiger worms for
digestion/decomposition of fecal matter. However, generally earth worms or
any composting worms can be used in principle instead of specific Tiger
worms. The Biofil digester is set
in a chamber/tank made of ferro-cement or brick (or any suitable
local material), which could be laid above or below ground level depending
on flood/groundwater level of the location. In the digester of a Biofil toilet,
the fecal solids are converted into vermicompost, which builds up slowly and
is safe to handle.
The digester for a full size Biofil toilet is about 3′-0″ x 6′-0″ (approx. 0.9 m x 1.9 m) in cross-section and 0.6 m (2′)
in effective depth for an average use up to 15 users per digester per day. The digester of the toilet consists of a
“filter bed” made up of stone chips, “porous concrete”, and coconut fiber; the tiger worms (about 200-300 gm) are
placed over the filter. The digester is covered with two concrete slabs: a bigger slab fitted with pan over which the
toilet superstructure is constructed; and a smaller slab (“inspection slab”) that can be lifted to check condition of
the “filter bed” and build-up of fecal matter/compost within the digester.
In the digester, the fecal matter is retained on the top of the filter and is digested by the tiger worms, while the
liquid (used for cleansing and regular O&M) drains through the filter media; this liquid effluent from the digester
then flows into a soakage pit for infiltration of liquid into the subsurface. Biofil toilets are designed to utilize the
subsurface infiltration capacity of soil, which is common for all on-site sanitation technologies. The digester is also
fitted with a vent pipe for natural aeration.
Operation and maintenance requirements

The Biofil toilets depend on “tiger worms” for digestion of fecal matter, and therefore have strict restrictions on
the use of chemical cleaning agents and disposal of materials in the toilet that are considered harmful for the Tiger
worms. The important O&M requirements for Biofil toilets are listed below:
(1) The Biofil toilet needs to be flushed with about 2L of water (maximum 3L) after every use; toilet papers
can be used.
(2) Only water and brush can be used for cleaning toilet (including walls and floors of toilet); use of chemical
cleaning agents (e.g., harpic, soap, bleaching power) is strictly prohibited.
(3) The digester/pit of Biofil toilet is designed for disposal of only human waste; disposal of any other material,
such as cigarette butt, cloth, plastics, brick chips/sand/silt, etc. into the toilet is strictly prohibited.
(4) The toilet should not be used for taking shower.
(5) Each toilet could be used by a maximum of 15 users.
Installation Process of the Toilet

Installation of Biofil toilets involves the following major steps:
(a) Casting of different portions of the digester including side-walls, top slab (with pan), beams, “porous slab”
and “porous beam” (that act as filter);
(b) Site preparation, casting of base of digester, installing and leveling side walls;
(c) Placing stone chips at digester bottom, and placing of concrete beam;
(d) Placing “porous slab” over stone chips and concrete beam;
(e) Placing porous beam over the porous slab, then fixing net over porous beam and slab, then placing another
porous beam over it, and finally placing a concrete beam on top;
(f) Placing coconut fiber and straw in the digester over net;
(h) Placing cover slab (fitted with pan) over the digester, erecting superstructure of the toilet, and putting in
vent pipe.
Baseline Sanitation Condition

The Biofil toilets have been installed in a low-income community at Panchgachia, Aminbazar, Dhaka-1348,
Bangladesh. The area is located beside river Turug and close to Dhaka-Aricha highway. Though located beside a
river, the area/community is on higher land and thus the inhabitants are not much affected by flood. Table 1.1
summarizes the status of baseline sanitation facilities at these households, including type of toilet, number of
families and users of the toilet, duration of use of the existing toilet, and information on desludging of toilet pits.
At the Panchgachia site, there were 15 toilets in the 15 households where the Biofil toilets have been installed
under the SanMark-CITY project. Table 1.1 shows the status of these toilets prior to the installation of the Biofil
toilets. Among these toilets, 8 were direct pit pour-flush toilets, one was alternating twin pit toilet, 3 were hanging
latrines, and 3 latrines were directly connected to nearby drain/water body. Thus, among the 15 toilets, fecal
matters of 6 (i.e. hanging latrines and latrines with not pits) were being discharged into the open environment
(nearby low-lying area, drain, river). Among the owners of 8 direct pit pour-flush toilets, three reported periodic
desludging. However, they also reported that the emptied pit contents were either discharged near the toilet or
into the nearby river. The remaining 5 owners of the direct pit toilets reported no desludging ever. Considering the
duration of use of these toilets, it appears that fecal matters of these toilets also find their way into the
environment (e.g. through openings/ cracks in the pits).
Thus Table 1.1 illustrates the alarming situation with respect to fecal sludge management in the project area at
Panchgachia. Direct discharge of fecal matters into open environment is a serious environment and public health
concern in this area.
Table 1.1: Status of baseline toilet facilities in households at Panchgachia where Biofil toilets have been installed
Problem
s
Duratio
Biofil No. associat
Name of the No. of Means of Desludging n
Toilet of Toilet type ed
Beneficiary family Desludging Frequency (yr) of Toilet
ID Users with
Use (yr)
Desludgi
ng
Using pipe
Once, after 2 years
B1 Mr. Hazrat Ali 4 11 Direct Pit and bad odor 8
of commencement
machine
B2 Mr. Nazimuddin 2 6 Direct Pit N/A Never N/A 8
Manual,
no
B3 Mr. Zahiruddin 2 12 Direct pit using 1 2
problem
bucket
Manual,
B4 Mr. Abdul Hai 3 12 Direct Pit using 2 month N/A 7
spades
B5 Mr. Dukhu Mia 1 10 Direct Pit N/A Never N/A 10
No pit, directly
B6 Mr. Masud 1 6 connected to N/A Never N/A 15
nearby open drain
B7 Mr. Shahabuddin 4 10 Direct Pit N/A Never N/A 1/2
B8 Mr. Bishu Mia 1 9 Direct Pit N/A Never N/A 1/2
B9 Mr. Manik 1 7 Hanging Never Never N/A 25
B10 Mr. Sattar 3 12 No pit, directly drains Never Never N/A 15
toward nearby river

No pit, directly drains
B11 Mr. Ataur 3 9 Never Never N/A 10
toward nearby river
After 4 years,
B12 Mr. Sharif 1 6 Alternate twin pit N/A started to use N/A 5
second pit
B13 Mr. Monir 5 11 Hanging Never Never N/A 10
B14 Mr. Monir 5 11 Hanging Never Never N/A 10
B15 Mr. Riazuddin 4 14 Direct Pit N/A Never N/A 10
Methodology for Technology Evaluation

As noted above, the sanitation systems in the areas/communities where the new toilet technologies have been
installed are not in good shape. All toilets in the project areas are intended for use as pour-flush toilets. However,
due to rapid build-up of fecal matter in the toilet pits and absence of effective pit-emptying services, fecal matter
and wastewater from most of these toilet pits (about 80%) are directly discharged into nearby low-lying areas
through pipes/drains. Therefore, it is clear that although a properly designed conventional pour-flush toilet is
“hygienic” and well accepted by users in all over Bangladesh, absence of pit emptying services (or FSM services)
has turned this technology into an unhygienic sanitation system. The same is also true for toilets connected to
septic tank system.
In this backdrop, the “new toilet technology” (Biofil) tested primarily to see if these could overcome the drawbacks
of traditional pour-flush toilets and septic tank system with regard to fecal sludge management . The “new toilet
technology” is designed to solve the FSM problems that are plaguing the conventional pit/pour-flush latrine and
septic tank systems e.g. frequent emptying, presence of bad smell, presence of flies and insects, unsafe handling
and disposal of sludge etc. The technology has a “digester” (set in a pit/chamber) that is the “heart” of the toilet
system; the digester significantly reduces or virtually eliminates accumulation of fecal matter, according to the
technology provider. Therefore, from the perspective of “technology evaluation”, it is of utmost importance to
assess whether the toilet technology is able to address the FSM problems (as claimed by the technology providers),
in addition to its ability to fulfill the general requirement of a “hygienic latrine”.
User-acceptance is also vital for the successful proliferation of a toilet technology. For example, a perfectly
“functional” (from technology perspective) toilet may not be well accepted by users because of strict operation
and maintenance requirements. While “technical performance” of a toilet would affect user-acceptance, user-
behavior (especially with regard to O&M) may also affect technical performance. For example, offensive smell
resulting from poor design of toilet venting system would adversely affect user-acceptance of a toilet. On the other
hand, improper use of a toilet (e.g., use of chemical agents for cleaning toilets) would adversely affect the technical
performance of the new toilet technology.
Therefore, the criteria for evaluation of the “new toilet technology” tested have been broadly divided into two
categories:
(a) Functionality (Technical Performance), and
(b) User-feedback.
Functionality (Technical Performance)

With regard to functionality or technical performance of a “toilet technology”, two questions are of prime
importance:
(1) Whether the toilet is “hygienic”?
(2) Whether the toilet reduces/ eliminates accumulation of fecal matter? [In other words “performance
of the digester” in reducing/ eliminating accumulation of fecal matter]
Fulfilling Criteria of a Hygienic Latrine

Any toilet technology should satisfy the “criteria” (or the “purpose” for which the criteria has been set) of a
“hygienic latrine” as stated in the Bangladesh National Sanitation Strategy 2005, to be acceptable as a viable
technology for large-scale implementation. The three “criteria” of a “hygienic latrine” and the intended purpose
of each are summarized in Table 1.2
Table 1.2: Criteria for a “hygienic latrine”
Criteria Intended “Purpose” Comment

In conventional pit/ pour-flush
Confinement of feces So that fecal matter and latrine,
wastewater from toilet does not fecal matter accumulates in a pit, and
come out into open environment,the liquid infiltrates into the
thereby not polluting
environment subsurface.
and endangering public health
Sealing of passage between Prevents insects/disease vectors latrine,
squat hole and pit from entering/exiting toilet pit; this is achieved through the use of a
also prevents odor. water-seal pan; in recent times
“SATO-pans” are also being used.
Provision for venting of foul gas To reduce/eliminate offensive latrine,
this is achieved through installation
generated within pit odor within/ surrounding the of
Toilet a vent pipe in the toilet pit.
As a part of technology evaluation, the ability of toilet technology in fulfilling these three criteria (or the intended
“purpose” of each criterion) has been assessed. The assessment has been made through evaluation of:
(a) Designs of the toilet (e.g., presence of vent pipe, type of seal in the toilet pan),
(b) Presence of offensive smell within/surrounding toilet (through field visits and survey among users),
(c) Testing of effluent characteristics for assessing its potential impact on environment and health if it
discharged in open environment; and
(d) Environmental condition of toilet-surrounding environment (through field visits and survey among
users).
Performance of the Digester of Toilet

In Biofil toilets, fecal matter, urine, (anal) cleansing water and cleaning water drop over a “filter”. The filter retains
the fecal matter and drains the liquid towards the soakage pit. The fecal matter retained on the filter is digested
by “tiger worms”, slowing down its build up. Over time, this process also produces vermicompost. Thus, two issues
are vital for effective performance of the Biofil digester:
(1) Ability of the “filter” to drain the liquid: If the filter is unable to drain the liquidproperly, water will
accumulate above the filter, submerging the tiger worms and the fecal matter. In such a situation, the tiger worms
will not be able to perform effectively (and may die off), and the fecal matter will continue to accumulate in the
digester. The performance of the filter of Biofil toilets was assessed through visual observation of the filter through
the inspection slab.
(2) Ability of Tiger worms to reduce accumulation of fecal matter in the digester: Theaccumulation of fecal
matter at the top of the filter bed of Biofil toilets was assessed through regular (monthly basis) visual observation
(through the “inspection slab”) of fecal matter build-up in the digester. Photographs were also taken during these
observations for assessment of build-up over time. In addition, some quick calculations were also made to compare
actual accumulation (observed) with accumulation that would have resulted if the toilets function as traditional
pit/pour-flush toilets.
Possible effects of the intensity of toilet use (i.e. number of users per toilet), and O&M (e.g., use of water, cleaning
agents) on performance of the digester was assessed based on information gathered from survey of users.
In Biofil toilets, vermicompost is produced in the digester, according to the technology providers, which needs to
be removed periodically. However, this process takes a long time (varying from a couple of years to over five years,
according to technology providers). Therefore, the ability of these technologies to produce vermicompost,
characteristics of the produced vermicompost, and methods for safe collection and disposal/use of vermicompost
could not be assessed during the span of this project.
User-feedback
As a part of the technology evaluation process, each toilet was visited once a month. During these visits, a simple
“checklist” was used to record condition of the toilet and its surroundings, and to gather user feedback on different
aspects. In addition, areas surrounding the toilets were inspected and discussions were carried out with toilet users
during these field visits.
The major issues covered in the checklist include: (a) usage-characteristics (number of users, amount of water use);
(b) condition within and surrounding the toilet (clean/unclean, presence of files/insects); (c) odor inside and
outside of the toilet; (d) O&M especially with regard to use of cleaning agents (since there is strict restrictions on
use of chemical cleaning agents); (e) crack/leakage in chambers/digester (if any); (f) blockage in pan and effluent
pipe (if any); (g) condition of the digester (through visual observation); and (h) user opinion on any difficulty/ other
issues.
The information gathered during field visits through the checklist, observations and discussions with users have
been analyzed to assess the user-acceptance of the technology and possible impact of user characteristics and
behavior on the performance of the toilet technology.
Evaluation of The Biofil Toilet System Functionality (Technical Performance)

Fulfilling Criteria of a Hygienic Latrine
The Biofil toilets appear to fulfill all three criteria of “hygienic latrine”. In Biofil toilets, the fecal matter remains
confined in the digester, where it undergoes decomposition by Tiger worms, while the liquid that infiltrates
through the “filter system” of the toilet is discharged into the subsurface through a soakage pit (filled with
stone chips that acts as a filter for further polishing of the effluent). Since the fecal matter remains confined
in the digester, and effluent is discharged into the subsurface, a Biofil toilet effectively fulfils the criterion –
confinement of feces – of a hygienic latrine.
The soakage pit could be fitted with a filter/treatment system

(stone chips) for further polishing of the effluent. As a part of
technology evaluation, effluent samples were collected from the
soakage pit of a Biofil toilet before and after its passage through the
stone chip filter. Table 1.3 shows the characteristics of effluent
samples. It shows that effluent samples, particularly the one
“before” filter is characterized by high concentration of pollutants,
particularly FC, COD, Ammonia. These results highlight the necessity of discharging the effluent in the
subsurface (through soakage pits), instead of discharging them into the open environment.
Table 1.3: Concentration of selected parameters in effluent samples collected on 16/02/15 fromsoakage pit
of a Biofil toilet (B6) before and after its passage through stone chip filter.
Toilet Sample
ID Description Concentration Present in Effluent
pH TDS TSS FC COD Ammonia Nitrate Orthophosphate
(mg/l) (mg/l) (cfu/100 ml) (mg/l) (mg/l) (NO3-N) (PO4)

Before Filter 6.64 2340 2400 TNTC 5940 212.8 280.0 166.4
B6
After Filter 6.70 1520 1540 TNTC 3650 120.8 240.0 106.8
TNTC: Too Numerous To Count
All Biofil toilets have been installed with “ceramic pan” with a water seal, which seals the passage between
the squat hole and the pit/digester (thereby fulfilling an important criterion of a hygienic latrine). Each Biofil
toilet has a 100 mm vent pipe for venting of foul gases. The size (100 mm diameter) and position (150 mm
above the highest level of toilet roof) of the vent pipe appears to be adequate. Table 1.4 shows status of odor
both inside and outside of the toilets, as recorded during field visits. It shows that the Biofil toilets are free
from bad odor; slight bad odor was recorded only for a couple of toilets during the field visits.
Table 1.4: Status of odor inside and outside of Biofil toilet as recorded during field visits
Monitoring Date 17-09-2014 16-10-2014 24-11-2014 30-12-2014 12-02-2014

Date of Inside Outside Inside Outside Inside Outside Inside Outside Inside Outside
Commencementtoilet toilet toilet Toilet toilet toilet toilet toilet toilet toilet
Toilet ID Number of User*
B1 11 28.08.2014
B2 6 31.08.2014
B3 12 31.08.2014
B4 12 31.08.2014
B5 10 31.08.2014
B6 6 31.08.2014
B7 10 31.08.2014
B8 9 31.08.2014
B9 7 15.09.2014
B10 12 15.09.2014
B11 9 15.09.2014
B12 6 15.09.2014
B13 11 15.09.2014
B14 11 15.09.2014
B15 14 15.09.2014
No Smell
Slight smell
Acute Smell
* according to baseline survey data

Performance of the Digester of Biofil Toilet

As discussed earlier, the performance of the digester of Biofil toilets has been evaluated in terms of the
ability of the digester filter to drain liquid and the ability of tiger worms in reducing accumulation of fecal
matter.
Ability of Digester Filter to Drain Liquid:

The ability of Biofil digester filters to drain liquid was assessed through visual observation of the digester
by removing the “inspection slab”. Based on the observation made up to February 2015, it appears that
the filter systems of the Biofil toilets are working. The digester filters of all Biofil toilets were able to drain
the liquid, and retained the fecal matter on the filter media for decomposition by tiger worms.
Reduction of Fecal Matter Accumulation by Tiger Worms

If the filter system of the digester of a Biofil toilet is able to properly drain the liquid (thereby preventing
water logging in the digester), the tiger worms would get the opportunity to digest the fecal matter
accumulated over the filter media. Possible reduction of fecal matter accumulation in Biofil digesters were
assessed through visual observation of the digesters on a monthly basis, and did not get any indication of
rapid accumulation of fecal matter, as would have observed for a pit/pour-flush latrine. During the later
stage of monitoring (December 2014-February 2015), presence of “blackened” matter around the edges
of the digester (surrounding the yellowish fresh matter) appears to suggest formation of “vermicompost”.
Visual observations and analysis of photographs taken over a five to six-month period appear to show
minimal accumulation of fecal matter within the digester.
In order to get some quantitative estimate of how much fecal matter would have accumulated within the
digesters if there were no tiger worms (i.e., if the toilets were working as traditional pit/pour flush latrine),
some quick calculations were done. Toilet B4, installed at the residence of Mr. Abdul Hai on 31/08/14 was
taken as a test case. This toilet is used by 12 users. Accumulation of fecal matter in the digester of the
toilet (without considering decomposition by tiger worms) was estimated according to the following
equation:
V = C. P. N
where, V = volume of fecal matter in m3
C = fecal matter accumulation rate; typical value 0.04 m3/person/yr for a pour-flush toilets
P = Number of toilet user, and
N = period of operation (in year)
From the date of installation of the toilet 31/08/14 to 12/02/15, when the last photograph of the digester
was taken, the toilet has been used for 165 days (or about 0.452 years). Hence estimated volume of fecal
matter that would have accumulated in the digester is, V = 0.04 x 12 x 0.452 = 0.217 m 3
Since the x-section area of the digester is about 1.536 m2, this volume of fecal matter would have filled
the digester to a depth of about 14.1 cm (or, 5.56 inches, i.e., close to 6 inches). However, visual
observation and photograph of the digester taken on 12/02/15 suggest minimal accumulation, possibly
less than 1 inch. This quick calculation suggests that accumulation of fecal matter within the digester is
being reduced by the tiger worms.
User Feedback
General Acceptance of Toilet

The first challenge at the beginning was to make the technology, which involves use of worms (tiger
worms), acceptable to the users. The project partners successfully overcame this challenge, and the user
families accepted the concept of the technology with enthusiasm. Since the superstructure of the Biofil
toilets are better than the toilets that were being used by the people before the commencement of the
project, the users initially accepted the toilets quite well. All Biofil toilets were installed with “ceramic
pans”, which is commonly used and well-accepted by the users.
Operation and Maintenance

The user families also accepted the somewhat strict operation and maintenance requirements of the
toilet, particularly with regard to cleaning of the toilet without using any chemical agents. Information
gathered during field visits suggests that by and large the users were following this and other operation
and maintenance instructions. According to the baseline survey, the family members of households where
the toilets were installed varied from 6 to 14, which is within the limit (i.e., 15) suggested by the
technology provider. Users reported using toilet 1 to 2 times for defecation and 2 to 3 times for urination;
reported average water use is about 3 liters per use. Therefore, performance of the toilet digesters does
not appear to have been adversely affected by user behavior (e.g., excessive use, use of chemical cleaning
agents). During field visits, most of the toilets were found to be clean, except for a few ones. Table 1.5
shows the condition of the toilets, as recorded during field visits.
Monitorin
g Date
17-09- 16-10- 24-11- 30-12-
2014 2014 2014 2014 12-02-2014
Name of the Date of
Toilet Commenc Outsi Outsi Out Outsid

ID Beneficiary ement Inside de Inside de Inside side Inside e Inside Outside
toil
toilet toilet toilet Toilet toilet et toilet toilet toilet toilet
Mr. Hazrat 28.08.201
B1 Ali 4
Mr. 31.08.201
B2 Nazimuddin 5
Mr. 31.08.201
B3 Zahiruddin 6
Mr. Abdul 31.08.201

B4 Hai 7
Mr. Dukhu 31.08.201
B5 Mia 8
31.08.201
B6 Mr. Masud 9
Mr.
Shahabuddi 31.08.202
B7 n 0
Mr. Bishu 31.08.202
B8 Mia 1
15.09.201
B9 Mr. Manik 4
15.09.201
B10 Mr. Sattar 4
15.09.201
B11 Mr. Ataur 4
15.09.201
B12 Mr. Sharif 4
15.09.201
B13 Mr. Monir 4
15.09.201
B14 Mr. Monir 4
Mr. 15.09.201
B15 Riazuddin 4
Clean
Not so clean
Dirty
Table 1.5: Condition of Biofil toilets, as recorded from visual observation during field visits
User Acceptance
The Biofil toilets appear to be widely accepted amongst the users with the overall experience much similar
to that of simple pour flush latrines. There are a number of reasons influencing the satisfaction of the
users. The toilet superstructures are significantly better than those used by the beneficiaries before
commencement of the project. By and large, the toilets do not produce any bad odor. The O&M are
relatively simple, except for the restriction on use of chemical agents for toilet cleaning (which the users
have adopted over regular usage) and there is no requirement for frequent deslugding of the pit/digester
as in conventional pit latrines.. Besides, since the untreated fecal matter is not disposed into the
surrounding environment (as commonly done for the previously used toilets to avoid accumulation of
fecal matter in toilet pits), and the effluent wastewater is safely discharged into the subsurface the overall
environment is also improved.
Summary Evaluation
Within the evaluation period from September 2014 to February 2015, the Biofil toilets (constructed
entirely with locally available materials, including the tiger worms) appear to be functioning well and the
technology has been well accepted by the users. The digester of the Biofil toilets appear to be functioning
as designed; the digester filters have been found to effectively draining liquid, creating a favorable
environment for the tiger worms to digest fecal matter accumulated over the filter bed. Visual
observation, analysis of photographs of the digester taken during the monitoring period, and quantitative
estimation of fecal matter accumulation suggest that the tiger worms are effective in reducing
accumulation of fecal matter in the digester.
Higher use, particularly higher water use (that could over-stress the filter system), and use of chemical
cleaning agents (that could kill the tiger worms in the digester) are possible risk factors for the Biofil toilets.
Since pour-flush system in Bangladesh uses significantly higher volume of water than micro-flush system
used in Ghana, the maximum number of users (15) set for each Biofil toilet by the technology provider
may need to be revised.
Conclusions and Recommendations
Conclusions
During the 6-month monitoring period, the Biofil toilets have performed well and the technology has been
well accepted by the users. The digester of the Biofil toilets have been found to be effectively draining
liquid, creating a favorable environment for the tiger worms to digest fecal matter accumulated over the
filter bed. Visual observation, analysis of photographs of the digester, and quantitative estimation of fecal
matter accumulation suggest that the tiger worms are effective in reducing accumulation of fecal matter
in the digester.
Recommendations
Based on the preliminary evaluation, from “technology perspective”, the Biofil technology has the
potential to serve as a sustainable sanitation option for households in slums, low-income communities
and beyond, which are currently being served by pit/pour -flush toilets and septic tank systems. In fact,
the Biofil toilet appears to be a very suitable option for implementation in the rural areas, where lack of
FSM services is also threatening sustainability of sanitation facilities; the typical family size and general
acceptance of “tiger worms” (as beneficial to soil) would facilitate implementation of the technology in
the rural areas. Efforts may therefore be taken to pilot the technology in rural areas. If successful, this
could be considered as a breakthrough in the management of fecal sludge in both urban slums and rural
areas currently served by pit/pour-flush latrines.
However, it must be emphasized very strongly that the “Biofil technology”, though simple in principle,
should not be taken lightly at all. The “filer system” of a Biofil toilet serves the purpose of draining liquid
and maintaining a suitable environment for tiger worms to digest the fecal matter. The design details of
the digester and the number of users using the toilet for which the digester is designed for must be strictly
followed, and the effluent discharge system (like soakage pit) must be properly constructed for the toilet
to drain and function effectively. Furthermore, proper training of masons and others involved in the
construction of Biofil toilets is also very important to ensure the overall quality of the digester. Besides,
the Biofil toilets in their current form costs approximately BDT 10,000 per digester as piloted in SanMark
CITY Project and are therefore, expensive for the urban and/or rural poor as compared to conventional
pit latrines which costs less than BDT 5000. Nevertheless, for a hygienic toilet, cost should not be
calculated only from financial point of view as there are other social impacts in terms of health and
sanitation. There are no incurred operational costs for maintaining the Biofil toilet on regular basis, and
according to the technology provider, the toilet will sustain more than twenty years. From these
perspectives, Biofil toilet is much less expensive than conventional single and twin pits latrine. Moreover,
capital and installation costs can be significantly reduced through further implementation efforts by
optimizing the technology.
Fecal Sludge Management (FSM) Scenario in Urban Areas of Bangladesh
Md. Mujibur Rahman1, Muhammad Ashraf Ali2, Mahbuboor Rahman Choudhury3,

Md. Azizur Rahman4, Asef Mohammad Redwan4, Nowroz Farhan Noor5, Aminul Islam Sohan5
Professor of Civil Engineering, BUET, and Team Leader, South Asia Urban Knowledge Hub (K-Hub), ITN-
BUET, Bangladesh Center; 2 Professor of Civil Engineering, BUET, and Urban Specialist, K-Hub, ITN-BUET,
Bangladesh Center; 3 Assistant Professor of Civil Engineering, BUET, and Environmental Specialist, K-Hub,
ITN-BUET, Bangladesh Center; 4 Research Officer, ITN-BUET; 5 Research Associate, ITN-BUET
Abstract
Except for about 20% area of Dhaka city, all urban areas of Bangladesh are served by on-site sanitation
(OSS) system. However, OSS systems in Bangladesh have been developed without much consideration to
the management of fecal sludge. Disposal of fecal sludge in low-lying areas and in lakes and canals within
urban areas is common, which is causing serious environmental degradation and endangering public
health. This study presents an assessment of the typical fecal sludge management (FSM) scenario in
selected urban areas of Bangladesh. In the absence of proper monitoring, septic tank system has been
developed very poorly in all urban areas. In many areas the system is altogether absent, and toilet
wastewater is directly discharged into storm drains/sewers; in some cases, there is septic tank but the
soakage pit is absent. In almost all cases, the septic tanks are poorly designed, constructed and
maintained. There is a lack of awareness among City Development Authorities, Paurashavas and real
estate developers about the importance of FSM, and the urban authorities do not have required capacity
to monitor design/construction of OSS facilities. Due to lack of effective pit emptying services, pour-flush
latrines in high-density urban slum areas are being constructed without “pits”, and fecal matters from
toilets are being discharged intentionally into open environment. For large cities with city corporations
(e.g., Dhaka, Chittagong, Rajshahi, Khulna) there is no clear assignment of responsibilities for management
of fecal sludge. As a result, the limited FSM initiatives in these urban areas are continuing in an
uncoordinated manner. Manual emptying, though very hazardous and often more expensive than
mechanical emptying, are being practiced in all urban areas. Mechanical desludging services, initiated by
some NGOs, Private Sector and Paurashavas, suffer from certain limitations. While there are some
promising initiatives in treatment of fecal sludge, significant research and development works are needed
for the development of effective fecal sludge treatment facilities, and possible production of useful by-
products (e.g., compost). There is significant scope for innovations in the design of mechanical emptying
equipment, and also in development of FSM business models involving private sector.
Introduction
Bangladesh has witnessed a remarkable growth in on-site sanitation facilities throughout the country over
the last decade (1, 2). Figure 1 shows the change in relative usage of different types of sanitation facilities
in urban areas of Bangladesh (1). During the last two decades, Bangladesh has been able to reduce the
prevalence of open defecation from 34% in 1990 to 1% in 2015; coverage by “improved sanitation
systems” also increased from 33% to 61% during this period. In urban areas, improved sanitation coverage
has increased from 47%, not so significantly, to 58%. Currently (2015), 28% of the total population and
about 30% of urban population depend on shared facilities. While the Joint Monitoring Program (JMP) of
WHO and Unicef does not consider shared facilities as “improved sanitation” due to maintenance reasons,
there are however other compelling factors for people to resort to shared facilities, e.g., space constraint
in densely populated urban areas.
100
Use of Different Types of Saniation Facilities by
90
80
Percentage of Population
70 Open defecation
60
Other unimproved
50
40 Shared Facilities
30
Improved
20
10
0
Urban Total Urban Total Urban Total
1990 2000 2012

Year
Figure 1: Relative usage of different types of sanitation facilities in urban areas of Bangladesh compared
to total national usage in the years of 1990, 2000, and 2012. (1)
The major progress in urban sanitation during the last two decades is the elimination of open defecation
amongst the poorest quintile (2) through use of on-site sanitation facilities. However, increasing use of
on-site sanitation facilities has generated a large demand for fecal sludge management (FSM) to keep the
toilets operational. In the absence of effective FSM services, the huge quantities of fecal sludge generated
in septic tanks and pits are inaptly managed. Disposal of fecal sludge in low-lying areas and in lakes and
canals within urban areas is common, leading to serious environmental degradation (2, 3, 4, 5).
In Bangladesh, major urban areas comprise of 11 City Corporations (CCs) and 325 Paurashavas
(Municipalities). Except for about 20% area of Dhaka city (covered by sewerage system), all urban areas
of Bangladesh are served by on-site sanitation system (2), which include septic tanks (in middle- and high-
income communities) and different forms of pit latrines (in slums and low-income communities). There
has been virtually no expansion of sewerage system anywhere in Bangladesh over the past decades; and
the country will continue to rely on relatively cheap and affordable on-site systems (6, 7, 8) in the
foreseeable future. A root cause for lack of FSM services is that there is no clear assignment of
responsibilities with regard to FSM among the utility service providers. As a result, there is a lack of
concerted effort by all concerned to address this serious issue (9, 10, 11). Therefore, the first major step
toward solving the FSM problems is to develop an institutional and regulatory framework for FSM in
consultation with all stakeholders, with clear assignment of responsibilities among the stakeholder
organizations (12). There are significant differences in institutional set up and FSM practices among and
within cities/towns, and proper understanding of the situation is a pre-requisite for development of
workable management framework.
The overall objective of the present case study was to assess the FSM scenario in different urban ettings.
The study involved data collection on FSM practices in different urban areas using a semi-structured
questionnaire, consultations, meetings and interviews, and physical survey/observation of sanitation
facilities and FSM practices. The specific objective of this study was to analyze some of the strengths and
deficiencies in the existing FSM practices in different urban setups of Bangladesh. The finding from the
present study provided useful data, information and insights for the development of institutional and
regulatory framework for FSM in urban areas of Bangladesh.
Methodology
Study Area
The case study was carried out in three different urban setup areas of Bangladesh: (a) urban slums in large
city, (b) urban developed areas in large city, and (c) Paurashava/ Municipal towns (Lakshmipur Paurashava
and Sirajganj Paurashava). The general features of different urban areas surveyed in the present study are
given in Table 1.
Table 1. General features of different urban setup areas surveyed in the present study.
Name and Area Number of
Type of Urban Populatio Features of Water Supply
Location of (acre Household
Area n System
Survey Area ) s
WSUP (an INGO), in
Kallyanpur
collaboration with DWASA, is
Urban slums in Pora Bastee, 2.99 30,000 4,000
providing water through limited
large cities Kallyanpur, (13) (13) (13)
collection points. Illegal DWASA
Dhaka
connections are also present.
Area n System
Survey Area ) s
Muktijoddha DWASA is providing more than
13.74 18,000 3,500
Slum, Mirpur, (a) 1000 water collection points in
(14) (14)
Dhaka the slum area.
Urban
Baridhara
developed 259 8,210 1815 Entire area is under DWASA
Diplomatic (a) (b) (b)
areas in large piped water supply.
Zone, Dhaka
cities
40% area is under piped water
supply; in remaining area water
Lakshmipur 4819 83,112 17,009
(b) (b) (b)
supply is provided using tube
Urban areas in Paurashava
wells, surface water sources,
small/
etc.
medium
townships
Sirajganj 7040 297,630 20,069 supply system; in remaining
Paurashava (17) (17) (17) area water supply is provided
using tube well, dug well, etc.
Data source: (a) Dhaka North City Corporation, available at: http://www.dncc.gov.bd;
(b)
Population Census 2011, Bangladesh Bureau of Statistics (BBS), available at: www.bbs.gov.bd.
Surveys and Data Collection

The survey involved data collection utilizing a semi-structured questionnaire; Focus Group Discussions
(FGDs); physical survey/observation of sanitation facilities and sludge management practices; and
informal discussion/meeting with key individuals (NGO representatives, representatives from housing
society and building caretakers, and Paurashava officials). The field survey in slums was facilitated by DSK,
a local NGO. The Baridhara Society and Swisscontact, an international NGO facilitated the field survey in
Baridhara. Field survey in Lakshmipur and Sirajganj Paurashavas was facilitated by the DPHE.
FSM Scenario in Urban Areas

Only 20% area of the capital city Dhaka is covered by sewer network and the collected sewage is conveyed
to the Pagla Sewage Treatment Plant (5). The sewer network is not functional in many areas due to
blockages (15). The Dhaka Water Supply and Sewerage Authority (DWASA) is responsible for maintenance
of the sewer network and the sewage treatment plant. On the other hand, the remaining urban areas of
the entire country are covered by on-site sanitation facilities (OSS) (5, 12).
The basic elements of FSM system is shown in Figure 2 (2, 9-12). In urban areas, the OSS facilities are
mainly septic tanks (with or without soakage pits) and different types of pit/pour-flush latrines. FSM
services involve emptying of pits/tanks, collecting in a tanker, transportation of the emptied fecal sludge
to a treatment plant, and finally disposal/reuse of effluent/end-products from treatment. In the present
case study, efforts have been made to analyze each element of FSM system in different urban settings.
Emptying and
User Interface Containment Collection Transport Treatment Disposal/Reuse
On-Site Sanitation (OSS) Facilities

Fecal Sludge Management
(Pit latrine/Septic tank)
Figure 2: Elements of FSM system for OSS facilities
FSM Status in Urban Slums

Types and design of sanitation facilities
Types of sanitation facilities: Different types of on-site sanitation facilities have been observed in the two
surveyed slum - “Kallyanpur Pora Bastee” and “Muktijoddha Slum”. Table 2 shows the types of sanitation
facilities in the two urban slums.
Table 2: Types of sanitation facilities in the urban slums surveyed

Slum Types Sanitation Facilities
Kallyanpur Pora Bastee  Community latrines connected to septic tanks
Muktijoddha Slum  Pour-flush latrines, household and shared, with pits (predominant)
 Pour-flush latrines with septic tanks with/without soakage pits
 Hanging latrines (200 in the slum)
Figure 3 shows distribution of different types of on-site sanitation facilities in the “Muktijoddha Slum”
observed in the present study. Among the 26 toilets physically surveyed, fecal matter from 16 (i.e., about
62% of the toilets) were directly being discharged into open environment, endangering public health (16).
As discussed below, fecal matters from the remaining toilets also eventually find their way into open
environment.
7.7 50.0 34.6 7.7
7.7 50.0 34.6 7.7
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Pour-flush toilet connected to septic tank Pour-flush toilet with no pit

Direct or off-set pit pour-flush toilet Hanging latrines
Figure 3:Direct
Distribution
or off-setof
piton-site sanitation
pour-flush toilet facilities
Hangingsurveyed
latrines in Muktijoddha Slum, Dhaka.
Design of sanitation facilities: Among the 7 direct-pit toilets surveyed in Muktijoddha slum, none had
provisions for desludging; this means that the toilet superstructure would have to be removed if the fecal
matter is to be desludged from the pit. The entire Kallyanpur Pora Bastee is covered by community latrines
connected to septic tanks; the sanitation facilities include 2-chamber to 6-chamber latrines. Table 3 shows
the dimensions of septic tanks for different types of community latrines. The number of user of these
latrines varies widely; for example, user of the six 2-chamber latrines varies from 50 to 300. Thus, it
appears that the number of users of a particular latrine was not considered or could not be estimated
properly during the design phase of the latrines. Space constraint might also have affected the design.
Physical survey and discussion with NGO representatives revealed that the septic tanks are not fitted with
inlet-T and outlet-T. The absence of inlet and outlet Ts would seriously affect treatment efficiency,
resulting in poor quality of effluent. However, discussion with an NGO representative revealed that there
is some logic in not providing the “inlet-T”. According to him, users often dispose children’s feces in
polythene bags as well as sanitary cloths into the toilets; these materials often get stuck at the mouth of
the inlet-T. Consequently, inlet-T has been eliminated from the design. It was also revealed that absence
of outlet-T in septic tanks is in fact causing some major problems. Polythene and cloths often float and
clog the opening of the outlet pipe of the septic tank, causing the toilet/tank to overflow. For some of the
community toilets, the septic tank effluents discharge into soakage pits, while for others the effluent
discharge directly into nearby water bodies. Lack of space for construction of soakage pit and
inadequate/poor infiltration capacity of soil is the main reasons for not constructing soakage pits.
Table 3: Dimensions of septic tanks in Kallyanpur Pora Bastee
Toilet Type Total Dimension of 2-Chamber Septic Tank

L (m) x W (m) x H (m)
5-Chamber 5.500 x 2.100 x 1.300
4-Chamber 4.325 x 1.925 x 1.400
3-Chamber 3.900 x 1.800 x 1.250
2-Chamber 2.725 x 1.525 x 1.400
Emptying and transportation of fecal sludge

Emptying of fecal sludge: Majority of OSS in Muktijoddha slum directly discharges fecal matter into nearby
low-lying areas or drains. For the remaining facilities, emptying of pits/ tanks is carried out when the
pits/tanks become full or they overflow. Manual emptying is the common practice. Households pay BDT
2000 to 3000 (about USD 25-37.5) to sweepers for desludging of a typical pit/tank. DSK provides limited
mechanical desludging service (using Vacutug) and some households in the slum avail this service.
Although cost of mechanical desludging is similar or even cheaper (about BDT 2000 per desludging event)
than manual desludging, many households cannot avail the service due to difficulties in accessing OSS
facility by the Vacutug. Vacutug operators mentioned that they often find different kinds of solid wastes
inside pits/ tanks, which makes pumping of fecal matter difficult.
The septic tanks of the community toilets in Kallyanpur Bastee are desludged when either the tank or
toilet overflows; in some cases, the caretakers reported of desludging at regular interval (e.g., every six
months to a year). Thus, the septic tanks are being used as a fecal sludge storage device, and are not
performing their desired. Both manual and mechanical methods are availed for desludging. Manual
desludging has a number of disadvantages, e.g., high cost (BDT 5000 to 6000 per septic tank, compared
to BDT 1000 to 1200 for mechanical desludging in this slum) and long desludging duration (1 to 3 days).
Transportation of fecal sludge: In case of mechanical desludging, the pumped fecal matter is often stored
in smaller containers (wheel barrow) that could be taken up to the OSS facility through narrow slum lanes;
subsequently the fecal matter is pumped into larger tanks of the Vacutug. In Dhaka city, there is no
designated site for treatment of fecal sludge. Emptied fecal matter is usually disposed in the nearby sewer
(through manholes), surface drains or low-lying areas. This practice is contributing to the environmental
pollution in the city. DSK, a Vacutug service provider, disposes the emptied fecal matter in DWASA
sewer/sewage lifting station (with permission from DWASA). But the sewer network or sewage lifting
stations are not designed to receive fecal sludge, and such activity would interfere with proper functioning
of these network facilities.
Figure 4: FSM scenario in urban slum areas
Treatment and disposal of fecal sludge
As noted above, there is no facility for treatment of fecal sludge in Dhaka city. In the absence of treatment
facilities the emptied fecal sludge eventually finds its way into the open environment. Figure 4 summarizes
the FSM scenario in urban slum areas of Bangladesh.
FSM Status in Developed Urban Areas
Types of sanitation facilities
Baridhara, a high-income area in Dhaka, is not covered by sewer network, but storm drainage
network/drains are available in the area. Here “septic tank system” is supposed to be the sanitation
system. This area is under the jurisdiction of “Rajuk”, the capital city development authority. Since this
area is not under sewerage system, all buildings constructed here must have septic tank system, according
to the National Building Code. This means that all buildings constructed here must had provisions of septic
tanks in the designs approved by Rajuk. However, it was revealed that most of the buildings here do not
have septic tanks, and none have soakage pits. Thus, the wastewater generated within the buildings is
being directly discharge into storm drainage system; the storm drainage system subsequently discharges
into the nearby Baridhara Lake.
This observation points to a major weakness in the construction/real estate industry – the city
development authority (in this case Rajuk) does not have the capacity to oversee whether buildings are
constructed according to the approved designs, and real estate developers are not aware of the
importance of the OSS facilities. This practice is rather common in all urban areas of the country.
In the high-income Baridhara area, most buildings do not have septic tanks and domestic wastewater is
directly discharged into storm drainage system. Some buildings have septic tanks, and these are desludged
periodically primarily by manual method employing sweepers; manual desludging of a septic tank costs
about BDT 4000 (USD 50) to 5000 (USD 62.5). Only one surveyed building reported availing mechanical
desludging, the cost of which reported to vary from BDT 15,000 (USD 187.5) to 20,000 (USD 250).
Reported desludging interval varied from 1 to 2 years. Overflow of septic tanks and odor nuisance were
reported as other important reasons for desludging septic tanks. The method of transportation and
disposal of fecal sludge is similar to those described for urban slums. The fecal matter is usually disposed
in public sewers, DWASA lifting stations, drains, or low-lying areas.
As discussed above, treatment of fecal sludge is the weakest component of fecal sludge management in
Dhaka city. No treatment facility has been developed and there is no visible initiative for establishment of
any fecal sludge treatment facility. The typical FSM scenario in developed urban areas is summarized in
Figure 5.
On-site
Collection Transportation Treatment Disposal/
sanitation
facility End use
Mechanical
Septic tank with collection of fecal
or without sludge from septic
soakage pit; tanks using
‘Vacutug’ Transportation of
septic tank
fecal sludge to
effluent
nearest public
discharge into
storm
storm Manual collection
sewer/drain/lift Disposal of
sewer/drain of fecal sludge by
station/ lowlands untreated
sweepers
fecal sludge to
nearby low
Direct discharge Collection of land/lake
Transportation of
of domestic fecal sludge in
fecal sludge
wastewater into municipal sewer
along storm
storm sewer /drain
sewer /drain
/drain
Figure 5: FSM scenario in developed urban areas in large cities without any organized FSM services
FSM Status in Paurashava Towns
Laksmipur Paurashava
Types of sanitation facilities: In Lakshmipur Paurashava the predominant OSS are (a) toilets connected to
septic tanks (with or without soakage pits); and (b) pour-flush latrines (direct and off-set pit). Sanitation
facilities of 11 establishments were physically surveyed, which included 7 houses, 1 school and 1 office.
Among these, two were off-set pit pour-flush toilets. The remaining were toilets connected to septic
tanks; only two of these had soakage pits.
Design of sanitation facilities: The dimensions of the surveyed septic tanks varied widely; the x-sectional
area varied from 12 x 4 to 25 x 16.5; depths of tanks could not be ascertained. The dimensions of septic
tanks do not appear to have any relationship with the number of users. Inlet-T was observed in one, while
inlet and outlet-Ts were found to be absent in three; for the remaining septic tanks, the inlet and outlet
points were not visible. There is no standard design practice for pit latrines, which are usually constructed
by masons. The Pourashava is responsible for checking designs of buildings/houses before providing
permission for construction. Discussion with Paurashava officials revealed that for buildings less than 5-
storied height, design of sanitation facilities are usually not given much priority while checking designs.
However, the Paurashava does not have enough manpower to oversee if the OSS facilities are constructed
properly.
In Lakshmipur Paurashava, people usually desludge their septic tanks/pits when they overflow; some also
reported desludging at fixed regular interval. The Paurashava introduced mechanical desludging service
in 2013, and many people are availing this service. The Paurashava has received 3 mechanical desludging
equipment (Vacutug) from the Secondary Town Water Supply and Sanitation Sector project (funded by
the GoB and ADB) run by DPHE. But the extent of service at this stage is limited. People also avail manual
desludging services, especially in areas inaccessible by Vacutug; manual desludging is slightly cheaper than
the mechanical service, costing about BDT 500 to 1000.
Lakshmipur Paurashava has established a fecal sludge treatment plant with support from the Secondary
Town Water Supply and Sanitation Sector project. DPHE designed and constructed the treatment plant
on a 0.30 acre land owned by the Paurashava.
The treatment plant is based on planted filter bed system (Reed Bed System) and sludge drying bed.
Currently, the plant receives about 42 m3 of sludge per week. The liquid effluent generated from the plant
is reported to satisfy the national discharge standards and are discharged into open environment. End-
use of treated sludge has not yet been considered and there is no data on the quality of compost or dried
sludge produced at the treatment plant.
Sirajganj Paurashava
Types of sanitation facilities: Major OSS facilities in Sirajganj Paurashava include: (a) pour flash toilets with
a single direct or off-set pit, (b) pour-flush toilet with twin off-set pit, (c) pour flash latrine with septic tank,
with or without soak pit. Presence of some hanging latrines was also reported. Sanitation coverage in the
Paurashava is reported to be about 96.2% (18). Among the sanitation facilities of 19 establishments
surveyed, 8 were direct pit pour-flash toilets, 4 twin offset pit latrine, 1 single offset pit latrine, and the
remaining 6 were pour-flash latrines connected to septic tank; 4 out of these 6 septic tanks had soakage
pits.
Design of sanitation facilities: Masons usually design septic tanks, and the size is fixed based on availability
of space, rather than user number. Except for one case, inlet and outlet T-s were absent in the surveyed
septic tanks. Pits are usually made of concrete rings with diameter of 2.5 to 3.5 feet, and height of 1 foot.
Typically 5 to 8 rings are used to construct a pit. Paurashava officials reported that while they check
designs of buildings, they do not have enough manpower to check whether the buildings are constructed
according to approved design. Bangladesh National Building Code (BNBC) provides some guideline for
design of septic tanks, but there is no guideline for design of pour-flush toilets.
Manual pit emptying is common in the Paurashava. The process is unhygienic, generates odor nuisance,
and hazardous to the manual emptier who do not use any safety gear. The cost of manual emptying varies
from Tk. 500 to 1000 per pit. The Paurashava started mechanical emptying service from December 2012
after obtaining a 2000 L capacity vacutug from Unicef; the collected sludge is transported to a treatment
plant. The emptying charge is Tk. 2500 for the first trip, and Tk. 1500 for the next trip, if needed. Most
participants of the FGD opined that the charge should be reduced in an affordable level. Currently the
demand for vacutug service is low.
Apart from cost, other problems associated with vacutug service include: (a) narrow access road or
adversely located (e.g., behind the house) septic tank/pit, making it difficult/ impossible for vacutug to
access it (see Figure 6); (b) pit/tank opening inadequate for entry of vacutug suction pipe; (c) difficulty in
removing hardened fecal sludge at the bottom of the pit/tank with vacutug.
(a) (b) (c)

a a a
Figure 6: Accessibility problem for desludging pit and septic tank: (a) pit not accessible by vacutug, (b)
septic tank manhole is located inside kitchen, (c) narrow walkway, not accessible by vacutug.
Apart from these, the FSM services offered by Sirajganj Paurashava is facing a number of other challenges.
As there is no separate unit for FSM/Vacutug service, the Conservancy Section of the Paurashava provides
this service. Pourashava does not have separate manpower or budget to operate this service. The driver
and sweepers of the vacutug service work on a contract-basis, and their jobs are not permanent. The
sweepers earn Tk. 200 per trip; driver of Vacutug gets a monthly salary of Tk. 4000, and additional Tk. 200
per trip. The driver and sweepers are carrying out the service without any protective gear.
A recent study in 30 cities of Asia and Africa compiled financial statement of 154 fecal sludge collection
businesses and established that the collection and transportation of fecal sludge is a rewarding business
when operated by private entrepreneurs (4, 17). The Paurashava cleaners also said that it would be
financially more beneficial if he could rent a “vacutug” system from the Paurashava and run his own
business with it.
Sirajganj Paurashava has established a fecal sludge treatment plant with technical support from DPHE in
2013-14 on a one acre land under GoB-ADB funded Secondary Town Water Supply and Sanitation Project.
After construction, DPHE has handed it over to the Paurashava for operation and maintenance. Currently,
the sludge emptied by vacutug is carried to the treatment plant. On the other hand, the manually emptied
sludge are still discharged into lowlands, surface drains, nearby ponds, as reported by FGD participants.
Vacutug transports the collected sludge in a closed container and disposes the sludge to the filter bed of
the treatment plant. At present, there is no caretaker to look after the treatment plant. The technical
performance of the plant could not be evaluated as a part of this study. Based on the experience of
Laksmipur and Sirajganj Paurashavas, Figure 7 summarizes FSM scenario in a typical Paurashava town.
FSM Intervention in the Country
FSM has recently been identified as an emerging challenge in urban areas of Bangladesh (2). The DPHE in
collaboration with UNICEF has undertaken several pilot projects of establishing treatment plants in
different city corporations and municipalities throughout the country. On the other hand the “Secondary
Town Water Supply & Sanitation Sector” project initiated fecal sludge treatment plants at 16 Paurashavas
since 2012. The Lakshmipur and Sirajganj Paurashavas surveyed under the present study are among these
16 Paurashavas. Some of these treatment plants are reported to be performing well (including the one in
Lakshmipur Paurashava), while others are not. The interest and capacity of Paurashava are important
factors for the success of FSM services including treatment. The basic concept of the FSM adopted in these
ongoing projects consists of collection of fecal sludge from septic tanks and pits through ‘vacutug’ and
transportation of the sludge for suitable treatment and/or disposal (2, 9, 10, 11). Pit emptying services
provided in Dhaka by some NGOs and private organizations are also limited to collection of fecal sludge
and subsequent inappropriate disposal in sewers/drains. The FSM initiatives in urban areas of Bangladesh
mostly have limited scope (12). Other than a few Paurashavas, these initiatives are on pilot basis and
provided by individuals and/or informal sectors (12).
On-site Disposal/
sanitation Collection Transportation Treatment
End use
facility
Disposal of treated
Transportation of effluent in open
Mechanical
fecal sludge to Treatment of environment
collection of fecal
sludge treatment fecal sludge
Household/com sludge using
plant using
munity based ‘Vacutug’
‘Vacutug’
pour-flush
latrines
connected to
pits or septic Transportation of
tank system fecal sludge to
Disposal of fecal
Manual collection nearby low
sludge in low
of fecal sludge by land/canal/
land/canal/rejected
sweepers rejected pond
pond
Figure 7: FSM scenario in Paurashava towns where FSM services have been initiated
Lessons Learned
The major findings of the case study are summarized below:
(1) On-site Sanitation System: In the absence of proper monitoring, OSS systems have been developed
very poorly in all urban areas. In many urban areas septic tanks are absent, and toilet wastewater
is directly discharged into storm drainage network. In some cases, soakage pit is absent. Due to lack
of pit emptying services, pour-flush latrines in high-density urban slums are being constructed
without “pits”, and fecal matters from toilets are flushed out into open environment.
(2) Design of OSS facilities: Septic tanks are not designed considering user number, and no desludging
frequency is assigned with the design. Proper inlet and outlet devices (i.e., Ts) are not provided, and
in most cases, soakage pits are absent. In almost all cases, the septic tanks are poorly designed,
constructed and maintained.
(3) Construction of OSS facilities: Although City Development Authorities and Paurashavas are
responsible for granting permission for construction of houses/ buildings after checking designs; the
system appears to be ineffective with regard to OSS facilities. Designs and construction of on-site
facilities are seldom checked or monitored. Urban authorities do not have required capacity (both
in term of training and manpower) to monitor design/construction of OSS facilities.
(4) Positive initiatives at Paurashavas: The Paurashava authorities are responsible for management of
on-site sanitation facilities (and hence FSM) according to the Local Government Act 2009. Due to
this clear assignment of responsibility, Government agencies, I/NGOs, and Development Partners
have started working together with Paurashava authorities on FSM, and some positive results are
already visible. However, the Paurashavas suffer from severe shortage of manpower and training.
(5) Lack of initiative in large cities: For large cities, there is no clear assignment of responsibilities for
FSM. As a result, the limited FSM initiatives in these large and high-density urban areas are
continuing in an uncoordinated and inappropriate manner, and not yielding desired results. This
situation highlights the importance of the proposed institutional and regulatory framework for FSM.
(6) Collection and transportation of fecal sludge: Manual emptying is being practiced in all urban areas.
Mechanical desludging services suffer from limitations that include lack of access in areas with
narrow roads and absence of a viable business model.
(7) Treatment of fecal sludge: There is limited experience of treatment of fecal sludge. Research is
needed for the development of effective fecal sludge treatment facilities, and possible production
of useful by-products (e.g., compost).
Conclusions
Fecal sludge management (FSM) has been identified as a major challenge, particularly for the urban areas
of Bangladesh. Inappropriate management of fecal sludge is causing environmental pollution and
becoming a major health risk. The poorly developed OSSs and their poor O&M is a result of long neglect
of the issue, especially at the local government level. Existing institutional set up at local government
institutions and other relevant organizations is highly inadequate, both in terms of capacity and training,
to tackle the huge challenge posed by inappropriate FSM. Development of an institutional and regulatory
framework for FSM, with clear assignment of responsibilities among the stakeholder
organizations/institutions, could be the first major step toward solving the FSM problems. Together with
the “framework”, the capacity of the key organizations/institutions responsible for FSM must be
enhanced through increasing manpower, capacity building trainings, and channeling funds for establishing
FSM infrastructure and services.
Acknowledgements
This work was supported by Asian Development Bank and Bill & Melinda Gates Foundation under the
South Asia Urban Knowledge Hub project. The authors gratefully acknowledge DSK (Dustho Shastho
Kendra), WaterAid Bangladesh, Dhaka North City Corporation (DNCC), DPHE, Lakshmipur and Sirajganj
Paurashava authorities for facilitating the field survey in respective areas.
References
(1) WHO-UNICEF Joint Monitoring Programme Report, 2014. Progress on Drinking Water and
Sanitation – 2014 Update, Switzerland.
(2) Local Government Division (LGD), Ministry of Local Government, Rural Development and
Cooperatives, Government of the People’s Republic of Bangladesh, 2013. Bangladesh Country
Paper. Fifth South Asian Conference on Sanitation (SACOSAN-V). October 22-24, 2013. Kathmundu,
Nepal.
(3) Opel, A., 2012. Absence of FaecalSludgeManagementShatters the Gains of Improved Sanitation
Coverage in Bangladesh. Sustainable Sanitation Practice. 13, 4 – 10.
(4) Chowdhry, S., Kone, D., 2012. Business Analysis of Fecal Sludge Management: Emptying and
Transportation Services in Africa and Asia, Bill & Melinda Gates Foundation, Seattle, WA.
(5) Opel, A., Islam, K., 2013. Faecal Sludge Management: A Critical Challenge for the Cities in Developing
Countries. Proceedings for the Asia Water Week 2013. March 13 – 15, 2013.ADB Headquarters,
Manila, Philippines.
(6) Franceys, R., Pickford, J., Reed, R., 1992. Guide to the Development of On-site Sanitation, World
Health Organization, Geneva, Switzerland.
(7) Trémolet, S., Kolsky, P., Perez, E., 2010. Financing On-Site Sanitation for the Poor: A Six Country
Comparative Review and Analysis, Washington, DC: Water and Sanitation Programme, World Bank.
(8) Cairncross, S., Bartram, J., Cumming, O., Brocklehurst, C., 2010. Hygiene, Sanitation, and Water:
What Needs to Be Done? PLoS Med 7(11): e1000365. doi: 10.1371/journal.pmed.1000365
(9) Opel, A., Bashar, M.,K., 2013. Inefficient Technology or Misperceived Demand: the Failure of Vacu-
tug Based Pit Emptying Services in Bangladesh. Waterlines, 32(3), 213 – 220.doi: 10.3362/1756-
3488.2013.022
(10) Jonathan, P., Masudul, Q., 2008. The challenge of servicing on-site sanitation in dense urban areas:
experiences from a pilot project in Dhaka. Waterlines. 27(2), 149–163.doi: 10.3362/1756-
3488.2008.017
(11) Jonathan, P., Tayler, K., 2003. Decentralized wastewater management in peri-urban areas in low-
income countries. Environment and Urbanization. 15(1), 75 – 90.doi:
10.1177/095624780301500119
(12) International Training Network, Bangladesh University of Engineering and Technology (ITN-BUET),
Policy Support Unit, Local Government Division, Bangladesh (PSU). Institutional and regulatory
framework for FSM in Bangladesh. Proceedings of 1st National Consultation Meeting on Institutional
and Regulatory Framework for Fecal Sludge Management (FSM) in Bangladesh. December 23, 2014.
ITN-BUET, Bangladesh.
(13) Khatun, F., Muntasir, M., Islam, I., 2012. Potential and prospects of on-site slum up-gradation
program in Dhaka. OIDA International Journal of Sustainable Development. 3 (10), 25–38
(14) Hoque, S., Sarker, T., Udoy, T., F., K., Khan, F., J., Muyeed, A., A., 2013. Condition of Basic Services-
Water Supply, Sanitation and Waste Management in Slums of Dhaka City: An Assessment.
Department of Civil Engineering, Ahsanullah University of Science and Technology, Dhaka.
(15) Tawhid, K.,G., 2004. Causes and Effects of Water Logging in Dhaka City, Bangladesh. TRITA-LWR
Master Thesis. KTH Stolkholm: Royal Institute of Technology.
(16) Ingallinella, A. M., Sanguinetti, G., Koottatep, T., Montangero, A., Strauss, M., 2002. The challenge
of faecal sludge management in urban areas: strategies, regulations and treatment options. Water
Science and Technology. 46 (10), 285–94.
Sirajganj Paurashava, 2011. Annual Report of Sirajganj Paurashava.
Technical Focus Session 3: Gender, Equity & Right (Bhutan)
Chair: Mr. Rinchen Wangdi, Chief Engineer,

PHED, Ministry of Health, Bhutan
Co-chair: Mr. Ugyen Rinzin, WASH Sector Leader,
SNV, Bhutan
Moderator: Mr. Abdul Motaleb, Senior Water and

Sanitation Specialist World Bank
Presenters:
- Ms. Rabeya Sultana, GWAPB, Bangladesh
- Mr. Rukhsat Hussain, SM Sehgal Foundation, India
- Ms. Tshering Choden, SNV Gender, Bhutan
- Mr. Alok Majumder, Bangladesh
Supporting Partners: UNICEF, FANSA, WSSCC
 Gender Mainstreaming in Sanitation Programme for Social Transformation and Empowerment,

Bangladesh
 Sanitation Budget tracking: A basic need for dignity count, Bangladesh
 “Role of rural women in sanitation and hygiene”- A Gender Study from Bhutan
 The Question of Attitude or Access: Sanitation through a Gender Lens, India
Gender Mainstreaming in Sanitation Programme for Social Transformation and Empowerment

Rabeya Sultana, Gender and Water Training Specialist, GWAPB &
M. M. Ahidul Islam Kazal, Program Manager, Max Foundation
Context and Background
Human degradation of water sources has left many populations, such as those in Bangladesh, living
withabundance and scarcity of water simultaneously. We are spoiling our water knowingly and
unknowingly every day; neither ground water, nor surface water, has been spared from contamination.
The rights to water and sanitation require that these resources are universally available, accessible, safe,
acceptable, and affordable without discrimination. The rights to water and sanitation require an explicit
focus on the most disadvantaged and marginalized, such as women that have been discussed at the 2013
SACOSAN-V conference held in Kathmandu, Nepal. Lack of access to safe water and sanitation leaves
vulnerable demographics susceptible to infectious disease, both in rural areas and urban slums. The Max
Foundation’s10current project, Max Value for WASH (Max-WASH), addresses those challenges through a
10
Max Foundation was founded in 2005 by Joke and Steven Le Poole after the death of their son Max. Today, Max
Foundation is a young and dynamic organization with offices in Amsterdam and Dhaka. The mission of Max
Foundation is to save as many children’s lives in the most efficient and effective way. Max Foundation integral
four-year holistic program reducing child mortality via integrated WASH approaches in the southern
coastal areas of Bangladesh. The overall objective of Max-WASH is to reduce child mortality by providing
access to safe drinking-water, sanitation, and hygiene education (WASH) throughout Bangladesh. These
water-related efforts are also compounded with providing primary healthcare for 800.000 people in the
southern coastal regions. The Max-WASH program has been implemented in the EKN funded Blue Gold
Program working area since September 2012, continuing until September 2016. Since 2013, The Gender
and Water Programme Bangladesh (GWAPB)11 has provided technical advisory supports to the Max-WASH
project to mainstream gender holistically throughout the project.
In 2011, almost two thirds (64%) of the world’s population relied on improved sanitation facilities, with
15% continuing to defecate in the open. Since 1990, almost 1.9 billion people have gained access to an
improved sanitation facility. The world, however, remains off-track to meet the Millennium Development
Goal’s (MDG) sanitation target, which requires reducing the proportion of people without access from
51% in 1990 and to 25% by 2015. The greatest progress has been made in East Asia, where sanitation
coverage has increased from 27% in 1990 to 67% in 2011. This amounts to more than 626 million people
gaining access to improved sanitation facilities over a 21-year period. An estimated 768 million people did
not use an improved source for drinking-water in 2011, including the 185 million who relied on surface
water to meet their daily drinking-water needs. By the end of 2011, 83% of the population without access
to an improved drinking water source lived in rural areas. Over 70% of global progress made in drinking-
water access has been achieved through the implementation of water pipes in communities’ homestead.
More than two thirds of the 1.5 billion people newly accessing home-based piped drinking water live in
urban areas.12
Open defecation rates have declined globally from 24% in 1990 to 15% in 2011. In absolute numbers, this
signifies a drop of 244 million people to a total 1.04 billion in 2011. The decline in the population practicing
open defecation has differed across regions; East Asia, Southeast Asia, Latin America, and the Caribbean
have seen a steady decline since the Joint Monitoring Program’s (JMP) 1990 measurements. In South Asia,
the population practicing open defecation peaked around 1995, after which it declined. Only in sub-
Saharan Africa is the number of people defecating in the open still increasing. 13
approach of WASH (Water, Sanitation and Hygiene) and HEALTH components like safe motherhood and nutrition
is very effective in preventing child mortality. Max Foundation started its programme operation in Bangladesh in
2005. Meanwhile, it has supported over 1.6 million people in 2569 communities and 22 slums in 9 Districts to receive
Max-WASH services.
11
The purpose of the GWAPB is to support water programmes co-financed by the Embassy of the Kingdom of the
Netherlands (EKN), civil society groups, water professionals, and government organisations in Bangladesh to adopt
and implement a gender mainstreaming strategy in their water related policies and practices, in order to achieve
measurable and positive impact on the lives of poor women and men.
12
WHO report on MDG 2014
13
2015 Human Development Report
By the end of 2011, 89% of the world population used an improved source of drinking water and 55% has
access to piped water on their homestead. An estimated 768 million people did not use an improved
source of drinking-water in 2011, including 185 Instruments that recognize the importance of
million who relied on surface water to meet their involving both women and men in the
daily drinking water needs. Urban drinking-water management of water and sanitation:
coverage has remained high over the past two
decades, and currently only 4% of the urban
 1977: United Nations Water Conference,
population relies on unimproved sources.
Mar del Plata, 1981-90; The International
However, in spite of the high urban drinking-
Drinking Water and Sanitation Decade.
water coverage rates, issues of service quality  The 1992 International Conference on
remain. Supplies are often intermittent and this Water and the Environment in Dublin
increases contamination risks. Of the 2.1 billion requires Gender mainstreaming as a
people who gained access since 1990, almost two prerequisite for sustainable water
thirds — 1.3 million — lived in urban areas. By the management:
end of 2011, 83% of the population without  Call for women’s participation and
involvement in water-related development
access to an improved drinking-water source
efforts: Agenda 21 (paragraph 18.70f), and
lived in rural areas. Over 70% of the global the Johannesburg Plan of Implementation
progress made in access to improved sources of (paragraph 25). 2005-2015 the
drinking-water has been achieved through International Decade for Action, ‘Water for
gaining access to piped drinking-water on Life’.
premises. More than two thirds of the 1.5 billion  Highlight the connectedness between
people who gained access to piped supplies at gender equality and women’s
empowerment: 1992 the Millennium
home live in urban areas.
Development Goals (MDGs).
 Access to clean water and sanitation as a
Inclusive WASH for all in Bangladesh: human right: 2010 Resolution 64/292, the
United Nations General Assembly.
Bangladesh has a long history of challenging the  The importance of empowering rural
practice of open defecation. The battle began in women as critical agents: 2012 Rio +20
Outcome Document.
the early 1970s — when the coverage was only
1% — by the Department of Public Health
Engineering (DPHE) through promoting sanitary latrines, In 1990, JMP reported 34% open defecation,
decreasing to 19% in 2000. As a result, the JMP 2015 report claims that open defecation is practiced by
1% of the households in Bangladesh. The success in Bangladesh has already has been mirrored in 30 other
countries throughout Asia, Africa and Latin America. While open defecation has been reduced, there are
still concerns about the sanitation of latrines throughout Bangladesh. The targets and coverage figures for
access to improved water and sanitation, provided by the 2013 Millennium Development Goal (MDG)
progress report for Bangladesh, are difficult to interpret due to inconsistent application of definitions and
national goals.
The government’s national targets were for 100% of the population to have access to both safe water by,
and to proper sanitation by 2013, modeling these targets off the MDG goals for global access to clean
water. While the government reported dramatic improvements in water access — with 98% of the
population reporting increased access 2006 — the identification of arsenic contamination led to the
estimated coverage being lowered to 78%. An additional recent achievement in the water sector has been
the prioritizing of WASH into the Bangladesh’s seventh 5th Year Plan, bringing it to the forefront of NGO
and government development cooperation.
Gender Mainstreaming-related challenges in WASH in Bangladesh:
Great strides in sanitation coverage have yet to solve the barriers in implementing WASH universally
across Bangladesh — climate change vulnerability, arsenic contamination of groundwater, rapid
urbanization, inequality, and widespread poverty. Much of the burdens of proper sanitation management
fall on the backs of women. The management of children’s waste and human sludge management are
expounded in isolated locations, creating a gap in the sustainability of WASH programs.
WASH, as an innovative approach to sanitation management, has yet to mainstream gender to its fullest
potential. It is crucial that WASH gender responsive, spanning the development of water resources,
management of water and sanitation services, and monitoring the access and benefits from these
services. This initiative requires researching and understanding the imposed gender roles that surround
access and harnessing of water resources. While current gender inequality clearly affects both men and
women through deepening poverty, the reality is that there are stark disparities. In the name of
mainstreaming gender throughout WASH programs, women and the girls’ role in the water value chain
must be recognized. A glaring example: public and private toilet facilities in Bangladesh not considering
women’s opinion for designing and implementation of WASH interventions. Without these
considerations, new programs are just reinforcing old challenges, and not confronting gender
discrimination that has been reinforced by interpretations of religious doctrine, cultural traditions, and
rituals.
It is undeniable that sanitation interventions are vital for women. The Water Supply and Sanitation
Collaborative Council’s (WSSCC) 2013 report shows that women’s involvement in sanitation is not only
crucial for human health, but also equally important for the socio-economic development of nations
around the world. Despite constructive outcomes, women’s involvement in the planning, design,
management and implementation of such interventions is not properly recognized and fully practiced in
reality. The post 2015 toolkit of WaterAid further confirms that if women are more involved in decision-
making in sanitation and hygiene efforts, progress towards achieving all the MDGs would advance
significantly.
The gender gap imposes significant costs on society in terms of lost agricultural output, food security, and
economic growth. Promoting gender equality is not only good for women, but also for sustainable
development for agriculture, livestock, and fisheries etc.
The State of Food and Agriculture (SOFA) estimates that, by giving women equal access to productive
resources and rural employment as men, they could increase yields on their farms by 20-30 percent.
Production gains of this magnitude could reduce the number of hungry people in the world by 12-17
percent, totaling 100-150 million people. Most of the world’s 1.2 billion poor people, two-thirds of whom
are women, live in water-scarce countries and do not have access to safe and reliable supplies of water.
At least 70 percent of the world’s poorest people are rural (IFAD, 2011), the bulk of these people
depending on agriculture for their livelihoods.
In addition to human-made barriers, natural disasters cause significant damage to both rural and urban
areas, and their environment. During disasters, the way women face risk and loss, preparedness, cultural
and conditional behavior, adaptability and recovery capacity is far different than men. Women face
specific challenges in the loss of livelihood opportunities, deprivation from relief materials, sexual
harassment and privacy concern related to defecation, while having a minimal place in response or
management activities. In every sense, water, sanitation and hygiene situation is worse in the urban
slums. Despite a much effort from the donors, NGOs, and governments, there is a little evidence of
improvement of the slums conditions in Bangladesh. The key reasons for inadequate slum improvement
are inadequate support structures, projects only providing short-term services, and absence of land rights.
Challenges and Barriers in women’s access to WASH
There is no comprehensive study researching social exclusion of the marginalized social groups in WASH
initiatives throughout Bangladesh. There is also limited research on the extent of social exclusion and
outcomes. A large portion of the existing research focuses on generic data instead of gender
disaggregated data, resulting in women’s lack of recognition, fear and insecurity, loss of cultural identity,
and social oppression.
There are 33.9 million adolescents, representing 30% of the total Bangladesh population. Sex and gender
differences emerge most sharply with the onset of puberty, affecting the life trajectories of girls and boys
in profoundly different ways. History shows that, adolescent girls and young women have less opportunity
and fewer resources than young men: less food, schooling and medical attention, less access to paid
employment and less free time, along with a strong possibility to be married off before the age of
eighteen. When puberty signals their potential for motherhood, girls may have to drop out of schools to
marry and begin childbearing (USAID Youth Policy, 2012).
In this patriarchal society, gender inequality is prevalent, disparity in rights and responsibilities between
boys and girls are enormous. The dropout rate for girls in secondary level is much higher than that of boys
which 16% and 10% respectively (Bangladesh Education Watch Report 2012-3). The lack of privacy causes
many girls to drop out from school when they reach puberty. Furthermore, adolescents with disabilities
are often subject to greater inequalities and less access to services than their peers without disabilities.
For adolescent girls with disabilities this discrimination is often exacerbated and the risks of sexual abuse
heightened.
Therefore adolescent girls need menstrual hygiene management facilities in the schools/toilets. It is
evident from the Bangladesh National Baseline Survey Preliminary Report 2014 that better coverage of
WASH facilities in the schools reduces drop-out rates. It is also a fact that the girls who continue their
education are less likely to get married early. For school-level interventions, secondary schools should be
targeted. As a result of a long advocacy campaign, the Ministry of Education of Government of Bangladesh
has issued a circular on 24th July 2015 to ensure decent sanitation facilities in every secondary and higher
secondary schools, colleges, and madrasas. The main focus of this circular is to create separate toilets for
girls equipped Menstrual Hygiene Management (MHM) services.
In general, WASH interventions should be introduced at two levels to reach an adequate number of girls
and women —at the community and school level. At the community level, priority should be given to girls
in the poorest families. The lack of toilets adjacent to the house, often in a distant bathing place
(pond/canal/tube well) can hinder a young girl’s privacy. High incidence of rape and abuse during travel
to defecate and bathe compels parents, especially from the poorest families, to marry off the girls as soon
as possible to ensure increased security. No formal research has been conducted to know exactly how
many women and adolescent girls are sexually abused when they go do their business or go outside of
the house for having a bath — anecdotal evidences and reports of the newspapers give an indication that
the number is huge.
Adult women also struggle most from the lack of adequate sanitation — an often unspoken part of the
water and sanitation crisis. The sanitation crisis for women can be summed up in one word: dignity.
Around Bangladesh, less than one in three people have access to a toilet. Like many countries, it is not
acceptable for a woman to relieve herself during the day in the rural part of Bangladesh. They wait hours
for nightfall, just to have privacy. This impacts health and puts their safety at risk. In essence, lack of
sanitation facilities due to poverty prevents from attending school or earning an income in a public place.
Approach of Max Value for WASH interventions
The Max Value for WASH interventions in Patuakhali and Barguna districts of Bangladesh began in 2012.
The program focuses on improving the water, sanitation and hygiene conditions in the polders and its
surrounding coastal areas, integrating components to address Sexual and Reproductive Health and Rights,
Safe Motherhood, and Stunted Growth.
MF intensive experience indicates that women and girls in Bangladesh are most often the primary users,
providers, and managers of water in their households, along with the guardians of household hygiene. If
a water system falls into disrepair, women are the ones forced to travel long distances over many hours
to meet their families’ water needs. These issues always place uneven burdens on women’s health and
social indicators. Additionally, religious customs disintegrate women from social advocacy. Realizing the
importance of women and men’s equal participation, WASH, MF is taking measures to reduce stigma on
women by ensuring a gender balance in their project activities.
Thereafter, MF developed a guideline for “Gender Integration in Max Value for WASH” Project. To
strengthen their gender component, MF rented technical and advisory supports from the Gender and
Water Programme Bangladesh (GWAPB), a project of the Embassy of the Kingdome of the Netherland
(EKN) for staff capacity development on mainstreaming gender into water-related projects throughout
Bangladesh. This work has lead to the creation of Gender Action Plans (GAP) for many projects.
The project’s ensures that women and girls benefit most when services are improved. MF formed
courtyard groups at the village level. By design, all members of the Courtyard Group Meeting are women.
The specific criteria for selection of group members includes:

- The most influential female members of respective households
- Emphasis is given to married female heads of the households and to women with children under
five
- Women who are not the head of their households to ensure a balance
Courtyard meetings are under the management of Community Support Groups (CSGs). Evidence and
detailed examples demonstrate the benefits of placing women at the core of WASH planning,
implementation, and operations of water and sanitation programme through CSGs. The CSG is a village-
based platform chaired by women and 10-18 other members, with a minimum of 7-9 women who are
willing to become change-makers for families and localities. Each Courtyard meeting is facilitated by
community staff members of the partner organizations (PNGO). The PNGOs supports the local volunteers
to gradually develop their skills on facilitation of Courtyard meetings. Women gather in a pre-selected
place at the beginning to design Group Session Planning Calendar. As a result, each Courtyard Group has
clearly defined meeting schedule including times, locations, etc. Session Planning Calendars have also
developed, based on the communication plan for Courtyard Messages and based on the number of
Courtyard Meeting issues. The PNGOs also help develop the Courtyard Session Planning Calendar after
receiving the communication plan from MF. The main tasks of Courtyard Group are to:
 Mobilize the female heads of each household and organize for the activities of the Courtyard Group.
 Development of courtyard-based Community maps and Courtyard meeting schedules.
 Distribute responsibilities for sanitation and hygiene promotion.
 Update the Community maps in each Courtyard meeting.
 Organize meetings (at least once a month) in selected Courtyards/places. The meetings are generally
applied demonstrations — knowledge transfer on water, sanitation, and hygiene to the community
members.
 Representatives of the Courtyard Groups report their progress in CBO (Community Based
Organization) meetings. The CBOs supports the Courtyard Groups in ensuring attendance of its
members
Each Ward has at least three CBOs formed by 13-21 participants, including community leaders and
representatives of the hardcore poor marginal people, and youth representatives. The structure is
designed to ensures that women occupy the Chairman and the general secretary positions. CBOs actively
involve the Ward Members (women elected members) and CSGs members in the committees as advisors.
The CBO reports to the Ward Watsan/WASH Committee, a union-based government structure that helps
bridge role the MF-based CBO, the Blue Gold supported CBO, and the Union WatSan/WASH Committee.
The Ward Watsan /WASH committee is mainly responsible for overseeing the overall progress in the
respective wards. They do reports about village and Ward-based progress and problems at the Union
level. Their main task is to play a lead role in achieving 100% latrine coverage in the Ward, which develops
integrated WASH and health plans according to the MVFW program. The Ward Watsan/WASH Committee
develops strong linkages between all CBO and Blue Gold Water Management Groups (WMG).
The Ward Watsan/WASH Committee supports he CSGs in mobilizes their resources for project
implementations, monitors the courtyard group activities, and verifies and recommends hardware sites,
and oversees the quality of hardware installation works. They also supports the CBO in developing lists of
hardcore poor families and endorses these lists for approval by the Union WatSan/WASH Committee.
Self-empowering women of CSGs innovates WASH practices
The above explanations clarify how the village-based Courtyard Groups members and CSGs are being
extremely involved in both the lower and upper tiers of society. The MF, through the CSGs, is
implementing adequate activities for social preparation and strengthening capacities of women. All the
women gather at the Courtyard meeting and CSG meetings to address their own needs for water and
sanitation. As a result, they are efficiently participating at all events within and beyond the WASH sector.
The programs has given due attention to women’s opinion and decisions for designing the WASH
messages and options — also selecting sites for installation with a their convenience and accessibility in
mind. A common suggestion they heeded was to install a water source on the premises of poor or
hardcore poor and household latrine within 12 steps of residence. That ensures better access to water for
rural women and adolescent girls; their strength and courage transforms local areas. With the support of
MF and its local partners, women organize their families to support each other towards the healthy
practice and build a healthy society. A women then continues to support one another and share
responsibilities, these efforts make an impact and take the project one step closer to ending the global
Watsan crisis.
Women now have more time for income-generating activities and free time that they need for family
members or their own welfare. The family’s economy and girl’s education also benefits. Freed from the
drudgery of water collection and management, children, especially girls, can go to school. At an individual
level, women and children are free from water-borne disease as tube well water are being used for
washing and other domestic activities. The CSG members report during Focus Group Discussions that
WASH interventions directly and indirectly contribute to prevent the child marriage from these areas. The
CSG members strongly believe that dignity, privacy, and security are some of the drivers toward child
marriage. All the CSG members and their WASH activities become very popular and accepted by the local
people because its potential to increase overall quality of life.
Through the project intervention, rural women are not becoming stronger only in their numbers in
attendance, but also in their increasing capacity. These women’s groups have been trained on three major
issues: sanitation, safe water, and menstrual hygiene management. The work of openly discussing
menstrual hygiene management to adolescent girls and their mothers is revolutionary. These women
become the hygiene teacher for their adolescent girls at home and neighbourhoods. Getting involved in
such issues, these women find a sense of self-importance and purpose towards spreading this
information, keeping them involved and motivated. These women are not simply talking to young girls,
but are also making facilities like separate bathing chamber including MH management facilities available
to the hands of the menstruating girls. Delivering sanitary pads has also become a newfound practice by
these women. One of the CSG of member of Dalchara Union, 8th Ward feels that she could start a business
of selling sanitary napkin from home.
Analysis of empowerment elements in line with the project intervention:
The Gender and Water Alliance (GWA) believes that empowerment is a process of change, enabling
people to make choices and transform them into desired actions and results. In doing so, people, not just
women, are taking control of their own lives, improving their own position, setting their own agenda,
gaining skills, developing confidence in themselves, solving problems, and developing self-sufficiency. It
refers to increasing the economic, social, political, and physical strength of any individual or entity. The
GWA and MF assessed if empowerment has taken place, by analyzing the level of progress in the four
elements of empowerment.
Therefore when assessing the level of empowerment we look at the four elements of empowerment
1. Physical empowerment:
The right to decide about one’s sexuality, to decide about the number of children and spacing between
them, right to proper healthcare, right to clean water, sanitation facilities and dignity, access to proper
menstrual management, the ability to resist violence, the right to safety and security (for example not to
be harassed or raped during nightly sanitary visits), having rest — particularly during pregnancy and
menstruation period, physical mobility, family planning methods/use of contraceptive, choice of food, etc.
2. Economic empowerment:
Right to choose one’s education, closer gender pay gap, right to work that one enjoys, right to decide
about spending benefits and income, access to relevant resources. Sometimes women have access to
income but have no control over it, for e.g. handing over salaries to husband, son, brother- or mother-in-
law. Economic empowerment leads to equal access to and control of means of production and to
economic independence.
3. Political empowerment
The right to organize oneself, the right to take part in the democratic processes, and to influence wider
development efforts: to be allowed to vote, to take an active part in Water User Associations (WUA), Small
Farmers Groups (SFG), to participate at the decision making levels (Executive Committee of the SFG, etc.),
to be confident in getting extension services from the local level nation-building departments like
Directorate of Agricultural Extension office, to be a member of the Union Parishad, etc. It leads to a
political voice and the creation of a power base in a self-determined direction.
4. Socio-cultural Empowerment:
Social empowerment means a positive self-image, social status, and a right to express your own personal
opinion. It leads to the right to one’s own independent identity and a sense of self-respect.
It is important to realize that these four aspects of empowerment are interrelated and should not be seen
as separate. For example, just being educated (socio-economic empowerment) on its own does not mean
a woman is empowered, if her husband does not allow her to work after marriage. Groups and individuals
— not only women — empower themselves if they are convinced they have the means to do so.
The prevailing acceptance of CSGs demonstrate how women’s empowerment and the improvement of
water supply, sanitation facilities, and hygiene practice are inextricably linked to economic and social
development. In the CSGs, women as beneficiaries not only deal with the technical and practical issues,
but also function as catalysts in educating their families and the neighbors about hygienic practices. The
effects of both improved service provision by Sani-Mart and better knowledge about hygiene are reflected
in improved health, less disease burden, and spending out of pocket money leading towards a better
quality of life. As described above, the project interventions highlight how the women leaders from the
CSGs gradually strive to overcome political, economic, social, and physical discrimination. There are more
subtle effects of these measures on the lives of women, such as greater confidence, increased capacity to
earn money, and women are likely to be healthier, happier and have more time to concentrate on making
the home a better place to live.
Presently MF is developing women-led social entrepreneur program to market health commodities such
as family-planning materials, affordable sanitary napkins, and also growth measurement services of
children less than two years of age. MF already has trained 200 more local women on ANC and PNC
councilors. This will be one of the initiatives to empower the women both politically and economically.
Success factors for empowerment
Physical empowerment
Physical empowerment of woman has become increasingly visible. At all levels, like Courtyard Meeting,
CSGs and CBOs, the women mention there improved health from construction of latrines at a central
place, access to safe drinking water from self-selected tube-well site, and applied knowledge on health
and sanitation issues. This health improvement goes beyond the individual level of the women part of
Courtyard Meeting, CSGs and CBOs, but extends throughout their villages or wards.
The decrease of diarrhea in the village as a whole, as well as the abandonment of open defecation, is
mentioned by all. As the Courtyard meeting topics work towards physical empowerment through
supporting women in working to prevent early marriages and child mortality. Also CSG members mention
the decrease in violence against women as a result of the WASH intervention.
By the CSG members, adolescent girls and their mother received message on menstrual hygiene
management. The messages on menstrual hygiene and sanitation have increased the physical
empowerment of the girls enormously. They are now aware of what menstruation is and how to deal with
it. They have managed to convince their parents that they need not skip school when it is their period,
and also have shared their new knowledge with their mothers and other family members. The girls feel
confident to discuss the topic amongst each other and are very happy with their mothers and CSG
members that bring relatively cheap sanitary pads from nearby shops.
Economic empowerment
During meeting with programme and field staff members of Shusilan, an implementing partner of MF,
they mentioned aspects of the social-cultural, physical and political empowerment arenas, but not
economic empowerment. In general, their perception reflects that economic empowerment is important,
but they did not consider it as a part of the empowerment concept.
Women often have very laborious lives jammed with domestic housework. Unfortunately, this work is not
considered formal labor and is unpaid — this is unfair. Most of the CSG members indicate that it is their
“leisure time” they are using to do the work for the projects. Considering the time spent, the social
acceptance has been gained, but there is no prevision for financial compensation for the women. Some
economic empowerment has taken place because as a result of the improved WASH facilities: water borne
diseases have decreased in all cases, especially diarrhea. This has resulted in women having to spend less
time on caring for the sick and in less money being spent on doctors’ bills. All women, involved with
Courtyard meeting groups and CSGs have their own small business like seed preservation, poultry rearing,
home state gardening etc.
Political empowerment
Political empowerment has increased at all levels of the MF WASH intervention. Individual woman
responded and the group mentions the increase in visible participation at different levels. Several forums
have been established where women actively participate in different meetings, In the CGS committees,
the president/Chairman are woman and 3-5 positions also represented by women.
Women are making decisions where a new toilet would be placed on her homestead. Most of them are
confidently and actively participating at decision-making levels of the CSGs and CBOs meetings. CBOs are
represented by elected Union Parishad women members of Ward and effectively participate in decision-
making to influence development efforts. Women gained the capacity and acceptance to exercised their
right to organize other women, they took part in decision making process for selection if tube-well site,
free latrines facilities from UP etc. They enjoyed the right to vote and to be voted, and their achievements
through their annual meeting prove their political empowerment.
Socio-cultural empowerment
It is very clear that both the self-confidence of these women as well as the esteem for them by others has
increased a lot because of WASH intervention. The Chairman of Dalchara CSG acknowledges that the
activities as a Chairman and the knowledge gained through the different training workshops have
increased her self-confidence. She is well respected by the villagers since she made the Union Chairman
heed he decision regarding the site for deep tube-well. She gains lot of appreciation especially from
women and young mothers who now spend less time for collecting water.
Neighbors consult her in cases of domestic violence, early marriage, dowry issue or any other familial
issue. She is proud of the acknowledgement she gets from others for her work and the trust they have in
her. The positive acceptance of the local people she considers the greatest reward of her work as a
volunteer. Other members of the Dalchara CSG feel proud of the improved health situation in the ward
that has been realized due to their activities.
The women of CSG group, due to the activities of the women in the committees, they have created an
environment where women’s leadership is now more socially accepted. Women are more respected
through spreading important knowledge and the visible accomplishments they have made in their society.
In summary, there is no doubt that MF WASH interventions and the membership of a CSGs committee
have increased the social-cultural empowerment of women in the working areas.
The paper has given the overview of the question: how we can catalyze transformative change that
enables women and girls to empower themselves effectively and sustainably, in partnership with men,
boys and the wider community? In sanitation, empowerment can serve as a mechanism for grounding
deep and broad-based social transformation. The findings also indicate that the process of social
transformation has space for further research at both the personal and structural levels. In this particular
project, social change is seen as an outcome of the development of individuals, achieved through capacity
building and access to material resources, while implementing the sanitation program with a gender
focus. Furthermore, it also strengthens the argument that women can be key agents of change if they are
empowered and allowed to be involved at all levels of planning, implementation, and monitoring.
Lesson Learnt:
- Active participation of both men and women in the decision-making groundwater and sanitation
services installed, as well as shared responsibility of managing the water and sanitation services,
are important due to their different roles and needs.
- In the WASH sector, women can play a key role in the effectiveness of prevention, disaster relief,
reconstruction and transformation of WASH works if they are valued from the beginning of
project cycle.
- In short- and long-term interventions, it is essential to include gender analysis and women’s
empowerment (economical, physical, political and Socio cultural) in the needs assessment in
order to provide appropriate WASH actions that are effective and safe, while restoring and
promoting dignity for women and men.
- Work closely with the media, the educational system, community-based organizations and
women’s groups to undertake the revolutionary task of transforming societal attitudes strongly
linked with sanitation practice to reduce violence against women.
- Women’s WASH-related vulnerability, especially in disasters or conflicts, can be decreased by

working with barriers from cultural and social constraints, such as women’s mobility.
- In the short term, all stakeholders of relevant projects can jointly design and carry out social and
gender analysis for feasibility studies, WASH-related environmental and social management
plans, and risk management.
- Developing gender indicators for performance monitoring and evaluation; Developing and
accessing methods, tools and indicators for monitoring, and evaluating gender impact
assessment;
Recommendations:
- Strengthen programme’s stakeholders including governments’ capacity to promote and sustain

the rights of women and to mainstream gender in to water and sanitation. Special emphasis can
be given to the Local Government Institutions.
- At the strategic level, the existence of gender specific objectives in WASH-related programmes
and projects needs to me mandatory and thus both the donor and implementing agencies must
advocate for it.
- In line with the above mentioned objectives, its crucial to ensure adequate incorporation of
indicators that accurately will monitor progress on water and sanitation in terms of gender, age,
health-status, disability, sustainability, equity, and geographical-regional variations.
- Implementing organizations can support studies that contribute to the understanding of the
different roles and behavior of women, men, and children related to WASH.
- At implementation level, ensure that both women and men, given their different roles, are given
equal attention in the promotion of WASH and training activities. Emphasize the relevance of
integrating boys and adult men’s contribution for gender equality could also be focused
throughout the programme interventions.
- Programme activities and budget allocation to train and empower women to become leaders and
role models that exercise their rights and take active participation in decision-making.
Conclusion:
Development agencies, policymakers, national governments and non-governmental organizations have

increasingly acknowledged women’s role in the management of water resources and sanitation.
Women’s empowerment is vital to sustainable development and the realization of human rights for all.
Empowering women is also an indispensable tool for advancing development and reducing poverty.
Gender equality is, first and foremost, a human right. Women are entitled to live in dignity and in
freedom from want and from fear. But equity means fair and impartial justice, both are equally
important irrespective of gender.
Sanitation Budget tracking: A basic need for dignity count
"SACOSAN declarations are recognizing the rights to sanitation to work progressively to realize the
programme and project and eventually in legislation." Respecting the human rights of its people should
be one of a government’s highest priorities. United Nations also declared water and sanitation as basic
human rights. Most of countries in South Asia, sanitation coverage is very low. As per Joint Monitoring
Programme report 2015, only 61% people in Bangladesh have access to improved sanitation. In particular
poor and marginalized women have limited access to improved sanitation. Therefore, it is pertinent to
ensure access to improve sanitation thus dignity and rights of poor and marginalized women will be
ensured.
DORP, a partner organization of WASH Alliance Bangladesh is working on budget tracking to ensure WASH
services in particular access to improved sanitation. DORP has been implementing a project "Health
village: WASH Monitoring perspective” Since 2011 to empower community people, specially women and
girls to enable them to demand for WASH rights, to ensure that local government and other service
providers in public sector respond to the demand of people, and to ensure that policy makers and key
actors take affirmative steps to right to water and sanitation.
The project has a four way approach of attaining the above mentioned objective. “Social mobilization” for
empowering the community by making them aware of their WASH rights; “Lobby and Advocacy” restoring
to different advocacy tools to make the voices of the poor women and marginalized heard both at local
and national levels; “WASH Monitoring” which ensure monitoring by the people especially the poor and
marginalized to ensure transparent and accountable interventions by the government; and “WASH
Budget Monitoring” to ensure efficient use of limited public resources by tracking public expenditure in
WASH sector. Union Parishad, Upazila Parishad, Department of Public Health Engineering (DPHE) both at
Upazila level has been targeted as WASH service providers while community as service recipients has been
targeted as beneficiaries of budget tracking. Health Village Group which is consisting of women, regularly
identify their WASH needs and express their need at various platforms of local government institutions at
Upazila and Union level. “Budget Club” a civil society platform is working as catalyst at Upazila level to
enabling environment for multi-stakeholders and increase budget allocation and raise voice on behalf of
women group.
3%-19% WASH budget has been increased through Budget Tracking process where community was
engaged and local government structured i.e. Union standing committees were revitalized . Budgeting
process has been empowered women as they are now asking their WASH share from local government
institutions through Public Hearing and regular data collecting through a structured monitoring format to
assess the expenditure for WASH.
The process has brought confidence both for right holders and duty bearers. As the local government
structures are similar to many South Asian countries, it is possible to replicate the model and get benefit
upon small investment. It is evident that through proper and systematic tracking, budget can be mobilized
and utilized to ensure better sanitation facilities and improve social dignity.
Authors:
Mr. Zobair Hasan, Chief (Research, Monitoring and Evaluation), Development Organization of Rural
Poor (DORP).
Mr. Alok Majumder (Country Coordinator), WASH Alliance Bangladesh, supported by WASH Alliance
International.
Introduction
Bangladesh has significantly improved in its water, sanitation and hygiene situation field in the last
decades. Much evidence depicts that policy, program and multi-stakeholders involvement in the process
has brought this success. Recently, government has undertaken special strategy for marginalized and
hard-to-reach areas to ensure water, sanitation and hygiene services in 3136 Unions in all over the country
focusing on reduce the inequality between urban and rural. However, budget plays a crucial role to keep
this pace in success. WASH Budget tracking is an initiative to see the financial involvement in this sector
while it also provides a roadmap to decision makers to address the commitment of the politicians as well
as government. General objective of this initiative is Poverty reduction through community
empowerment, increased access to and use of safe water and sanitation services, improved hygiene
practices for women and the marginalized, and establishing 22 agendas of Health Village Model. To
achieve these, 47 categories of activities are to be executed each year through four approaches, which
are, i) social mobilization, ii) lobby and advocacy, iii) WASH monitoring, and iv) WASH budget monitoring
in six different sub-districts in Bangladesh.
Water supply and sanitation in Bangladesh is characterized by a number of achievements and

challenges. Sanitation faces its own set of challenges, with only 61% of the population
estimated to have had access to adequate sanitation facilities in 2015. A new approach to
improve sanitation coverage in rural areas, the community-led total sanitation concept that
has been first introduced in Bangladesh, is credited for having contributed significantly to the
increase in sanitation coverage since 2000. The government has adopted a number of policies
to remedy the challenges in the sector, including National strategy for Safe Water Supply and
Sanitation 2014 as well as a National Sanitation Strategy of 2005. Among others, these
policies emphasize decentralization, user participation, the role of women, and "appropriate
pricing rules".
In last 5 years, Local Government Division under the Ministry of LGRDC has produced number of strategy
and Plans which gave a policy guideline for all stakeholders who are involved in water supply, sanitation
and hygiene issue. Now the challenges are to operationalise those into the ground. This Budget Tracking
analysis is a small initiative, through which will help to see the ground reality and how budget is allocated
and utilized at Unions to improve the WASH situation. How the allocation can be adequate for per capita
that is also trying to come up with this analysis. For example, in Health sector, WHO recommended US$
35/per capita/year is needed for primary health care, although it is far below (US$ 14 or BDT
1130/capita/year) from the recommended. But there are no recommendations for the WASH sector.
However, Planning Commission has estimated a budget need to reach to the MDG goal. If we could take
this as a benchmark of our allocation for WASH, then Tracking is helping to see the progress. On the other
hand, there is no separate fiscal year basis allocation for WASH under Ministry of LGRDC. Various facility
based, institutional based, geographic location based budget is allocated for WASH and most of the
allocation is under Annual Development Program (ADP) or direct project approach through Local
Government Institutions (i.e. Union Parishad, Municipality and WASAs). However, the DPHE is sole
responsible to provide rural water supply, sanitation and hygiene facilities, But it is not counting the
peoples need and prepare its budget. It receives allocation from LGD and through some projects they
provide WASH service particularly some materials and salary of their HR. Further, Union Parishad under
Local Government Institutions (LGI) of LGD is also playing an important role in water and sanitation
facilities for the community. In these circumstances, Budget Tracking initiative is trying to analyze the
Institutional Budget allocation and its utilization in relation to MDG targets BDT 945 per capita in 2013.
Implementation Area
The project has been implemented in 6 Upazilas 14 across Bangladesh where the status of the health,
water, Sanitation, Hygiene and economic situation are neglected than the country average. DORP has
selected those Upazilas where the poor community cannot practice their Health and Water and Sanitation
rights. DORP considers 6 Upazilas from coastal, flood prone, Haor (Wet land), and plain land areas. Despite
of various WASH related data from different organization, groups, national and international NGOs, civil
societies; it is preferable to use government statistics and information. Government statistics address the
total country which also helps us to work with government mechanism by using those statistics in reality
checking. The total population of proposed upazilas is around 15,41,027 according to the (Union Parishad
2013) Population Census 2001, Community Series, Bangladesh Bureau of Statistics-BBS. The average
population of each union is almost 30216. Literacy rate is 45.97 and average size of each household is 4.86
persons.
Implementation Methodology
In this project, DORP works at three levels, which are Union, Upazila and National. At Union level, petition
submission made to the respective authority by community people for addressing the issues, promotional
activities regarding public health issues, organize monthly Health Village Group (HVG) meeting, Pre
Budget dialogue with Community, Open Budget Session at Union Parishad, discussion with students
about Schools Water, Sanitation and Hygiene (WASH) Monitoring Session & SRHR (Sexual and
Reproductive Health Rights), Stakeholder dialogue (Community group, UP, FWC, CC, Health complex &
DPHE), Union Water, Sanitation and Hygiene Standing Committee Meeting, facilitate Union development
coordination committee (UDCC)meeting and Public Hearing at Union level on WASH budget utilisation.
These activities lead to some outputs and outcomes, which are as follows, Community awareness on
WASH Budget through Visibility through Billboard, Banner, Wall painting and small board. Community
alerted to make demands related to WASH and participate at union budget process, thus making sure that
community WASH need has been accounted. Eventually it has been assumed that Local Government
Institution (need based) budget allocated by Union Parishad/DPHE and community received the WASH
services/facilities from Department of Public Health Engineering (DPHE) and Union Parishad.
At Upazila level, engaging Budget Club members and Local NGO networks members, a number of lobbying
and advocacy initiatives will be undertaken, i.e. Consultation Meeting, Advocacy meeting, Meeting with
Upazila & District administrative level, and Union development coordination committee meeting where
local WASH related decision makers are engaged. These meetings assisted Upazila Health Complex/DPHE
to be responsive to community on increasing WASH budget and capacity of LGI on budget tracking. As a
model of 6 Unions, other 24 Unions will be involved in scaling up concept where all 5 Approaches i.e.
Campaign and promotion, lobbying and advocacy, WASH service monitoring, WASH budget Monitoring
and Capacity building, along with FIETS3 and Health Village model will be integrated. Upazila level’s
Advocacy result will reach to all unions. For example, while Upazila DPHE is responsible to provide WASH
services to all Unions of that Upazila, this WASH budget Monitoring initiative will see to its implementation
in reality in targeted Upazila and remind the service providing Authority if Unions do not get the service
or support.
14
Barguna Sadar, Ramgati, Fakirhat, Sirajgonj Sadar, Bhuapur, Kuliarchar
At the national level advocacy with policy makers, campaign, join different national and international
programme was helpful to us to share our views and raise voice on particular issue to the respective
authority.
Specifically, we observed different WASH related days, arrange Television and Radio Program, one to one
and round table meeting with policy makers, organize workshop on budget tracking training/coaching
with WASH Alliance members, participate in Bangladesh WASH Alliance activities, networking with various
stakeholders, publish position Paper and Fact Sheet at National level. We assume that through these
activities communities were well informed about the commitment of the Government regarding yearly
WASH budget at national and community level. Outcome could be commitment of WASH budget
allocation by LGD, MOH&FW and Planning Commission, thus keeping the Government vigilant to keep its
promise and the LGD to allocate need based WASH budget. Timely allocation and expenditure of
increased budget was the ultimate impact at community level, which can enhance the living standard of
people. This have made an impact on national development criterion and achieve the goals set out in the
MDGs.
To understand the WASH budget situation including its availability, regular linking and networking with
line Ministries is important. Monitor and track the budget is a process by knowing WASH budget related
information and identifying the government’s commitment. Therefore collection of various documents
including yearly Annual Development Program (ADP) and Revenue budget is a relevant activity in the
pathway of change. Tracking the budget calendar is also another path way to reach to the ultimate goal.
When budget is being prepared, how it goes to Upazila level and how it is received by Union is also
essential in the Tracking process. In the path way, to ensure accountability and to remind the
government’s commitment, engaging media will provide an added value to reach to the goal. In the
national level budget preparation, following steps are now taken. These are very important to achieve
various pathways of theory of change.
Result:
3%-19% WASH budget has been increased in four fiscal years through Budget Tracking process where
community was engaged and local government structured i.e. Union standing committees were
revitalized . Availability, accessibility, sufficiency, equity and quality are the five major pillars of right to
water and sanitation while investing in WASH is an underlying pre-requisite for strengthening those
pillars. Proper and sufficient budgetary allocation is very crucial to establish and ensuring rights, and
Bangladesh has proven by showing its result that how a country became Open Defecation Free (ODF) with
a very low per capita investment Tk.234 in FY2014-15, which is less than one-fourth of the required per
capita budget allocation to attain the MDG-7 relating to water and sanitation is Tk 947 in 2015. Following
graphs shows some micro level evidence based findings which have given a clear picture of budgeting
scenario on WASH in four fiscal years.
The percentage share of total Union Parishad (UP) budget spent for WASH sector is in most cases higher
than the percentage of national budget spent for WASH sector for the country as a whole. For reference,
refer to the above figure which shows that the average percentage share of UP budget spent for WASH in
project UPs is higher compared to the national average. This implies that due to interventions by DORP
project to improve WASH budgeting, there were notable positive outcomes. While the positive signs
witnessed in budgetary allocations for project areas may not solely be caused by DORP interventions, it
may still be inferred that the project initiatives have left some form of impact and played at least a partial
role in bringing about positive change. The recommendation here is that policy makers at the national
level should seriously consider the impact left by this particular project in improving WASH budgeting in
the UPs and also consider replication of such interventions across the country. It may be expected that
with enhanced people’s participation (due to awareness raising campaigns) and monitoring by the people
(through use of participatory budget tracking tools) WASH budgeting at UP level may improve significantly
all over Bangladesh.
Budgeting process has also been empowered women as they are now asking their WASH share from local
government institutions through Public Hearing and regular data collecting through a structured
monitoring format to assess the expenditure for WASH.
Per Capita Allocation for WASH in 6 Unions FY 2015-16
Gourichonna Union (Barguna Sadar) Tk 81
Gobindashi (Bhuapur) Tk 40
Lokhpur (Fakirhat) Tk 31
Soydabad (Sirajgonj Sadar) Tk 52
Choysuti (Kuliarchar) Tk 16
Char Poragacha (Ramgati) Tk 32
Although officially budget is not allocating in line with per capita management, but it is interesting to know
the real picture of per capita allocation on Sanitation, so that we can realize how budget reflects in the
dignity count. This also provides us the reflection of how less allocation can also bring the changes in
sector. However, other social and economic intervention also interlinked with the success of ODF.
People’s participation and accountability

In addition to increasing WASH budget, involving people in budgeting preparation leads to a growing trust
in local government institutions. Interestingly, results of our efforts were not only seen in the Union
Parishads (local government units) where the programme was implemented, but also in the neighboring
Union Parishads because they saw the benefits Budget Tracking could bring them. Budget tracking process
and ward level pre-budget meeting, provided ample opportunity to the women and marginalized people
to raise their voices to ensure WASH facilities at their village. Accountability and transparency of Union
parishad has also increased.
Budget Tracking process makes Jahanara as Leader of the Community and Increased Dignity
Jahanara is 58 years old and lives in Khajuratala village of Gourichonna Union of Barguna district. She was
a retired family welfare visitor. When DORP asked Jahanara to be part of the Wash Budget Monitoring
Club and also involved in budget tracking process. She gladly accepted this proposal and started working
as change maker. Jahanara is regularly participating in the budget club meeting, bringing village and union
level problems at the Upazila level.
Since Jahanara joined the WBMC in 2007, she got a wider scope than before. Now she also works with
school girls on menstrual hygiene and sanitation. It was DORP that took her to these schools to talk to
girls, and she notices that the girls also take the message home and share it with their mothers and other
family members.
She even goes to upper level for lobby and advocacy for her constituency. Through her work for the WBMC
she realized the importance of a family health centre, so she started meeting high officials at their offices
and to write applications to the officials at different levels. In 2008 she managed to get the family health
clinic established. It is of very high quality and won a prize for safe deliveries three years in a row. Jahanara
now more empowered and honored in the society.
Conclusion
Budget tracking has been found one of the good tools for increasing WASH budget and proper utilization
of WASH budget which meet the rights obligation of the poor. This has brought a space where right
holders and duty bearers can share each other and solve the issue. Budget tracking yield good result in
capacity building of union parishas office bearers and Office Secretary to ensure people’s participation in
union parishad activities. Linkage has been established with the government service providers, Unions
Parisahd and community people. It has been found that duplication of resource has also been reduced
through this budget tracking process. People’s confidence level on local government institutions
increased. But this is not easy for the NGOs. At the initial stage NGOs have to invest more time and energy
to motivate and aware local government representatives for initiating budget tracking. However, budget
tracking process is cost effective in WASH service delivery. Quality of service can also be improved through
this process. This connects the disconnects and giving an opportunity to express their needs on basic
sanitation to duty bearers and increase dignity.
“Role of rural women in sanitation and hygiene”- A Gender Study from Bhutan
Author: Ms. Tshering Choden, SNV Gender, Inclusion and Governance Specialist
Background
The Rural Sanitation and Hygiene Programme (RSAHP) in Bhutan started in 2008 with a pilot project in
four sub-districts, which expanded to Lhuntse and Pemagatshel districts from 2010-2013. With the
success of the initial phases of the RSAHP, the Ministry of Health (MoH), SNV and Gross National
Happiness Commission (GNHC) agreed to scale-up the RSAHP nationwide as part of the 11th Five-Year Plan
2013-2018. With support from the Australian Government, PHED-SNV (Public Health Engineering Division
– SNV- Netherlands Development Organisation) up-scaled RSAHP activities with target districts to Samtse
and Dagana in 2014. In this four-year project the Gender equality and Social Inclusion (GSI) plan plays an
integral part to ensure gender and social inclusion in the project. One of the key project outcomes is
‘ImprovedGender Equality’, stressing the significance of gender inclusion and equity in improving rural
sanitation and hygiene outcomes in communities. Furthermore, the 11th Five-Year Plan of the RGoB (Royal
Government of Bhutan) targets a more gender friendly environment for women’s participation in
development, underlining a national commitment to gender equality.
The key objectives of this study are to:

 Enhance the understanding of the situation of women and men in terms of the gender dynamics in
the communities with regards to the relevant themes of the study in the selected districts of Samtse,
Samdrup Jongkhar and Wangdue Phodrang.
 Identify areas of gender bias/discrimination/exclusion in Bhutan in the WASH (Water, Sanitation and
Hygiene) sector (if any).
 Produce specific study-based findings and recommendations on how to make the RSAHP programme
more gender sensitive (to be incorporated in the RSAHP strategy)
 Improve the capacity of the RSAHP implementers at all levels to integrate gender into the
implementation of programme components to achieve improved sanitation and hygiene for all.
Gender Situation in Bhutan

A common statement found in many documents dealing with gender issues in Bhutan is that women enjoy
relative freedom and equality with men in many spheres of life, enjoy equal rights and do not suffer overt
discrimination. This statement is often made when comparing the situation of women in Bhutan with
those in neighboring countries. Nevertheless, this does not mean Bhutanese women do not face
challenges. In fact, they continue to lag behind in a number of areas, such as politics and decision-making,
tertiary education and business. Rural women, especially, are seen as even more vulnerable.
Women are also not well represented in the civil service, particularly at upper levels with the most
influence on policy decisions.In 2012, women accounted for 36 per cent of all civil servants, with 6 per
cent in the executive category. There was only one woman among 20 Dzongdags (district administrators)
and very few female judges. Women are also under-represented among government officers with field
postings to manage regulatory affairs, advise local governments, deliver extension services or teach in
schools. This means few women are in the decision and information feedback loops about local needs and
the suitability of development programmes. Moreover, they are still under-represented among elected
representatives at local government level (7 per cent)15. Women’s representation in Parliament was lower
after the 2013 elections (National Council (NC): 2/5 women nominated, 0/20 women elected; National
Assembly (NA): 4/47 women elected) than after the first round in 2008 (NC: 2/5 women nominated, 3/20
women elected: NA: 4/47 women elected).
The Asian Development Bank and the United Nations supported-Bhutan Gender Equality Diagnostic of
Selected Sectors Report (2014) also states that women are poorly represented in decision-making
positions in Parliament and civil service and further states that the local government elections in 2011
also resulted in disappointingly few women running for office and succeeding as candidates. Contributing
factors could include a lack of functional literacy skills (an educational requirement for local office), the
widespread view that politics is a male activity and women’s lack of confidence in taking on public roles.
Another factor could be that success in local elections brings heavy responsibilities and limited
remuneration. Given women’s already heavy workloads, another job may not be seen an attractive
option. (Low remuneration may also account for the number of elected positions for which there were no
candidates, male or female.) These observations suggest that the public, including adults and upcoming
generations, have limited exposure to women in modern leadership roles. An interesting perspective on
this issue is provided by a study in India that showed how views on women’s capacity for leadership
became more positive once communities had experience of women in public office (which became
widespread in India with a quota system for women in local government). A challenge for Bhutan is to
reach a level of women’s representation that can shift public expectations.
As per the Annual Health Bulletin Report 2012, women in Bhutan suffer more from depression and anxiety
(Absolute numbers: 242 vs 197 in the 15-49 year age group and 35 vs 17 in the 50-64 year age group) and
girls in the 1-4 year age group are more malnourished (53 vs 24). Health records in 2011 showed that
more men/boys got treated for diarrhea, dysentery and skin diseases at all age groups than females. This
raises the question of accessibility to hospitals and BHUs for women/girls during times of illness.
15Institute for Management Studies (2011), Study report on Women’s Political Participation in 2011 Local Government Election.
Submitted to NCWC.
Overall, enrolment of girls in tertiary education is much lower than boys with only two girls for every five
boys enrolled at tertiary level16. The adult literacy rate remains lower for women (47 per cent) than for
men (69 per cent)17, and this is particularly true in rural areas. Literacy rates among young women aged
15-24 were found to be the lowest in the eastern region (43 per cent), particularly in Tashiyangtse and
Trashigang18.
As of 2011, a higher percentage of female workers (83 per cent compared to 60 per cent for males) fall in
the categories of own account and unpaid family workers (agriculture and non-agriculture). As per the
Millennium Development Goals (MDGs) framework, these worker categories are considered ‘vulnerable
employment’ characterized by informal working arrangements, lack of adequate social protection, low
pay and difficult working conditions. Moreover, unemployment continues to be higher for women (4.5
per cent) than men (1.8 per cent). Strikingly, women constitute 70 per cent of the unemployed. Similarly,
underemployment seems to affect more women than men and is believed to be a significant issue in the
country, particularly in agriculture which employs a large proportion of women.
The Country Analysis for Bhutan 2012, prepared as part of the formulation process of the United Nations
Development Assistance Framework for 2014-2018, analyses the causes of gender gaps in Bhutan. The
document states that:
“Gender inequality in Bhutan has mainly been attributed to the following root causes:(1) social
expectations and norms (traditional roles girls and women are expected to play and acceptance of these
roles by them, attitudes towards violence against women), (2) cultural beliefs and stereotypes (e.g. that
women are less capable than men), (3) traditional inheritance patterns of family property (matrilineal
especially in the western and central regions, which implies the moral obligation for women to take care
of their parents), (4) lower education and literacy levels, especially among poor and rural women, (5) lack
of self-confidence, self-esteem, poor self-image and (6) poverty.
Some of the common underlying factors that have been cited as having an influence on opportunities
for women include: (1) women’s double or triple burden, (2) lack of daycare facilities, especially in rural
areas, (3) dependence on men for financial support, (4) limited access to information, including awareness
and information on their rights, (5) limited exposure, (6) gender blind/neutral approach of the
government and (7) lack of role models in leadership positions, especially in rural areas.”
The World Bank-supported Gender Policy Note 2013 sums up that in Bhutan gender roles in household
work and childcare represent constraints to women’s opportunities at various stages of life, in that they
limit girls’ study time, affect career choice and impede career advancement.
The 11thFive-Year Plan targets a more gender friendly environment for women’s participation in
development: The plan situates the promotion of gender equality as a key element to strengthen
16 Ministry of Education, Royal Government of Bhutan (2011), Annual Education Statistics, 2011.
17 Ibid.
18 National Statistics Bureau, Royal Government of Bhutan, UNICEF and UNFPA (2011), Monitoring the situation of children and
women. Bhutan Multiple Indicator Survey 2010.

governance. It sets out four areas for attention and commits to preparation of legislation on quotas for
women’s representation in local and national elected bodies as well as the implementation of gender
mainstreaming strategies by government agencies.
Additional tools have been adopted in support of gender mainstreaming: The 2012 protocol for Policy
Formulation issued by the Gross National Happiness Commission directs all policy proponents to
mainstream gender issues in policy preparation. Compliance is monitored through two documents to be
submitted along with all policy concept notes: (i) the GNH Policy Screening Tool (which includes gender
impacts as one of the variables to be scored under the governance theme) and (ii) a policy protocol report
(which outlines four points to be addressed in the gender analysis of policy alternatives and their
implications).
A strategy to implement a gender-responsive planning and budgeting approach is also being explored as
a means of strengthening policy and programme development. An initial focus is to ensure that the
gender-specific initiatives identified by various departments and agencies in the 11th plan are funded,
together with the prioritized remaining measures from the NPAG (National Plan of Action for Gender).
Another tool under development is the Gender Monitoring System, under which departments and
agencies make online reports on results and changes identified as a result of gender mainstreaming
approaches in the 11th plan.
This report also identifies the existence of institutional structures in Bhutan to promote action on gender
equality issues such as:
- The responsibility of all ministries and agencies to address gender equality
- The National Commission of Women and Children (NCWC) has a strategic policy and advisory role in
support of gender equality
- The network of gender focal points is a key mechanism to increase attention on gender equality
issues
- Local governments also have an important role to address gender equality issues.Under the
decentralisation process under way for some time in Bhutan, local governments are important
players in managing local development and providing a range of services to the population. As part
of preparing five-year plans, local governments were asked to mainstream gender (as well as
environment, disaster risk reduction, climate change, and poverty). In a consultation with local
government officials for this report, participants called for more advocacy and awareness activities
at local level on gender equality issues and strategies, and for support to increase their capacity. They
also called for a stronger link between the local and national levels on gender equality to facilitate
greater exposure and support. The NCWC has prioritized following up all these issues during the 11th
plan period.
The NCWC’s National Strategy for 2014-2019 has underpinned the current gender situation in Bhutan
under various strategic priority areas, with key strategies identified for each of these areas19.
It is important to be well aware and take the above-mentioned aspects into account during the
implementation of the RSAHP in Bhutan.
The United Nation’s Committee on the Elimination of Discrimination against Women in its concluding
observations to Bhutan (2007) expressed its grave concern at women’s low level of participation in
decision-making bodies, including Parliament, the government and the diplomatic service, and at regional
and local levels. This rate of participation has, in some cases, decreased in recent years. The committee
requested the State party implement, as a matter of urgency, sustained policies aimed at the promotion
of women’s full, active and equal participation in decision-making in all areas of public and political life. In
particular, the committee encouraged the State party to review criteria required for certain positions
when such requirements turn into obstacles or barriers to women’s access to decision-making. It also
recommended the use of temporary measures according to Article 4, Paragraph 1, of the Convention and
in the committee’s general recommendations 25 and 23. The committee further recommended the
implementation of awareness-raising activities on the importance of women’s participation in decision-
making positions during the current transition of society as a whole, including in its remote and rural
areas. Furthermore, the committee recommended that the State party continue to take measures to
improve women’s access to general, mental health and reproductive health care, for all women, including
older women, and women in rural and remote areas. The committee requested the State party provide
information in its next periodic report regarding the existence of an integral health policy for women,
including facilities for cancer screenings.
It urged the State party to make every effort to increase women’s access to healthcare facilities and
confidential medical assistance by trained personnel, in particular in rural and remote areas, despite the
difficult terrain. Moreover, the need to empower women in economic development and to pay greater
attention to the rights and needs of rural women was strongly recommended.
The NCWC National Strategy for 2014-2019 identified the following major challenges in relation to
women’s limited participation in decision-making:
- Social and cultural gender stereotypes as one of the key barriers to women’s participation in the
development arena.
- The genderneutral approach adopted by all agencies has resulted in the absence/inadequate
availability of infrastructure facilities, support services, laws and policies needed to facilitate women’s
participation in development.
- As highlighted in the CEDAW report 2007, age-old social and cultural values give primacy to men and
perpetuate deep-rooted values within society that discriminate against women, especially amongst
the rural population. Men are privileged as a result and this privilege extends to several spheres,
including privileged access to the economic, educational, political and social spheres. Cultural norms
19 List of relevant priority areas with their strategies are annexed.

typically place the responsibility of reproduction squarely on the shoulders of women and men’s
failure to share the household work and child rearing activities and lack of support services inhibit
women from upgrading their knowledge and skills and participating in public life and political
activities.
In terms of economic empowerment, labour force participation of women (67 per cent) is as high as men
(72 per cent). However, there are significant gender disparities in income earning opportunities. Few
women hold regularly paid jobs. Only 13 per cent of female workers hold regular paying jobs compared to
34 per cent of male workers (LFS 2011). Furthermore, female youth unemployment (age 20-24) is as high
as 12 per cent compared to males at 7 per cent.
The rural poverty rate is about 10-times higher in rural Bhutan (16.7 per cent) than in urban areas (1.8 per
cent) (Bhutan Poverty Analysis 2012). Moreover, as per the Poverty Analysis Report 2013, female-headed
households in Bhutan were poorer than male-headed ones. Poverty rates are high in Dagana, Samtse,
Lhuentse, Pemagatshel and Zhemgang. Many HHs in rural areas depend on locally available skills to
construct sanitation facilities using local materials and locally available materials as a substitute for
sanitary products. Often there is limited access and availability of sanitary products and services, while
locally available materials are seen as affordable.
Gender and WASH

Globally, the significance of WASH conditions to enhance women’s lives has been increasingly recognised
within the WASH sector. Surveys in 45 developing countries found that 72 per cent of day-to-day
responsibilities for collecting and managing water in HHs falls to women and girls (JMP, 2010, p. 29).
However, women are still often excluded from meaningful participation in WASH processes. It has been
found that ‘all too often, women are not as centrally engaged in water and sanitation efforts as they
should be’ (WSSCC and WEDC, 2006). Panda notes that ‘recognition of gender issues in water
management policies and projects exists only on paper’, with a ‘lack of real on-ground efforts to effectively
address gender differences and inequities in water and the absence of meaningful integration of gender
questions in mainstream water analyses and discussions’ (Panda, 2007, p. 324).
A recent study in Timor-Leste provided quantified evidence of the benefits of women’s increased
participation in WASH activities, particularly if women have responsibility for decision-making. The study
showed that water systems were more likely to function well if women actively participated in community
WASH committees. It also found that WASH committees were more likely to have adequate funds for
operations and maintenance when women were active on such committees. The study also revealed that
the benefits of women’s contributions were found to increase in direct proportion to how actively the
women participated. Thus, it is important that women are not only assigned token roles, but must be
encouraged and enabled to participate fully, including in decision-making. The study also cited another
study that found women were better able to deal with disagreements and explain difficult issues to
communities, as they were ‘more patient’ than men. The same study found that while men were likely to
think short-term, women were more likely to decide in favour of more durable solutions (Brown, 2013
cited in BESIK’s GMF Study, 2014).
Thus, the aim of this gender study on rural WASH in Bhutan is to formulate recommendations to work
towards gender equality in WASH. This is important as it will help girls and women as well as boys and
men live healthier and more dignified lives.
Methodology
This qualitative study was conducted in the three districts of Samtse (in the south), Samdrup Jongkhar (in
the east) and Wangdue Phodrang (in the west). The following participatory tools were adopted: 1). focus
group discussions (FGD), 2) guided transect walks (GTW) with women and men in communities, 3) in-
depth interviews (IDI) with local leaders and 4) key informant interviews (KII) with officials and leaders at
Dzongkhags.
The study team was trained for three days on the use of these tools by an international consultant and
fieldwork was conducted from 11 August to 4, September 2014 by officials from the MoH, SNV, a national
consultant and research assistants. The study team achieved almost equal participation of women and
men (61 women and 55 men). Four themes of relevance were selected for this study: 1) assess the gender
division of WASH-related labour within the household (HH), 2) decision-making at HH level in general
including for sanitation and hygiene, 3) decision-making at community level, 4) access, privacy and safety
issues related to WASH for rural women and men. The key findings of this study under each selected
theme are outlined as follows, with implications for the RSAHP under each theme.
Division of WASH-related HH labour

Questions on HH-related WASH activities, in the form of a card-ranking exercise, were asked to know the
key HH member responsible for WASH-related HH work in terms of gender. They revealed that HH WASH-
related work was mostly done by adult women in all three districts, with help from adolescent girls and
elderly grandmothers. Men reported they undertook WASH-related HH work if a wife was sick or absent.
Gendered restrictions with regard to HH work were stronger in Nepali-speaking HH communities in
Samtse, than in Samdrup Jongkhar and Wangdue, where both sexes saw women as most suitable to do
HH work. This community belief was stronger in more remote villages with limited road access
(Khempagaon in Samtse, Wangphu in Samdrup Jongkhar). Meanwhile, a more balanced HH division of
labour was found in richer HHs and where women were educated. Importantly, the caste system among
the Nepali-speaking HHs play a significant role in gender beliefs, with a distinct division of labour in upper
caste HHs.
The elderly, as revealed by IDIs, KIIs and study team observations, were found to have a lower threshold
for changes in gender roles and strongly believed in tradition/practices in contrast to younger community
members. In all meetings and interviews, younger men (aged 25-35 years) accepted women leaders and
engagement of women in development work. It is also important to note that single women-headed HHs
faced greater challenges in constructing toilets, with women in FGDs reporting that single women-headed
HHs were burdened by HH and outside work, while some local leaders said such HHs faced a shortage of
labour to farm and be available to attend meetings.
Decision-making at HH level
Under this theme, questions were asked to assess who had decision-making power at HH level, for toilet
construction, expenditure on construction (location, type, and timing) and factors influencing such
decision-making.
Overall, men were found to be the major decision-makers at HH level on toilet construction (type/location
of toilet) in studied districts for social/cultural and economic reasons. Some degree of joint decision-
making existed in non-Nepali speaking HHs, in contrast to Nepali speaking HHs where men dominated. In
general, decisions linked to large expenses were made by men at HH level, while women took smaller
decisions to buy weekly vegetables and groceries for the HH. The rationale for such decision-making,
expressed in interviews, was men are the main income earners at HH level and have networks and
exposure to deliver more information and confidence in decision-making, while there was a common
belief by women and men in traditions and practices that men are key decision-makers. For example,
women had little influence on final decisions made by husbands as stated by women from Wangphu, in
Samdrup Jongkhar. Discussions with men revealed that affordability and decision-making hierarchy were
influential factors for the type/location/construction of toilets by a HH. The definition of HH heads also
emerged during the study as a key variable, with study participants revealing they often followed census
data norms to define and name HH heads in favour of men, while participants in meetings did not write
their own names unless they were the father/husband from a HH.
Decision-making at community level

The focus here was to identify the characteristics and views of current leadership as well as the levels of
acceptance and capability of women and men as leaders. Most development work decisions were found
to be made by men, as they take most leadership positions in Bhutanese society. In contrast, the majority
of women at Gewog level reported to a male manager and had limited decision-making power. Barriers
to women taking up leadership roles included a perceived lack of education or simple book-keeping skills,
HH work burdens, less acceptance from society and exposure to information/media, networks and norms
outside village/rural areas than men. Women reported they could not participate in Gewog-level elections
due to husbands’ failure to support them. Some female leaders also revealed they did more work than
men for less income such as working as a Tshogpga (lower post) rather than as a Gup or Mangmi.
In Nepali speaking HHs in Samtse, no women were found to be in leadership posts and many said they
were prepared from a young age to be good housewives to serve their husbands. Numerous stereotypes
emerged during discussions on leadership. Senior male Government officials at the district offices said the
lower number of women in decision-making positions was because: “Women are not reliable”, “not
forthcoming” and “don’t take opportunities.” Whereas, women said the reasons were: “HH work”, “not
forthcoming”, “less educated than men”, “biologically women are weaker”, “dependent on tradition and
culture of men being decision-makers.” These views reflect the gender stereotypes in Bhutan surrounding
leadership. In fact, men referred to women leaders as “Phogay zum bay yoemi”20.
20 Like a man.
In FGDs, perceptions of younger and elderly women differed with the latter less interested in leadership
or technical roles than the former. Many women and men respondents stressed education and networks
as key factors to winning decision-making positions.
Interestingly, somerole models to usher in gender equality in Bhutan were identified by women in Samtse,
Wangdue and these included Minister Dorji Choden, Drangpon, Anti-corruption Chairperson Dasho Neten
Zangmo. Women with exposure to urban settings as well as people and government officials with a higher
social ranking (economic/income) were seen as influential role models in their communities. However,
only a few local women leaders were also heads of their HHs.
In general, women’s participation in decision-making forums at district levels is determined by positions

in society and most leadership posts are held by men. In IDIs with basic health unit (BHU) staff, it was
confirmed women mostly attended health meetings, but did not actively participate in mixed gendered
groups. In particular, women reported being shy and afraid of men in meetings, especially ones facilitated
by men. Women also lacked confidence to compete with men and in public speaking.
Women’s participation in meetings depended on the venue, language used, availability and culture. In
Wangphu, women had to walk for up to three hours to the Gewog office. Fewer women from Nepali
speaking communities in Samtse participated than other areas due to HH work and only attended when
men were unavailable. Other barriers to women’s participation were invitations expressly asking men to
participate (in Samtse), an age limit for participants (<18 to >55 years in Samdrup Jongkhar and Wangdue)
and invitations emphasizing vocal participation in meetings “go shey ney shey”. Women in Wangphu said
men took part when senior officials visited or in higher Gewog-level meetings. A greater turnout of men
was also evident from Nepali speaking HHs and non-Nepali speaking communities in Samtse, if topics to
be discussed were viewed as important. Women also faced mobility restrictions due to culture, social
norms and gender-specified tasks at home such as caregiving and HH work, long walking distances and
the need to carry small children when travelling. In particular, Nepali speaking women from Samtse faced
social restrictions on their mobility due to social/cultural reasons, such as husbands not providing
permission or society’s disapproval.
Study discussions, with women and men’s FGSs conducted separately, also revealed some interesting
trends. The study team observed that women were more vocal and active during women-only FGDs, than
mixed-group discussions.
Women from Nepali speaking HHs were found to be even more reticent than those from non-Nepali
speaking HHs, where male local leaders dominated mixed group discussions. In many FGDs, women were
not even sure about their ages. In addition, elderly women and female heads of HHs were more outspoken
during separate group discussions in all districts than other women.
Women’s interest in technical roles was also apparent, with study teams meeting women already involved
in technical roles as assistants (masonry and carpentry). However, some men (especially from Nepali
speaking villages in Samtse) were not supportive of women taking up technical roles as they were viewed
as not being interested and physically weaker. The mechanization of masonry/carpentry to become more
women friendly was advocated in some IDIs, but women’s HH work burden must first be reduced.
Moreover, not all women have benefited from women’s economic empowerment projects. In Samtse,
tailoring and weaving training was provided to Nepali speaking and non-Nepali speaking communities,
but women from Nepali speaking HHs faced restrictions on their mobility. Tailoring is also associated with
lower castes. At present, women’s income-generating opportunities are restricted to shop-keeping as
witnessed in visited villages, while some participated in weaving. Many women expressed interest in
income-generating activities.
Interestingly, differences in women and men’s perspectives on decision-making roles emerged. The
importance of more women in leadership was amplified by participants’ discussing women’s and men’s
different areas of interest. Women were found to think more collectively than men and certain social and
women-related issues were better understood by women. However, these issues are often not easily
discussed with men. In all the districts, women in FGDs and informal conversations said women could only
understand women’s issues. In KIIs, few women shared that having an equal number of women as sector
heads would ensure “women’s perspectives” in any programme decision-making.
In terms of current women leadership, almost all female local leaders were heads of their HHs (divorced,
single, widow). Revealingly, a female Mangmi (deputy local leader) said: “I would not have been able to
participate in decision-making if I was still married, because my husband gave me hell even for talking to
other men, such as government officials.” To increase women’s participation in decision-making, study
participants also made a number of important suggestions such as the formation of women-only groups
to enable women to become leaders (made by Ms. Daw Zangmo in Sipsoo Gewog, a local woman farmers’
group leader) and use of community groups as a platform to empower women leaders (groups formed by
RENEW-a local NGO for women’s empowerment and Ministry of Agriculture and Forest have encouraged
other women to become active in their communities). Women leaders confirmed that joining such groups
empowered women.
In this study, gender advocates able to work with the RSAHP were also identified. They include women
leaders in Sipsoo Gewog in Samtse, a young Gup (local leader) in Yoeseltse Gewog in Samtse, a female
Mangmi (deputy local leader) in Pemathang Gewog in Samdrup Jongkhar and a female ex-Tshogpa (village
representative) in Phobji Gewog, Wangdue. “Thayma Tshogpa” (Informal religious group) could also be
used as an entry point to instill equality and gender sensitization messages. Feedback from respondents
also stated the need for separate meetings with women and men for women’s meaningful participation
in discussions and decision-making.
Access, privacy and safety issues

Participants were asked about access to safe sanitation and menstrual hygiene management (women
only) as well as any privacy and safety issues faced by women and girls to learn about privacy, safety and
menstruation issues to be taken into account by the RSAHP.
Women and children were found to face more risks related to privacy, safety and access due to pat latrines
(PL), hilly topography and mothers taking care of children’s sanitation needs. Some women participants
with far away PLs refrained from toilet use until mornings due to fears at night. To emphasize the point,
women during FGDs said men’s privacy and access to toilets was not a concern as they have greater
freedom and acceptance to show their bodies publicly. “Man can urinate and bathe in the open air.” “Keeti
mancha haru saru par cha”21. Most men in gender-specific FGDs were reluctant to discuss privacy/safety
issues of women. Geographical location and culture determine the type of toilet constructed for a
particular HH. Nepali speaking HHs in the south, with warmer climate, had flush toilets with washing
facilities attached, while non-Nepali speaking HHs in the south rarely had washing facilities. Most HHs in
the east and west (Samdrup Jongkhar and Wangdue) had PLs without washing facilities. Water shortages
and a lack of bathing stations also presented challenges for women’s menstrual hygiene management.
Except for Nepali speaking HHs, most other HHs in visited villages did not have bathrooms as they used
PLs. Women from these HHs said they were not comfortable with this situation due to privacy concerns.
In all districts, women expressed challenges in menstrual hygiene management, such as having to bathe
under tap stands at night while menstruating and most times not bathing even though they understood
its importance.
Taboos surrounding menstruation also present further restrictions for women in Nepali speaking
communities in Samtse due to their beliefs that women cannot do certain things during menstruation. As
a result, women struggle to do HH work during menstruation. While non-Nepali speaking HHs in Samtse
and Pemathang and Wangphu do not have many restrictions, women cannot do offerings in the altar
room or cross the horse rope when menstruating.
In Komatrang, Wangdue women and men share many beliefs such as women cannot normally plough or
touch dead bodies and during menstruation cannot do house mud ramping. However, in Zhi Zhi village
there are no such restrictions. However, some participants from non-Nepali speaking communities,
originally from eastern parts of the country and now living in Samtse and resettlement areas in Samdrup
Jongkhar, reported taboos surrounding menstruating women, not common in their previous
communities.
Other examples of poor menstrual hygiene management were also evident, with women using towels
during menstruation, not drying them properly in the sun due to shyness to hang cloths in the open.
Women also believed they would bleed more if they bathe during menstruation. Many women revealed
they could easily dispose off used sanitary pads/towels in PLs, while women with flush toilets faced
challenges in the proper disposal of used sanitary pads/towels.
In contrast, Nepali speaking households of Samtse - as observed in the field and in the GTW – had access
to better sanitation and hygiene facilities (menstrual hygiene) than mixed communities in this district and
the other two. In Komatrang, women revealed they did not change their sanitary pads/towels once they
went outside their house for farm work. Nepali speaking HH women in Samtse and in Samdrup Jongkhar
Women face difficulties to urinate/bath in the open.

21
said they changed their sanitary pads/towels, but not within a six-hour timeframe. It was observed that
menstrual hygiene was not a topic openly discussed in communities, including with female BHU staff.
Women in FGDs were hesitant to discuss the issue until they were made comfortable by a female
facilitator.
Further key findings from this study, in addition to findings per theme, are as follows:
Other gender stereotypes, not in the interests of Bhutanese women, were observed and some phrases
commonly heard during the study included: “Amtsu chekhey me chey bey”22. Such views can hinder
women’s participation in development work, especially as men’s respected role at home means women
are burdened with HH work. The stereotype that women are “physically weaker” can also impede
women’s participation in productive activities, such as masonry/carpentry. As one woman from the
Wangphu FGD reported: “We are so interested, but we feel we are incapable and this makes me sad”.
The study team also witnessed a prevalence of early marriage/early pregnancy, domestic violence and
rape cases. In fact, girls in the survey areas often marry as early as 13-years-old to men above 18 years.
There were also cases of school dropouts due to early pregnancy, leading to a gender gap in tertiary
education. In two villages, there were cases of rape of girls below 18 years by their relatives. Some women
reported that: “The raped women were from poor backgrounds or had no education”, “one was referred
to as “laa-tey”23 and her husband keeps battering her.”
In FGDs, many cases of domestic violence were reported, especially abuse by alcoholic husbands. The high
incidence of domestic violence in rural areas (Samtse had the highest number of cases24) is a major issue
impacting upon women’s lives and is of relevance to any development programme, particularly those to
increase women’s participation in development.
Education and income were identified as being linked to changes in gender roles for decision-making.
Women of Tsakaling, Garigoan and Wangphu were found to be optimistic about the future. Changes in
gender roles in decision-making are linked to education and this point was made by women and men in
KIIs, FGDs and IDIs to achieve gender equality in decision-making. This indicates a change in gender
attitudes because government education opportunities and awareness raising programmes means more
educated wives will result in a more balanced division of labour and decision-making roles.
Overall, all communities were found to have knowledge about basic sanitation and hygiene. In terms of
knowledge, most HHs knew about sanitation and hygiene from meetings/campaigns given by BHU staff,
radio and television. In particular, women and men in rural Bhutan viewed TV and radio as good BCC
channels. But, challenges in terms of sound sanitation and hygiene practices were pointed out by local
leaders in communities where knowledge did not translate into practice. When asked about critical times
22
Women are not capable.
23 A cognitive disabled person.
24 Report from RENEW Bhutan: http://www.bbs.bt/news/?p=46711
for hand washing with soap, respondents displayed sound knowledge, but failed to identify changing a
baby’s diaper/after handling small children’s feces.
Interestingly, school children emerged as good mediums to disseminate sanitation and hygiene
information as all respondents displayed knowledge about the need to practice good sanitation and
hygiene that was also brought home by children from school. Better sanitation and hygiene facilities were
also observed by the study team in villages closer to main highways/paved roads.
BHU staff were found to have influential sanitation and hygiene roles in all three districts, with inputs into
the construction of toilets and warnings that communities faced penalties and fines for non-construction.
Another strong motivator was social pressure, as participants said the community would disapprove if
toilets were not constructed.
A lack of sex-disaggregated data collection and gender awareness and analysis was also apparent at
district level and this could hamper the development programmes being planned and implemented in a
gender sensitive manner.
The study team discovered a lack of gender integration in development activities. Local leaders at district
and sub-district levels were aware of gender gaps in Bhutan, but did not know how to integrate knowledge
into development activities. Almost all KII and IDI respondents saw no tangible benefit in segregating
data, but while acknowledging gender as a donor requirement they questioned the business case for
integrating gender. Some district leaders were aware of the need to integrate gender in planning, policies
and programmes, but lacked know-how to put it into practice. The study also discovered that sex
disaggregated data recorded in the health sector is a requirement, yet most KII and IDI respondents failed
to see the link between gender and WASH. On a separate note, shortages in the supply of cement were
reported in Wangdue and other communities not accessible by road.
Recommendations
This study has identified the root causes of gender differences and inequality in relation to WASH in
Bhutan, with the following recommendations based on its findings and a review of secondary data,
including global gender and WASH literature. Recommendations are made for the four components of the
RSAHP separately and also for the whole RSAHP in general.
Recommendations for the Governance Component

 Development of a gender implementation plan: A detailed implementation plan with timelines,
accountability and resource allocation should be developed for the implementation of this
study’srecommendations. The plan could compile and share experiences of good practices and
develop guidelines for gender mainstreaming for the RSAHP.
 Gender sensitization at all levels and sex-disaggregated data collection and analysis.
 Gender inclusive budgeting in planning at all levels: For the RSAHP to be gender sensitive, it will need
an additional budget. Such budget allocations should cover additional female representation with
women leaders from farmers’ groups, successful women entrepreneurs/suppliers/masons to

showcase their success stories. Extra provisions should be made available to encourage female WASH
staff to make field visits.
 Pro-poor support mechanisms, particularly for female-headed HHs and the elderly: Explore ways to
help the poorest at multi-stakeholder meetings to improve sanitation.
Recommendations for the Demand Creation Component

Gender sensitive and inclusive facilitation: RSAHP meetings should be favourable to women participants.
Community Development for Health (CDH) manual must be gender sensitive: The CDH manual must be
reviewed to ensure it is gender sensitive.
Incorporate shared WASH-related divisions of labour at HH level in demand creation: As part of the
demand creation processes, the additional required labour should be discussed with women and men as
women’s responses should be taken into account in final decision-making. This process should incorporate
awareness and sensitization on the need for men to share toilet cleaning and maintenance responsibilities
incorporated in CDH to avoid burdening women.
Recommendations for the Supply Chain Component

To ensure supply chain studies and marketing materials, consider the choices and needs of female
consumers.
 Marketing skills training for women shopkeepers and potential women leaders: Provide simple
marketing skills training as part of masonry training.
 Encourage female RSAHP suppliers of sanitation materials: Women shopkeepers should be
encouraged to sell soap, sanitary napkins and hardware materials for toilet construction in villages.
 Encourage female masons: Include interested women in masonry training, specifically those engaged
as assistants during construction.
Recommendations for the BCC (Behaviour Change Communication) Component

 Work with men to improve sanitation and hygiene for all:The RSAHP needs to change men’s
attitudes to achieve improved sanitation and hygiene.
 Stress hand washing with soap (HWWS) at critical times: Particularly HWWS after changing a baby’s
diaper/after handling small children’s feces.
 Incorporate menstrual hygiene management in BCC activities, with a focus on schools.
 Develop more gender sensitive communications.
 Menstruation matters: Talk about it at the Global Menstrual Hygiene Day celebration.
Recommendations for the RSAHP

 A commitment to gender equality as a development goal in itself and as an integral part of WASH
work that needs to be adopted and put consistently into practice at institutional and organisational
levels. This means SNV and the MoH must build capacity and accountability to ensure all work is
informed by gender analysis and underpinned by a commitment to address practical gender needs
and strategic gender interests in WASH programming as well as create an enabling environment at
organisational level for achievement of these results, in terms of policy and practice.
 Increase emphasis on women’s active participation in all RSAHP activities. Gender sensitivity in
meetings is needed to take this study’s findings into account and increase emphasis on women’s
active participation in all RSAHP activities within the PHED.
 Sensitise men, local leaders and women on gender in WASH.
 Ensure women and men enjoy equal access to information.
 Capacity development to consider the needs of women and men in the design (type/location) of
toilet(s).
 Work with local civil society organisations (CSOs) for mobilisation of women for effective
participation in RSAHP activities.
 Gender sensitive conduct in all RSAHP activities. Engage local leaders, especially women leaders, to
serve as role models to mainstream gender in WASH.
 Thayma Tshogpa” can be used as an entry point to instill equality and gender sensitization messages,
especially in eastern parts of the country.
 Another entry point for gender mainstreaming in RSAHP is building on United Nations Children’s
Fund (UNICEF) and DYS C4D messages used by some BHUs as some health assistants (HAs) have
already been trained.
 Celebrate International Women’s Day on 8 March: For increased advocacy and
discussion/sensitization on gender in WASH, it is recommended the RSAHP uses the next international
women’s day to officially launch and disseminate a press release on the publication of this gender
study report to highlight the current situation of rural women in Bhutan with regards to WASH.
 All RSAHP products/publications reviewed through a gender lens: Ensure there is no re-enforcement
of existing gender stereotypes.
 Capacity development of programme focal experts (PHED, LNW, SNV WASH) in gender
mainstreaming in RSAHP: During the course of this study, the attitude of RSAHP personnel towards
gender mainstreaming was noted (such as mansplaining female research assistants in the field,
critiquing a particular gender/women-related finding and mocking gender issues), which risks trickling
down to field implementers and negating RSAHP’s efforts to achieve gender equality in WASH.
Therefore, it is essential that programme personnel from central level be required to adopt a positive
attitude towards gender equality and act as good role models to achieve gender equality in WASH.
Clear and consistent messages must come from senior levels that set clear expectations about
standards of gender-related conduct by all personnel. Expected standards of attitudes and
demeanour could be set out in the recommended Code of Conduct. It is also important for gender
equality standards to be reflected in human resources processes, such as recruitment, job
descriptions and performance reviews. People with positive attitudes towards women and gender
equality must be recruited to achieve institutional change.
 Use of participatory tools and other gender sensitive tools from current WASH resources on gender
in all RSAHP activities is needed, particularly the need to use the SNV Gender Equality and Social
Inclusion Note developed for the Sustainable Sanitation and Hygiene for All programme.
The findings from this gender study has led to the formulation of a series of recommendations at different
levels (organisational, during implementation, M&E) for the different WASH stakeholders in the country
to address the gender related concerns in the WASH sector in Bhutan. At the organisational level, a
commitment to gender equality as a development goal in itself and as an integral part of WASH work was
recommended to be adopted and put consistently into practice at the institutional and organisational
levels. This means that SNV and the Ministry of Health (the main stakeholders in the rural wash
programme in Bhutan) must build capacity and accountability for ensuring that all work is informed by
gender analysis and is underpinned by a commitment to addressing both practical gender needs and
strategic gender interests in WASH programming; and create an enabling environment at organisational
level for the achievement of these results, in terms of both policy and practice. During implementation,
different recommendations for the four different components of the existing rural wash programme has
been discussed. Recommendation for the governance component include the development of a detailed
implementation plan with timelines, accountability and resource allocation (or indication of resources
required and a plan for how those resources will be sourced) for the implementation of the
recommendations from this study; development of guidelines for gender mainstreaming for the rural
WASH programme; gender sensitization at all levels and sex-disaggregated data collection and analysis;
gender inclusive budgeting in the central/district/community level plans.
This gender study is part of SNV’s technical assistance to the Ministry of Health as part of the 4-year
Australian Government’s Department of Foreign Affairs and Trade funded rural WASH project in Bhutan.
For more information on the detailed findings and recommendations from the study, please contact Ms.
Tshering Choden (gender, inclusion and governance specialist), SNV Bhutan at [email protected]
The Question of Attitude or Access: Sanitation through a Gender Lens
Authors: Rukhsat Hussain and Niti Saxena
Introduction
Sanitation occupies a central position in development discourses globally. As the world transits from
millennium development goals to sustainable development goals, sanitation continues to be recognized
as a domain requiring attention. Talking about the global initiatives towards addressing issues related to
sanitation, myriad efforts are evident. However, the current UN statistics clearly reveal that the
millennium development goal aimed at halving the proportion of people not having access to sanitation
by 2015 remains far from being achieved. The MDG progress report released by the UN showcases that
2.4 billion people continue to lack access to basic sanitation services such as toilets or latrines (UN, 2015).
Resonating with the global scenario is the sanitation situation in India where emerging trends suggest that
the country will face a huge sanitation crisis in the coming years. (Hazra, 2013). With the ever-growing
population countrywide, the government and civil society continue to grapple with the issue of sanitation
taking into cognizance that 53% Indian households do not own a toilet (Census, 2011). The situation is
observably worse in the rural areas.
Sanitation for All: Government Initiatives

Recognizing sanitation to be one of the basic determinants of quality of life, the Government of India has
undertaken several steps to make sanitation available for all. Over time, these steps have largely focused
on providing technical and financial assistance to the poor. The very first effort to extend subsidies for
latrine construction dates back to 1986 through the Central Rural Sanitation Program. However, almost a
decade later, the program was considered to be highly deficient being supply driven, highly subsidized
and infrastructure oriented. Owing to these shortcomings, the government reformulated the program to
making it community driven and awareness generating and renamed it as the Total Sanitation Campaign
(TSC). The TSC was initiated in the year 1999 with the overarching objective of bringing improvement in
the quality of life of people, especially in rural areas. The approach transformed from being supply driven
to being demand driven, community led and people centered. To give an additional thrust to the
campaign, the government launched the Nirmal Gram Puraskar (NGP) for the purpose of recognizing the
achievements and efforts made in ensuring full sanitation coverage (MDWS, 2015). The award emerged
as an effective stimulus that gave the required impetus to the campaign. In the year 2012, the campaign
was renamed as Nirmal Bharat Abhiyan owing to the success of Nirmal Gram Puraskar.
While the objectives largely remained the same, the rechristening was undertaken to accelerate the
sanitation coverage in rural areas in order to maximize the outreach in rural communities. Over time, the
sanitation infrastructure in the country has undergone massive transformation, especially evident in the
rural pockets with a relative increase in the number of toilets constructed (Mandal, 2008) What remains
to be transformed is now recognized as the behavioral perception towards using a sanitation facility. State
and country reports coherently indicate that integrating infrastructure with a behavior change
communication approach is necessary to help such initiatives achieve the desired objectives.
Very recently, the Government launched the Swachh Bharat Mission (SBM) which is an overhauled version
of the Nirmal Bharat Abhiyan. The objectives, focus and approach of the mission have been refurbished.
SBM was launched as a countrywide mission in the year 2014. Unlike the previous campaigns and
missions, SBM has a timeline attached to it. It aims that within a span of five years, India will be free from
open defecation, manual scavenging and will have full proof mechanisms of disposing municipal solid
waste (Kaul, 2014). In the last one year of implementation, SBM indicates to have spread awareness and
brought people together to work towards the cause of providing sanitation for all.
Sanitation Situation in India

The sanitation situation in India is faced with multiple challenges. At the outset, the urban rural divide
poses multifaceted problems that require customized, more aptly, contextualized solutions. Evidence
suggests that poor sanitation affects health, education, personal security, human dignity and
environment. This effect is strikingly skewed towards women and children. Statistics provided by UNICEF
(2015) indicate that only 11 percent of Indian rural families dispose of child faeces safely. 44% women
dispose of their children’s faeces in the open which increases the risk of microbial contamination of water
raising the incidence of diarrhea in children. A report by the magazine, Down to Earth establishes poor
sanitation as one of the factors responsible for high incidence of malnutrition in India (Pandey & Singh,
2013). Besides children, women are also the most vulnerable groups when it comes to sanitation. An
observable divide between men and women especially in the case of developing countries is in sanitation
and hygiene. The provision of hygiene and sanitation are often considered women’s tasks. However,
societal barriers restrict women from being involved in decision-making processes related to toilets,
sanitation programs and projects. Thus, in the absence of sanitation facilities, women often wait until dark
to defecate in the open. This is one of the main reasons why women drink less water causing several
health problems. Attempting to ‘hold out’ until evening results in physical harm such as urinary tract
infections. Despite such evident ill effects of open defecation, the country continues its struggle in
providing adequate sanitation facility for all.
Alongside this backdrop, myriad efforts by the government through the years after independence have
failed to bring in the desired impact. A joint WHO-UNICEF report released in the year 2015 states that
nine out of ten people still practicing open defecation live in rural areas (JMP, 2015). Despite the
government providing subsidies on toilet construction specifically in the rural pockets of the country, rural
inhabitants prefer defecating in the open. Statistics indicate that India has been constructing 1.5 million
toilets a year under its Total Sanitation Campaign. However, at SACOSAN in Delhi in the year 2008, Prime
Minister Manmohan Singh himself admitted that 50 percent of the toilets constructed under TSC remain
unused. The situation is found to be even worse in select regions across the country (Khambete, 2012).
This paper showcases the sanitation situation in Mewat, a remote district in the state of Haryana.
The Case of Mewat

Haryana is a landlocked state in Northern part of India surrounded by Punjab, Himachal Pradesh, Uttar
Pradesh, Delhi and Rajasthan. The state accommodates a population of 25 million with an overall density
of 573 persons per square kilometer. According to Census 2011, latrines were available in 68.6%
households in the state with the rest defecating in the open.
Within the state of Haryana lies Mewat district that continues to live in the 16th century tied within the
shackles of poverty. People in Mewat continue to live a life of backwardness with continuing worsening
quality across all domains. The district came into existence in the year 2005 when it was carved out from
Gurgaon and Faridabad as the 20th district of Haryana. The geographical location of the region is such that
it falls at a distance of around 30 kilometers from Gurgaon. However, despite the proximity, Mewat is
untouched by development and lags behind other districts in the state on almost all indicators of growth
and development (Saxena, 2013).
The current paper examines the sanitation situation in Mewat. The purpose of the study was to analyze
the gender25 perspectives towards not constructing toilets. Gender organizes social relations in everyday
life as well as in the major social structures (Kendall, 2013). The paper attempts to capture gender-
25
Gender is defined as the culturally and socially constructed difference between males and females found in the
meanings, beliefs, and practices associated with masculinity and feminity.
disaggregated perceptions towards sanitation as literature suggests that women do not have equal access
to sanitation resources. Due to cultural norms, men in households do not feel as restrained to urinate or
defecate outside, especially in rural India. Thus, women without having access to a sanitation facility tend
to relieve themselves in the night or early morning in the fear of being seen by males. This puts them in
danger from sexual harassment or animal attacks (Narasimhan, 2002). In light of these gender disparities,
this paper attempts to capture gender disaggregated perceptual insights on the issue of sanitation.
Perspectives towards constructing and using a sanitation facility are differentiated across socio economic,
religious and occupational categories. The study attempts to identify the relevant attitudinal factors for
not constructing toilets or non-usage of constructed toilets. The paper is divided into four sections. The
first section provides an overview of the global scenario of sanitation, the Indian context and a backdrop
of Mewat district. Methodology of the study and sampling design are discussed in section two. The third
section presents the major results of the study followed by discussing the way forward in section four.
Methodology
Primary data was collected from Mewat district of Haryana. The sample comprised of 43 villages spread
across all blocks26. 18020 households were interviewed in the study. Household census enumeration27
method was used to collect data. Thus, all consenting households participated in the study.
The 43 villages28 included in the study were selected through stratified random sampling. In totality,
Mewat district has 431 villages, 10% of which was chosen as the final sample for the study.
Sampling Methodology
To obtain a stratified sample, population of the villages and income level were chosen as the stratification
variables. Villages were selected within strata with probability proportional to size. The allocation of
sample across the strata was done in such as way that the size of the sample within a stratum was
proportional to the total size of the stratum. Thereafter, the target population and excluded population
was defined. Villages with zero population and/or zero income were excluded. Based on the stratification
26
Mewat district has five blocks namely, Tauru, Firozpur Jhirka, Nuh, Nagina and Punhana.
27
A ‘household’ is usually a group of persons who normally live together and take their meals
from a common kitchen unless the exigencies of work prevent any of them from doing so.
Persons in a household may be related or unrelated or a mix of both. However, if a group of
unrelated persons live in a census house but do not take their meals from the common kitchen,
then they are not constituent of a common household. Each such person should be treated as a
separate household (Census India, 2015).
28
Patakpur Punhana, Thekra, Khedla Kalan, Naharpur, Andhaki, Chudlika, Malaka, Patan Udaipuri, Rajpur, Laphuri,
Pachgaon, Udaka, Chilla, Salamba, Shadipur, Bajarka, Notki, Sukhpuri, Akhlimpur Firozpur, Mundeta, Raniyala
Patakpur, Bhirawati, Kherli Khurd, Phalendi, Gudhala, Mahoon, Bissar Akbarpur, Hathan Gaon, Palgardi, Gojaka,
Rithath, Aterna Shamshabad, Bhakroji, Badli, Dhadoli Kalan, Indri, Tirwara, Bisru, Bichhor, Padheni, Singar, Rithath,
Sangel
variables, nine strata29 were created using percentiles. Till 33th percentile, villages were termed as low,
34th to 66th percentile villages were termed as medium, and 67th percentile onwards, villages were termed
as high.
To establish a proportionate allocation of sample across strata, it was ensured that the number of villages
selected from each stratum were proportional to the total stratum size.
Proportionate Number of villages: The proportionate number of villages required from the first stratum
is 43 * (Defined villages in those strata/Total villages of all strata) = X villages.
The village sample was achieved by using the sampling interval30. A random number between one and
sampling interval was chosen at random through the random number generator. The output termed as
random start (RS) was then used to build up the series:
RS; RS + SI; RS + 2SI; RS + 3SI; RS + 4SI; RS + 5SI; RS + 6SI; RS + 7SI; RS + 8SI; RS + 9SI.
Continuing in this manner, the desired number of villages was selected.
Major Findings
The section discusses the key results emerging out of the data analysis undertaken. They are divided into
three sections. Section one discusses the socio economic profile of respondent households. Toilet
ownership pattern is discussed in the second section along with usage statistics. The third section
highlights the gender-disaggregated perspectives towards influencing toilet construction.
Socio Economic Profile of Respondent Households
The socio economic profile of the respondent households is drawn through examining the caste and
29
Stratum_1: Small village Low income
Stratum_2: Small village Medium income
Stratum_3: Small village High income
Stratum_4: Medium village Low income
Stratum_5: Medium village Medium income
Stratum_6: Medium village High income
Stratum_7: High village Low income
Stratum_8: High village Medium income
Stratum_9: High village High income
30
Sampling interval is the ratio of total number of population in that stratum to number of villages selected in that
stratum.
religious distribution, economic situation, and occupational engagement. Obtaining an overview of the
socio economic situation of the respondent households is useful in drawing inferences on the attitudes
and perceptions related to the issue under investigation.
Caste and Religion

Caste wise distribution of the respondent households indicates dominance of backward caste population.
Demographic data on Mewat clearly indicates dominance of Meo Muslims, a unique ethnic group
characteristic of the district. Meo Muslims have been categorized by the government as backward caste
(BC). Thus, caste based profiling of the respondent population hints at dominance of backward caste with
81% households mentioning to fall in the BC category. Scheduled caste population is estimated to be 11%
and general caste population is 8%. Resonating with the caste distribution is the religious distribution of
the households presented in figure 1.
Hindu Muslim
22%
78%
Figure 1: Religious Distribution
Economic Distribution
In order to aid the development of the rural poor, the Government of India has several schemes and
policies. To ensure that the subsidies and benefits of these policies reach the right people, the government
issues cards based on the socio economic status of every household. The card ownership is indicative of
the entitlements a household is eligible for. Exploration of the type of card ownership in the study villages
highlights the dominance of above poverty line (APL) households with around 55% households owning an
APL card. Figure 2 showcases the cardholdership pattern of the respondent households.
A strikingly evident facet emerging from the disaggregation of respondent population according to the
cardholder ship pattern is that a considerable chunk of the population does not own any card. About 19%
households mention not owning any card which indicates that they will not be able to access entitlements
under several government schemes and policies. Discussions on the ground reveal that several
households have applied for cards but have not heard back from the local administration. A considerable
proportion of households in this section also claim to fall under the below poverty line (BPL) category but
are unable to get their cards made as they are unaware of the procedure of application. The absence of a
card prevents them from accessing funds meant for infrastructure improvement of the household,
including toilets.
BPL APL AAY Don’t know No Card
19% 22%
1%
3%
55%
Figure 2: Cardholdership Pattern
Occupational Engagement
Understanding the occupational engagements of adults in a household is an important indicator to
estimate its socio economic situation. A look into the occupational engagement pattern of the respondent
households indicates that a major chunk of the respondents are engaged in laboring. About 45% of the
respondent households earn their major income through laboring. Among the laborers, majority mention
to be agricultural laborers working on other people’s farms. About a quarter of the respondent population
is engaged in farming. Driving is also found to be a major source of income for 13% households. About 9%
households are engaged in occupations such as government jobs, livestock rearing or are surviving solely
on pension.The next section discusses the toilet ownership pattern and the extent of usage in households
from a gender disaggregated perspective.
Toilet Presence and Usage

In a region like Mewat, owning a toilet is a challenge and using it optimally is another. While more than
half the population owns APL cards, it is no guarantee that they own a toilet. A look into the toilet
ownership pattern presents a dismal picture. As figure 3 suggests, a little over only a quarter of the total
respondent households own a toilet. With 72% respondent households not owning a toilet, it becomes
clear that a major chunk of the population is either defecating in the open or using community toilets.
72.2
27.8
Yes No
Figure 3: Toilet Ownership Pattern
Ownership of toilets is also studied in relation to the socio economic characteristics of the respondent
households. As is evident from table 1, more number of households owning above poverty line cards own
toilets when compared with other cardholders. A trend resonating with the previous discussion also
emerges from the analysis wherein only 10% households not having any card own toilets.
Table 1: Socio Economic Characteristics and Toilet Ownership
Socio Economic Sub Categories Presence of Toilet

Characteristics (in percentage)
Cardholdership pattern Below poverty line 25.6
Above poverty line 34.8
Antyodaya 26.1
Don’t know 27.2
No card 10.2
Occupational Engagement Driver 21.6
Pattern Laborer 19.1
Farmer 38.5
Self Employed 37.3
Other such as government job, 43.4
pensioners, anganwadi workers
Caste Distribution General 60.0
Scheduled Caste 24.8
Backward Caste 25.2
Occupational disaggregation also reveals interesting trends. While more number of households engaged
in farming tend to have toilets, toilet ownership is found to be surprisingly high among self employed
households as well as households where major source of occupation is a government job or a private job.
Caste and religious composition analysis reveals that majority of households in the general category own
toilets. Given that majority of inhabitants in Mewat are Meo Muslims who are categorized as backward
caste, it can be assumed that the General caste comprises of Hindu population. Analyzing the presence of
toilets in relation to the religious composition reveals consistent picture with comparatively more number
of Hindu households (39%) owning toilets than Muslim households (25%). The emerging trends are found
to be significantly correlated.
Further investigations reveal that of the households which own a toilet facility, 93% have constructed it
on their own. Few households have taken outside financial help in constructing toilets as presented in
figure 4. Thus, financial subsidies extended to the targeted beneficiaries through government schemes
and policies do not appear to be of much influence in the sampled region. The majority of households
having constructed toilets on their own is more indicative of ownership due to ‘felt need’ than an
externally stimulated action.
Other such as organisations like 2.7

Sehgal Foundation, World Vision
Government 4.7
Self 92.7
Figure 4: Source of Toilet Construction
As evidence suggests, owning a toilet is not necessary a guarantee that it is functional and in use. A look
into the functional status of toilets in households that have them reveals that 98% toilets are functional.
Extent of usage of toilets is examined among households owning toilets that are functional. Table 2
showcases that in 11% of households, not every member of the household is using a toilet. Upon
exploration of the reasons as to why the toilet usage is not 100%, resource constraints 31 emerge to be a
major deterring factor.
31
Resource constraints imply obstacles in the construction of toilets due to lack of resources such as space and
water
Table 2: Toilet Usage
Extent of Usage
All members use toilet 89 % Some people go out in the open 11 %
Reasons for Non Usage
Not enough space 27.2
No need for toilet 9.8
Problem of water 35.5
Foul smell 2.1
Don’t like using toilet 4.8
Pit full 2.3
Like open field 7.6
Some time 2.1
During illness 2.1
Other such as use community toilet,
go for walk, incomplete 6.5
As table 2 suggests, the problem of water is cited by maximum number of respondents. This resonates
with the overarching deficit of potable water in Mewat region. With majority of villages having saline
ground water, it becomes difficult for a considerable number of households to procure potable water for
drinking and other domestic purposes. Owning a toilet thus, becomes an additional challenge. The
situation becomes more profound as it is the women in the households responsible for procuring and
managing water in the household. Owning a toilet would therefore mean more rounds of water fetching
exercise putting an additional burden on the women.
Factors Influencing Toilet Construction

Construction of a toilet may be influenced by several interpersonal and societal factors. This section
examines the factors influencing toilet construction from a gender lens. The factors explained by
respondents are divided into two parts. While one part encompasses the constraints in constructing a
sanitation facility due to dearth of resources, the other part includes attitudinal factors deterring
construction of a sanitation facility.
As table clearly indicates the proportion of females willing to construct a sanitation facility are more than
the number of male respondents who are willing. Discussions further reveal that the women who respond
in the negative are largely the ones who are not ready to take a decision on their own and thus, prefer to
voice the decision of the head of the household, who in a patriarchal society like Mewat, is almost always
a male. The extent of subordination to men and the inability to voice their concerns magnifies the
difficulties women have to undergo with respect to sanitation.
Table 3: Inhibiting Factors Influencing Toilet Construction: Gender Disaggregated Perspective32

Factors Percentage of male Percentage of
respondents female respondents
Negative attitude 19.9 12.0
(Unwilling and prefer
to defecate in open)
Resource constraints 77.6 85.6
(Lack of space, water)
The resource constraints are also highlighted by a larger percentage of women than men. The analysis
further reveals that there are several inhibiting factors associated with not constructing a sanitation
facility. Females largely indicate that lack of water or space prevents them from constructing the
sanitation facility. Whereas, discussions with men yield space to be the only problem.
Thus, it becomes clear that it is the ‘attitude’ and not ‘access’ that prevents construction and usage of
improved sanitation facilities. Gender disaggregation of responses further highlights contradicting
viewpoints wherein women tend to be in favor of owning a sanitation facility and men deciding in the
negative. It therefore becomes necessary that initiatives aimed at eradication of open defecation also
focus on gender differentials that operate more pervasively among the rural poor.
Way Forward
Key findings from the study predominantly underscore the need to revisit the various schemes and
policies the country has at hand to combat the sanitation crisis. It emerges from the analysis that
attitudinal sensitization facilitating the use of a sanitation facility is equally or may be, more important
when compared with the issue of access to an improved sanitation facility. Even though, access to an
improved sanitation facility continues to be a challenge for many, there are innumerable cases where
availability of a sanitation facility does not ensure a shift from open defecation to usage of the sanitation
facility.
A major shift is required in the approach of sanitation campaigns wherein not only the access is improved
but the attitude is also transformed. In the long term, behavior change communication becomes
imperative to sensitize people towards the use of sanitation facilities and the positive aspects associated
with it. Demonstrated impact will also be beneficial in drawing people towards the positives of organized
sanitation. In the wake of increasing water crisis across the globe, it also becomes necessary to evolve
sanitation solutions that are water efficient and replicable. These solutions are urgently required in semi
arid regions like Mewat where access to potable water is a bigger everyday challenge.
The sanitation situation in India continues to be in a grave form that further becomes insurmountable
with the voices of women not being taken into consideration. While women are the ones largely held
responsible for managing hygiene and sanitation at the household level, their voices are neither asked for
32
The percentages do not sum up to 100 as 2.5% respondents did not give any response on the question.
nor considered when voiced while taking household or community level decisions related to sanitation.
The gender-disaggregated analysis presented through this paper thus provides ample evidence that
sanitation needs to be looked at through a gender lens to bring about the desired change.
References
Census, (2011). Census of India. Retrieved on Oct 8, 2015 from www.census2011.co.in
Census India (2015). Concepts and Definitions. Retrieved on October 10, 2015 from
http://censusindia.gov.in/Data_Products/Data_Highlights/Data_Highlights_link/concepts_def_h
h.pdf
Pandey, K. & Singh, J. (2013). Why India Remains Malnourished. Retrieved on October 10, 2015 from
http://www.downtoearth.org.in/coverage/why-india-remains-malnourished-42697
Hazra, A. (2013). Rural Sanitation and Role of Women: A Study in Birbhum District of West Bengal.
Department of Social Work, Assam University, Silchar. Retrieved on 05/22/2015 from
shodhganga.inflibnet.ac.in/bitstream/10603/21977/1/01_title.pdf
JMP (2015). Update Report of the WHO/UNICEF Joint Monitoring Programme for Water Supply and
Sanitation. Retrieved on October 12, 2015 from http://www.unwater.org/publications/jmp/en/
Kaul, K. (2014). Swachh Bharat Abhiyaan: Prospects and Challenges. Retrieved on October 12, 2015 from
http://www.cbgaindia.org/files/featured_articles/Swachh%20Bharat%20Abhiyan,%20Prospects%20and
%20Challenges.pdf
Kendall, D. (2013). Sociology in Our Times. Stamford CT, USA: Cengage Learning.
Khambete, A.K. (2012). The Sanitation Crisis in India: An Urgent Need to Look Beyond Toilet Provision.
Retrieved on October 20, 2015 from
http://www.indiawaterportal.org/articles/sanitation-crisis-india-urgent-need-look-beyond-toilet-
provision
Mandal, K. (2008). Rural Sanitation: A step towards achieving the Millennium Development Goal No 7,
Target 10. Retrieved from http://www.nistads.res.in/indiasnt2008/t6rural/t6rur8.htm on
October 24, 2015
MDWS (2015). About NBA. Retrieved on October 25, 2015 from

http://tsc.gov.in/TSC/NBA/AboutNBA.aspx
Narasimhan, S. (2002, July 1). Sanitation: The hidden gender problem. India Together. Retrieved on
September 1, 2015 from http://indiatogether.org/women/health/sanitation0702.htm
Saxena, N. (2013). Socio Economic Profile of Select Villages of Mewat. Technical Paper 5. Sehgal
Foundation Publication. Gurgaon, Haryana.
UN (2015). Sustainable Development Goals. Retrieved on October 1, 2015 from

http://www.un.org/sustainabledevelopment/water-and-sanitation/
UNICEF (2015). Eliminate Open Defecation. Retrieved on September 20, 2015 from
http://unicef.in/Whatwedo/11/Eliminate-Open-Defecation
Technical Focus Session 4: R&D Innovation (India)
Chair: Shri. Saraswati Prasad IAS, Joint Secretary,

MDWS, GoI
Co-chair: Mr. Chris Williams, Exec. Director WSSCC
Moderator: Prof. Dr. M. Ashraf Ali, Director, ITN-BUET
Presenters:
- Mr. F. Conor Riggs, Bangladesh
- Mr. Digbijoy Dey, BRAC, Bangladesh
- Ms. Shilpi Roy, Water for People, India
- Ms. Sudip Sen, Sr. VP-Stone, India
- Ms. Rokeya Ahmed, Water and Sanitation Specialist,
World Bank, Bangladesh
Supporting Partners: WSSCC, WSP,BMGF
 Fostering disruptive design innovations in sanitation marketing in Bangladesh

 Faecal Sludge Management in small towns: BRAC WASH Initiative, Bangladesh
 Innovation in Sanitation sector: e-Catalogue for Individual Household Toilet (IHHL), India
 Reducing costs and improving quality in rural sanitation options through innovation and
research, Bangladesh
Fostering disruptive design innovations in sanitation marketing in Bangladesh
F. Conor Riggs, Jess MacArthur, Raisa Chowdhury, Chetan Kaanadka, Sajia Mridha
(iDE Bangladesh)
[email protected]
Introduction
Bangladesh is one of the few countries to achieve a drastic reduction in open defecation, with current
reported rates as low as 5 percent in 2015. In 1990, the rate of open defecation was 34 percent, which
represents a significant achievement. However the reduction in the rate of open defecation has not been
directly reflected as an increase in the rates of access to improved sanitation. Still, nationally only 61
percent population is reported to have access to improved sanitation compared to 31 percent in 1990.
Bangladesh is the only country in the region where progress has been faster among the poorest and the
sanitation gap has been significantly reduced (Joint Monitoring Programme, 2015).
This dramatic reduction in open defecation was achieved through numbers of mechanisms including
Community Led Total Sanitation (CLTS). The approach was developed in Bangladesh in the 1990s and since
then, has been implemented in a number of other countries in Asia and Africa. One of the key principles
of the approach has been the creation of demand for improved latrines, and the perception that a sense
of pride and dignity can motivate a family to build a latrine. In 2003, the government introduced a subsidy
program through which extreme-poor families were provided with a voucher for latrine materials (rings
and slabs) to facilitate more equitable access to sanitation. This subsidized system created a high demand
for materials, which could not be met by the existing Department of Public Health Engineering (DPHE)
system. To facilitate the demand, the private sector was developed and latrine production centres were
established across the country. Since then, the number of centres has increased dramatically. However,
the centres have not significantly changed their product range, nor do their sales model to adapt to the
needs of a highly socially and economically variable population.
The community based sanitation approaches in Bangladesh have been successful in making low cost, basic
latrines available to millions of citizens. Achieving improved sanitation outcomes, however, requires
people to move towards more hygienic, higher quality latrines which effectively reduce human exposure
to faeces. This involves key ‘hardware’ challenges, such as ensuring latrines are both technically sound,
culturally appropriate, affordable and easily available; ‘software’ challenges such as ensuring that
customers demand and maintain hygienic latrines. In addition, ensuring the necessary enabling
environment to both facilitate the design, sale and follow-up support necessary, even in remote areas, as
well as ensuring the effective planning, implementation and monitoring of allocations and interventions
to ensure that the needs of the most vulnerable are addressed, are also essential.
Driven by social factors such as inequitable access to sanitation; health impact; and the need to ensure
the safety, dignity and privacy of household members – particularly of women and children - there is a
need to solidify scaled and sustainable systems that ensure access to improved latrines. Importantly, the
range of economic conditions, levels of existing government support and environmental considerations
highlight the importance of having a flexible model to address the sanitation needs of low-income
households in a sustainable manner.
While local sanitation providers and cost effective sanitation technologies are readily available, in many
cases, these are not reaching rural consumers in more remote locations due to ineffective distribution
strategies. In rural Bangladesh, trained producers generally do not install latrines because the cost of an
improved latrine plus the opportunity cost for the local latrine producer who can invest their time to make
more rings and slabs to generate revenue, is seen as too high for consumers. The market for affordable
sanitation products in rural Bangladesh is fundamentally characterised by a lack of formal commercial
linkages between the installers of latrines and the commercial firms with quality products. Relationships
between local latrine producers and commercial producers (lead firms) are typically limited to the
purchase of latrine inputs. While a number of large scale commercial producers operate through
expansive dealer/retail networks throughout the country, these producers do not provide any support
services such as, marketing, sales training or credit to latrine producers (MacArthur et al. 2015; Riggs and
Kaanadka, 2015).
With limited access to product services, local latrine producers (LPs) have limited ability to offer different
options from the existing sanitary products. LPs also have low incentives to promote higher quality
products, as moderate- or low-quality products require fewer inputs and increase profitability. As a result,
local latrine producers exhibit low marketing capability, resulting in passive penetration of low cost and
low quality sanitation products to low-income customers. Regular seasonal flooding and vulnerability to
natural disasters further act as disincentives to a quality sanitation investment.
Weak upward linkages between small enterprises or entrepreneurs and large-scale commercial producers
also limit critical insights into potential market openings, which could encourage innovative product
offerings for low-income market segments (Riggs and Kaanadka, 2015). While numerous designs exist for
various environments, there are weak systems to determine which technologies are more commercially
viable or how sanitation technologies can be developed and emended in various contexts, such as areas
of high ground water.
In Bangladesh, some private sector sanitation technology providers are offering hygienic, cost-effective
sanitation technologies. However, often these are not reaching the rural consumers, primarily because of
the lack of flexible, innovative and effective distribution strategies to reach the poor and those in remote
and Hard To Reach (HtR) areas.
The phrase “disruptive innovation”, coined by Clayton M. Christensen in the mid-1990s, was described as
technology innovation that overtakes an existing market by applying different set of values (Christensen,
1997). Innovation for Bottom of Pyramid consumers (Prahalad 2004) is not only product design now; it
goes beyond that including the business in the equation. Disruptive design is describes as combination of
both process and product by Markides (2006). Whereas process refers to business model innovation,
product refers to technical innovation. It is the combination of both process and product innovation that
leverages existing systems moves a system to being disruptive. Here innovation is seeking to disrupt
market modalities in product delivery, supply chain, services and manufacturing. While these innovations
could be seen as evolutionary developments to existing paradigms, they are ultimately disruptive as they
aim to overtake markets sustainably and at scale (MacArthur et al. 2015).
Guiding Principles
iDE-Bangladesh employees a unique set of guiding principles in our sanitation work. These principles have
been developed out of a rich understanding of disruptive conditions of the market systems at play for
consumer goods in Bangladesh, the existing sanitation market and the enabling environment which
interacts heavily in this system to design disruptor solutions.
Firstly, the team seeks to incorporate all key aspects of a market system, which have been classified into
four major themes: product, capacity, linkages and networks. Product reviews the product and service
offerings that are available for consumers. Capacity reviews the physical, know-how, financial and
administrative capacity of local service providers, sales agents and dealers who are directly involved with
last-mile sales. Linkages refer to the intra-personal supply and demand linkages that are required to
ensure an operating market system. These can be both informal and formal linkages such as a relationship
between a dealer and retailer or informal such as the relationship between a sales agent and a household.
Networks refer to large-scale interactions between different bodies of stakeholders. These can refer to
supply deals between local service providers and local government or deals between associations of
service providers and the private sector. The lines between these four categories are not black-and-white;
however the framing offers a method by which to cluster interventions and learning.
Secondly, the team seeks to leverage existing infrastructure as much as possible. Examples of this could
be leveraging existing public sector funding, national private firms, existing supply chains and existing local
service providers. Rigorous analysis is undertaken to identify existing network systems. For example, the
consumer products that are made of plastic have significant market reach in Bangladesh even in hard to
reach areas. By leveraging such a sector in hard to reach areas are more sustainable and with further
scale.
The team then identifies brands that operate with an innovative spirit, who have a strong track record for
quality, who are dedicated to reaching the poor, who have a market share which can achieve sustainability
and scale and who are willing to take a risk into a new sanitation market sector. Another example is to
work with existing local level public financing for latrines through existing NGO (Non-Governmental
Organization) work. These two cases will be further elaborated on in the case studies below.
Guiding Approach
The WASH team at iDE-Bangladesh also employs Human Centered Design (HCD) principles (IDEO, 2013)
in all aspects of program intervention and strategy development. HCD encourages a learner’s mindset
throughout the process while developing products, business models and marketing strategies. The
processes are continuously iterative and seek to build on the two guiding principles of full market systems
and leveraging infrastructure. The team uses three phases – Hear, Create and Deliver.
Hear – In the hear phase the team seeks to learn as much as possible about the market system before
moving towards innovative solutions. Ideally the learning from the hear phase go beyond simply product
and service insights to uncover barriers and levers for stronger market systems in product and service
development, capacity building, demand and supply linkage creation as well as network formation. The
learning from this phase are continuously referred through and often the team revisits these initial
insights. Uniquely the insights that are not even written down often become the most strategic in the
deliver phase as the create phase uncovers new ways to look at the market system not originally
understood.
Create – In the create phase the team seeks to create innovation solutions. Sometimes solutions must be
contextualized, others require full development and still others require scaling from an existing pilot. The
create phase also offers an opportunity to hook relevant stakeholders and link them into a sustainable
and scale market system. This can include the national private sector, local private sector and the public
sector. The team is careful to not limit the creation phase just to products or services – here the innovation
in business models and marketing strategies is just as important and often overlooked in traditional
models.
Deliver – In the deliver phase the team seeks to move innovations beyond proof of concept and link
products and services to their relevant business models and marketing strategies while leveraging existing
infrastructure in a full market system for sustainability and scale. Here the four aspects of a market system
become the points for interventions, activities and continuous learning.
Four Case Studies

iDE has a portfolio of sanitation marketing projects all of which use these guiding principles and the HCD
approach to deliver sustainable sanitation solutions in Bangladesh at scale. Six projects have created the
platform for four unique case studies. The projects are described as follows.
The SanMark Pilot (2012-2014) project, funded by Swiss Agency for Development Cooperation (SDC),
Water and Sanitation Program (WSP) program of the World Bank, and supported by the United Nations
Childrens Fund (UNICEF) aimed to develop new approaches in achieving hygiene coverage across rural
communities by creating a feasible market system for hygienic, affordable, and desirable latrine provision
through designing a new latrine product based on demand from the consumers which will be branded
and promoted; developing the skills of Latrine Producers (LPs); and forming public private platforms to
underpin coordination at the local level.
Profitable Opportunities for Food Security (PROOFS) is a four year (2013-2017) project funded by The
Embassy of Netherlands and implemented by the consortium of ICCO Cooperation, iDE, and BOP
Innovation Center aims to improve access of 80,000 Base-of-the-Pyramid farmers and Consumers in rural
Bangladesh to sufficient, safe and nutritious food, drinking water and sanitation to maintain healthy and
productive lives.
SanMark-CITY: Intelligent Design in Urban Sanitation Marketing (2013-2015) is funded by Bill & Melinda
Gates Foundation and implemented by the consortium of ICCO Corporation, iDE and Dustho Shastho
Kendra (DSK). SanMark-CITY is designed to explore the potential of four on-site composting toilet
technologies for slums in urban Bangladesh in sustainable and affordable manner - Tiger Toilet, Sun-Mar,
Enbiolet, and the Biofill.
SanMark-SUPPORT: BRWSSP (Technical assistance to Bangladesh Rural Water Supply and Sanitation
Project) project provides technical assistance to Department of Public health and Engineering (DPHE) for
implementing the sanitation sub-component of the BRWSSP project. Funded by Water and Sanitation
Program (WSP) program of the World Bank, iDE is providing capacity building trainings to 500 local latrine
producers and 300 DPHE local officials and technical backstopping and monitoring support during this
twenty six month project (2014-2016).
SanMark-SEAMs (Sanitation Marketing in Southern and Eastern Area Markets) project (2014-2015) is
funded by The United Nations Childrens’ Fund (UNICEF) aims to join the "seams" of the margins of current
achievement in rural basic sanitation in Bangladesh by large-scale, ongoing modalities of sanitation
programming with markets-based solutions related to Sanitation Marketing for increasing hygienic
sanitation coverage. SanMark-SEAMs facilitates improved sanitation product sales for improved health
outcomes; and utilize the Human Centered Design (HCD) process for research, development and
demonstration of customer-oriented hygienic latrine product(s) and markets-based business and service
delivery models.
SanMark-SUPPORT: IFRC (Sanitation Marketing Support: International Federation Of The Red Cross And
Red Crescent Societies) is a Australian Red Cross funded technical assistance package to IFRC WASH
programming, namely CDI 2 - WASH Program (Community Based Development Initiatives - Water and
Sanitation Hygiene Promotion) implemented by Bangladesh Red Crescent Society (BDRCS), to address
systemic challenges which slow down the delivery of sustainable and scalable sanitation products and
services to low income consumers in rural Bangladesh. To achieve the program goals, CDI 2 program staff
will be coached in Sanitation Marketing approaches and tools and CDI 2 activities will be supported
through ongoing technical assistance to achieve project targets.
The following four case studies review one area of success that iDE has seen in each of the four named
thematic regions in a market system: product, capacity, linkages and networks.
CASE STUDY 1: TRANSLATING INSIGHTS INTO PRODUCTS- The SaTo to SanBox EXPERIENCE
Hear
SanMark-Pilot was the first project through which iDE initiated the identification of existing disruptee
conditions for the sanitation products and processes in Bangladesh. The team- which included experts
from iDE and American Standard Brand (ASB)- spent weeks to gather insights on behavioral and technical
aspects which hindered achieving sustainable sanitation at scale. The key finding was that the current
siphons or water traps requires too much water to flush the feces and maintain water seal which triggers
the household to break the water seal or often install the latrine without one. Water scarcity was not a
problem for the households to manage but the rural households do not store water inside the latrine and
when they take water by a ‘bodna’ to clean themselves and flush, this 2 litre capacity container falls
inadequate to flush with the current trap design. People need to carry water multiple times to the latrine
to flush properly, which ultimately results in an unhygienic latrine either a broken water seal or none at
all.
It was also identified that a household does not have access to a complete sanitation product, rather
purchases components from different sources to build a latrine. Thus, there is no standardization of the
offering and the quality varies vastly depending on the consumers’ technical know-how of a hygienic
latrine, where the focus often shifts to aesthetics of the latrine rather than the technical details.
Create
The learnings were then translated into an “entry point” innovation-SaTo pan (derived from “Safe Toilet”),
that generated key “disruptive design principles”. The SaTo pan is an inexpensive plastic pan with
counterweight trap door for pour flush latrines designed by ASB that can be flushed with half a bodna
water and maintains a water seal. The key focus while developing the product was to make sure that it
will not require significant behavior change in terms of water usage that was seen during the hear phase.
The manufacturing of the product was then done by a lead national plastics firm in Bangladesh reputed
for delivering quality to BoP consumers, RFL.
This relationship between iDE and RFL then emerged beyond one product and one project into an
institutional relationship exploring and developing of multiple products, the major one being a latrine
mid-structure SanBox (Sanitation in a box). SanBox is the next step for the consumers in the sanitation
ladder to an offset pit system from a direct pit that includes footstep, flush funnel and pipes to connect
to pits. This product will reduce the need for consumers to buy the components one by one and will offer
a mass manufactured, quality controlled, bundled product delivered by a national conglomerate at scale.
Deliver
SaTo pan is mass manufactured and distributed by RFL in Bangladesh through their widespread network
of over 3,500 retailers in every district of the country. RFL has also picked up the disconnected latrine
producers in this network treating them as retailers for the product. iDE has connected RFL with the latrine
producers through different programming under iDE WASH portfolio- namely SanMark- Pilot, SanMark-
SEAMs, and PROOFS to provide them the support of the lead firm for product innovation, quality control,
mass marketing and the brand recognition. Till date, RFL has produced over 350,000 SaTo pans and
distributed them through different channels. Leveraging the same network, SanBox will be introduced in
the market in late 2015.
CASE STUDY 2: DEVELOPING CAPACITY OF THE CENTRAL ACTOR- ONE MODULE AT A TIME
Hear
Under the SanMark Pilot, SEAMs and PROOFS projects, much effort was taken to understand how best to
engage with the extensive network of latrine producers who are currently working across Bangladesh.
The team estimates that there are approximately 10,000 of these entrepreneurs nationally and they often
live from mass order to mass order. They are often unable to get financing and do not have the business
formality or linkages to continue quality business once NGO and government contracts are completed.
Most of these latrine producers often are also passive sellers and are unable to engage with the
community to explain why latrines are even important.
One latrine producer in the SEAMs project told us that he has no plan to ever invest profits back into his
business for business expansion in spite of paying very high interest on loans. His reasoning was that
“profit is for my family, loans are for the business”. This mentality is common across producers and the
seasonality of sales restricts many of these producers from expanding product lines, securing better
financing and maintaining employees. Often the producers are unable to access quality inputs once NGO
projects finish and many latrine producers are unable to make profit from mass sales, as they often
underestimate their costing.
Across the projects, iDE spent time listening to over 500 latrine producers to understand exactly what the
actual requirements were in a training system. While it is evident that many of these producers require
training, much of the available training is on competing ideas of what makes a hygienic latrine or training
that is mandatory to get the mass order that follows.
For the technical assistance projects, SanMark-SUPPORT:BRWSSP and SanMark-SUPPORT: IFRC, iDE
listened to latrine producers to engage them as a service provider for the projects through a specific
tendering or subsidy modality developed for that particular project to provide latrines to project
beneficiaries.
Create
Based on these learnings, the team used design principles to collaboratively create a holistic capacity
training for sanitation entrepreneurs (also known as latrine producers or local sanitation service
providers). The team identified capacity gaps in all four of the market system aspects: business skills,
creating quality products and services, marketing and selling to communities, and creating mutually
beneficial linkages. Stemming from a rate of 8% literacy rate amongst producers in some of the project
areas, the team sought to produce training curriculum that used consistent symbols instead of words.
These symbols become easily recognizable as the training progresses. Additionally, the training was
developed to be six modules. Each module is a one-day activity based training that incorporates each of
thematic areas. Group discussions and simple but effective tools such as an augmented Business Model
Canvas provide the backbone of this training.
For the SanMark-SUPPORT:BRWSSP project, the capacity development modules included specific
technology construction for latrines endorsed by Department of Health and Engineering (DPHE) for this
particular project and how to apply for the tender for construction of latrines in their working areas. For
SanMark-SUPPORT:IFRC project, the training will include designing service delivery model for each
community and installing latrines at extreme poor households in the working areas following the specific
voucher scheme for CDI 2 Sanitation component.
Deliver
As of October 2015, 108 latrine producers have been trained in this methodology (with another 320
currently in training). Field results are highly positive and latrine producers have seen increases in sales,
increased confidence in creating both public and private sector deals and linkages, increased ability create
demand amongst their consumer base, better business management and a better understanding of what
makes quality products. The team has heard positive feedback from the private public and NGO sectors
about how the training is able to draw out the natural business capacities in these entrepreneurs. Besides
this, 312 latrine producers have been trained and 110 are being trained currently through the technical
assistance projects as of October 2015.
One latrine producer in PROOFS began as a producer who sold poor quality (in his own words) ring/slab
from his small shop. After working with the program he has drastically increased his business, expanded
into new product lines, is no longer reliant on NGO orders, is able to order and stock quality inputs, and is
able to conduct a sales pitch to his consumers. He has also articulated the importance of quality control
and offering a product warranty. Originally he was using a ratio of 1:4:5 for his cement:sand:brick chips
mixture, but took a risk after our training to change his ratio to 1:3:4 (not quite the 1:2:3 we recommend,
but a start). This risk paid off and now he is known as the highest quality producer in the area and has
increased profit instead of seeing loss as he originally expected. He is happy to be recognized as a
community leader at events and says that the training was really the catalyst to changing his status.
By building on the specific gaps identified through the hear phase, building a holistic training and meeting
producers where they are at while envisioning where they can be, the team believes that this training
could be packaged and shared with private sector partners who wish to build capacity for increased
quality, sustainability and scale.
CASE STUDY 3: LINKING LATRINE PRODUCERS TO A NATIONAL SUPPLY CHAIN

Hear
While SanMark Pilot offered a proof of concept for the improved product lines, PROOFS and SEAMs have
offered opportunities to prototype and pilot the business models and product supply chains associated
with these product lines. After hearing of difficulties in accessing products through existing linkages in
hard to reach areas, the team began researching the barriers and opportunities for strengthening these
weak linkages through a bottleneck review. This research uncovered a number of unique barriers. One is
that the turnover of private sector representatives in hard to reach areas in high which means that
producers often do not have a valid phone number through which to place orders. Additionally in areas
that are hard to reach are often areas where subsidized orders are common. Many subsidy schemes bring
products inputs from a centralized supply center for distribution, however this decreases the incentive for
dealers and retailers to stock improved products.
Furthermore prices tend to be hire for improved product inputs for several reasons including:
transportation costs because of further distance to distributions depots, local monopolies for new
products and a low demand for bulk purchasing schemes. In some of these areas even purchasing sand
can become a challenge.
Create
Based on these barriers to continuous and affordable supply of quality product inputs, the team put
together several recommended business models and incentive schemes to keep dealers in the business
model, ultimately keeping access to improved products open to consumers. One of these concepts was
to create business associations of producers in hard to reach areas. These associations could work
together to build demand, lobby subsidy programs for more sustainable product supply models, bulk
order inputs and incentivize dealers to keep stocking products.
Deliver
In the Patuakhali district in Southern Bangladesh, these identified concerns were significant and both
SEAMs and PROOFS projects were working in these areas. Instead of pushing a linkage network or
association on the producers, the team made basic suggestions at informal rapport building sessions and
through the final module in the capacity training. Through these simple suggestions 60 producers have
currently banded together to create a formal business association. Each member has paid 1000 taka to
join the association and sub-groups are forming. The association has elected leadership and is working to
create bulk purchasing agreements, is lobbying subsidy programs for sustainable product supply models
and is working together to build demand for improved products.
CASE STUDY 4: CREATING NETWORK WITH LOCAL GOVERNMENT INSTITUTIONS

Hear:
SanMark-Pilot provided the opportunity to explore facilitating engagement with local government
institutions without developing new process to do so. This is the proof of concept for utilizing existing
sanitation subsidies to deliver hygienic latrines to the extreme poor households. The Union Parishads (UP)
receive a regular budget to provide hygienic latrine which includes three rings and one slab with plastic
pan. The team explored the process of how UP decisions are made, how the products and services are
delivered to the doorstep of the household, and how the payment process works between the UP and the
latrine producer.
Create:
From there, the team facilitated creating platform for the latrine producer to inform the UP WATSAN
committee and the Chairman about his product offerings and services. Rather than developing a MoU
between the project and the UP to have certain numbers of latrines delivered, iDE aimed to develop a
relationship between the UP and latrine producer. In the meetings, latrine producer delivered a ‘sales
pitch’ describing his services and the benefits of SaTo pan in a direct pit latrine and his other services.
Though the total value of a subsidized latrine was in par with the product offering of a latrine producer,
the price of individual components became the concern. The UPs used to allocate BDT 80 for a pan, SaTo
pan was above that price range. The UP chairman of Kismat Gonokoir union of Durgapur upazila in
Rajshahi district was the first to revise the component price for subsidized latrines in his working location
to ensure hygienic latrine is provided to his constituents through a sustainable channel which was later
adapted by many. A revised cost structure was developed and latrine producers were contracted to
provide certain number of latrines within a specific time period following a payment schedule discussed
and agreed by both the parties. The specifics of those agreements varied from UP to UP based on the
subsidy amount available and the latrine producer’s ability to deliver the products.
Deliver:
1,497 units of latrines were sold during SanMark-Pilot in eight UPs through such contracts. Whereas the
UP paid for the components, the consumers paid for the transportation. The UP chairman also ensured
to follow up on the installation of the latrines later before paying the latrine producer fully and closing the
contract. In the starting, the contracts were for small numbers like twenty units, it was observed that
some UP chairmen were re-contracting the latrine producers for delivering more products. This short term
engagement modality was appreciated by both the UP chairmen and the latrine producers as it gave the
UP chairman to first evaluate and then increase his engagement with a certain latrine producer and do it
as much as his funds allowed him to in a certain period. On the other hand, the latrine producers could
finish a certain order, get paid for it and then engage into the next one allowing him financial liquidity.
This created a sustainable relationship between the institution and latrine producer that lasted beyond
the project timeframe. The modality of engagement was later scaled in SanMark-SEAMs and PROOFs the
respective working areas.
Conclusion:
By incorporating all components of a market system and by leverage existing structures for sustainable
growth at scale, iDE has developed both products and processes that are grounded in the potential of
each stakeholder. Standing on the foundation of thirty years of sanitation work in Bangladesh and by
engaging the private sector’s ability to manufacture at scale and their unique positioning to reach the
furthest corners of Bangladesh through a robust supply, the iDE team is working to connect the dots
through disruptive solutions- both in business models, marketing systems, products and services.
References:
Christensen, C. M. (1997) The Innovator’s Dilemma. Cambridge, MA: Harvard Business School Press.
IDEO.ORG (2013). Human Centred Design Toolkit. http://www.hcdconnect.org/

Joint Monitoring Programme (2015) Progress on sanitation and drinking-water - 2015 update. WHO and
UNICEF.
MacArthur, J., Riggs, F.C., and Chowdhury, R. (2015) Disruptive design in sanitation marketing: Lessons
from product and process innovations in Bangladesh. 38th WEDC
International Conference. Loughborough University, UK.
Markides, C. (2006) Disruptive Innovation: In Need of Better Theory. Journal of Product Innovation
Prahalad, K. C. (2004) The Fortune at the Bottom of the Pyramid. Upper Saddle River, NJ: Wharton School
Publishing.
Riggs, F. C., Kaanadka, C. (2015) Facilitating adoption of a private sector led open innovation approach
to rural sanitation marketing in Bangladesh. Technologies for Development. pp 101-110
Fecal Sludge Management (FSM) Scenario in Urban Areas of Bangladesh
Md. Mujibur Rahman1, Muhammad Ashraf Ali2, Mahbuboor Rahman Choudhury3,

Md. Azizur Rahman4, Asef Mohammad Redwan4, Nowroz Farhan Noor5, Aminul Islam Sohan5
Professor of Civil Engineering, BUET, and Team Leader, South Asia Urban Knowledge Hub (K-Hub), ITN-
BUET, Bangladesh Center; 2 Professor of Civil Engineering, BUET, and Urban Specialist, K-Hub, ITN-BUET,
Bangladesh Center; 3 Assistant Professor of Civil Engineering, BUET, and Environmental Specialist, K-Hub,
ITN-BUET, Bangladesh Center; 4 Research Officer, ITN-BUET; 5 Research Associate, ITN-BUET
Abstract
Except for about 20% area of Dhaka city, all urban areas of Bangladesh are served by on-site sanitation
(OSS) system. However, OSS systems in Bangladesh have been developed without much consideration to
the management of fecal sludge. Disposal of fecal sludge in low-lying areas and in lakes and canals within
urban areas is common, which is causing serious environmental degradation and endangering public
health. This study presents an assessment of the typical fecal sludge management (FSM) scenario in
selected urban areas of Bangladesh. In the absence of proper monitoring, septic tank system has been
developed very poorly in all urban areas. In many areas the system is altogether absent, and toilet
wastewater is directly discharged into storm drains/sewers; in some cases, there is septic tank but the
soakage pit is absent. In almost all cases, the septic tanks are poorly designed, constructed and
maintained. There is a lack of awareness among City Development Authorities, Paurashavas and real
estate developers about the importance of FSM, and the urban authorities do not have required capacity
to monitor design/construction of OSS facilities. Due to lack of effective pit emptying services, pour-flush
latrines in high-density urban slum areas are being constructed without “pits”, and fecal matters from
toilets are being discharged intentionally into open environment. For large cities with city corporations
(e.g., Dhaka, Chittagong, Rajshahi, Khulna) there is no clear assignment of responsibilities for management
of fecal sludge. As a result, the limited FSM initiatives in these urban areas are continuing in an
uncoordinated manner. Manual emptying, though very hazardous and often more expensive than
mechanical emptying, are being practiced in all urban areas. Mechanical desludging services, initiated by
some NGOs, Private Sector and Paurashavas, suffer from certain limitations. While there are some
promising initiatives in treatment of fecal sludge, significant research and development works are needed
for the development of effective fecal sludge treatment facilities, and possible production of useful by-
products (e.g., compost). There is significant scope for innovations in the design of mechanical emptying
equipment, and also in development of FSM business models involving private sector.
Introduction
Bangladesh has witnessed a remarkable growth in on-site sanitation facilities throughout the country over
the last decade (1, 2). Figure 1 shows the change in relative usage of different types of sanitation facilities
in urban areas of Bangladesh (1). During the last two decades, Bangladesh has been able to reduce the
prevalence of open defecation from 34% in 1990 to 1% in 2015; coverage by “improved sanitation
systems” also increased from 33% to 61% during this period. In urban areas, improved sanitation coverage
has increased from 47%, not so significantly, to 58%. Currently (2015), 28% of the total population and
about 30% of urban population depend on shared facilities. While the Joint Monitoring Program (JMP) of
WHO and Unicef does not consider shared facilities as “improved sanitation” due to maintenance reasons,
there are however other compelling factors for people to resort to shared facilities, e.g., space constraint
in densely populated urban areas.
100
Use of Different Types of Saniation Facilities by
90
80
Percentage of Population
70 Open defecation
60
Other unimproved
50
40 Shared Facilities
30
Improved
20
10
0
Urban Total Urban Total Urban Total
1990 2000 2012

Year
Figure 1: Relative usage of different types of sanitation facilities in urban areas of Bangladesh compared
to total national usage in the years of 1990, 2000, and 2012. (1)
The major progress in urban sanitation during the last two decades is the elimination of open defecation
amongst the poorest quintile (2) through use of on-site sanitation facilities. However, increasing use of
on-site sanitation facilities has generated a large demand for fecal sludge management (FSM) to keep the
toilets operational. In the absence of effective FSM services, the huge quantities of fecal sludge generated
in septic tanks and pits are inaptly managed. Disposal of fecal sludge in low-lying areas and in lakes and
canals within urban areas is common, leading to serious environmental degradation (2, 3, 4, 5).
In Bangladesh, major urban areas comprise of 11 City Corporations (CCs) and 325 Paurashavas
(Municipalities). Except for about 20% area of Dhaka city (covered by sewerage system), all urban areas
of Bangladesh are served by on-site sanitation system (2), which include septic tanks (in middle- and high-
income communities) and different forms of pit latrines (in slums and low-income communities). There
has been virtually no expansion of sewerage system anywhere in Bangladesh over the past decades; and
the country will continue to rely on relatively cheap and affordable on-site systems (6, 7, 8) in the
foreseeable future. A root cause for lack of FSM services is that there is no clear assignment of
responsibilities with regard to FSM among the utility service providers. As a result, there is a lack of
concerted effort by all concerned to address this serious issue (9, 10, 11). Therefore, the first major step
toward solving the FSM problems is to develop an institutional and regulatory framework for FSM in
consultation with all stakeholders, with clear assignment of responsibilities among the stakeholder
organizations (12). There are significant differences in institutional set up and FSM practices among and
within cities/towns, and proper understanding of the situation is a pre-requisite for development of
workable management framework.
The overall objective of the present case study was to assess the FSM scenario in different urban ettings.
The study involved data collection on FSM practices in different urban areas using a semi-structured
questionnaire, consultations, meetings and interviews, and physical survey/observation of sanitation
facilities and FSM practices. The specific objective of this study was to analyze some of the strengths and
deficiencies in the existing FSM practices in different urban setups of Bangladesh. The finding from the
present study provided useful data, information and insights for the development of institutional and
regulatory framework for FSM in urban areas of Bangladesh.
Methodology
Study Area
The case study was carried out in three different urban setup areas of Bangladesh: (a) urban slums in large
city, (b) urban developed areas in large city, and (c) Paurashava/ Municipal towns (Lakshmipur Paurashava
and Sirajganj Paurashava). The general features of different urban areas surveyed in the present study are
given in Table 1.
Table 1. General features of different urban setup areas surveyed in the present study.
Area n System
Survey Area ) s
WSUP (an INGO), in
Kallyanpur
collaboration with DWASA, is
Pora Bastee, 2.99 30,000 4,000
providing water through limited
Kallyanpur, (13) (13) (13)
Urban slums in collection points. Illegal DWASA
Dhaka
large cities connections are also present.
Muktijoddha DWASA is providing more than
13.74 18,000 3,500
Slum, Mirpur, (a) 1000 water collection points in
(14) (14)
Dhaka the slum area.
Urban
Baridhara
developed 259 8,210 1815 Entire area is under DWASA
Diplomatic (a) (b) (b)
areas in large piped water supply.
Zone, Dhaka
cities
supply; in remaining area water
Lakshmipur 4819 83,112 17,009
(b) (b) (b)
supply is provided using tube
Urban areas in Paurashava
wells, surface water sources,
small/
etc.
medium
townships
Sirajganj 7040 297,630 20,069 supply system; in remaining
Paurashava (17) (17) (17) area water supply is provided
using tube well, dug well, etc.
Data source: (a) Dhaka North City Corporation, available at: http://www.dncc.gov.bd;
(b)
Population Census 2011, Bangladesh Bureau of Statistics (BBS), available at: www.bbs.gov.bd.
Surveys and Data Collection
The survey involved data collection utilizing a semi-structured questionnaire; Focus Group Discussions
(FGDs); physical survey/observation of sanitation facilities and sludge management practices; and
informal discussion/meeting with key individuals (NGO representatives, representatives from housing
society and building caretakers, and Paurashava officials). The field survey in slums was facilitated by DSK,
a local NGO. The Baridhara Society and Swisscontact, an international NGO facilitated the field survey in
Baridhara. Field survey in Lakshmipur and Sirajganj Paurashavas was facilitated by the DPHE.
FSM Scenario in Urban Areas

Only 20% area of the capital city Dhaka is covered by sewer network and the collected sewage is conveyed
to the Pagla Sewage Treatment Plant (5). The sewer network is not functional in many areas due to
blockages (15). The Dhaka Water Supply and Sewerage Authority (DWASA) is responsible for maintenance
of the sewer network and the sewage treatment plant. On the other hand, the remaining urban areas of
the entire country are covered by on-site sanitation facilities (OSS) (5, 12).
The basic elements of FSM system is shown in Figure 2 (2, 9-12). In urban areas, the OSS facilities are
mainly septic tanks (with or without soakage pits) and different types of pit/pour-flush latrines. FSM
services involve emptying of pits/tanks, collecting in a tanker, transportation of the emptied fecal sludge
to a treatment plant, and finally disposal/reuse of effluent/end-products from treatment. In the present
case study, efforts have been made to analyze each element of FSM system in different urban settings.
Emptying and
User Interface Containment Collection Transport Treatment Disposal/Reuse
On-Site Sanitation (OSS) Facilities

Fecal Sludge Management
(Pit latrine/Septic tank)
Figure 2: Elements of FSM system for OSS facilities
FSM Status in Urban Slums

Types of sanitation facilities: Different types of on-site sanitation facilities have been observed in the two
surveyed slum - “Kallyanpur Pora Bastee” and “Muktijoddha Slum”. Table 2 shows the types of sanitation
facilities in the two urban slums.
Table 2: Types of sanitation facilities in the urban slums surveyed

Slum Types Sanitation Facilities
Kallyanpur Pora Bastee  Community latrines connected to septic tanks
Muktijoddha Slum  Pour-flush latrines, household and shared, with pits (predominant)
 Pour-flush latrines with septic tanks with/without soakage pits
 Hanging latrines (200 in the slum)
Figure 3 shows distribution of different types of on-site sanitation facilities in the “Muktijoddha Slum”
observed in the present study. Among the 26 toilets physically surveyed, fecal matter from 16 (i.e., about
62% of the toilets) were directly being discharged into open environment, endangering public health (16).
As discussed below, fecal matters from the remaining toilets also eventually find their way into open
environment.
7.7 50.0 34.6 7.7
7.7 50.0 34.6 7.7
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Direct or off-set pit pour-flush toilet Hanging latrines
Figure 3:Direct
Distribution
or off-setof
piton-site sanitation
pour-flush toilet facilities
Hangingsurveyed
latrines in Muktijoddha Slum, Dhaka.
Design of sanitation facilities: Among the 7 direct-pit toilets surveyed in Muktijoddha slum, none had
provisions for desludging; this means that the toilet superstructure would have to be removed if the fecal
matter is to be desludged from the pit. The entire Kallyanpur Pora Bastee is covered by community latrines
connected to septic tanks; the sanitation facilities include 2-chamber to 6-chamber latrines. Table 3 shows
the dimensions of septic tanks for different types of community latrines. The number of user of these
latrines varies widely; for example, user of the six 2-chamber latrines varies from 50 to 300. Thus, it
appears that the number of users of a particular latrine was not considered or could not be estimated
properly during the design phase of the latrines. Space constraint might also have affected the design.
Physical survey and discussion with NGO representatives revealed that the septic tanks are not fitted with
inlet-T and outlet-T. The absence of inlet and outlet Ts would seriously affect treatment efficiency,
resulting in poor quality of effluent. However, discussion with an NGO representative revealed that there
is some logic in not providing the “inlet-T”. According to him, users often dispose children’s feces in
polythene bags as well as sanitary cloths into the toilets; these materials often get stuck at the mouth of
the inlet-T. Consequently, inlet-T has been eliminated from the design. It was also revealed that absence
of outlet-T in septic tanks is in fact causing some major problems. Polythene and cloths often float and
clog the opening of the outlet pipe of the septic tank, causing the toilet/tank to overflow. For some of the
community toilets, the septic tank effluents discharge into soakage pits, while for others the effluent
discharge directly into nearby water bodies. Lack of space for construction of soakage pit and
inadequate/poor infiltration capacity of soil is the main reasons for not constructing soakage pits.
Table 3: Dimensions of septic tanks in Kallyanpur Pora Bastee
Toilet Type Total Dimension of 2-Chamber Septic Tank

L (m) x W (m) x H (m)
5-Chamber 5.500 x 2.100 x 1.300
4-Chamber 4.325 x 1.925 x 1.400
3-Chamber 3.900 x 1.800 x 1.250
2-Chamber 2.725 x 1.525 x 1.400

Emptying of fecal sludge: Majority of OSS in Muktijoddha slum directly discharges fecal matter into nearby
low-lying areas or drains. For the remaining facilities, emptying of pits/ tanks is carried out when the
pits/tanks become full or they overflow. Manual emptying is the common practice. Households pay BDT
2000 to 3000 (about USD 25-37.5) to sweepers for desludging of a typical pit/tank. DSK provides limited
mechanical desludging service (using Vacutug) and some households in the slum avail this service.
Although cost of mechanical desludging is similar or even cheaper (about BDT 2000 per desludging event)
than manual desludging, many households cannot avail the service due to difficulties in accessing OSS
facility by the Vacutug. Vacutug operators mentioned that they often find different kinds of solid wastes
inside pits/ tanks, which makes pumping of fecal matter difficult.
The septic tanks of the community toilets in Kallyanpur Bastee are desludged when either the tank or
toilet overflows; in some cases, the caretakers reported of desludging at regular interval (e.g., every six
months to a year). Thus, the septic tanks are being used as a fecal sludge storage device, and are not
performing their desired. Both manual and mechanical methods are availed for desludging. Manual
desludging has a number of disadvantages, e.g., high cost (BDT 5000 to 6000 per septic tank, compared
to BDT 1000 to 1200 for mechanical desludging in this slum) and long desludging duration (1 to 3 days).
Transportation of fecal sludge: In case of mechanical desludging, the pumped fecal matter is often stored
in smaller containers (wheel barrow) that could be taken up to the OSS facility through narrow slum lanes;
subsequently the fecal matter is pumped into larger tanks of the Vacutug. In Dhaka city, there is no
designated site for treatment of fecal sludge. Emptied fecal matter is usually disposed in the nearby sewer
(through manholes), surface drains or low-lying areas. This practice is contributing to the environmental
pollution in the city. DSK, a Vacutug service provider, disposes the emptied fecal matter in DWASA
sewer/sewage lifting station (with permission from DWASA). But the sewer network or sewage lifting
stations are not designed to receive fecal sludge, and such activity would interfere with proper functioning
of these network facilities.
Figure 4: FSM scenario in urban slum areas

As noted above, there is no facility for treatment of fecal sludge in Dhaka city. In the absence of treatment
facilities the emptied fecal sludge eventually finds its way into the open environment. Figure 4 summarizes
the FSM scenario in urban slum areas of Bangladesh.
FSM Status in Developed Urban Areas
Types of sanitation facilities
Baridhara, a high-income area in Dhaka, is not covered by sewer network, but storm drainage
network/drains are available in the area. Here “septic tank system” is supposed to be the sanitation
system. This area is under the jurisdiction of “Rajuk”, the capital city development authority. Since this
area is not under sewerage system, all buildings constructed here must have septic tank system, according
to the National Building Code. This means that all buildings constructed here must had provisions of septic
tanks in the designs approved by Rajuk. However, it was revealed that most of the buildings here do not
have septic tanks, and none have soakage pits. Thus, the wastewater generated within the buildings is
being directly discharge into storm drainage system; the storm drainage system subsequently discharges
into the nearby Baridhara Lake.
This observation points to a major weakness in the construction/real estate industry – the city
development authority (in this case Rajuk) does not have the capacity to oversee whether buildings are
constructed according to the approved designs, and real estate developers are not aware of the
importance of the OSS facilities. This practice is rather common in all urban areas of the country.
In the high-income Baridhara area, most buildings do not have septic tanks and domestic wastewater is
directly discharged into storm drainage system. Some buildings have septic tanks, and these are desludged
periodically primarily by manual method employing sweepers; manual desludging of a septic tank costs
about BDT 4000 (USD 50) to 5000 (USD 62.5). Only one surveyed building reported availing mechanical
desludging, the cost of which reported to vary from BDT 15,000 (USD 187.5) to 20,000 (USD 250).
Reported desludging interval varied from 1 to 2 years. Overflow of septic tanks and odor nuisance were
reported as other important reasons for desludging septic tanks. The method of transportation and
disposal of fecal sludge is similar to those described for urban slums. The fecal matter is usually disposed
in public sewers, DWASA lifting stations, drains, or low-lying areas.
As discussed above, treatment of fecal sludge is the weakest component of fecal sludge management in
Dhaka city. No treatment facility has been developed and there is no visible initiative for establishment of
any fecal sludge treatment facility. The typical FSM scenario in developed urban areas is summarized in
Figure 5.
On-site
Collection Transportation Treatment Disposal/
sanitation
facility End use
Mechanical
Septic tank with collection of fecal
or without sludge from septic
soakage pit; tanks using
‘Vacutug’ Transportation of
septic tank
fecal sludge to
effluent
nearest public
discharge into
storm
storm Manual collection
sewer/drain/lift Disposal of
sewer/drain of fecal sludge by
station/ lowlands untreated
sweepers
fecal sludge to
nearby low
Direct discharge Collection of land/lake
Transportation of
of domestic fecal sludge in
fecal sludge
wastewater into municipal sewer
along storm
storm sewer /drain
sewer /drain
/drain
Figure 5: FSM scenario in developed urban areas in large cities without any organized FSM services
FSM Status in Paurashava Towns
Laksmipur Paurashava

Types of sanitation facilities: In Lakshmipur Paurashava the predominant OSS are (a) toilets connected to
septic tanks (with or without soakage pits); and (b) pour-flush latrines (direct and off-set pit). Sanitation
facilities of 11 establishments were physically surveyed, which included 7 houses, 1 school and 1 office.
Among these, two were off-set pit pour-flush toilets. The remaining were toilets connected to septic
tanks; only two of these had soakage pits.
Design of sanitation facilities: The dimensions of the surveyed septic tanks varied widely; the x-sectional
area varied from 12 x 4 to 25 x 16.5; depths of tanks could not be ascertained. The dimensions of septic
tanks do not appear to have any relationship with the number of users. Inlet-T was observed in one, while
inlet and outlet-Ts were found to be absent in three; for the remaining septic tanks, the inlet and outlet
points were not visible. There is no standard design practice for pit latrines, which are usually constructed
by masons. The Pourashava is responsible for checking designs of buildings/houses before providing
permission for construction. Discussion with Paurashava officials revealed that for buildings less than 5-
storied height, design of sanitation facilities are usually not given much priority while checking designs.
However, the Paurashava does not have enough manpower to oversee if the OSS facilities are constructed
properly.
In Lakshmipur Paurashava, people usually desludge their septic tanks/pits when they overflow; some also
reported desludging at fixed regular interval. The Paurashava introduced mechanical desludging service
in 2013, and many people are availing this service. The Paurashava has received 3 mechanical desludging
equipment (Vacutug) from the Secondary Town Water Supply and Sanitation Sector project (funded by
the GoB and ADB) run by DPHE. But the extent of service at this stage is limited. People also avail manual
desludging services, especially in areas inaccessible by Vacutug; manual desludging is slightly cheaper than
the mechanical service, costing about BDT 500 to 1000.
Lakshmipur Paurashava has established a fecal sludge treatment plant with support from the Secondary
Town Water Supply and Sanitation Sector project. DPHE designed and constructed the treatment plant
on a 0.30 acre land owned by the Paurashava.
The treatment plant is based on planted filter bed system (Reed Bed System) and sludge drying bed.
Currently, the plant receives about 42 m3 of sludge per week. The liquid effluent generated from the plant
is reported to satisfy the national discharge standards and are discharged into open environment. End-
use of treated sludge has not yet been considered and there is no data on the quality of compost or dried
sludge produced at the treatment plant.
Sirajganj Paurashava
Types of sanitation facilities: Major OSS facilities in Sirajganj Paurashava include: (a) pour flash toilets with
a single direct or off-set pit, (b) pour-flush toilet with twin off-set pit, (c) pour flash latrine with septic tank,
with or without soak pit. Presence of some hanging latrines was also reported. Sanitation coverage in the
Paurashava is reported to be about 96.2% (18). Among the sanitation facilities of 19 establishments
surveyed, 8 were direct pit pour-flash toilets, 4 twin offset pit latrine, 1 single offset pit latrine, and the
remaining 6 were pour-flash latrines connected to septic tank; 4 out of these 6 septic tanks had soakage
pits.
Design of sanitation facilities: Masons usually design septic tanks, and the size is fixed based on availability
of space, rather than user number. Except for one case, inlet and outlet T-s were absent in the surveyed
septic tanks. Pits are usually made of concrete rings with diameter of 2.5 to 3.5 feet, and height of 1 foot.
Typically 5 to 8 rings are used to construct a pit. Paurashava officials reported that while they check
designs of buildings, they do not have enough manpower to check whether the buildings are constructed
according to approved design. Bangladesh National Building Code (BNBC) provides some guideline for
design of septic tanks, but there is no guideline for design of pour-flush toilets.
Manual pit emptying is common in the Paurashava. The process is unhygienic, generates odor nuisance,
and hazardous to the manual emptier who do not use any safety gear. The cost of manual emptying varies
from Tk. 500 to 1000 per pit. The Paurashava started mechanical emptying service from December 2012
after obtaining a 2000 L capacity vacutug from Unicef; the collected sludge is transported to a treatment
plant. The emptying charge is Tk. 2500 for the first trip, and Tk. 1500 for the next trip, if needed. Most
participants of the FGD opined that the charge should be reduced in an affordable level. Currently the
demand for vacutug service is low.
Apart from cost, other problems associated with vacutug service include: (a) narrow access road or
adversely located (e.g., behind the house) septic tank/pit, making it difficult/ impossible for vacutug to
access it (see Figure 6); (b) pit/tank opening inadequate for entry of vacutug suction pipe; (c) difficulty in
removing hardened fecal sludge at the bottom of the pit/tank with vacutug.
(a) (b) (c)

a a a
Figure 6: Accessibility problem for desludging pit and septic tank: (a) pit not accessible by vacutug, (b)
septic tank manhole is located inside kitchen, (c) narrow walkway, not accessible by vacutug.
Apart from these, the FSM services offered by Sirajganj Paurashava is facing a number of other challenges.
As there is no separate unit for FSM/Vacutug service, the Conservancy Section of the Paurashava provides
this service. Pourashava does not have separate manpower or budget to operate this service. The driver
and sweepers of the vacutug service work on a contract-basis, and their jobs are not permanent. The
sweepers earn Tk. 200 per trip; driver of Vacutug gets a monthly salary of Tk. 4000, and additional Tk. 200
per trip. The driver and sweepers are carrying out the service without any protective gear.
A recent study in 30 cities of Asia and Africa compiled financial statement of 154 fecal sludge collection
businesses and established that the collection and transportation of fecal sludge is a rewarding business
when operated by private entrepreneurs (4, 17). The Paurashava cleaners also said that it would be
financially more beneficial if he could rent a “vacutug” system from the Paurashava and run his own
business with it.
Sirajganj Paurashava has established a fecal sludge treatment plant with technical support from DPHE in
2013-14 on a one acre land under GoB-ADB funded Secondary Town Water Supply and Sanitation Project.
After construction, DPHE has handed it over to the Paurashava for operation and maintenance. Currently,
the sludge emptied by vacutug is carried to the treatment plant. On the other hand, the manually emptied
sludge are still discharged into lowlands, surface drains, nearby ponds, as reported by FGD participants.
Vacutug transports the collected sludge in a closed container and disposes the sludge to the filter bed of
the treatment plant. At present, there is no caretaker to look after the treatment plant. The technical
performance of the plant could not be evaluated as a part of this study. Based on the experience of
Laksmipur and Sirajganj Paurashavas, Figure 7 summarizes FSM scenario in a typical Paurashava town.
FSM Intervention in the Country
FSM has recently been identified as an emerging challenge in urban areas of Bangladesh (2). The DPHE in
collaboration with UNICEF has undertaken several pilot projects of establishing treatment plants in
different city corporations and municipalities throughout the country. On the other hand the “Secondary
Town Water Supply & Sanitation Sector” project initiated fecal sludge treatment plants at 16 Paurashavas
since 2012. The Lakshmipur and Sirajganj Paurashavas surveyed under the present study are among these
16 Paurashavas. Some of these treatment plants are reported to be performing well (including the one in
Lakshmipur Paurashava), while others are not. The interest and capacity of Paurashava are important
factors for the success of FSM services including treatment. The basic concept of the FSM adopted in these
ongoing projects consists of collection of fecal sludge from septic tanks and pits through ‘vacutug’ and
transportation of the sludge for suitable treatment and/or disposal (2, 9, 10, 11). Pit emptying services
provided in Dhaka by some NGOs and private organizations are also limited to collection of fecal sludge
and subsequent inappropriate disposal in sewers/drains. The FSM initiatives in urban areas of Bangladesh
mostly have limited scope (12). Other than a few Paurashavas, these initiatives are on pilot basis and
provided by individuals and/or informal sectors (12).
On-site Disposal/
sanitation Collection Transportation Treatment
End use
facility
Disposal of treated
Transportation of effluent in open
Mechanical
fecal sludge to Treatment of environment
collection of fecal
sludge treatment fecal sludge
Household/com sludge using
plant using
munity based ‘Vacutug’
‘Vacutug’
pour-flush
latrines
connected to
pits or septic Transportation of
tank system fecal sludge to
Disposal of fecal
Manual collection nearby low
sludge in low
of fecal sludge by land/canal/
land/canal/rejected
sweepers rejected pond
pond
Figure 7: FSM scenario in Paurashava towns where FSM services have been initiated
Lessons Learned
The major findings of the case study are summarized below:
(8) On-site Sanitation System: In the absence of proper monitoring, OSS systems have been developed
very poorly in all urban areas. In many urban areas septic tanks are absent, and toilet wastewater
is directly discharged into storm drainage network. In some cases, soakage pit is absent. Due to lack
of pit emptying services, pour-flush latrines in high-density urban slums are being constructed
without “pits”, and fecal matters from toilets are flushed out into open environment.
(9) Design of OSS facilities: Septic tanks are not designed considering user number, and no desludging
frequency is assigned with the design. Proper inlet and outlet devices (i.e., Ts) are not provided, and
in most cases, soakage pits are absent. In almost all cases, the septic tanks are poorly designed,
constructed and maintained.
(10) Construction of OSS facilities: Although City Development Authorities and Paurashavas are
responsible for granting permission for construction of houses/ buildings after checking designs; the
system appears to be ineffective with regard to OSS facilities. Designs and construction of on-site
facilities are seldom checked or monitored. Urban authorities do not have required capacity (both
in term of training and manpower) to monitor design/construction of OSS facilities.
(11) Positive initiatives at Paurashavas: The Paurashava authorities are responsible for management of
on-site sanitation facilities (and hence FSM) according to the Local Government Act 2009. Due to
this clear assignment of responsibility, Government agencies, I/NGOs, and Development Partners
have started working together with Paurashava authorities on FSM, and some positive results are
already visible. However, the Paurashavas suffer from severe shortage of manpower and training.
(12) Lack of initiative in large cities: For large cities, there is no clear assignment of responsibilities for
FSM. As a result, the limited FSM initiatives in these large and high-density urban areas are
continuing in an uncoordinated and inappropriate manner, and not yielding desired results. This
situation highlights the importance of the proposed institutional and regulatory framework for FSM.
(13) Collection and transportation of fecal sludge: Manual emptying is being practiced in all urban areas.
Mechanical desludging services suffer from limitations that include lack of access in areas with
narrow roads and absence of a viable business model.
(14) Treatment of fecal sludge: There is limited experience of treatment of fecal sludge. Research is
needed for the development of effective fecal sludge treatment facilities, and possible production
of useful by-products (e.g., compost).
Conclusions
Fecal sludge management (FSM) has been identified as a major challenge, particularly for the urban areas
of Bangladesh. Inappropriate management of fecal sludge is causing environmental pollution and
becoming a major health risk. The poorly developed OSSs and their poor O&M is a result of long neglect
of the issue, especially at the local government level. Existing institutional set up at local government
institutions and other relevant organizations is highly inadequate, both in terms of capacity and training,
to tackle the huge challenge posed by inappropriate FSM. Development of an institutional and regulatory
framework for FSM, with clear assignment of responsibilities among the stakeholder
organizations/institutions, could be the first major step toward solving the FSM problems. Together with
the “framework”, the capacity of the key organizations/institutions responsible for FSM must be
enhanced through increasing manpower, capacity building trainings, and channeling funds for establishing
FSM infrastructure and services.
Acknowledgements
This work was supported by Asian Development Bank and Bill & Melinda Gates Foundation under the
South Asia Urban Knowledge Hub project. The authors gratefully acknowledge DSK (Dustho Shastho
Kendra), WaterAid Bangladesh, Dhaka North City Corporation (DNCC), DPHE, Lakshmipur and Sirajganj
Paurashava authorities for facilitating the field survey in respective areas.
References
(17) WHO-UNICEF Joint Monitoring Programme Report, 2014. Progress on Drinking Water and
Sanitation – 2014 Update, Switzerland.
(18) Local Government Division (LGD), Ministry of Local Government, Rural Development and
Cooperatives, Government of the People’s Republic of Bangladesh, 2013. Bangladesh Country
Paper. Fifth South Asian Conference on Sanitation (SACOSAN-V). October 22-24, 2013. Kathmundu,
Nepal.
(19) Opel, A., 2012. Absence of FaecalSludgeManagementShatters the Gains of Improved Sanitation
Coverage in Bangladesh. Sustainable Sanitation Practice. 13, 4 – 10.
(20) Chowdhry, S., Kone, D., 2012. Business Analysis of Fecal Sludge Management: Emptying and
Transportation Services in Africa and Asia, Bill & Melinda Gates Foundation, Seattle, WA.
(21) Opel, A., Islam, K., 2013. Faecal Sludge Management: A Critical Challenge for the Cities in Developing
Countries. Proceedings for the Asia Water Week 2013. March 13 – 15, 2013.ADB Headquarters,
Manila, Philippines.
(22) Franceys, R., Pickford, J., Reed, R., 1992. Guide to the Development of On-site Sanitation, World
Health Organization, Geneva, Switzerland.
(23) Trémolet, S., Kolsky, P., Perez, E., 2010. Financing On-Site Sanitation for the Poor: A Six Country
Comparative Review and Analysis, Washington, DC: Water and Sanitation Programme, World Bank.
(24) Cairncross, S., Bartram, J., Cumming, O., Brocklehurst, C., 2010. Hygiene, Sanitation, and Water:
What Needs to Be Done? PLoS Med 7(11): e1000365. doi: 10.1371/journal.pmed.1000365
(25) Opel, A., Bashar, M.,K., 2013. Inefficient Technology or Misperceived Demand: the Failure of Vacu-
tug Based Pit Emptying Services in Bangladesh. Waterlines, 32(3), 213 – 220.doi: 10.3362/1756-
3488.2013.022
(26) Jonathan, P., Masudul, Q., 2008. The challenge of servicing on-site sanitation in dense urban areas:
experiences from a pilot project in Dhaka. Waterlines. 27(2), 149–163.doi: 10.3362/1756-
3488.2008.017
(27) Jonathan, P., Tayler, K., 2003. Decentralized wastewater management in peri-urban areas in low-
income countries. Environment and Urbanization. 15(1), 75 – 90.doi:
10.1177/095624780301500119
(28) International Training Network, Bangladesh University of Engineering and Technology (ITN-BUET),
Policy Support Unit, Local Government Division, Bangladesh (PSU). Institutional and regulatory
framework for FSM in Bangladesh. Proceedings of 1st National Consultation Meeting on Institutional
and Regulatory Framework for Fecal Sludge Management (FSM) in Bangladesh. December 23, 2014.
ITN-BUET, Bangladesh.
(29) Khatun, F., Muntasir, M., Islam, I., 2012. Potential and prospects of on-site slum up-gradation
program in Dhaka. OIDA International Journal of Sustainable Development. 3 (10), 25–38
(30) Hoque, S., Sarker, T., Udoy, T., F., K., Khan, F., J., Muyeed, A., A., 2013. Condition of Basic Services-
Water Supply, Sanitation and Waste Management in Slums of Dhaka City: An Assessment.
Department of Civil Engineering, Ahsanullah University of Science and Technology, Dhaka.
(31) Tawhid, K.,G., 2004. Causes and Effects of Water Logging in Dhaka City, Bangladesh. TRITA-LWR
Master Thesis. KTH Stolkholm: Royal Institute of Technology.
(32) Ingallinella, A. M., Sanguinetti, G., Koottatep, T., Montangero, A., Strauss, M., 2002. The challenge
of faecal sludge management in urban areas: strategies, regulations and treatment options. Water
Science and Technology. 46 (10), 285–94.
(33) Sirajganj Paurashava, 2011. Annual Report of Sirajganj Paurashava.
Innovation in Sanitation sector: e-Catalogue for Individual Household Toilet (IHHL)

Abstract
As of 2014, 626 million people, or 50% of India’s total population, defecate in the open. To address the
issue of open defecation and other environmental sanitation issues in the rural areas, the Government of
India (GoI) launched a flagship program of Swachh Bharat Mission (Gramin) with the goal of achieving
100% sanitation coverage by 2019. The flagship program includes financial support, technical skills,
capacity building, and Information Education and Communication (IEC) support to achieve the mission.
While a detailed guideline on various types of household toilet designs, both front and backend, was
developed and disseminated by the Ministry of Drinking Water and Sanitation (MDWS), its impact has
varied since water and sanitation are a ‘State’ subject and its implementation intensity varies from state
to state. To bridge this gap, Water For People has developed an innovative application: the e-Catalogue.
The e-Catalogue is a tool through which the family or customer can design their own toilet, based on their
individual budget. The e-Catalogue is a flash-based software application for desktop and laptops, and an
Android application for tablets and smartphones. This software application presents different toilet
models to customers in a way that gives them the freedom to design their own toilet model from different
materials within their budget. It also helps to generate demand among households to choose and
construct their desirable toilet models.
Using this tool, customers can completely customize their toilets using various construction materials such
as brick, fly ash, stones, a variety of septic tanks, different doors, and an assortment of pits. From there,
the tool generates an animated pictorial display of the structure, and includes the cost of each associated
material. Once the customer has designed their dream toilet they can email or download the design, and
take it to their local point of purchase to order the supplies they’ll need.
Household use of the e-Catalogue to design a desirable toilet results in the following benefits:
• Provides an opportunity for families to choose their desirable household toilet options
• Provides a clear understanding on the various designs, technologies and costs for families
• Provides an opportunity for the families to make their own decisions on toilet design as opposed to the
typical mason-driven decision making
• It allows families to get an instant idea about the cost and allows them to quickly compare the price of
the different options.
• Bridges the gap between national policy/technical guidelines and choices available on ground
• Provides an opportunity for the families to monitor the construction and have greater quality control as
the family gets the photo (3-dimension) of the selected toilet with materials before the construction.
The e-Catalogue is not only useful for families to choose their desirable toilet options, it is also beneficial
for the stakeholders involved in the promotion of household toilets such as Swachhta Doots, SHGs, Gram
Panchayats, Auxillary Nurse Midwife (ANM) & Accredited Social Health Activist (ASHA) workers, Rural
Sanitary Marts, Village Water & Sanitation Committee, NGOs etc. to showcase various toilet options to
the families to select the one they like.
Introduction
A few weeks ago, a national daily citing a survey stated that despite the government’s aggressively
promoted ‘Swachh Bharat Mission’, the actual toilet sales were decreasing day by day. This is despite the
fact that there is a growing awareness on the importance of cleanliness, good sanitation, availability of
government subsidy, and recognition of the need for safety for women and children.
A study by a non-profit research institution deduced that most people who openly defecate find it
enjoyable, convenient and comfortable. This means that if these people are able to build an aspirational
toilet, that is convenient and comfortable, they will be more inclined to use it every day. However, they
currently do not have a choice and cannot express an opinion, in choosing the type of toilet they want,
within their budget. People shy away from expressing their preferences, simply because they believe that
they do not have a choice, instead accepting the one option offered by their mason or nearest sanitation
entrepreneur.
Water For People, Sanitation & the evolution of the e-Catalogue

Imagine a land where people have reliable and ongoing access to clean water and hygienic sanitation
facilities, giving way to good health, livelihood opportunities and citizens with a true sense of well-being?
‘Everyone Forever’ is an initiative by Water For People to fulfill this vision of providing lifelong access to
drinking water and toilets to every school and every household in the districts where Water For People
works.
Focusing on sustainable solutions, Water For People has been implementing a ‘Sanitation as a Business’
(SaaB) model, collaborating with local governments and other stakeholders to create and improve supply
chains and generate demand for sanitation infrastructure and services, developing various latrine
products & options and engaging local entrepreneurs in sanitation businesses.
As Water For People has built its’ understanding of the supply chain and demand for sanitation services,
the lack of options, has been identified as a major constraint to enable demand to be increased. People
want choice, and an ability to imagine a future toilet structure, with a ‘price’ has been an important to
facilitating that demand, and engagement between households and entrepreneurs.
So, the idea of developing software that would showcase different type of toilets, their various
components, price of each of the components and the finished toilet, was born.
e-Catalogue for Individual Household Sanitation

e-Catalogue is a tool in which the family / customer can design their own toilet as per their economic
status. This ‘Flash’ based software that can be used on desktops laptops and on Android based mobile
devices to showcase different toilet model options and the cost.
A mock-up version of different types of toilets can be virtually constructed using various materials for
example brick, fly-ash, or stone. There are also a variety of septic tanks, doors, and pit options from which
to choose, all in an animated pictorial display with individual material costs indicated. Customers can print
out the final design and corresponding cost.
The need for e-Catalogue

There was a lack of choice for the families to choose their desirable sanitation option. Householders have
always been dependent on masons or sanitation entrepreneurs to select the toilet for them, which may
or may not fulfill their requirements.
Sometimes, there was a massive difference between the promised and delivered toilet. The e-Catalogue
aims to help people visualize the toilet with various combinations of materials along with the government-
approved market price.
One of the most important things that e-Catalogue hopes to achieve is bridging the gap between national
sanitation related policy/technical guidelines and the choices actually available on the ground. After all, if
the toilet is not to the taste of the householder, no policy or law will be able to ensure the actual usage of
the toilet. Swachh Bharat Mission aims to eradicate open defecation by 2019 and provides subsidy of Rs.
12,000 to families to encourage them to build toilets. If the family knows that it can customize the toilet
within (or beyond, if the family’s budget allows) Rs. 12,000, without any extra or hidden costs, it will also
help to minimize and eventually prevent any misuse of the subsidy.
Functionality of e-Catalogue
The e-Catalogue is primarily a ‘Flash’ based software, which will soon be available for Android platforms
too. That is, the file can be used in laptops, desktops, and eventually smartphones and tablets.
The e-Catalogue combines pictorial representation in the form of 3-D graphics and software programs to
give a real-life effect to the proposed toilet. Since it shows various available material of all components of
a toilet such as platforms, doors, pans, walls, and several waste disposal options such as leach pits, septic
tanks, biodigester, biogas etc., along with the individual and total price of the component and the toilet
respectively, it assists the users to choose whatever they deem fit for their household.
After the family selects the toilet, the e-Catalogue generates a 2D plan, estimate and 3-D View of the
selected toilet, which is then printed and given to the customer as their reference copy along with the
agreement to build the toilet by the sanitation entrepreneur.
The e-Catalogue is expected to be used by Swachhta Doots, Sanitation Production Centers, Rural Sanitary
Marts, Sanitation Entrepreneurs, Self Help Groups, Gram Panchayat, Panchayati Raj Institution members,
Auxiliary Nurse Midwifery (ANM), Accredited Social Health Activist (ASHA) & Anganwadi workers, Village
Water & Satiation Committees, District Water & Satiation Committees, State Water & Satiation
Committees, Block / District / State Coordinators of Swachh Bharat Mission and NGOs / INGOs / MFIs
involved in sanitation promotion.
Summation
The e-Catalogue is a part of Water For People's mission, and specifically its SaaB program, to increase the
demand for household toilets, which ultimately improves health and reduces open defecation - a major
issue in rural and impoverished regions around the world. Launched on 21 April 2015, Water For People
and MDWS sees the e-Catalogue as a great tool to help them reach full sanitation coverage across rural
India by October 2, 2019, under the Swachh Bharat Mission. In addition, we are confident that this
‘informative, engaging, and innovative’ app will be an integral part of Swachh Bharat Mission’s success.
Moving forward it will be a priority to teach the sanitation entrepreneurs how to use the app and ensure
that every household knows it exists. Because when it comes down to it, awareness is key to ensuring
continual progress toward achieving full water and sanitation coverage for ‘Everyone Forever’.
Technical Focus Session 5: Financing for Sanitation & International Cooperation (Maldives)
Chair: Md. Mosthafa, Director, Ministry of

Environment and Energy
Co-chair: Mr. Henry Zal Northover, Global Head of
Policy, WaterAid UK
Moderator: Dr. Liakath Ali, Director, Water Aid
Presenters:
- Mr. Abhishek Mendiratta, India
- Mr. Rabin Lal Shrestha, WaterAid & FANSA
- Guy Hutton, WSP-World Bank
- Prof. K.K. Pandey, IIPA, India
Supporting Partners: Water Aid, WHO
 Financing of Sanitation an essential component of Sanitation Marketing, a Case Study of

Rajasthan, India
 Sustainable and equitable Financing of Sanitation Services, WaterAid & FANSA
 Achieving Sustainable and Universal Access to Sanitation and Hygiene in South Asia: Cost and
Financing Assessment, World Bank
 Financing Sanitation: Indian Experience and Lessons for SAARC Countries, India
Sustainable and equitable Financing of sanitation services
by:
Rabin Lal Shrestha, Water Aid
Ramisetty Murali, FANSA
Govind Bahadur Shrestha, Water Aid Nepal
ABSTRACT: We are at a turning point when the Millennium Development Goal (MDG) period ends and the
Sustainable Development (SD)Framework starts. The focus of the sanitation MDG target was on halving
the the proportion of people living without sustainable access to basic sanitation through separating
human contact from faeces. The SD framework has linked sanitation with health, education and poverty.
It states that no Sustainable Development Goals (SDGs) and targets will be met unless no groups or
communities are left out. It has set targets for universal water and sanitation for all by 2030. SAARC
Countries can be considered from two perspectives—some, such as India are able to mobilise substantial
domestic resources for development, while others such as Nepal and Bhutan remain significantly
dependent on external resources. In the case of India, the problem is hence not necessarily the volume of
financial resource allocated but rather the problem of delivery mechanisms, monitoring and
accountability. While in the case of Nepal the problem lies both around resource sufficiency and reaching
the unreached. Furthermore, both countries (India and Nepal) are narrowly focused on the First Generation
of Sanitation, i.e. eliminating Open Defecation (OD). The time has come to think beyond OD. This is true
for all SAARC Countries. The overall objective of this paper is to vision sanitation financing from the
perspectives of the SDGs and the SDG Framework—i.e. reaching universal access to water, sanitation and
hygiene (WASH) by 2030.The specific objectives are: to analyse regional/within country disparities on
WASH financing; to explore sustainable financing strategies in order to meet universal access of sanitation
by 2030. The paper summarises the key issues related to financing sanitation, and to propose sustainable
financial strategies for achieving a long-term shift in sanitation coverage. It also suggests governance
measures required for ensuring coordinated financial flows, appropriate use of limited public resources
and well-targeted resources to achieve equity.
Keywords: Water; sanitation; hygiene; sustainable development framework; domestic resource

mobilisation, external aid and regional/national disparities
Introduction: the consequences of inadequate and inappropriate spending on sanitation
The UN Secretary-General Ban Ki-moon-- We agree that spending on sanitation and water for all is wise.
Resources are scarce. With the right allocations, we can optimize the funds and reach all people in the world.
We need: firm commitment. We need strong institutions to reach people living in slums and remote areas and
to make sure that services last…The UNDSG stated “we have made commitments to spend more money and
also to spend the money we have more wisely.
Nearly 2.5 billion people globally are without safe sanitation and 1.5 billion additional people are
projected to need safe sanitation services by 2030 when the Sustainable Development Goal period ends
with the target of providing sanitation for everyone and everywhere. Significant additional number of
schools and health centres will need improved sanitation and hygiene facilities. Inadequate financial
resources will leave many people and public institutions like schools and health centres without improved
sanitation facilities even by 2030. This will have serious implications on the attainment of successful
outcomes for health and nutrition, education and poverty reduction. Though overall basic sanitation
status is improving over the decade, gaps between rich and poor is widening. Appropriate and effectively
targeted financial plans and delivery are the need to minimize the gaps of between the haves and the
have nots. The UNDSG rightly pointed out that we have made commitments to spend more money and
also to spend the money we have more wisely.
Situation: the status of sanitation financing
Mr. Takeshi Osuga, Deputy Director General of the International Cooperation Bureau, Ministry of
Foreign Affairs delivered that “Japan’s ODA on water and sanitation in 2013 is estimated to be at least 2.3
billion U.S. dollars, including 490 million U.S. dollars for African countries. Japan will continue its
cooperation in this sector and its ODA will be delivered in such a way that it will facilitate and promote
women’s active role and participation in society.”
The external support agencies have made their commitments to increase sanitation financing and called
upon finance ministers also to increase domestic resource mobilisation (Sanitation and Water for All High
Level Meeting, SWA HLM 2014). Finance ministers from the South Asia region have committed to increase
sanitation financing. All SACOSANs (from I to V) have committed to increase the transparency of funding
on sanitation.
Hon. Dr. Hazrat Omar Zakhilwal, Minister of Finance of Afghanistan, stated that “water and sanitation
continues to be a priority of the Afghani government and of its people. It comes up not only in its own context but
also when discussing health priorities and rural development”. Nepal’s Minister of Finance, Hon. Dr. Ram
Sharan Mahat - stressed that there are challenges and urged the international community to close the financial
gap between what the government is committing to and what is needed. – SWA HLM 2014World Bank President
Dr. Jim Yong Kim emphasized that “We want Finance Ministers to ensure that countries have the resources to
prioritize sanitation and that other ministries have the skills and knowledge they need to succeed. But today we
need ministries of finance to lead on sanitation” – SWA HLM 2014
In India Prime Minister Modi has made sanitation a special priority through the Swachha Bharat Mission
(SBM) and allocated substantial domestic resources to achieve sanitation for all by 2019.
External WASH Resources in the Region: Aid commitments to water and sanitation were 6.1% of total
official development assistance (ODA) in 2012. Development aid for water and sanitation has risen from
4.7% to 6.1% of total development aid from 2010 to 2012, and nearly doubled as a proportion of total aid
since 2002.
The largest share of aid (38%) is allocated to Sub-Saharan Africa where water and sanitation coverage is
critically low. The majority of the population without basic water and sanitation live in Southern Asia
however and receive only 13% of aid commitments. Annual figures show a fluctuating trend (See- Chart
2) but the five-year moving average shows a consistent pattern (See Chart 3). If this trend continues,
SAARC countries will receive around USD 2 billion in the year 2030 and cumulative aid from 2015 to 2030
will be around 28 billion USD (see Chart 3). The average increase of external aid per annum is expected to
be USD 27.29 Million. The country-by-country forecast of external resources is presented in Annex 1.
Domestic Resource in the Region: The SAARC member countries in terms of WASH aid dependency can
be categorized into three groups- high, moderate and low. Afghanistan is highly aid dependent (76% of
the sector is funded externally) followed by Bhutan at 44%. In Pakistan, Nepal and Bangladesh government
domestic resources, including households and communities, are very significant contributors to the WASH
sector. They constitute 84%, 74% and 64% of total WASH expenditure. India has the largest capacity for
domestic resource mobilisation in the sector, including through innovative approaches for raising funds
for sanitation. The current state of sanitation domestic funding stands at a minimum annual amount of
US$4.2 million in Afghanistan, US$26.6 million in Bangladesh, US$1 million in Bhutan, US$1.54 billion in
India, US$14 million in Nepal and US$37.7 million in Pakistan.(See Table 1)
Resources requirement and Gap: South Asia region requires US$26.078 billion to achieve universal
access to sanitation by 2030. Country wise resources requirement in million USD are: Afghanistan (63),
Bangladesh (1284), Bhutan (36), India (21260), Nepal (725) and Pakistan (2509).
The figures indicate that India is an exceptional country with enough domestic resources and no funding
gap. However, Pakistan and Nepal have major budget deficits, and the sanitation financing gap will not be
filled on the basis of the current trends in external support. For the other countries in the region, if the
current trends of domestic and external resources continue, there is potential to meet resources
requirement to meet sanitation for all by 2030. (See Table 2)
India case study of Domestic Resource Generation:
Swacch Bharat Cess: India Government expects to collect around Rs 10,000 crore (nearly 1.5 billion US $) from Swachh Bharat cess for full
year 2015-16 by imposing a levy at a rate of 0.5%, which will translate into a tax of 50 paisa only on every one hundred rupees worth of taxable
services”."Swachh Bharat Cess is not another tax but a step towards involving each and every citizen in making contribution to Swachh
Bharat". <
Swacch Bharat Kosh: The Kosh (Trust) has been set up by the Ministry of Finance and is managed by a Governing Council headed by
Expenditure Secretary. Its functioning is monitored on a quarterly basis by the Finance Minister and by the Prime Minister from time-to-time.
The Prime Minister himself will acknowledge contributions of over Rs 1 crore made by individuals and of over Rs 20 crore by corporate donors.
The implementation of the projects/activities is supposed to be carried out by the existing institutions at the state, district, and sub district level,
with no new institutions created.
Corporate social responsibility (CSR): The new Companies Act 2013 in India has made it mandatory for large corporates to devote at least
2% of their profits for CSR. Much of this spending has been dedicated to the construction of toilets in rural and urban schools. Commercial
Banks (e.g. the Oriental Bank of Commerce, IDBI), Public Sector undertakings (e.g. Coal India, NTPC, GAIL) and many other corporates (e.g.
TCS, ITC) have committed to specific targets in terms of toilets to be constructed. Even the smaller companies who are not covered under the
CSR rules are also showing an interest in funding toilet construction and the clean India cause. The India Sanitation coalition is a unique
initiative to promote partnership approaches for sanitation development.
India case of Resource Disbursement Mechanisms
The Central and the State governments: As per the DO letter No.32/PSO/FS dated 28-10-15 the GOI will share 60% and States are expected to
share 40% cost of promoting rural sanitation. However in the case of North Eastern states the central Government funding is upto 90%. In the
case of Jammu and Kashmir, North Eastern States and special category states the sharing would be 90% by the GOI and 10% by these states.
For Union Territories the funding is 100% from the Central Government.
National Rural Employment Guarantee scheme: This is a special scheme launched by GOI to enhance livelihood security of people in rural
areas by providing at least 100 days of assured employment for every family in need of wage employment. People employed under the scheme
will be taking up predominantly human unskilled labour work with an aim to build durable community assets like tanks, ponds, land development,
roads etc. The GOI under SBM allows scope for dovetailing any centrally-sponsored schemes for achieving the SBM objectives. The Ministry of
Rural Development has issued special orders dated 19th January 2015 to dovetail this NREGS scheme for promotion of Individual Household
toilets with the same cost norm of Rs.12,000 per toilet. The beneficiary family would get paid for the family labour for construction of toilets and
the local labour groups would also be supported to produce in bulk the material required (bricks, cement rings etc). States are given flexibility
to use this scheme to promote compost pits, soak pits etc required for solid and liquid waste management. About 2 crore toilets in rural areas are
targeted for a 5- year period under this scheme. This is out of the total 6 crore toilets to be built for ensuring that every household has access to
an improved toilet in India so that open defecation is completely eliminated.
Case study of Nepal: Financial Resource allocation: The sanitation (latrinisation and liquid waste) and solid
waste management budget increased significantly in the fiscal year 2013/14 with an increase of 63% for sanitation
and 183% for solid waste. In the last five years, the Department of Education has allocated NPR 4.2 billion for the
construction of 15,700 toilets in community schools, especially targeted for girl-friendly sanitation facilities.
Adequacy and utilisation: The financial resource requirement to meet sanitation for all by 2030 (the SDG Target)
is NRs. 7.5 billion (1 US $ = 100 NPR=75 million US $). The current Trend of 1.5 billion rupees (15 million US$)
per year allocation is good enough to meet the sanitation goal for ODF. However, if the costs for liquid waste and
solid waste management and post-earthquake reconstruction/rehabilitation are included, the budget allocation is
inadequate to meet the targets. The Resource gap is 37 billion NPR (370 million US $) compared to an allocation
of 43 billion in liquid wastes and 11 billion NPR compared to an allocation of 7 billion NPR in solid waste (The
World Bank 2014). In school sanitation the gap is 4.2 billion NPR (DoE/Water Aid 2014).
Source: Estimated from Red Books of Nepal
Sustainable Development Goals – a new opportunity
The ‘Sustainable Development Goals’, or SDGs, include Goal 6 which aims to ‘Ensure availability and
sustainable management of water and sanitation for all’. Target 6.2 states “By 2030, achieve access to
adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention
to the needs of women and girls and those in vulnerable situations.” SDG goal 3 aims to ‘ensure healthy
lives and promote well-being for all at all ages’. Target 3.8 aims to achieve universal health coverage,
including financial risk protection, access to quality essential health care services and access to safe,
effective, quality and affordable essential medicines and vaccines for all. Target 3.9 aims to substantially
reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and
contamination. The SDGs target everyone everywhere, which means it is not isolated to household or
communities but also to institutions including health care facilities and other public places. The aspiration
of the SDGsis not to leave anyone behind.
Innovative Practices in Sanitation Financing
Microfinance for sanitation: The women Self Help Group (SHG) movement under the stream of Banks
linkage as well as financial service provision by different forms Micro Finance Institutions has had
phenomenal growth in India spread out to most states. The microfinance industry has grown significantly
in India with an estimated total portfolio of nearly Rs. 40,000 crore (US$ 6.5 bn approx.) (MFIN, 2014).
Over the past few years, some micro-finance institutions (MFIs) with reasonably sized portfolios have
focused on sanitation. For example, Guardian (Gramalaya Urban and Rural Development Initiatives and
Network) , works in four districts of Tamil Nadu and has an outstanding portfolio of over Rs. 11 crore (US$
1.9 mn approx.). Another MFI, Grameen Koota with a presence in Karnataka, Maharashtra and Tamil
Nadu, disbursed Rs. 100 crore (US$ 16.7 mn approx.) in water and sanitation loans in 2014. BWDC, Basix,
BISWA, ESAF, FWWB, SEWA Bank are other MFIs which have gained significant experience in providing
large number of water and sanitation loans. There shows good evidence of the potential for women SHG
networks and MFIs in demand generation, sustainable financing, accelerated construction and ensuring
sustainable use of toilets.
Provision of Revolving fund in the district: A Revolving Fund has been made available at the district level
out of the SBM (G) funds. This fund may be given to Societies, Self Help Groups or other groups as decided
by the states, whose credit worthiness is established, for providing cheap finance to their members for the
construction of toilets. Loans from this fund are supposed to be repaid in 12-18 installments. States will
have the flexibility to decide the terms and conditions for the Revolving fund. This Revolving fund can be
accessed by Above the Poverty Line (APL) households not covered for Incentives under the guidelines.
Households which have availed Incentives under any Sanitation scheme earlier can also access such finance
as loans. Those households (Below Poverty Line, BPL, and APL) covered under the Incentive can also bid
for financing under the Revolving Fund to meet the additional cost of improved toilets with a bathing
facility. Registered SHGs with proven credentials can approach the DWSM for such funding. Up to 5% of
the district project outlay subject to maximum of Rs. 1.50 crore, can be used as Revolving fund, including
for funding to set up RSMs/PCs. Provision of the Revolving Fund in a district is approved by the
DWSM/DWSC. The Revolving fund is shared between Centre and State on an 80:20 basis (Guidelines,
2014).
In Bangladesh, Nepal and Pakistan there are different innovative ways of raising funds. These countries
have shown their capability to generate significant contributions from households and communities. In
Bangladesh out of 100 US $ households/communities contribute up to 37 US$ of sanitation costs. The
figure stands at 25 in Pakistan and 19 in Nepal.
Bottlenecks: what stands in the way of better sanitation financing?
Translating political will and commitment into action: There is no lack of high level political
commitments globally or in South Asia. However, the challenge is translating these into action
through the disbursement of committed resources. Globally aid disbursements were only 60% of aid
commitments in 2012. While aid commitments for water and sanitation have increased rapidly, aid
disbursements have remained relatively constant at US$ 6.6 billion and US$ 6.7 billion for 2010 and
2012, respectively (OECD, 2014). South Asia countries are not an exception to this.
 Although MFIs have good potential to contribute to sanitation financing needs in India, their actual
lending remains very low. It has not been scaled up for several reasons, including a lack of
proactive policy support from the Government to integrate sanitation into micro finance lending.
There is also a shortage of collaborative linkages. In addition the capability and willingness of
states to meet 40% of the financial incentive differs considerably between states. In Nepal, the
National Reconstruction and Rehabilitation Fund has targeted programmes in earthquake-

affected areas, but it needs clear guidelines to address and fund sanitation needs
Comprehensive and comparable national data measuring the full set of sanitation financing needs for
poor and vulnerable communities is broadly absent. This makes it difficult to understand the scale of
the problem and target resources effectively. Many countries show a widening gap between poor,
vulnerable communities and rich
 In India, a consistent increase in the flow of funding for improved sanitation facilities has not
significantly benefited the people in the lowest wealth quintile. The gap between the poorest and
richest in India with respect to access to improved toilet facilities has increased by 22% from 1995
to 2012 (JMP 2015). In Nepal, the sanitation aspects of reconstruction and recovery are
complicated by the no-subsidy principle. This may significantly delay the resumption of current
progress towards sanitation targets. This may require a reconsideration and revision of the
existing zero subsidy policy for sanitation with the introduction of some form of household
incentives, given the severe income challenges faced by many households.
A lack of timely allocation of adequate resources for installation and upkeep of WASH infrastructure
further hinders progress. Poor supervision and a lack of funds to maintain WASH facilities cause them to
deteriorate and break down, at times permanently. This is particularly true for institutional sanitation in
schools and health care facilities.
Sanitation Marketing leading to sustainable and cost effective mechanism though some countries have
realized its need but has yet to be fully realized.
In India, the idea of localised production centers for sanitary material has received broad support, but it
has not yet been realised. . In the recent past there have been sporadic initiatives from local government
authorities taking measures for local production of some components of toilets, and bulk procurement of
sanitation materials.
The complicated implementation machinery for delivery of subsidies is impacting on adequate demand
generation, behavioural change and monitoring, particularly at the community level. The utilization of IEC
budgets and the quality of interventions need substantial improvement. The Corporate Social
Responsibility (CSR) investments also focus on hardware components with little attention being paid to
behavioural changes.
Way forward: what will it take to improve Sanitation Financing?
Sanitation and hygiene is a shared responsibility and concern that underpins the agenda of ‘leave no-one
behind’. Sanitation financing is thus not only a concern of the water sector Ministry but equally a
responsibility of the Health sector Ministry, Education Ministry and Finance Ministry. The sector and cross
sector ministries can undertake the following initiatives to improve sanitation and hygiene financing
status:
- The SDGs are an opportunity for member states to develop plans of action to realise universal
WASH Coverage, universal health coverage and universal education coverage by 2030.
- SACOSANs and SWA HLMs have agreed to increase sanitation financing, use it better and develop
indicators to assess allocation and expenditure. These agreements need to be translated into
action by the development and implementation of agreed indicators.
- Ministries should systematically analyse the collected financial data and use the information to
prioritise and target investments to cater to the sanitation needs of poor and vulnerable
communities.
- Improve coordination with other Ministries with responsibilities for investing and monitoring
WASH facilities.
- SAARC governments should seek the assistance of external support agencies to build capacity, set
standards, monitor compliance and share best practice.
- External support agencies should increase their financial commitments and disbursements in
countries where there is huge gap in resource requirements to meet sanitation goal by 2030.
- All SAARC countries have problems in tracking the allocation of sanitation financing, its
expenditure and programme expenditure that is targeted to poor and vulnerable groups. There
is a need to increase transparency, report on budgets and spending, conduct analysis and use this
to adjust the programme design wherever required.
India and Nepal specific further way forward are:

India:
 Engaging multiple agencies and partners in SBM is positive but it requires a harmony in the basic
approach, proper monitoring, reporting and coordination mechanisms to avoid duplication and
ensure mutual accountability.
 To offset the disparities in sanitation coverage, a sub plan approach needs to be developed with
time bound plans and dedicated financial resources to reach sanitation services to socially and
geographically vulnerable groups of people. The monitoring framework should provide
segregated information on the progress of sanitation with respect to these communities.
 Achieving sanitation progress needs promotional and social marketing efforts. Indicators for
assessing the readiness of the community for collective behavioural change should form influence
decisions on financing the actual construction of toilets. Collective resolution to end open
defecation and the willingness of the beneficiaries to share the cost of construction are good
indicators of readiness to change behaviour.
 Considering the extent of demand and the complex needs for sanitation products and services it
is unlikely that a supply chain managed by the Governments alone can do the job. There is a need
to bring in other players including market and local entrepreneurs. Part of public funds must be
invested to support capital mobilisation from the market, capacity development and creating
basic infrastructure that makes it a feasible and sustainable proposition for such entrepreneurs
to get into supply chain of sanitation products and services.
 There is huge demand for sanitation loans, but there are very few and limited initiatives from
Nationalised Banks and MFIs in responding to this demand. From the previous lending records
there is evidence of high repayment by the borrowers. Conjoint approach with hygiene
promotion, recognition and engaging MFIs as sanitation sector partners, capital incentives,
coordination and monitoring mechanisms are some of the key interventions needed from the
National Government to realise the full potential of SHG networks and MFIs for sustainable and
equitable sanitation financing.
Nepal:
 While the latrinisation budget is sufficient, increased resources and efforts are required in liquid
waste management and school sanitation.
About the Authors

Rabin Lal Shrestha is Regional Advocacy Manager for WaterAid in South Asia. Ramisetty Murali is FANSA,
South Asia Regional Convener and Govind Bahadur Shrestha is Research and Advocacy Officer in WaterAid
Nepal.
Annexes:
Chart 2: Annual External Resource support on WASH Chart 3: Smoothed Five years moving
average trend
Pakistan India Nepal Pakistan India Nepal
Bangladesh Afghanistan Bhutan Bangladesh Afghanistan Bhutan
Sri Lanka Maldives Total
Sri Lanka Maldives Total
1500
2000
1500 1000
1000
500
500
0
0 Mid Mid - Mid- Mid - Mid - Overall
2005 2006 2007 2008 2009 2010 2011 2012 2013 2007 2008 2009 2010 2011 Average
(ODA Figures in Million USD- OECD 2014) (ODA Figures in Million USD-smoothed data
from OECD 2014)
Table1: Domestic resource mobilisation for water and sanitation
WASH Internal Sanitation Internal Resource in Million USD

Resources
Country Figures in Million USD Min. estimate @10% Max. estimate
of WASH budget @20% of WASH budget
Afghanistan 42 4.2 8.4
Bangladesh 266 26.6 53.2
15% block allocation of annual development budget is continued for sanitation at the lowest
administrative units. (90% subsidy for hard core poor)
Bhutan 10 1 2
Funds/Resources secured for two priority districts for sanitation and hygiene in the 11th FYP (2013-
18)
India (FY 10,560* - 1540
2014-15) SBM programme initiated by PM
Nepal 140** 14 28
Sanitation Master Plan states 20% of WASH investment to go in sanitation
Pakistan 375 37.5 75
PATS a priority programme
Source: Estimated from GLAAS 2014 and SACOSAN Country Papers
Table2: Resource requirement, availability and gap to meet sanitation for all by 2030
Population in 000 Budget in Million USD
Additional Required Domestic Resource Remark

Population population budget to Resource gap till 2015
in 2030 to be meet available after
served by sanitation if 2015 domestic
2030 SDG by budget resource
2030 trend is mobilisation
continued
Afghanistan 49,743 39,500 264 63 201 Likely to
Bangladesh 194,373 96,522 1,284 399 885 meet gaps
Bhutan 1,068 680 36 18 18 from donors
Nepal 34,890 21,807 725 210 515
Pakistan 246,108 125,696 2,509 563 1,946 Not Likely to

meet gaps
from donors
(estimate is
only 128
Million USD
external
support)
Sub Total 526,182 284,205 4,818 1,606 3,213
India 21,260 23,100 (1,840)
1,577,841 1,064,885 Principal
funding from
domestic
resources
Grand Total 26,078 24,705 1,373
2,129,391 1,349,090
Source: WaterAid unpublished report on regional sanitation financing, 2015
References:
DWSS/MoUD , Government of Nepal, 2014, National Management Information Management 2014,
Department of Education (DoE) and WaterAid Nepal, 2014 WASH Financing in Community Schools of
Nepal 2014, Government of India, Management Information system, 2015
Government of India, 2014, Swaccha Bharat Abhiyan Guidelines,Government of India, India Country Paper
for SACOSAN-VI.
Govind Shrestha, Republica, August 12, 2015 Lack of funding has placed water and sanitation under risk,
Raise Invesement, Opinion,
Ministry of Education, Government of Nepal Flash I Report 2011/12,
Ministry of Finance, Government of Nepal, Red Books, Estimates of Expenditure, 2010/11-12/12-13/13-

14/14-15/16
M. Mehta and D. Mehta, 2014, Open defevcation in cities: A faltering India Story, Ideas for IndiaMehta,
M.M, 2014, Identifying new mechanisms for financing urban sanitation, presented at first meeting
of the working group at National Housing Bank, New Delhi, Mimeo,
Mehta Meera and Andreas Knapp, WSP Africa 2014; The challenges of financing sanitation for meeting
the Millennium development Goals
MFIN, 2014, MFin Micrometer
National Planning Commission of Nepal, 2015, Post Disaster National Report 2015,
OECD, 2014, Development Co-operation Report, Mobilising Resources for sustainable development,
Population Pyramids of the World from 1950 to 2100
Save the Children Nepal, 16 August 2015, Supporting Children’s Education in the Aftermath of the Nepal
Earthquakes, A Brief for the Government of Nepal and International Donors, The Economic Times,
Nov 25, 2014, Government launches “Swaccha Bharat Kosh” to channelise public funds.
WaterAid, 2015 unpublished report on regional sanitation financing,
WHO/UNICEF, 2015, Progress on Sanitation and Drinking Water; 2015 update and MDG assessment,
World Bank, Reducing Poverty by Closing South Asia's Infrastructure Gap,
Sophie Tremolet, TVS Ravi Kumar, 2013, Research Report: Evaluating the potential of Micro Finance for
sanitation financing in India
Achieving Sustainable and Universal Access to Sanitation and Hygiene in South Asia: Cost and
Financing Assessment
Water and Sanitation Program, Water Global Practice, World Bank33
ABSTRACT: Financing is fundamental in achieving universal access to sanitation and hygiene. This study
estimates the costs of achieving national targets on sanitation, and assesses current and potential future
financing sources. The estimated total financial requirement to serve the unserved with improved
sanitation and hygiene in eight South Asian countries is US$ 14.4 billion per year, with an additional US$
27.1 billion required per year for safe extraction, conveyance and treatment of human excreta. Rural areas
account for approximately 70% of these totals. Existing financing covers under 10% of these total needs.
While an estimated 78% of existing financing comes from public sector and 12% from donors, it is likely
that the remaining proportion accounted for by households and the private sector is underestimated.
Financing strategies are required to make more efficient use of existing financing and to explore new and
innovative financing sources.
Keywords: Financing; costs; universal access
Introduction
Countries of South Asia have vastly different effective sanitation coverage and hygiene practices.
While most countries did not achieve the sanitation component of MDG target 7c (to reduce the unserved
population by half by 2015), many however still aim to achieve universal sanitation coverage by the early-
to mid-2020s. Hence to inform the debate on how countries can achieve universal coverage of sanitation
and hygiene services, this study presents the estimated costs of achieving sanitation and hygiene targets
by the target year of each country and assesses the contributions made by governments, donors, private
sector and households in financing these services.
Material and Methods

The study covers the unserved populations of the eight participating countries of the South Asian
Conference on Sanitation (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri
Lanka). While each of these countries has set universal coverage targets for sanitation, each has a different
starting point in 2015 in terms of level of coverage as well as different target years. Three major variables
inform this study: rates of sanitation and hygiene coverage, costs of provision, and the current or planned
33
Study undertaken by a team lead by Guy Hutton: Mili Varughese, Joep Verhagen, and V. Ratna Reddy (consultant).
levels of expenditure in the sector. The analysis is broken down by rural and urban populations, and two
levels of sanitation service are assessed: ‘improved’ sanitation according to current JMP definitions, and
‘safely managed’ sanitation which includes safe extraction, conveyance and treatment and disposal of
human excreta. Hygiene in this study refers to the presence of a hand washing station with water and
soap available, or if not soap, other effective local materials for hand washing. Unit costs and coverage by
technology (dry and wet pit latrines, and septic tanks) are taken for estimating the cost of improved
sanitation. In the case of safe sanitation incremental costs of sewerage with treatment and septic tank
with fecal sludge management (FSM) in urban areas are estimated, while in rural areas it includes a pit
latrine option with either FSM or sewerage and treatment. Expenditure pertains to total expenditure on
sanitation and hygiene by different players covering public funds, households, donors and the private
sector.
Cost of Achieving the Universal Sanitation & Hygiene Targets
The total financial requirement to extend and sustain access to the unserved to achieve 100 percent
coverage of improved sanitation and hygiene in eight South Asian countries is US$ 14.4 billion per year
(see Figure 1). Two-thirds of this sum is required in rural areas. The average annual cost per capita served
varies according to technology chosen, between US$ 12.8 – US$ 14.5 in urban areas and US$ 4.0 – US$
13.3 in rural areas.
An additional US$ 27.1 billion are required per year to achieve safe sanitation by the respective target
years. 72% of this sum is required in rural areas. The average annual cost per capita served varies
according to technology chosen, between US$ 6.7 – US$ 24.0 in urban areas and US$ 21.6 – US$ 23.8 in
rural areas.
Total costs are made up of capital, operations and maintenance costs, as shown in Figure 1. Sourcing
the financing for large one-off capital costs is challenging, but also ensuring recurrent costs are covered is
vital for the sustained, quality provision of the service. Overall, it is estimated that while one time capital
costs (CapEx) account for about 53 percent of the total costs, recurring costs account for the remaining
costs (24 percent for each of CapManEx and OpEx). The proportion of cost in CapEx versus recurrent costs
is similar between rural and urban areas. On an annual per capita basis, capital costs of improved
sanitation vary are about US$ 6.7 in urban areas to US$ 2.3 – US$ 6.8 in rural areas, while safe sanitation
adds an additional US$ 3.0 – US$ 11.3 in urban areas to US$ 10.9 – US$ 14.1 in rural areas.
Across South Asia, the annual capital costs as a proportion of GDP range from 0.45% for improved
sanitation and hygiene to 1.45% for safe sanitation and hygiene (inclusive of improved sanitation) (see
Table 1).
Figure 1. Cost of Providing Improved Sanitation, Safe Sanitation and Hygiene in South Asia
30.0
US$ Billions 27.1
25.0
19.7
20.0
14.3
15.0
10.8 11.7
10.0 7.4
6.0 6.3 6.6 7.3
3.8 1.6 3.5 1.7 4.8 1.5 4.2 1.3 2.4 4.4
5.0
2.2 1.7 2.7 1.8 0.6 3.0 2.2 2.7
0.1 0.1 1.0 0.0 0.1 0.3 0.9 0.5
0.0
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
CapEx CapManEx OpEx Total
Improved Safe Hygiene
Note: total costs of meetings safe sanitation with hygiene are calculated as the sum of the three columns
in the chart
Financial Gap
The financial gap is the difference between the estimated cost of the services and the actual
expenditure. The expenditure includes public, donor and to some extent household financing, while
excluding private sector investments due to lack of consolidated data sources. While cost requirements
are estimated comprehensively based on the modeled data, there were gaps in expenditure data in some
countries, as the data is not available for all the sub-sectors or it is not up-to-date. Therefore, the financial
gap presented here may not be accurate but it should be broadly indicative of the state of finances in the
respective countries.
The estimated financial gap indicates that there is a shortfall of about US$ 6.5 billion per year in the
region until the target year set by countries for providing the rural population with universal access to
improved sanitation (Figure 2). There is an additional shortfall of US$ 2.1 billion per year estimated for
achieving 100% rural hygiene coverage. Coverage in urban areas requires further investments in the order
of US$ 3.4 billion per year for improved sanitation and US$ 0.44 billion for hygiene. In the case of safe
sanitation the gap is an additional US$ 19.0 billion per year for rural areas and US$ 6.3 billion per year for
urban areas (Figure 2). Overall, for safe sanitation and hygiene inclusive of improved sanitation, this adds
to an estimated gap of US$ 27.7 billion for rural areas and US$ 10.1 billion for urban areas, or US$ 37.8
billion in total.
Figure 2. South Asia: Finances Available and Financial Gap

USS
RSS
UH
RH
UIS
RIS
0 5 10 15 20 25
US$ Billions
Public External Household Gap
Note: RIS= Rural Improved Sanitation; US= Urban Improved Sanitation; RH= Rural Hygiene; UH= Urban
Hygiene; RSS= Rural Safe Sanitation; USS= Urban Safe Sanitation.
Figure 3 shows the proportion of these costs contributed by each country. All countries, except
Maldives and Sri Lanka, have a substantial financial gap even for achieving improved sanitation and
hygiene. India has the highest gap followed by Nepal and Pakistan due to their large unserved populations.
Together these three countries account for 96 % of the region’s financial gap (Figure 3). In the case of
Nepal, the relatively large gap could be due to the absence of data on external funding. In all the countries
the gap is more for rural than for urban areas. The current main sources of financing include public (78%),
followed by external donors (12%) and households (10%). In all the countries, except India, donor
contribution to the sector is substantial. Countries like Afghanistan depend heavily on external funding
due to their poor economic conditions.
Figure 3. Relative Shares of Financial Gap (Improved sanitation and Hygiene) Across South Asian Countries
Sri Lanka Afghanistan
Pakistan 0% 1%
3% Bangladesh
Nepal 3%
5% Bhutan
Maldives 0%
0%
India
88%
Scenario Analysis
In Scenario I where universal coverage is to be achieved by 2030, the financial gap in the South Asia region
is about US$ 5 billion per year to provide improved sanitation and hygiene for the entire region (Figure 4)
compared with US$ 12.5 billion when using national target years. An additional US$ 12.8 billion per year
is required to provide safe sanitation by 2030 compared with US$ 25 billion under national target years.
In the case high cost technology option (Scenario-II) the financial gap increases on the baseline by US$ 5.1
billion per year in the case of improved sanitation while an additional US$ 5.4 billion over and above the
base line in the case of safe sanitation. That is a total of US$10.5 billion over the base line is required to
achieve safe sanitation and hygiene, using national target years. In the case of low cost technology option
(Scenario-III) the fund requirement (gap) is US$ 8.4 billion per year as against the US$ 12.5 billion of the
baseline for providing improved sanitation and hygiene. In the case of safe sanitation an additional US$
24 billion is required per year. Thus extending the national targets till 2030 (Scenario-I) as well as the low
cost option (Scenario-III) would reduce the financial gap when compared to the baseline scenario. Across
the countries India accounts for the largest share followed by Pakistan and Bangladesh.
Figure 4. Financing Gap: Scenario Analysis

25
20
US$ Billions
15
10
0
Improved Safe Improved Safe Improved Safe
sanitation Sanitation sanitation Sanitation sanitation Sanitation
Scenario-I Scenario-II Scenario-III
Sanitation Rural 2.04 8.98 9.72 19.62 2.76 18.36
Sanitation Urban 1.50 3.83 4.46 10.75 2.26 2.24
Hygiene Rural 1.11 1.11 2.96 2.96 2.96 2.96
Hygiene Urban 0.42 0.42 0.44 0.44 0.44 0.44
Note: safe sanitation financing gap is in addition to improved sanitation financing gap
Strategies for financing

Given the significant financing gaps for achieving universal access to improved sanitation and hygiene
in most countries of South Asia, financing strategies are required to bridge this gap. Financing strategies
vary across countries depending on each country's socioeconomic context. At the regional level there are
three main funding sources: public, external donors and households. Public sector funding accounts for
78% of the total funding in the sector followed by external (12 %) and households (10%). The relative
shares of these sources vary across the countries and also between rural and urban areas. Importantly, as
household incomes grow and the operating environment improves for the private sector, investments
from the private sector are expected to increase, with a resulting increase in cost recovery from
households. In some countries like India where the sector is growing at a rapid pace, private sector could
provide substantial support if harnessed.
Public finance: Financial requirements of improved sanitation and hygiene ranges from 0.06 percent
(Sri Lanka) and 2.95 percent (Nepal) of their respective Gross Domestic Product (GDP) (See Table 1). For
safe sanitation and hygiene (including improved), the fund requirements ranges from 0.28 percent
(Maldives) and 3.93 percent (Nepal) of their GDP. In four countries, extending safe sanitation and hygiene
to the unserved populations costs less than 1% of GDP, and in two countries it is between 1% and 2% of
GDP. Such low requirements in most countries indicate the potential for allocations within the 'fiscal
space' in most of the countries. Against these requirements for safe sanitation by the national target year,
the actual allocations are significantly lower in all the countries. On a positive note, current expenditures
exceed requirements for improved sanitation and hygiene in the Maldives and Sri Lanka. However, in
many countries the current expenditure is only a small fraction even of improved sanitation and hygiene,
such as in Afghanistan, India, Nepal and Pakistan. Increasing the allocations is not sufficient alone to raise
the level of expenditures, as allocated budgets are not being spent in many countries. Thus institutional
capacities to increase both the demand for and supply of goods and services need to be strengthened.
Table 1. Required and Actual Expenditure on Sanitation and Hygiene as a Proportion of GDP
Country Required Funding as % of GDP Current Expenditure as % of GDP
Improved Hygiene Improved and safe Public Total

Sanitatio sanitation and
n hygiene
Afghanistan 0.19% 0.02% 0.76% 0.002 0.10
Bangladesh 0.21% 0.02% 0.76% 0.15 0.40
Bhutan 0.29% 0.03% 0.70% 0.005* 0.02*
India 0.39% 0.12% 1.62% 0.05 0.06
Maldives 0.05% 0.01% 0.25% 0.13 0.20
Nepal 2.46% 0.10% 3.58% 0.13 0.20
Pakistan 0.12% 0.02% 0.68% 0.01 0.02
Sri Lanka 0.03% 0.03% 0.44% 0.04 0.15
Total 0.35% 0.10% 1.45% 0.08 0.19
Note: * Includes only public expenditure in rural areas and household expenditure.
Household financing: Rationalizing and targeting the infrastructure subsidies to the most deserving
and allocating funds for activities that could create demand for sanitation services is more effective than
universal subsidies. At the same time, public investments and public action should focus on collection and
disposal of fecal sludge in urban areas as households cannot deal with these on their own. However, costs
can be recovered from non-poor households on these services. Thus cost based tariffs for services would
enhance the household contribution. Besides, better sewerage and disposal mechanisms would
encourage households to invest in toilets and use them. At the same time due consideration for
affordability is required, especially in countries like Afghanistan and India.
Donor funding: Donor funding is crucial in some of the countries where public resources are scarce.
Donor funding commitments often require appropriate policy environment and other conditions, which
are in the interest of the sector. Thus creating conducive policy environment is a pre-condition for donor
funding support. Donor funding could be targeted for complementing the public funds, where donors
could provide state of the art technological or institutional solutions.
Private sector funding: In most of the South Asian countries private sector is growing at a healthy
pace. As the sector is increasingly gaining economic strength, national governments can tap this potential
sector for resource mobilization or investments in the sanitation and hygiene sector. Countries like India
have a policy of corporate social responsibility where every qualifying company is required to spend 2
percent of their net profits towards social sector development. Governments can influence the allocation
of funds to the priority sectors like sanitation and hygiene. Private sector also can create models of
excellence in service delivery through their initiatives. Private companies can also partner with
government and / or communities and work towards efficient utilization of funds.
Efficient allocation of resources: Apart from quantity, quality of expenditure is equally important.
Resource allocation should be aimed at yielding maximum and sustainable services. One of main issues in
this regard is subsidies. Subsidies often distort the entire sector and sets in inefficiencies at all levels. Value
for money analysis could come in handy while determining the resource allocation. Transparency,
accountability and participation (TAP) pay a key role in improving the efficiency of resource allocations.
Conclusion
The analysis clearly brings out the substantial financing gaps for achieving universal coverage of improved
sanitation and hygiene for most South Asian countries, even under a timeframe of 2030 (Scenario-I)
instead of the earlier national target years. Though public finance is the major source of funding in most
of the countries, all of them, except India, depend heavily on external sources (donors). The future funding
strategies include enhancing public funding within the given fiscal space of the respective country,
enhancing the household contribution through reduction in subsidies, tariff and user charges, private
sector funding and efficient allocation of funds. The following aspects need policy attention at the regional
and national levels:
 Existing financing systems appear to be very poor across all countries, as some of the countries don't
even indicate budget sub-heads. This clearly indicates the low priority accorded to sanitation and
hygiene in South Asia.
 Streamlining the accounting systems where allocations could be monitored at sector and subsector
levels (sanitation and hygiene), by administrative breakdown (e.g. rural and urban) and by cost
components (CapEx; CapManEx; OpEx).
 While sector allocations need to be enhanced, there is an urgent need to strengthen institutional
aspects that enhance the capacities to spend allocations efficiently and regulate services.
 Targeting public investments to strengthen demand for services and good sanitation and hygiene
practices, as well as targeting of infrastructure subsidies to a more limited population segment (e.g.
poor households) while enhancing household investments on household-level infrastructure. This
includes implementing PPCP (Public, Private and Community Partnership) models for integrated
approaches to effective and sustainable sanitation coverage
 Given the large coverage gaps in rural areas in South Asia, financing and capacities need to be targeted
to rural areas to achieve universal coverage.
Technical Focus Session 6: WASH in Institutions & Public Places (Nepal)
Chair: Er. Ram Chandra Devkota, Director General of

Dept. of Watersupply & Sewerage
Co-chair: Ms. Lajana Manandhar, Executive Director,
Lumanti
Moderator: Mr. Alok Majumder, Country

Coordinator, WASH Alliance
Presenters:
- Mr. Mahbub Ul Alam, Bangladesh
- Mr. Hendrik Van Norden, UNICEF ROSA
- Mr. Kabindra Bikram Karki, MoUD, Nepal
Supporting Partners: UNICEF, Water Aid, WHO
 Inequalities in sanitation and handwashing facilities among Bangladeshi schools; implications on

hygiene practices, Bangladesh
 Non-Utilization of Sanitary Infrastructure (NUSI) tool to operationalize defunct toilets, India
 WASH in Institutions and Public Places for transforming lives – Sanitation Matters!, Nepal
 Water, sanitation and hygiene in health care facilities in South Asia, Nepal
Inequalities in sanitation and handwashing facilities among Bangladeshi schools; implications

on hygiene practices
Authors:
Mahbub-Ul Alam1, Stephen P. Luby2, Amal K. Halder1, Abul K. Shoab1, Probir K. Ghosh1, Md. Mahbubur
Rahman1, Md. Khairul Islam3, Aftab Opel3, Leanne Unicomb1
1
Center for Communicable Diseases, icddr,b
2
Stanford University, USA
3
Water Aid Bangladesh
Background:
Absence of adequate sanitation and handwashing infrastructure in schools hampers optimal handwashing
and sanitation behavior. National averages in Bangladesh do not characterize inequalities in access within
the population. Better knowledge of inequalities could help decision-makers identify groups at greatest
need and allocate resources for more equitable outcomes. The objective of this study was to explore the
inequalities in sanitation and handwashing infrastructure in urban and rural, and primary and secondary
schools in Bangladesh and the implications on students' hygiene practices.
Methods:
From March to June 2013 we conducted a nationally representative, cross-sectional study in Bangladeshi
schools as part of the Bangladesh National Hygiene Baseline Survey. We sampled 700 primary and
secondary schools both from 50 urban and 50 rural clusters using a probability proportional to size
sampling technique. For the selection of rural clusters we used National Population and Housing Census
2011 data, and for the urban sampling frame we used the 2006 Urban Health Survey data. We sampled
the seven government and non-government schools, at both primary and secondary level, nearest to the
midpoint of each cluster and thus selected 700 schools. Field teams administered the survey orally using
a computer tablet-based structured questionnaire and conducted facility spot checks. Teams conducted
facilities spot checks in each school for the presence of improved toilets according to WHO/UNICEF Joint
Monitoring Program definition and accessible in terms of the door unlocked from the outside and
accessible to students (can use when needed and not kept locked) and available handwashing location
inside or near (<30 feet) the toilet with water and soap for post toileting. We defined a toilet as 'functional'
if students could use it on the day of the survey, if it had a working door and if it was lockable from the
inside with a latch. Field teams interviewed 2,800 school students to know their knowledge, attitude, skills
and practice regarding their sanitation and handwashing behavior. At the end of interview field team also
checked student’s hands whether their palms and finger pads were visibly clean and asked them to
demonstrate washing hands after defecation.
We performed descriptive analysis to determine student characteristics, school facilities for sanitation
and handwashing for students. We reported means and standard deviations for continuous variables that
were normally distributed. All percentages and means reported are weighted for national estimates. We
used probability proportional to size technique to select clusters, but not sampling units (schools) from
within the clusters. We used a sampling weight to determine national estimates, calculated as f=1/F,
where F is the total number of population clusters. We used generalized estimating equation to account
for the clustered design in calculating differences.
We obtained ethical approval from icddr,b’s ethical review committee and the Policy Support Unit of the
Ministry of Local Government. We obtained informed oral assent from participants and informed written
consent from their guardians as well as consent of head teacher. Confidentiality of information was
maintained by omitting personal identifiers from the questionnaires during analysis.
Results:
Demographic characteristics
We included 271 (77%) primary and 79 (23%) secondary schools in rural areas, and 240 (69%) primary and
110 (31%) secondary schools in urban areas (Table-1). Both in urban and rural area, the majority (rural:
56%, urban: 61%, p=0.031) of the interviewed students were female and the majority (rural: 59%, urban:
52%, p=0.019) of the interviewed student’s age was <10 years (Table-1).
Water facilities
Improved, functional drinking water source were very common in urban schools, significantly more than
rural (urban: 91%, rural: 79%, p<0.001). In the rural areas, the most common source of improved drinking
water was a shallow tube well/tara pump (rural: 51%, urban: 36%, p<0.001), whereas urban schools were
more likely to use municipal water (urban: 33%, rural: 3%, p<0.001) (Table-2).
Testing for the presence of arsenic was uncommon. Tube well were the source of improved source of
drinking water in the rural areas among 75% of schools and only 20% of these were tested for arsenic
contamination in the year prior to the survey. Similarly, among the 55% of tube wells in urban schools,
14% were tested for arsenic in the year prior to the survey. Urban school students were more likely to
carry drinking water from home or from outer sources than rural school students (urban: 37%, rural: 10%,
p<0.001).
Sanitation facilities
The major portion of schools in rural area had improved pit sanitary latrine (62%) and the majority of
urban schools had toilet with improved septic tank (45%). Nationally, 84% of schools had an improved
toilet for students (rural: 84, urban: 91, p<0.005). However, only 43% of rural and 61% of urban schools
had functional improved toilets that were accessible for students (p<0.001) on the day of the survey.
Toilets were absent at 5% of rural primary schools and 1% of urban primary schools (Table-3).
Secondary school students had greater access to improved toilets compared to primary schools (57%
versus 41%, p<0.001) (Table-4). Only 17% in rural schools and 19% in urban schools appeared to be clean
(floor, slab and pan) with functional improved unlocked toilet for students (Table-3). Overall there was an
average 213 students per toilet at each school. The student: toilet ratio was higher in urban schools
(urban: 247, rural: 208, p<0.037) and in primary schools (primary: 214, secondary: 208, p<0.043).
Handwashing location after defecation

Urban schools had a handwashing location inside or near (<30 feet) the toilet with water and soap
presence (rural: 31%, urban: 46%, p<0.001) and urban schools reported spending more money to
purchase soap ($. 1.32 versus $. 0.72, p<0.001). Toilets for students had better arrangement with water
and soap in secondary schools (secondary: 42%, primary: 30%, p<0.001).
Implication on students’ practices

Students in urban areas were more likely to have hands that the field team judged as physically clean than
students from rural areas (urban: 45%, rural: 31%, p<0.001) and secondary school students were more
likely to have clean hands than primary school students (secondary: 49%, primary: 27%, p<0.001). We
found no significant difference between urban and rural or between primary and secondary school
students' knowledge about important times to wash hands with soap. When we asked students to
demonstrate handwashing after defecation, we found no significant difference between urban and rural
or between primary and secondary school students (Table-5).
Discussion:
According to UNICEF, children’s development, education and safety depends on having access to clean
water, knowledge about hygiene and a sanitary environment34. Insufficient water, sanitation and hygiene
facilities in schools contribute in poor health outcomes among children including infectious,
gastrointestinal, neuro-cognitive and psychological illnesses 35. Insufficient water, sanitation and hygiene
settings have been revealed to decrease of educational outcomes in children by resulting to absence 36 37
38 39
and weakened cognitive capacities40 41 42. Although this study reveals that 84% of schools had an
improved toilet for students, only 43% of rural and 61% of urban schools had functional improved toilets
that were accessible for students. This scenario illustrate that primary schools had limited access to the
functional improved toilets that were accessible for students in schools especially in rural areas which is
34
(United Nations Children's Emergency Fund), Bangladesh. 2012. Water, Environment and
Sanitation. (Online) Available at: http://www.unicef.org/bangladesh/wes.html (Accessed 5
February 2012).
35
Jasper, C.; Le, T.T.; Bartram, J. Water and sanitation in schools: A systematic review of the
health
and educational outcomes. Int J. Environ. Res. Public Health 2012, 9, 2772–2787.
36
Alexander, K.T.; Dreibelbis, R.; Freeman, M.C.; Ojeny, B.; Rheingans, R. Improving service
delivery of water, sanitation, and hygiene in primary schools: A cluster-randomized trial in
western
kenya. J. Water Health 2013, 11, 507–519.
37
Blanton, E.; Ombeki, S.; Oluoch, G.O.; Mwaki, A.; Wannemuehler, K.; Quick, R. Evaluation
of the role of school children in the promotion of point-of-use water treatment and handwashing
in schoolsand households—Nyanza province, western Kenya, 2007. Amer. J. Trop. Med. Hyg.
2010, 82, 664–671.
38
Freeman, M.C.; Greene, L.E.; Dreibelbis, R.; Saboori, S.; Muga, R.; Brumback, B.; Rheingans,
R. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on
pupil absence in Nyanza province, Kenya: A cluster-randomized trial. Trop. Med. Int. Health
2012, 17,380–391.
39
O’Reilly, C.E.; Freeman, M.C.; Ravani, M.; Migele, J.; Mwaki, A.; Ayalo, M.; Ombeki, S.;
Hoekstra, R.M.; Quick, R. The impact of a school-based safe water and hygiene programme
onknowledge and practices of students and their parents: Nyanza Province, western Kenya,
2006.Epidemiol. Infect. 2008, 136, 80–91.
40
Bar-David, Y.; Urkin, J.; Kozminsky, E. The effect of voluntary dehydration on cognitive
functions of elementary school children. Acta Paediatr. 2005, 94, 1667–1673.
Bartlett, S. Water, sanitation and urban children: The need to go beyond “improved” provision.
41
Environ. Urban. 2003, 15, 57–70.

42
Benton, D.; Burgess, N. The effect of the consumption of water on the memory and attention
of children. Appetite 2009, 53, 143–146.
similar to another study conducted in Pakistan 43. Although both urban and rural schools showed low
status of cleanliness, rural schools showed lower cleanliness than urban schools. Urban areas had
significantly higher student-to-toilet ratios than rural areas.
UNICEF-WSP document ‘Toolkit on Hygiene Sanitation and Water in Schools’ suggested that a ratio of
average 25 students per toilet should be the basis of calculation. However, this study reveals that overall
there was an average 213 students per toilet at each school. These figures illustrate the inadequacy of
sanitary facilities in schools. High ratio of users per toilet results poor maintenance and cause of non
functional conditions.
Another significant finding in this study is the low arrangement of soap and water present inside or nearby
the toilet, where rural and primary schools had lower handwashing facilities than urban schools and
secondary schools. Most schools in developing countries do not provide adequate hand washing facilities.
Where these facilities are available, they may be maintained poorly having not sufficient hand washing
agents, be inaccessible, or be improperly used. A number of studies suggest that hand washing with soap
is the critical component of this behavior and that hand washing only with water provides little or no
benefit44. Inadequate water and sanitation services were linked with an increased diarrheal frequency and
reflect the importance of water storage practices on childhood health45.
Schools in rural areas had low improved functional drinking water sources than urban schools which
support another study findings conducted in Nicaragua46. Following patterns in water infrastructure, the
percentage of schools with sanitation infrastructure presented rural-urban differences with coverage of
79% in rural schools, 91% in urban schools. Unavailability of water and soap is regarded as one of the
major reason of compromising hygiene and sanitary practices47. Personal hygiene can be achieved if
adequate water is available48. Theories of habitual behavior suggest that making handwashing habitual
43
K. and Ahmed, R. 2006. Addressing special needs of girls Challenges in school. Presented in
SACOSAN II, 2006 at Islamabad, Pakistan. pp. 3-4
44
Curtis, V., and Cairncross, S (2003). Effect of washing hands with soap on diarrhoea risk in
the community: A systematic review. The Lancet, 3(5): 275-281.]
45
Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community-
William Checkley, Robert H Gilman, Robert E Black, Leonardo D Epstein, Lilia Cabrera,
Charles R Sterling,Lawrence H Moulton
46
Water, Sanitation, and Hygiene in Schools in Low Socio-Economic Regions in Nicaragua: A
Cross-Sectional Survey : Tania Jordanova 1,*, Ryan Cronk 1, Wanda Obando 2, Octavio
Zeledon Medina 3, Rinko Kinoshita 2 and Jamie Bartram 1,* Int. J. Environ. Res. Public Health
2015, 12, 6197-6217; doi:10.3390/ijerph120606197
47
Mensah P, Yeboah-Manu D, Owusu- Darko K and Ablordey A Street foods in Accra, Ghana:
how safe are they? Bulletin of the World Health Organization. The International Journal of
Public Health. 80, (7). WHO, Geneva.2002: 546-553)
48
Latham MC Human nutrition in tropical Africa. FAO, Rome. 1997: 329-437.
requires creating a stable context for handwashing that can be met by making sure infrastructure for
handwashing at all times49.
Inequalities in water, sanitation and hygiene facilities access between urban and rural schools in this study
is consistent with studies 50 51 in other countries on inequalities in access to water, sanitation and hygiene
facilities. Water and sanitation systems in rural areas be likely to less functional than those in urban areas,
comparatively urban areas had better access to water, sanitation and hygiene facilities operations and
maintenance 52 53.
Conclusion:
Limiting student access to toilets, especially in rural schools and primary schools, requires further
exploration and needs to be addressed. Handwashing awareness of students should improve to ensure
better practices along with handwashing facilities in the schools. To encourage good practices, school
authorities should ensure adequate sanitation and handwashing facilities in all schools. Interventions to
promote handwashing might save a million lives. More and better-designed trials are needed to measure
the impact of washing hands on diarrhoea and acute respiratory infections in developing countries54.
49
Habit vs. intention in the prediction of future behaviour: The role of frequency, context
stability and mental accessibility of past behavior_Unna N. Danner1,*, Henk Aarts1 and Nanne K.
de Vries2_Article first published online: 24 DEC 2010 DOI: 10.1348/014466607X230876
50
Cumming, O.; Elliott, M.; Overbo, A.; Bartram, J. Does global progress on sanitation really lag
behind water? An analysis of global progress on community-and household-level access to safe
water and sanitation. PLoS ONE 2014, 9, doi:10.1371/journal.pone.0114699.
51
Fehr, A.; Sahin, M.; Freeman, M.C. Sub-national inequities in philippine water access
associated with poverty and water potential. J. Water Sanit. Hyg Develop 2013, 3, 638–645.
52
Christenson, E.; Bain, R.; Wright, J.; Aondoakaa, S.; Hossain, R.; Bartram, J. Examining the
influence of urban definition when assessing relative safety of drinking-water in Nigeria.
Sci. Total Environ. 2014, 490, 301–312.
53
Montgomery, M.A.; Bartram, J.; Elimelech, M. Increasing functional sustainability of water
andsanitation supplies in rural sub-Saharan Africa. Environ. Eng. Sci. 2009, 26, 1017–1023.
54
Curtis, V., and Cairncross, S (2003). Effect of washing hands with soap on diarrhoea risk in
the community: A systematic review. The Lancet, 3(5): 275-281.
Table 1: Summary of school and respondent characteristics, National Hygiene Survey, 2013
Indicator Rural Urban Difference 95% CI
*
n/N % n/N % (%)
Type of School:
Primary 271/350 77 240/350 69 -8.9 (0.012) (-15.8, -1.9)
Secondary 79/350 23 110/350 31 8.9 (0.012) (1.9, 15.8)
Female students in 61,050/117,2 125,274/225,
52 55 3.4 (0.001) (1.4, 5.5)
school: 63 027
Mean number of
N=350 335 N=350 643 308 (0.000) (207, 409)
students per school
Respondents from
school:
Head master 186/350 53 189/350 54 0.9 (0.601) (-2.4, 4.1)
Teacher 164/350 47 161/350 46 -0.9 (0.601) (-4.1, 2.4)
Female students 787/1,400 56 859/1,400 61 5.1 (0.031) (0.5, 9.8)
Age group of
interviewed students :
<10 years 831/1,400 59 732/1,400 52 -7.1 (0.019) (-13, -1.1)
< 10 years
464/1,400 33 421/1,400 30 -3.1 (0.130) (-7.0, 0.9)
(female)
> 10 years
323/1,400 23 438/1,400 31 8.2 (0.004) (2.6, 13.8)
(female)
*
Clustering effect adjusted for cluster by using Generalized Estimating Equation (GEE) model
Table 2: Drinking water sources at schools (spot checked)

n/N % n/N % (%)*
‡ §
Improved functional drinking water
275/350 79 318/350 91 12.3 (0.000) (5.8, 18.8)
source at schools:
Drinking water sources by types at
schools:
(-28.2, -
Shallow tube-well 179/350 51 127/350 36 -14.9 (0.029)
1.5)
Deep tube-well 84/350 24 66/350 19 -5.1 (0.318) (-15.2, 5.0)
Protected dug- well/spring 2/350 1 2/350 1 0.0 (1.000) (-1.6, 1.6)
Tap water into school compound 11/350 3 117/350 33 30.3 (0.000) (19, 41.5)
Tap water into area outside
1/350 0 5/350 1 1.1 (0.146) (-0.4, 2.7)
compound/public
Direct / unprotected channel‡ 2/350 1 2/350 1 0.0 (1.000) (-1.1, 1.1)
No functional water sources at (-17.8, -
71/350 20 31/350 9 -11.4 (0.000)
school 5.1)
Arsenic contamination tested in last

71/350 20 50/350 14 -6.0 (0.061) (-12.3, 0.3)
yearǁ:
Students carried drinking water from 144/140 513/140 (18.9,
¶
10 37 26.4 (0.000)
home 0 0 33.8)
*
Clustering effect adjusted for cluster by using Generalized Estimating Equation (GEE) model;
‡
According to JMP Definition Improved sources are: Piped water into dwelling or yard/plot, Public tap or
standpipe, Tubewell or borehole, Protected dug well, Protected spring, Rainwater;
§
Water is available during the survey period and year round (Observed);
ǁ Information reported by headmaster/teacher or identified as red or green painted tubewell during spot
check
¶
Students were asked what they usually do
Table 3: Access to sanitation and handwashing facilities for students

% or % or (%)*
n/N n/N
mean mean
Functional‡ improved§ toilet facilities
293/350 84 320/350 91 7.7 (0.004) (2.5, 12.9)
available at schools
No toilet at school for students 17/350 5 2/350 1 -4.3 (0.001) (-6.7, -1.8)
Number of students per toilet N=293 74 N=320 87 14 (0.008) (3.6, 24)
Functional Improved unlocked toilets 149/350 43 214/350 61 15.5 (0.003) (5.2, 25.7)
Number of students per functional,
N=149 67 N=214 85 16.5 (0.002) (6.0, 27)
improved, unlocked toilet
Functional improved unlocked toilet
for students that appeared clean 58/350 17 66/350 19 2.3 (0.488) (-4.2, 8.7)
(floor, slab and pan)
Schools that have toilet for students
by category:
Piped sewer system- improved 1/350 0 57/350 16 16.0 (0.000) (8.1, 23.9)
Septic tank- improved 99/350 28 157/350 45 16.6 (0.005) (4.9, 28.2)
(-38.8, -
Pit- Sanitary- improved 218/350 62 126/350 36 -26.3 (0.000)
13.8)
Flush anywhere- unimproved 4/350 1 5/350 1 0.3 (0.776) (-1.7, 2.2)
Open pit- unimproved 11/350 3 3/350 1 -2.3 (0.043) (-4.5, -0.1)
No facilities 17/350 5 2/350 1 -4.3 (0.001) (-6.7, -1.8)
*
‡
Toilets were useable year the round;
§
Improved toilet according to JMP: Flush or pour-flush to - piped sewer system, septic tank, pit toilet,
Ventilated improved pit (VIP) toilet, Pit toilet with slab, Composting toilet;
ǁ Toilet always unlocked for students during school hours
Table 4: Student hand cleanliness, handwashing demonstration and amount spent for soap purchase
*
n/N % n/N % (%)
Water and soap available inside or
108/350 31 161/350 46 15.1 (0.001) (5.9, 24)
nearby (<30 feet from the toilet)
Students hands –(finger pad, finger
434/1,40 627/1,40
nails inside and outside and palms) 31 45 13.8 (0.000) (8.2, 19.4)
0 0
appeared clean
Students washed both hands with
382/1,40 425/1,40
soap during handwashing 27 30 3.1 (0.344) (-3.3, 9.4)
0 0
demonstration
Average amount of money (USD)
spent per school in last 30 days for
N=350 0.73 N=350 1.32 0.6 (0.000) (0.3, 0.9)
bar or liquid soap purchase
(Reported by headmaster/ teacher)
*
Table 5: Student handwashing knowledge: important times to wash hands with soap (open ended)
Indicator School with Difference 95% CI
*
designated HW Rest of the school (%)
place with soap
n/N % n/N %
Before food preparation 89/1,116 8 113/1,684 7 3.2 (0.045) (0.1, 6.2)
1,445/1,68
Before eating 990/1,116 89 86 1.9 (0.364) (-2.2, 5.9)
4
Before feeding a child 35/1,116 3 39/1,684 2 0.8 (0.323) (-0.8, 2.5)
1,561/1,68
After defecation 1050/1,116 94 93 3.7 (0.001) (1.5, 6.0)
4
After cleaning a defecated
3/1,116 0.3 3/1,684 0.2 -0.1 (0.634) (-0.3, 0.2)
child/cleaning child's feces
*
Non – Utilization of Sanitary Infrastructure (NUSI) tool to operationalize defunct toilets

By
V.Ganapathy (Liaision Officer, Exnora International, Chennai &
Special Correspondent THE HINDU (Retd.) Mail id: [email protected]
NUSI tool to operationalize defunct or underutilized community toilets.
I am extremely happy to inform you that the new Swachh Bharat Mission (SBM) announced by the Prime
Minister Mr.Narendra Modi in August 2014 aims not just in providing toilets for over 60% of the Indian
population but in ensuring the principle of Fecal sludge management in the toilet models so that India
would become a nation with environmentally friendly sustainable sanitation facilities. Under the SBM it
has been recognized that what is below the toilet(where the treatment of human waste takes place) is as
or more important than what is above the ground.
Exnora’s advocacy of NUSP & CSP
ExNoRa International, Chennai has been working in the field of Sanitation, Solid Waste Management and
health and hygiene for over 25 years. It has been a facilitator basically with the vision of improving the
capacity of the different stakeholders so that the facility provided will be sustainable. The Government of
India came out with the National Urban Sanitation Policy in 2008. Exnora in collaboration with WaterAid,
a U.K. based funding agency, Exnora International since 2010 decided to create awareness among Urban
local bodies, elected representatives of the ULBs and with the grass root level officials. It in touch with the
heads of departments of ULB at the state level held discussions with the state sanitation programmes and
aligned its own approaches with the Government policies. It translated into Tamil the basic concept and
action plan of the NUSP and distributed the same to the ULBs( Municipal Corporations and Municipal
towns and Town Panchayats).
22 Towns Selected based on ULBs demand:
Exnora adopted a participatory approach in all its programmes. It in collaboration with WaterAid , it
selected nine Municipal towns in the first phase(2010-13). The selection of the town was such that they
differed in agro-climatic conditions, and different cultural communities . Udhagamandalam a hill station,
Kulithalai on the banks of the river Cauvery, Velankanni a coastal christian pilgrim centre and
Tiruvannamalai in the heartland which attracted several lakhs of pilgrims etc. The idea was that the
challenges faced in CSP preparations in different regions could be understood and solutions suggested so
that replication and scaling up of CSP will be easier. There are 16 Corporations, 129 Municipalities and
529 Town Panchayats which all needed City Sanitation Plans for better sanitation facilities, sewage
management, solid waste Management storm water drainage and water supply.
In the second phase 13 towns were selected all in one region, Tiruppur region comprising of the four
districts of Udhagamandalam, Coimbatore, Erode and Tiruppur. Exnora has prepared CSPs for all the
towns as per NUSP guidelines. The CSPs of 9 towns have been handed over to the department of
Municipal Administration and the CSPs of 13 more Municipalities will be handed over by 31st March.
Community led Total Sanitation (CLTS) in CSP towns
Exnora made a distinction between community toilets and public toilets. Community toilets were those
constructed in areas where the individual householders were not having adequate space in their houses
and had access to sanitation in the community toilet. Over 95% of the users were residents of the same
area who used the toilet every day. On the other hand the public toilet was toilet complexes in railway
stations , bus stations , sports grounds etc. People who use the public toilets were mostly commuters who
were moving from place to place and towns to towns. This group of users had no difficulty or mindset to
pay a user fee for the visit to the toilet.
Revelation of condition of community toilets during CSP study.
During CSP preparation in 22 towns in close collaboration with the local community and Urban local body
it was revealed that much of the infrastructure facilities (Community toilets) created by the ULBs were
not put into full use. Though at the beginning the toilets constructed at a cost of 5-7 lakhs some years ago
residents of the area welcomed the same and considered it a boon to end the ignominy of open
defecation. The local bodies which constructed the toilets had not taken up the critical issue of Operation
and Maintenance of the toilets. People who had no space for construction of IHHLS in their own homes
and started using the toilets soon found that there was no O & M system. However in the absence of a
clear O & M protocol many of the CLTS developed problems. Most of the users also had not used toilets
and were not aware of the proper minimum toilet usage practices. A majority of them, first generation
toilet users, though wanted to use the toilets found the same in such a bad condition that within a year
the toilet had become unusable and most of them abandoned using the toilet and that they were
unfortunately again forced to revert to Open defecation. This is true of a large number of Integrated
women sanitary complexes also built by the Government earlier.
ExNoRa after preliminary studies found that the cost of retrofitting the same was less that 20% of the cost
of construction of a new toilet. A systematic study by Exnora staff revealed that the basic defects in the
toilets were the failure of water source,
plumbing system, leading to non availability of
water or stagnation of black water within the
toilet campus or blockage of the pipes leading to
the treatment septic tank. There were certain
basic defects in the construction of the
treatment tank such as absence of proper
manholes, poor plastering of the covering slabs
at the top leading to overflowing of sewage
resulting in overflowing of the blackwater in and
around the toilet making it an unhygienic spot
repugnant to the users. Absence of power
supply, wild growth of bushes on the path
leading to the community toilet and in and around

the community toilets also contributed it falling
into disuse. Some users had blocked the toilet pan
with broken bottles and plastic cups. Sanitary
napkins were stacked on the Jali works built for
ventilation.
O & M committee meeting

O & M committee & NUSI Tool
ExNoRa studied over 350 community toilets in 20 municipal towns and developed a new tool - Non
Utilization of Sanitary Infrastructure (NUSI) facilities and how to retrofit the same and more importantly
establish a user group to be in charge of Operation & Maintenance of the Community toilet.
After NUSI study, Exnora decided to intervene and restore the toilet to a usable condition. It interacted
with the community and organised a series of focused group discussions motivating them to take charge
of the O & M of the toilet. It organized a meeting of users of the Kavalkaran street in Kulithalai built two
years ago but was abandoned due to highly unhygienic conditions by the users. Exnora invited all the users
of the toilet to a common place near the toilet. The local ward councilor and the local sanitary staff also
were invited for the meeting. At the meeting the various problems studied by Exnora in the town were
explained to them. Some photographs of the very poor conditions of the toilets were also displayed. Soon
all the toilet users came to the conclusion that if they took over the supervision of the O & M of the toilet
it will improve the matters drastically. The ward member and the staff of Kulithalai Municipality agreed
to repair the toilets on condition that the users would form and O & M committee.
 The O & M committee comprised of 12 members who were regular users of the facility.
 Awareness on using the public toilet was created among the residents through exposure
visit to successful facilities, street plays etc and were encouraged to use the facility and
maintain cleanliness of their property.
 A register was maintained to ensure that the municipal staff cleaned the toilet daily. The
Supervisor or the Commissioner during their field rounds verified the register and counter
signed and gave their remarks.
 Waste bins with tight lid were kept for safe disposal of sanitary napkins which are
otherwise regularly dumped in the toilet seats leading to frequent clogging.
On seeing the successful and neat and hygienic toilet in Kavalkaran street in Kulithalai, there was demand
from other four toilets for immediate action and formation of O & M committees.
An O & M committee was formed and through the committee, representations were made to the
Municipality to renovate the facility and open it for public use. Representatives of ExNoRa International
facilitated meetings and face to face discussion of the issue with the higher officials and paved the way
for speedy renovation of the facility.
A federation of representatives from each toilet (President,Secretary) has been formed in the town who
meet the Municipal staff at regular intervals to make any suggestions for improvement or correction of
deficiencies. The Kulithalai experiment clearly indicates that social mobilization and awareness generation
on the need and usage of community toilets were very important for the sustainable functioning of the
toilets. The Municipality need not spend huge amounts on construction of new toilets but could establish
O & M committees so that with minimum expenditure they could be maintained well and the environment
could be neat and clean. Building better understanding among the public,strengthening the local
organisations and community participation are the key mantras for successful functioning of community
toilets. All programmes of ExNoRa international and WaterAid are not NGO driven programmes but are
participatory and community owned programmes.
NUSI Study Questionnaire:
On the basis of the study, the ULBs found retrofitting and better O & M system was economically attractive
and also ensured long term O & M of the toilets. A separate questionnaire was prepared and the Exnora
team alongwith the Community members visited the toilets and studied the actual status of the toilet
facilities. The tool helped the local women to understand the simple methods of O & M and how to ensure
that the cleaning staff performed their duties regularly and efficiently. With the tool about 300 O & M
teams(user groups) mostly women were formed for the day to day up keep of the community toilet. The
user group members were not cleaning the toilets but ensuring that the sanitary staff performed their
work each and every day without fail.
The O & M groups also ensured that the Community toilet got sufficient cleaning materials from the ULB.
The Exnora team visited the toilets at regular intervals to educate and motivate the O & M committee
members. The Exnora team also formed Federation of O & M committees in three towns. They acted as
a link between the community and the ULB authorities. This has resulted in a drastic change in the
condition of the community toilets. The NUSI tool is being preferred by many ULBs and ExNoRa is
promoting the same.
Slice approach
The complex problem of open defecation looks grim due to its magnitude. However through slice
approach, it is fragmented in to simple steps (technical, social and institutional) and handled effectively.
The minor repairs executed with the general funds of the ULB brought in visible changes and attracted
locals to use in the absence of other alternatives. Parallel to this, the social mobilization and preparatory
efforts through systematic approaches added strength to the initiative.
Impact and Conclusion
The systematic approach which is tested and proved successful is currently being replicated in
other 22 CSP towns and O&M committees are formed to improve number of toilet users and better
maintenance of the facility. The State Government has recognised the strength of this approach and is
asking other ULBs to adopt this approach to ensure sustainability of the created sanitation infrastructures.
The use of tool is done in a participatory manner involving the users and the ULB as a service provider.
ExNoRa International limited its role for minimal handholding to avoid the NGO approach and the long
term dependence of an external agency for addressing even a simple issue. Thanks to NUSI tool those
resorting to open defecation first then abandoned the toilets due to its poor and unhygienic condition
have once again come back to use the toilets and also understood that it is worth paying for toilet usage
if it is maintained neat, clean and hygienic.
A newly built community toilet in Mettupalayam maintained by the O & M committee
Sl. Name of the Population Families Public Unused Unused *Renovated Renovated O & MC
No Municipality (2011 census) toilet public Public toilet’s public toilet Public toilet’s
toilet seats seats
1 Udumalaipettai 61,150 17,526 23 6 30 5 20 10

2 Palladam 42,243 14,077 28 4 12 12 102 6
3 Kangeyam 33,263 9,723 8 1 14 0 0 2
4 Vellakoil 40,250 12,157 11 5 39 3 26 4
5 Dharapuram 56,163 15,826 36 6 44 11 107 7
6 Pollachi 90,124 25,904 39 6 42 21 174 14
7 Valaparai 74,181 19,503 13 1 10 0 0 2
8 Mettupalayam 69,128 18,493 33 7 68 6 58 9
9 Bhavani 39,352 11,160 32 4 30 4 30 8
10 Punchaipuliampatti 18,974 7,333 8 0 0 4 32 2
11 Sathyamangalam 38,323 10,898 32 8 60 2 20 6
12 Gobichettipalayam 59,407 17,436 37 8 47 2 12 4
13 Uthagamandalam 87,422 24,686 99 18 127 18 108 5
14 Coonoor 45,714 12,405 44 12 83 6 34 5
15 Nelliyalam 44,590 10,729 9 6 38 0 0 2
16 Gudalur 50,035 11,598 23 7 50 0 0 3
17 Thiruvalluvar 54,416 13604 13 1 76 0 0 6
18 Vailankanni 11,707 3238 13 3 11 3 11 4
19 Thiruvannamalai 136,583 29472 22 7 80 5 60 0
20 Aranthangi 40,829 10340 14 2 20 4 32 6
21 Walajapet 32,464 7750 14 7 78 5 40 6
22 Kulithalai 28,368 7560 21 4 22 13 112 20

Total 1,154,686 311,418 572 123 981 124 978 131
BETTER SANITATION BETTER LIFE

230 6th South Asian Conference on Sanitation (SACOSAN-VI)
WASH in Institutions and Public Places for transforming lives – Sanitation Matters!
Authors:
Kabindra Bikram Karki,Sector Efficiency Improvement Unit, MoUD, [email protected]
Shikha Shrestha, WaterAid Nepal, Rearch & Advocacy Manager, [email protected]
Nam Raj Khatri, WASH Expert, [email protected]
Himalaya Panthi, Nepal Water for Health (NEWAH), Social Development Manager
Keshab Shrestha, Urban Environment Management Society (UEMS), Programme Coordinator
Sanna-Leena Rautanen, Resham Phuldel, Kalpana Dishwa, Rural Water Supply and Sanitation Project in
Western Nepal (RWSS-WN) Phase II, [email protected]
Gunaraj Shrestha, NC, WSSCC, Gunaraj_shrestha@ yahoo.com
Manima Budhathoki, CODEF Nepal
Introduction
Nepal’s accelerated achievement in sanitation, 70% in 2014 is commendable. Open Defecation Free (ODF)
movement is at its height55. Nepal has set a national target of providing water and sanitation facilities for
all by 2017. Till recent past, Sanitation was heavily subsidized intervention. Now it is being taken as social
norms. Ultra poor are covered by safety-net such as output based aid (OBA) approach. The approach
provides hardware support for the ultra-poor and lonely old aged people, as the lack of these can
compromise the ODF status. Despite of frog-leap progress in household toilet construction, the goal of
attaining ODF Nepal seems challenging in absence of toilet facilities in public places and institutions.
The Sanitation and Hygiene Master Plan (SHMP) 2011 has proved to be the guide-post for sanitation
movement in Nepal in recent years. It outlines a key criterion for ODF that all schools, health facilities and
public institutions should have Child, Gender and Differently-abled friendly (CGD) friendly water, toilet and
hand washing including menstrual hygiene facilities. It emphasizes on provision of public toilets, apart from
household toilets, in order to achieve good personal, household and environmental sanitation. It has also
envisioned an institutional setup from central level to the grass-root level (Figure 1).
SHMP 2011 has also clearly indicated CGD friendly options as:
• Child friendly features: “include water taps, knobs and latches of toilet doors and windows at suitable
heights and convenience for children at different ages.”
• Gender friendly features: “the location of the toilet should be appropriately selected in a safe and
secure place and the door, windows and ventilation should safeguard privacy. In addition to water, in
schools and other public institutions, the toilet should have facilities for maintaining menstrual hygiene
management (MHM).”
• Differently-abled friendly toilet: “should include a ramp up to toilet, sufficient space for a wheelchair
in the passage, hand railing in the passage and, within the toilet cubicles, appropriate types of seating
arrangements and support on the toilet.”
5527 districts out of 75, 78 municipalities out of a total of 191, and 2013 VDCs out of total 3276 declared ODF zones as
of mid October 2015
RWSSP-WN, WaterAid Nepal (WAN) and Federation of Water & Sanitation Users of Nepal (FEDWASUN) are
using Social Accountability Tools like Community Scorecard with simple 20 indicators for common
understanding on girl friendly provisions on WASH in schools (WinS).
MoUD
National Sanitation & Hygiene Sector Stakeholder Group

Coordination Committee (Sharing, consultation &
(Executive Committee chaired dissemination- chaired by
Secretary)
by Secretary, 16 members)
Water Quality Sanitation and Hygiene Other Thematic

Steering Committee Steering Committee Groups
17 Members
San &Hygiene
Coordination Committee
Regional WASHCC
District WASHCC
Municipal/Village
WASHCC
Figure: Sector Institutional Set up
Not only in institutions but community/city-wide ODF campaign also requires public toilets in public places
and highways for maintaining ODF conditions. Public toilet is defined as a small building containing one or
more toilets with urinals and hand washing facilities available for general public. There has been increased
attention for constructing public toilets catering special needs of women and girls, children and persons
with disabilities. There are negligible numbers of public toilets in the country and poor condition of these
toilets is further repelling people from using these services. None of the public toilets in Kathmandu is
constructed catering need of persons with disabilities. However, Clean City Program 2013 together with
recent budget policy of constructing at least 400 public toilets in Kathmandu valley brings ample of
opportunities for building user friendly public toilets. This paper also highlights technology, operations,
management, including sludge management aspect, of one of the public toilets based on case study
prepared as part of Joint Sector Review 2014.
Health care facilities should establish themselves as the model institution demonstrating clean and healthy
environment. It comprises of indicators like safe and adequate water, good toilet facilities, hygienic and
clean environment of premises as well as cleanliness of beds, wards and toilets; proper health care waste
management and demonstrated hygienic behavior by health workers and patients. The paper briefly
presents the status of safe water and sanitation condition and hygienic behavior demonstrated in the health
facilities.
Situation is now aggravated by the earthquake, damage equivalent to $ 114 millions affecting 7700 water
supply and 388,000 toilets in 31 districts56 challenging women and girls dignity including MHM. This paper
tries to explore and identify the perceptions and barriers/challenges to MHM faced by women and girls
under temporary shelter during the devastating earthquake on April 25, 2015 and its continued aftershocks.
Materials and Methods:

The paper is prepared by reviewing legal frameworks, policy and plan, learning and analyses in the areas of
WASH in institutions and public places. Learning documents, case studies and assessments are primary
source of information. Different presentations and studies made on WASH in institutions has been
consolidated for identifying key recommendations for promoting sustainable sanitation facilities and
hygienic condition in institutions and public places. Some of the key approaches followed by the authors
were:
 Assessment of Public, Institutional and School Latrines under RWSSP-WN Phase II utilized primary data
collected for baseline of the project and sharpening the working approach of the project.
 Content on Public toilet finding is mainly based on the case study prepared for the Second Joint Sector
Review (JSR) of WASH sector. Learning visit was organized as a process of the JSR to understand the
situation in the five development regions of Nepal in various themes. The case study of Dhankuta
Municipality in Eastern Nepal has been used as the key content.
 Some of the WinS content has been developed by consolidating experiences and insights of WaterAid,
NEWAH, FEDWASUN, UEMS working together with Department of Education (DoE), School
Management Committees (SMC), Child Clubs, Parent-Teacher Associations (PTAs). Besides, RWSSP-WN
analysis on WASH in institutions has also been incorporated.
 WASH in Health Facilities content has been extracted from the analyses of key two reports from WHO
and WaterAid on status of WASH in Health Facilities.
 MHM substance has been generated by an assessment conducted in temporary shelters located in
Tudikhel, Social Welfare Council Premise and Chuchepati areas of Kathmandu. In-depth interview
focused on women having kids and school and college going girls; FGD with 9 women and girls in each
group; Spot Observations were used as the means of information collection. Besides, learning of
WaterAid on MHM in shelters has also been included.
56PDNA 2015, 31 districts out of total 75 districts affected and 14 declared as “crisis hit” from the earthquake
Scenario, Issues and Challenges

Present status and Policy Environment
Constitution of Nepal has recognized safe water and sanitation as fundamental rights. The Master Plan has
outlined that all institutions should have users-friendly clean, hygienic toilets with hand washing station
and proper waste management facilities and clean and hygienic premises. It has mentioned that there
should be CGD friendly WASH facilities together with MHM facilities. Besides, Guidelines on Disable Friendly
Infrastructure Facilities and Communication Services has clearly spelt out for the need of accessible public
toilets as well as toilets in public offices and entertainment centers should also be constructed considering
different needs of person with disabilities.
The country is in the process of finalizing new Water and Sanitation Policy and Act as well as WASH Sector
Development Plan (SDP). All these acts, policies and plans have given due focus on WASH in institutions.
School Sector Reform Plan (SSRP) 2009-15, emphasizes on minimum conditions required for meeting
various needs on physical and learning environment of students. The National Framework for Child Friendly
School 2010 has set minimum standards including separate male and female toilets with separate
arrangement of urination and defecation with running water, for girls and boys, at a ratio of one toilet for
50 students. Guidelines on Disabled Friendly Infrastructure Facilities and Communication Services 2013 and
Total Sanitation Guideline 2015 (draft) are other key policy documents that have defined user friendly
WASH in Institutions.
Department of Education states that there are 29,630 community schools with 6,293,112 students. Nearly
80% of these schools have toilet and drinking water facilities. However, only 68% have separate toilets for
girls. In contrary to the standard of one toilet for 50 students, in reality 88 students are using one toilet.
There is need of constructing nearly 54,680 toilets to meet the above standard by 2017. However, the
situation is now aggravated by the earthquake affecting 5748 schools damaging nearly 3800 school toilets
and 1600 water supply in 59 Districts57. The Department admit it’s less emphasis on the software activities
targeting hygienic behavior promotion and accountability promotion for ensuring sustainability and
functionality.
Total 316 toilets supported in RWSSP-WN Phase I, were assessed using the “Saniscores” defined as
described below:
0: Not completed/not used = damaged beyond use
1: Completed but not used/less use or extremely dirty/recently completed not in use yet
2: Completed, used but dirty
3: Completed, used but could be cleaner/some damage
4: Completed, clean but less used
5: Completed, used, clean and has water – perfect case
It was found that 9% were not completed; 8% completed but not used or extremely dirty beyond use; 16%
used but dirty; 43% used but could be cleaner with minor physical damage; and 13% clean but less used.
Only 11% was used, clean and had water. While 83% were in use, majority (76%) were not clean and/or had
57Department of Education based on Cluster Assessment, October 2015

issues with their physical condition. Sustainability of these services was dependent on effectiveness of
community supervision and monitoring.
Study conducted in 31 out of 234 hospitals (13%) indicated that 84% have water from safe protected source,
over 52% from acceptable source and 16% from worse protected ones. Situation of government and private
hospitals are not the same. Similarly, health posts of villages are less equipped and relatively more
unhygienic. 58
WHO, 2012 study revealed that 84% hospitals do not have proper waste water management. More than
half, i.e. 42% of hospitals have poor level of hand washing facilities. Similarly, 39% of hospitals did not have
hand washing materials and most of the hand washing stations for patients and visitors did not have soap.
Nearly half of the hospitals only have acceptable food hygiene. There is still less clarity in institutional
strategic direction in the health sector and the Ministry of Health is in the process of preparing National
Environmental Health and Hygiene Strategy 2016-2020.
55% 52%
20% 18%
0% 0%
Water Water Access of Person with Toilet Toilet with

Treatment Quality water for disability without dustbins
Monitoring patients/ and child faecal
Provision care takers friendly stains
toilet
Source: Assessment of WASH Status in Health Facilities, WaterAid Nepal & NFCC, 2015
Sector Financing Deficit

Sanitation and Hygiene should not be treated in isolation ignoring its inter-linkage with other
development facets like health and education. Therefore, sector financing of these sectors should be
analyzed together.
58
Environmental Health Condition of Hospitals in Nepal, WHO and Center for Public Health and Environmental
Development (CEPHED), 2012
Budget Trend in WASH, Health and Education (NRs in billions)
98.6
86
81
57 63.2 63.4
46.4
33.7 37.8 41.3
18.7 24.5 27.1 22.5
9 9.3 9 9.3 13.1 15.3 16.6
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
WASH Health Education
Source: WaterAid Nepal analyses based on GoN Budget,2015

In Nepal, 60% of the WASH sector budget is government fund whereas 80% and 84% are government
funds for health and education sectors.59 Therefore, the government commitment towards these two
sectors are relatively higher than WASH sector so the integration on WASH in these sectors should not
be undermined for achieving total sanitation in the country.
It is estimated that NRs 6.6 billion annual budget is required for constructing girl friendly toilets to meet
standard of 1:50 students by 2017, however, the current allocation of NRs. 1 billion budget indicates
huge budget gap in the educational sector.60 It has been estimated that NRs 600,000 is required for
constructing each girl friendly toilet; however the Department of Education is allocating only NRs
400,000 per toilet. Lower budget allocation is considered as one of the key reasons of lower demands
of toilet construction in the community schools.
On the other hand, there is requirement of constructing at least 19,000 toilets per year considering
number of damaged toilets. However, the Department has the plan for constructing 700 girl friendly
toilets, 1000 common toilets and maintenance of 700 toilets. It clearly indicates the budget deficit in
WinS. In case of WASH in health facilities, a clear financing gap analyses is yet to be conducted.
Sustainable Management of Public toilets
Public toilet should be located in the area where people are likely to search for toilet. The draft Total
Sanitation Guideline states that public toilet should be constructed in all transport terminals, major bus
parks, central areas, shopping centres, refuelling stations, parks, sports and leisure areas, hotels,
restaurants, industries and public offices. It has also indicated that there should be public toilets in every
5 Km along main road. It should have adequate operating time and provision for intensification for use
during peak times. Considering the challenge of sustained cost effective services of the public toilets,
the draft Guidelines has some management options. It has stated that public sanitation facility should
be owned by local body and management committees comprising of local bodies, community leaders,
NGO/CBO.
59
WaterAid analysis of Government Budget , 2015
60 Department of Education Presentation on WASH Sector Stakeholder Group Meeting, October 2015
235
Proper planning of public toilets is required to ensure secured space, adequate lightening, user friendly
options considering special needs of women and girls, children and person with disabilities. It is a
challenging task to maintain hygienic environment and increased morale of operating staff or people
with adequate funding for operation and maintenance. There should be good provision for ensuring
adequate water availability, sludge and solid waste management.
It is essential to ensure at least equal number of male and female toilet provisions considering needs of
different users. There should be well defined minimum acceptable queuing times calculated on the basis
of potential number of users. It is essential to manage acceptable opening hours so that it can be opened
24 hours a day. Security of the premise should be considered taking into account negatives, crimes and
anti-social factors. There should be established principles of the Spatial Toilet Hierarchy Plan with proper
management plan with resources for management, maintenance and sustainability.
The operator, individual or group contracted through proper bidding process should provide sanitation
services on behalf of management committee (MC). The selected operator should sign a contract with
the MC in the presence of technical service provider, which stipulates in detail the rights and
responsibilities of three parties as well as the rights and responsibilities of the customers and other
stakeholders. The operator has to carry out regular technical inspections. The operator is also
responsible for maintaining clean hygienic condition. Customers should pay the operator the charges
fixed by the MC.
Public Toilet in Dhankuta Bus station was constructed as a conscious effort to make the bus station free
from open urination and defecation. Taxi Association, a private sector entity, was selected as an ideal
partner. The toilet was constructed in 2010 with a contribution of Rs 38,60,000 by the municipality and
Rs 40,000 by the Taxi Association. Biogas plant of the toilet was supported by Bio Gas Support Program.
This toilet consists of separate chambers for male and female with additional facilities for bathing,
changing room and sanitary napkin disposal bins and a store room. This toilet has been maintained by
one person who collects Rs 2 and Rs 5 for urination and defecation. He pays Rs.9000 per month to
Municipality and Rs.3000 to Taxi Association and earns about Rs 1000 per day. He, with his saving, has
also bought a washing machine and now provides laundry service as well charging Rs 20 per cloth.
Sustainable management of public toilet in Dhankuta has been possible due to presence of well thought
model owned by local authorities that is responsible for engaging private group for operation and
maintenance along with presence of professional technical team for monitoring and technical support.
User friendly WASH services require understanding complexities together with proper monitoring
mechanisms
The RWSSP-WN Phase II Baseline found that 57% of 294 completed and used latrines had water supply
facility and 60% had hand washing facility. Only 24% were described as ‘CGD’ friendly. Even out of the
school toilets, only 22% were CGD friendly. The District-wise differences were also very clear: there were
Districts where none of the toilets were described as CGD friendly, for instance, while another District
could have 78% described as such. This indicates that the technical drawings do'nt have these features
as a template. Therefore, if CGD qualities are not encouraged by community, CGD friendly provisions
will not materialize. This calls for both technical design templates and feasibility study formats that do

pay affirmative specific attention to CGD features. Furthermore, if these are not verified in timely
monitoring with quality indicators before proceeding to construction phase, they may not be there.
Table 2. Facilities observed (N-294)
Institu Institu
Public School Grand Public School Grand
-tional -tional
Facilities toilet toilet Total toilet toilet Total
toilet toilet
(#) (#) (#) (%) (%) (%)
(#) (%)
Water supply - No 44 21 61 126 53% 40% 38% 43%
Water supply - Yes 39 31 98 168 47% 60% 62% 57%
Handwashing - No 29 25 64 118 35% 48% 40% 40%
Handwashing - Yes 54 27 95 176 65% 52% 60% 60%
CGD friendly - No 60 40 124 224 72% 77% 78% 76%
CGD friendly - Yes 23 12 35 70 28% 23% 22% 24%
Grand Total 83 52 159 294 100% 100% 100% 100%
Source: RWSSP-WN verification survey (March/April 2014)
While defining service delivery models and standards for these

facilities, the users should be taken as the point of entry: who are
they? What are their expectations? What are the options for
providing both sanitation and hygiene services, what would they
expect? What kind of other services can be included, and how
Fig 2: Multiple-services
these should be considered from the beginning before finalizing
service delivery thinking
any technical designs?
needed
Defining the number and types of users would be a challenging task. Schools toilets have a fixed number
of daily users whose behaviour can be influenced with the existing behaviour change communications
tools, an institutional sanitation facility may have a very limited number of both regular and one-time
users, both known and unknown people; public sanitation, in turn, was characterized by potentially very
large number of unknown users and their frequency of use. The categorization could help to draw
attention to those facilities that are more likely to become critical and therefore make it possible to
provide more targeted post-construction support.
237
Sustainable access to water

supply is critical as the full
benefit just cannot be
realized without both
sanitation and hygiene.
Access to hand washing
facility implies that water is
available inside or close
to/within the visibility of the
toilet.
Fig 3: Understanding diversity in numbers and types of user
Menstrual Hygiene Management in Emergency

Even though assessment was conducted in Kathmandu, Menstruation was still a taboo topic and was
not discussed openly. It was interesting to note that menstruation was taboo only for Brahmin, Chhetri
and few ethnic groups. They were not allowed to go to kitchen, cook food, go to worshipping space,
plant vegetables or to touch the fruits plants in the garden but the picture was totally different to ethnic
group like Tamang, Rai, and Magar. They still did not touch God but they were not banned from
household chores including cooking. Even within Brahmin, Chhetri and few ethnic groups, there was
difference between joint and nucleus family, the former being stricter.
Assessment is based in city area, so 90% of women used sanitary pads and they felt more comfortable
and confident as they feel less afraid of leaking and being ashamed in public. They appreciated pads as
they did not have to wash and reuse them unlike clothes. However, 10% women chose clothes due to
unaffordable cost of the pads. Most of women (98%) knew that they should wrap their sanitary pads in
paper and throw in dustbin, in case of clothes: wash it and dry in sun.
In case of emergency, there were less preparedness to cater special needs of women and girls. In the
earthquake, women and their family members were so scared that they could not collect anything from
their damaged house. So, women who menstruated in the earthquake period had to use whatever
clothes they had with them.
A 19 years girl took shelter in Chuchepati as soon as earthquake hit, she had menstruation period next
day, and she didn’t tell anyone because she was very scared. She had to cook for whole family, she felt
great guilt that she touched during her menstruation. She expressed that when she used to be at home
and during her period then there were some places which were prohibited from visiting or certain
activities in which she was not allowed to be part of. She was not allowed to worship God and
restricted from cooking, entering a garden or fetching water. But now she performed all the restricted

jobs when she was in shelter. She compares the situation and portrays that she is too guilty for doing
that.
Source: WSSCC, October 2015
It is not only this guilt but also access to WASH infrastructure required during menstruation period has
affected women’s right to live with dignity.
Saya Nagarkoti, a 20-year old earthquake survivor from Lele-6 says, "Because of the damage to my
house, and the water supplies in my village, I am now staying in one room with my whole family. The
toilet we have is very small and lies far away from my house. It is difficult after dark during the nighttime.
I had to ask my dad and brother, to leave the house for some time, to change my sanitary towel. It’s very
difficult to wash the towels to reuse due to lack of water. Most women here use cloths for a day or two
and they are not able to change and wash them, due to lack of toilets and water services. This has made
it even harder to manage their period, while rebuilding their lives after the earthquake."
Source :WaterAid Nepal, October 2015
There were some fortunate women in the temporary shelter who received packets of sanitary napkins.
They shared that first couple of days were very hard because there were not water and toilet facilities
in the shelter. Later, water and toilet in the shelter was somehow managed. The people in shelters
nearby cities did not have much problems regarding menstruation management as they were at reach
of every rescuer that provided hygiene kits. WASH Cluster, Hygiene Technical Working Group had
contributed in standardizing the hygiene kits considering special needs of women and girls.
Essentiality of Holistic Partnership Approach for sustained change
WASH in Institutions should consider holistic water, improved sanitation and sustained
approach encompassing approaches for hygiene promotion in institutions.
empowering communities so that they are able
to demand and claim their rights. It should be
backed up with accountable and responsive
duty bearers who are committed to ensure
enabling policy and sector financing to protect
rights and demands of people. In order to make
these options financially viable and sustainable,
social entrepreneurship and private sector
engagement should also be considered. Strong
coordination amongst these diverse
stakeholders ranging from community,
government stakeholders, private sectors,
social entrepreneurs and media stakeholders
would support in synergizing the efforts for
achieving the common goal of promoting safe
239
District WASH Coordination Committees are key mechanisms for promoting collaboration between
WASH and other concerned agencies for promoting status of WASH in institutions. Active engagement
of diverse stakeholders has been a key challenge at various levels of coordination. Due to ineffective
sharing mechanisms of schools and Water and Sanitation users Committees and Water Service
Providing Agencies, schools often lack water provisions that have further challenged the maintenances
of environmental health in schools.
FEDWASUN has initiated the process of adopting Community Score Card as a means for empowering
especially girl students and increase accountability of service providers. It is taken as the approach for
conducting joint participatory M&E in presence of students; SMC, PTA, Teachers for improving girl
friendly sanitation in respective schools. There are list of 20 indicators on girl friendly sanitation
focusing on MHM, personal hygiene including hand washing and provision of CGD friendly water and
toilet facilities.
Hygiene promotion through routine immunization program in Nepal is an initiative for integrating
hygiene promotion interventions in the national immunization program of Ministry of Health in four
Districts (Bardiya, Jajarkot, Nawalparasi, Myagdi). Department of Health has completed hygiene
promotion training package for capacitating Female Child Health Volunteers for sensitizing new
mothers for immunizing their children. The project is still in the initial phase with possibilities of scaling
up in the future.
Some NGOs like UEMS, has conducted capacity building events targeting poor women for producing
low cost sanitary pads. These low cost reusable pads have been helpful for girls/women who cannot
afford to spend money for disposable pads that is also not a good solution from solid waste
management perspective in countries like Nepal.
Civil Society Organizations like NEWAH has played a pivotal role in organizing awareness and behavior
change WASH initiatives in Schools with key focus on MHM mobilizing child clubs, SMC, PTA with the
help of illustration based IEC materials. These initiatives has helped in promoting knowledge of
community members mainly girls on different aspects of menstruation and menstrual hygiene and
also provided platform at the local level to start up discussion and debates to help these girls and
women to come out from the stigma associated with menstruation by breaking the silence on the
social taboos. In terms of emergency, these special needs of CGD should be given a high priority while
designing response, recovery and reconstruction.
Next steps for transforming dignity as sanitation matters
Sustained progress on WASH in Institutions requires committed actions at various levels initiating from
global and regional to local sites where the changes happen considering quality performance.

6th South Asian Conference on Sanitation (SACOSAN-VI)241
Expediting regional and global commitment

SACoSan, a government led sanitation convention should continue commitment for promoting
favorable policy environment and ensuring adequately resourced national, sub national sanitation and
hygiene plans for accelerated progress of sanitation and hygiene in educational, health, public
institutions and work places. The platform should also consider increasing strategic actions for
enabling meaningful engagement of children, adolescents, women, the elderly and people with
disabilities and other marginalized sections of society in decision making processes of sanitation and
hygiene policies and programs for increased attention on their special needs and concerns.
SDGs have set the goal-6 for ensuring availability and sustainable management of water and sanitation
for all by 2030. The second target related to ending open defecation has specified a need for taking
consideration on needs of women and girls and those in vulnerable situation as targets. It has also
emphasized on increased participation of local communities for improving water and sanitation
management that clearly links with WASH in Institutions.
Policy and plan frameworks for streamlining cross sector coordination
The draft Umbrella WASH Act and Policy are assumed to streamline the coordinated efforts with
Ministries like Federal Affairs and Local Development; Education; Health that will contribute in
accelerated progress on WASH in Institutions. Similarly, Department of Education is in process of
preparing WinS Guideline and Ministry of Health has initiated discussion for preparing National
Environmental Health and Hygiene Strategy. These policy provisions and guidelines will contribute in
promoting coordinated efforts in cross sector engagement in the country.
The draft WASH Sector Development Plan (SDP) has incorporated indicator “percentage of community
institutions namely schools and health facilities; public offices and key urban locations with CGD
friendly WASH Services. Besides, it has also included an expected result with regard to sector
coordination and inter-agency collaboration. Therefore, it can be stated that the plan has clearly
recognized the need for sector and cross sector coordination and collaboration. The mechanisms for
implementing these plans and policy provisions should be strengthened so that these documents are
translated into actions at the ground.
241
Managing sector financing deficit

WASH Sector Financing Strategy is also being drafted in parallel with the SDP so that “no credible plans
should fail due to financing gap”. In this case, there should be proper allocation of the budget required
for promoting WinS, health facilities, public places and institutions. In this context, sector financing
analyses of education and health sector should be continued as the base for lobbying with concerned
stakeholders for their increased attention on WASH agenda.
The recent aftermath of earthquake has brought increased investment in recovery interventions in
the country. Proper linkage with these humanitarian interventions should be increased for integrating
WASH interventions in the recovery projects.
Engagement of private sectors for promoting WASH in institutions should be explored widely. In this
case, there should be more enabling environment for increased engagement of the private agencies.
In terms of MHM, collaboration and campaigning with MITRA Samaj who focuses on proper disposal
of sanitary napkins will help in raising and addressing the concerns simultaneously. So, exploration of
partnership with these agencies and other private sectors including private schools and hospitals
should also be strengthened.
5.4. Engaging local communities for ensuring sustainability and functionality
People and community are key agents for bringing and sustaining any changes and that’s also true for
promoting WASH in Institutions. In most schools, there are limited budget for managing regular
maintenance cost of WASH services. Some schools have also adopted “One Child, One Soap” at the
campaign that has eased the management of soaps and keeping ownership of soap management to
students. Furthermore, MHM related requirements of girl students should be analyzed on the basis of
social, cultural, economic and geographic contexts for scaling up MHM services in schools. There
should be a provision established for operation and maintenance within these institutions to ensure
functionality of these WASH services and provisions.
Increased awareness and sensitization events of community, duty bearers and service providers
should be continued. Promotion of Social Accountability Tools like Community Score Card, Public
Hearing and Social Audits should be promoted for increased accountability in strengthening WASH in
Institutions.
Networking and alliance building of civil society stakeholders, government agencies and service
providers should be strengthened for collaboration and partnership including performance and
outcome monitoring for increased sustainability of these WASH in Institutions endeavors.
References:
Constitution of Nepal, 2015
Government of Nepal (2015), Post Disaster Need Assessment Report
Government of Nepal (2015), Draft Total Sanitation Guideline
Government of Nepal (2015), Draft Water, Sanitation and Hygiene Sector Development Plan
Government of Nepal (2015), Education Cluster Assessment
Department of Education (2015), Presentation on WASH Sector Stakeholder Group Meeting

Rural Water Supply & Sanitation Project-Western Nepal (2015), Baseline Report for phase-II.
WaterAid Nepal, Nepal Fertility Care Center(2015), WASH Assessment in Health facilities.
WaterAid Nepal (2015), Analysis of Government Budget
Government of Nepal, (2014), Second JSR Compilation of case studies and learning visits
Government of Nepal (2014), Draft Bill on Water and Sanitation
Government of Nepal (2009), School Sector Reform Plan : 2009-15
Government of Nepal (2010) National Framework of Child Friendly Schools
WHO and Center for Public Health and Environmental Development (2012), Environmental Health
Conditions of Hospitals in Nepal
Government of Nepal (2011), Sanitation and Hygiene Master Plan
Water, sanitation and hygiene in health care facilities in South Asia
Authors: Rabin Lal Shrestha: [email protected]

Upama Adhikari: [email protected]
Hendrik van Norden: [email protected]
ABSTRACT: The state of water and sanitation infrastructure, and the practice of good hygiene and
infection prevention and control measures.in health care facilities in South Asia is alarming. There is
limited data on the use of safe drinking water, clean toilets and routine handwashing practices and
adequate hand washing facilities in these centres. The data that is available indicates that some health
centres lack water supply and many lack toilets. Many facilities are not safe or reliable, often
inadequate for staff, patients and visitors. There is an urgent need for both the health and WASH
sectors to prioritize WASH facilities and practices in health care facilities. Setting and enforcing
national standards and norms, including WASH practices, in information management systems,
increasing investments and motivating staff for good WASH practices are key elements of the way
forward. Good WASH practices in health care facilities will benefit safe deliveries, overall infection
prevention and control, and set an example for communities at large.
Keywords: Water; sanitation; hygiene; practices; health-care; facilities
Introduction: the consequences of poor WASH in health care facilities
“The health consequences of poor water, sanitation and hygiene services are enormous. I can think of
no other environmental determinant that causes such profound, debilitating, and dehumanizing
misery…. Speaking as a health professional, I am deeply concerned that many health care facilities still
lack access to even basic water, sanitation, and hand-washing facilities” -- Margaret Chan, WHO
Director General
243
The purpose of health care facilities is to promote health and healing. Adequate WASH standards in
health care facilities, and in particular safe hygiene practices such as hand washing by healthcare staff,
patients and visitors, help ensure quality and safe care and minimize the risk of infection for patients,
caregivers, healthcare workers and surrounding communities. High standards of cleanliness in health
care facilities also serve to promote the observance of such practices among the general public and
encourage health services utilization. Poor WASH practices compromise the standards and safety of
basic, routine health services, such as child delivery. Good WASH practices in health care facilities thus
contribute to both universal health coverage and WASH coverage by 2030. WASH in health care
facilities is therefore a joint responsibility and shared incentive for both the health and WASH sector
Ministries.
Unsafe drinking water, the lack of clean toilets, poor handwashing practices and poor hygiene around
birth in health care facilities cause up to 56 percent of all neonatal deaths among hospital-born babies
in developing countries (WHO 2011). Among newborns, sepsis and other severe infections are major
killers, estimated to cause 430,000 deaths annually. The risks associated with sepsis are 34 times
greater in low resource settings (Oza et al., 2015). Lack of water supply and toilets in health care
facilities may discourage women from giving birth in these facilities or cause delays in care-seeking
(Velleman et al., 2014). Estimates show that of every hundred patients hospitalized in developing
countries, ten will acquire infections associated with health care (WHO 2011). In developing countries,
illnesses caused by drinking unsafe water, open defecation or using unsafe toilets or not washing
hands with soap fill half of the hospital beds (UNDP Human Development Report 2006).
Situation: the status of WASH in health care facilities
In low and middle income countries, 38% of health care facilities do not have an improved water
source, 19% do not have improved sanitation and 35% do not have water and soap for hand washing
(WHO, UNICEF 2015).
In South-East Asia, very little WASH data is available, especially for sanitation and hygiene. For
instance, for Sri Lanka where household sanitation coverage is impressive, figures are not available for
sanitation and hygiene coverage in health care facilities (see Annex 1). The lack of data is a barrier
towards better understanding and addressing needs. Water coverage in health care facilities in the
South-East Asia region is 78% but no regional estimates are available for sanitation and hygiene.
Across the region, large disparities in WASH services in health care facilities exist. For example, hygiene
coverage in health care facilities in Nepal is as low as 19% and as high as 91% in Bhutan (see Annex 1).
More than 75 percent of the Asian and Pacific countries have an approved national policy for the
provision of water and sanitation in health facilities. However, less than 40 percent of the countries
have plans for WASH in their health care facilities that are fully implemented, funded and regularly
reviewed. A 2014 hygiene survey in Bangladesh found that healthcare workers used only 46 percent
of hand washing opportunities and only two percent followed the recommended hand washing
practice (DPHE, Water Aid et.al 2014).
Nepal case study

From July till September 2015, WaterAid Nepal and the Nepal Fertility Care Center, carried out an
assessment of water, sanitation and hygiene facilities in health. The assessment was conducted in 20
peripheral level health facilities in three districts, all of which offer delivery services. Three districts
were selected randomly and the selection of health facilities was done by the respective District
(Public) Health Offices. The broad objective of the assessment was to assess the status of water,
sanitation and hygiene facilities and hygiene practices in these health institutions.
The tools used were key informant interviews, in-depth interviews with health facility in-charge and
staff (cleaners, food handler, laundry person), observation checklist, focus group discussions, and
client exit interviews.
Findings:
The Nepal health sector policy and guidelines state that the provision of safe drinking water is
mandatory in all health care facilities. However, there is a big gap between policy and practice. Despite
the fact that 90% of the sampled health care facilities have water facilities, only 20% of the patients
and care takers have access to those facilities. Furthermore, monitoring of water quality is absent.
100 90
80 %
60 55
40 20
20 0
0
Have drinking water
Treat drinking water
water to patients/care
Monitoring of water
Accesbility of drinking
supply for 24 hours
quality
takers
Access to sanitation (toilets) shows a similar scenario. Toilet coverage is above 90%, but only half are
in good condition and the other half are in pathetic condition, as shown in the photos below.
245
Pic 1: Good condition toilets in health care facilities
Pic 2: Unhygienic toilets in health care facilities

Pic 3: Non-functioning toilets in a health care facility
Nearly one-third of out-patient departments of the health institutions had hand washing stations and
two-thirds of them had soap. However, not all are gender-friendly and hygienic, as shown in the
picture below.
Pic 4: Inappropriate design of handwashing facility in a health care facility.
Sustainable Development Goals – a new opportunity
The ‘Sustainable Development Goals’, or SDGs, include Goal 6 which aims to ‘Ensure availability and
sustainable management of water and sanitation for all’. Target 6.2 states “By 2030, achieve access to
adequate and equitable sanitation and hygiene for all and end open defecation, paying special
attention to the needs of women and girls and those in vulnerable situations.” SDG goal 3 aims to
‘ensure healthy lives and promote well-being for all at all ages’. Target 3.8 aims to achieve universal
health coverage, including financial risk protection, access to quality essential health care services and
access to safe, effective, quality and affordable essential medicines and vaccines for all. Target 3.9
aims to substantially reduce the number of deaths and illnesses from hazardous chemicals and air,
water and soil pollution and contamination. The SDGs target everyone everywhere which means it is
247
not isolated to household or community but also to institutions like health care facilities and other
public places. The SDGs aspiration is not to leave anyone behind.
Best Practices in the Health sector
Health Management Information Systems (HMIS) are routine reporting systems developed and
managed by national governments to collect data on a range of health-related indicators (e.g. diseases
diagnosed and treated, number of beds available per hospital, etc.) (WHO, 2010). Unlike surveys that
collect data by independent enumerators, HMIS depends on self-reporting by health care staff. HMIS
should include WASH indicators, reflecting water use, toilet use and other hygiene practices in health
care facilities.
WHO has issued guidelines for water, sanitation and hygiene in health care facilities (WHO, 2008). This
includes standards for water quantity and quality, water access, sanitation quantity, sanitation access
and hygiene in health care facilities. Many national governments have reflected these guidelines in
their national standards and have developed guidelines for implementation to these standards.
Improvements are needed in HMIS to monitor the implementation of the global WHO guidelines.
JMP (WHO, UNICEF-JMP 2015) has proposed good indicators for WASH in health care facilities, for
possible use in SDG monitoring. The proposed JMP indicators include: percentage of health care
facilities with (i) an improved drinking water source on premises and water points accessible to all
users, all the time. (ii) improved gender-separated toilet facility on or near premises (at least one toilet
for every 20 users at in-patient centres, at least four toilets for staff, female, male and child patients
in outpatient areas, (iii) handwashing facility with soap and water in or near sanitation facilities, food
preparation and patient care areas, (iv) private place for washing hands, private parts and clothes,
drying reusable materials and safe disposal of used menstrual materials. After the SDG monitoring
indicators have been adopted, these indicators need to be widely promoted at regional level and
national levels.
Many countries (Afghanistan, Bangladesh, India (at state level), Lao PDR, Mongolia, Nepal, The
Philippines in the South East Asia and Pacific region have included WASH in their health sector policies
and plans. The need is to implement these policies and plans, backed by adequate financing and
monitoring.
Bottlenecks: what stands in the way of better WASH in health care facilities?
Political will and commitment to ensuring even the most basic WASH standards in health care
facilities is sorely lacking in many countries. In the 2013 WHO Global Analysis and Assessment of
Sanitation and Drinking-Water, more than 75 percent of the Asian and Pacific countries that reported
had an approved national policy for the provision of water and sanitation in health facilities. But less
than 40 percent of the countries had plans that are fully implemented, funded and regularly reviewed.
Comprehensive and comparable national data measuring the full set of WASH needs in health care
facilities is broadly absent. This makes it difficult to understand the scale of the problem and target
resources effectively. Many countries lack indicators for these measures in their Health Management

Information System or Service Availability and Readiness Assessments. Even those that do gather the
information do not necessarily synthesize, analyze or act upon it.
Operation and maintenance protocols for WASH facilities in health care facilities are often partial or
non-existent. This leads to a lack of accountability for ensuring that WASH infrastructure and patient
safety protocols are adhered to as part of the overall performance of health care facilities.
A lack of timely allocation of adequate resources for installation and upkeep of WASH infrastructure
further hinders progress. Poor supervision and lack of funds to maintain WASH facilities cause them
to deteriorate and break down, at times permanently.
With insufficient financial allocations being a major constraint, the improvement of WASH in health
care facilities and its impact on health outcomes must be seen as a necessary prerequisite for
achieving wider development aims, including workforce productivity and economic growth. Improving
health outcomes has been shown to be a sound investment. Thirty to fifty percent of Asia’s economic
growth between 1965 and 1990 can be attributed to a reduction in infant and child mortality and
fertility rates, and improvements in reproductive health.
Way forward: what will it take to improve WASH in health care facilities?
WASH is shared responsibility and concern that underpins the agenda of ‘leave no-one behind’. WASH
is thus not only a concern of the water sector Ministry but equally a responsibility of the Health sector
Ministry. Ministries of Health that regulate and supervise health care facilities have prime
responsibility to ensure proper WASH practices in health care facilities, including children and disabled
people. Ministries of Health can undertake the following initiatives to improve WASH practices in
health care facilities:
- The SDGs are an opportunity for member states to develop plans of action to realize the global
goals on health and WASH in pursuit of universal health coverage and universal WASH
coverage by 2030.
- WHO has issued guidelines for WASH in health care facilities. Where not yet done, national
governments need to prepare and adopt national standards for WASH in health care facilities,
and pursue implementation.
- Invest in additional WASH facilities, and refurbish/upgrade existing facilities, so as to meet
national standards and norms. All new health care facilities must have WASH facilities to
national standards and norms.
- Train health staff in essential WASH practices, in hygiene promotion and in the operation and
maintenance of WASH facilities.
- Define indicators for WASH in health care facilities and include these in their Health
Management Information Systems and in Service Availability and Readiness Assessment
surveys. Systematically analyse collected data and use the information to prioritize
investments.
- Award/reward the health care facility with the best WASH practices maintained year-round.
Introduce a benchmarking system for WASH practices in health care facilities.
249
- Improve coordination with other Ministries with responsibilities for providing WASH facilities
in health care facilities.
- Seek the assistance of external support agencies for building capacities, setting standards,
monitoring compliance and sharing of best practices.
References
 WHO, UNICEF-JMP 2015, WASH Post 2015
 WaterAid, WHO, UNICEF (2014), Water, Sanitation and Hygiene in health care facilities in Asia and
the Pacific.
 WHO GLAAS 2013
 Water, Sanitation and hygiene in health care facilities. Status in low- and middle-income countries
and way forward. Ryan Cronk, Prof Jamie Bartram. WHO, UNICEF, 2015.
Annex 1: WASH coverage in health care facilities in South East Asia countries
Countries Water supply Sanitation Hygiene coverage

coverage in % in %
coverage in %
Afghanistan 56 91 72
Bangladesh 97 53 79
Bhutan 90 n.a 91
Cambodia 67 n.a n.a
India 72 59 n.a
Mongolia 45 n.a n.a
Nepal 84 71 19
Sri Lanka 86 n.a n.a
Timor L’este 17 98 88
South East Asia 78 n.a n.a
Global 62 81 65
Water, sanitation and hygiene in health care facilities. Status in low- and middle-income countries,
WHO and UNICEF 2015

Annex 2: WASH in Health Care Facilities: HMIS, policies and plans
1 Current availability of WASH Yes: Afghanistan

indicators in national HMIS
Partially: Nepal
Under discussion: Lao PDR
No: Bangladesh, Bhutan, Cambodia, India,

Mongolia, Pakistan and The Philippines
2 WASH in health sector policies Yes: Afghanistan, Bangladesh, India (at state level),
and plans Lao PDR, Mongolia, Nepal, The Philippines
No: Bhutan, Pakistan
About the Authors

Rabin Lal Shrestha is Regional Advocacy Manager for WaterAid in South Asia. Upama Adhikari is
Health Advocacy Officer in WaterAid Nepal. Hendrik van Norden is Regional Adviser (Sanitation and
Hygiene) in the UNICEF Regional Office for South Asia.
251
Technical Focus Session 7: Climate Change & Sanitation (Pakistan)
Chair: Prof. Dr. M. Ashraf Ali, Director, ITN-BUET
Moderator: Dr. Tanveer Ahsan, Executive Director,

DevCon
Presenters:
- Mr. B.S. Bisht and Purvi Vyas, India
- Mr. Farid Safi, Afghanistan
- Mr. Shah M.D. Anowar Kamal, UST, Bangladesh
Supporting Partners: Plan International
 Sanitation strategies: Enhancing resilience to climate change, India

 The impact of climate change on sanitation, Afghanistan
 Water is life and sanitation is the way of life, Bangladesh
MISSING

Technical Focus Session 8: Sanitation for Hard to Reach Areas (Sri Lanka)
Chair: Mr. Rauf Hakeem, Minister National Water

Supply and Drainage Board, Sri Lanka
Moderator: Ms. Hasin Jahan, Country Director,

Practical Action, Bangladesh
Presenters:
- Mr. N.I. Wickremasinghe, NWSDB, Sri Lanka
- Ms. J.M. Saumya Niroshanie Jayasooriya, NWSDB,
Sri Lanka
- Ms. Kusum Athukorala, SWP, Sri Lanka
Supporting Partners: FANSA, WSSCC
 Ensuring water safety applying sustainable sanitation and hygiene promotion programmes
for marginalized communities – Sri Lankan Experience - Gampola Water Supply Scheme and
Paradeka River Catchment, Sri Lanka
 Best Practices in Promoting Hygiene in Post Conflict Areas; A Case study of NEP WASH
Project, Sri Lanka
 A Triple-A approach for promoting sustainable school sanitation – Lessons learnt from
Central Province, Sri Lanka
Ensuring water safety applying sustainable sanitation and hygiene promotion programmes
for marginalized communities – Sri Lankan Experience - Gampola Water Supply Scheme and
Paradeka River Catchment
Author: N.I.Wickremasinghe, Senior Sociologist, National Water Supply and Drainage Board
Key Words: Catchment, Sanitation, Hygiene Promotion, Water Safety
Abstract
National Water Supply and Drainage Board (NWSDB) is the sole authority in Sri Lanka responsible for
supplying drinking water to the country. The NWSDB is providing drinking water to the people by using
best technologies, good practices for water treatment, disinfection and distribution. Even though good
practices and good technologies are used in these processes the risk of water contamination is still
high.
The August 2007 incident at Paradeka in Gampola area is a milestone disaster which occurred due to
bacteriologically contaminated water. Hundreds of people were infected and two were reported dead
253
due to outbreaks of hepatitis A virus. Gampola is a sub town in Kandy district, and Kandy itself is the
capital city of the Central Province of Sri Lanka. Paradeka River is the main source of water feeding the
Gampola Water Supply Scheme. It is located 14 Km upstream of the Gampola Town. Potable drinking
water is gravitated from Paradeka treatment plant to the Gampola Township and suburbs. Mostly The
estate workers who attend to plantation activities are residing in line-settlements and they have been
deprived of basic needs and lack sanitation and hygienically approved drinking water.
The World Health organization guide-lines on drinking water quality aim to protect public health and
a key way to ensure this is through the adaption of Water Safety Plans (WSP). Application of WSP can
provide guaranteed safe quality water to the consumers. Therefore Water Safety Plan is the most
effective means of consistently ensuring the safety of a drinking water supply through the use of a
comprehensive risk assessment and risk management approach that encompasses all steps in water
supply from catchment to consumer. Construction of toilets and field rest rooms to minimize open
defecation practices during working hours was undertaken under the programme. In addition three
small gravity water supply schemes for all toilets to ensure the link between water supply and
sanitation were constructed. UNICEF country office financed this programme with the multi-objective
of improving living conditions of estate workers, improving the catchment area and minimizing
catchment pollution.
This is a success story culminating in a win-win situation. The relevant work was carried out by three
different organizations namely the NWSDB, the Plantation Human Development Trust (PHDT) and
Plantation Companies. They worked together to achieve catchment development, improved living
conditions for plantation workers and to ensure the profitability of the plantation industry.
Background
National Water Supply and Drainage Board (NWSDB) is the key authority in Sri Lanka responsible for
supplying pipe borne drinking water to the people, which was established under the National Water
Supply and Drainage Board Act No 2 passed by the Sri Lanka Parliament in 1974. Community based
organizations (CBO) and local authorities are also having legal authority to provide drinking water to
the people under its purview. NWSDB has been providing drinking water to the people by using best
technologies, good practices for water treatment, disinfection and distribution. Even though good
practices and technologies are used in these processes still the risk of water contamination is high.
According to water quality reports of the health ministry, water quality of some local authority WSS
and CBO schemes are not at an acceptable level. The most talked about incident at Paradeka in
Gampola area is one of the disasters which occurred due to bacteriologically contaminated water.
Accordingly, the need for the existence of an efficient management tool to overcome such crises was
emphasized.
The water quality in Sri Lanka varies from area to area due to their elevation, geological type,
sociological factors, rain pattern, agriculture, and farming practices etc. These quality variations
sometimes pose a risk to consumers in the area as poor quality the water may cause sicknesses.
Waterborne diseases could be acute or even chronic. Rivers, irrigation tanks, lakes and ground water
are the major sources of drinking water. Most of the pipe borne water is drawn from those sources.
During the last decade raw water contamination increased and therefore the purification processes
became more complex and difficult. Urbanization, industrialization, population growth and migration,
natural disasters, unorganized agriculture and animal husbandry are the major sources that

contaminate water bodies. Sewage, oil, grease, heavy metals, agro chemicals, pharmaceutical
compounds, nutrients and other persistent organic pollutants are major threats contributing to
contamination. Current processes and controls connected to water treatment and distribution are
found to be inadequate to minimize water quality risks to an acceptable level. Therefore sustainable
and practical solutions are required to manage current water quality issues. Water Safety Plans are
one of the key options to address this issue.
Incidents
One morning in May 2007 the citizens of Gampola Town close to Kandy City in the Central Province of
Sri Lanka were shocked due to rumors spreading in and around the Gampola town that many people
were suffering due to an outbreak of Hepatitis A. Many were reported hospitalized. At the end of the
day nearly 600 patients were identified as victims of Hepatitis A virus and two were reported dead.
Schools and some shops were temporarily closed and public life was collapsing in Gampola area.
Hepatitis A is a waterborne disease and is one of the main health concerns relating to contaminated
water and inadequate sanitation. Endemic and epidemic diseases resulting from unsafe water affect
many humans within a short period.
Mass media gave a lot of publicity to the issue and it became a widely discussed matter in the country.
What follows is a report appearing in one of the national papers regarding the issue.
Figure 1 : Media report on Gampola Hepatitus A outbreack
All stake holders connected to drinking water supplies in Gampola area decided to jointly inspect and
study what led to this situation. Finally it was concluded that upstream of water sources of Gampola
was one of main causes responsible for transmission of Hepatitis A virus. Paradeka oya is a tributary
of Mahawali River and raw water is obtained from it to the Paradeka Oya Water Treatment Plant for
providing drinking water to Gampola Town. In addition another intake named Nayapana also exists in
upstream Patradeka Oya treatment plant. However the field study results indicated that Paradeka Oya
intake was more polluted in comparison to the Nayapana intake.
255
Figure 2: Paradeka Oya Catchment Figure 3: Gampola Town
During this study it was identified that 245 families were not using toilets and that they normally use
the river catchment for open defecation. There was no proper solid waste management system within
estate premises and many families were dumping solid waste directly to the soil, which got washed
away and deposited in water bodies during rains. It was discovered in the study that some toilets
were directly diverted to the stream in and around the area contaminating and polluting the water
sources.
In addition Pussellawa town also had no proper solid waste management system and all urban solid
waste was dumped into an unprotected dumping yard. It also is a main cause leading to contamination
of Paradeka Oya stream. It was also found that a high content of fertilizers, agro chemicals and
pesticides have been used by tea plantations and vegetable cultivations in the area. The NWSDB
intake was found to be not up to the standard, needing improvement, and Paradeka old treatment
plant also identified as need to be augmented due to duration of operation. Most of the people living
in upstream of Paradeka catchment were not aware that Paradeka Oya is one of the main streams
providing drinking water to Gampola town area. It was not of much importance to them however
because they were not at all being benefitted by the water treatment plant concerned. The treated
water is carried 14 kilometers downstream by gravity to serve another community.
To address this issue in the short term the health authorities agreed to provide sanitation facilities to
the needy families. However the programme was not successful to the desired level as the
communities refused to participate in construction activities because the PHDT and the estate
management was not involved in the planning phase. As the medium term solution the NWSDB
constructed a new treatment plant with DANIDA assistance, which was commissioned within a year
and handed over to the operational section, which operated and maintained it. Thus, water security
was ensured in Gampola Town, but the threat of catchment pollution could not be tackled due to lack
of concern to improve the catchment. In this context some stakeholders such as Plantation companies,
PHDT, Udapathatha Local Authority, Udapalatha Divisional Secretariat, NWSDB, Schools, CBOs and
communities in the Paradeka Oya and Nayapana catchment have a prominent, collective role to play
and without their co-operation it would be difficult to achieve any worthwhile success in the matter.

Project Area
Paradekaoya and Nayapana catchments are situated in upstream Gampola Town along Gampola
Nuwaraeliya Road. Paradeka treatment plant is located 14 Km upstream in close proximity to this
road. Paradeka Oya catchment comprises of two parts mainly Paradeka catchment and Nayapana
Catchment. Both catchments include two administrative divisions, viz Udapalatha and Kothmale.
Udapalatha division is under Kandy district and Kothmale is under Nuwaraeliya district. The total
catchment area of the Paradeka Oya is 11.713 km2 in extent and Nayapana catchment is approximately
5.5 km2 .The main feeding source of Nayapana stream starts from Doragala village. The catchment
area of Nayapana is totally covered with tea estates and Paradeka Oya catchment has a mixed cover
including villages, small towns and estates. For the Paradeka WTP 1/6 portion of water (nearly
1000m3) is used as raw water from this catchment from Pussellawa to Paradeka and remaining part
from Nayapana Catchment. Seven Grama Niladhari Divisions namely Paradeka, Wahugepitiya,
Pussellawa, Doragala, Delta Gemunupura, Nawakadadora and Pussalawa Gama are included in these
catchments.
Figure 4: Land Use Map Figure 5: Administrative Map
The catchment area extends over several estates, villages and peri-urban areas. The tea estates are
Rosthschild (includes part of Black forest Estate), Melfort , Sogama ( includes part of Bluemount estate
and Chaply), Railand, Edwardhillwatta, Delta watta and New Peacock Estate( Part). Pussellawa
township is located in upstream of treatment plant and small village centers named Paradeka and
Wahugepitiya are located downstream of treatment plant and upstream of intake location.
According to 2011 Census and Statistics, the total population of the catchment area is 23,946 living in
approximately 5000 families. The estate workers who attend to plantation activities are residing in
line-settlements. Life pattern and living conditions of the estate workers are not satisfactory as they
are deprived of basic needs compared to other parts of the country. Administration setup of the estate
sectors are different compared to urban and rural sectors in Sri Lanka. Estate lands belong to
Plantation companies and there is no land ownership to estate workers. Therefore estate workers are
a landless community and they have a high dependency ratio compared to urban and rural sectors.
257
Figure 6 : Line settlement Figure 7: Livlyhood pattern
The New Treatment Plant
New Paradeka water treatment plant construction after the Hepatitus A epidamic insidence is a
conventional plant. It consists of fine screening at the intake, cascade aeration, rapid mixer,
flocculator, four sludge sedimentation basins, three rapid sand filtration and one disinfection unit. For
the flocculation PAC (poly aluminium chloride) is used as coagulant. 2.5% PAC solution is prepared by
dissolving 92.5 kg of PAC in 3.7m3 water. For disinfection two gas chlorination units are currently used.
One unit is kept as a standby system. Other than that bleaching solution chlorination unit was installed
in case of emergency. It has a automation Backwash system. Lime is applied before aeration for pH
correction. However, this is only conducted if there is a need for pH and/or alkalinity correction at the
start. Jar test, pH, Turbidity, conductivity, Residual Chlorine (RCL) measurements are taken daily.
Figure 9: Flow Diagram Figure 10: New plant view
The total treatment plant design capacity is 6600 m3/day and maximum turbidity of water can be
treated only 800 NUT and peak capacity 5800 m3/day. Totally 6600 connections have been provided
by this scheme and two reservoirs and one pumping scheme exist. 24 /7 water supply has been

ensured and total length of distribution is 18 KM and more than 67 KM of distribution lines are
available.
Application of Water Safety Plan
Water Safety Plan (WSP) has been recognized as one of the most effective tools which can be applied
in water sector to ensure water safety from catchment to the consumer level. It is a multi-barrier
approach which simplifies the process of identifying the hazards from catchment to consumer level,
prioritizing the risk from hazards and applying best possible control measures as appropriate. It is a
golden opportunity opened to Paradeka WSS because it was the first batch selected to prepare Water
Safety Plan (WSP) on a pilot basis under WHO guidance. In the first instance WHO selected six WSS in
Sri Lanka to prepare WSPs and Paradeka WSS was also selected for it. After the training programme
NWSDB took initial steps to form a WSP team and it comprised three teams namely WSP
Implementation, Experts and Stake Holders. This paper has more concern on activities of Stake Holder
team because its activities are more oriented towards catchment to intake. This team comprises of
representatives from the NWSDB, Divisional Secretary, and Estate mangers, PHDT, Health
Department, Respective Grama Niladharis, Estate medical Officer and Estate Welfare Officer. This
team describes Water Supply System and conducts field visits several times identifying hazards from
catchment to intake and intake to treatment and they also identify storage, distribution and consumer
end issues.
This paper highlights only analyzing of issues from catchment to intake because scope of this paper
does not include an elaborate analysis of treatment, distribution, storage and consumer ends. WSP
Team identified hazards and risks in the water supply system and it was conducted taking into account
existing records, historical events, local knowledge and onsite visits to identify causes that could affect
the safety of a water supply and establish what is required to control the hazards in order to provide
safe drinking-water. The WSP team considered all potential biological, physical, chemical and
radiological hazards that could be associated with the water supply. It is important to rank the hazards
in order to establish priorities. The WSP team used a semi-quantitative risk assessment, to calculate a
priority score for each identified hazard. The objective of the prioritization matrix is to rank hazardous
events to provide a focus on the most significant hazards. The likelihood and severity was derived from
the team’s technical knowledge and expertise, historical data and relevant guidelines. Following tables
describe the semi quantitative risk matrix used to rate the likelihood or frequency and severity or
consequences of the hazards when it occurred for calculation of the risk score.
259
Table No 1: Risk rating method
WSP team documented the existing and potential control measures for each of the identified hazards
from catchment to the point of use. The team validates each control to determine its efficacy at its
point in the water supply system through site inspection and based on monitoring data. Reassessment
of risk was conducted taking into account the effectiveness of each of the controls. The risks were
prioritized in terms of their likely impact to the capacity of the system to deliver safe water.
Improvement plans for each hazard were prepared and they could be categorized as immediate,
medium term and long term actions. Following table explains the hazard analysis risk assessment of
Paradeka Oya catchment. (Please note that this table not includes a full hazard table due to scope of
the paper).
Table No 2: Hazard / Risk Table in Paradeka catchment Area (Only selected items)
Hazardous Hazard L, hood S, raty Risk Risk Control Control Reassess

Event Score Rating Measures Measures ment risk,
Effective then risk
class
Increased Chemica 3 2 6 Medium CEA and No, Medium
Turbidity in l NBRO Violations of
raw water Microbi Regulation regulations
due to illegal al s and Illegal
construction constructions
s in taking place
catchment at a high level
area.

Debris clog Chemica 3 2 6 Medium Frequent There is an Low

intakes due l cleaning of effect of
to improper Microbi the intake cleaning
solid waste al frequently
managemen
t in
Catchment
Increase Microbi 4 5 20 Very Local No, e-coli Very High
e.coli in row al High Authority increasing
water due and health continuously
Illegal septic departmen
discharge t act
and open
defecation
people who
without
using toilets
Increase Microbi 4 5 20 Very Land No control Very High
heavy metal al High ordinance
in row water R,logical and CEA
due using regulations
Agrochemic
als /
Pesticide
and fertilizer
for
vegetable
cultivation
and tea
plantation
Increase Chemica 3 5 15 High CEA and No Control High
tolerability l Health
in Row Microbi departmen
water due to al t
Town R,logical monitoring
Discharges
An improvement or upgrade plan was drawn up for each of the significant risks with ineffective
controls or non-existing controls identified in the reassessment of risks assuming that other less
significant risks can also be controlled by these improvement measures. Each of the identified
improvement/upgrade has an owner to take responsibility for its implementation and target
implementation due dates were also identified. Improvement / upgrade plans can include short,
medium or long-term programs. These plans should be monitored to confirm improvements have
261
been made and are effective and that WSP has been updated accordingly. Following improvement
plans would be identified with the improvement of sanitation facilities within catchment area specially
estate community. Following table does not mention all improvement plans. It highlights only
sanitation improvement activities.
Table No 3: Improvement Plans (Only selected items)
Improvement Plan Justification Key Out Comes Accountability Time Line

- Informed LA CEA and Stake Holders Continues
Decrease Turbidity DS enforce low. specially GN, activity
Minimizing illegal
in row water and - Tree plantation and Estate
constructions in
improving row landscaping of slope management
catchment area
water quality area. and Local
- Protected crown land Authority
- Assist construction of Medium
toilets to families who term
not to use toilets.
- Conduct awareness NWSDB, PHDT
Minimizing e.coli in improving raw
programmes to and Estate
raw water water quality
educate using toilets Management
- Taken Legal action health
who make septage Department
discharge to streams
Implementations of Improvement Plan
According to WSP, the main objective of the improvement plan is to improve sanitation facilities in
Paradeka oya catchment minimizing ecoli percentage in raw water in keeping with NWSDB standards
and justification of the proposed activity was in improving raw water quality with less or free of ecoli
just before the intake. According to the field visits of WSP team and available data it was identified
that approximately 250 families do not use toilets due to lack of sanitation facilities and they practise
open defecation using steams in and around the catchment.
To address this issue NWSDB forwarded a proposal to UNICEF and they agreed to assist the
construction of 250 toilets, 4 field rest rooms and 3 gravity water supply schemes for the estate
community in Paradeka oya catchment. The NWSDB is the executing agency for this programme and
PHDT was selected as an implementing agency. Under the purview of PHDT a Housing Development
Cooperative Society was formed in each and every Estate. This societies responsible for selection of
beneficiaries, purchasing building materials, supervision of construction of toilets, field rest rooms
and gravity water supply schemes. Estate Managers should be the ex-officio chairmen of the societies
and the rest of the office bearers should be elected from the estate communities. The estate Welfare
Officer, Estate Medical Officer and Technical Officer seconded to the estate from PHDT are responsible
for overseeing the functioning of the Cooperative Society. PHDT and Estates welcome this proposal
because it would address PHDT and Estate mandates to upgrade the sanitation facilities of estate

workers. In addition Public Health Inspector and Public Health Nurses under the Department of Health
are responsible for the implementation of the Public Health Act. NWSDB prepared BOQs and designs
of toilets, Gravity Water Supply Schemes and Field Rest Rooms. Total financial support was given by
the UNICEF and construction payments were approved by the NWSDB. Paying authority was PHDT.
Contractor was appointed from the registered contractors list of PHDT and contract was awarded
under the open bidding system. All partners signed an MOU and implemented this program.
Figure 11: Toilet Contraction in catchment Figure 12: Project Information in Sogam Estate
Community awareness programmes were implemented parallel to ongoing construction activities. It

was a difficult task due to behavioral patterns of the estate community such as their lack of punctuality
in attending meetings, knowledge gaps, low education, cultural habits and isolation from the greater
society. During the field visits and discussions the WSP team had with community members it was
found that the elderly members of the estate communities were reluctant to use toilets because they
were used to open defecation for generations. In addition some mothers in estate communities
believed that children’s excreta was not harmful for a health and therefore it was OK for kids to
practise open defecation outside the residential area. The habit of using soap for hand-washing after
using the toilet was extremely rare in the estate communities. However the attitudes of the younger
generation seem to have changed to the better in this context. They seem to be keen on using
improved toilets and to look upon open defecation as an appalling practice. Some estate workers
complained that they lack toilet facilities in estates to answer their calls of nature. As there was no
other alternative they had to use nearby streams for the purpose. It was in fact the reason that led to
the inclusion of field rest rooms in the plans.
According to the prior agreement community awareness programs were jointly planned by the
NWSDB, PHDT and the Health Department. The plans were not limited just to awareness workshops.
The plans also included monitoring and evaluation. It was planned to use communication tools such
as Flash Cards and Audio Visual presentations for changing habits and attitudes, and finally experience
sharing group discussions among representatives of the same community. In the end verbal
agreements were entered into with the beneficiaries including elders, who agreed to use toilets and
with mothers to put children’s excreta to toilet pits. In addition it was possible to convince the mothers
263
that even children’s excreta carried bacteria harmful to human health. Welfare officers of estates were
tasked with the responsibility of monitoring the progress of the implementation of activities decided
at the programmes.
Awareness programmes were not limited only to addressing usage habits. They also addressed issues
relating to the need to maintain clean toilets and the need to wash hands using soap after using the
toilet and after cleaning children. Active participation and contributions of the Public Health
Inspectors in the respective areas was imperative to the identification of issues affecting catchment
areas and planning of and implementing appropriate community awareness programs to ensure their
success.
Other achievements of this programme were the provision of water to the toilets, completion of pipe
laying and renovating the existing Gravity WSS. These three WSSs provided more than 150
connections and 22 yard taps. Six estate workers were trained on basic chlorination and of pipe fitting.
In addition agreements were entered into with estate managements for maintaining the 3 field rest
rooms. According to the report on water quality the WSP has resulted in a significant reduction in the
concentration of e-coli in Paradeka oya intake, in comparison to the earlier situation.
1600
1400
1200
1000
Total Colifurm
800
Ecoli
600
400
200
0
2008 2009 2010 2011 2012 2013 2014
Figure 12: Annual average e-coli percentage concentrate in intake location at Paradeka Oya
Conclusion
It has been reported that implementation of WSP in Paradeka Treatment plant and catchment has
resulted in a significant improvement in the water quality of the treatment plant in all parameters.
Actually it was a great positive impact vis-à-vis the situation that obtained at the time of the hepatitis
A epidemic outbreak in 2007 and in addition it has immensely contributed to build confidence once
again in Paradeka Treatment plant. Furthermore the implementation of WSP has apparently
improved the overall appearance of the Water Treatment Plant. It put management and
administrative activities on the right track. Incidentally, WSP helped the Paradeka Plant to get selected
as the best plant in Sri Lanka at the World Water Day Competition held in 2013 based on criteria
relating to best performance in all respects.

The results show that planning and implementation of water safety programmes could help bridge
the gap and create a strong link between the stake holders as well as the community. In addition the
WSP implemented in Paradeka contributed to the realization of goals of all the stake holders,
especially with regard to improvements in the sanitation sphere. For example PHDT goal was
upgrading of living standard of the estate community by providing drinking water and sanitation
facilities to the estate community. By contributing towards upgrading living standards the Plantation
Company realized its goal of forging a strong link between the Estate Management and the worker
community. In addition Health Department has achieved its public health goals and the NWSDB has
achieved its goals of protecting the catchment area, minimizing treatment costs and providing drinking
water to a wider consumer population. This is really is a win- win situation for all concerned.
Acknowledgements
I wish to extend my sincere gratitude to the National Water Supply and Drainage Board, WSP/WQS
team for the assistance and Plantation Human Development Trust, Pussellawa Plantation and Health
Department for giving all the data and assistances: WSP team deserves thanks for the assistance
extended in implementation of WSP activities specially Paradeka Treatment Plant. Finally, a special
word of thanks to Officer In Charge (OIC) in Paradeka Treatment Plant Mr Ajith Godamulla , Senior
Chemist Mr Asoka Jaywardena, and Mr N.P.Karunadasa for proofreading editing of this document.
References:
World Health Organization, Geneva 2009: Water Safety Plan Manual: Step by step risk management
for drinking water supplys: World Health Organization, International Water Association
Department of Census and Statistics 2012: Statistics Hand Book
National Water Supply and Drainage Board, 2014: Water Safety Plan Document, Paradeka Water
Supply Scheme: Non published document
Best Practices in Promoting Hygiene in Post Conflict Areas;

A Case study of NEP WASH Project, Sri Lanka
Author: J. M. Saumya NiroshanieJayasooriya

Sociologist
National Water Supply & Drainage Board
[email protected]
Co Author: A.H. Gunapala
Assistant General Manager (Community Water Supply)
National Water Supply & Drainage Board
[email protected]
Abstract
Hygiene refers to a specific set of practice, which ensures the good health. Good hygienic practices are
useful to maintaining health and preventing disease especially through cleanliness. Good hygienic
265
practices are considered as good habits which can be varied according to different cultures and gender
disparities prevailing in the society. AUSAID funded, World Bank assisted NEP-WASH pilot project was
operated in post conflict areas in 11 GNDs in Mannar and Trincomalee districts in the northern and
eastern provinces of Sri Lanka to ensure access to safe drinking water, improved access to sanitation
and adoption of best hygienic practices. This project was characterized by community participation,
social inclusion and stakeholder consultation which would maximize participation, accountability and
innovation in executing the project activities with special focus on promoting hygiene education. It is
expected to have a significant improvement in the livelihoods of conflict affected communities who
have been resettled in their original places of residence. This pilot project provided an arena to scaling
up WASH interventions to contribute to economic advancement and social wellbeing of people. The
Health Habit Card was especially introduced among selected grades of school children, in eleven sub
project areas in Mannar and Trincomalee Districts as a strategy to promote sanitation and hygiene
status schools in post conflict areas. The objective of introducing this card to the school children was
to promote their good hygiene practices and to deliver this message to their families as change agents
since children are more effective in conveying a message to their parents, guardians, siblings and
elders. Methodology of promoting this hygiene card is to conduct awareness creating workshops for
the school children¸ teachers and other selected communities in both districts. Special tools were used
to attract the school children by printing the cards with WASH related pictures. Key stakeholders of
this Health Habit Card are the parents, teachers, the school prefects in the selected schools, and staff
of zonal education offices. More than 3000 families in selected sub projects in two districts were
benefitted through this hygiene promotion programmes. Monitoring and supervision of this activity
were done by the school principals, field health officers, Public Health Inspectors(PHIs) and the project
officials through no. of meetings, discussions, field visits, and reports. The major outcome/results of
this study are the ability to change the attitudes and behavioral patterns of school children towards
personal hygiene and encouraged parents and other members of families to practice good health
habits through school children. In addition, this work is appreciated by everyone including the donor
agencies and other schools located in the adjacent regions to replicate this method of Health Habit
Card in to their schools as well.
Keywords: livelihoods, hygienic practices, stakeholder consultations, safe drinking water, social
wellbeing
Introduction
When it comes to human social welfare, increase of the coverage of water, sanitation and hygiene
(WASH) and ensuring the easy access to those services is one way to achieve poverty reduction and
social empowerment. Lack of access to these services creates inequality, marginalization and
deprivation from the main stream of the society. However, Sri Lanka records achieving the Millennium
Development Goals (MDGs) with the access to safe drinking water and better sanitation facilities in a
satisfactory level. Further to that, the country is heading towards 2030 to achieving Sustainable
Development Goals (SDGs) to ensure availability and sustainable management of water and sanitation
for all.
However, still the issues of disparities and the less access to services by poor are remaining as huge
challenges creating several problems in the rural communities. Those issues become more complex
during the civil war taken placed in Northern and Eastern Provinces in Sri Lanka over thirty years. After

defeating the LTTE by Sri Lankan government in 2009 it was needed to develop a special mechanism
for the provision of basic needs especially water and sanitation facilities to the vulnerable
communities living in the post conflict areas.
Background
The post conflict development strategy of the Sri
Lankan Government mainly aims to increase the
total coverage of safe drinking water, sanitation
facilities, education and health facilities as a
primary objective of the national development
policy. North East Provincial Water, Sanitation
and Hygiene (NEP-WASH) pilot project was
implemented by the World Bank (WB) with the
financial assistance of the Australian Agency for
International Development (AUSAID) to
evel facilitate the conflict affected rural communities
in provision of safe drinking water and basic
sanitation and hygiene facilities.
Since the project has identified WASH sector as a priority area to support for the communities affected
by civil war. It was recognized 11 Grama Niladhari Divisions (GNDs) in Mannar and Trincomalee
Districts in northern and eastern provinces of Sri Lanka to ensure the safe drinking water, improved
sanitation facilities and good hygienic practices. This project is characterized by community
participation, social inclusion and stakeholder consultations. And it is expected to improve the quality
of life and the livelihoods of the conflict affected rural communities who have been resettled from
their original places of living.
Hence, this pilot project was carried out to scale up WASH interventions for the betterment of
economic advancement and social wellbeing. The project covered 2303 households with a total
population of 8262 persons in war affected 11 sub project areas in Trincomalee and Mannar Districts.
All of them were belonged to different ethnic groups Sinhala, Tamil and Muslim. Most of them were
internally displaced communities and the relocated people. The female headed households among
the selected beneficiaries are relatively high as 12% in Mannar District and 5% in Trincomalee District.
The NEP WASH Project was implemented by the National Water Supply & Drainage Board (NWSDB)
of the Ministry of Water Supply & Drainage (MWSD). The NWSDB has got the relevant technical
expertise and implemented the overall project activities through the District Rural Water and
Sanitation Divisions. The project approach was to ensure the community participation, accountability
with special focus on gender balance and hygiene education.
However, it was difficult to mobilize these communities as they were undergone serious mental agony
due to civil war. Lack of access to basic needs was a huge challenge for them to overcome and they
were not completely settled in their mindset though they returned to their own villages. They were in
a mood of transitional period from conflict to post conflict era. Since the project area is belonged to
the dry zone, the communities in these regions have restricted access to natural sources of water.
267
With this growing demand for safe drinking water, the project aimed to ensure transparency,
accountability in provision safe water and sanitation facilities.
Objectives
NEP-WASH project prioritized hygiene to
promote behavioral changes to ensure good
health. The main rationale for supporting good
hygienic practices has been a mismatch
between safe water supply and unhygienic
habits. It promoted hygiene education and
knowledge to ensure the behavioral change and
the sustained health outcomes. These hygiene
awareness programmes focused on both the
provision of hygiene facilities (latrines, water
iciaries supply, hand washing facilities, solid waste
disposal etc.) and the development of necessary knowledge, attitudes, values and life skills that
promote better sanitation and hygiene practices in families, schools and communities.
In school settings, school sanitation and hygiene education makes safe water and sanitation facilities
and hygiene part of the school curriculum. Most school sanitation and hygiene education programmes
focus on the following common objectives
 Creating a healthy and safe learning environment

 Helping children to develop knowledge, attitudes and life skills that support the adoption of
good hygiene behaviours and better health
 Reaching out to families and communities to encourage safe hygiene and sanitation practices.
Methodology
The methodology with reference to the hygiene
promotion programme of the NEPWASH Project
was bit comprehensive with two ways of
actions. One was targeted as the school
community while the remaining target group
was the village community living in the
Trincomalee and Mannar Districts. The school
programme targeted particularly the primary
school children although the students in higher
grades were also included. The project
facilitated for lectures, demonstrations, posters,
art/ essay competitions and street dramas while
the health authorities and other relevant key government officials served as resource persons.
The Health Habit Card was introduced as a specific tool to change the attitudes and the hygiene
behavior of the students. It was introduced to record the hygienic practices of the students while at

home. The parents were involved in marking the cards. The students took the messages home and
educated the family members through these Health Habit Card system.
The health messages communicated including hand washing with cleaning agents after going to toilet
and before food preparation, storing water to prevent contamination, boiling water, water quality,
chlorination, consequences of open defecation, safe disposal of excreta, solid waste management,
water pollution, dengue prevention and clean environment, keeping water sources clean, distances
to be maintained in locating the wells and toilets, personal hygiene including menstrual health etc.
Particularly the students who were in grades two to five were engaged with this Health Habit Card
programme. And these messages were communicated effectively through a combination of lectures,
posters, questions and answers and above all, through video clips and demonstrations. Apart from
that, the awareness materials such as posters, flyers, brochures and certificates of awards also
distributed among the students to encourage them with this hygiene education programme.
Outcome/Results
The hygiene promotion campaigns conducted
by the project have therefore resulted in
enhancing awareness and adoption of improved
hygienic practices both at schools and home. As
a result of this hygiene card programme, the
children could explain and demonstrate hand
washing. According to some mothers of the 11
sub project communities, they learned proper
hand washing techniques from their children
who took part in the school awareness
ce Cards programme, and they also practice these at
home. This change in health behaviors is a
noteworthy achievement in the context of the general poverty of the communities and their
socioeconomic, standing livelihoods.
Household Toilet Facilities under

construction
Conclusion
In conclusion, it was a great achievement initiated by the NEP-WASH project to change the behavioral
patterns of the students promoting good hygienic practices. Children were able to disseminate this
message among their families and the communities. In addition to that, a significant attitudinal change
269
of the students, parents, teachers in these sub project areas is highlighted the fact that the importance
in adopting this Health Habit Card system to uplift the best practices in hygiene education programme.
Apart from that, this system was greatly appreciated by some donor agencies, relevant government
and non-governmental stakeholders, policy makers and the political authorities to adopt this method
to the other adjacent schools and the communities in other provinces in Sri Lanka.
References
 Adams, John (2009) Water, Sanitation and Hygiene Standards for Schools in Low-cost Settings,
World Health Organization, Geneva
 An Inclusive Approach for School Sanitation & Hygiene Education: Strategy, norms & designs
(2008) Government of India and UNICEF New Delhi,India
 Bolt, E and Cairncross, S (2004)Sustainability of Hygiene Behaviour and the Effectiveness of
Change Interventions: Lessons learned on research methodologies and research
implementation from a multi-country research study, IRC International Water and Sanitation
Centre, Delft, the Netherlands
 Brocklehurst, Clarissa (2004).The Case for Water and Sanitation, World BankWater and
Sanitation Programme, Africa
 Curtis, Valerie (2001) Evidence of Behaviour Change Following a Hygiene Promotion
Programme in Burkina Faso, Bulletin of the World Health Organization
 Education for All Global Monitoring Report (2011) UNESCO, Paris
 Mooijman, Annemarieke (2006) Manual on Hygiene Education in Schools:Teachers
Guidebook, CCF-UNICEF, Colombo, Sri Lanka
 Mooijman, Annemarieke (2010) Strengthening Water, Sanitation and Hygiene in Schools: A
WASH guidance manual with a focus on South Asia, UNICEF Regional Office for South Asia, IRC
and Water Supply and Sanitation Collaborative Council
 Njunguna, Vincent (2008) The Sustainability and Impact of School Sanitation, Water and
Hygiene Education in Kenya, United Nations Children’s Fund and IRC International Water and
Sanitation Centre, New York and the Netherlands
 Rehfuss, Katrin(2011) Child Friendly Schools: How children in Sri Lanka learn the importance
of safe drinking water, Malteser International, Malta
 School Sanitation and Hygiene Education Programme Guideline, 5th ed. (2006) Department
of Water Supply and Sewerage and UNICEF, Nepal
 Talaat, Maha (2011)Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed
Influenza and Absenteeism in Schoolchildren, Cairo, Egypt
 Towards Effective Programming for WASH in Schools: A manual on scaling up programmes for
water, sanitation and hygiene in schools (2007) IRC International Water and Sanitation Centre,
Delft, the Netherlands

A Triple-A approach for promoting sustainable school sanitation – Lessons learnt from
Kusum Athukorala, Lalith Seneviratna, Lionel Jayawickrema, Chandana Seneviratna and Madubhashini
Makehelwala
Background
NetWwater (Network of women water professionals) Sri Lanka was set up in 1999 to counter the
perceived neglect of gender and WID issues in the formulation of the World Water Vision process in
Sri Lanka by creating an advocacy and pressure group. This group has continued to pioneer activities
supporting capacity building for women water professionals, equity and gender issues in the water
sector. NetWwater has continuous programs to promote awareness on IWRM, gender and water;
provide IWRM related material in national languages; study and highlight relevance of gender issues
on a district level; to draw attention of policy makers to importance of gender issues in water sector.
As a woman’s organization, NetWwater has intergenerational equity as one of its three main areas of
focus and considers school children’s health to be a critical development indicator. Recent activities
carried out in schools have revealed very poor sanitation levels in schools as well as the related issue
of declining water quality in the environment due to discharge of sewage into water ways .
The ancient Sri Lankan culture was historically characterized by its high priority to maintained a clean
environment by good sanitation practices and hygiene. The ancient civilization of 5th C. AD
Anuradapura provides remarkable examples of well designed latrine systems. Post-colonial Sri Lanka
was widely commended for its attention to provision of sanitation coverage and health indices. Sri
Lanka has high national coverage for access to improved water supply and sanitation, at 84 and 86 per
cent respectively. The 2012 Census states that 98 % of the households have their own toilet facilities
and the percentage of households which are not using a toilet at all is only 1.7 %.
However, these figures mask considerable disparities and a need for customized solutions in
underserved geographic locations, including remote rural areas, the plantation sector, and pockets in
the former conflict area in the North and the East of the country. Nevertheless increasing of fecal
contamination of rivers is observed due to poor management of domestic sewerage systems, negative
community attitudes, lack of awareness and lack of environmental regulations for household
wastewater discharge especially related to urban and periurban settlements of Sri Lanka. Especially in
Central Province which had many sensitive watersheds, environmental issues due to rampant
deforestation, waste dumping and rapid urbanization cause concern especially to downstream users.
The percentage of schools with improved water sources ranges between 80-85 percentage points.
And while national data exists, it does not adequately take into account the continuous availability of
water, maintenance and accessibility of facilities or the quality of the water sources. Indicators on end-
use behavior and practices (washing hands with soap, environmental safety in disposing of human
excreta, menstrual hygiene) are also limited, resulting in critical gaps in interventions. Although
policies are in place to promote access and quality, enforcement requires commitment and
strengthening. Cost recovery for sanitaiton remains an issue, as does the long-term maintenance of
271
facilities, especially for community-based systems. In schools, administrators lack the time, capacity
and funds to undertake “soft” components such as hygiene promotion.
Poor outcomes in the education and health sectors, particularly with regard to malnutrition, are
closely linked with lack of access to good-quality water and sanitation. Currently one in every three
preschoolers reportedly suffer from malnutrition. The spread of water-borne diseases due to
bacteriological contamination or long-term exposure to suspected chemical contamination is an ever
increasing concern in Sri Lanka. It has been reported that some areas where populations are still being
resettled in post conflict areas have up to 40 per cent of households who practice open defecation,
contributing to heavy water pollution and water borne diseases.
Background to School Sanitation in Sri Lanka

Water sanitation and hygiene as directly linked with human wellbeing received an impetus by the UN
Millennium Development Goals. Furthermore during the period of MDG activity sanitation was
recognized by the UN as a fundamental human right, essential for human dignity and human well
being. In order to reach this goal, there was an escalation of resources spent on improving the health
of school-aged children, highlighting the need for hygiene promotion with installation of WATSAN and
hand-washing facilities in schools given priority in development programs.
Unfortunately International Year of Sanitation was not been a catalyst to the anticipated extent in
raising awareness on the need for qualitative and quantitative improvements in sanitation in Sri Lanka.
Though International Year of Sanitation served to focus attention on the much neglected issue, efforts
by UN agencies are just one part of the equation. Real change demands resources, commitment, policy
changes and other concrete steps by governments, civil society and all stakeholders. Such action must
be based on a correct understanding of the ground reality.
Though there has long been a high premium on education and child welfare in Sri Lanka, school
sanitation has not always been viewed as a high profile investment issue within the education system.
The below table taken from a state sponsored study, reveals a gap in access to school sanitation
facilities, even within the relatively better endowed districts.
Table 1 Number of Schools with Basic Amenities such as Toilets, Urinals and Safe Water in 2000
Source; “Study on the School Health Programme” (Policy Planning Studies of the Ministry of Health and
Indigenous Medicine)

According to the school census of 2007, in Sri Lanka 3658 schools did not have adequate sanitation
facilities and 2373 did not have drinking water facilities. UNICEF data circa this period too indicates
that 20% of schools in Sri Lanka lack adequate safe water and sanitation facilities. In most cases the
available means of sanitation continued to be unhygienic and lead to many illnesses, especially among
children.
The South Asia Conference on Sanitation IV( SACOSAN) was held in Colombo in April 4-6th 2011 was
a catalyctic event which did help raise profile for school sanitation . School sanitation and menstrual
hygiene management were underlined as key areas for improvement to be undertaken according to
the resultant South Asian ministerial declaration. SACOSAN gave some impetus for undertaking
interventions in school sanitation with backing of political and administrative decision makers. UNICEF
school sanitation programs especially the Child Friendly school concept too has had a positive impact
on improving sanitation facilities. Nevertheless in 2015 the Sri Lankan Minister of Education reported
that there were yet 500 schools without any sanitation facilities at all while there were still schools
with 2000 students who which had only one toilet. NetWwater’s interest in school sanitation was
triggered by a school program held in 2008 in a Kandy school which had only one functional toilet for
1000 students and another school with 66 students and no toilet.
Why a Triple A Approach?

Addressing this complex issue with its longterm cultural connotations is a complicated process calling
for multilateral approaches with support of a wide array of partners such as Department of Education,
Ministry of Health, civil society, private sector, parents and other relevant partners. It is this issue
which is addressed by the Triple A approach which advocate sustainable sanitation that goes beyond
mere provision of facilities and call for a change in toilet culture where sensitized stakeholders
undertake maintenance and regular cleansing systems which must be in place along with new or
upgraded facilities.
The focus of this Triple A approach activity is as follows
Awareness – Sensitizing all related stakeholders regarding school sanitation needs ; stakeholder
consensus supporting political will and commitment; Building profile and sensitivity to an invisible
need by holding awareness sessions, road shows, street drama and water related competitions .
Advocacy – Building a informed constituency regarding the current context by carrying out a situation
analysis highlighting sanitation situation in the entire Central Province thereby creating an evidence
based advocacy
Highlighting the invisible threat to children’s health due to polluted water ways and wells caused by
indiscriminate discharge of sewage
Action –With support of the private sector, building and renovating safe school sanitation systems
with addition of rain water harvesting tanks to ensure a ready supply of water for cleansing; ensuring
a maintenance plan with support of parent and civil society groups.
As NetWwater have identified school sanitation as a critical area needing improvement with its
partners in order to carry out the Triple A plan, an evidence based advocacy was seen as necessary.
Anecdotal evidence abounds regarding school sanitation but an empirical study of school sanitation
273
was lacking. Therefore it was proposed that a situation analysis of giving a preliminary view of the
current status of sanitation in schools be undertaken.
It is to be emphasized that the school population represents roughly 1/5th of the provincial population
of the Central Province. Therefore, providing suitable school water supply and sanitation facilities is
very important in the view of health and hygiene requirements of this very significant group and the
entire province.
School sanitation in Central Province – study findings

There are 1462 schools in Central Province which come under three main categories such as Type One,
Two and Three based on the available resources. They are administered by 15 Education Zones which
are headed by Zonal Directors under the Provincial Director of Education. The following table shows
that the distribution of those schools among the districts zones and types.
Table 02 Schools distribution among the zones by type in Central Province
Sources – Provincial department of Education, Central Province 2008

The following table reports the status of sanitation facilities in schools surveyed.
Table 3 School categorization by status of toilet facilities surveyed
* = This category includes both National & Provincial schools which coming under Category type one
G = Girls, B =Boys

This study indicates that school sanitation systems in Central Province were not sufficient in quality or
quantity for the needs of the school going community. Most schools have poor toilet infrastructure
compounded by inadequate water supplies that lead to rapid deterioration and neglect of the
infrastructure but also has major impact on hygiene and health in most public schools. Within the
school administration system, low priority seems to have been given for school sanitation and this is
seen as a major reason why the great majority of toilets and urinals in Central province schools are
not in a usable condition.
The average percentage of usable toilets for girl students was only around 60% and boy students 40%
in the schools in Central Province. Girl children are the most affected and their menstrual hygiene and
related schooling suffers. This situation is worse in the Kandy district than the Matale and Nuwaraeliya
districts. Over 75% urinals in schools were unusable for both girls and boys. Among the unusable
toilets about 1/4th were seen as possible to be put back in to use with minimal low cost repairs which
indicates that lack of resources alone is not the issue.
The study indicates that school sanitation had not been seen as a critical priority by educational
authorities. Replacement and maintenance of systems is not timely or systematic. Most minor
damages to toilets have been allowed to escalate to a point where major rehabilitation and
replacements are needed.
Very few schools have a regular daily cleansing regime (5%) while 58% have none at all. The lack of
water supply is seen as a major barrier to systematic cleansing. The limited access to toilets has also
resulted in the school community decreasing or stopping their water intake to dangerous levels during
school hours, thereby affecting their long term health status.
The lack of a water supply during school hours is among the major reasons limiting toilet availability.
This reason is strongly connected with the poor cleansing factor as well and leads to poor overall
hygiene, lack of hand washing as well.
In few schools the toilets and urinals were situated far away from their class rooms and girl children
especially had security concerns. Therefore the students were discouraged to use toilets and urinals
during the school times especially during the rainy seasons and after hours. Girls’ schools are
particularly affected and most toilet arrangements are not girl friendly. In the absence of adequate
toilet facilities it has been found that most girls deprive themselves of drinking water during school
hours. Both teachers and school children suffer in general due to lack of sanitation facilities. Quite
apart from the risk of diarrheal disease due to lack of good school sanitation, there is the longterm
implication of kidney failure as children compensate for non availability of latrines by limiting their
water intake. Children often do not bring water to school; in some case teachers had requested
children not to bring water as there are no toilets. Therefore they could spend almost 8 hours a day
without water during their school life. It seemed that some school authorities are not even aware of
the discomfort and the possible long term negative impacts caused to students by these oversights.
Menstruating girls are also noticed to have a higher degree of absenteeism due to lack of facilities.
The study indicates that many reasons for limiting use of toilets and urinals during the schools times
are avoidable if concerned school stakeholders can be persuaded to make a special effort to 1)
275
establish a regular cleansing mechanism and 2) adequate funds are made available to carry out timely
low cost maintenance and repairs.
Building an Advocacy program in Central Province

Based on these activities the Central Province education authorities and NetWwater held an Apex
meeting in January 2011 bringing together key stakeholders for formulation of a joint activity for
creating an attitudinal change of related stakeholders in the administration in order to improve the
ground situation. A high degree of support was received by the Provincial authorities including the
political hierarchy. A school sanitation leaflet and a poster in two national languages to be distributed
to all schools in the province has been prepared by SLWP with sponsorship from Brandix Lanka PLC a
leading private sector company. Investment has been made in supporting school sanitation through
infrastructure development in Central Province.
SLWP and NetWwater have been working in school awareness program for more than ten years. As it
was felt that a pilot activity was essential to high light the issue, it was decided to focus on the Central
Province and Denuwara Educational zone, mainly due to the interest and support of school education
authorities.
NetWwater with its local partners in Central Province have carried out many advocacy and research
activities to counter the manifold anthropogenic challenges related to water and sanitation.
NetWwater works with partner from private state and university sectors which include the Sri Lanka
Water Partnership (SLWP), CAPNET Lanka (affiliate of Capnet global), Regional Service centre of the
National Water Supply and Drainage Board, Central Provincial Council and Regional health authorities.
These include advocacy related to schools sensitization, community awareness programs, roadshows,
street drama, river bank clean ups and studies of water bodies especially related to Nanu Oya. Thereby
a strong network of partners has been built up in Central Province especially in Denuwara Education
Zone (Udunuwara Yatinuwara) in Kandy district.
Activities carried out in schools in Central Province have revealed very poor sanitation levels in schools
and the related issue of declining water quality due to discharge of sewage into water ways . Therefore
with its network of partners - SLWP, Central Province Ministry of Education, Denuwara Education Zone
and Lions Club Pilmatalawe, it has been active in promoting plans for a sustainable school sanitation
campaign in the Central Province of Sri Lanka mobilizing school, agency and community stakeholders.
As a result of this campaign sanitation has been recognized as a high priority need, affecting children’s
health and a generation of school children in Denuwara Education Zone and Central Province is being
made aware of the long term dangers of lack of access to sanitation.
Advocacy to Action
Many activities undertaken by NetWwater and SLWP have potential for corporate sponsor
involvement for giving a message or are part of it representing its social consciousness and
involvement with society in general which is now the objective of most corporates under their CSR
programmes. Conservation of water and natural resources, gender and youth issues,
health/sanitation, access to water and water quality, capacity building and knowledge dissemination
are some aspects that resonate with sponsors based on their own identified or niche interests.

Though water for drinking is either brought by students themselves or they have access to well water
the lack of a water supply system to facilitate toilet maintenance is seen as a major reason for disuse
and neglect of school toilets in Central Province. In fact most of the toilets that have fallen into disuse
are those without adequate accessible water for cleansing.
National Development Bank (NDB),NetWwater and SLWP jointly committed to support a pilot activity
in school sanitation in Denuwara School zone, Central Province in 2013. Considering expressed
interests of NDB in school childrens’ well being, their involvement in the under mentioned activities
are mutually beneficial. It offers opportunities for NDB to further enhance its profile as a corporate
closely associated with water and health for schools. Seventeen schools were provided with
sustainable sanitation and rainwater harvesting systems for cleansing. This was preceded with
programs for parents, teachers, schools administrators and children. Activities such as street drama,
art competitions were used to highlight the issue. Civil society auditors supported through monitoring
and funding small scale activities in schools.
The Dept of Education added a section on school sanitation to their monthly school monitoring activity
thereby supporting authorities and enabling quick response to requested repairs.
Spinoffs from School sanitation program –Menstrual Hygiene Management (MHM) and water
quality assessments
The surveys, the evidence based advocacy and ongoing interaction activates had all highlighted the
need for a menstrual hygiene management program to support improved health for girl children and
reduce absenteeism among adolescent girls. Poor MHM practices are also a major cause for blockages
and failures in school sanitation systems. Unfortunately the current culture of silence regarding sex
education and menstruation has led to the issue being long sidelined. In 2014 NetWwater with support
from NDB used its long term linkages and networks in the Denuwara Zone to launch an activity on
MHM.
A workshop was held in Giragama Training Centre, Kandy with support from NDB for teacher
counselors to commemorate World Menstrual Hygiene Day 2014; 56 school counselors, all women
and 7 other resource persons from the Denuwara Education school in Kandy district attended this
activity . Thirty other invited student counselors did not attend as they said, as men, they felt that this
is not an appropriate activity for them. This underlines the need for more awareness creation for
officers in the education sector and the need to sensitize both men and women school administrators.
This was a pioneering activity for school Menstrual Hygiene awareness programs in Central Province.
It flagged the MHM issue and led to school levels activities where the issue resonated with mainly
female teachers. As a result the attending schools carried out related activities and reported back to
the Denuwara Zonal director and the Provincial Director. Some have initiated fund raising activities
such as school fairs to raise funds for purchase of napkin disposal bins. On February 24rd 2015 the
Central Province Provincial education dept conducted an activity to formulate a MHM work plan for
2015 leading to a very successful activity on International MHM Day program on May 28th for which
eventually 70 schools in the zone carried out activities. Boys schools marked the day with a sanitation
system shramadana (volunteer work session).
277
The Central Province has many of the most important watersheds in the country which are fast getting
polluted due to uncontrolled discharge of sewage. Based on the Denuwara Zone platform NetWwater
has launched a Citizen Science program in water quality assessment for schools. This is a part of a
South Asia Regional activity conducted by the Nepal Water Conservation Foundation, Katmandu with
support from the US State Department. Five schools in Denuwara education zone have been trained
in water quality assessments and provided with test kits. The activity is as yet ongoing.
Conclusions
The hygiene and sanitation facilities in many schools in Sri Lanka continued to be currently inadequate.
As the existent school sanitation facilities were frequently not separated according to sex and do not
ensure privacy, the negative impact on girls is greater than on boys. Adolescent girls miss schooling
for an average of three days a month where sanitation needs are not met by school facilities.
School sanitation can be improved with improvement or provision of infrastructure, if systematic

cleansing and maintenance systems are put in place and if sanitation is accorded the priority it
requires. Sensitization programs and an evidence based advocacy leading to attitude changes and
proactive thinking is a priority among parents and school administration authorities coupled with
programs to promote behavioral change in students. School level administration needs to be held
accountable for maintenance and timely repairs of onsite sanitation facilities with the Provincial
education authorities responsible for monitoring of repairs which cannot be carried out by school
authorities alone due to lack of funds.
Children and young adults if informed and educated, can be powerful agents in creating a new demand
for better environment and as such need to co opted as partners. Children are powerful forces in
impacting on adult choices and creating demand as marketing specialists have long understood.
However there has never been a demand for school sanitation which traditionally has been a non issue
and with it pollution of water ways continues unabated.
The following facets of the Triple A activity can be replicated in other situations related to school
sanitation.
- Mobilizing all related stakeholders focussing on the sanitation needs of the school system
-Informing them regarding the current context by carrying out a situation analysis highlighting
sanitation situation
- Creating a felt need to revisit sanitation issues within the school community leading to a self
assessment of sanitation status
- Highlighting the invisible threat to health due to polluted water ways and wells due to
indiscriminate discharge of sewage
- Create a community awareness on the right to sanitation
- Build up supporting political will and commitment through sensitization and advocacy programs
List of References
Athukorala Kusum Some Reflections on Equity, Inclusion and Sustainability issues related to Sanitation
and Hygiene Services in Sri Lanka 2011

Ferdinando D N J. Water Supply and Sewerage Development in Sri Lanka. Institute of Engineers Sri
Lanka, Colombo 2006
Hettiarachchi Missaka An Iconoclastic View of Sanitation in Modern Sri Lanka,Young Professional
Symposium,Sri 2012
Hettiarachchi Missaka and Athukorala Kusum Case Study On The Sustainability Of Urban Water
Services In The Small And Medium Town Ships Located In The Upper Mahaweli Basin Of Sri
Lanka, Stockholm Water Symposium 2006
NetWwater -Situation Analysis of School Sanitation in Central Province, Sri Lanka 2011
Policy Planning Studies of the Ministry of Health and Indigenous Medicine) Study on the School Health
Programme” 2000
279
CONFERENCE EXHIBITION
The exhibition stalls were a key attraction for the conference delegates. Stalls for set up by member
countries and development partners sharing their various publications, materials highlighting
innovation and learning. Various IEC materials and souvenirs were distributed to the delegates. The
exhibition area was mostly visited during the lunch and the tea breaks. The delegates visiting the
stalls were briefed by the hosts disseminating knowledge and learning.

SIDE EVENTS
There were 12 side events held on day 1 & 2 of the conference. The side events were mainly
conducted by the development partners and few by the participating countries. Each session had 2
to 3 speakers followed by question answer session and discussion.
Side Event 1 - Evidence to Improve Lives
Chair:?
Moderator: Dr Pavani Ram, Uni. of Buffalo
Presenters:
- Dr Md. Mahbubur Rahman, ICDDRB
- Mr. Robert Chambers, IDS Sussex
- Mr. Tapan Kumar Nath, Govt of Bangladesh
- Ms. Chaitali Chattopadhyay, WSSCC
Lead Agency: WSSCC
Side Event 2 – Swachh Bharat Mission
Chair: Mr. Saraswati Prasad, IAS, Additional

Secretary, Ministry of Drinking Water and
Sanitation, Government of India
Moderator: Preetha Prabhakaran and Natasha
Sharma, CLTS Foundation
Presenters:
-Mr. Nipun Vinayak, SBMG Director, MDWS
-Ms. M Geetha, SBM Director
-SBM Director, Chhattisgarh
-Remarks by other state champions
Closing Remarks: Additional Secretary, Ministry of
Drinking Water and Sanitation, Government of
India
Lead Agency: MDWS
281
Side Event 3 (a) – Journey to Zero: Sanitation Movement in Bangladesh
Chair:?
Co-Chair: Mr. Hrachya (Charlie) Sargsyan, Chief of

WASH Section, UNICEF Bangladesh
Moderator: Mr. Khairul Islam, WaterAid Country

Representative, Bangladesh
Presenters: Dr. Suzanne Hanchett?
Lead Agency: UNICEF & WaterAid
Side Event 3 (b) – Disaster and Sanitation: Learning from Nepal
Chair:
Moderator:
No Picture
Presenters:
Lead Agency: UNICEF Nepal
Side Event 4: Raising Voices of Children/Youth for Sanitation Improvement in the

Communities/Schools
Chair:
Moderator:
Presenters:
Lead Agency: Sri Lanka SACOSAN Secretariat
Side Event 5: Public Private Partnerships in FSM in the SAARC Region

Chair:
Moderator:
Presenters:
Lead Agency: WSUP, UNICEF, DWASA, SNV,

Practical Action
Side Event 6 (a): Faecal Waste Management in Urban Areas with a Focus on Small Towns –
Getting Right the Policy & Practice
Chair:
Moderator:
No Picture
Presenters:
Lead Agency: FANSA
Side Event 6 (b): Health & Safety Along the Sanitation Value Chain
Chair:
Moderator:
No Picture
Presenters:
Lead Agency: SNV
283
Side Event 7: Appropriate Community Sanitation Approaches for Sustainable

Developments
Chair: Mr. Henk van Norden, Regional WASH

Adviser, UNICEF ROSA
Moderator: Mr. Anowar Kamal, UST
Presenters:
- Mr. Nipun Vinayak, Director SBM, India
- Ms. Suzanne Hanchett, Planning Alternative for
Change
- Ms. Srijana Karki, ENPHO Nepal
Lead Agency: ROSA & BCO
Side Event 8: Payment by Results – An Effective Programme Implementation Approach
Chair:
Moderator:
Presenters:
Lead Agency: Plan Bangladesh
Side Event 9: Data for Decision Making – Costs & Services for WASH in Schools
Chair:
Moderator:
Presenters:
Lead Agency: Splash
Side Event 10: New WHO Initiatives on Sanitation & Health

Chair:
Moderator:
Presenters:
Lead Agency: WHO
Side Event 11: Fecal Sludge Management
Chair:
Moderator:
Presenters:
Lead Agency: DWASA & WSUP, UNICEF
Side Event 12: Menstrual Hygiene Management: Progress in Policy & Practice in South Asia
Chair: Additional Secretary, Government of India
Moderator: Ms. Archana Patkar, WSSCC & Ms.

Therese Mahon, WaterAid UK
Presenters:
- Mr.Vinod Mishra, India
- Mr. Ghulam Qadir, Afghanistan
- Ms. Rina Ray
- Mr. Kitchnme Bawa
- Ms. Payden Kezang
- Mr. Roshan Shreshta
Lead Agency: WSSCC
285
MINISTERIAL MEETING
The ministerial meeting was held on the last day of the conference. The hon’ble ministers and heads
of country delegations participated in the meeting. The meeting was chaired by hon’ble Minister,
Ministry of LGRD & Co-operatives, Bangladesh and supported by the Secretary LGRD and Co-
operatives. Draft declaration was presented to the ministers by the working groups members. Their
feedback and input was incorporated and the final draft was shared in the closing ceremony for their
signatures and endorsement. The declaration was read out to the conference delegates in the
closing ceremony.

Names of the Ministers at SACOSAN VI
Mr. Khandker Mosharraf Hossain, MP, Hon’ble Minister, Ministry of LGRD &
Co-operatives, Government of People’s Republic of Bangladesh
Mr. Shri Birender Singh, Hon’ble Minister of Rural Development, Panchayati

Raj & Drinking Water and Sanitation, Government of Republic of India
Dr. Pandup Tshering, Officiating Hon’ble Health Minister, Government of

Kingdom of Bhutan
Mr. Abdullah Ziyad, Hon’ble Minister, Ministry of Environment and Energy,

Government of Republic of Maldives
Mr. Atiqullah Khawasi, Hon’ble Deputy Minister, Ministry of Rural

Rehabilitation and Development, Government of Islamic Republic of
Afghanistan
287
POSTER PRESENTATION
(Add pictures here)

VVIPs VISIT TO BANGABANDHU MUSEUM

(Add pictures here)
289
CULTURAL PROGRAMME
(Pictures missing)

FIELD VISITS
Field visits were organized for the regional and global delegates to the sanitation and hygiene
programmes implemented by the government departments and development partners in
Bangladesh. The field visit focused on the best practices and learnings on ground and gave an
opportunity to the delegates for cross regional leaning and exchange.
291
CONTACT FOCAL PERSONS
Mr. Rinchen Wangdi, Chief Engineer, Public

Mr. Balasubramanian Govindasamy,
Health Engineering Division, Department of
Deputy Advisor, MDWS
Public Health, Thimphu : Bhutan.
[email protected] [email protected], [email protected]
Mr. Mohamed Mosthafa

rwangdi Mr. Rajan Raj Pandey,
Director Water & Sanitation Deptt, MEE Joint Secretary, MWSS,

[email protected] [email protected]
Mr. B. W. Ranjith Balssuriya,

General Manager, National Water Supply and
Drainage Board [email protected],
Here text txet ereH
[email protected]
,,
[email protected]

THE DHAKA DECLARATION

We, the Heads of Delegation from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan
and Sri Lanka participating in the 6th South Asian Conference on Sanitation (SACOSAN-VI) in Dhaka,
Bangladesh, January 11-13, 2016, which was attended by Ministers, State and Deputy Ministers, Civil
Servants, Civil Society, Academia, Development Partners, Private Sector, adolescents, differently-
abled men and women, sanitation workers:
(1) Endorse the ambition and interdependence of the 17 Sustainable Development Goals and
clearly outline the importance of sanitation and hygiene as crucial for achieving Goals 1,
2,3,4,5,6,8 and 10 in South Asia;
(2) Appreciate the transition from the MDGs to the SDGs and recognize that this will require a
new vision, strategies, stronger systems and more diverse participation;
(3) Understand that while the SACOSAN process has contributed immensely to the progress of
sanitation in South Asia, highlighting hygiene, equity and sustainability aspects of sanitation,
the region needs to accelerate sanitation coverage and hygiene behavior change to achieve
SDG target 6.2;
(4) Recognize that urban sanitation, unreached people and areas, hygiene issues, sanitation in
public places, and resilience of sanitation facilities to climate change need greater attention;
(5) Appreciate the contribution of different stakeholders towards increasing the diversity of
participation and achieving the objectives of the SACOSAN process;
(6) Reaffirm past SAVOSAN commitments between 2003 and 2013;
SACOSAN VI unanimously resolves and commits to:
1. The achievement of the SDG target 6.2: By 2030, to achieve access to adequate and equitable
sanitation and hygiene for all, and end open defecation, paying special attention to the needs
of women and girls and those in vulnerable situations;
2. Strengthen the enabling environment including but not limited to, revised national policies,
strategies, well-resourced plans reflecting the new SDG target and indicator(s) leading to
better sanitation and hygiene outcomes. Call on external financing agencies to increase their
support, where required, to national sanitation and hygiene plans through financial and
technical assistance
3. Prioritize the poorest and most marginalized, bridging the gaps in access to and use of
appropriate sanitation and hygiene services for children, adolescents, women, differently-
abled people, or those excluded due to age, caste, ethnicity, religion or gender, living in hard
to reach areas or affected by disasters. Prioritise menstrual hygiene management for women
and girls;
4. Encourage people driven approaches and emphasize credible country-level mechanisms for
monitoring key outcomes such as improvements in sanitation coverage, achievement of open
defecation-free households and communities, equitable and sustainable delivery of services
including solid and liquid waste management and hygiene behaviour change;
293
5. Emphasize urban sanitation and address sanitation and hygiene gaps especially in underserved
or unserved settlements and poor urban neighbourhoods; solid and liquid waste management,
faecal sludge management and the involvement of urban local bodies and communities;
6. Develop and implement standards and a regulatory framework, wherever required, to ensure
the dignity, adequate remuneration, occupational health and safety of sanitation workers
(involved in solid and liquid waste management), including those worker in the informal sector;
7. Promote continual learning and sharing of experiences and innovations between and within
countries by various mechanisms including: i. A functional and dynamic SACOSAN Secretariat
in Sri Lanka by 2018; ii. An ICWG with an expanded role to enhance knowledge exchange and
learning between meetings; iii. Relevant research and development; iv. Appropriate use of
information technology and traditional and new forms of media;
8. Promote sanitation and hygiene in relevant regional forums including the next SAARC summit
and the implementation of the SAARC regional action framework for sanitation;
9. Actively involve local bodies, young people, school children, marginalized groups, especially
women and girls, differently-abled persons, civil society, media, academia and the private
sector in the SACOSAN process at all stages and levels, and in the acceleration of sanitation
and hygiene outcomes in the region;
10. Progressively ensure adequate, inclusive and safe institutional sanitation and hygiene,
including but not limited to educational and health facilities, transport hubs, market and work
places;
11. Promote environmentally sound and climate resilient sanitation facilities.
We express our profound appreciation to the Government and People of Bangladesh for their
excellent hosting of this event and for their generosity and hospitality.

ACKNOWLEDGEMENTS
This is our pleasure to acknowledge the financial and other support from the following Development
Partners in organizing the SACOSAN VI in Dhaka, Bangladesh on 11th – 13th January 2016
S. No Name of the Development Partners

1 UNICEF
2 World Bank
3 New Venture Fund (NVF)
4 Water Supply and Sanitation Collaborative Council (WSSCC)
5 EKN Netherlands
6 WaterAid Bangladesh
7 SNV- Netherlands Development Organization
8 Bangladesh Rural Advancement Committee (BRAC)
9 Water & Sanitation for the Urban Poor (WSUP)
10 Practical Action Bangladesh (PAB)
295
CLOSING CEREMONY
The closing of SACOSAN VI conference was held on the day
3 of the conference. The Honorable Minister, Ministry of [Type a quote from the document or
LGRD & Co-operatives joined the session as the chief guest. the summary of an interesting point.
The country focal person Bangladesh read out the You can position the text box
declaration of the conference. The UN and the World Bank anywhere in the document. Use the
representatives addressed the audience emphasizing their Text Box Tools tab to change the
strong commitment to enable the people of South Asia to formatting of the pull quote text
improve sanitation practices. The heads of country box.]
delegations gave their brief closing remarks and thanked
the Government of Bangladesh for their remarkable hosting of the conference.
The Secretary General SAARC Mr. Arjun B. Thapa also addressed the audience. He commended the
work of all the Member States who were part of the process of SACOSAN, for their enthusiasm,
commitment and hard work in reaching a consensus and paving the way for moving forward, together,
on the issue of sanitation and hygiene.
Memento was presented to the country focal persons and the heads of the delegations by the Chief
Guest. The SACOSAN Chair presented a memento to the Chief Guest for his valuable participation and
support throughout the conference.
The Secretary, Local Government Division and Chairman, SACOSAN-VI Organizing Committee gave his
closing remarks. On behalf of the Ministry, he expressed gratitude to all development partners,
particularly UNICEF, WSP and WaterAid for providing support in the organization of 6th SACOSAN. He
thanked the media, NGOs, private sector and other partners for their active participation and support.
The Honorable Minister, Ministry of LGRD & Co-operatives gave his closing address. He congratulated
the Ministry of LGRD for organizing this important conference on sanitation and extended his thanks
to all the delegates from home and abroad for attending this conference.
The conference was formally closed by vote of thanks by the Coordinator, SACOSAN VI Secretariat
Picture Picture Picture

Speech of the UN Representative

Picture missing Mr. Edouard Beigbeder,
Representative UNICEF
Bangladesh
 Today’s Chief Guest Honorable Minister for LGRD & Co-operatives of the People’s Republic of
Bangladesh Mr. Khandker Mosharraf Hossain MP
 Honorable Ministers of the other South Asian countries
 Honorable Chairperson of the closing session Mr. Abdul Malek, Secretary, Local Government
Division, Government of Bangladesh
 Development partners and practitioners from home and abroad;
 Distinguished guests
 Ladies and gentlemen
Good afternoon and Assalamu Alaikum. AP-NADER SHOBAI KE SHU-VECH-CHA (Greetings to

you all)
On behalf of UNICEF, I would like to thank our host and felicitate the Government of Bangladesh for
organizing this Sixth South Asia Conference on Sanitation, and giving me an opportunity to speak in
front of such a distinguished gathering.
At the very outset, I want to emphasize the strong commitment of UNICEF to enable the people of
South Asia to improve sanitation practices. Sanitation is a basic human right, vital to the survival,
growth and development of children.
In 2013, at the fifth SACOSAN conference in Kathmandu, governments pledged to improve sanitation
in the region. While the region did not achieve the MDG target for sanitation, there are achievements
which demonstrate South Asia’s ability to make progress.
In Bangladesh, open defection has reduced from 19 per cent in 2000 to 1 per cent in 2015: a
phenomenal achievement! This shows that with the right policies, strategies, investments, and
sustained leadership by government and the civil society, open defecation can be eliminated. Indeed,
Bangladesh has embarked on its “Journey to zero”, to eliminate open defecation in the coming years.
297
In 2014, the Prime Minister of India announced the Swachh Bharat Mission, for a Clean India, including
the elimination of open defecation by October 2019. This has resulted in revisions in India’s rural
sanitation programme, allowing the States greater flexibility.
In Pakistan, the 18th amendment to the Constitution enhanced provincial autonomy, including their
responsibilities for sanitation programmes. The provincial governments are adopting their version of
the Pakistan Approaches to Total Sanitation, using provincial budgets for implementation.
In Nepal, the social movement to end open defecation by 2017 has now resulted in stopping open
defecation in 21 out of 75 districts and close to half of the village development committees.
Despite these progresses, there is still a very long way to go …
India alone accounts for more than 90 per cent of the open defecators in South Asia. While some
states are making headway, the pace and scale of reducing open defecation still needs to increase
dramatically, especially in the large-burden states.
There are also huge disparities in sanitation coverage, between rural and urban areas, among ethnic
minorities and between rich and poor. This demonstrates that children in such households are at
greatest risk of the consequences of open defecation.
Children across South Asia too often suffer from illnesses caused by drinking unsafe water, lack of
healthy sanitation and poor hygiene behaviors. Repeated bouts of diarrhoea drain nutrients from the
body, contributing to stunting of children. Stunted children are not just shorter and thinner, they are
more vulnerable to disease and their brains may not develop as they should.
South Asia also holds the key to global polio eradication. Initiatives in Afghanistan and Pakistan to
improve sanitation and hygiene are helping overcome community resistance to polio immunization
while also reducing disease transmission.
Clean toilets at home allow women and girls crucial privacy, dignity and safety. Separate toilets for
girls in schools improve girls’ school attendance and learning. Today’s child is tomorrow’s adult, and
sanitation behavior is much easier changed at a young age than later in life.
On 25 September 2015, the 193 Member States of the United Nations adopted the Sustainable
Development Goals, a global agenda to end poverty by 2030 and pursue a sustainable future.
The SDG target for sanitation brings even greater challenges. SDG target 6.2 aims for universal
coverage of adequate and equitable sanitation and hygiene. The indicator proposed is defined as
‘safely managed sanitation’. This is much more demanding than the MDG target for sanitation, which
only aimed to halve the proportion of the population not using improved sanitation facilities. There
is also SDG target 6.3, aiming to halve the proportion of untreated waste water: another huge
challenge for rapidly urbanising South Asia.
Achieving the SDG sanitation targets will mainly be done under the leadership of Governments
through mobilising public and private domestic resources and attracting investments from the capital
markets. Donor funding helps but will not be sufficient on its own.

UNICEF will continue to focus on the highest priority, aiming to reduce the number of open defecators
in South Asia from 620 million in 2014 to 500 million in 2017. This requires a five-fold increase in the
average rate of reduction. With India’s commitment to eliminate open defecation by 2019, and the
Swach Bharat programme increasingly focusing on the use of toilets rather than merely building
toilets, this result may be feasible.
The Dhaka Declaration, which you have just now adopted, reflects both the commitment and resolve
of governments to attain the new SDG sanitation targets. Now the hard work has to start to reflect
these targets into national policies, targets, plans, strategies and resource allocations.
In conclusion, I would like to emphasize that good sanitation is the birthright of every child and we
must all work together to realize that right for all South Asians.
Thank you all.
299
Speech of the World Bank Representative

Mr. Parameswaran Lyer
Picture missing Practice Manager, Water GP,
World Bank, Bangladesh
(Speech missing)

Address by his excellency

Mr. Arjun B. Thapa,
Picture missing Secretary General of SAARC
The Hon’ble Khandker Mosharraf Hossain, MP, Minister of Local Government, Rural Development and
Cooperatives, Government of the People’s Republic of Bangladesh
Hon. Ministers, Distinguished Representatives from International Organizations
Distinguished Delegates, Ladies and Gentlemen
As I meet you all here once again, it gives me immense pleasure to address the Closing Ceremony of
the Sixth South Asian Conference on Sanitation (SACOSAN-VI). I am pleased and honoured to be here
to celebrate a common path in addressing sanitation and hygiene, that we have paved for South Asia,
through the Dhaka Declaration, which was adopted by the Member States today.
I would like to congratulate the Government of Bangladesh for hosting this important Conference, and
for the excellent organisation of the various technical sessions and side events, which has eventually
lead to the formulation of this important document before us, which reflects the true spirit of the
theme of the Conference, “Better Sanitation, Better Life”. On the same note, let me commend the
work of all the Member States who are part of the process of SACOSAN, for their enthusiasm,
commitment and hard work in reaching a consensus and paving the way for moving forward, together,
on this important issue. It is my fervent hope that this Declaration will go down in the history of South
Asia as a landmark achievement in addressing issues of sanitation and hygiene.
The Dhaka Declaration not only affirms the spirit of the ambition of the global Sustainable
Development Goals, but also registers the region’s commitment to accelerate the achievement of the
related targets under the SDGs.
As we are all aware, Declaration, among others, highlights areas of planning, monitoring, governance,
financing, budgeting and regional collaboration aspects, related to sanitation and hygiene in South
Asia. It is definitely heartening to see such a comprehensive, ambitious and collaborative set of
understanding set out in the Declaration. However, while we celebrate a fruitful outcome of the
deliberations of the Conference today, let us remind ourselves that, this is only the beginning of a long
and arduous journey ahead of us. In this regard, I cannot overemphasize the importance of translating
our commitments on paper into timely implementation and action, which is the key to achieving our
goal of ‘sanitation for all’.
As I have mentioned in my speech at the inaugural ceremony, SAARC provides a platform for the
Member States to share experiences and learn collectively from the best practices, to accelerate
301
progress towards achieving clean and safe sanitation in the region. The “South Asia Regional Action
Framework for Sanitation” which was launched by SAARC in 2014, with the support of UNICEF is in
line with the directives of the SAARC Health Ministers. The Framework recognizes SACOSAN as a key
regional process for the promotion of sanitation in South Asia and agrees to continue to ensure the
effectiveness of the SACOSAN process by obliging themselves to report specifically against the
SACOSAN commitments, and to support the monitoring and implementation initiatives of SACOSAN
in its previous meetings.
Therefore, I must highlight here that the linkage of SACOSAN to the SAARC process has already been
initiated by the Member States, which will further strengthen the region’s collective effort to tackle
this issue on a regional level in South Asia. It is through such linkages, exchange of ideas and sharing
of experiences that we can truly accelerate our progress and achievements in this regard. I hope that,
similar to the desire expressed in the Declaration, Member States here will take forward theimportant
elements of the SACOSAN and its lessons, into the SAARC process through the relevant forums in
SAARC, such as the Technical Committee for Health and Population and the Meeting of the SAARC
Health Ministers.
Before I conclude, I would like to place on record my sincere appreciation and gratitude to the
esteemed Government of Bangladesh for the warm reception and gracious hospitality extended to
me and my delegation. Since our arrival in Dhaka,we were made to feel at home, and it is for this
reason that we will be departing Dhaka tomorrow, with the anticipation to return once again.
Let me also express my sincere hope that when we will all meet again, at the Seventh SACOSAN, we
will have many more success stories to share, best practices to learn from and achievements to
celebrate. Let us all once again, reiterate our commitment to the South Asian people, to provide them
with their basic right to sanitation in order to allow them to live a life of dignity, in an environment
that is safe and clean.
I thank you all for your kind attention, and wish the distinguished delegates who are here from outside
Bangladesh, a safe and comfortable journey back home.

Vote of thanks: Hon’able Secretary, Ministry of LGRD

& Cooperatives, Government of the People’s Republic
of Bangladesh
Picture missing
(Draft Speech)
Hon’able Secretary, Ministry of LGRD & Cooperatives, Government of the People’s Republic of
Bangladesh
BismillahirRahmanir Rahim
 Chief Guest of the Inaugural session of SACOSAN-VI, theHon’able President of Government of

the People’s Republic of Bangladesh ;
 Chairman of the Inaugural session of SACOSAN-VI;
 Honorable visiting Ministers and Head of Delegations from participating countries;
 Honorable Ministers and Members of Parliaments;
 My colleagues;
 Excellencies, Members of the diplomatic missions;

 Representatives of Mass Media;
 Participants;
 Distinguish guests;
 Ladies and Gentlemen
AssalamuAlaikum
I am pleased that the Ministry of LGRD &Cooperatives of Bangladesh gets the opportunity to organize
the 6th South Asian Conference on Sanitation ( SACOSAN-VI ) in Dhaka and this Conference is being
attended by delegates from the South Asian countries, heads of international organizations, NGOs,
sanitation experts, and others concerned.
The Conference provided South Asian countries an excellent opportunity to present their progress in
sanitation and share information on innovative approaches and strategies. There are several
examples of best practices in the region that can be replicated with some modifications to suit local
conditions in individual countries. Although much has been achieved after 1st SACOSAN, the overall
303
picture of sanitation in South Asia still not satisfactory yet and the practice of open defecation,
unsanitary disposal of human excreta and other unhygienic practices by the majority of people in this
region is a serious threat to the quality of life, control of disease and the environment
I am sure that the 6th SACOSAN will guide the region towards the way forward from where we
started during 1st SACOSAN. In the last decades, sanitation coverage in Bangladesh increased
significantly. In 2003, 42% people used to practice open defecation where, as per JMP report open
defecation has been reduced to 1% in Bangladesh. It shows that the people of our country have
become more conscious than before about sanitation practice. It is surely the outcome of previous
SACOSANs.
The Ministry would like to express its gratitude to all development partners, particularly UNICEF,
Water and Sanitation Program and Water Aid who provided support in the organization of 6th
SACOSAN. We are also thankful to the media, NGOs, private sector and other partners for their active
participation and support. Finally, I would like to express my sincere hope that the conference will
come out with concrete and pragmatic approach making the conference a milestone in the history
of sanitation promotion.
I, on behalf of Ministry of LGRD & Cooperatives, wish every success of this 6th South Asian
Conference on Sanitation (SACOSAN-VI).
Thank you all.

Address by Chief Guest, Hon’able Minister of

Government of the People’s Republic of Bangladesh
(picture missing)
BismillahirRahmanir Rahim
 Honorable chairman;
 Honorable visiting Ministers and Head of Delegations from participating countries;
 Honorable Ministers and Members of Parliaments;
 My colleagues;
 Excellencies, Members of the diplomatic missions;
 Representatives of Mass Media;
 Participants;
 Distinguish guests;
Ladies and Gentlemen
AssalamuAlaikum and very good morning
It is a great pleasure for me to have this proud privilege and opportunity to welcome you all
participants and excellences attending the “6th South Asian Conference on Sanitation” and
congratulate the ministry of LGRD for organizing this important conference on sanitation and I like to
extend my Thanks to all the delegates from home and abroad for attending this conference.
It is my honor and pleasure to thank our special guests, head of the delegation and members of
delegations from abroad for taking all the trouble to travel to Bangladesh to attend This conference. I
hope your stay in Dhaka for last three days have been enjoyable and suitable.
I express my deep satisfaction to be here with you in the closing session of 6th SACOSAN. It is really a
great opportunity for the Government of Bangladesh to arrange such a huge conference.
As all of are aware that Bangladesh is the pioneer of SACOSAN initiated in 2003. With the passage of
time, Bangladesh has hosted SACOSAN 2nd time by the SACOSAN-VI. We feel honored to become the
part of SACOSAN history. In Bangladesh, the emphasis has been placed on the confinement of faces
and reducing open defecation rather than the construction of improved latrine. Now the challenge is
to bring all people from fixed place defecation to improved and hygienic latrine use. To achieve a
healthier future of our nation, the present Govt. under the leadership of Sheikh Hasina has also declare
305
to provide one toilet for one house in their election manifesto. We have also to face challenges
regarding urban sanitation, hard to reach areas, climate change, sustainability, shared latrine, hygiene
issues and total sanitation coverage. Most of those are common for our member countries also.
Despite of our continuous effort there may be some lapses and short coming in the management and
could not extend our hospitality as your expectation for many reasons.
I thank you all and wish you a healthy and prosperous life.

ANNEXES
1. PRESENTATIONS (Country Presentations/Plenary Sessions/TFS/Side Event)
2. COUNTRY PAPERS
3. PLENARY SESSION PAPERS
4. TFS PAPERS
5. SIDE EVENT PAPERS
6. PRE-SACOSAN EVENTS
7. SACOSAN VI SECRETARIAT
8. OVERVIEW OF SACOSAN VI SUB-COMMITTEES
9. LIST OF COUNTRY/REGIONAL/INTERNATIONAL DELEGATES
10. PHOTOGRAPHS
307

SCOSAN VI Proceedings

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Bangabandhu Sheikh Mujibur Rahman

Father of the Nation

Md. Abdul Hamid Sheikh Hasina

2 BACKGROUND & INTRODUCTION

The key objectives of SACOSAN VI is to:

 SDG challenges and the way forward

Pre SACOSAN-VI Day (Sunday) 10 January, 2016

Day 1 (Monday) 11 January, 2016

*Each session will be for 45 minutes only.

Day 2 (Tuesday) 12 January, 2016

es for impleme WASH in and sustain progress

Day 3 (Wednesday) 13 January, 2016

The SACOSAN declaration is the key outcome of the

The conference was inaugurated by the Hon’ble Md. Abdul Hamid,

The conference inaugural ceremony was attended by the ministers

The conference was inaugurated with the national

SACOSAN-VI theme song with live performance by Shilpakala

Address by His Excellency Mr. Arjun B. Thapa,

The Hon’ble Khandker Mosharraf Hossain,

Minister for Local Government, Rural Development and Cooperatives of Bangladesh,

Hon. Ministers, Excellencies, Distinguished Delegates, Ladies and Gentlemen,

I wish the Conference every success.

Speech by Mr. Atiqullah Khawasi, Hon’ble Deputy

Speech of Shri Birender Singh,

Speech by H.E. Mr. Shuja Alam, High Commissioner,

Speech by the Secretary, Ministry of City Planning &

Hon’ble President of the People’s Republic of Bangladesh, Mr Md. Abdul Hamid

Ladies and Gentlemen

Assalamualaikum and very good morning.

to enhance sanitation converge. Ministry of Local Government, Rural Development and

Speech of the Chief Guest,

KEY NOTE SPEECH

A keynote speech was made by Professor M. Feroze Ahmed, Vice

He emphasized that SACOSAN needs to develop a

Afghanistan Country Paper

In Afghanistan, overall access to improved sanitation facilities are

Most recently the government has introduced the Citizen’s

The political commitment of the government and a multi-

Bangladesh has evolved some good practice to share with the

Bhutan Country Paper

Despite the commendable progress made in sanitation and

The progress in sanitation has witnessed a spurt, since the launch of

Maldives Country Paper

The government of Maldives attaches a high priority to the Health

Provision of appropriate water supply and sewerage services is

The Government seeks out to involve the private sector in developing,

The Government of Nepal has set a target to achieve universal

After enforcement of the Master Plan, National Sanitation and Hygiene

Pakistan Country Paper

Pakistan has made steady progress towards achieving an open

According to the Joint Monitoring Programme (JMP) Report 2015,

Provision of water and sanitation has been one of the highest

REVIEW OF SACOSAN-V COMMITMENTS (TLP)

Signing of the Ministerial declaration with specific commitments has been an

The progress against the ten commitments signed at SACOSAN V, using an

Plenary Session 1: Community Approaches to Sanitation & Hygiene

Chair: Mr. Jyotirmay Dutta, Additional Secretary

Moderator: Dr. Kamal Kar, Chairman, CLTS

Plenary Session 2: Innovation on Sanitation & Hygiene

Chair: Mr. SaurendraNath Chakrabhartty, Additional