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Total sanitation in South Asia


									 Discussion paper

                                  Total sanitation
                                  in South Asia
                                  the challenges ahead
  This paper has been prepared
  for the second South Asian
  Conference on Sanitation

  May 2006

                                  WaterAid/ Liba Taylor

                                       <    Government sanitation services are not reaching the poorest
                                            and most vulnerable people and are not addressing the
                                            specific needs of women, children and disabled people
                                       <    There is a looming urban sanitation crisis in South Asia and
                                            governments are not tackling this with the sense of urgency
                                       <    Current levels of investment in sanitation are not sufficient to
                                            meet national and international sanitation targets
                                       <    The rush to meet national and international sanitation targets
WaterAid - water for life                   is resulting in construction of latrines only, so called
The international NGO dedicated             “latrinisation”, and not in “total sanitation”
exclusively to the provision of        <    National monitoring systems continue only to count latrines and
safe domestic water, sanitation             do not provide information on the number of totally sanitised
and hygiene education to the                communities and on the sustainability of sanitation facilities
world’s poorest people.
       he majority of people                 improved sanitation, and in urban   The South Asian Conference on
       in South Asia still lack              areas the figure is 34% (United     Sanitation (SACOSAN) held in
       access to adequate                    Nations, 2005). The clear links     Dhaka in 2003 was a landmark
sanitation. The latest UN                    between access to adequate          event in meeting the challenge of
Millennium Development Goals                 sanitation and poverty reduction    ensuring access to adequate
(MDG) report indicates that in               have been repeatedly                sanitation for all South Asians. The
South Asia in rural areas 76% of             demonstrated.                       conference resulted in the first
the population do not use                                                        ever regional, ministerial level
                                                                                 Declaration on sanitation in which
                                                                                 governments committed to
                                                                                 accelerate progress in sanitation
                                                                                 and hygiene through a people-
                                                                                 centred, community-led, gender-
                                                                                 sensitive and demand-driven

                                                                                 SACOSAN gave new momentum to
                                                                                 the sanitation sector and many
                                                                                 countries have made exemplary
                                                                                 efforts to meet the commitments
                                                                                 made in the Declaration.
                                                                                 Governments in India and
                                                                                 Bangladesh have launched
                                                                                 national level sanitation
                                                                                 programmes and increased
                                                                                 budget allocations to sanitation;
                                                                                 in Nepal the Government has
                                                                                 drafted national sanitation and
                                                                                 hygiene guidelines; in Bangladesh
                                                                                 a national sanitation strategy has
                                                                                 been approved; and in all three
                                                                                 countries innovative approaches
                                                                                 are being adopted by
                                                                                 governments, for example awards
                                                                                 for sanitised communities.1

                                                                                 Yet if the vision of a South Asia
    WaterAid/ Caroline Penn                                                      free of open defecation and with
                                                                                 people living in dignity is to

    Examples for this paper are taken only from Bangladesh, India and Nepal.

become a reality, governments
need to take a number of actions
in response to key emerging

1. National sanitation
programmes must be refocused to
reach the poorest and most
vulnerable people and address
the needs of women, children and
disabled people. These
programmes should be
implemented by local
governments and NGOs and
citizens should be made aware of
their entitlements from the

2. Policies must be formulated
and programmes and investment
plans initiated through multi-
stakeholder processes, to tackle                                                              WaterAid/ Marco Betti

the looming urban sanitation
crisis, recognising the right of all   community, NGO teams.                  increases in access to
people to sanitation. These            Governments need to publish            sanitation will, on present
programmes should include              annual performance reports on          trends, result in the deaths of
mapping of all slum areas and          sanitation.                            an extra 10 million children
appropriate technologies, such as                                             globally by the time the MDG
community managed toilet blocks.       SACOSAN 2 provides governments         target is finally reached in 2026
                                       with an opportunity to                 (WaterAid, 2005:1).
3. The level and quality of            demonstrate their commitment to
financing for sanitation must be       act on these issues through the        We also urge governments to
further increased.                     Islamabad Declaration. Our             reaffirm the commitments they
                                       recommendations on how these           made in the Dhaka Declaration.
4. Sanitation monitoring must be       issues can be tackled are given in     In particular governments must
strengthened to focus on all           this paper. With only another four     reaffirm the need for gender-
aspects of total sanitation and go     SACOSANs prior to 2015 it is           sensitive sanitation programmes
beyond counting latrines.              critical that ministers begin to act   and the commitment to
Monitoring and declaration of          with a sense of urgency. The           establish an inter-country
totally sanitised areas should be      failure to deliver the required        working group on SACOSAN.
done by joint government,

Key issues
Key issues in moving forward
on the SACOSAN 1 agenda
                                        ince the first SACOSAN      Sanitation services
                                        in 2003 there have          are not reaching the
                                        been a number of            poorest people
                               initiatives by governments to

                               accelerate sanitation coverage. In          ational sanitation
                               Bangladesh, India and Nepal,                coverage is increasing yet
                               WaterAid and partners have been      sanitation services are not
                               supporting these. However, based     reaching the poorest and most
                               on knowledge and insights from       vulnerable people (WaterAid,
                               our work with communities, and       2005:2). In the Dhaka Declaration
                               our experiences, research and        (2003) countries noted that “it is
                               analysis of these government         the vulnerable and marginalised
                               initiatives, we are concerned that   population in urban and rural
                               a number of key emerging issues      areas that suffer most from
                               are yet to be satisfactorily         minimal access to sanitation
                               addressed by governments across      facilities”. However, new
                               the region. These issues, our        programmes are still not reaching
                               modest attempts to address them      these people. In Nepal two-thirds
                               and our recommendations to           of districts have sanitation
                               governments are outlined below.      coverage below the national
                                                                    average and these are the
                                                                    poorest and most inaccessible
                                                                    districts (WaterAid Nepal, 2004). In
                                                                    India the Government’s Total
                                                                    Sanitation Campaign provides
                                                                    subsidised latrines to poor
                                                                    households. Yet due to limited
                                                                    participation of communities in
                                                                    decisions over which households
                                                                    should receive subsidised latrines,
                                                                    and lack of information about the
                                                                    campaign in remote villages, many
                                                                    poor and vulnerable households
                                                                    are not covered by the campaign.
                                                                    In Bangladesh, drawing
                                                                    experiences from other public
                                                                    subsidy programmes, there is
                                                                    concern that subsidies provided
                                                                    by national programmes through
                                                                    local government institutions are
     WaterAid/ Anita Pradhan
                                                                    not always reaching the poorest.

                                                                    WaterAid and partners have
                                                                    been researching and
                                                           highlighting this issue by publishing
                                                           comparisons of district sanitation
There are various reasons why this                         coverage and raising concerns of
is happening. Some are related to                          subsidy leakage with governments.
geography: latrine components are                          We are working with the private
expensive in remote areas and there                        sector to establish sanitation
remains a lack of technical                                production centres in remote areas,
sanitation options for the poor and                        making materials available at
vulnerable living in difficult                             affordable prices. We are following
geographical locations, such as                            gender and poverty-sensitive
flood-prone areas. Other reasons                           approaches in our projects and we
are legal: governments are reluctant                       promote child friendly latrine
to provide services to people living                       designs. We are also piloting
on non-tenured land, where most of                         disabled friendly technology
the urban poor reside. And others                          options.
are institutional: local government
institutions are inexperienced at                          We have also initiated a series of
managing large scale, pro-poor                             Citizens’ Action projects across the
sanitation programmes. Yet the                             region, working with communities to
outcome is the same everywhere,                            achieve accountability in the
everyday: the poor face the indignity                      provision of water and sanitation
of open defecation.                                        services. In these projects people
                                                           learn about their rights, entitlements
                                                           and responsibilities under various
                                                           government water and sanitation
                                                           programmes, research and map their
                                                           current access to sanitation and
                                                           then engage with service providers
                                                           in a dialogue to secure improved
                                                           service provision.

               Governments need to conduct reviews, in consultation with all stakeholders, to
               find out whether national sanitation programmes are actually reaching the poorest.
       Then governments need to establish, implement and evaluate improved mechanisms for
       reaching the poorest. Where possible these programmes should be implemented by local
       governments, strengthening their capacity in the process. Government funding should also be
       provided for NGOs to support local government in delivering sanitation services. All citizens
       need to be made aware of their entitlements under these programmes.

Governments are not
ready to address the
looming urban
sanitation crisis

R    apid urbanisation across
      South Asia is putting a strain
on urban sanitation systems. In
many towns and cities piped
sewerage systems do not even
exist. Where they do exist
connectivity is generally low and
the poor and vulnerable are not
connected. One in three city
dwellers lives in slum areas and
the number of slum dwellers in
South Asia has increased by a
quarter over the last decade
(United Nations, 2005). Slums are
very rarely connected to city
sanitation infrastructure and the
sanitation situation is deplorable.
Official data on sanitation is
                                        WaterAid/ Liba Taylor
generally insufficient and
unreliable, and that for urban
areas is worse. This means that
the actual status of sanitation in     and sanitation and plans on how       generate adequate funds
towns and cities in the region is      services will be provided to people   themselves, nor access financing,
not known. Where some data are         living in slums. New national         to address their sanitation needs.
available, analysis shows that         sanitation programmes launched
progress towards the MDGs in           after SACOSAN 1 are focused on        One of the main reasons for this
urban areas is slower than in rural    rural areas only. Many larger         crisis is the indifference by the
areas.                                 urban centres have access to          urban middle classes who cocoon
                                       infrastructure projects funded by     themselves from the effects of
                                       donors. However, research shows       poor sanitation, either by availing
Governments do not seem to be
                                       that many of these projects do not    themselves of the minimal
prepared to tackle this looming
                                       result in improved services for the   networked sewerage that does
crisis. Bangladesh, India and
                                       poor (WaterAid, 2006). Smaller        exist or by moving to self-
Nepal still lack comprehensive
                                       urban centres can neither             contained colonies with
policies on urban water supply

                                                                                    WaterAid and
                                                                                    partners have
                                                                               been raising these
                                                                               issues with
                                                                               highlighting the
                                                                               need for more
                                                                               realistic urban
                                                                               sanitation coverage
                                                                               figures. We have
                                                                               been encouraging
                                                                               governments to
                                                                               sanitation policies
                                                                               for urban areas.
                                                                               WaterAid has
                                                                               recently conducted
                                                                               research on the
                                                                               effectiveness of
                                                      WaterAid/ Jim Holmes
                                                                               Asian Development
                                                                               Bank projects in
                                                                               serving the poorest
independent sanitation provision. There is also a lack of data on              with sanitation
sanitation in urban areas and this is compounded by confusion over             (WaterAid, 2006).
what sanitation actually means in an urban context and by a lack of an         At the same time
accepted definition. Institutional responsibility for urban sanitation         we are striving to
remains unclear. It is often split across a number of departments,             develop and
resulting in lack of coordination. In many countries local urban bodies        popularise
are mandated to provide sanitation services yet lack the financial resources   effective urban
and the technical know-how to do so.                                           sanitation
                                                                               technologies such
                                                                               as community
                                                                               managed sanitation
                                                                               blocks. These
                                                                               technologies are
                    Governments need to urgently                               designed to meet
                    review the sanitation situation in urban                   the specific needs
          areas and develop, adequately resource and                           of women and
          implement urban sanitation policies and                              children, who are
          programmes, through multi-stakeholder review                         particularly
          processes, recognising the right of all people to                    vulnerable to the
          sanitation. These programmes should include                          impact of poor
          mapping of all slum areas and appropriate                            sanitation.
          technologies, such as community managed toilet

                              WaterAid/ Anita Pradhan

                              Inadequate and
                              inefficient financing
                              for sanitation

     WaterAid/ Marco Betti
                              C    urrent levels of investment
                                   in sanitation are not sufficient to
                              meet national and international
                              sanitation targets. Where financing is
                              available disbursements are slow
                              and the absorption of funds is low.
                              Sector financing calculations for
                              Nepal estimate that only 8% of
                              sector expenditure goes to
                              sanitation. This is happening despite
                              the fact that sanitation coverage lags
                              behind that of water (25% versus
                              71%) and there is an annual
                              financing gap of US$6million for
                              household sanitation alone if the
                              Millennium Development Target for
                              sanitation is to be met (WaterAid
                              Nepal, 2004). In India it is calculated
                              that there is a shortfall of $6.4 billion
                              in financing needed to be bridged
                              between 2002 and 2015 to reach the
                              MDG sanitation target in rural areas.
                              However allocations and annual
                              increases continue to be skewed
                              towards rural water supply where
    WaterAid/ Anita Pradhan
                              coverage is relatively higher
                              (WaterAid India, 2005).

                                                                                             WaterAid has
                                                                                             been calculating
                                                                                        the financing gaps
                                                        WaterAid/ Abir Abdullah         in meeting
                                                                                        sanitation targets in
Ultimately this stems from the low      on sanitation are often not known.              all the countries
priority given by governments to        Furthermore, financial transfers                where we work. We
sanitation. This results in minimal     from central to local government                have been using
funding for sanitation when             through multiple layers result in               these calculations
limited development resources are       delays in fund disbursement and                 to demonstrate to
allocated across sectors. In most       low utilisation of allocated funds.             governments and
countries national budgets do not       The decision by the Government                  donors the need for
provide a separate allocation for       of Bangladesh to allocate 20% of                more and better
sanitation. This means most             the local government annual                     financing.
funding for sanitation is lumped        development programme to
with that for water and most is         sanitation is a positive example of
spent on water supply projects.         how this can be addressed by
Actual allocations and expenditure      governments.

                   Governments need to publish estimates of financing required to meet
                   national sanitation targets, current expenditure and available resources. On the
         basis of these estimates, increased priority needs to be given to sanitation in national
         budgets. Governments must review the financing flows of national sanitation
         programmes and make these as effective as possible to ensure full utilisation of
         allocated resources. The recent statements on sanitation in the South Asian Association
         for Regional Cooperation (SAARC) Dhaka Declaration, 2005, show that this forum is
         beginning to recognise the sanitation crisis. Governments need to explore the
         possibility of the using the SAARC Development Fund for forwarding the SACOSAN
         agenda at the regional level.

                                                                                                      WaterAid and
Monitoring of sanitation is still                                                                     partners are raising
                                                                                            these concerns with
limited to counting latrines                                                                governments and
                                                                                            undertaking research in

A     fter SACOSAN 1 many                    only. Use of household latrines, hand          “officially sanitised
      governments increased efforts          washing and other hygiene practices            communities” to highlight
to accelerate sanitation coverage            and provision of latrines in schools and       the extra work that needs to
and this is to be commended. Yet             public places are not being monitored.         be done to achieve actual
the rush to meet targets is resulting        Monitoring systems continue to count           total sanitation. We are also
in construction of latrines only, so         latrines only and do not provide               collating all data on
called “latrinisation”, and not in           information on the number of totally           sanitation coverage,
“total sanitation”. In the Dhaka             sanitised communities and most                 highlighting inconsistencies
Declaration (2003) countries                 importantly on sustainability.                 and weaknesses of various
demonstrated their understanding of          Furthermore there are questions over           surveys, and pushing for
the broader nature of total                  the validity and accuracy of monitoring        agreement on definitions and
sanitation. The Declaration                  data for sanitation.                           use of agreed questions in
highlighted that the thrust of                                                              all national surveys. In
sanitation programmes “should be                                                            Nepal, WaterAid is
                                             This is caused by pressure to
on the elimination of open                                                                  supporting a government
                                             demonstrate results, created by
defecation and other unhygienic                                                             task force which aims to
                                             national and international targets.
practices, as well as the promotion                                                         produce reliable data at the
                                             When in a hurry to deliver, building and
of good hygiene practices”. There is                                                        local level. In all the
                                             counting latrines is far easier than
evidence however that countries are                                                         projects WaterAid supports it
                                             promoting hygiene and measuring
falling short of this principle.                                                            promotes use of community
                                             behaviour change. In most countries
                                                                                            monitoring mechanisms
                                             there are no coherent management
                                                                                            where communities
Across the region communities are            information systems for the sector and
                                                                                            themselves measure
being declared as “totally sanitised”        no third party validation of coverage
                                                                                            behaviour change.
on the basis of latrine construction         figures.

         Governments need to adopt minimum standards in declaring areas as totally sanitised. These must include:
          < No open defecation.
          < Hygienic latrines available to and used by all.
          < Proper maintenance of latrines for continual use.
          < Improved hygienic practice.
           < Proper management of solid waste, household wastewater and storm water.
Governments need to ensure that their national sanitation programmes include all the components required to achieve
totally sanitised communities according to this definition. Monitoring and declaration of totally sanitised communities
should be done by joint government, community and NGO teams. Governments need then to publish regular annual
updates on sanitation coverage using both hardware (ie latrine construction) and software (ie latrine use and hand
washing) indicators. In these reports all data should be disaggregated on the basis of gender and poverty so it is clear
who is benefiting from improvements. Coupled with publishing of financial information recommended above, this will
provide a picture of the status of the sanitation sector and a basis for realistic delivery plans.

               WaterAid and W
                                                                                    aterAid and its partner organisations are committed to work
                                                                                    with all stakeholders and make their contribution to
                                                                              improving sanitation in the region for the poorest and most

              partners’                                                       vulnerable. WaterAid aims to scale up its work in sanitation. By
                                                                              2010 WaterAid will be helping 1.5 million people gain access to

         commitment to                                                        sanitation every year through its projects and partners.

                                                                              The calls in this paper have been endorsed by WaterAid country
                                                                              programmes and partners across the region.

    WaterAid Bangladesh Partners

                                                                                    Association for Realisation        Assistance for Slum          Dhaka Ahsania
                                                                                     of Basic Needs (ARBAN)              Dwellers (ASD)             Mission (DAM)

    Dushtha Shasthya
      Kendra (DSK)            Green Hill (GH)            Mahideb Jubo Somaj                                         NGO Forum For Drinking              PHULKI
                                                                                            NABOLOK                Water Supply & Sanitation
                                                        Kallayan Somity (MJSKS)

                            Population Services &          Rural Health and                 SHUSHILAN                Unnayan Shahojogy             Village Education
       PRODIPON                                              Development                                                Team (UST)              Resource Center (VERC)
                            Training Centre (PSTC)          Society (RHDS)

   WaterAid India Partners
                                                                                                                                                Research in Environment,
                                                                                                                    Modern Architects of       Education And Development
                                                                                             ABHIYAN                 Rural India (MARI)             Society (REEDS)

                                                                                                                                                     Association for
                                                                                                                                                   Women's Education
   Gram Swarajya Samiti      Integrated Development          Janhith Vikas                                                                          and Development
      Ghoshi (GSSG)              Foundation (IDF)            Samithi (JVS)                GRAM JYOTI                    GRAMALAYA                       (AWED)

                                                                                                                                                       Bhartiya Jan
                                                                                                                                                     Utthan Parishad
    Social Awareness
     Institute (SAI)        Sambhav Social Service         Sankalp Sanskritik     Swami Vivekananda Youth                   ADITHI
                            Organisation (SAMBHAV)          Samiti (SANKALP)         Movement (SVYM)

    WaterAid Nepal Partners
                                                      Federation of Drinking       Non Governmental Organisation     Nepal Water for Health      Lumanti Support Group
                                                     Water and Sanitation Users      Forum for Urban Water and             (NEWAH)                for Shelter (LUMANTI)
                                                        Nepal (FEDWASUN)               Sanitation (NGOFUWS)

WaterAid Asia region country programmes

 WaterAid Bangladesh                    WaterAid India                               WaterAid Nepal                             WaterAid Pakistan
 House - 97/B, Road - 25                25, Navjivan Vihar, Malviya Nagar            Shanta Bhawan, Lalitpur, Nepal             Block 14, Civic Centre
 Block - A, Banani, Dhaka - 1213        New Delhi – 110017                           GPO Box: 20214, Kathmandu, Nepal           Sector G-6, Islamabad, Pakistan
 Telephone: + 880 2 8815757/ 8818521    Telephone: + 91 11 26692206/ 26693724        Telephone: + 977 1 5552764/ 5552765        Telephone: + 92 51 282 6582
 Fax: + 880 2 8818521                   Fax: + 91 11 26691468                        Fax: + 977 1 5547420                       Fax: + 92 51 282 2037
 Email:         Email:                 Email:       Email:
References                                    Summary of main
1.  His Majesty’s Government of
    Nepal National Planning
    Commission (2002) The Tenth               recommendations to
    Five Year Plan
2. South Asian Conference on                  governments
    Sanitation (2003) The Dhaka
    Declaration on Sanitation
3. United Nations (2005) The                  To ensure that the poorest and most vulnerable
    Millennium Development Goals              benefit from national sanitation programmes
    Report                                    <   Conduct reviews, in consultation with all stakeholders, to find out
4. WaterAid (2005:1) Dying for the                whether national sanitation programmes are actually reaching
    Toilet                                        the poorest.
5. WaterAid (2005:2) Getting to               <   Establish, implement and evaluate improved mechanisms for
    Boiling Point                                 reaching the poorest and addressing the needs of women,
6. WaterAid (2006) Getting to                     children and disabled people.
    Boiling Point: 2006 Update                <   Implement sanitation programmes through local government,
7. WaterAid (2006) Water for All? A               strengthening their capacity in the process.
    study on the effectiveness of             <   Provide funding for NGOs to support local government in
    Asian Development Bank water                  delivering sanitation services.
    and sanitation projects in                <   Make citizens aware of their entitlements under these
    serving the poorest of the poor               programmes.
8. WaterAid India (2005) Drinking
    Water and Sanitation Status in            To tackle the looming urban sanitation crisis
    India: Coverage, Financing and            <   Urgently review the sanitation situation in urban areas.
    Emerging Concerns                         <   Develop, adequately resource and implement urban sanitation
9. WaterAid India (2006) India                    policies and programmes, through multi-stakeholder review
    Country Situation Paper for                   processes, recognising the right of all people to sanitation.
    SACOSAN 2, forthcoming                    <   Map all slum areas and support provision of community
10. WaterAid Nepal (2004) The                     managed toilet blocks in slums.
    Water and Sanitation Millennium
    Development Targets in Nepal              To increase the quantity and quality
11. WaterAid Nepal (2006) Nepal               of financing for sanitation
    Country Situation Paper for               <   Publish estimates of financing required to meet national
    SACOSAN 2, forthcoming                        sanitation targets, current expenditure and available resources.
                                              <   Increase financing to sanitation and review the financing flows of
                                                  national sanitation programmes and make these as effective as
                                                  possible to ensure full utilisation of allocated resources.
                                              <   Use the SAARC Development Fund for forwarding the SACOSAN
                                                  agenda at the regional level.

      For More information,                   To strengthen monitoring of total sanitation
      please contact:                         <   Adopt minimum standards in declaring areas totally sanitised.
      WaterAid, 47-49 Durham Street
      London SE11 5JD, UK
                                              <   Form joint government, community and NGO teams to monitor
      Telephone: + 44 (0) 20 7793 4500            and declare totally sanitised communities.
      Fax: + 44 (0) 20 7793 4545              <   Publish annual updates on sanitation coverage including information
                                                  on hygiene practices
      UK charity registration number 288701

                                              To increase regional learning and collaboration                        on the SACOSAN agenda
                                              <   Activate the inter-country working group on SACOSAN.

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