Government of Andhra Pradesh Rural Water Supply and Sanitation Departmentaprwssp.ap.nic.in/worldbank/APRWSSP SHP FInal Report April 2009.pdf · Rural Water Supply and Sanitation Department

Government of Andhra Pradesh Rural Water Supply and Sanitation Department

Andhra Pradesh Rural Water Supply and Sanitation Project

Under The World Bank Assistance

Study on Sanitation and Hygiene Promotion

Final Report

April 2009

The World Bank Supported Andhra Pradesh Rural Water Supply and Sanitation Project Sanitation and Hygiene Promotion – Final Report – April 2009

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Table of Contents

Table of Contents ................................................................................... 2 List of Acronyms .................................................................................... 5 1 Introduction ...................................................................................... 7

1.1 Background ........................................................................................................... 7 1.1.1 Objectives ...................................................................................................... 7 1.1.2 Components ................................................................................................... 8

1.2 Need for SHP Study............................................................................................... 8 1.2.1 Objectives of the study ................................................................................... 8

1.3 Scope of Work and Key Tasks ............................................................................... 9 1.4 Approach and Methodology ................................................................................... 9

1.4.1 Sampling Rationale ...................................................................................... 10 1.4.2 Research Tools............................................................................................. 12

1.5 Organization of the Report ................................................................................... 12 2 Global and National Scenario on Sanitation ............................ 13

2.1 What is Sanitation ................................................................................................ 13 2.2 Global Scenario ................................................................................................... 13

Source: Web at UNICEF, 2004. ................................................................................... 14 2.2.1 Facts About Sanitation Source ..................................................................... 14 2.2.2 International Year of Sanitation .................................................................... 16

2.3 National Scenario ................................................................................................ 17 2.3.1 Environmental Sanitation and Personal Hygiene ..................................... 17

2.4 Profile of Andhra Pradesh .................................................................................... 18 2.4.1 Geographic and Physiographic Profile.......................................................... 18

2.5 Demographic Profile ............................................................................................ 18 2.6 Regional Socio-cultural Variations ...................................................................... 19 2.7 Primary Data ....................................................................................................... 20

2.7.1 Sex Ratio ..................................................................................................... 20 2.7.2 Religion and Caste Composition .................................................................. 20 2.7.3 Ration Cards ................................................................................................ 21 2.7.4 Literacy........................................................................................................ 22 2.7.5 Land and Assets ........................................................................................... 23 2.7.6 Dwelling ...................................................................................................... 24

2.8 Salient Features and Issues for the Project............................................................ 24 3 Sanitation Status in Andhra Pradesh ......................................... 25

3.1 Introduction ......................................................................................................... 25 3.2 Rural School Sanitation ....................................................................................... 26 3.3 Status of Water Borne Diseases ........................................................................... 27 3.4 Incidence of Water Borne Diseases ...................................................................... 27 3.5 Primary Data on Sanitation .................................................................................. 28

3.5.1 Usage ........................................................................................................... 29 3.5.2 Reasons for not Using Latrines..................................................................... 30

3.6 Open Defecation .................................................................................................. 30 3.6.1 Site .............................................................................................................. 31

3.7 Environmental Sanitation ..................................................................................... 31 3.7.1 Solid Waste Disposal ................................................................................... 31 3.7.2 Waste Water Disposal .................................................................................. 32 3.7.3 Sewage Disposal .......................................................................................... 33


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3.7.4 Fodder Waste/ Dung Disposal ...................................................................... 33 3.7.5 School Sanitation ......................................................................................... 34

3.8 Awareness of Water Borne Diseases .................................................................... 35 3.9 Water Handling Practices..................................................................................... 35 3.10 Personal Hygiene ................................................................................................. 36 3.11 Availability of Medical Facilities ......................................................................... 38 3.12 Elements of Sanitation ......................................................................................... 39 3.13 Issues ................................................................................................................... 39

4 Sanitation Policies and Programs of Andhra Pradesh ............. 41 4.1 Total Sanitation Campaign ................................................................................... 41

4.1.1 Lesson Learnt .............................................................................................. 41 4.2 NGP .................................................................................................................... 41 4.3 Shubhram ............................................................................................................ 42 4.4 Indiramma Program ............................................................................................. 43 4.5 Partnership with other agencies ............................................................................ 43

4.5.1 CLTS Approach ........................................................................................... 44 4.5.2 CLTS Process .............................................................................................. 45 4.5.3 Triggers Approach ....................................................................................... 45 4.5.4 Shifts from Traditional Approach ................................................................. 46 4.5.5 Partnering with SERP - IKP ......................................................................... 47

4.6 Institutional Arrangements ................................................................................... 47 4.7 Institutions related to Policy, Planning and M&E ................................................. 48

4.7.1 Secretary, RWSS ......................................................................................... 48 4.7.2 SWSM, DWSM, MWSC and VWSC ........................................................... 48 4.7.3 Panchayat Raj Institutions ............................................................................ 52 4.7.4 Tribal Related – ITDA and VTDA ............................................................... 53

4.8 Implementation and Operations - RWSS Department ........................................... 54 4.8.1 Engineer-in-Chief ........................................................................................ 54 4.8.2 Chief Engineers............................................................................................ 55 4.8.3 SEs and EEs ................................................................................................. 55 4.8.4 DEEs and AEEs/AEs ................................................................................... 55 4.8.5 Manpower .................................................................................................... 56

4.9 Key Strengths and Weaknesses of RWSSD.......................................................... 56 4.9.1 Key strengths ............................................................................................... 56

4.10 Issues for Consideration ....................................................................................... 57 5 Approach for APRWSSP .............................................................. 59

5.1 Introduction ......................................................................................................... 59 5.2 Objectives of Sanitation and Hygiene Promotion ................................................. 60

5.2.1 Project Focus ............................................................................................... 60 5.3 Strategy ............................................................................................................... 61 5.4 Implementation Arrangements ............................................................................. 64 5.5 Monitoring and Evaluation .................................................................................. 66 5.6 Budget ................................................................................................................. 66


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List of Tables Table 1: Region wise sample details ............................................................................... 11 Table 2: Research Tools .................................................................................................... 12 Table 3: AP Demographic Profile ................................................................................... 19 Table 4: Religious Composition by Region .................................................................... 21 Table 5: Region wise Caste Composition ....................................................................... 21 Table 6: Region wise Ration Cards Details .................................................................... 21 Table 7: Region wise Education among Male Family Member .................................... 22 Table 8: Region wise Education among Female Family Member ................................ 22 Table 9: HH possess Wet Land ....................................................................................... 23 Table 10: Region wise HH Assets Details ...................................................................... 23 Table 11: Region wise Type of House Structure ............................................................ 24 Table 12: Region wise HH Having Electricity Connection ........................................... 24 Table 13: Status of Rural Sanitation Coverage in AP .................................................... 25 Table 14: Rural School Sanitation Status in AP.............................................................. 26 Table 15: Cases of Water Borne Diseases in AP in Last 5 Years ................................... 27 Table 16: Households by Incidence of Water Borne Diseases in Last 6 Months ......... 28 Table 17: Region wise Households with Latrine ........................................................... 28 Table 18: Households by Latrine Usage ......................................................................... 29 Table 19: Gender and Usage of Latrine .......................................................................... 29 Table 20: Reasons for not using latrines ......................................................................... 30 Table 21: Defecation Practice of those who do not own Latrines................................. 30 Table 22: Site of Open Defecation ................................................................................... 31 Table 23: Children Defecation ......................................................................................... 31 Table 24: Households by Solid Waste Disposal ............................................................. 32 Table 25: Households by Waste Water Disposal ........................................................... 32 Table 26: Household by Sewage Disposal...................................................................... 33 Table 27: Households by Fodder Waste/Dung Disposal ............................................. 33 Table 28: School Sanitation Status in Sampled Villages ................................................ 34 Table 29: Girl Sanitation Facilities in Schools in Sampled Villages.............................. 34 Table 30: Working Condition of School Latrine ............................................................ 34 Table 31: Households by Knowledge About Water Borne Diseases ........................... 35 Table 32: Households by Water Treatment Methods .................................................... 35 Table 33: Households by Drinking Water Handling Practices..................................... 36 Table 34: Households by Hand Wash Practices ............................................................ 36 Table 35: Agent for Wash Hands ..................................................................................... 37 Table 36: HH Members take Bath ................................................................................... 37 Table 37: Gender and Bathing Habits ............................................................................. 37 Table 38: Availability of Medical Facilities in Sample Villages .................................... 38 Table 39: Number of Awards Winning GPs in AP During Last 3 Years ..................... 42 Table 40: Manpower of RWSS department .................................................................... 56 Table 41: Institutional Arrangement for Implementation of Sanitation Component . 64 Table 42: Budget for Sanitation and Hygiene Promotion of APRWSSP ...................... 66


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List of Acronyms

AP Andhra Pradesh APL Above Poverty Level APRWSSP Andhra Pradesh Rural Water Supply and Sanitation Project BC Backward Class BCC Behaviour Change Communication BPL Below Poverty Level CDD Community Driven Development CE Chief Engineer DEE Deputy Executive Engineer DPSU District Project Support Unit DRP District Resource Persons DWSM District Water and Sanitation Committee EE Executive Engineer E-in-C Engineer-in-Chief FGD Focus Group Discussions GP Gram Panchayat GPWSC Gram Panchayat Water and Sanitation Committee HH Households HNU Health and Nutrition Unit IEC Information, Education and Communication IHSL Individual Household Sanitary Latrine IKP Indira Kranti Patham ISL Individual Sanitary Latrines MP Mandal Parishad MRP Mandal Resource Persons MTP Medium Term Program MWSC Mandal Water and Sanitation Committee PD Project Director PIP Project Implementation Plan PRI Panchayat Raj Institutions RWSS Rural Water Supply and Sanitation RWSSD Rural Water Supply and Sanitation Department SC Scheduled Caste SE Superintendent Engineer SERP Society for Elimination of Rural Poverty SLWM Solid and Liquid Waste Management SO Support Organizations SPSU State Project Support Unit SSC Secondary School Certificate ST Scheduled Tribe SWSM State Water and Sanitation Mission


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TSC Total Sanitation Campaign UGD Under Ground Drainage VWSC Village Water and Sanitation Committee WB The World Bank


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1 Introduction

1.1 Background

Government of Andhra Pradesh through the Rural Water Supply and Sanitation Department (RWSSD) is currently preparing a Rural Water Supply and Sanitation Program (APRWSSP) under the World Bank assistance. This APRWSSP presents the Rural Water Supply and Sanitation (RWSS) sector investment program and implementation action plan, referred to as the Medium Term Program (MTP), for realising the goals of the vision of GoAP for the RWSS sector by 2013. It would serve as a financial action plan for channelling investment funds and other resources for integrated rural water supply and sanitation development in the state for the program period. In 2006, GoAP issued RWSS sector vision and policy. Key features of the Vision are:

Devolution of funds, functions and functionaries to the Panchayat Raj Institutions (PRIs);

Enforcement of full recovery of Operation and Maintenance (O&M) cost and sharing of capital cost (taking into consideration affordability, particularly by disadvantaged groups); and

Improvement of the "accountability framework" by clarifying roles and responsibilities of various actors of the RWSS sector at the state, district and village level, including responsibilities for policy formulation, financing, regulation, construction, operations and maintenance.

This vision has introduced two major changes. They are:

Transfer of responsibility for planning, design and construction of the RWSS infrastructure and the operation of the RWSS service to the PRIs and communities

Evolution of the role of RWSSD into that of a provider of technical assistance to the PRIs.

1.1.1 Objectives The objective of this APRWSSP is to increase access of rural communities to reliable, sustainable and affordable Rural Water Supply and Sanitation (RWSS) services. APRWSSP aims at coverage of 1878 Not Covered (NC) and 199 No Safe Source (NSS) habitations with water supply. Coverage of 766 Partially Covered (PC) habitations in five years during the MTP is the target for Rural Water Supply. This project will also carry out some augmentations and improvements to Single Village Schemes (SVS) and Multi Village Schemes (MVS). The targets for sanitation suggest provision of soak pits and household toilets, in 2843 habitation, Under Ground Drainage (UGD) & Solid and Liquid Waste Management (SLWM) facilities for 55 Mandal headquarters, and sullage drains with pavement for major GPs covered under the project.


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1.1.2 Components

Three components of APRWSP are:

Policies, Institutional Reforms and Capacity Building Investment Monitoring and Evaluation

Parameters of outcome indicators for monitoring are defined as follows:

Percentage habitations with improved drinking water and sanitation services

Percentage rural households with access to safe and adequate water supply throughout the year

Percentage rural households adopting improved hygiene and sanitation practices; and

Improvements in cost recovery, and collection efficiency; contributions to capital and O&M Costs

As a part of the project preparation, the GoAP carried out the study on Sanitation and Hygiene Promotion (SHP) to develop a strategy with an implementation plan to achieve the set sanitation goals under the proposed project. This report outlines the findings of the SHP study. 1.2 Need for SHP Study

The objective of the sanitation and hygiene promotion study is to assist the GoAP to further develop the sanitation and hygiene component as an integral part of the proposed AP Rural Water Supply and Sanitation Project, based on the baseline information and strategic decisions taken by the state. 1.2.1 Objectives of the study The purpose of the proposed study is to formulate a comprehensive & realistic assessment of the sanitation and hygiene promotion status in the state by developing and updating the available data. Further it is expected that the study outputs will contribute to the development of an appropriate Sanitation and Hygiene Promotion Strategy in lieu of the proposed RWSS Medium Term Sector Program planned for 2009-14. The specific objectives of this study are: To asses the current sector status of the sanitation and hygiene promotion

component and To identify issues that merit attention from the perspective of developing a

sanitation strategy for the proposed AP Rural Water and Sanitation Program.


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1.3 Scope of Work and Key Tasks

This study attempts to understand the broader requirements of provision of sanitation and hygiene promotion services in a sustained manner, promoting a demand responsive approach and facilitating reforms across the sector. Specifically assessments related to the current sector status and the commitment of the major role players in the Sector were made while also identifying gaps and deliverables. In addition the following issues were also assessed;

Implementation of the TSC/SHP program in the State: Modalities of the GOI, State and Donor funded sanitation and hygiene programs, achievements, failure, expenditures incurred. Specific visits to two NGP awarded GPs to assess the success of the changed approach of transferring construction of sanitation facilities into changed hygiene behavior.

Inclusion of the latrine component and other hygiene aspects, if any into the Indiramma Housing program

Evidence of visible ‘Triggers for behavior change’ with regards to sanitation and its integration into the socio economic culture of the people.

Specifically the study attempted to review the following:

Available technical options for sanitation and hygiene promotion including the IHL, School sanitation, Anganwadi sanitation Community Latrines, Solid Waste Management, Liquid Waste Management, RSMs, PCs keeping in mind the different regions and terrains

Available Technical, Institutional and financial arrangements Requirement of resources ‘Behavior- practice’ and ‘triggers’ that ‘motivate behavior change’ Existing IEC/HRD strategies Existing M&E systems Capacities of the PRIs, the authority they enjoy, resources available (financial,

human) and the mandate required for integration of service delivery keeping in view the future requirements to coordinate the health/hygiene/sanitation/water supply programs in future.

1.4 Approach and Methodology

A combination of methodologies was adopted to carry out this study that comprised the following steps. Desk review: At the outset, all the documents related sanitation policies of the national and state governments, guidelines, government orders, progress reports and other relevant documents were reviewed


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Interactions with stakeholders: In addition to the desk review detailed discussions were held with various stakeholders at state as well as the district levels covering the policy makers, implementing officials, NGOs, training institutes, and external support agencies like Water and sanitation program –South Asia (WSP-SA), UNICEF etc Focus group discussions: Detailed focus group discussions were held with elected representatives, community leaders, members of SHG, GPs and VWSCs in the selected villages with a semi structured check lists. The FGDs helped the study team to assess the potential impacts of the ongoing sanitation programs, issues and challenges related to the water supply and sanitation programs. Participatory Rural Appraisal techniques: The study team conducted PRA exercises to understand the sanitation situation using the social mapping, sanitation walk/ transact walks, small group discussions for triangulation of the findings and discussions with individual households in the sample villages Coordination with other studies and integration of the data from baseline assessment: A holistic perspective was gathered by i) coordinating with other agencies and ii) by integrating data from the baseline assessment conducted by Center for Excellence in Management and Technology Pvt. Ltd. (CEMT), which preceded this study. State level workshop on “scaling up of Shubram communities in AP”: The Study team participated in a two day state level workshop on sanitation attended by state level officials of RWS and PR department, member Secretaries of the DWSCs, Chief Executive Officers (CEOs), District Panchayats officers, representatives from District support units, other states and WSP-SA. Detailed deliberations were held on achievements, plans, challenges, issues and way forward during the workshop. 1.4.1 Sampling Rationale During the study a multi stage stratified random sampling process was adopted to ensure participation of all groups of stakeholders and beneficiaries in providing the inputs for the assessment. The sample villages were selected representing each of three regions viz. Coastal Andhra, Rayalaseema and Telangana. Of the total of 34 habitations in 31 Mandals the region-wise distribution is Telangana (14) Coastal Andhra (11) and Rayalaseema (9). The list of sample villages is given as Annexure 1. Table 3 below furnishes the district-wise and Mandal-wise distribution of habitations.


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Table 1: Region wise sample details Region District No. of

Mandals No. of Habitations

Andhra Region Srikakulam 3 3 West Godavari 3 3 Rayalaseema Region Chittoor 3 3 Kadapa 3 3 Kurnool 2 3 Telangana Region Karimnagar 3 3 Mahaboobnagar 2 3 Rangareddy 3 3 Fluoride Affected

Villages Nalgonda 5 5

Prakasam 4 5 GRAND TOTAL 31 34 Type of Sanitation Facilities: Villages with different types of sanitation facilities like ISLs, drains, SWM systems, etc. were chosen to represent the reality on the ground. Availability and Quality of Water: Scarcity and poor quality of water, both pose a significant challenge to the state of Andhra Pradesh. Out of the sample of 34 habitations measures were taken to include under served villages and fluoride affected villages (10), thus factoring in quantity and quality problems of water in the state. Type of Source: The water supply schemes in Andhra Pradesh have both surface water and groundwater as sources. The sample covers both types of sources. In the sample, 25 schemes depend on groundwater and 9 schemes depend on surface water. Tribal Coverage: Andhra Pradesh has substantial tribal population and has scheduled areas too. The sample includes both the aspects. There are 20 villages with tribal population in the sample.


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1.4.2 Research Tools The details of tools and techniques used for the assessment study are presented in table below. Table 2: Research Tools S. No.

Techniques Tools/ Instruments

Respondents

1 Social Mapping

Checklist Community Members from the habitations to be benefited / affected by the project, PRI Members, etc.

2 Household Survey

Household Interview Schedule/ Questionnaire

Community Members from the habitations to be benefited / affected by the project

3 Focus Group Discussions


4 Public Consultations


Both quantitative and qualitative data analysis techniques were employed during the assessment study. Required software packages (Microsoft Access, SPSS etc.) were used for carrying out the collation, data coding, analysis and generation of outputs. 1.5 Organization of the Report

This report is organized under 5 chapters. This first chapter gives the introduction to this report. It includes background, objectives, scope of the physical activities, need for study, scope of work and key tasks. The second provides a macro perspective of global and national scenario on sanitation and the physical and demographic profile of the state, while the third chapter gives sanitation status in Andhra Pradesh. The fourth chapter presents the sanitation policies and programs in Andhra Pradesh including the institutional arrangements present. The fifth chapter gives the approach and strategy and budget for the APRWSSP.


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2 Global and National Scenario on Sanitation

2.1 What is Sanitation

The general perception of sanitation is ‘the disposal of human excreta and construction of latrines’. The World Health Organization defines it as ‘Control of all those factors in man’s physical environment which exercise or may exercise a harmful effect on his health, physical development and survival’. Water and Sanitation is one of the primary drivers of public health. Lack of sanitation is a serious health risk and an affront to human dignity. It affects billions of people around the world, particularly the poor and disadvantaged. Public health interventions that secure adequate sanitation in communities prevent the spread of disease and save lives. They raise the quality of life for many, particularly women who are often in charge of domestic tasks, and face personal risks when they relieve themselves in the open. Sanitation is a basic need and a way to ensure better health. The United Nations has declared 2008 as the International Year of Sanitation to make it a priority for governments, organizations, civil society and private partners worldwide. 2.2 Global Scenario

In 2002, about 1.1 billion people (17% of the global population) lacked access to improved water sources, while 2.6 billion people (42% of the global population), lacked access to improved sanitation. o Five of the top ten killer diseases of children aged 1-4 years in rural areas are

related to water and sanitation. These are Diarrhea, Malaria, Schistosomiasis, Trachoma and intestinal worms (Roundworm, whip worm, hookworm).

o The annual mortality due to diarrhea is 1.8 million; of which close to 90% are children under 5, mostly in developing countries.

o Similarly, the annual mortality due to malaria is 1.3 million, of which over 90% are children under 5.

Much of this mortality and morbidity may be attributed to diseases of poor sanitation and poor personal hygiene. As per the United Nations Report, India stands lowest (33%) in terms of sanitation coverage in the South Asian Region. Access to water and sanitation in different countries in south Asia region is presented in the table below.


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Table: Access to Water and Sanitation in South Asia, 2004

Country

Total Rural

Population % Access to Water

% Access to Sanitation

% Population

% Access to Water

% Access to Sanitation

Afghanistan 28574000 39 34 76 31 29 Bangladesh 139215000 74 39 75 72 35 Bhutan 2116000 62 70 91 60 70 India 1087124000 86 33 72 83 22 Maldives 321000 83 59 71 76 42 Nepal 26591000 90 35 85 89 30 Pakistan 154794000 91 59 66 89 41 Sri Lanka 20570000 79 91 79 74 89

Source: Web at UNICEF, 2004. 2.2.1 Facts About Sanitation Source

1. Around 2.6 billion people lack access to adequate sanitation globally. The regions with the lowest coverage are sub-Saharan Africa (37%), southern Asia (38%) and eastern Asia (45%). Underlying issues that add to the challenge in many countries include weak infrastructure and scarce resources to improve the situation.

2. Lack of sanitation facilities forces people to defecate in the open, near water sources, or in open areas. This increases the risk of transmitting disease. About 1.1 million liters of raw sewage is dumped into the Ganges in India every minute. One gram of faeces in untreated water may contain 10 million viruses, one million bacteria, 1000 parasite cysts and 100 worm eggs. This simply indicates the magnitude of the problem.

3. Examples of diseases transmitted through water contaminated by human waste include diarrhea, cholera, dysentery, typhoid, and hepatitis A. In Africa, 115 people die every hour from diseases linked to poor sanitation, poor hygiene and contaminated water.

4. Health-care facilities need proper sanitation and health practitioners must observe good hygiene to control infection. Worldwide, 5% to 30% of patients develop one or more avoidable infections during stays in health-care facilities.

5. Each year more than 200 million people are affected by droughts, floods, tropical storms, earthquakes, forest fires, and other hazards. Sanitation is an essential component in emergency response and rehabilitation efforts to stem the spread of diseases.

6. Studies show that improved sanitation reduces diarrhea death rates by a third.

7. Adequate sanitation encourages children to attend schools, particularly girls. Access to latrines raises school attendance rates for children. Provision of separate sanitary facilities contributes to girls’ enrolment in schools.


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8. Hygiene education and promotion of hand washing are simple. Cost-effective measures that can reduce diarrhea cases by up to 45%. Even when ideal sanitation is not available, instituting good hygiene practices in communities will lead to better health. Proper hygiene goes hand-in-hand with the use of improved facilities to prevent disease.

9. The economic benefits of sanitation are persuasive. For every one unit of money invested in improved sanitation, ensures 9 times return in value. Those benefits are experienced specifically by poor children, and in the disadvantaged communities that need them most.

10. The Millennium Development Goals target 75% global sanitation coverage by 2015. The cost to reach the milestone is estimated at US$ 14 billion annually through the period. Among other health gains, sanitation is estimated to reduce diarrhea cases by 391 million worldwide each year.

Millennium Development Goals (MDGs)

The MDGs stand for a renewed commitment to overcome persistent poverty and address many of the most enduring failures of human development. Halving the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015, is one of the targets defined for achieving the MDGs. The overall MDGs and Water & Sanitation-specific MDGs are shown in the diagram below:

Millennium Development Goals Water & Sanitation Targets In adopting the Millennium Development Goals, the countries of the world pledged to reduce by half the proportion of people without access to safe drinking water and basic sanitation. The results so far are mixed. With the exception of sub-Saharan Africa, the world is well on its way to meeting the drinking water target by 2015, but progress in sanitation is stalled in many developing regions. In the water supply and

1. Eradicate extreme poverty and Hunger 2. Achieve universal primary Education 3. Promote gender equality and Empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and Other diseases 7. Ensure environmental Sustainability 8. Develop a global partnership for Development

Target 9: Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources

Target 10: Halve by 2015 the proportion of

people without sustainable access to safe drinking water and sanitation

Target 11: By 2020 to have achieved a

significant improvement in the lives of at least 100 million slum dwellers


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sanitation sector, monitoring progress towards achieving the MDG targets is essential for maintaining and putting into practice the political commitment both of national governments and the international community. However, background information on the water supply and sanitation sector remains unsatisfactory; and the reliability of existing statistics is uneven. 2.2.2 International Year of Sanitation The United Nations has proclaimed the period 2005-2015 to be the International Decade for Action – Water for Life, and the year 2008 as the Year of Sanitation, with the aim of injecting some urgency into strategies for achieving the water and sanitation targets. This aims to stimulate open dialogue on every level while creating a context for political leadership and government commitments to allocate greater resources for sanitation for the poor, stressing the positive impact on health and gender equity. The Objectives of IYS are given below:

Increase awareness and commitment from actors at all levels, both inside and

outside the sector, on the importance of reaching the sanitation MDG, including health, gender equity, economy and environment issues via compelling and frank communication, robust monitoring data, and sound evidence.

Mobilize Government(from national to local) existing alliances, financial institutions, major groups the private sector and the UN agencies via rapid collaborative agreements on how and who will undertake needed steps now.

Secure real commitments to review, develop and implement roadmaps and national plans to scale up sanitation programs and strengthen sanitation policies via the assignment of clear responsibilities for getting this done at the national and international levels.

Encourage demand driven sustainable and traditional solutions, and informed choices by recognizing the importance of working from the bottom up with practitioners and communities.

Secure increased financing to jump start and sustain progress via commitments from National budgets and development partner allocations.

Develop and strengthen institutional and human capacity via recognition at all levels that progress in sanitation toward the MDGs involves interlinked programs in hygiene, household facilities (such as toilets and washing facilities) and wastewater treatment. Community mobilization , the recognition of women’s key role and stake along with an appropriate mix of ‘software’ and ‘hardware’ interventions are essential

Enhance the sustainability and therefore the effectiveness of available sanitation solutions, to enhance health impacts, social and cultural acceptance, technological and institutional appropriateness, and the protection of the environment and natural resources.

Promote and capture learning to enhance the evidence base and knowledge on sanitation which will greatly contribute to the advocacy and increase investments in the sector.


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2.3 National Scenario

According to 2001 Census, 64% of total population and 78% of the rural population does not have access to any form of sanitary facility. However, according to National Family Health Survey (NHFS) of 2006, 44.5% of the total population and 26% of the rural population had access to toilet. Latest estimates of the Department of Drinking Water Supply indicate that the rural sanitation coverage has since increased to about 50% by the beginning of 2008.

Infant Mortality Rate (IMR) in rural India is as high as 57 per thousand live birth (NFHS, 2006) while the under 5 child mortality rate is 74. Over 44% of children under the age group of 5 are malnourished in the country. About 2.1 million child deaths occur every year in India, which is the highest figure for any single country in the world. Compared to urban areas, infant mortality rate is very high in rural areas and especially for the age group 1-4, the rural rate is twice as high as the urban rate (NHFS, 2006). Much of this mortality and morbidity may be attributed to diseases of poor sanitation and poor personal hygiene. Children suffering from frequent diarrhea, remain malnourished, physically and mentally underdeveloped and susceptible to other ailments. Ascariasis (Roundworm disease), a common childhood ailment in India adds to severe malnutrition, vitamin deficiency, and other conditions that may call for expensive diagnostic and treatment procedures. De-worming may give only temporary relief, because in areas with poor sanitation recurrent infections are almost a certainty. 2.3.1 Environmental Sanitation and Personal Hygiene Practice of open defecation by 56% of rural families (2007) contaminates the soil, the surface water and even the ground water with the disease-causing micro-organisms. Household refuse containing decomposable garbage, animal dung etc, indiscriminately dumped in the villages allows uncontrolled breeding of flies, and harbor rats and other pests. Waste water from different domestic and community sources not drained properly, favor breeding of mosquitoes. Contaminated drinking water is the commonest medium for transmission of diseases like diarrhea, cholera, typhoid, dysentery, polio, hepatitis etc. and yet the safety of drinking water is not given the due importance. Food and drinks are not properly protected against dust and invasion of flies and other insects. Most of the rural kitchens equipped with traditional chullahs emit smoke that contains noxious gases endanger the health of the users, especially the pregnant mothers and children. Basic items of personal hygiene, proper hand washing with soap etc are often neglected.


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2.4 Profile of Andhra Pradesh Andhra Pradesh is the fifth largest state in India both in geographical area (an area of 2, 76,754 sq. km, accounting for 8.4 % of India's territory) and population wise (76.21 million accounting for 7.41 % of India’s population of 1028 million). AP lies between 12o41' and 22o longitude and 77o and 84o40' latitude. It forms the major link between the north and the south of India. It is bounded by Madhya Pradesh and Orissa in the north, the Bay of Bengal in the east, Tamil Nadu and Karnataka in the south and Maharashtra in the west. AP has the longest coastline of 972 km in India. There are three main regions in the state i) Coastal Andhra ii) Rayalaseema and iii) Telangana with 22 districts, 1104 Mandals and 21856 GPs. 2.4.1 Geographic and Physiographic Profile The state is endowed with a variety of physiographic features ranging from high hills, thick forests, undulating plains to a coastal deltaic environment. The state has the advantage of having most of the east flowing rivers in the heart of the state bringing in abundant supplies of surface water from the Western and Eastern Ghats and Deccan Plateau up to the Bay of Bengal. The major, medium and minor rivers that flow through the state number about 40. Of these, the most important rain fed rivers are Godavari, Krishna, Pennar, Thungabhadra, Vamsadhara and Nagavali. Nearly 75% of its area is covered by the river basins of the Godavari, Krishna and Pennar, and their tributaries. There are 17 smaller rivers like the Sarada, Nagavali and Musi, as well as several streams. Godavari and Krishna are the two major perennial rivers, and with their extensive canal system, provide assured irrigation. The rainfall is influenced by both the south-west, north-west and north-east monsoons. The average annual rainfall in the state is 925 mm. A majority of the rainfall in AP is contributed by south-west monsoon (68.5%) during the months June to September, followed by north-east monsoon (22.3%) during the months October to December. The rest (9.2%) of the rainfall is received during the winter and summer months. The rainfall distribution in the three regions of the state differs with the season and monsoon. The influence of the south-west monsoon is predominant in the Telangana region (764.5 mm) followed by Coastal Andhra (602.26 mm) and Rayalaseema (378.5 mm), where as, the north-east monsoon provides a high amount of rainfall (316.8 mm) to Coastal Andhra area followed by Rayalaseema (224.3) and Telangana (97.1 mm). There are no significant differences in the distribution of rainfall during the winter and hot weather periods among the three regions. 2.5 Demographic Profile Andhra Pradesh is the most populous state in south India although the decadal growth rate is showing a declining trend. Some of the important demographics of the state are compared to all-India averages to ascertain the state’s relative performance and presented in the table below.


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Table 3: AP Demographic Profile Item Andhra

Pradesh All-India

Total population (Census 2001) (in million) 76.21 1028.61 Decadal growth rate (Census 2001) (%) 14.59 21.54 Crude Birth Rate (SRS 2006) 19.00 24.10 Crude Death Rate (SRS 2006) 7.00 7.50 Total Fertility Rate (SRS 2004) 2.00 2.90 Infant Mortality Rate (SRS 2006) 59.00 58.00 Maternal Mortality Ratio (SRS 2001 - 2003) 195.00 301.00 Female Sex Ratio (Census 2001) (per 1000 males) 978.00 933.00 Population below poverty line (%) 15.77 26.10 Schedule Caste population (in million) 12.34 166.64 Schedule Tribe population (in million) 5.02 84.33 Literacy rate (Census 2001) (%) 61.11 65.38 Female literacy Rate (Census 2001) (%) 50.40 53.70 Human Development Index (HDI)* 0.609 0.621 Gender Development Index (GDI)* 0.595 0.609 Planning Commission, Government of India, March 2002 2.6 Regional Socio-cultural Variations The three regions vary in terms of history, geography, social and cultural aspects. While the Telangana was part of the princely Hyderabad State ruled by Qutub Shahis, Moghals and Nizam before the Independence, the coastal Andhra and Rayalaseema were under the British rule. Before the colonial days, Srikrishnadevaraya and his dynasty ruled the Rayalaseema, and Gajapathis and others ruled the Andhra region. Geographically, Andhra area is coastal region endowed with fertile soils due to alluvial deposits of Godavari and Krishna rivers, whereas the Telangana region stands on Deccan plateau with large sections of stony terrain. The Rayalaseema is a dry region with patches of black-cotton soil, but not fertile. As mentioned above, the Andhra region gets more rainfall due to monsoons, the Telangana and Rayalaseema gets less rainfall. Linguistically, Telangana is heavily influenced by Urdu and Muslim culture, the official language of the government and the religion of the rulers respectively. To some extent there is an influence of Maharashtrian culture also. In Rayalaseema, the boarder districts of Chittoor and Ananthapur are influenced by Tamil and Kannada. The Andhra region has very little influence of other languages. The extension of Eastern Ghats provides forest cover and hill-ranges in the state, and it is mostly found in the Telangana district (25.4%) and less in Andhra (17.4%) and Rayalaseema (10.2%). These forests and hills are abodes of tribal populations of the state. Andhra Pradesh state has 33 scheduled tribes who contribute 6.60 percent to the total population. Their concentration is high in Telangana districts such as Adilabad (16.74 %), Nalgonda (10.55%), Warangal (14.10%), and Khammam (26.47 %). The tribal population is more only in Visakhapatnam district (14.55%) in Andhra region. In Rayalaseema


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districts the percentage of tribal populations is low. All these tribal groups in most of the cases have their own dialect and distinct cultural practices. They generally live in hill areas depending on the shifting cultivation, collection of forest produce, hunting and so on. There are villages in all areas exclusively inhabited by tribes mostly in scheduled areas, and in some villages there is multi-ethnic population mostly in non-scheduled areas. Thus, these three regions are different in several ways: forests and hills, plain terrains, tribal and non-tribal composition, fertility of soils, wet and dry lands, distinctive cultural practices etc. 2.7 Primary Data

This chapter gives the socio-economic profile, details such as family type and size, of the households in the sampled habitations. 2.7.1 Sex Ratio The total number of males and females in the villages selected for the study consists 7,358 and 7,080 respectively, bringing the male and female ratio to 962 females for 1000 males. The overall state sex ratio is 978 females to 1000 males. Compared to the all India average of 933 female for 1000 males, Andhra stands out better. 2.7.2 Religion and Caste Composition Overall Situation: About 91% of the interviewed households practice Hinduism, about 6% belongs to Islam and about 3% follow Christianity, thus making 9% of the total population as non-Hindus. Regional Variation: Telangana region has the largest Hindu population (93%), followed by Andhra region with 88% and Rayalaseema with 88%. Rayalaseema region has the highest Muslim population (11%), where as Andhra has the lowest (1.28%); Telangana falls somewhere in between with 5.27%. Andhra region has the highest Christian followers with about 11%, Telangana stands second with 1.54% and Rayalaseema has less than 1% of Christian population. Close to 95% of the Hindu population lives in fluoride affected area, where as the proportion is only about 4.57% and 1.31% among Muslims and Christians respectively.


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Table 4: Religious Composition by Region Religious Composition by Region

Andhra Rayalaseema Telangana Fluoride Affected Total

% % % % Freq % Hindu 87.85 87.77 93.06 94.12 2733 91.10 Muslim 1.28 11.15 5.27 4.57 182 6.07 Christian 10.87 0.96 1.54 1.31 83 2.77 Others 0.00 0.12 0.13 0.00 2 0.07 Total 100 100 100 100 3000 100

Overall situation: About 42% of the interviewed households belong to backward classes, while 26% belong to general category. 23% of the interviewed households belong to Scheduled Castes and 9% Scheduled Tribes. Regional variation: The similar pattern of high percentage of the population belonging to marginalized sections is also seen between the three regions, although there are minor variations in the distribution. Table 5: Region wise Caste Composition Andhra Rayalaseema Telangana Total % % % Freq % General 33.26 36.21 14.01 774 25.80 SC 29.00 16.07 24.29 693 23.10 ST 9.17 12.11 14.40 277 9.23 BC 28.57 35.61 47.30 1256 41.87 Total 100 100 100 3000 100

As the SCs and STs live a little away from the main village where higher and lower castes live, and their population is sizable, there is a demand for an inclusive policy. 2.7.3 Ration Cards Possessing ration cards is an indicator of the financial status of the household. Among interviewed households about 90% hold BPL (Below Poverty Line) cards, 7% have APL cards and 4% do not have any cards. Table 6: Region wise Ration Cards Details Andhra Rayalaseema Telangana Total % % % Freq % BPL 91.47 90.89 91.13 2693 89.77 APL 5.97 6.95 5.27 196 6.53 No Card 2.56 2.16 3.60 111 3.70 Total 100 100 100 3000 100


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2.7.4 Literacy Overall situation: About 17% of the male family members are illiterates. About 40% had high school education and 20% have studied upto SSC. About 11% have studied up to Intermediate and 7% up to degree level. Diploma holders, post graduates and professionals are the lowest at 2.70%, 1.43% and 1.20% respectively. Regional variation: Significant variation in educational attainment is observed between the three regions. For example, Andhra has the highest percentage of illiterates (23%) as compared to Rayalaseema (17%) and Telangana (19%). However, Andhra region has also the highest percentage of male family members who have studied up to class IX (51%), where as in Rayalaseema and Telangana it stands at 32% and 37% respectively. Table 7: Region wise Education among Male Family Member Andhra Rayalaseema Telangana Total % % % Freq % Illiterate 22.81 17.03 19.92 513 17.10 I-IX Class 50.53 32.13 37.40 1191 39.70 SSC 8.74 23.02 19.02 595 19.83 Intermediate 7.68 12.47 14.14 332 11.07 Diploma 3.20 3.60 1.03 81 2.70 Degree 5.33 8.15 6.43 209 6.97 PG 1.07 2.28 1.67 43 1.43 Professional 0.64 1.32 0.39 36 1.20 Total 100 100 100 3000 100

Overall situation: Among the female members the illiteracy rate is 36%. Very insignificant numbers of females have received education up to post graduation (0.63%) and professional level (0.33%). Regional variation: Female illiteracy rate is highest in Telangana (41%), lowest in Andhra (29%) and Rayalaseema stands in between with 34% of female being illiterates. Table 8: Region wise Education among Female Family Member Andhra Rayalaseema Telangana Total % % % Freq % Illiterate 28.78 34.17 40.87 1068 35.60 1-9 Class 52.67 38.85 35.73 1271 42.37 SSC 7.46 14.99 11.44 342 11.40 Intermediate 7.04 7.07 7.46 186 6.20 Diploma 2.13 0.36 0.13 18 0.60 Degree 1.49 3.12 3.21 86 2.87 PG 0.21 1.08 0.77 19 0.63 Professional 0.21 0.36 0.39 10 0.33 Total 100 100 100 3000 100


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2.7.5 Land and Assets Among the interviewed households about 27% possesses wet land for irrigation. Telangana has the highest (43%) possession of wet land followed by Rayalaseema (26%) and Andhra 11%. fluoride affected villages (22%) and Andhra region (11%). Table 9: HH possess Wet Land Andhra Rayalaseema Telangana Total % % % Freq % Yes 11.09 26.02 43.19 804 26.80 No 88.91 73.98 56.81 2196 73.20 Total 100 100 100 3000 100

Household assets range from ownership of low value items such as bicycles (40%) to high value durables like two wheelers (11%), three wheelers (1.27%), four wheelers (0.8%) tractors (1.43%) and televisions (41.20%). Table 10: Region wise HH Assets Details Andhra Rayalaseema Telangana Total % % % Freq % Cycle 64.18 22.18 43.57 1217 40.57 Two Wheeler 18.55 5.64 13.37 334 11.13 Three Wheeler 1.49 0.36 1.80 38 1.27 Four Wheeler 0.43 0.24 1.03 24 0.80 Radio/ Tape Recorder 5.33 14.27 9.64 303 10.10 Television 56.50 33.21 38.05 1236 41.20 Fridge 5.76 3.72 3.98 124 4.13 Tractor 1.71 1.32 1.93 43 1.43 Gas Connection 33.05 8.63 21.98 586 19.53 Carts 2.35 10.07 1.93 147 4.90 Telephone 10.23 8.87 6.30 238 7.93 Mobile Phone 14.50 15.83 28.53 618 20.60 Cable Connection 55.65 18.11 29.95 931 31.03


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2.7.6 Dwelling Among the interviewed households 39% live in pucca houses and 47% live in semi-pucca houses while the rest live in kutcha houses. Table 11: Region wise Type of House Structure

Region wise Type of House Structure Andhra Rayalaseema Telangana Fluoride Affected Total % % % % Freq % Kutcha 20.04 18.82 5.14 14.36 423 14.10 Semi-pucca 40.30 40.65 61.05 43.85 1406 46.87 Pucca 39.66 40.53 33.80 41.78 1171 39.03 Total 100 100 100 100 3000 100

Although most houses have electricity connection, only 85% answered in the affirmative and rest preferred to answer in the negative. Table 12: Region wise HH Having Electricity Connection

Region wise HH Having Electricity Connection Andhra Rayalaseema Telangana Fluoride Affected Total % % % % Freq % Yes 90.62 75.06 84.32 91.84 2551 85.03 No 9.38 24.94 15.68 8.16 449 14.97 Total 100 100 100 100 3000 100

2.8 Salient Features and Issues for the Project The following salient features emerge form the secondary social economic profile of the state and primary data on the sample population given above: Literacy: The literacy rates in general are low in comparison with the national averages. It is pertinent to note that the female literacy rate is particularly lower than the national average. This has a direct bearing on the IEC campaigns and women’s participation. Poverty: Poverty levels are quite high with nearly 90% possessing BPL cards. A large number of households depend on manual labor (agriculture labor) for livelihood. This is pertinent to rural water & sanitation, especially with the issue of ability to pay for the operation and maintenance costs. Communication: The potential reach of mass communication is quite high because of wide ownership of mass communication equipments (television, radio, mobile phones and land phones) in the villages. Thus use mass media holds a potential key to reach large masses through IEC.


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3 Sanitation Status in Andhra Pradesh

3.1 Introduction

The Government of Andhra Pradesh is implementing Total Sanitation Campaign (TSC) in 22 districts. Historically, the state had sanitation programs under various schemes like CRSP, HUDC assisted sanitation program etc. After launching of the TSC in the state, the coverage of household toilet has risen to 58 %, surpassing the national average. During the last two years 153 GPs of the state have received NGP awards. On the flip side, in spite of high toilet coverage, the state has received only 3% of total NGPs awarded in the last three years. There is an immediate need to scale up these efforts. GoAP has integrated the sanitation component in the ongoing “INDIRAMMA” housing scheme. The state has also earmarked funds for solid and liquid waste management (environmental sanitation facilities). The state has launched an annual competition, “Shubram” rewards program, amongst the Gram Panchayats in the state, to reward them with the title of Cleanest Gram Panchayats. The awards provides financial rewards at different levels (Mandal, district, division and state), based on competition, to PRIs that have been most successful in improving the safe and hygienic disposal of excreta, solid waste and waste water. In addition, cleanest MPs and ZPs in the state will also be awarded. Each district has adopted different approaches to scale up sanitation including CLTS approaches by few districts with technical assistance from WSP-SA The progress achieved under the TSC program (up to May 2008) is presented in the table below. About 53% of total HHs has been covered by TSC, of which 45% HH are above poverty line and only 58% are below poverty line. Table 13: Status of Rural Sanitation Coverage in AP

Progress achieved so far in sanitation sector as per TSC (May – 2008)

Category Total

Households Households with

IHHL %

Coverage Households Below Poverty Line 6521091 3763039 57.71 Households Above Poverty Line 3629688 1618591 44.59 Total Households 10150779 5381630 53.02

The 2001 census data indicates the following: Only 27% of have bathrooms within their houses. Consequently, 73% bathe near

water points, with limited or no privacy. Only about 6% households are connected to closed drainage and 35% are

connected to open drainage. 59% do not have drainage facilities.


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The lack of latrine and drainage facilities are greatly contributing to the environmental degradation in and around the villages and posing direct threat to their health.

3.2 Rural School Sanitation

Details of SCHOOL TOILETS Achieve d in Andhra Pradesh

2372 1999

245158729 1969

12624 138881325

57421

113861

2001-02

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

Total Target

Figure 1; Details of School Toilets Achieved in AP Table 14: Rural School Sanitation Status in AP

School Sanitation Status S No Category Total 1 Total No Schools 113861 2 Schools with Toilets 57421 3 % age Coverage 59.21

Out of 113861 schools (both Government and private) in rural area about 59% schools have sanitation facilities. And there is separate facility available for girl students in higher Secondary Schools.


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3.3 Status of Water Borne Diseases

The Department of Health has identified the Acute Diarrhoeal (including GE & Cholera), Viral Hepatitis and Enteric Fever as three water born diseases. The following table shows number of cases of water borne diseases in the past five years. Large number of cases of Acute Diarrhoeal (Including GE & Cholera) was reported in 2003. Similarly viral hepatitis in 2004 and enteric fever in 2005 were reported. Table 15: Cases of Water Borne Diseases in AP in Last 5 Years

Cases of Water Borne Diseases in Last 5 Years

S No Year

Acute Diarrhoeal (Including GE &

Cholera) Viral

Hepatitis Enteric Fever

1 2003 1637915 23065 151882 2 2004 1361790 29590 148827 3 2005 1619537 29293 172549 4 2006 1331818 22990 129177 5 2007 1516818 10302 124414

3.4 Incidence of Water Borne Diseases

Using recall method, responses were sought from the community members as to ‘how many people suffered from diseases in the last six months?’ The responses are tabulated below. Overall situation: The overall incidence indicates high prevalence of Typhoid (4.75%), closely followed by Malaria (4.04%), while other diseases showing a low incidence of occurrence, ranging from 0.79% to (GE) to 0.37% (diarrhea). The low reporting of diarrhea runs contrary to the known statistics. This is primarily because i) the survey is conducted during April –May, before the onset of monsoon, when the incidence is low and ii) weak memory recall. Regional variation: High incidence of Typhoid was reported in Rayalaseema region (39.73%), as compared to 4.39% in Andhra and 4.75% in Telangana region. Rayalaseema also reported high incidence of Malaria (14.35%). Following the overall state trends, the incidence of diarrhea was reported to be far lower than the actual incidence.


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Table 16: Households by Incidence of Water Borne Diseases in Last 6 Months Incidence of Diseases in Last 6 Months

Andhra Region

Rayalaseema Region

Telangana Region Total

% % % % Freq Typhoid 4.39 39.73 4.75 13.02 245 Malaria 2.70 14.35 4.04 6.27 118 Diarrhea 0.68 0.89 0.09 0.37 7 GE 0.34 0.44 1.05 0.79 15 Cholera 1.01 1.33 0.18 0.58 11 JE 0.00 0.44 1.05 0.74 14

N=1889

3.5 Primary Data on Sanitation

The practice of open defecation is wide spread in almost all the villages. It is carried out either in the open fields or in earmarked corners of the village. In some extreme cases it is carried out in any open space, whether within the village or outside. The phenomenon of owning of individual household latrines (IHL) is only 34% across the sample villages. it may be noted that the coverage for the state is about 53%. The situation is further worsened when we consider the fact that use of latrine is at least partly de-linked from owning one (refer usage). There is enough empirical evidence to indicate that owning a latrine does not necessarily mean putting it to use, because open defecation has a general social sanction. Table 17: Region wise Households with Latrine

Region wise HH Having Latrine

Andhra Region

Rayalaseema Region


% % % % Freq Yes 45.27 22.39 36.25 34.36 649 No 54.73 77.61 63.75 65.64 1240 Total 100(296) 100(451) 100(1142) 100 1889

Overall situation: Less than 35% of the households own individual toilets. Regional variation: The region-wise break-up of ownership of household toilets present a dismal picture. The percentage of households not owning household toilets range from a minimum of 55% in Andhra region to a maximum of about 78% in Rayalaseema region with Telangana region falling somewhere in between (64%). The sanitation situation and public hygiene in all the three regions therefore, calls for a high priority attention.


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3.5.1 Usage Overall situation: The use of latrine is about 25.89% in the state, which is a pointer to the fact that close to 75% of households do not use toilets, despite owning. There is definitely a disconnect between ownership and use of toilets. Typical example is: Valbapur village in Elakathurtthy Mandal of Karimnagar district. This village won the NGP award in 2006, but about 20HH (of a total of 300 HH) continues with open defecation practices. Regional variation: Use of household latrines is the lowest in Andhra region (9.70%) and highest in Telangana region (32.37%). In Rayalaseema region it stands at 20.79%. As discussed earlier the literacy rate also is the lowest in Andhra region. Table 18: Households by Latrine Usage

Latrine Usage

Andhra Region

Rayalaseema Region


% % % % Freq Yes 9.70 20.79 32.37 25.89 168 No 90.30 79.21 67.63 74.11 481 Total 100 100 100 100 649

Table 19: Gender and Usage of Latrine Gender and Usage of Latrine Male Female Total % % % Freq Using Latrine 27.3 37.1 27.9 306 Not Using Latrine 72.7 62.9 72.1 791 Total 100 100 100 1097 The analysis of gender and usage of latrine shows that more women (37.1%) use latrine as compared to men (27.3%); privacy being the main factor driving this behavior amongst women. Further, the family type and use shows that nuclear families tend to prefer latrine use more than joint families.


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3.5.2 Reasons for not Using Latrines Table 20: Reasons for not using latrines

Reasons for not using latrines Fear of pit getting filled fast 33.45 No Water supply in Latrine 16.5 Inconvenient in defecating in latrine 8.12 Smell 12.67 Defecating while in fields during work 15.39 Defecating near water sources 8.57 Not in habit of defecating in confined space 5.3 Total 100

The reasons for not using individual latrine vary from the fear of pit getting filled fast (33.45%), lack of water supply (16.5%), inconvenience of confined space (8.12%), foul smell (12.67%), ease of defecating in the field while at work (15.39%), ease of defecating near the water source (8.57%), to the habits of defecating in the open (5.3%). 3.6 Open Defecation

Table 21: Defecation Practice of those who do not own Latrines HH Members who do not Have Latrine Defecates

Andhra Region

Rayalaseema Region


% % % % Freq Public Latrine 0.62 0.29 0.41 0.40 5 Fields 99.38 99.71 99.59 99.60 1235 Total 100 100 100 100 1240

Response was sought to the question, from those who do not own toilets, ‘where do they defecate’ and the results are shown in the table. A very high percentage (99.6%) responded that they do so in the open fields and only about 0.40% choosing public latrine options. This behavior is uniformly spread across regions with no significant interregional variations. Detailed Analysis: As indicated in the table below, the open fields are generally fall in the catchment areas of tanks, rivers, ponds and/or on the road side. In many villages these are very close to the drinking water source, thus posing a high risk of drinking water contamination.


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3.6.1 Site Table 22: Site of Open Defecation

Site of Open Defecation

Andhra Region

Rayalaseema Region


% % % % Freq Near Water Source 9.26 25.14 33.93 28.23 350 Slope Ground 61.11 27.43 45.19 42.26 524 Catchments 3.70 42.29 11.54 19.19 238 On Road Side 25.93 5.14 9.34 10.32 128 Total 100 100 100 100 1240

Table 23: Children Defecation

Children Defecates


% % % % Freq % Inside the House 11.19 8.20 15.41 8.8 169 9.98 Outside the House 65.03 39.21 44.34 51.6 779 46.01 Uses Latrine 11.89 19.81 18.87 26.2 353 20.85 Drains 11.89 32.79 21.38 13.4 392 23.15 Total 100 100 100 100 1693 100

One dominant reason why children do not use latrine is that the latrine designs. They are designed to suit only adults. If child friendly latrines are made, use of latrine amongst children can be encouraged.

3.7 Environmental Sanitation

3.7.1 Solid Waste Disposal Indiscriminate disposal of garbage are observed in all the surveyed villages. Drainage maintenance is poor; they remain clogged at many places due to careless dumping of solid wastes into the drains. Only about 12.28% of the households use compost pit options, with a large majority dumping the waste either on roads (44.10%) or filing it in bins (12.02%).


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Table 24: Households by Solid Waste Disposal Solid Waste Disposal

Andhra Region

Rayalaseema Region


% % % % Freq In Bins 42.23 13.30 3.68 12.02 227 Outside on Road 48.99 56.98 37.74 44.10 833 In Front of House 8.45 13.97 44.57 31.60 597 In Compost Pit 0.34 15.74 14.01 12.28 232 Total 100 100 100 100 1889

Information regarding various methods of garbage disposal was sought from the surveyed households and based on the current practices they were categorized into four major types viz. i) bins ii) outside on the road iii) in front of the house and iv) in compost pits. Once again, large regional variation has been observed as summarized below: i. Dumping the waste in bins is observed by about 42% of the households in

Andhra region, where as the same practice is relatively low in Rayalaseema (13.30%) and Telangana region (3.68%).

ii. Disposing off waste outside the road is common in Rayalaseema (56.98%) and Andhra regions (48.99%), where as in Telangana this practice is lower with about 38% of the households practicing it. Dumping the waste in front of the house is practiced by about 45%, 14% and 9% in Telangana, Rayalaseema and Andhra regions respectively. The unhygienic practice of disposing off waste in the open (outside the road or in front of the house) is widely practiced in all the regions.

iii. Compost pit option is used by a very few number of households in all the three regions (0.34% in Andhra 15.74% in Rayalaseema and 14.01% in Telangana).

3.7.2 Waste Water Disposal Table 25: Households by Waste Water Disposal

HH Waste Water Disposal

Andhra Region

Rayalaseema Region


% % % % Freq Drain 67.91 2.22 40.98 35.94 679 Soak Pit 25.34 93.13 31.61 45.31 856 Open 6.76 4.66 27.41 18.74 354 Total 100 100 100 100 1889

At an aggregate level, 45% of the households use soak pit for waste water disposal, followed by 36% opting for drains. About 19% leave the waste water in the open. The region-wise analysis offers a different trend. While in Andhra region, disposing off the waste water in drains is the most frequently used option (68%), in the


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Rayalaseema, soak pits take a precedent with an overwhelming majority (93%) choosing that option. In the Telangana region, it is roughly an even three way spilt between Drains (41%), Soak pits (32%) and Open Disposal (27%). 3.7.3 Sewage Disposal Table 26: Household by Sewage Disposal

HH Sewage Disposal by Region Andhra Rayalaseema Telangana Total % % % % Freq Pit/ Own Septic Tank 96.27 87.13 92.27 92.30 599 Let in Open Ground 2.24 6.93 2.90 3.39 22 Others (Drains) 1.49 5.94 4.83 4.31 28 Total 100 100 100 100 649

It is interesting to note that 92% of HH which have ISL are connected to own septic tank. Only 3% HH let out the sewage in open ground and rest 5% chose other options, including letting it off in the drains. 3.7.4 Fodder Waste/ Dung Disposal Table 27: Households by Fodder Waste/Dung Disposal

Disposal of Fodder Waste/ Dung by Region Andhra Rayalaseema Telangana Total % % % % Freq House Back Yard 85.71 44.38 51.91 52.77 276 Outside Village 12.24 53.13 41.08 42.07 220 Compost Pit 2.04 2.50 7.01 5.16 27 Total 100 100 100 100 523

Live stock related waste is another major challenge faced by most villages. State-wide analysis indicates that about 53% of HH dispose it off in the house backyard and about 42% leave it outside the village. Only about 5% use compost pit option. This high percentage of unhygienic practice of livestock waste disposal turns out to be a breeding ground for flies, mosquitoes and other insects. Region-wise figures as shown in the table above indicate a high incidence of unhygienic practices of fodder waste/dung disposal (back yard of the house and/or outside the village) across three regions.


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3.7.5 School Sanitation The school sanitation facilities in the state appear to be reasonably good with about 76% of the schools having sanitation facilities. Table 28: School Sanitation Status in Sampled Villages

School Sanitation by Region Andhra Rayalaseema Telangana Total % % % % Nos. Yes 25 100 83.33 76.19 16 No 75 0 16.67 23.81 5 Total 100(4) 100(5) 100(12) 100 21

Table 29: Girl Sanitation Facilities in Schools in Sampled Villages Girl Sanitation Facilities in Schools by Region

Andhra Rayalaseema Telangana Total % % % % Nos. Yes 100 60 90 81.25 13 No 0 40 10 18.75 3 Total 100 100 100 100 16

The region-wise analysis of school sanitation was conducted from two distinct perspectives: i) existence of the facility in the schools and ii) provision for sanitation facilities exclusively for girls. From the perspective of existence of the facility, Rayalaseema region stands out with 100%, where as from the perspective of provision exclusively for girls, it is the Andhra region that stands out with an equal percentage. Field observations during the survey indicated that maintenance of sanitation facilities in the schools is very poor; many of them have been abandoned. Proper disposal of waste is absent and in almost all schools it is let out in open. The general condition of latrines in Andhra region is reasonably good and 100% of the latrines are in working condition; in Rayalaseema and Telangana regions only about 80% and 70% are in working condition. From the perspective of filed level analysis, one important caveat is in order. The high percentage of school latrines being in working condition does not necessarily mean, all of them are put to use children. Instances abound, where the area surrounding the toilets are used as open latrines, despite the toilets being in working condition and enough water supply is available. Table 30: Working Condition of School Latrine

Condition of School latrines by Region Andhra Rayalaseema Telangana Total % % % % Nos. Working 100 80 70 75 12 Not Working 0 20 30 25 4 Total 100 100 100 100 16


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3.8 Awareness of Water Borne Diseases

Around 63% of HH in the state have reported that they have some knowledge about water borne diseases. However, deeper explorations revealed that their knowledge is limited to knowing about the occurrence diarrhea and other stomach related infections. Table 31: Households by Knowledge About Water Borne Diseases

Knowledge About Water Borne Diseases by Region Andhra Rayalaseema Telangana Total % % % % Freq Yes 72.30 73.61 57.09 63.42 1198 No 27.70 26.39 42.91 36.58 691 Total 100 100 100 100 1889

The Regional analysis of knowledge levels indicate that the awareness is relatively high (over 70%) in Andhra and Rayalaseema regions, where as Telangana region ranks low with only about 57%. 3.9 Water Handling Practices

Various practices are used in handling water at the household level. In more than 85% of the households water is consumed directly without any treatment, even in fluoride affected regions. About 11% HH filter the drinking water using cloth and those who boil and use candle filter are 2% of the households. Less than 2% of the households treat water using by mixing alum or herbs. Using safe practices like taking water with laddle from the container is very rare (6.56%), but protecting water container with cover or lid is widely practiced (69.35%). Customized tanks or tanks with taps are used in about 25% of the households. Table 32: Households by Water Treatment Methods

Water Treatment Methods SVS MVS Total % % % Freq Use water without treating 83.89 82.16 83.64 1580 Boiling 2.47 1.49 2.33 44 Filtering by Cloth 11.85 15.99 12.44 235 Use Candle Filters 0.25 0.37 0.26 5 Mixing Alum/Herbs 1.54 0.00 1.32 25 Total 100 100 100 1889


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Table 33: Households by Drinking Water Handling Practices Drinking Water Handling

SVS MVS Total % % % Freq Use Ladle 7.35 1.86 6.56 124 Cover or Lid 64.63 97.77 69.35 1310 Customized Pot/Tank with Tap 28.02 0.37 24.09 455 Total 100 100 100 1889

3.10 Personal Hygiene

Use Ladle Cover or Lid Customized Pot/Tankwith Tap

6.56

69.35 24.09

HH Drinking Water Handling Practice

Figure 2: HH Drinking Water Handling Practices A series of questions were asked to understand the personal hygiene practices of respondents and the results are tabulated below. From the data it can be inferred that good personal hygiene practices exist in all the three regions with a high percentage of households washing hands before and after eating and also after defecation. Table 34: Households by Hand Wash Practices

HH Member Practices Hand Wash by Region Andhra Rayalaseema Telangana Total % % % % Freq Before & After Eating 14.53 3.10 3.85 5.35 101 After Defecation 11.82 3.33 1.93 3.81 72 Both 73.65 93.57 94.22 90.84 1716 Total 100 100 100 100 1889


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Table 35: Agent for Wash Hands

Agent for Wash Hands Andhra Rayalaseema Telangana Total % % % % Freq Soap 83.11 87.80 92.82 90.10 1702 Mud 5.74 2.66 1.05 2.17 41 Ash 3.04 6.87 1.40 2.96 56 Only with Water 8.11 2.66 4.73 4.76 90 Total 100 100 100 100 1889

Soap is commonly used cleaning agent for washing hands followed by ash and mud. Only less than 5% of households wash hand with water alone. Table 36: HH Members take Bath

HH Members take Bath


% % % % Freq % Daily 99.36 57.43 89.46 74.76 2328 77.60 Once in Two Days 0.00 35.85 7.97 21.65 560 18.67 Twice a Week 0.43 5.64 2.19 3.26 96 3.20 Weekly Once 0.21 1.08 0.39 0.33 16 0.53 Total 100 100 100 100 3000 100

Table 37: Gender and Bathing Habits Gender and Bathing Habits Daily Once in Two

Days Twice a Week Weekly Once Total

% % % % % Freq Male 77.2 19.0 3.2 0.5 100 2743 Female 81.7 14.8 3.1 0.4 100 257 Total 77.6 18.7 3.2 0.5 100 3000 Gender analysis of bathing habit indicates that women bath more regularly than men. It is the cultural norm that women are supposed to maintain cleanliness, and socialize the children toward clean habits.


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3.11 Availability of Medical Facilities

Table 38: Availability of Medical Facilities in Sample Villages

Availability of Medical Facilities in Sampled Villages

Andhra Region

Rayalaseema Region


Primary Health Center 50 60 25 38.10 Sub Center 0 40 50 38.10 Pvt. Medical Practitioner 50 60 66.67 61.90

Overall Situation: The availability of medical infrastructure in the sample villages were analyzed as shown in the table above and it is found that PHC facilities are available in about 38% of the villages and sub-centers also exist in an equal number of villages. Private Medical Practitioners are reported to be practicing in about 62% of the villages.

50

0

50

60

40

60

25

50

67

38 38

62

Andhra Region RayalaseemaRegion


Availability of M edical Facilities

Primary Health Center Sub Center Pvt. Medical Practitioner

Figure 3: Availability of Medical Facilities in Sampled Villages Regional Analysis: The status of health infrastructure varies significantly across three regions. Availability of PHC is the highest in Rayalaseema (60%) and lowest in Telangana (25%). While the villages surveyed in Andhra region have reported no sub-centres such facilities are available in about 40% and 50% of the villages in Rayalaseema and Telangana regions respectively. However, what is interesting to note that despite the availability of reasonable levels of sub-centre infrastructure, private medical practitioners thrive (66.67%) in Telangana region.


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3.12 Elements of Sanitation

S.No. Sanitation

Elements Attributes

1 Personal Hygiene Hand Washing After Defecation and Before Eating

Drinking Potable Water Brushing Bathing Nail Clipping Wearing Clean Clothes Periodic Cropping and Combing Hair

2 Household Hygiene

Having and Using Latrine at all times Using a Smokeless Choola/ LPG Stove Clean House Safe Storage and Handling of Food and Water Sullage Disposal Solid Waste Disposal

3 Community Hygiene

Potable Water Supply Liquid Waste Management Solid Waste Management Storm Water Drains Clean Pavements

The three elements of sanitation given above reflect on health of the individual in the community. 3.13 Issues

The present level of sanitation coverage in the state is only 50 %, while the rural household coverage is only 30 %. This implies that still more than 70 percent of rural population resorts to open defecation with its associated contamination risk to water supply sources and public health. Open defecation constitutes a major non-point source of pollution of surface and ground waters in addition to soil contamination. This problem is more acute in densely populated settlements, especially in coastal areas. Poor environmental sanitation conditions and lack of adequate supply of safe water are factors responsible for high incidence of water bone / water related diseases among the rural population. The main factors affecting the status of sanitation in the villages are the following:

Wastewater generated by the households, including the wastewater from cattle sheds, flows into open surface drains leading to stagnation in the lanes and by-lanes. The presence of stagnant water in the villages is linked to the incidence of malaria and other vector-borne diseases. Due to a combination of poor environmental sanitation and poor personal hygiene, diahorreal


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diseases, cholera and typhoid cases have been commonly reported in the rural areas. Without adequate arrangements for treatment and disposal, the wastewater often seeps into hand pumps, open dug wells and pipelines, and the water quality of the village ponds has deteriorated leading to loss of productive uses and contamination of the shallow aquifer. Incidences have been reported of effluent overflowing from the septic tanks and finding its way to the village drains.

Women participation is rather poor. It is predominantly women and children who are affected by the poor sanitary conditions in the household and community. Being the managers of water and sanitation at household level women participation is necessary for bringing in behavior change. This is an issue where the project needs to make sure that female opinion is given adequate importance and their participation is ensured.

Latrine usage is very low. While about 65% of the household do not have latrines, only 28% of those who are having are using them. Nearly 56% of the children are made to defecate inside or outside the house. This poses a serious threat to the health of the family and community. This is a matter of concern for the project to raise awareness levels to put the existing toilets to use and build for all.

Community sanitation is just below average. With nearly 72% of the people throwing garbage in front of their house or on the road, sanitary conditions in the villages are poor. This requires Information Education and Communications campaigns and Behavior Change Communication using local media and locally acceptable methods.

Hygiene behavior at personnel level is rudimentary. With nearly 22% of the people not bathing daily, this is a major matter of concern. Change in these habits can only come about with intense Information Education and Communications campaigns and Behavior Change Communication using local media.


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4 Sanitation Policies and Programs of Andhra Pradesh

4.1 Total Sanitation Campaign

Total Sanitation Campaign is a comprehensive program to ensure sanitation facilities in rural areas with broader goal to eradicate the practice of open defecation. TSC as a part of reform principles was initiated in 1999 when Central Rural Sanitation Program was restructured making it demand driven and people centered. It follows a principle of “low to no subsidy” where a nominal subsidy in the form of incentive is given to rural poor households for construction of toilets. 4.1.1 Lesson Learnt Although the TSC was launched in 1999, the pace of progress has been gradual. Though most TSC was included in programs, financial allocations for sanitation often are not adequate due to lack of priority attached to the program which often takes a back seat to water which is a more politically important area. The second reason lies in the fact that there has been inadequate emphasis on capacity building and IEC activities with no involvement of the cutting edge level staff for implementing a ‘demand’ driven project. The implementation machinery at the field level, which is quite familiar with working of the supply driven, target oriented schemes of the government need to be sensitized further to the challenges of this ‘demand’ driven approach. For this, a change in the outlook and functioning of the implementation staff of the scheme is needed. Management of this change in approach requires more attention. Some of the other challenges are: high dependence on subsidy schemes, inadequate provision of low cost and region specific technological options, poor quality of construction, poor attention to the use and operation and maintenance of the sanitation facilities. 4.2 NGP

Nirmal Gram Puraskar (NGP-Clean Village Award) was instituted by the Government of India on 2nd October 2003 to recognize, encourage and facilitate PRIs and those individuals and organizations that work with them to achieve total sanitation. The award was designed based on the success achieved by PRIs in Nandigram II block in East Midnapur district of West Bengal to achieve full sanitation coverage and eliminate the practice of open defecation. Using innovative financial incentives to ignite positive sanitation and hygiene behavioral changes in rural communities was unheard a strategy prior to the launching of NGP in India, which has certainly revolutionized the means and


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methods of promoting the rural sanitation on a large scale. This model demonstrates how an incentive strategy can motivate the PRIs in taking up sanitation promotion activities and shift their priorities from hardware and infrastructure provision to change in behavior. Eligible Village Panchayats, Blocks, and Districts are those that achieve (a) 100% sanitation coverage of individual households, (b) 100% school sanitation coverage, (c) free from open defecation and (d) maintain environmental cleanliness. Also eligible for the award are individuals and organizations, which have been the driving force for effecting full sanitation coverage in their respective geographical areas. Table 39: Number of Awards Winning GPs in AP During Last 3 Years

No of Award Winning GPs in Last 3 Years S No Year No of GPs 1 2005 - 2 2006 10 3 2007 143

Source: DDWS, GoI The above table shows that from no award in 2005 to 10 GPs wining in 2006 and gradually 143 GPs won awards in 2007. Due to the recent efforts in achieving total sanitation, many GPs have applied for NGP in 2008. NGP has succeeded in setting off a healthy competition among GPs. The award has brought about a silent revolution in the sector of sanitation. The pride and honour associated with receiving an award from the President of India is a reason in itself for elected heads of GPs to take a personal interest in covering all households and schools with sanitation facilities under TSC. To meet all the eligibility criteria, they pay attention to eradicating open defecation as well as solid and liquid waste management in villages. However, sustainability of open defecation free status attained by the GPs is a matter of concern. India has a history of having ‘slipped back habitations’ with respect to water supply. The NGP has created a country wide enthusiasm and a competitive spirit amongst Gram Panchayats. The NGP contributed in accelerating the pace of the TSC which has been operational since 1999. 4.3 Shubhram

SHUBRAM (meaning cleanliness in local vernacular) program was promoted with the motto of ‘Making Total Sanitation a way of life’ in the 22 Districts that the TSC program is being implemented with the technical and training inputs of water and sanitation program-South Asia (WSP-SA). SHUBHRAM is an annual competition hosted by the GoAP to select the cleanest GP, cleanest Mandal Parishads and Cleanest Zilla Parishads in the state by providing financial awards to the Panchayat bodies at different levels (Mandal, district and state).SHUBRAM is the GOAPs


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program of providing additional incentives to local governments to achieve excellence through triggering community participation and action in environmental sanitation. The program was launched on July 2, 2007 with the motto of creating healthy competition among the GPs to compete for the NGP. The program was to bring about a distinct shift in the general perception of sanitation including safe and hygienic disposal of excreta, solid and liquid waste disposal. Further it was envisaged that more number of GPs could be motivated to qualify for the NGP by adopting this program of receiving additional incentives in the form of SHUBRAM awards by actively involving the local governments. Any local body that had attained the status of ‘open defecation free’ (ODF) was eligible to apply for the award. To give an added impetus to the program, the CM during the NGP award ceremony assured that individual latrines would be constructed as part of Employment guarantee program. Officers/NGOs motivating the GPs for SHUBRAM would also be given awards. In other words `SHUBHRAM is an annual competition hosted by the GoAP to select the cleanest GP, cleanest Mandal Parishads and Cleanest Zilla Parishads in the state by providing financial awards to the Panchayat bodies at different levels (Mandal, District and state). 4.4 Indiramma Program

The GoI‘s support to the Indira Awas Yojana saw its translation of support at the state level to the State Housing program called the Indiramma Housing program. The GoAP, through G.O. Rt. No 1170 launched the Indiramma Housing Program in April 2006 to construct 16.32 lakh new houses in the selected GPs and provide ISLs, along with the houses. Instructions were given to take up construction of latrines also simultaneously along with the house construction based on the TSC guidelines. Till December 2007, as per the information available with the SWSM(Annexure IX), 18,39,628 units have been sanctioned. Of them 11, 03,751(59.9%) units have been grounded and 2,91,262(16.8%) units have been completed and balance to be completed is 15,48,366(84.16%) against a financial release of Rs. 9077.84 lakhs and expenditure of 4390.40 (%) Progress report of ISLs in Indiramma Housing colonies is annexed in Annexure IX 4.5 Partnership with other agencies

Water and Sanitation Program - South Asia ( WSP-SA) has been supporting the Endeavour of the Government of AP in improving rural sanitation In AP. WSP is providing technical assistance through capacity building, communication, policy advice and other hand holding support in implementing sanitation programs. This support includes day to day advice by the Coordinator who is stationed in Hyderabad and operates from SWSM, exposure visits (both national and


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international), workshops and orientations at state and district levels, Documentation, review and feedback etc. Under the capacity building support 30-40 master trainers are trained in each district on Community Led Total Sanitation (CLTS) approach to achieve total sanitation. WSP has assisted the GoAP in designing and implementation of state reward scheme “Shubram”, for sanitation. UNICEF: UNICEF is focusing its efforts in Medak and Ananthapur district to achieve total sanitation and supporting the district administration in this regard. UNICEF has appointed district coordinators and support staff for this purpose. UNICEF has identified NGOs to support the sanitation movements in these two districts and is funding them. District level NGOs: The RWSSD has appointed district level NGOs for supporting the DWSC in preparing the Gram Panchayats for achieving the Nirmal Gram Puraskar Awards. These NGOs motivate and mobilize the community towards total sanitation. 4.5.1 CLTS Approach Poor access to adequate sanitation, resulting in the practice of widespread open defecation, has negative health and social impacts on communities, particularly in terms of diseases such as diarrhea and cholera. Community-led total sanitation (CLTS) involves facilitating a process to inspire and empower rural communities to stop open defecation and to build and use latrines, without offering external subsidies to purchase hardware such as pans and pipes. Through the use of PRA methods, the community members analyze their own sanitation profile including the extent of open defecation and the spread of faecal-oral contamination that detrimentally affects every one of them. The CLTS approach ignites a sense of disgust and shame among the community. They collectively realize the terrible impact of open defecation, that they quite literally will be ingesting one another’s ‘shit’ so long open defecation continues. This realization mobilizes them into initiating collective action to improve the sanitation situation in the community. If facilitated properly, CLTS can trigger community-led local action to stop open defecation totally, and without subsidies or prescriptions for latrine models from an external sanitation program. Once ignited, the CLTS triggers almost immediate action and communities start digging holes for construction of homemade pit latrines. Families start making toilets within their means, or share toilets in order to become a 100 per cent open defecation-free village. Once achieved, the proud community puts up a board at the entrance to the village stating that no one in their village defecates in the open and they will not allow others to do so. The key to successful spread of CLTS will be sustaining good quality facilitation.


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4.5.2 CLTS Process Community-Led Total Sanitation is based on stimulating a collective sense of disgust and shame among community members as they confront the crude facts about mass open defecation and its negative impacts on the entire community. The basic assumption is that no human being can stay unmoved once they have learned that they are ingesting other people’s faeces. Generally communities react strongly and immediately try to find ways to change this through their own effort. CLTS involves no subsidy. Subsidy only induces an attitude of external expectation and dependence. Neither does CLTS prescribe latrine models. Rather, it encourages the initiative and capacity of the community. The aim is to ignite and encourage a self-motivated desire to change behaviour. Certain sections of the community will have particular motivations for wanting to change the status quo. For example: Families who do own toilets discover that they are just as prone to faecal-oral

contamination due to the actions of those who don’t. Landless people are often criticized and abused for defecating in other people’s

land. Women and young girls suffer the most from the lack of privacy in open

defecation. Religious leaders realize the meaninglessness of wearing clean clothes as they are

dirtied by human excreta. The strong feelings and drive to act of these different sections of the community should not be ignored. Rather, they could be encouraged to form their own pressure groups to encourage others to change. The following is a rough sequence of steps which is followed, and tools that are applied in triggering CLTS in villages. This is definitely not the only way of triggering CLTS. However there are some essential elements which will be emphasized. The following steps are generally followed in triggering CLTS.

Introduction and rapport building Participatory analysis Ignition moment Action planning by community Follow up

4.5.3 Triggers Approach Trigger is an approach or concept/event/situation/individual/group/tool, which makes you to think and act. A trigger can operate at the community level or at the individual level only. Behavior change can be triggered by the following:


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Help people assess and analyze their sanitation situation through various ‘trigger tools’.

Let people decide whether they want to change their behaviour related to defecation or continue with the existing practice

Sharing of information on issues related to low to high cost technology options, availability of sanitary material, etc on collective demand of the community

Facilitate collective action at the community level through follow-ups Trigger tools for used for behavior change are:

Defecation area transect walk (Walk of shame) Defecation mapping Calculation of faeces Flow diagram-Faecal-oral transmission route Calculation of amount of faeces being ingested by a person Calculation of medical expenses Water quality testing

4.5.4 Shifts from Traditional Approach Elements Target Driven Partial

Sanitation Community Led Total Sanitation

Start With Things People Core Activity Constructing Latrines Igniting and facilitating

processes Latrines designed by

Engineers Community innovators

Number of designs One or a few Many Main materials Cement, pipes, bricks, etc.

purchased from outside Bamboo, wood, tin, jute, plastic, etc. almost all locally available

Cash cost High Can be under Rs. 500 Indicators Latrines constructed Open defecation ended Sustainability Partial and patchy High Who benefits The better off All including the poorest Key motivation Subsidy Disgust and self-respect Coverage / usage Partial Total Benefits Lower: open defecation

Continuing Higher: open defecation ends

The implications of these shifts may be significant for institutions wishing to adopt or scale up CLTS. It implies change in institutional and personal mindsets and behaviours which tend to be philanthropic (i.e. to subsidize), professional (i.e. to promote high standards), and bureaucratic (i.e. to spend big budgets). CLTS, on the other hand, is founded on the principles of no hardware subsidy and local ‘non-expert’ facilitation by community facilitators, supported by low-cost training, none


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of which require much budget. It aims to be a truly community-led process and scaling up also needs to be driven at the community level. It must not be driven by needs to disperse funds. International agencies, including NGOs, have a role to play in promoting international spread and in supporting local and national initiatives. Government and national NGOs have roles in assuring favourable conditions and supporting ignition and lateral spread. All need to recognize the importance of ‘light touch’ support so that CLTS can be ignited and, once ignited, can spread from community to community. 4.5.5 Partnering with SERP - IKP The RWSSD is partnering with SERP-IKP in some pilot Mandals of two districts for implementing Total Sanitation Campaign. IKP is vested with the responsibility of mobilizing communities using CLTS approach in these pilot Mandals. The required funds for implementing latrine construction works are transferred to IKP. Training programs for the IKP staff were conducted with the assistance of WSP-SA through their resource agency Samaj Vikas Development Support Organization. The initial community mobilization activities are taken up in these Mandals. 4.6 Institutional Arrangements

In Andhra Pradesh, rural water supply and sanitation policy making and monitoring and evaluation (governance and management related) are dealt with by different institutions. At the state level The Principal Secretary, Rural Water Supply and Sanitation Department, GOAP and the State Water and sanitation Mission and at the district level the District Water and Sanitation Mission provides governance and management. As the PRIs too are involved in provision of water and sanitation, at the state level The Secretary, Panchayat Raj, at district level the Zilla Parishad, at Mandal level the Mandal Parishad and at village level Gram Panchayat provides the governance and management. In the tribal areas, the ITDA at area level and VTDA at village level, provides governance and management inputs and support. The implementation and operations are dealt with by the Rural Water Supply and Sanitation Department. During 2007, the RWSSD was separated from the Panchayat Raj Department creating a department exclusively to look after the RWSS related implementation and operations. These institutional and implementation arrangements are detailed in the following sub-sections.


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4.7 Institutions related to Policy, Planning and M&E

4.7.1 Secretary, RWSS The Secretary to Government, RWSS is responsible for overall planning and issuance of policy guidelines and government orders for the RWSS sector. Besides being responsible for overall monitoring of the progress (both physical and financial) in the RWSS sector and evaluation, the Secretary is responsible for budget appraisal and allocation of funds to the RWSS sector. At present, the Secretary accords administrative sanction for RWSS works costing above Rs. 10 lakh. 4.7.2 SWSM, DWSM, MWSC and VWSC The State Water and Sanitation Mission (SWSM) is the apex body at the state level responsible for formulation of policies and guidelines and overall implementation and monitoring of the schemes undertaken under Swajaladhara and Total Sanitation Campaign (TSC). The SWSM is headed by the Secretary of the RWSSD, Government of Andhra Pradesh and assisted by a Program Director. The key functions of the SWSM are as below:

Assistance to the GOAP in improving the quality of RWSS Provision of overall policy guidance in sector reforms and assisting GOAP in

identification and implementation of sector strategies Coordination with various departments of GOAP, GOI and other sector

partners Monitoring, evaluation and implementation of sector plans Overall management of pilot projects Internal and external resource management to support financing

requirements of the sector Coordination with institutions and personnel at the district, Mandal and

village / Gram Panchayat levels The Secretary, RWSS as the head of the SWSM is responsible for issuing Policy guidelines and Government Orders, Overall monitoring, Funding budgets, borrowing and Administrative approval of works under Accelerated Rural Water Supply (ARWS) program. The Project Director, SWSM is responsible for issue of Policy guidelines, Approval of schemes, Periodic review of implementation, Coordination with other departments, Monitoring & Evaluation of physical & financial progress, Integration & operation of capacity development programs and Resource management for future financing requirements. The SWSM is supported by two committees; the Apex Committee and the Executive Committee. The Apex Committee is headed by the Chief Secretary. The Secretaries to GOAP of Rural Water Supply, Rural Development, Panchayat Raj, Education, Health, Finance, Planning and Information & Public Relations departments function as members of


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the apex committee. The Apex Committee meets every quarter to provide guidance on policy related issues in the RWSS sector. The Executive Committee provides necessary technical advice and assistance to the Apex Committee. The Committee is headed by the Secretary, RWSS and the Joint Secretary, RWSS functions as its member Secretary. The members of the committee include Chief Engineers from the departments of: Rural Water Supply, Rural Development, Panchayat Raj Department, Education, Health, Finance, Planning and Information & Public Relations. 4.7.2.1 District Water and Sanitation Mission

At the district level, the District Water & Sanitation Mission (DWSM) and District Water & Sanitation Committee (DWSC) are the principal bodies for execution of projects under Swajaladhara and TSC. The DWSC is headed by the District Collector and convened by the Superintending Engineer (SE), RWSSD. The Mandal Water & Sanitation Committee and Village Water & Sanitation Committees are principal bodies at the Mandal and village levels respectively for implementation and supervision of programs under Swajaladhara and TSC. The District Water and Sanitation Committee (DWSC) is a Committee of the Zilla Parishad/ DWSM. The DWSM meets as often as possible but not less than four times a year. It considers and takes note of all schemes under Swajaladhara which have been technically scrutinized and approved by the DWSC. It reviews the implementation, progress of Swajaladhara and the Total Sanitation Campaign (where it has been launched) in the district. 4.7.2.1.1 District Water Supply & Sanitation Committee The DWSC is headed by the District Collector. DWSC will have District level officers such as the Superintending Engineer of RWSS, District Education Officer, District Health Officer, Project Director DRDA, District Panchayat Raj Officer, District Social Welfare Officer, and District Information & Public Relations Officer. In addition 3 members who shall be experts and/ from reputed NGOs and women’s groups, may be co-opted into the Committee as members with the prior approval of the SWSM. The Superintending Engineer, RWSS functions as the Member Secretary of the DWSC. In most districts, the DWSC is assisted by a District Support Unit (DSU). In the districts surveyed, the DSU is managed by a DEE, RWSS. The functions of the District Water & Sanitation Committee (DWSC) are as follows:

Formulation, management and monitoring of Swajaladhara and TSC projects Scrutiny and approval of the schemes submitted by the Gram Panchayat Selection of agencies and/ NGOs and enter into agreements for social

mobilization, capacity development, communication, project management and supervision

Sensitizing public representatives, officials and the general public about the Swajaladhara principles


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Engaging Institutions for imparting training for capacity development of all stakeholders, and undertaking communication campaign; and

Interaction with SWSM, State Government and the Government of India 4.7.2.1.2 District Support Unit The DSU is formed of District Resource Persons (DRPs) from various specialized fields such as IEC, capacity building and Management Information Systems. The DRPs are employed from the private sector in the districts which were surveyed. The functions of the District Support Unit (DSU) are as follows:

Implement IEC strategies as decided by the DWSC including conducting workshops and orientations

Capacity building of all relevant stakeholders Maintain databases consisting of baseline information on sanitation aspects of

the district including household latrines, school latrines and their usage Prepare financial management systems and controls Promote establishment of rural sanitary marts and production centers Coordinate with NGOs and Support Organizations (SOs) imparting IEC

activities Prepare Project Implementation Plan (PIP) and assist DWSC in implementing

the same Information procured during field visits seem to suggest that the average establishment cost of a DSU is about Rs. 35,000 – Rs. 40,000 per month. A majority of the funds are spent for payments of salaries to the DRPs. The funds for DSU are currently being channeled through funds earmarked for IEC and capacity building for TSC. 4.7.2.2 Mandal Water Supply & Sanitation Committee

The Mandal Water and Sanitation Committee (MWSC) is the arm of the Water & Sanitation Mission at the Mandal level. The MWSC is chaired by the President of the Mandal Parishad (MP). The DEE RWSS functions as the co-Chairman of the MWSC. The members of the MWSC include Mandal Development Officer, Mandal Revenue Officer, Mandal Executive Officer, Sub-Inspector of Police at the Mandal level, AEE RWSS, AEE Panchayat Raj, AEE Mandal Parishad, Mandal Education Officer, Medical Officer and Members from women’s association. The Mandal Resource Persons (MRPs) assist the MWSC in discharging the following mandated duties and functions:

Management and monitoring of Swajaladhara and TSC projects at the Mandal level

Scrutiny of the schemes submitted by the Gram Panchayat and forwarding them to the DWSC

Cooperation with NGOs for social mobilization, capacity development, communication, project management and supervision


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Sensitizing the public representatives, officials and the general public about the Swajaladhara principles

Guidance and support to institutions for imparting training for capacity development of all stakeholders, and undertaking communication campaign

As per the guidelines, MRPs should possess professional skills in the areas of social science and community mobilization. In the Mandals surveyed, the MRPs are employed from the private sector, mostly fresh graduates. The MRPs receive an entitlement of Rs. 4,000 to Rs. 4,500 per month. Some of the key issues highlighted during field visits were that the MRPs are facing difficulties in delivering up to their expectations due to poor participation from the community. 4.7.2.3 Village Water & Sanitation Committee

At the village level, the Village Water and Sanitation Committees (VWSC) play an important role in implementation of reform projects under Swajaladhara and TSC. The VWSC is chaired by the Sarpanch (the elected head of the Gram Panchayat). The members of the VWSC include GP level Panchayat Secretary, Members from women’s groups, Members from the youth clubs, Village Development Officer and Treasurer (elected in the Gram Sabha). The VWSCs are responsible for execution of the following key functions:

Ensuring GPs to take up Swajaladhara implementation in each Gram Sabha meeting

Ensuring community participation and decision making in all phases of scheme activities

Organizing community contributions towards capital costs, both in cash and kind (land, labour or materials)

Opening and managing bank account for depositing community cash contributions, O&M funds and management of project funds

Signing of various agreements with the DWSC Planning, designing, and implementing all drinking water and sanitation

activities Procuring construction materials/goods and selection of contractors (where

necessary) and supervision of construction activities Commissioning and takeover of completed water supply and sanitation

works through a joint inspection with DWSC Collection of funds through tariff charges and deposit same for O&M of water

supply and sanitation works for proper managing and financing of O&M of the services on a sustainable basis; and empowering of women for day to day operation and repairs of the scheme

Creating and promoting integration of drinking water, sanitation and hygiene in the Panchayat; and

Participation in communication and development activities in other villages


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4.7.3 Panchayat Raj Institutions The state of Andhra Pradesh stood second in introducing the Panchayat Raj system in India in order to establish democratic institutions at the grass root level. The Gram Panchayats (GP) stand at the base of the three-tier structure of local governance with the Mandal Parishad at the intermediate level and the Zilla Parishad at the district level. Along with 22 Zilla Parishads and 1095 Mandal Parishads, there are 21943 Gram Panchayats in AP covering a population of more than 55 million people. It is necessary to highlight the lack of a clear definition of what a GP is in Andhra Pradesh. The population of a GP varies from 300 to more than 3,000. This does, in fact, raise a question on the economic viability of smaller GPs. The responsibilities of GP include: a) Implementing land reform measures, including consolidation of land holdings and cooperative management of community lands; b) Implementing programs related to agriculture, animal husbandry, cottage industry, pre-primary and primary education, health and sanitation, women, children, destitute people and people with disabilities; c) Resource planning by preparing an inventory of human and natural resources and other assets at the village level; d) Preparing and prioritizing plans/ programs to harness these resources to meet local needs and aspirations; and e) Disseminating technology to increase farm and related production; expanding services like health, veterinary and sanitation services in their jurisdiction. The 73rd Constitutional Amendment and the consequent Andhra Pradesh Panchayat Raj Act 1994 assigns local bodies the responsibility of providing safe drinking water supply and sanitation. Under the AP Panchayat Raj Act, O&M of water supply installations is the responsibility of Gram Panchayats. The Act also empowers the Gram Panchayat to collect house tax (10% of which is intended for use in water supply) from its constituents. In reality, most of the Gram Panchayats have financial constraints in taking over the responsibility of O&M. The Act, at the gram Panchayat level, provides for the constitution of ‘beneficiary committees’ for the execution of works of the GP and ‘functional committees’ for agriculture, public health, water supply, sanitation, family planning, education and communication. Under this act VWSCs are formed. The functions of the VWSCs are given in the above sub-section. VWSC is a committee of the Gram Panchayat. Mandal Parishads co-ordinate rural development activities within their jurisdiction and consolidate Panchayat plans into a Mandal Parishad plan. At Mandal level MWSC are formed. The functions of the MWSC are given in the above sub-section. The MWSC is a committee of the Mandal Parishad. The Zilla Parishad organizes data collection and consolidation of Mandal Parishad plans, allocation of funds and approval of Mandal Parishad budgets. According to the Panchayat Raj Act, the ZP will have seven standing committees, which have since been formed. The chairman of ZP will be the chairman of four committees, the vice-chairman of ZP of one committee and two women members of two committees.


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At the district level DWSM and DWSC are bodies which exclusively work on water and sanitation issues. The DWSM has the representation of the district level officers including the District Panchayat Officer. The DWSC is constituted at the district level, as a registered society, under the overall supervision, control and guidance of Zilla Parishad. The present status of functional devolution in AP shows that its position is lowest among a few important states. Out of 29 items specified in the 11th schedule, it transferred functions in respect of sixteen (16) subjects of which five (05) subjects are with funds (agriculture, drinking water supply, minor irrigation tanks, social forestry, primary and secondary education and Khadi and village industries) and only two subjects are with functionaries (drinking water supply and minor irrigation tanks). Thirteen (13) functions still remain to be transferred; twenty-four (24) subjects with funds; and twenty-seven (27) subjects with functionaries. By contrast, in Karnataka all the 29 subjects/ departments have been transferred to Panchayats with funds, functions and functionaries. Kerala comes next, followed by West Bengal and Madhya Pradesh (Report of the Tenth Five Year Plan Working Group 2001). 4.7.4 Tribal Related – ITDA and VTDA 4.7.4.1 Integrated Tribal Development Authority

Andhra Pradesh has identified ten areas having concentration of tribals in contiguous areas. Special Development Agencies like Integrated Tribal Development Agencies (ITDAs) have been created for overall tribal development in these areas. Objective is to ensure an integrated approach towards implementation of developmental programs for tribals in the (tribal) sub plan areas. The Project Officers of ITDAs are vested with both development as well as regulatory responsibilities with the administrative control over all other line departmental officers including the revenue and tribal department personnel in the district. This way, all the three streams – revenue, development and law and order, are all streamlined, with a single line administration in Tribal Sub Plan areas. Further, all developmental programs in the sub plan area need to be approved by ITDAs. Andhra Pradesh has 10 ITDAs covering the TSP areas in Srikakulam, Vizianagaram, Visakhapatnam, East Godavari, Khammam, Warangal, Karimnagar, Adilabad, Mahaboobnagar, Kurnool and Nellore districts. The ITDA is the nodal agency for integrating all welfare and developmental programs for tribal development. The ITDA functions under the umbrella of the Tribal Welfare Commissionerate at Hyderabad. The institutional and implementation arrangements in these areas are detailed in the Tribal Development Plan.


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4.7.4.2 Village Tribal Development Agency

In Andhra Pradesh, the State Government has enacted Act 7 of 1998 extending Panchayat Raj to scheduled areas. Relevant Rules under the Act are yet to be issued. Meanwhile, in the tribal areas of the State, community based organizations viz. Village Tribal Development Agency (VTDA) has been promoted by ITDAs. The VTDAs are actively involved in planning, implementing and monitoring various tribal development activities at habitation level. Tribal Welfare Department has found VTDA as a viable and functional structure in carrying out Panchayat Extension to Scheduled Areas Act (PESA Act) effectively in tribal areas. The Tribal Welfare Department attempted to integrate the existing PR structure with the new community based movements. In order to ensure a proper integration, it was ordered that the Sarpanch of the Gram Panchayat shall be the president of the VTDA and the secretary of the VTDA should be a woman selected from among the SHG members of the village. Government has also issued instructions that all works up to a maximum cost of Rs.10.00 lakh each shall be entrusted to VTDAs on nomination basis. The involvement of VTDA in the developmental activities in the Scheduled Areas is detailed in the Tribal Development Plan. 4.8 Implementation and Operations - RWSS Department

The Engineer-in-Chief (ENC), RWSS department and the Chief Engineers (CE) are the key personnel at the state level responsible for program management and implementation in the RWSS sector. The officials at the state level are responsible for according administrative and technical (based on size) approvals for projects and monitoring and evaluation of works being undertaken. The overall functions of the state level institutions are:

Provision of policy guidelines for the RWSS sector Overall planning, implementation and monitoring of schemes/ works in the

sector Coordination with institutions and personnel at the district, Mandal and

village levels for implementation and monitoring of sector programs 4.8.1 Engineer-in-Chief The Engineer-in-Chief (EnC) is responsible for overall control of works in the RWSS sector in the state. The EnC is responsible for according administrative sanction for RWSS works up to Rs. 10 lakh. The EnC is empowered to accord technical sanction for works above Rs. 50 lakh.


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4.8.2 Chief Engineers The Chief Engineers (CEs) are responsible for planning and implementation of RWSS works within their mandated geographical constituencies or work areas. At present, the RWSS works in the state are being looked after by 3 CEs – 2 in charge of sector works in their geographical constituencies and the third in charge of Communication and Capacity Development. The CEs are in charge of reviewing proposals and forwarding them for administrative sanction to the E-n-C and / or the Secretary, RWSS. The CEs are empowered to accord technical sanction of works for up to Rs. 50 lakh. The CEs take up Monthly review of works and Achievement of physical targets. The CE, CCDU does Planning & implementation of capacity building programs and Monitoring performance of staff. 4.8.3 SEs and EEs The Superintending Engineers (SE) and Executive Engineers (EE) – in hierarchical order – are responsible for implementation of the sector programs at the district level. The officials at the district level play an important role in monitoring and evaluation, besides executing the projects. The SEs are in charge of implementation and monitoring of RWSS schemes in a district. The SE is assisted by two EEs (on an average) who in turn execute responsibilities in their respective sub-divisions. The SEs are in charge of preparation of budgets for the entire district and responsible for preparation of annual administrative reports of the progress made in the district. The SE is vested with powers to accord technical sanction for RWSS works in their respective districts where the project cost is under Rs. 50 lakh. The EEs are responsible for implementation and monitoring of RWSS works in their respective sub-divisions in a district. They are entrusted with responsibilities of preparation of budgets, monitoring of works, accord technical sanction of works up to Rs. 10 lakh and monitoring of works. 4.8.4 DEEs and AEEs/AEs The Deputy Executive Engineer (DEE) and Assistant Executive Engineer (AEE)/ Assistant Engineer (AE), RWSS function as representatives of the RWSS department at the Mandal level. There are no official representatives of the RWSS department at the village level. The AEE/ AE extend technical support to the GPs in execution of their responsibilities towards operations and maintenance of SVS and intra village facilities of MVS.

The DEE is in charge of about 2-3 Mandals in the district. The DEEs report to the EEs and SEs at the sub-divisional and district levels. The DEEs are assisted by AEEs/ AEs who are in charge of RWSS works in GPs. The DEEs are in charge of monthly review and overall control of works undertaken at the GP level. They are in charge of preparation of budgets for their respective Mandals which are compiled at the


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district level by the EE/ SE. The DEEs are vested with powers for accordance of technical sanction for works up to Rs. 2 lakhs. The AEEs/ AEs provide the necessary technical support to GPs in implementation of schemes at the GP level. The AEEs/ AEs interact with the community and GP on a regular basis and monitor the ongoing works. They are in charge of preparation of line estimates should projects be conceptualized for implementation. They also facilitate preparation of detailed project reports. They function as Technical advisor to GP and have Technical sanction powers for works upto Rs. 0.25 lakh. 4.8.5 Manpower The existing manpower details of RWSS department across various levels are presented in the table below: Table 40: Manpower of RWSS department Category Level Number Engineer-in-Chief State 1 Chief Engineers State 3 Superintending Engineers State 2 Superintending Engineers District 20 Executive Engineers Sub-divisional 52 Deputy Executive Engineers Mandal 315 Assistant Executive Engineers / Assistant Engineers Mandal 1,831 Joint Director (Geology) State 1 Senior Geologists State 6 Junior Geologists District 41 Supporting staff * Various levels 6,400 Work charged employees * Various levels 7,850 * Includes staff and employees of the entire Panchayat Raj Engineering Department which includes RWSS and PRED Roads Wing 4.9 Key Strengths and Weaknesses of RWSSD

4.9.1 Key strengths

Presently the state has an extensive network of rural water supply infrastructure through SVS & MVS and sanitation infrastructure through household sanitary latrines, community latrines, school sanitation infrastructure.

Initiation of devolution of O&M responsibility to the ZPs and GPs. The O&M of the common facilities of the MVS are under the control of the ZP and O&M of the SVS and intra village facilities of the MVS are under the control of the GPs.

Since the introduction of the Sector Reforms Program (SRP) and Swajaladhara programs, concepts of Demand Driven participation and decentralization is


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taking place. The competent and experienced technical human resource pool, whose preference is to serve the sector, is available with the RWSSD.

High design standards and reasonable construction quality. Formation of Water & Sanitation Missions – at state and district levels – to

adopt demand driven approach in the sector. Key weaknesses

RWSSD has not been able to achieve good coverage in terms of water supply and sanitation. For example, only 43% of habitations are Fully Covered by RWS schemes and NSS habitations are still to be covered; rural household sanitation coverage is only 53%.

Vacant positions in the RWSSD makes it weak, duly considering the fact that there are nearly 57% of the habitations are either under covered or have problems. Another fact is that some of the present staff have given preference to PR, but are in RWSSD as positions were not available in PR.

The current institutional structure of the RWSSD does not fully subscribe to the principles of the demand driven approach that the state is contemplating to scale up. Structural changes to the RWSSD need to be undertaken so as to ensure that operational linkages between the RWSSD and the Water & Sanitation Missions (WSMs), at the state, district, Mandal and village levels, are fortified. Such fortification is a requirement for scaling up and sustaining demand driven approaches in the RWSS sector in the state.

The current system of administrative sanction and technical sanction results in long process time and often time delays in execution. More and more decentralization is required – both for functions as well as decisions. The current procedural bottlenecks and delays in drawing up the schemes, sanctioning of schemes, funds flow and procurement methods are delaying schemes.

The fund-flow through the RWSS department shows limited decentralization in case of capital works. The transfer of funds to the ZP and GP for O&M of MVS and SVS are positive trends that indicate devolution of responsibilities to the lower levels in government. However, the RWSS sector should move towards adopting a more decentralized fund flow structure similar to reform programs like Swajaladhara and TSC. Capacities of personnel at the district, Mandal and village levels need to be significantly augmented to promote such devolution of responsibilities.

4.10 Issues for Consideration Presently, Top-down (supply driven) approach is followed in scheme designing, implementation and O&M phases. Presently, RWSSD is solely responsible for all activities starting from project conceptualization, planning, designing, implementation to O&M phase. In these phases, only limited inputs are taken from actual users and other stakeholders in terms of demand, technology choice, siting of infrastructure facilities, etc. Some of the key institutional issues, contributing to


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service and performance, are identified during field visits and stakeholder discussions are given below for consideration by APRWSSP.

Staff strength: During the bifurcation of the Panchayat Raj (PR) department into RWSSD and PR, majority of the staff preferred to remain in PR. This situation has resulted in vacant positions in the RWSSD. Recently the senior positions in RWSSD have been filled through promotions. Some positions at the AE/AEE, DEE level still remain vacant.

Technical Support: There are sizable number (1953) of NSS habitations in the state. The technologies adopted for fluoride affected villages are not working satisfactorily mainly due to operation and maintenance reasons. There is a requirement for building capacity of the department in terms of innovation in new, simple and community friendly technologies.

Change in Roles: At present, the role of RWSSD is that of a provider of water and sanitation assets. In view of decentralization and devolution of roles and responsibilities pertaining to planning, implementation and O&M of water supply to ZPs and GPs, the RWSSD role will shift to that of facilitator and provider of technical support to the ZPs and GPs. RWSSD is not geared up to such a cultural shift and thus there is a need for preparing the personnel for this transformation.

Conflicting Roles: Governance, policy making and execution roles have converged at present into the RWSS department. There is need for separation of the governance aspect from the project execution roles and responsibilities.

Community Participation: Limited participation of the community, in planning, implementation and O&M of RWSS facilities, is a key issue to be tackled in the RWSS sector. The limited community involvement is partly because of the supply driven approach and partly due to lack of awareness among users about the benefits that could accrue from active involvement. Significant IEC efforts need to be effectively channeled to improve community participation.

Weak PRIs: Though the PRIs have been given the mandate for water supply and sanitation, there are financially and technically weak. They are not in a position to operate and maintain the water supply schemes in a proper manner. When compared to the GP, Self Help Groups (SHGs) and the Village Organizations (VOs) in the villages are active and financially strong.

Limited Capacity: There is limited technical capacity in the community and in PRIs to effectively take over and manage RWSS services, as there has been no role for them historically. The plans of GOAP to scale up demand-driven approaches in the state would require the support of substantial IEC activities at the village level to promote awareness and build capacities of people to handle RWSS facilities and inculcate a sense of ownership. The capacity of the community and users need to be substantially augmented so as to enable their effective participation in planning, design, implementation, monitoring & evaluation, financial management and O&M of the RWSS facilities.

In the Scheduled Areas roles of ITDA and VTDA need to be considered keeping in mind the Provisions of PESA Act.


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5 Approach for APRWSSP

5.1 Introduction

This study reveals that the sanitation condition in the state is below average (keeping in mind that even a small percentage of unhygienic conditions can affect the whole community) in terms of personal hygiene, household hygiene and community hygiene. The following general issues have emerged from the study. Literacy: The literacy rates are low in comparison with the national averages. It is pertinent to the project that the female literacy rate is lower than the national average. This will have a bearing on the IEC campaigns and women participation in the project bearing in mind that the women are the primary mangers of the water and sanitation at household level. Poverty: Poverty levels are quite high with nearly 90% possessing BPL cards. Those who have wetland constitute only. Most of the people from the sample households are laborers and agricultural laborers. This is an issue for ht project in terms of their capacity to contribute and pay for operation and maintenance. Communication: Usage of television, radio, mobile phones and land phones is quite high in the sample villages. These media can be made use of for IEC and BCC campaigns. The Following sanitation specific issues have emerged form the study: Waste Water: Wastewater generated by the households, including the wastewater from cattle sheds, flows into open surface drains leading to stagnation in the lanes and by-lanes. The presence of stagnant water in the villages is linked to the incidence of malaria and other vector-borne diseases. Due to a combination of poor environmental sanitation and poor personal hygiene, diahorreal diseases, cholera and typhoid cases have been commonly reported in the rural areas. Without adequate arrangements for treatment and disposal, the wastewater often seeps into hand pumps, open dug wells and pipelines, and the water quality of the village ponds has deteriorated leading to loss of productive uses and contamination of the shallow aquifer. Incidences have been reported of effluent overflowing from the septic tanks and finding its way to the village drains. Women Participation: Women participation is rather poor. It is predominantly women and children who are affected by the poor sanitary conditions in the household and community. Being the managers of water and sanitation at household level women participation is necessary for bringing in behaviour change. This is an issue where the project needs to make sure that female opinion is given adequate importance and their participation is ensured. Latrine Usage: Latrine usage is very low. While about 65% of the household do not have latrines, only 28% of those who are having are using them. Nearly 56% of the


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children are made to defecate inside or outside the house. This poses a serious threat to the health of the family and community. This is a matter of concern for the project to raise awareness levels to put the existing toilets to use and build for all. Community Sanitation: Community sanitation is just below average. With nearly 72% of the people throwing garbage in front of their house or on the road, sanitary conditions in the villages are poor. This requires Information Education and Communications campaigns and Behaviour Change Communication using local media local methods. Hygiene Behavior: Hygiene behaviour at personnel level is average. With nearly 22% of the people not bathing daily, this is a matter of concern for the project. Again this requires Information Education and Communications campaigns and Behaviour Change Communication using local media local methods.

5.2 Objectives of Sanitation and Hygiene Promotion This SHP aims at promoting such behavioral changes which would help prevent water and sanitation related morbidity. It largely relates to daily routines such as the collection and handling of water; relieving oneself; hand washing before eating and after defection, etc. Efforts at behavior change starts with an understanding of what diseases mean to people, what diseases they recognize and their perceptions about cause and prevention. Essentially, the project would create an enabling environment for the community, specially women, to start analyzing the sanitation situation and draw plans accordingly. As mentioned earlier, this SHP comprises three distinct elements: personal hygiene; household hygiene; community environmental sanitation. The objectives include,

enhancing awareness about the prevalence of water quality (specially, fluoride effects), its consequences and possible mitigatory measures

fostering understanding of relationship and complementarily between water, sanitation and health

increase awareness of the benefits of improved WS&S facilities and there by creating a demand for safe water and sanitation

Strengthening local capacities for a self-sustaining and gender sensitive sanitation and hygiene promotion program.

5.2.1 Project Focus

The project would focus on the following areas: safe disposal of human excreta safe handling of drinking water disposal of waste water; both sullage and storm water solid waste disposal


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The project would focus on three fronts; personal hygiene, household hygiene and community environmental sanitation. In order to complement hygiene behavioral changes, project would assist investing in the creation of following physical facilities

Household Soak Pits Household latrines Pavements and Drains Solid and Liquid Waste Management Under Ground Drainage

5.3 Strategy The proposed strategy commences with demand creation. The challenge therefore is to transit from the traditional supply driven mode to emphasis on demand creation, thereby ensuring higher degree of people’s participation. Several approaches can be adopted for this. Some of the key principles of the strategy are:

Ensuring political ownership Convergence of resources at the grass root level Commitment of all state level institutions Providing a choice of technology to suit the local situation Starting from the top to the bottom and up again Ensuring effective learning, monitoring and improvement Capacity strengthening.

Sanitation and Hygiene promotion as an all encompassing component should be all inclusive. It is very essential to anchor the approach in and around the local socio-cultural mores. The strategies should respect the individual priorities while motivating them towards the common good.

The traditional understanding of limiting Sanitation to only constructing ISLs, needs to be abandoned. Likewise hygiene education must move beyond the uni-focus of promoting hand washing- nail cutting or bathing. Strategically promoting sanitation as a way of life becomes imperative. The sanitation and hygiene promotion strategy requires adopting a holistic planned approach, wherein all the components required for the promotion of the concept is given equal weight age (like ISLs and drains and the IEC). It is essential to strategically spell out outputs against time frames and deliverables. Strategically prioritized planning is the first step to ensure achievement of end results.. Strategically it also becomes essential to address the issue of ownership. As revealed during the survey, often assets created in the community are not maintained due to various reasons. Institutions sharing responsibilities also add to the confusion as


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accountability and transparency become major issues. While the overall accountability can reside in one department, other departments need to be involved to ensure convergence. Strategically it is also important to review the IEC component. The IEC component, its delivery mechanism, and the various other channels of communication all need to be reviewed to asses the quality and the kind of messages that are being communicated to ensure a good communication strategy is planned for. The other Departments like the health Department, education department also through their extension staff address the issue of sanitation and hygiene education. While the need for a multi thronged approach is acknowledged there is apprehensions about the quality of inputs and outputs. Ex. RWSS/IEC messages and the MPHWS/ASHA messages. Strategically it is required for the entire Department/ personnel involved in hygiene promotion communicate the same kind of messages.

The need for Technology options for communities covering different topographical and sociological conditions has been a much debated issue over the years. Strategically this issue needs to be addressed in those Districts/regions where specific problems have been reported from. The SEs/Member Secretaries/DSUs should be encouraged to take a lead and the PMU/SWSM at the state level should facilitate the process. Flexibility in approach as a principle has always been part of the sanitation and hygiene program but efforts must be made to ensure program implementation also addresses these issues to strategically address the burning issue of technological choice. Sustained efforts by all the implementers with a common agenda are essential for motivating communities. Strategically the intervention should be based on the same principles but with situation specific inputs. Experiences elsewhere have established the fact that planned systematic follow up interventions over a given period of time have yielded positive results. It is essential to strategically also promote a level of functional coordination between the various line departments, local government institutions and the NGOs for integrating water supply, sanitation and hygiene promotion. This should be done at all the levels. At the State level a policy directive can be arrived at between the main agencies water supply, health, education and social welfare (both departments involved in programs for women and children and health education) for a coordinated vision to achieve ODF status for the state. The PMU/CCDU/SWSM could take the lead for a joint meeting and policy commitment with joint plan of actions. The second level of coordination could be at the District level. The DC/SE/ DSU could take the initiative of working out the district strategies and reframing the district plan of actions. At the ZP/Mandal level the ERDO/CEO/MWSC/Mandal Resource Person could take the lead to work out ZP/Mandal specific action plans. Finally at the GP level, the GP specific targets and action plans could be prepared and executed by the GP Sarpanch/Secretary/ MPHW/ASHA Volunteer/ AEE/NGO all working together as a team with specific NGO inputs planned for.


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Given the fact that sanitation and hygiene promotion are not yet a priority for the community, it is important to radically change the approach and reverse the process and make it top down with directives and outcomes specified. Like the CLTS approach, there is need for new approaches to be introduced to help wake communities from the hitherto complacent attitudes and approaches. A system of inbuilt accountability will ensure more responsive, responsible communities and achievable targets. The strategy essentially will be premised on using the CLTS approach, social marketing principles. This comprises of using the CLTS approach for achieving the overall objective of the SHP. The SWSM will arrange for training of master trainers in CLTS approach in each district. The SWSM will arrange for their refresher training as well as and when required. The social marketing principles will be used in developing and disseminating Information, Education and Communication (IEC) materials. The materials will be distinctly of two types: (i) inter personal, such as brochure, flip charts, manuals stickers etc. and (ii) mass media materials. The latter will be in three categories: folk program campaign, wall paintings/ posters, audio cassettes disseminated chiefly through radio, and audio/video spots/movies chiefly to be disseminated through television. Project will place a Hygiene Education Professional in each of the project districts, who will be guided by a state level Specialist. Responsibility for SHP at the village level will rest with SOs who will be trained appropriately for the purpose. Project also proposes to identify a female youth in each village and develop her as a Village Health and Hygiene Facilitator. While the state agency will design and duplicate IEC materials, responsibility for campaigning will be shared by the state and district agencies. SHP will be one of the modules under the Village Water Supply and Sanitation Plan to be prepared by the communities (with the help from SO). Planning for SHP at the village level will be through participatory healthy home surveys (employing PRA approaches). This essentially involves: Communities developing attributes of a 'healthy home' and 'healthy individual' Against this, map the existing situation, to arrive at a baseline information Identifying what practices put people at risk or illness Correspondingly prioritize SHP interventions Identify the sub-groups requiring intervention and make adjustments

accordingly Build on the community's existing perceptions that motivate change in behavior

rather than imposing external reasons.


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5.4 Implementation Arrangements

The following table depicts the role and responsibilities of the major sanitation players. Table 41: Institutional Arrangement for Implementation of Sanitation Component Level Institution Function Responsibility State State water

Sanitation Mission (SWSM)/ SPSU

Ensure overall implementation of the sanitation component in the projects

Arrange funds required for implementing the provisions of sanitation.

Ensure availability of required human resources for implementation of sanitation

Ensure that recommendations from supervision and monitoring are integrated into the project.

PD, SPSU supported SPSU

District District Water and Sanitation Mission (DWSM)/ DWSC

Training and Capacity Building of SOs and GPWSC on sanitation related issues.

Coordination between various players and actors involved in sanitation

Coordinate with other line departments on environment related issues; in particular with health and women and child welfare departments.

SE, DWSM supported by DPSU

DPSU Day-to-day management, responsible for undertaking all activities necessary for implementation of the sanitation,

Carry out regular monitoring and supervision of the sanitation implementation through appropriate mechanisms (and report the same to SWSM and DWSM as necessary).

Provide technical advice and guidance on sanitation to SO, GPs & GPWSCs;

Ensure capacity building of all stakeholders in sanitation

Design and implement IEC campaigns for sanitation

Maintain a database consisting of relevant baseline sanitation information of the district

Co-ordinate with institutions, agencies and individuals relating to sanitation

Collect, collate and publish data and

SE, DWSM, DPSU, DRPs


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Level Institution Function Responsibility information on sanitation implementation in the project

Mandal Mandal Water and Sanitation Committee

Monitoring of sector projects at the Mandal level

Coordination with NGOs for ensuring integration of sanitation in all relevant project activities including capacity development, communication, project management and supervision

Sensitizing the public representatives, officials and the general public about the provisions of the sanitation and need

Create demand for sanitation

Chairman, MWSM, DEE, RWSSD

Village GP Water and Sanitation Committee (GPWSC) with the support of Support Organization (SO)

Participation in preparation of Detailed Scheme Report (DSR) and integration of sanitation component.

Certifying the implementation of sanitation component as part of the implementation completion report

Facilitate IEC activities regarding water conservation, sanitation and hygiene among the villagers.

President, GPWSC, SO, AEE/ AE, RWSSD

Support Organization (SO)

Provide support to the AEE/EE RWSSD in preparing the sanitation component

Facilitating participation of the community in preparation DSR and in certification process for implementation completion report.

Liaison with health department, women and child welfare department, rural development department, and other related departments at scheme level for ensuring implementation of identified sanitation measures

Provide support in execution of the IEC activities

Directors of SO

Scheme Level Committee (SLC)

Participation in identification and preparation of sanitation component

Participation in certification process for implementation of sanitation component as part of implementation completion report

To make efforts for spreading awareness regarding sanitation and hygiene among the member villages of the MVSs.

President, GPWSC, SO, AEE/ AE, RWSSD


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5.5 Monitoring and Evaluation

Project will plan for a three-fold monitoring and evaluation:

Community based healthy home surveys. PHHS will be conducted in all the project villages five times during the scheme cycle. Results of each survey will be consolidated for the district and state level. While the community based monitoring may involve as many number of indicators as the community feels appropriate, aggregation will be done for a few, but critical parameters only. Process Monitoring. SHP will form a part of an overall process monitoring study, done batch-wise by an external agency. This will also assess the appropriateness and effectiveness of the IEC materials including communication messages. Health Impact Evaluation. The project will design and implement a systematic quantitative evaluation of health impacts of the overall project. Base line information being already generated, subsequent assessments will be made, during 3rd and 5th year, comparing both 'with and without' as well as 'before and after' situations. 5.6 Budget

This budget covers the cost of IEC and other support activities for implementation of sanitation and promotion of hygiene. Capacity building at the grassroots level is another component to ensure smooth implementation of sanitation and hygiene activities and also setting up an institutional system for long term beyond the project period. The cost of construction of sanitation is not included in this budget as it is included in the project cost. Capacity building costs are included in the capacity building budget. The overall budget is presented in the table below: Table 42: Budget for Sanitation and Hygiene Promotion of APRWSSP S.No. Particulars Quantity Rate in Rs. Amount

1 Village Health and Hygiene Facilitators 2843 500 1,421,500 2 Health Home Surveys 2843 10,000 28,430,000 3 IEC activities at habitation level 2843 5,000 14,215,000 4 Process Monitoring (3 regions twice each) 3 1,500,000 4,500,000 5 Health Impact Evaluation (as above) 3 2,000,000 6,000,000 6 Studies on Sanitation (as above) 3 1,000,000 3,000,000

Sub-Total 57,566,500 Contingencies 10% 5,756,650 TOTAL 63,323,150

Documents

Government of Andhra Pradesh Rural Water Supply and Sanitation Departmentaprwssp.ap.nic.in/worldbank/APRWSSP SHP FInal Report April 2009.pdf · Rural Water Supply and Sanitation Department