Memorandum submitted by Nepal Water for
Health (NEWAH)
GENDER ASPECTS
OF WSS ISSUES
Summary
The way water and sanitation projects are planned,
designed, implemented and managed in Nepal has a huge impact on
women and the poor. Though the primary users of water services
women are often excluded from any sort of decision-making about
and access to the benefits provided by a project. The neglect
of the concerns of the poor and socially excluded groups further
marginalizes them. Water and sanitation, however, are directly
linked to improvements in the lives of women. In order to provide
more equitable and sustainable services, new approaches need to
address gender issues and the concerns of the poor. Such approaches
also help reduce poverty and create social harmony and thus pave
the way for a peaceful society.
Introduction
1. Nepal Water for Health (NEWAH) is a national-level,
non-governmental organisation committed to improving the lives
of rural Nepalis through the provision of clean drinking water,
health education and sanitation services. Over the years, issues
related to social inclusion and equity have become integral parts
of NEWAH and its programmes are promoted through its Gender and
Poverty Sensitive Approach (GAP) (www.newah.org.np). NEWAH is
keen to use this opportunity to contribute to the Committee's
inquiry into the gender aspects of water and sanitation.
2. 82% of the population in Nepal has access
to clean drinking water. At just 39%, access to proper latrines
falls much behind (Nepal Living Standard Survey Volume 1, 2004).
Nepal's Tenth Plan (2002-07) aims to provide 85% of the population
with access to water supply and 50% with sanitation services.
The target spelled out in the Rural Water Supply and Sanitation
National Policy 2004—to achieve universal coverage in water
supply and sanitation by 2017 is challenging. The variations in
data on the sector raise questions about their reliability, but
whichever data are used, sanitation coverage lags far behind that
of drinking water. Hygienic behaviour, particularly that associated
with defecation and hand washing, is poor in many parts of the
country. Especially for women, children, the poor and socially
excluded groups, poor sanitation and hygiene compromise the health
benefits that can be attained from access to improved drinking
water.
3. Women and children are the primary water
collectors for their families, spending two to four hours a day
on this task. Since much water is collected from unsafe sources
and used, approximately 15,000 children die every year before
they reach their fifth birthday (UNICEF 2004). The excessive workload
and drudgery associated with water collection has an adverse impact
on women's health. In Nepal, the maternal mortality rate is 539
per 100,000 women aged 15 to 49 years. This rate is one of the
highest in the world (UNDP 2004:54). Poor understanding of the
dangers of open defecation and other unhealthy practices exacerbates
the health risks which face any population. In addition, the loss
of productive capacity and expenditure on medicines significantly
depletes household assets. The harassment and suffering that women
and young girls face while collecting water from great distances
and while meeting nature's call at night are largely unaccounted
for. Access to safe drinking water and sanitation is necessary
if their health status is to improve. The provision of income-generating
opportunities for poverty reduction is also essential.
4. During the 1990s NEWAH supported communities
in implementing integrated drinking water, hygiene education and
sanitation projects through a demand-driven approach. While this
approach did help bring services closer to communities, it left
many critical issues unaddressed. The approach unwittingly seemed
to reinforce the deep-rooted practices of exclusion by and domination
of the local elite and so-called high caste males over all aspects
of projects. Since poverty and gender issues were considered peripheral,
women and even poor men were often excluded from any form of decision-making
and from opportunities created by projects. This discrepancy,
in turn, led to unequal access to safe drinking water between
the better off and the poorest socio-economic groups and contributed
both to the lack of sustainability of the projects and to social
disharmony.
NEWAH'S GENDER
AND POVERTY
APPROACH (GAP)
5. In response to these issues, in 1999
NEWAH began developing a GAP strategy based on the understanding
that gender, caste inequity and poverty issues must be addressed
to achieve more equitable and sustainable outcomes. Equitable
access to a sustainable drinking water supply and improved sanitation
is fundamental to the Millennium Development Goals (MDGs) concerning
water and sanitation and the elimination of poverty. An intense
process was pursued to reach a common understanding of gender
and poverty issues amongst all staff members and to internalise
the concepts at the organisational level. DFID and WaterAid provided
financial support to begin the approach.
6. To support the process number of changes
and adjustments were implemented within the organisation. Various
levels of trainings and workshops were organised for senior-level
managers, division heads and staff who were directly involved
in programme implementation. A GAP Unit was formed in 2000 and
staff were selected as in-house gender facilitators to carry forward
GAP-sensitive programming at NEWAH's headquarters and in its regional
offices. The personnel policy of the organisation and programme
implementation policies and procedures were reviewed and revised
to conform to this approach.
7. The specific objectives of the GAP approach
are as follows:
— Increase access to water supply
and sanitation services for the poor and for other socially excluded
groups.
— Increase access to health and
hygiene education for women, men and out-of-school girls and boys.
— Promote greater gender equity
and increase the participation of women, the poor and disadvantaged
groups in project design, implementation and operation.
8. NEWAH's Gender and Poverty strategy aims
to ensure that benefits obtained through improved water supply
and hygiene practices are sustainable and reach women and the
poorest. By institutionalising such a process, the programme aimed
to improve the social status, self-confidence of these groups
and to promote their participation in decision-making processes.
Specific interventions at the project level include the following:
— Providing gender awareness training
to local partners (NGOs/Community Based Organisations) and communities.
— Building the confidence of women
and of poor men to participate in projects.
— Conducting well-being ranking
of households to identify poor members of communities.
— Introducing a graded rate system
of operation and maintenance (O&M) payments according to socio-economic
group.
— Providing technical training
to women and poor men.
— Paying half wages to the poorest
for their unskilled labour contribution.
— Giving priority for project-paid
jobs to women and poor men.
— Creating gender-balanced community
water and sanitation user committees (WSUCs).
— Providing health, hygiene and
sanitation education to men as well as women.
— Providing health, hygiene and
sanitation education to in-school and out-of-school children.
— Introducing a flexible policy
for the number of households per water point in cases of social
exclusion.
— Consulting women about the location
of water points and design modifications to meet practical needs.
— Constructing children's and
gender-friendly school latrines.
— Providing free latrine components
to the poorest households.
— Providing technical training
on kitchen gardening.
— Introducing gender-sensitive
savings and credit organisation to mobilise the O&M fund for
economic activities at the community level.
The piloting of GAP Projects: An Assessment and
Findings
9. From 2000 to 2002 five GAP pilot projects—three
gravity flow systems in the hills and two shallow tube wells in
the Tarai (the southern plains)—were piloted in each of
the five development regions of Nepal to address existing inequities,
promote gender equality and social justice and provide livelihood
opportunities.
10. In 2003 the GAP pilot projects were
assessed using the NEWAH Participatory Assessment (NPA)[45]
methodology to evaluate whether and to what extent the approach
was successful in achieving its objectives. Ten non-GAP projects
(regular NEWAH projects) were also assessed to serve as a point
of comparison. The assessments were conducted in June 2003, one
year after the pilot projects were completed.
11. The findings showed that the GAP pilot
projects worked better than the non-GAP projects in various aspects.
The GAP pilot projects provided more equitable access to water
and sanitation for women, poor and disadvantaged groups because
they used Participatory Rural Appraisal (PRA) tools, adopted a
flexible water point policy, involved women in the design and
location of water supply points, and provided free latrine components
to the poorest. The poorest and women had opportunities to earn
additional income during the project through availability of more
water and through livelihood-supporting activities. Access to
hygiene education by men and out-of-school children was enhanced
and transformations in gender roles identified (eg women filled
decision-making and technical positions and men helped with household
chores). The increase in girl's attendance in schools has remarkably
contributed to overcome the gender gap in education. The findings
successfully demonstrated that gender, poverty and social exclusion
issues can be dealt with through the right kind of interventions
and that these interventions lead to improvements in domestic
and community gender relations and to enhanced social status,
greater self-confidence and improved well-being for women and
the poor.
Key Issues and Lessons Learned
12. The key lessons learned from the assessment
of the GAP approach have helped improve NEWAH's GAP strategy.
In turn, the strategy has helped establish direction and vision
for long-term planning. The approach has also helped NEWAH as
an organisation to make a commitment to GAP. The key lessons learned
are as follows.
— Disaggregating of data:
Disaggregating data by gender, socio-economic group and caste/ethnicity
can help to identify to what extent women, the poor and socially
excluded groups are being reached and benefited.
— Innovative approaches for
health and hygiene promotion: The GAP activities that have
been successful include targeting out-of-school children for health
and hygiene education, employing children as key agents of change
in the promotion of good hygiene, training male community health
workers (traditionally a women's role) to foster change in men's
attitudes where female community health workers cannot make headway,
providing refresher health education sessions during project implementation
to ensure sustained hygienic practices, and providing bathing
units to ensure privacy while promoting good hygiene.
— Special support to improve
latrine coverage: While the provision of free latrine components
to the poorest households was found to be a positive intervention
overall, some of the most destitute households could not afford
the superstructure and did not benefit. These poorest households,
disadvantaged groups such as poor female-headed households, the
aged and the physically handicapped and their households should
receive priority and be provided with subsidies or suitable and
affordable alternatives.
— Monitoring the sustainability
of the intervention: Monitoring is both crucial and challenging.
It must be viewed as an essential component of projects. Future
projects should be designed with greater emphasis on social inclusion
so that women, the poor, the disadvantaged, and the physically
handicapped are not deprived of the benefits of water, health
education and sanitation services.
GAP Mainstreaming and New Developments
13. In 2005 NEWAH began mainstreaming the
GAP approach in all its projects. Each year about 80 drinking
water supply, health education and sanitation projects are implemented
through NEWAH's five regional offices situated in each of the
five development regions of Nepal. The GAP approach has been mainstreamed
in all projects and at the organisational level.
14. Detailed and summary reports and two
leaflets on the GAP approach have been produced for dissemination
and posters and a GAP training manual have also been developed.
The GAP findings have been shared time and again in various international
and regional forums like the 28th and 30th WEDC conferences and
the 2003 South Asian Conference on Sanitation (SACOSAN) in Dhaka.
These findings have also been disseminated within Nepal at the
national level through national-regional and district-level seminars.
The NEWAH GAP learning were also an invaluable input to the ADB-funded
Community-Based Water Supply and Sanitation Project Preparation
Technical Assistance (PPTA) to Nepal in 2003. In addition, NEWAH
was actively involved in advocating and influencing the government
sector during the preparation of the National Rural Water Supply
and Sanitation Policies and Strategies (2004); as a result, the
learning, areas of reflection and issues of the NEWAH GAP approach
have been successfully incorporated into these documents.
15. The GAP approach is sensitive towards
the gender and social inclusion aspects of NEWAH staff pertaining
to leaves, travel, transfer, promotion and recruitment. Mothers
with small children are also given special consideration. Other
developments include the preparation of a disability-sensitive
policy, the review and revision of personnel and programme implementation
policies from a livelihood and social inclusion perspective, and
training and orientation for new and old staff on gender and social
inclusion.
16. A second NPA evaluation (NPA II) of
six projects (four hill and two Tarai pilot projects from the
fiscal year 2003/04) was conducted in March 2006. The objectives
of the evaluation were more or less the same as those of the first
NPA. The overall evaluation showed positive changes in water,
health education and sanitation from gender, poverty and sustainability
perspectives.
A glimpse into the impact of the GAP approach
in NEWAH programmes
17. Man Bahadur Bhujel, a male community
worker in the village of Phaperthum initially felt a little odd
since there was no tradition of men participating in health issues.
Health had always been the responsibility of women. After attending
NEWAH training, however, he learnt about many health issues. He
convinced men to participate in health education activities conducted
at the local settlements and the participants found the activities
useful in their daily lives. All the men who received health education
training put what they learnt into practice. Man Bahadur reported
that since the men in the community have started receiving health
education they have become aware of its importance and no longer
need convincing from their wives.
Source: NPA Evaluation, June 2003
18. Tola Budha, a woman from Simratipokhari
GAP pilot project, participated in the construction of a water
supply project by transporting the pipe and cement, digging the
pipeline and collecting local construction materials. As a member
of a poor household, she received 50% of the going wage for labour
and received the components for latrine construction for free.
With the wages she earned she was able to buy and raise goats.
She feels that the GAP approach of providing half wages to the
poorest households for their unskilled labour contribution was
beneficial. It allowed poor women and men to actively participate
in project activities without being disadvantaged. The provision
has indirectly helped provide livelihood opportunities.
Source: Interview with Tola Budha, NPA evaluation,
June 2003
20. Women played an active role in a campaign
to build a latrine for every household in Karkidanda, Bhumisthan
in Dhading District as part of the Community Led Total Sanitation
project facilitated by NEWAH. Most Karkidanda men commute to the
nearby town of Simle for work daily. Those without work do not
stay at home either. "Without the help of women, this campaign
would have crashed midway," says Mangal Das Duwal, a senior
technician involved in the project. Although Sunkeshari, a local
woman, made a living from sewing, she did unskilled work so that
with the wages it fetched she could buy a sack of cement, a ceramic
pan and three kilos of iron rods. Her latrine was built at a cost
of NRs 2,500, a price which included the costs of construction,
the materials and wages. She is happy that she is using a latrine
and feels that her social standing has improved.
Source: Toilets change lives of women, Sancharika
Lekhmala, October 2004
21. While mixing cement, gravel and sand,
45-year-old Raxi Devi Chaudhary of Siswani, Siraha District sighs,
wipes the sweat from her forehead and says, "Now I am going
to get back my land." She challenged the traditional purdah
(women behind the curtain) system in the Tarai and participated
in gender awareness training under the drinking water, health
education and sanitation project supported by NEWAH. The well-being
ranking done during the project's preparatory phase showed that
she belonged to the category of ultra-poor households. Benefiting
from the GAP policy of providing paid job opportunities to women
from poor, ethnic and dalit (so-called untouchable) groups,
she volunteered to work as a mason. She feels the project has
been successful in introducing an equal wage system to her community.
Earlier there was a discrepancy between the rates for men and
those for women. "I earn as much as my male counterparts
(NRs 155 a day) in this programme," she declares. She aspires
to retrieve her land by paying back the loan she took and to use
her income to send her son to school.
Source: A woman's courage in saving her land
from being lost, NEWAH ERO, 2005
22. There was no end to Thulimaya's ecstasy
to see water flow out of the new tap. Just a day before, she had
got drenched while washing her clothes and utensils at an open
pipe. Twelve years ago, she accidentally fell on her way to cut
grass and was paralysed from her waist down. Her husband threw
her out of the house and remarried. Prior to the implementation
of the Tangmang drinking water, health education and sanitation
project in Ghairing, Parbat District, with NEWAH's support, Thulimaya
Pun was unable to go and fetch water. Personal hygiene was a major
problem for her. She says, "Earlier while working I sometimes
had to change twice a day after getting wet; now, since this tap
has been installed, I am very relieved. I needed this type of
tap." She had expressed concern to NEWAH's technician about
the problems using regular taps posed for people with physical
disabilities. Taking her concern into consideration, a tap was
placed at a lower level where she could reach it.
Source: Annual Report July 2004-June 2005
23. Karan Singh Saud of Purnagiri community
of Chandani is busy in his factory, which produces latrine rings
and slabs. Earlier he used to migrate looking for jobs. It was
difficult for him to support his family of seven. Karan Singh
and four other people were trained as sanitation masons when the
project was implemented. Karan opened up a factory to produce
latrine materials by practicing his newly acquired skills. At
present he employs four masons from the community in his factory.
Karan Singh says, "After NEWAH provided health and hygiene
education, community members began understanding the importance
of latrines and began constructing toilets. The set of formwork
(to produce rings and slabs) provided by NEWAH worked as stimulus.
My enterprise is profitable since sanitation projects were initiated
in neighbouring communities." Open defecation was a widespread
and common practice in the community. Now things have changed.
Source: Karan Singh's contribution for promotion
of sanitation, Paani Ra Sarsafai Newsletter, February 2006
RECOMMENDATIONS
24. Based on the successes of the GAP approach
of NEWAH, we urge the International Development Select Committee
to take action in the following areas:
— Replicate the GAP approach,
adapted to meet specific needs, in all DFID-funded water and sanitation
programmes at the country, region and global levels.
— Designate a water and sanitation
expert trained in gender issues as a water and sanitation focal
person in each country to enhance the DFID's advisory role.
— Enable programmes to scale up
water and sanitation projects based on their expertise in the
GAP approach.
— Apply the GAP approach to other
DFID natural resource management projects to minimise potential
conflict due to unequal access to and distribution of resources.
October 2006
45 NEWAH Participatory Assessment (NPA) is a modification
of the Methodology of Participatory Assessment (MPA) developed
by IRC and UNDP/World Bank Water and Sanitation project to suit
NEWAH's requirements and the context of Nepal. It addresses not
only gender but also caste, ethnicity and poverty issues and enables
community men and women to relate their individual experiences. Back
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