Memorandum submitted by Gram Vikas, India
IMPROVING HEALTH AND EDUCATION THROUGH WATER
AND SANITATION INTERVENTIONS
EXECUTIVE SUMMARY
The water target set in relation to environmental
sustainability, as part of the Millennium Development Goals formulated
in 2000, seeks "to halve, by 2015, the proportion of people
without sustainable access to safe drinking water."[169]
The World Summit on Sustainable Development, 2002, adds an additional
sanitation target—to halve by the year 2015, the proportion
of people who do not have access to basic sanitation.
Water and sanitation can clearly be identified
as priority sectors for social interventionist strategies in a
developing country context; the same holds for the sectors of
health and education. At the same time, it is quite evident that
the linkages between water, sanitation, health and education act
as important factors that determine the scope of interventionist
strategies in water and sanitation. Therefore, it is necessary
to view these interventions not as isolated areas of endeavour
but as constituent elements of an integrated development paradigm,
as linked in their external impact as the sectors themselves are
linked in their internal logic.
What follows is a brief exposition on these
linkages, against the backdrop of Gram Vikas' work under MANTRA
(Movement and Action Network for Transformation of Rural Areas),
our interventionist framework that attempts to position itself
at these critical points of cross-sectoral intersection between
water, sanitation, health and education.
ABOUT THE
ORGANISATION
Gram Vikas is a rural development organisation
working at the grassroots to enable poor and marginalized communities
in Orissa achieve a dignified quality of life, through social
interventionist measures that are sustainable, socially inclusive
and gender equitable. Started as a society in 1979, it has now
expanded to serve a population of 36,495 households in 559 villages
across 17 districts of Orissa.[170]
Simultaneously, it also partners with other NGOs in Orissa and
other states of India.
Gram Vikas' overall approach, built around the
concept of integrated habitat development, is termed MANTRA (Movement
and Action Network for Transformation of Rural Areas). A field
study conducted by Gram Vikas in 1991-92 found that over 94% of
households in rural Orissa in India do not have access to protected
water, and less than 1% have sanitation facilities. Water and
sanitation is therefore MANTRA's strategic entry point; under
our integrated habitat development model, initial interventions
in water and sanitation then broaden out into initiatives in health
and education.
WATER, SANITATION,
HEALTH AND
EDUCATION: A CROSS-SECTORAL
PERSPECTIVE
1. Around 1.2 billion people in the world
do not have access to safe water, while 2.6 billion lack access
to basic sanitation facilities.[171]
2. Inferior quality of water and sanitation
infrastructures and availability is a clear precursor of poor
health. According to a study on rural morbidity and mortality
conducted by Gram Vikas, 80% of diseases can be traced directly
back to contaminated water.[172]
A range of diseases are contracted in this manner, from cholera,
dengue and diarrhoea, to infections of the skin, to stomach disorders,
to other ailments such as malaria that are also associated with
unhygienic sanitary conditions
3. Besides the actual diseases, a not-so-apparent
but far more insidious impact of poor water and sanitation is
a general lowering of body immunity, which negatively affects
the efficient exercise of even routine functions. This in turn
can be linked to physical weakness and lethargy, high rates of
absenteeism from work, and psychological ailments such as depression.
4. Women, children and the old are even
more adversely affected. Differential sex-role socialization and
the subsequent allocation of tasks puts the entire burden and
drudgery of fetching water on women; this added, to the already
higher risks faced by rural women due to under-nutrition as well
as vulnerability to diseases such as reproductive ailments, results
in an even higher correlation between water, sanitation and women's
health. Children as well as the old, on account of their weaker
immune systems, are similarly disadvantaged.
5. These linkages also extend to the area
of education. Poor rural families operate under great financial
constraints. As a consequence, the immediate impact of a large
chunk of family revenue being diverted towards health expenditures
is that there are lesser funds available for children's education,
which in any case is seen as a luxury by these families for whom
affording even two square meals a day is a daily challenge. Also,
ill-health arising as a consequence of poor water and sanitation
adversely impacts education in multiple ways—by increasing
absenteeism on account of recurrent illness, by reducing the attention
span of students and making them lethargic, and by sapping their
essential vitality, thus making them passive recipients of, rather
than active contributors to, their own education.
WATER, SANITATION,
HEALTH, AND
EDUCATION: DFID'S
DIRECTION
6. Water and sanitation have long been among
DFID's priority areas. DFID's 2004 Action Plan stressed on the
centrality of clean water and sanitation as a core theme in discussions
with developing country governments.[173]
The Plan also highlighted the need to support international partnerships
that can improve coordination in water and sanitation; DFID' involvement
with the World Bank and the European Commission, NGO's such as
Water Aid, and partnerships such as the Global Water Partnership
can be seen in this light.
7. At the same time, the 2004 Plan stresses
on the need to provide evidence that improved water and sanitation
impacts positively on all aspects of life. Two such important
aspects are health and education.
8. In education, DFID provides bilateral
support to programmes in over 30 developing countries around the
world, to help them meet the education MDG's in a coordinated
manner. Particular countries targeted include India, with its
high number of out-of-school children, and programmes supported
in India include those such as the Sarva Shiksha Abhiyan (SSA)
that aims at providing basic education to all children of school-going
age.[174]
9. In health, DFID's Health Strategy
2006 recognizes the need for new collaborations between the international
community, national governments and civil society, in light of
the fact that poor countries share a disproportionate burden of
avoidable ill health, death and disability.[175]
10. Clearly, there is recognition of
the linkages between water, sanitation, health and education.
This is true not only of donor bodies such as DFID, but also other
international organizations, national governments, and civil society.
However, this recognition does not necessarily translate into
clear policy directives aimed at formulating an integrated approach
to development.
USING WATER
AND SANITATION
TO IMPROVE
HEALTH AND
EDUCATION: RECOMMENDATIONS
FOR ACTION
International Level
11. Though contemporary trends signal an
increasing awareness of the integrated nature of development,
efforts need to be stepped up to formulate a clear, coordinated
policy advocating `total development' models.[176]
International organizations need to accord greatest
importance to grassroots, bottom-up initiatives, where the efforts
of NGO's and CBO's are directed towards facilitating interventions
whose demands are articulated by the populations they intend to
serve. In the long run, such a process contributes to empowerment
in greater measure than might models of top-down dictated growth.[177]
12. Agencies such as DFID therefore have
a substantial role to play in nudging donor trends towards an
appreciation of local-led initiatives that use water and sanitation
interventions innovatively, to impact upon health and education
in a contextual, need-based manner, and of international partnerships
promoting country and region-specific research.
13. The most important role of international
agencies and organizations is therefore that of a facilitator
that makes available to grassroots initiatives the specialist
knowledge, technical expertise and proven innovations that are
not so easily accessed in micro-settings.[178]
National and Local Level
14. These levels are responsible for feeding
in field information into higher levels of policy, which in turn
can formulate general frameworks to be adapted to local settings.
The actual implementation, therefore, is most effective at this
level. For instance, water and sanitation impacts differently
on education and health in different settings. For instance, in
rural India, improved water and sanitation stands to impact the
education of girls more favourably than that of boys.[179]
15. Given the knowledge of local situations
that is possessed by this level, the scope for innovations is
greatest here. Need-based programmes and interventionist strategies
can be designed on the basis of actual data from the field, the
examples of which can be numerous.
MANTRA, for instance, facilitates village-led
programmes for building water and sanitation infrastructure in
villages, which then becomes the entry point for further activities
in heath and education. Some of these activities include the opening
of Primary Health Centres, the training of village health workers
and running of health camps, and opening of residential schools
for disadvantaged—tribal as well as non-tribal poor children.
October 2006
169 http://www.un.org/millenniumgoals/ Back
170
Annual Report 2005-06, Gram Vikas, Mohuda, p 6. Back
171
http://www.dfid.gov.uk/pubs/files/update-water-sanitation.pdf Back
172
Gram Vikas, p 9. Back
173
http://www.dfid.gov.uk/pubs/files/update-water-sanitation.pdf Back
174
http://www.dfid.gov.uk/mdg/educationfactsheet.asp Back
175
http://www.dfid.gov.uk/consultations/healthstrategy.pdf Back
176
In the context of overall village backwardness, Gram Vikas'
MANTRA model, aimed at an integrated habitat development with
water and sanitation as its entry point, may be more effective
than insulated sectoral interventions in water and sanitation
alone. Back
177
In the context of water and sanitation, one example could be
Gram Vikas' MANTRA model, whose interventions are strictly based
on a 100% demand of services from each family of the village,
and an acceptance of the responsibilities, such as cost-sharing,
that such a demand entails. Even if one family remains unconvinced,
Gram Vikas does not intervene on principle till a unanimous decision
is passed at the village level. This often leads to interesting
developments in villages, and the process of democratic consensus-building
that can be witnessed in a milieu that is otherwise fragmented
by caste, class and gender cleavages, is a miracle in its own
right. Back
178
Examples of such knowledge and expertise can be numerous. For
instance, innovations that are made in agriculture, renewable
energy, water supply, sanitation, transport, housing etc. Back
179
This is because of the particular cultural context, where women
are responsible for the collection and management of water for
their households. Back
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