Lived experiences of sanitation and hygiene access

Highlights from the study:

• Universal access to and use of toilets has not yet been achieved, and people affected by poverty and marginalisation remain excluded;.
• Existing toilets need retrofitting and maintenance to become usable;
• Need to consider context specific adaptations for programming for tough physical conditions such as flooding and drought;
• Caste-based inequality is prevalent with major implications for access to sanitation and hygiene services; and
• Behaviour change programming remains relevant for these contexts.

In 2022, FINISH Mondial and the Sanitation Learning Hub (SLH) conducted a participatory and immersive research study to understand ground realities and lived experiences of sanitation and hygiene access in Nandurbar district, Maharashtra and Darbhanga district, Bihar in India.

The main objectives for the immersion were to identify challenges and barriers towards access to and use of sanitation and hygiene services within challenging contexts, capture community voices and find contextually rooted ways to identify enablers towards safe and equitable access to and use of sanitation and hygiene services in these areas; and inform FINISH programme design and support the development of human-centric strategies for improving access to sanitation hygiene services for marginalised and left-out communities, while strengthening gender equality and social inclusion (GESI).

Way forward

The authors have synthesised the findings from the thrust areas and suggest following recommendations to address the problems surrounding universal access to water, sanitation and hygiene (WASH) services in challenging contexts.

Social and behaviour change

• Bringing about change in behaviour and social norms is crucial to address and transform inequities in caste and gender norms, attitudes, beliefs, and lifestyles. Reinventing social and behaviour change communications is an area of immediate and urgent need. For instance, as health and economic benefits from toilet use take time to materialise, motivation to build and use a toilet could be linked with immediate gains such convenience, cleanliness, upward social mobility, and so on.

Contextual and local challenges such as socio-economic divides and prevalent attitudes and beliefs should be factored in the communication and sensitisation campaign. Recognising the diversity of social norms and cultures, contextualised messaging voiced by local leaders should be designed with a human-centric approach at micro levels. It is important to address these barriers while recognising intersecting issues beyond sanitation and hygiene.

• Awareness raising and behaviour change activities should make a deliberate attempt to include marginalised and left-out communities. Instead of village-level campaigns, discussions with women’s groups, youths, adolescents, farmer, and so on should be held at habitation level to establish rapport and trust.
• Social media platforms offer a strong medium to connect with youth and, through them, to push the WASH agenda. Led by local champions and youth, messaging can target not only issues about sanitation and hygiene but other emerging issues like climate, environment gender equality, and so on.
• Strengthening WASH services in institutions such as schools, anganwadis, and health care facilities is critical to complement sustainable behaviour change among households, and especially for children and adolescents. This could create pathways to change the behaviour of adults and elders.

Access, usage and sustainability of WASH facilities and services

• Toilets are still perceived as an expensive investment for construction and maintenance. Promoting low-cost improved sanitation with the use of local materials will improve the upkeep of toilets for poorer households. Such services should be provided by village-level entrepreneurs, with after-sales operations and maintenance services and easy financing options.

Simplifying toilet technology, with a focus on the substructure (below the ground), for both users and masons is important to promote sustainable toilets and to ensure safe management of human waste.

• Appropriate technologies that are flood resilient, suitable for rocky terrains, and all-weather accessible can be promoted through a market-based approach.
• Local entrepreneurs should be identified, trained, and supported to enable strong, market-based WASH services, including toilet construction and repair, hygiene services, water supply, operations and maintenance, and waste management.

Equity and inclusion

• Easy access to credit from nationalised banks, grassroot financial organisation, or microfinance will help bridge the credit need for investing in WASH services. Financial support from the government or corporate social responsibility (CSR) grants to support the poorest of the poor might still be needed.

WASH programming should also integrate gender equality interventions with a focus on adolescent boys and gender roles and norms. For example, menstrual hygiene management interventions should include boys and young men in the conversation.

• Non-availability or poor functionality of public/community toilets excludes a large section of economically and socially disadvantaged households from accessing and using toilet facilities. This can be enhanced with improved community participation and building a business model around operation and maintenance (O&M) of shared WASH facilities.

Solid and liquid waste management

• Solid and liquid waste management services should be addressed with low-cost solutions, designed in a participative manner with the community.
• Solid waste management services should be delivered by local entrepreneurs, which will enable a circular ecosystem while creating livelihoods. This will become more critical with the increasing impact of climate change.
• Learnings from existing examples of successful rural solid and liquid waste management can be adapted to meet local contexts.

Institutional set up and governance

Water is inherently linked with sanitation and hygiene, both in terms of availability and quality. Jal Jeevan Mission (JJM) provides an opportunity to strengthen these linkages. While a household tap water supply can improve water availability and hence toilet use, safe technology options should be marketed for their impact on groundwater quality during floods or in tough terrain. Village Water and Sanitation Committees or Water User Committees provide an opportunity to not only support JJM interventions but also work towards sustainability of sanitation and hygiene supported by non-governmental organisations (NGOs) and the government.

• While the government has developed comprehensive guidelines, they must be supported by clear rules, with participatory implementation and monitoring by local communities. Adherence and non-compliance must be rewarded and sanctioned respectively.
• Accredited Social Health Activist (ASHA) and Anganwadi Centre (AWC) workers should be leveraged to create awareness about safe menstrual hygiene management and menstrual waste disposal options.
• Panchayati Raj Institution (PRI) members should be trained on how to leverage other schemes and funds for WASH and Open Defecation Free (ODF)-sustainability.

Read the full report here

Citation: Sneha, S. and Sen, S. (2023) 'Immersive Research for Safer Sanitation in Bihar and Maharashtra, India', SLH Learning Paper 14, The Sanitation Learning Hub, Brighton: Institute of Development Studies, DOI: 10.19088/SLH.2023.009

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