Asia-Pacific Water Forum

WASH Campaign in Schools - a holistic approach for school sanitation and hygiene education in Kerala (India)

Dr.Roy Kunjappy
Executive Director
Centre for Community Health Research
Sadanathil bungalow, Vettikavala, Kottarakara, Kerala, India.
E-mail:roycchr@satyam.net.in

Introduction

Kerala is a narrow strip of land located at the southern tip of Indian sub-continent, situated between the Arabian sea and Western Ghats. The total area of the state is barely 38,863 sq. km with 580 km of coastline. Kerala State has the second highest density of population (727 persons per sq. km ) among all Indian States. In per capita income, it ranks as one of the poorest in India. The State is generally classified as backward in terms of its poor industrial development and faltering production of foodgrains.

The remarkable achievements of Kerala in the field of health in reducing mortality and fertility and improving life expectancy have attracted the attention of health experts and social scientists world over. The population has rapidly declining rate of growth, a advanced literacy and education, a slowly reducing mortality rate and a high degree of population mobility. Low birth and death rates along with higher female sex ration and higher female life expectancy in population of Kerala is a unique phenomenon in developing countries like India. But on the other hand, the levels of rate of morbidity and nutritional deficiencies present a different picture. The low mortality-high morbidity syndrome in Kerala's health situation has got serious implications.

The co-existence of the diseases of poverty with diseases of affluence is the picture characterising the morbidity profile of the State. The dominant disease group comprises diarrhoeal diseases, gastroenteritis, dysentery, cholera, infectious hepatitis, malaria, worm diseases, typhoid, polio, rotavirus infections, E-coli infections, japanese encephalitis, dengue fever, conjunctivitis, weils disease and skin ulcers were identified as the common water-borne and water-related diseases in the area. In addition to this, emerging trends of HIV/AIDS positive cases have been a major threat to the health sector of Kerala.

In 1991 a study was conducted by Kerala Pollution Control Board in association with the SEU on the bacteriological quality of dug wells in Kerala. It was observed that "water in none of the open dug wells investigated is of drinking water quality standards" as prescribed by Bureau of India Standard. Since Kerala is the only place in the world having highest density of open dug well (250 per sq.km) and 50% of population used this as the only source of water for drinking.

In this context, Centre for Community Health Research ( CCHR), Kerala in association with the Govt. of The Netherlands ( Director General for International Co-operation via CDS) conducted an in-depth investigation on the causes of drinking water contamination and its possible impact and implications on the health status of the people in Kerala. It was observed that all drinking water sources in the areas including open dug wells, tube wells, municipal piped water supply (KWA) and public and private small tap water supplies to be found not safe for drinking and reported highly contaminated due to high percentage of fecal and total coliforms. Non-sanitary latrines, dumping of domestic wastes, lack of drainage facilities, proximity of dug wells and water sources, water logging environment, open defecation, lapses in drinking water disinfection and source protection were found to be the main causes of large scale contamination of drinking water sources.

It was observed diarrhoea (33%), gastroenteritis (30%), worm diseases (23%), typhoid (8%), cholera (2%), polio (2%), amoebic dysentery (1%) were identified as the main water-borne and water-related diseases in the area.

Non-sanitary latrines and open defecation reported to be one of the reasons for high water-borne morbidity in Kerala. Calvert and Andersson (2000) observed that sanitation is very poor in the fishing villages along the cost of Kerala. Over 80% of the households have no latrines and at least 50% obtained water from communal wells. Open-air defecation is the norm and, combined with poor hygiene and the proximity of communal wells to private soakaways or pit latrines, results in the contamination of most wells with coliform bacteria.

The noted significance of the study was observed a "wide gap" in the awareness on safe drinking water, sanitation and hygiene promotion in the mindset of the people. Provision of safe and clean drinking water, decent sanitation facilities along with best hygiene practices will create a change in the attitude/behavior of the people. That will accelerate a reduction in the present morbidity pattern and to improve the quality of life of the people in the area to a great extent.

Centre for Community health Research (CCHR), Kerala along with other stakeholders of the WASH- India is being undertaking this programme in selected schools in Kerala State called "WASH Campaign in Schools - a holistic approach for school sanitation and hygiene education in Kerala (India)" for a better hygiene behavior and healthy environment in schools.

WASH Campaign -International, National and Local context: Globally,1099 millions people lack access to safe water while in India, 125 million people lack access to safe water. Globally, 2600 million people defecate in the open where as in India, 700 million people lack access to sanitation facilities & resort to defecate in the open. Diarrhoea claims the lives of 2 million children around the world every year while one million children in India die of diarrhoeal diseases each year directly as a result of drinking unsafe water and living in unhygienic conditions India is one among the developing countries facing serious drinking water problems. It was reported that a major freshwater crisis is gradually unfolding in India as a result of inadequate water management and environmental degradation by human action. The objective of the programme is to raise consciousness about sanitation and hygiene, gain the commitment of political, social and opinion leaders around the world and, ultimately, bring about the structural and behavioural changes that will provide a permanent solution to this preventable international crisis.

WASH Campaign in India: WSSCC-India Chapter and WaterAid-India have jointly designed and produced 9 posters in English for the WASH Campaign in India.

Following are few programme Modules of WASH in Schools:

(a) Sanitation - ways within our means: This illustrates various aspects of a "clean village" and a "unclean village". The clean village is depicted as the "heaven on the earth" whereas the unclean village as the "hell on the earth". In an unclean village, there is illustration of open defecation, water stagnation, waste accumulation, various sources of drinking water contamination in wells, ponds and other drinking water sources. While in a clean village, there is Water and Sanitation Committee (WASAN)/ Village Development Committee (VDC) for making decisions and for empowering the local communities. Further to depicts on sanitary latrines, compost pit, wastewater for kitchen garden, good hand pumps/ sanitary wells etc.

(b) Simple practices for a healthy life: This poster illustrates various means of hygiene promotion for a health life. Depiction of key hygiene behaviours include water handling, personal hygiene, safe disposal of human faeces, food hygiene, safe disposal of animal and solid waste, safe disposal of liquid waste and village sanitation. In water handling, pictures to explain the use of a safe water source for drinking water collection, keeping of water containers in home and the necessity of a ladle/tap/tilt to pour drinking water in order to avoid dipping hands in water. There are three pictures in personal hygiene to explain the benefit of hand washing. In safe disposal of human faeces, there are illustrations on sanitary latrine for defecation, disposal of child faeces and safe disposal of faeces if a latrine is yet to be built. Pictures on food hygiene depict keeping up of food in kitchen, cleaning of vegetables before cooking and how to cook pork meat etc. Illustrations on safe disposal of animal and solid wastes explained how to dispose animal waste away from a water body and a dwelling area, disposal of animal and other bio-degradable wastes in compost pit and safe disposal of non-degradable waste in the household environment. Safe disposal of liquid waste depicts how to raise a kitchen garden with wastewater from household, use of a soak pit to dispose wastewater and regular maintenance of drainage canal in order to ensure free flow of wastewater. There are three pictures to explain the various aspects of village sanitation, which include protection of water sources by avoiding open defecation and washing of animals near the source. Promotion of Village Committees, maintenance of village sanitation and regular cleaning are some of the main components of this section.

(c) The Facts and the Solutions: In this section, there is a comparison of Global and Indian scenario on safe drinking water, sanitation, hygiene and health. It was noted that globally, 1099 million people lack access to safe drinking water whereas in India it was 125 million. In terms of open defecation, 2403 million people in the world as a whole resort to open defecation while in India alone 700 million people lack access to sanitation facilities and defecate in the open. Diarrhoea claims the lives of 2 million children around the world every year but in India it was noted that 1 million children lose their lives to diarrhoea every year. Pictures to illustrate the solutions for the above said problems are safe drinking water, sanitary latrines and hand washing with soap.

(d) Timely Action Saves Lives - Treat Dehydration With ORS/SSS: Various pictures of this poster to explain how to prepare ORS and Sugar Salt Solution (SSS). Some of the very important points mentioned during the preparation ORS/SSS that before preparing ORS/SSS, hands, utensils and spoons should be washed by using any cleaning agent. The vessels containing the ORS/SSS should be covered and do not use the prepared ORS solution for more than 24 hours and SSS for more than 8 hours. Directions are given to those affected with diarrhoea should have a diet supplemented with fruit juice, butter milk, black tea with lemon, tender coconut water, rice or dhal porridge. Further, lactating mothers should continue to breast feed children affected with diarrhoea.

(e) Hand Washing -Washing away germs, preventing diseases: Hands are the body's feeders and cleaners and helping to eat and keep the bodies clean, including defecation. If hands do not wash at critical times, particularly after handling human faeces, fecal germs can be transmitted, leading to diarrhoeal diseases. There are pictures to depict what are the "Critical times" when hand washing should be practices. The pictures to explain the critical times mainly after disposing of child faeces, after defecation and anal cleaning, after washing children's bottoms, after agriculture work, after any cleaning activity, after children's play, before cooking serving food, before eating and before feeding children. Practicing hand washing can prevent diseases like diarrhoea, cholera, jaundice, typhoid, amoebiasis and skin diseases. Soap, ash, soap nut powder and soil can be used as cleaning agents for washing hands.

(f) Faecal - oral Transmission Route: Depictions on faecal-oral transmission route are faeces, flies/pet animals, fields, fluids (water), fingers and food. Illustrations are given to block the faecal-oral transmission route include using of toilet, proper hand washing, using safe water source and good handling practices, and adopting good food hygiene practices. Diarrhoea, dysentry, cholera, typhoid, polio, jaundice, gastroenteritis and intestinal worms are common diseases cause due to slight contact and transfer of germs from faeces.

(g) Kitchen Gardens: This session demonstrates uses of waste water from households and other sources for generating nutritious food. Pools of stagnant wastewater are the breeding grounds for mosquitoes that are the carries of many lives threatening diseases. Wastewater can be channeled to raise a kitchen garden where abundant nutritious vegetables and greens can be grown. Kitchen gardens can be raised near the sources of wastewater disposal. The ideal places include bathrooms, hand pumps, tap stands, sanitary wells etc. The benefits of kitchen gardens include the prevention of mosquito breeding, safe disposal of waste water, vegetables and greens add nutritious value to food by preventing malnutrition and promoting health, income can be generated from the sale of vegetables, vector-borne diseases like malaria and elephantiasis are prevented, and clean and green surroundings with better quality of life.

(h) Our Children are the future. Can we afford to exclude them: This is a message to the society and all stakeholders of the sector that children are the future and it is the responsibility to all to prevent the death of 2 million children every year due to water-borne diseases. Further to recall that it is the duty and responsibility of every body to provide access to water and sanitation facilities in all schools and enabling children to learn and practice their proper use and management. We can make a difference through education and awareness on the practice of hygiene behaviours to children and through them, to the community. Further, by making children active partners in all water and sanitation programmes at schools.

(i) Who is responsible? - "We" : Finally, the depiction on who is responsible for the pitiful situation on water, sanitation and health illustrates that nobody other than "we" are responsible to manage, maintain and operate the system. Capacity building by providing proper training will create an ideal situation for the problems.

Over all Objective:
* To provide better hygiene behavior and healthy environment in schools in order to improve the quality of life of the future generation.
* Though the programme is focussed in schools, the main stakeholders are school children, teachers and parents. In addition to that Water and Sanitation Committees (WATSAN), Local Panchayats (PRIs), Anganwadis (Mahilasamajams), ICDS, PHCs, CBOs, NGOs in the respective localities are the key players of WASH Campaign in schools since the WASH Campaign is a holistic approach for sustainability on safe drinking water, sanitation and hygiene promotion. Thus to ensure a healthy school environment and to support safe hygiene behavior to the future generation.
* Intensive awareness will be given to children on various aspects of safe and clean drinking water, water contamination, disease transmission, waste disposal, sanitary latrine, impact of open defecation and water-borne diseases, mosquito menace, hand washing, sanitary wells, hand pumps, ORS/SSS, Household Centred Environmental Sanitation (HCES), food hygiene and many.
* Conception and production of Information, Education and Communication (IEC) tools.
* Dissemination of knowledge at grass-root level is important for a change in the attitude of the people. So schools are the best place for a start.
* Schools are the ideal places of learning for children and they have a crucial role in the process of community development. Schools can be able to stimulate children for a behavior change. If there is adequate facilities on enough safe drinking water, sanitation and hygiene facilities in schools, children as well as teachers can act as role models of the society. This will definitely influence the communities for a better change in their attitude and approach.

Activities:

* Translate all the 9 WASH Posters of WSSCC- India Chapter in to the regional language (malayalam) for intensive campaign in schools.
* To design and produce a Handbook and a Resource book for schoolteachers for the safe use of drinking water, school sanitation and hygiene education. This provides practical guidance to safe use of drinking water, school sanitation and hygiene education practices.
* Awareness will be given to school children on water-borne diseases like cholera, amoebic dysentery, gastroenteritis, diarrohoeal diseases, typhoid, hepatitis, polio, viral infections, ascariasis and schistosomiasis. Further, intensive awareness will be provided to children on the causes and prevention on water-related diseases like malaria, filariasis, japanese encephalitis, dengue fever, yellow fever, trachoma, scabies, conjunctivitis, skin ulcers and allergy.
* Awareness camps, symposia, seminars, children congress, water quiz, competitions, rallies, will be conducted in all selected schools as part of WASH Campaign. Selected children will be sent to State and National level competitions and incentives will be given to those selected.
* To constitute "WASH school committees" and "Eco-clubs" with the co-operation and participation of pupils, teachers, parent-teachers association (PTA) and school directors.
* Parent-teachers associations (PTAs), school directors, panchayats (PRIs) and other local stakeholders will take the responsibilities for the construction of water supply and sanitary facilities in the respective schools. Further in association with the construction of water supply and sanitation facilities in schools with local stakeholder participation (Local self-governments (Panchayats),CBOs, NGOs, self-help groups and other grass-root organisations)
* Building the capacity of local stakeholders considered as one of the most important element for the successful implementation of the programme. Training modules on safe use of drinking water, decent sanitation and best hygiene practices will be provided to the stakeholders of the programme.
* Children's project/models based on safe drinking water, sanitation, hygiene promotion will be invited in children congress. Innovative projects will be selected for further studies.
* Try to implement environmental awareness/school sanitation/hygiene in school syllabus for a healthy school environment.
* Monitoring and evaluation of drinking water status, health status, sanitary status and hygiene behavior of children as well as the local communities through an epidemiological survey. Thus to understand the actual position of drinking water, health status, sanitary status, hygiene behavior of the children and the local communities in the respective areas.
* Evaluation on the impact of WASH Campaign in schools to be monitored periodically.
* Advocacy at local and State level will be an important component for a policy change at all levels. There will be strong liaison between government and stakeholders of the programme. Therefore, best practices and experiences will be replicated and propagate in other areas.
* Immunisation of children will be conducted against prevalent water-borne and water-related diseases.
* Simple disinfection methods of dug wells and available water for drinking will be demonstrated to children in order to reduce water-borne morbidity.
* Models for domestic solid waste disposal will be displayed in all schools as part of Household Centred Environmental Sanitation (HCES).
*Intense awareness will be given to mosquito eradication.
*Exhibition on models of sanitary latrines/sanitary wells/compost latrine/safety distance of dug well and water body will be conducted.
* During rainy season, medical camps will be conducted in rural and semi-urban schools as part of WASH Campaign in association with PHCs, CBOs, NGOs, Local Self-Governments (PRIs), civil organisations and other grass-root bodies in order to detect and prevent water-borne and water-related diseases.

Expected outcome of the project
* 90% improvement in the hygiene behavior of school children and 80% improvement in the sanitary and drinking water facilities, resulted a noticeable change in the quality of life of the future generation.
* Best practices and experiences will be replicated and propagate in other areas.
* It would be a model of dissemination of knowledge at grass-root for a behaviour change.
* Resource Book and WASH posters in malayalam (regional language) would be valuable materials for future programmes in other schools in the State of Kerala.
* Environmental awareness in the minds of the children will create a sense of responsibility for a healthy environment not only in schools but also in households and finally in the society as a whole.
* Building the capacity of all stakeholders may create a momentum in the society as a whole on safe drinking water, improved sanitation and hygiene behaviour.
* Advocacy at local level may lead to a policy change at the State and National level with strong stakeholder participation.
* Information utilization would be a good tool for further course of action. Web-site information on various activities will be able to use for future activities and follow-ups.
* A considerable reduction in the morbidity pattern would be noticed and this will lead to the improvement of the quality of life of the local people as part of the global target of Millennium Developmental Goals(MDG)

| by Dr.Roy Kunjappy | 03.24 2007 04:32 | url: |

Overexploitation of Groundwater in India by Multi National Companies: a violation of the basic human rights of the poor.



The International Year of freshwater in 2003 was celebrated world over in conjunction with the 3rd World water Forum in Kyoto, Japan. It was targeted for doubling the numbers of people with access to safe drinking water by 2015, to mitigate the droughts and flood situation, minimising the degradation of land and water resources, increasing the access to sanitation and water in order to improve human health and reduce infant and child mortality. But in India, there was no notable improvement recorded in the quantity and quality situation of drinking water. Two thirds of the earth’s surface is covered by water but 97.5 percent of this water is saline (oceans and sea) and not fit for drinking and other domestic purposes. Of the remaining 2.5 percent, only 0.5 percent is available for drinking and other domestic as freshwater sources found in rivers, lakes and as underground water. It was further noted that 40% of world’s population lives areas of acute water scarcity. UN Population Fund predicts that there will be acute of shortage of freshwater by 2050. About 3 billion people do not have adequate sanitation facilities, and 11,000 children die of water-related diseases every day. In India, one fifth of urban population and three quarters of rural population do not have access to safe drinking water unless there will be no integrated water management strategy.



It was estimated that 1,683 million cubic meters of water flow every year through Indian rivers. While our rivers are dying due to industrial pollution, accumulation of domestic sewage, agricultural runoff, pesticides, sand mining, extraction of water and irrigation etc. Our rivers flowing through the Metropolitan cities like Yamuna in Delhi, Hoogly in Calcatta and Cooum in Chennai are highly polluted and spreading diseases to millions. Water scarcity, pollution and stress are the creations of modern India. In 1951, there were less than 5,000 public tube wells and 10,000 diesel-powered motors and pumps. But today, there are 67,000 public tube wells and 13 to 14 million diesel-powered motors and pumps, increasing at a rate of one million every year. Regular monitoring of groundwater (1996-2003) along the Chennai coast shows an alarming doubling and tripling of salinity levels. Fluoride is contaminating drinking water all over India whereas there is arsenic contamination in the groundwater of West Bengal. The actual problem in India today is the extensive withdrawal of groundwater. The Deccan, Eastern and western parts of India are among the worst water-stressed areas of the world whereas the rest of the country follows close behind. Once water was in abundance in those parts of India- Kerala, West Bengal and Chirrapunje- have developed acute shortage of water due to deforestation, which results in the silting up of rivers, thereby reducing their water-holding capacity. When rains arrive or snows melt, the water spills over and floods adjoining areas, causing as great devastation as a drought.



The advanced technology on drilling and pumping methods have resulted in massive exploitation of ground water mainly for irrigation which is about 85% of the total withdrawal and approximately 15% for industrial and domestic purposes. The area under groundwater cultivation has increased from 6.5 million hectors in 1950-51 to about 40 million hectors in 2002-03. Owing to considerable advancement in agricultural and industrial development, it has resulted in increasing the demand of fresh water. The exploration of ground water to meet the increasing demand of rising population from 360 million in 1951 to over 1 billion at present is causing the imbalance between over-withdrawal of ground water and inadequate recharge. This has resulted in rapid lowering of water table in the region. Over withdrawal along the coastal belts has resulted in saline intrusion into the potable ground water aquifers. ( Ref: R.C. Panda, 2003, 3WWF, Kyoto).



The indiscriminate exploitation of groundwater has changed the hydro-geo-chemical environment of the aquifers and enhanced the toxic and chemical levels of water beyond the permissible limit, mainly fluoride, arsenic, TDS, nitrate etc. The direct health impact on these toxic chemicals in drinking water leading to the manifestation of various water-borne and water-related diseases (Source: Rajiv Gandhi Drinking water Mission, Government of India, 2003) . Government of India has reported that water-borne diseases have serious health implications due to high morbidity and mortality, and with potentiality of epidemics. Further, young children bear maximum of disease burden. India loses every year about 400000 children under 5 years of age mainly due to diarrhoea (GOI, 2003). Recently, a remarkable observation made by the Central Bureau of Health Intelligence, Government of India is that while the massive investment have been made by the Central and State Governments in India over the last 5 decade, morbidity and mortality due to water borne and water related diseases have not declined proportionately to the extent of increase in the availability of potable water supply.
Water is nature’s free gift to life on earth. It has become a marketable commodity, with extensive withdrawal controlled by unauthorized agencies, and multinationals licensed by the local governments, selling us our own water in bottles. (Ref: New India Express daily, November 2003).



A classical example of this situation was found in Palakad district of Kerala. Hindustan Coca-Cola Beverages Company in Plachimada in Palakad district was established in 2000 March in 14 hectares of mostly multi-cropped agricultural land, barely 2 km from the river Chitturpuzha and in the vicinity of a number of reservoirs and irrigation canals. Within two years of its inauguration, protests became commonplace in front of the unit, as several places in the neighbourhood, including 10 colonies of Dalit and tribal people, began to experience acute water scarcity (Frontline, June 20, 2003). Local people started complaining about the quality of the water in the areas surrounding the plant, and in August 2003 a BBC Radio 4 inquiry found the company guilty of distributing from its unit sludge containing dangerously high levels of the toxic substances.

| by Dr.Roy Kunjappy | 02.16 2007 07:11 | url: |

The followup initiative through weblog is good initiative. Each can participate and put his observation, experience and input online. Great!

| by Kashinath Vajpai | 01.19 2007 03:13 | url: |

Haritika is working in bundelkhand region of madhya pradesh and UP and mainly working on water conservation in semi arid area converting unirrigated land in to irrigated land about 25000 acre then providing better quality seed.

| by Avani Mohan singh | 01.18 2007 12:13 | url: |