Peoples Perspective on Sanitation: Pakistan Paper By Qutub, S.A. and S.A.A.Salman Introduction The South Asian Conference on Sanitation (SACOSAN) is being held in Sri Lanka in April 2011. WaterAid, Water Supply and Sanitation Collaborative Council (WSSCC) and FANSA have formed a coalition to jointly engage with the SACOSAN process in South Asia. The main objective is to provide a civil society platform for bringing the voice of affected communities and people working at the grass roots to the official SACOSAN forum. The coalition has conducted studies in five countries on the peoples perspective on sanitation as per a common guiding note for a semi-structured interview. This report brings together interviews conducted in Pakistan, assesses the common factors in peoples perceptions, and highlights the emerging issues for sustainable sanitation. The semi-structured questionnaire was translated into Urdu for application at the grass roots level in Pakistan. The interviews for the case studies were conducted by field units of NGOs working in the WATSAN sector. The information collected covers selected urban and rural areas of Punjab and Sindh, the two larger provinces of Pakistan, with due consideration to obtaining the views of both men and women, and persons belonging to majority and minority communities. A total of 39 completed interviews were returned in time for this paper. They were sorted for respondent (gender, majority or minority community), type of settlement (urban or rural), and category of intervention (successful, unsuccessful or none). This paper is based mainly on the 15 case studies that provide relatively more elaborate responses and observations, and which together cover a range of situations. This paper is limited in several respects. The questionnaire was sent to organizations that volunteered for the survey in all provinces and Federal territories, but responses were received in time from only five districts representing two provinces. It is a major lacuna in the context of the diverse culture and sanitation practices in the provinces and territories of Pakistan. Disabled or differently-able persons have yet to be interviewed. So the present version of the paper also lacks the perspectives of the estimated 2.5% of national population that is disabled or differently-able, such as the blind and lame, many of whom have special needs for convenient and dignified defecation, such as hand-holds and other toilet accessories. The paper is presented as a pioneering attempt at collating the voices of people on sanitation, and projecting sanitation issues as seen by diverse individuals and communities to policy making audiences. It could be particularly relevant in an era of limited Government resources, and after the failure of decades of supply-driven latrine and sewerage construction. 1
Case Studies This is a study of peoples perceptions. So what they recall about the history of sanitary interventions in their village or town and understand about its success or otherwise are of primary importance. Accordingly, their categorization of sanitary interventions has been used in compiling the report. The interviewees responses have been reproduced in first person singular, taking care to translate their intended meaning accurately in English. Observers notations have been made in the Case Studies, where a proper appreciation of the situation of a village or town requires a broader perspective. The 15 case studies comprise five cases of No Intervention, four cases of Unsuccessful Intervention, and six cases of Successful Intervention. No Intervention The five respondents in this group have strong and clear perceptions about the importance of sanitation, as very important for life. They are also clear that Open defecation is the biggest problem of our area. There is a wide variation in sanitary coverage within the group with house latrines ranging from almost none to 95 percent. Yet all the respondents describe miserable sanitary and health situations, with frequent illnesses, inconvenience especially for old people and women, feelings of degradation and shame, dishonor, children not attending and dropping out of school, and a dirty environment. What is also common is a sense of the failure of the community to work together, and of Government failing to fulfill its duties. Unsuccessful Intervention The four respondents in this group share the perception that Sanitation is very important for being healthy and report that the people of their area know about importance of personal and home cleanliness and food hygiene for healthy living. There is wide variation in sanitary coverage ranging from 100 percent Open Defecation to 75 percent households with latrines installed. What is common is that people recall a Government or NGO intervention to either install sanitation and drainage infrastructure or to train people in sanitary practices, purifying water and constructing latrines. The perceived failure of the project is the second common theme for this group. Successful Intervention The six respondents in this group agree that, Sanitation is most important for reducing poverty and ill-health. Their appreciation of sanitation extends beyond personal, home and food hygiene to concepts about the cleanliness of streets and localities. Open Defecation has been reduced to less than 30 percent of the population and to less than 2 percent in the best case. Another common feature is that the respondents recall a recent catalytic intervention to mobilize the community for collective work on sanitation and hygiene. However, the Observers note that Total Sanitation has not been achieved in any situation, with more efforts needed to reinforce sanitary and hygienic practices especially among children. Further work is also needed for final effluent disposal and solid waste management in all cases. 2
Common Contributory Factors The community leaders who responded to the survey are well aware of the importance of sanitation and hygiene. In turn they believe that their communities do have basic information about sanitation. However, all mention the gap between knowledge and practice. The reasons for the gap include (i) restricted concept of personal and home hygiene, (ii) minding own business and not striving for a collective solution, (iii) lack of clarity in the roles of Government, communities and individuals, and (iv) poverty. Another reason not directly mentioned but hinted at is ethnic divides. One perceived reason for the failure of sanitation interventions is a focus on the elites. Respondents mention that privileged sectors of the village or town were provided with sewerage and drainage, but that the system has not worked. Schools have been provided with latrines but they are not maintained. Another reason for failure is sporadic social mobilization by a visiting NGO and lack of regular follow-up. It is essential to work with the marginalized communities and individuals, but as one responder mentioned it is not enough. It is also essential to work on the regressive attitudes of the local elites to achieve a change in sanitation behaviors and habits. The technical failure of sewerage lines was commonly mentioned. Improper design (of gradients) is one element. But more generally, wherever sewers are laid without the involvement of people, they frequently become choked quickly. The respondents mentioned the following factors as ingredients for success of their sanitation program: Involvement of the people from the start, for example, a weekly meeting in the center of the village to plan and decide future steps; Hygiene promotion and behavior change; Local leadership, specifically their understanding of the advantages of sanitation for all inhabitants; Community ownership; Active participation of women; An inclusive approach, reaching out to marginalized communities and individuals; A process that is accountable to communities; Achieving clarity about responsibilities, including maintenance; and Regular follow up by the program promoters Key Issues and Challenges for Sustainable Sanitation in Pakistan Total Sanitation has not been achieved in any of the 39 villages and towns that were surveyed for this study. Even in the best situation, where 98 percent of households use a latrine, drainage remains an issue. Furthermore, success may be limited to excreta disposal, and not extend to solid waste management. It is also not automatic that the benefits of a sanitation program are extended to women, to the disabled, and to individuals that are marginalized for any other reason. Their access has to be ensured. 3
Annexes Table 1: Categories of Respondents for Selected Case Studies Annex 1: Case Studies of Areas with No Intervention Annex 2: Case Studies of Areas with Unsuccessful Interventions Annex 3: Case Studies of Areas with Successful Interventions 4
Table 1: Categories of Respondents for Selected Case Studies 5
Q/No Case No. Gender Village/Place Sector District Province Project Category 1 F Jungle Barali Rural Vehari Punjab Not Intervened 2 F 230 EB Rural Vehari Punjab Not Intervened 3 M Andhloo Rural Badin Sindh Not Intervened 4 M Khan Ganj Baksh Urban Chakwal Punjab Not Intervened 5 M Bhai Khan Lashari Rural Dadoo Sindh Not Intervened 6 F WB 83 Rural Vehari Punjab Unsuccessful Intervention 7 F Johi Urban Dadoo Sindh Unsuccessful Intervention 8 M Aaqli Rural Matti Gharparkar Sindh Unsuccessful Intervention 9 M WB 12 Rural Vehari Punjab Unsuccessful Intervention 10 F 63 KBN Rural Vehari Punjab Successful Intervention 11 M EB 204 Rural Vehari Punjab Successful Intervention 12 M Dhok Qadoo Urban Chakwal Punjab Successful Intervention 13 M Tanyila Urban Chakwal Punjab Successful Intervention 14 M Dhok Dabri Rural Chakwal Punjab Successful Intervention 15 M Maoza Cheddho Rural Vehari Punjab Successful intervention 6
Annex 1: Case Studies of areas with No Intervention 7
Cases Study No 1. I am Sughran Bibi, a house wife from the area of Jungle Barali. Jungle Barali is a rural area, union council number 34 in Tehsil and District Vehari. The area is composed of 225 households with approximately 2200 population. There is no health facility in the area and generally found diseases in the area are fever, skin problems and jaundice. A government primary school each for boys and girls is functional. There is no facility of sanitation in village and 70% households do not have latrines. People have dig pits in their homes and empty them when they are filled. I think sanitation is very important for one s health. It is important for life that clothes, home and streets should be clean. I think sanitation facilities are most important for reducing poverty and for health and getting rid of diseases. I also think that access to clean water is everyone s right. People in the vicinity are aware of basic information regarding sanitation like cleanliness of body, covering the edibles, cleaning of home and streets but majority of village residents do not act upon this. There has been no intervention in our village regarding sanitation improvement. Waste water from houses is occasionally gathered in streets, people defecate in open, old age people and children have to go to fields during rain. Women while going out face problems of privacy. Above all we do not have access to clean drinkable water. People of village, in the absence of sanitation facilities feel degraded especially when guests arrive. Many people have migrated from this place just because of poor sanitation conditions. Water is stagnant at different places in the area that helps mosquitoes to grow, as a result malaria is quite common in the area with other skin diseases. 8
I feel there is a dire need of sewerage and gutter system in this village along with latrines in households. We also need a dumping place for solid waste collection. Clean water should be provided to every household. I think poverty and lack of awareness and sensitization are the core reasons for people not taking any step to improve their sanitation conditions. People usually are concerned with their own business and do not strive collectively for solution of any problem. A few unsuccessful efforts were made in the past but women were not involved at all. Moreover any representative of government or any other organization never visited this place with regard to sanitation enhancement. Government has built schools in the area but it does not provide health centre and drains which are big issues of the area. It is government responsibility that it should expand people s right to them. I do not know much about non government organizations, if they help people we deserve that. I believe if people collectively struggle for the solution of problems, they can achieve any goal. Enumerator s observation: Village is deprived of any cleanliness system or sewerage system. There are latrines in 30% households, rest of them defecate in open. One can see human feces at various places. Most of the people in village are poor and they cannot construct latrines. 9
Case Study No. 2: Section C was filled by the enumerator but the information for this village makes it fit for unsuccessful intervention. The case study is presented in the words of respondent. According to her there has been no intervention but some time in past there has been laying of a drainage system. My name is Ms. Khursheed Bibi and I am chairperson of school management committee. My area is rural and is known as village 230-EB of Tehsil and District Vehari. In this area there are roughly 300 households and about 2500 individuals. Quacks are the maximum health service we can attain. Two government s and one private school are running in our area. I think sanitation is very important for healthy life but people lack consciousness about it. I think cleanliness is most important for status then health and prevention of diseases. Every person tries her/his level best to keep cleanliness and it equally important for all either a rich or poor person. There is a household level arrangement of cleanliness in the community. People tend to keep their houses clean to prevent diseases. During last one year approximately 80% of the households are benefiting from sanitation facilities in the area. Almost in all the houses latrines are present but 50% people of the area defecate in open as they do not know its disadvantages. There is drainage system in half of the village while rest deprives it. There is no system of solid waste management and people use streets and empty plots to dump it. Children, both boys and girls use toilets in their schools. People in general know about health and hygiene e.g. cleaning their bodies regularly but they lack attitude of maintaining it. Like they know the importance of hand washing but do not act upon it. I guess only 10% people in the village are active regarding their cleanliness. 10
There has been no intervention in our area regarding sanitation and open defecation and filthy environment are our biggest problems. I think people do not feel shame about these conditions if they do they would have worked for it, in other words they do not feel it as their problem. I guess for sanitation improvement first of all this community requires sensitization. Government never focused their attention to this area neither did any NGO. We also lack water supply scheme in our area. Enumerator s observation: The village is not feces free and street are full of filth. Area lacks solid waste management system. 11
Case Study No 3 I am Mithoo and I am resident of village Andhloo in Lawari Shareef which is further a union council of Tehsil and District Badin. The village holds an approximate population of 1500 individuals adjusted in around 500 households. The population is divided into two major religions Muslim and Hindu, I belong to Hindu religion which is in minority. There are 4 secondary level schools operational in this region. A basic health unit also functions to meet the health related needs of people. My definition of sanitation is keeping your body and area free of dirt and garbage to stay away from diseases. Cleanliness is also vital for achieving education and raising one s status in society. In our area 70% of the household include latrines in them and people use them but rest of the portion of the population uses fields to defecate. Mostly schools have functional latrines for children. I do not know about international rights but I believe good sanitation conditions should be provided to all humans. People of my area do have knowledge about cleaning their bodies, cleaning the house, environmental cleaning and proper use of water but majority do not act upon them. Our area never got free of human and animal feces. We have been using field for defecation for centuries. Defecation in open is biggest problem in our area. People know about demerits of defecating in open but they are not conscious about it. Although maximum households have latrines but village lacks a sewerage system. In my opinion for this much population there should be proper gutter system installed in village. The foremost reasons for not having any initiative regarding sanitation in this village are that it is not people s preference, they think it is government s responsibility while governments departments do not pay heed towards this area. We need a collective 12
forceful attempt to push government to provide us this basic need of all the human beings. 13
Case Study no 4: People know me as Mouhammad Rafiq. I depend on daily income based work for mine and my family s living. I am illiterate and I live in an urban area known as Khan Ganj Buksh in Tehsil and District Chakwal. I guess population of the neighbouring area is more or less 700 dwellers while family units would be 130-140. To the best of my knowledge commonly found diseases in this area fever, flu and typhoid. Sanitation is very important life. Food hygiene prevents diseases for us and keeps the children healthy. It is important part of our religion too. Cleanliness helps a person gaining better education and higher position in society. Hand washing with soap after defecation is very important for maintaining hygiene. In our locality we have access to water for daily use, there is an open drainage system and in most of the houses latrines have been installed. I think 95% of the community takes advantage of sanitation conditions while 15% of the households defecate in open but they wash their hands with soap after defecation. All schools in our area have fully operational latrines but a quite high number of students use latrines at their houses during recess at school. I deem education, health and prevention from diseases as basic human rights. I do not know about international rights but I consider that all people should be provided with basic health and sanitation facilities. Currently this community faces problems of open defecation by some percentage of its population. Those problems include concerns for women s privacy, children s health and dirty environment as there is no proper solid waste management system in place. People feel dishonoured, catch diseases, children s shortage of attendance at schools and over all a dirty environment in absence of appropriate sanitation conditions. 14
This community requires a good sewerage system, solid waste management system and construction of latrines for households lacking them. The source of water is also a bit far way from locality which causes problems. We cannot solve these issues without an aggregate strive of community members. Government and NGOs should play their role for developing this very community. Enumerator s observation: Almost all the household had latrines in their houses. Solid waste management seems an issue for the community 15
Case Study No. 5: I am Nadeem and I belong to a rural area called Bhai Khan Lashari in Tehsil and District Daadoo. The estimated population of community is about 1000 with150 households. There are two government primary schools each for boys and girls. There is no health facility in the area and commonly found diseases are Diarrhea, skin diseases and Malaria. For me sanitation is getting free of diseases, when we do not take care of sanitation conditions we catch various diseases. 80% of community members defecate in open and they are not benefiting from sanitation facilities. There is no system of drainage, sewer or solid waste in our area. In schools there is no separate latrine for teachers and students but latrines are in useable condition. People in our area know basics about sanitation like cleaning of body, keeping food away from flies and other insects by covering it and cleaning of houses. They also know about use of water in sensible way but mostly people do not act upon this information. Sometimes they do not care for it and at other places they do have resources to follow good sanitation practices and lack of education is another reason. There has been no initiative from government or any other organization for our village to improve sanitation. We have problems like defecating in open, physical environment is also dirty that further causes troubles to women children and old age people. People feel degraded and deprived on these conditions. Often these conditions cause spread of contagious diseases due to which children s education is affected. The number of latrines in our area is almost zero, people are poor and they do not have capacity to build it on their own. Both men and women mostly are involved in agriculture due to poverty, as a result it becomes hard for us to keep good sanitation condition at our homes. 16
Poverty is the main reason for our problems and also government and any other development organization never focused on our area. I think community members are also no united and do not work collectively. In our community mostly people think that it is government s responsibility and they do strive for solution of their problems. Enumerator s Observation: People are mostly involve in agriculture and very poor. Area is full of human and animal feces. Area is not equipped with any kind of sanitation condition like drainage, sewer or solid waste management system. 17
Annex II: Case Studies of areas with unsuccessful intervention 18
Case Study No. 1 (Unsuccessful) I am Ms. Munazza Yasmeen. I am teacher by profession. I belong to WB 83, a rural area of Tehsil and District Vehari. There are approximately 350 households and a population of 2800 individuals. Only few quacks are present in the area on the name of health facility. Two middle class level schools for boys and girls are present in the vicinity. Sanitation is very important for being healthy. We shall not fall sick if sanitation conditions are good around us. Sanitation first of all helps us in prevention from disease and remain healthy. Also it is important for education, status and alleviation of poverty. There is no arrangement of cleanliness in our village but people do take care of cleanliness at household level. I think 75% of percent households have latrines in their homes and 50% of area is provided with drainage system. There is no solid waste management system at all. In school for boys, latrine is functional but not all kids use them while in school for girls there are seven latrines but only 2 are functional, so not girls use latrines in school. Sanitation has been taken as a right of common people at national and international level and it is government s prime responsibility to extend it to people. I think people of this area know that cleaning the body is necessary for health and we all like to keep our homes very clean. But we usually do not cover edibles. People despite having information about sanitation do not act upon it. Government department introduced drainage system in our village in 2002 but it was laid down only in half of the area. So now waste water gets stagnant in streets and affects daily life of people. As it was government s initiative so, community participation 19
was low. The material used in this project was of very bad quality so now this facility is not functional anymore. The core reasons for its failure are a) lack of planning at government s level and b) non inclusive and non participatory nature of project for community. Only influential people got their streets paved so benefits of this project could not be extended to all. I believe that there should be dissemination of accurate information among community members regarding this issue. Once they will be sensitized, they themselves will cooperate with any private or government department and solve this issue. Enumerator s Observation: The village is not free of human feces. People usually use empty plots to dump the solid waste which further causes spread of diseases. 20
Case Study No 2. (Unsuccessful) I am Kaneez Fatima. I live in urban area of Johi in District Dadoo. Total population of this area is about 25000 while it is composed of various groups from multiple ethnicities like Hindu, Jamali and Rodnai etc. There are 4 primary, 1 elementary, 2 secondary level government schools with 1 college. There contains government as well as private health facilities. Commonly found diseases are skin problem, abdominal diseases, Malaria, Diarrhea and Hepatitis etc. For me, sanitation means an environment which is disease free. I think sanitation is very important for living healthy. If your environment is clean you enjoy your life and catch fewer diseases. Sanitation is also important for your status and attaining good education. In our area, at household level people sweep their houses, take bath, use latrines and wash their hands after using it etc. but I think only 50% of household are benefiting from health and hygiene conditions. Not in all houses latrines are present, drains are open and do not function well, they are mostly chocked. There are latrines in schools for children but administration does not spend money on them so they are in useable condition. People clean their bodies and houses but do not care if edible are placed uncovered or they are not concerned for environmental cleanliness. There is a mix ratio of people who use water or vice versa Sanitation and drinkable water are part of human rights but in urban areas population is huge. It is main cause of depriving people from their rights and source of poor sanitation conditions. In 2007 and NGO run a sanitation program in the area but due to poverty people were not able to sustain any change and also follow up by the organization was good. They 21
constructed latrines in some of the part of area and informed people about health and hygiene. I believe the reason for failure of this project was inability of the organization to involve people as it should had been. They did not follow up properly with community and may funds were not enough. Moreover local administration was inefficient and there was no system for disposing solid waste. Progress was shown only in papers. By involving local people and asking their preferences into the program this could be more successful. I also suggest running this program for longer period of time that will bring sustained change in people. Municipal department should be more effective otherwise it will be all in vain. Enumerator s Observation: There are human and animal feces at various places in locality. The system of latrines is not good in the area. People think that their forefathers have been living in same way. There is no arrangement of privacy for women and they have to go to fields in early morning, in day time it becomes difficult for them. People fear of snake and insect bites at night. 22
Case Study no. 3: (unsuccessful) My name is Bux Meghward and I belong to a rural area Aaqli in Tehsil Islam Kot and District Matti Garparker. Total numbers of households in this locality are 105 and about 800 individuals live here. There are various castes in this area and Meghward is considered a low social caste. There is no health service providing facility in this area and most common diseases are skin problems, stomach diseases, urinary track problems, kidney problems, Malaria and Hepatitis. There is one primary school for boys but no school for girls. I describe sanitation as keeping environment free of dirt, garbage and anything filthy. It helps in protection from diseases and ensures clean environment. People in our area only take care of sanitation at their household level by sweeping their houses. Hundred percent community members defecate in open. There is no system of sewerage or drainage and solid waste management in our area. In school latrine is not present for boys. I have no idea about international and national level rights. An initiative was taken by government and an NGO since 2004 to 2009, in which they trained people on sanitation practices, purifying water and constructing latrines. As people in this community are very poor they were not able to construct latrines without any financial aid so the program flopped. I think this program can be improved by providing people built latrines and train them to use latrine properly. Plus only latrines will not work we shall also need drainage system and organize committees for it repair and maintenance. Enumerator s Observation: 23
People go into jungle and ground for defecation. Human feces can be seen at various places. Case Study No. 4. (Unsuccessful) I am Lal Deen and I am retired government school teacher. I represent village 12 WB, which is situated in Tehsil and District Vehari. There are about 700 households with 5000 inhabitants. There are 2 government schools and 1 private school in the area. There is no facility of health but quacks in our vicinity and Hepatitis is most commonly found diseases. According to my opinion sanitation is to clean one own self, house, streets and village. Sanitation and health are inevitable for each other and its helps in improving environment. I am sure that cleanliness should be one s first priority in life as it helps in reducing poverty, it assists you in attaining education, it is also important for good health and prevention from illness. Occupants of the village, at household level try to take care of their personal hygiene, cleanliness of home specifically kitchen and toilets, plus keep eatables safe from flies and other insects. But outside household level sanitation conditions are not good, only 5% people of the village are beneficiaries of facilities of sanitation. Around 60 70 % community members defecate in open. Although in schools both for boys and girls toilets are functional and children use them. About 40% population of the village know about basic sanitation requirements like cleaning body regularly, cleaning houses, covering edibles and sensible use of water but they rarely act upon them. Further streets remain filled with garbage and waste as they lack information about environment cleanliness. 24
Safe drinking water and good sanitation conditions are not only basic needs of all humankind but they are also basic rights. Provision of these rights must be ensured for all human beings. In 2006 Plan Pakistan completed a project of laying sewerage line in our village in cooperation with local community based organization. The project could not be approved as successful due to multiple reasons. There were technical problems i.e. high level of sewerage line at some points stopping the free flow of water and latterly project engineer did not approve a change in project design to rectify the defects that eliminated peoples interest in that activity. Another gray area of the project was minimum involvement of community in its activities by project team which further caused lack of ownership ad sense of responsibility among people. I believe if we include community share in any form either their participation or financial assistance the project will be successful in future. Enumerator s observation: About 60 70 % houses lack latrines, people go to fields for defecation or they use empty plots. They do not know the disadvantages of defecating in open. 25
Annex III: Case Studies of areas with successful intervention 26
Case study no. 1: (successful) My name is Anees Bibi and I am a lady health worker in Chak (synonym of village in Punjabi language) number 63-KBN in Tehsil and District Vehari. The village is includes 150 households with 3000 population approximately. (population ratio with household doesn t match). There is no school for children in this area. The only health facility in the area is in form of my presence, a lady health worker. Common diseases in the area are flu, fever and stomach problems. What I think of sanitation is cleanliness of streets and Mohallah (word in local language used for a cluster of houses with 3 to 10 streets: roughly 30 to 50 houses), properly clean latrine and its regular use, washing hands with soap before and after meals, cleanliness of kitchen at household level. Cleanliness is half faith for us. Our worship/prayers will not be acceptable without cleanliness. I think sanitation is important first of all for reducing poverty and health. It also plays substantial role in prevention of diseases, enhancing education and status. If we can maintain cleanliness at household and village level, we shall be avoiding many diseases and village looks will also be improved. People in village keep sanitation keep their houses, latrines and kitchens clean. They also manage solid waste well enough at household level. During last one year almost all the households are benefiting from sanitation condition. Roughly 7% of the households, defecate in open. An awareness raising program on sanitation and use of latrine is currently running with them. Although the use of latrines is quite prevalent in village but it lacks drains and proper dumping place for solid waste is missing in village. 27
Good sanitation conditions and safe drinkable water are the basic the right of all humans and they are approved at international level. It is government s foremost responsibility to make sure the provision these to commoners of the country. People in village know about sanitation measurements like cleaning body, cleaning houses, kitchen and latrines, covering edibles, keeping environment free of smoke but I guess only 60 % people take these step here. Since 2005-06 an NGO PIEDAR and Plan Pakistan started a sanitation program with cooperation of community based organization Masha-Allah Trakiyati Tanzeem in our village. The main components of the program are community participation regarding enhancing sanitation conditions and increase use of latrines in community. Although village lacks sewerage system but Local organization in cooperation with PIEDAR/Plan helped in construction of latrines in all houses of village and now it working to ensure its 100 % usage. Awareness raising sessions on advantages of use of latrines and disadvantages open defecation are ceaselessly being held with community members for both males and females. I consider this program successful due to ownership of work being done by community, not only the construction of latrines but their maintenance is also their responsibility and they are doing it well. This program proved to be very inclusive for community and people knew about its merits since its initiation. Local and organization and NGOs were accountable to community and technical support provided by them remarkable. I would like to highlight women s participation here especially. Before construction of latrine women used to face a lot of problems in terms of privacy while defecating in open. This not only encouraged community members but also women to contribute for the success of this program. 28
Life has been easy for people now regarding certain sanitation problems. Like people especially women do not have to face the privacy problem during defecation. During rainy season and at night it was hard for older people and children to go out for defecation now they are safe from it. I feel although people try to maintain cleanliness here in this village but still as further steps to run this program successfully, there should be awareness raising with people still not using latrines regularly. We also need to make sure the use of water in latrines, hand washing after latrines and prevention from diseases in 100% community especially children. a strong follow up is required Enumerator s Observation: There are latrines in 100% houses of the village but 70 % people use them. Few people do not know the disadvantages of defecating in open. Mostly children are seen defecating in open. 29
Case study no. 2: (successful) My name is Amjad and I belong to Christian community in village Chak number 204 EB in Tehsil and district Vehari. There are two major communities in this village Muslims and Christians. Population roughly estimates to 3000 with 200 households. There are three schools in the area two for boys and one for girls. A dispensary is working in the area while there are quacks too providing health services to people. I think health and hygiene is very important part of one s life rather life is incomplete with cleanliness. Sanitation includes personal hygiene, house cleanliness and cleanliness at village level. Most importantly we can avoid many diseases by maintaining hygiene and keep our selves fit and healthy. By avoiding our expenses on treatment we can alleviate poverty that further raises our status in society. Sanitation is given importance in our village people clean houses especially kitchen and latrines is cleaned regularly. Around 70% of households in the village are taking advantages from health and hygiene facilities. Remaining 30% community is poor and they cannot construct latrines on their own so they have to defecate in open. Solid waste management is a weaker area and usually empty plots are used for deposit the waste from households. Latrines are present in all schools for boys and girls and are useable. As rights are concerned, I think clean water and all other basic rights should be provided to people. Inhabitants of the village know about personal hygiene like hand washing, regular nails cutting, taking bath and wearing clean clothes. At household level people understand the importance of cleanliness in kitchen and utensils and cover edibles. They also have knowledge about important occasions of hand washing like before and after meals, use of clean water and cleanliness of latrines. 90% people try to follow these practices but they face problems due to lack of resources. 30
The village has been intervened for sanitation conditions improvement at different points in time i.e. government started a program in 1993, in 2003 Plan Pakistan and latest in 2006 PIEDAR in joint venture with Plan Pakistan. A sewerage system has been laid in village which is running quite effectively. The area is free of human feces and there a sewerage system in village. I think the project is 90% successful and people are getting benefited out of it. Rest of the community members are now following by observing the positive outcomes on others. If the later are given proper awareness the project can be successful 100%. I believe involvement of local people made it a success, people use to hold a meeting weekly in the centre of village to plan and decide future steps. Women were also involved in awareness raising sessions. This program should be properly repair and maintained for sustainability. Funds availability should be ensured for future continuation of this initiative. There are quite visible impacts of the initiative as people now know about health and hygiene, their health has improved, their expense on treatment of illnesses has reduced substantially. Women do not have to throw waste water out of homes. Streets are clean so people especially disable people do no face problems in passing by the streets. 31
Case study no. 3: My name is Rashid Ahmed and I belong to an area known as Dhok Qadoo in Tehsil and District Chakwal. Majority of people belong to agriculture and approximately in 90 households there are 500 individuals inhabit. A government primary school for boys is operational here. Usually people catch seasonal diseases in our area. I guess that sanitation is personal hygiene, street cleaning, unchecked drains and area free of garbage and dirt etc. Sanitation is essential for health for all human beings. One who is clean can avoid diseases many common diseases. The clean environment again ensures one s health. Above all it is one of the most important factors in our religion. Acting upon sanitation practices will finally ensure an elevation of people s status in society. I think in this locality around 20% of households defecate in open at empty plots. Very few people care for hand washing before taking meals and food preparation and after going to toilets. There is no sewerage and solid waste management system in our community. Open drains have been supplied to all community. The latrine in government boys school is not working due to unavailability of water in school. I do not know about united nation s list of rights extended to people. An organization Sabawon started a water and sanitation program in 2009 in our area. I think the program proved successful because most of the people now know about disadvantages of unhygienic practices. The factors contributing to the success of this program understanding of local leadership of the advantages of sanitation, hygiene education for maximum people in community and regular follow up of program authorities. 32
The program has brought many changes in our lives, I would mention some of them here like awareness of the community regarding sanitation practices have been increased, proper and regular use of latrines at household level and also incorporation of hygienic practices in our daily routine etc. For future strategy I think this community will need more financial assistance for construction of latrines, capacity building of community based organization for it strength and regular campaigns on sanitation in community. Enumerator s Observation: 20% of the households do not have latrines so village is not free of human feces. Open drains run through whole community and they are full of not only waste water but also one can see them chocked with solid waste generated by households. 33
Case Study no. 4: I am Muhammad Ameer from Tanyila, an urban area of Tehsil and District Chakwal. The community is composed off about 200 households which hold around 1400 residents. Two government primary schools for girls and one for boys are operational in our area. a lady health worker is debuted on this area for health services provision and people usually catch diseases like eyes infections, heart diseases and fever etc. Upon sanitation, my point of view is that it ensures good health and good environment. Sanitation guarantees a higher status for you first of all and health and better chances for attaining education are also attached with sanitation. I think 50% of community members avail sanitation conditions. 98% of community uses latrines for defecation but a sewerage system does not exist here while drainage system is also in poor condition. I guess 99% community uses empty plots to dispose their solid waste. In schools toilets are available for children in useable condition except in one for girls school in which water is unavailable. I do not know about international rights but I believe that clean drinkable water and sanitation condition are basic rights of all humans. I also believe that food hygiene ensures healthy future generation. Use of soap after toilet use is very important for children. Plan Pakistan instigated a project on sanitation in 2002-03. Most important components of the projects were construction of latrines in community and schools, water supply, construction of school building and awareness raising and training sessions on sanitation. I consider this project successful as only 2 3 % households in community are left without latrines. 34
Maximum community especially women participation in project, understanding of local leadership of the project, availability of resources like water and funds can be identified as core reasons for the success of project. But I feel we have not achieved the target, we still need more awareness raising and training session with community to sustain the project. Community members should be involved in planning at all the steps and community should be able to raise their own funding so that it should be independent in future, not looking for any from donor or external help. We need to follow up on water supply scheme for community, sewerage system, streets pavement and two or three lady health workers for community at least. Government can help us by linking our community to main road and by providing us with a dispensary. Enumerator s observation: The environment of the community was in bad condition due no proper system of solid waste disposal. 35
Case study no 5. My name is Muhammad Zamurud and I live in Dhok Dabri in Tehsil and District Chakwal. It is a rural area with approximate population of over 2000 and estimated total households are about 400. Sanitation is very important for health of people and keeping environment clean. One can prevent diseases and can show good performance in education too by maintaining good health which is result of good health. There 15% of the households defecating in open in the community. Open drain system is implanted in the 60% community area. Streets are paved but there is no solid waste management system in our area. In schools there are toilets for children and all of them are in useable condition. People in community know about personal hygiene, food hygiene and domestic hygiene but we do not know about rights regarding sanitation. As not all the households have latrines in their houses, the area is not completely human feces free. Open defecation not only contaminates environment but also causing diseases in community. Sabawon and Plan International implemented a project in our community to improve sanitation conditions. The main components of the project were personal hygiene, domestic hygiene, environmental hygiene and safe drinking water. Involvement of community to the fullest in all the project activities and understanding of local leadership were most significant contributing factors making this initiative a success. 36
I think we still have to go a long, we need build the capacity of community forum for sanitation and community based organization. Also networking with government department needs to enhanced and we also need financial assistance for future. Although the community is not human feces free but its sanitation conditions have improved a lot. Our knowledge regarding personal hygiene, domestic hygiene, environmental and safe drinking water, that will bring change in behavior in future. 37
Case Study No. 6 I am Tanvir Manzoor and I am resident of Maoza Cheddho in Tehsil and District Vehari. It is a rural area and estimated total population is 4000. Cheddho caste is in minority here. Most common diseases are Jaundice, Malaria and flu etc. In my view sanitation is very important. It is half faith for us. Both sanitation and health are inevitable for each other. Sanitation includes personal hygiene, domestic hygiene, village cleanliness and even cleanliness of children s school. Sanitation is very important for health and prevention from diseases. At household level people in my area use dustbins for collecting solid waste, they clean their houses especially latrines and kitchens. For last one year I think majority of households are getting advantages of health and hygiene conditions. Only 2 % of the total households do not own a latrine in their houses. There is no arrangement of drainage and managing solid waste. People use empty land for disposing waste. In schools for children both for boys and girls latrine are present and functional condition. Mostly people know about good sanitation practices like washing hands with soap, brushing teeth, taking bath and wearing clean cloths, covering edibles save it from germs and other contamination. At domestic level cleanliness of kitchen and toilet is highly important. Substantial numbers of people know about proper use of water, it should not be wasted. In 2005-06 PIEDAR and Plan ran a project in our community in which people were trained on health and hygiene and toilets were constructed for community in their houses. 38
The interest of community members made the project successful. Our ladies had to go out for defecation and they had to face problems of privacy. Now due to construction of latrines all including men, women old aged and children are at great relief. The project was very inclusive in it nature and it provided everyone to participate. Women also contributed enthusiastically and held training sessions at household level. Local leadership was so interested in this activity that basically it was their initiative. I feel we need to hold sessions with children and women until we can see complete change in their behaviors. Enumerator s Observation: The locality is almost free of human feces, mostly people use latrines for defecation and wash their hand with soap after it. Soap was present in latrine observed. 39