Sanitation Nepal Will Tillett 01-2008
Total Page：16
File Type：pdf, Size：1020Kb
Appropriate Approaches to Hygiene and Environmental Sanitation in Remote Communities of Mugu and Humla Districts, Western Nepal Will Tillett January 2008 Technical Department WASH sector, ACF-France Will Tillett, 01-2008 2 Executive Summary Mugu and Humla are among the least developed of the 75 districts of Nepal; which itself is one of the poorest countries in the world. The mountainous districts are remote and drought prone, and the prolonged conflict in the area has impaired local governance, social organisation, and community based services. Action contre la Faim (ACF), has been operating water supply, sanitation and hygiene activities in the area since 2006, and launched this study, in association with the University of Cranfield (UK), to investigate the most appropriate approaches to sanitation and hygiene for the remote communities in the districts. The research, undertaken over 2007-2008 included over 80 qualitative interviews with communities and key informants, along with meetings to build on the experience of a diverse range of sanitation and hygiene ‘actors’ operating across Nepal. A range of approaches to sanitation and hygiene have been piloted, and applied across the country, but little research as been undertaken in Mugu and Humla; districts with some of the lowest sanitation coverage of the nation. Open defecation is prevalent in the area, and poor hygiene and environmental management practices create serious public health risks. Diarrhoea is the biggest cause of mortality in the districts, and there is a widespread prevalence of intestinal worms, skin infections, and child malnutrition. Personal and clothes washing is infrequent, and child hygiene is an area of particular concern. Although hygiene and sanitation may be the priority of the outsider, they are lower priorities to the communities, particularly in light of uncertainties of food and water supplies. Whilst not necessarily health related, interviewees perceive issues with their current situation, and barriers to attaining improved practices, such as soap, external material and water access, time availability of mothers, and the ‘dirtiness’ of the villages. Children are deemed autonomous for their hygiene and sanitation needs from an early age, and there is limited parent to child teaching on these topics. The post-conflict communities experience a lack of social cohesion, leadership and initiative, although the recent emergence of Mother’s groups hold potential to drive change. The few sanitation ‘actors’ in the area mention issues of poor coordination of activities, and conflicting policies for community incentives and subsidies are leading to increasing community demands and expectations. Due to material and transport costs, ‘conventional’ latrine designs incur both high per-capita costs, and hold poor potential for replicability without assistance. Due to restricted field access, many projects have taken a ‘hardware’ focus, with limited ‘software’ activities of mobilisation, participation and demand building; limiting the uptake and usage of latrines, and the future sustainability of interventions. Future approaches in the area could take on longer-term, ‘software’ orientated activities, building demand, and empowering communities to drive change by themselves. Strong mobilisation and sustained follow-up support is crucial. Projects could strengthen the local private sector and supply chains, build up the local skills base, and develop partnerships with local institutions for ongoing sustainability. The issue of sanitation should be addressed as a community initiative, through participatory mobilisation techniques, driving for 100% coverage, and usage . Projects offering no material subsidy for latrines may be ineffective in this context. Therefore a basic (minimal) subsidy is suggested, augmented with sanitation marketing for households aspiring for higher standards of latrines. Local government could play a key role in coordinating sanitation approaches and for the ongoing support for community driven sanitation in the area. Hygiene promotion (HP) should be prioritised to address the key risk practices, and relevant to the communities perceptions of the issues. Community level mobilisation and problem identification, should be followed by more targeted HP sessions, and enabling factors should be addressed. Low-cost solutions for environmental sanitation hold strong potential to contribute to improving food security, and should be promoted as such. Child hygiene is a complex issue, and could be addressed through a multi-channel approach, including; improving environmental sanitation, developing child care practices and direct HP to children, through schools and community based activities. Implementing sanitation and hygiene projects in the area is challenging. However, change can occur, albeit with time, and should be driven by the communities themselves. In light of national targets and financial constraints, approaches to hygiene and sanitation in the area need to be coordinated, low-cost, replicable, and sustainable. A holistic and integrated approach should be taken to work towards the common goal of reducing mortality and morbidity through malnutrition and sanitary related diseases. Will Tillett, 01-2008 3 Will Tillett, 01-2008 4 Acknowledgements I would like to extend my gratitude to both ACF and Cranfield University for giving me the opportunity to take part in this study. Thank you to Richard Carter and Jean Lapegue for all their support, knowledge and insights in this research, and for their time spent reviewing a gigantic draft. Thanks to all the NGOs and sector workers who contributed to this research, particularly to Oliver Jones of WaterAid, and the team at NEWAH, from whom I learnt a great deal. Thanks to all the staff of ACF Nepal for your insights, assistance and company over the study period, particularly the logistics team, who seem to make miracles happen. Thanks to all the French expatriates for keeping up stocks of wine and pate, in a sea of rice and lentils. My gratitude, as always, extends to my parents, for their constant encouragement, support and understanding. Finally, my gratitude extends to the inhabitants of Mugu and Humla districts, for their kind hospitality, and for their openness to discuss at length about their defecation habits to a strange looking ‘outsider’. Will Tillett Water, sanitation and Hygiene Researcher [email protected] The photographs in this manual were taken by and are reproduced with the permission of Will Tillett. Will Tillett, 01-2008 5 Presenting ACF-IN Approaches and Programmes Action Contre la Faim (ACF) (formerly Action Internationale Contre la Faim) is an independent, a-political non- governmental humanitarian organisation which is internationally recognised as one of the world's premier organisations in combating hunger. ACF intervenes in humanitarian situations involving war, famine, natural disasters and other crises to bring help to displaced people, refugees and any other populations in danger. After the emergency is over, continuity of action helps affected people recover their independence through medium and long-term programmes. The prevention of disasters is also one of its objectives. ACF developed an international network with the opening of Accion Contra el Hambre in Madrid and Action Against Hunger in London and New York and recently an office in Toronto. ACF-IN has 350 international volunteers and 4,000 national staff working in over 40 countries and responds in all four areas involved in the fight against hunger and malnutrition: nutrition, health, food security, and water, sanitation and hygiene. The Charter Action Contre la Faim (ACF) is a non-governmental organisation. Private, non-political, non-denominational and non-profit making, it was set up in France in 1979 to intervene in countries throughout the world. ACF vocation is to save lives by combating hunger, disease, and those crises threatening the lives of men, women and children. ACF intervenes in the following situations: • In natural or man-made crises which threaten food security or result in famine, • In situations of social/ economic breakdown linked to internal or external circumstances which place particular groups of people in an extremely vulnerable position, • In situations where survival depends on humanitarian aid. ACF intervenes either during the crisis itself, through emergency actions, or afterwards, through rehabilitation and sustainable development programmes. ACF also intervenes in the prevention of certain high risk situations. The ultimate aim of all of ACF’s programmes is to enable the beneficiaries to regain their autonomy and self- sufficiency as soon as possible. ACF respects the following principles: INDEPENDENCE - ACF acts according to its own principles so as to maintain its moral and financial independence. ACFs actions are not defined in terms of domestic or foreign policies nor in the interest of any government. NEUTRALITY - ACF maintains strict political and religious neutrality. Nevertheless, ACF can denounce human rights violations that it has witnessed as well as obstacles put in the way of its humanitarian action. NON DISCRIMINATION - A victim is a victim. ACF refutes all discrimination based on race, sex, ethnicity, religion, nationality, opinion or social class. FREE AND DIRECT ACCESS TO VICTIMS - ACF demands free access to victims and direct control of its programmes. ACF uses all the means available to achieve these principles, and will denounce and act against