822 INRA9.4 Project "Clean"

0

The SWACH experience in

United Nations Children's Fund, Country Office with financial assistance from the Swedish International Development Ager~- Project "Clean

The SWACH experience in Rajasthan

LIBRARY IRC PO Box 93190, 2509 AD THE HAGUE Te!.: +31 70 30 689 80 Fax: +31 70 35 899 64 BARCODE: £

LO:

United Nations Children's Fund, India Country Office With financial assistance from the Swedish International Development Agency (SIDA) The district of was created out of the northern part of the erstwhile district of in April 1991. Information preceding this date refers to both districts under the name of Udaipur.

UNICEF 1994

The designation employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delineation of its frontiers or boundaries.

Project "Clean" The SWACH Experience in Rajasthan UNICEF Rajasthan

Compilation, design and layout Shampa Banerjee

Editing and technical advice : Eleanora de Guzman Beito Bauza

While ascribing everything good in this book to our several colleagues, any errors and omissions are entirely attributed, to the authors, '/he views expressed do not necessarily reflect the official policies of UNICEF.

Photographs : SWACH and UNICEF

Any part of this book may be freely reproduced with the appropriate acknowledgement

Published by UNICEF Rajasthan 2 Raj Bhawan Road Civil Lines Contents

Jaipur 302 006 1 Project "Clean"/ 1 The Land/1 The People/ 4 2 The fight against Guinea-worm/ 5 When the Worm Turns/7 A Strategy for Change/7 Surgical Extraction/ 10 3 From Guinea-worm to good health practices/ 11 The Organization/11 A Different Style of Operation/ 12 In the Beginning/ 12 The Preparatory Phase/ 13 Getting to Know the Community/ 14 Planning Intervention/ 15 ; • . A Multi-directional Endeavour/ 15 Expanding Horizons/ 19 4 Communicating the SWACH message/ 20 The Awareness Campaign/ 20 Training the Trainers/ 20 Transferring Skills and Knowledge/ 21 The NGO Contribution/ 22 Communicating the SWACH Message/ 27 The Lessons Learnt/ 24 5 The personal touch/ 25 The Animator/ 25 Selecting the Right Person/25 For the Women, a New World/ 27 The Scouts/ 28 6 Surgical extraction of Guinea-worm : a solution to many ills/ 30 Surgical Extraction and Swift Relief/ 30 How Effective is the Procedure? A Sociological Study/ 32 Solely from a Medical Point of View/32 7 Installing the hardware/ 35 Converting Stepwells/ 35 Stage One: Identifying Villages with the Greatest Need/ 36 Stage Two: Identifying Stepwells for Conversion/ 36 Stage Three: Interacting with Individuals and the Community/ 37 Stage Four: Drawing up Estimates and Designing Models/ 37 Stage Five: Planning and Reviewing the Work/ 38 Stage Six: Procuring and Distributing Material Needed for Conversion/ 38 Stage Seven: A Hands-on Job/ 38 Handpumps for Safe Water/ 39 A Community Decision and a New Methodology/ 39 Stage One: Selecting the Village/ 40 Stage Two: Identifying the Site for Drilling/ 40 Stage Three: Planning the Drilling of Boreholes/ 41 Stage Four: Planning the Movement of Rigs/ 41 Stage Five: Drilling the Boreholes/ 41 Stage Six: Installing the Handpump/ 42 A Special Feature: Handpump Amenities for Environmental Sanitation/ 43 Problems in Site Selection/ 43 Repairing and Maintaining the Handpumps/ 44 Training for Handpump Mechanics/ 44 Stage One: Selecting the Right Mechanic/ 45 Stage Two: Training the Mechanics/ 45 Stage Three: Preparing for the Job/45 Women as Handpump Mechanics: a Revolutionary Idea/ 45 8 Fighting the cyclops: the funnel filter/ 48 Testing for Chemical and Biological Impurities/ 48 Carriers of Guineaworm/ 48 Implementing a Chemical Intervention/ 49 The Final Solution: a Fool-proof Filter/ 50 9 The need for constant vigilance/ 51 The Framework for Evaluation and Assessment/ 51 The Need for Constant Vigilance/ 52 10 Sustaining success/ 54 Looking beyond the Numbers/ 54 Consolidating the Gains/ 54 11 Changing the lives of rural women/ 56 Organizing the Camps/ 56 The Impact Study/ 57 The Findings of the Study : Environmental Sanitation/ 57 General Awareness/ 59 Training of Traditional Midwives/ 60 Growing a Kitchen Garden/ 62 Information — a Step towards a New Life/ 64 12 The story of two women/ 66 One: Kanni Bai, Villlage Iswal/ 66 Water Collection/ 66 Sanitation at the Handpump/ 766 Sanitation at Home/ 67 Washing and Bathing/ 67 Cattle Shed/67 ' . : Food and Sanitation/ 67 Attitude towards the Camp/ 67 Two: Narbada, Village Vaijpur/ 67 Water Collection/67 Sanitation at the Handpump/ 68 Sanitation at Home/ 68 Washing and Bathing/ 68 Cattle Shed/68 Food and Sanitation/ 68 Attitude towards the Camp/ 68 13 Two villages: the project in operation/ 70 One: Village Amarsingh-ka-Gara, District/ 71 Wells/ 71" Handpumps/ 71 Environmental Sanitation/ 72 Health and Hygiene/ 72 Village Contact Drive/ 73 Two: Village Palthoor, District/ 73 Wells/ 73 Handpumps/ 73 Environmental Sanitation/ 74 Village Contact Drive/74 14 Changing the perceptions of villagers in Udaipur/ 75 Jalapka/75 Kurdau/ 76 Water and Guinea-worm/ 76 Information about Guinea-worm/ 76 At the Water Source/ 77 Is there a Cultural Perception of Water?/ 77 Defining the Boundaries of Intervention/ 77 ACKNOWLEDGEMENT

SWACH Project stands for the commitment and contributions made by all staff. Only because of their permanent enthusiasm and continued support, the objectives of the Project were achieved.

The driving force behind SWACH was the leadership, able administration and enthusiasm of several IAS (Indian Administrative Service) officers - Mr. Parvender Singh Panwar (1986-1988), Mr. Indu Bhushan (1988- 1989), Mr. Mukesh Sharma (.1989-1991), Mr. T. S. Sandhu (.1991-1992), Mr. J. C. Mohanty ("1992-1994), Mrs. Shubhra Singh (1994-November, 1995) and Mr. S. K. Ilawa (November, 1995 till date).

They were assisted by a devoted team consisting of Mr. Anil Bhandari, Ms. Vimal Chordia, Mr. N. S. Singhvi and Ms. Alka Shrimali, who officiated as Assistant Directors.

The contributions made by the following officers in implementation of the project is praiseworthy.

Udalpur Dungarpur Banswara Mr. Vikram Singh Mr. S. L. Bohra Mr. K. L. Bhandari Mr. C. P. Kumbhat Mr. S. L. Devpura Mr. S. N. Dave Mr. R. Singh Mr. S. C. Audichya Mr. M. M. Taunk Mr. Dalbeer Singh Mr. P. R. Jain '

The project acknowledges with gratitude, the financial assistance of the Swedish International Develop- ment Agency (S1DA) which supported the Project for ten years and the partnership with UN1CEF India Country Office and Rajasthan Field Office. Noteworthy is the constant guidance received from Dr. Jon E. Rohde, M.D., Ms. Ann-Lis Svensson, Mr. Rupert Talbot, Mr. Aung Chein, and Ms. Sumita C. Ganguly. Signifi- cant contributions have been made by Ms. Fleanora de Guzman and Dr. Bcrto Bauza, M.D. of the Rajasthan Field Office in review, editing and guiding the preparation of this book. The support of Mr. G. S. Gulati in printing and publishing of the book is also acknowledged with thanks.

Finally, we would fail in our duty if we do not acknowledge the devotion and dedication of SWACH Scouts and Animators who are villagers themselves. All credit goes to them for their constant vigilance which will eventually help to eradicate one of the most dreaded diseases from the face of this country veiy shortly.

UNICEF, Rajasthan Field Office Jaipur Project "Clean" - The Setting

FT\ he Integrated Sanitation, Water, and Community I Icalth Project is best known in the south of Rajasthan by its acronym, SWACII. It. is easy to remember, especially since it sounds exactly like a word in which appropriately means "clean", A joint programme of the and Unicef, with financial assistance from the Swedish International Development Authority (SID A),and the Government of India SWACH was started in the southern districts of Dungarpur and Banswara in 1986. Two years later, the project was extended to include Udaipur

: and Rajsamand. significantly to its success, -The land ::-:;:: • •:• ~=^y ™-: -~y\

SWACH is a result of long-standing . Growing concern about the Rajasthan, with its desert lands and cooperation between the ravages of water borne diseases swiftly reducing forest cover, has Government of India and Unicef in in developing countries, especially faced drought conditions the field of water supply and among children, was one of repeatedly in the recent past. environmental sanitation. An the critical factors that led to the Between the sandy soil and the integrated, area-specific project, it UN declaration of 1980-1990 as rocky hillsides, the state simmers in has been a trial ground for new the International Drinking Water the long drawn out summers, when concepts and methods for the Supply and Sanitation Decade. the meagre water and vegetation delivery of services with the active At the same time, SIDA's have to be shared by both man and involvement of the community. own involvement with water beast. This is also a state where Inter-sectoral cooperation within resources development pro- distance effectively isolates the government is an essential grammes reflected that orga- habitations and the rough terrain element in the project and nization's belief in the importance makes it doubly difficult to deliver convergence with other Unicef of sale water in the effort to improve basic services to the people. supported programmes, such as community health, enhance Development of Women & Children productivity and growth and With a total population of in Rural Areas (DWCRA), Women's accelerate the process of change. 44, 005,990 and a decadal growth Development Programme (WDP) Rajasthan seemed highly eligible rate (28.07%) higher than the and Integrated Child Development for SIDA's support in this area of national average (23-50%), Services (ICDS), has contributed activity. Rajasthan's per capita income at desert is inexorably shifting down Rajasthan: Crude Birth Rate, 1992 to the Aravalli wall from the north- west, a few banyan, mahua, mango and wild plum trees have mana- Urban ged to resist both the desert and the ravages caused by the clearing of forests for timber and mining Rural operations. Zinc, silver, lead, sandstone and marble were extracted from the region, Total increasing the aridity of the land and rendering scarce both renewable and non-renewable 26 28 30 32 34 36 resources. In 1975, Udaipur had Source: Sample Registration Scheme, Government of India 4266 sq. km of forest cover, with 101 days of rainfall per year. Ten current prices has been computed between the ages of 10 and 14 years years later, the forest cover had in 1989-90 at Rs 3595 (US $ 115), far was 18.33- More than 77 per cent of halved and rainfall had decreased below the national average of Rs the population live in the rural areas to 64 days per year. 4252 (US $ 136). The sex ratio was of the state, sometimes in remote 913, against the national figure of and inaccessible habitats. About 30 The face of the hills is scored with 929 in 1991. Although the southern per cent of the population belong the path of many streams, but they districts display much higher to the Scheduled Castes and Tribes. were always mainly seasonal. The figures, with Dungarpur reaching a The highest concentration of tribal settlements had open wells number of 1045 females per Scheduled Tribe population in the and ponds that stored water for thousand males in 1981, this may state, ranging from 34.33 to 72.63 both drinking and agriculture. The be due to the mass migration of per cent, belong to four districts — landlords, who mostly belonged to male workers from these districts to Rajsamand, Udaipur, Dungarpur the warrior caste, dug more neighbouring states. The total and Banswara. wells out of sub-soil rock, and to literacy rate is 38.81, with female make the process easier, made literacy at an abysmal 20.84. The Aravalli range of mountains ledges or steps that not only helped According to 1981 figures, the divide the state on a north-east/ to dig deeper, but also made the percentage of females married south-west axis. Although the Thar water accessible when the water level was at its lowest. More Rajasthan: Infant Mortality Rate, 1991 elaborate stepwells were commis- sioned by kings, near temples or on occasions of birth, death, marriage Urban 50 or military victory. In Udaipur, artificial lakes were also built in the name of the queen, as emergency Rural reservoirs. Of the 100 lakes and ponds in the area, two of the largest, Raj Samand and Jai Samand, were Total commissioned as famine relief work in the last century.

20 40 60 100 Scarcity of water is particularly visible in Dungarpur and Banswara. Source: Sample Registration Scheme, Government of India In 1981, the proportion of area Rajasthan: Deviation from Normal Rainfall, 1991

L_x ^y//y//i +10 to-10 -10 to-20 -20to^0 ^Oto-50 -50 to-70 Percentage of deviation

Source: Public Health Engineering Department, Jaipur

under irrigation in the whole of Today, the main problems of rural, Consequently, the water table is Kajasthan was 21 per cent, while in water supply in the state can be getting lower each year. these two districts it was less than 9 encapsulated as follows: The remoteness of some of the per cent. * With only 34 kilometres • About 40 per cent of the land is rural settlements makes it of national highway in Dungarpur desert or falls in the semi-arid virtually impossible for drilling and none in Banswara, several zone. rigs to reach them. villages have only unmetalled roads which are submerged during the • Desertification is enhanced by The groundwater has high monsoons. Carrying drilling rigs for scanty rainfall. Deviation from salinity and fluoride content: tubewells to the interiors, therefore, the norm in annual rainfall was 4280 villages in 21 districts of becomes a major challenge. 17 percent in 1991. the state have water with fluoride pound the problem of water contamination.

The tribals were here long before the came. They lived off the forest products, collecting, using, selling and bartering timber, grasses, honey, beeswax, bamboo and gum. They practised shifting cultivation, growing corn, pulses, and rice on the slopes of hills and cm stream beds. With the growth of Rajput feudalism in the mid-16th century, the forest population slowly became absorbed by the tenant landlord system of the Rajputs. Many tribal families came and joined the villages of the Rajputs in the valleys, and settled down in small hamlets — pbalasor bhagels -— adjoining the main village.

Today the number of purely tribal settlements has reduced in Udaipur, but Dungarpur and Banswara still have a veiy high number of tribals in their population. Severe drought conditions and resulting poverty have often led to mass migration of male workers from these parts. The women and children are generally content of over 1.5 ppm. More There is high incidence of left behind as the men journey to than 5000 villages have water guineaworm and other water other states such as or even with total dissolved solids (TDS) borne diseases. Maharashtra, where they work in higher than the permissible Lack of health education and the industrial centres or the service limits. poor sanitation habits com- sector in the cities. •

1 "Managing Guineaworm, Health and Water Supply, the SWACH Project ofRajasthan," Anil Bhatt in association with Salil Dave, Indian Institute of Management, Ahmedabad, 1989, p. 6. The fight against guineaworm

uineaworms have flourished in tropical, arid climates in African countries and in the Indian subcontinent for generations. Not being a killer, the disease caused by guineaworms did not receive as much attention as it deserved, until the 1980s, when with growing concern about the disease, research was undertaken on the feasibility and economic necessity of control. This resulted in a resolution of the United Nations World Health Assembly in 1986, endorsing the elimination of dracunculiasis (as the disease is medically known) as part of the Clean Drinking Water and Sanitation Decade (1981-90).

The disease has been well documented in various African countries. Dracunculiasis has been shown to be a major cause of school absenteeism and a serious cause of permanent drop-outs. There is increasing evidence that it is also detrimental to maternal and child health. Annual loss in Africa is in the range of 300 million to one billion US dollars a year.

Guineaworm, the focus and entry 1993, there were 545 cases reported & . In 1995, no cases were point of the SWACII project, is by the Medical and Health reported in Udaipur. Today, the endemic in Rajasthan, especially in Department in the State. In 1994, goal of a Guineaworm free state by the southern part of the state. In no cases were reported in the 1996 no longer seems as unreal as it 1984, there were 6776 affected SWACH areas of Dungarpur and did when the SWACI1 project was villages in the state and the number Banswara and cases were reported launched. of known cases was 15,210. By the in Udaipur. 443 cases were detected end of 1992, the number of villages in the Western Rajasthan districts of Today the patients of guineaworm was down to 957, with 792 cases. In , , , Banner are primarily the rural poor. But in with gentle tension as it Guineaworm Cases in the Project Area emerges — a process that, takes many clays. Modern medicine can only offer anti-biotic therapy, tetanus toxoid and bandages.

When the Worm Turns

Guineaworm disease, or clracunculiasis, is a 1984 1985 1986 1987 1988 1989 1990 1991 1992 parasitic disease caused by the nematode H Udaipur C Dungarpur I Banswara species Dracunculus Source: Mid-year Review of NfCD, Delhi, 1993 Medinensis, The disease is transmitted to the days before piped water, both and, more important, no one knew humans when they drink polluted rich and poor had guineaworm. In how to prevent it. Patients were water that contains infected southern Rajasthan, where water treated for abscess and ulceration copepods (water fleas which was collected from stepwells and after the worm had to belong to the genus cyclops), •which artificial ponds, the disease was emerge. Even today, traditional act as the intermediate hosts for the endemic and even the royal family practitioners all over the world nematode. of has had incidence of prefer to allow the worm to come Infective larvae of the parasite guineaworm for at least the past out spontaneously, rather than contained within cyclops are 1 three decades. rupture it and let the toxic reactions releasecl into the stomach after follow. To hasten the emergence of cyclops are destroyed by gastric There was no cure for the disease the worm, they wrap it on a stick juice. Once larvae are freed into the Guinea worm Affected Villages and Reported Cases, 1993

• Villages m Cases

Mrthnrafthtrii Madhya Pradaih Andhra Prndavh Karnafaks Gujarat fiftjaithan Villages 26 126 55 110 4 667 Cases 0 178 0 29 0 545

Source: National Institute of Communicable Diseases, Guineaworn Eradication Programme in India Fifth Independent Evaluation, December 1993; Medical Health and Family Welfare Directorate, Report of GWEP in Rajasthan, January 1994. Rajasthan : Reported Guineaworm Cases in the Districts, 1994

Ajmer V> Tonk < Sawai Madhopur

Source : Rajasthan Integrated Guineaworm Eradication Project Report and SWACH Report, 1995.

human body, they migrate to the million larvae. Usually a painful water may be ingested by cyclops subcutaneous tissues where they blister is formed before the which mature to the infectious mate. The male worm dies, but the worm emerges through the skin. stage, usually in two to three weeks. female always survives. After the blister bursts, the anterior If a person drinks water with The incubation period is from 10 to part of the worm (uterus) is infected cyclops, the cycle starts 12 months, during which time no exposed. When the affected part of again. symptoms occur. After this period, the body is immersed in water, the the female worm grows to about worm releases thousands of first- When the worm erupts, an ulcer one metre long and migrates to a stage larvae. If the worm is not usually forms, and physical position under the skin, most extracted, it will continue to expel extraction of the parasite with the frequently in the legs. larvae for some time, whenever the traditional method of rolling the affected part of the body comes in worm on a stick is done. The contact with water. procedure takes from one to three The mature female worm has months. Pain and secondary a uterus filled with one to three The larvae released in the bacteria infection are common. In Table 1 : Disability and work loss in l6l patients with a single guineaworm, by treatment category

Treatment No. (%) Average no. of Average no. of of patients workdays lost days disabled

Extracted before larvae released 23 (14) 3.1 9.5

Extracted after larvae released 15 (9) 12.5 22.4

Partial extractions 9(6) 16.1 47.4

Inflammation prevents extraction 50 (31) 18.1 35.2

Abscess drained 36 (22) 28.1 39.1

Ulcer cleaned and dressed 28 (17) 27.4 45.8

Source: "Surgical Extraction of Guineaworm: Disability Reduction and Contribution to Disease Control", Jon E. Rhode ct. al, American Journal of Tropical Medicine and Hygiene, 48 (1), 1993, pp. 71-76. ' . ,

Table 2 : Duration of symptoms and disability prior to treatment, by stage of presentation

Symptoms No. of Average no. Average no. Average no. patients of days since of days of days first aware disabled aware before that guineaworm prior to onset of was present treatment morbidity

Prior to eruption 23 11.5 4.0 7.5

Erupted but no inflammation 17 17.7 8.4 9.3

Erupted and inflamed 53 25.0 13.5 11.5

Abscess 38 33.8 24.4 9.8

Ulcer 29 390 - 28.9 10.1

Source: "Surgical Extraction of Guineaworm: Disability Reduction and Contribution to Disease Control", Jon E. Rhode et al, American Journal of Tropical Medicine and Hygiene, 48 (1), 1993, pp. 71-76.

8 The Life-cycle of a guineaworm

Patient immerses foot in water : In the water, copepods ingest the guinea worm releases larvae in water larvae

Drinking water is collected from the In eleven months, a mature female same water source containing copepods worm is formed in the body "infected" with guineaworm larvae

When the water is drunk, the copepods die, but the larvae survive and enter the human body through the stomach :::;: : the worm before it emerges some cases, arthritis, deep "Surgical Extraction'-i-^^ri :-:- \ abscesses and secondary infections through the skin. As a patient is generally aware of the presence of provoke important disabilities in One item in all these intervention 2 the worm about 10 days before it the patients. methods is unique to SWACH, emerges, it is possible to extract it which has sent the achievement at this stage, thereby reducing A Strategy for Change :;; graph soaring within a short period chances of transmission of the of time — surgical guineaworm disease. Guineaworm is the only water- extraction. Painless and quick borne disease which is transmitted extraction of the worm has led to solely through drinking con- patients reporting to the medical SWACH not only promoted and taminated water. The SWACH inter- units long before the disease turns adopted this procedure as part of ventions, therefore, were planned painful. This has resulted in swiftly its guineaworm eradication • To interrupt the life-cycle of the decreasing the number of patients programme, it also launched a guineaworm at multiple points and has made it possible for the massive effort to inform the people of water utilization. SWACH team to initiate preventive about its efficacy along with that of actions before more people get other preventive measures adopted • To inform the rural communities infected by the disease. by the project. The assumption was about the spread and control of that a well-informed community, the disease. During the past 20 years, ayurvedic3 aware of the positive impact of a • To provide curative medication practitioners in southern Rajasthan service would actively participate and surgical remedies for those have developed this simple in the programme and demand that suffering from the disease. surgical procedure to remove service. D

1 "Village Study on Water Use and Perceptions", Chris Deegan, Unicef (Rajasthan), 1990. 2 MPH VBC Tropical Disease Paper No. 4, Donald Hopkins, August 1990. Published under WASH Field Report No. 322. 3 Ayurveda, an ancient medical science that has survived through centuries in India, provides medication distilled from natural sources.

10 From guineaworm to good health practices

*T« he objectives of SWACH go far providing the environment for This is not to imply that guineaworm beyond the eradication of increased productivity, would in its had less importance for the guineaworm: turn, critically raise the levels of government departments. It merely • To improve the quality of life aspiration for a better life. With points to the fact that sometimes a and socio-economic conditions guineaworm as its focus, the project single priority area gets submerged in the rural areas of four southern could swiftly reach its beneficiaries in a sea of priorities. A project districts of Rajasthan — by promising immediate solutions approach could overcome this Rajsamand, Udaipur, Dungarpur to a problem that had lasted for hurdle by limiting its activities to a and Banswara — with special generations. Guineaworm was short period of time and a specific reference to women and visible, tangible, and painful. By area of operation — just where children. first removing the pain and then intervention was most needed. • To reduce the incidence of destroying the source of the disease, guineaworm, diarrhoea and the SWACH teams gained the The time limit was possible because other water borne diseases people's confidence and support. guineaworm is a disease that can among children and other be eradicated within a short period members of the rural population. In the districts of Dungarpur, of time through intensive control • To promote community Banswara, Udaipur and Rajsamand, measures. But the limited duration involvement and self-reliance in water, sanitation and guineaworm also required that the activities be the planning, implementation control activities had always been carried out in a swift and sure and maintenance of drinking undertaken by different manner, and whenever a change of water supply. government departments which direction was required, it was • To encourage and sustain good operated within the boundaries of important to take quick decisions health practices among the rural the usual rules, regulations and and immediate steps. To circum- population. procedures that are necessary vent these constraints, SWACH features of all broad-based evolved a semi-autonomous Two major interventions for government programmes. This was organization that could provide achieving these objectives were before SWACH took over. The quicker responses to challenges. identified as progress was slow then, not only • Provision of safe drinking water because of the regulatory by means of converted stepwells constraints, but also because the and handpumps. Public Health Engineering To this end, the project was put • Health education and promotion Department (PHED) and the Health under the Tribal Area Development through village contact teams Department, which did most of the Department (TAD), as a part of the (VCTs) and existing village level work, were responsible for the Rajasthan Tribal Area Development workers. entire state and for many other Cooperative Federation (RTADCF), programmes. The control of an autonomous cooperative Thus, SWACH attempted to achieve guineaworm, therefore, could not society. The Commissioner who in the long-term a holistic change become the prime concern of these heads TAD was made the ex-officio in the health perceptions of the departments, taking precedence Chairperson of SWACH, so that the rural community which, by over all others. project could have the day-to-day 11 Caste Composition of Rural Population in Dungarpur and Banswara

Region Caste group Scheduled Scheduled High and Total Tribe Caste other castes

Survey districts 1,070,789 65,611 333,732 1,470,132 (72.8) (4.5) (22.7) (100.00) Banswara 637,912 38,343 155,158 831,413 (76.7) (4.6) (18.7) (100.00) Dungarpur 432,877 27,268 178,567 638,719 (67.8) (4.3) (27.9) (100.00)

Figures in parantheses are percentages of total rural population. Source: "A Dascline Study of Banswara and Dungarpur Districts of Rajasthan (India),' Institute of Development Studies, Jaipur, 1986. support of the government while it great deal of difference to the project. Also, the contribution of retained its autonomy. To give it efficiency of the project. Decisions individual leaders throughout the greater freedom of operation, a were taken quickly, travel sanctions project cannot be overstated. separate organization was created were worked out on the spot, and solely to run the project, with an the choice of hardware could be Acertain dynamism was established Indian Administrative Services (IAS) based on performance, durability early because hierarchical job officer as its director. and long-term economy rather than definitions were set aside whenever only on the short term gains of the there was immediate work in hand. The director and his supporting staff lowest tender submitted. Everybody was expected to and were located in Udaipur, the main did pitch in for all jobs, whether it office of the project. The field offices As the recruitment was limited to was a workshop being organized at the district headquarters were the life of the project, all important overnight in the city, or a camp headed by project officers directly staff were taken on deputation from being set up in a remote location, responsible for the implementation different departments of the or a hitch in drilling operations of the project in their respective government. Here, too, the main requiring immediate trouble- districts. Assistant project officers consideration was not the shooting. The deliberate and were separately responsible for the government rules and regulations conscious attempt to make the technical, educational and medical as applied to transfers and liens, project a combined team effort interventions. A health educator but the fact that a particular officer continued and was evident in both reported to the assistant project was most suitable for the specific increased efficiency and job officer for education, while junior job. Officers were interviewed and satisfaction among the staff. The engineers helped the assistant assessed carefully before they were sense of family became the project officer responsible for taken on board. management strategy for the technical infrastructure. project, which helped to iron out inter-personal and inter-office Unlike the resource- starved problems relatively easily. government departments, the From the very beginning, SWACH SWACH project, with its donor established a functional style that ^l funding, was well-equipped with allowed it to work unhindered by basic: office and transport facilities, the usual bureaucratic constraints. In 1986, when SWACH first began thus allowing it freedom from This was partly made possible by functioning, its activities were recurring problems of a petty nature the style of leadership that was in concentrated in 12 blocks of two in its daily functioning. This made a operation in the early years of the small districts in Rajasthan — 12 Dungarpur and Banswara—with a ground. The existing water sources of the number of stepwells to be population of 1.8 million people. included some 5000 tubewells fitted converted to draw wells, the In 1988, with the inclusion of with handpumps, an estimated 2700 number of new water sources to Udaipur and Rajsamand, the stepwells and a large number of be constructed and old ones number of people served by the both community and private open improved, and the resource and 1 project rose to nearly five million. wells. training needs for field staff 'The Larget group belonging to 5270 and voluntary workers. villages in the four districts, were The survey stated that the total A limited sociological study, too, primarily of tribal origin, on the cultivated area in the two districts was carried out to determine lowest rung of the economic ladder, came to a mere 37.3 per cent, while community attitudes towards mostly non-literate and victims of only 8.8 per cent of it was irrigated. drinking water and health in the water scarcity and drought Wells, tubewells and artificial lakes rural communities and the problems conditions. were the main sources of irrigation. faced, specifically, by women in With an appalling literacy rale and the collection and distribution of lack of health aware-ness, the In the same year, when the Institute water for the family. of Development Studies (IDS), people, especially children, Jaipur, undertook a baseline chronically suffered from water survey in the project districts of borne diseases. The incidence of In December 1985, a workshop was Dungarpur and Banswara, they guin-eaworm disease was so high held in Udaipur, attended by the found that the region suffered that the two small districts together concerned local agencies ancl non- regularly from droughts, resulting accounted for 27 per cent of all governmental organizations in famine in the rural areas. The 6100 guineaworm infested villages (NGOs) working in the villages. land-holdings were small and in the entire state and 11 per cent of The NGOs associated with the generally low-yielding, and a large all such villages in the whole of project were Seva Mandir, Social number of the population earned a India. Work and Research Centre, Bharatiya Lok Kala Mandal and Mira Kala Mandir. At the workshop, the participants evolved methodologies and organizational arrangements for the training of different levels of officers and field staff. They also planned the development of training materials.

Based on the findings of the studies and the recommendations of the workshop, a Plan of livelihood only seasonally, as The Preparatory Phase : :i landless agricultural labour. The Action was drawn up jointly by region represented a rugged terrain, Unicef and the Government of drained by the river Mahi. The first of the series of studies was Rajasthan. For those involved in Deforestation in the hills had led to a hydrogeological assessment delineating the perimeters of future massive sheet and gully erosion which indicated adequate project activities, this was in itself a and the gradual silling up of the availability of safe drinking water learning process which they would river basin. The water table varied for the scattered population in the utilize later in the implemen-tation from 3 to 15 metres below the project area. Estimates were made and moni-toring of the project. 13 Finally, early in Literacy in Dungarpur and Banswara 1986, the IDS base- line study •was Rajas than Banswara Dungarpur Total Total Rural Total Rural commissioned, which was to form Male 36.3 26 23 23 26.6 the basis for impact Female 11.4 7.5 5 5 5.7 assessments and evaluations in later Source: "A Baseline Study of Banswara and Dungarpur Districts of Rajasthan (India)", stages of the Institute of Development Studies, Jaipur, 1986, Table 2.81. project. The study was expected to analyse the socio- methods of raising awareness initial field activities proved too economic variables in the two and involving the local ambitious, but the modest districts of Banswara and community in the conversion of achievements once again proved Dungarpur and relate them to the stepwells and the installation of to be a learning process of immense general issues of health and handpumps. value. Twelve stepwells were morbidity with special reference to • It would generate more data that converted to draw wells during the guineaworm disease. would help to give the Plan of April and May 1985 by the block The preparatory phase also Action its final shape. authorities. The experience envisaged the initiation of a limited revealed that the technical aspect number of field activities. This was Logistics problems, such as of the work was complicated designed to fulfil three objectives: procuring riser pipes for the enough for the Gram Panchayat to • It would build and sustain local installation of handpumps, or even undertake it on their own in the interest in the project and give it filling all the posts on the future. In addition, some of the a lasting and positive identity. organization chart, slowed down required transport vehicles were • It would develop, through direct the process in the beginning. The purchased during this period, field trials, more appropriate quantitative expectations of the drilling equipment was ordered and

Villages, Population and 1Households in Survey Districts

Name of Panchayat Number of Area Population Households Samiti/Block Villages (000 ha) (000) (000)

Banswara District 1463 503.3 831.4 140.1 Ghatol 222 77.8 135.2 23.6 Gar hi 167 71.1 152.0 26.0 Banswara 221 75.6 134.5 23.5 Bagidora 136 52.2 105.5 17.1 210 65.2 73.9 11.7 Sajjangarh 186 39.2 75.9 12.3 Bhukhiya 123 33.7 63.3 10.5 Peepalkhoont 198 88.4 91.1 15.1 Dungarpur District 837 379.3 638.7 113.8 Aspur 144 68.3 122.0 23.7 146 59.0 128.8 22.8 216 126.0 145.9 26.0 Dungarpur 156 54.8 103.7 18.2

Survey Districts 2125 811.3 1331.8 230.8

Source: Census of India, 1981, District Census Handbook for Banswara and Dungarpur.

14 a training programme for the VCTs a generally neglected factor in filter drinking water was present in was prepared. interventions in water supply: the the villages, many homes still did preference for a particular water not possess the double coloured source on the basis of individual filter cloth that was being distributed taste rather than availability or by SWACH at the time, near were accessibility. Even in a land hit by they overly concerned about it. The studies and the interventions drought, during times when water Instead, they often used a single at the preparatory stage had opened is available, people exercise their layer of thin cotton cloth which a window into the community in personal choice in the matter of would not block out the cyclops these two districts. Additional collection of drinking water. This carrying the guineaworm larvae. information came from official was later confirmed by a 1990 Incidentally, the double coloured reports and the 1985 Search Report Unicef commissioned study in cloth filter was devised so that it of the Health Department which Udaipur. Most of the villagers prefer would be easy to remember to have stated that there were 3306 cases of to drink well water rather than the the white side up always while guineaworm in Dungarpur district water from handpumps which is filtering water. Its effectiveness was and 654 cases in Banswara. stated to be metallic in taste and not later questioned and the cloth filter However, it would be prudent to as "sweet" as well water.2 was replaced by a plastic funnel remember that these figures belong filter with a High Density Poly- to pre-SWACH days, when lack of Later surveys, such as the one ethylene mesh. information or interest would result undertaken in 1989 by the Indian In statistical terms, amenities, in under-reporting of guineaworm Institute of Management, although only of a basic nature, are cases. The figures were probably Ahmedabad, in the first two project available in some villages in the much higher in reality. According districts, mention another facLor that project area. But these villages are to the report there were 5l6 operates in rural communities very few in number. Also, statistics guineaworm affected villages in the which limits the efficacy of cannot reflect the exact state of eight blocks of Banswara and 611 development efforts. A conceptual these amenities and to what extent in four blocks in Dungarpur; the understanding of a health need does all of them are functional all the number of stepwells was 700 in not always translate itself into time. By most recognized indicators Banswara and 2000 in Dungarpur. effective action. Thus, although the of development, Banswara and survey team found that the Dungarpur would be identified as The baseline survey brought to light knowledge about the necessity to two of the extremely backward

Villages Without Basic Amenities in Dungarpur and Banswara

Basic amenities Number of villages without amenities and their distance from villages with amenities Less than 5 km 5 to 10 km 10 to 15 km Total B.wara D.pur B.wara D.pur B.wara D.pur B.wara D.pur

Educational facility 552 220 22 11 4 _ 578 281 Medical facility 829 435 342 209 125 60 1296 704 Drinking water 10 2 1 - 1 1 12 3 Post and telegraph 842 487 271 88 164 30 1277 605 Market 315 25 338 39 770 77 1423 141 Communication 708 410 271 140 212 56 1191 606

Source: "A Baseline Study of Banswara and Dungarpur Districts of Rajasthan (India)," Institute of Development Studies, Jaipur, 1986.

15 districts of the country. Similarly, incidence of water borne diseases. medical workers and traditional the positive sex ratio can be birth attendants, and provide them misleading as it is skewed by the The approach adopted by the with additional training and fact of seasonal migrations by male project was based on certain information that would help pursue members of poor families to places fundamental principles, the first of the objectives of the project. However, the core person to initiate of work in neighbouring states. which was that all interventions had and mobilize support for the project to be carried out with the full in the village would be the "social consent and participation of the The survey also noted the animator", a person •who belonged advantages of the social community. Special emphasis was to the same community, who would composition of the region — the placed on women's involvement as be continuously trained and predominance of Scheduled Tribes it was their responsibility to collect supported by the project.3 in the population of the two districts. and organize the distribution of Although dominant caste structures water within the household. A Multi-directional Endeavour and economic interests do exist in the area, in a large number of Although the implementation of the SWACH evolved a number of villages where Scheduled Tribes are project's aims would be carried out programmes in an effort to create a the major social group, socio- by various official organizations wide network of activities, all of economic differentiation in the working in the field of water and which ultimately converged upon ownership of land and livestock as sanitation, it was considered the fundamental issues of health well as class distinctions are not important that the project take and a more productive existence in significantly present. However, the responsibility for ensuring that the rural community in these official power structures, such as these interventions were districts. Today these programmes the local Panchayat, the lower levels coordinated and integrated at the operate across all four project of government and police village level. districts. bureaucracy, petty traders and contractors play important roles in Training was considered to be • Orientation programmes were community decision making. important in initiating and organized for officials, middle sustaining the planned changes and level managers and grassroots the project, was to undertake the functionaries of various task of building up skills, methods government departments, such The project's stated objectives were and organizational capacity among as PHED, which was translated into the following action its own staff as well as among those instrumental in implementing plans: of participating agencies. the hardware infrastructure • Assist villagers in upgrading necessary to the project; the existing unsafe water sources It was also decided that besides Health Department of the state such as stepwells. implementing the hardw government; the Integrated • Provide new tubewells fitted are infrastructure for safe water Child Development Services with handpumps to habitations supply and environmental (ICDS) which has direct access suffering from scarcity of safe sanitation, the project should to the youngest children and water supply. also provide intensive health their mothers with its integrated • Strengthen and further improve education in schools, adult and programme for health and operation and maintenance non-formal education centres, education; the Women's systems for handpumps and health institutions and anganwadi Development Programme converted stepwells. centres. (WDP) which mobilizes women • Establish a process of for empowerment in village continuous health education in The project would naturally seek communilies; and the Education the project area. the support of change agents Department of the state • Improve domestic and environ- already working in the village, such government. The programmes mental sanitation to reduce as teachers, health guides, para- provided information about 16 SWACH activities and disease. Specially trained teams worm — who were trained to encouraged inter-departmental went to villages where detect and report guineaworm collaboration. guineaworm was endemic, patients in the early stages of the SWACH activities required the organized meetings and cultural disease. Through their efforts, cooperation of the people the activities which entertained many patients were treated project was designed to benefit. while they educated. The effort before they could transmit the All long-term interventions was to make the villagers willing disease. envisage a stage when participants in the sharing of development efforts must be information. • The scouts brought the patients sustained by the beneficiaries. to the special treatment camps No outside agency, be it In selected villages, animators organized by SWACH mobile government or voluntary, can were chosen from women's medical teams. Here the patients take permanent responsibility groups already active in the underwent a safe surgical for people's lives, without village, to provide continued procedure to extract the worms. critically injuring the health education and maintain a They were also told about how community's internal impetus link between the project and the to prevent guineaworm and for change. To involve the community. They were chosen given water filters for their people in their efforts, therefore, for their interest in the work, drinking water. The patients SWACH organized village their ability to articulate and helped the SWACH team identify contact drives, when villagers discuss the concerned issues and infected water sources and the would tell other villagers about their acceptability in the village District Health Departments SWACH objectives. community. Each animator were called in to treat wells with worked to bring about changes temephos, a chemical harmless The village contact drives used in health behaviour in her own to humans. both traditional and modern and two nearby villages. The communication methodologies. aim was to promote personal • On the basis of information A team of two men and two and family hygiene, environ- received at the camps and from women were trained from each mental sanitation, care and other sources, stepwells in the Gram Panchayat.4 For 15 days maintenance of handpumps, use villages of guineaworm patients the team spent a day in each of safe water and the prevention were converted to draw wells, village under the jurisdiction of of guineaworm disease. to prevent patients from walking the Gram Panchayat, spreading into the water and transmitting the SWACH messages through SWACH also supported local the disease. house-to-house contact and NGOs to run three-day organizing group meetings, awareness camps, where village • SWACH gave priority to remote cultural shows, posters, slogans women were given information guineaworm affected villages and school parades. In the on SWACH concerns and and hamlets. Once the process, the team gathered encouraged to improve handpump sites were chosen information on water, sanitation conditions in their homes and by the village women, the and the incidence of community. SWACH hydrogeologists guineaworm. surveyed the sites. The PHED Village contact drives, animators were called in to drill the finally From April to June, the main and Health Department searches recommended sites and guineaworm season when the together provided SWACH contractors under the mature female worm erupted out with reports of guineaworm supervision of PHED and of the body of its human host, patients. In 1991, SWACH SWACH installed the SWACH ran special campaigns started recruiting scouts — handpumps. to inform villagers about the young men from villages with prevention and treatment of the a high incidence of guinea- • Generally, handpumps in rural 17 Breaking the Life-cycle of a Guineaworm

Life-Cycle Possible intervention

Infected person • Health education to prevent patients steps into water stepping into water sources. source and • Protection, upgradation of unsafe water guineaworm sources. expels larvae • Provision of new safe water sources.

Person drinks Temephos application to kill copepods. water with • Use of fish as bio-control measure for copepods bearing copepods. the guineaworm Filtering of drinking water. larvae • Health education and drinking from safe water sources.

Treating the patient by surgically The worm matures extracting the worm before it emerges. and emerges • If the worm is already out, bandaging through the skin the affected part to avoid bacterial infection and larvae leakage. • Provide health education.

areas are not perceived as the were willing to take the pools. To avoid the health responsibility of any individual responsibility, and handpumps hazards thus created, SWACH or community, because in most usually remain in working order designed washing platforms and cases, they have been installed in the project villages. cattle troughs which collected by some outside authority. Meanwhile, the women waste water for reuse. A further Attempts to provide safe water developed a new status by addition was a drain leading off through the installation of successfully undertaking what the washing platform to water a handpumps have often failed was considered a man's job. small kitchen garden which the with the first instance of villagers were encouraged to mechanical breakdown. Although a platform was built plant near each handpump. As SWACH trained local women in around a handpump, the water the locally made soap used in handpump maintenance. As the draining out of the platform these villages does not contain women are the ones most tended to collect in the chemicals, the drained water affected by water scarcity, they surrounding grounds in stagnant cannot harm the vegetation. 18 Guineaworm Patients Treated by SWACH Teams in 10 Blocks of Udaipur, 1988 and 1990

1988 1990 Guineaworm Affected Guineaworm Affected patients villages patients villages

Kumbhalgarh 55 14 83 30 69 8 0 0 Gogunda 462 23 116 21 Girwa 94 9 62 18 Kotra 44 5 72 6 697 79 238 54 107 3 58 10 Sarada 549 42 436 74 Salumber 301 34 135 32 Kherwara 255 23 3 3

TOTAL 2633 240 1203 248

Source: "Village Study

Although SWACH did not build , in 10 blocks with a 1,604,653, of whom 729,696 were latrines and urinals for high incidence of guineaworm. of tribal origin. The number of individual homes, it encouraged purely tribal villages in these 10 villagers to do so by providing a Udaipur and Rajsamand have a blocks was 381.5 Between 1988 and subsidy and building simple, lower concentration of tribal 1990, SWACH medical teams treated easy to replicate, demonstration population than the first two project a total of 6415 patients (not counting units in selected schools in the districts. However, the general the repeat patients) in this area. project area. The school units conditions of life are very similar to Among the patients treated by are used and maintained by the those already studied in the SWACH medical teams, children students and teachers preparatory phase. The habits, below the age of .15 numbered 653 themselves. attitudes and social and economic in 1988, 715 in 1989 and 347 in status of a majority of the rural 1990. These were crucial years for population in Udaipur are no guineaworm detection in Udaipur. different from those of people in As the villagers became acquainted Because of the high incidence of the neighbouring districts of with the organized services of guineaworm in Udaipur and Banswara and Dungarpur. SWACI I, their awareness increased Rajsamand, in 1988, the project area and more ancl more guineaworm was extended to include these In 1988, the tota 1 number of villages affected people reported to the districts. Work was concentrated in the 10 blocks of Udaipur was medical teams well in time for the initially in the southern part of 2135, with a population of worms to be surgically extracted.

1 IC.EP Plan of Action, 1986-1990, Jointly Prepared by the Government of Rajasthan and UNICEF. 2 "Village Study on Water Use and Perceptions and Statistical Profile on Treated/Reported Guineaworm Patients and Villages", Chris Deegan, UNICEF, 1990. 3 IGEP Plan of Action, 1986-1990, Jointly Prepared by the Government of Rajasthan and UNICEF. 4 An elected body headed by the Sarpanch, which forms the local self-government unit for a cluster of about 15 villages. 5 "Village Study on Water Use and Perceptions and Statistical Profile on Treated/Reported Guineaworm Patients and Villages", Chris Deegan, UMCEF, 1990. 19 Communicating the SWACH message

uineaworm disease is reach the maximum number of phases, through May and June 1989, transmitted through people in the shortest period of in all 18 Panchayat Samitis of contami na ted drinking water —- this time. The first village contact drive, Udaipur ancl Rajsamand, when 300 was the first important message in September 1986, had 90 VCTs VCTs visited 3117 villages in these SWACH had to communicate to its travelling on foot covering 977 districts. target audience. It took a lot of guineaworm affected villages in the thinking and strategic planning districts of Dungarpur and The team members were local men before the message could be Banswara. Each of the VCTs and women selected and trained transferred simply and comprised two male and two female by SWACH. For the selection of the convincingly. The second important members who had undergone a team members, SWACH had message was — the water was five-day residential training course. requested the recommendations of contaminated by guineaworm By 1990, SWACH had organized various rural level functionaries, patients who entered the water two village contact drives in such as the Panchayat, the Block source. And that marked a return to Dungarpur and Banswara and two Development Officer (BDO), the the cycle of infestation. in Udaipur. Sarpanch and the Gram Sevak, as well as agencies working in the Even today there may be only a few The drives were organized for a area such as the 1CDS, the Non- villagers in the four SWACH districts twofold purpose: to elicit health formal and Adult Education of Rajasthan, who fully comprehend and sanitation information from the Department, the PHED and the the life cycle of the guineaworm; villages covered and to educate and Health Department. but each and every villager can inform the people about describe how to rid the village of guineaworm disease and other Training the Trainers • • ; guineaworm—by filtering drinking health concerns. However, a certain water with a funnel filter and by not flexibility was built into the concept, The recruits needed sufficient allowing guineaworm patients to of tne

Pu ppet shows were developed only during the fourth village contact drive and proved to be a great success. The animators and scouts performed in the shows themselves, improvising on their stories as they went along. The puppets often talked directly to the villagers, drawing them into a lively exchange of views and in the process, passing on information on health and guineaworm disease.

21 Health education was a major component of the project. Suitable educational material was developed by SWACH with the help of local artists and educators. The process started with the organization of a workshop where project personnel and artists, poets and composers pooled their resources to create the most effective means of communication. Both medium and message were discussed at: length, keeping in focus the extensive oral traditions of the area. Folk and traditional songs were adapted to convey messages regarding health, sanitation and safe water. The material was tested in the field the project, the people themselves government departments. At night, before being mass-produced, to became the medium for further puppet shows and cultural determine the level of transfer of knowledge and programmes organized by the VCT comprehension and acceptance in information on guineaworm with help from the villagers the community. eradication, safe water and enlivened the process of learning environmental sanitation. for the community. The process included a review of materials produced for earlier Many activities were undertaken as The drives were organized as an drives, which helped to retain part of the village contact drives. annual event and worked also as a flexibility of design, and changes Children were taught relevant self-monitoring device for the entire could be incorporated from time to slogans and taken out in a project. time according to the immediate procession in the morning. This needs of the project. was the Prabhat Pheri. Group meetings were held during the day The SWACH message used every to discuss health problems and their At one time, NGOs working in the medium that could possibly be solutions. Slogans were written with villages of India were perceived as utilized to reach the rural audience. the involvement of the villagers and more appropriate alternatives to While hardware interventions for posters were pasted on the walls of government intervention at the safe drinking water began with the dwellings. Door to door visits by micro level. But that was a long inception of the project, a large the VCTs brought the SWACH time ago. The concepts and training network was developed to message home to everyone and at strategies introduced and create a body of grassroots-level the same time, the teams collected developed by them twenty years workers, the animators, who information on guineaworm ago have consistently percolated to belonged to the community and patients, drinkingwatersources and the macro level government became key personnel in both sanitation requirements. Where programmes. Today, there is a formulation and delivery of project necessary, sites for handpumps definite effort within the official objectives. Audio-visual were identified in consultation with development bureaucracy to communication strategies and village women. emulate or adapt the NGO strategies material were developed through wherever possible and the small discussion and interaction with Local opinion leaders like the agencies are considered a valuable grassroots-level workers and local Sarpanch and the school teacher asset for supportive work in the artists, poets and composers. The were drawn into the programme field. participatory nature of the project for the day, along with the field s ensured that, in the final stages of functionaries from various In the four SWACH districts, a 22 network of NGOs have been from Udaipur and Rajsamand. covered on video as a result of a assisting the project in various collaboration with Video SEWA capacities. During the village Capacity building is an area where from Ahmedabad.

contact drives, the NGOs helped to the NGOs have been making on- :"• • ••• . * ..;;;;; • • • ••"••.;,•• :. ,:.":: • identify participants from the going contributions. NGOs like Communicating the SWACH villages; they also worked with Astha from Udaipur, Chetna from : Message •••.... SWACH in the implementation and Ahmedabad and Parvati from follow-up of the drives. Organizing Maharashtra have assisted SWACH The SWACH message emphasized training programmes for an in designing and conducting the health education, belter health increasing number of VCTs was training programmes. This includes practices and guineaworm their responsibility, as was the development of training eradication, as part of an integrated conceptualizing and running modules for the training of effort to improve the quality of life awareness camps for women. supervisory staff from various for the rural people of these districts. departments of the government. With guineaworm eradication as its The women's camps were most visible entry point, the project organized to mobilize the local The NGOs were also instrumental has been able to draw upon the women in various health and in the planning and developing community's own resources and environmental activities, and draw communication materials used in initiate a process of change in the them out of the secondary existence the SWACH programme. Apart from attitude towards family health and that patriarchal social norms have the workshops where hygiene. The direct involvement of imposed upon them for communication materials were the community in the project has generations. Seventy-two camps discussed, reviewed and formulated also resulted in greater information were organized in 1989, for with the help of the NGOs, the sharing and a sense of example, attended by 2409 women SWACH intervention approach was empowerment among women who 23 have played important roles in the project as animators and handpump mechanics,

A multi-level evaluative structure began with the animators who were also the major record keepers of the programme. SWACH called upon outside expertise from time to time to support and enrich the internal evaluative machinery. Specialist organizations and individuals have undertaken a large number of studies of different aspects of the project throughout its lifespan, auditing its progress, its innovative structure and its unique information and facilities in problems and its lessons. These method of safe surgical extraction resource starved countries with a studies have resulted in, among of guinea worm are important tropical climate. The SWACH other things, a large body of contributions to similar efforts all experience is particularly valid for recommendations that reflect some over the world. environments where a vast number of the problems that arise in such a Guineaworm, although it once of people have to make do with project as well as provide possible affected rich and poor alike, is now inadequate health delivery systems solutions. They have also more or less confined to and limited facilities in their daily established that the project's communities deprived of health lives. •

24 The personal touch

o he is 18 years old and her name is Jamkubai. She has read up to the seventh class. Even though as a child she married someone equally young chosen by her family, she still lives in her father's home. She will begin the life of a married woman soon enough, but perhaps she will never be quite like the other girls in the village. She even looks different from her friends, some of whom gather round her to help carry her load of paper. She is more businesslike, witli little of the traditional colourful ornamental exterior of the Rajasthani village belle. . • no access to women in homes other handpump maintenance and repair; Jamkubai is an animator for than their own. Paradoxically, it is motivators for planting kitchen SWACH. the women, confined to their own gardens utilizing waste water from little corner in the community and the handpumps; coordinators for leading a secondary existence, who different developmental have a free entry into all homes. A functionaries working in the village. She is known as sachetak in the network, of women, once They have helped promote local tongue. She is the vital organic established, can reach across the improved health practice and link between the project and the barrier to the men too through the environmental sanitation; community. family links. A woman animator constructed smokeless chulhas in therefore seemed the ideal person three villages; conducted women's With water and sanitation as two of to carry out the complex collection awareness camps; tracked down the major concerns of the project, it of tasks assigned by the project. guineaworm cases and informed was decided that the animator Through the years, these women the SWACH medical teams; and should ideally be a woman. In the proved to be invaluable assets to right through it all, kept the line of household, water and sanitation SWACH. communication open between the concern the women most of all. It project staff and the people. would be easier for a woman The role of the animator was animator to reach other women in defined variously throughout the the village. With all their powers of project, and no single definition decision making, men are limited can describe it fully. SWACH The concept of a social animator to the male world in the closed animators have worked as health was there in the project right from village society; they have little or educators; supervisors of its inception. However, it took a 25 long time to work out the gumeaworm message, and, at the the animators belonged to parameters of the job in a way that same time, raise the consciousness Scheduled Castes and Scheduled would make the animatora credible of the women. Tribes, the weakest, sections of and acceptable person both to the society. In Dungarpur, however, project staff and to the rural Finally, the project took the initiative 18 of the 44 animators came from beneficiaries. Among the many in early 1988 and began recruiting higher caste Hindu homes. About hurdles were the following, women as animators. In each block half of them hacl not gone beyond • Men in the community did not a day-long recruitment camp was the fifth class, but in Banswara, allow the women to participate held and women came to know about 36 per cent had read up to in community activities. about it through an informal high school. • Women were afraid of network of friends and family participating because of the members who had been earlier By June 1988, 21 supervisors had social barriers to women's associated with development also been appointed. Together, the involvement in these activities. programmes, or through members animators and supervisors were of the VCTs, instructors of non- expected to cover about 700 villages The real relevance of the need to formal and adult education — a little over 30 per cent of the change attitudes and habits that had programmes, WDP sathins, and villages in the two districts. To begin lasted for generations was NGOs working in the area. Some of with, each animator had to visit five perceived only gradually, and as them were sent to the camps by the to seven villages regularly, with a the project moved forward, the BDO, or the Sarpanch of the village. population of 4000 to 5000. It soon priorities changed. The project became evident that instead of attempted to overcome these The first lot of animators were from covering a large area, it was better hurdles through women's the first two project districts: 71 to concentrate on fewer villages awareness campaigns. Camps were from Banswara and 44 from and then move on to a new cluster organized during the day and in the Dungarpur. A majority of them were of villages. A follow-up could be evenings there were puppet shows, between the ages of 18 and 26. In done the next year on the first set of role plays, etc. to communicate the Banswara, more than 60 per cent of villages. An animator today visits

Bhanwari Bai of Badgaon1

Among all the animators of Udaipur district., now want to construct soak pits in their own homes. Bhanwari Bai had the highest score in the lest that As the handpumps in the village do not have washing followed the animators' training programme. She platforjns or cattle troughs, it is difficult to keep the belongs to the brahmin caste and has been working surroundings clean. For Bhanwari Bai it is a constant as an animator ever since her training. With six battle to keep the handpumps clean and functioning. children and a blind husband, she is the only She feels she has too much to do for too little pay. wage earner in her family. She enjoys her work in However, she is keen to continue with the work, not her cluster of three villages, hut it is her own village only because it gives her a livelihood, but also because and her own caste group that have benefitted most she is aware of the positive impact of the programme. from her work. Ihe maximum number of funnel The local auxiliary nurse midwife (ANM), the school filters have been distributed among the brahmin teacher and the Sarpanch are all very supportive households and 17 latrines have been built in towards her, as are the brahmin women. The trihals brahmin areas. Only one latrine was constructed too are aware of her work, even though she does not in the area where the tribal community visit them frequently, lives, Bhanwari Bai says, it is difficult to convince tribal people about the need to build their own Bhanwari Bai is a typical example of a promising latrines. animator who has achieved much, hut within a smaller framework than the one delineated for her. In her own village, Badgaon, Bhanwari Bai has Support, guidance, encouragement, and perhaps some achieved a great deal. Soak pits have been dug additional incentive from SWA CI1 would help increase and are working well. Some of the village women her effectiveness in the community.

26 each of her three villages within women brought up in a highly As animators, for the first time in five kilometres of her home, about patriarchal environment, with a their lives, they saw themselves as six times a month. predetermined future of people with a purpose. They were subservience and toil. As girl of use to the entire community and By 1992, there were 352 animators children, they were perceived as nobody, not even the men, could in action in four districts of the already belonging to another home deny that. They realized that they state, along with 897 scouts and 99 — the home of their husbands — were doing non-traditional work, supervisors. and as such, bad investments for and for a salary which, however their fathers. As women, they small it was, meant a great deal to the Wbin«ht a New World; remained at the back of the queue their families. In traditional in the distribution of food, perceptions, they were doing "a The animators who worked in the nourishment and health in the man's job" and doing it with project, did so not only because of family. They worked all day in the confidence and efficiency. The the monetary incentive, but also house and in the field without any work also gave them time and space because it was a new and visible remuneration. Their work outside their confined existence. It stimulating experience which was not measured in terms of gave them entry into a new world. changed their lives. One look at money and hence was considered Jamkubai and her colleagues would non-existent, Therefore, they had This was the final motivating factor explain this factor much better than no right to decision making in any — empowerment — that was to a thousand words. area which was considered play a major role in the recruitment important enough by the male of women handpump mechanics These animators were young members of the community. as well.

Kamla Devi of Katumbi2

Katumbi is a tribal village with a population of borne diseases andguineaworm. They also know how 2500. Situated 20 kilometres away from the well water gets infected with guineaworm. The Peepalkhanl, the block headquarters inBanswara, children are not allowed to defecate near their homes the village has a bus stand and a post office. and if only they had enough money, the villagers Kamla Devi, 35 years old, is the animator in would be quite willing to build their own sanitary charge of this village. She belongs to the Scheduled latrines, 'lhe women generally keep their homes clean Caste. even though most of them are mud huts with two rooms and hardly any ventilation. They throw garbage, Other than the stepwells and individually owned kitchen waste and coivdung in a compost pit located wells, there are six handpumps in the village. The near the fields and house their cattle in a separate handpumps have been used more ever since shed. SWACH came to the village four years ago. Even so, there are tribal families who get their water Kamla Devi makes frequent home visits to check on from the wells because the handpumps are too far cleanliness and talks to the people about health and away from, their homes. All the handpumps have sanitation. Sometimes she stands near a handpump cattle troughs and washing platforms and the and observes how it is being utilized. She organizes waste water is diverted to the cultivated fields. The street plays and processions, uses songs and discussions handpumps are kept clean; the surroundings are to convey her message to the community. free of garbage, or insects. The women in the village regularly filter their water and use the The people in Katumbi are poor and with low or non- washing platform to clean the vessels and wash existent literacy skills. As tribals, they also belong to a clothes. There is also a woman handpump less privileged section of society. But these factors have mechanic working in the village, so the handpumps not worked as deterrents in their willingness to improve are in excellent condition. their lives. Katumbi is an example of how much a motivated and hardworking animator can achieve in The women in the village are aware that filtering terms of community response to a development the water keeps their families safe from water programme.

27 LIST OF COORDINATORS/SCOUTS/ANIMATORS & WOMEN'S GROUPS SWACH PROJECT AREA (JULY 1994 TO JUNE 1995) Panchayat Samiti Supervisor Coordinatoi Scout Animator Total (Block) Udaipur 13 44 383 238 678

Dungarpur • 5 25 184 105 319 Banswara 9 10 106 50 175 TOTAL 27 79 673 393 1172 Source: SWACH Donor Report, 1994-95

The training was participatory in discharge of the larvae in case the The Scouts: nature and had a large audio-visual patient went into a water source; The female animators were assisted component. The scouts were taught and it. identified the person as a in their task of reporting cases by how to identify the patients and fill guineaworm patient. At the end of male scouts. Villagers as well as in reporting forms. In case the worm the training course, the scouts were village level functionaries helped was already on its way out through given a kit containing bandages, the project to identify these young a blister, the men were also taught educational material, a register, men. Six training courses were to bandage the affected limb with reporting forms and postcards. organized in 1990-91, where the medication for swelling and pain. prospective scouts went through The special bandage came with a To support and motivate the scouts, the same sort of intensive drill that plastic backing and served two the project appointed coordinators had been used for the animators. other purposes — it prevented the selected from the members of local

28 NGOs and from earlier village water sources, and escorted patients guineaworm patient to the medical contact drives. The coordinators to the SWACH medical treatment camps at a pre-infective stage. This were trained along with the scouts, camps. incentive was increased to Rs. 500 bul they attended additional sessions on supervision and in the last two years of the project reporfing. Each coordinator was Surveying the water sources (1994-95). responsible for anything between was another regular task for 10 to 30 scouts, whom they would the scouts. They updated the As a support system for the meet regularly in their villages as SWACH records and assisted project with special focus on well as during prearranged the local health workers in the guineaworm, the scouts have fortnightly review meetings. chemical treatment of unsafe wells. performed an invaluable service. Their reports were discussed along The increasing number of patients The scouts supported the animators With the cases at the fornightly by visiting the villagers in their who were treated before they meetings and the information was homes weekly to check out on old reached the infective stage bear and new guineaworm patients. shared with the local Primary witness to their labour. The zero Their main purpose was to detect Health Centres (PHC). A special incidence of the disease achieved patients before they reach the incentive scheme provided the in 1995 bear testimony to the infective stage. They also educated scouts a payment of Rs 100 in significance of the scouts' patients about the health hazard addition to their normal salary, contribution. associated with their entering open whenever they brought a

Bhanwari Bai's experience based on "Role of Animators in Promoting Health and Sanitation among Rural and Tribal Women in the SWACH Districts of Udaipur and Banswara," Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1991. Kami a Devi's experience based on "Role of Animators in Promoting Health and Sanitation among Rural and Tribal Women in the SWACH Districts of Udaipur and Banswara," Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1991- 29 Surgical extraction of guineaworm: a solution to many ills

or over a century it has been ^Surgical Extraction arid because excessive tension known that guineaworm is Swift Relief ••,,.:, .. \ could result in disruption of the transmitted by cyclops, water fleas worm and anaphylaxis or that ingest the guineaworm Patients who have had guineaworm allergic reactions. 1 n contrast to larvae left in it by an emerging worm before, can very easily make out worms that have partially when a patient immerses the the presence of a new worm days emerged and are surrounded exposed worm in an unprotected before it is ready to emerge. They by an inflammatory reaction, at water source. The traditional are aware of the worm moving this early stage the worm is method of drawing out the under the skin once it has come up readily dislodged from the emerging worm on a stick, when to the subcutaneous region. Also, tissues and with gentle and accompanied by bandaging of the the position of the worm is actually persistent massaging, it can be lesions, can help to prevent visible under the skin. By palpating completely and painlessly secondary infection as well as the skin, the surgeon can more removed. contamination of the watersources. clearly identify the course of the But it takes a long time and cannot worm. After disinfecting the • In some cases, adhesion to the wipe out the pain, the suffering, the affected area with alcohol, this is underlying tissues makes disability or the loss of livelihood. how the surgeon will handle the extraction from a single incision case: impossible. In such a case, a Modern medical practitioners second incision close to the area usually get to see the patients only • The mid-portion of the worm is of adherence may be required when the worm has erupted and identified and following local to release the intact worm. often after toxic effects have set in anaesthesia with 0.5 ml of as a result of the spilling out of • One case in 10 requires actual procaine, a 1-cm incision is larvae in the subcutaneous tissue. disruption of the worm, •which made parallel to the body of the This means that the worm can no is done only following careful worm. longer be extracted safely and has milking of the entire contents to be left to come out on its own, • The blunt end of a sterile needle of the body of the worm to taking weeks, while the doctor is used to withdraw the worm avoid any local or systemic prescribes antibiotic therapy, from the subcutaneous area, reaction to the highly allergenic tetanus toxoid and the use of with a second needle beingused larvae when the worm is bandages. to tease away adherent disrupted. The incision is then connective tissue, which allows bandaged and healing occurs In southern Rajasthan, ayurvedic the worm to emerge from the within a few days.' doctors who form a part of the rural wound and be gently grasped. health delivery system, have in the • The surgeon applies constant The entire surgical process last two decades developed an traction, being careful not to described above generally takes innovative procedure for extracting disrupt the worm body, and about three to five minutes. It is the worm surgically, which avoids gentle massaging of the area to simple and painless, but can only the hazards of the older method release the worm from tissue be undertaken when medical still in use in most parts of the • adhesions. This is the most attention is sought prior to eruption world. delicate part of the operation of the worm. 30 THE PROCESS OF SURGICAL EXTRACTION

31 presence. Surgical intervention at patients and disinfection of A Sociological Study • the primary stage, when the worm open water sources, which could be removed intact, break the chain of transmission. This extraction procedure was dramatically reduced morbidity and • A reduction in transmission •scrutinized by different teams of the number of work days lost. The of the disease as a result of experts. In 1990, a study team surgical procedure was more the extraction of the worm observed the precedure as applied difficult once the worm had before it has the opportunity to to more than 800 patients. The emerged and begun to eject its release its larvae into the patients were treated by a mobile larvae. The inflammation of the area environment, 2 team headed by Dr B.L. Sharma, made it nearly impossible to extract which served more than 3000 the worm completely and without The findings of the study villages in Udaipur district, under rupturing it. Rupturing of the worm emphasized the need for intensive the SWACH project. Of these, l6l led to release of the larvae and local health education and large-scale patients who had presented no infection, causing disability that communication efforts in the more than a single worm, were lasted for months. attempt to eradicate guineaworm taken as the basis for measuring disease. To be most effective in disability related to a single worm The study felt that although healing and controlling the disease, and the effects of surgical traditional healers in India had the surgical extraction procedure intervention. Symptoms, days of practised similar extraction must rely on the people's willing illness and work loss were recorded techniques for a very long time, the participation in the effort to and patients visited in their homes lack of local anaesthesia and the eradicate guineaworm. This implies until they resumed normal activities. absence of sterile techniques at that that the people must first have the time made such interventions required information which would The study found that extractions hazardous for the patients. Modern motivate them to report the cases at performed before the appearance aseptic techniques, on the other an early stage. A significant role of a vesicle meant only three days hand, and the use of the Simplest was played by the social animators of work loss and the wound surgical instruments under local and health educators in this context. completely healed within nine days. anaesthesia, not only made the Demonstrations of the positive Even after eruption, wherever it procedure painless, but reduced results of this method of extracting was possible to extract the worm disability from the usual six to eight the worm also would have a direct using this procedure, disability was weeks to a mere day or two after effect on the community. substantially reduced in extraction — the time it takes to comparison with the traditional heal an ordinary, small cut. methods. The cases where the number of days of work loss The study identified the most exceeded 20 days and healing took significant results of this procedure A second ma jor study that evaluated six weeks or more, the adhesions as the surgical extraction procedure had made it impossible to remove • A dramatic reduction in both was conducted by a team whose the entire worm. But with proper acute and chronic disability concerns were addressed directly medical care and the draining of associated with guineaworm to the medical efficacy of the the abscess, the patients were safe infection. procedure and its long term from the common after effects. acceptability within the medical • A dramatic increase in both the profession. A four-member team of ease of detecting cases and in The study found that most patients experts from the All presentation at an early stage of attending the SWACH medical India Institute of Medical Services the infection. camps were actually aware of the (AIIMS) in Delhi visited Udaipur in presence of the worm days before • A resulting improvement in July 1991 with the objective of the onset of morbidity or disability control and containment evaluating at first hand the surgical associated with the worm's procedures, such as isolation of extraction of guineaworm as it was 32 being carried out by the SWACH there, to get an idea of the would help to identify possible medical teams. The evaluation was professional attitude towards this obstructions in similar projects in to be based on the feedback the procedure. Three of them had never diverse environments. team received on specific areas of removed a guineaworm and did interest: not think it was necessary to do so. • The system of merely bandaging • Safety of the surgical procedure All three believed in a "wait and the cases where the blister has and its secondary infection rate watch"policy until the worm formed should be modified to and potential. erupted, after which they would the application of a dressing • Efficacy of the procedure as treat the wound as any other pad followed by the application measured by the success Kate in abscess. Interestingly, in support of a broad, waterproof surgical removing the entire worm. of their beliefs, the doctors pointed tape, to completely seal off the • Benefits to the patient in terms out that none of the accepted worm from the exterior. A of reduced morbidity and textbooks advocated surgical simple cloth bandage will let enhanced recovery in contrast removal of the worm before it the larvae escape into the water. to the conventional emerged from the skin. The fourth • The surgical technique should management of the condition. doctor, however, claimed to have be slightly modified so thai the • Acceptability of the procedure surgically removed guineaworms a wound is closed with a butterfly for the patient and its potential number of times earlier in his career shaped adhesive plaster applied for meeting the felt needs of the and was aware of the lack of risk so as to keep the cut edges in population. • involved and the considerable apposition whenever the incision • The likely impact on the advantages of removing the worm tends to gape, because of its eradication programme. before it broke the skin. position on the body, or when it is longer than about 0.5 cm. Although the short visit did not The AIIMS team's recommendations • If the technique of surgical allow for a systematic, in-depth, began with enthusiastic support for extraction is to be considered statistically valid study, it did allow the procedure: the treatment of choice for the the members of the team to see the The surgical removal of pre-emergent stage, the number medical teams in action and judge Guineaworms, especially of people trained in the for themselves the impact of the those in the first stage technique wil 1 have to be greatly surgical extraction procedure on (that is before the worm has increased. the individual and the community. erupted) should be the The team met the fieldworkers and method of choice for the • Training material should be officers and were given a clear idea management of Guinea produced for this purpose, of the objectives, methodology and worm disease.... There is no including audio-visual material, activities of the SWACH project other form of treatment which would visual ly clarify the before witnessing patients being that gives any comparable process. operated on for guineaworm. They degree of relief to the patient. • Publicity should be given to the also examined earlier patients who procedure so that more people had already undergone surgical The team made detailed are informed about its intervention for guineaworm, recommendations. Some of them acceptability in the community listened to the views of over a pointed out organizational as well as within the medical hundred past patients and members weaknesses such as lack of profession. of affected villages, and scrutinized adequate collaboration between the many converted stepwells and government's health services and • Protected and converted wells handpumps in the area. the SWACH teams. Others referred should be sign-posted. Once to training needs, or even the people come to associate On the last day of their stay, the improvements in wound the sign with safe drinking AIIMS team visited a referral management techniques. A random water, they will drink only from hospital and talked to four doctors selection of the recommendations sign-posted wells.3 33 In reponse to the recommendations SWACH districts as well as building a relationship with the of the A11MS team of medical elsewhere. community. This was important for experts, SWACH has prepared a project which had long-term goals detailed guidelines and video For SWACH, the visible benefits of that went far beyond immediate teaching modules for guineaworm the surgical extraction procedure gains, eradication efforts within the contributed significantly towards •

1 "Surgical Extraction of Guinea Worm: Disability Reduction and Contribution to Disease Control," Jon E. Rhode et al, American Journal ofTropical Medicine and Hygiene, 48 (1), 1993, pp- 71-74. . 2 "Surgical Extraction of Guinea Worm: Disability Reduction and Contribution to Disease Control," Jon E, Rhode et al, American Journal of Tropical Medicine and Hygiene, 48 (1), 1993- 3 AIIMS Report on the Surgical Extraction of Guinea Worm in the Swach District of Udaipur, 1991.

34 Installing the hardware

he Plan of Action had No standard design was used in the wells with temephos 50 per recommended that the civil converting the stepwells, but care cent EC to kill the cyclops, and engineering activity of the project had to be taken to tailor the design inculcating the habit of filtering should be entrusted to the Gram to the specific requirements of the water fordrinking purposes at home Panchayats, who had the capability well. Once the steps were closed, a as long-term preventive measures. of independently undertaking the parapet was built around the well conversion of step-wells, while the and pulleys fitted for the drawing Although the conversion work was project provided the funds and of water with a rope and bucket, eventually undertaken by SWACH, supplies. The villagers were familiar thus eliminating all possibilities of the workers made consistent efforts with the skills required to build direct physical contact with the to retain the community's interest wells and all that was really needed water of the well. In some cases, in the project. To this end, the wells was for the project to be able to the wells were fitted with for conversion were first identified supervise and guide them in the handpumps. by VCTs whose members belonged work. to the local community. Conversion of the stepwells was Subsequently, junior engineers But these were early days and the one of the highest priority employed by the project were motivating impact on the operations in the first year of the consulted for feasibility. The need community of the network of project. SWACH workers knew that, to identify these wells arose out of animators and scouts had not yet by closing the stepwells, they would the fact that many more wells gained adequate strength. In immediately cut off any further existed in the region than what the addition, with the proposed transmission of guineaworm project could reasonably deal with Panchayat elections in the offing, it disease. The next stages would be in this initial phase. It was decided was difficult to arouse enough chemical treatment of the water of to rank the wells on a scale of interest among local opinion leaders in the conversion process within such a short time. Finally, it was decided that the project should begin the work with its own staff.

The conversion of stepwells could only begin by mid-October 1986, after the first village contact drive had been completed and the water in the wells had receded sufficiently after the monsoon. Between October 1986 and June 1987, 1912 out of the targetted 2200 stepwells were converted to draw wells. priority, and to convert only those Conversion of stepwells and their major objective of the programme, wells which were identified as maintenance were ongoing it was decided that priority would actual or potential sources for activities of the project. Priori- be given to those villages which guineaworm disease. tization of the wells according to reported the largest number of their primary use was necessary guineaworm cases. Information The pace of the work picked up only because the project did not about these villages came through after some initial slowing down have the kind of resources needed village contact drives, house visits to convert of animators and the medical each and searches undertaken by the Number of Stepwells Converted up to June 1995 every well in National Guineaworm Eradication Period Banswara/ Udaipur Total the area. Programme. Any seriously Dungarpur This implied conflicting information among that wells these three sources was to be 1986-1987 1912 0 1912 which were checked up directly by the project 1987-1988 957 1063 2020 totally or staff. 1988-1989 1636 1799 163 mostly used 1989-1990 133 725 858 1990-1991 374 535 909 for drinking It was also decided that the villages 1991-1992 325 423 748 water were thus identified could not. be taken 1992-1993 324 611 935 the first to be up entirely in isolation of their 1993-1994 - • 223 converted. neighbours. It was felt necessary to

19944995 - - 91 adopt a "cluster" approach to ensure Total 4188 4993 9495 Innumerable swift control over the disease. wells are Working not just in a single village, Source: SWACH Progress Report, UNICEF, 1993, used for but in a group of villages implied a 1994,1995. irrigation certain economy of scale: it saved purposes in on staff resources and made for resulting from organizational snags this part of the state. These were more efficient transport of material in the second quarter of 1987. At not earmarked for conversion, required for infrastructural change. the beginning of the project, 2700 even though thirsty fanners did wells were targeted for conversion drink from them during working •Stage I'wo: Identifying : i in Banswara and Dungarpur hours. The assumption here was ;::;;;Sitepwclls for Conversion ;i and 3200 in Udaipur and that the likelihood of contamination was immensely aggravated in wells Rajsamand. By 1993, the wells Once a village and a cluster were that were used primarily for actually converted numbered 4188 identified, the junior engineers were domestic purposes. Converting in Banswara and Dungarpur — supposed to take on the task of them would swiftly control the 155.11 percent of the target —and spread of the disease and lead to its making a comprehensive list of all 4993 in the other two districts — eradication; while, in the absence the wells to be converted within 156.03 per cent of the target. By of any positive indication of the cluster. In the process of 1995, 9495 wells were converted in contamination, the wells used for identifying the wells, it was also the whole project area. irrigation could be left unprotected possible to mark out wells which without endangering the needed to be provided with a The original or model-estimate community. handpump. The requirement for expenditure for the work was Rs Guidelines were set up for every such handpumps was passed on to 5500 (US $ 176) per well converted stage of the programme. the Project Director who would in 1986-87, and Rs 6000 (US $ 192) immediately initiate the process of in 1987-88. By the end of June 1988, Stage One:ideHtifyingVillageis procuring the necessary equipment. the annual actual average cost per with the Greatest Need well was down to Rs 3954 (US $ Before sanctioning the conversions 127). With guineaworm eradication a however, the Project Officer and 36 the Assistant Project Officer Project Implementation Committee converted were not all of the same (Technical) were expected to visit were called upon to intervene. size or type. Taking into account at least 30 per cent of the listed some basic characteristics of the On the other hand, there could also stepwells. Such a random check stepwells in the area, a few model be occasions when the project staff would ensure that the wells designs were prepared. These were pressurized by the community conformed to the project criteria. would serve as general guidelines to convert a stepwell that did not For example, wells that were used to the staff in making the necessary meet the priority criteria. The project solely for irrigation were not. to be changes for conversion, as well as staff, and when required, the Project converted. Only those wells which provide a basis for estimating the Director, were then expected to appeared to have a direct resulting expenditure. However, as carefully explain the position of the connection with the spread of the wells could not be transformed project and convince the people guineaworm disease would qualify in any standardized manner, the about the validity of their stand. for change. But among such •wells, junior engineers were expected to the ones that provided drinking All such communication with the treat each well as a unique case and water to the largest numbers would beneficiaries of the project were evolve the most suitable and be the first to be taken up for carried out in the form of a dialogue, economic: design for that particular conversion. a sharing of knowledge and well. While evolving the design, a information about health and junior engineer was supposed to The verification effort also included sanitation, a gentle breaking down ensure the cooperation of the local the assessment of all other drinking of any resistance. The assumption people, as that was the only way water sources in the cluster, so that was that more often than not the the design could genuinely fulfil future planning could take into villagers had perfectly good reasons the felt needs of the people. Also, account the need for new water for their objections, or they had consulting with the community was sources, the requirement for repair valid questions that needed to be a way of bestowing a sense of and maintenance of existing ones answered satisfactorily before they responsibility on the community and the execution of sanitary could accept the change. for the upkeep of the converted interventions, as well as work out well. efficient drilling and rig movement The project staff were urged to explain the project in detail to the routines. The final design and estimate for villagers, clearly stating the long- converting a well took into account term goals and the holistic Stage Three: Interacting with the following considerations: approach. At the same time they Individuals and the Community • The conversion must be so were exhorted not to make designed as to totally prevent unrealistic promises about when or There was one self-imposed rule any human contact with the to what extent utilities could be which was strictly followed right water. provided. through the project. No stepwell • A parapet should be raised was converted to a draw well Conversion of private stepwells around the well so that children without the consent of the demanded that the owner make a were not endangered. community orthe individual owner, formal request to the project and • The edge of the parapet should even when government regulations fill up and sign a formwhic h stated slope outwards so that it would protected the decisions of the the number of people using the not be used as a washing project staff. This meant that the well and the number of people platform and no waste water project staff might from time to time affected by guineaworm disease would drip into the well. have to spend extra hours in after drinking the well water. • The well should preferably be attempting to educate and convince dewatered so that it could be the people concerned, before any cleaned properly. change could be instigated. Where • All plants in and around the persuasion did not prove easy, the well should be removed and all Project Director and the District Stepwells that needed to be gaps and holes in the walls 37 procurement of materials would begin while the estimates were still being prepared for each well in a cluster. The annual target would provide a broad pattern of requirement for materials such as cement, • sand and stone, handpumps or pulleys.

Arrangement for the purchase and transport of such items would have to be made before the final expenditure could be ascertained, simply because waiting for the estimate of each well meant a long gap between planning and plastered above seepage level, execution—defeating the purpose to avoid future pollution. Stage Five! Planning arid of the project. The longer the wells : The mud at the bottom of the Reviewing the Work ' . ' "• •:•=• were left unattended, the greater well should be removed as it would be the number of people usually (contained) cyclops Targets set up at the beginning of suffering from guineaworm disease. especially during the cold the year only applied in so far as Also, multiple sources for the season when the conversions they formed a framework within required material would mean less were scheduled. which to evolve the short term bottlenecks. Draw wells used by less than 20 plans. It was considered easiest households were to be given a to stick to a monthly schedule for During the monitoring meetings at single pulley. immediate work plans, reviews the beginning of every month, In only a limited number of and accounting. Reviews of assessment was made of the cases, mostly where wells were the hardware inputs were to be requirements of each junior in public places and used by based on the monthly progress engineer, following which the more than a single community, reports prepared by the junior material was sent to the actual handpumps would be attached engineers. construction site of the local to the wells to increase public centralized store maintained by the access to the available water. A major concern in this activity was junior engineer. When a well was used for both the coordination of the two irrigation and drinking water, fundamental aspects of the SWACH Stage Seven: A Hands-on Joibi:::: the conversion of the well project — the hardware should take into account the interventions and the "software" The construction work was to possible use of a pumpset. activities like the training of follow a seasonal pattern, Otherwise, the owner might grassroots workers, health dependent on the availability of have to tear down or damage a education and community labourers and the height of the section of the parapet to have involvement. water table in the well. Right after the pumpset functioning. the monsoons, the water table was For the purposes of record • Stage Six: Procuring and too high for work to be carried out keeping, the converted well Distributing Material Needed effectively. In the winter, which should be marked clearly with for Conversion ;; ^E would otherwise be the ideal time a plaque stating the year and of the year for converting the wells, month of conversion and giving It was decided that based on the dewatering of the wells might an identi-fication number. target set for the year, the interfere with irrigation. However, 38 the period when the maximum transmission of guineaworm disease took place every year, was between April and June, and the conversion of the wells would thus have to be completed before the summer set in.

The construction work had three stages — dismantling, earth work and masonry — and in making the estimates the junior engineers had to depend on the basic scheduled rates acceptable to the state government. There would be occasion to exceed these limits and in those cases, the estimate needed a special approval of the Project of Udaipur, Rajsamand, Dungarpur The SWACH intervention intended Director. and Banswara, the handpump is to change this scenario forever. The helping specifically to eradicate the communication and motivational Once the construction was over, dreaded guineaworm. input of the project laid particular the converted well was left emphasis on the people's own unutilized for at least a week to responsibility in improving the allow time for the new wall and health and life of the community. parapet, the frame and the pulley Integrated into this effort was an to become part of the old well. Two major problems were additional impetus to bring the Guarding the well against misuse associated with official inter- women forward and help to give during this time could very well be vention in this area: them a voice. a task for the community to take up • The selection of the previous together, At the same time, to ensure sites was not always based on In the tradition-bound society of that the conversion of the wells had maximum accessibility. Rajasthan, women have played been undertaken systematically and • An effective system for routine particularly submissive roles for efficiently, a routine inspection maintenance and repair had generations. This is not to Say that schedule was developed for the never been put in place. in the villages of southern Rajasthan senior project staff. As a result, many of the working women are always hidden from the handpumps were monopolized public eye. However, their by a small number of people or jurisdiction is so limited that their were situated in so public a place marginalization in their own that the village women would community has been far greater Handpumps have indeed reversed not go to them. When the hand- than in many other parts of the the curve of suffering in the villages pumps developed problems, they country. Yet, it is the women who of Rajasthan. They have brought were abandoned by the people, collect and distribute water in the safe drinking water in dry, rocky either because no one took household and it is they who tend terrain, to villages far away from responsibility for maintaining a the sick. The project's perception the state's health services, and handpump, or because it was a was that it would be merely logical reduced morbidity from water complicated and long drawn out to involve the women in decision borne diseases that affect large process to get a mechanic through making in the installation of sections of the population, most of the official channels to repair the handpumps. If in the process the whom are children. In the districts handpump. women gain a sense of self-worth 39 and learn to assert their rights, the sites. SWACH hydrogeologists spatial distribution of the community can only benefit from identified drilling sites with the help handpumps was particularly their achievements. of hydrogeological maps provided inefficient, it was decided to have To make sure that the villagers were by the government of Rajasthan and more handpumps than required by not only aware but also involved in Wadi Terrameters,' which the general criteria. the activity, SWACH workers improved the success rate of the established an appropriate set of drillings effort from 85 per cent to Stage TWb: Identifying the "Site : procedures. The sites for 91 per cent. " for Drilling •.••..;..'.. :•;...: ; ••/§ handpump installation were chosen by Lhe villagers, primarily the Stage One: Selecting the Village Site selection began in an area with women who were asked to express the lowest density of handpumps their priorities during village contact The hydrogeologist was to make and a high guineaworm infestation. drives. Every site was thereafter an invaluable contribution to the The selection was planned in such checked by the project staff to selection of the drilling site. But a way a s to allow for easy movement ensure they fulfilled social, before that, a rough and ready needs of the rig from one site to another. environmental, technical and assessment had to be undertaken. All the sites in a single village, for hydrogeological requirements. The criteria were example, would have to be decided Today this methodology has • There should be one handpump upon at the same time, so that the percolated to the government to 200 people in a compact rig would not have to return to the department PHED, which applies habitation. village again and again. Areas it to drilling operations, wherever • Hamlets with a population of known to have high failure rates possible, in other parts of the state. 100 and above who have no would require thorough handpump, shoulcl be provided hydrogeological investigation Wadi The failure rate has been low within with one. Terrameters would be used in such the project, primarily because of • In hamlets with less than 100 areas, along with maps showing the careful assessment of drilling population, the stepwells lineaments. should be converted, but A simultaneous activity was the handpumps may village contact drive run by a team be installed if there of local people trained for the were no stepwells. purpose. Through its continued • Wherever efforts to disseminate the handpumps guineaworm message, the VCTs reportedly gathered information on a variety produce bad of activities and problems quality water, a associated with health and handpump environmental sanitation. The may be fitted to requirement of handpumps an available emerged from this interaction at stepwell rather the village level, particularly with than drill a new women. borehole. A few additional points to For villages with a remember in choosing the site for a higher incidence of handpump were guineaworm, • The users, especially the villages with women, should approve of the scattered dwel- proposed location of the lings, or where the handpump. • There should be sufficient • Sites where the ground water optimum use could be made of the indication that drilling will yield was uncertain and experience handpumps that were installed. an acceptable water supply. showed a more than 15 per cent • The site should be at least 30 failure rate in the past. The Project Officers and the Project metres away from any sanitary Director were responsible for disposal facility. The procedure followed to remind seeing that a fair assessment was • A good drainage facility should the planners and engineers of the made of the site from both the be available so that there is no need for special strategies was to technological and the community water-logging near the mark out areas with these problems point of view. A system was worked handpump. on a map. out by which PHED and SWACH • All local residents should have could simultaneously evaluate the free access to the handpump. Stage Four: Planning the information received on the • The selected site should not : I;; Movement of Rigs ."."''-•' selected sites. belong to a private owner. In the SWACH districts, the drilling Planning efficient rig movement : Stage Three: Planning the j; was undertaken by the PHED of was a major achievement, and both Drilling of Boreholes • the Rajasthan government, the same PHED and SWACH were involved people who have been doing the in it. The rigs were assigned in a Keeping these considerations in job for many years. What made a way that would suit the mind, the guidelines for this part of difference was the contribution of hydrogeological conditions of the area, and be available for drilling the work began with the drilling of SWACH in selecting the site and all bores in a single cluster of villages boreholes. The two major concerns regulating the drilling. It cut down at one go. Once the rig movement were on unnecessary expenditure and plan was prepared, it was shared • Selection of a suitable site. time in many ways. The government among the Project Officer • Adoption of minimum criteria agency knew its job well, but being concerned, the Assistant Engineer for the quality of drilling. a large scale operation, it did not (drilling) and the Project Director have the capacity to go into as much at the start of every quarter. It was already evident that although detail as SWACH could in the limited the project area had one handpump area under its supervision. As a Stage Five: Drilling the for less than 250 people, the ratio result, duplication of effort in the ; Boreholes was much worse if accessibility was same area did not take place and taken into account. A major with efficient site management, The drilling team not only ensured proportion of water related diseases in the area appeared to be concentrated in localities where the HJ$SW8? handpumps were too far away and there was no safe source for drinking water. The project wanted to effectively combat such a condition, but it also needed to be aware of the physical constraints of the specific geographical area.

To this end, planning the installation of handpumps involved keeping in mind • Sites which were difficult to reach. • Sites which had collapsible formations. that they had reached the selected where there was a possibility of the installation of handpumps. site, but also they make available striking water at much lower levels, However, along with the project water samples to a chemical and a depth of 70 metres was staff, the PHED personnel too were recommended. Collapsible bacteriological laboratory for expected to be directly involved in formations make drilling beyond a testing. Salinity, foul odour and certain depth impossible. In such ensuring the quality of work put in brackish taste would mean the effort areas, after at least 30 metres, the by the outside agencies. The was a failure. yield rate was to be the criterion. guiding document followed was When drilling with equipment such UNICEF's Manual on the India Mark The drilling crew also had a social as the ODEX-165, the minimum II Handpump Installation and role to play. In every village, a crowd depth was to be 50 metres even Maintenance." would gather whenever the crew with collapsible formations. In all arrived.This was an excellent cases the water column was to be at To minimize the time gap between opportunity to pass on some of the least 25 metres. drilling and installation, a set of information that motivated the drilling effort. The drilling crew was therefore On the first week of every month, a directives were worked out. trained and provided with suitable report was made on the success • The installation process should communication material to talk to the and failure of the boreholes drilled start within 30 days of drilling people informally on water, health, during the previous month. This the borehole. hygiene and sanitation. included drilling depth, wateryield • To keep to this deadline, the and quality assessment of the water. contractors were to be supplied A casing pipe of minimum six in advance with material metres in length, properly sealed iti Installihg-the^'' •:::: required to construct the against percolation, was provided Handpump : platform and the pedestal. with the borewell. On the basis of • Other material, such as pipes the hydrogeological studies, it was Although the drilling work was and cylinder assembly could decided that a minimum drilling undertaken by PHED, a government reach the contractors when the depth of 50 metres was required for entity, SWACH relied on outside platform and the pedestal had Dungarpur and Banswara and 60 contractors for handpump been built, as these would be metres forUdaipu r and Rajsamand, installation, for reasons of logistics required some days after the To get a yield of 720 litres per hour that may not be significant for construction work was in all four districts. similar work being done in other completed. A minimum of one countries. Essentially, it eased the week's time is required as In areas with hard rock formations, time gap between the drilling and "curing" time between the construction of a platform and the actual installation of the handpump. • The contractors should be given a copy of the rig movement plan to help them plan their own movements. • Ideally, the contractor should provide a number of installation teams to speed up the work.

The project targets were 4300 handpumps in Banswara and Dungarpur and 4000 in Udaipur. By June 1993, 99.14 per cent of the targeted number of handpumps had been installed in Banswara and Dungarpur, while in Udaipur the connected through a small size less articulate common members percentage was 90.17. By 1995,8660 draw, provides drinking water for of the community, especially the handpumps were installed in the cattle. The washing platform is women. During the village contact entire project area- 104% of the separated from the handpump drives, special effort was made to target. Improved drainage facilities platform and is utilized for cleaning consult women for the selection of were provided for 5539 handpumps utensils and clothes, thus checking handpump sites. in Banswara and Dungarpur, spilling of water around handpump representing 97 per cent of the platform and keeping the The first campaign started in target. In Udaipur, the surrounding clean. Dungarpur and Banswara on l6th corresponding figures were 10,088 As the rural population hardly ever and 17th September 1986. Nearly and 112 per cent. The numbers use soaps with chemicals for their 100 VCTs covered 1023 villages in include handpumps which already washing purposes, the water the two districts. In the second existed in the area, before the released from the washi ng platform campaign organized between 25th SWACH project began operating. is safe for use in kitchen gardens. April and 10th May 1987,188 teams Animators and health workers in went to 1962 villages, covering Social animators and health the SWACH project, therefore, almost the entire project area. educators took over once the encouraged the villagers to use this handpump was ready for use. At waste water for kitchen gardens or There was occasionally some this stage, it was important to small plantations. Wherever unspoken conflict between what demonstrate to the community the possible, a drain was built to the VCT recommended and what best way to utilize the handpump channel the waste water to a patch the hydrogeologist would finally so that repair and maintenance of green. At the side of the washing accept. But whenever the needs could be minimized. platform, a cattle trough was added hydrogeologist was a person more where required, once again linked ^:y.;"-*;":-:-':;-i:i::i^":M:::-:--:-:.;:;::f::«;;-:i:^'^Jte-':":'"^:-i:| sensitive to the project's aims and : to the handpump platform. yj&..:::: :;- Special •:•. Feature?::;-: felt motivated by them, the ^Handpump Amenities for cooperation between the people -Environmental Sanitation • Probietns in Site Selection : and the technical staff was evident in the final choice of the site and the The SWACH designed the In areas of water scarcity combined execution of the installation work. handpump amenities with certain with poverty and lack of easy access For example, in one village which additional features for optimum use to development services, nestled in a hollow on the hillside, of water and sanitation purposes. handpumps are generally perceived the villagers built a temporary Just a handpump platform with an as sources of power. In the past, mudbank and road right across their outlet for waste water can very many such installations were made cultivated fields — a massive easily create a swamp at the nearest at sites which were out of reach to activity— just to get the drilling rig point where the water settles the rural poor, for social, cultural or to the interior of the village. outside the platform. This even sheer physical reasons such subsequently becomes a major as distance. Sometimes, people in Project monitoring efforts often health hazard for breeding positions of power would even identified the remoteness and mosquitoes and other insects and appropriate a handpump and claim roughness of the terrain as the contaminating the ground water. it as their personal property. As a reasons behind a rig's failure to result, handpumps were often successfully drill a borehole. But it To circumvent the problem, installed in private places, rather is possible that on some of these a washing platform and a cattle than in a central and easily occasions, it was really a failure of water trough were designed for accessible spot in residential areas. communication between the construction at a distance from the implementers of the project and handpump platform. The cattle The SWACH strategy was to involve the beneficiaries themselves.2 trough filled up with waste water everybody in the village — the from the handpump platform influential leadership as well as the Not all technical staff were able to 43 establish an atmosphere of mutual inform the Number of Handpumps Installed up to June 1995 respect in the villages where they Sarpanch at the time of the worked. Sometimes it was difficult Period Banswara/ Udaipur Total for them to accept that a poor rural next Dungarpur population, deprived of the Panchayat advantages of urban middle-class meeting. The 1986-1987 587 0 587 education and upbringing, could Sarpanch 1987-1988 1065 36 1101 1988-1989 851 516 1367 possibly know, where they wanted would, then, let the 1989-1990 1036 600 1636 their water source better; that 1990-1991 430 1391 1821 having dug their own wells for handpump 1991-1992 230 932 1162 generations, rural people could mechanic 1992-1993 64 132 196 have developed their own know about 1993-1994 362 indigenous methods for even the problem. 1994-1995 428 testing the soil. Total 4263 3607 8660 The Repairing and Maintaining the mechanics Source: SWACH Progress Report, Unicef, 1993,1994- were 1995. Handpumps ••; ; : • ;: members of Information collected during the the community identified and were supposed to buy their own first village contact drives in the trained by the Panchayat Samit.i. spare parts and the payment, was project areas had revealed that Kach mechanic was supposed to sanctioned only after the Sarpanch nearly one-filth of the handpumps look after 40 handpumps, but certified that a pump had been in these districts were out of order only undertook minor repairs, actually repaired. while the major repairs were and had been in that state for some This was an enormously handled by the PHED. time. The factors that contributed complicated procedure for a job to this situation were that needed to be accomplished • Lack of information about the quickly. After all, the handpumps The mechanics were supposed to procedure to be followed for were not only controlling water be paid Rs 11 (US $ 0.35) per month an officially appointed scarcity in the region, but also per handpump, and Rs 65 (US $ mechanic to visit a pump. working as preventive mechanisms 2.08) per year per handpump were • Complexity of the procedure. for water borne diseases. kept aside for the spare parts.3 They • Lack of community incentive and responsibility about a public utility.

Target oriented projects have always relied on their mounting list of numbers, but more often than not neglected the post installation monitoring, maintenance arid repair, without which no technical intervention can possibly have a long-term impact.

In the days before SWACH, when a handpump broke down, the villagers would inform their Panchayat member, who would

44 For the SWACH project therefore, proportion to the number of Him, an animator from the establishment and continuance handpumps likely to be Kutumbi village in Banswam of' a well-functioning maintenance installed in the given year, and said, "I asked my father, 'Aren't system were two of the biggest the number to be allotted to we used to hard manual labour, challenges in the handpump each mechanic. working in the fields and installation programme. carrying two or three heavy pitchers of water for miles everyday? Don't we suffer most when the handpump breaks Once the recruitment was down?' He softened, but was To begin with, SWACH workers completed, the persons were to be still reluctant. So I persuaded planned to identify new mechanics trained at a technical institute for him: 'Let me go for the training and simultaneously upgrade the six months, of which three months at least. If it is too difficult, I'll skills of the existing ones. But by would be devoted to field training. give it up.' He relented and said August 1988, only 49 new In the case of SWACH, the training I could go for training and then mechanics and 70 of the existing was to take place in the Industrial he would see!" 140 mechanics had been trained by Technical Institute (I'll) available SWACH in maintaining and in the project area. A stipend of Rs the year could emerge from the repairing handpumps. It was a slow 150 (US $ 4.80) per month was to be reports of existing mechanics. and problematic process. The paid to the trainees. The project process followed was: would also pay an honorarium to A one-month refresher training course was also on the schedule at Stage One: Selecting the the staff and the cost of materials the ITI for the existing mechanics. Right Mechanic i: : ~~ for the training. An already developed syllabus was to be adopted with minor changes, Selection was done on the basis of Stage Three: Preparing for •• primarily to train the mechanics in the following criteria. theJob the software component of the • The person should not have any programme. seasonal activity such as The areas and number of pumps agricultural work, as this would to be allotted to each recruit were While evolving the guidelines, it hamper repair and maintenance to be decided upon while was felt that a basic problem with work during the peak seasons. the training was in progress. repair and maintenence was that • Preference will be given to There were other concerns such as maintenance was invariably persons with knowledge of guiding the mechanics in procuring neglected as it was equated with carpentry, blacksmithy and loans for their tools as quickly as repair. Being a mechanical device, repair of other simple machines. possible and overseeing the quality of the tools bought. A list was a handpump requires routine • The person should be educated prepared of approved suppliers of maintenance for optimal up to at least class VII and know tools as specified in the UNICEF performance. This necessitated the bicycling. manual for the India Mark II creation of a system of scheduled • The person should belong to handpump. maintenance which would also the same area where the include periodic replacement of maintenance and repair work is It was hoped that the Panchayat some parts, such as the leather required. Samitis — the Block level bucket, which was found to be the • The necessary tools should be administrative units —would make most vulnerable part of the pump. bought from personal funds or bulk purchases of the required To this end, a time schedule was to through a bank loan of up to Rs spare parts in consultation with be worked out indicating the dates 4000 (US $ 128). when a mechanic should visit a PHED, so that they were of a 4 • The number of mechanics standard quality. A realistic estimate pump. selected should be in of the spare parts requirements for 45 It was difficult to break into a system from the Institute of Industrial pump, the number of riser pipes, that had been in place lor a long Training, it was decided that the the height of the water table and time despite its inherent women mechanics would be conditions of the parts inside the inefficiencies. The effort interfered working in teams of three. This pump. The information was used with the discretionary powers would make them feel secure when for preparing an effective exercised by the Sarpanch in matters travelling to other villages; it would maintenance plan for the of recruiting mechanics. By reassure their families about their handpumps. attempting to increase the number safety; it would make it easier to \ of mechanics, the project was carry the heavy tool kit, or take out After the three months of training actually reducing the number of and lower the assembly at the site. were over, each group received tool handpumps per mechanic and The team of three women was kits and their formal contracts from making the job less attractive. The expected to maintain the same their Panchayat Samitis for the project also tried to initiate number of handpumps maintained maintenance of 30 to 40 handpumps , scheduled preventive maintenance, by a single male mechanic. An in their area. Initially the new such as changing the washer and intensive fortnight-long residential mechanics were teased by the men, greasing the joints at regular training course was planned, to be but it soon stopped when the men intervals: this was perceived as followed by two and a half months realized that these women were unnecessary and extra labour, of supervision and practical both capable and efficient and had something the mechanics were not fieldwork near their homes. actually learnt more than many of happy to take on. The concept of the earlier male mechanics. preventive maintenance was quite The training course started on 22 alien to the community.5 December 1988. Innovative games, In 1989, 24_jwomen handpump exercises and audio-visual material mechanics were trained in the were used to make the training districts of Dungarpur and interesting and memorable. Banswara. The next year, 24 more Subsequently, during field training, women were trained in Udaipur The idea of women handpump women mechanics opened up 30 and began working as mechanics mechanics was initiated in one of pumps, took out the riser pipes, with the Rural Development the animators' training sessions in cleaned and greased the parts, Department. The logic behind this 1988. Local women were already changed the washers and any other move was that it is women who being trained by SWACII as damaged parts. They recorded the suffer most when the pumps fail. It animators and participating in information about the depth of each is they who have to walk a longer village contact drives and other activities which promoted health awareness and environmental sanitation. More than half of the animators displayed interest in getting trained in handpump maintenance. But when they went to talk it over with the men in their families, the idea was immediately rejected. Repairing handpumps was a man's job, they said; it was hard manual labour. How could women handle hammers and heavy metal pipes? But the women persevered.

After discussions with existing male mechanics, animators and trainers 46 distance to fetch the water. If the specially designed for the women the women and assist them in car- water is not safe for drinking, it is and teams of three women were rying the tools or handling the heavy they who have to tend the sick. It is allotted a single area of work. What parts of the pump. The extra income in their interest, therefore, to have started as a source of curiosity and was an additional incentive to that the pumps functioning all the time. even ridicule from the male of increasing self-confidence in the members of the community, ended women and their gaining an It was also an attempt to involve the up as much appreciated service. independent status within the village women in a community Women mechanics responded community.^ activity which struck a blow to their promptly to all calls of help and stereotypical roles and gave them a even managed to extract voluntary This is a strategy that has much to sense of purpose and equality. Even help from the men when handling contribute in rural communities of a limited success of such an effort heavier metal parts of the pump. any developing country, where would be worthwhile. The women women do long hours of labour, mostly came from the ranks of the In 1992, when a formal assessment but remain unremunerated and animators who had already been of the scheme was carried out, it unappreciated by their men. At the working for the project and were was revealed that not a single same time, it is a self-help ready to take on a new challenge. handpump allocated to the women mechanism that would be valued For many of them it was a valid mechanics ever remained out. of by the women themselves. source of income for the family. order for more than 24 hours. The The training component was villagers themselves would go to n

1 Instruments used for ground water exploration. Wadi Terrameters allow almost any type of survey to be conducted with high precision, and help to determine depth of water table, aquifer thickness, and water quality. 2 "Managing Guineaworm, Health and Water Supply, the SWACH Project of Rajasthan," Anil Bhatt in association with Salil Dave, Indian Institute of Management, Ahmedabad, 1989, pp. 17. 3 "Managing Guineaworm, Health and Water Supply, the SWACH Project of Rajasthan," Anil Bhatt in association with Salil Dave, Indian Institute of Management, Ahmedabad, 1989, pp. 18. 4 Based on Implementation Guidelines for Drinking Water, The SWACH Manual, vol. 1. 5 "Managing Guineaworm, Health and Water Supply, the SWACH Project of Rajasthan," Anil Bhatt in association with Salil Dave, Indian Institute of Management, Ahmedabad, 1989, pp. 20. 6 A Note on SWACH, UN1CEF 1992.

47 8 Fighting the Cyclops: the funnel filter

T nfrastructural interventions are over 3000 villages in the districts of water to make it potable. not infallible, nor can ihey by Udaipur, Dungarpur and Banswara. themselves totally eradicate The villages were finally selected Verifying the bio-logical guineaworm or other water borne on the basis of accessibility and the parameters, the study found definite diseases. Even after the right extent of guineaworm infestation. indication of widespread seepage infrastructure has been put in place, of organic matter or sewage laden it is necessary to initiate a Testing for Chemical and •••£. surface water into the ground water. monitoring process, and other al lied Biological Impurities • •". This indicated that there was interventions as a strategy to immediate need to remove garbage maintain a standard of safety in the Almost all the chemical parameters dumps, latrines, cattle sheds, etc. available drinking water. assessed were within the prescribed from the vicinity of the affected limits of WHO, except water water sources, even though the In December 1989, SWACH initiated hardness, chlorides and fluoride, relative safety of handpumps was a study by the department of which were found in higher confirmed when compared with Limnology and Fisheries, University concentrdtitaTS of Rajasthan, to assess the water in some of quality of rural stepwells and the water handpumps in the project districts. sources. The study was also expected to assess the existing domestic water Wherever filtering system and if required, the presen- develop an improved design for a ce of chlo- filter. rides and fluoride The objectives of the study were and the enumerated as follows. hardness of • To understand the population water ex- structure and distribution of ceeded the planktonic copepods in prescribed stepwells. limits of • To develop an efficient low- WHO, the cost fabric filter. study • To evaluate the suitability of identified WHO and other field kits for the area as water and plankton analysis in vulnerable the SWACH project area. and recom- mended Initially, a statistical model was abandoning developed for sampling stepwells, or suitably converted wells and handpumps in treating the 48 stepwells and converted wells in the area. The worst affected were the unconverted stepwells.

Chlorination was suggested as the simplest solution. Powdered chlorine or calcium hypochloride is available in the form of compressed tablets which can be added to a pot of water. New disinfectants available include hydrogen peroxide with catalytic silver.

Cyclops and their larval stages, called nauplii, live in the water of non-infective stage and the number stepwells than in the converted wells and are the intermediary hosts ingested is very low. wells. of guineaworm. The cyclops species M. leuckartm a well known By the time the nauplii become This is because with constant vector of the dracunculus worm all adult cyclops, the guineaworm human interference, the stepwell over the world. M. varicam and P. larvae they have ingested reach the water has a larger quantity of finely fimbriatus have been reported to infective stage, rendering them divided organic matter which is be naturally infested with unsafe. food for the cyclops. With less guineaworm larvae in Rajasthan. organic matter in the converted Despite the fact that there is wells, the population of cyclops It is believed that only the adult seasonal variation in the number of becomes naturally lower. cyclops serve as primary vectors of cyclops in a water source because the worm in the infective stages. of their breeding periodicity, they The study suggested that for However, it is known that the are present almost throughout the artificial control of the cyclops nauplii too ingest the guineaworm year in any water body. Rtil there population, the disposal of organic larvae, although the larvae are in a are always more cyclops in waste in the water should be prevented. In addition, periodic removal of algae, macrophytes and deposits at the bottom of the water source would help, as would releasing fish which eat and destroy the cyclops.

Converting the stepwells was only one of the methods by which the SWACH project attempted to control the transmission of guineaworm disease. By itself, it would not be a final solution to 49 The study concluded that the green and white cloth filter also had a short life span of 3 to 6 months, depending upon the manner and extent of use.

The best solution was to produce a filter with a mesh size of 0.07 mm, small enough to remove all cyclops and their nauplii. At the same time it was important that the fabric should maintain an efficient filtration rate over a period of time.

Filters made with bolting silk no. 30 were found to have all the necessary attributes. However, as the fabric was too expensive for mass guineaworm. Organic matter desirable in drinking water. The production, high quality, high cannot be wholly removed from a algae promote bacterial growth and density polyethylene (HOPE) water source; neither can the the growth of cyclops. Some blue- became the final choice. Cyclops population be entirely greens also produce harmful toxins, eliminated. although they are rare in water that The HDPE mesh is strong and used is being constantly used and thus under normal conditions, should To support the effort, the project replenished. last for about one year. It also has a team also treated the water of the high filtering rate of one litre per 17 seconds, which is more than that of wells with an organo-phosphorous The Final Solution:' any other fabric used in the project. compound called temephos. The The main body of the filter was dose was 1 ppm and the periodicity designed to be a plastic funnel, of the application was 30 days. The Conversion of wells, treatment of with the filter mesh fixed to the study found that this intervention water sources with temephos and narrow end of the funnel. Once the could help to reduce the cyclops in provision of handpumps have all original mesh wore out, it could be the well, but there was a margin of contributed towards safer water for replaced with another affixed to a failure. the people of the SWACH districts. small plastic rim which could be Two temephos treated wells were But the final proof of safety against screwed on to the narrow end of kept under constant observation guineaworm is good health the funnel like a cap. for the recurrence of cyclops for a practices, which include the habit period of two months. In hot of filtering drinking water. The SWACH chose one of five designs temperatures, the cyclops study took a close look at the filter anci this was fabricated and tested reappeared after 20 days. It is then in use and designed an for acceptance at the village level possible that the treatment would improved version which became a independently by a local centre be more effective if it is undertaken major input in the project. for agriculture science. After the at shorter intervals during the new filter was produced and SUMMER season. However, there All filters used by SWACH were distributed, the animators carried are other problems attached to that tested for their mesh size. It was in their kits the small replacement solution. found that they could only keep caps for use when required. Mass out the larger cyclops and therefore produced,the filter costs less than The phosphate in temephos could not be totally relied upon to Rs 7 Cor US $ 0.23) a piece. increases algal growth, especially render the water completely safe • of blue-greens which are not from guineaworm transmission. 50 The need for constant vigilance

he functional flexibility that had - external assessments, e.g. Government of India, UNICEF and become part of the SWACH through spot and sample SIDA and occasional independent project organization, required an surveys of key problems. evaluations by experts and reputed innovative approach to its - reviews. organizations. monitoring and evaluation efforts. The short time span for the ultimate The monitoring framework of the The monitoring indicators were goal of eradicating guineaworm project created an efficient scheme identified as from these districts dictated the of regular reports from the field. • Training of Anganwadi workers, necessity for a foolproof monitoring The statistical data generated by health guides, social animators strategy—at least as far as humanly these reports went into a and village contact teams. possible. computerized database for future • Number of trained handpump analysis. The numbers have always mechanics and incidence of The Plan of Action stated: been generally encouraging in the drop-out. As the project involves a number project. Most of the activities had • Number of group meetings held of exploratory and, as yet, untried been well planned and appeared regarding community awareness activities... it is essential that a to have a positive impact on the and health improvements. simple composite monitoring beneficiaries. Stepwells were • Number of stepwells, system be developed as early as converted, handpumps were handpumps or any other possible. This will enable the installed, medical camps for surgical engineering interventions and project management as well as extraction of guineaworm were the quality of their construction. GOR and UNICEF to continuously held across the area. The numbers • Functioning and utilization of review and, if necessary, adjust in the database grew daily facilities constructed. the concrete operations. The throughout the SWACII years. With the best of intentions, the Plan overall system will comprise the of Action did not spell out in detail following major processes: The last item in the Plan of Action the methodology for monitoring, - inbuilt physical, financial and referred to annual reviews to be which would have to be developed performance monitoring, carried out jointly by the and honed to the specific based largely on existing Government of Rajasthan and requirements of the project and routines within the respective UNICEF with the participation of reassessed from time to time. The implementing agencies. the Government of India and SIDA. operational framework of the - participatory monitoring, These reviews were also meant to monitoring exercise was, therefore, particularly through the social finalize and approve the workplan formulated jointly by UNICEF and animators, on the performance for the forthcoming year. the Project Director, along with the of the project delivery system, design and testing of monitoring including conditions [of] and =:;; The Framework formats. Detailed work plans, problems with handpumps and : Evaluation and Assessment .-!:: however, were formulated by the converted stepwells. pro ject staff and the implementation - periodic inspection reports The Plan of Action also mentioned was reviewed annually. through standardized a mid-term evaluation to be The set of formats that were checklists. undertaken in 1988, by the produced for the physical, financial 51 PHYSICAL TARGETS AND ACHIEVEMENTS, 1990 TO 1995

ACTIVITY FIRST PHASE SECOND PHASE TOTAL B/D U/R TOTAL UPTO JUNE 1995 UPTO JUNE 1995 Target Achieve % Target Achieve % Target Achieve % Target Achieve % Target Achieve % -ment -ment -ment -ment -ment Drilling of Boreholes 5036 4723 94 4706 4329 92 9742 9052 93 1020 896 88 10762 9948 92

Successful Tubewells 4300 4279 99 4000 3749 94 8300 8021 97 900 818 94 9200 8839 96 Handpumps Installed 4300 4257 99 4000 3704 93 8300 7961 96 900 699 78 9200 8660 94 Stepw e Us Converted 3600 4164 116 3900 4989 128 7500 9153 122 600 342 57 8100 9495 117 Construction of washing platforms and cattle troughs 5450 6177 113 6100 7717 127 11550 13894 120 700 227 32 12250 14121 115 Handpump drainage improvement 5700 5539 97 9000 10088 1.12 14700 15627 106 1000 378 38 15700 16005 102 Construction of school latrines 600 691 115 1000 874 87 1600 1565 98 - - - 1600 1565 98

Construction of Animators' latrines - 149 - - 132 - - 281 - - - - - 281 -

Construction of Household latrines 600 2318 386 1100 4555 414 1700 6873 404 1600 236 15 3300 7109 215 Construction of Urinals - 605 - - 984 - - 1589 - - - - - 1589 - Village Drainage Schemes implemented 12 18 150 12 16 133 24 34 142 17 17 100 41 51 124 Handpump platform improvement 1500 1631 109 750 1357 181 2250 2988 132 100 993 - 2350 3981 169

Reconstruction of cattle troughs - 148 - - 80 - • 228 - - - - - 228 -

Reconstruction of washing platforms - 50 - - 55 - - 105 - - - - - 105 - Hydrofracturing of failured

boreholes - 13 - - 13 - - 26 - - - - - 26 -

Repair of old converted stepwells - 100 - - 134 - - 234 - 150 90 6o 150 324 216

Source: SWACH Progress Report, 1993,1994, 1995 Immediate Steps to be Taken on the Identification of a Guineaworm Patieni

2 Days fr 2Day^J 3 Days | 3 Days || 15 Days | 15 Days fc

Case Management, Temephos Organizing Activating Converting Installing or taking all application awareness village all unsafe repairing information from in all camp and guineaworm drinking handpumps. patient regarding drinking Intensive eradication water his travel, and water Surveillance camp. sources to water sources sources in Committee. safe sources. which he might the village have infected; and providing health adjoining education to the villages. patient, family members and community. 1 r \ 0 case in 1995 1 and performance monitoring to know what number of stepwells sources of information on the status included quarterly reports to be had been converted and at what of various project components. submitted by the Project Director cost. The extent of utilization of the to the TAD Commissioner and converted wells would indicate the Further evaluative material was UNICEF, based on reports acceptance level of that particular generated through periodic studies submitted to the Project Director physical intervention. It was equally of the project by specialized outside by the Project Officers in the first important to know how far the agencies. In addition to providing week of every month. The Project community participated in a certain insight into the community's felt Officers' reports were reviewed at activity to get an idea of whether needs and the quality of the a meeting every month and formed there was actual change of intervention efforts, the studies the basis for discussions in the perception and behaviour resulting offered recommendations that meetings of the District Project from the activity. This feedback helped to reassess problems and Implementation Committees which would come from the animators' introduce improvements in the had the power to intervene in inter- reports to the office of the Assistant implementation of the project. agency coordination issues. The Project Officer responsible for Project Director's reports, on the health education. Asetof guidelines The Need for Constant Vigilance other hand, were periodically were developed for this purpose discussed at a meeting of the which were reflected in the design The SWACH effort is now in its final Committee of Directors which was of the log books carried by the phase. The number of cases has concerned wit h inter-departmental animators in their regular course of dropped to zero, but it is important coordination at the project level. work. that vigilant Surveillance be sustained till eradication is The Plan of Action used the phrase The periodic inspection reports declared after three consecutive "participatory monitoring" to mentioned in the Plan of Action years of zero incidence is achieved. describe the qualitative checks and took the form of tour notes of Even a single patient left undetected balances that the project was to SWACH functionaries and UNICEF at this stage may mean a resurgence employ for successful personnel associated with the of the disease, for a single implementation. It was not enough project, which became additional guineaworm can transmit the 53 disease to an entire community. launched ig * 1990-1991, was surgical extraction of the expanded tb# next year when it guineaworm was followed by the The case containment strategy was found that the scouts were most application of temephos in the adopted by SWACH attempts to effective in their own villages. In water sources accessible to the detect every patient at an early stage 1992, therefore, the project selected patient and funnel filters were of the disease and take ihe necessary 927 scouts and 103 coordinators distributed in the area to contain steps to prevent transmission. In from all villages under surveillance. transmission of the disease through 1992, the scouts managed to bring In villages which were in the vicinity contaminated drinking water. for treatment 88 per cent of the of the surveillance villages, orwere patients before they had reached linked to them by main all-weather Constant vigilance has indeed the infective stage, resulting in a roads, intensive village contact brought up rich rewards. The 90% drop in cases in 1993. In 1993, drives were periodically dramatic change in the trend of the scouts detected 91 per cent of cases undertaken and school children disease in these four endemic in the pre-emergent stage, resulting were mobilized to detect districts is a matter of hope, not in a 95% drop in cases in 1994. In guineaworm cases. only for the people who have 1994 scouts detected 100 percent suffered from guineaworm disease of cases resulting in zero cases in Case detection was the primary for generations, but also for health 1995. stage of the SWACH surveillance planners who can transform the strategy. Once a patient was micro level experiences of SWACH The Guineaworm Surveillance identified, a number of measures into macro realities in other parts of Scouts Scheme, which was were adopted in quick succession: the country.

54 10 Sustaining success

ince 1993 there has been no focal point of a project that was struggle for survival — two factors S case of guineaworm in primarily conceived to bring about that have always been major Banswara. In 1994, Dungarpur a transformation in the lives of the obstacles to social change. and Rajsamand reported no rural people. cases of guineaworm. In 1995 Looking beyond the Numbers- Udalpur also reported no case Through the SWACH years, Intensification of the efforts at this of guineaworm. The SWACH guineaworm became a symbol of last stage of the project certainly area is now free of guineaworm. all that conspired to keep the rural achieved the desired results in Even though guineaworm society in the grip of poverty and eradication is only a part of what backwardness. statistical terms. But the greatest they had set out to do, the endemic Winning the battle against challenge facing SWACH now is status of the four districts, combined the formulation of a strategy to build with the visibility of the required guineaworm, therefore, symbolized interventions and achievements, a victory against ignorance and upon the physical and qualitative made guineaworm eradication the apathy generated by years of gains of the project.

55 A village specific strategy has been efforts on consolidating their gains. campaigns. evolved at this stage to ensure that By keeping guineaworm out of • Disseminate information on vigilance is maintained and action these villages, they hope to retain guineaworm, water, health and promptly taken in the case of a new the community's interest in health sanitation through all possible guineaworm patient. But much of and the environment, and keep media. the work load of detection, alive the realization that the villagers • Focus on health and sanitation treatment and preventive action will have a stake in official development issues to improve general health have to be supervised by the efforts — that they are not just the status. villagers themselves in the future. beneficiaries but also the agents of • Generate Community involve- By giving them a glimpse of a better, change. A shortlist of SWACH ment so that they take over healthier and more productive responsibilities in 1995 looks like surveillance after SWACH ends. existence, the SWACH team hopes this: to generate a demand in the villagers • Sustain the surveillance work Meanwhile, 1995 is a landmark year for the same services from the for continued zero incidence. for in the villages of Dungarpur, official sources that will continue • Treat patients (if any) immediately Banswara, Udaipur andRajsamand. to function in these areas. to check further transmission. It marks the end of the dreaded • Isolate the patient—keep him/ guineaworm and the beginning of her away from water sources. a time when an awakened people • Maintain all drinking water will demand and work for their In this last phase of the project, the sources. right to better health and sanitation. SWACH team will concentrate their • Continue social mobilization •

56 11 Changing the lives of rural women

T"1 he broader aims of the SWACH Environmental sanitation vegetables and fruit that could -*- project included the sharing of camps: the focus was on safe be grown by reusing waste health information with the rural sources of drinking water; water from handpumps; community and inculcating good sanitary conditions near water compost making; use of health practices as a prelude to sources; handpumps and caring fertilizers and plant protection increased productivity and a better for them; water use and storage; measures; methods of storage life. As water and family health are recycling waste water from and preservation; and cooking very much the responsibility of handpumps; sanitary latrines to save nutrients. women in the rural community, and soak pits; control of disease SWACH attempted to draw out bearing insects that breed in village women and encourage them stagnant water; and disposal of to actively participate in the garbage and waste water. The camps were started from the programme. In the process the month of July 1988 in Udaipur project also promoted the General awareness camps: the district and continued for a year. At empowerment of women. issues related to general health the official level, camps such as and sanitation; immunization these are usually organized by the Once SWACH began functioning, for children and pregnant District Rural Development Agency the lives of women in these rural women; oral rehydraiion (DRDA), which takes the help of districts changed. However, this therapy; management and locally active NGOs to do the change did not happen overnight, prevention of common grassroots level work. nor were all women at once keen to childhood diseases; water be participants in the programme. borne diseases and how to In its effort to avoid duplication The process began with the project control them; use and storage and integrate with work being done and was carried on through a series of safe drinking water; personal in the field by government and other of awareness camps organized for and environmental sanitation. agencies, SWACH decided to leave the women, which allowed them to the organizing of the camps to change their knowledge and Camps for training of dais or DRDA and the NGOs. The funds practice in the areas of water, health traditional midwives: with less came from SWACH, and along with and environmental sanitation over that 50 per cent of the villages it, came technical support in the time. covered by trained birth form of teaching material and aids, attendants,1 training was given resource persons, provision of In 1989, an impact study of these in prenatal and post natal care transport, etc. Representatives from camps was assigned to the of the mother, safe childbirth SWACH, DRDA and UN1CEF Department of Home Science practices, risks involved in formed the coordination Extension Education, College of chidbirth and care of the committee. The committee carried Home Science, Rajasthan newborn. out multiple tasks: University. The study was carried • Planning and developing the out in six administrative blocks of Kitchen gardening camps: the course contents and teaching Udaipur district, and covered a emphasis was on nutrition, materials. sample of 43 villages. Four types of balanced diet and better • Checking on the available awareness camps were studied: cooking methods; appropriate resources, infrastructure and 57 expertise available with local running camps for women. practices advocated at these NGOs who would participate However, it was felt thai there was camps. in the programme. need to familiarize them with the • To measure to what extent the • Setting guidelines and an annual concept, philosophy and objectives acquisition of knowledge was action plan for the effective of SWACH which needed to be affected by personal and socio- implementation of the camps. reflected in the work done at the economic variables. • Monitoring the day-to-day camps. • To study the effectiveness of running of the camps. organizational inputs by Two sets of durations were planned The workshop also held a critical separate NGOs, especially in for the women's camps: review of a previous set of camps, relation to the educational • The residential ones lasted for to better understand and develop content and its coverage, the three days and the participants, the methodologies to be used in teaching methods and aids who came from a cluster of the SWACH camps. The design and used, learners' participation, villages, were expected to stay content of the resource material coordination with other in the village where the camp used in the previous camps were organizations and the was being organized. In these also discussed and a tentative management of the camp. camps, the evenings could be programme was worked out for the utilized for both educational next six months. It must be remembered that of the and recreational activities for total sample of 207 rural women in an audience that was captive. :: The Impact Study ••.: ::: the camp, only eight had formal • The non-residential ones lasted education up to the primary level. for five days. These camps took The impact study was initiated after Most of them were married, had place in one large village, with 50 camps had already been nuclear families, came from low a cluster of small neighbouring conducted by 16 NGOs over the caste groups and had agriculture as hamlets. As they all lived in the first eight months of the programme. their main occupation. A majority locality, the women came to The objectives of the study were of them belonged to families of the cramps for five to six hours identified as: small and marginal farmers and had each day. • To study whether rural/tribal very little social interaction. As most women had gained adequate of them were illiterate, their level of Before the camps began, an knowledge of health and exposure to information was orientation workshop was sanitation after attending the extremely low and limited to the organized, by ORDA and one of the four different types of camps. immediate concerns of daily NGOs, where 40 participants came • To investigate whether these existence. from the 21 NGOs in the area. All of women had adopted some of them had previous experience of the health and sanitation The Findings of the Study:: Environmental Sanitation

Pre-test and post-test findings on the general knowledge of the women participants about environmental sanitation revealed an encouraging trend. The level of knowledge before the camp was low and exposure to information evidently had an immediate impact. When the participants were distributed in different categories of knowledge after the camp was over, it was revealed that a majority of them, about 55 per cent, exhibited good or fair knowledge of the subject, and only a few were A majority of the participants for using double-sided filters. Many in the poor or very poor category. displayed fair to good knowledge of the better practices were Analysis by components of about safe drinking water and the followed more because they were knowledge also gave a satisfactory use, care and maintenance of part of a tradition, rather than result. handpumps; while a majority of because of a logical reason. Most of non-participants had poor or very them did not understand the After the camp, a comparison w poor knowledge of these relationship between a sanitary as made of the knowledge level of components. The knowledge of the environment and good health. the participants and non- need for sanitary surroundings near Cleanliness in the home should be participants, to reassess the earlier homes and water sources was low practised, they said, because it made findings. This approach also made in both groups, but the women the house look good. Once again, it possible to obtain information who participated in the camps had the connection between cleanliness from a larger number of women a relatively better score than those and health was missing. and provided time-series data to who did not. determine the retention of Sanitary latrines proved to be knowledge over a period of time. It A breakdown of participant another problem area, as the became evident that in both knowledge by components also concept did not fit in with a culture categories a majority had poor revealed that in many cases the that had developed outdoors. Many overall knowledge of the subject. knowledge they already possessed, considered a sanitary latrine at However, the number of women was partial. .For example, many home as something dirty. Similarly, with a fair knowledge of the subject women knew that water from the being used to a dark and increased significantly among those storage pot should be taken out inadequately ventilated kitchen, it who had attended the camp; while, with a separate v container with a was difficult for the women to the number with very poor long handle, but had not bothered understand the need for light and knowledge was significantly higher to find out why the handle was fresh air,- neither of which were among the non-participating important. They knew the use of strongly connected with health in women. filters, but did not know the reason their minds.

Pre and Post Test Knowledge Scores of Participants in Environmental Sanitation Camp

0 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 12 3 4 5 6 7 8 9 10 11 12 13 14 15 16 "1718 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Participant number

-pre-test • post-test

Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p.44A. 59 ••:•{• •;::::: women participants was the subject of women's groups, and the role :::::: of the same study. During the three of such groups in solving A three-day residential general days, most of the time was devoted social, personal and economic awareness camp with 38 to discussions on the formation problems for women. A talk Mean % Scores of Pre and Post Test and Gain in Knowledge in Different Components of Environmental Sanitation Components Initial mean/scores Post mean % scores Gain in knowledge

Safe drinking water 45.59 75.00 29.41 Use, care and maintenance of handpump 38.89 59.94 21.05 Sanitary surroundings for house and water source 27.96 49.89 21.88 Household cleanliness 59.86 88.60 28.80 Diseases through flies, mosquitoes and their control 24.71 61.70 36.99 Prevention of communicable diseases 20.12 54.95 34.83 Panchayat's rolfc in keeping the village clean 7.60 29.24 21.64

Source; Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 46

Knowledge of Participants and Non-participants of Different Legal participants Components in Environmental Sanitation Non Participants

Safe drinking Use and care Sanitary Household Diseases Prevention of Role of the water of surroundings cleanliness through flies communicable Panchayat in handpumps near homes and diseases sanitation and water mosquitoes Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 49A.

60 was also organized on Oral and 75 non-participants, provided these training camps had improved Rehydration Therapy (ORT) and a confirmation of the findings of their level of knowledge immunization of children and the single camp. Both groups considerably. Among non- pregnant women. registered poor levels of participants, 8333 per cent had very information on the specific area of poor overall knowledge of the The study found that the format interest of the study. Although five relevant topics while the rest of this camp was inadequate as of the seven components found the registered poor knowledge. Among far as transferring information participants ahead of the non- participants of the camps, none on health, sanitation and safe participants, the difference was not belonged to the "very poor" water was concerned. The talk on significant. category; 58.33 per cent registered ORT and immunization was too poor knowledge and the rest had a brief to enhance the know- •::••• •:• . i:::!^" ='-'S;;SliiSiir :::i:::::::::::'"" '«' fair knowledge of the topics. : Training iof Traditional ledge level of the women in these Measured separately, the areas. There was also no teach- knowledge of different components ing aid used and it was difficult for of the training programme was the participants to retain whatever The study team first looked at higher in the participants of the they heard. The prea -single training camp where programme in most cases. test and post-test results showed the participants registered a marginal change in the knowledge tremendous improvement in levels and bore witness to the their knowledge level after the The study team felt that the training fact that general awareness camp. To get a wider picture, camp was of too short a duration camps might not always be the right a composite study was made of fora subject that was of a somewhat venues for disseminating 65 participants from three training specialized and technical nature. It information on environmental camps and 65 non-participants. was evident that the training sanitation, safe water and All of them worked as midwives, programme did have a positive guineaworm, as they were likely to but their overall knowledge in impact; only this could have been have other priorities. ante- and post-natal care and further enhanced if more time was safe childbirth was not found to given to the participants to absorb A study of 65 participants drawn be satisfactory. Nevertheless, the large body of information that from five general awareness camps, the midwives who had attended was offered to them.

Overall Knowledge of Environmental Sanitation in Participant and Non-participant Women

Participant Non-participant Very Poor Good Fair Very Poor 2.02 1.02 9.85 29.7

Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 49A. 61 Five Days at a Camp: A Diary

Dav 1 Morning: The faculty and participants vet to Demonstrations of the solar cooker and the know each other. pit latrine.

Afternoon: Talk on environment. Talk on maternal health, high mortality rate deforestation leading to less rainfall and of women and children in India, age at lowering of the ground water level. marriage and conception of first child, prenatal diet, need for immunization of Talk on importance of conservation to fight pregnant women, problems of pregnancy, soil erosion and role of women in these anaemia and weakness, preparations for activities. and care and precautions during delivery, importance of hygiene during and after Day 2 Morning. A prayer and a song celebrating delivery, importance of family planning. health and sanitation, followed by informal discussion on talks given on the first day. Afternoon: Discussions on personal, hvviene. household cleanliness, importance of This develops into a discussion about sanitary pits and latrines, and sanitation concepts of natural environment and village and disease. environment, harmful effects of pollution, control of disease carrying insects, and Demonstration of how to prepare oral measures to improve village environment. rehydration therapy (ORT) and discussion about its importance. In course of the discussion, some women mention, the best way to he healthy is to keep Day 4 Morning: A visit to a handpump and the home clean. But this is not easy to demonstration of its operation, care of achieve across the village, as the people do handpumps and how to keep it and the not do anything together as a community. surroundings clean. This leads to the formation of a committee of both men and women volunteers who would Talk on the role of women in the help to keep the village clean. community, their role as workers, the need for training and types of training courses Talk on nutrition, health, balanced diets, available for women cultivators. simple labour saving devices in the kitchen and income generating activities for women. Afternoon: Informal discussion on health and hygiene, followed by talk on safe Afternoon: Talk on sources of water, how drinking water. A slide of water containing water gets contaminated, domestic methods guineaworm larvae is shown to each of keeping water clean and why women participant under the microscope. A should know about safe drinking water. discussion follows on the life cycle of the guineaworm and ways to prevent Talk on safe delivery of babies at home, care guineaworm disease. of the mother and newborn, breastfeeding, babies at risk and immunization. A Talk on communicable diseases and their discussion follows on the right age for prevention. marriage, how conception takes place, need for spacing between children and methods of Talk on how to maintain a clean home and family planning. care of cattle.

Day 3 Morning: Talk on how to know when water Cultural programme. becomes dirty, reasons for looking for a safe source of drinking water, diseases caused by Dav 5 Morning: The whole dav is devoted to a dirty water, flies and mosquitoes, how water review of all that took place in the past four sources can be kept clean, the handpump days, through discussions and question- and purifying water with alum. answer sessions. In the afternoon, at the end of the camp, everyone is given a double Talk on literacy for women. layered, two-coloured cloth filter.

62 During the period of the study, a single three-day residential camp was organized in Udaipur to train 17 women participants in growing a kitchen garden. As against the pre-test score of 20.83 per cent, the post-test score was 46.47 per cent — indicating a remarkable gain in knowledge. Some of the areas where the participants started with very little knowledge, the improvement was remarkable. Only one component, that of making a compost pit, did not participants had poor knowledge The count for those with a fair register a high level of of kitchen gardening, the countwas knowledge of the subject was 11.23 improvement. A comparison 44 per cent for those who attended for the non-participants and 53.33 between participants and non- the camp. Among the non- for the participants. Inaddition, 2.66 participants emphasized the gains participants, 21.34 per cent had very per cent of the participants had a from the training camp. poor knowledge, a category that good knowledge of the subject, While 67.41 per cent of non- did not exist among the participants. while none had reached that level

Knowledge of Rural Women in Different Components of General Awareness

Food and sanitation

Child care

Personal hygiene

Common diseases

Immunization

Care, maintenance and operation of handpumps Safe water and sanitary surroundings near water source

10 20 30 40 50 60 70

I Participants I Non-participants

Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 109A.

63 among the non-participants.

—aiStep ; towards a New Life

Of the four types of camps which formed the basis of the study, only camps for general awareness disappointed the team with their low scores. This does not take away from the value of such a camp; but obviously, a general awareness camp for women cannot have safe- water, health and environmental sanitation as its primary theme, as it is essentially concerned with economic and social problems that patriarchal community. SWACH, on specially affect women in a advantage of dealing with a specific the other hand, has the rare area of work which is forever

Knowledge of Rural Women of Different Components of Midwifery

Immunization

Family planning

Risk babies

Breast feeding

Care of the newborn

Childbirth

Abortion and risk

Antenatal care

Symptoms, bodily changes and problems during pregnancy-

Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasfhan Agricultural University, Udaipur, 1989, p. 109A.

64 Knowledge of Different Components of Kitchen Gardening in Rural Womer

Storage and preservation of fruits and vegetables

Importance of fruits and vegetables and saving nutrients while cooking

Making compost pits

Cultivating fruits and vegetables

Nursery preparation

Concept and importance of kitchen gardens

0 10 20 30

I Participants I Non-participants

Source: Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 179A.

for water affects babies and mothers too.

Not surprisingly, the SWACH women's camps, along with giving specific information to the women participants, have also achieved some of what the general awareness camps do. They have developed the ability to draw more and more women out of their confined existence at home and into the life of the community. For many women from the SWACH project villages, the camps mark their entry into a new life — a less subservient and spilling over into the domain of Uie wiiii its locus on birth associated more productive life and the general—water affects everybody, problems, can only extend the dawning of a sense of self-worth. Even the midwives training camp scope of the SWACH programme, •

1 Women Awareness Camps, an Impact Study, Dept. of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989, p. 16. ' 65 12 The story of two women

1TI he women's camps were -*- initiated by SWACH in the hope that women's participation in the project would provide the intervention efforts with a firm backing within the community from the people who were most affected both by the availability of water and illness in the family. There was also the hope that women would carry the message of health, sanitation and safe water right to the heart of the family, and in the process would create the atmosphere for greater productivity and a better life in which they themselves would play a pivotal rather than a secondary • Water'Collection -: •.•.:; ,2f-'.\-\"bother to make another one like it role. themselves. The family mostly get their water The study which assessed the from the nearby handpump, but they There are two handpumps in the effectiveness of the different types also bring water from the well, village, but one of them has dried up of camps organized for women in because they prefer the taste of the some time ago. At the handpump, the project area for a year, also well water. For drinking and the family pots are cleaned with ash included case studies of participating cooking, water is stored in the home before being filled. The filter is also women, from which the following in earthen pots and metal containers. washed before and after use. But two case studies were taken. * The containers are sparkling clean the pots are carried home and kept covered on a raised uncovered. None of the family One: Kanni Bai, VHUage Iswal platform. For bathing, there are members wash their hands before cement tanks. taking water from the peat, which Kanni Bai is a Scheduled Tribe they do by dipping a glass into the widow of middle age, and a mother For filtering the drinking water, pot. Children are not permitted to of two grown-up sons who have however, the family use a take water from the pot. children of their own. They all live discoloured old piece of cloth. Even together in one house and work on though they are aware of the double- Sanitation at the Handpump their own land. Kanni Bai is the only layered filter and the long handled midwife in the area and has attended mug for taking water out of the pot, The handpump the family go to is the training camp for midwives. One they do not use either of them. They placed on a slope and the soil is of her sons is an active member of did have a double-layered filter from sandy and rocky. No water can village contact drives organized by the awareness camp, but when it gather there. Excess water flows SWACH. got worn out with use, they did not down a roughly made drain. Women 66 of the village wash and bathe just a children generally look dirty. They and feels that camps should be held few feet away from the handpump. clean their teeth daily with ash or frequently to reinforce what is being Kanni Bai's daughter-in-law notices coal dust. The adults in the family go taught to the village women. some of the family's cows near the for defecation to the fields, but the handpump. She quickly packs some children use an open space near the mud at the mouth of the drain, fills home. Hands are washed with soap the platform with water and makes afterwards. Narbada, a girl from a Scheduled the cows drink from it. She seems to Tribe, is only 15 years old and studies be unaware that cattle should drink in the fifth class. She has participated from a separate trough. in only one general awareness camp The family owns two cows, two held in her village. Her family earns Sanitation at Home bulls and five or six goats. The goats a livelihood through agriculture and are kept in the inner verandah, in by using their bullock cart for Kanni Bai's family live in a house front of the living room. The cows transporting goods for other people. which is partly made of clay. There are in the shed in front of the house. Narbada lives with her grandfather, are two new rooms made with The shed is not always clean as an aunt, her parents and two school- bricks which have enough there is no drain. The garbage going brothers who are 12 and 10 ventilation and light. The old part of collects in a corner and is thrown in years old. the house is one big room, a small a pit on the farm every few days. kitchen and a closed verandah with In Narbada's village, alcoholism is a no windows, but there is electricity. major problem. The Anganwadi The interior is kept clean and though worker says that the men regularly there is no proper facility for waste Pots and pans are cleaned with ash drink and beat their wives. Most of disposal, the surroundings have no and the women do not wash their the women go out to work as garbage lying around. The house is hands before starting work in the labourers. The men come home in on a hilly slope and there is therefore kitchen, but hands are washed the afternoons and sit idle. The no stagnant water. Garbage is before and after a meal. The kitchen women return from work in the fields thrown in a corner of the cattle shed waste is thrown out into the to more work at home. located at the entrance of the home. courtyard and food is kept uncovered. Fruit and vegetables are The kitchen is dark and as food is not eaten regularly. Pulses and wheat cooked on a traditional stove, the are Lhe staple food. Although plenty The handpump is the only source of walls are black with soot. Cooking is of vegetables are grown on the farm, water for the family, although there done in clay vessels and food is they are mostly for sale. are wells in the village. Narbada stored in the living room. knows that the handpump is the safest source of water and that dirty ; Washing and Bathing " water is the cause of several diseases Kanni Bai's son is now the head of like guineaworm, diarrhoea and Both activities are done in an open the family. He is happy to have his cholera. courtyard where a cement water mother involved in different tank stands on a raised platform. activities in the camp, but does not The drinking water in her home is There is a well on the farm which is want his wife to do it, as she has kept in clean clay and metal jars also used for bathing and washing. many household responsibilities to covered with clay plates and placed The tank water for having a bath is fulfil and no spare time. on a raised platform. Water is reused for washing clothes. Soap is collected in clay pots which are not usually used for either activity. Kanni Bai herself says that the camps washed beforehand. The filter is, have taught her many new things however, a discoloured piece of old The infants in the family are kept about sanitation. She has also learnt cloth washed before and after use. clean and look healthy, but the older about preventing several diseases, The pot is brought home uncovered. 67 Although they know about the buildings with one large room in has to collect water from a distance, double-layered filter, Narbada is not each and thatch roofs. Both houses this is her way of conserving water. allowed to make one at home by her have a wooden attic with a little She appears unaware of the possible mother, who is old-fashioned and door near the ceiling, where bad effects of reused water for orthodox. firewood and fodder are stored. The bathing all her children, houses are clean, but dark and The family do nol wash their hands overcrowded. There are no In Narbada's family, the adults use when they take out water from the windows because they are not twigs from mango trees to clean pots, nor do they use a long handled considered safe. their teeth, but Narbada's little mug. brothers use tooth brushes and tooth The kitchen is part of the big room, paste. The boys look healthy and separated from it by large clay vessels more or less clean, but Narbada for storing grain. Food is cooked in herself does not look strong. She The handpump used by the family clay vessels on a traditional stove says that she has to do most of the has dirt and stagnant water around and the walls are sooty. The kitchen housework as her mother does not it. There is an outlet for the water to does not look tidy and all the utensils keep well. be channelled to the fields, but it is are kept on the floor. Waste water is not buil t properly and does not work thrown outside the home and There are no sanitary latrines in the too well. Narbada, however, cleans garbage is collected in a corner, to village and the family go to the fields up the handpump platform when be disposed of later. for defecation. Hands are cleaned she comes to draw water. with clay afterwards.

Other families wash clothes, bathe and clean utensils near the Narbada says that the family wash handpump and the cattle drink from and bathe usually at the well in the There is no separate cattle shed. The buckets kept just a few feet away. field. But it is evident that neither cattle are kept in one section of the There are three handpumps in the activity takes place daily. Her next big room in one of the structures. village and all of them are in good door neighbour is a woman who The room is divided by a two feet working order. attended the awareness camp with high mud wall. There are two cows her. She is seen washing a child with and half a dozen goats. The dung is soap in a tub. The tub water is reused collected and taken to a compost over and over again for the other pit. The family live in two separate clay children in the family. As the mother

When Narbada is asked to make some lime juice, she makes it in an unwashed glass, without washing her hands. She throws the peels outside the house.

She says that the family eat pulses and wheat and a little vegetable .But they are too poor to have vegetables regularly.

Narbada attended the camp without telling her parents, and because the into the programme! her aware of many things she did Anganwadi worker had told her she- not know about. But her father would learn sewing at the camp. Narbada feels now that the camp thought it was a waste of time, she When the Anganwadi worker was was useful and that she learnt a says. Her mother appears quite asked why she had given false great deal about water, health, indifferent and points out that information, she said that the women immunization, common ailments women have a lot of work at home in the village were not interested in and sanitation. Although she is not and in the field. When a three-day anything other than sewing and in a position to change the practices camp takes place in the village, if all embroidery, so she used this piece of adults at home, she feels the camp the women go there, who will do of falsehood to draw the women has done her a lot of good and made the work?

1 This chapter is based on Women Awareness Camps, an Impact Study, Department of Home Science Extension Education, College of Home Science, Rajasthan Agricultural University, Udaipur, 1989. 69 13 Two villages: the project in operation

*Tp he case studies below were The village studies led to some of stepwells. Once converted, selected from a longer study general observations: it could be easily identified from undertaken in 1989 by research a distance because of its students from the Indian Institute • There was very definite decline cemented exterior and a smooth of Management, Ahmedabad. As in the number of guineaworm parapet. It was also something the project had just started operating cases. The SWACH medical that clearly benefitted a number in Udaipur at the time, the study teams were known for quick of people at a time. The benefits covers the two districts where response and patients had penetrated enough for the SWACH first began, Dungarpurand voluntarily presented communities to take initiative Banswara, and serves as a mid- themselves for treatment. in identifying wells for project evaluation of achievements During treatment, the entire conversion. and failures of the project, primarily village gathered and this as a management exercise. provided opportunity for the • Handpumps appeared to have SWACH team to pass on been installed with a distinct Five villages from each district were information about the life cycle bias in favour of poorer and chosen for special scrutiny.1 The of the guineaworm and backward areas. However, well basic components for the village measures being taken for water was preferred by studies were the incidence of prevention and cure. The everyone as handpump water guineaworm, stepwell conversion, medical intervention for was supposed to have a metallic handpumps, domestic and guineaworm had brought taste. In tribal villages, where environmental sanitation, health credibility to the project. the pattern of settlement is and hygiene awareness and village scattered, the handpumps might contact drives. • The most tangible activity of be more in number, but less the project was the conversion heavily utilized and often not Five of the villages had a totally tribal population, fouro f them were poorly connected by roads, three villages could be categorized as economically backward and three more were only partially developed. Eight of them were far away from the project office and of them, four belonged to remote locations. Two of the villages had no guineaworm cases at all, while four of them had high guineaworm incidence records. The first intensive awareness campaign had been carried out in these villages in September 1986. 70 well maintained. In large different tasks that when it came the May count. One of them was a villages with a mixed to large villages, they tended to tribal boy working on a Rajput's population, there was a higher ignore the peripheral hamlets. farm. He drank from a farm well as density of population and One of the major plus points there were no handpumps nearby. handpumps were better was the multi-media approach maintained and promptly which attracted both children Situated near the , the repaired when required. and adults. In villages with village was two kilometres from a scattered dwellings, however, larger settlement of upper caste • The handpumps also had women were not contacted with households, where handpumps attached to them cattle troughs, as much zeal as they were in the were the predominantwatersource. drainage channels for more concentrated settlements. But for the tribals of this village, plantations and washing drinking water came from the three platforms. But not all the The individual studies included wells which were also used for handpumps had proper here describe not just the positive, irrigation, while washing and drainage. The cattle troughs but also the negative aspects of the bathing were done in the river. were poorly utilized and project effort. They might help to apparently had a design identify problems and gaps in Wei problem. Worst of all, there project management in other similar appeared to be no interest in endeavours. All the wells were located in the the community to maintain fields, where bullocks tied to these structures. Cattle troughs wooden wheels drew water for and drains were not cleaned irrigation in leather buckets, while often enough and water drinking water was pulled by an collected near some With a population of 638 distributed iron pulley. handpumps. in 120 households, the village was almost totally tribal in character. It In 1987, the project approached a • The village contact drives had had access to a paved road, but the tribal, Tejia, who agreed to have his clearly had an impact on the nearest bus stop and post office stepwell converted. He and six school going population, who were five kilometres away. The other villagers worked for 15 days seemed to be aware of many of literacy rate was 8 per cent. There on the conversion of the well in the health and hygiene was no Anganwadi in the village, return for five kilograms of wheat priorities. As for the adults, all but it did have a primary and middle per head per day. of them had information about school. There was also a PHC sub- guineaworm disease, but knew centre and an Ayurvedic A second stepwell belonged to very little else about other dispensary. There were seven old ChhatarSingh, who could probably aspects of health. The double- handpumps, including two private easily pay for the conversion work, layered cloth filters from ones. One of three stepwells had but preferred to have the project do SWACH were still few in been converted by SWACH, which the job for him. The project refused, number and the villagers, had also built one latrine, one said Singh, because the expense reluctant to make their own washing platform, one cattle trough for converting this particular well filters, used old pieces of cloth and improved the construction of would far exceed the budget. A to filter drinking water. five drains. third stepwell was situated about 300 metres from the school and • The intensive awareness No cases of guineaworm were used by at least ten tribal families. campaigns had reached even discovered during the first two the very remote villages and village contact drives in 1986 and conveyed the message 1987. In 1988, however, the SWACH effectively. However, the teams medical team visited the village None of the seven handpumps in were expected to do so many when seven cases were reported in the village, including the two that 71 were privately owned, had been .• Environmental Sanltatiott drank from the nearest well — they built by the project. Two of them certainly did not filter the water. were in the main settlement, one The project office reports None of the tribal homes seemed to near a Rajput's house and another mentioned a cattle trough have the project's double-layered near the PHC sub-centre. Of the constructed by the project. It could filter. others, one was behind the school, not be located by the study team. one a little distant from it, and one No one seemed to know anything Soap was rarely used for at the edge of the main settlement, about it. But. the drains attached to washing or bathing. After where the scattered tribal dwellings the handpump platforms had been defecation in the open fields, both began. lengthened to channel the water hands and the mug for carrying away from it. Unfortunately, the water were scrubbed with clay. A The two handpumps in the main handpump nearthe PHC sub-centre few people used soaps and deter- settlement and the one behind the had too many houses near it and gents from the solitary store in the school were the ones that there was just no space for adequate village. functioned best. The one at the drainage. The lenghtening of the edge of the main settlement usually drain had had no effect there. . Village Contact Drive'"::-\:^,:§M went dry after a couple of hours of use in the morning. This was A single block of two latrines and "Clean is beautiful! Clean your teeth because the number of riser pipes three urinals had been constructed everyday!" "Filter all drinking water! was not enough. Once the water by the project. The latrines had locks Abolish guineaworm disease!" level went down, it took many hours on them. The urinals looked as if Slogans adorned some walls in the to recharge. One handpump did they were being used. main settlement. not work at all because its riser pipes had clogged, said the local A washing platform had been built The VCT had held a cultural show mechanic, Bhagwati Shankar. at the handpump behind the school, in the evening, after the village but it needed to be bigger as the contact drive a year ago. Before Shankar was trained by the project women used it in groups rather sudden rain interrupted the and worked part time as a mechanic than singly, and those who could programme, a puppet show and a for Aniarsingh-ka-Gara and its not fit in, went to the handpump play were staged on the land surrounding villages. He went on platform for washing clothes and opposite a Rajput home. The his bicycle everywhere, to ensure utensils. children seemed to know the that all the handpumps were in messages from last year's drive. A proper working order. He also group of young boys promptly The surroundings and interiors of learnt about breakdowns in the listed what they could recall: fortnightly Panchayat meetings. the tribal homes were clean. There were no heaps of garbage or Filter all water before drinking. cowdung festering in the sun. The Keep the home and The Rajput's handpump had homes •were swept and swabbed surroundings clean. been making a creaking noise for regularly. Go to the doctor for curing the past three months, the handle guineaworm disease, not to the was wobbly and needed a lot of effort to work. Shankar shrugged it village quack. off. "It's bearing is broken, that's Do not bathe or defecate near all. Nothing much can happen, Everyone knew drinking water the handpump. except the axle might break. When should be filtered. But that did not Do not leave food exposed. that happens, I'll replace them mean they did it the right way, or Eat while the food is still warm. both," he said calmly. This did it at all. Most homes used a Keep all utensils clean. handpump was used about eight to single layer of old cloth to filter 10 hours a day by the people living drinking water. When they went to They also recalled the play they in the main settlement. work in the fields, most of them had seen, about a son-in-law from 72 the city, who was particular about drinking water. He explain- ed the life cycle of the guineaworm to his father-in-law and urged him to use the hand pump and a proper filter. Waiting for the priest to attend a ceremony at home, the family discovered that the priest, who travelled in many villages, was infected with guinea- worm. Now they would have to ask the priest not to enter the stepwells, as he might contaminate the water.

Obviously, the play had quite an "At one time not too long on their farm, a kilometre from his impact on the upper caste ago, almost every household had home. His brothers lived in a house community. It is not everyday that a guineaworm patient," said near the well. The well had a low one talks of priests as a source of a villager. "Sometimes a whole parapet and the inner walls were contamination, even if it is only family fell ill at the same time partially cemented. The steps were because of a disease he has and relatives had to be called in left as they were. Khatra entered contracted by accident. However, to look after them." In September the well every evening for a bath despite the theme, the adult tribals 19H6, the first village contact before going home. The well did not remember the story clearly. drive had unearthed 93 patients. provided drinking water for his They could hardly recall the village The project look immediate action, brothers' households and he too contact drive a year ago. and the number was down to 10 drank from it during the day. What during the drive in April 1987. In was more distressing was that Two: Village Palthoor, May 1988, there were six patients in Khatra was a handpump mechanic Dungarpur District ::;;;;;: the village. who had led a VCT in the 1987 drive. A totally tribal village with a population of 872, distributed over 132 households, Palthoor w With no river or pond in the vicinity, as poorly connected with the the villagers depended mostly One of the two old handpumps in outside world, with an unpaved on the stepwells. The project the village was next to a temple, a approach road, a bus stand and converted nine of them and despite short distance from where the a post office eight kilometres away. the five additional handpumps Sarpanch lived. There were less Literacy rate was nine per cent. installed by them, the wells than five households there. The There was an Anganwadi and performed a useful function in a other was near Khatra's house in a primary school in the village, community that lived in scattered the interior of the village. The five but no health care facility. There habitations. Not all the wells were handpumps installed by the project were two old handpumps, and converted the same way, or were very much in the interior, two five more were installed by the according to the same design. A of them in places till then project. Nine stepwells in the public: well had a protective iron inaccessible to drilling rigs. village were converted by the grill, while the private ones had a Coordinated by the Nehru Yuvak project, which also built cattle simpler and cheaper design. Kendra, a local NGO, a hundred troughs and washing platforms and young men, displaying tremendous improved the drainage near the Khatra and his brothers owned one community spirit, worked for 10 handpumps. of the converted stepwells. It was days to build a path that would 73 carry the drilling rig to the less after a while. to escape. Dry twigs and dung cakes accessible sites. were used as fuel. Recesses in the None of the homes visited seemed walls were used as shelves, one of All handpumps in the village were to be using any method to filter the them for keeping the drinking in working order. Not surprising, water, except one, where the water. Although the room was since there were nine mechanics in filtering was done with a single swept clean everyday, it was always the village, all recruited in 1981 by layer of an old piece of cloth, with full of smoke and the smell of the government. The handpumps no distinction made between the animals. were mostly used in the mornings, two sides when filtering, but accessibility remained a problem, since the land was hilly Khatra's two-room house did and houses scattered. Nowhere was not leave a pleasant impression. The VCT stayed in the Anganwadi the density high enough to have a He lived there with his wife, his during its two-day programme in single handpump to serve a large three children, 10 goats, a bullock the village, last time they were here. number of people. and a few hens. The animals They visited every home in the stayed in the inner room, which village and organized a cultural ;;;; ; Sanitation •• ^ was also a store for grain, clothes programme in the Anganwadi and cots to sleep in. In summer, courtyard. There were about 200 With no concentrated use of the family slept in the courtyard. people in the audience. The the handpumps, drainage was In winter they used the front children remembered the occasion not a problem. The hilly area room, which also served as a living very well. One of them gave a vivid provided enough slopes for the room and kitchen during the description of the programme and moderate amount of spill to roll day. There were no windows, and they all seemed to have learnt the away. There was also enough open a one-foot square opening above messages well and even understood space for the water to evaporate the stove barely allowed the smoke them.

1 This chapter is based on Managing Guineaworm, Health and Water Supply, the SWACH Project of Rajasthan, Anil Bhatt in association with Salil Dave, Indian Institute of Management, Ahmedabad, 1989. 74 14 Changing the perceptions of villagers in Udaipur

he toughest test of any project precepts. water. But the tribals seemed to is how far it has succeeded in • There was a considerable look upon converted stepwells changing the attitude and number of hidden patients who and handpumps as alternative perceptions of the people. As these had not been flushed out by the ways of accessing or storing are not elements that are visibly village contact drives and had water. transformed over a short period of not attended a medical camp. • Maintenance and repair of all time, monitoring such change while Among identified hidden hardware interventions were a time-bound project is still patients, 40 per cent were perceived to be the responsi- operational, is a valuable part of children under 15 years of age. bility of the government and any development programme. Some of the reasons were not of individual users, owners, Much of the results are initially not apathy, resignation or tolerance or the community. positive, but monitoring helps to to the disease and sometimes understand the social and culture even lack of information about specific problems that obstruct the a reporting system. desired change, and help to develop • More than economic hardship Jalapka was a tribal village 92 more suitable strategies for the and permanent disability, pain kilometres from Udaipur city and future. and temporary disability were 27 kilometres from the nearest all- considered the important side weather road. Located at the end of One of the many studies sponsored effects of guineaworm disease. a narrow forested valley, it had 165 by SWACH in 1990 took a close • Nearly 80 per cent of the treated scattered households. Income was look at this difficult aspect of the patients were tribals, even mostly generated from agriculture, programme.1 Although the results though the incidence of but only six per cent of the land was showed that the project, was having guineaworm was highest in the cultivated. Corn, rice, pulses, wheat a significant impact on prevention mixed caste villages. This might and millet were grown seasonally. and cure of guineaworm disease, be due to the scattered character No crops were grown in summer health care messages remained a of tribal dwellings. By being because of the acute shortage of challenge in these rural and remote located outside the main mixed water. Most families raised goats areas where behaviour was dictated settlements, it was possible that for extra income. Migrant labour by tradition. the tribal dwellings did not was another source of receive the full benefits of supplementary income. The results of the study suggested educational extension some general observations: programmes or hardware There was a single primary school interventions. in Jalapka; older children walked • The physical environment, • Well water was mostly the first seven kilometres to the nearest particularly the accessibility of choice for drinking water, as middle school. Most of the adults in the village to outside handpump water did not taste the village were illiterate. communication was as as good to the villagers. important a consideration in the • Most mixed caste communities There were over 80 water sources infiltration of new ideas and understood the significance of in Jalapka, including natural springs behaviour as were cultural clean, uncontaminated drinking and small pits. Twenty-four wells 75 and 10 handpumps provided water In 1990, Kurdau had a primary because of guineaworm. InKurdau, for irrigation and drinking. Drinking school where 66 per cent of the however, almost, all the patients water was mostly collected from girls and 73 per cent of the boys interviewed stated that they had the 15 wells converted by the came from Rajput families. For the stopped work completely for at least project. adults, the literacy level was either 30 days before being treated. After very low or non-existent. treatment, they were back to work In 1988-89, among the SWACH within 10 days. Many of the patients treated tribal villages, Jalapka was Between 1988 and 1989, 35 per were aware of the loss of income one of the 10 tribal villages with the cent of the villagers were infected and productivity that resulted from highest incidence of guineaworm. with guineaworm — one of 10 the disease. In 1990 there were no reported highest scores in the mixed villages cases of guineaworm here. Jalapka of the district. Of the patients, 70 Most of the people interviewed had 12 medical camps between per cent were tribals. In 1990, there appeared to know that guineaworm 1988 and 1989. Other than were no reported cases in Kurdau. disease spread through drinking converting 15 st.epwells to draw Kurdau had 28 water sources —25 contaminated water from stepwells wells, the project installed one wells, 2 handpumps and the that had not been converted, handpump and constructed seasonal stream. Of the wells, 18 although they were not so clear washing platforms, cattle troughs were stepwells, 15 of which had about the life cycle of the and improved drainage for two been converted by the project. Both guineaworm. After the medical more existing handpumps. Filter the handpumps were installed by camps, many households in Jalapka cloth was distributed in the village, the Panchayat Samiti in 1987. In started using handpumps for but by 1990 they were no longer 1990 only one of them was still drinking water, something that they evident. Everyone claimed that they working, never did before. In Kurdau the filtered drinking water, but many tribal population continued to of them were seen not to do so. SWACII held 18 medical camps and depend on the converted stepwells, Also, the filters available were just one awareness camp in the village mainly because they preferred the old pieces of cloth, discoloured with between 1988 and 1989. taste of the water and because the use. handpump was situated far away from their dwellings.

Only eight of 79 households Information about Kurdau had a mixed population interviewed in the two villages Guineaworm ''• •;=•;;• of mostly Rajputs and tribals, the could say anything about a system latter forming 42 per cent of for reporting guineaworm cases. In Jalapka, 43 per cent, of the the total. Located 10 kilometres All eight households belonged to respondents said that guineaworm away from the Udaipur-Gogunda Kurdau. Four of them had patients could be prevented if water was road, the village straddled who were called to attend the strained before drinking. Only a the Ruparoli, a seasonal stream. medical camps after someone came very few people stated that reliance Thirty-six per cent of the village and made a list of patients in the on handpump water prevented land was cultivated, of which 28 village. However, they knew guineaworm, while another small per cent belonged to the tribal nothing of a postcard, reporting number claimed that prevention families. Corn, rice, wheat, pulses system or a particular person in the could be achieved if no one entered and mustard were grown here, but village who was responsible for a stepwell. In Kurdau, on the other not in summer when irrigation reporting guineaworm cases to the hand, almost everyone knew that became a problem. Agriculture was medical team. filtered water and handpump water the main source of income and, as could prevent the spread of with Jalapka, in Kurdau too, migrant Of the patients interviewed in guineaworm. In Kurdau, both labour provided supplementary Jalapka, only 38 per cent said they tribals and non-tribals were aware income. had stopped work completely that there were less number of cases 76 of guineaworm disease in 1990 responsible for the maintenance Is there a Cultural | because of the SWACH package of and repair of the handpumps. Perception of Water? medical treatment, conversion of Among the users of wells, most stepwells and handpump people felt that the wells ought to The study found no consistent trend installation. In both villages, be looked after by the owners, in the villages to indicate such a however, almost everybody knew although a few did say that either phenomenon. The responses that guineaworm was a very old the "guineaworm people" or the represented personal opinions and disease, present in the community "government" should be preferences or family rules, for generations. responsible for the work they had primarily based on accessibility and done. Most of them knew that the taste. In fact the knowledge that users of wells should be the ones to guineaworm disease could be keep the wells clean. By this they prevented through control of the In Kurdau, there was general sense meant 1 hat the wells should be kept water source appeared to have had of satisfaction about the free of run-off, soap, dirt and refuse secondary importance in their lives. workmanship of the converted while they were being used, but wells. It was also felt that drainage facilities should be the converted wells stayed clean, provided by the "government". while the stepwells were open to They agreed that unlike wells, all kinds of surface dirt and handpumps could not be For urban development planners, contamination. In Jalapka, half of contaminated as they were a it may be difficult to understand the owners of the converted wells "closed" water source. how a population that has suffered complained about the pain for generations because of workmanship and stated that parts Being unused to pulleys, many guineaworm could have taken it of the walls of three wells had of the respondents said they did with so much equanimity. Yet, the already caved in. They also not find the converted wells study makes it quite clear that the grumbled about having to buy rope convenient to use, but accepted concern for change came and bucket to draw the water. But that conversion was a good thing. from outside and was not perceived they all agreed that the wells were Most respondents felt that as a felt need by the community cleaner now and free from handpumps were particularly until the outsiders came. This guineaworm infection. useful during the summer days phenomenon may be common to when the wells ran dry. Prevention the rural poor of all developing All handpump users were of guineaworm was not seen as the nations, where survival takes up convinced that "government" was primary advantage. so much of the people's time and energy, that unless a disease is perceivably life threatening, it will be borne with fortitude and even apathy. It is a factor that any development intervention effort must take into account.

This study, therefore, had based its explorations on a set of assumptions that would control the analysis of its findings and put the concept of change in the correct perspective:

• That persons who are living a marginal existence largely dependent on environmental 77 conditions for their welfare, attributed to individuals in • That choice of particular often do not differentiate varying degrees according to drinking water sources is not between cure and prevention age, sex and community. assumed to be a decision of or the seriousness of various distance or convenience, but illnesses. This is not to say they That there is every possibility may include qualitative do not have the information, that the dynamics of who variables of taste, habit or but rather that cultural and/or receives treatment for ownership.^ economic priorities often guineaworm disease may su percede attention for effective depend on age and sex within The validity of these assumptions is treatment. the pressures of local social universal, and can form the interaction and perceptions of foundation for similar explorations • That access to water sources is who needs treatment. Decision- in any community of the world often based on local social or making about one's personal where there are people suffering political decisions of purity and health is not always an from the ravages of guineaworm pollution. These values are individual's own decision. disease. •

This chapter is based on Village Study on Water Use and Perceptions and Statistical Profile on Treated/Reported Guineaworm Patients and Villages, Chris Deegan, UNICEF, Udaipur, 1990. Village Study on Water Use and Perceptions and Statistical Profile on Treated/Reported Guineaworm Patients and Villages, Chris Deegan, UNICEF, Udaipur, 1990, pp. 10-11.

78