Taking Stock of cleanliness in Punjab: Examining Awareness of Rural Women about Total Sanitation Campaign

 

ABSTRACT:

The main focus of the present paper is to assess the level of awareness of women regards Village Health and Sanitation Committee (VHSC) and Total Sanitation Campaign (TSC) for sanitation and health promotion of the rural women in Punjab in context of National Rural Health Mission now named National Health Mission. The past experience suggest that the successive national governments, aid organization, and charities have sponsored sewerage and toilet construction to improve access, however, this approach has not brought speedy progress as per expectations. Though the toilets have been built but they remain unused in most places because they are either technically or culturally inappropriate or the householders have not been taught the benefits of them. In recent years, Clean India Campaign or Swachh Bharat Abhiyan (SBA) a flagship programme of Government of India, has been launched to eliminate open defecation, insanitary toilets, eradicate manual scavenging, ensure complete disposal and reuse of solid and liquid wastes, and above all bring behavioral changes. It is a well established fact that inadequate sanitation facilities and lack of awareness not only result in several health problems but also affect social and economic development of a country. To achieve the desired outcomes women need to be educated on the importance of sanitation both in rural and urban areas by focusing on household behaviours and community action. Against this backdrop the researcher intends to study the Campaign, its challenges and issues aiming primarily at examining the level of awareness of the women in the rural areas. It was found that the women are not aware about the different health and hygiene schemes meant for them, especially about VHSC and TSC. On the whole; the present paper is based on primary survey and finds a general lack of awareness among the rural women about the basic sanitation schemes.

 

 

 

INTRODUCTION:

Sanitation is not something new or separate from us; instead it is a way of life and fundamental to all development. Most people have been part of a sanitation program from as early as primary school. Sanitation literally denotes measures significant for improving and protecting health and well-being of the people.

 

It is a system that promotes appropriate disposal of human wastes, proper use of toilets and discourages open space defecation.

 

*Post Doctoral Fellowship, Department of Social Work, Punjabi University, Patiala:

The World Health Organization (WHO) 2018 defined sanitation access to and use of facilities and services for the safe disposal of human urine and faeces. The word 'sanitation' also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal.¹ Sanitation in India dates to the time of Indus Valley Civilization and much beyond that. Emphasising the relative importance, Mahatma Gandhi had once said, "Sanitation is more important than Independence." Lack of Sanitation is not only a public health disaster but also a social problem. India has acknowledged the fact that sanitation is a cornerstone in the all-round well-being of a person. It not only affects a person's health but also dignity.²

 

The Government of India (GoI) has launched several policies across rural India. The programme of the Indian government, Central Rural Sanitation Programme (CRSP) began in 1986 with the objective of providing for 80 percent subsidy for construction of individual sanitary latrines for BPL household on demand basis. The CRSP was restructured in 1999, with a shift from high subsidy to low subsidy model. The supply driven approach was altered to a demand driven model with increased emphasis on public participation. In 2001 the CRSP was renewed with the introduction of the Total Sanitation Campaign (TCS), which carried forward the demand driven approach focusing on awareness building. The programme cost in TCS were shared between Union (60 percent share), state governments (20 percent share) and the beneficiary (20 percent share). TCS successfully encourages households to finance their own toilets while giving financial incentives to the underprivileged.³ The Department of Drinking Water Supply and Sanitation, under the ministry of rural development has been making consistent efforts under TSC to eradicate open defecation.

 

As a stimulus to the TSC, the Nirmal Gram Puraskar (NGP) was launched, to recognize the achievements and efforts of Gram Panchyats towards full sanitation coverage. In 2007 TSC was renamed Nirmal Bharat Abhiyan (NBA). The NBA had been converged with the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) to facilitate the rural households with fund availability for creating their sanitation facilities. It was not until the inception of the National Urban Sanitation Policy (NUSP) in 2008, that urban sanitation was allotted focused attention at the national level. According to Pragati, The India National Interest Review (2014), the focus of the centrally sponsored schemes, such as Jawaharlal Nehru National Urban Renewal Mission (JNNURM), Urban Infrastructure Development Scheme for Small and Medium Towns (UIDSSMT), Rajiv Awas Yojna, etc. has shifted on service delivery outcomes rather than on infrastructure creation. Several other large sanitation programs have been launched in urban India since then such as Basic Services for Urban Poor (BSUP) under JNNURM.⁴

 

The Village Health and Sanitation Committee (VHSC) under the umbrella of Panchayati Raj Institutions were constituted for the effective implementation of National Rural Health Mission. After the implementation of NRHM in Punjab in 2005, it was directed by the Mission Director of NRHM to constitute VHSC in 2007 which was later (2013) termed as Village Health, Sanitation and Nutrition Committee (VHSNC). Village Health, Sanitation Committee has been entrusted with the responsibility of village level planning for health care in rural areas and enhancing people's participation in improving health care services by increasing awareness about health services with special focus on women and children. VHSC comprises of Facilitaors, MPHW, elected representatives of PRIs, School teachers, members of NGOs, ex-service men and members of weaker sections of society.⁵

 

Village Health, Sanitation and Nutrition Committee (VHSNC) In addition to the defined activities of VHSNC as per NRHM framework of implementation, will also engage with and monitor status, issues and action pertaining to nutrition.⁶ The National Rural Health Mission (NRHM) hopes to achieve its goal of providing universal access to equitable, affordable and quality health care, especially for the poor and vulnerable communities in rural areas, through involvement of the Panchayati Raj Institutions (PRI). Every village with a population of up to 1500 shall receive an annual untied grant of up to Rs. 10,000, after constitution and orientation of the VHSNC.⁷

 

An intensive review of the studies concerned with Government policies on health and sanitation schemes for people of rural areas has revealed that women are still not fully aware about the schemes available to them on health and sanitation and as a result their health suffers and also lack of awareness is inversely related to empowerment, which in true sense  means gaining control of one's life. An attempt has been made to explore the level of awareness of rural women in relation to Village Health and Sanitation Committee and Total Sanitation Campaign under National Rural Health Mission which is the central motif of this paper.

 

The State Government should take initiative to generate awareness among the general public about the sanitation schemes to be implemented/being implemented for improving the hygiene of rural people especially women. The different departments of the State Governments through electronic and print media could take up Information, Education and Communication activities on a massive scale to raise general awareness level of rural population about various development programmes undertaken for them as well as to make them conscious of their rights and entitlements, health, hygiene and other sanitation measures.

 

There are various schemes announced by the government for health and sanitation and the primary focus should be on awareness if the aim of these programmes is to be optimally achieved. The people in charge for these government schemes must be fully aware themselves so that they can impart knowledge and play their roles in an effective way. One such study revealed that majority of the members of the VHSNC were not aware of the role and objectives of the committee specially that these committees were formed to spend the untied funds for village sanitation and cleaning. Very few reported that they attended training organised by the health department for their capacity building.⁸ In another study, on Total Sanitaion Campaign, it mentions that though, TSC aimed to be demand-driven, and used tools like, Information, Education and Communication (IEC), aiming to increase awareness and generate demand. But, the vision could not be realized. Although some IEC was used, emphasis was on hardware implementation and subsidies instead of on awareness, participation and behaviour change. The study mentioned that where Committee members visited house-to-house to encourage residents to build toilets for reasons of children’s health and women’s dignity, were near the goal of achieving an ODF village. Meanwhile, in Namuda Gram Panchayat in Haryana sanitation coverage was only 57 percent by 2011, due to low quality s of services, lack of raising awareness and focus on cash subsidy distribution. In Himachal Pradesh, sanitation is the most demand-driven, and door-to-door campaigning and community theatre by sanitation committees, anganwadi workers or members of women’s groups, proved to be powerful for creating awareness and yielded remarkable results. So, in states where awareness generating was high, participation was high too, but on the whole, TSC was not implemented as a community led, people-centred and demand-driven programme.⁹ An organisation named Samhita Social Ventures is of the similar view that the government is focused on building toilets but demand is not being created. Spending on IEC is 15 percent of the budget, which is second to creating infrastructure. Behaviour change communication is the need to ensure toilet usage.¹⁰

 

THE STUDY:

The locus of this study is Punjab which is one of the progressive states of India. As in India, so in Punjab, the women have suffered discrimination in various forms and have remained marginalised. However, in modern times, especially since independence, successive Governments in Punjab attempted to raise the status of the people by taking several measures. For sanitation and health and have definitely improved the quality of life but to a low extent, i.e. for a small section of the people. Though there is no doubt that there are more toilets in Punjab as compared to other parts of India yet the benefit of various Government schemes have not been fully reaped.

 

METHODOLOGY:

The present study was conducted in the villages of Patiala District. In this study we assessed the level of awareness among rural women about Village Health Sanitation Committee and Total Sanitation Campaign in reference to health and sanitation. The study has been carried out in 8 blocks Patran (76 villages); Nabha (174 villages); Patiala, Sanaur, Bhunerheri (358 villages); Rajpura, Ghanaur (277) and Samana (61 villages).  For the sample of the present study, the principle unit of drawing the sample was a village. Keeping in view the equal representation of each of the 08 Community Blocks in Patiala District, 04 villages were randomly selected from each block. It may be able to give an overall picture of the awareness level of rural women in the entire state. In the last stage a total of 320 rural beneficiaries in the age group of 17-45 years (randomly selecting 10 women from the selected villages) would be interviewed to know their perception and views about various aspects of NRHM in reference to Village Health Sanitation Committee and Total Sanitation Campaign.

 

The major aim of this research paper is to study the level of awareness among the rural women about the sanitation facilities being provided by the Governments under NRHM, namely by VHSC and TSC. In this paper we analyze the barriers of backwardness and marginalization of rural women. Keeping in view the limited time and facilities the investigator selected only one district of Punjab with the assumption that it represented the whole population.

 

The data was collected in the months of July and August 2011 with the help of a pre-designed and structured interview schedule. The interview schedule consisted of questions framed to collect the relevant information according to the pre-decided objectives of the present study.

 

FINDINGS OF THE STUDY:

A large number of schemes have been launched and implemented to raise the quality of life of the rural people, especially with focus on women.  It includes the schemes of providing health facilities and also focusing on hygiene and sanitation. Is very important that a reasonable amount of the total funds is spared for generating awareness through IEC activities particularly in remote rural areas where awareness levels are particularly low, so that the women are more aware about various developmental programmes undertaken for them in the area as well as conscious of their rights and entitlements. Further, funds from the Scheme should be utilised for training and sensitizing staff and members of the committees in the enforcement agencies. Low level of awareness about these schemes among the women along with apathy of administrative officials in implementation of these schemes and programmes are a hindrance in providing and maintaining health and hygiene. 

 

Majority of the targeted beneficiaries do not get the benefits from the government schemes just because of their ignorance about them. With this in mind, the respondents were asked if they knew about the government schemes and the agency provided them in the villages. 

 

Village Health and Sanitation Committee:

NRHM promotes integration of nutrition and health. Village health and nutrition days are to be organized under this coordinated effort. It aims to promote health awareness generation and nutrition education.¹⁰ Village Health and Sanitation Committee (VHSC) is an important aspect of the NRHM in carrying out the village health plan. It represents the lowest level management structure and set-up to facilitate village level development programs. To enable VHSC to reflect the aspirations of the local community especially of the poor households, 50 percent of its members should be women. These committees are within the umbrella of Panchayati Raj Institutions. Now (2013) it has been expanded and includes nutrition within its ambit with the active participation of ASHAs, ANMs and Anganwadi workers. Among the various activities the prime is, to create awareness about nutritional issues and also act as a grievances redressal forum on health and nutrition issues.¹¹

 

Table 1: Distribution of Respondents as per Awareness about Village Health Sanitation Committee 

S. No	Frequency	Distribution of Respondents as per Awareness about Village Health Sanitation Committee						Total
		Dudhan Sadhan	Harpalpur	Kauli	Bhadson	Shutrana	Kalomajra
1.	Fully Aware	15 (30.0)	0 (.0)	32 (64.0)	10 (20.0)	0 (.0)	14 (28.0)	71 (23.7)
2.	Partially Aware	28 (56.0)	43 (86.0)	9 (18.0)	27 (54.0)	12 (24.0)	25 (50.0)	144 (48.0)
3.	Not at all Aware	7 (14.0)	7 (14.0)	9 (18.0)	13 (26.0)	38 (76.0)	11 (22.0)	85 (28.3)
Total		50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	300 (100.0)

Figures in parentheses denote percentages

 

Figure 1:  Shows Distribution of Respondents Regarding Awareness about Village Health and Sanitation Committee

 

The village wise break-up of data depicts that in Patiala block out of the total respondents maximum awareness (64%) was about the Village Health and Sanitation Committee. One of the major roles of VHSC is to organize Village Health and Nutrition Day (VHND) which is known as Mamta Diwas in Patiala District. It is organized on Wednesday or Friday in some blocks and is organized at the Anganwadi centers or in the health center. Out of the 23.7 percent that is a little more than three fifth of the rural women, all were aware of Mamta Diwas. While, none (0) of the women were fully aware about it in Shutrana village. Most of the women were partially aware (48 percent) about the VHSC and 28.3 percent were not at all aware. Majority of the rural women were aware of the VHND though they were not aware of the terminology. This is similar with the study on awareness and utilization of National Rural Health Mission services among rural people in Maharashtra which aimed to evaluate the percentage of people aware and utilize the NRHM services. Quantative research method was adopted to conduct this study that revealed in its analysis that more than half (59.6 percent) of the people had inadequate awareness regarding National Rural Health Mission services.¹²

 

Thus it is clear that the awareness of the women about the government the committee is very low. It is hearting to note that the Mamta Diwas strategy is generating interest among all sections of society. If conducted properly it shall help immensely in reducing malnutrition levels among children and mothers too. It because of varied reasons but the major one is lack of IEC among others like illiteracy of these rural women.

 

A report of Ministry of Health and Family welfare, Gujarat (Banaskantha, 2011) also mentioned that 66 percent of the respondents in a village in Gujarat were aware of village health day but only 13 percent reported awareness about VHSC in their village.¹³

 

Total Sanitation Campaign:

The Government of India runs the Total Sanitation Campaign (TSC) which is being administrated by the Ministry of Drinking Water and Sanitation. It aims to provide access to individual toilets to all rural households. Good sanitation is a major determinant of health indicator. It came into focus in the Government of India in the World Water Decade of 1980s.

 

 

Rural sanitation was addressed by the Government of India (GoI) in the 1980s through the Central Rural Sanitation Programme (CRSP) which was started in 1986 to provide sanitation facilities in rural areas. It was a supply driven, highly subsidy and infrastructure oriented programme. As a restructure of the CSRP in 1999, the Ministry of Rural Development and the central government introduced the Total Sanitation Campaign (TSC) to accelerate sanitation coverage throughout the country, particularly in rural areas to "improve the l quality of life and accelerate sanitation coverage through access to toilets to all by 2012. It focused on information and education to generate public demand for sanitation facilities. It also recognised the importance of local leadership, and integrated rewards to encourage participation The Government introduced an award, called Nirmal Gram Puraskar (NGP) in October 2003 for districts, blocks, and Gram Panchayats with 100 percent sanitation coverage of individual households, school and those that are free from open defecation. The TSC made some progress and scaled significantly in the first decade, but was not very effective. It was renamed Nirmal Bharat Abhiyan in 2012 and relaunched as Swachh Bharat Abhiyan in 2014.¹⁴

 

The main objectives of the TSC are to bring about an improvement in the general quality of life in the rural areas and generate felt demand for sanitation facilities through awareness creation and health education. It also aims to eliminate open defecation to minimize risk of contamination of drinking water and food.¹⁵

 

 

 

Table 2. Distribution of respondents as per awareness about Total Sanitation Campaign

S. No	Have you heard of Total Sanitation Campaign?	Distribution of respondents as per awareness about Total Sanitation Campaign						Total
		Dudhan Sadhan	Harpalpur	Kauli	Bhadson	Shutrana	Kalomajra
1.	Fully Aware	0	0	0	0	5 (10)	0	5 (1.7)
2.	Partially Aware	2 (4.0)	10 (20.0)	1 (2.0)	6 (12.0)	34 (68.0)	11 (22.0)	64 (21.3)
3.	Not at all Aware	48 (96.0)	40 (80.0)	49 (98.0)	44 (88.0)	11 (22.0)	39 (78.0)	231 (77.0)
Total		50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	300(100.0)

Figures in parentheses denotes percentages

 

 

ASHA, one of the key components of the National Rural Health Mission and works as interface between community and public health system to promote health care at household level. ASHA can contribute towards Behavior Change Communication (BCC) and motivate households to construct and use a toilet, for which she is to get Rupees 75/- per house. This is also in line with the vision of Nirmal Bharat. Very few, a little more than one fifth (23 percent) have heard about total sanitation campaign, even those women who have heard are not aware that it aims to provide household toilets. Many respondents said that there were few toilets, i.e. every household did not have a toilet in the village. More than three fourth (77 percent) said that they were not at all aware about the scheme. The Minister of State, Ministry of Drinking Water and Sanitation, Sh. B. Solanki too opines that focus should be to increase knowledge and perceived importance of sanitation and hygiene practices in order to change age old system of open defecation, which is no longer acceptance in India¹⁴. This in turn shall affect health. Thus it is clear that the awareness of rural poor women about the NRHM schemes is very low.

 

 

Table 3. Distribution of respondents as per Awareness about Household Toilets under Total Sanitation Campaign

S. No	Are you aware of Total Sanitation Campaign which promotes household toilets?	Distribution of Respondents as per Awareness about household toilets under Total Sanitation Campaign						Total
		Dudhan Sadhan	Harpalpur	Kauli	Bhadson	Shutrana	Kalomajra
1.	Fully Aware	2 (4.0)	0	0	0	0	0	2 (0.7)
2.	Partially Aware	3 (6.0)	10 (20.0)	1 (2.0)	6 (12.0)	37 (74.0)	9 (18.0)	66 (22.0)
3.	Not at all Aware	45 (90.0)	40 (80.0)	49 (98.0)	44 (88.0)	13 (26.0)	41 (82.0)	232 (77.3)
Total		50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	50 (100.0)	300 (100.0)

Figures in parentheses denote percentages

 

Building toilets is one of the prime aims of TSC. The rural women were not aware of any such scheme under TSC. More than half (77.3 percent) were not all aware of the household toilet scheme under TSC. While a meager number, that is only 0.7 percent were fully aware, these women were from Dudhan Sadhan village. Some of the women were partially aware, that is 22 percent and had some knowledge about toilets and TSC.

The sanitation problem in the country has a strong cultural component. A study published in 2013 estimated “that 72.63% in rural India in the sample states practice Open Defecation (OD) irrespective of having or not having toilet facilities. The predominant reasons for the OD are lack of awareness, established age-old practice.¹⁵

 

In another study, it was highlighted that successful sanitation depends on three factors. The first being political will (both government and NGOs) to support usage of toilets. Second, there should be one to one contact among rural people, relatives and neighbours (social pressure) on usage and building of toilets. Lastly, there should be a political ecology framework that assures access to water which is the key to successful sanitation.¹⁶

 

CONCLUSION AND RECOMMENDATION:

It may be concluded here that the rural women are not fully aware about the programme called National Rural Health Mission but they are aware of Cash Benefit Scheme/ Janani Suraksha Yojna, though not in detail. Not all have heard of a Village Health and Sanitation Committee neither are they aware of Total Sanitation Campaign which promotes toilets in every household. When the scheme was discussed with the rural women they inquired, ‘how can this be possible as there is no proper drainage system and it gets worse during the rainy season…. the village has good road in the outer area but inside where we live there is no road at all...’ Women miss out on health services due to lack of transport Whatever little they know of the schemes and programmes they have learnt from ASHA and their family members. ASHA is a great source of information though there is a long way to go to achieve the Mission’s goals of Health for all. In order to raise the general awareness among the rural population for successful implementation of various health programmes for bringing improvement in their quality of life, there is need for systematic and sustained Information, Education and Communication (IEC) activities in the rural areas targeted at the ignorant population. So, awareness on various health schemes is a must so that the rural people could avail proper benefits of these health programmes.

 

REFERENCES:

1.      World Health Organization: Guidelines on Sanitation and Health. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/274939/9789241514705-eng.pdf?ua=1, on January 20, 2019

2.      Rathi, Dr. Shubhangi: Importance of Gandhian thoughts about Cleanliness. Retrievd from https://www.mkgandhi.org/articles/gandhian-thoughts-about-cleanliness.html, January 18, 2019

4.      3.Nirmal Bharat: Total Sanitation for All. (n.d.). Retrieved from http://www.archive.india.gov.in/spotlight/spotlight_archive.php, July 2017

5.      Bhaumik Sukanya. Y. Kumar. Avinash. (2014). India’s Sanitation Story. Retrieved from www.pragati.nationalinterest.in, June 2017

6.      Ahmed, Dr Shaik Iftikhar: Functioning of Village Health Sanitation and Nutrition Committees in Punjab: An Appraisal. Retrived from https://www.researchgate.net/publication/327552213_Functioning_of_Village_Health_Sanitation_and_Nutrition_Committees_in_Punjab_An_Appraisal On January 17, 2019

7.      Pandey, Arvind and Singh, Vikram. (2011). Tied, Untied Fund? Assessment of Village Health and Sanitation Committee involvement in Utilisation of Untied Fund. CHEER Society: Rajasthan

8.      State Health Resource Centre. (2012). Village Health Sanitation and Nutrition Committees (VHSNCs) in Chhattisgarh. Raipur.

9.      Ahmed, Dr Shaik Iftikhar: Functioning of Village Health Sanitation and Nutrition Committees in Punjab: An Appraisal. Retrived from https://www.researchgate.net/publication/327552213_Functioning_of_Village_Health_Sanitation_and_Nutrition_Committees_in_Punjab_An_Appraisal On January 17, 2019

10.   An untold story of policy failure: the total sanitation campaign in India. Article in Water Policy · November 2013. Retrieved from http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/untold_story_of_policy_failure. pdf, on January 2, 2019

11.   Krishnamurthy. Vaidyanathan. (n.d.) Looking beyond toilets: The need for sustainable sanitation solutions. Samitha. Retrieved from http://www.samhita.org/looking-beyond-toilets-the-need-for-sustainable-sanitation-solutions/

12.   Ministry of Health and Family Welfare, GOI. Annual Report 2007-08. Rural Health Care in India. Retrieved from http://shodhganga.inflibnet.ac.in/bitstream/10603/7296/11/11_chapter%202.pdf

13.   Ray SK. Awareness and Utilization of National Rural Health Mission Services Among People of Selected Rural Areas in The State of Maharashtra. Natl J Community Med 2014: 5(4); 387-91. Retrieved from https://www.ejmanager.com/mnstemps/159/159-1456734983.pdf

14.   Ministry of Health and Family welfare, Gujarat (Banaskantha, 2011)

15.   14.Total Sanitaion Campaign. Retrieved From http://www.nrega.nic.in/netnrega/forum/8-TSC.pdf

16.   15. Case study. August 25, 2017. India's Total Sanitaion Campaign. Retrieved from  https://www.centreforpublicimpact.org/case-study/total-sanitation-campaign-india/ on January 1, 2019

17.   Louis, Elizabeth and O’Reilly, Kathleen. (2014). The toilet tripod: Understanding successful sanitation in Rural India. Health and Place. Vol 29. Pg 43-51. Retrieved from www.Sciencedirect.com

 

 

 

 

 

Accepted on 20.05.2019            © A&V Publications All right reserved