PEOPLE WATER & SANITATION WHAT THEY KNOW, BELIEVE AND DO IN RURAL INDIA

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Title
PEOPLE
WATER & SANITATION
WHAT THEY KNOW, BELIEVE AND DO
IN RURAL INDIA
extracted text
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PEOPLE
WATER & SANITATION
WHAT THEY KNOW, BELIEVE AND DO
IN RURAL INDIA

ulUSIT (DEF (DOWEENlTg
Page No.
Introduction

2

Where do people
get water from ?

4

How do they collect,
use and store water ?

7

What do they believe
about water?

10

"It is a Government
Pump"

13

Cleanliness: People's
Perception

18

. Personal Hygiene

21

Household hygiene

23

What happens to
| human waste ?

26

, Sanitary latrines:
' The 'Great unknown'

30

’ Reach of Media

35

l

J

i

■

1

INTRODUCTION
Lack of a sufficient quantity of potable wa­
ter, poor sanitation services and lack of
hygiene awareness contribute to most of
the sickness prevalent in India. Children
are the ones most vulnerable. It is esti­
mated that 2500 children below five die of
diarrhoeal diseases every day in India.
Millions more live on, perhaps surviving
recurrent attacks but suffering retardation
of physical and mental growth due to diar­
rhoea draining their bodies of vital nutri­
ents. The loss to the nation also includes
180, 00,00,000 person hours of productive
work lost due to water and sanitation re­
lated diseases every year.

Although sanitation coverage is still a mini­
mal 3 per cent in the country, provision of
at least one source of safe drinking water
to all villages in India is a target nearing
completion in 1990.
However, since the late 1980s, a realisation
has been growing among policy makers
that provision of services will not automati­
cally lower mortality and morbidity rates
and achievement of physical targets is no
reason for complacence. Improving pub­
lic health through better water supply and
sanitation is a matter of changing people's
behavior related to the use of water and
hygiene.

For a system designed for a one way flow of
inputs and instructions from the planner to
Courtesy Krishan Kalra

2

the people, this has been a difficult realise
tion. The government of India's Technol­
ogy Mission on Drinking Water instituted in
1986 decided to meet the challenge head­
long. UNICEF was requested to help de­
velop a strategy for bringing about desir­
able behavioral changes among people
as well as within the system delivering water
supply and sanitation services.
The first step was to understand whose
behaviour (target group) would have to
change, which behaviour patterns needed
to change in what direction (target re­
sponse), and what messages would need
to be addressed to specific groups to ef­
fect these changes. These questions raised
more fundamental ones like what do people
already know, believe and do in terms of
water use and hygiene in different parts of
the country? Why do they believe what
they do? How do they define 'safe water'.
'unsafe water' ’cleanliness','health'? The
only answers then available were the sub­
jective assumptions of planners and imple­
mentors but no reliable information to base
a strategy upon. In a country of India's size
with an enormous- heterogeneity of cul­
tures, the implications of planners' igno­
rance on the issue were obvious.

In order to build a firm foundation for plan­
ning strategies for social mobilisation and
behavioral change, at the request of the
Government of India, UNICEF commissioned
a country wide knowledge, attitudes and
practices study on water use and hygiene
in rural areas during 1988-89.
The study, conducted by IMRB, a premier
market research organisation of the coun­
try, covered more than 7900 individuals in
villages of 22 districts in eight major states
of the country. Sampling criteria included
socio-economic indicators, geo-climatic
variations and availability of water in the
region, to yield as representative a sample
of the rural population as possible. The study
also covered a sizable sample of Water
Supply and Sanitation programme imple­
mentors in these states. It was conducted
in two phases, using qualitative and quan­
titative methods like focus group discus­
sions, interviews using semi-structured ques­
tionnaires and direct observations by field
investigators.

3

WHERE OO PEOPLE
CET WATER EPOM ?
Traditional open dugwells continue to be
the primary source of water for all purposes
including drinking in 7 out of 8 states sur­
veyed. The handpump comes a close sec­
ond, except in West Bengal where it is the
primary source. Dugwell - handpump - tap
is generally the order of preference for
drinking water sources. Nearly 10 per cent
households collect drinking water from ex­
posed surface sources like lakes, ponds,
canals or rivers. In Gujarat and Manipur the
majority collect and use rain water mainly
for purposes other than drinking.

Dugwells are visited approximately 12 times
a day, public handpumps and taps 9 times,
rivers, lakes or streams 6 times.
Households in U.P. and West Bengal have
handpumps within 40-80 metres of their
homes. In Rajasthan, Gujarat, Tamil Nadu
and Andhra Pradesh the pump is 2 to 3
times as far from homes. In Rajasthan and
Gujarat wells are thrice as far from homes
as handpumps. Across the states one
spends about 2.2 hours a day walking to
and from wells. The figures are 1.3 hours for
handpumps, taps and ponds, 2.4 hours for
rlvers/streams.

Nearly four out of every five people sur­
veyed have a handpump in their village.
Uttar Pradesh & West Bengal have mostly
traditional handpumps which may be he
shallow pumps. Tamil Nadu,

4

In Uttar Pradesh and West Bengal most
people regularly drink handpump water.
In all other states 13-18 per cent people
reportedly never use it for drinking. Inter­
estingly, the implementors' perception of
people's use of handpump water for drink­
ing is 14 per cent higher than is really the
case. They also think that the handpump is
the primary source of drinking water for the
largest majority whereas according to
people it is the dugwell.

Over half the non-users of Mark II handpump
say that the pump is located too far away
for their convenience. One out of three
non-users also feels that its water tastes
salty, mineralised, looks rusty or smells
medicinal. They have fewer complaints
regarding the look, taste and smell of wa­
ter from traditional shallow handpumps.
However, the traditional handpump is of­
ten monopolised by a few which is not the
case with the Mark II pump.

USES OF HAND PUMP WATER

Madhya Pradesh, Rajasthan and Manipur
mainly have the deep well Mark II. Andhra
Pradesh and Gujarat have an overlap of
both types.

M

ACTUAL %

H

IMPLEMENTORS’VIEW

5

□

Handpumps have brought
water closer to homes and
cut down on time/effort
needed to collect water from
traditional sources. However,
this does not necessarily
mean that people have, by
and large, switched over to
drinking the safer water from
the groundwater sources
provided.

□

Since dugwells continue to
be the most frequently used
source of drinking water
qcross the country, there may
be a need to devote atten­
tion to improving water qual­
ity in these wells through tech­
nical and informational in­
terventions.

□

The principal reason for non­
use of Mark II handpumps
seems to be related to its lo­
cation, which is considered
inconveniently far by a ma­
jority of its users i.e. women.

6

□

Popular
resistance
to
deepwell handpump water
related to its salinity or miner­
alised taste in certain regions
may not be overcome sim­
ply through promotion of
Mark II pump as the safest
water source. Particularly if
the alternative sources in the

same area like shallow
dugwells offer better tasting
water. In such areas it may
be more relevant to concen­
trate on community educ­
tion for well protection.

now t< Iff > <xiircr, store
ANO USE WATER ?
The principal water collector in Indian
households in the woman, usually between
15-35 years old. She collects about 192
litres of water per day for each average
household of 7 members.

AVERAGE VOLUME OF WATER COLLECTED PER HOUSEHOLD
PER DAY (Litres)

WHO COLLECTS WATER FOR
HOUSEHOLDS
WATER SOURCE VISITED : 6-12 TIMES/DAY

TO COLLECT APPROX. 192 LITRES/DAY
TIME SPENT: 1.2 - 3.5 HOURS/DAY

WOMEN

<15 Yrs.

7

Water is stored in the same vessel in which
it is collected, in 3 out of 4 households. In
Gujarat, Madhya Pradesh and Rajasthan
the water pot is often stored above ground
level on special platforms/niches, away
from reach of animals and small children.
Elsewhere it is usually on the floor. The
storage pot is kept covered every where
except in Uttar Pradesh where 41 per cent
leave it uncovered. In Gujarat and Rajast­
han water is usually filtered before storing.
Women report this practice more often than
men do. Only 4 per cent boil water before
storing. They are in Manipur and Tamil
Nadu. In addition 1 out of every 4 house­
holds in Manipur also uses alum or chlorine
to disinfect water.

In 68 per cent households drinking water is
taken out of storage pots using containers
without handles, causing hands to be
dipped in the water.. Observations show
repeated hand contact with drinking wa­
ter during collection, transportation, stor­
age and serving in all the states. The desir­
able practice of using long-handled ladles
to take water out is not prevalent any­
where except in Manipur. Another good
practice i.e. pouring water out exists mainly
in West Bengal,
Present practices of storing and using drink­
ing water In rural households illustrate many
currently active routes of contamination.
The high incidence of filtering of water by

8

women in guineaworm afflicted areas like
Gujarat and Rajasthan probably indicates
the impact of concerted health education
■inputs promoting this practice in the area
over the past several years.. Women re­
spond better to such educational efforts
since they are the collectors and manag­
ers of drinking water for the family.

UH!
f /H I F < f W (
I 41 F L f € A T f C N S
Promotion of hygiene awareness
needs to be based on state-spe­
cific water handling practices
and directed towards women in
rural homes of the state. Examples
of desirable state-specific bias in
communication could be :

West
Bengal
and
Manipur

Drinking water
should be
stored above
floor level.

Uttar
Pradesh

Focus on
keeping
drinking water
covered.

Madhya
Pradesh
and
Andhra
Pradesh

Promote
filtering as
Guineaworm
prevalence in
these states is
substantial.

All states

Promote pouring
out/using long
handled ladles
for taking
drinking water
out of storage
pot.

9

WtiAT DC THEY BELIEVE
ABOUT WATER?
Good and Bad Water
Popular definition of 'Good drinking water'
is water that is visually clear, tastes sweet
(free of unpleasant flavours and odours)
and cooks food well/quickly.

Conversely, bad water or water unfit for
drinking is that which is visually unclear, has
tinge of colour, salty/metallic taste or smell
and water in which grains/pulses take a
long time to cook.
Thus, popular definition of good drinking
water covers both safe and unsafe sources.
The criteria people presently use to distin­
guish 'good' drinking water from 'bad' can
at times cause classification of water from
certain safe sources as 'unfit for drinking'
e.g. deepwell handpump water which may
have a metaillc/mineralised taste or rusty
appearance. The study already indicates
that faced with a choice between a
handpump and a well people often opt for
the well water for drinking and cooking.
While look and taste are universally used
evaluation criteria for water, Its 'cooking
quality' is particularly important to women,
who make the final choice about the wa­
ter source used for drinking/cooking In their
families. Most implementors are not con­
scious of the significance women attach to
the 'cooking quality' of water.

10

ATTRIBUTES OF “GOOD WATER” FOR DRINKING
FREE FROM GERMS

HAND PUMP WATER

COOKS FOOD WELL
SWEET TO TASTE

VISUALLY CLEAR

□

PEOPLE'S VIEW

®

IMPLEMENTORS'VIEW

ATTRIBUTES OF “BAD WATER” FOR DRINKING

HAS VISIBLE'GERMS’

SALTY/BAD TASTING

FOOD DOES NOT

COOK WELL

MUDDY/UNCLEAR

___________________

B

PEOPLE'S VIEW

H

IMPLEMENTORS' VIEW

Water and Health
There is a large area of public ignorance
about how health is affected by bad drink­
ing water. In the absence of factual knowl­
edge, misconceptions and vague guesses
are used to explain the relationship.
Across the states 88-95% people believe
that bad drinking water causes health
problems. However, when asked what these
health problems are, the majority mention
fever, cough and clods, throat ache etc.
which are not directly related to drinking
unsafe water. Only 10-18 per cent people
across India are aware that bad drinking
water causes diarrhoea, stomach disorders,
cholera. This awareness is higher in the
eastern states. In West Bengal and Manipur
more than 55 per cent know about bad
drinking water - diarrhoea linkage. 13 per
cent of the total sample erroneously link
malaria with bad drinking water.

Focussed communication efforts in guineaworm/fluorosis affected areas have man­
aged to raise public awareness about the
relationship to 5 to 20 times the state aver­
age. In the guineaworm affected district
of Udaipur 22 per cent people are aware of
bad drinking water causing the disease, as
opposed to only 1.6 per cent In the rest of
the Rajasthan state. Similarly, 11 per cent
people of the fluorosis affected Amreli dis­
trict are aware of the fluorosis - drinking
water link although only 2 per cent know
about it in the rest of Gujarat.

PEOPLE’S PERCEPTIONS ON HEALTH PROBLEMS CAUSED
BY BAD DRINKING WATER

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IMPL6CATICHS
□

□

Mostof the implications here
pertain to peoples' percep­
tions and resulting behaviour.
Popular, definition of 'good
drinking water', needs to be
modified through sustained
communication efforts, to
become 'safe drinking wa­
ter'. However, it may be dif­
ficult as well as unnecessary
to explain the germ theory in
detail to users.
Communication could aim
at public recognition of water
sources that may carry dis­
ease (unsafe) and sources
that will not carry disease
(safe). Through interpersonal
communication user com­
munities can be helped to
identify and classify their own
water sources as ;

i)

12

open to pollution, there­
fore unsafe,

ii)

protected from pollu­
tion, therefore safe.

□

Communication can focus
on region and state-specific
user behaviour at water
sources and homes to high­
light prevalent practices that
pollute drinking water. Pub­
licity can help build public
pressure against these prac­
tices and suggest alternative,
non-polluting solutions e.g.
washing and bathing plat­
forms near handpumps
which are connected to
soakage pits, to prevent stag­
nant water pools around the
pump.

□

Bad drinking water - diarrhoreal diseases link must
be established and con­
stantly reinforced in people's
minds forcefully through all
media forcefully through all

media channels available.
Along with it, each region/
state would need to promote
4-5 key practices for hygienic
handling of drinking water,
during collection, transpor­
tation, storage/use at home.
These practices would have
to be related to the way
water is currently handled by
users in each region, to iden­
tify and counteract specific
routes of contamination
prevalent there.

“IT IS A GOVERNMENT
PUMP”
'Public handpumps' continue to be looked
upon as the government's property and re­
sponsibility. Although one quarter of all the
users feel they should look after day to day
maintenance, they expect the actual cost
to be borne primarily by the government
and secondarily by the Panchayat (Village
Council)

Two out of three users of public handpumps
believe them to be the property of the
government. This belief is particularly strong
in Northern and Central parts of the coun­
try. In Andhra Pradesh and Gujarat 30-41
per cent think it belongs to the Panchayat
(Village Council). People's ownership is an
unfamiliar concept in Rajasthan, Madhya
Pradesh and Andhra Pradesh, but is widely
accepted in the eastern states.

13

Although the majority of the users do not
believe that the pump belongs to them,
nearly one fourth agree that maintaining it
is their own responsibility. Manipur and
West Bengal lead the rest in acknowledg­
ing public responsibility for handpump main­
tenance. Andhra Pradesh comes last in
this respect.

Nearly half the users in West Bengal and
Manipur feel that the villagers themselves
should pay for repairs. Only 9-14 per cent
do so in Madhya Pradesh, Andhra Pradesh,
Rajasthan and Tamil Nadu.

Significantly more literate persons apd men
expect the government to bear the cost of
repairs, as compared to illiterate persons
and women.

14

Willingness to Pay
“If villages were asked to pay d fixed amount
per month regularly towards handpump
maintenance failing which the pump would
not be repaired, how much would you be
willing to pay?”.
In response to this question implementors
had predicted that no one would pay, but
on an average two out of three respon­
dents expressed their willingness to ay a
monthly fee. The largest proportion of users
willing to pay are in West Bengal (89 per
cent), followed by Manipur (81 per cent),
Uttar Pradesh, Andhra Pradesh and Gujarat
(70-80 per cent). In Tamil Nadu and Rajast­
han about half are willing to pay, but only
one third are willing in Madhya Pradesh.

the user is willing to pay and the extent of
water scarcity in the State Literacy and sex
do not seem to influence this amount.
If maintenance and new installations are
made conditional to people's contribution,
it seems probable that they will willingly
share the cost, although at present the pro­
gramme implementors feel that no one will
contribute. 41 per cent of the people sur­
veyed say that they are willing to contrib­
ute for new handpump installations, if it is
conditional to their contribution. The high­

est proportion of positive responsfes came
from Manipur (62 per cent) and the lowest
from Madhya Pradesh (18 percent). Other
states had 42-43 per cent willing respon­
dents. Expectedly, upper income house­
holds, younger and literate respondents
are more willing to pay. Significantly more
women than men are willing to pay for new
handpump installations.

The average amount each family is willing
to pay is Rs. 61.50, although the median
amount is Rs. 16.

WILL PEOPLE PAY FOR MAINTENANCE OF HAND PUMPS, IF ASKED?

Younger and literate respondents are sig­
nificantly more willing to pay as compared
to the older and illiterate ones. Income,
however does not appear to be a major
factor as there is only a 6 per cent differ­
ence between the lowest and highest in­
come categories in this study*

The average amount each family is willing
to pay per month ranges from Rs. 4.30 in
West Bengal to Rs. 20.40 in Rajasthan. There
seems to be a clear link between the amount
•Lowest : less than Rs. 500 per month
Highest: Rs. 2.500 + per month

15

Do the Women have a say ?
Rural women who are the principal users
and beneficiaries of water supply services
are at present peripheral and somewhat
incidental to the programme. Implemen­
tors of the programme know this but are
not required to do anything about the
anomaly.

ARE PEOPLE WILLING TO CONTRIBUTE FOR INSTALLATION
OF HAND PUMPS?
IMPLEMENTORS’ IMPRESSION

OF VILLAGERS’ VIEW (%)

VILLAGERS' VIEW (%)

Two out of three implementors state that, in
theory, women should be consulted about
selecting pump sites. In practice, however,
women's opinions are not considered in
selecting drilling sites, according to imple­
mentors in all the states except West Ben­
gal. Even where women are asked, it is
usually through representatives like village
functionaries or male members of the
household and not through direct interac­
tion. According to implementors, women's
opinions are not considered because
"women do not come forward" (57 per
cent), "village representatives represent
women also" (10 per cent) and women
"need not be asked since geohydrological
and land availability considerations deter­
mine sites" (10 per cent).
Majority of the implementors state that they
are satisfied with the present system of site
selection.

16

□

The present process of pro­
viding water supply services
needs to be examined to
identify what causes the
public handpump to be la­
belled as 'government prop­
erty' instead of 'people's
property'.

□

Definite community involve­
ment measures necessary for
the public assets to acquire
a 'people's property' image
need to be built into the sys­
tem providing water supply
services.

□

There seems to be a larger
potential for financial in­
volvement of users in main­
tenance and new/additional
installations that what the im­
plementors believe.

□

Putting the above into ac­
tion will require major revi­
sions in the present proce­
dures and structures of the
service delivery system as
well as a redefinition of tar­
gets for the next decade.

17

CLEANLINESS: PEOPLES’
PERCEPTION
"We should have enough money for fresh
food and clean clothes first”
- poor villager, Andhra Pradesh
"One has to go to work, no time, so
house is unclean."
- poor villager, Rajasthan
"If people are healthy, they have the
stamina to keep the house clean."
- poor villager, Tamil Nadu

"If all basic amenities are present, people
will have interest in being clean".
- rich villager. West Bengal
Among the village folk in India, "Cleanli­
ness" is understood as a holistic concept,
emanating from within the person — from
one's thoughts and behaviour and extend­
ing to one's physical self, home and envi­
ronment, in that order.

However, time and money are seen as
major constraints to achieving the desired
level of cleanliness. "Cleanliness" is low on
the average family list of priorities. Poor
families see it as a desirable but improb­
able ideal, to be pursued by those who can
spare the effort and resources. There seems
to be, in their minds a high positive correla­
tion between time/money avilability and
different levels of hygiene, i.e.
Level 1 - personal hygiene
Level 2 - household hygiene
Level 3 - environmental hygiene

PEOPLES’ PERCEPTIONS
SOME LINK

PERSONAL HYGIENE
WEAKER LINK

HOUSEHOLD HYGIENE
ENVIRONMENTAL HYGIENE

HEALTH
ALMOST NO LINK

HEALTH

AND HABITS
HAND WASH AFTER DEFECATION AND BEFORE EATING

WASTE WATER LET OUT INTO STREET/CESS PObL/OPEN AREA OUTSIDE MdURF.................
DEFECATION OUTDOORS, AWAY FROM HOME
OUTSIDE HOUSE
..........
COVERING OF EXCRETA : NEVER

...................................................................................

99%
62%

92%
99%

ENVIRONMENTAL CLEANLINESS IS qecm ao -r.RESPONSIBILITY. INDIVIDUALS DO NOT FFFi
™E GRAM PANCHAYAT’S
0 NOT FEEL THEY CAN DO ANYTHING ABOUT IT

18

This graded relationship results in most
people attempting to practice a rudimen­
tary amount of personal hygiene and a
lesser amount of household hygiene but
almost no effort is directed towards main­
taining environmental hygiene which seems
to be beyond everyone's area of responsi­
bility. The Panchayat (Village Council) is
expected to look after environmental sani­
tation of the village without the villagers'
involvement.
Most people are aware of a link between
hygiene and health but it is a belief lacking
conviction, diluted by years of resigned tol­
erance of unhygienic surroundings. While
personal hygiene and to some extent
household hygiene are believed to influ­
ence health, people fall to see the possibil­
ity of environmental hygiene influencing
their health. Nor do they see themselves as
factors influencing the quality of their own
environment.

19

P£BJS©NAB_ tiVCIENir
Awareness of personal hygiene is high but
often exists only at a theoretical level.
Shortage of money, time and lack of con­
viction about its necessity cause people to
be negligent of personal hygiene. This is an
area where inadequacy of public ameni­
ties and economic status of families con­
tinue to inhibit desirable behavioural
changes substantially, despite educational
and motivational efforts.

Handwashing after defecation, before and
after eating and cleaning of mouth every­
day are reportedly universal. Six people
out of every ten wash their hands with
water and a little ash or mud. About one
quarter use soap with water the rest wash
with water only. Mouths are most often
brushed with a chewed up twig.
A daily bath is infrequent. A little over half
bathe every 2-4 days. In water scarce
areas like Barmer in Rajasthan, one may

bathe only fortnightly. Use of soap is irregu­
lar, linked to special occasions and consid­
ered somewhat a luxury. Soap is used more
frequently by upper income groups,
younger and literate villagers and by
women.
Although people recognize that changing
clothes ought to go together with bathing,
regular changing and washing of clothes is
not considered feasible by most.

As one poor peasant from West Beng
commented :
“If one has money, one will have cle
clothes since he can have more th
one set of clothes”.

The use of footwear is infrequent and lir
ited to special occasions or when goir
out of the village. Men think it is necessa
more often thanwomen. The major co
straint to using footwear in everyday life
lack of habit and its cost.

PERSONAL HYGIENE
Awareness of personal hygiene is high but
often exists only at a theoretical level.
Shortage of money, time and lack of con­
viction about its necessity cause people to
be negligent of personal hygiene. This is an
area where inadequacy of public ameni­
ties and economic status of families con­
tinue to inhibit desirable behavioural
changes substantially, despite educational
and motivational efforts.
Handwashing after defecation, before and
after eating and cleaning of mouth every­
day are reportedly universal. Six people
out of every ten wash their hands with
water and a little ash or mud. About one
quarter use soap with water the rest wash
with water only. Mouths are most often
brushed with a chewed up twig.
A daily bath is infrequent. A little over half
bathe every 2-4 days. In water scarce
areas like Barmer in Rajasthan, one may

bathe only fortnightly. Use of soap is irregu­
lar, linked to special occasions and consid­
ered somewhat a luxury. Soap is used more
frequently by upper income groups,
younger and literate villagers and by
women.

Although people recognize that changing
clothes ought to go together with bathing,
regular changing and washing of clothes is
not considered feasible by most.

As one poor peasant from West Bengal
commented :
“If one has money, one will have clean
clothes since he can have more than
one set of clothes”.

The use of footwear is infrequent and lim­
ited to special occasions or when going
out of the village. Men think it is necessary
more often than women. The major con­
straint to using footwear in everyday life is
lack of habit and its cost.

S € ♦< f
P M P P C S N c
I H P I I € A P g C N §
before trying to promote
those requiring immediate fi­
nancial outlay e.g.

use of fresh ash forhandwashing, but not mud.
building of household
soak pits.

□

□

22

Personal hygiene needs to
be made easier to practise
through greater per capita
availability of water and
measures like subsidising
soap for instance. Without
such facilities, hygiene edu­
cation can perhaps have
only limited impact on
people's practices.

Under the present circum­
stances, it seems relevant to
selectively promote those
habits that can improve the
existing status at no cost,

covering of excreta with
soil until a latrine is ac­
quired.

Communication for improv­
ing personal hygiene must be
locally formulated (e.g. at a
district level), in keeping with
what is feasible for the ma­
jority to practise in the re­
gion. Failure to do this has
often resulted in people dis­
missing hygienic practices
as impractical, and inappro­
priate for their way of life, an
'unaffordable luxury'.

HOUSEHOLD HYCIENE
Traditional beliefs and social pressures en­
force maintenance of 'visible cleanliness'
within the household by the rural house­
wife. However, what happens immediately
outside the walls of the house is not consid­
ered her responsibility, nor that of any other
family member. Burdened with her usual
chores, she ends up keeping a clean look­
ing home amidst surroundings made dirty
by waste water and garbage generated
by her own household.
Need for cleanliness within the home is
emphasised in rural communities. A clean
house is associated with less sickness and
well being of family members. Household
cleanliness is the housewife's responsibility
and she meets with strong social disap­
proval if her household remains dirty. The
only resources needed are time and effort
of the housewife and villagers feel that
even the poorest woman can manage to
keep a clean house.

Traditionally, the highest priority is the
cooking and eating area, followed by the
sleeping area. The cooking area is swept
clean of food particles, ash and garbage
after every meal. Regular mud plastering
of kitchen floor and cooking stove (Chullah) is prevalent in all the states. Washing
and cleaning of utensils is done after every
meal in the courtyard or kitchen from where
a drain leads to outside the house. In case
of lack of space within the house, utensils
are washed beside the roadside drain or at
the village pond (West Bengal), using ash,
mud and natural fibre scrubbers.

Villagers are aware of the need to cover
food and drinking water to keep away flies
and insects. It is understood that cleaning
the kitchen regularly prevents flies and in­
sects. The need to wash and eat food and
give children clean food was mentioned in
Gujarat. However, those who report all
these practices also state that most villag­
ers ( including themselves) are negligent
and do not follow them as rigorously as
they should.

What Happens to
Household Waste?
More than 80 per cent households throw
garbage into a private or common gar­
bage pit. The rest throw it anywhere within
or outside the courtyard. Only 8 per cent
mention the use of manure pits.

Waste water generated in the household is
simply let out into the village street/outside
the house boundary by 62 per cent fami­
lies. Only 5 per cent mention using a pri­
vate soak pit and 12 per cent lead it into a
kitchen garden.
81 per cent households have domestic
animals, mainly cows and buffaloes. A
third of them store and use the dung as
fuel, for plastering walls or manure. 15 to 2®
per cent families, however throw it away as
garbage. This practice is common in Gujarat
and Tamil Nadu. Almost half the respon­
dents do not believe that cow dung or
buffalo dung can be harmful to human
health. Dung of other animals could be
harmful, buffalo dung less so and cow dung
least of all.

24

S C

H I
I +1 I L C I \ C
f /H P L f C 4 PIONS
No-cost simple sanitation meas­
ures like household soakage pits
and garbage pits are not prac­
tised widely in the villages. The
present situation reflects a lack
of public awareness of such self­
help interventions, rather than a
lack of motivation since tradition
and religion in India provide
ample motivation for keeping
one's habitat clean. The situ­
ation calls for direct contact with
village women for promotion of
such sanitation interventions
through interpersonal communi­
cation and demonstrations by
familiar village motivators. Al­
ready there are isolated pockets
in the country where village sani­
tation has been vastly improved
using this strategy.

25

WHAT HATTENS IT
HUMAN WASTE ?
Current Practices:
In rural India excreta disposal is still by and
large a matter of letting nature take its own
course. 92 per cent people surveyed defe­
cate out of doors, at sites common for all
categories of villagers. About one tenth
express a distinct preference for sites close
to a water source. Privacy is the overriding
concern while selecting a site.
Those who do use private latrines range
from 3 per cent of the state sample in Ra­
jasthan to 12 per cent in Madhya Pradesh,
the overall average being 8 per cent for all
the states. Manipur stands out as the state
where 85 per cent reportedly use private
latrines. Majority of the latrine owners and
users predictably belong to upper income
households. Only 2 per cent of the illiterate
persons use latrines as compared to 13 per
cent of the literate ones. While those hav­
ing household latrines regularly use them,
community latrines are used by less than 10
per cent of these who have access to them.

Almost all who defecate outdoors do not
cover or dispose of their excreta in any
manner. Washing of hands after defeca­
tion is a universal practice. However, 23
per cent wash only with water. This prac­
tice is most prevalent in Tamil Nadu, Andhra
Pradesh and Manipur. 14 per cent use
soap and water. More than 6 out of 10

EXISTENCE AND USE OF
LATRINES
wash using water and mud or ash. This
practice is popular in Uttar Pradesh, Rajast­
han, West Bengal and Madhya Pradesh.

Soap usage is a recent phenomenon, found
among the young, the literate and the
upper income group. Use of water only is
markedly higher among older persons and
poorer families. Use of mud or ash as a
cleaning material with water seems to
prevail across all socio-economic catego­
ries.

□ EXISTS

26

S USED

Beliefs Behind Practices

Knowledge Behind Beliefs

The majority think they really have no choice
and outdoor defecation is a necessary evil.
Women feel this more often than men. But
31 per cent people also feel the practice
has advantages like fresh air and absence
of unpleasant smell. 8 per cent even think
outdoor defecation is a cleaner way of life
since excreta is deposited far from the
home. This is mentioned more often by
poorer families, older persons and men
rather then women.

Although 63 per cent people think that
exposed excreta can be harmful to health,
less than 20 per cent are correctly aware
how the harm is caused. There is a strong
belief that the bad smell emanating from
excreta is the principal cause of ill-health/
carrier of germs that are breathed in.
Negative feelings about outdoor defeca­
tion are related to polluting aspects of
contact with exposed excreta, i.e., revul­
sion rather than the fear of contracting dis­
eases. More than one thirds realise that
exposed excreta breeds flies and mosqui­
toes, but understanding regarding these
vectors contaminating food is limited to
upper income and literate groups only.

Those who do mention specific disadvan­
tages of outdoor defecation, speak mainly
about occasion or situation-related prob­
lems rather than a sustained difficulty.
Almost two thirds of the sample think it is
problematic during the night, the rainy
season, for sick and old people. Nearly 30
per cent also mention lack of privacy and
having to walk long distances to find suit­
able spots. These problems are voiced
very frequently in densely populated states
like West Bengal and Uttar Pradesh and
nnost often, by women in almost all states.
Health hazards of the practice are not men­
tioned by more than 7 per cent of the
people

27

As many as 37 per cent of the people either
do not believe that exposed excreta can
endanger health, or do not know whether
this is possible. They feel that excreta is
deposited so far away from their homes
that it cannot affect them. In any case,
dogs and pigs eat it and clean up the area,
according to them.
There is an unspoken tolerance of a young
child's excreta which is considered less
harmful than that of adults. An unweaned
infant's excreta is considered 'absolutely
harmless' as it is made up of mother's milk
and nothing else. Since these are disposed
of within or close to the household they
represent a major health hazard for the
family.
16 per cent of the implementors of Sanita­
tion programmes are also not sure whether
exposed excreta can harm health. Also,
only 10 per cent of the implementors sur­
veyed mention 'health education/communication' as one of their job responsibilities.

Since people do not perceive clear links
between environmental conditions and
their own health, there is a general lack of
concern about exposed excreta. How­
ever, in crowded villages where secluded
spots and vegetation cover for privacy are
becoming scarce, outdoor defecation is
becoming problematic and a desire for
change seems to be building up, specially
among women.

28

Sanitation programme imple­
mentors need to capitalise
on growing motivation for
latrine adoption by focussing
on crowded villages and
women's groups.

All programme implementors
have to be fully convinced
about the health hazards of
outdoor defecation, to be
able to promote sanitation
practices. They must also be­
come more conscious of their
prime responsibility of inform­
ing and motivating commu­
nity members.
Building on the universality
of handwashing as an al­
ready prevalent desirable
practice, communication
efforts must aim at making it
more hygiene-effective. For
example communication
could spell out that hand­

washing only with water does
not really clean. The only
way to assure cleanliness is
to wash with water and soap
or fresh ash. Mud does not
clean, but can actually
cause contamination, thus
should not be used for clean­
ing purposes.
□

□

The harmful effects of infants’
and children's faeces have
to be highlighted in all com­
munication efforts, targeting
the same to mothers. Hygi­
enic handling of children's
faeces, whether or not the
household owns a latrine, is
a key behavioural change
to be promoted.

It may be difficult to explain
the faeco-oral cycle of dis­
ease transmission in terms of
invisible disease - causing mi­
croorganisms to community
members. Health education
can take advantage of
people's perception of pol­
luting aspects of excreta to
explain how sickness travels
from
exposed
excreta
through flies, food and wa­
ter to healthy persons.

29

SANITARY LATRINES:
TEE ‘TREAT UNKNOWN’
Public awareness of an alternative to out­
door defecation Is limited. Only 37 and 52
per cent people have reportedly ever seen
a dry or pour flush type of latrine respec­
tively. Those who have ever used one are
even fewer in number. Apart from the
minority who own a household toilet, the
rest have encountered latrines only at public
places like railway stations, bus terminals,
health centres etc. where maintenance
levels are often far from desirable. Pre­
dictably, the first Impressions are unlikely to
have been positive.

About 5 per cent people also have access
to community latrines. Whereas almost all
who own private latrines use and clean
them regularly, community latrines are rarely
used by anyone due to lack of mainte­
nance. In majority of latrine-owning fami­
lies all members use the facility. Wherever
selected members use it, they are invari­
ably the female members of the house­
hold.

Knowledge
65 per cent do know that excreta flushed
away from pans goes into a pit into the
ground. Thereafter what happens is an
area of widespread confusion.
30 per cent do not know how often the pit
will have to be cleaned out/emptied.
Another 43 per cent think that it will have to

AWARENESS & USE OF LATRINES

Families having private household latrines
range from 4 per cent In Uttar Pradesh to 15
per cent In West Bengal, with the rest of the
states falling in between. Manipur stands
out as a state where four out of every five
families own private latrines, In stark con­
trast to the rest of the country . They are
usually the dry type of latrine. The rest of
the states report a mix of dry and pour-flush
types, the latter being more popular in
West Bengal, Tamil Nadu and Gujarat.
Predictably, latrine ownership Is positively
correlated with Income and literacy.

PERCENTAGE

□

30

USED

n

SEEN

be cleaned out a lot more frequently than
is actually needed. While the correct fre­
quency ranges from once every 3-5 years
depending on family size, as many as one
fifth think this has to be done every 6 weeks
or more often.

Although, in reality, pH
entsatthetime
ofcleaning would be a . y, odourless sui;
stance, the majority think That they would
be liquid (53 per cent), and foul smelling
(81 per cent) or are simply not sure what
they would be like (19 per cent).
More than half do not know that the pit
contents can be used as manure. They
envisage having to dig another pit and
transfer the contents, or transporting the
stinking mass to a point outside the village
or the house.

71 per cent across the country are un­
aware that government subsidy is avail­
able for private latrine construction. While
the household's actual contribution under
the subsidised programme is not more than
Rs.300-400/- (US $ 17-23 approx.), popular
perceptions of the cost to the family range
from Rs.2000 to Rs. 10,000 per latrine (US $
117-588 approx.)
The level of ignorance and misconceptions
about all these questions is significantly
higher among women, the lower income
groups, the older group and the illiterates.

Attitudes and Interest
As many as 86 per cent people feel there
are distinct advantages to having private
latrines. 'Convenience' is clearly the single
largest perceived advantage, as it would
provide privacy, eliminate time and en­
ergy spent in walking long distances and
be useful during rains, winter, nights and
sickness. Convenience at particular times
is the most important motivating factor in
Andhra Pradesh, Gujarat and West Bengal.
Privacy is the prime advantage perceived
by women and also by the inhabitants of
West Bengal, Rajasthan, Uttar Pradesh.
Health benefits as an advantage of having
a private latrine are rarely mentioned in
any state.
Among the states, villages in West Bengal
are most in favour of household latrines,
followed by Andhra Pradesh and Gujarat.
Upper income groups, literate persons and
women are significantly more in favour of
latrines than poorer families, illiterate per­
sons and men respectively.
The minority who mention disadvantages
of having household latrines are afraid of
accumulation of filth near the house and
foul smell resulting from it.

32

j 82-95 per cent of the non-owners of house­
hold latrines in all the states express strong
interest in getting private latrines con­
structed. The highest population of unin­
terested persons is in Tamil Nadu, followed
by Madhya Pradesh and Andhra Pradesh.
Notably, the reasons given for lack of inter­
est include, lack of space (36 per cent),
; fear of dirt and foul smell near the house (38
per cent) and lack of water (20 per cent)
but not lack of money.

ate and better off people, who are more
exposed to urban influences and media
are markedly more favourably disposed
towards adopting sanitary latrines. Women.,
although less literate and less exposed to
new information are also more motivated
to adopt latrines. There also exists a gener­
ally favourable climate for behavioural
change because of the perceived advan­
tages of convenience and saving of time
and effort through having private latrines.

If the government provides a subsidy, the
average potential latrine owner in rural
India says that he/she is willing to contrib­
ute about Rs.570 for getting a private la­
trine. Estimation of what a family expects
to pay is highest in Rajasthan (Rs.716), and
lowest in Manipur (Rs.393), but even the
lowest amount is sufficient under the pres­
ently available government programme.
On the whole, about 15 per cent are unwill­
ing to pay for a latrine. They belong to
lower income groups, older age groups
and are usually illiterate. Among the states,
Madhya Pradesh seems to have the maxi­
mum number of 'unwilling' households (23
per cent) and Manipur the least (5 per
cent).

Yet, coverage of population with sanita­
tion facilities is painfully low and slow. Half
the population is unaware that facilities
exist. Those who are aware do not clearly
know what these are like, how they work,
what they cost, what effort/resources will
be needed to maintain them, how they will
influence or alter their overall quality of life.
Ignorance is further aggravated by serious
misconceptions acting as effective barri­
ers to acceptance. The vision of having to
dig an Infinite number of excreta pits here­
after or clean out pits of slushy stinking
masses of excreta every six weeks are more
than sufficient to deter even the most inter­
ested individual. Coupled with these, the
widespread ignorance of available subsi­
dies and perceived costs which are 10 to
15 times the real cost make latrines appear
as a 'questionable' facility 'Impossible to
afford' for the majority.

To summarise the issue, it appears that
people in rural India are still far from being
adequately aware that there are feasible,
affordable and more hygienic alternatives
to defecating outdoors. The younger, liter­

33

done so far) will not capture
people's attention and inter­
est, when they see it primar­
ily as something that will
make life more comfortable.
Health benefits may be pro­
moted as an additional ad­
vantage, while highlighting
the convenience and pri­
vacy factors.

The KAP study provides several
pointers for the required social
marketing strategy; which must
necessarily be synchronized with
a localised service delivery sys­
tem capable of responding to
village level articulation of de­
mand, The principal features of
such a strategy would be as fol­
lows:

If possible, it should begin by
focussing on groups and situ­
ations where problems of out­
door defecation are being
felt more intensely and a
desire for change is building
up i.e. among women, in
districts having densely popu­
lated villages,
□

34

It should capitalise on the
existing motivation i.e, for
greater convenience and
privacy. Promoting the pri­
vate latrine as the 'Protector
of health' perse (as has been

□

Presently available media
materials do not adequately
address the information gaps
in people's minds regarding
how the latrine works and
what the user has to do about
regular/periodic mainte­
nance. Communicators and
designers of communication
materials have to consciously
address themselves towards
filling these gaps.

□

Widespread publicity using
village level mass media net­
works about sanitation serv­
ices available, costs to the

acceptor, subsidy/assistance
available and whom to
contact must become essen­
tial features of every district
2-3 times a year.
□

Villagers who see/hear/read
anything over mass media
on this highly personal and
intimate area of their lives
need to be able to discuss it
interpersonally with persons
of their own sex before
doubts are resolved, convic­
tion can be reached, deci­
sions can be taken and desire/demand expressed for
acquiring facilities. Indispen­
sable to the sanitation pro­
gramme is the presence of
block/village level motiva­
tors of both sexes who are
adequately trained to be
able to provide required in­
formation and make the nec­
essary contacts between vil­
lagers and the programme
delivery mechanism.

REACH ©F
Media outreach into rural India seems to
be fairly high, with every 4 to 6 persons out
of 10 being exposed to some electronic
mass medium. Apart from these there are
upto five categories of village level func­
tionaries who can reach 10-90 per cent
villagers with messages on water and sani­
tation. Women seem to respond better to
these messages than men, but have lower
access to most media.

REACH OF PRINCIPAL MASS MEDIA IN DIFFERENT STATES

Villagers in different states have varying
exposure to media. Mass media like radio
and films seem to be reaching more vil­
lages in Andhra Pradesh than anywhere
else. Reach of interpersonal media is high
in Gujarat and Andhra Pradesh. Rajasthan
is poorly reached by mass media. Interper­
sonal media channels do not seem to be
reaching most villagers in Uttar Pradesh.

35

Among mass media channels, radio reigns
supreme in every state. Films came a close
second, followed by folk media and lastly
by television.
Among interpersonal media the most vis­
ible and familiar figure in the village is the
school teacher in all the states. In compari­
son to the rest of the states, Gujarat, Tamil
Nadu and Andhra Pradesh villages seem to
be better served by other village level
functionaries like health workers, Anganwadi workers and government person­
nel acting as communicators on water and
sanitation issues.

Exposure to media is found to be positively
co-reiated to income but not related to
age. Literacy and being born male seem
to guarantee higher exposure to all media.

36

REACH OF INTERPERSONAL MEDIA IN DIFFERENT STATES

Of those exposed to different media, vary­
ing proportions recalled messages on wa­
ter and sanitation received over the same.
The highest recall was from radio followed
by television and films, health workers,
government officers, school teacher and
Anganwadi workers. Folk media at present
do not seem to be carrying many water
and sanitation related messages although
their reach is better than that of TV in most
states. The only village level functionary of
the water supply programme i.e. the
handpump caretaker is not carrying these
messages at all to the community.

RECALL OF WATER/SANITATION MESSAGES
FROM DIFFERENT MEDIA

37

The maximum number of messages recalled
are about the right type/source of water
and household purification of water, closely
followed by household storage of collected
water. To a lesser extent messages are also
recalled about household cleanliness and
disposal of human waste.

SEX DIFFERENTIAL IN MEDIA REACH

Although women's exposure to radio, TV
and films Is lower than that of men, recall of
water and sanitation related messages from
all these media was 15 per cent higher
among women.

r-j
L-1

MEDIA

MEN

women

YET, 12-16% MORE WOMEN RECALLED WATER & SANITATION MESSAGES RECEIVED OVER ANY MEDIA

38

□

□

Greater use needs to be
made of the radio for spread­
ing an awareness of safe
water and hygiene. The vast
network of local radio sta­
tions in India, broadcasting
in local languages and dia­
lects provide the most eco­
nomical means for dissemi­
nating this information far
and wide to rural homes and
difficult to reach areas.

The interpersonal communi­
cators available at village
level are not being fully util­
ised. There is no alternative
to energising this cadre of in­
fluencers with motivation,
communication skill training,
visual and other communi­
cations aids.

□

The outreach and effective­
ness of folk media for spread­
ing awareness has not yet
been harnessed for hygiene
education in the country.
States should explore possi­
bilities with indigenous me­
dia forms as these have the
ability to translate new infor­
mation in a way instantly ac­
ceptable to their audiences.

□

All forms of communication
need to be targeted to
women specifically for maxi­
mum impact upon hygiene
behaviour of families.

□

Different media forms have
to be designed and used in
such a manner that they re­
inforce each other rather
than confuse the end re­
ceiver with a multiplicity of
communication products.

□

Since the objective of the
programme is to bring about
behavioral changes to im­
prove health, communica­
tion and motivational re­
quirements of the pro­
gramme now need to be
given their rightful status at
every level, through official
allocations of adequate
funds, specialised personnel
and time in every project
cycle.

39

40

Of those exposed to different media, vary­
ing proportions recalled messages on wa­
ter and sanitation received over the same.
The highest recall was from radio followed
by television and films, health workers,
government officers, school teacher and
Anganwadi workers. Folk media at present
do not seem to be carrying many water
and sanitation related messages although
their reach is better than that of TV in most
states. The only village level functionary of
the water supply programme i.e. the
handpump caretaker is not carrying these
messages at all to the community.

RECALL OF WATER/SANITATION MESSAGES
FROM DIFFERENT MEDIA

37
Media
1917.pdf

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