HEALTH FOR THE MILLIONS-VOL-7-NO-4 AUGUST 1981
Item
- Title
- HEALTH FOR THE MILLIONS-VOL-7-NO-4 AUGUST 1981
- extracted text
-
Vol. VII
No. 4
A
Bimonthly
of
the
Voluntary
Health
Association
of
India
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034 '
India
JMtypJeSS
Jar ware Mater
AUGUST
1981
HEALTH FOR THE MILLIONS
Vol. VII
No. 4
August 1981
Editorial
CONTENTS
1. Water, Sanitation
and Health
3. Water in Dry Hills
5. Sanitation with
Participation
9. Walking Less for More
Water
10-11. Voluntary Agencies and
Sanitation, and
Disposal Systems used
Our previous issue was focussed on drugs. This
issue has the theme water and sanitation. We aim to high
light some issues on water and sanitation as relevant to
India.
The problem of water and sanitation is complex in a
country as diverse as ours. Many of you would have your
own experiences to narrate. You would have attempted
to introduce better water supply and sanitation facilities in
your community. Or you may know somebody who has
tried. The result may have been a success or a failure or in
between. Write to us and share with us and all our fellow
readers. Write to us also on any experiences related to
health which you feel should be more well-known.
Incidentally, we are in the so-called International
Drinking Water Supply and Sanitation Decade (1981-90).
Please see the back cover.
in India
16. A School for Cleanliness
17. Low Cost Drugs Page
18. News from the States
Editor : S. Srinivasan
Executive Editor : Augustine
Veliath
Production : P. P. Khanna
Assistance : P. George and
John Agacy
Circulation : L. K. Murthy
Owned and
published by the
Voluntary Health Association of
India, C-14, Community Centre,
Safdarjung Development
Area,
New Delhi-110016, and printed
at Printsman, New Delhi.
We owe much editorial help and guidance for this
issue to Shri T. Vijayendra —who was also the Executive
Editor of this magazine for some time in 1 979.
In the last issue on drugs we were similarly helped
in the design by many, and chiefly by Mira Shiva, our
colleague. Mira is an M. D. and an unusual person. She
is always bubbling with ideas and facts. Like her historical
namesake she has a tremendous commitment and a pas
sion for VHAI philosophy and goals. We failed to men
tion this in the last issue, an editorial oversight deeply re
gretted. Her contribution in this issue includes the piece
on Safai Vidyalaya and the column on drugs.
*
•
♦
We have been receiving many enquiries about the
delay in publication. This is chiefly due to a series of
unanticipated delays. We will be back on schedule by the
end of the year.
Water, Sanitation and Health
Water affects the health of a
poor people in a cruel way. Water
is essential for health. It makes up
nine-tenths of the human body's
volume and two-thirds of its weight.
No one can survive without water
for more than a few days. The
amount and quality of water avail
able to people is directly related to
their economic wellbeing.
Most diseases can be prevented
by the correct use of water. In
India, 60 per cent of the diseases
can be eliminated with clean drink
ing water to the people. And 80
percent of the diseases can be cut
down by good clean drinking water
and sanitation facilities. Would it
make more sense to teach more of
water management and sanitation
in our medical colleges, nursing
schools and many other health re
lated courses, than the many not
so relevant items in the curriculum ?
Water-caused diseases related to
lack of proper water and sanitation
could be divided into five types :
Water-borne—spread by drink
ing or washing hands, food or
utensils in contaminated water.
Water-caused Morbidity and Mortality for Asia, Africa and Latin America
Infection
Infections
thousands
/year
WATER-BORNE
Amebiasis
400,000
30
7-10
3
DISEASES
Diarrhoeas
3-5,000,000
5-10,000
3-5
2
Polio
80,000
10-20
3,0004-
2
Typhoid
1,000
25
14-28
2
3
WATER-WASHED
DISEASES
Deaths
thousands
/year
Average
Relative
no. of disability*
days lost
per case
800,000
1,000,000
20
7-10
12,000
Very low
500-3,000
Trichuriasis
(whipworm)
500,000
Low
7-18
WATER-BASED
DISEASES
Schistosomiasis
(bilharzia)
200,000
500-1000
600-1000
DISEASES WITH
WATER-RELATED
VECTORS
African trypanosomiasis
1,000
(sleeping sickness)
Malaria
800,000
5
150
1
1,200
3-5
2
30,000
20-50
3,000
1-2
7-9,000,000
50-60
100
4
Ascariasis
(roundworm)
Leprosy
Onchocerciasis
(river blindness)
FAECAL DISPOSAL
DISEASES
Source :
Hookworm
2-3
3
3-4
after Julia A. Walsh and Kenneth S. Warren, Selective Primary Healthcare: An Interim Strategy for Disease
Control in Developing Countries, The New England Journal of Medicine, vol 301, no 18, November 1, 1979, p 967.
*
1 means the sufferer is bedridden; 2 able to function to some extenl; 3 able to work; 4 experiences minor effects.
HEALTH FOR THE MILLIONS/aUGUST
I 98 I
I
which acts as a passive vehicle
for the infecting agent. Waterwashed—spread by poor per
sonal hygiene and insufficient
water for washing. Lack of pro
per facilities for human waste
disposal is another contributing
factor.
Water-based—trans
mitted by a vector which spends
a part of its life cycle in water.
Contact with water thus infected
conveys the disease-causing
parasite through the skin or
mouth. Water-related vectors
—contracted through infection
carrying insects which breed in
water and live near it, especially
when it is stagnant. Faecal
disposal diseases—caused by
organisms that breed in excreta
when sanitation is defective.
The table on the previous page
shows figures for Africa, Asia and
Latin America (1977-78).
Social and Economic
Costs
The social and economic costs
to a poor society because of waterrelated sicknesses can be quite
disastrous. Typical consequences
are : loss of income and human
productivity, resulting in more
poverty for the family; and loss to
gross national product. In India,
water-borne diseases alone claim
73 million work days every year.
The cost, in terms of medical treat
ment, has been estimated to be
around 500 crores of rupees every
year.
In almost all villages in India,
it is still the burden of women to
procure water from wells, ponds,
rivers and other sources far and
near. This itself results in spending
enormous amount of time for a
few litres of water. Could this time
be used better with a better water
supply system ?
In India, the problem of water
supply in both rural and urban
areas is further complicated by
class and caste factors. The upper
classes and the "higher" castes
manage to control the better sour
ces of water, leaving the less
hygienic of the not-so-hygienic
water to the less privileged. Or in
many cases none at all.
Water and Sanitation
Clean or safe drinking water by
itself may not prevent water-related
diseases in the community. Water
with improved sanitation and exACCESS TO COMMUNITY
WATER SUPPLY AND EXCRETA
DISPOSAL SERVICES IN
DEVELOPING COUNTRIES
AVERAGES FOR 1970-1980
PATHS TO SAFE WATER AND SANITATION
(Courtesy UNICEF)
SOURCES OF
POLLUTION/
INFECTION
EXCRETA-,
REFUSE—
WASHING —
PESTICI DE
RA D WATER
SOURCE-----IMPROPER
STORAGE
WASHING AND CLEANING
DRINKING
COOKING
BATHING
FOOD PRODUCTION
(7) ACTION TO IMPROVE SANITATION
Improve sanitation and water quality
Provide more water, improve personal cleanliness
DISEASES RESULTING FROM
POLLUTED WATER, LACK OF
SANITATION AND PERSONAL
HYGIENE
©
WATERBORNE
cholera, typhoid, infectious hepatitis
WATER-WASHED
scabies, yaws, leprosy, trachoma
WATER-BASED
Protect source, avoid infection
schistosomiasis, guinea worm
(Courtesy UNICEF)
Achieve total piped water coverage of population
(“Safe Water and Sanitation for all”)
WATER-RELATED VECTORS
Improve excreta sanitation and education
FECAL DISPOSED
SAFE WATER
PROPER REFUSE
WASTEWATER
DISPOSAL
malaria, sleeping-sickness, yellow fever
hookworm, clonorchiasis. fasciolopsiasis
creta disposal and health educa
tion can result in significant health
improvement.
Clean water can
easily get polluted—at source,
during transport or storage, or
during and after usage. All these
many ways of contamination of
water can result in a number of
debilitating diseases.
More than 5,65,000 villages in
India and almost all major towns
and cities suffer from a lack of safe
water supply and proper sanitation.
The problem is immense and com
plex but surmountable to a large
extent. The tremendous need for
action at all levels is obvious.
♦
2
♦
♦
HEALTH FOR THE MILLIONS/aUGUST
1 98 1
WATER IN DRY HILLS
The Story of Sukhomajri
(How does one bring back water to a water-scarce area—where trees have been felled madly,
and where there are no nearby streams nor easy access to ground water ? The Sukhomajri
story describes an on-going experiment of people's participation in environmental conserva
tion).
Sukhomajri is a village in the
Shivalik hills some twenty-five
kilometers from Chandigarh. Until
three years ago Sukhomajri was a
drought prone village—if the mon
soon failed, as it often does, the
kharif crop of maize would wither
away in August. The rabi crops of
gram and desi wheat would not
bear a grain. Sukhomajri ran chro
nic deficits of food and fodder,.
Conventional irrigation was not
possible as canals could not be
brought into the hills. There were
no perennial streams nearby, and
ground water, if at all, was far too
deep. Where could one possibly get
water in these dry hills?
Uncontrolled Grazing
Villages in the Shivaliks typi
cally are settlements in the flood
plains of the hillocks. The hill spurs
begin where the agricultural fields
end. These hill sides, though
mostly government reserve forests,
are and have always been the graz
ing ground for village cattle. Un
controlled grazing and indiscrimi
nate cutting of trees for fuel and
commercial purposes has caused
widespread denudation in these
hills, leading to severe erosion in
the monsoon rains.
Until three years ago the hill
sides that form the backdrop of
Sukhomajri were among the worst
of the denuded Shivaliks. There
were virtually no trees and grasses
in these hills because of uncont
rolled cattle grazing. Due to the
jugal th for the millionsMugust
The dry hills of Sukhomajri before the experiment...
lack of trees and grasscover, the
hills would virtually melt under the
monsoon rains.
Transformation
That was some three years ago.
Today the villagers in Sukho
majri can produce at least two
assured crops even in an year of
drought. They have begun using
better seeds and fertilizers with
higher yields. They have stopped
grazing their cattle in the surround
ing hills. Trees and grasses have
started growing in the hills. Sukho
majri is more prosperous today
than three years ago. There is more
food and fodder produced in the
village now. The physical environ
ment—the natural resource base
around Sukhomajri, is more stable
and productive today than it was
three years ago.
1981
This transformation is the result
of an experiment that the Central
Soil and Water Conservation Re
search and Training Institute at
Chandigarh took up in 1978.
Scientists from this Institute began
an operational research project in
Sukhomajri. The idea was to de
monstrate under real life conditions
the viability of scientific techniques
of soil and water conservation.
The scientists learned soon that
their techniques of soil and water
conservation would not go very
far unless grazing was stopped in
the hills. They asked the villagers
to stop grazing of cattle. A few
agreed but most did not. Some
even showed the scientists the
way out of Sukhomajri I Environ
mental conservation might be cru
cial in the long run but the villagers
were more concerned about their
3
short term grazing needs. They
feared loss of access to the hills
for ever, and even appropriation
by government of village common
lands at the foot of the hills. What
is more, there was nothing tangible
and significant in the short run for
the villagers to rally round.
Traditionally irrigation benefits are
tied to land ownership : If you own
land you benefit from irrigation in
proportion to your land holding.
If you are landless, hard luck !
However, if the landless had water
rights they could trade these in
cash or in kind, particularly where
there is a net water deficit as at
Problems of.......
Sukhomajri in spite of the dam.
Happily, the scientists were will
This was resolved when the
ing to learn. Their innovation paid
villagers among themselves agreed
off when they built a small earthen
that every family would get an
dam by plugging one of the ravines.
equal share of water, irrespective
The dam would control erosion
of land holding. This system has
and flooding downstream by hold
worked for over a year now and
ing back monsoon flood waters
there have been instances of trad
from the hills. It would irrigate
ing surplus water for share cropp
village agricultural landsand above
ing rights and other favours in
all it would induce villagers to stop
kind.
grazing in the hills to protect their
The second problem was how
own valuable asset—the dam, from
to manage and maintain the pro
getting silted up. Irrigation would
ject. Someone would have to res
increase consumption right away
pond to water demand, regulate
and would lead to environmental
distribution, collect water charges
conservation in the long run.
and arrange repairs. Also, though
So far so good.
the villagers had now agreed to
Water Management
abstain from grazing the hills in
Irrigation brought in more pro their own interest, there would be
blems. Firstly, how do you distri deviants and someone would have
bute the water so that everyone, to monitor them and bring social
landed and landless, feels involved? pressure to bear on them. Two
’"and after the experiment.
4
options were considered : One
was for the Institute to post an
employee in
the village and
run the project and the other
was to help the villagers set
up an organization of their own to
tun the project while the Institute
gradually withdrew from the dayto-day responsibility. The first
alternative was clearly full of pit
falls—the Institute would have to
divert attention from research to
perpetually run a village develop
ment project. Given the life saving
quality of water, the Institute
employee in the village could
become a centre of power and
power does corrupt. The cost of
running the project would be high,
making irrigation costly to the
villagers and, most importantly,
this way the project would never
be owned by the villagers, i.e., the
onus of sustaining the enthusiasm
of the villagers would always
remain on the Institute.
Therefore the second alternative
was chosen.
Project personnel helped the
villagers set up an Association as a
duly registered society. This Asso
ciation has taken over the opera
tions and maintenance responsi
bility. The Association has em
ployed a young, literate villager on
a part-time basis to distribute
water and collect water fees.
Printed copies of equal (hourly)
denomination are used for water
distribution and exchange. Institute
staff continue to oversee the pro
ject and will withdraw gradually.
y As of now the experiment
seems to be working. There has
been no grazing in the hills. The
village Association is performing
well.
The experiment has been repli
cated at another village nearby and
can be replicated in hilly terrains
all over the country.
HEALTH FOR THE MILLIONS/aUGUST
1981
T. VIJAYENDRA
Sanitation with Participation
a
— is it possible?
Sanitation and excreta disposal in urban and rural areas are complex problems. There are
no ready-made solutions.. Solutions for particular communities have to be worked out
in consultation with the people who are likely to use them, the implementing agency and
competent technicians. In this article, we discuss primarily the experiences of an urban
agency and the related issues of participation in sanitation.
The unsafe disposal of faecal
matter and the lack of potable
drinking water are major causes of
morbidity in India. They are typi
fied by the large number of deaths
in our country. In the case of
human excreta disposal systems,
the situation is particularly bad
because few people take interest
in it, and discussion is considered
impolite to the extent of being even
vulgar 1 The attitude among even
educated Indians seems to be :
Please keep it out of sight and do
not mention it while we are eating.
There are also wrong beliefs that
flush latrines and underground
sewerage are the proper things,
and it is because of our poverty,
our cities and villages are dirty.
Some people are also aware of the
plight of the Harijans who have to
carry it on their heads in many
parts of the country.
serious problems and even if we
had the money, critics say that it
is probably worse than the present
situation.
Meanwhile, surveys continue to
show that the vast majority of the
Indian population
suffers from
parasitic infections and soil-trans
mitted helminths. Research con
ducted among slum dwellers and
rural populations near Delhi, Cal
cutta, Bombay, Aurangabad and
Lucknow, are reported to indicate
that the lowest percentage suffer
ing such infections is as high as
36.2% which is one-third of the
population. The level of infections
is generally quoted to be around
66% and often as high as 80%.
The plans of the Government of
India include provision of safe
drinking water for its entire urban
Urban Sanitation—Haves & Have nots
No. of urban households in the country
using toilets connected to the sewerage
systems.
Explosive Situation
In reality, the situation is quite
explosive.
The growing urban
problem is making the problem
frighteningly serious. More and
more people are using railway
tracks and bylanes making the city
and towns literally hell holes. Less
and less Harijans are prepared to
do the job. The cost of the sewer
system and treatment plants is
prohibitively large and we just
cannot meet the situation. The
existing sewer systems are facing
health for the millions/august
In nine of the major states and
union territories, 40% of the house
holds are without latrines while
in the eastern states and union
territories, 40% of the households
are without latrines. In Manipur,
Tripura and Meghalaya this figure
is less than 10%. In general, only
20% of the rural population has
some sort of access to toilets. And
the figures for urban populations
(see box) are quite shocking and
can now be expected to be worse,
because of increasing populations,
than at the time of the National
Sample Survey,
No with exclusive use of toilets in the
urban areas (the remainder share with
other households or use public toilets).
No. of urban households with
water-borne latrines connected to
septic, tanks.
Percentage of urban population serve
with bucket latrines.
Percentage of urban population with
no toilets.
—National Sample Survey, 1978
1981
20%
7%
14%
33.3%
33.3%
and rural population by 1990. There
are also plans to provide facilities
like toilets; adequate drainage and
garbage disposal services. How
ever, in the rural areas, only 25%
of the population is to be brought
under the sanitation programme
during the period of the water
supply and sanitation decade,
1981-1990. The problem is medi
cal, social and managerial.
Methods Adopted
There have been broadly four
strategies in dealing with the dispo
sal of human excreta (see the box
below). This is of course apart
from the traditionally predominant
way of open air defecation in the
fields, open grounds, railway lines,
dirty nallas and river banks. In the
latter cases, it is particularly humi
liating for women to go necessarily
either early in the morning or after
dark. In Bombay, cases have come
to light where they were raped on
such occasions. (It is this section
of the population also that is the
victim of the most important and
the biggest group of diseases
known as enteric diseases).
One-third of the urban popula
tion in our country is served by the
bucket privy. Apart from being un
healthy and a strong source of
disease, they are extremely un
pleasant. People prefer to do it in
the open than use them. Its most
damaging weakness lies in the
employment of human beings in
such dehumanising work. Mahatma
Gandhi was very moved by their
plight and did much to remove the
social stigma. He initiated several
programmes for Bhangi Mukti and
founded the Harijan Sevak Sangh.
These programmes have contributed
significantly to the development of
an alternative, cheap and sefe
latrine.
Appropriate Economics
The underground sewer system
is an alternative to the bucket
latrines. But the costs are prohibi?
tive for this system and therefore
is to be ruled out in the considera
tion of any lowcost options for the
entire country. To get an estimate
of the all-India picture : At the pre
sent rate of taxation if the entire
revenue of the central and state
governments was to be exclusively
used for 60 years for provision of
underground sewerage, only half
Four Ways of Excreta Disposal
METHOD
1
2
3
4
With water
Yes
Yes
No
No
With transport
Yes
No
Yes
No
the population of the country at
that time would be covered. Also,
there are tremendous possibilities
of drinking water and river water
pollution because of the sewage
system. The sewage system takes
up as much as 40% of the pumped
water supply in the town. The large
amounts of sewage sludge has to
be disposed of in rural areas (in
cases of urban drainage). This is
only shifting the problem to the
rural areas. The sewage system and
flush toilets are typical products of
Western industrial revolution. The
Western approach typically comes
from ecology considerations and
not from cost considerations or the
impossibility of providing latrines
for everyone, because they have
flush toilets in most houses.
Different countries are experi
menting with different methods :
incinerating toilets,
composting
toilets, biological toilets, oil flushed
toilets, vaccum systems, aerobic
tanks, etc. Evidently there are many
technologically possible solutions
and which one will be appropriate
depends on all the social factors of
a situation—economic, social and
cultural. Solutions in India have to
be low-cost, technologically simple,
so that people with little training
can use it and of course it has to
be ecologically sound. The last
means the possibility of using the
waste as manures. Gandhian and
other agencies have worked to
wards precisely such a solution.
Work in India
—Flush toilet connected-]
to sewer
—Z qua privy connected
to sewer
—Flush toilet joined to septic tank
—Cesspool, aqua privy
biogas plant
6
Buckets &
bore hole
latrines
Compost
Pit
latrines
The oldest method—squatting
in the field —is still used in majority
of rural areas. This method is still
an excellent method and can be
slightly improved by covering the
excreta with mud. The saprophytic
bacteria in the upper layers of the
soil destroy the pathogens in the
excreta. The result is a stable
humus-like product and if the
HEALTH FOR THE MILLIONS/AUGUST
I 98 1
Sulabh Shouchalaya
Sansthan
not only use it for the latiine faci
lities, but also to bathe and wash
clothes.
Users and non-users
Initially the greatest users were
the mobile population. Among the
regular users were the rickshaw
pullers of Patna town. Over the
years other people have joined.
Taking washing powder for cleaning hands
The first category is the shop
keepers and their assistants, hotel
boys, etc. Secondly, people who
come for shopping also use them.
So market facility too has become
important and pays well. Today
people from middle class come in
cars. Muslim women in Burkha
too come and use it with confi
dence. The Sansthan also has rules
for free facilities to those who
cannot afford it.
The history and work of this
Gandhian organisation in Patna
has already been discussed in this
magazine. (Public Latrines for
Urban Poor, Decemberl 979. Contact
address : Shri Bindeshwar Pathak,
Sulabh International, Near Reserve
Participation and...
Bank, Patna-800001.) The Sans
than propagates essentially a pit
The most noteworthy feature
privy with a water seal. The credit of the Sansthan is the participation
of the Sansthan is that it has help of the people. The income in
build and propagate it in mass scale Patna, for instance, rose from Rs.
and has made necessary modifica 500/- per day to 600, 1100, 1500,
tions. The users of the Sansthan 2000 and now it is Rs. 2200-'-. It is
HEALTH FOR THE MlLLIONS/AUGUST
important to note that their income
is from the beneficiaries and in the
form of 10 paise and 5 paise per
use of the latrine and not from the
donations from rich people. That
the Sansthan is self-sufficient in
this public facility, is an unique
thing in the world. How has this
come about ? The Sulabh Shouc
halaya facilities are neat and clean.
It is so clean that my friend who
Photo : Madhu Sarin
materials spread out, it dries
rapidly. This can also serve as an
excellent manure for fields. How
ever, this method is not fit for urban
areas because of aesthetic consi
derations and for want of space.
Even in rural areas with extensive
cultivation particularly in rice fields
and in the rainy season, it becomes
difficult. Lack of sun keeps the
stench longer and pathogens do
not die out easily. People working
in the fields get and spread enteric
diseases rapidly. Also, the explod
ing numbers of people force us to
search for other viable alternatives.
These present designs have taken
a long time to evolve through the
unsuccessful, foul-smelling and
dangerous latrines—which is one
of the reasons people are very re
luctant to construct latrines or use
them.
At present in India, there are
two methods in situations where
sewerage is not available. One is
the septic latrine and the other is
the modified pit latrine. The cost of
housing is common to both. The
latrine itself costs around Rs.2000/for the septic tank and around
Rs. 500/- for the modified pit
latrine known as Sulabh Shouchalaya.
did not hesitate throwing in match
sticks and ashes, felt very embar
rassed and could not find a place
to throw them ! People initially
hesitated and asked questions. But
now it is a seven to eight year old
institution. People know about it,
use it and pay for it without hesi
tation. A culture and a tradition
has been created which can be
called a civic sense and public
utility in the best meaning of the
term. Today people from all classes
come and use it.
By and large, as a policy for a
new
town
(like
Hyderabad,
Howrah), the Sansthan asks for
a two-year 50% subsidy for main
tenance and feels confident that
cc. ..TVITY HEALTH CELL
371 \ Main, I Block
Koramungala
Bangalore-580034 *
India
1981
i
after two years it will workout to
be self-sufficient.
But one cannot be lulled by the
success. There are still the poorest
of the poor, who cannot afford to
pay or do not live near the facility.
The location of the facility is
so chosen that 75% of the users
can pay for it. Poor people who
live in slums cannot afford a latrine
of their own and a public facility.
of water supply and sanitation in
the community. The Sulabh Shouchalaya Sansthan experience and
that of Safai Vidyalaya (Ahmedabad) has indicated to us that parti
cipation by the community is not
impossible.
An excellent review of conclu
sions from a wide literature on the
participation of communities in
water supply and sanitation pro
grammes is :
Participation and
community with the various techno
logical solutions which are feasibl e,
ranging from simple source protec
tion and pit latrines to multiple
house connections. Community
choice should include the possi
bility of rejection of any immediate
source improvement. Although this
may seem a negative outcome,
each community has its own crite
ria for calculating sets of trade-ofs,
so that their perceptions of the use
fulness and effects of improve
ments may differ considerably from
those af the agency. Besides, selfmade choices will ensure a greater
commitment than solutions pre
sented from outside."
Photo: Madhu Sarin
Recommended Study
Sulabh Shouchalaya i.
The location of the facility will
not function in a self-sufficient
manner. Creating a free facility on
the other hand, will increase
demands from places that can pay
and will kill the basic spirit of selfreliance.
The problem is tough and the
Sansthan has no ready-made solu
tions. In one place, a local
group of people have taken the
responsibility and they get Rs. 2/per month from local users. Today
three to four units are being tried.
Participation
Some form of participation or
the other has now been recognised
to be a key to successful systems
8
water logged area.
Education in Community Water
Supply and Sanitation Programme :
A Literature Review by Christine
Van Wijk-Sijbcsma (204 pages,
1979, Technical paper No. 12 from
International Reference Centre for
Community Water Supply). Some
authors of this book have observed
that handpumps are broken down
20 to 70% of the time. In some
countries village water systems are
breaking down faster than they are
being built. "A community is more
likely to cooperate in the imple
mentation, operation and mainte
nance of new systems if it has had
a say in the preparation of plans".
Many authors have stressed
"the importance of presenting the
Concludingly, it may be helpful
if we mention books and sources
for those readers intending to do
something in their communities.
The bibliography Low Cost Techno
logy Options for Sanitation: A
State of the Art Review (184 pages
by Witold Rybczynski, Chongrak
Polprasert, and Michael McGarry,
1978) offers an excellent summary
of the technologies relevant to
urban and rural settings in develop
ing countries, and is a guide to
hard-to-get technical litereture.
The book Sanitation Without
Water by Uno Winblad and Wen
Kilama is an excellent book that
discusses technologies that could
be appropriate to Indian conditions,
with modifications. Similarly, the
booklet Small Excreta Disposal
Systems (published by the Ross
Institute) is an useful small refe
rence manual on the range of
options available for small com
munities. "Design formulas are
included when appropriate and (for
experienced people) it is possible,
using this booklet, to design the
main elements of the system". The
WHO publication of the same name
{Continued on page 16)
HEALTH for the millions/august
1981
CHINU
Walking Less For More Water
The Evolution of India Mark II Pumps
Water. Where / get it ? Oh, I walk two hours every time, and two hours back. I do this twice
a day. Are we sick ? Oh / Often we have running stomachs, especially small brothers and
sisters. If only we could get a well in the village
"
—Nkobo girl.
Southern Sudan
The two basic problems of
drinking water are : It is not avail
able easily and it is unhygienic.
And in those villages it is available,
it does not easily percolate to the
poor and the less privileged.
Plan was only Rs 3 crores, whereas
the Draft Sixth Plan (1978-83)
makes a provision of Rs 1458
crores. However, to meet the goal
of the Water Decade to provide
potable water to all by 1990, the
Some 1.53 lakh villages, out of
a total of 5.76 lakh villages in
India, are classified as "problem"
villages, that is, they are located in
remote, hilly or desert areas where
the water source is below a depth
of 50 feet or 1.6 km away; or
where the water contains elements
dangerous to health, endemic to
cholera and worm infestations ; or
where sources contain excessive
fluorides, chlorides, iron, etc. These
villages
without an adequate
water supply are not evenly distri
buted in the country. Some areas
like West Bengal, Karnataka and
Tamil Nadu are better off whereas
Assam, AP, Rajasthan, Himachal
Pradesh and Jammu and Kashmir
suffer severely. The table below
indicates the extent of the problem.
The government has attempted
to give priority to the problem
under such schemes as Acce
lerated Rural Water Supply Pro
gramme (1972-74 and 1977-78)
and the Minimum Needs Pro
gramme (1977-78). By 1978, some
58,000 villages are reported to
have been covered. The expendi
ture during the First Five Year
health for the millions/august
1981
resource
requirements are esti
mated to be Rs. 7000 crores I
Water Below
The exploitation of ground
water has invariably emerged as
Percentage of villages without adequate water supply (1977-78)
Name of the State
Percent
1. Andhra Pradesh
2. Assam
3. Bihar
4. Gujarat
5. Haryana
6. Karnataka
7. Kerala
8. Madhya Pradesh
9. Maharashtra
10. Orissa
11. Punjab
12. Rajasthan
13. Tamil Nadu
14. Uttar Pradesh
15. West Bengal
16. Himachal Pradesh
17. Jammu & Kashmir
18. Nagaland
19. Tripura
20. Manipur
21. Meghalaya
Sikkim
58
69
24
18
50
3
36
10
11
23
11
52
7
27
2
61
80
38
41
33
33
N.A.
Total average
26
Source : GO I Report
{Continued on page 12}
9
A study of the work of some
voluntary agencies in the matter of
sanitation is helpful in planning for
communities elsewhere in the
country. D.K. Mishra in the Oxfam
Report, A Survey of Selected Sani
tation Projects in India (March
1981) has this to conclude : "Sani
tation is yet to become a priority
for the 'last-man', whether residing
in a rural or an urban area, as his
needs are different...The living
conditions of the urban poor
are more unhygienic than their
counterparts in villages. When a
sanitation programme is designed,
the priority areas should be urban
slums, and not rural areas". The
S.S.S. of Patna (see the article
Sanitation with Participation in this
issue), for instance, believe that
in rural areas, housing is a priority
and not sanitation. Hence they
refuse to talk of rural sanitation.
The Safai Vidyalaya, Ahmedabad,
is working mostly on a conversion
programme of bucket latrines,
which again is an urban concept.
The Institute of Public Health,
Poonamalle (Madras) is also doing
mainly extension work in rural
areas. Only the Maharashtra
Gandhi Smarak Nidhi, Pune, has
attempted to work in rural areas
because of the availability of a large
number of subsidies in Maharashtra
State for sanitation work, and due
to a team of committed workers.
Finance is not a problem for the
MGSN generally.
However, the same (about
finance) cannot be said for most
rural areas in the country. Hence
low-cost options have to be thought
of. But with low-cost models, the
maintenance of the system, in the
long-run, depends primarily on the
user and his outlook and attitude.
Safai Vidyalaya, Ahmedabad, for
instance, takes the responsibility
for maintenance during the initial
period when people are learning
to use latrines, but in the long run
it is the people's responsibility.
The
MGSN,
established in
1950, organises training pro
grammes for social and municipal
workers on its ongoing projects.
Each project runs for a week. It
also arranges training programmes
in other states. The only condition
is that they need to be informed
directly in a bucket. Buckets are
Septic Tank
removed manually or by wheel
This is a device to break up the
barrows, bullock carts, etc. The
sewerage into a sediment and an
system as practiced is unhygienic
effluent, both of which can be dis
and is a health hazard to the com
posed of safely and without any
munity and to the scavengers parti
nuisance. Septic tank systems need
cularly. It is quite an inhuman sys
more water and are costly to
tem. Condemns for life, those en
install. A 20-user septic tank with
gaged in scavenging, as social
out superstructure costs about Rs.
outcasts.
2,500. Therefore, its construction is
expensive. Meets technical stan PRAI Type
dards fully. Used extensively in
This type of latrine was evolved
to jvns where access to a sewerage at the Planning Research and
line is not available. The system Action Institute (PRAI), Lucknow.
has to be emptied periodically.
Basically consists of a pit dug into
the ground with a depth of six to
Bucket Privy
ten feet. Pit is lined with honey
Quite commonly used in many comb brickwork and cement mortar.
towns in India. Excreta is collected Sludge, earth, other minerals, etc.
10
Voluntary
Agencies
two months in advance. Through
the efforts of MGSN, some 50,393
latrines in various urban and rural
areas of Maharashtra were cons
tructed up to 1978-79. It also pro
duces pans (for the delivery end of
the latrines) together with the
Malpatra
Utpadan
and
Sanitation
The Kalyani Lutheran World
Service (LWS)
Settlement,
Kalyani, West Bengal, a colony of
Santhal tribals has an Oxfam Sani
tation Unit installed. About 100
people use it every day. The unit
appears to be underutilized. The
LWS is also working on a lowcost sanitary latrine which is a
water seal type dug well only one
foot deep and two feet six inches
in diameter.
Kendra,
and the Sarvodaya
Samiti, Andhalgaon, Bhandra
district. These last two organisa
tions are also involved in other
work similar to MGSN in rural and
urban areas around them.
Amraoti,
The Centre of Science for
Villages, Wardha, displays on its
The Friends Rural Centre,
Rasuliya, Hoshangabad, M.P.,
demonstration plot the bachelor's
lavatory which is suitable for two
or three users and works on septic
tank principles. The Harijan Sevak
Sangh, New Delhi, is a national
organisation with Bhangi Mukti
and Bhangi Kashta Mukti among its
main programmes. The Delhi unit
of the Sangh assists in construc
tion of public latrines. The Gandhi-
had initiated the development of
water seal latrine pans in 1957 as
an extension of the famous Barputti latrine. The Vidya Bhawan
Rural Institute, Udaypur, has pro
posals to work on sanitation in
rural areas through 35 polytechnics
in the country. But its ideas are
reportedly vague.
gram Institute of Rural Health
Disposal Systems used in India
found in faeces, accummulate in
this pit. When the pit is full, it is
emptied and reused. Pit fills at
the rate of one cubic foot per user
per year. No danger of ground
water pollution in this system
unless the water is very high. Pit
latrine should not be fitted with a
flushing system. By using abun
dant water, the soil around the pit
gets saturated quickly
which
reduces the life of the pit.
Aqua Privy
This is an improved form of sep
tic tank. Requires less water. Can
health for the millions/august
1981
j
|
be built on any kind of soil. Settled
solids are removed from time to
time. Fresh water is not needed for
flushing. Ablution water is found
to be sufficient. Aqua privy meets
all sanitation requirements from a
health viewpoint. Does not require
scavenging. Can easily be used in
the provision of public latrines.
Bore Hole
Bore hole latrines are cons
tructed by boring a hole about
10 feet deep and nine to sixteen
inches in diameter. This system is
useful when there is little available
HEALTH FOR THE MILLIONS/AUGUST
and Family Planning, Ambathurai, Madurai, Tamil Nadu, has taken
up environmental sanitation work,
such as the installation of hand
flush latrines in villages in Athoor
block, drainage, the provision of a
protected water supply and smoke
less chullas, etc. These schemes
are generally run under the training
programmes for sanitation workers,
the funds being provided from the
programmes. The Institute has a
small work shed for the construc
tion of latrine pans, pipes, pit
covers etc. These components are
supplied to the beneficiaries at a
subsidised cost and the knowledge
is provided by the training staff.
The Institute is attempting to popu
larise water seal latrines and drai
nage schemes and the response
has been favourable.
creta as organic manure holds
great interest to people in rural
areas. They realise chemical ferti
lisers alone are not sufficient for
better yields. So the way to
approach cleanliness and health,
says Nawrekarji, is to talk about
the wastage of excreta as against
its utility as manure. The villagers
respond positively to this and not
to sanitation by itself. Shri Nawrekar has successfully installed 20
gobar gas plants alongside the
latrines.
space. The life of this style of
latrine is short. The bore may be
filled within 12to 15 months when
7 to 10 persons use it regularly.
When the bore is filled, a fresh
bore is made. Disadvantages : May
require special mechanical equip
ment to bore the hole; chances of
subsidence are high.
quires less water and is very
popular for its manure content.
As the author of the above
quoted Oxfam report remarks, most
voluntary agencies are inspired by
the Gandhian philosophy. "This
seems to be an important factor in
this field in initiating any pro
gramme". Voluntary agencies also
enjoy greater freedom in experi
menting with low-cost latrines.
According to Shri Bhau Nawre- Some of them have succeeded in
karji, a pioneer who was responsi doing noteworthy work. Govern
ble for propagating the famous mentinstitutions on the other hand
Naigaon latrines, villagers are very have had little impact. This is
suspicious of anyone who wishes because of bureaucracy and a lack
to introduce sanitary conditions. of flexibility in their approach. A
They are reminded of the unhygie humane exception seems to be the
nic conditions of urban latrines on Planning Research and Action
their visits to cities. However, ex- institute (PRAI), Lucknow.
Sulabh
Swach
Shouchalaya (Sopa Latrine)
Commonly used in rural areas of
Maharashtra. This type of latrine
makes use of a special type of pan
and has a hinged tin flap at the
pan outlet. Flap closes after the
passage of faeces into the pit
(therefore flies do not hover
around). Pit is lined with honey
comb brickwork. The system re
1981
Hand Flush Latrine
Consists of an especially made
squatting plate in which a water
seal pan is incorporated. The seat is
installed directly over the pit. This
type meetsail health requirements.
Can be located near or within
the dwelling unit. It is simple
and cheap to build in rural areas.
Manure Pit
A modification to the hand flush
type. Before the latrine is put to
use, the pit is partially filled with
grass, leaves, paper, etc. for com
posting. When the pit is filled, it is
covered with similar waste mate
rials and a layer of earth. The
squatting plate is then placed on a
second pit for continued use.
Manure from the first pit is taken
out after six to eight months.
11
I
{Continued from page 9)
a solution to man/ of the prob
lem villages. A large number of
such areas are in the rocky areas
of the country. Consolidated for
mations are present in the major
part of the country, including
almost the entire Indian peninsula
which consists of hard rock for
mations. Such hard rock forma
tions have led to the use of rigs
for drilling the terrain in search of
ground water, sometimes at depths
greater than 100 feet. The exploi
tation of ground water is the best
alternative for the widely dispersed
rural communities. Also it is safe
and potable even without filtration.
This cannot be said of most open
wells, rivers, lakes and ponds.
UNICEF's Role
The involvement of the UN
Children's organisation—UNICEFstarted with the successful use of
1 I rigs procured through UNICEF.
This was under an emergency pro
gramme to provide water supply in
the drought affected areas of UP
and Bihar during 1967-68. Their
continued effective use in the
drought affected areas of AP and
Bihar led to schemes, involving the
government and UNICEF. These
schemes require the utilisation of
drilling rigs and the utilisation of
ground water for the rural water
supply programme in a big way.
The assistance from UNICEF
continued during the Fourth and
Fifth Plan periods. The emphasis
was on the supply of drilling rigs,
spare parts, accessories, etc. to
assist the State Governments in
exploiting
the
ground
water.
UNICEF has supplied till date more
than 200 rigs (There are more than
500 drilling machines today in the
country, counting those that are
with private agencies and voluntary
agencies like the Social Work Re
search Centre, Tilonia, etc. Many
of the States have gone in for pur
chase of indigenous as well as
12
imported
rigs).
An estimated
number of 40,000 bores have been
made by the rigs supplied through
UNICEF. This benefits approxi
mately 25,000 villages.
High Breakdown Rate
A common feature of the initial
years of the Rural Water Supply
Programme was the frequent break
down of the cast-iron pumps which
were used to tap ground water.
These handpumps were designed
for single family use. They were
patterned on types earlier used in
rural areas in the West. As a result,
they were not suitable for commu
nity use. The Government of India
thus requested UNICEF in 1974 to
participate actively in the develop
ment of a heavy duty community
handpump which could stand up to
the strenuous requirements of pro
viding a continuous supply of safe
drinking water to a relatively large
number of beneficiaries.
Considerable R Er D has been
invested in India in the Jalna or
Sholapur pump: low cost with low
maintenance needs. It was first
developed at the former Church
of Scotland Mission at Jalna in
Maharashtra during the late 1960's,
and was then taken up at the
Sholapur Well Service. Its design
has .been improved since, and
patented to prevent sub-standard
pumps being made by other firms
or agencies.
The Mark II
Continued efforts of the Govern
ment of India, UNICEF, CSIR,
WHO, etc. led to the development
of the India Mark 11 handpump. This
is an improved version of the
Sholapur pump. It is an all-steel
heavy duty handpump specifically
designed for community operation.
It is able to function for consider
able lengths of time without break-
HEALTH TOR THE MILLIONS/aTJGUST
1981
THREE-TIER MAINTENANCE
SYSTEM
team situated at the block level.
The block team is in turn suppor
ted by the third tier: an even more
well-equipped mobile maintenance
team at the district level. Each dis
trict has one or more mobile main
tenance teams—one team for every
500-600 handpumps.
Costs Accruing
The UNICEF provides rigs for
drilling, the India mark II hand
pumps for pumping the water, and
training and advisory services for
installation and maintenance. The
annual drilling targets are in the
range of 150 to 200 wells per year
At Village level
down and/or the need for major
repairs.
One of the major reasons the
old cast iron pumps broke down or
were not in operation for long
periods of time was poor mainte
nance facilities. The Handpump
Rejuvenation and Maintenance Pro
gramme that began in 1974-75 had
therefore two aims : replacement
of old cast-iron pumps with the
India Mark II handpump and deve
loping a maintenance structure.
3-Tier System
The result of the latter was the
three-tier
maintenance
system,
first developed as an outcome of
drought in Tirunelveli District,
Tamil Nadu 1 975-76. The system
was a success and was adopted
by the Tamil Nadu Government for
the entire state. Subsequently, the
three-tier maintenance system is
being adopted in other states of
the country as well. The bottom
tier is a village handpump caretaker,
sometimes called the "barefoot
handpump doctor". This person
works at the village level on a
voluntary basis and is trained to
take care of minor maintenance.
Whenever a major job is required
on the pump, he sends a postcard
to the second tier : a maintenance
HEALTH FOR THE MILLIONS/AUGUST
per new rig depending upon depth
of aquifier, casing required, etc.
Till 1980, UNICEF had supplied
approximately 40,000 India Mark II
handpumps to the various states,
and another 16,000 pumps are on
order. The State Governments
have also placed orders with quali
fied Indian manufacturers including
the public sector unit : National
Small Industries Corporation. There
are strict ISI specifications for these
handpumps. Furthermore, UNICEF
has supplied more than 165 vehi
cles for the mobile maintenance
teams.
The cost of the Mark II pump
inclusive of pump, rod and cylinder
is Rs. 1500/-. It costs an average
of Rs. 15,000/- to Rs. 25,000/- to
198 1
drill a 1 50 feet deep hole of 4-6
inches diameter. In MP the costs
are reported to be less for drilling.
The annual cost of the three-tier
maintenance system has been esti
mated at about Rs. 1.5 lakhs for
500 pumps. Each India Mark II
pump therefore costs about Rs.
320/- per year to maintain which
compares with Rs. 500/- to Rs.
650/- required to maintain sub
standard pumps.
Confidence Again
The design of the pump itself is a
matter of great satisfaction to those
who were involved. A British Con
sumers' Association report called it
the best of its kind in the world.
"The India Mark II handpump and
the three-tier system have together
once again given us confidence in
rural water supply programmes",
says a UNICEF official, who earlier
faced a barrage of breakdowns
and maintenance problems that
looked almost insolvable for a long
time. The success of the Tirunel
veli experiment and the three-tier
system has resulted in many State
Governments taking a renewed
interest in handpumps. Community
participation at the village level
has been a key factor in the success
of the India Mark II pump and the
three-tier system.
Improved Health ? .
The objectives of the UNICEF
and government agencies for dri II-
At district level
13
ing and installation of pumps is to
reduce the incidence of water
borne diseases, thereby contribut
ing to a decline in infant and child
mortality and morbidity. Specific
objectives include : ensuring the
continuous availability of a mini
mum of 40 litres of potable water
per person per day; installing one
tube-well with dependable hand
pump for every 250 people; second
tube-well and handpump where
the population exceeds 250 ora
school or health facility exists; and
so on. Will health improve there
by?
dysentery and various diarrhoeal
infections are as much waterwashed as they are water-borne.
An improvement in the quality of
drinking water would not cut down
their incidence very much. Impro
ved water supply in some cases,
can increase health risks. Lack of
drainage can encourage mosquitoes
and other disease vectors. In India,
the population at risk from filariasis
has increased about 20-fold to over
125 million over the past 15 years.
One reason is believed to be im
proved water supplies without
drainage systems.
It may not, and it will not un
less improved water supply and
sanitation are coupled with health
education and community parti
cipation. Several diseases generally
thought of as water-borne are
affected not so much by water
quality as by the quantity of water
and the manner in which it is used.
This is true especially of the waterwashed diseases like scabies, skin
sepsis, trachoma and fungal infec
tions. Even diseases like bacillary
Voluntary Roles
There are other bottlenecks and
obstacles in providing potable water
to rural communities. One rig can
drill more than 1 00 wells in a year.
But the average in India has not
been more than 20 till date. This
is because the requests for drilling
and installation has to be routed
through State Governments. Then
there are local political forces and
groups that interfere with the
attempts of well-intentioned, targetoriented government officials. Even
when installed, the handpumps
continue to be used more by the
richer sections of the community
and the upper castes. The poor
shy away because of caste-domi
nation.
Voluntary agencies could faci
litate peaceful choice of a place
for the installation of the pump in
the village. They could help acce
lerate the flow of funds and facili
ties from the various government
agencies; ensure community parti
cipation and provide the link with
health by health education. Some
enterprising voluntary agencies in
the country have even procured
their own drilling rigs. Others could
do so, if feasible for them.
(Voluntary agencies interested in
implementation could contact for
further details : Raymond L.M.
Janssens, Project Officer, WES,
UNICEF,
Lodhi Estate,
New
Delhi-17 0003.
UNICEF training
kits are available to those interested
in starting their own programmes).
Ways in which water supply projects can lead to a worsening of the
relative position of the poor
# Dominant groups might receive a subsidized service
which the poor do not receive, e.g. individual supply to
their homes without a corresponding payment.
• Access to the new water supply might be restricted or
monopolized. This danger includes cases where the
design of the project appears to cover the poor as well,
but actual flow is limited or diverted, so that only the
dominant group benefits, e.g. by use of water for farm
ing purposes in such quantities that the supply does not
reach the homes of the poor.
• Water used for agricultural or commercial purposes by
dominant groups may increase their income in ways
which are not available to the poor; this can then lead to
changes which worsen not just the relative, but also the
absolute position of the poor—changes in land tenure,
for example, or the discontinuance of arrangements to
share food in times of disaster.
• Employment opportunities in the form of water carrying
may be lost.
O Equal contributions exacted from all inhabitants for the
construction or running costs of the water supply may
mean a charge which poor families are in no position to
afford.
• Voluntary work demanded at peak times in the agri
cultural work cycle may lead to a substantial decrease in
production.
© The power of the dominant group may be increased by
the patronage available, e.g. in the selection of a
water supply operator on a salary. At the least, the
village-level organization of the programme, in collabora
tion with a powerful external agency, will be a political
resource in terms of prestige.
Excerpted from Community aspects of rural water supply
and sanitation programmes at village level, Checklist no. 4,
by E.L.P. Hessing and P. Kerkhoven, paper presented at
the Research Study Group Meeting on Appropriate
Technology for Improvement of Environmental Health at
the Village Level, New Delhi, 16-20 October 1978. SEA/
EH/RSG/ Meet. 1/4, 2a.
HEALTH FOR THE MILLIONS/aUGUST
I 981
COST OF THE WATER DECADE
NEEDS:
SERVICE LEVELS :
1990 population of developing countries needing water
supply and sanitation (in millions).
Case 1*
(100% coverage using 1980 WHO Target Urban
Service Standard Distribution)
Urban
Water Supply
70% house connection
30% stand pipe
Sanitation
40% sewerage
40% septic tanks
20% latrine and
communal latrines
Water Supply
20% house connection
40% standpipe
40% handpumps
Sanitation
80% sewerage
20% latrine
Sanitation
650
1,670
2,320
Water
640
1,570
2,210
Urban
Rural
Total
COSTS :
Rural
Per Capita costs of alternative types of water supply
and sanitation (1978 USS)
Urban
Rural
Case 2*
(80% coverage with service standard as
suggested)
Water Supply
40% house connection
40% standpipe
Sanitation
25% sewerage
15% septic tanks
40% latrine and
communal latrines
Water Supply
10% house connection
30% standpipe
40% handpumps
Sanitation
10% sewerage
70% latrines
Water Supply
with house connection
with standpipe
with handpumps
$120
40
—
$150
40
25
Urban
250
100
30
250
—
20
Rural
Sanitation
with sewerage
with septic tank
with latrine
* Both sets of figures are only rough approximations. They
are bound to rise further when costs of operation and
maintenance are added to installation costs.
SOURCE : World Bank, Basic Needs : Water Supply and
Waste Disposal, Dec. 10, 979 pp. 6-7.
Wishing form WASH
Asking from AFPRO
The Water and Sanitation for Health (WASH)
Project is an USAID sponsored agency which
aims to provide centrally-funded services to
improve drinking water and sanitation "with a
minimum of administrative effort and delay".
WASH offers services to, among others, private
voluntary organisations in the AID developing
countries including India. Its services range from
general technical assistance, technology transfer
for water supply and sanitation, manpower develop
ment and training, and
information support.
Further in- formation can be had from: Information
Director, WASH Project Coordination and Informa
tion Center, Room 1002, 1611 North Kent Street,
Arlington, Virginia, 22209, USA.
The Action For Food Production (AFPRO)
is a non-profit organisation located in Delhi. It
coordinates, supports, evaluates and gives technical
guidance to food production projects of non
governmental and voluntary agencies. It works in
close collaboration with the Government of India.
HEALTH FOR THE MILLIONS/AUGUST
I 981
AFPRO also receives several enquiries and
requests for advice on appropriate technology re
lated to water, irrigation, agri- culture, animal
harnessed transport, solar and wind energy,
biogas, rural latrines and housing, and recycling
of wastes, including polluted waters. For further
details, readers may write fto AFPRO, C-17,
Community Centre, SDA, New Delhi-110016.
15
A School For Cleanliness
Safai Vidyalaya, Ahmedabad, is
housed in Parixit Sadan, named
after Parixitlal Mazumdar, one of
the pioneers of the Harijan move
ment. Housed in the Vidyalaya are
the many lifesize models as well as
miniatures of the different types of
latrines, chullas, soakage pits, etc.
The Vidyalaya offers trainning faci
lities to government bureaucrats,
voluntary bodies,
school
and
college
students,
panchayat
officials, PWD engineers, sanitary
inspectors
and
others.
The
Vidyalaya, which acts as an hono
rary adviser to the Gujarat Govern
ment, has been making concerted
efforts to motivate communities
about the need to participate in
their own sanitation by way of
Shivirs (camps). Over a lakh bucket
latrines were converted in 1969-77.
By the end of 1977, some 45,000
were still to be converted. The
Safai Vidyalaya's work has proved
to a significant extent, that change
can be created by determined
work.
As a training centre it has an
important role. Its concepts are
being increasingly accepted even
in rural communities. Ishwarbhai,
who is the prime force behind
Safai Vidyalaya, is an unassuming
man, enthusiastic and passionate
about his mission. He told VHAI
that he would be willing to con
duct training workshops in sanita
tion in English and in Hindi, at any
part of the country. Preferably,
such workshops would need to be
coordinated through the local or
state branch of the Harijan Sewak
Sangh. The host institution would
need to take care of Ishwarbhai's
travel, food and stay.
The emphasis behind much of
the work of Safai Vidyalaya is the
16
search for technologies that are
simple, low-cost and appropriate,
those that require less water and
are easy to maintain.
Readers
interested in implementation in
their own communities could con
tact Ishwarbhai, Safai Vidyalaya
Harijan Ashram, Ashram Road,
Ahmedabad—380027.
— Mira
Container Gardening
In the tropics, where sunlight
is abundant, a family with little
or no land can produce fresh
food right at home—in con
tainers. Container gardening is
cheap, allows food to be grown
with minimal exposure to chemi
cal substances, and is quick.
Ceylon spinach, for example,
yields its first harvest in 24 days
and seven more harvests within
188 days. One plant can produce
as much as 1.8 kilograms of
spinach.
All sorts of household items
can serve as containers: plastic
bags, milk cartons, tin cans,
wooden buckets, even old bas-
kets. Fragile containers can be
reinforced with wire and string.
Growing Food in Containers
in the Tropics discusses sites,
soil preparation, plant care, in
sects and diseases, harvests,
choice of plants, and productivi
ty. It has sections on roots and
tubers, fruits, vegetables, legu
mes, spices and condiments, and
leaf vegetables. It also rates 11
crops and over 30 varieties sui
table for container gardening
both inside and out.
Available from:
Mayaguez
Institute of Tropical Agriculture:
USDA; PO. Box 70, Mayaguez,
Puerto Rico 00708 USA.
(Continued from page 8)
WE NEED YOU
discusses Management of Solid
Wastes in Developing Countries—
refuse collection and transport,
sanitary landfills, and composting
of urban wastes. Lastly, Arnold
Pacey's Rural Sanitation : Planning
and Appraisal (64 pages, 1980,
ITDG) : This is a booklet written
for hospital staff and community
development workers in third world
countries who are planning to
start sanitation or hygiene improve
ment programmes in rural areas.
Doctors
(The books and references men
tioned above can be made available
through VHAI on request
—Ed. HfM.)
Wanted a Surgeon M.S., F.R.C.S.
and Physician M.D., M.R.C.P. for a
general hospital with 125 beds. For
further information please contact :
Administrator,
Mercy Hospital,
Baridih, Jamshedpur 831017.
Professionals
Hemkhail Trust requires for their
rural development project a group
of professionals—doctors, agro
chemists, geologists,
engineers,
designers, teachers, sociologists—
to work together as a team. Interes
ted individuals/institutions may con
tact : Mr Yogendra Jain, Hemkhail
Trust, 139 Johari Bazar, Jaipur302003.
HEALTH FOR THE MILLIONS/AUGUST
1981
LOW COST DRUGS PAGE
DRUGS BULLETIN
DRUGS BULLETIN is brought out by the Department of Pharmacology, Postgraduate Institute of Medi
cal Education & Research, Chandigarh. Editor: Dr. V. S. Mathur.
The Bulletin publishes articles covering drug management of various diseases.
features are :
A.
B.
Plus its regular
From the Desk of the Drugs Controller of India.
Generic names/Brand Name/Drug Houses and prices of drugs.
Sample
DRUGS USED IN PULMONARY TUBERCULOSIS
Generic Name
Streptomycin
Isoniazide
(From July '81 issue:
Vol. 4 No. 3)
Drug House
Presentation
Packing
Price
Ps. p.
Ambistryn-S
Sarabhai
Merstrep
Streptonex
Sugacin
MSD
Pfizer
HAL
Inj. 0.75 gm.
1 gm.
Inj. 1 gm.
Inj. 1 gm.
Inj. 0.75 gm.
1 gm.
0.75 gm vial
1 gm. vial
1 gm. vial
1 gm. vial
0.75 gm. vial
1 gm. vial
1.03
1.18
1.18
1.57
1.01
1.19
Ipcazide
Ipca
120 ml.
7.85
Isokin
Warner
Liquid : 100 mg/
5 ml
Tab : 100 mg
100 Tabs.
1000 Tabs.
3.94
30.38
Warner
Pfizer
Liquid : 50 mg/
5 ml
Tab. 300 mg.
Tab. 50 mg.
200 ml
10 tabs.
1000 tabs.
5000 tabs.
100 tabs.
1000 tabs.
5000 tads.
30 tabs.
1000 tabs.
1000 tabs.
100 tabs.
1000 tabs.
2500 tabs.
6.40
1.88
17.81
82.27
4.50
30.38
144.19
3.41
86.38
15.43
3.51
25.98
60.99
Brand Name
Isokin 300
Isonex
Tab. 100 mg.
Isonex Fort
Pfizer
Tab. 300 mg.
Nidrazid
Sarabhai
Tab. 50 mg.
100 mg.
-
Useful for health personnel with some knowledge of Pharmacology.
articlescan be made available at a later date.)
HEALTH FOR THE MILLIONS/AUGUST
1 98 I
(Reprints of the more relevant
VUM -Y HEAlTH
Mein, | Block
Koramongala
^angalorO-5S0034
India
,7
17
nem
1981. There were 26 participants.
The main features were small group
discussions, games, exercises, etc.
There are also plans to hold a
VHW conference
during
the
Dushehra holidays at Bhopal.
*
*
*
Bihar
Kerala
Bihar VHA is planning a twoday convention for village health
workers of Palamau district at
Chandwa on October 2-3, 1981
and a physical assessment work
shop from November 2-7, 1 981 at
Kurji Holy Family Hospital, Patna.
One of the emerging trends
among
KVHS members is the
increasing interest in holistic health.
Holistic health was the theme of
their annual general body meeting
held on July 29, 1981. Dr. J C
Vijayan who had his training in
holistic health in the States was
one of the key facilitators at the
annual general body meeting be
sides George Ninan of VHAI. There
has been a great interest in VHS
and Communitv health among the
participants of diocesan develop
ment seminars,
Kothamengalam
diocese. KVHS has been invited
to conduct orientation programmes
in community health for all the
community health projects in the
diocese.
For further details please contact
Mr. M. Zaman, Executive Secretary
of Bihar VHA at Kurji Holy Family
Hospital, Patna-800010.
West Bengal
Community health and develop
ment training is prominent in WB
VHA's activities and plans. The
VHA has already trained 23 Ch
trainees. A follow-up meeting is
planned for November 1981. WB
VHA is also helping to market the
goods of voluntary organizations
and to solve their marketing pro
blems, and making new posters on
health and development.
The future plans of WB VHA
include follow-up of trainees and
seminars and workshops on human
relations, holistic health, school
health, health education, commu
nity health and development, etc.
In addition, it is also planned
to organise three community health
develpoment training workshops
per year in various districts of West
Bengal and a statewide health and
development convention once a
year.
18
Uttar Pradesh
A workshop on health and
development
was
organised
from September 19-21, 1981 at
Rajpur, Dehradun, UP. The work
shop was sponsored by various
groups working in health, rural
development and related fields to
share their experiences, problems,
etc.
Tunnie Martin, coordinator for
the region, is planning another com
munity health workshop at Vigyan
Shiksha Kendra head office at
Attara, UP, from December 7-14,
1981.
Madhya Pradesh
MPVHA organised a workshop
for community and village health
workers from April 28 to May 3,
Research
and Development
Organisation,Tansen Road, Gwalior
—474002, has developed a very
simple and inexpensive field test
for fecal pollution of drinking
water, suitable for screening rural
water supply systems and large
scale screening of urban water
supplies. For details write to
Dr. J.S. Mahashabde, president
MPVHA, Indore
Eye Hospital
Society, 84 Jawahar Marg,Indore,
MP.
New Delhi
VHAI has designed a 15-month
course in community health team
training. This course emerged from
an evaluation of short term courses
in community health and develop
ment since 1974. The broad
objective of this programme is to
help prepare teams to participate
in building of healthy individuals
and health communities through
integrated development with em
phasis in people's involvement
using appropriate and local resour
ces and responding to community
needs.
The first training programme
begins on September 1 3 and ends
on December 15, 1982. This pro
gramme is for the groups working
with Bhil tribals in Western India.
The participants will meet at
regular intervals for the training
and spend a major part of their 15
months in their own place of work
implementing what
they have
learnt. They will be visited by the
VHAI team twice during the course.
There are 15 participants for the
first such programme. The first
HEALTH FOR THE MILI.IONS/aUGUST
1981
Andhra Pradesh
AP VHA's future plans include
seminars and workshops on evalua
tion of nutritional programmes,
educational materials, school health,
village health workers' convention,
etc.
*
*
*
responsibility, nutritional aware
ness, social and environmental
sensitivity, physical fitness and
stress management. There were
discussions on biogenics, yoga,
foot reflexology, dream counselling
and air, water and food pollution.
Many of the participants concluded
with contracts for change and
exciting ideas and plans for imple
menting it in their respective insti
tutions.
During July-August '81, AP
VHA hosted two extremely suc
cessful workshops : Holistic Health
Karnataka
and Advanced TA. The Holistic
Health workshop was of six days
The St. John's Medical College
duration and attended by more has been subject to major problems
than 35 participants. The resource for the past one year. Strong differ
team included Sr. Carol Huss and ences have emerged between the
Chinu, Renu, Mira and George from privately run Catholic Medical
VHAI. The sessions covered all five College and the Bangalore univer
dimensions of holistic health : self sity. The university has shown a
prolonged indecisiveness, according
to the college sources, in granting
it permanent affiliation, sanction
for post-graduate courses, and re
cognition of the campus hospital as
a teaching hospital. A recent action
of the university has been to dis
affiliate the college and deny it the
privileges of the Bangalore univer
sity. Through a notification and
press release, the first MBBS stu
dents who had joined in August
1980 were informed on July 19,
1981 that they would not be per
mitted to appear for the examina
tions slated for August 10, 1981.
Meanwhile, St. John's has filed
a writ petition in the court seeking
among other things permission to
the management to continue ad
missions for 1981-82.
♦
♦
*
News
Creative Winners
Health For the Millions joins
many grateful people in congratu
lating Dr. Pramod Karan Sethi for
being awarded the Ramon Magasaysay award ("the Asian Nobel
Prize") this year for community
leadership. Dr. Sethi's Jaipur foot
(see "New Hope for Rural Ampu
tees", in Health for The Millions,
October
1978, for fa
detailed
description)
has brought
hope
to thousands of cripples in the
country.
We also congratulate Dr Robert
Sperry of the California Institute of
Technology for winning this year's
Nobel Prize for physiology and
medicine. Dr Sperry, who shared
the coveted prize Jwith Professors
David Hubei and Torsten N. Wiesel,
was awarded the prize in recogni
tion of his studies of the brain :
"brilliantly succeeded in extracting
the secrets from both hemispheres
20
of thebrain and in demonstrating
that they are highly specialised and
also that many higher functions
are centred in the right hemis
phere." Some consequences of the
discovery of Dr. Sperry were ex
plored in our February 1981 issue
in "A Kind of Conspiracy”.
way for the commission, wh ch, it
is hoped, will be formally establi
shed in 1 982.
The IMC will aim to “secure the
widest possible commitment by
physicians and other health workers
to respect human rights and medi
cal ethics, and to stimulate a high
—Ed. HFM level of vigilance for breaches or
failure in observance of these princi
*
*
♦
ples. The Commission will investi
gate situations and cases that do
Commission for
not conform with the established
human rights principles, and take
Health and Human
action to secure observance of
these
principles. It will promote
Rights
education of and exchange .of in
It is accepted in principle that formation among physicians and
physicians and other health workers other health workers concerning
can and should be closely identi the ethical principles of health work
fied with the cause of human rights. and human rights. The contact
Now, a formal commission is to be address of the Commission's pre
formed : The International Medical paratory committee is : P. 0. Box
Commission (IMC) for Health and 105, 1225 Chene-Bourge, Geneva,
Human Rights. A preparatory com Switzerland.
♦
♦
*
mittee has been set up to pave the
HEALTH FOR THE MILLIONS/AUGUST 1981
OBITUARY
J P Naik
(September 5,1907—August 30,1981)
In 1930, he joined the Civil Disobedience Move
ment and was imprisoned for two years in the Bellary
jail. It was during his underground days that he
adopted the name J.P. Naik (his earlier name was
V. H. Ghotge) by which he has been known ever after.
On his release from jail in 1932, Naik started rural
development work in a number of villages at UppinBetigeri in Dharwar district. Two of the villages in
district, namaly, Uppin-Betigery and Kardigud, were
awarded the Sir Frederick Sykes Villages Improve
ment Shield for the Dharwar division in 1937.
In 1940, Rao Bahadur P.C. Patil, who was then
Education Minister of the princely State of Kolhapur,
invited him to assist in the educational reconstruction
of the State. Naik started his work as a part-time
Educational Adviser, but soon rose to the position of
Development Secretary. Characteristically enough,
Naik worked 18 hours a day but accepted no salary.
In 1948, he established the Indian Institute of Educa
tion. Simultaneously, he established Shri Mouni
Vidyapeeth, a rural institute at Gargoti in Kolhapur
district
The list of participants at the meeting held in Delhi
to condole J.P. Naik's death would read like an Indian
Who's Who of education. But it is not only educa
tionists who will miss him.
Naik's concern for the poor, the underprivileged
and the oppressed, led him to take a keen interest in
the problems of health care especially for the rural
areas. He worked as a member on the Shrivastava
Committee, Gopalan Committee on Drug Addiction,
and on the ICMR—ICSSR Paneion Alternatives in
Health.
His most significant contribution in this
behalf is the report of the study group set up jointly
by the ICSSR and the ICMR entitled "Health for All :
An Alternative Strategy".
Naik began his woiking life at the age of five on a
farm in a small village, Bahirewadi, in Kolhapur
district.
The next phase of Naik's life began in 1959, when
Dr. K. L. Shrimali, the then Union Education Minister,
invited him to Delhi to assist him in the task of edu
cational reconstruction at the national level. Naik
refused to accept a salary and maintained himself
throughout his stay in Delhi on small earnings from
lectures, books and other writings. In May 1969,
Naik established the Indian Council of Social Science
Research and was its Chief Executive for the first nine
years.
Naik was not only an institution-builder but also a
prolific writer. Concern for the education of the people
stimulated most of his writings on education. Between
1942 and 1978, Naik wrote about 30 books and
edited five. He wrote innumerable papers for national
and international journals in addition to some books
and papers in Marathi and Kannada. People who
cherish good values in life will continue to find in him
an inspiration.
The embfem of the International Drinking
Water Supply and Sanitation Decade has the
following components.
• The image of a drop, which is readily
identified with drinking water and sanita
tion in all parts of the world.
* Within the large drop, signifying the
Decade as a whole, ten small drops re
present each year within the Decade.
• The sprinkling, configuration of drops
suggests the spreading of drinking water
and sanitation services throughout the
world, in line with the Decade goal of
"clean water and adequate sanitation for
all by the year 1980."
• The encircling olive-branch wreath symbo
lizes the United Nations' supporting and
promotional role in the Decade.
For Private Circulation Only
Position: 659 (7 views)