Mohammed Manzoor Akheel CHLP 2012.pdf
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Soch <1
building community health
Sanitation Activities at a
Village under CHC
Working Area
ohammed Manzoor Akheel
Intern, Community Health Cell, SOCHARA
2012
Guided by:
Mr. A. S. Mohammad
Coordinator
*
Mr. I. M. Prah lad
Training & Research
Assistant
| I
Comm unit} Health Cell.
■
SOCHARA. Bangalore
2d
Source: I oral Sanitation Campaign. Karnataka
1
85/2,1st Main, Maruthi Nagar, Bangalore, Karnataka - 560068
"Sanitation is more important
than independence"
- Mahatma Gandhi
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Source: Total Sanitation Campaign, Karnataka
Report submitted on 15th June 2012
2012
Sanitation Activities at a Village under CHC Working Area
PAGE NO.
CONTENTS
SL. NO.
1.
LIST OF ABBREVIATIONS USED
2
2.
INTRODUCTION
3
3.
REVIEW OF LITERATURE i
4
4.
PURPOSE
5
5.
OBJECTIVES
5
6.
METHODOLOGY
6-7
7.
KEY FINDINGS
7- 16
8.
DISCUSSION
16- 17
9.
CONCLUSION
17- 18
10.
RECOMMENDATIONS
11.
ACKNOWLEDGEMENTS
19
12.
FURTHER READING
20
8 5 / 2, I s t Main, Marathi N a g a r, Bangalore, Karnataka
I
18-19
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Sanitation Activities at a Village under CHC Working Area
LIST OF ABBREVIATIONS USED
APL - Above Poverty Line
IB
BPL -Below Poverty Line
CHC - Community Health Cell
CUTS - Community-Led Total Sanitation
CRSP - Central Rural Sanitation Program
GP - Gram Panchayat
NGO - Non Governmental Organization
OD - Open Defecation
■Mb
PC - Production Center
Mb
'
:
:
;
U
raHMHHMnH
RSM - Rural Sanitary Mart
SOCHARA - Society for Community Health Awareness Research and Action
i
TSC - Total Sanitation Campaign
8 5 / 2, 1 s t Main, Marathi Nagar, B a n g alore, Ku r it a t a k a
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Sanitation Activities at a Village under CHC Working Area
Preliminary Inquiry
Introduction
Sanitation is a basic necessity that affects everyone’s life. Proper disposal of
household waste is important to prevent fecal-oral and vector borne diseases. As per
the 2011 census, only 21.9% of households in rural India have access to household
latrines. The Central Rural Sanitation Program (CRSP) launched in 1986 and revised
in 1992 was a traditional, supply-driven subsidy-oriented program. In April 1999,
CRSP was restructured and launched as the Total Sanitation Campaign (TSC) making
it people oriented and demand driven. The program is implemented in a campaign
mode with the district as a unit.
Report Card Status of Total Sanitation Campaign (TSC) as on 12/6/2012
STATE
KARNATAKA
Project
Project
. a
%age
Components
Objective
Achievement
IHHL BPL
----------------------2889224
2015705
69.77
IHHL APL
2981691
2158788
72.40
IHHL Total
58709151
4174493
71.10
School Toilet
39267
41972
106.89
Sanitary
1305
859
65.82
Anganvvadi
26353
28161
106.86
RSM
290
217
74.83
8 5/2, 1st Main, Marathi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Literature Review - Community Led Total Sanitation (CLTS)
CLTS is widely and correctly recognized as a revolutionary participatory approach to
rural sanitation. The approach has been adopted and implemented for the past nine
years with a wide spread in Bangladesh, India, Indonesia, Pakistan, Ethiopia and
Kenya. Other countries that have embraced CLTS include; Zambia, Nigeria, Uganda,
Malawi, Mozambique, Tanzania to mention a few. CLTS is an innovation by Kamal
Kar who worked with the national NGO Vi|lage Education Resource Centre (VERC)
supported by an international NGO WaterAid in a small community of Rajshahi
district in Bangladesh. Kamal Kar has remained an energetic and dedicated
disseminator of CLTS around the world.
CLTS is an approach in which people in rural communities are facilitated to do their
own appraisal and analysis, come to their own conclusions, and take their own action.
They are not instructed nor taught. With CLTS in its classic form, there is a small
team of facilitators who do the pre triggering which involves community profiling of
sanitation; triggering which involves assisting communities to realize their sanitation
practices and the post triggering activities which involves assisting communities in
solving sanitation problems. The facilitators may be government, NGOs, or leaders
from their communities.
Words like target group and beneficiary have been causing communities to develop
sense of dependence, expectation, and community subordination. Communities are
teachers in their environment, and should not be taken as passive recipients. This is
thus a triggering point to take a paradigm/approach shift from seeing communities as
beneficiaries, mere participants, and passive recipients to seeing them as active
partners, as teachers, as decision-makers. We should seek their consultation; involve
them and empower them.
8 5 / 2, 1st Main, Marathi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Purpose of the inquiry
The village (Budihala, Bagalkot district) in which the study is done had no latrines
before the CLTS process was initiated. A practice such as latrine usage takes a long
time to become one’s habit. To facilitate rapid behavior change CLTS if found
effective at many places. This process was started in this village to motivate people
and change their behavior towards open defecation. Hence an attempt is made to
understand the implementation of this process at the village level and its outcomes,
and to identify the various reasons for its success or failure.
Objectives
The preliminary inquiry was carried out with the following objectives:
i.
To know the process adopted to scale up sanitation coverage and its outcome;
11.
To assess the sustainability of the outcome and identify the key issues in
promoting this process for sanitation improvement;
iii.
Based on these, to recommend suitable modifications for improving the
activities.
8 5 / 21 1st Main, Marathi N a g a r, Ba n g a lore, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
Methodology
Study Design
The study was a Preliminary Inquiry into the sanitation activities that were taken up to
improve the sanitation coverage.
Study Place
The study was conducted in a village named Budihala, Badami taluk, Bagalkot
district, it village belongs to Katharki panchayat, having a population of-1000 with
140 households. It is a partially flood affected area. The village has one primary
school and one anganwadi center. The people are predominantly agricultural laborers
and most of the families belong to below poverty line category. Majority of them
belong to Mahadiga community.
Study Participants
The inquiry was conducted by interviewing the key informants of the village and
household visits.
Interview of key informants: Data was collected through interviews of stakeholders
viz. District Sanitation Coordinator, members of Gram Panchayat and key village
informants. Interviews were conducted to inquire about the process that was carried
. i
I
out to scale-up sanitation coverage in the village.
Interviews were conducted with the district sanitation coordinator, one gram
panchayat member who is involved in the sanitation activities of the village and one
community leader of the village.
8 5 / 2, 1st Main, M a r u t h i N a g a r 9 11 a n g a I o r e, K a r it a t a k a
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Sanitation Activities at a Village under CHC Working Area
Interview of supporting agencies: The role of two private agencies in improving the
sanitation condition of the village was also explored. The two agencies which are
supporting the whole process of improving the sanitation condition at the village are;
Community Health Cell, SOCHARA, Bangalore
HeadStreams, Bagalkot
Key informants from the supporting agencies were also interviewed to understand the
1
process that is followed to improve the sanitation practices in the village.
House-to-house visits: All the households which had constructed the latrines as a
result of this process were visited and interviewed. A schedule was used to record the
usage status of latrines and the reasons for their use/non-use were inquired and
recorded.
Study Period
The preliminary inquiry was conducted during May - June 2012.
Components
The following components were considered for the inquiry:
Process: The process that was followed to scale-up the sanitation coverage at the
village was inquired from the study participants.
Outcome: The outcome of the process was measured in terms of number of latrines
built and being used regularly.
8 5/2, 1st Main, Marathi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Key Findings
CLTS Process
The CLTS process was started in June, 2010 and has been accomplished in the
campaign mode. The entire process was people-centered and demand-driven. The
primary emphasis was on community motivation and action and it did not make use of
the subsidies or any incentives to motivate the people.
Pre-triggering
This was a very important stage as it helped to identify the community needs and
fashion out an appropriate strategy. The pre-triggering stage had been devoted to
community entry and booking of dates for CLTS triggering activities. Also, the pre
triggering stage included extensive participatory data collection (community
profiling) on community level institutions, sanitation and hygiene situation and
community leadership structure and status. The participatory data collection process
helped in determining the outcome of triggering and it also helped the CLTS
facilitation team assess the status of the community in terms of the sanitation
behaviour and adapt strategies accordingly. IEC activities were initiated to spread
awareness about sanitation among the people. This was done through wall paintings
and community orientation meetings.
Triggering Stage
Great emphasis was laid on mass community presence and participation for
triggering. Sometimes triggering had to be done on weekends in order to achieve this
objective which made collective action easier. This confirms the notion that
communities make their own plans according to what they believe they can achieve
on their own.
8 5/2, 1st Main, Marathi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Tools Used
Interactions with CLTS facilitators and community members pointed to the
effectiveness of some of the tools that were used.
Rapport building with the community members to make them feel comfortable
and to gain their confidence.
> The “faeces calculation'* tool especially when it immediately followed the
Defecation Map was found very revealing by the community as members were to
appreciate the level of faecal contamination in their areas.
> The defecation area transect walk (Walk of Shame) could be adopted as a ‘must
use tool* since it succeeded in invoking the desired effect. It was the Walk of
Shame that enabled members to know the magnitude and state of open defecation
in their community. The lenses through which they assessed their community
seemed to change as they embarked on the walk of shame with “outsiders”.
> The use of some tools such as the “glass exercise” to explain the contamination of
water and the use of such water for drinking purposes greatly contributed to the
triggering process.
> The cost of illness and health expenditure due to poor sanitation was also one of
the triggering tools used to motivate them to build the toilets.
A case of successful triggering:
!
|
Ramesh (name changed) is a person affected with poliomyelitis. When asked about his
defecation practices before triggering he said “7 can ft walk. My two brothers or any two
persons have to carry me to the field for defecation. If no one is present I have to defecate
in front of my home. This is very shameful and disgusting. ”
When staff from CHC and HeadStreams approached them and motivated them to build toilet
at home, the family agreed instantly and on the very same day they arranged for the materials
and the toilet was built in no time.
After the toilet construction the family members said aWe are very happy that we have our
own toilet. Now everyone can use it anytime. Ramesh can anytime use the toilet with
minimal help. A wonderful thing has happened to us today because of CHC and
HeadStreams. We are very happy and thankful. ”
8 5/2, 1st Main, Marathi N a g a r, Bangalore, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
2012
Post-Triggering
The post-triggering stage was very important because implementation was not
automatically smooth when communities had been triggered and drawn action plans.
In cases where there was regular and concrete post-triggering support that was well
facilitated, communities drew and implemented their action plans to appreciable
levels. Various activities were taken up to sustain the new behavior, they are as
follows;
> Exposure visit: An exposure visit to Belgaum, organized by HeadStreams, was
held involving the Gram Panchayat members, staff of HeadStreams, and District
& Taluk Sanitation Coordinators. This helped in understanding of the innovative
ideas to improve overall panchayat governance and also the sanitation.
> Resource team: Resource team was formed by two staff members of the
HeadStreams located at Badami taluk. This was formed with the objective to
provide continuous technical assistance and reinforcement at local level. The
resource team was trained for 5 days in CLTS to perform its functions effectively.
> Swachata committee: A Swachata committee by HeadStreams was constituted at
the village level consisting of a school Head Master, Gram Panchayat members
and HeadStreams staff. This works at the village level to continuously improve
the sanitation status of the village.
8 5/2, 1st Main, M a r u t It i N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
2012
Role of agencies
Conun unity Health Cell, SOCHARA, Bangalore:
It is actively involved in providing support to the gram panchayat, the local network
partner (HeadStreams) and also to the community directly regularly. The main areas
of work of this organization include:
> Trainings - for community, local network partner staff
Technical Assistance - construction of toilets and maintenance
Coordination - with district and taluk officials and other concerned members
Follow-up - to ensure sustainability of the activities
HeadStreams, Bagalkot:
It is a local agency having its unit at Badami taluk. Il has its main focus on the
implementation of the activities and regular follow-up of the activities and utilization.
The main areas of work of this organization include:
Implementation - activities planned for sanitation coverage
> Follow-up - to ensure action and utilization
> Replication - in other villages based on its successes
8 5/2, /st Main, Maruthi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Stage
Activities
>
Pre-triggering
2012
Comments
Meeting with community
members to introduce CLTS
Done satisfactorily
process.
r- Walk of shame
Faeces calculation
Successful in triggering
Faecal oral routes
the community
Triggering
Cost of illness
Post-triggering
Follow up
Needs strengthening
Outcomes
The inquiry showed that the CLTS approach was definitely effective in terms of
generating shame and disgust in people. Some community members interviewed said,
“We felt ashamed of the poor hygiene status, we learned that we were eating our
faeces and got to know about how germs get into our bodies". This was, however, not
easy for them to admit at the initial stage. The tendency was for community members
to brush over the point and rush in to indicate what plans they had put in place to
rectify the situation. For communities in which people's sense of dignity did not
extend to their defecation practices, it is very reassuring to note that if CLTS is well
facilitated it can generate the required responses. At the end of the day the process is
able to get community members to admit that they were practicing Open Defecation
(OD).
8 5 / 2, I s t Main, Maruthi N a g a r, Bangalore, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
Table- 01: Community Training
No. of trainings conducted for the community
01
Total no. of houses in the village
140
No. of households attended the training
35
25% of 140
No. of households triggered & constructed latrines
32
91.4% of 35
A community training was conducted to motivate the people and educate them about
the harmful effects of open defecation. 35 members were selected for the training
I
1
including the school teachers, community leader, gram panchayat member and other
self-help group (SHG) members. They were selected purposively so as to initiate an
effective campaign against open defecation and start latrine use in the village. This
group of people was having great potential for accepting the change and motivates
other people in the village.
Table - 02: Mason Trainings
No. of Mason trainings conducted
02
No. of Masons trained
11
Once the community is triggered and ready to build latrines, it becomes very essential
to provide them with technical support so that they can construct latrines in a proper
way. Hence masons in the village and few from the neighboring villages were trained
on the technical aspects of latrine construction. This enabled the people of the village
to build latrines which are sustainable for a long time and also as per the needs of the
people. The mason training was an important step in providing the community with
technical assistance they needed.
8 5/2, 1st Main, Marathi N a g a r, Bangalore, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
Table - 03: Workshops
No. of workshops conducted
01
No. of officials attended
20
No. of community members attended
80
The workshop was conducted by HeadStreams and was presided over by the Deputy
Commissioner of the district. This was supported by the Gram Panchayat, Community
Health Cell, Bangalore, HeadStreams, Bagalkot and the district and the taluk
sanitation coordinators. This was conducted after the triggering process so that the
motivation is reinforced. The Deputy Commissioner also distributed 25 pans to the
households free-of-cost to encourage them to use the latrines and stop open
defecation.
Table - 04: Sustainability
No.
%
No. of households currently using latrines
08
25.0%
No. of households currently NOT using latrines
24
75.0%
32
100%
Usage status of latrines
Total no. of constructed latrines
Table - 05: Reasons for non-usage of latrines
SI. No.
Reasons
No.
Percent
1
Habit
9
37.5%
2
Bad odour from latrines
4
16.7%
3
No water
3
12.5%
4
Latrines are very small - Uncomfortable
2
8.3%
5
No one to maintain it
2
8.3%
6
No pits constructed in latrines
2
8.3%
7
No electricity
2
8.3%
24
100%
Total
8 5/2, 1st Main, Marathi N a g a r, Mangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
SI. No.
”T~
Table - 06: Reasons for usage of latrines
Reasons
No.
2012
Percent
Motivation & benefits of good sanitation
03
37.5%
2
Maintain privacy of women
02
25.0%
3
Easy access to latrines
02
25.0%
Person with disability living in house
01
12.5%
08
100%
Total
Key Issues
Poor participation & coordination from gram panchayat members: It was observed
that the gram panchayat members are not actively involved in the sanitation activities.
Consultations and coordination doesn't happen regularly with all the involved
agencies and community.
Lack of technical expertise: Technical assistance is not provided for all the latrines
that have been constructed in the village. Two latrines were constructed without the
pits and hence being unused.
Inadequate follow-up: After the process took place and the people started using the
latrines, follow-up was not done properly. This led to the increase in number of
people who reverted back to open defecation though latrines were constructed and
were being used initially.
Poor involvement of the community leaders: The community leaders are not actively
involved in promoting sanitation practices in the village. This has led to slow progress
of the sanitation improvement.
8 5/2, 1st Main, Marathi N a g a r, Bangalore, Karnataka
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Sanitation Activities at a Village under CHC Working Area
Failure to sustain behavior change: The people in the village were motivated
successfully and initially were using the latrines regularly. But over a period of time,
due to poor follow-up and reinforcement, the new behavior did not sustain.
APL families left out? All the families who attended the trainings and constructed the
latrines belonged to the below poverty line category. This was due to purposive
selection of households for the process implementation.
i
Subsidy by govt, - A constraint? This may be one of the reasons for excluding the
families above poverty line. Currently, cash incentive is given only to the below
poverty line families. This may act as a constraint
No RSM/PC: Currently there are no Rural Sanitary Marts (RSM)ZProduction Centers
(PC) in the district. Those which had been opened in the past had to be closed down.
Neglecting this aspect can create a big gap between the requirement and supply of
sanitation items.
Discussion
The CLTS approach involves facilitating a process to inspire and empower rural
communities to stop open defecation and to build and use latrines without offering
external subsidies to procure materials and services. It transfonns the community
perception and understanding of sanitation and builds on local practices and
innovations to provide appropriate services to meet the needs and capacity of the
population. This approach contrasts in many ways to the commonly held attitudes and
mindsets of government, donors, NGOs, and the private sector who wish to support
and promote sanitation using the more subsidy based approach of providing pre
designed systems.
8 5/2, 1st Main, Marathi N a g a r, Bangui o re, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
Improved sanitation contributes in the fonn of health, social, and economic benefits
and will be an important step in ensuring the development and welfare of rural
communities. A regular review of the program will help in identifying important
factors that need to be strengthened, modified or rectified to ensure its success.
Community-Led Total Sanitation (CLTS) is a new approach to sanitation promotion
that encourages community self-analysis of existing defecation patterns and threats,
and promotes local solutions to reduce and ultimately eliminate the practice of open
defecation. CLTS initiatives do not stress latrine construction per se, and avoid the
use of hardware subsidies. Instead, mobilization efforts focus on helping communities
and individuals'' understand the health risks of open defecation and use disgust and
shame as “triggers” to promote action, which ultimately lead to the construction and
exclusive use of locally-built low-cost household latrines. The ultimate goal of CLTS
is that communities achieve and maintain “open defecation-free” status and improved
hygiene practices.
Conclusion
CLTS is one important strategy for stopping open defecation and leads to sustainable
behavioural changes. It has significant potential to empower many people to construct
low cost latrines and therefore to improve the coverage for sanitation.
The CLTS process undertaken in Budihala since 2010 has demonstrated that it can
rapidly change perception and attitude of communities towards sanitation practices
and inspire actions to take up improved services. This has offered an opportunity for
creating the momentum needed to accelerate and sustain access to improved
sanitation across the village.
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Sanitation Activities at a Village under CHC Working Area
There are still a number of challenges in ensuring the sustainability of the community
support services necessary to maintain the sanitation improvement momentum. The
efforts to fully engage the institutional set up for sanitation improvement in the
development and application of the CLTS approach is a sure way to achieve wider
acceptance and commitment among key stakeholders.
Recommendations
Develop team effort: During the campaign, the community and the governmental and
other agencies must work as partners. The government staff and officers must take the
initiative, and participate in IEC activities. Emphasis must be given to develop a sense
of team work for improving the sanitation condition of the village. All the members of
the community, gram panchayat, local leaders, and supporting organizations must
work together for the purpose.
Encourage women participation: Women play important roles as beneficiaries,
targets, and resources during the campaign. Women must be encouraged to perform
various roles as fund raisers, motivators, initiators, surveillance workers, and
implementers. Women participation and leadership through SHGs, gram panchayat
membership, as well as teachers play an important role in improving the sanitation
i
'
condition.
Reinforce behavior change: There must be constant follow-up in the village to ensure
sustainability and reinforce the new behavior and make it a habit. This must be done
collectively by all the members of the team and the responsibility to ensure follow-up
activities must be entrusted to one particular agency.
8 5 / 2, 1st Main, Marathi N a g a r, Bangalore, K a r n a t a k a
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Sanitation Activities at a Village under CHC Working Area
Provide technical assistance: Technical advice is essential during the construction of
the toilets and
Regular monitoring & follow-up: A mechanism for regular follow-up and continuous
reinforcement of behavior change must be developed so as to maintain sustainability.
Establish RSM/PC: Efforts must be made to establish rural sanitary marts (RSM) and
production centers (PC) to ensure sanitary rpaterials at reasonable cost. I
Acknowledgements
I am grateful to Dr. Ravi Narayan and Dr. Thelma Narayan, SOCHARA,
Bangalore, for providing me such an excellent opportunity to work with their team.
I express my profound gratitude and sincere thanks with esteemed reverence to my
guides Mr. A. S. Mohammad, Coordinator, Community Health Cell, and Mr. I. M.
Prahlad, Training & Research Assistant, Community Health Cell, for their invaluable
guidance, constant support, encouragement, and words of inspiration during the study.
I feel extremely fortunate to have been worked under their esteemed guidance.
It gives me immense pleasure to express my deep sense of gratitude and heartfelt
thanks to the whole team of SOCHARA for their valuable guidance and motivation
throughout the study.
I extend my heartfelt thanks to the staff of HeadStreams, Bagalkot, District Sanitation
Coordinator, Bagalkot and the community members of the village for their
cooperation, support and help in carrying out the study.
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Sanitation Activities at a Village under CHC Working Area
Further Reading
1. Cairncross S. Sanitation in the developing world: Current status and future
solutions. Int J Environ Health Res 2003; 13:S 123.31.
2. Curtis V. Talking dirty: How to save a million lives. Int J Environ Health Res
2003;13:S73.9.
3. Registrar General and Census Commissioner, Government of India, Census 2011.
Available from: http://www.censusindia.gov.in
4. Making sanitation work. Jal Manthan Water and Sanitation Programme 2002:5.
5. Department of Drinking Water Supply. Ministry of Rural Development,
Government of India. Guidelines ofTSC. Central Rural Sanitation Programme 2004.
6. Sanan D, Moulik S. Community-Led Total Sanitation in Rural Areas. An
Approach that works. Water and Sanitation Programme 2007:6-8.
7. Ismail (). Tripathy L. Patjoshi P. Women's participation in TSC-The Orissa
experience,. UNICEF, India: Colombo, Sri Lanka: 32nd WEDC International
Conference 2006.
8. Scaling-Up Rural Sanitation in South Asia: Lessons Learned from Bangladesh,
India, and Pakistan. Water and Sanitation Programme 2005.
9. Rajiv Gandhi National Drinking Water Mission. Mid-term Evaluation of Total
Sanitation Campaign Programme. DDWS, Ministry of Rural Development,
Government of India. 2005:23:187-200.
10. Rural Sanitary Marts and Production Centres-An evaluation. Water, Environment
and Sanitation Section. New Delhi, India: UNICEF 2004:3 .7.
1 1. Kar K, Pasteur K. IDS Working Paper 257. Subsidy or self-respect? Community
led total sanitation. An update on recent developments. England: Institute of
Development Studies 2005:4.5.
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