Policy & Practice Review: Gender & WASH in the Urban Context

Policy & Practice review: Gender & waSH in the Urban context Health of the Urban Poor Program Prepared by Health of the Urban Poor (HUP) Program Population Foundation of India B-28, Qutub Institutional Area, New Delhi – 110016 author Padmaja Nair, Consultant, HUP CEDPA, India Shipra Saxena, Sr. Water Supply and Sanitation Specialist PFI HUP Biraja Kabi Satapathy, Water Supply and Sanitation Specialist PFI HUP Madhu Joshi, Senior Advisor, Gender and Governance CEDPA, India Special inputs Dr. Sanjay Pandey, Program Director, PFI Dr. Aparajita Gogoi, Country Director, CEDPD, India Dr. Sainath Banerjee, Chief of Party PFI HUP Mandira Kalra Kalaan, Sr. Manager Advocacy & Communication PFI Dr. Abhijit Prabhughate, Director Knowledge Management and Research PFI HUP Dr. Sharmila Ghosh Neogi, USAID Anand Rudra, USAID edited by Shree Venkatram, Consultant PFI Peer reviewed By: Kuntala Lahiri-Dutt, Senior Fellow, Water Resource Management in Asia Paciic Program, Canberra, ANU Dr. Aditya Bastola, PhD from Women’s Studies Department at Pune University Renu Khosla, Director at Center for Urban and Regional Excellence (CURE) Dr. Anjal Prakash, Executive Director at SaciWATERs Depinder Kapur, India Wash Forum, New Delhi Gouri Choudhury, President Action India Photographs HUP Cover photo: Marye Van Der Heida, 2013 Published September 2013 copyright: The contents of this publication may be used freely for not-for-proit purposes, provided the users duly acknowledge the Publishers. However, anyone intending to use the contents for commercial purposes must obtain prior permission from the publishers. Policy & Practice review: Gender & waSH in the Urban context PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM d Message Gender mainstreaming in various policies and programs underlines the concerns and perspectives of both women and men in development program designing. Historically, there exist wide gender gaps in development programs that have tilted adversely against women. The process of gender mainstreaming, therefore, provides an opportunity to give special attention to women’s concerns while simultaneously addressing men’s issues. This is even more relevant in the case of water and sanitation programs, as the concept of dignity and health of women is associated with access to sanitation and water facilities and other related issues in day--to-day life. In this regard, the study on “Gender and WASH”, carried out jointly by Population Foundation of India (PFI) and the Centre for Development and Population Activities (CEDPA) India, is signiicant. It is with great pleasure that I present this study report, “Policy and Practice Review: Gender and Water, Sanitation and & Hygiene (WASH) in the Urban Context” under USAID’s Health for Urban Poor (HUP) Program, published by PFI. Research for the study involved desk reviews, consultations, and individual meetings with government oicials, development professionals, functionaries of civil society organizations, community-based organizations and the community from the slums. This report attempts to incorporate the views and feedback of all key stakeholders mentioned above. It provides insights into the present status of WASH from a gendered perspective in an urban context. Concrete suggestions on key policy, strategy and practices on improved WASH are outlined. I sincerely hope that this report will be of use to government oicials, urban local bodies (ULBs), development partners, professionals of urban health and WASH, program implementing agencies, researchers and civil society actors in understanding urban gender issues within water and sanitation programs. I also hope it will help them design and implement WASH programs keeping in mind the concerns, needs, and participation of both women and men. I congratulate and thank CEDPA India for a excellent report. Poonam Mutreja Executive Director, PFI Foreword CEDPA India’s mission is to empower women in all sectors of development with the belief that achieving gender equality is essential for development, democracy, and global progress. CEDPA India works in partnership with government, local non-governmental organizations (NGos) and communities to design and implement programs in three areas: gender and governance, youth education and development, and maternal/reproductive health. As a technical partner in the Health of the Urban Poor (HUP) initiative, CEDPA India’s contribution has been to provide technical assistance under the thematic areas of public-private partnerships (PPPs), gender mainstreaming, and nutrition and water, sanitation and hygiene (WASH) in the context of urban health. With over 300 million people, cities and towns in India constitute the second largest urban system in the world. As per the 2011 Census, for the irst time since Independence, the absolute increase in population is more in urban areas than in rural areas. While on the one hand, cities are perceived as the engines of the country’s economic growth; on the lip side, the escalating population igures present serious challenges to governance, eicient delivery of services, and social inclusion in urban centers of the country. An important feature of urban life is the condition of women in towns and cities; it is a condition marked by historical and multiple marginalization. Although women are not the only group whose activities in public spaces are constrained or who are conined to the private world of the home, this should not obscure the fact that the "gendered city" is still an aspiration and not yet a reality. It is in this context that CEDPA India undertook this policy and practice review under the HUP project, with the primary objective of analyzing existing policy, schemes and practices relating to WASH in urban locations in India and recommending ways to address gender policy gaps and implementation models of gender mainstreaming. This is a critical component of the HUP as it focuses on the central concern of women and girls who, with the increasing feminization of poverty, constitute the majority of the urban poor. often it is assumed that development interventions (especially those relating to power, infrastructure, WASH, etc.) will automatically beneit women and relect their priorities and gender analysis of these issues are not undertaken. Women are most afected by lack of sanitation and clean, safe sources of water, as it not only impacts their health but also their security and livelihoods. Any pro poor urban water and sanitation governance can only be successful if it addresses the concerns of half the population, namely, women and girls, and ensures their efective participation in governance. Therefore, it is critical to build skills and understanding of gender issues and their linkages with WASH, demonstrated through gender-sensitive indicators, gender disaggregated data, and eforts to make gender issues visible. This study report recommends a series of closely linked long-term and short-term interventions to correct the anomalies and gaps in the urban WASH sector with respect to adoption of a gendered approach. In the long term, the focus should be on improving the institutional structure and capacities and the program planning and management processes to ensure a gender-integrated approach with a targeted focus on women. Dr. Aparajita Gogoi Executive Director CEDPA India CONTENTS List of Tables, Figures and Boxes Executive Summary 1 1. 5 2. 3. 4. 5. 6. 7. BACKGRoUND 1.1 About the Health of the Urban Poor Program 1.2 Using a Gender Lens on WASH 1.3 Structure of the Report SCoPE AND METHoDoLoGy oF THE STUDy 2.1 Scope of the Study 2.2 Methodology and Framework 2.3 Study Sites 7 CoNCEPTS, TRENDS, AND DISCoURSE IN THE GLoBAL CoNTExT 3.1 Urbanization and Trends 3.2 WASH: Water, Sanitation, and Hygiene 3.3 The Gender Perspective on Urban WASH THE GENDERED FACE oF URBANIZATIoN IN INDIA 4.1 Pattern of Urbanization 4.2 Status of Women in Urban Areas THE GENDERED FACE oF WATER AND SANITATIoN IN URBAN INDIA 5.1 Status of WASH in Cities 5.2 Impact of Poor Water and Sanitation on Women in Urban Areas HoW HAVE PoLICIES AND PRoGRAMS ADDRESSED GENDER ISSUES IN URBAN WASH 6.1 The Institutions that Shape the Policies and Program 6.2 The Policies and Program 6.3 How International and Bilateral Agencies, International and Local NGos Address WASH and Gender 6.4 Is “Gender” an Explicit and Strategized Theme in Policies and Practice? EMERGING ISSUES AND SUGGESTIoNS 7.1 Emerging Issues 7.2 Suggestions 7.3 Suggestions for the Immediate and Short Run Bibliography 9 17 23 29 55 65 iii PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM List of Abbreviations PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM tables 3.1 Gender and MDG Targets 14 4.1 Urbanization Trends 17 4.2 Selected Demographic Indicators 18 4.3 Sex Ratio in the Rural and Urban Areas 20 5.1 Status of Drinking Water Supply in Urban Areas of Selected States (% Population Covered) 23 5.2 No Toilets and open Defecation (%) 24 6.1 Framework for Performance Indicators 33 6.2 Indicators for Rating Cities 35 Figures 2.1 Data Extraction Framework 8 Boxes 6.1 National School Sanitation Initiative: Parameters for Selection 37 6.2 Malgodown-Behera Sahi Where Men and Women Worked Together to Bring About a Change in Health and Hygiene 38 6.3 Total Sanitation in Tiruchirapalli Where Women Lead and Men Followed 44 6.4 “Baandhani” and Their Eforts to Improve Sanitation in Pune and Sangli 46 6.5 How Women Pavement Dwellers in Mumbai Constructed Toilets to Suit their Needs 48 6.6 Protecting Livelihoods of Women Waste Pickers: Kagad Kach Patra Kashtkari Panchayat 50 6.7 The Essence of the Eleventh Plan Strategy for Women Agency and Child Rights 53 iv ABBREVIATIONS Asian Development Bank Accelerated Urban Water Supply Program Basic Services for the Urban Poor Basti Unnayan Paridad Community-based organization City Development Plan Community Development Society Convention to Eliminate all Forms of Discriminations Against Women Centre for Development and Population Activities Council on Energy, Environment and Water Confederation of Indian Industries Cuttack Municipal Corporation City Sanitation Plan City Sanitation Task Force Disability Adjusted Life year Department of International Development Environmental Improvement of Urban Slums Five year Plan Gender and Development Gross Domestic Product Deutsche Gesellschaft fur Internationale Zusammenarbeit Government of India High Powered Empowered Committee Health of the Urban Poor Integrated Housing and Slum Development Program Indian Institute of Health Management and Research International Institute for Population Sciences Integrated Low Cost Sanitation Scheme International Nongovernmental organizations Joint Management Program Jawaharlal Nehru National Urban Renewal Mission Kagad Kach Patra Kashtkari Panchayat Labor Force Participation Rate Millennium Development Goals Mission for Eradication of Poverty in Municipal Areas Mahila Housing Trust- Self Help Women’s Association Ministry of Housing and Urban Poverty Alleviation PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM ADB AUWSP BSUP BUP CBo CDP CDS CEDAW CEDPA CEEW CII CMC CSP CSTF DALy DFID EIUS FyP GAD GDP GIZ GoI HPEC HUP IHSDP IIHMR IIPS ILCS INGo JMP JNNURM KKPKP LFPR MDGs MEPMA MHT-SEWA MoHUPA v PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM MoUD MP MSW NCU NFHS NGo NHG NHP NMEW NRHM NSSI NUHM NUSP NWP PFI PHED PMC PPP RAy RWA SACoSAN SHE SHGs SJSRy SLBM SPARC SSA SSS SWaCH TCC UBS UBSP UIDSSMT ULB UNDP UNICEF USAID WASH WAVE WHo WID WSHG WSP vi Ministry of Urban Development Madhya Pradesh Municipal Solid Waste National Commission on Urbanisation National Family Health Survey Nongovernmental organization Neighborhood Groups National Housing Policy National Mission for Empowerment of Women National Rural Health Mission National School Sanitation Initiative National Urban Health Mission National Urban Sanitation Policy National Water Policy Population Foundation of India Public Health Engineering Departments Pune Municipal Corporation Public Private Partnership Rajiv Awas yojana Resident Welfare Association South Asian Conference on Sanitation Sanitation and Hygiene Education Self-Help Groups Swaran Jayanti Sahari Rozgar yojana Service Level Bench Mark Society for the Promotion of Area Resource Centres Sarva Shiksha Abiyan State Sanitation Strategy Solid Waste Collection and Handling Tiruchirapalli City Corporation Urban Basic Services Urban Basic Services for the Poor Urban Infrastructure Development Schemes for Small & Medium Towns Urban Local Body United Nations Development Programme United Nations International Children’s Emergency Fund United States Agency for International Development Water, Sanitation and Hygiene Women Action for Village Empowerment World Health organization Women-in-Development Women Self-Help Group Water and Sanitation Program 1. Between August and November 2012, the Centre for Development and Population Activities (CEDPA) India commissioned a study to review the gender context of the existing policies and practices in urban Water, Sanitation and Hygiene (WASH) in India. The study was part of the Health of the Urban Poor (HUP) program being led by the Population Foundation of India (PFI) and a consortium of partners, including CEDPA India, and supported by the United States Agency for International Development (USAID). 2. HUP is targeting improvements in the health status of the urban poor by adopting efective, eicient and sustainable strategic intervention approaches, and the principle of convergence for various development programs. WASH is being addressed as a determinant of health under HUP. Gender mainstreaming within WASH and other components is being attempted because HUP believes that the need for WASH services as well as the impact of poor quality services on men and women is diferent and to the advantage of men than women. 3. The study examined the overall urban context, the impact of poor and inadequate WASH services on women in the urban areas and the policy and program response of the state and non-state agencies. 4. The study was undertaken through extensive review of existing reports and publications on gender and WASH; scanning of policies, programs and schemes related to urban WASH; consultation, interviews and ield visits with a range of stakeholders including policy makers, program managers, sector experts and civil society organizations. 5. Summary of the issues and recommendations from the study as follows: 1 i. The study observed that availability and access to safe water and sanitation is limited for the urban poor. Data indicates that over 25 percent of the urban population in India does not have access to tap water supply1 and over 50 million people defecate in the open in a day (HPEC 2011). The economic impact of inadequate sanitation is large and amounts to 2.6 percent of the gross domestic product (GDP) of the country and the cost per Disability Adjusted Life year (DALy) per person due to poor sanitation is Rs 5,400 and due to poor hygiene it is Rs 900. The impact on the poorest 20 percent of households is the highest and the coping mechanism adopted by such households is obviously time-consuming, costly and, at times, also unsafe with most of the burden of management falling on the women and girl children. ii. The impact of poor water and sanitation on women and girl children is well documented and includes a range of vulnerabilities: time and opportunity cost for work lost because of the additional time spent in collecting water; susceptibility to waterborne diseases and diseases due to unhygienic conditions afecting health and subsequently livelihood and income; conlicts around the water points for space and priorities; physical and sexual harassment while collecting water from tankers; sexual harassment at the community toilet complexes; the indignity of open defecation because of lack of or inadequate sanitation facilities; the loss of dignity and embarrassment while disposing of www.censusindia.gov.in/2011census 1 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM EXECUTIVE SUMMARY PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM menstrual waste; poor designs and poor maintenance of infrastructure raising both safety and health issues. Besides, culture and societal norms across the world dictate that a female accord greater privacy for bathing, defecating and managing menstrual hygiene. iii. Both the state and civil society organizations have been attempting to respond to this situation. However, while some good practices have emerged, by and large policies and programs have remained “gender blind”. And the concept of “gender” is conspicuously absent in the limited policy and plan documents on urban water and sanitation that have evolved over the years. The key observations of this study are: 2 • In urban areas women fare worse then men on most fronts: they have greater diiculties in accessing resources and in making decisions to ensure that water and sanitation facilities and services are tailored to meet their needs; and they are more vulnerable to evictions because of an uncertain tenure. Women living in unrecognized and unapproved slums or settlements who have the primary responsibility of ensuring these services for their families have greater issues of access to WASH facilities. And those living on the streets, railway platforms, foot paths etc are more vulnerable than women living in the slums. Women are exposed to greater risks and vulnerabilities on all fronts in the urban areas, with vulnerability to violence of all kinds cutting across all dimensions. • Establishing a gender perspective within the urban water and sanitation sector would require an analysis and understanding of the concepts of urbanization, poverty, and slums; of the dynamics of service delivery and the location of gender itself in a contextual framework. Any intervention to improve services to the poor also needs to take into account that they are not a homogeneous category or conined to slums alone. • The tendency to focus on facilities instead of improved services, perhaps excludes possibilities of assessing and understanding the service needs of various sections of the community in terms • Community participation has been advocated by the state for efective and eicient implementation and planning and encouraging ownership and better maintenance and upkeep of facilities. In reality, however, the state has not elaborated on the deinitions or provided guidelines for community participation and inclusion in line with policy statements and the needs of the project objectives and cycle. The study concludes that the WASH sector does not have an overall cohesive policy or strategy and hence gender equity and inclusion are mere concepts that have been introduced into the sector with no commensurate and efective action plan. • On the other hand, most successful cases of community participation in the urban water and sanitation sector have centered around women’s groups that are either especially constituted for the purpose or entrusted with the responsibility as part of the overall empowerment of women. However, the study cautions that in such an approach the burden on women tends to increase in terms of participation in planning and management during the process of implementation and perhaps, also in maintenance activities. • Finally, because of the conspicuous lack of a hygiene promotion strategy that addresses the behavior change of the various groups in the community, WASH interventions will not only remain as a mere provision of facilities but will also fail to recognize and address the diferent needs and practices of men and women and of boys and girls. The lack of a perspective hence limits the scope of addressing critical issues like menstrual hygiene and hand washing to isolated projects. iv. The study hence recommends a series of tightly linked long-term and short-term interventions to correct the anomalies and gaps in the urban WASH sector with respect to adoption of a gender approach. In the long term, the focus should be on improving the institutional structure and capacities and the program planning and management processes to ensure a gender-integrated approach with a targeted focus on women. More speciically: • The deinition of “gender” in the context of urban WASH needs to be established. In order to operationalize the concept, an exhaustive checklist to ensure gender mainstreaming from the policy level through the program and project cycle in urban WASH needs to be developed and adopted by all stakeholders across the sector. Gender needs to be looked at from both the men’s and women’s perspective. • An integrated urban WASH policy and strategy needs to be developed at the national level together with state-level policies. The policy should include all the sub-sectors—water, sanitation, solid and liquid waste management—with hygiene and health as immediate areas of impact. The policy will need to be followed with the development of a clear strategy and detailed operational guidelines that may then be adapted by the state, in line with state policies. The policy and guidelines need to be developed on the basis of a series of research inputs, including formative research on WASH-related perceptions and the practices of various socioeconomic groups with data disaggregated by gender and age. • Further, integrated projects developed within the water and sanitation sector should identify the objectives and activities within a logically sequenced project cycle and within each cycle assess 3 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM of class, caste, occupations and, most importantly, gender. However, given the infrastructure and management orientation of the policies and programs, the agencies themselves are not structured to address issues of inclusion and gender. Hence, there is little scope for delivering services tailored to meet the aspirations, needs and demands of the diferent segments of the community, or with a gender perspective. and plan for mainstreaming gender. A WASH database disaggregated by sex, age, and other social groups should be created as baseline and for monitoring progress and impact. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM • 6. All stakeholders and agencies in the sector at the state and urban local body (ULB) levels should be assisted to develop a conceptual understanding of inclusion and gender mainstreaming in an urban WASH program. Also, capacities of ULBs and sector agencies should be developed to design, plan and implement an inclusive project which also has gender focus. In fact, all projects and schemes need to converge at the ULB and the capacities of the ULBs built, in terms of both manpower and training, so as to enable them to efectively address gender issues. Further, the ULBs need to be assisted in preparing annual budgets focusing on planning a pro-poor budget head and integrating the WASH component. In the short run, the immediate activities need to focus on a review of key sector documents like City Development Plans (CDPs), State Urban Sanitation Strategy (SUSS), City Sanitation Plans (CSPs), Five year Plans (FyPs) and program documents to assess if they are gender inclusive, identify gaps and then recommend inputs to strengthen them. Attempts should also be made to efect improvements in the existing Service Level Bench Mark and the City Sanitation Rating Index to relect levels of gender integration achieved. When gender and social inclusion indicators become part of the rating systems, there will be more chances of interventions being designed accordingly. Further, based on the guidelines of the National Strategy for Urban Poor Project (NSUP), the states may be encouraged and facilitated to develop a communication strategy to promote sanitation and hygiene in the urban areas. The strategy should target both men and women and focus on key risk practices. It needs be implemented in a campaign mode. 4 1. BACKGROUND 1.1.1 The Health of the Urban Poor is a USAID-supported program, managed and implemented by the PFI and a consortium of partners, including Plan-India and the Indian Institute of Health Management Research (IIHMR), Jaipur, as sub-recipient, Micro Insurance Academy, International Institute for Population Sciences (IIPS), Bhorukha Charitable Trust and CEDPA India as technical partners. It is being implemented in eight states— Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan, odisha, Bihar, Uttarakhand and Chhattisgarh. Besides, ive cities—Pune, Bhubaneswar, Jaipur, Delhi, and Agra—have also been taken up to develop demonstration projects. 1.1.2 The goal of HUP is to improve the health status of the urban poor by adopting efective, eicient, and sustainable strategic intervention approaches, and the principle of convergence for various development programs. It, therefore, aims to support the Government of India and the selected states to improve the delivery and utilization of maternal, child health, and nutrition services, including the promotion of water supply, sanitation and hygiene promotion to urban poor communities. HUP does this through technical assistance to national, state, and local governments and other agencies as well as other USAID-supported agencies, donors, and development partners working on urban health issues. The speciic objectives of HUP are to: i. Provide quality technical assistance to the Government of India and the selected states and cities for efective implementation of the proposed National Urban Health Mission (NUHM) and the urban health components of the National Rural Health Mission (NRHM). ii. Expand partnerships in urban health, including engaging the commercial sector in Public Private Partnership (PPP) activities. iii. Promote the convergence of diferent Government of India urban health and development eforts. iv. Strengthen the evidence-based rigor of city-level demonstration and learning eforts. 1.1.3 The project, hence, primarily: • Aims at improving the health status of the urban poor by strengthening the eforts of the ULBs and civil society organizations by providing technical assistance • Stresses on sustainability aspects and improved health outcomes • Addresses the health care needs in a “mission” mode • Emphasizes institutional convergence of various programs and schemes • Addresses WASH as an integral part, and a determinant of, health 5 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 1.1 about the Health of the Urban Poor Program 1.2 Using a Gender lens on waSH PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 1.2.1 Water, sanitation and hygiene (WASH) is being addressed as a determinant of health under HUP. While there is no provision for hardware within the project, HUP, through awareness generation, capacity building and advocacy, attempts to ensure that both the community and the state understand and respond to WASH as contributing toward the improved health status of the community. The design of the WASH interventions in HUP is inluenced by the fact that poor WASH services are responsible for a signiicant percentage of illnesses. These are now being delivered primarily through hygiene promotion activities at the community level and through advocacy for the same with the states and local agencies. 1.2.2 Gender mainstreaming within WASH and other components is being attempted because the HUP program believes that the need for WASH services as well as the impact of poor quality of WASH services on women and men is diferent and is to the disadvantage of women. Hence, it is necessary to design, plan, and implement WASH interventions with a gender perspective. CEDPA India, HUP’s technical partner in the consortium, is providing gender inputs and, as part of its initiative to take the agenda forward, commissioned a study in August 2012 to review the existing WASH policies and programs in the urban areas through a gender lens. The aim was to primarily document the extent and nature of gender integration, if any, within programs and practices and the impact therein. 1.3 Structure of the report The report is organized into seven sections: Sections 1 and 2 provide the background to the study; Section 3 deines the concepts of water, sanitation, hygiene, and gender in the urban context and in relation to each other, and also relects on the current global discourse in the sector; Section 4 provides a broad, national-level view of the status of urbanization in India and the impact on women in urban areas; Section 5 focuses on the status of WASH in urban areas in the context of coverage, access, and challenges, and the consequent impact on women; Section 6 reviews existing policies and programs in the sector and the gender component within each; and Section 7 provides the conclusions from the study and recommendations. 6 2. SCOPE AND METHODOLOGY OF THE STUDY 2.1.1 The study focuses on a gender review of existing policies and selected schemes at both national and state levels with respect to WASH and aims at proposing guidelines and recommendations for gender mainstreaming in the sector. This is expected to feed into advocacy opportunities at the national and state levels in the context of NUHM, Jawaharlal Nehru National Urban Renewal Mission (JNNURM) Phase II and the Twelfth Five year Plan. 2.1.2 The primary objective of this review is to analyze existing policies, schemes and practices relating to WASH in urban locations in India and recommend ways to address gender policy gaps and implementation models of gender mainstreaming. The rationale behind the study is the belief that gender analysis of projects are not undertaken because it is assumed development interventions will automatically beneit women and relect their priorities. on the other hand, there is evidence that any pro-poor urban water and sanitation governance can only be successful if it addresses the concerns of half the population, namely, women and girls, and ensures their efective participation in its design and implementation. It is therefore critical to build skills and understanding of gender issues and their linkages with WASH at the policy making and service delivery levels that are demonstrated through gender-sensitive indicators, gender disaggregated data and strategies to make gender issues visible. 2.1.3 The objectives and scope of the study are to: • Compile and document strategic information on existing policies and schemes on WASH in India and analyze the gender gap therein • Review and compile information of successful/efective interventions/good practices on gender integration in WASH by states and civil society organizations • Make policy recommendations for gender mainstreaming in WASH within NUHM, JNNURM II and other relevant programs • Make speciic scheme-related recommendations for gender mainstreaming in WASH 2.2 Methodology and Framework 2.2.1 The methodology adopted for the study was based primarily on an extensive review of documents and discussions with key stakeholders from government, civil society organizations and community, which in turn is based on the data extraction framework as indicated in Figure 2.1. 2.2.2 The extraction framework was designed to ensure that WASH in urban areas was looked at from both perspectives – as an inclusive service and from a gender mainstreaming one. It was assumed that while both the approaches overlap, it would ensure that gender as a crosscutting issue across diferent forms of exclusion, including caste and class, was addressed. 7 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 2.1 Scope of the Study FiGUre 2:1 DATA ExTRACTIoN FRAMEWoRK National PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Sector Proile & Status: Gender Perspectives & implications • Urban WASH—Concept, Deinition, Components • Urbanization, Slums, Infrastructure • Coverage and Access • Policies and Programs • Commitments, Voices • Approaches and Strategies • Inclusion and Rights • Community-based Strategies • PPP • Technologies • Governance, Institutions and Capacities • Resources (Funds and Budgets) State ULB Gender and waSH • From WID to GAD: Concepts & Implications • Proile of the Constituency: Social/ Cultural/ Political / Economic/occupations • Indicators of Women’s Involvement & Impact Practical issues • Use and Access • Workload and Convenience • Funds and Resources • Privacy/Violence/Safety • Health: Self and Family • Livelihood Emerging Issues RECoMMENDATIoNS Global Strategic • Participation • Empowerment – Social – Political – Economic (including opportunity Cost) Case Studies/ Best Practices Note: GAD: Gender and Development; WID: Women-in-Development. 2.3 Study Sites While much of the focus was on the review and analysis of documents, site visits to selected HUP states and demonstration cities were also undertaken to understand PFI HUP’s strategy and possibilities for mainstreaming gender in WASH within this framework. The site visits were made to Bhubaneswar and Pune. Brief discussions were also held with the HUP (PFI) team in Uttar Pradesh. Visits were also made to Hyderabad and Mumbai, which were non-HUP sites, in order to generate lessons from work done there under other programs. The site visits included discussions with the HUP team, state and ULB-level oicials, a range of civil society and community-based organizations as well as visits to slums and interactions with the community. 8 3.1 Urbanization and trends 3.1.1 over the last four decades, the world has witnessed unprecedented growth in urban population. From the mid-1970s, the balance of distribution of population between the rural and urban began to tilt in favor of the latter and today over 50 percent of the world’s people are reported to be living in cities and towns2. By 2050, the urban population is predicted to rise even further to 70 percent. 3.1.2 The levels of urbanization across various development groups has, however, been uneven with the less developed regions showing lower levels of urbanization than the more developed areas. It is, however, expected that in the years to come most of the growth in urban population would take place in the developing regions. Ironically, despite the lower levels of urbanization, Asia is even today reportedly home to almost half of the urban population in the world. Recent studies (UN-DESA 2012; UN Habitat 2009) indicate that not only is the urban population concentrated in a few countries, with China, India and the United States accounting for 37 percent of the population, but the growth in the coming decades is also predicted to be greater in few countries, with China and India together accounting for one-third of the projected growth.3 3.1.3 What, then, is an “urban” area? It is generally deined in terms of place-based characteristics and as a complex function of population size and density, of social and economic organizations and activities, and of transformation of the natural environment into a built environment (Weeks 2010). “Urbanization” itself is, on the other hand, the process of increase in the proportion of people living in urban areas, occurring as a result of the combined efects of a natural growth in urban population and migration from rural to urban areas. 3.1.4 It is now widely recognized that urbanization is a powerful process that is diicult to reverse. While it brings in economies of scale and eiciencies, it also leads to overcrowding, unsanitary conditions, environmental degradation, social and economic exclusions and vulnerabilities, denial of entitlements and associated conlicts and violence. It has also been observed that in developing countries, urbanization often occurs hand in hand with a rise in urban poverty—in terms of both scale and intensity. The impact of urban poverty is manifold and severe: inadequate and increasing backlogs in the delivery of basic services; increasingly poor status of adequate shelter and insecurity of tenure; increasing vulnerability to environmental health problems; intra-city inequalities and vulnerability, especially of the marginalized social classes and women, children and youth; lack of participation of communities; and a lack of political will (Mehta 2000). 3.1.5 “Slums” are the visible physical manifestation of poverty and inequalities in the cities. A slum itself is generally deined as an area that lacks adequate housing and basic services, including access to safe water and sanitation, and secure tenure is often a precondition to access adequate housing and services. “Shelter deprivation” is hence the overarching characteristic that deines a slum. A UN Habitat report (UN Habitat 2006) 2 2008 is considered to be the landmark year when the urban population equaled that of the rural population. The urban population is projected to grow by 1.4 billion between 2011 and 2030, out of which China is expected to account for 276 million and India for 218 million people. Beyond 2030, India is expected to be the major contributor, although China (1 billion) will continue to have the largest number of people living in urban areas followed by India (0.9 billion) by 2050. 3 9 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 3. CONCEPTS, TRENDS, AND DISCOURSE IN THE GLOBAL CONTEXT PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM observes that globally one in every three city dwellers lives in a slum, accounting for nearly one billion slum dwellers in 2005. The report also states that more than 90 percent of these slum dwellers are located in the developing countries of the world. In absolute numbers, Asia has the highest share of slum dwellers, and again, most of them (63 percent) live in India. Studies also indicate that women-headed households sufer disproportionately more from inadequate housing in slums and poor settlements (UN Habitat 2008). 3.2 waSH: water, Sanitation, and Hygiene 3.2.1 “WASH” is the popular acronym for the organically-related triumvirate of safe water, sanitation, and hygiene. It is a complex component that broadly consists of safe water use, collection, treatment, and disposal of human waste, including solid and liquid domestic waste, all of which require the adoption of minimum standards of hygiene, apart from access to appropriate facilities. The purpose of appropriate and adequate WASH is to reduce risks to human health by managing factors in the environment that lead to health and related problems. Hence, managing WASH falls within the realms of “Public Health”. 3.2.2 The Millennium Development Goals (MDG) has set a target (Target 10) to halve by 2015 the proportion of people without access to safe drinking water and sanitation. Achieving Target 10 is expected to have a snowball efect on other targets as well. It is expected to contribute to the following: reduction of child mortality (Target 10); decrease in the incidence of infectious diseases (Target 8); improvement of maternal health (Target 6); improvement in the quality of life of the slum population (Target 11); and gender equality and empowerment of women (Target 3). Eventually, Target 10 would contribute to poverty reduction (Target 1) and reduction of hunger (Target 2). 3.2.3 The Joint Monitoring Program (JMP) Report (2012) of WHo-UNICEF observes that while the MDG target for safe water supply has been achieved, it is unlikely that the sanitation target will be reached by 2015. Lack of political priority for sanitation and hygiene with commensurate fund allocations, lack of awareness about the enormity of the sanitation crisis, lack of demand in the communities, and weak capacities of local 10 3.2.4 Solid waste management is another grossly neglected aspect of WASH and rapidly reaching critical stage in many cities. Municipal Solid Waste (MSW) generation in 2010 at the global level was estimated to be about 1.3 billion ton a year and expected to rise to 2.2 billion ton by 2025. However, there are obvious variations by region and cities and even within cities. MSW generation is inluenced by the level of economic development, industrialization, the environment and local climate, and the culture and habits of communities. Appropriate and adequate methods, technology and equipment, inancial resources, willingness of communities to pay, waste disposal sites, etc., are some of the key diiculties faced in the management of urban waste. 3.2.5 Underlying the provision and access to facilities is another critical issue—that of adoption of hygienic habits and practices. Experience indicates that facilities alone are not suicient to ensure the full beneit of safe water and sanitation. Hygienic practices, inluenced by long-standing traditions and cultures, need to be promoted in a planned way. The key practices that are being widely advocated currently are hand washing at critical times, safe disposal of child feces, safe handling of drinking water, and menstrual hygiene management. 3.2.6 Moreover, inequities appear to be the order of the day in the urban WASH sector across the globe. The JMP Report indicates sharp variations in access to piped water supply between the poorest and the richest segments of the population. An analysis of the same region also reveals that women and girls bear the burden of collection of water: in 71 percent of all households without water on the premises, women and girls are mainly responsible for collection while only in 29 percent of households do men and boys undertake this task. While women are reported to spend a combined 16 million hours each day collecting drinking water, men spend only 6 million hours. Thus, the poor, and women and children amongst the poor, appear to be the most burdened by the lack of adequate water and sanitation facilities. Its linkages with health, education of the girl child and the environment are also well established. WHo reports that poor sanitation and lack of safe water causes 1.4 million child deaths by diarrhoea every year and 2.5 million lives would be saved by achieving the MDG targets by 2015. 3.2.7 Lack of political will, institutional capacities, land and tenurial issues and lack of engagement of communities are often stated as reasons for the poor status of WASH in urban areas. In order to address these issues, in 2010, the UN General Assembly declared water and sanitation as a human right essential to the full enjoyment of life and all other human rights. It conirmed that right to water and sanitation is derived from the right to the highest attainable standards of physical and mental health as well as the right to human life and dignity. Hence, by implication, the right to water and sanitation is also governed by the principles of availability, safety, acceptability, accessibility, afordability, participation, non-discrimination, and accountability. 3.3 the Gender Perspective on Urban waSH a. From “women in Development” to “Gender and Development” 3.3.1 “Gender” is the term that describes the social relationships between and characteristics of, men and women. It describes men’s and women’s participation in the determination of their lives including the access to rights, power, and control over resources. Race, ethnicity, religion, caste, society, culture, and traditions teach the men and women behavior, attitudes, roles, and activities that are appropriate for a speciic category and also how each category should relate to the other. Hence, gender identity, characteristics and roles are 11 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM governments are some of the reasons attributed to the poor performance of sanitation programs. The data also relects the fact that while improvements in coverage in both water and sanitation has occurred at a higher rate in the rural areas, the urban part of the world shows far better coverage, albeit with an increasing number of unserved population because of the rapid pace of urbanization. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM learnt and acquired by individuals and, consequently, can be changed through appropriate interventions. 3.3.2 The women’s agenda in the development sector gained momentum during the UN Decade for Women (1976–85) and was strengthened in the course of a string of UN conferences on women, especially the Mexico Conference in 1975, Copenhagen in 1980, Nairobi in 1985, and Beijing in 1995. The UN Convention to Eliminate all Forms of Discrimination Against Women (CEDAW) in 1981 reairmed the concept of dignity and equal rights of men and women and irmly brought gender equality into the development agenda, including that of water and sanitation. 3.3.3 “Gender” as a development concept has evolved from a “Women-in-Development” (WID) approach to a “Gender-and -Development” (GAD) one. The WID approach viewed women as being “left out” of development. It hence called for greater attention to women in development policy and practices. It was based on the belief that if resources were made directly available to women and they were integrated into the development process, the activities would be implemented with greater efectiveness and the women themselves would be able to contribute economically to development. However, the WID approach came under severe criticism as it largely remained limited to isolated income generation projects with a welfare orientation. It was also criticized for not bringing about any substantial change in the women’s situation or existing power relations. The perceived shortcoming was the fact that it did not challenge the male bias in the environment in which it operates and ignored the structural causes leading to women’s unequal position in development.4 3.3.4 A Gender and Development approach, on the other hand, is built around the understanding that women have always participated in the development process but from an unequal and unacknowledged position. More importantly, it works towards equity and respect for human rights and the belief that women 4 There was also the “Women and Development” approach that came into existence before Gender and Development (GAD) to address the shortcomings in WID; however, like the WID, it was criticized for grouping women together without giving much thought to diferences in race, class, caste, and ethnicity. 12 3.3.5 Finally, the gender mainstreaming approach is the more integrated version of GAD and is built around the understanding that the concerns and perspectives of women and men need to be addressed in all development initiatives and that gender relation, roles, and responsibilities inluence the participation of men and women in development programs (UN Habitat 2006). As is evident, gender mainstreaming addresses the needs, concerns, and participation of both men and women. However, it is often argued that because gender gaps are very wide and biased against women and because women play multiple roles and shoulder multiple responsibilities of caregiver, housekeeper, and livelihood supporter, a process of gender mainstreaming would provide opportunities to gives special attention to women while at the same time also addressing men’s issues. b. emergence of Gender on the Global waSH Policy agenda 3.3.6 At the global level, gender in WASH initially drew attention in 1977, during the World Water Conference in Mar del Plata when the 1980s was declared as the water and sanitation decade, with the slogan “Water and Sanitation for All”. There was a paradigm shift in approach and inequalities, including the marginalization of women which began to be addressed. Subsequently, in 1992, the Dublin Principles recognized that women play a central part in the provision, management, and safeguarding of water. Further, water was recognized as an economic commodity with an economic value for its users, including women. Gender integration in WASH was further strengthened when the United Nations Conference on Environment and Development in Rio de Janeiro in 1992 recognized women as environmental managers;5 the Rio+206 made governments commit to support capacity building in water and sanitation infrastructure and services and to ensure that these are gender-sensitive; and the ongoing International Decade for Action on Water for Life (2005–15) strives to ensure women’s participation and involvement in water-related development eforts. And, most importantly, the declaration of water and sanitation as a human right by the UN General Assembly in 2010 ensures nondiscrimination while the MDGs accorded a separate space to gender equality and WASH. 3.3.7 The importance of a women-oriented perspective in WASH programs is now globally recognized because women are central to providing, managing, and conserving water as well as ensuring “public health and private dignity”. Several studies (WSP 2010; UN-DESA and UNW-DPC, 2008) emphasize the need for putting women at the center of planning for WASH facilities and services because they are the primary stakeholders in the WASH sector and the primary providers and managers of water in households. c. Shift from “women-centered” to “Gender-Based” Programs 3.3.8 over the last decade, however, there has been a visible shift from a women-centered to a gendered approach because it is believed that a gendered approach can create a framework of cooperation between 5 In 2000, the Gender and Water Alliance (GWA) network was set up with support from the governments of the Netherlands and the United Kingdom. 6 Also known as Earth Summit 2012. It was the third United Nations Conference on Sustainable Development (UNCSD), hosted by Brazil in Rio de Janeiro. 13 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM improve their position relative to men in ways that will be of beneit to the whole community. The GAD approach also works on the principle that gender is cross-sectoral and a social concern and also underpins the WASH development objectives of eiciency, efectiveness, and equity. It further allows a program to address both the strategic and practical gender needs, wherein the former are generally linked to living conditions and basic services like water and sanitation and the latter to relative improvements in women’s disadvantaged position in society vis-à-vis men’s position. It refers to issues of power, control over resources and decision making. Most gender-integrated approaches aim to fulill the practical needs in the process of which some strategic needs are addressed contributing to the overall empowerment of women (Coates 1999; Reeves and Baden 2000). men and women so that the insights and experiences of both are available to develop a more efective and eicient program. The arguments in favor of a gendered approach, like that for a women-centered approach, are many and revolve around both economic and social aspects of water and sanitation (UN Habitat 2006). 3.3.9 The link between gender equality, women’s empowerment, and the relevant water and sanitation targets of the MDG are clearly visible (Table 3.1). PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM taBle 3:1 GENDER AND MDG TARGETS MDG targets Key Points Ensure Environmental Sustainability (Goal 7) Halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation (Target 10). Contribution of domestic water supply and sanitation. Contribution of sound water resources management and development. Promote gender equality and empower women (Goal 3) • Improved water services give women more time for productive endeavours adult education, empowerment activities and leisure. Community-based organizations (CBos) for water management can improve the social capital of women by giving them leadership and networking opportunities and building solidarity among them. • Convenient access to water and sanitation facilities increases privacy and reduces risk to women and girls of sexual harassment/assault while collecting water. • Higher rates of child survival are a precursor to the demographic transition to lower fertility rates; having fewer children reduces women’s household responsibilities and increases their opportunities for personal development. Source: Stockholm International Water Institute (SIWI) and United Nations Millennium Project (2005) (as quoted in UN Water (2006)). d. Gender Mainstreaming in waSH 3.3.10 In recent years, therefore, gender integration and mainstreaming has been given considerable attention in WASH policies and programs across countries. Approaches and strategies have been outlined, primarily by international agencies” specialist institutions like the Water and Sanitation Program (WSP) of the World Bank, UNICEF, WaterAid, the Water and Sanitation Collaborative Council among others. The WSP (2010), based on good practices across the globe, emphasizes that gender mainstreaming has to be part of the program and project cycle. It identiies policy formulation as the starting point for gender mainstreaming: irstly, a gendered water and sanitation policy will relect the government’s intentions and commitment to redress inequalities and articulate the goals and approaches to achieve them. The policy is also the basis of strategy development and resource allocation. Secondly, the operational level is critical for gender mainstreaming because decisions made here shape engagement with communities. Hence, the WSP observes that institutions like nongovernmental organizations (NGos), utilities, donor agencies and local government bodies engaged in the sector need to adopt policies and strategies that address gender at the level of both internal workplace policies and service delivery strategies. Thirdly, efective gender mainstreaming can only be achieved through an eicient sex disaggregated monitoring system that allows the planners and managers to assess the impact on men and women, boys and girls, the rich and the poor. 14 3.3.12 Speciic tools and strategies to generate and channel the voices of both men and women, who lack information and a platform to do so, are advocated and used by many countries. organizing communities and providing a space for interface with service delivery and decision-making agencies has now become a part of most water and sanitation sector programs. However, it is believed that unless women are given considered space, they tend to get largely marginalized with token presence and voice. Hence, it is advised that sector meetings at the community level need to be organized to overcome cultural barriers to women’s participation; sector agencies need to provide information for decision making on policies, strategies, plans, and investments, in a format that is user-friendly and accessible to women; sector agencies need to allow citizens to inluence their plans, budgets and strategies, based on the voices of both women and men (WSP, 2010). 3.3.13 In spite of all these eforts and the fact that gender in urban areas began to receive attention since the early years of the last decade, the impact has been limited. A recent study (Joshi et al. 2012) observes that the poor in the urban areas are not a homogeneous community and are divided by sociopolitical and economic diferences and other aspects of basic human capital. yet the sanitation needs of the poor, taking into account the diferences in sex, are the same as those of the better of households, that is, adequate water, privacy, safety, and human dignity for various activities related to personal and environmental sanitation. Gender issues are most often not considered in the policy and practice of sanitation, and inequity in needs and access to basic services has always been the norm. While water and sanitation facilities managed exclusively by women perform better and do meet the practical needs of women, they do not lead to their empowerment. Instead, it is seen to increase their burden with an additional responsibility, added to the fact that household responsibilities related to sanitation also fall on the women. The study questions the role of men in such a situation and advocates for more emphasis on changing their existing attitude with respect to gender roles. It also observes that the women’s need for privacy is not so much because of biological diferences, but because of social norms. The study, in fact, goes on to revalidate a growing concern that while provision of services is way below the desired level, gender issues are grossly ignored in urban areas. 3.3.14 The challenges are many, and among them are the negative perceptions about women, their role and capabilities, and the lack of understanding and sensitivity of decision makers and sector agencies about gender. Technology, infrastructure, management, operations and maintenance (o&M) are largely considered to be gender neutral and hence ignore the diferent needs of men and women. These are compounded by persistent political, social, cultural and caste constraints, and unequal social relations which restricts the full participation of all sections of the community as well as participation and decision making within households. Gender mainstreaming is hence more often than not limited to token interventions, fragile community structures and institutions, in spite of policy commitments and strategic tools. 15 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 3.3.11 A UN Expert Group meeting of UN agencies in 2008 (UN-DESA and UNW-DPC, March 2009) on gender disaggregated data identiied six key areas which needed to be addressed immediately. These were adequacy and availability of water at the household level for daily needs; the time spent, by sex, to collect water; relationships between transportation and gender in collecting water; sanitation facilities (if any) are actually used by men and women; women’s participation in decision-making processes regarding water and sanitation at all levels; and sanitation at schools, including speciic information on facilities provided separately for male and female, extent of actual use by male and female, extent to which those facilities meet the speciic needs of girls in terms of safety, privacy, proximity, hygiene, cleanliness, water and provision for menstruation. Checklists and indicators to plan and assess the inputs and impact of gender mainstreaming in the water and sanitation sector, from appraisal to evaluation stages, have also been developed by agencies for every phase of the project cycle (AFDB 2009; WSP 2010). PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 16 4. THE GENDERED FACE OF URBANIZATION IN INDIA 4.1.1 In India, urban areas are deined as “statutory” or “municipal” towns and “census” towns. While the former categorization is on the basis of the municipal status granted to the settlement (revenue based), the latter is based on demographic7 and economic criteria, that is, a minimum population of 5,000, at least 75 percent of the male population engaged in non-agricultural pursuits and a population density of at least 400 per sq km (Census 2011). Table 4.1 shows the increase in the number of towns of various categories in the last decade. taBle 4.1: URBANIZATIoN TRENDS 2001 2011 35 35 No. of Towns 5,161 7,935 2,774 No. of Statutory Towns 3,799 4,041 242 No. of Census Towns 1,362 3,894 2,532 No. of States/UT increase Source: Census of India 2011(www.censusindia.gov.in/2011census). 4.1.2 According to the 2011 census (Table 4.2), urbanization has increased faster than expected. Also, for the irst time since independence, the absolute increase in the urban population was higher than that in the rural population. The urban population grew to 377 million showing a growth rate of 2.76 percent per annum during 2001–11, while the level of urbanization increased from 27.7 percent in 2001 to 31.1 percent in 2011, an increase of 1.2 percentage points than the previous decade. The number of towns at the national level increased from 5,161 to 7,935 in 2011 out of which 2,532 were census towns and 242 statutory. 7 Class I: 100,000 and above; Class II: 50,000–100,000; Class III: 20,000–50,000; Class IV: 10,000–20,000; Class V: 5000–10,000; Class VI: less than 5,000. 17 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 4.1 Pattern of Urbanization taBle 4.2: SELECTED DEMoGRAPHIC INDICAToRS total rural Urban Persons 1,210,193,422 833,087,663 377,105,760 Males 623,724,248 427,917,052 195,807,196 Females 586,464,174 405,170,610 181,298,564 Population PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Decadal Population Growth rate (%) Persons 17.64 12.18 31.80 Males 17.19 12.12 30.06 Females 18.12 12.25 33.73 940 947 926 914 919 902 Persons 74.04 68.91 84.98 Males 82.14 78.57 89.67 Females 65.46 58.75 79.92 Sex ratio (Females per 1,000 males) child Sex ratio literacy rate Source: Census of India 2011. (www.censusindia.gov.in/2011census) 4.1.3 At the state level, urbanization shows a diverse pattern with economically advanced states showing higher levels of urbanization. All the southern states, along with Punjab, Haryana, Gujarat, Maharashtra and West Bengal, have higher urbanization levels than the national average and small states like Goa continue to top the list (62 percent urban) followed by Mizoram (51.5 percent). States which lag behind are Himachal Pradesh at the bottom with a 10 percent level of urbanization, followed by Bihar (11.3 percent), Assam (14 percent) and orissa (16.6 percent). other states like Uttar Pradesh, Rajasthan, Madhya Pradesh, Chhattisgarh and Jharkhand also continue to have lower levels of urbanization than the national average. 4.1.4 A large number of new towns (2,774) have emerged during the last decade, contributing signiicantly to the speeding up of urbanization. However, the process of urbanization in India has continued to be topheavy, oriented towards large cities. In 1951, there were only ive cities with a population of over one million and 41 cities with a population above 100,000. In 2001, these numbers increased to 53 with Rajasthan (3), Uttar Pradesh (7), Bihar (1), Jharkhand (3), Chhattisgarh (2) and Madhya Pradesh (4) together accounting for 20 of these. The country now also has around 455 urban areas with a population of over 100,000 with Uttar Pradesh (63) accounting for the largest numbers.8 4.1.5 Inequalities in urban areas are most visible in the existence of slums. The census and other data (Indian Institute of Human Settlements, 2012) indicate that although the million plus cities account for 40 percent of the slum population in the country,9 80 percent of the urban poor live in the small and medium towns (less than 100,000 population). Quite a signiicant percentage of the urban poor are concentrated in the states 8 Number of over 100,000 population towns in other HUP states: Uttarakhand (6); Rajasthan (29); Bihar (26); Jharkhand (10); odisha (10); Chhattisgarh (9); Madhya Pradesh (32). 9 In 1991, 21.3 percent of the urban population lived in slums and in 2001, although there was no systematic census of the slum population, a limited survey of selected 1,743 cities showed that 23.5 percent of the population lived in slums. 18 4.1.6 Urban poverty in the country is large and widespread and although the head count ratio of urban poverty is reported to have declined over the years, the rate of decline is observed to be lower than that of rural poverty. Moreover, progress in terms of reducing the incidence of urban poverty has been highly uneven across the country. In 2001, almost 26 percent of the population in urban areas reportedly lived below the poverty line; this is reported to have reduced to 21 percent by 2011. Employment remains largely informal (70 percent) with 60 percent of the urban employed being wage earners and 67 percent of this category being informal wage workers. Most work is in the non-trade sector, including as ragpickers and domestic workers, and many of them are women. 4.2 Status of women in Urban areas 4.2.1 The women in urban areas, especially the poor living in the slums and on pavements, are more vulnerable than many other categories of the population. The 2011 census indicates that the sex ratio in India has shown a marginal increase from 933 in 2001 to 940 in 2011. In the urban areas it has increased from 900 women per 1,000 men in 2001 to 925 women per 1,000 men in 2011. In fact, now almost half the city population in India comprises women. However, the overall trend since independence has been of concern as the overall sex ratio has declined from 946 in 1951 to 940 in 2011. Uttarakhand, Jharkhand, odisha, and Chhattisgarh are relatively better placed with sex ratios above the national average, while Uttar Pradesh and Bihar, followed closely by Rajasthan and Madhya Pradesh, have low rates (see Table 4.3). 19 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM of Bihar, Madhya Pradesh, Uttar Pradesh, orissa and Rajasthan. Data from the 2011 census reveals that 32 percent in urban areas live in a one-room house, 29 percent of the urban population do not have access to tap water, 19 percent have no latrine facility within the house and 7 percent of the urban population still do not have access to electricity. taBle 4.3: SEx RATIo IN THE RURAL AND URBAN AREAS PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM region rural Urban overall India 947 926 940 Uttarakhand 1000 883 963 Rajasthan 932 911 926 Uttar Pradesh 914 888 908 Bihar 919 891 916 Jharkhand 960 908 947 orissa 988 934 978 Chhattisgarh 1002 956 991 Madhya Pradesh 936 916 930 Source: Census of India 2011 (censusindia.gov.in). 4.2.2 The National Family Health Survey (NFHS) data series (2005–6), the 2011 census and other studies also indicate an overall alarming trend in the sex ratio and the status of urban women: • There is a decline in the sex ratio of the population in the age group 0–6 and in the sex ratio at birth; and a child mortality rate that is 61 percent higher for girls than for boys. It is evident from Table 4.3; the sex ratio for urban areas across states is well below that of rural areas, perhaps because of multiple reasons ranging from the increased use of sex-determination tests to male-only migrations from rural areas. • In terms of literacy and education, women fare better in the urban areas as compared to the rural women, and gender disparities in literacy in the rural areas is greater than in the urban areas and declines sharply with household wealth; however, one fourth of the women in urban areas remain illiterate. What is encouraging though is the fact that there is gender equality in school attendance in urban areas. For instance, NFHS-3 data indicates that in 2005–6, for every age category (6–10, 11–14, 15–17), the percentage of boys and girls attending school in the urban areas was almost the same, whereas in rural areas diferences exist and increase with age. In terms of employment and work participation, NFHS data indicates that controlling for wealth and education, women in rural areas are more likely to be employed than women in urban areas and the relationship between employment and wealth for women in turn suggests that perhaps work is an economic necessity. • The work participation rates for women in urban areas are indeed revealing: female labor force participation rate (LFPR) declined to 14.6 percent in 2009–10 from 17.8 percent in 2004–5; one ifth of the women workers in urban India are casual workers and incidence of casualization is more amongst women; women in urban areas are largely concentrated in “other” services, with 37 percent of the workers employed as domestic workers; 30 percent of urban women workers are illiterate as compared to 11 percent of men; 52 percent of the regular women workers and over 90 percent of the casual workers in urban areas do not receive any social security beneits; only 10.5 percent of the female regular workers are eligible for provident fund/pension. • The health indicators, although relecting a better position when compared to women in rural areas, show poorly in terms of similar indicators for men in urban areas. Similarly, the health indicators for poor women in urban areas also fare poorly when compared to non-poor women. • The number of women-headed households has been on the rise and female household heads have been found to be, on average, older than the male heads. They also have less education than the average male 20 • There are 4.9 million single-member women households in the country and 25 percent of these are found in urban areas. In Chhattisgarh, Madhya Pradesh, odisha, Maharashtra, Gujarat, Andhra Pradesh, and Tamil Nadu, 20 percent of the households are single-member female-headed. Around 48 percent of the number of female-headed households has a toilet within the premises, while 59 percent of these have bathing facilities in their compounds. Eighteen percent of female-headed households in urban areas have to walk more than 500 m to fetch potable water.10 • However, urban women fare marginally better in terms of decision making. For instance, among currently married women, 45 percent of women in urban areas participate in taking household decisions as against 33 percent in rural areas. Although the incidence of spousal violence among married women in urban areas is high (30 percent), it is nevertheless less than that experienced by women in rural areas (40 percent). • Finally, women in cities, cutting across class and profession, face continuous and diferent forms of sexual harassment in crowded as well as secluded places, including public transport, cars, markets, roads, public toilets and parks. Lack of clean and safe public toilets add to women’s insecurity, as reported by approximately 44 percent women and 40 percent men. other infrastructure, such as non-functioning street lights, rutted pavements, poorly maintained public spaces like parks, heighten feelings of insecurity (Jagori and UN Women 2011). 10 Times of India, December 29, 2012. 21 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM head as well as the average women in the population. Not surprisingly, they are overrepresented in the lowest wealth quintiles and underrepresented in the highest quintiles, indicating that female-headed households are perhaps economically more vulnerable than their male counterparts. Following from all of the above, women, on average, have lower per capita access to resources of all kinds. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 22 5.1 Status of waSH in cities a. water Supply 5.1.1 The status of safe drinking water and sanitation in urban areas across India varies from state to state and from city to city within a state (Table 5.1). The 2011 census indicates that around 71 percent of the urban population had access to tap water supply, while the remaining largely relied on handpumps and tube wells. Sixty-two percent of the tap water was treated, while a little over 1 percent of the well/handpump water was covered. The data also indicates that a little over 71 percent of the population had access to sources that were within the premises of the house. What is of concern, however, is that although the situation is far better in the urban areas as compared to the rural areas, there has been only marginal improvement in the overall status of access to improved sources in the former during the last decade. This is in spite of the planned interventions that have been in place during the period. The data generated by the JMP of WHo-UNICEF is somewhat similar on some counts. According to JMP 2012, in the year 2010, about 97 percent of the urban population had access to improved sources of water supply out of which only 48 percent had access to improved piped water supply. The JMP, however, does not provide the sex disaggregated data. taBle 5.1: STATUS oF DRINKING WATER SUPPLy IN URBAN AREAS oF SELECTED STATES (% PoPULATIoN CoVERED) india/States Source of Drinking water Supply location of Drinking water Supply tap well HP others within Premises Near Premises away From Premises India 70.6 6.2 20.8 2.5 71.2 20.7 8.1 Uttarakhand 78.4 0.2 20.2 1.1 88.7 7.8 3.5 Rajasthan 82.6 1.5 11.7 4.2 78.2 14.1 7.7 UP 51.5 0.8 46.3 1.3 78.8 16.0 5.2 Bihar 20.0 3.3 74.7 2.0 75.5 17.5 7.0 Jharkhand 41.6 19.3 36.9 2.3 59.2 23.1 17.8 orissa 48.0 18.4 31.7 1.9 56.9 24.7 18.5 Chhattisgarh 62.5 5.1 31.4 1.o 49.7 37.4 12.9 MP 62.2 5.5 29.9 2.4 55.4 30.1 14.5 Source: Census of India 2011 (censusindia.gov.in). 23 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 5. THE GENDERED FACE OF WATER AND SANITATION IN URBAN INDIA PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 5.1.2 With reference to the states, Uttarakhand and Rajasthan appear to be in a relatively better position while Jharkhand, odisha and Bihar are way below the national average. Barring Uttarakhand and Rajasthan, where the topography and ground conditions do not allow for handpumps and well water, the other states, especially Bihar and Uttar Pradesh, rely heavily on handpumps, even in urban areas and especially in the poor settlements. It is here that people often resort to buying water at a cost that is disproportionately higher than what is charged by the states for individual private connections in better of localities. 5.1.3 The major impact of a poor service delivery system falls on the poor, who generally receive water through public stand posts at ixed hours in the day or through handpumps. Among poor families, it is the women and girls who shoulder the responsibility of fetching and storing water which impacts their work eiciency and security. Data indicates that eight million children in urban areas are at risk from poor water supply (HPEC 2011). The lower income households, with no access to public sources, have then to rely on private sources where they end up paying a higher cost. For instance, a WSP study (WSP 2009) states that over 13,000 tankers in Chennai and 1,400 in Delhi are in the business of supplying water to the city, and mostly to the poor and underserviced areas. b. Sanitation, Sewerage and Solid waste Management 5.1.4 The Census 2011 states that 18.6 percent of the population living in urban areas do not have toilets and 12.6 percent of the population defecate in the open. obviously, the situation in terms of availability of physical infrastructure is far better than that in the rural areas where over 69 percent of the population still do not have toilets. Moreover, in urban areas, the percentage of houses with improved toilets with water closet has increased to 72.6 percent (2011) from 46.1 percent in 2001, while correspondingly the percentage of houses with pit toilets has decreased from 14.6 percent to 7.1 percent. Among the states, Bihar, Jharkhand, orissa and Madhya Pradesh are some of the worst of with igures far above the national average. These are also the states where the level of urbanization is low (Table 5.2). taBle 5.2: No ToILETS AND oPEN DEFECATIoN (%) india/States No toilets open Defecation 2011 2001 India 18.6 26.3 12.6 Uttarakhand 6.4 13.1 4.7 Rajasthan 18.0 23.9 16.7 Uttar Pradesh 16.9 20.0 14.8 Bihar 31.0 30.3 28.9 Jharkhand 32.8 33.3 31.0 orissa 35.2 40.3 33.2 Chhattisgarh 39.8 47.4 34.4 Madhya Pradesh 25.8 32.3 22.5 Source: Census of India 2011 (censusindia.gov.in). 5.1.5 The HPEC (2011) observes that sanitation is a bigger challenge in urban areas than in rural areas. Inadequate sewerage networks make many poor households continue to be dependent on poorly maintained and serviced public toilets. As a result, in terms of sheer numbers, over 50 million people in India are reported to defecate in the open in a day. Citing a seminal WSP study (WSP, 2010), HPEC reports that the estimated total economic impact of inadequate sanitation amounted to 2.6 percent of the gross 24 5.1.6 The fact that a rating exercise undertaken by the Ministry of Urban Development in 2010 (GoI 2010b) observed that none of the 423 cities that were rated found to be healthy and clean indicates the alarming state of sanitation in urban areas in the country. In fact, around 190 cities were reported to be on the verge of an environmental crisis. The rating exercise threw up other discouraging data: 4,861 towns and cities in India out of a total of 5,161 (prior to the publication of the 2011 census) do not have even partial sewerage network; less than 20 percent of the road network is covered by storm water drains; only 21 percent of the waste water generated is treated as against 57 percent in South Africa. A study conducted by the Confederation of Indian Industry (CII) and Council on Energy, Environment and Water (CEEW) cited in HPEC 2011, indicated that due to a lack of waste water treatment, over $15 billion was spent on treating waterborne diseases in India. 5.1.7 Similarly, the status of solid waste management is far below the expected standards and norms. Waste collection is reported to range from 70 to 90 percent in major metro cities in the country and is less than 50 percent in the smaller towns. Less than 30 percent of the solid waste is segregated and scientiic disposal is absent across cities. The waste generation in cities is expected to increase at an annual rate of 5 percent (HPEC, 2011). While several types of agencies, including the private sector and NGos, are involved in the collection of waste, disposal has no takers and the dumping sites as well as the process of collection and dumping is fraught with health and environmental risks. 5.1.8 Because of the persistently poor service conditions, various committees and missions have time and again urged states and their agencies to focus on inclusive services that are aligned to both urban and economic growth. For this to become efective the focus will need to shift from creating infrastructure to delivering services and, consequently, to improved governance and capacities. 25 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM domestic product (GDP) of the country in 2006. The total cost in terms of DALy of diarrheal diseases for children because of poor sanitation is a whooping Rs 5 billion and the cost per DALy per person due to poor sanitation is Rs 5,400 and due to poor hygiene is Rs 900. The study also observes that the impact of poor sanitation and hygiene on the poorest 20 percent of the households is the highest. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 5.2 impact of Poor water and Sanitation on women in Urban areas 5.2.1 The economically poor and socially marginalized obviously bear the brunt of poor water and sanitation services in urban areas. The impact of poor services on women is multi-pronged and ranges from increased burden of work to poor health of both self and family to issues of privacy, safety, dignity as well as livelihoods. Recent studies (Travers, et al. 2011; Lennon 2011) undertaken in the slums of Delhi, Mumbai, Hyderabad and elsewhere sum up the situation and list the gender-based disadvantages in accessing water and sanitation facilities and services. In the case of water these include: • Time and opportunity cost for work lost because of the additional time spent in collecting water, which in any case is a scarce commodity; absenteeism of girl children from school for the same reason; susceptibility to waterborne diseases and diseases due to unhygienic conditions which afect livelihood and income; conlicts around the water points for space and priorities; also physical and sexual harassment while collecting water from tankers. • Management of water, although to a lesser extent in urban than in rural areas, also includes many other tasks like water management for both domestic and productive purposes as well as for ceremonial and therapeutic ones. The degree of participation of men and women in all these uses difers according to social and economic classiication of communities and according to age, religion, time, and place. Within the community itself, the tasks fall disproportionately on some men and women (Jha 2010). • Similarly, in the case of toilets at home, the task of cleaning, fetching, and storing water, all fall on women. Within communities in both rural and urban areas, the traditional practices of assigning the task of cleaning toilets to the lowest the dalit communities continues, with women constituting the largest percentage of cleaners. In schools with toilets, and under the garb of “child clubs and the dignity of labor”, children are made to clean the premises and toilets. However, on close scrutiny it has been observed that these are mostly children, both boys and girls, from dalit communities.11 11 From various ield notes of the researcher. 26 Water shortage forces the slum dwellers to adopt “unreliable and demeaning” options to obtain it. They are also compelled to use water sparingly. Alternatively, they resort to buying water at costs that are as high as Rs 30 per day—about one fourth their daily earnings and much higher that what the better of households would pay for a highly subsidized government scheme. Again, the burden of ensuring that money is available for buying, undertaking the diicult task of collecting it and then judiciously budgeting its use, falls on the women of the household (Beinecke 2011). • In case of sanitation, the problems are even more intense and relate to the health, dignity and safety of women. These include sexual harassment at the community toilet complexes as well as when walking back and forth to and from the toilet; the indignity of open defecation because of lack of or inadequate sanitation facilities; the risk of being attacked for money or molestation when women venture out in the dark, and hence the need to go out in groups of three or four; the loss of dignity and embarrassment while disposing of menstrual waste; poor designs and poor maintenance of infrastructure raising both safety and health issues; the health risks related to the women having to wait until dark to urinate and defecate; and during periods of menstruation, pregnancy, or illness, such restrictions cause more health risks. Additionally, for the adolescent girl child, it is also missing school because of lack of facilities in schools. • Besides slums, the urban areas also have a substantial percentage of pavement dwellers who are generally worse of than slum dwellers in terms of shelter and basic services. Reportedly, only 5 percent of pavement dwellers have access to sanitation facilities through the night shelter set up by some of the municipal bodies and through pay and use public toilets like Sulabh Shauchalaya (Joshi, et al (2010). However, since the latter involves payment, not all pavement dwellers can aford to use these facilities all the time. Many adolescent girls end up using the facilities only during their menstrual cycle. Most of the younger generation are aware of the use of sanitary towels but do not have the means to buy them and hence resort to using old cloth, which is used and thrown of or washed and dried for reuse. However, washing and drying in privacy is also a problem. In fact, like in the rural areas, women in the urban areas, too, are careful about disposing soiled pads without anyone watching and casting an evil eye (Joshi et al. 2012). • Sanitation as well as use of water by pavement dwellers is also inluenced by the lack of storage facilities as well as by the nature of their jobs. For instance, beggars prefer to remain dirty as this apparently underscores their plight, while ragpickers do not have an opportunity to bathe regularly. Mothers, like in the rural areas, do not consider the feces of young children to be “dirty” or harmful and are careless about washing their hands with soap (ibid.). In fact, a formative study undertaken in the slums of Bihar observes that a signiicant percentage of population still use mud to wash their hands (Knowledge Links 2012). • Besides, in sanitation the tasks of cleaning drains, removing solid waste and carting away human feces and waste falls on particular communities, with the most menial of the tasks being the responsibility of the women within the community. over a million people, mostly women and children from dalit communities, are still believed to be engaged as manual scavengers, though oicial data gives a much lower igure of a little over 100,000 families.12 In urban (as well as in rural areas) of the country, scavenging continues in spite of legislations that strictly prohibit such practices and rehabilitate scavengers. Gender disparity is prevalent amongst the communities that traditionally carry out this task with women cleaning and clearing out the feces and men carrying it to the dumping site. Wages for this task are higher for men than women and men have been observed to fare better than women scavengers during rehabilitation and appear to move more easily from one profession to another. This is because they have had better access to the “male oriented”, productive world and have better physical mobility as they are not bound by the 12 National Public Hearing on “Rehabilitation of Manual Scavengers and Their Children In India”, March 28, 2012. 27 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM • PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM demands of household responsibilities and child care. Women, on the other hand, are expected to work and bring in a share of income into the home. While the women in the community are free to move within the bounds of work outside, yet the responsibilities at home limit their opportunities to move out of the scavenging occupation (Joshi et al. 2012). • There are other critical areas where women are again at a disadvantage—for both want of adequate services and facilities and awareness related to their own personal hygiene and the care of their children. For instance, bathing in open is a diicult task because of lack of privacy and space. While men do not ind it diicult to bathe in the open, women are forced to put up with the indignities of bathing in public or fetching water and bathing in an enclosed area in their crowded and cramped houses. Lack of adequate water close to their homes also means the inadequate practice of washing hands at critical times • Hence, it is not surprising that studies indicate that most adult and adolescent females living in the slums perceive adequate sanitation in terms of individual latrines and/or privacy and convenience during defecation; water connections at home with adequate water for household cleaning needs; personal cleanliness (bathing, wearing clean clothes, oiling hair) and ensuring the same for children; washing utensils; washing clothes; sweeping, cleaning the front yard with water and cow dung; cleaning the house; keeping the bathroom and latrine clean. 5.2.2 Studies (ibid.) have concluded that water and sanitation needs are basic human needs and common across cultures, although practices may difer. Hence “understanding identities and diferences by gender” matters because, irstly, regardless of location, household cleaning tasks are the responsibilities of women and to ensure that they perform these tasks well, moral strictures are applied to them. And, secondly, irrespective of cultures, a higher level of secrecy is applied to a female body, which leads to a greater demand for seclusion and privacy for bathing, defecating and managing menstrual hygiene. 28 6.1 the institutions that Shape the Policies and Programs 6.1.1 In India, urban water supply and sanitation is primarily a state subject and the respective state governments are expected to lay down the policies for the allocation of water for various purposes and establish the institutional systems for its management. Institutional arrangements vary from state to state and include state-level Public Health Engineering Departments (PHED), specialized state-level water supply and sanitation boards, and, in a few cases, even specialized city-level boards and municipal corporations and other types of ULBs. Within states, functions of capital works and operation and maintenance (o&M) are often split between two agencies. While the 74th Amendment (1992) advocates the decentralization of water and sanitation functions, among others, to the ULBs, the process has been slow because of a combination of factors ranging from capacities of ULBs to the reluctance of the states and the bureaucracy to delegate power.13 o&M rests with city-level specialist agencies, for example, Jal Sansthans in Uttar Pradesh, or the municipal body. Hence, what is predominantly visible at the state level is a fractured institutional setup with little coordination between the agencies responsible for design and capital works and those which are responsible for o&M. 6.1.2 The central government, however, wields the greater power through policy pronouncements and programs tied to a signiicant and major, share of funds through the budget route. The Ministry of Urban Development (MoUD) is the nodal department for all policy, regulatory, and program-related work and funds. The Ministry of Housing and Urban Poverty Alleviation (MoHUPA), set up in its current form in 2004, primarily caters to the slums and is the principal provider of water and sanitation to the poor in the cities. The Central Public Health and Environmental Engineering organization provides technical support and sets standards and norms of service. The MoUD also receives support and coordinates with the Ministry of Health and Family Welfare (MoHW), Ministry of Water Resources (MoWR), Ministry of Environment and Forests (MoEF) and the Planning Commission. 6.1.3 Apart from these institutions that are directly engaged in the business of water supply and sanitation, over the years special slum development and poverty alleviation cells and missions have emerged in several states. These are part of a particular project mandate or overall policy directions from the central government, for instance, the Urban Poverty Cells in all the ULBs under the Swaran Jayanti Sahari Rozgar yojana (SJSRy) or Kudumbashree in Kerala and the Mission for Eradication of Poverty in Municipal Areas (MEPMA). These institutions are technically stafed with social, community development and gender development specialists and have the mandate for overall inclusive development and equity. Thus, the institutional structure, which in the early years was largely oriented towards ensuring adequate water supply, application of appropriate technology and managing funds and programs, has seen some changes—perhaps more on paper than in functions—in response to changes in the policy and program approaches in the sector. 13 Water supply and sanitation has always been the purview of the local government as part of its public health functions. The 74th Amendment in a way only endorsed this responsibility. 29 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 6. HOW HAVE POLICIES AND PROGRAMS ADDRESSED GENDER ISSUES IN URBAN WASH 6.1.4 Besides, some international and bilateral agencies like the World Bank, Asian Development Bank (ADB), Department for International Development (DFID) (UK Aid), GIZ, United States Agency for International Development (USAID) and international nongovernmental organizations (INGos) like WaterAid and Bill & Melinda Gates Foundation also provide support either through independent stand-alone programs or pooling in resources with the central or states governments to strengthen ongoing initiatives. The support is both for hardware as well as institutional development and inclusion of the poor and the marginalized. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 6.2 the Policies and Program 6.2.1 Given that both men and women play diferent roles in managing water and women are at greater physical and health risks because of inadequate access to facilities, it would seem that the water and sanitation sector needs to irmly mainstream gender into its overall framework. However, while attempts have been made to integrate elements of gender and inclusion issues in the rural water and sanitation sector in India, the urban policies and programs, by and large, have remained “gender blind” (Panda and Agarwal 2012). A review of the policies and programs in the sector indicates that while there has been a paradigm shift in approach from supply-driven to community-based and inclusive approaches in the rural areas, this is far less evident in the urban interventions. 6.2.2 overall, the trend in the urban sector has been to rely almost exclusively on centrally-sponsored schemes and infrastructure development, albeit the fact that a decision to decentralize services was taken as far back as 1992 via the 74th Amendment and reiterated in the new genre of programs under the umbrella of the JNNURM. The absence of a lack of engagement with communities in the urban areas is also relected in the near absence of gender integration in the WASH policies and programs in the urban sector. In fact, apart from the recent National Urban Sanitation Policy (NUSP 2008), the urban water and sanitation sector conspicuously lacks a comprehensive policy statement. This section briely traces the evolution of the urban WASH sector in the country through a gender lens and attempts to describe selected intervention led by state and non-state agencies in this context. 30 6.2.3. Urban water supply and sanitation has been part of the national agenda since the beginning of the plan period. Although it did not merit a separate even then was only a partial policy until the irst NUSP was formulated in 2008. Initially, water and sanitation were launched as part of the health plan, wherein the lack of hygienic environment, safe water supply, and proper removal of human waste were identiied as some of the factors for the existence of a large number of preventable diseases in the country, especially impacting women and children. However, it soon became linked with the urban development and housing sector and acquired separate budgets under it. And, hence, while ensuring clean water and hygienic conditions become the driving objectives of the sector, targeting endemic waterborne diseases through safe water supply and management of excreta and sewage was adopted as the broad strategy. Thereafter, schemes were launched in all successive ive year plans and were generally integrated with housing projects for various social and economic groups or were stand-alone schemes for speciic categories of cities. 6.2.4 The slums and poverty settlements were brought within the scope of water and sanitation interventions as way back as in 1972 through the Environmental Improvement of Urban Slums (EIUS) program which continued in various forms and names till it was subsumed into the JNNURM in 2005. Inclusion was addressed to the extent that these projects specially targeted the poor and the marginalized. However, there was no provision to further disaggregate this category into social and gender groups. 6.2.5 In the early 1980s, the UN-led International Water and Sanitation Decade (1981–90), of which India was a participant, brought about signiicant changes in focus and understanding and a irm commitment by India to adopt decentralized, community-based and sustainable principles of development in both rural and urban sectors. This included a commitment to bring about institutional reforms promoting an integrated approach, including changes in procedures, attitudes and behavior, and the full participation of women at all levels in sector institutions, together with community management of services and adoption of appropriate technologies.14 Thus, community management and participation was formally brought into project designs and programs began to look at the issue of women within the sector. 6.2.6 Meanwhile, the lack of toilets and the prevailing practice of manual scavenging and disposal of human excreta was becoming a concern. The Integrated Low Cost Sanitation Scheme (ILCS), the irst standalone sanitation scheme for urban areas, was launched in 1980. The issue of addressing manual scavenging was sought to be strengthened with the enactment of the Manual Scavengers and Construction of Dry Latrine (Prohibition) Act, 1993, and much later, in 2007, the Self Employment Scheme for the Rehabilitation of Manual Scavengers was also launched. However, critical gaps in the selection of beneiciaries and poor implementation have prevented the program from making any signiicant impact on the status of scavengers, most of who are women. Hence, a new bill—The Prohibition of Employment as Manual Scavengers and their Rehabilitation Bill, 2012—with stricter provisions was introduced and passes by Lok Sabha and Rajya Sabha in 2012. 6.2.7 In 1988–89 (Seventh Five year Plan), the Urban Basic Services (UBS) program, subsequently universalized as the Urban Basic Services for the Poor (UBSP) program in 1991, for the irst time brought poor women in an institutionalized form into the planning and management of urban basic services through participatory community-based structures. The services included water supply and sanitation, apart from other needs of the community. The UBSP was subsequently subsumed into the JNNURM. This period also saw the emergence of other policies and programs that had or could have had an impact on the urban WASH sector. For instance, the National Commission on Urbanisation (1985–86), the National Water Policy (NWP), 1987, and the National 14 The New Delhi Statement adopted at the Global Consultation on Safe Water and Sanitation for the 1990s, held in New Delhi, September, 10–14, 1990. 31 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM From a limited identity to independent Program PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Housing Policy (NHP), 198815. The National Housing and Urban Habitat Policy, 2007, speciically states its intention of making special provisions for women: • Involving women at all levels of decision making thus ensuring their participation in the formulation and implementation of housing policies and programs. • Addressing the special needs of women-headed households, single women, working women, and women in diicult circumstances in relation to housing serviced by basic amenities. 6.2.8 Finally, in 1993–94, the Accelerated Urban Water Supply Program (AUWSP) was launched for towns with a population of less than 20,000. The principal aim of the program was to improve the quality of life of the poor, especially the most vulnerable sections of the population, such as women, children, and marginalized communities, who do not have access to safe water. Community participation was a critical approach. AUWSP also recommended building the capacities of the community itself so as to enable them to take care of o&M themselves. As such, the community was to be involved right from the planning stage of the project. Piped water supply was to be encouraged and low cost technologies to be adopted. AUWSP was revised from time to time and inally subsumed into the Urban Infrastructure Development Scheme for Small and Medium Towns (UIDSSMT) in 2005–6. the reforms agenda: a Paradigm Shift 6.2.9 The Tenth Five year Plan (2002–7) set certain ambitious objectives and targets including that of 100 percent coverage of the urban population with safe water supply during the plan period and 30 percent with sanitation. It also indicated that water was to be managed as a commodity and that there was to be a change in the role of government from direct service provider to that of a facilitator and leading to privatization. Besides, the focus was to be on investment requirements, institutional restructuring, better services, and people’s participation. These objectives found a place in a reform-oriented urban sectorwide program, the JNNURM, launched in December 2005 and catering to 63 cities, and its counterpart the UIDSSMT and Integrated Housing and Slum Development Program (IHSDP) for the remaining non-mission cities. 6.2.10 The JNNURM aims to get the state governments to commit themselves to structural reforms, following the failure of the central government to achieve this, despite several carrot-and-stick measures and incentive schemes. Hence, the strategy included a set of mandatory and optional reforms targeting the ULBs as well as the states. Amongst these, some of the following are of relevance to the water and sanitation sector: enactment of laws pertaining to the provision of basic services to the urban poor including security of tenure at afordable prices; improved housing, water supply, sanitation, and ensuring delivery of other already existing universal services of the government for education, health and social security; implementation of decentralization measures as envisaged in the 74th Amendment; ensuring that states engaged with ULBs in the planning function of parastatals as well as delivery of services to the citizens; and the enactment of the Community Participation Law to institutionalize citizen participation and introducing the concept of the Area Sabha in urban areas. Moreover, a mandatory CDP was to ensure that a perspective urban plan would be developed, based on the collective aspirations and needs of all citizens including the poor. 6.2.11 In order to ensure improvement in services and establish accountability of the service provider and institutions of water governance, the Government of India has developed and introduced the concept of Service Level Bench Marks (SLBMs). The SLBM is broadly deined as “a minimum set of standard performance parameters that are commonly understood and used by all stakeholders across the country” (GoI 2010c). The MoUD has issued guidelines for identifying a minimum set of standard performance parameters, for deining 15 The NWP and NHP have been subsequently revised. 32 a common minimum framework for monitoring and reporting on these indicators, and for operationalizing the framework in a phased manner (Table 6.1). water Supply waste water Management • Coverage of water supply connections • Coverage of toilets • Per capita supply of water • Coverage of waste water network services • Extent of metering of water connections • Collection eiciency of waste water network • Extent of non-revenue water • Adequacy of waste water treatment capacity • Continuity of water supply • Quality of waste water treatment • Quality of water supplied • Extent of reuse and recycling of waste water • Cost recovery in water supply services • Extent of cost recovery in waste water management • Eiciency in redressal of customer complaints • Eiciency in collection of water supply-related charges • Eiciency in redressal of customer complaints Solid waste Management (SwM) Storm water Drainage • Household level coverage of SWM services • Coverage of storm water drainage network • Eiciency of collection of municipal solid waste • Incidence of water logging/looding PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM taBle 6.1: FRAMEWoRK FoR PERFoRMANCE INDICAToRS • Eiciency in collection of sewerage-related charges • Extent of segregation of municipal solid waste • Extent of municipal solid waste recovered • Extent of scientiic disposal of municipal solid waste • Extent of cost recovery in SWM services • Eiciency in redressal of customer complaints • Eiciency in collection of SWM-related user charges Source: Extracted from GoI (2010c). SacoSaN: a Political commitment to Sanitation 6.2.12 India’s commitments to the Millennium Development Campaign (2002) and the goals set by the UN and the South Asian Conference on Sanitation (SACoSAN), an inter-ministerial coalition of countries in South Asia initiated in 2003, appears to have inluenced the sector objectives and strategy to some extent ever since the Tenth Plan. 6.2.13 While the MDG commitments have been discussed earlier, the irst SACoSAN conference in Dhaka in 2003 acknowledged that the unhygienic practices by a majority of people in the region were a serious threat to the quality of life, control of diseases, and the environment. It agreed that the focus of sanitation and hygiene in the region should be based on a paradigm that was “people-centered, community-led, gender sensitive and demand-driven”. Hence, one of the key principles was that it should recognize the need for gender-sensitive programs. 33 6.2.14 Since then three more SACoSANs have been held in Islamabad, Delhi, and Colombo and each of these has emphasized that the needs and concerns of women and the most vulnerable (children, especially girl children, the diferently abled, and the elderly) was to be addressed as a priority; the special sanitation needs of women, for example, menstrual hygiene management was to be integrated in planning, implementation, monitoring, and measurement of program outcomes; the key role of women in managing sanitation and hygiene in community settings was to be enhanced; and greater thrust was to be placed on promoting adequate sanitation in schools with separate facilities for boys and girls. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM National Urban Sanitation Policy and Strategy 6.2.15 In fact, in India, SACoSAN III was followed by the declaration of the irst comprehensive sanitation policy, the NUSP, by the Government of India. The policy aims to make all “cities and towns ... sanitized, healthy and liveable and ensure and sustain good public health and environmental outcomes for all …citizens with a special focus on hygienic and afordable sanitation facilities for the urban poor and women” (GoI, 2008). observing that poor awareness, fragmented institutional roles and responsibilities, lack of an integrated citywide approach, limited choice of technology, inability to reach the unserved and the poor, lack of demand responsiveness and certain skewed and discriminating social and occupational anomalies within the sanitation sector act as barriers, the policy has three broad objectives: (i) awareness generation and behavior change; (ii) open defecation-free cities and (iii) integrated citywide sanitation. The strategy for achieving these objectives are to be deined in speciic state-level Strategic Plans and CSPs, mandatory for accessing funds from the Government of India. The policy also provides for rating cities on a sanitation scale to identify and award those that are totally sanitized. The cities are ranked in four categories ranging from cities on the brink of a public health and environmental “emergency” to cities that are “healthy and clean”. The irst such rating was undertaken in 2010 and only four cities qualiied. The process for identifying cities in the second round is currently on (Table 6.2). 34 output-Related Indicators Process-Related Indicators A. No open defecation A. Monitoring & Evaluation systems are in place to track incidences of open defecation. B. C. • Access and use of toilets by the urban poor and other unserved households—individual and community sanitation facilities. • Access and use of toilets for loating and institutional populations—adequate public sanitation facilities. • No open defecation visible. • Eliminate manual scavenging and provide personnel protection equipment to sanitary workers. Proportion of total human excreta generation that is safely collected. Proportion of total black waste water generation that is treated and safely disposed. D. Proportion of total grey waste water generation that is treated and safely disposed. E. Proportion of treated waste water that is recycled and reused for non-potable applications. F. Proportion of total storm water and drainage that is eiciently and safely managed. B. All sewerage systems in the city are working properly and there is no ex-iltration. C. Septage/sludge is regularly cleaned, safely transported and disposed after treatment, from on-site systems in the city. D. Underground and surface drainage systems are functioning and are well-maintained. E. Solid waste management (collection and treatment) systems are eicient (and are in conformity with the MSW Rules, 2003). F. There is clear institutional responsibility assigned; documented operational systems in practice for (B)/(C) to (E). G. Sanctions for deviance on part of polluters and institutions is clearly laid out and followed in practice. G. G. Proportion of total solid waste generation that is regularly collected. H. H. Proportion of total solid waste generation that is treated and safely disposed. I. I. City wastes cause no adverse impacts on surrounding areas outside city limits. outcome-Related Indicators A. Improved quality of drinking water in city compared to baseline. B. Improved water quality in water bodies in and around city compared to baseline. C. Reduction in waterborne disease incidence among city population compared to baseline. Source: GoI (2010b). 6.2.16 The MoUD also provided guidelines for developing State Sanitation Strategies (SSPs) and CSPs that were mandatory for securing central government funds. The state-level strategies were to be developed around a broad framework that included reaching the unserved population and the urban poor at the state level which would mean resolving issues related to tenure, space, and afordability constraints for providing, preferably, individual sanitation facilities and community facilities where individual provision is not feasible. 6.2.17 Similarly, a framework for developing a CSP for achieving 100 percent sanitation in individual cities has also been provided by the MoUD. The framework again emphasizes the need to assign and deine institutional responsibilities, with the ULBs playing the key role and focusing on awareness generation. A citywide approach 35 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM taBle 6.2: INDICAToRS FoR RATING CITIES PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM ensures that the needs of the unreached and the poor are addressed by adopting low cost appropriate technology. The focus on the client and on generating demand and ensuring sustained improvements are the base of the framework. A multistakeholder City Sanitation Task Force is to be constituted up front, consisting of all agencies directly and indirectly involved in the sector, including Resident Welfare Associations (RWAs), slums, and civil society representatives, representatives of state government departments, representatives from unions of the safai karamchari, ragpickers and sanitation workers. The task force is to be entrusted with the responsibility of planning and launching the campaign and providing overall guidance to the ULBs and other concerned agencies. For reaching the poor and unserved, the CSP must adopt participatory approaches to consult the poor settlements and involve them in the process of planning and management of sanitation arrangements. At least 20 percent of the funds under the sanitation sector are to be earmarked for the urban poor. 6.2.18 Several states, including Uttar Pradesh, Bihar, odisha, Chhattisgarh, Madhya Pradesh, and Uttarakhand, among others, have formulated state-level strategies and have completed or are in the process of preparing CSPs for their respective cities in states. odisha has gone some steps ahead and also developed “odisha Urban Water and Sanitation Communication Strategy” to build a constituency and support for water and sanitation sector reforms initiatives among diverse stakeholders, including slum dwellers, service providers and elected representatives. odisha is also probably the only state that has come out with guidelines for community and public toilets, that gives serious consideration not only to the needs of women and children but also to what would motivate men to construct toilets. While most of the state strategies are broad-based, they have, for the irst time, provided the states with an opportunity to look at the dimensions of the problem in the context of their respective states and formulate strategies accordingly. The other element of the strategy is the scope that it provides for building a database and putting into place a conceptually doable monitoring system. However, most of the state-level strategy documents as well as the CSPs continue to be heavily tilted toward provision of physical infrastructure. 6.3 How international and Bilateral agencies, international and local NGos address waSH and Gender 6.3.1 Since the early 1990s, several externally supported programs have been largely dovetailed into the existing policies and programs of the central and state government, often with progressive ULBs as key partners. For instance, • The World Bank supported the Slum Sanitation Program in Mumbai in collaboration with the Mumbai Municipal Corporation and local NGos in early 2000, apart from the support provided to several states as part of the citywide water supply and sewerage programs. • The Water and Sanitation Program (WSP-South Asia) of the World Bank collaborates with the national and state governments to pilot innovative strategies and models covering a range of technical, institutional, poverty, and inclusion-based issues. It has been instrumental in introducing concepts and approaches like Community Led Total Sanitation and other innovative methods for community participation, including that of women. 36 Similar citywide support is provided by the Asian Development Bank (ADB) in several states, including Madhya Pradesh and Bihar, in collaboration with the states and concerned ULBs. • The United Nations Development Programme (UNDP) supports the development of sanitation models in selected cities, while other UN agencies like UN Habitat is implementing its Water For Cities program in selected cities in Madhya Pradesh and has introduced concepts of gender assessment and gender mainstreaming in WASH programs in urban areas. • UNICEF collaborated with the central and state governments for conceptualizing and piloting the UBS program wherein water and sanitation were key components. • DFID (UK Aid) has supported a series of urban development projects in Cochin, Vishakapatnam, Vijayawada, Hyderabad, Kolkata and, in recent years, in several cities of Madhya Pradesh and Bihar, focusing on slum development and poverty reduction wherein water supply and sanitation have been key inputs. • GIZ, the German development agency, collaborates with the MoUD and seven select states including Chhattisgarh, Maharashtra, and Madhya Pradesh, and 10 ULBs in planning, implementing, operating and maintaining sustainable citywide sanitation. In 2010, GIZ also agreed to support the preparation of CSPs in six cities, namely, Shimla, Varanasi, Nasik, Raipur, Kochi, and Tirupati and the development of State Sanitation Strategy (SSS) and upscaling activities under the National School Sanitation Initiative (NSSI) through its “Support to the National Urban Sanitation Policy” program (Box 6.1). Box 6.1: NATIoNAL SCHooL SANITATIoN INITIATIVE: PARAMETERS FoR SELECTIoN Parameters for selection include: 1. Sustainability: Demonstrated success geared toward hygiene/safe sanitation. 2. Reliability: Potential for replication of practices/models resulting in better service delivery. 3. Innovation: Demonstrated innovation in the use of ideas, technology/resources. 4. Dynamism: online sanitation ratings of the school plus activity points scored by taking up appreciable initiatives in the following areas:  Improving sanitation facilities for the girl child.  Best performing health & wellness clubs.  Sustainability of the efort.  Waste management & disposal.  Water conservation and waste water recycling and its utilization.  Safe hygiene practices.  Waste segregation & waste management.  Awareness generation eforts and impact leading to behavioral change.  Water & Sanitation: Tangible improvements in service delivery. • GIZ is also supporting the Ministry of Human Resource Development (MoHRD) in implementing the NSSI and is collaborating with the Central Board of Secondary Education (CBSE) in improving sanitation facilities in select schools across India and in building awareness on issues concerning sanitation and hygiene. Sanitation is one of the six thematic areas identiied for establishing a Health Promoting School. • WaterAid partners with the state governments and ULBs, especially in the area of sanitation focusing on inclusion and rights in states like Madhya Pradesh, Bihar, odisha and Uttar Pradesh. In odisha, for instance, while it has implemented integrated projects in Puri and Bhubaneswar and also addressed WASH in schools in Bhubaneswar, its primary strategy has been to empower the communities through knowledge, 37 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM • information and capacity building. WaterAid adopts principles of inclusion and equity, with rights as a crosscutting theme, thereby bringing the issue of gender into the scope of work (Box 6.2). Box 6.2: MALGoDoWN-BEHERA SAHI WHERE MEN AND WoMEN WoRKED ToGETHER To BRING ABoUT A CHANGE IN HEALTH AND HyGIENE PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Background Cuttack is located at the apex of the delta of Mahanadi River. Most of the over 250 slums, located within the limits of the Cuttack Municipal Corporation (CMC), were earlier villages that surrounded the city and catered to its needs. However, with time these villages were absorbed into the city, but continued to retain their village character. Even today, with their narrow and winding roads and little civic facilities, living conditions are diicult. Malgodown-Behera Sahi is one of the more prominent of these villages-turned-slums and is located in the prime business area of the city. The congested settlement houses around 1,500 people, mostly families who had migrated from Andhra Pradesh several years back. The situation in the slum prior to 2003 was very poor in terms of access to safe water supply and toilets. There were insuicient water points, with broken taps, platforms and drains, and one community toilet catering to the densely populated slum. There were about six to seven open drains in the slum that were used for defecation. This, together with a lack of hygiene, led to diarrhea and vomiting, cold and coughs being a constant factor in the slum and reportedly even leading to infant deaths. The community toilet was constructed by the CMC way back in 1987. It had ive seats each for men and women, with no attached areas for bathing and washing. There was no user fee and no ixed cost allocated by the CMC for its maintenance. Hence, without resources or arrangements the toilet was poorly maintained and the community continued to use the drains and open areas for defecation. The community toilet has since been renovated and now also has attached and separate bathrooms for men and women. It also has eight child-friendly toilets for children. This has been made possible by the collective eforts of the community and women’s groups supported by SAI, a local NGo and WaterAid. the Process The focus was on organizing and sensitizing the community, building community groups, hygiene promotion and ensuring improved infrastructure and facilities. The strategy was to form a joint front to arrest environmental degradation. SAI initiated the activities in 2003 with technical and budget support from WaterAid. The support included the construction of new and protected drinking water facilities and repair of the old ones, repair of the community toilet and construction of household toilets and soak pits. A participatory approach was used to ensure the inclusion of all sections of the community and ensure ownership of facilities and services. Initially, four “Women Self-Help Groups” (WSHG) and some youth clubs were formed. Through the WSHGs, the women were encouraged to take up thrift and credit activities. The WSHGs were also exposed to a series of trainings and capacity building to improve their understanding of health and hygiene and to build a sense of ownership for the facilities created. Subsequently, other community-based organizations (CBos) were formed over time for slum development and included the Basti Unnayan Parisad (BUP) as the apex body and the water and sanitation (WATSAN) Committee and WASH team. The BUP consisted of 100 members and was registered in 1992 as a CBo by the Cuttack municipality. The WATSAN Committee, in turn, consisted of representatives from all the SHGs, the BUP and the youth clubs. Decisions were taken collectively by these CBos. The youth clubs were instrumental in mobilizing the community and in the renovation of the community toilet. They lent a hand in procuring skilled masons and materials, and volunteered to guard the material during the construction process. 38 In order to facilitate a public discussion on the general practice of open defecation in the slums, providing a community toilet latrine was the irst essential need to be addressed. The existing community toilet built in 1987 by CMC had been contracted to Sulabh International for periodic maintenance. With the support of SAI, the CBos obtained permission from the CMC to renovate the existing community toilet and it was agreed by all that SAI would be entrusted with the job of renovation. To begin with, the construction, supervision, procurement and technical committees were formed involving slum dwellers and SAI entered into an agreement with the BUP. Subsequently, the Women’s Action for Sanitation & Hygiene (WASH) team was formed and trained for operation and maintenance (o&M) of the community toilet. The community toilet was constructed with the wholehearted support of the community and named “AAMA SAUCHALAyA” (our Toilet) and was formally inaugurated by the Collector of Cuttack on August 4, 2005. The total cost of the toilet was Rs 3,86,844. Men, women and children together contributed Rs 60,000 in terms of labor and watch and ward functions. It includes four toilets each for men and women with attached bathing rooms and eight child-friendly toilets for children. In order to operate and maintain the community toilet, the WATSAN committee, in discussion with the slum community, ixed Rs 1 per family per day as user fee. Hence, each family pays Rs 30 per month for o&M. However, the very poor who cannot aford to pay, old people with no support system, children, and guests of any household in the slum are excluded from the user fee. There are three lady caretakers who take care of the toilet in shifts. The caretakers are paid Rs 600, Rs 300 and Rs 600 per month for the morning, afternoon and night shifts, respectively. A cleaner has also been engaged and is paid Rs 1,500 per month. The total cost of maintenance, including consumables, is Rs 3,800 per month. As on August 2011, the WATSAN Committee had a balance of Rs 64,000 in its account. The WATSAN Committee acknowledges that the credit for the maintenance of the community toilet goes entirely to the WASH team. the impact There is remarkable improvement in the hygiene behavior of the community, which has led to better health conditions and overall well-being. “Many of our children were dying because of diarrhoea and dysentery, which was a real matter of concern in our locality; but it, is not the case now. We go to the toilet for defecation, drink water supplied from pipes, wash hands before taking food, after defecation and before handling food. “Ama Swachalaya” has got happiness for us.” (Kuntala Behera, community member). Source: Case note developed by Biraja Kabi Satapathy, Water and Sanitation Specialist, HUP-PFI, odisha. The Health of the Urban Poor Program is supported by USAID and led by the Population Foundation of India (PFI) in partnership with Plan India, Indian Institute of Health Management and Research (IIHMR), Centre for Development and Population Activities (CEDPA) India and others. Water and sanitation is included as a component in the program as it is considered to be a determinant of health. Primarily, HUP aims to improve the delivery and utilization of maternal and child health and nutritional services in the poor communities in the urban areas. This it, does by providing policy, advocacy, and capacity building support to the relevant departments at the central level and in its partner states. Although it works primarily with the Health and Family Welfare Department and the Women and Child Development Department, Housing and Urban 39 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM The community was involved in the process from the very beginning of the project and capacity building was critical to the process. The WATSAN Committee went on an exposure visit to Trichy and shared their experience with other committees and the slum dwellers. The SHGs, who were initially hesitant to participate, were mobilized through constant interventions and capacity building. The initially reluctant women and SHG members gradually began to take an interest and inally took the lead in WATSAN. They continue to do the same till date. Development Department and at the local level it interacts closely with the ULBs to push its WASH agenda to improve the overall health and nutrition status of women and children. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM • The Bill & Melinda Gates Foundation, with a focus on water and sanitation, is funding an initiative to develop an innovative, sustainable, scalable urban community sanitation model in the cities of Bhubaneswar and Cuttack in odisha and promoting sanitation and hygiene through Self-Help Groups (SHGs) in the city of Katihar in Bihar (with SEWA Bharat as the partner). 6.3.2 Again, many of these interventions are part of the larger integrated infrastructure or slum improvement programs, except for those implemented by sector-focused agencies like WaterAid and WSP. While the World Bank and ADB collaborations are signiicant in terms of the funds involved, they as well as the others aim at bringing about improvements in the institutional structure and performance, in program and project management and, above all, in ensuring improved access and equity to the poor and marginalized communities. In many cases the projects are implemented in partnership with local NGos and community participation, including women. This is both a key policy mandate as well as a strategic approach. Community mobilization and organization leading to the formation of community-based groups is the base of such programs, with capacity building of communities and improved interface with ULBs and other service providers being critical inputs. And, increasingly, the trend has been to form exclusive women’s groups on the patterns of the SHGs and entrust responsibilities to them with the knowledge that while there are greater prospects of the projects being delivered with greater eiciency and efectiveness, the women are also empowered in the process. 6.4 is “Gender” an explicit and Strategized theme in Policies and Practice? 6.4.1 The concept of “gender” is conspicuously absent in the limited policy and plan documents on urban water and sanitation that have evolved over the years. Until the beginning of the 1980s there was hardly any reference to the community or its participation and hence women or gender as a constituency also did not merit mention. The Water and Sanitation Decade (1980–90), which was the irst instance when a comprehensive review and perspective was developed in the sector as a whole, brought in the concept of community participation and the need to look at the speciic needs of women in urban areas. The National Commission on Urbanisation (NCU) further highlighted the need to look at urban poverty and its constituents, especially women and children, in a diferent light and also emphasized the need for the involvement of communities and ULBs. The NCU’s focus on the poor and the marginalized was also an extension of the overall shift from “welfare” to “development” oriented planning within the framework of the “ive year plan” and a recognition that women and children also mattered. However, while this and the commitments to the Global Water and Sanitation Decade did introduce strategies for community and women’s participation in the rural water supply and sanitation programs, the urban sector remained more or less passive and continued with its supply-driven infrastructure and facilities approach. 6.4.2 Subsequent to the Water and Sanitation Decade, the ive-year plans began to lag the community’s role in the operation and maintenance of water points and other assets created. However, the plan deinition of the concept was limited to token statements like “…consulting and involving women at all stages of program and project planning…”, or “NGos and community participation to be encouraged by State governments…” with the latter in a way equating the role of NGos and communities as one and the same. Furthermore, the policies and plans were not backed by any speciic guidelines and the concept of “women’s participation” remained a mere statement that could not be internalized and translated into action plans with indicators to measure progress and impact. In fact, involvement in taking the commitment of international and regional agendas like the MDGs and SACoSAN, wherein women’s participation and gender have matured into mainstreamed strategies in several participating countries, does not seem to have made any signiicant impact on the urban WASH sector and its limited programs of intervention in India. 40 6.4.4 The NUSP and the SSSs and CSPs that emerge out of it merely refer to the urban poor and women. The policy acknowledges the impact of poor sanitation on women and the need to address this. It broadly talks about “reaching out to the unserved and the poor” without in any way deining the proile of the “unserved” and the “poor”. Moreover, the issues of the poor and unserved have been addressed solely from the point of tenure security and lack of availability of land acting as barriers to access! Hence, the guidelines for the preparation of the CSP, which otherwise gives a comprehensive framework from establishing baselines to identifying impact and outcome, provides little scope for relecting on the needs of the women or gender-based needs. The CSP also requires the establishment of a City Sanitation Task Force as a mandatory precondition. Although the task force plays a pivotal role and can inluence the provision of sanitation in the city, it does not specify the inclusion of a social or gender specialist in the team. Most of the CSPs that have been prepared so far do not have a gender or social development specialist on board the task force; however, some CSPs, like that of Shimla, have talked about the lack of “gender-sensitive” community toilet designs, the impact on women, and the need to make provisions for them. Similarly, the Sanitation Rating Criteria, on the basis of which cities are to be declared totally sanitized or otherwise, does not have any speciic indicator to assess inclusion and gender integration. As such, it is apprehended that the CSP will predictably be another plan document that would ignore gender-based needs. 6.4.5 The only two stand-alone schemes—Integrated Low Cost Sanitation (ILCS) and Accelerated Urban Water Supply Program (AUWSP), when it existed—similarly did not have a clear-cut strategy for community participation and inclusion of women. To its credit, though, the AUWSP states that community participation was the “cardinal” principle and that improvement in the quality of the life of the poor, especially women, was one of its key objectives. But, thereafter, no guidelines were provided to operationalize participation, so much so that various evaluations undertaken during the course of the implementation of the program do not even address the issue or bring it within the scope of the evaluation. Similarly, although a large number of sanitation workers and manual scavengers are women, the Manual Scavengers and Construction of Dry Latrine (Prohibition) Act and its successor, the newly introduced bill, do not refer to the separate roles played by men and women. Thus, while the act and the scheme attempt to do away with an age-old custom that discriminates a particular community, it fails to address the issue of discrimination within the community itself and the speciic impact of scavenging on men and women. In the case of ragpickers, while several civil society organizations have been making relatively successful attempts to organize and facilitate them to acquire better working conditions and basic services. They have been conscious about bringing women in communities within the scope of interventions, but there have been no policy and program interventions on the part of the states as yet. 6.4.6 on the other hand, integrated slum development projects like the Basic Services for the Urban Poor (BSUP), where water and sanitation were critical components, were conceptualized and designed with women 41 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 6.4.3 The shift from compartmentalized programs and projects into a sector-wide reforms process under the irst phase of JNNURM has also not achieved much in terms of community participation, inclusion and gender, although there are separate missions—Basic Services for the Urban Poor (BSUP) and Integrated Housing and Slum Development Program (IHSDP)—focusing on the poor. There is also a mandatory reform that makes it necessary to earmark at least 20 percent of the municipal budget for the poor. on the other hand, projects under BSUP and IHSDP, which have a water and sanitation component, are merely being implemented as construction projects (barring a few where NGos and civil society organizations have been active); and system improvement processes, like establishment of SLBMs for water and sanitation, are silent on the gender and inclusion front. The SLBM, which otherwise is a dynamic and exhaustive system for rating the city in terms of eiciency, efectiveness, and coverage of services, falls short of providing and monitoring a gender disaggregated picture. The Report Card, that the SLBM generates, is hence “genderless” and does not relect the extent of inclusion achieved in a given year. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM at the centre and provided with tremendous opportunities to plan and manage the WASH services. Under the UBSP, women from poor communities were organized into neighborhood groups (NHGs) and federated and networked at ward and city levels into Neighbourhood Committees and Community Development Societies (CDS). The groups were trained and empowered to identify their basic service needs at the neighborhood level and the subsequent plans that emerged were then consolidated at the city level. The plans were to be considered by the ULBs with the NHGs/CDS monitoring the progress of implementation. Women hence conceptually had a signiicant opportunity to ensure that basic services like water and sanitation reached them and in the way they wanted. However, apart from Kerala, where the program evolved into a statewide process involving a large network of women and bottom-up planning (Kudumbashree), most of the other states have failed to efectively utilize the concept16 and the program. 6.4.7 What is of concern, however, is that in terms of the institutional structure and the delivery mechanism in the WASH sector, there has been little scope for gender mainstreaming. As stated earlier, water and sanitation is the responsibility of the states and delivered through line departments or parastatal agencies and the ULBs. However, these departments and agencies are structured, primarily, as engineering and administrative units with little scope for internalizing strategies for community and customer orientation. Infrastructure, rather than improving services, is generally the mandate. Hence, most of them fail to address the needs of the various sections of the society. Projects are designed almost exclusively within and around technical norms and mathematical projections of infrastructure and service requirements. 6.4.8 While capacity building is a distinct and well- funded component within the rural water and sanitation sector, in the urban projects this is yet to be structured and delivered to respond to the needs of the stakeholders, especially the ULBs, line departments and the frontline workers. The Eleventh Plan made attempts to focus on building capacities of the ULBs through a series of interventions. However, these were disjointed and have not looked at capacity requirements in a broader perspective. This element is almost totally absent in the case of gender mainstreaming. However, some beginnings have been made in externally funded projects like the Water for Cities program of the UN Habitat in Madhya Pradesh, which has made some serious attempts to begin by assessing and developing strategies for gender mainstreaming. 6.4.9 In terms of budget allocation, most of the funds for water and sanitation low from the central government via the states and the ULB route through stand-alone projects or integrated schemes. At present, funding is almost exclusively through JNNURM and its sub-missions. The area of concern is the inadequacy of budgetary allocation, on the one hand, and the inability of urban institutions, especially municipal bodies, to absorb and manage these funds, on the other. Secondly, although some amount is earmarked for o&M, it is grossly inadequate. Under these circumstances, not only are the ULBs and other agencies unable to provide adequately for the urban poor, but focusing on the special needs of women in terms of design, location, and adequate number of facilities is not a planned priority. A recent study (Travers et al. 2011) on gender budgeting in water and sanitation with reference to the slums of Delhi concluded that although the union and most state governments have adopted the practice of gender budgeting and generate an annual Gender Budget Statement, water and sanitation is not speciically relected in it. Further, the concerned water and sanitation departments and agencies at the union or state levels also do not provide gender disaggregated data, which makes it diicult to assess the volume spent on women in the provision of water and sanitation. In fact, gender budgeting is generally limited to reporting the allocated budget and expenditure against programs and schemes that are clearly directed toward the development and welfare of women. on the other hand, there is no system to analyze the budget and expenditure in the provision of universal basic services like water and sanitation. 6.4.10 Having said that, it has been observed that wherever the states and the ULBs have been progressive and willing to experiment, some innovative and thoughtfully planned community-based strategies have 16 The concept of NHGs and CDS is now part of the urban poverty alleviation program SJSRy. 42 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM evolved, with many of them scoring success. A signiicant number of these projects have centered around the active participation of women and women’s groups or have been designed keeping the needs of women in mind, while others have focused on the broader concept of CBos. Most of them have been in partnership with the ULB and often supported by the state or a non-state agency. 6.4.11 For instance, the partnership between the city corporation of Tiruchirapalli, local NGos and Water Aid (INGo) led to the establishment of community toilets across the city (Box 6.3). Central to the strategy was the focus on women and women’s SHGs, dialogues with men on the beneits of sanitation to themselves and their families and to the community at large the overall empowerment of women and integration of other issues relevant to women, like domestic violence. The program is also rated as a success because of the establishment of a community-based system for the o&M of the toilets. Similarly, a slum sanitation program initiated by the Pune Municipal Corporation (PMC) and led by the then municipal commissioner in the late 1990s for the construction of community toilet blocks by NGos had some success where the NGos had engaged intensely with the communities and established a women-led community participation process. Two of the NGos involved, namely, SAPRC and Shelter Associates (Box 6.4) worked through their respective women’s groups— Mahila Milan and Baandhani. While the PMC provided funds, electricity and water, the NGos together with the CBos prepared the design of the community toilets and, in some cases, even constructed and maintained them by collecting monthly family contributions. Although the women led the show, in most cases the men provided support. 43 Box 6.3: ToTAL SANITATIoN IN TIRUCHIRAPALLI WHERE WoMEN LEAD AND MEN FoLLoWED Background PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Tiruchirapalli, with a population of a little over a million people, is the second largest municipal corporation in the state of Tamil Nadu. There are around 280 slums in the city, located along railway lines and on open grounds which belong to the state government or local bodies or temples. While 70 percent of these slums are categorized as “approved” by the government, the remaining fall into the category of “unapproved”. The slum population of 162,000 accounts for almost 25 percent of the city population. Before 2000, Tiruchirapalli was one of the most unhygienic cities in the country, with minimal basic services and frequent outbreaks of waterborne diseases. The Tiruchirapalli City Corporation (TCC) had constructed several community toilets during the 1980s and 1990s and had also managed them on its own. However, due to inadequate arrangements for maintenance, most of these community toilets had gradually fallen into disuse. open defecation was rampant and the women complained about fecal contamination of water sources and the lack of initiative on the part of the male community leaders and TCC to improve the situation. The scenario began to change in the year 2000, when TCC, together with Gramalaya, a local NGo and WaterAid, a UK-based NGo, initiated a collaborative project to improve the situation. Initially launched in a few select slums, the project was scaled up over the years to cover the entire city. Today, Tiruchirapalli is ranked as the sixth cleanest city in the country. This success is largely attributed to the active participation of women’s groups in the management of community toilets as well as in the promotion of healthy and hygienic practices. Mobilizing and organizing the community: a women-led Process Gramalaya began operations in 2000, with a survey in the slums to assess the situation. Gramalaya realized that it was important to ensure the regular and adequate maintenance of the toilets, apart from renovating and constructing new ones. Hence, it followed a two-pronged strategy: irst, by identifying and strengthening adequate manpower resources for daily maintenance of the toilets, and, second, by framing a suitable inancial management plan for the sustenance of the community-managed sanitation system. The project included the renovation of old community toilets and installation of individual and new ones; and, most importantly, it also included the mobilization of the community to manage the toilets as well as adopt hygienic practices. WaterAid provided funds for the equipment and installation, Gramalaya the capacity building and community mobilization components, and the government subsidized the land, electricity, and water supply requirements as well as provided loans to community members. Gramalaya at irst established women’s SHGs in the slums, with each SHG consisting of 15 to 20 members. Thereafter, the Sanitation and Hygiene Education (SHE) team was established at the slum level, consisting of all the members of the SHG, and a joint bank account was opened in the name of two of the chosen leaders of SHE. These two women also represented SHE in the Women Action for Village Empowerment (WAVE), a federation of all SHEs and other women SHGs registered under the Tamil Nadu Corporation for Development of Women. Participation of the community and outreach was considerable, since, on average, one woman from almost half the households in the community was a member of the SHGs and, consequently, SHE. 44 on seeing the success of the interventions and the impact on the environment in the slum, the men who had earlier shown no interest wanted to join in. The women created the Association for Water, Sanitation and Hygiene (AWASH) to allow men’s participation. outcome The toilets managed by the SHE teams are better designed and more user-friendly than those managed by the TCC. The SHG-managed toilets have more seats for children and more bathing and clothes washing facilities. Besides, hand-washing facilities (basins with soap) are available in these WAVE-supported toilets. Some of the caretakers even encourage users to wash their hands. The SHE teams also sell soaps, shampoo sachets, oil and talcum powder in the toilet complex. In fact, the facilities in these toilets are much better as compared to other toilets. However, apart from installing hand pumps, constructing community toilets with child-friendly toilet facilities, renovating community toilets and constructing household toilets with the help of SHGs, the most signiicant contribution of the collaborative venture led by the women has been the signiicant fall in the incidences of diarrhoea among children from 73 percent to 10 percent and among adults from 10 percent to 2 percent and a consequent reduction in household medical expenses to the tune of over 80 percent. Besides, the maintenance of the community toilets has also resulted in providing employment opportunities to some community members and has encouraged women leaders to come forward. Studies indicate that because women were directly involved in managing all aspects of sanitation, including inancial supervision and reuse of earnings for slum welfare activities, both their skills as well as sense of empowerment was enhanced. The TCC built more toilets and handed over half of them to the SHGs for maintenance. All the 211 approved slums now have community toilets, out of which 167 are managed by women groups. Source: Compiled from: (i) Sadhukhan et al ( June, 2012); (ii) UN (2006); (iii) Water Aid (2008). 45 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM The SHE teams were entrusted with the responsibility for planning, implementation, monitoring and maintenance of the entire sanitation program, including raising awareness within the community and ensuring that people moved away from the practice of open defecation. Each SHE team took responsibility for the o&M of the toilet on a monthly rotation basis. Each member also had to take up the responsibility of a caretaker for a day in the month. Besides, most SHEs also employed a male and female cleaner to clean the men’s and women’s toilets and a watch woman for guarding the facility and for the operation of the water pump. The SHE teams ixed the user fees for defecation, bathing, and washing clothes. While the rates varied for adults and children, urination and use by children, the elderly and single women was free. Cash collections were deposited in the bank account and the books of accounts were meticulously maintained by the SHE team while the TCC regularly audited the accounts. The surplus, after covering o&M expenses, was used for health and sanitation-related promotional activities in the community. In case of major expenditure, the SHE team was authorized to take a loan from the WAVE federation. Box 6.4: BAANDHANI’S EFFoRTS To IMPRoVE SANITATIoN IN PUNE AND SANGLI Sanitation in Pune PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Pune is a fast-growing city, and in 2000 approximately half its population lived in about 500 informal settlements. Most of them lacked basic services, especially sanitation. The Pune Municipal Corporation (PMC) is responsible for providing communal toilets in informal settlements—both construction and maintenance. However, although several toilet blocks had been built over the years, many of them were in poor condition. The then municipal commissioner took it up upon himself to improve the situation, but this time with the involvement of NGos. PMc-NGo-cBo collaboration Eight NGos were selected and initially given the responsibility of demolition and reconstruction of old dilapidated toilet blocks. Subsequently, they were to build new blocks on new sites. Shelter Associates took responsibility for the construction and maintenance of 13 community toilet blocks in Ambedkar Nagar settlement, in the fringe village of Dhayari and two other fringe villages where they have been working with a collective of women since 1998. For Shelter Associates this was an institutional arrangement with potential for poor women and men to have some involvement in a project which directly afected their settlements. Shelter’s approach is based on the concept of community-led interventions and organizing and empowering communities is critical to the process of provision and management of facilities. “Baandhani” (which in the local parlance means “building together”), a collective of women and men, has evolved as the platform for community participation. According to Shelter, Baandhani works on the basis of three key principles: the power of numbers, the power of money, and the power of information. In operational terms the “power of numbers” assumes that the community as a whole would be able to deal with problems which an individual cannot tackle; the “power of money” is based on the assumption that when the poor demand basic services as a right they also accept the responsibility to pay for it in cash, labor or for upkeep and management; and the “power of information” ensures that the community can conidently ask for its rights, backed by knowledge and information. Baandhani has thus been groomed to partner Shelter in all its activities and is speciically responsible for crisis savings, planning for resettlement and settlement improvement, toilet maintenance, facilitating the slum surveys and engaging in informed negotiations with the municipal agencies for better services. Baandhani also works closely with Shelter during the construction phase and so far has motivated households to provide building material and unskilled labor while also supervising the work. community in construction Skilled people from within the settlements were employed to work on the project, which increased local interest and a sense of connection to the new toilets. Residents from Kirkitwadi fringe village worked on their toilet block and two Shanti Nagar residents took on the painting of their toilets and added their own murals to the block. They also painted other blocks in the same area. In Ambedkar Nagar, in Dhayari fringe village, community involvement was central from the start. Women played a key role in organizing the materials on site, keeping track of deliveries, coordinating on a daily basis with the Shelter Associates oice and organizing community members to carry materials from the road to the construction site. 46 Each of the new blocks built by Shelter Associates was diferent, according to the needs and ideas of the local people and the available site and space. Each block has a small toilet for children under the age of ive. This consists of a half-pipe which the children can squat over and is located inside or just outside the women’s side, where mothers or older sisters can supervise. This is lushed in the same way as the adult toilets, by the women who accompany the children. The number of toilets is adequate so there have been no queuing problems with respect to the toilets which are already in operation. community Managed Maintenance Shelter Associates’ focus has been on involving local people in the maintenance of the completed block. Community members are best able to work out a maintenance system which will function efectively in their own settlement. This does not mean that local people are expected to clean and repair the toilets themselves; instead it places them in a position where they decide who will maintain them and how, and can ensure that the work is satisfactory. Such a system is also likely to be more sustainable over the long term since it reduces the dependence of poor women and men on outsiders for clean and functioning toilets, whether the outsiders are the corporation employees or an NGo. Source: Extracted from Hobson (2000) and Nair (2006). 6.4.12 In 2012, the Bhubaneswar Municipal Corporation (BMC) entered into a collaboration with the Mahila Housing Trust (MHT-SEWA) for constructing in situ houses under the BSUP program, with individual toilets as a component. Mahila Milan, the women’s group of MHT, has not only improved on the design of the overall house to suit the location and space available, but also resurveyed the community so that the actual beneiciaries could be identiied. The women from Mahila Milan justify the extent of their involvement and workload as a practical strategy as the men are engaged with the business of earning a living. Moreover, it is also more diicult for the men to amicably interact with the oicials from the municipal corporation and other government agencies. Similarly, the Slum Networking Project in Ahmedabad is a partnership between the Ahmedabad Municipal Corporation (AMC), NGos (MHT, SAATH and World Vision), and communities (CBos) and was initiated in 1995 (then in partnership with the private sector). The project aims at providing access to water and sanitation to the households living in the slums and chawls of Ahmedabad, together with drains, street lights, etc. All partners contribute, with the AMC bearing about 80 percent of the cost of the physical infrastructure and the community the remaining 20 percent. The NGos are responsible for the community processes and also implement other development interventions in the area and are paid on the basis of per household for the networking component. Most of the NGos either created exclusive women’s CBos or encouraged women to lead the process. The successful elements from the project have been included in the Gujarat States Urban Slums Policy. MHT has now taken the concept forward to other states like Madhya Pradesh, Rajasthan and odisha. 47 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM In most settlements, Shelter Associates was able to generate some interest at the design stage despite the lack of time for extensive discussions or workshops. Inputs from local women and men have deined some signiicant aspects of the layouts. other design changes emerged later. In high-density Shanti Nagar, women living next to the toilets suggested shielding walls at the toilet entrances. In SangamWadi, women residents were indecisive about the position of the entrance to the women’s toilets. Initially, they asked for it to be on the opposite side to the men’s in order to minimize harassment but then changed their minds during construction because the new position placed the entrance in front of a house which, they decided, was to be avoided as a priority. Box 6.5: HoW WoMEN PAVEMENT DWELLERS IN MUMBAI CoNSTRUCTED ToILETS To SUIT THEIR NEEDS life of women on the Pavements PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Sixty-ive percent of Mumbai’s total land area comprises sidewalk slums. A large percentage of this area is used by poor and marginalized communities who have constructed their dwelling units on the pavements in the city. The life of pavement dwellers is hard. They have no steady source of income and are forced to take odd and often physically exacting jobs. It is even harder for the women on the pavements and most of them end up taking up jobs like hawking goods and ragpicking. Legally, these pavement slums have no access to basic services and hence are highly vulnerable to extortion from local musclemen who extract for the dwelling units and also force them to pay in cash or kind for basic amenities such as water, electricity, and toilet use. Again, the women sufer the most. They have to travel lengthy distances to the municipal pump, wait for hours for the water truck to arrive and, similarly, line up to pay for the use of the toilet. Thus, a family on the pavement has to pay a substantial part of its daily income for accessing basic services. toilets and Services that do not cater to the community’s Needs There have been several attempts to resolve the situation. In 1994, the Bombay Sewerage Disposal Project (BDSP) was launched with the support of the World Bank. one of its primary goals was to establish toilets for at least one million people, particularly the pavement dwellers, throughout the streets and sidewalks of Mumbai. Several community toilet blocks were thus built between 1994–97. However, most of them remained unused or were soon abandoned primarily because of design failure and poor maintenance. The toilet design did not provide adequate privacy for the women and was narrow in approach and hence prone to congestion during peak hours; the doors of the toilets opened inwards, thus further constricting the space and poor ventilation made for a stiling environment; the design of the aqua privy was unsafe for little children; and as there were no surrounding wall around the complex it could be viewed from the street, especially after the cheap material used eroded with time. the Solution: toilets Built and Maintained by the women of the Pavement When all requests to the municipal government and agencies failed, the women from the pavements began to look elsewhere for support and formed an alliance with the Society for the Promotion of Area Resource Centres (SPARC) and two CBos, the National Slum Dwellers Federations and Mahila Milan. It was a collaborative venture with SPARC conducting surveys to obtain an accurate count of functioning toilet seats and the National Slum Dwellers Federations and Mahila Milan helping to organize the women from the pavements and slums into toilet committees and equipping them with strength and power to control the technology and management of the toilets. Each toilet committee was not only responsible for managing and cleaning the toilet blocks, they also took the responsibility for researching, holding counsels, planning, building, administering and maintaining the community toilet blocks. They worked together with local architects to evolve design plans for the toilet blocks. However, they retained supervisory veto powers to change or modify the designs according to their speciications. The design of the toilet itself is a study in contracts and was the primary reason for the success of the venture: It has exterior walls that are built around the toilet stalls themselves. As a result, even when the stall doors erode, the privacy would be retained. Furthermore, the exterior walls have no plumbing attachments unlike the ones constructed earlier and therefore are not subject to rust and leakages. The stone slabs that the women have chosen for construction over the ceramic loor tiles, makes the toilet blocks more sustainable, clean and more acceptable to others living around the slum. The doors of this model swing outward, which eliminates contact with the stall’s walls and also makes it easier to navigate. Each stall is ventilated on all four sides. 48 once these women toilet committees were established and given a voice within their communities, Mahila Milan took over the role of establishing them as a workers’ union so that they would be able to practice their trade and create a sustainable profession and existence as toilet designers and constructors. Thus, Mahila Milan developed an all-women centralized “Builders” Guild’ of masons, construction workers, plumbers and electricians. Each of these women has been fully trained in designing and building low cost houses and toilets. Their initiatives spread to other communities where more toilet committees were formed as a result. These toilet committees gained easy acceptance from the slum communities as the women proved that they were not only able to design and construct fully functional toilet blocks that met the cultural speciications but also because they were able to stand up against the middlemen. The women contribute their own unskilled labor for upkeep, upgrading, and are fully responsible for on-site maintenance of the toilet blocks, which reduced costs further. Source: Extracted from Sharma (2006). 49 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM The women’s design also takes into consideration the safety of themselves and their children. By simply having both the men and women enter from two separate lines behind their respective stalls, the congestion and bottleneck efect are reduced; also, the stalls waiting area is women or men only, which eliminates the harassment as well as provides a safer environment for children to enter and use the facilities safely. once inside the complex, the women have specially designed shallow latrines for children’s use only. These “baby channels” allow the children to squat within their mother’s enclosures keeping them safely within site and of of the streets. Thus, a more community friendly design has led to increased usage and consequently a cleaner environment and a healthier community. 6.4.13 The ULBs have also been initiating and supporting initiatives other than the provisioning of infrastructure and services. For instance, the PMC entered into a contract with SWaCH (Seva Sahakari Sanstha Maryadit, also known as the Solid Waste Collection and Handling), a wholly owned cooperative of self-employed waste pickers which provides front-end waste management services to the residents of Pune. Promoted by Kagad Kach Patra Kashtkari Panchayat (KKPKP), a membership-based trade union of 9,000 waste pickers, 80 percent of whom are women, today SWaCH services almost 400,000 households across 15 municipal wards. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM Box 6.6: PRoTECTING LIVELIHooDS oF WoMEN WASTE PICKERS: KAGAD KACH PATRA KASHTKARI PANCHAyAT introduction Waste pickers, “kabariwalas” or ragpickers, as they are also known, constitute a signiicant percentage of the urban poor and live in conditions of utter deprivation. Their settlements also double up as the site where the waste collected from other parts of the city is sorted and tagged for sale. In other words, these are the unoicial dumping grounds. Because of the nature of their work they are pushed to living at the edge of settlements or separate and isolated settlements that are poorly serviced in terms of water and sanitation facilities. over the last decade, their traditional occupation has also been under threat from large agencies that now see wealth in the waste and have found an entrance into the business because of the policy of the states to encourage private participation in the sector. Kagad Kach Patra Kashtkari Panchayat (KKPKP), a registered trade union of waste pickers in Maharashtra, 70 percent of whose over 6,000 members are women, have however come together to sort out their lives through collective decision making and action. Most of the members are from the dalit communities. organization and agenda: a Gendered approach Formally launched in 1993 in Pune during the course of the implementation of an adult education program, KKPKP was started after prolonged interactions with the local waste pickers and the realization that what the waste pickers most wanted was not to learn new skills and enter new occupations, but to change the hard and exploitative conditions of their work. Thus, the initial group of waste pickers came together to establish the collective identity and interests of scrap collectors. Both men and women working as scrap collectors were eligible to become members irrespective of caste, region and religious ailiation, and the union decided to not only address the immediate and sectoral needs of members but also ight against injustice and exploitation. The strategy adopted by the union is based on the following understanding:  That the unprotected and unrecognized waste pickers and itinerant buyers are the poorest and the most marginalized among poor urban workers. on the one hand, they tend to be left out in the development initiatives because of the nature of their work; on the other, they get subsumed into the urban informal sector. Hence, the strategy is to get waste pickings recognized as a trade.  That poverty is not only an economic issue but also has social, cultural, and political dimensions. Hence a holistic approach that encompasses struggle against all forms of injustice, inequality, and exclusion in the social, economic and political spheres is adopted.  That development and livelihood activities, such as the credit cooperative and the scrap store, alone cannot challenge entrenched power structures. on the other hand, they sustain the involvement of members for whom the costs of struggle are high. Hence, a combination of mass struggle and development interventions have to be adopted. 50 The union is headed by a president and supported by the general secretary, the joint secretary and the treasurer. There are 11 members on the statutory governing board, eight of whom are scrap collectors, two men and six women. The representatives’ council consisting of 80 elected representatives—75 women and ive men—and the oice bearers govern the union. The council meets once a month to deliberate issues and for review, planning and decision making. The decision-making process is consensual and democratic. Members belong to the scrap collectors living in slums spread across the Pune Urban Agglomeration comprising Pune-Pimpri-Chinchwad. achievements Using a process-oriented methodology, where self-analysis and collective decision making are the means to empowerment, the union has achieved much since its inception. on the one hand, it uses peaceful agitational methods and, on the other, it also focuses on social development issues like domestic violence, child marriage and education, and freeing women from the clutches of moneylenders and gold loans, unlike traditional unions. Following are some of its landmark achievements:  Based on evidence of their social, economic, and environmental value, the scrap collectors lobbied to be recognized as “workers” by the PMC and, subsequently, the government of Maharashtra also recognized them as such in 1995–96. This led to the scrap collectors being issued identity (ID) cards which not only gave them an oicial status and sanction for collecting scrap from the city, but also a sense of self-worth and dignity.  KKPKP negotiated for space for sorting scrap in the bylanes of the city. Subsequently, in 1998, they were also provided with a piece of land by the PMC, free of cost, to construct a cooperative scrap store.  In the same year, the central government aided scheme for pre-metric scholarship, which was until then only open to the children from families engaged in carrying night soil, was extended to the children of waste pickers. Because of this and similar eforts, the percent of child labor in scrap collection has been reduced considerably.  In 2003, the PMC institutionalized a medical insurance scheme for all registered ragpickers, wherein the PMC paid the premium and made a provision for it in its annual budget after KKPKP successfully argued for it. A contributory group insurance policy (LIC) to cover accidental and natural death had been launched earlier in 1997–98.  KKPKP has been able to claim other states’ resources on the basis of being recognized by the states. KKPKP is also struggling for other medical facilities from state-run hospitals. They are also in the process of preparing a comprehensive health plan.  Within the community, KKPKP have been addressing such social issues as rape, child marriage, and domestic violence. 51 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM  The women waste pickers acknowledge the fact that the men in the community have an advantage over them in the ield of work as they are more mobile and less vulnerable to harassment. At the same time, they are also aware that men in the sector are equally poor, from the same castes, and almost as powerless as them; the diference lies in the degree of powerlessness. However, violence and inequalities are more pronounced within the households, and women, while resenting it on one hand, also accept it as the man’s need to “exhibit their masculinity somewhere”. Hence, although the union includes both men and women, it recognizes and addresses the gender inequalities. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM  one of the most efective and innovative achievements, however, has been the promotion of Solid Waste Collection and Handling (SWaCH). It is the irst wholly-owned cooperative of self-employed ragpickers in India and has been contracted by the PMC to provide door-to-door waste collection services across Pune. SWaCH was born out of the response of KKPKP to the Municipal Solid Waste Management Rule formulated by the Government of India in the year 2000. The rule stipulates that identiied municipalities in the country had to undertake doorstep collection of solid waste and also promote segregation at the household level. Most municipalities chose to contract out the service to local or large multinational agencies, at the cost of the waste pickers. KKPKP, on the other hand, thought of integrating the waste pickers into the SWM process and initiated a pilot project in 2005 which was scaled up as SWaCH in 2008 across all the 144 municipal wards in the city. Source: Compiled from Chikarmane and Narayan (2005) and Nair and CHF (2009). 6.4.14 on a larger statewide scale in Bihar, under a DFID-supported program, women’s neighborhood groups are being formed and trained to undertake micro-planning for basic services, including water and sanitation. Further, they are also being empowered through federated committees at the slum level to monitor the construction of activities that are primarily the responsibility of the ULBs and engineering cells of the government. on the other hand, in Madhya Pradesh, attempts have been made to mainstream gender into urban planning and management under the UN Habitat’s Water For Asian Cities program and the ADB-supported program in the four cities of Bhopal, Indore, Gwalior and Jabalpur for the improvement and expansion of urban water supply, sewerage and sanitation, water drainage and solid waste management. The strategy, developed and implemented with the collaboration of the ULBs, the states and a local NGo, is aimed at reducing the number of people—women and men, girls and boys—without access to adequate water and sanitation; covering 100 percent of the population (both women and men) with appropriate, adequate, and sustainable water and sanitation services in the selected cities; ensuring that all schools have full-time water supply and separate and appropriate toilets for boys and girls; and that local women and their groups manage the functioning of water and community sanitation facilities in the slums. The program also developed commensurate indicators to monitor progress and impact. 6.4.15 However, planners and practitioners are now increasingly advocating the need to assess the additional “burden” that the women may face when programs become women-centric. Apart from the fact that the women become responsible for planning and managing project implementation, the task of operating and managing facilities also becomes their responsibility. Additionally, while hygiene education interventions leading to improved awareness does lead to the adoption of better practices, it may also increase the burden on women by way of increased tasks like bathing children more regularly, cleaning the house and kitchen, boiling water, etc. (Jha 2010) and also activities that are part of the larger community participation. 6.4.16 It is evident that the water and sanitation policies and schemes—whether stand-alone or integrated— have not expanded their scope to include inclusive and gender-mainstreamed approaches. At the same time, however, potentials and opportunities to do so exist, as can be seen by the initiatives taken by some of the states and ULBs. Under SACoSAN, India has committed itself to undertake very speciic time bound plans to improve the overall situation within a rights perspective. This also includes the establishment of a monitoring mechanism and indicators of participation and inclusion. Further, other sector policies like the proposed National Urban Health Mission (NUHM), Sarva Shiksha Abhiyan (SSA), National Mission for Empowerment of Women (NMEW) and decisions taken at the last SACoSAN present opportunities to mainstream gender. While the draft NUHM provides for women’s groups—Mahila Arogya Samities—as a medium of interaction with communities at the household level, like the NRHM it also seeks to integrate water, sanitation and hygiene interventions for improvement in the overall status of health of poor communities in the urban areas. Further, 52 6.4.17 In fact, the beginning of the 1980s saw women’s development being hesitantly brought into the plan agenda, thereafter moving from focus on women-in-development (WID) to women’s empowerment and gender equality with the Seventh, Ninth and subsequent plans. However, it was the outgoing Eleventh Plan which for the irst time recognized women as both equal citizens and agents of economic and social growth. The Eleventh Plan hence adopted a multi-pronged approach to gender equity that aimed at providing women with basic entitlements, ensuring their participation and adequate representation at the highest policy levels, strengthening existing institutional mechanisms and creating new ones for gender mainstreaming and efective policy implementation, and ensuring an environment free from all forms of violence against women, among others. This approach was to be applied across sectors with the adoption of a convergence strategy (GoI, Planning Commission, 2008a). Box 6.7: THE ESSENCE oF THE ELEVENTH PLAN STRATEGy FoR WoMENS AGENCy AND CHILD RIGHTS  Recognition of the right of every woman and child to develop to her/his full potential.  Recognition of the diferential needs of diferent groups of women and children.  Need for inter-sectoral convergence as well as focused women and child-speciic measures through MoWCD.  Partnership with civil society to create permanent institutional mechanisms that incorporate the experiences, capacities and knowledge of voluntary organizations and women’s groups in the process of development planning. Source: Extracted from the Planning Commission (2008b). 6.4.18 The process of ensuring participation and gender equity across sectors was further strengthened when in 2010 a National Mission for Empowerment of Women was launched under the Ministry of Women and Child Development (MoWCD). Access to health, drinking water, sanitation and hygiene facilities for women is one of the six focus areas of the mission with convergence of schemes and strengthening the institutional framework for the same being one of the key strategies. The Ministry of Housing and Poverty Alleviation (MHUPA) as well as the Ministry of Health and Family Welfare (MoHWF) are two of the partner ministries in the mission. However, the urban water and sanitation sector has so far failed to absorb and integrate the provisions of the plan. 6.4 .19Hence, while gender is missing from the urban WASH agenda in practice or is limited to women’s participation, there is scope to revisit and interpret programs along a gendered line. 53 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM SSA and the school sanitation initiative provide ample opportunities for addressing both infrastructure and hygiene promotion issues in schools for both boys and girls. And, most importantly, a separate women and child development department and agenda exist with the goal to improve the situation of women. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 54 7. eMerGiNG iSSUeS aND SUGGeStioNS 7.1.1 Water and sanitation is a universal basic service in a rural and an urban context. This implies that at one level both men and women, irrespective of age, class, social groups and location, have basic minimum needs aligned to their biological and bodily requirements. At another level, the needs are inluenced by cultures and traditions, by trades and occupations, by virtue of households being located in the urban or rural areas, and, to some extent, the diferent climatic regions. Hence, use and practices related to water and sanitation may difer from community to community and between men and women within communities and caste groups. Establishing a gender perspective within the urban water and sanitation sector would, therefore, require an analysis and understanding of three separate yet interlinked scenarios, that of (i) urbanization, poverty, and slums (ii) service delivery and (iii) the location of gender itself in a contextual framework. 7.1.2 Urbanization in India, as described earlier in this report, has been marked by a relatively slow pace of growth but with a large population in actual numbers. The bigger cities have become more crowded and the number of settlements designated as Class I have increased signiicantly. Data and demographers predict a faster pace of growth in the coming decades, with the economically advanced states showing higher levels of urbanization and faster development in some states (southern and western states), calling for urgent action but diferent strategies for the smaller and larger cities.17 Further, data also indicates that cities are sprawling and extending their boundaries beyond their existing administrative limits, bringing into focus the diicult issue of providing urban services for a population that is still rural in occupation, culture and lifestyle. 7.1.3 Then, again, migration over the last decade has been on the increase (from 42 % to 56 %t), with the larger cities attracting the largest share of migrants and poorer and less developed states (Uttar Pradesh and Bihar) contributing signiicantly to the outlow. The sheer number of population in urban areas puts increasing pressure on land and other productive resources and services. Service provision against this background would entail acknowledging and understanding the dynamic proile and growth trends amongst diferent categories of urban areas. It would also mean developing strategies at a scale and with dimensions that can be handled only through careful planning and decentralized structures with the right capacity and adequate resources. Within this scenario, unless speciic policies and approaches are adopted and checks and measures are put in place, marginalized sections of the community, especially women, get left out of the beneits. 7.1.4 The most worrisome physical manifestation of the pattern of urbanization in India is the visible existence of poverty, the stark inequalities and the growing number of slums, in both large and small cities. Besides, the large number of homeless population and squatters who live on pavements, footpaths, and under bridges and lyovers is evidence of the inability of city governments to provide for all its citizens. While the slums themselves have to contend with issues of land tenure and insecurity, grossly inadequate housing and basic services and the accompanying risks and vulnerabilities that go with it, these problems multiply in the case of the homeless. Given that living in the urban areas is more monetized than in rural areas, access to services and facilities becomes that much more challenging for the poor and the marginalized. Therefore, 17 The Twelfth Five year Plan and the proposed JNNURM Phase II will focus on the small and medium towns. 55 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 7.1 emerging issues PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM while the existence of poor communities in cities and towns is a function of the complex process of urbanization, any interventions to improve services need to take into account that the poor are not a homogeneous category and neither are they conined to the slums alone—they also live on the streets and on the fringes of cities in settlements that are more rural than urban in character. 7.1.5. Within this scenario women fare worst on most fronts. Although poor women in urban areas apparently have relatively greater access to health, education and jobs than their counterparts in the rural areas, they remain more disadvantaged and vulnerable than the men in the urban areas because they are generally more income poor than the latter, face greater diiculties in accessing resources and in decision making to ensure that facilities and services are tailored to meet their speciic needs. In comparison to the rural areas, a large number of poor women in urban settlements are constantly vulnerable to evictions because of uncertain tenure. Where tenureship is uncertain, services are also uncertain because state agencies are weary of investing—they fear that either the slum dweller will be encouraged to retain his hold over the land or the investments will go waste in the event of the slum being removed. Hence, women living in unrecognized and unapproved slums or settlements have greater issues of access to WASH facilities and services. Among women from poor urban communities, those living on the streets may be more vulnerable than women living in the slums. Women are, in fact, exposed to greater risks and vulnerabilities on all fronts in the urban areas, with vulnerability to violence of all kinds cutting across all dimensions. 7.1.6 In terms of WASH this translates into issues of infrastructure and services catering to the speciic needs of women and ensuring their health, safety, and dignity; services that are time and cost saving for women in terms of money spent on accessing them as well as health costs of self and family because of poor services; facilities that are well maintained and sustainable for continued use; WASH-related activities at the household and community level that are shared equally by men and women; and knowledge, information and facilities on hygiene at the personal, household and community level. Women require private space, for personal use, washing and care of children. 56 7.1.8 The lack of integration and a holistic perspective is compounded by the multiplicity of agencies in the urban areas with no functional linkages. Water and sanitation itself is the responsibility of more than one agency, while women’s empowerment and urban institutions like schools, anganwadis and hospitals are under diferent departments with no efective structure or system for coordination. on the other hand, the Urban Local Bodies (ULBs), which have been conceptualized for decentralization and local governance, not only lack capacities and resources, but also have not been allowed to function—barring in a few states—as mandated because of political and bureaucratic vested interests. Hence, the 74th Amendment as well as the mandatory reforms under JNNURM, which could have brought in the much needed community interface, coordination, integration, transparency and accountability, especially in the context of the poor and the marginalized, remain weak. Moreover, following the infrastructure and management orientation of the policies and programs, the agencies themselves are not structured to address issues of inclusion and gender. Hence, there is little scope for delivering services tailored to meet the aspirations, needs and demands of the diferent segments of the community, or with a gender perspective. 7.1.9 Water and sanitation facilities in urban areas are delivered as a stand-alone scheme or as part of an integrated slum development or housing scheme. In the case of the poor, the focus is almost exclusively on slums, leaving other poor households out of any program beneits. Even in the case of slums, those without a clear tenure status are often deprived of program beneits, even though the draft National Slum Policy and similar policies in several other states stipulate that water and sanitation as a basic service must be provided irrespective of tenure. Furthermore, in slums and settlements that have been fortunate enough to have facilities installed, operation and maintenance is an issue because of the division of responsibilities, multiple agencies, lack of manpower and resources for maintenance, and the failure to generate user fees and ownership in the community. Poor maintenance of facilities like community toilets means that women cannot use them, or if they do, they are more prone to health risks. 7.1.10 As a result, the facilities either fall into disuse or are appropriated by the more powerful inhabitants of the community at the cost of the rest. The tendency to look at slums in isolation has been perpetuated by the absence of a citywide network approach and the tendency to provide short-term low cost technology to slums in the name of easier and afordable operation and maintenance. Hence, hand pumps instead of piped water supply, stand posts instead of house connections, community toilets instead of household toilets, leach pit technology instead of septic tanks and sewerage systems are the general norms still being practiced. The result is that often the facilities cannot stand the test of time and do not sustain, pushing the communities back to their earlier state of deprivation. Then, again, the fact that a compartmentalized approach to water, sanitation, and solid waste 57 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 7.1.7 The state has responded with several interventions over the years, but these have primarily addressed infrastructure and services both in the city at large and also in the context of poor communities in slum settlements. There has been a shift from mere infrastructure and physical development to address urban planning and management as a function of economic development and slums as an issue of poverty and marginalization. The conceptual shift in approach has highlighted inequities in access to services by virtue of class, communities, and gender and has brought in decentralization and community participation as planning and management tools. Attempts have also been made to develop policy and legislative frameworks with commensurate changes in the institutional and governance structure and to look at the city with a more holistic and long-term perspective (for example, the JNNURM and the CDPs. However, these eforts continue to be largely sectoral (for example, health, education, poverty and livelihoods, water and sanitation, etc.) in focus, with little evidence of a serious strategy for vertical or lateral integration or even a basic strategy for inclusion and gender integration. Hence, the poor and the marginalized settlements remain isolated pockets or appendages in the framework of city development, deprived of entitlement by virtue of questionable tenure and income poverty, and at the receiving end of ad hoc schemes and beneits. Amongst them the women continue to be more vulnerable by virtue of their assigned roles and functions within the household and community. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM management is the trend with some services meriting a policy statement and deined strategy while others remain limited ring-fenced schemes does not encourage the planning and development of comprehensive service-oriented facilities that respond to the needs of various consumers. The tendency, at least until recently, has also been to focus on facilities instead of improved services, thereby excluding possibilities of assessing and understanding service needs of various sections of the community in terms of class, caste, occupation and gender. 7.1.11 Community participation has been advocated by the state as a possible panacea for many of these problems—of efective and eicient implementation and planning, of ownership and better maintenance and upkeep of facilities. In reality, however, the state has not elaborated on the deinitions or provided guidelines for community participation and inclusion in line with policy statements and the needs of the project objectives and cycle. This compels one to question the reasons for the state’s adoption of community and women’s participation as an approach: Is it because of global commitments? or is it because of the mandate of a donor or aid agency? or is it to simply transfer responsibilities to the communities because the state itself has failed? or is it because the state genuinely believes that participation of the community, and especially women, would lead to a win-win situation for all stakeholders. This is a complex issue with perhaps various reasons, wherein improvements in service delivery and equity issues have not always been the predominant reason. So while the state engages in token inputs, the more innovative and committed among the non-state agencies have put the concept of inclusion and community participation into relatively efective practice. 7.1.12 Most successful cases of community participation in the urban water and sanitation sector have centered around women’s groups either especially constituted for the purpose, or entrusted with the responsibility as part of the overall empowerment of women. Studies have proved that involving women in the planning and management of water and sanitation facilities and services does lead to improved eiciency of water use, improved sustainability of water supply systems, protection of water resources, and positive economic and social beneits. In the case of sanitation, it improves overall access to acceptable sanitation, increases coverage, improves school attendance, reduces incidence of violence, and improves protection of water resources through improved hygiene practices and use of environment-friendly technologies like EcoSan. 7.1.13 However, in such an approach, the water and sanitation dynamics associated with men generally tends to get ignored and the burden on women tends to increase in terms of participation in planning and management during the process of implementation and perhaps also in maintenance activities. More importantly, if the male members of the community are not adequately involved, and do not adopt hygienic practices, the beneits will be dissipated, for sanitation requires a whole community approach. Further, while community participation and women’s involvement is time consuming and since in most cases such community groups do not have any institutional stability, the beneits of participation, including gendered participation, may get diluted over time. Hence, community institutions and women’s groups need to have functional linkages with the ULBs for support and sustenance. The extent to which such an approach impacts upon women’s strategic needs is 58 7.1.14 As stated earlier, the urban WASH sector also accommodates typical occupational communities—waste pickers and manual scavengers—a large percentage of whom are women. While both occupations as a whole are vulnerable to social exclusion and health risks, women in these groups are more vulnerable. Often, the lower level tasks within the occupation are assigned to them, women waste pickers are vulnerable to harassment by the police, local goons and even molestations when they move around the city to collect waste, generally in the wee hours of the morning. The income earned, on the other hand, comes in at the end of the cycle of picking and sorting and the task is usually handled by men. Thus, women in these communities are at a disadvantage from within as well as from the wider community. 7.1.15 While manual scavenging has received attention in the form of acts and bills for abolition, the act in no way attempts to address the separate conditions and needs of the men and women engaged in the occupation. The waste pickers, on the other hand, do not even have the beneit of a dedicated policy. However, recently, the beneits of social protection available to the unorganized sector have also been extended to them. In terms of livelihood, both the manual scavengers and the waste pickers are in danger of losing their traditional livelihoods—the former to an overall ban on manual scavenging and the latter because of the move toward privatizing solid waste management in cities and contracting it out to large companies. While the scavengers may beneit from an inbuilt process of rehabilitation, the waste pickers will have to fend for themselves. While both men and women will lose livelihoods and income, the burden of managing household income will fall more heavily on the women in the community. Therefore, a considered rehabilitation plan for men and women from both these occupational groups is called for. 7.1.16 There are other gaps within the urban WASH sector that need to be addressed, both in the context of a whole city approach as well as equity and gender. For instance, the relatively limited attention given to WASH in schools and anganwadis has been of concern. In terms of infrastructure and facilities, these are covered under the Sarva Shiksha Abhiyan (SSA) and the recently instituted National School Sanitation Initiative (NSSI) provides scope for government schools to improve themselves. However, while the SSA’s performance in urban schools is questionable, the NSSI is only a self-rating system and is largely dependent on the schools own interests and initiative. Similarly, although most states have now provided toilets in anganwadis, these are not always functional or well maintained. In fact, in the absence of maintenance and adequate water facilities, a signiicant number of school and anganwadi toilets remain unused. Again, while lack of well maintained toilets is an issue for both boys and girls in schools, it is more so in the case of the girl child. The need is to establish a funding system for the use and maintenance of facilities provided in schools and anganwadis. 7.1.17 The more critical gap is the almost conspicuous absence of a strategy for hygiene promotion catering to the practices of the various segments of the urban community, especially the poor. The National Urban Sanitation Policy (NUSP) acknowledges the fact that lack of awareness is a key obstacle for promoting better practices and hence has awareness creation and behavior change as one of its goals. It also proposes to develop a national-level strategy for communication and advocates the states to do the same. While an urban focused national strategy is yet to be drafted, perhaps the only state that has prepared one focusing on urban areas is odisha. In the absence of a hygiene promotion strategy that addresses behavior change of the various groups in the community, WASH interventions will remain as a mere provision of facilities and will also fail to recognize and address the diferent needs and practices of men and women and of boys and girls. The lack of a perspective hence limits the scope of addressing critical issues like menstrual hygiene and hand washing to isolated projects. 59 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM dependent not solely on mere participation in a WASH program, but on the extent to which they have been involved in decision making and in managing resources. It calls for extensive support and capacity building of groups over a period of time and continued handholding, program convergence, and institutional support. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 7.1.18 The overwhelming conclusion from a review of the policies, programs, and practices of gender integration in the WASH sector is that the sector itself does not have a cohesive policy or strategy. Hence, gender equity and inclusion are mere concepts that have been introduced into the sector with no commensurate and efective action plan. At the same time, however, isolated examples of successful participation of women and attempts to integrate the concept of gender into WASH project planning have begun to emerge and lessons from these could form the basis of improving WASH policy and program interventions. 7.2 Suggestions 7.2.1 The recommendations are based on the conclusion that in order to ensure gender-mainstreamed interventions in the urban water and sanitation sector, the focus has to be on, irstly, building a comprehensive understanding and strategy for the sector as a whole; and, secondly, addressing gender mainstreaming as part of an inclusive strategy. However, these are long-term measures and some corrective interventions are also required in the short run. The key long-term recommendations following from this review are as follows. 7.2.1.1 concepts and Deinitions 1. The components of WASH—water, sanitation, solid and liquid waste management as well as adoption of hygiene practices—need to be deined in the urban context and interrelationships established. Further, the inluence and impact of WASH on overall well-being, especially in terms of health and livelihoods, need to be analyzed and the proximal and distal factors identiied therein. Hygiene practices are more or less ignored in the urban programs. However, these again need to be addressed as an integral part of WASH and, as experience indicates, in a campaign mode, targeting change in practice of selected critical behaviors that will have a far-reaching efect. For instance, hand washing, menstrual hygiene management, child care and stopping open defecation. 2. Urban poverty should be viewed and understood not only from the perspective of income poverty but also as deprivation in terms of adequate housing and basic services and other social welfare facilities, and exclusion by virtue of being marginalized because of caste, class, and sex. The vulnerability of women 60 3. The deinition of “gender” in the context of urban WASH and the diference between the “gender mainstreaming” approach and a “women-centric” approach in the sector needs to be established. Gender issues crosscut diferent forms of social exclusion and this needs to be speciically recognized and addressed by planners and managers. This would imply that social, economic, age, and geographic exclusions, as well as exclusions based on physical and mental capabilities, are addressed through a gender lens. This would not only facilitate the development of a more holistic program, but would also ensure that the more marginalized among women are brought within the scope of the program beneit. The Twelfth Five year Plan has for the irst time looked at inclusiveness as a multidimensional aspect and describes inclusiveness in terms of poverty, group equality, inequality, regional balance, employment, and empowerment. While expanding on group equality, it observes that “… women span the entire income spectrum… but there are gender-based issues of inclusiveness that are relevant all along the spectrum” (Planning Commission (2012). 4. In order to operationalize the concept, an exhaustive checklist to ensure gender mainstreaming from the policy level through the program and project cycle in urban WASH needs to be developed and adopted by all stakeholders across the sector. 7.2.1.2 Sector Policy 1. The absence of a comprehensive urban WASH policy is evident in the piecemeal and ad hoc programs and schemes that are currently being implemented in the urban sector. While the NUSP is a positive beginning on this front, it would perhaps be more efective when implemented in conjunction with a similar policy for water. Hence, integrated urban WASH policies and strategies need to be developed at the national level together with state-level policies. The policy should include all the sub-sectors— water, sanitation, solid and liquid waste management—with hygiene and health as immediate areas of impact. It should articulate the sector vision and mission related to the management of the relevant natural resource, environment, technology, institutions and capacities, stakeholders, communities, hygiene and behavior change and potential approaches, including PPPs, amongst others. The policy will also need to acknowledge forms of social exclusion and gender as crosscutting diferent forms of social exclusion. 2. The policy will need to be followed with the development of a clear strategy and detailed operational guidelines that may then be adapted by the states, in line with the state policies. The policy and guidelines will need to be developed on the basis of a series of research inputs, including formative research on WASH-related perceptions and practices of various socioeconomic groups, with data disaggregated by gender and age. This would give an opportunity to actually design the project inputs on the basis of a realistic inclusive approach incorporating the aspirations and needs of men and women across age, class, and community. 7.2.1.3 Program and Project Planning and Management 1. integrated Project Design: Integrated projects developed within the water and sanitation sector should identify the objectives and activities within a logically sequenced project cycle and within each cycle assess and plan for mainstreaming gender. This would entail a process of assessing the existing impact of WASH on men and women and the changes that are expected to occur after the interventions and, accordingly, tailoring activities. In terms of gender mainstreaming, the policy should create an enabling environment through research and analysis, ensuring equitable rights and participation; adequate and 61 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM and girls in the urban context needs to be acknowledged and articulated in policy documents on urban WASH. PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM appropriate institutional arrangements that are gender-sensitive and have the capacity to address issues of inclusion; and put in place operational arrangements that can translate the policy into action. 2. Gender Disaggregated Database: There is a need to adopt a uniform practice of generating disaggregated data and to this efect a WASH database, disaggregated by sex, age, class, communities, and caste should be created as baseline and for monitoring progress and impact. Meanwhile, the existing system of Service Level Bench Marks or SLBMs being used to improve the delivery of water and the Sanitation Rating System for encouraging improvements in the status of sanitation need to be reviewed and revised to capture and relect equity and gender status. 3. Develop Scale-up Models of Successful Projects: Considering that the scale of operations across states is large and hence undertaking intensive community participation that provides scope for women to participate and decide (on the lines of successful pilots) may be practically diicult and resource intensive, there is a need to develop alternative scale-up models, incorporating lessons from successful pilots and small-scale projects already implemented. Successful elements could then be developed into implementable checklists that could be used by the ULBs and other implementing agencies of the government. 4. convergence approach: The strategy will also need to clearly identify sectors, areas, and programs where convergence is required and would add value to the WASH interventions. Action plans will then have to take a cross-sectoral approach with commensurate coordinating mechanisms. As it is evident that efective WASH at the city level is a function of facilities—with focus on access and safety—services and practices of communities at one level and a function of several interrelated departments including health, education and women and child development, functional coordination is critical and can be best efected at the ULB level. All projects and schemes can converge at the ULB level. Hence, the capacities of the ULBs need to be built both in terms of manpower and training so as to enable them to function efectively by addressing issues of gender. 5. Privacy and Dignity issues: on the design front, the facilities, especially community toilets and toilets in schools, need to be designed keeping in mind women’s need for privacy, safety, and dignity. 62 1. UlB capacity Development: The ULBs, unlike the Panchayati raj institutions (PRIs) in the rural areas, have had only limited beneits from capacity building interventions. The ULBs need to be promoted as the key institution to deliver WASH services. Hence, the capacities of the ULBs need to be developed to plan and manage WASH by adopting an inclusive and gender-focused strategy. In order to do so, the ULBs need to have a dedicated structure or cell as the Kudumbashree in Kerala or the Mission for Eradication of Poverty in Municipal Areas (MEPMA) in Andhra Pradesh. The existing Urban Poverty Alleviation Cell is inadequate in mandate and capacity to deliver inclusive and gender-focused interventions. At the same time, it should also be ensured that women are promoted in the decision-making process from the planning to the implementation stage and from the ministerial level to the household. 2. Mandatory Meeting and Procedures: The Community Participation Law, the Area Sabhas and Ward Committees, as mandated under the JNNURM as well as the 74th Amendment, need to be urgently instituted in all states. This would far better enable participation of the community, including women. Restructuring has to go hand in hand with capacity building. While limited eforts have been made within the country for capacity building of institutions to mainstream gender in WASH, agencies like UN Habitat, WSP and local institutions and organizations have developed modules and have resources to take the process forward. 7.3 Suggestions for the immediate and Short run 7.3.1 While policy and strategic changes are advocated with central and states level governments and other stakeholders in the sector, this study recommends that in the immediate and short run the following immediate steps may be taken: 1. State-level Gender review Sector Documents: Review key sector documents in the partner states to assess if it is a gender and social inclusive document, identify gaps, and recommend inputs to strengthen it. The documents will include the CDPs, SUSSs and CSPs, and communication plans. It will also include the states ive year plans/annual plans, water and sanitation as well as the integrated housing projects under the BSUP/IHSDP, and any projects under the Rajiv Awas yojana (RAy) where WASH is also a component. 2. Develop Gender Parameters for SlBM and city Sanitation rating index: Review and recommend ways to make the SLBM and the City Sanitation Rating Index to relect the levels of inclusiveness achieved. When gender and social inclusion indicators become part of the rating systems, there will be more chances of interventions being designed accordingly. 3. Facilitate Stakeholder capacity Development on Gender and waSH: Facilitate the stakeholders and agencies in the sector at the state and ULB levels to develop a conceptual understanding of gender and social inclusion in an urban WASH program. Also, build capacities of ULBs and sector agencies to design, plan, and implement an inclusive project which also has a gender focus. This would mean supporting the ULBs to mainstream gender at every level of the project. Develop capacity building and training modules to this efect, targeting the elected representatives and oicials of the ULBs. 4. communication Strategy: Based on the guidelines of the National Strategy for Urban Poor Project (NSUP), facilitate states to develop a communication strategy to promote sanitation and hygiene in the urban areas. The strategy should target both men and women as well as children, adolescents, and vulnerable groups and key risk practices and be implemented in a campaign mode. The general practice in WASH is to largely target messages at women, in the belief that they are the primary managers of water at home 63 PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM 7.2.1.4 institutions and capacity PoLICy & PRACTICE REVIEW: GENDER & WASH IN THE URBAN CoNTExT HEALTH oF THE URBAN PooR PRoGRAM and the caretakers of the family’s health and hygiene-related needs. This approach tends to overlook and underplay the role of men in relation to WASH. Hence, communication and hygiene promotion should address both men and women. 5. Gender Budgeting: Facilitate the ULBs to prepare annual budgets focusing on planning its pro-poor budget head and integrating the WASH component. This would entail that the interventions are identiied and budget allocations done in an inclusive manner, using poverty, social and gender assessment tools. 6. Build capacity of Frontline workers: Ensure that ongoing WASH projects at the community level have a strong focus on inclusion and gender. Focus on ward councilors, frontline workers and Mahila Arogya Samitis to ensure inclusive WASH interventions. 7. Gender waSH checklist: Develop an exhaustive checklist to be used during an urban WASH project cycle, from planning and design to evaluations and impact assessment. 8. Gender Disaggregated Database: Develop a standardized system for generating a disaggregated database for planning and managing an inclusive and gender-based WASH project. 9. Undertake research and Documentation that are directly related to the above activities. It is clearly evident that in spite of the fact that “gender” as a concept has been introduced into the urban WASH agenda in India, it has a long way to go in terms of clear policies, programs, strategies, and institutional capacities. 64 African Development Bank (AFDB) (2009). 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