Accessible WASH: Perspective and Practices

ABSTRACT  

This article is written to explore the perspective and practices in accessible WASH in Nepal. The analysis was done using the empirical data collected from the field interviews from diverse stakeholders in different districts of Nepal. These data were complemented by policies and guideline, author’s first hands field observations and published reports and literatures. This article argues that only building a ramp or other infrastructures is not enough, it should be accessible from the other perspectives. Accessible infrastructure seems to be useful to mainly people with disabilities, but it is in fact useful for everyone, in so doing, it is about accessible of WASH perspective. It also focuses on policies and guideline made and the current implementation practices as well.

Key words; WASH, accessible, disability friendly

BACKGROUND

The dictionary meaning of “accessible” is obtainable; attainable: easy to approach, reach, enter, speak with, or use, that can be used, entered, reached, etc. WASH stands for Water, Sanitation, and Hygiene. Basically, the WASH facilities/services which are easy to approach, reach, enter, and use is known as Accessible WASH. Water, sanitation, and hygiene services and facilities are traditionally designed for the so called average persons, which ignore the fact that in the real communities, people come with a wide range of shapes, sizes, abilities, and needs. As a result, a large number of people are excluded from normal services and facilities. One such group is people with disabilities.

Over a billion people are estimated to live with some form of disability. This corresponds to about 15 percent of the world’s population. Between 110 million (2.2 percent) and 190 million (3.8 percent) people 15 years and older have significant difficulties in functioning. Furthermore, the rates of disability are increasing in part due to aging populations and an increase in chronic health conditions. Apart from this, the growing conflicts, natural disasters, and humanitarian crisis around the word have significant impact to increase the disability numbers. The South-East Asia Region has the second highest prevalence rate of moderate disability (16 percent) and the third highest prevalence rate of severe disability (12.9 percent)i. As reported in Post Disaster Need Assessment Report (PDNA) 20015, about two percent (or 513,321) of the total Nepali population is reported to have some kind of disability. Physical disability constitutes 36.3 percent; followed by blindness/low vision (18.5 percent), deaf/hard to hearing (15.4 percent), speech problem (11.5 percent), multiple disabilities (7.5 percent), mental disability (6 percent), intellectual disability (2.9 percent) and deaf-blind (1.8 percent). Within the 14 most affected communities, it can be deduced that 322,110.78 have physical disability, 163,043 of which are women and girls.

In recent decades, Nepal has made significant progress in access to WASH facilities in communities, public institutions, and schools. Coverage of the water supply has been estimated to be 87.0 percent (DWSS 2072/73) that includes 52.3 percent coverage by piped water supply systems. All of the districts have coverage above 70 percent. Nineteen districts have coverage of more than 90 percent, 41 districts between 80 to 90 percent and 14 districts below 80 percent. Rupandehi, Manang, and Kailali reported nearly 100 percent coverage. Coverage of basic sanitation has been estimated to be 87.3 percent (DWSS 2072/73). Coverage is highest in Mid-Western Region, followed by the Far-Western Region, Western Region, Eastern Region and Central Region, respectively.

The government of Nepal had aimed to achieve the universal sanitation coverage by 2017 and the progress has been made rapidly. Due to the hard hit from 2015 earthquake and other unavoidable circumstances, this has delayed the momentum and could not meet the target as envisioned. However, the government including civil societies are working hard to make it happen with active participation and engagement of the local government and community.

The universal coverage of WASH services means the access to WASH services by all.  The government also has the mandate to ensure the accessible WASH to everyone and all the WASH development programmes have a mandate to implement the inclusive WASH with no one left behind. Although the government, including civil societies and WASH stakeholders are talking about the Accessible WASH; I am interested to know what does this Accessible WASH means, understanding and people perceptions of diverse actors.

To date, I worked with WASH and non-WASH professionals, including community development workers, university students, NGO leaders as well as non-WASH actors (who do not directly work in WASH). When I talked about the accessible WASH I found diverse and interesting views from them. I decided to explore more on people’s perceptions, understanding and practices. Therefore, this article is written based on the qualitative study where people from diverse fields were interviewed during field visits and individual meeting regarding the accessible WASH issues.

LEGAL FRAMEWORK, NATIONAL POLICY AND GUIDELINES

The global development agenda SDG#6 target number 6.2 states “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations”.

After the earthquake 2015, Ministry of Health come up with standard guidelines for post-disaster guidelines which give description and drawings of “Universal toilets” that needs to be constructed in each reconstructed health facilities. “Universal toilets”: A separate toilet for non-disabled person should be provided with appropriate standard size to accommodate a wheelchair equipped with grab bars. No steps are allowed in toilets which inhibit the wheelchairs to enter. For this, prior arrangements should be made during construction of structural frame such as the design of dropped slab or ramp for the raised toilets.

Design of Toilet placed in guideline

The School Sector Development Plan (SSDP) 2016 highlighted that lack of disabled friendly WASH facilities is a barrier for children with disabilities to enroll and remain in school. Hence, SSDP 2016 makes mandatory to have a gender-segregated and disabled friendly WASH facilities in school. A separate toilet for differently able person should be provided with appropriate standard size to accommodate wheelchair equipped with grab bars. No steps are allowed in toilets which inhibit the wheelchairs to enter. For this, prior arrangements should be made during construction of structural frame such as design of dropped slab or ramp for the raised toilets.

PERCPTION AND PRACTICES ON ACCESIBLE WASH

A toilet is everyday business for all: a case of Audit

In early 2017, I was dealing with an audits firm who came to do an audit of WASH and Nutrition integrated project which was implemented in two earthquake-affected districts in Nepal. Together with Financial Audit, they planned a field visit to Rasuwa district for the field verification of the expenses. As a part of WASH intervention, the project had supported to construct CGD (Child, Gender,& Disability) friendly WASH facilities in schools and healthcare facilities. There were around one-third of the project cost was allocated for CGD friendly WASH services in school and the expenses were made accordingly. After the field visit, auditor came back with a comment; I found disable friendly toilets constructed in a school where the school itself is in hill and school itself is not accessible for disabled people. The construction of disabled-friendly toilet at that school is a waste of resources.

Health Post Building with ramp and toilet inside the building

Being responsible person of the project, I had to elucidate the reason of constructing CGD friendly toilet. Its government mandate to construct CGD-friendly toilet and every development actorshould follow the government mandate-which was the very first response came to my mind. At the same time I also accept the comment raised by the audit. The school is not accessible for persons with disabilities, what is the significance of having disable friendly toilet?Also, I was not sure whether there were children living with disabilities were in those schools or not. Suddenly, I remembered one of my friends who was sufferingfrom Polio since his childhood. He shared that his brother used to take him to school by carrying him on his back, but when he had to go to the toilet to pee, it was difficult for him and he had no option rather than controlling the pee during school time. Taking this example, I addressed the comment of the Auditor.

Health Post Building with ramp and toilet inside the buildingThese days, people are aware and there is no such discrimination, myths, and misconception towards person with disability. People can admit their children into school, and it is urgent requirements to have an accessible WASH facilities in school. On another hand, maybe people may not admit their children with disabilities to school thinking of the difficulties they mightface in school due to lack of accessible WASH services. As an inclusive agency, we need to promote inclusive WASH facilities in school, so that parents can be encouraged to send their children to the school. Also, it has been made a mandatory by the Ministry of Education to have a gender segregated and user-friendly WASH facilities in school.

This story was shared by a WASH colleague while discussing about the accessible WASH few weeks back. I realized people have a lack an understanding of accessible WASH and is unaware about the essence of accessible WASH. In view of the audit perspective, they were looking from the perspective of access to roads and geographical remoteness. However, the geographical remoteness and the senescence of accessible WASH services are dissimilar. It’s high time to ensure the accessible WASH services in all the institutions matter what the geographical location is as the doing WASH is every day and every hour business, another setting may differ and maintain by the time.

How do you showcasethe structures really matter

Duringmy working tenure in 2016/17 after the hard hit by the Nepal earthquake in 2015, we had implemented WASH recovery programme in two earthquake-affected districts; Nuwakot and Rasuwa.   The project was mainly focused on construction and rehabilitation of rural community water supply as well as WASH infrastructure construction in schools and health facilities in different rural municipality of the districts as per the government mandate. In a field monitoring visit in a health post in Nuwakot district, I observed an appreciative work with24 hours water supply, separate gender and person with disability friendly toilet blocks with ramp, drinking water tap and hand washing platform. The Nurse in Health post was happy with the support provided by the project, especially having water tap with twenty-four hours running water in a birthing center. Before there was no continuous water supply and it was difficult to maintain the hygiene. Apart from that, I saw a locked toilet which was tagged as “disabled- friendly toilet”. I was curious to know why that toilet is not in use.

This toilet is built for persons with disabilities and these people hardly visit the health facilities. None of the persons with disabilities patient visited after the construction of new building. Persons without disabilities really do not want to use that toilet as that was tagged as “Disabled-friendly toilet- a Watchman explained.

The Ministry of Health of the Nepal Government has a mandate to construct accessible WASH facilities in health facilities. The reconstruction programme has been done accordingly. Being a WASH professional, I am happy to see the progress made as the accessible WASH facilities is in priorities.

At the same time, I felt as embarrassed as still we are far behind to create harmony among the people.  The above case- person without disability does not want to use disabled-friendly toilet not because of the toilet is being occupied by the disable people, but they do not want to be tagged as persons withdisabilities by using disabled-friendly toilet. I can easily sense the presence of discrimination among people living with disabilities and non-disabled people. Now the question arises is it necessary to tag the toilet itself as for persons with disabilities? Are we (development agencies) using appropriate words to introduce the people living with disabilities? I realized that it would have been used, if we said that this toilet is accessible toilet and every type of user can access and use this.

Just having Ramp does not mean an accessible

In a newly constructed prefabricate health post building, I saw a good toilet facility which was constructed by a reputed organization advocating for accessible WASH. The health post is also functioning as birthing center.  According to the health post In-charge, in an average six delivery cases are coming every month. I noticed the health entrance of the health facilities is well constructed with ramp and room were easily accessible. When it comes to the toilet, it’s very neat and clean, well equipped with 24-hours water supply but the toilet is not comfortable to be used by persons with disabilities.

Take initiative first, perfection comes spontaneously- A case from Rasuwa

At the time of a partner visit in Rasuwa district of Nepal, I saw three cubicle toilets in one of the local NGO offices. Each cubical was tagged with different name such as “Male”, “Female” & “Disable”. I was keen to know if a toilet labeled with name “Disabled “has different features. However, I could not find any difference in interior of these toile units. I observed that they built it just for the formality. I decided to ask to the organization head the reason behind leveling one toilet as “Disable”. Without any delay and pointing towards the toilet blocks, I asked him- how did you come up with the idea of labeling similar toilet block with different names? He hesitated for a while (maybe he was not sure what to say and not) and said- he is aware of the persons with disabilities different needs through television advertisements and during social campaigns. But these issues came up in his priority only after the earthquake in 2015. In the past days, disability was not on their priority of intervention rather more focused on environmental conservation and sports programme.

During earthquake in 2015, some people were injured who had a difficult time due to lack of accessible infrastructures. Even family members spent time to take care of the persons with disabilities for personal cleanness and hygiene purpose. I realized, if we start with our organization, it can be easier for the people who visit our office as well as it can be model to others. This is how we decided to construct this cubicle for people with disabilities. We had no idea about the exact design of the persons with disabilities toilet. If we can construct separate toilet for them, at least they will feel comfortable to use the toilet. Our organization has a training hall which often use by many organizations for training and meeting purpose. We have been organizing several meeting and training ourselves. Persons with disabilities have also been attending the meeting, training and consultation workshops.

In one training workshop, one participant was using crutches. During break, I saw a queue in both male and female toilets. At the same time, I noticed that people who used crutches went to the toilet and came back. Once he came back from toilet, I talked to him and asked about his experience and benefits of having separate toilet. He explained that if there was no designated toilet for him, he had to be on that queue standing with support from that crutches and which is bit difficult. He was not just happy to have a separate toilet but also thanked to me and my organization. Once I heard this, it gives me more satisfaction that we constructed this toilet although we did not have enough idea of what does accessible toilet look like. A summary of the story shared by Mr. Santosh Ghale, Chairperson of the organization.

This organization is one of the major implementing actor of the Earthquake Post Recovery programme in a district. Now, their capacity have been developed by many international development organizations who are partnering with. They have been constructing many toilets in schools and health care facilities in WASH recovery and temporary learning centers.

This case of NGO from Rasuwa can represent many other districts. Yet, the disability issues are not a priority of the people unless they have a programme or are aware and empower enough themselves. Still, the frontline workers have limited knowledge, skills and understanding of the accessible WASH. Together with the development works, the understanding and practices are being replicated over time. But this is not enough if we really want to see the progress in inclusive development from the beginning. There is urgent need to create enabling an environment for developing the capacity and skills in from grassroots level. With the recent decentralization in federal states, every local government unit requires the development of public institutions (governmental offices, health facilities, schools, and institutions). Based on the current practices and understanding, it is hard to ensure the accessible WASH facilities. The policy and guidelines do not merely work unless this is disseminated and initiated by concerned people.  The government and civil society need to work out together for creating the enabling environment to ensure the accessible WASH services everywhere which requires joint effort, solid planning, and prompt implementation.

TAKE AWAY NOTE:

  • The accessible WASH facility is more familiar among developmental agencies working on WASH. The government mandate, guidelines and skills are not transferred at the local level. More work is yet to do for awareness raising, capacity and skills development and implementation.
  • The inclusive and user friendly WASH facility sounds better than the current practices of tagging the “disabled-friendly toilet”, where everyone can free to use easily and efficiently. By doing so, this will also help to change the thinking of the ordinary people as well as people living with disability and create equity and equality. Let’s make the same toilet as user friendly/accessible for everyone.

In the context of developing accessible WASH facilities, this is more practice and adopted in reconstruction programme after the earthquake as compare to before. Good perception towards accessible WASH is there but proper knowledge and skilled is still yet to develop. With the recent decentralization in federal states, every local government unit requires the development of public institutions (governmental offices, health facilities, schools and institutions). The integration of accessible WASH facilities in the ongoing development of the local government structures will make remarkable changes.

WHO 2018

Post Disaster Need Assessment Report, 2015

WASH sector status report, 2016

Sustainable Development Goal, (2016-2030)/ Goal no. 6.2

Standard Guidelines for Post-Disaster Reconstruction of Health Buildings published by Government of Nepal, Ministry of Health and Population, 2015, page no. 14

References

Author’s Bio

Giri Raj Khatri recently worked as a Water, Sanitation, and Hygiene (WASH) programme manager of Action against Hunger in Nepal and as a WASH advisor of SNV Netherlands Development Organization in Cambodia. As a WASH practitioner, he conducted several training programs and WASH project activities in Nepal, Bhutan, and Ghana. He previously served as a project coordinator for the UN-Habitat Urban Youth Fund Project and Nepal WASH Alliance Project, both spawned by the Environment and Public Health Organization in Nepal. Mr. Khatri obtained his Master of Environmental Science at Tribhuvan University and is pursuing a Masters in Water Resource Management and Governance at IHE Delft Institute for Water Education in the Netherlands.