Our Community Action Guide

© 2007 MKFC Stockholm College

Our Community Action Guide

Our
Community
Action Guide


contents
4 phase 1 – lessons learnt 8 phase 2 – choose your coMMunity goals

4 Micro credit - role Model (piedar) 8 1. clean hands – no More dirtyness
4 What
4 How 8 2. clean Water – sustainable systeM for Kitchen and hygien
4 Description of activities

4 Why 8 3. clean sanitation – for all ZitiZens
4 Benefits for Our Community:
8 4. Zero deaths of neWborn child or birth giving WoMan
4 sanitation - QKaeMp
5 What 8 5. iMMuniZation / vaccination saving lives – no More infections
5 Why
5 Results 8 6. Micro credit

5 sanitation at school
5 What and How 9 phase 3 – our coMMunity activities
5 Why
9 1. clean hands – no More dirtyness
6 protecting Water 9 1. Dispose faeces safely: Use a toilet
6 What 9 2. Wash the hands
6 Why 9 3. Wash the face
6 How 10 4. Use water from safe source
7 Expected Results 10 5. Dangerous food
10 6. Store food right
10 7. Safe disposal of all household

10 2. clean Water – sustainable systeM for Kitchen and hygiene
10 Families and communities can protect their water supply by:
10 Families can keep water clean in the home by:

10 3. clean sanitation – for all ZitiZens
10 Sanitation is a Basic Human Need
11 The benefits of proper Water and Sanitation System in Our Community
11 How about us - what can we do?
11 Step by Step Plan
11 Our Goal
11 Why – Why Not?
11 There got to be a good plan: including

11 Yes Good Sanitation – For All Citizens
11 How to learn these skills – who are the councellors
11 Lessons Learned - Water and Sanitation Envolve Woman and the whole family – 5 reasons

12 Unsafe Sanitation system – how to improve?
12 Baby Deaths
12 Community Heroes make Better Sanitation
12 The installation of latrines and lane sewers brought 5 direct benefits to women and children.
13 Getting government support is not easy – Help from own community is needed

2



13 How to build a latrine
13 Other latrine options include:
14 Cost examples
14 Working for 100% Sanitation
14 The approach is based on the following key principles:
14 Key aspects of the approach
14 Outcomes of the approach
15 Gender Aspects
15 Water Crisis; A Special Report
15 Water Use – how to get better practisces:

15 5. iMMuniZation / vaccination saving lives – no More infections
15 Woman Immunization
15 Immunization is urgent!
16 Age Immunizations to be given
16 Immunization protects
16 against several dangerous diseases
16 Why against measles – can cause death
16 Polio
16 Tetanus bacteria
17 Breastmilk protects
17 Vitamin A
17 Diarrhoea
17 1. Diarrhoea kills children

17 2. Immediate help from a trained health worker is needed.

17 4. The child needs at least an extra meal

17 5. Use Trained Health Worker to save life

18 6. To prevent diarrhoea

18 7. Good Hygiene = Wash your hands

18 6. Micro credit

3



phase 1 – lessons learnt

Description of activities
What Identify, Make a list of important issues – Credit to individual poor under social guarantees
and problems in Our Community – Credit to solidarity groups after requisite savings;
Why Why Not? Discuss why to do this. and
How Good Practice. How the problem can – Promoting community organizations as Micro-Fi- -
be solved? Learn from others (Lessons nance Operators.
learnt).
When Time and Follow Up Work. Decide how • Identification of small male and female entrepre-
-
you are meeting the people and how to neurs
make follow ups. • Formation and mobilizing lane committees in
the area for saving
• Training of Fabric (Dupata) Painting, community
Examples of ifferent projects that gives benefits for mobilization skills and health and hygiene educa- -
Our Community tion to selected women of the same areas
• Video documentary on micro credit Urdu edition
Micro credit - role Model (piedar) • Recovery and monitoring of the credit
PIEDAR is a Non-Governmental Organization, NGO, • Staff training in Enterprise Development
working with practices and innovations for sustain- -
able development has been targeting the poorest Why
of the poor of those households with incomes less To demonstrate:
than two thousand rupees per month. The loan • a successful micro-credit work
amounts varied from 7000 to 15000. Community • to develop and test a model promoting Govern-
-
based organizations of men and women had suc- - ment and community partnership in the co-
cessfully operated small saving and loan schemes. operative development and management of a
Program had distributed five million rupees to 463 sanitation system in the same areas.
individual, 34 solidarity groups of five to eight per-
-
sons each and two community organizations. Benefits for Our Community:
Mobilizing our Community for local upliftment
What -
through a Micro-credit and an Enterprise Devel-
To improve household income, specially targeting opment Programme.
women entrepreneurs and the object poor and to
create a linkage between micro-credit and individu-
-
al entrepreneurs. sanitation - QKaeMp
QKAEMP – The Quetta Katchi Abadies Environmen- -
How tal management Program (QKAEMP) that works
To improve the incomes of households, especially for local development and environmental manage- -
the women, by guidance in productive activities ment. In the project promotes self-help for environ- -
and credit secured through social mobilization. mental management at the community level. The
approach relies on building up the institutional
capacities of intermediate organizations for sanita--
tion and related services.

4



Community and lane organizations bring together latrines, which has improved household environ- -
households for installing lane level infrastruc-
- ment;
ture. Households contribute half the cost and are • Lane organizations established links with district
involved in all aspects of planning, designing and government to pave 140 streets;
implementation. • Around 50,000 persons have benefited.

• Preparing communications material: Awareness sanitation at school
raising - door to door campaigns, lane film shows What and How
• Social mobilization - local area workshops, walk- The sanitation block in Simle school is encouraging
a-cause, and so on Participatory surveys and plan-- girls to stay on in school.
ning - making area and lane maps
• Formation of Mohalla committees - male and The school is located in the foothills of the Himala--
female yas in Nepal. The most people here have farming as
• Providing technical support for laying drains, the main source of income and their crops fill the
sewers, and for installing Pour Flush Latrines, terraced slopes. But, because the villages are spread
PFLs. Joint oversight of construction. across the hills, schools tend to be built in lower,
central areas where more pupils can reach them.
What
The project provides training in sanitation, solid Why
waste management, social mobilization, and hy- - For those whose houses sit on the top of hills the
giene. journey to school can become a long trek.

Why Fifteen year old Sumita is one such pupil. Her fam- -
The aim is to impart skills for operating and rep-- ily is from a marginalised group who live and farm
licating without further external help. A simple, at the top of a steep hill. ”I walk very fast on the way to
user-friendly computer programme has been de- - school and it only takes 30 minutes,” she explains ”but
veloped to optimize the design of lane sewers and on the way back up it takes two hours as it is steep and I
generate transparent quantities and costs. get hungry and tired and so have to walk more slowly.”

Results In the developing world girls are less likely to get
The project is on-going and has achieved the follow-
- an education than boys. Nearly a quarter of girls
ing results till December 2002: worldwide do not complete primary school and
• Formed 187 lane organizations and 181 WLOs for many more do not complete secondary school.
environmental management and lane level devel- -
opment; While difficult journeys like Sumita’s or pressure
• Lane organizations have laid 150,000 running to stay at home and help with chores like collect- -
feet of sewers; ing water are all factors in keeping girls away from
• Nearly all the sewers are functional and well school, one simple reason for girls dropping out is
maintained by the communities; that their schools don’t have latrines or separate
• Households have constructed more than 5000 facilities for girls and boys. Teenage girls are par-
-
ticularly affected.

5



Sumita explains the problem, ”We used to go to the Environmental problems associated with tourism
bush where there were bamboo plants - we used to hide have also emerged at some of the more accessible
under the bamboo to go to the loo. It was really difficult upstream lakes. These include fishing with small
especially during our periods or when we had diarrhoea. mesh nets, littering, open dumping of human ex- -
We wouldn’t come to school then and used to stay at home creta, and cutting down trees for fuel wood.
instead.”
Why
Finding a private place to go to the toilet was a big Participatory Rural Appraisal (PRA) exercises were
issue for Sumita and her friends, especially with undertaken with local men and women, and local
teenage boys around. ”We used to have to run when we priorities established. Communities were encour- -
saw the boys coming. Sometimes the boys used to see us aged to manage tourism around their common
defecating and then used to tease and embarrass us.” lakefront properties, to protect the fisheries from
poachers, and to manage the demand for fuel wood.
Then, having raced up the hill to find some privacy
the girls would have to get to their next class before How
the bell went, and they found this harder still. ”If Project programme funds were used in participa- -
you aren’t in time you miss the class and so when we had tory manner to make culverts, restore a hydro
our period we often had to attend one class and then miss power station, complete a water supply scheme and
the next hour of class. We often had to leave class or go construct public toilets.
home early.” The project also established links between the com--
munities and a micro-finance agency for further
”It used to make us sad to miss school because of this - if self-help development.
we had a toilet we could continue our classes instead. We
could save our time and carry on our education as well.” The project trained 34 unemployed youth in the
practical skills needed by an eco-guide.
The girls not only faced problems at school, but at It provided certificates of training, and helped them
home too. ”Sometimes our parents didn’t understand the secure start-up loans for tent, beddings and stoves.
situation - sometimes when we came home early they just Most were able to re-pay the loan with earnings
told us off” she continues. from the first season.

protecting Water As a part of the project, an international expert
What trained five young professionals in the methods of
Upper Swat is known for its scenic beauty, pine environmental valuation.
forests, wildlife, rivers, lakes and trout fishing. How-
-
ever the rapid growth of tourism has damaged the PIEDAR conducted surveys with these trained staff
local environment. For example, unplanned resort to assess the carrying capacity for tourism and the
development has lead to serious overcrowding and willingness of tourists to pay for environmental
pollution at the confluence of Ushu and Utror rivers values. The willingness of many tourists to pay for a
at Kalam. pristine environment, for fishing with rod and line,
and for guided wilderness tours were shared with
local tribal groups.

6



• Preparing communications material: Awareness The project envisages that by 2002 these sub- CBOs
raising - door to door campaigns, lane film shows and LOs in these areas will be well established,
• Social mobilization - local area workshops, walk- characterized by democratic rules of operation and
a-cause, and so on Participatory surveys and plan- - financial solvency including self-confidence and
ning - making area and lane maps self-respect among the communities. Such institu- -
• Skill and capacity development - training of staff tional development will result in higher prevalence
and partners Formation of Mohalla committees of good hygiene practices, in safer disposal of excre--
– male and female ta and sullage water, in effective solid waste man--
• Providing technical support for laying drains, agement, and more forestation on public spaces in
sewers, and for installing Pour Flush Latrines, unplanned settlements.
PFLs. Joint oversight of construction, and
• Lateral and vertical promotion of project experi-- By 2002, all the target lanes will have their own
ence for scaling up. organizations and own savings, all target lanes will
have functioning sewers and access to filth depots.
Expected Results At least 85 per cent of age 5-plus children will regu-
-
By 2002, a successful project will improve environ-- larly wash hands with soap after defecation, and
mental conditions in around 50-60 neighborhoods around 60% of the saplings planted in the public
or sub districts within the Katchi Abadies of Quetta. spaces in Katchi Abadies will have survived. These
selected indicators of the success of the Program
may be supplemented by other similar measures.

7



phase 2 – choose your coMMunity goals
Choose your community goals and use lessons learnt – make an activity plan.

1. clean hands – no More dirtyness 4. Zero deaths of neWborn
What needed - Step by Step Plan child or birth giving WoMan
Why needed – Why Not? What needed - Step by Step Plan
Envolve Everybody Why needed – Why Not?
Who to Envolve – Role Models. Lesson learnt Envolve Everybody
How- Good Practice Plan Who to Envolve – Role Models. Lesson learnt
When – Time and Follow Up Workers How- Good Practice Plan
Decision: Yes / No When – Time and Follow Up Workers
Decision: Yes / No
2. clean Water – sustainable » Give support to the health workers!
systeM for Kitchen and hygien
What needed - Step by Step Plan 5. iMMuniZation / vaccination
Why needed – Why Not? saving lives – no More infections
Envolve Everybody What needed - Step by Step Plan
Who to Envolve – Role Models. Lesson learnt Why needed – Why Not?
How- Good Practice Plan Envolve Everybody
When – Time and Follow Up Workers Who to Envolve – Role Models. Lesson learnt
Decision: Yes / No How- Good Practice Plan
When – Time and Follow Up Workers
3. clean sanitation Decision: Yes / No
– for all ZitiZens
What needed - Step by Step Plan 6. Micro credit
Why needed – Why Not? What needed - Step by Step Plan
Envolve Everybody Why needed – Why Not?
Who to Envolve – Role Models. Lesson learnt Envolve Everybody
How- Good Practice Plan Who to Envolve – Role Model.s Lesson learnt
When – Time and Follow Up Workers How- Good Practice Plan
Decision: Yes / No When – Time and Follow Up Workers
Decision: Yes / No

8



phase 3 – our coMMunity activities

1. clean hands – no More dirtyness ing the hands with soap and water or ash and water
More than half of all illnesses and deaths among removes germs. Rinsing the fingers with water is
young children are caused by germs that get into not enough – both hands need to be rubbed with
their mouths through food or water or dirty hands. soap or ash. This helps to stop germs and dirt from
Many of these germs come from human and animal getting onto food or into the mouth. Washing the
faeces. hands can also prevent infection with worms. Soap
and water or ash and water should be placed con- -
Children are easily infected with worms, which veniently near the latrine or toilet.
deplete the body’s nutrients. Worms and their
eggs can be found in human and animal faeces It is especially important to wash the hands after
and urine, in surface water and soil, and in poorly defecating and after cleaning the bottom of a baby
cooked meat. Children should not play near the or child who has just defecated. It is also important
latrine, toilet or defecation areas. Shoes should be to wash hands after handling animals and raw
worn near latrines to prevent worms from entering foods.
the body through the skin of the feet.
- Children living in areas where worms are common Hands should always be washed before preparing,
should be treated two to three times per year with a serving or eating food, and before feeding children.
recommended antihelmenthic medication. Children should be taught to wash both hands after
defecating and before eating to help protect them--
Prevent illnesses, especially diarrhoea by good hy-
- from illness.
giene practices:
• putting all faeces in a toilet or latrine; Children often put their hands into their mouths,
• washing hands with soap and water or ash and so it is important to wash a child’s hands often, es-
-
water after defecating or handling children’s pecially after they have been playing in dirt or with
faeces, and before feeding children or touching animals.
food; and
• animal faeces are kept away from the house, 3. Wash the face
paths, wells and children’s play areas. Washing the face with soap and water every day
helps to prevent eye infections. In some parts of the
Everyone in the community needs to work together world, eye infections can lead to trachoma, which
to build and use toilets and latrines, protect wa-
- can cause blindness.
ter sources, and safely dispose of waste water and
garbage. A dirty face attracts flies, spreading the germs they
carry from person to person. The eyes may become
1. Dispose faeces safely: Use a toilet sore or infected and vision may be impaired or lost
All faeces should be disposed of safely. Using a toi-
- if the eyes are not kept clean and healthy.
let or latrine is the best way.
If the eyes are healthy, the white part is clear, the
2. Wash the hands eyes are moist and shiny, and vision is sharp. If the
All family members, including children, need to eyes are extremely dry or very red and sore, if there
wash their hands thoroughly with soap and water is a discharge or if there is difficulty seeing, then
or ash and water after contact with faeces, before the child should be examined by a health worker as
touching food, and before feeding children. Wash- - soon as possible.

9



4. Use water from safe source Families and communities can protect their water
Only use water that is from a safe source or is puri-
- supply by:
fied. Water containers need to be kept covered to • keeping wells covered and installing a handpump
keep the water clean. • disposing of faeces and waste water (especially
from latrines and household cleaning) well away
5. Dangerous food from any water source used for cooking, drinking
Raw or leftover food can be dangerous. Raw food or washing
should be washed or cooked. Cooked food should be • building latrines at least 15 metres away and
eaten without delay or thoroughly reheated. downhill from a water source
• always keeping buckets, ropes and jars used to
6. Store food right collect and store water as clean as possible by
Food, utensils and food preparation surfaces should storing them in a clean place, rather than on the
be kept clean. Food should be stored in covered ground
containers. • keeping animals away from drinking water
sources and family living areas
7. Safe disposal of all household • avoiding the use of pesticides or chemicals any--
Safe disposal of all household refuse helps prevent where near a water source.
illness.
Families can keep water clean in the home by:
2. clean Water – sustainable • storing drinking water in a clean, covered con-
-
systeM for Kitchen and hygiene tainer
Families have fewer illnesses when they have an • avoid touching clean water with unclean hands
adequate supply of clean water and know how to • taking water out of the container with a clean
keep it free of germs. If the water is not clean it can ladle or cup
be purified by boiling or filtering. • having a tap on the water container
• not allowing anyone to put their hands into the
Clean water sources include properly constructed container or to drink directly from it
and maintained piped systems, tube-wells, protect-
- • keeping animals away from stored water.
ed dug wells and springs.
If there is uncertainty about the safety of the drink-
-
Only use water that is from a safe source or is ing water, local authorities should be consulted.
purified. Water containers need to be kept cov- -
ered to keep the water clean. 3. clean sanitation
– for all ZitiZens

Water from unsafe sources – such as ponds, rivers, Sanitation is a Basic Human Need
open tanks and step-wells – can be made safer by The sanitation is poor. Only one of ten rural house-
-
boiling. Water should be stored in a covered con-
- holds in Pakistan have any sewage collection and
tainer to keep it clean. disposal system. In most villages, the narrow lanes
between the houses are not properly surfaced. That
means that rainwater, kitchen run off, animal
waste and human waste accumulate in the streets.

10



The benefits of proper Water and Sanitation System in Our Community
“Hygiene is more important than the sanitation and the sanitation is more important than the water.”

In the majority of rural areas, household, farmyard into healthful home and community environments.
and small-scale industrial effluents flow into sur-- Water is a basic need for survival, but convenient
face ponds, rivers or the canal irrigation system. access to water contributes to human health only in
conjunction with adequate sanitation and hygienic
How about us - what can we do? habits.
To achieve a good solution to wastewater manage- -
ment and sanitation problems is to devise projects Nearly two-thirds of the government primary
based on community requirements and to involve schools are without latrines. How important is it as
community members. a contributing factor for the low enrolment rates of
the girl child? Many adolescent girls certainly drop
Step by Step Plan out for lack of separate and secure washrooms.

Our Goal: Families are major beneficiaries of improved sanita-
-
No Dirty Water – Yes Good Sanitation tion.

It has been established that improvement in water
Why – Why Not? and sanitation services can lead to improved health,
There got to be a good plan: including education, income, food production, employment,
To safely carry treated waste away from the village independence, and more security for women.
– either into the fields where it can be used as ferti-
-
lizer or into a water channel. Lessons Learned - Water and Sanitation
Envolve Woman and the whole family – 5 reasons
The effects of cleaner streets and a proper wastewa-- Women need to be consulted when policies and
ter disposal system are clear and plans are being drafted and projects implemented
immediate: because they deal with water every day. The whole
• people can move about more freely in their daily family benefits.
life
• People can also engage in social and ritual events 1. In many Pakistani communities, women‘s sur- -
with more comfort, when they no longer have to vival and that of their households, depends on
worry about staying clean. access to and control of natural resources, such
• clean streets means fewer mosquitoes and other as water.
pests
• Fewer people fall ill and the children miss fewer 2. Women and men have distinct responsibilities
days at school. and different stakes in using and managing water
• People take more responsibility, and keep the and water systems. In Pakistani societies, women
streets clean. and girls collect virtually every litre of water for
• Better health for everybody and particulary for cooking, bathing, cleaning, and maintaining
women and children. health and hygiene. They draw upand supply
most of the water for raising small livestock and
Yes Good Sanitation – For All Citizens growing home vegetables.
How to learn these skills – who are the councellors
There are wide gaps in knowledge and skills at each 3. Women carry out 80% of water-related work
level in translating the provision of these services through out the world. They are often the manag-
-

11



ers of community water supply, have extensive Although women provide about 70 percent of the
knowledge and experience, and have learned to unpaid time spent for caring for family members,
protect water resources in order to preserve them that contribution to the global economy remains
for future generations. invisible. Their diverse roles are not recognized. All
household work (cooking, cleaning, baby sitting,
4 Women often spend four to five hours per day water fetching, wood collection and cleaningof the
carrying heavy containers and suffer acute physi-
- sanitation place) is the responsibility of women.
cal problems – a burden that is made worse in
drought-prone or polluted areas. Community Heroes make Better Sanitation
The Local Government Ordinance, 2001 has de- -
5. Travelling long distances from home in search volved a range of functions, including water supply
of water sources increases the labour burden for and sanitation, to elected district and sub-district
women and limits time for other activities, in- - administrations. For women reserved one-third of
cluding income-generating work and education. local government representation. It has created a
If water and fuel sources are scarce, time for girls window for women in policy making and imple- -
to attend school and study is also curtailed. Girls mentation. It is always needed to explain the com- -
may even be forced to drop out of school to assist mon needs of males, females and children in this
in collecting water or because of limited facilities regard. Otherwise the old tradition with bad results
and water supplies for sanitation and personal is leading the new project.
hygiene.
Men may be the main actors in the installation
Unsafe Sanitation system – how to improve? of sanitation and policy making because of their
In rural areas, people also use ventilated pit latrine strength, physical power to do it. And they can
(VIP) and twin pit latrine and the latrine with the make two good systems for All in our village, one
septic tank. More than half the human excreta and for women and one for men to begin with. This
blackwater are not disposed off safely. This water good practise can all inhabitants take over to their
stands in the streets or ponds, creating a bad smell homes and schools.
and providing a habitat for mosquitoes and flies,
which spread malaria and diarrhoea. The installation of latrines and lane sewers
brought 5 direct benefits to women and chil- -
Baby Deaths dren.
The infant death rate is very high in the area due to 1. A great convenience of use at any time of day.
un-safe drinking water and un-hygienic practices. In fact, going out at night is a big problem for
Women get to the water source after miles of walk- - girls and women.
ing and stayed in the line for hours to get water 2. The health condition of the family improves
from the open dugwell. The quality of water is very and health related expenses go down as a
poor. direct result of sanitation.
3. The drainage of blackwater and smells from
Women are not used to washing their hands after the street, the children could play there with--
cleaning up their children‘s excreta and not wash-- out getting dirty.
ing their hands before cooking food for the chil-
- 4. The savings in time in making the children
dren. This unhygienic practice causes diarrhoea and the house clean.
among the children.

12



5. Less mosquitoes and flies in the area. the pit and then placed over it. These can be
made by trained latrine builders in a village or
Neighbouring villages can benefit of our work through a central construction point set up by
and good practice. the project - where they can be bought at low
cost. These are often called ’sani marts’.

Getting government support is not easy – Help Build a shelter of locally-available materials
from own community is needed such as wood or bamboo around the latrine to
“Help from community organisations such as OPP is an provide privacy. In some places bricks are also
advantage” said Nisar Sario, executive district officer used - depending on what each family can af- -
for work and services of the Karachi city district ford.
government. The Orangi Pilot Project or OPP is one
of the world’s best-known non-government projects Place a hand washing facility outside - this
in the large-scale provision of sanitation for the could be a gourd filled with water, that has a
urban poor, started 1980. It was not until 1991 that small hole drilled in it and a twig for a plug.
the Karachi Municipial government recognized the
Orangi project´s work and integrated the model in
its planning for the area. Before Water and sanita- - Other latrine options include:
tion was the work of residents in Karachi´s Orangi Ventilated improved pit latrines have a vent pipe
that initiated sanitation projects in the settlement included in the design which takes away smells and
in the 1980s. insects. Insects are attracted to the light at the top
of the vent pipe and then trapped at the top by a
How to build a latrine screen.
The most common type of latrine is a dry pit
latrine. Here is a step by step guide on how to Pour flush latrines are built where people use water
build one. to clean themselves after they have used the latrine.
In these the latrine pan is placed a few metres away
Find a suitable site and dig a pit that is at least from the pit and a pipe with a water seal in the u-
three metres deep and completely above the bend stops flies and smells escaping the pit.
water table.
Eco-san latrines create a renewable source of fertile
Depending on the type of latrine, line the pit compost from human waste. At their simplest fami- -
with bricks, concrete rings or other locally- lies simply plant a tree once the shallow latrine pit
available materials. is filled, while the more permanent fossa alterna
has two pits - one of which remains covered while
Build a squat slab to cover the pit, that has a the other is in use. Users add soil and ash after each
keyhole shaped drop hole and foot pads. This use to help dry the contents, and once the first pit
needs to be strong enough to regularly hold a is full, it is covered and left to compost while the
person’s weight and so is often made of con- - second pit is used. Then the first is dug out and the
crete (as pictured) which is pre-cast away from compost used for crops and the process is repeated.

13



Sanitation blocks are built in urban areas where are trained to become trainers; the community
the higher population densities mean that differ- - determines the best water supply and sanitation
ent sanitation solutions are needed. Pit latrines fill infrastructure option and hygiene promotion
too quickly and can pollute underground water education inputs are facilitated.
sources. In some cases septic tanks are used but, • Empowerment. People’s capacities, skills and
where possible sanitation blocks, which are owned indigenous knowledge are recognised and valued.
and managed by the community, are built that are Support is provided in the form of capacity-build--
connected to the city’s piped sewerage. ing to strengthen the ability of individuals who
emerge as leaders to work as agents of change
Cost examples within the community. Communities act as facili- -
• £8 pays for enough cement to tating agents in their neighbouring areas. Em- -
produce four latrine slabs in Malawi powered communities increase their confidence
• £15 buys an ecological to analyse and voice their needs constructively to
sanitation latrine in Mozambique local government agencies or other development
• £350 pays for a school sanitation programmes.
block for 150 boys and girls in India
Key aspects of the approach
Working for 100% Sanitation • People’s skills, abilities and knowledge are valued
• No open defecation or open/hanging latrine use. • 0% subsidy for latrine construction
• Effective hand-washing after defecation and be- - • Whole community’ approach
fore eating / taking or handling food. • Use of participatory research tools to analyse the
• Food and water are covered. problems
• Latrines are well managed. • Formation of Village Development Committees
• Clean courtyards and roadsides. - local engineering groups
• Garbage is disposed of in a fixed place, such as a • Identification of potential community leaders
pit and involve them as community ‘catalysts’
• Safe water use for all domestic purposes. • Mobilisation of local resources
• Water points are well managed. • Involvement of local government
• Waste water is disposed of down drains or in a • Involve micro credit
fixed place.
• No spitting in public places. Outcomes of the approach
• Sandals are worn when defecating. • More than 300 villages are 100% sanitised
• 20 innovative hygienic latrine designs have been
The approach is based on put forward by communities
the following key principles: • A cultural shift from ‘top down’ to ‘bottom up’
• Integration. Safe water supply, environmental approaches has happened in the organisation and
sanitation and hygiene promotion are addressed at community level
simultaneously. Projects are appropriate, sustain-
- • WaterAid Bangladesh and partners are providing
able and affordable for the community. training support to a number of local and inter--
• Participation. The whole community, includ- - national aid agencies to integrate the approach
ing the hardcore poor, are actively involved in • The Government of India is replicating approach
project planning, implementation, monitoring in the state of Maharastra
and evaluation. Individuals in the community

14



Gender Aspects • The water resources are not unlimited. Most of
In Bangladesh there is a rigid division of labour the inhabitants think: ”Water is very cheap, and
regarding activity related to water, sanitation and it is not a rare commodity. I don´t have to take
hygiene promotion. Women and adolescent girls care of it.” Although that a minimum amount
are disproportionately burdened by inadequate and of water should not be overcharged, the large
poor quality water and sanitation services as they consumers should be made to realise that potable
normally collect water, clean the household and water was not a free commodity.
care for the sick. Lack of privacy in sanitation facili-
-
ties also exposes them to increased risks of urinary 5. iMMuniZation / vaccination
tract infection, reproductive health problems and saving lives – no More infections
physical attack. Children who are immunized are protected from
these dangerous diseases, which often lead to dis- -
Women have reported that improved access to ability or death. All children have the right to this
water and sanitation services has resulted in a more protection. Every girl and boy needs to be immu- -
productive use of time and resources. Traditional nized.
gender roles are being challenged as men and
women recognise the direct contribution that wom- - It is essential that all parents know why, when,
en’s participation is making to the community’s where and how many times the child should be
improvement and to household economic benefits. immunized. Parents also need to know that it is
Through the process of forming and developing safe to immunize the child even if the child has an
community institutions women have increased illness or a disability or is suffering from malnutri-
-
their confidence and capabilities in private and tion.
public spheres.
All children, including those who are disabled, need
Water Crisis; A Special Report to be vaccinated. A child is immunized by vaccines,
Experts predict that with consumption rates and a which are injected or given by mouth. The vaccines
population growth of 4 million people a year, one work by building up the child’s defences against
out of three people in Pakistan will face critical disease. Immunization only works if given before
shortages of water, ”threatening their very survival”. the disease strikes.

Water Use – how to get better practisces: Woman Immunization
• Unsustainable acriculture practices are used All pregnant women need to be immunized to pro- -
throughout the country. Many of the experts tect themselves and their infants against tetanus.
in Pakistan believes that the warning signs has
helped people to ”wake up” and hepled them to Immunization is urgent!
learn and use more modern watering systems Every child needs a series of immunizations
(drip irrigation and pivot sprinkling systems), during the first year of life. It is essential that
which reduce the water requirement by 60 per- - infants complete the full number of immuniza- -
cent. tions – otherwise the vaccines may not work.

15



Age Immunizations to be given • A new or sterile needle and syringe must be used
for every person being immunized. People should
At birth insist on this.
BCG**, polio and, in some countries, hepatitis B • Disease can spread quickly when people are
crowded together. All children living in congest--
6 weeks ed conditions, particularly in refugee or disaster
DPT**, polio and, in some countries, situations, should be immunized immediately,
hepatitis B and Hib especially against measles.

10 weeks Immunization protects
DPT, polio and, in some countries, against several dangerous diseases
hepatitis B and Hib
14 weeks A child who is not immunized is more likely to
DPT, polio and, in some countries, suffer illness, become permanently disabled or
hepatitis B and Hib become undernourished and die.

9 months
Measles (12-15 months in industrialized coun-- A child who is not immunized is very likely to get
tries) and, in some countries, yellow fever, measles, whooping cough and other diseases that
mumps and rubella. can kill. Children who survive these diseases are
weakened and may not grow well or may be perma- -
*National immunization schedules may differ nently disabled. They may die later from malnutri- -
slightly from country to country. tion and other illnesses.
**BCG offers partial protection against some
forms of tuberculosis and leprosy; DPT protects Why against measles – can cause death
against diphtheria, pertussis (whooping cough) All children need to be immunized against measles,
and tetanus. which is a major cause of malnutrition, poor men- -
tal development, and hearing and visual impair- -
ments. The signs that a child has measles are a fever
• Immunization is urget! and rash that have lasted for three days or more,
• Immunization protects against several dangerous together with a cough, a runny nose or red eyes.
diseases. A child who is not immunized is more Measles can cause death.
likely to suffer illness, become permanently disa--
bled or become undernourished and die. Polio
• It is safe to immunize a child who has a minor All children, everywhere, need to be immunized
illness, a disability or who is malnourished against polio. The signs of polio are a floppy limb or
• All pregnant women need to be protected against the inability to move. For every 200 children who
tetanus. Even if the woman was immunized ear- - are infected, one will be disabled for life.
lier, she may need additional tetanus toxoid vac--
cinations. Check with a health worker for advice Tetanus bacteria
and tetanus toxoid immunization. Tetanus bacteria or spores, which grow in dirty
cuts, can be deadly without a tetanus immuniza- -
tion.

16



• Immunizing a woman with at least two doses of Diarrhoea
tetanus toxoid before or during pregnancy pro- - Diarrhoea is caused by germs that are swal- -
tects not only the woman but also her newborn lowed, especially germs from faeces. This hap- -
for the first weeks of the baby’s life. pens most often where there is unsafe disposal
• At six weeks of age, the baby needs the first dose of faeces, poor hygiene practices or a lack of
of DPT to extend the protection against tetanus. clean drinking water, or when infants are not
breastfed. Infants who are fed only breastmilk
In countries where hepatitis B is a problem, up seldom get diarrhoea.
to 10 out of every 100 children will harbour the
infection for life if they are not immunized. Chil-
- When families and communities work together
dren who are infected with hepatitis B are likely to they can do much to prevent the conditions
develop liver cancer when they are older. that cause diarrhoea.

In some countries, epidemics of yellow fever put 1. Diarrhoea kills children
many young children’s lives at risk. Vaccination can Diarrhoea kills children by draining liquid from
prevent the disease. the body, thus dehydrating the child. As soon as
diarrhoea starts, it is essential that the child be
In many countries, pneumonia caused by the given extra fluids as well as regular foods and
Haemophilus influenzae type B (Hib) germ kills fluids.
many young children. The Hib germ can also cause
childhood meningitis. This germ is one of the most 2. Immediate help from a
dangerous for children, particularly for those under trained health worker is needed.
five. Hib immunization can prevent these deaths. A child’s life is in danger if there are several
watery stools within an hour or if there is blood
Breastmilk protects in the faeces. Immediate help from a trained
Breastmilk and colostrum, the thick yellow milk health worker is needed.
produced during the first few days after birth, pro-- 3. Breastfeeding is safe
vide protection against pneumonia, diarrhoea and Breastfeeding can reduce the severity and fre- -
other diseases. Protection lasts for as long as the quency of diarrhoea.
child is breastfed.
4. The child needs at least an extra meal
Vitamin A A child with diarrhoea needs to continue eating
Vitamin A helps children fight infections and pre- - regularly. While recovering from diarrhoea, the
vents blindness. Vitamin A is found in breastmilk, child needs at least an extra meal every day for
liver, fish, dairy products, some orange and yellow at least two weeks
fruits and vegetables, and some green leafy vegeta- -
bles. In areas of vitamin A deficiency, children aged 5. Use Trained Health Worker to save life
six months and older should be given vitamin A If the child is dehydrated with severe or persist-
-
capsules or liquid when they are immunized or dur- - ent diarrhoea, only oral rehydration solution
ing National Immunization Days. Vitamin A is also or medicines recommended by a trained health
an important part of measles treatment. worker should be used. Other diarrhoea medi- -
cines are generally ineffective and could be
harmful to the child.

17



6. To prevent diarrhoea
To prevent diarrhoea, all faeces should be dis-
-
posed of in a latrine or toilet or buried.

7. Good Hygiene = Wash your hands
Good hygiene practices protect against diar-
-
rhoea. Hands should be thoroughly washed
with soap and water or ash and water after
contact with faeces, and before touching food
or feeding children.

6. Micro credit
Use micro credit system to build up, for instance,
the needed sanitation. The healthy costs much
more. Always.

18

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