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SWASHTHA - Strengthening Water, Air, Sanitation and Hygiene Treasuring Health

SWASHTHA Building healthy communities

Practical Action's SWASHTHA project in Bharatpur, Butwal, Gulariya and Tikapur municipalities of Nepal focussed on the health and wellbeing of the urban and peri urban settlements, by improving access to safe water, improved sanitation condition, better hygiene practices, proper waste management and better kitchen management. We hope that the stories in this report will inspire other communities to walk in the same path towards better sanitation and health.

Implementation dates: January 2009 - December 2012
Co-funding: EC NSA Nepal, UN-Habitat, Isle of Man Government
Contact person: Binaya Shrestha

This project aims to develop and promote integrated approaches by addressing major environmental health risks, such as indoor air quality, water quality, sanitation facilities and hygiene behaviours to create healthy homes benefiting 30,000 women and children in urban and peri urban settlements of Bharatpur, Butwal, Gulariya and Tikapur Municipalities.

The target beneficiaries of the project are mainly women and children from the socially excluded communities in all four municipalities and marginalised ethnic and other caste groups. The project also addresses a few urban environmental problems of neighbouring municipalities and small towns, ie., Ratnanagar, Ramgram, Sidharthanagar, Sunawal, Bardaghat and Kawasoti.

The four year project is co-funded by the European Union under its Non State Actors in Development (NEPAL) programme, the UN-HABITAT's Water for Asian Cities Programme and Isle of Man Government. The project is implemented through its local partners - Environment and Public Health Organisation (ENPHO) and Municipal Association of Nepal (MuAN).

Objective

The overall objective is to contribute to sustainable improvement in health and well being of vulnerable population especially, women and children residing in urban and per-urban settlements of Bharatpur, Butwal, Gularia and Tikapur Municipalities.

Integration of water sanitation hygiene and indoor air for healthy life

Each year 1.5 million people die because of diarrhea and another 1.6 million people die because of indoor air pollution (IAP) globally.  Water sanitation related diseases and indoor air pollution (IAP) are amongst the top killers in Nepal. 14700 people are dying each year because of unsafe water, lack of sanitation and unhygienic behaviors. There is another estimates that 12700 children under five die because of acute respiratory infection (ARI) and diarrheal disease annually due to poor hygiene and sanitation Similarly, 7500 people are dying each year due to IAP, a kitchen killer. Among these deaths, more than 50 percent are of age under 5. WASH (water, air, sanitation and hygiene) related diseases attributes for more than 10 percent death each year in Nepal. There is an estimate that about 10 billion Nepalese Rupees loss each year because of poor hygiene and environmental sanitation. Similarly, there is another estimate of about 10 billion Nepalese Rupees annual loss due to IAP.

The project SWASHTHA (Strengthening Water, Air, Sanitation and Hygiene Treasuring Health) is therefore designed to contribute in reducing such losses through integrated WASH interventions in some urban and peri-urban areas of Nepal.  SWASHTHA project focuses to improve the health and well being of the urban and peri urban settlements of Bharatpur, Butwal, Gulariya and Tikapur municipalities. The project is working in 19 communities in these four municipalities and 2 Village Development Committes (VDCs) of Chitawan district.  The project also focuses on the few urban environmental problems of some neighboring municipalities and small towns like Ratnagar, Ramgram, Sidharthanagar, Sunawal, Bardaghat and Kawasoti. The four year (2009 – 2012) project is funded by European Union under its Non-State Actors in Development (NEPAL) programme and co-financed by UN-HABITAT's Water for Asian Cities Programme. The project’s implementing partners are Municipal Association of Nepal (MuAN), Environment and Public Health Organization (ENPHO) and Practical Action Nepal Office as Non State Actors (NSA) and respective municipalities and VDCs as State Actors. The overall objective of the project is to improve health and wellbeing of vulnerable population especially, women and children residing in urban and periurban communities of project areas. The expected outcomes of the project are to reduce health cost through preventing WASH related diseases, creating clean environment and improved hygiene practice.

Safe water is the first component of the project. Water should not only be safe in source but it should be safe till it is consumed. It is therefore important to deliver safe drinking water from its catchments to consumers (“in Nepali Mul Dekhi Mukh samma”). Low cost household water treatment options like boiling, chlorination, filtration and SODIS (solar disinfection) methods are promoted in project communities. Concrete platforms are constructed to avoid ground water source protection. Better sanitation is the second major component, where sanitizing faeces is a key facet. The project promotes low cost toilets as per the choice of households including single pit pour flush, wet ECOSAN, dry ECOSAN and bio gas attached toilets. Alongside, dish washing platform (Juthelno), dish drying rack (Chang) and cattle shed improvement are also promoted to better health outcomes. Use of local resources has been encouraged while promoting such interventions.

Hygiene is the third component of the project. Local change agents like Female Community Health Volunteers (FCHVs), teachers and students are trained and mobilized to aware beneficiaries for safe hygiene practices. Kitchen management is the fourth component of the project. Major project interventions to reduce IAP are promotion of improved cooked stoves (ICS), ventilation improvement, bio gas and kitchen space management. Fifth and the last component of the project is waste management. The project has promoted 3R (reduce, reuse and recycle) principle in managing solid waste of project communities. Household and community composting are some of the major interventions under this component.

Access to safe water is increased to the beneficiaries. Two communities have been declared as safe water community (SWC). The project with the support of local stakeholders are able to declare open defecation free (ODF) in 14 project communities out of 21. OD is significantly reduced in other remaining communities too. People have expressed that awareness on hygiene has increased and adopted safe hygiene practices accordingly. More than 300 FCHVs are trained on each component of the project and are mobilized in the project communities. Pollution level of indoor air in intervened households has reduced significantly. Similarly, awareness of waste management has also increased. Further, a community in Chitwan has been declared as SWASHTHA (Healthy) community after satisfactory interventions of all project components.

Changing behavior of people is complex as change might be discomfort even it is better. Project has applied ignition participatory rural appraisal (IPRA) tools to trigger behavioral change. Despite of successes, it is to be mentioned that 5 to 10 percent toilet are still not being used properly, some water filters are already defunct, still some people do not wash hand properly, some installed ICS are not used and waste is not being managed properly. However in overall, there are visible positive changes in health of people in the project communities. It can be concluded that improvement on these five components definitely help to create a healthy home and with these healthy homes, a healthy community will form.

There are some visible changes like reduction of diarrheal and smoke related diseases. FCHVs have expressed that use of rehydration medicine (Jivan Jal) has reduced significantly in project communities. Communities are cleaner because of reduction of OD and better waste management. Exact mapping of the outcomes will be revealed by health impact study being performed by an independent consultant. The study result will be measured against the baseline data taken before the project interventions in order to measure the success of the project and will be available by November 2012.

SWASHTHA Building healthy communities

Practical Action's SWASHTHA project in Bharatpur, Butwal, Gulariya and Tikapur municipalities of Nepal focussed on the health and wellbeing of the urban and peri urban settlements, by improving access to safe water, improved sanitation condition, better hygiene practices, proper waste management and better kitchen management. We hope that the stories in this report will inspire other communities to walk in the same path towards better sanitation and health.

SWASHTHA Lessons Learnt

The SWASTHA project (Strengthening Water, Air, Sanitation and Hygiene Treasuring Health) developed and promoted integrated approaches by addressing major environmental health risks in Nepal, such as indoor air quality, water quality, sanitation facilities, and hygiene behaviours. This report documents the lessons learnt, and recommends strategies, approaches and activities for an ideal water and sanitation project for poor, vulnerable and excluded communities.

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