Dear all,

I am happy to share the synthesis document of the discussion. Thank you for your inputs for this very interesting topic.

Regards,
Nitya

Dear all,

I came across this article on NDTV today - swachhindia.ndtv.com/poshan-maah-2021-de...=home-ndtv_campaigns

Its an excellent analysis of why malnutrition continues to persist, and even increase, in India despite large national programmes. Part of the reason is the way they are executed. Another is the fall in incomes from 2015. But conspicuous by its absence is WASH - the article makes no mention of WASH programmes and linkages between water, sanitation and hygiene and improved health and nutrition. With respect to the experts from nutrition, who have been quoted, and NDTV, I would like to state that WASH is an important contributing factor for better nutrition. You can supplement and complement food all you want but if nutrients cannot be absorbed, you are stuck at ground level. And repeated episodes of diarrhoea, or infestation by intestinal worms (soil-transmitted helminths), compromise the ability of the body to absorb nutrients. And poor WASH is the main cause of both.

To be fair, the Ministry of Jal Shakti does a mention in the second last line.

Regards,
Nitya

DearSuSanA  Forum  Members, 
Wish to bring to your kind notice the concept on COD-Controlled Open Defecation
This concept has been referred by me repeatedly in our SuSanAForum,  in my last post had referred to afew aspects as given  below:
 
1.General aspects on COD- Controlled Open Defecation :  Explained by me on info available from the field:
One area used for 3 to 4  weeks by a section of communities, and identical space allocated for men, women and children and others in separate areas as decided by the Authorities.  The spaces would be in use and shut down in 3to 4 weeks or say monthly as convenient. When the spaces are changed over, the spaces used earlier goes for total cleanup and all bio- sludges ( night-soil)  removed and taken up forbio- composting. The process of composting ie conversion to compost happens in 4 to 6 weeks, depending on local weather conditions Etc. The bio- produces are duly utilised in respective agri- farms Etc. In a way the conversion process is
well sustained and maintained thus, for the desired results.     
This information has been highlighted and also explained by Government release  astitled below, refers :as attached 
Doc 1. Controlled Open Defecation COD pgs 36,37

2. COD  concept  has been explained  by Press release by UP Govtt. in one of their Quarterly Bulletin May, 2014  referring to Alternate arrangements for a large section of people during Maha Khumbh time at Prayag, UP. Site cleaning
and use of bio- sludges done with the process of bio- composting Etc.                                                 
This information has been highlighted and also explained by the concerned State Department vide their document as titled below, refers : as attached         .      
Doc 2. Toilets & Sanitation COD Kumbh May, 2014 .                              

3. One occasion was during Kerala Floods :Aug 2018
Witnessed  total eviction of communities fromtheir habitats in 2016, 2017 and also again in 2019, 
In all these occasions CBOs- Community Based Organisations  under lead NGO Kutumbhshree,Trivandrum  had organised makeshift toilet spaces as for privacy and at high ground of many habitats .                                                                                                                                                        This information has been highlighted and also explained by the concerned NGO vide their document as titled below, as attached          . Doc 3. Flood Relief Activities Kudumbashree Aug 2018   

I had referred to these details in my earlierposts in this SuSanA Forum.

With well wishes. 
Prof Ajit Seshadri 
The Vigyan Vijay Foundation Ngo,  New Delhi. 

Attachments  given :
1.ControlledOpen Defecation COD pgs 36,37.                                                                                                                                                                                    2.Toilets & Sanitation COD Kumbh May, 2014.                                                                                                                                                                                    3.Flood Relief Activities Kudumbashree Aug 2018   

Hi Ajit,

Please provide more information on COD if you have got it.

Regards,
Nitya

Dear Sujoy da and Paresh,

The baseline report of 2016 is available at pdf.usaid.gov/pdf_docs/PA00MM9F.pdf. The endline is available at pdf.usaid.gov/pdf_docs/PA00TQ5Q.pdf.

Regards,
Sunetra

Dear Dr Sujoy Majumdar, 

Indeed very pleased to feel your appreciation on the COD - concept. 

I have come across this COD concept on many occasions,  
One occasion was during Kerala Floods :
Witnessed  total eviction of communities from their habitats in 2016, 2017 and also again in 2019, 

In all these occasions CBOs under lead NGO .... Kutumbh, Trivandrum  had organised makeshift toilet spaces as for privacy and at high ground of many habitats .

I had been then associated with providing alternative power arrangements for ops of Signal Towers on restricted basis, using operable Trucks DC Supply for charging Batteries Etc.
I had become aware of this COD arrangement, this COD- mechanism reportedly was carried out to communities satisfaction..
Have sought more details,
I will give you when I get them.

This concept was again reported by CEPT on one of  their Quarterly Bulletin referring to Alternate arrangements for a large section of people during Maha Khumbh time at Prayag, UP.

I had referred to these details in my earlier posts in this SuSanA Forum.

With well wishes. 
Prof Ajit Seshadri 
The Vigyan Vijay Foundation Ngo,  New Delhi. 

Great to hear about Nourish, Sunetra.

Do share the final reports .. I would be especially interested up look at your assessment tools used for Baseline and Endline

regards

Sujoy Mojumdar

Very interesting information, Dr Sheshadri.

Would it be possible for you to share  some location/example where the Controlled Open defecation (COD)  in practices, and how it is planned.

Will be very useful to know.

Dear all,

Nripendra makes an important point, to consider the status of WASH in schools. The Swachh Vidyalaya campaign drew attention to school toilets and drinking water. As per the dashboard coverage is very high. A key feature of the campaign was to ensure that every school in India has a set of functioning and well maintained water, sanitation and hygiene facilities. Water, sanitation and hygiene in schools refers to a combination of technical and human development components that are necessary to produce a healthy school environment and to develop or support appropriate health and hygiene behaviours.

As many as 95.82% schools have a boy's toilet and 95.86% have a girl's toilet. 97% have drinking water. These are official figures. The Annual Status of Education Report figures indicate coverage is lower, at 74%, 66% and 75%, respectively. Nevertheless, there has been a significant increase from 2010.

These do not tell us if the toilets and drinking water facilities actually work. Or if the water is safe to drink. It is hard to draw conclusions based on the hardware numbers. NFHS data that shows malnutrition decreasing very slowly. In this discussion, it would be useful to understand how you have assessed/evaluated integrated programs on nutrition and WASH? Did you use specific indicators or tools?

Dear Sunetraji,
Thank you for a posting a detailed account of the NOURISH programme. Request you to provide links to reports (if any) and figure 1 of a legible resolution. 

I am also curious to know more about the two of the 4 strategies, viz; creating demand and building capacity. It would be great if you could detail a bit on the measures taken under these two heads and share reports (if any) of their effectiveness. 

Thank you
paresh

Dear All,
Concerted efforts are missing for emphasis on WASH and Nutrition Linkage ...... . Still, there  is a need to formulate action plan to ensure meaningful and participatory involvement of all stakeholders for eventual effectiveness of WASH activities to facilitate the Nutrition.

An important aspect in this regard, is the inter-sectoral convergence. For example, the Stakeholders working in the Nutrition Sector should not consider only about the Food and their respective calorie values alone, but also about the importance of sustained WASH practices to get maximum out of such calorie food values. As an instance, Mid-day Meal Programme in School (being implemented in India ) is sponsored by Government in Schools keeping in view of importance on adequate Nutrition, but the conditions in the schools, arising out of absence of  well maintained WASH facilities or the Hand Washing practices, should also not be ignored, otherwise, which may eventually hamper the desired impacts from the Govt. policy on food and nutrition.

Apart from that the necessary emphasis on food varieties (along with nutrition aspects) is also not linked with the importance on selection of food menu based on location specific adverse water qualities.

Thanks and Regards.
Nripendra Kumar Sarma
Superintending Engineer,
PHED, Assam, India

Swachh Bharat Abhiyan (Clean India Mission) (SBM) was launched on 2nd October 2014. The mission's activities include construction of toilets in private, community, and public spaces, as well as solid and liquid waste management. Furthermore, the campaign tries to achieve a change in hygiene practices of urban and rural stakeholders through information, education, communication (IEC) activities, and public awareness programs (SBM-G 2014). 

Human excreta acts as a host for various pathogens and can cause several diseases including cholera, typhoid, hepatitis, and polio (www.euro.who.int/__data/assets/pdf_file/0013/102316/e79822.pdf). Several reports have shown a positive association between open defecation and poor health of children.

The occurrence of open defecation is one of the reasons behind stunting. In households without open defecation, children grow taller, as they do in villages with higher toilet use in comparison to children growing in an environment with high open defecation in private and community spaces. Even when the household itself has a toilet, any other person in the village defecating in the open may harm the overall welfare of the community by exposing them to pathogens and diseases. The bacteria in human feces cause intestinal infections, which leads to diarrhea and is one of the leading arguments explaining the relationship between stunted child growth and open defecation (www.ncbi.nlm.nih.gov/pmc/articles/PMC3774764/). 

An external factor, female literacy is a more relevant influencing parameter compared to open defecation when looking at child stunting rates. Children of mothers with high maternal health literacy were found to be only half likely to be stunted than children of mothers with poor health literacy (academic.oup.com/jn/article/146/7/1402/4585750). 

The Swachh Bharat Mission focuses on building toilets while its Information, Education, and Communication activities aim to bring about behavioral change in health and hygiene practices to trigger greater demand for sanitary facilities. A huge amount of funding has gone towards IEC initiatives under Swachh Bharat Mission. Out of the three components of IEC, “Information” and “Communication” activities are short-term and easy to implement but the third component, “Education” is an outcome which cannot be achieved in shorter time intervals. 
The efforts of the Swachh Bharat Mission and related programs towards constructing toilets won't be effective unless sufficient attention is also paid to female literacy. Being an important factor in the reduction of open defecation, policymakers must focus on an integrated approach that includes increasing awareness of female stakeholders and educating them as part of such programs. Such a focus on educating women, especially on health, nutrition, and hygiene, is likely to assure a reduction in the incidence of OD and child stunting simultaneously in India.