An optimal outcome of Inclusive Sanitation approach, as well as its supporting investments, should be focused on the provision of and access to appropriate and sustainable sanitation services for all individuals, to derive holistic social and health benefits. The targeting of specific unserved and underserved groups is imperative for inclusive sanitation projects. In the context of the Indian population, these groups include women (adolescent girls, widows, single women), transgenders, informal workforce (construction labour, street vendors, house helps, maids etc.), homeless and transient population, frontline sanitary workers, ethnic minorities, and persons who are differently abled and elderly, among others.
Inclusive sanitation thrusts on the need for a framework that encompasses the elements addressing inclusive sanitation concerns across the entire sanitation value chain for the unserved and underserved communities. This further urges upon the need for hygienic and well-maintained toilet facilities for the public and the community at large, consequently enabling an individual the entitlement of their basic right as a citizen when away from the residence. Building upon this social gap, a focused approach towards attaining goals and targets outlined under SDG Goal 5, 6, 9 and 10 is expected to enable the achievement of citywide inclusive sanitation and hygiene.
The urban sanitation planning is highlighted as a part of the National Urban Sanitation Policy (NUSP) from
2008. The NUSP is well aligned with the inclusive sanitation principles, including a
comprehensive planning approach, the City Sanitation Plan (CSP), that is cross-sectoral and aims
to be the go-to document for city managers in aspects underlining sanitation (including solid
waste and storm water drainage, and water supply). Despite the CSP being the core implementation
instrument of the NUSP vision, the support of international agencies such as GIZ and World Bank in implementing and developing an
operational framework of the CSP, the promised impact has not been delivered.
Although there has been a tremendous increase (~43% in 2014-15 vs ~90% in 2018-19) in the number
of indoor toilets being built, due to the NUSP and Swachh Bharat Mission (SBM), thousands of
people in India still do not have access to hygienic sanitation facilities. Multiple beliefs and
predispositions that have been traditionally held toward toilets and sanitation are
misconstrued, leading to the under-examination of sociological implications of open defecation.
This is specifically true when factors such as gender, ethnic minorities, disability, and age
are involved. These communities face multiple challenges while accessing sanitation
infrastructures:
Underlying factors such as diverse experiences, needs and priorities of workers themselves
have taken a back seat while focus has primarily been on establishing occupational health
and safety, technological solutions, and policies and regulations.
Inadequate attention towards inclusive and equitable approaches for a majority of the
marginalized communities living in the cities has become prevalent, particularly in the
aftermath of the COVID-19 pandemic.
The post-pandemic vulnerabilities have also been highlighted by the tremendous risk of using
the community toilets and other shared facilities, particularly for women, girls,
transgender individuals, and individuals with disabilities.
Unequal participation of all people, including individuals at risk of exclusion, has led to
a lesser opportunity for society to reach optimum potential with regard to its economy,
public health, environment, governance, and cohesion.
The unavailability of access to safe sanitation significantly endangers the population of a
state / city by rendering them potentially prone to fecally transmitted disease.
Navigating work and domestic responsibilities, a lack of social security,
negative impacts of physical labor on their reproductive health, poor access
to healthcare, vulnerabilities to sexual violence and harassment at home and
work, job insecurity, housing and education, chronic morbidity, and lack of
participation in decision-making activities adversely impacts mental and
physical health of women who face “double” or
“triple” discrimination due to caste, gender and occupation
There is a lack of information pertaining to workers with existing
disabilities who undertake sanitary and workers who have a disability,
because of sanitation work
There is a need for attention towards how the rights of workers with
pre-existing (physical and psychological) needs can be realized and the
availability and accessibility of facilities in low-income settlements
where sanitation workers commonly live
Sanitary work continues to be associated with low-class and religious,
racial and ethnic minorities around the world, particularly in South
Asia
Despite the banning of health compromising practices, introduction of
new machines, and dignification of job titles, hazardous waste work is a
common form of waged and unwaged labor in most low-and-middle income
countries (LMIC)
Child waste pickers financially contribute to low-income households, but
often cannot avoid risks including traffic accidents, being trapped in
waste compressors, slipping or falling, and being cut by waste materials
Families face the financial burden of treating wide-ranging health
problems among waste collector children, including malnutrition,
respiratory issues, skin problems, fatigue, vision impairments, among
others
(Figure 1: Barriers to Inclusive Sanitation across Communities.
Source: Frontiers in Water)
Provision of infrastructure through access to individual household toilets, menstrual hygiene
management (MHM) facilities in community and public toilets, among others, have been an area of
emerging focus. In addition, it is important to initiate specific activities and programs that
enable structural transformation to empower women and the socially
discriminated. Supporting women by giving access to the cutting-edge digital technologies used by the State will improve their empowerment
and the results of service delivery.
A variety of elements need to be factored in when developing, designing, and implementing
investments in urban sanitation and services which are innovative, effective, efficient, and
useful. Existing and planned frameworks need to encompass elements that address inclusive
sanitation concerns across the entire sanitation value chain with particular focus on:
Poor communities and other un-served or under-served settlements, including women, aged,
persons with disabilities, transgender individuals and other socially excluded
Equal representation of women and socially excluded groups in all decision-making bodies and
institutions related to sanitation
Coverage across the national and the local levels, to increase agency and participation of
all community members in sanitation as decision-makers, consumers, and providers of services
across the value chain
A city-wide as-is assessment of the existing sanitation infrastructure is essential to build an
understanding of the current situation across the city, which includes the following key
factors:
(Figure 2: Key Factors of As-Is Assessment for Inclusive Sanitation. Source: NFSSM
Alliance, 2020)
The as-is assessment holds value and relevance as there is no disaggregation of the city-wide
sanitation data across inclusive groups at the city level. Disaggregated data across inclusive
groups can be used for planning process to reduce inequalities, effective policy formulation,
and the evaluation and monitoring of the effectiveness of inclusive sanitation policies. The
assessment would further feed into analyzing the demand and supply gap in terms of services and
structures and would constitute as a critical input in undertaking the following:
Stakeholder-consulted community toilets/public toilets (CT/PT) that are
undertaken at the slum and the ward level to design public sanitation
infrastructure features and addressing the needs concerning the
upgradation/retrofitting of the existing CT/PT.
Focused on the infrastructural needs of women, aged, differently abled
persons, transgender, and migrants, marginalized and urban poor through a
bottom-up approach. Apart from including gender-specific cubicles/bathing
spaces, provisions need to be made for separate space for washing, and
ensuring MHM, among others.
Address differentials encompassing gender and other excluded group through
the converging of funding sources across different city-levels, user fees,
and other revenue sources by refering to convergence guidelines such as the
Deendayal Antyodaya Yojana-National Urban Livelihoods Mission (DAY-NULM) and
SBM.
Inclusion of women, men, differently abled persons, transgender and
front-line sanitary workers across urban elected representatives for the
formation of City Level Task Force and Ward and Slum level community
structures - to fix service tariffs and oversee operation & maintenance
of the PT/CT and FSTPs.
Enable a holistic approach that caters to all city dwellers, including groups
that are vulnerable and marginalized.
(Figure 3: Outcomes of As-Is Assessment. Source: NFSSM Alliance, 2020)
The establishment of systems and processes towards ensuring sanitation for all at all times
should be guided by an exhaustive checklist for (inclusive sanitation), which ensures the
addressal of concerns around adequacy and quality of sanitation infrastructures and services.
The inclusive sanitation checklist should also articulate these concerns to the Urban Local
Bodies, City Sanitation Task Force, and Ward-level and Slum-level Sanitation Committee.
Situational Analysis: ‘As-is’ Assessment of the inclusive sanitation
The ‘As-is’ assessment assesses the gaps between the existing and desired sanitation
infrastructure and service delivery for promoting and strengthening Inclusive Sanitation across
the sanitation value chain (containment, emptying and conveyance transport, treatment, and
reuse) through a citywide survey. The assessment should be followed by the outlining of a
roadmap for equitable and inclusive sanitation at the city-level.
Policy, Planning, and Implementation of inclusive sanitation
An existing or the development of a policy framework and guidance based on the
‘as-is’ assessment is crucial in enabling inclusive sanitation for the city.
Further, a City Sanitation Plan (CSP) that is undertaken with the participation of all
representative sections of society (including women and other vulnerable groups), including a
disaster mitigation plan with strong focus on WASH should be ensured. The implementation of
these policies and plans should consider financing options (earmarking of funds, participatory
budgeting process, and inclusive budgeting) as well as convergence with departments /
organizations for better utilization of resources.
Access to Sanitation Services – Community and Public Toilets
To enable the equitable and inclusive use of sanitation infrastructure such as community and
public toilets, states and cities should ensure to address the key concerns of all communities,
including women, differently abled, transgender, and senior / elderly citizens.
Ensure the incorporation of features related to safety, privacy,
menstrual hygiene management, pregnancy-related concerns, care giver
economy concerns, and tariff rates into the public sanitation
infrastructure to avoid any harassment.
The features should include a safe location, clear signs / directions
and branding, separate entrance for gender-allocated sections, robust
structures, well-lit spaces with regular power supply, design for
privacy, units for washing / bathing, access to basic amenities such as
water and soap, menstrual products and washing / disposal facilities for
them, diaper changing stations, breastfeeding stations, family-friendly
cubicles, and gender-allocated caretakers, among others.
Ensure the addressal of the concerns of differently abled individuals in
the public sanitation infrastructure design, including citizens
suffering from locomotor disabilities and visual impairment.
The key features should include basic requirements such as separate
toilet cubicles, door handles and locks, accessibility to washbasin,
soap facilities, waste disposal locations, and menstrual product
outlets. Further, care must be taken to incorporate adequately spaced
entrances with appropriate signage, support structures for accessibility
(ramps, handrails, grab bars), trained caretakers, and display for
toll-free assistance and user fee.
Ensure the addressal of the concerns of transgenders in the public
sanitation infrastructure design.
The key features should include basic requirements such as
gender-neutral toilet cubicles with handwashing facilities, facilities
for menstrual hygiene management including water access, accessibility
to menstruation products, and clean litter bins. Further, care must be
taken to provide trained caretakers, and display for toll-free
assistance and equitable user fee.
Ensure the addressal of the concerns of elderly citizens in the public
sanitation infrastructure design. The key features should include basic
requirements such as toilet cubicles with handwashing facilities, facilities
for menstrual hygiene management, and accessibility within cubicle. Further,
care must be taken to display for toll-free assistance.
(Figure 4: Key Factors to Ensure Equitable Accessibility of Sanitation
across Communities. Source: NFSSM Alliance, 2020)
Inclusive Sanitation in Institutions – Schools, Hospitals, and ULBs
While addressing the key concerns of all respective communities, states and cities should also
ensure to include other publicly available sanitation facilities across institutions such as
schools, hospitals and healthcare facilities, and offices of the ULB / public institutions /
marketplaces / bus and railway stations / other institutions including FSTP sites.
Ensure the incorporation of features related to safety, privacy,
menstrual hygiene management, pregnancy-related concerns, care giver
economy concerns, and tariff rates into the public sanitation
infrastructure to avoid any harassment.
The features should include a safe location, clear signs / directions
and branding, separate entrance for gender-allocated sections, robust
structures, well-lit spaces with regular power supply, design for
privacy, units for washing / bathing, access to basic amenities such as
water and soap, menstrual products and washing / disposal facilities for
them, diaper changing stations, breastfeeding stations, family-friendly
cubicles, and gender-allocated caretakers, among others.
Ensure the addressal of the concerns of differently abled individuals in
the public sanitation infrastructure design, including citizens
suffering from locomotor disabilities and visual impairment.
The key features should include basic requirements such as separate
toilet cubicles, door handles and locks, accessibility to washbasin,
soap facilities, waste disposal locations, and menstrual product
outlets. Further, care must be taken to incorporate adequately spaced
entrances with appropriate signage, support structures for accessibility
(ramps, handrails, grab bars), trained caretakers, and display for
toll-free assistance and user fee.
Ensure the addressal of the concerns of transgenders in the public
sanitation infrastructure design.
The key features should include basic requirements such as
gender-neutral toilet cubicles with handwashing facilities, facilities
for menstrual hygiene management including water access, accessibility
to menstruation products, and clean litter bins. Further, care must be
taken to provide trained caretakers, and display for toll-free
assistance and equitable user fee.
(Figure 5: Inclusive Sanitation in Institutions. Source: NFSSM
Alliance, 2020)
Capacity Building of Stakeholders
Stakeholders across the value chain should undergo trainings and capacity development programs on
key inclusivity principles and activities regularly.
Various Acts and Legislations such as Sexual Harassment of Women at
Workplace (Prevention, Prohibition and Redressal) Act, 2013 and
Prohibition of Employment as Manual Scavengers and their Rehabilitation
Act, 2013
Gender and Inclusive Sanitation, Gender Responsive Budgeting, Framework,
and Reporting to ensure addressal of complex social and gender issues
identified
Various Acts and Legislations such as Sexual Harassment of Women at
Workplace (Prevention, Prohibition and Redressal) Act, 2013 and
Prohibition of Employment as Manual Scavengers and their Rehabilitation
Act, 2013
Use of safety equipment, protective gear and safety protocols across the
sanitation value chain.
Linking different schemes and programs with sanitary workers
Occupational and Safety Health (OHS)
FSSM, desludging operations, and other FSTP
Skill upgradation training for both women and transgender led by the
state with employment opportunities in the sanitation sector
Trained caretakers to be responsive to the requirements of female users.
Caretaker trained to inspect the maintenance issues and ensure
coordination with the community for proper water storage, management,
and distribution.
Development of IEC material capacity building of women, men and transgender
in accessing sanitation services, addressing inclusive sanitation barriers,
and prevention of manual scavenging and hazardous cleaning
(Figure 6: Capacity Development for Stakeholders across Sanitation
Value Chain. Source: NFSSM Alliance, 2020)
Inclusion of Frontline Sanitary Workers
The existence of a sanitary workers association including both frontline sanitary workers and
waste pickers should ensure that they are engaged in the business of waste management actively
with access to and utilization of full safety gear as per the prescribed norms. Further, assessments should
be caried out if waste handling is done mechanically and for periodic health checkups for these
workers.
Inclusion in inclusive sanitation systems
Cities should ensure the adherence to operational inclusive sanitation guidelines / regulations
developed by the state / city with:
Defined mechanisms for performance levels and setting meaningful, progressive, and inclusive
targets
Systems in place to reach out to different segments within a city efficiently and equitably
Incorporate the futuristic urbanization needs in current design
ULBs providing services at discounted rates for marginalized population through licensed
service providers
Guidelines to introduce KPI and regular water quality and sludge test
Periodic review of operators and monitoring system
Further, registered associations should ensure provision of full safety gear as per the prescribed norms and assess if waste
handling is done mechanically and for periodic health checkups for trained workers.
Health, safety, and welfare of sanitation workers
The safety of sanitation/ de-sludging workers is a top priority since it involves risks such as
physical injury, the inhalation of toxic gases, contact with fecal sludge, and other
problems during the de-sludging process. The safety of sanitation workers affected by several
underlying problems along with the ongoing actions to address the occupational safety concerns for de-sludging workers are mentioned in
the below table.
Safety issues
Solution
Lack of safe de-sludging tools
Identify the necessary equipment and instruments for safe desludging (e.g.,
the tools needed to remove septic tank blockages without manual
intervention)
Use of non-standardized unsafe de-sludging procedures
Create emergency and safety procedures to guarantee safe de-sludging
Lack of emergency preparedness skills
Create emergency and safety procedures to guarantee safe de-sludging
offering advice on creating personalized first aid and emergency kits
Limited access to the right Personal Protective Equipment (PPE)
Locate and field-testing suitable, approved PPE
Modifying current PPE only slightly to verify usability during field testing
Dearth of safe de-sludging protocols
Provide training to workers to teach them how to use personal protective
equipment, safety equipment, first aid supplies, and safety protocols
(Table 1: Safety issues and solutions to address the occupational
safety concerns for de-sludging workers. Source: Tamil Nadu Urban Sanitation Support Programme
(TNUSSP))
Some of the initiatives for Occupational and Healthy safety of Sanitation workers
include-
Health camps- Exclusively for sanitation employees, health camps can be
frequently conducted by city corporation. These can include necessary body check-up, counseling,
and awareness campaigns, as well as providing medical services and diagnostics.
Social Security and Welfare- To make it easier for sanitation employees to
receive welfare and security programs including old-age and widow pensions and financial aid for
the poor and disabled, it is necessary to provide sanitation workers with valid ID cards, and
institutionalize the sanitation workers role by signing them up with the welfare board.
Alternative livelihoods- Programs for entrepreneurship development can also
being established to increase their alternatives for a living. Need based trainings depending
upon recipients' objectives and assisting them in identifying businesses based on market
demands can help them break barriers that generally occur due to lack of education, exposure,
and social stigma.
Equal pay- Despite the persistent gender disparities in many professions, equal
pay for equal effort has long been a standard in the sanitation industry. Sensitization
workshops for de-sludging operators and sessions for supervisors can be organized to raise
awareness even further and generate equal opportunities for all.
Sustainability and scaling- Formulating informal/ local bodies consisting
of volunteers from sanitation workers settlement to help establish safe sanitation ecosystem in
place which can help-
Safeguard the shared sanitation system
Prevent open defecation in the neighborhood
Help the sanitation employees access government assistance programs
Reinforce sanitation workers' usage of PPE
Sustenance – Operational Efficiency
Cities should ensure that memorandums of understanding (MoUs) / contracts with Community Groups
are undertaken for delegating power and ownership to community forums (ward forum and slum
forums) for operation and maintenance of the public sanitation infrastructures (CT/PTs and
FSTPs) in their respective areas. Differential tariff structures should be in place for groups
to access sanitation infrastructure. Further, the performance of a ULB should be tied to
regulatory penalties, incentives, independent and autonomous accountability systems to ensure
meeting of operational expenses, while convergence of tax funding should focus on improving
financial capacity. Periodic monitoring by ULBs should be in place to ensure basic operational
capability of citywide sanitation infrastructure.
The institution of sanitation infrastructure that encompasses the inclusive needs of all communities in a city is a pre-requisite to mark inclusive sanitation at a city level. The inclusive sanitation should be planned for a duration that spans 5 years, depending upon the city’s demographic profile – concentration of urban poor and unregulated urban settlements, sanitation service accessibility, and the emerging urbanization needs of the city. The inclusive sanitation implementation strategy should be spearheaded by Urban Local Bodies (ULBs), focusing on planning of sanitation services, and supporting investments for integrated and incremental systems that prioritize the achievement of inclusivity, safety, and sustainability.
Apart from the as-is assessment of public sanitation infrastructure and the City-Level Inclusive Sanitation Planning (CSP), a phase-wise approach (typically for 1-3 years) should focus on an implementation roadmap and through the lens of equity and inclusiveness, incorporate the retrofitting needs of dysfunctional sanitation amenities.
Phase 1
Ascertain the existing situation of urban sanitation infrastructure through an as-is assessment (including CT/PT and FSTPs)
Review existing institutional landscape for urban sanitation as part of the inclusive sanitation
Representative task forces / sanitation groups to be formed at City, Ward and Slum level that includes all community members
Use the as-is assessment to draw insights from existing public sanitation infrastructure.
Ensure reflection on gender, urban poor and other marginalized sections while integrating inclusive budgeting with planning in cities. Incorporate an annual incremental increase for inclusive budgeting.
Optimize capacity building of elected representatives, ULB staff, and sanitation workers, with periodic reviews
Implementation of inclusive sanitation in 25% of the public sanitation infrastructure (CT/PTs)
Public sanitation infrastructure monitoring and scoping of the retrofitting needs of dysfunctional sanitation amenities to be performed regularly
Optimize capacity building of elected representatives, ULB staff and sanitation workers, with periodic reviews
Implementation of inclusive sanitation in 50% of the public sanitation infrastructure (CT/PTs)
Public sanitation infrastructure monitoring and scoping of the retrofitting needs of dysfunctional sanitation amenities to be performed regularly
Optimize capacity building of elected representatives, ULB staff and sanitation workers, with periodic reviews
Implementation of inclusive sanitation in 75% of the public sanitation infrastructure (CT/PTs)
Public sanitation infrastructure monitoring and scoping of the retrofitting needs of dysfunctional sanitation amenities to be performed regularly
Optimize capacity building of elected representatives, ULB staff and sanitation workers, with periodic reviews
Implementation of inclusive sanitation in 100% of the public sanitation infrastructure (CT/PTs)
Public sanitation infrastructure monitoring and scoping of the retrofitting needs of dysfunctional sanitation amenities to be performed regularly
Optimize capacity building of elected representatives, ULB staff and sanitation workers, with periodic reviews
A stepwise workflow where assessments and investments are made on basic inclusive technologies in the first phase, followed by emphasizing advanced technologies and service in subsequent phases will be crucial in achieving a city-level plan for inclusive sanitation. These sustained sanitation solutions that are in conjunction with incremental approach at every phase should help in achieving inclusive sanitation in the true sense.
Inclusive De-sludging Service Provision
Equitable service delivery for all societal sectors is ensured through inclusive sanitation. Due to a variety of barriers, including cost, short-notice availability of de-sludging services, and physical accessibility, the urban poor are unable to receive these services. Some ULBs continue to conduct subsidized services in addition to the on-demand de-sludging services offered by commercial operators, but the availability of these services is restricted and consumes time. The de-sludging trucks also encounter physical challenges such as difficult access to septic tanks and pits and narrow paths to reach urban poor households. Therefore, it is necessary to develop last mile service delivery models that are enabling to reach the urban poor, public facilities, institutions, and businesses, as well as locations with challenging terrain.
To address challenges around last-mile service delivery it is critical to look at informal settlements where nearly half of the households rely on septic tank toilets to collect fecal waste. The wastewater and FS are collected in a tank close to the toilet as part of a septic tank system. Fecal waste is intended to be routinely emptied by ULBs or private contractors. Unmonitored private players often, allow for inconsistent FS disposal.
For effective sanitation, government can place portable toilets with adequate water supplies and a staff member in charge of cleaning and maintaining the facilities at a predetermined walking distance.
A gradual transition from temporary communal latrines to private, household-owned facilities. This can be possible by the distribution of digging kits for latrines and other construction supplies, as well as by improved sanitation campaigns.
The municipality can supervise drainage systems, authorize development plans that include the toilet structure, and support households with individual toilets.
Vogel et al. (2022). Gender and Sanitation: Women’s Experiences in Rural Regions and Urban Slums in India. Societies, [online] 12(1), p.18. doi: https://doi.org/10.3390/soc12010018.
Nabide, I.K. (2017). Operation, maintenance and management framework for ensuring sustainable WASH facilities in refugee settlements and host community contexts. [online] 40.87.110.99. Available at: http://40.87.110.99/handle/123456789/5170
