Inclusive programme approaches key to sustain sanitation access and move toward better health outcomes

Nov 27, 2019


Asad Umar
Senior Programme Officer - WASH & Health, Aga Khan Foundation
Satviki Varma
Programme Officer- WASH & Health, Aga Khan Foundation

A family in Bihar, India, stands proudly in front of their new toilet. Photo: Angad Khanna. 


The Aga Khan Development Network’s (AKDN) multi-state sanitation initiative, led by Aga Khan Foundation (AKF) and in partnership with Aga Khan Rural Support Programme and the Aga Khan Agency for Habitat, now in its fifth year of implementation, was conceptualized in 2015 to support the Clean India Mission. The interventions, are aimed atimproving household sanitation access by 1) changing mindsets and behaviors through a mix of innovative interpersonal and mid media approaches,  and 2) facilitating accesss to materials, credits, and skilled masons to accommodate the growing demand for toilets.This is being done across 1000 villages from 32 blocks in 21 districts of Gujarat and Bihar in Madhya Pradesh and in Uttar Pradesh, have resulted in improved sanitation access for 140,000 households and their families.AKF also introduced a technology based tracking tool AKVO Flow which looked at assessing physical infrastructure and behaviours, and followed over 3000 households toilets from 2017 to 2019. Data showed that 95% of toilets constructed are still in use and functional, a testimony of community ownership and high quality of construction.

Self Help Groups (SHGs) designed for women’s empowerment have helped women take up leadership roles in sanitation planning, delivery, and monitoring. In the state of Gujarat, SHG federations have successfully led large-scale open defecation-free (ODF) campaigns. Interventions on menstrual hygiene management addressed the specific concerns of this target group and empowered  over 28,000 women and girls to improve their menstrual hygiene practices. To address the pernicious problem of exclusion, the initiative tried to break the inertia by addressing barriers, such as low level of awareness on sanitation, relatively weak local governance structure, lack of awareness about personal hygiene, and difficult environmental conditions, such as hard rock and high water tables.

While interventions continue to consolidate household sanitation access, in 2017, we also introduced a dedicated school hygiene programme with strong behavior change components. Hygiene interventions addressed simple yet effective behaviors like handwashing with soap,  good toilet habits, and water storage and handling. With support from Reckitt Benckiser, this initiative is currently under implementation across 3000 schools in three states of Gujarat, Bihar, and Uttar Pradesh, benefitting over 300,000 students. In more than 200 schools the intervention includes WASH infrastructure models: separate toilets for boys and girls, drinking water facilities, handwashing platforms,  and clean and hygienic areas around the midday meal.  

Smiling school girls in India
Student participants of one of the school hygiene programs in Patna are all smiles Photo: Akanksha Dua.

AKDN also recognises  that WASH services in health care facilities are fundamental to providing quality care, especially in maternity and primary-care settings where they are often absent. AKF is supporting four districts to improve the availability of functional WASH facilties and healthcare worker hygiene behaviour.

The Initiative as designed with the explicit objective of working in some of the most disadvantaged parts with marginalised populations having lower sanitation coverage and a higher prevalence of preventable diseases. Health impact data trends of the project so far suggests that with improved sanitation access, ODF villages have a much lower prevalence of various waterborne diseases like diarrhoea. A final report will be available in the coming weeks.

The AKDN Sanitation Initiaitve, closely aligned with Clean India Mission campaign, demonstrates that the coming together of key stakeholders, such as government, local village institutions, communities, women’s groups has helped to promote inclusive sanitation coverage and sustain ODF status at scale, a pathway to improved health outcomes.

Going forward, the AKDN Sanitation initiative will continue its core focus on sustaining the gains made under the Initiative, while also strengthening its work around WASH in schools, early childhood centers, and healthcare facilities. In alignment with the Government of India’s ten-year rural sanitation strategy, the focus will equally be on addressing the interlinked areas of menstrual hygiene management,  household water securety, and solid liquid waste management.  AKF will also focus on layering a dedicated programme on health and nutrition in these ODF villages, as it believes that layering on a health and nutrition programme in areas that have already achieved WASH security will lead to greater health impacts.