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‘We shall not finally defeat Typhoid, Cholera, Infectious Hepatitis, T.B., Malaria or many of the other infectious diseases that plague the developing world until we have also won the battle for safe drinking water, sanitation and basic health care’, mentioned Kofi Anan, the U. N. Secretary GeneraI in 2006, and then the UN Deputy Secretary-General issued a call to action on sanitation that included the elimination of open defecation by 2025. Safe sanitation is one of the foundations of a healthy, comfortable, and dignified life. Yet, the reality for billions of people is living without safe sanitation facilities like toilets, waste treatment, disposal and safe re-use of water. Sanitation is a major component of human development. Improved sanitation is defined, by WHO as facilities that “ensure hygienic separation of human excreta from human contact”. It comprises the sanitary disposal and management of human excreta and solid waste, drainage of domestic waste water and proper solid-waste-disposal including facilities such as flush/pour flush (piped sewer system, septic tank, pit latrine), Ventilated Improved Pit (VIP) latrine, pit latrine with slab, and a composting toilet.

Poor sanitation is a serious threat to the cleanliness of the environment as it contaminates surface water resources used for the supply of drinking water. Groundwater is also vulnerable to pollution from human waste since it is recharged from surface water. WHO report (2006) on ‘Sanitation Challenges: Turning Commitment into Reality’ demonstrates that nearly 40% of the world's population (2.4 billion) have no access to hygienic means of personal sanitation. WHO estimates that globally 1.8 million people die each year from diarrhoeal diseases and 133 million people suffer from soil-transmitted acute intestinal helminth infection which results in massive dysentery and anemia. Most of the diseases are spread by pathogens (disease causing organisms) found in human excreta (feces and urine). Infection is transmitted to a new host through a variety of routes. The most affected are the population in developing countries particularly peri-urban dwellers or rural inhabitants. The report mentions that every year more than 2.2 million people in developing countries die from various communicable diseases associated with lack of access to safe drinking water or poor sanitation and hygiene. An effective way to control these diseases is to create barriers which prevent pathogens from entering the environment. Hence better management of feces through the provision of sanitation.

The United Nations adopted water and sanitation as Human Rights and started celebrating World Toilet Day on November 19^th to raise awareness about access to hygienic toilets and the human costs of unsafe sanitation. Sustainable Development Goal 6 aims at water and sanitation for all by 2030. Rural sanitation is on the Indian government’s agenda as the tenth Five Year Plan of India states that drinking water supply and sanitation facilities are very important and crucial for achieving the goal of “Health for All”. Though the government has decided to achieve the goal of expansion and improvement of sanitation facilities along with other social infrastructure, India has a long way to go. Human Development Report of India (2008)estimates that only 31% of the population in India has adequate sanitation facilities. The report further states that 829 000 people die each year from diarrhoea because of unsafe drinking-water, sanitation, and hand hygiene.Poor sanitation is linked to transmission of diarrheal diseases such as cholera and dysentery, as well as typhoid, intestinal worm infections and polio. It exacerbates and contributes to the spread of antimicrobial resistance.

Punjab is one of the most developed states of India having the second rank on Human Development Index among all other major states. However, amidst prosperity, pockets of deprivation remain in certain areas. Sanitation is one of them. The sanitation data on rural Punjab by National Family Health Survey II (2008-09) reveals that only 16% of the population of  rural Punjab has flush toilets, 15% has pit toilets and  67% has no toilet facility at all . This survey depicts a grim picture of health in rural Punjab. The infant mortality rate in the state is reported to be fifty-seven per thousand live births. One in every fourteen children dies before reaching the age of 5 years. Anemia is a serious problem among every population group of women with prevalence ranging from 37% to 53%. Overall, forty-one percent of women in Punjab have some degree of anemia and 13 % are moderateiy to severely anemic. This reveals that poor sanitation increases health risks and is specifically more harmful to women. For instance, women who suffer from worm infections and other diseases may become anemic and undernourished, increasing the risk of maternal death.

Anemia, spontaneous abortion, and preterm birth are closely associated with soil-transmitted helminth infections. Recurrent infection  results in chronic energy malnutrition , poor immunity and anemia  affecting  physical and mental health, especially of women and children. Anemia, even if mild, leads to cognitive impairment, intellectual retardation and low productivity. It also causes a lack of concentration, poor scholastic achievements and poor performance in school activities among children. Anemia in women increases the complications of pregnancy, birth of low-weight babies and chronic under-nutrition. The impact of improved water supply, sanitation and hygiene on morbidity and mortality can be tremendous. WHO 2014 reports that sanitation and hygiene infrastructure can reduce morbidity from ascariasis by 29%  and hookworm by 4%. This shows that the health cost of ignoring the need for adequate sanitation is far too great. Therefore, there is a need to attract more investment and institutional attention to this subject.

As poor sanitation has a direct bearing on health, there needs to be more investment in sanitation which will automatically reduce the state’s burden on the health sector. Though water supply is plenty in rural Punjab, the benefits from improved water supply can be fully exploited only when sanitation is improved, and hygiene is promoted at the same time. Investments in water quality improvement can reduce deaths. Thus, sensitive and planned investment in sanitation can result in better public health.

Nevertheless, when the State fails to do the needful, outside intervention is required. At the failure of the government agencies to provide proper sanitation facilities, some educated and socially committed Non-Resident-Indians (NRIs), who left Punjab a long time ago and struggled hard to carve a niche for themselves in foreign lands, today, want to give back to their country.  They have come forward to change the rural landscape of Punjab by providing basic civic amenities - like underground sewerage, piped water supply, paved streets, solar-powered street lights, wastewater treatment plant and children’s park etc - starting from their own ancestral villages and extending them to other villages of Punjab.

Their actions, according to Dhesi (2009) are often driven by their  yearnings for roots, social status and prestige to fill a perceived void in donors’ lives, whose intervention infuses not only substantial financial resources but also, what Levitt (1998) calls,  ‘social remittance’ including new ideas, practices, social capital, and identities circulated between sending and receiving communities.

Village Life Improvement Project (VLIP), started by the Indo-Canadian Friendship Society, formed by NRIs in Canada, is one such example which started this daunting task and NRIs from the U.K. and U.S.A followed the lead. Playing the role of negotiators, managers and crusaders these NRIs want to improve people’s health living in the villages, give them a better quality of life, bring them community pride and create environmental awareness and up-gradation. After its success in village Kharoudi, many other villages have followed the model and have completed their journey in this direction. Many more ambitious villages have been enveloped by this improvement project, replicating the same.

To study the VlIP initiative in rural sanitation, village Kharoudi was selected for this case study. Data was collected in 2010 from seventy respondents, most of whom happened to be women for the simple reason of their being available at the time of the interview. Respondents were selected randomly. Members of VLIP and members of Panchayat were also interviewed. An Interview schedule was used to collect both quantitative and qualitative data. Village Kharoudi near Mahilpur is in the district of Hoshiarpur, Punjab. Kharoudi was the first village where VLIP was launched in 2000 and was completed in 2005. Founder member and crusader of VLIP, Dr. Gurdev Singh Gill, a Canadian citizen is from this very village. Kharoudi has a population of 700 persons living in 150 households. This village has a large NRI population. There is one elementary school and one gurdwara in the village. However, the village lacks a dispensary and a temple.Kharoudi has been declared a model village by ex-president of India Dr. A. P. J. Abdul Kalam Azad who awarded it 1st Nirmal Gram Puruskar in Feb 2005 (Ministry of Rural Development, Government of India). Today it boasts of underground sewerage, flush toilets, piped water supply to each household, concrete-paved streets, a primary school with computer education, solar street lights, four parks, one exclusively for children and an internet kiosk. Modern Panchayat House with residential facilities is another highlight of the village. Socio-Economic Profile of the Respondents:- Data collected from the respondents confirm that the majority of the respondents in the study are Sikhs (N=40) followed by Hindus, who are twenty-nine in number. Only one respondent is of the Muslim religion. The Caste distribution of the respondents includes the majority belonging to scheduled caste and backward class. Jat is found to be the second largest community in the village mainly engaged in agriculture. Data on the income of the respondents depict that most of the families fall in the income bracket of Rs. 5,000-10,000 per month followed by those whose income is more than Rs. 10,000 per month. However, the income of 15 respondents is less than Rs. 5,000. Sixteen families are earning more than Rs 20,000. Most of the respondents have no education, while others have gained education up to matric or higher secondary. The Occupation of most of the heads of the households is either agriculturist or wage laborer. Fifteen people are engaged in government jobs (defense services, school teaching or anganwariwork), whereas few others are dependent upon small businesses or remittances from abroad.

Water and Sanitation Facilities at Household Level

Poor sanitation and hygiene lead to direful diseases and hookworm infection. Effective management of feces at household level is  the first step to stop infection transmission resulting in a high rate of morbidity and mortality, which can be achieved by proper sewerage facilities at home. One of the major objectives of VLIP has been to lay underground sewerage systems in the village and provide sewerage connection to all houses. The Information gained through interviews reveals the availability of sanitation facilities in village Kharoudi. The Majority of the houses (N=56) have flush toilets installed. Households with bathrooms are also the same in number.

However, there are more houses without toilets than without bathrooms. The reason for this could be that bathing is considered more private than defecating and the construction of a bathroom costs much less than the installation of a flush toilet. Another main reason for the lack of toilet facility was found to be lack of finances, particularly among Dalits. Other reasons include low awareness of the potential health benefits of better hygiene practices, high subsidies, and inadequate education about the seriousness of the issue. Perception of the costs of having a household toilet as being very high and in most cases unaffordable, and the sheer convenience (at least for men) of open defecation (vis-à-vis an enclosed space) are some of the other factors for lack of sanitation facilities.

Water availability at the doorstep is an important civic amenity for people in rural areas. Due to the rapidly declining groundwater table, hand pump and well water is not readily available throughout the year. Besides that, it is not even safe for consumption due to rising levels of soil pollutants. Under the VLIP each household has been provided the facility for individual water connection. This facility has made villagers’ life convenient, particularly for women, who had to walk long distances to fetch potable water. Women were asked about the source of water supply to their households. Thirty-eight households in the sample have tap water facilities, out of which twenty-two families have a dual source of water, i.e., tap and hand pump. Six families have motor facilities as well. whereas only twelve households rely upon ground water, for lack of finances. It is important to note that most of these households got tap water after VLIP provided this facility in the village.

It is important to note that benefits from advanced water supply systems can only be fully exploited when sanitation is improved, simultaneously with promotion of hygiene. This lack of recognition was reflected in the absence of a target for sanitation among the Millennium Development Goals, to match the water target.

Disposal of Waste

Proper disposal of different types of waste is an integral part of rural sanitation. In village Kharoudi, as in any other village, liquid waste was disposed of in open gutters which was the main source of flies and mosquitos. However, under the Village Life Improvement Project (VLIP), an underground sewerage system has been laid out in the village. Wastewater of the whole village gets collected in a pond constructed at one end of the village where a treatment plant has been set up for wastewater treatment. This treated water is used for agriculture. Solid waste other than cattle dung is found to be disposed of in open land outside the village by way of composting. Until 2011 there was no proper procedure of garbage disposal. People wanted the VLIP or village Panchayat to take steps to manage and treat solid waste.

Cleanliness in Respondents’ Households

Observations were made at the time of the interview regarding the cleanliness of the village households. The Majority of houses observed poor cleanliness (N=41), while cleanliness at the rest of the houses was either average or good. It has been observed that even though the overall cleanliness of the village has tremendously improved, cleanliness in individual households still needs attention. The main reason for poor cleanliness is that cattle sheds are usually adjacent to the houses. They are the main source of flies and mosquitoes.  Even though VLIP has provided the basic infrastructure for sanitation and other civic amenities, there is a strong need for an Information, Education and Communication (IEC) campaign. Overall, the VLIP project has introduced sound hygiene behavior which is of capital importance to minimize the burden of infectious diseases. It has abolished manual scavenging by converting dry latrines into flush toilets and safe disposal of domestic liquid and solid waste into night soil.

Community Participation in VLIP

VLIP aims to provide a bottom-up approach to the integrated and sustainable development of village life with the participation of village people. People’s involvement in any kind of development is crucial for its sustenance. Information gathered through the data collection process proves that people only from thirty-two households participated in the VLIP. While twenty-four families showed no evidence of participation in the VLIP, other fourteen respondents refused to respond to this particular question signifying a lack of interest in the VLIP. Out of seventy households, thirty families had no participation whatsoever in the village improvement campaign in the village. This is a significant number.  Probing the issue further revealed that caste based politics in the village has been the main cause for non-participation in VLIP. Active participation in the VLIP has been observed more by high caste villagers than the scheduled caste population of the village.Those who participated in the VLIP contributed mostly in form of labour whereas households having NRI members contributed mostly by donating money, all of whom are Jat Sikhs. Their names are inscribed on a pillar of appreciation in the village. Three families contributed by donating food during the paving of the roads.

Gender-Specific Impact of Improved Sanitation in Village Kharoudi

Improved sanitation measures easily accessible at home provide women not only privacy and reduced exposure to the threat of violence and health hazards but also more time for productive activities & income generation, adult education, childcare, leisure and opportunities for personal development. Besides that, these can have an invisible impact on their psychology, inspirations and dreams. The shift in women’s self-perception can have a far reaching impact on the development and well being of their families.

Lack of appropriate and adequate toilet and sanitation facilities affect women and adolescent girls the most. Because of their anatomy women are more susceptible to urinary and reproductive tract infections. Women are the ones who are responsible for picking up human excreta for the sick, disabled and infants and usually there is no provision for sanitary disposal of excreta. This additional and unpaid hygiene work makes women vulnerable to diseases who already suffer from lack of literacy, widespread ignorance, low social status and malnutrition. Lack of privacy, personal safety and upkeep of hygiene and sanitation are other problems faced by women as compared to men. Due to our socio-cultural norms, women do not relieve themselves in public the way men do. Young girls and boys often do not differ in their personal sanitation habits as both may relieve themselves in the open.  However, when girls approach puberty, they often have to meet more and stricter cultural requirements than boys. They have to use secluded places which are often farther from home, go only with a group of other girls and only during the twilight hours  or defecate only at home and dispose of human and solid waste or stop attending school etc.

Sanitation needs and demands differ with gender. Men attach less importance to these facilities because it affects them less. For women, it has always been a taboo to talk about sanitation related issues. Therefore, rural sanitation has neither been perceived as a priority nor has it been provided as a public good by the village panchayats and local bodies which are by and large male dominated. It was only in 1986 that the Government of India formulated the Rural Sanitation Programme which comes under the State sector’s Minimum Needs Programme (MNP). This programme at present is called Total Sanitation Campaign (TSC).

Going out to relieve themselves for women is a health hazard. They punish their bodies by forcing restraints. A study conducted in relief camps of Gujarat as reported in India Together (a web based newsletter, 14^th March 2006)   reveals that  women hesitate to drink water and try to cut down food and fluid intake to ensure that their need to use a toilet is reduced as much as possible. Reduced food intake develops anaemia. Insufficient fluid in the body results in kidney problems. Poor health makes them vulnerable to frequent infections and illnesses and brings down their work productivity as well.

With Punjab’s low sex ratio (895 girls per 1000 boys as per Census 2021), India cannot afford to lose more women knowing the  long term implications on our socio-cultural milieu. Thus, sanitation should be treated to empower women as the status of women’s health substantially influences the overall health status of the family and the community.         

Majority of the respondents in the present study (N=33) experienced VLIP to be very beneficial for them, particularly, the sewerage facility which has made the life of these women much more convenient, especially as they look after the sick, the aged and others including infants and guests. Nineteen respondents perceived the toilet facility as time saving as they need not go far from home for nature’s call. Another benefit of toilet facilities, as perceived by women, is their security. For some, having this facility is a status symbol in society. Respondents (women) were asked to describe the benefits of a water treatment plant as this was something new to them. Many of them found a positive impact of the water treatment plant, with no clogging of water in the streets. Hence no stink and breeding diseases. The treated water is let out in the fields for agricultural purposes. Due to the water treatment plant, women claim that, not only has the cleanliness of the village significantly improved but the beautification of the village has happened as never before and this has resulted in reduction of household chores for them and, perhaps more time for self-care.

There is tremendous change perceived by the villagers after the VLIP is complete. Cleanliness, paved roads, solar street lights, and parks are the order of the day. Researcher herself visited the village several times and found that roads were neat, clean and free from dirt and garbage. As there are no open gutters, there was no water clogging on roadsides, which otherwise is a common site in any Indian village. VLIF has introduced cost effective technologies in the construction of sanitary facilities including WHO approved wastewater management, treatment, and cycling. It has abolished manual scavenging by converting dry latrines into flush toilets and safe disposal of domestic liquid and solid waste. Playing the role of negotiators, managers and crusaders the project activists (NRIs) aim to expand this project beyond health care by rendering basic infrastructure to larger issues of community development. The VLIF has encompassed social education by providing good hygiene behaviour among community members which is of capital importance to minimize the burden of infectious diseases. Aimed at improving the health of the people living in villages, the project gave villagers a better quality of life and brought environmental up-gradation, awareness, and community pride. Village Kharoudi, for instance, is free from mosquitoes and flies by 80% and no case of malaria has been incurred since the inception of the project.

The overall objective of the project was to develop a strategy for improving sanitation which, once established, should be sustained by the community by allowing the intervention agency to move to other areas to replicate the approach. This new visionary concept has gradually started building pressure on politicians and bureaucrats to  make sanitation and hygiene a reality for rural masses . It has also inspired other NRIs to emulate the experience in their respective villages and has created a great deal of enthusiasm in the diaspora. Its final success depends upon the sincerity and streamlined approach of the government.

Impediments in Future Maintenance of the VLIP Project

One of the challenges, as stated by Dusenbery (2009), faced by philanthropists in Punjab has been motivating locals to take ownership and collective responsibility for maintaining and sustaining philanthropic projects once started. Sanitation facilities and infrastructure provided by the VLIP could have  low levels of sustainability if the community does not manage, monitor, implement and maintain it. VLIP indeed encounters the same challenge.

Financial contribution to sustain the project is also desired from the community. Government can take concrete steps to make community contribution mandatory. Anything free is not valued and it makes the community impotent. Perceptive and behavioural changes through information and communication channels, traditional mass media, and hygiene promotion in schools along with community participation are must for the success of the programme. This can gradually build pressure on politicians and bureaucrats to  make sanitation and hygiene a reality for all.

A few  people in the village mentioned their resistance to the VLIP, in whose perception not much has happened in terms of any advantage to them. They were critical about the poor maintenance of the infrastructure provided. They feel excluded mainly due to caste politics. Since visible changes cannot be denied in the village, they were encouraged to give their views, at least, about tangible changes that cannot be denied. After consistent persuasion to speak up, they acknowledged that due to VLIP there are pucca roads in the village that have made their lives smoother. Apart from providing sanitation infrastructure, VLIP’s efforts to uplift the subordinated groups in the village hierarchy would be a welcome approach.

Nevertheless, in this backdrop, greater mobilization of resources and the involvement of decision makers at all levels is desirable. At the State level, red-tapism and corruption are big hurdles. Political will and significant commitments are required lest the targets should remain distant unreachable goals.

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