A few weeks back I had the opportunity to visit a couple of partners in Tamil Nadu. These two partners are facing a difficult task—sanitation and hygiene implementation through community participation. One project is in the urban slums of Trichy while the other one is a rural project a few hours outside of Trichy. These communities have open defecation rates of 90%. The problem mostly lies on the women. Women feel embarrassed and ashamed to go out in the open, so as a result they only go in the early mornings or late at night—basically during pitch black. Menstrual Health is a topic that is only now being addressed with organizations developing their own branch of sanitary napkin production, sold cheaply to women in rural areas. In addition to the burden on women, open defecation pollutes water sources, thereby leading to diarrhea, one of the biggest killers of children in the developing world.

Whether rural or urban (and urban more so), this is tough work. They’ve both used different approaches to address this public health issue, which I think may be something to follow down the line as their programs reach full capacity.

In the urban context, we visited a partner that has already spent some time in the slums, about 5 years, and they are just now making progress. What they’ve done is to leverage the strength of the women. With one hierarchical structure developing and one already in place, the NGO has organized the women of the slums to be animators and motivators. The lowest layer is Self-Help Groups of 10 to 20 women, who then get organized into Sanitation Education groups, and finally those groups get federated into Committees. The committees, in turn, work directly with the corporation (state govt) to voice their issues on sanitation and water within the community. And mind you, this structure spans over 200 slums. First of all, to even get to this structure is a LOT of work. The NGO had to first build demand, and they will constantly have to build demand. Not just for toilets and sanitation, but for the concept of these committees and why it is so vital for the community to participate in their own public health sustenance. Key words here are ‘community participation’.

In the rural program, the partner is literally working from scratch. Their first task was to build trust with all the communities of each village they wanted to help. Check. Time taken: 1.5 years. Now, they’ve created after school programs (‘joyful learning centers’) for children ages 8 and up, where they educate kids about sanitation and hygiene through fun games and activities. They also teach meditation and yoga. Here, the teachers of each village are the NGO’s ‘in’ to the residents. The teachers hold these after school programs in outdoor spaces, and with support from them along with the demand from the women for toilets and safety, the NGO has committed to building toilets for the community paid for by the community.

Now an interesting thing i’ve mentioned is “paid for by the community”.  In the urban setting, the toilets are Community Manage Toilets (CMTs), and in the rural setting, the toilets will be household toilets. Either way, if the community does not feel responsible or feel like a vested owner in the toilet, they are less likely to engage in maintenance and use.  The CMTs are pay and use—1 Rs. for toilet use, and 2 Rs. for bathroom use. Accounts and ledgers are meticulously kept. Everyone who goes in and out has their name written down.  For the household toilets, the ‘beneficiary’ will contribute some, as they will not be able to leverage the Total Sanitation Campaign (TSC) funds, and the rest of the cost will be tendered through loans.

So which method is easier? More successful? Feasible? We don’t know. It takes time, patience on the part of the grassroots NGO, and enthusiasm from the beneficiaries. Both NGOs are also thinking of creating self-sustaining entities of the communities they are working with. After all, the ultimate victory would be to better the public health of the community such that the next generation carries on good practices while the intervening NGO has slipped out. As we develop better models, we have to create an intervention model that works inside-out (from the users to us). From our experience, we are not convinced that the programs would sustain without the NGOs.

But what I realized very quickly is that the beneficiaries, whether children or adults, are excited to tell their story. They ask you to stay for a meal, they tell you to come back, they want to share with you what they’ve learned, and how they’ve done it. And while they are sharing their experiences, you see what they struggle with very visibly—no proper drainage system, no superstructure for existing toilets, husbands drinking and gambling, child brides. Of course this does not exist in every scenario, but it does exist. So the NGO, whether the intervening one or the funding one, has to decipher for itself in what way it wants to be involved—there are just so many interconnected issues, how do you solve one without looking at the other?