Water, Sanitation and Hygiene Conditions in ...

Proceedings of 3rd International Green Health Conference 2015

ISBN: 978-93-84659-54-7

Water, Sanitation and Hygiene Conditions in Rehabilitated and Non-rehabilitated Slums of M-ward Mumbai, India Ankit Anand Population Research Centre, Institute for Social and Economic Change, Bangalore Environmental Health Resource Hub, School of Habitat Studies,TISS,Mumbai [email protected] Annu Baranwal Dept. of Sociology, University of Mumbai, Mumbai Environmental Health Resource Hub, School of Habitat Studies, TISS,Mumbai [email protected] Emma Van Rij Public Health Sciences Department, Karolinska Institute, Stockholm [email protected] Nobhojit Roy Public Health Sciences Department, Karolinska Institute, Stockholm Environmental Health Resource Hub, School of Habitat Studies,TISS,Mumbai [email protected]

Abstract This study had assessed the water, sanitation and hygiene conditions in rehabilitated slum (Natwar Parekh Compound) and non-rehabilitated slum (Raffiq Nagar) of M-ward, Mumbai, India. Data was collected using a structured questionnaire. This study was based on a household survey conducted in two-stage systematic sampling. The survey included sections on basic demographic information, drinking water and water for other household purposes, sanitation and hygiene practices. The study revealed that there were dissimilarities in the living conditions of rehabilitated and non-rehabilitated slums. People living in rehabilitated slums had higher access to fundamental amenities compared with non-rehabilitated slums. Rehabilitated slums had better knowledge, attitude and practices towards water, sanitation and hygiene. Nonrehabilitated slums had low access to basic services and civic amenities which affected their quality of life and health. This study showed the importance of further rehabilitation and awareness needed for the

slum improvement. It encourages for a holistic approach towards improved individual and community led development programs in slum areas. Thus, not only clean water, but abundant water close to home, sanitation which does not just provide better health but also dignity and the hygiene education is important for improved lives in slums.

Keywords:

Water; Sanitation; Hygiene; Rehabiliated slum; Non rehabilitated slum; M Ward; Mumbai; India

1.Introduction In September 2000, world leaders came together to set the time bound goals to reduce extreme poverty in the world and named it millennium development goals. Out of these goals water supply and sanitation targets became part of the seventh goal, which aims to reduce by half the proportion of people without access to water and sanitation by 2015. But the impact of water, sanitation and hygiene was not limited only to certain sectors in the past years. Water scarcity and poor quality, lack of access to good

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sanitation and clean drinking water and poor hygiene contribute to malnutrition, poor health of women and children, undermine economic growth; threaten development, peace and security around the world [1]. Due to rapidly increasing numbers of urban slum dwellers, a specific target on slums in millennium development goal 7, target 11, was adopted which aims to significantly improve the lives of at least 100 million slum dwellers by the year 2020 [2] Despite substantial progress has been made in most areas towards MDG goals still much more effort is needed to reach the set targets [3]. As per the report of UN Human Settlement (2003), in 2001, the urban population in the less developed parts of the world increased by 36%, which contributed to the growth in the number of urban households by the same ratio. Thus temporary settlements like slums had increased. There were 924 million or 36% of the world urban population lived in slums in 2001. Around 44% of this population lived in developing regions in comparison to only 6% in developed regions. Asia, including all its sub regions showed 554 million, which was 60 % of the world’s total slum population. Seeing the enormous growth of people living in slums the growth in population of slum dwellers was predicted to be more than two billion in the next thirty years (4). Thus, the world had seen a speedy urbanization in the past many years, especially the developing countries and India is no exception to it. Urbanization in India increased tenfold between the years 1901 to 2001.The urban centers offer various employment opportunities and ways of livelihood which attracts migration. But the infrastructural condition in terms of housing, quantity and quality of drinking water, drainage conditions of these cities are not sufficient to hold the outsized migrated population. Unrestrained prices of lands and high priced housing forces these migrants to live in temporary settlements like slums, squatters. People live in the outskirts of cities, pavements, railway tracks, hills [5]. According to census of India 2011, slums were reported from 2,543 towns which are 63%. The largest percentage of slums were reported from Maharashtra (18.1%) followed by Andhra Pradesh and West Bengal. 38 % of the slum households were in 46 million plus cities (6). At the time of the National Family Health Survey-3, India, in the year 2005-06, the highest percentage of households in the census-designated slum areas were in Mumbai (56 %), followed by Meerut (43%). The National family Health Survey also notifies that the urban population

ISBN: 978-93-84659-54-7

in India is expected to increase to more than 550 million in 2030 [7]. In Mumbai the situation is especially precarious. Close to 2000 slum settlements have been identified in the city, and together they are home to more than 50% of Mumbai’s population. The majority of slums has predominantly permanent and semi-permanent housing structures, like brick walls and cement roofs. Living space is very small, as only 9% has an area of more than 20m2 and 42% of slum households have a dwelling of less than 10m2 [8], which is much less than the recommended 3.5m2 covered living space per person in emergency settings [9]. Only two thirds of the city’s households have access to improved private toilet facilities, and access is limited to even less than 10% of poor households living in the slums [10]. In 73% of the slums, people depend on government provided community toilets, which are often unhygienic due to overuse, poor maintenance, and lack of water supply [8]. Many slum dwellers do not have access to water taps, and rely on informal water sources with high costs. Public water pipelines are badly maintained and the supply is unreliable. Water may only be available a few hours a day and is sometimes of bad quality and unfit for drinking [11]. The fact that the most frequently reported diseases in the Mumbai slums are related to poor environmental health, such as malaria, dysentery, cholera, jaundice and typhoid [8], shows that the situation poses a great public health risk to those living in the slums. Therefore, Mumbai city at some point lacks the capacity to hold the water and sanitation needs of the slum communities, posing serious risk to the environment and the health of the entire city. Sphere standard states that effective water, sanitation and hygiene programs and exchange of information between the people who are conducting these programs and the community people is very important to improve the conditions of communities [12]. This study aims to compare the knowledge, attitude and practice of slum dwellers towards water, sanitation and hygiene in rehabilitated (Natwar Parekh Compound, Shivaji Nagar) and nonrehabilitated (Raffiq Nagar, Shivaji Nagar) slums of Mumbai. It will facilitate understanding the situation of water, sanitation and hygiene conditions in two different types of slum settings. There are multiple terms used for the redevelopment and improvement of slums in the literatures like resettlement,rehabilitation and others, but in this study the term ‘rehabilitation’ is used.

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1.2 Study Area The study area for this study is Shivaji Nagar, an urban slum in the western M-ward of Mumbai, India. To the northeast of it is a dumping ground, which is surrounded on the eastern and northern side of a branch of the Thane creek. Estimations of the population in the slum vary from 200,000 by the government; to at least 600,000 by researchers and community social workers. Within the slum area, two specific sites were chosen. First slum was a rehabilitated slum Natwar Parekh Compound,located in the catchment area of Doctors For You (DFY), a local non-profit organization that operates a health facility in a section in the north-west of Shivaji Nagar. This region has been part of a slum

ISBN: 978-93-84659-54-7

rehabilitation project, and people have been moved into permanent housing structures, usually known as vertical slums. The second slum area was Raffiq Nagar which was a non-rehabilitated slum, located in the north of Shivaji Nagar next to the dumping ground and a branch of the Thane Creek. This site was not part of the slum rehabilitation program, and people here live in non-permanent or semi permanent structures. The Niramaya Health Foundation (NHF), another local non- governmental organization (NGO), operates a health facility in this area. The satellite map of the region is rendered below (Figure 1).

Figure1: Satellite picture of the relative locations of Raffiq Nagar (rehabilitated) and Natwar Parekh compound (non-rehabilitated) slums

Source: Google Map

2. Material and Methods Due to the structural differences between rehabilitated and non rehabilitated slums slightly different sampling methodologies were used. In the Natwar Parekh Compound, a map of the area was obtained from DFY with 61 numbered apartment buildings. A random selection of 10 buildings was made, and subsequently 10 households were selected for each building. Given that all buildings have eight

floors, and each floor contains 12 apartments, the total number of households per building is estimated at 96. In order to select 10 out of 96 households, we chose a random starting point between one and ten, and systematically selected the following nine households with as election interval often. Household numbers started with one for the household at the entrance of the building on the ground floor. Circular numbering was applied, so that if any household number higher than 96 were selected, counting was

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continued again from household number one. If any household was non‐responsive, the household to the left was asked to participate in the survey. This

ISBN: 978-93-84659-54-7

sampling method gave a total of 98 households in this area. Figure 2 and 3 depicts the structure of resettled slum.

Figure 2: Rehabilitated Slum (Natwar Parekh Compound)

As Raffiq Nagar was the non‐rehabilitated area, it was not as clearly organized and no register of the households was available. Based on a satellite image and observation of the area, it was determined that the selected area consisted of 18 small lanes on both sides of the main road. In a systematic way 5 lanes were selected on both sides, taking every third lane. For each lane, the first ten households were selected for the survey. If any household was non-responsive, the following household was asked to participate in the study, until a total of ten respondents were found

for each lane. This resulted in a sample size of 100 households. Households were included if the respondent was an adult (15 years or older, based on National Family Health Survey 2005-2006, India, who was willing to participate). Before conducting the survey, the questionnaire was validated by a pilot study. A total of 198 households were approached, 98 in rehabilitated and 100 in non-rehabilitated slum. An approval from an ethics committee have been obtained before undertaking the research from internal review board of Tata Institute of Social Sciences, Mumbai, India.

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ISBN: 978-93-84659-54-7

Figure 3: Non Rehabilitated Slum (Raffiq Nagar)

Data was collected using a structured questionnaire, which consisted of a total of 55 questions. The survey included sections on basic demographic information, drinking water and water for other household purposes, sanitation, hygiene practices. The questions used in this KAP survey were based on WHO and UNICEF's “Core questions on water, sanitation and

hygiene' WHO,UNICEF. Core questions on drinking water and sanitation for household surveys. Geneva: 2006. (14) and other KAP surveys (15-16). The structural differences of the rehabilitated and nonrehabilitated slums can be seen in the figures above. In which figure 2 shows rehabilitated slum and figure 3 represents non-rehabilitated slum.

3. Results and Findings Table 1 shows the socioeconomic profile of the study site Raffiq Nagar and Natwar Parekh Compound, in both the slums there was a high percentage of Muslim population followed by Hindus. General and OBC were the most dominant castes in these communities. Slum dwellers were mostly involved in private jobs or they were self employed or got involved in other unskilled works. The percentage of the population working in non-rehabilitated slum was higher than rehabilitated slum as they were rehabilitated from different slums. There was not much difference in the percentage of nuclear and joint families in both of the slums, but in nonrehabilitated slum nuclear families were more than the other slum. Educational status of the head of the household was found to be up to 8th standard in most of the families and many of them were not educated.

So there were some similarities and dissimilarities in the socioeconomic profile of the two slums. Table 2 shows that the main source of drinking water in rehabilitated slum was piped water into dwelling, thus had a source of drinking water exclusively for their household, and for non-rehabilitated slum it was tanker truck. Tanker truck used to bring their daily water. People used to buy it in every third or fourth day as they couldn’t afford to buy it daily. In both the slums there were flush toilets for rehabilitated slums exclusively inside the households and nonrehabilitated slums were dependent upon the public flush toilets which were in the most unhygienic and very dirty conditions in comparison to rehabilitated ones.

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ISBN: 978-93-84659-54-7

Table1: Profile of the sampled Households in rehabilitated and non-rehabilitaed slums of M-ward Mumbai

Household Characteristics Hindu Religion Muslim Others Scheduled Caste/Tribe Caste General OBC Government Working status Private of head of the Self employed/others household Not working Nuclear Type of Family Joint Education status No Education of head of the Up to 8th standard household Above 8th standard Mean age of respondent* Mean HH size#

Non Rehabilitated

Rehabilitated

Total

N 1 99 0 0 79 0 2 64 30 0 60 40 20 57 22 100 98

N 43 44 11 4 7 71 6 56 17 19 47 44 29 46 22 97 88

N 44 143 11 4 86 71 8 120 47 19 107 84 49 103 44 197 186

Percentage 1.0 99.0 0.0 0.0 100.0 0.0 2.1 66.7 31.2 0.0 60.0 40.0 20.2 57.6 22.2 33.5* 5.9#

Percentage 43.9 44.9 11.2 4.9 8.5 86.6 6.1 57.1 17.3 19.4 51.6 48.4 29.9 47.4 22.7 40.3* 5.5#

Percentage 22.2 72.2 5.6 2.5 53.4 44.1 4.1 61.9 24.2 9.8 56.0 44.0 25.0 52.6 22.4 36.8 5.7

*average number of years, #average number of household members

Table 2: Water and Sanitation conditions by type of slum WASH conditions

Source of drinking water Access to source of drinking water Type of toilet facility Access to a toilet facility Treatment of water /Methods used for treatment Cleanliness condition of toilet

Piped water into dwelling Piped water into yard /plot Public tank/stand pipe Tanker truck Household exclusive use Public source Flush toilet No facility Exclusive use of household Public source No facility Nothing Boil Add Bleach/Chlorine Strain it through a cloth Use a water filter Completely clean Partially clean All dirty

Figure 4, interprets that there wasn’t much difference found in the habit of cleaning hands after toilet in both the rehabilitated and non-rehabilitated slums, but a major difference was there for washing hands

Rehabilitated Slum (%) 99.0 0.0 1.0 0.0 98.8 1.2 100 0.0 98.9 0.0 1.1 19.4 52.7 3.2 14.0 10.8 34.1 62.5 3.4

Non Rehabilitated Slum (%) 0.0 8.0 13.0 79.0 0.0 100 93 6 4.0 90.0 6.0 46.9 41.2 5.1 33.7 3.1 11.8 5.4 82.8

N 96 8 14 79 81 101 186 6 92 90 7 64 60 8 46 13 41 60 80

before having food and cooking. This might because of the major difference in the availability of water in the two areas.

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ISBN: 978-93-84659-54-7

Figure 4: Hygiene conditions by type of slum non resettled

resettled

9

Wash hand before cooking meal

78.4 15

Wash hand before having food

81.4 93 90.7

Wash hand after toilet

52.5

Take bath daily

100

Table 3 shows the correlations among socioeconomic characteristics, water, sanitation and hygiene practices the slums. Except for the habit of washing hands before toilet, all the other habit of washing hands before food and before cooking meal was significantly positively correlated with source of drinking water and access to drinking water and toilet facility. The practice of taking bath daily is significantly correlated with washing hands before having food and cooking and also the cleanliness condition of the toilet. Treating water was also found to be significantly correlated with source of drinking

water and access to drinking water and toilet facility. Cleanliness of toilets was significantly correlated with type of toilet facility and access to toilet facilities. Caste and religion also significantly correlated with a habit of washing hands before food and before cooking meal, treatment of water and cleanliness of the toilets. Habits of washing hands after toilet, before having food, and before cooking food were also significantly correlated with each other. Number of household members and whether the family is nuclear or joint does not find too much correlation with hygiene practices in the slums.

Table 3: Correlation of Socioeconomic characteristics, Water, Sanitation and Hygiene Condition in Slums of M-Ward, Mumbai Water, sanitation and hygiene conditions

Wash hand after toilet

Wash hand before cooking meals .699**

Treatment water

-0.042

Wash hand before having food .661**

Source of drinking water Access to source of drinking water Type of toilet facility Access to a toilet facility Wash hand after toilet# Wash hand before having food# Wash hand before cooking meal# Take a bath daily Treatment of water Cleanliness condition of toilet

.245**

.674**

-0.053

.633**

.677**

.310**

.632**

-0.052 -0.043 1.000 0.135 .146*

-0.131*** .484** 0.135*** 1.000 .809**

-0.028 .567** .146* .809** 1.000

0.065 .315** 0.103 0.099 .143*

0.135*** .638** 0 .451** .472**

.094 0.103 0.07

.372** 0.099 .451**

.371* .143* .472**

.138 1.000 .200**

.364** .200** 1.000

-.788** .210** .700** -0.012 -0.047

-.221** .169* .275** 0.114 -.165*

-.645** .301** .644** .173* 0.081

0.045 -.736** Caste 0.134 .178* Religion -0.042 .665** Type of slum -0.014 0.042 No of household members 0.054 -0.014 Type of family # With water and soap/ash/etc..*P