Monthly Archives: August 2013

Dealing openly with open defecation

Of the world’s seven billion people, 1.1 billion people still defecate in the open. With 638 million people engaging in this, India is the open defecation capital of the world.

The countries where open defecation is most widely practiced are the same countries with the highest numbers of under-five child deaths, high levels of under-nutrition and poverty, and large disparities of wealth. Each year, 1.5 million children around the world under the age of five, and 1,000 a day in India alone, die of diarrhoea caused by unsanitary conditions and poor hygiene, exacerbated by the ongoing practice of open defecation.


After more than a decade of work by the World Toilet Organisation, the UN has now formally recognised 19 November as World Toilet Day – a huge step forward in addressing the problem of open defecation. Help more children to reach their fifth birthday by supporting the work of civil society organisations to improve sanitation and hygiene.  Find out more at:

Find out more about the UN and World Toilet Day:


WASH in Indian schools: A national mission

Sanitation and hygiene issues in schools remain high on the development agenda in India, more than a decade after the start of the Total Sanitation Campaign, evidenced by the holding of the first WASH in Schools Leadership Course held in Delhi from 6-9 August. The course was organised by the Ministry of Drinking Water and Sanitation (MDWS), the Administrative Staff College of India and UNICEF. More than 130 Water, Sanitation and Hygiene (WASH) and Educational professionals from 25 states are reported to have participated. 
The course aims to increase the capacity of local and national actors working in WASH in schools (WinS) interventions under the Nirmal Bharat Abhiyan (Total Sanitation Campaign).

Although a lot of progress has been made under the TSC, there is still a lot of work to be done. As the Secretary of the MDWS, Mr. Pankaj Jain, stated, “WASH in Schools should be a National Mission”. At the moment, it is far beyond achieving success at a national level. Mr Louis George’s Arsenault, Representative, UNICEF, acknowledged WASH in Schools as a critical component of child-friendly education, contributing to a healthy and conducive learning environment and a significant reduction in absenteeism and dropout rates, especially among girls. “It also has an impact on enhanced primary school attendance, improved health and cognitive development, increasing girls’ participation in school,” he said.


With WASH programmes still lacking in schools across India, HEEALS (Health Education Environment And Livelihood Society), based in Gurgaon, is trying to contribute towards a national mission by conducting WASH awareness in schools in slum areas and unauthorized zones where no other WASH agents are operating. HEEALS plans to carry out a Water Sanitation Menstrual Hygiene & Girl Education Awareness project across five different states of India including Uttar Pradesh, Rajasthan, Himachal Pradesh, New Delhi NCR Region and, Leh and Ladakh. The project aims to go into the interior parts of these states where water, sanitation and menstrual hygiene practice are far beyond the reach of most people. “The awareness project will be carried out in places where the dropout rate among girls in schools is high due to the non-availability of separate toilets and lack of awareness about sanitation and menstrual hygiene”, says HEEALS’ Managing Director, Gaurav Kashyap.

Without the work of civil society organisations such as HEEALS and support for their work, the realisation of WASH at a national level can only be aspirational.  Find out more about the work of HEEALS and offer your support at: www.heealsorg. Read the full UNICEF article at:

Addressing the critical issue of menstrual hygiene in India

UNICEF reports that in countries worldwide where menstrual hygiene is taboo, girls in puberty are typically absent for 20% of the school year. Most girls drop out at around 11 to 12-years-old and miss school not simply because they fear being teased by their classmates if they show stains from their period, but also because they are not educated about their periods and their need for safe and clean facilities is not prioritised. In India, 66 % of girls’ schools do not have functioning girls’ toilets resulting in a drop out rate of more than 40% of girls after finishing year 5. Around 23 % of girls drop out of school every year in India due to a lack of menstrual hygiene facilities including toilets or adequate disposal units for sanitary pads.

Girl outside toilet

In A Decade of the Total Sanitation Campaign (TSC): Rapid Assessment of Processes and Outcomes, undertaken by the Water and Sanitation Programme, in 2010, it states, ‘Disaggregating the impacts of sanitation by gender reveals that the privacy afforded by access to adequate sanitation facilities imparts a sense of dignity, especially to women and young girls. Access to safe sanitation in schools is also linked to continued education enrolment by young girls and teenage women, particularly at puberty (Bruijne et al 2007).’ Despite this statement, there has been a lack of attention paid to providing menstrual hygiene services in the TSC.  This failing not only impacts directly on girls and women but also on the achievement of Millenium Development Goals relating to social exclusion, access to water, sanitation and hygiene services, education and health.

This failing is partially reflective of the gendered balance of power. The TSC represents a departure from the way that conventional rural sanitation programmes have previously been implemented. According to programme guidelines, the TSC seeks to be community-led and demand-driven rather than target-led and supply-driven.  But who is leading the community and driving demand? Women are often excluded from decision-making processes and not represented in community decisions. By generating more awareness of menstrual hygiene, more children can be kept in schools creating a better future for the individual and community, and contributing to MDG 3 of promoting gender equality and the empowerment of women. Menstrual hygiene is a critical issue for agencies to address because lack of facilities to ensure it effect the disempowered and improving facilities is in itself a means of empowerment.

A 2011 programme by UNICEF shows how an improvement in facilities can directly lead to a drop in absenteeism. One school in Krishnagiri noted that over two thirds of girls studying in standard 8 and 9 skipped school during their periods with one third of these girls eventually dropping out.  Following UNICEF’s Menstrual Hygiene and Management programme and the installation of disposal units in schools, the dropout and absenteeism rate in the school has come down to almost zero and academic performance has reportedly improved. (

HEEALS (Health, Education, Environment And Livelihood Society), based in Gurgaon, is currently working on an awareness campaign for better sanitation and hygiene practices and the provision of girls’ toilets in five states: Delhi (National Capital Region), Uttar Pradesh, Rajasthan, Leh Ladakh, Himachal Pradesh and Haryana. HEEALS typically works in slum schools or schools in unauthorised areas where no other NGOs are working. It also works with orphanages and refugee camps. Find out more about its Water Sanitation Hygiene and Girl Education Project at  and support our work.



Tackling anaemia in the battle for better menstrual hygiene

It is a well-established fact that around 23% of girls drop out of school every year in India due to inadequate menstrual hygiene facilities including lack of access to functioning toilets for girls in 66% of schools.  Research is also starting to show, however, a significant link between girls dropping out of school because of anaemia, exacerbated by the onset of puberty and menstruation, causing drop out due to illness in addition to lack of sanitary facilities.  In fact, according to WHO estimates, India has one of the highest levels of anaemia in the world mostly affecting adolescent girls in a country that contains 20% of the world’s adolescent population.


 Anaemia has been found to affect up to 79% of children in India and around 56% of girls between the ages of 15 and 19, rising to 70% of girls in some areas such as Jharkhand.  High rates of anaemia are thought to be due to low levels of iron content in women’s diets from early childhood. Anaemia can have devastating effects medically on mental development, physical growth and on the development of women’s children later in life. Recent data show that 30 per cent of girls aged 15-19 are currently married or in union, compared to only 5 per cent of boys of the same age and therefore, potential children are highly susceptible to health problems because of the prevalence of anaemia within this age group of girls.

Anaemia can also have a detrimental impact academically, with girls often dropping out of school because they fall behind due to absence caused by illness.  Symptoms of anaemia include loss of appetite, weakness, shortness of breath and also heavy menstrual flow, which is particularly problematic where basic menstrual hygiene facilities are lacking. A 2011 study found, for example, that 86% of girls did not change sanitary napkins at school, which was partly attributed to lack of facilities.

HEEALS appreciates that a holistic approach is needed to tackle these various integrated issues related to the problem of menstrual hygiene and female education. In addition to trying to raise money to build toilets, HEEALS is also planning to run some health camps in August to screen girls for anaemia and provide iron tablets where necessary guided by empirical evidence that a weekly supplement of 100mg  of elemental iron and 500ug folic acid (IFA) is effective in decreasing the incidence and prevalence of anaemia in adolescents. An anaemia prevention programme run in Jharkhand through UNICEF has seen drop-out rates fall from more than 50% to less than 5% for the 656 girls enrolled at school since the start of the scheme showing that dealing with this issue can have truly transformative results.

In order to carry out these programmes, HEEALS needs your support. Visit: to find out more about its work.


New evidence of links between water, sanitation, hygiene and stunting

In July 2013, HEEALS highlighted the findings of a multiple country study conducted in 2008, which showed that 25% of stunting in children aged 24 months could be attributable to five or more diarrhoeal episodes experienced in the first 2 years of life. Poor height growth, or stunting, affects 165m children worldwide, increasing the risk of death and reducing productivity in adulthood, according to the WHO. Stunting can lead to poorer school performance, early school drop-out and, as a result, lower economic well-being in later life. A study in Peru suggested that while diarrhoea could explain 16% of stunting, access to sanitation and water services could explain a much greater 40%. Up until now, however, there has been no significant scientific evidence to prove a link between sanitation and stunting.

Evidence has now been found of a small increase in height – about 0.5cm – in under-fives living in households with good sanitation. The evidence from 14 studies involving nearly 10,000 children comes from a review of evidence known as the Cochrane review, led by the London School of Hygiene & Tropical Medicine (LSHTM) and the international charity WaterAid.

The analysis has suggested, for the first time, that better access to water, sanitation and hygiene may have a small but important impact on the growth of young children. Dr Alan Dangour, a public health nutritionist at the LSHTM who led the report is quoted by the BBC as saying:”It makes absolute sense that there should be a link between dirty water, diarrhoea and growth outcomes but it’s interesting that it’s never been shown before.”



Find out more about water, sanitation and hygiene at:

Read the full BBC article:


Campaign to provide water sanitation and menstrual hygiene awareness to Indian girls and children

HEEALS needs support to deliver its innovative WASH campaign to 33,111 girls and children in 5 States of India over a 3 month-period. The cost of the campaign is minimal in comparison to the impact it could have but HEEALS still needs to reach its fundraising target of $6,200 to make it a reality.  Find out more at: