Thanks to the Clean India Campaign called Swachh Bharat Mission (SBM), the multiple facets of WASH (safely managed water, sanitation, and hygiene) are well-understood in the country now, and if applied consistently over time, these interventions have the potential to serve as barriers to human-to-human transmission of the Covid-19 virus in homes, communities, healthcare facilities, schools, and other public spaces.
There are three aspects that India Sanitation Coalition (ISC) at FICCI wishes to highlight in terms of best practices, the knowledge and observance of which has the potential to transform the public health landscape of the country as it deals with the spread and management of the deadly pandemic alongside some of the most advanced nations in the world.
The following is a framework for actions in wash around:
1. Handwashing with soap and water: One of the most important measures that can be used to prevent infection with the Covid-19 virus.
2. Public and community toilets usage protocol: A felt need during the pandemic for planning, implementation, O&M, and monitoring and evaluation of public sanitation facilities with a view to sustaining the ODF gains achieved through SBM 1.0.
3. FSM systems: If set up and maintained well from end to end, they have the potential to mitigate current public health and environment challenges posed by the untreated septage and sewage.
Hand hygiene
Guiding principles: As Covid-19 cases in India surge, there is one consumer product, critical to our fight against the pandemic and that is soap.
Respiratory viruses—SARS-CoV-2, the flu, and the common cold—can be transmitted via our hands. As Centres for Disease Control and Prevention puts it, “our hands are the front lines in the war against Covid-19.”
They recommend washing hands with soap and water as the top way to clean our hands and only if soap and water are not available, using a hand sanitiser with at least 60% alcohol can help.
A DEFINITIVE GUIDE TO HANDWASHING CAN BE ENUMERATED IN THE FOLLOWING 8
STEPS —
1. Get your hands wet first: Getting your hands wet first primes your skin for the soap, so that it can get down into crevices and folds more effectively than when your hands are dry. So, turn on the tap and get your hands really wet first.
2. Squirt enough soap from the soap dispenser to lather your hands well: You will need enough soap to truly cover your hands in foam, or to be able to rub up a good lather that will cover both hands thoroughly. Soaps that come out as foam may need a couple of squirts, while liquid soaps may need just one squirt, but need more rubbing to work up a good lather.
3. Scrub soapy hands for at least 30 seconds to one minute: Thoroughly scrub the palms of your hands, and then move to the backs of your hands and keep scrubbing. Scrub between the fingers and around your thumb. Get under the fingernails too. Rub your fingers between each other well to get the soap down in there. Being this thorough ensures that you really scrub off any dirt and microbes that can get embedded in between skin folds and under fingernails.
4. Rinse the lather off completely: Keep rubbing as you rinse the soap off your hands to make sure it all comes off. All the grime that was on your hands should now be in the bubbles you have lathered up, so you will need to make sure all those bubbles go down the drain, taking the dirt with them.
5. But how do I turn off the tap after I wash my hands? You have a couple of options here: You can use your elbow to turn the tap off, or you can use the paper towel you have dried your hands with to turn it off.
6. Dry off your hands: There should be at least one paper towel dispenser near the sinks, preferably one of the no-touch variety. If you must touch a lever to get it going, use your elbow if possible. Once you have a paper towel, pat your hands dry. But before you toss it in the trash, look around at your washroom exit and water turn-off options. Use the paper towel to turn off the tap.
7. Exit the restroom without touching handles or knobs, if possible: If you need to use a handle to pull open the restroom door, use that paper towel on the handle, not your freshly washed hands. We suggest keeping the garbage can near the restroom door to make disposal easier without making people touch the door handle. If the door can be pushed open with a hip, shoulder, or elbow, avoid using your hands at all.
8. Use hand sanitizer if needed: If the ergonomics of your restroom prevent you from following these steps exactly (e.g. you have to touch the door handle to get out of the restroom for some reason) find the nearest hand sanitizing station for a spritz and a rub.
COMMUNITY AND PUBLIC TOILETS (CT/PT) MANAGEMENT & USE
Guiding principles: A community toilet block is a shared facility provided for a group of households or an entire settlement. It is usually located in or around the community and used by the defined users of the community whereas public toilets are provided for the floating population in places such as markets, railway stations or other public areas and used by the undefined users2.
Pattern of use of a community toilet slightly differs with that of public toilet. Community toilets are used mostly by the concerned community members. Most of the working males and female members use toilets between 5 AM to 10 AM. During noon, females who are not working use toilets to relieve themselves as well as for washing clothes. Fewer people use community toilets during evening and night.
In case of public toilets, the usage pattern varies considerably depending on the location of such toilets. A public toilet located at railway station is used almost throughout the day till late evening. Likewise, such toilets located at interstate busy bus terminals operates almost 24 hours a day. Whereas a public toilet located in a park / zoo, operates during the official time of operation of such institutions.
Prior to any forms of user education, it is crucial for the CT/PT owners and operators to strongly commit in adopting good design guidelines to provide quality toilets with user-friendly facilities and enough amenities including hand soap and handwashing stations. Proper training of cleaning attendants in toilet cleaning should also be conducted to effectively maintain the toilets the right way. Only with the complete adoption of the above practices can user education be successfully implemented3.
The practice: Having public education messages in the toilets can help persuade users to do their part in keeping toilets clean as also to stick to the standard practices on hand hygiene and social distancing in order to keep SARS-CoV-2 at bay. In order to be effective in persuading people to do their part, suitable messages highlighting these measures need to be attended to, and assimilated and remembered before any collective outcome on behaviour change can be expected of the CT/PT users.
Message content, and design and message placement are critical in inducing any behaviour change that may transform the landscape of CT/PT use in India benefitting inter alia the cause of containment of the current disease outbreak. People readily attend to visuals. This makes the use of visuals an important part of the design of the message. Generally, visuals should be:
(i) Simple and uncluttered
(ii) Attractive
(iii) Eye-catching4
The messages could be as follows:
1. Keep a 3-metre distance from the toilet attendant when requesting access
2. Wear your mask while accessing service here
3. Keep toilet seat clean and dry
4. Check that the toilet is flushed thoroughly after use
5. Keep the floor clean and dry
6. Use hand dryer or hand towels
7. Please put litter into bins
8. Use amenities with care, etc.
It is recommended that audio messages be suitably designed and played too at these installations to remind users of the necessity and urgency to adopt a behavioural pattern that would prevent themselves from being infected by the corona virus. A combination of music and educational messages can be attempted with sensors that will trigger automatic playing of the latter when there is human traffic.
WASTE MANAGEMENT INCLUDING FAECAL SLUDGE AND SEPTAGE (FSSM)
Guiding principles: Chair, India Sanitation Coalition, recently wrote a column in Times Now—"We need to create resilient cities. Other than pollution, look at how we manage water resources, including faecal sludge management, sanitation more broadly, water access and climate change. If set up and maintained well from end to end, FSSM systems have the potential to mitigate the current public health and environment challenges posed by untreated sewage”5.
Some 80 percent of the world’s wastewater is dumped—largely untreated—back into the environment, polluting rivers, lakes, and oceans.
More than 60 per cent of sewage generated by urban India enters untreated into water bodies like rivers, resulting in pollution and making the water unfit for human consumption (NGT)6.
In Delhi, untreated sewage makes its way to the Yamuna, adding to its pollution and it is responsible for 70% of the river's pollution.
Without action, the challenges will only increase by 2050, when global demand for freshwater is expected to be one-third greater than it is now.
The practice and possibilities: Onsite sanitation technologies serve 2.7 billion people worldwide, and the number is likely to grow to 5 billion by 2030. Sewer-based systems, on the other hand, are prohibitively expensive and resource-intensive7.
In fact, the cost of FSM (decentralised) technologies is five times less expensive than conventional sewer-based ones in urban areas, depending on the local conditions. These represent viable and more affordable options, however, if the entire service chain gets managed adequately.
Chair, ISC accordingly summarises in her recent column, “The cost of FSM (decentralized) technologies are significantly less expensive than conventional sewer-based systems. They are also much less resource-intensive both in terms of water requirements and energy use. Given that most of the population depends on on-site systems, it is imperative, therefore, that we come together as communities, RWAs, municipalities to look at solutions for treating our sewage and protecting the scarce water resources we depend on.”
Given the common situation of publicly financed waste and sanitation services, the term ‘business’ model might appear out-of-place in this sector. However, with increasing calls for cost recovery and private sector participation, the thinking is changing, and business models are needed to conceptualise sustainable sanitation service chains: models for emptying and transport of faecal sludge; models linking emptying, transport and treatment as well as those emphasising reuse at the end of the service chain; and models covering the entire sanitation service chain from toilet access to reuse. Corporates have a definite role to play here too.
As the country attempts to block person-to-person transmission of Covid 19, this timely best practices note curated by the India Sanitation Coalition Secretariat brings to the fore WASH interventions which we were disseminating widely over the last 5 years under the sanitation agenda of the country by Government and international agencies, Corporates through well-funded media programs, and NGOs. The messages and collaterals already exist and with a little tweaking the effort needs to be revived as it may well help flatten the curve of Covid infection in India.
To know more about WASH initiatives in the Covid-19 response space, please log on to www.indiasanitationcoalition.org