India : Advanced Project Preparedness for Poverty Reduction - Supporting Clean Village Environments for MDGs (Subproject 17)

Health / Health insurance and subsidized health programs

On 31 August 2009, ADB approved the provision of a Technical Assistance Cluster (C-TA) to India for Advanced Project Preparedness for Poverty Reduction to the Government of India. The C-TA is financed on a grant basis through the Department of International Development (DFID), funded by the Government of the United Kingdom, under the DFID and ADB Partnership for India, 2009-2013. The C-TA is implemented until 31 December 2013 in two phases: The first phase (Phase 1), in the amount of $14 million equivalent, covers 17 component TA projects with completion by 31 August 2012. The second phase (Phase 2), approved through a major change in scope and implementation arrangements by the ADB Board on 4 October 2011, entails an increase of $8 million equivalent and the addition of 9 new component TA projects to be completed by 31 December 2013. The TA component-subproject 17 'Supporting Clean Village Enviroments for MDGs' is included in Phase 2 of the C-TA for 2011. The Government has requested ADB to finance $600,000 equivalent on a grant basis under the TA Cluster for Advanced Project Preparedness for Poverty Reduction, funded by the Government of United Kingdom through DFID.

TA Objectives: Through its support for improved sanitation and clean village environments, the impact of the subproject will contribute to India achieving targets related to MDG 4 (child mortality) and MDG 7 (environmental sustainability) in rural India.

Expected Outcome: The expected outcome of the subproject is increased knowledge and capacity of MWDS and state and local government officials to strengthen implementation of Total Sanitation Campaign (TSC). Key outputs and activities are as follows:

a. Operations Diagnostics: A rapid assessment will be carried out of TSC implementation experiences at state and local government level in 3 selected states. This includes review of TSC strategy and processes, governance and institutional structures, technology options, financing and incentives, monitoring and supervision mechanisms, entrepreneurial capacity, and comprehensive capacity development needs on both supply and demand-creation sides.

b. Tools and Pilots: Based on findings of the diagnostics, locally responsive tools, models, and/or processes related to key relevant areas of TSC and the MDWS Ten Year Rural Sanitation and Hygiene Strategy (2012-2022) will be developed. These may relate to aspects of (i) supply chain: technology options, business models to ensure adequate supply chain and services, and approaches to catalyze private entrepreneurial capacity in rural sanitation; (ii) demand-creation: elements of a strategic program for behavior change with consistent messages; and (iii) enabling environment: recommendations on monitoring system, incentive structures, financing options, and building local administrative capacities, and innovative uses of ICT. The developed tools and approaches will be selectively piloted in 2 districts of different geographical areas to test their applicability to local contexts, and for further refinement.

c. Plan of Operations to Strengthen TSC Implementation: With experience from the assessments and piloted interventions, a report will be prepared for MWDS on plan of operations or recommendations to bridge implementation gaps at national TSC program level and/ or state levels to scale-up and strengthen India's rural sanitation agenda. The report will also include program support and adjustment requirements to support the MDWS with the shift to NTSM over the next 5-10 years. A national-level workshop will be organized to share and agree on acceptability of the report's recommendations to stakeholders and to support TSC policy enhancement.

Despite being one the fastest growing economies, access to adequate sanitation (MDG 7) remains far lower in India compared to many other countries with similar or lower Gross Domestic Product (GDP). The problem of poor sanitation is particularly daunting in rural areas, where the vast majority still practices open-defecation as the norm. The impacts on human health of poor sanitation and unhygienic practices are significant, with links to spread of diarrheal diseases and intestinal infections that are among leading causes of malnutrition, illness and death especially among India's children. India recognizes that its sanitation problems lie not just on the lack of facilities or funding but on peoples' traditional attitudes and behavior. Beginning 1999, the GOI restructured its Central Rural Sanitation Program (CRSP) with a paradigm shift in approach to people-centered and community-led total sanitation under banner of Total Sanitation Campaign (TSC). Despite the huge investments made by GOI for the flagship program, and impressive successes attained in many states, the results have generally not been commensurate with GOI's expectations. There are significant disparities among states and districts and also slippages once villages attain open defection free (ODF) status. At the present rate of coverage, it is expected that ODF India will be reached only by 2017 at the national level, while sustainability may still remain an issue. GOI recognizes that for sustainable rural sanitation and for the program to gain full momentum, innovative programmatic solutions are needed to bridge critical gaps in TSC implementation, including issues of access, quality and usage, behavior change, poverty and targeting, private sector participation, integrating total sanitation, and creating an enabling environment.

Government Strategy. The Ministry of Drinking Water and Sanitation (MDWS) recently promulgated the Ten Year Rural Sanitation and Hygiene Strategy (2012-2022). Aligning with the Government Planning Commission's next 12th Five Year Plan (2012-2017), the MDWS plans to incrementally shift from the present project-based approach of TSC to a more comprehensive National Total Sanitation Mission (NTSM). However, the operational modality, supporting structures, and other practical implementation aspects of NTSM need to be further developed and refined. Effective operational tools and models in rural sanitation, especially for lagging states, need to be further sought based on TSC implementation experience, as well as global and regional best practices.

Accelerated achievement towards Millenium Development Goals 4 and 7 targets in selected rural areas of lagging states in India.

(i) Reduced proportion of rural population without access to adequate sanitation

(ii) Reduction in Under-five years child mortality

Increased knowledge and capacity of Ministry of Drinking Water and Sanitation, state and local government officials to strengthen implementation of Total Sanitation Campaign.

1. Operations diagnostics on Total Sanitation Campaign implementation experiences at local government level in selected states

2. Tool-kit and materials developed and selectively piloted

3. Final report on operations plan and necessary program adjustments to increase scale and effectiveness of Total Sanitation Campaign