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Handbook on Accessible Household Sanitation for Persons with Disabilities (PwDs)

Ministry of DrinKinG WAtEr AnD sAnitAtionsWACHH BHArAt Mission (GrAMin)

GoVErnMEnt of inDiADECEMBER 2015

Handbook on AccessibleHousehold SanitationFacilities for Personswith Disabilities (PwDs)

MINISTRY OF DRINKING WATER & SANITATIONSWACHH BHARAT MISSION (GRAMIN)

GOVERNMENT OF INDIADecember 2015


Copyright - © WaterAid India, 2015

Photo credits

Cover photo: WaterAid/Guilhem Alandry

Page 8, clockwise from top extreme right

WaterAid/Marco Betti

WaterAid/Marco Betti

WaterAid/Pragya Gupta

WaterAid/Sridevi Sunderarajan

WaterAid/Pragya Gupta

All other images:

WaterAid/Jane Wilbur

WaterAid/Hazel Jones

WaterAid/Sumantra Mukherjee

Abbreviations

AIP Annual Implementation Plan

BPL Below Poverty Level

CSO Civil Society Organisation

CFT Cubic feet

DFID Department for International Development

DPO Disabled People’s Organisation

DWSD District Water and Sanitation Department

DWSM District Water and Sanitation Mission

GP Gram Panchayat

MDWS Ministry of Drinking Water and Sanitation

NGO Non-Government Organisation

ODF Open Defecation Free

PHED Public Health Engineering Department

PIP Project Implementation Plan

PRI Panchayati Raj Institution

PWDs Persons with Disabilities

RTE Right to Education

SBM Swachh Bharat Mission

VWSC Village Water and Sanitation Committee

WSS Water Supply and Sanitation

WASH Water, Sanitation and Hygiene

WEDC Water Engineering and Development Centre

Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)

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Introduction

Government of India has madeproactive legislation to address the needof basic services for persons with

disability. India is a signatory to the Declarationon the Full Participation and Equality of Peoplewith Disabilities in the Asia Pacific Region. Indiais also a signatory to the Biwako MillenniumFramework for action towards an inclusive,barrier free and rights based society. Indiasigned the UN Convention on Protection andPromotion of the Rights and Dignity of Personswith Disabilities on 30th March, 2007, the day itopened for signature. India ratified the UNConvention on 1st October, 2008.

Much before the UN Convention, under Article253 of the Constitution, the Government of Indiaenacted "The Persons with Disabilities (EqualOpportunities, Protection of Rights and FullParticipation) Act, 1995", in the effort to ensureequal opportunities for persons with disabilitiesand their full participation in nation-building. TheAct extends to the whole of India except the Stateof Jammu and Kashmir. The Government ofJammu & Kashmir has enacted "The Persons withDisabilities (Equal Opportunities, Protection ofRights & Full Participation) Act, 1998". TheConstitution of India ensures equality, freedom,

justice and dignity of all individuals and implicitlymandates an inclusive society for all includingthe persons with disabilities. The Constitution inthe schedule of subjects lays direct responsibilityof the empowerment of the persons withdisabilities on the State Governments therefore,the primary responsibility to empower thepersons with disability rests with the StateGovernments.

A multi-sectoral collaborative approach, involvingall the appropriate Governments i.e. Ministries ofthe Central Government, the State Governments/UTs, Central/State undertakings, local authoritiesand other appropriate authorities is beingfollowed in implementation of various provisionsof the Act.

The Ministry of Drinking Water and Sanitation(MDWS) apart from substantially increasing theGovernment assistance for household toilets hasalso broadened the eligibility beyond BPL1categories to firmly include households havingPersons with Disabilities (PwDs). The newSwachh Bharat Mission (Gramin) while focusingon universal sanitation coverage is also lookingat better ways of addressing needs of Personswith Disabilities.



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Why a handbook for accessible designoptions for PwDs

In spite of the enabling policies and guidelines atnational and state level, there has been challengesfaced by implementers and service providersbecause of a lack of appropriate and cost effectivetechnology options which are PwD friendly, lack ofskills to deal with PwDs, absence of adequateinformation on inclusive toilet designs notreaching the district and block functionaries,inherent existing challenges in inter-sectoralcoordination and lack of skilled NGOs.

• Improved knowledge and awareness ofcommunities on disability and barriers to access

• Inclusion of PwDs in decision makingprocesses including platforms like the villagewater and sanitation committees, parent teacherassociations and school managementcommittees

• Improved capacities of service providers(including PHED functionaries), local governmentinstitutions, disabled people’s organisations andCSOs to address inclusive and accessible WASHprogramming at households, communities andinstitutions level

• Barrier free accessible and cost effectivemodels in WASH for PwDs which can informinclusive WASH costing in governmentprogrammes leading to a menu of accessibletechnical options to address barrier freesanitation access for PwDs in households

Rationale for accessible design optionsfor PwDs

• BenefBenefBenefBenefBenefitsitsitsitsits of of of of of i i i i incncncncnclululululusssssiiiiive fve fve fve fve facacacacaciiiiilitlitlitlitlitieieieieies. s. s. s. s. Many people,such as the elderly, pregnant women, girls,parents with small children and people who areinjured or sick may have difficulty with balance,

co-ordination, weak grip, squatting or lifting.Because of this they experience many of thesame problems as disabled people, althoughthey are not described in this way. Inclusiveplanning of water and sanitation servicestherefore benefits the whole community, andoften involves only minor adjustments to ordinaryservices.

• Cost effectiveness. Cost effectiveness. Cost effectiveness. Cost effectiveness. Cost effectiveness. It is cost effective andcheaper to plan from the outset to make servicesinclusive for disabled people, than to provide addon special services which only a small minoritybenefit from. The most cost-effective way toimprove access for children with disabilities is toincorporate accessibility into the design from theoutset (inclusive design) rather than makingexpensive changes later.

• EnEnEnEnEnvvvvviiiiirrrrronmentonmentonmentonmentonment f f f f factactactactactorororororsssss. However well designedthe latrine, other factors such as location,distance and approach path affect accessibilityand need to be a part of planning and design.

Technical options in this booklet willaddress the needs of:

• Primary users in communities: Persons withdisabilities - Persons with visual disability andlocomotor disability including pregnant womenand senior citizens/ older people.

Who can use the handbook?

This handbook can be used by Governmentfunctionaries, water and sanitation engineers,representatives of Panchayati Raj Institutions,WASH sector professionals, disabled people'sorganisations and disability service providers,and organisations representing or working withother socially excluded groups. This handbook isexpected to serve as a practical guide and have abetter understanding of:



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• The problems facing disabled people, elderlypeople and other vulnerable groups in accessingwater, hygiene and sanitation facilities

• Challenges facing the sanitation sector inserving vulnerable groups and persons withdisabilities

• Possible solutions to address these issuesunder Swacch Bharat Mission (Gramin)

How to use the handbook?

This handbook can be used in various ways:

• As a starting point for discussion withhouseholds

• As a way of encouraging communities toconsider design options

• By disabled people’s organisations

• Capacity building of government and NGOfunctionaries implementing Swachh BharatMission (Gramin)

• As flashcards - images can be enlarged andstuck on card

• As posters - images can be printed and usedfor group discussions

Capacity building

• Training for district level engineers, NGOsand PRIs on barriers to access andaccessible solutions

• Training on conducting accessible audits

• Improve knowledge of sanitation andhygiene among DPOs so that they canadvocate more effectively

• Improve knowledge of disabled peopleabout how sanitation facilities can beadapted to meet their needs

Technical specifications are not given beyond thedesigns piloted and shared here, because alldimensions should be based on users’ needs.

The aim is to provide as much ‘independentaccess’ as possible - this means facilities that aperson can use without help, or with minimumhelp. If possible, try out ideas first to work out:how high a seat or support rail should be? Howwide the entrance should be? To work out howmuch space is needed inside a latrine, mark outthe area on the ground using rocks or branches.Ask different users to try moving and squatting/sitting inside, and adjust if necessary.

Costs and materials itemised here are purelysuggestive and serve as examples because theywill vary between communities and states.

Actions at state and district level

• "Key functionaries at the state and districtlevel to take part in a participatory barrieranalysis (see "Who can use the handbook" onpage 10 ).

• Key functionaries at district and block level tomeet representatives from disabled people’sorganisations, and from the health, education,aging and WASH sectors.

• Key functionaries from the district and statelevel to take part in accessibility and safetyaudits within the community, or at any venuewhere meetings are being held.

• District Annual Implementation Plans toinclude targets on improving access and use foreveryone in planning, budgeting, andmonitoring.



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• Include access and use by disabled people as acriteria of ODF in national ODF verificationprotocols.

• District Water Supply and Sanitationfunctionaries and DPOs collaborate and coordinatetheir activities to improve service delivery.

• Bring the issues into the public realm throughpublications, mass media, meetings and events.Use available data on the topic from interviewswith different people, insights from changestories, accessibility audits and the participatorybarrier analysis.

• Include accessible sanitation designs innational standards and protocols.

Actions at village and panchayat level

This set of actions is meant for Swachhata doots,village/GP level motivators, PRIs, WARD membersand NGOs working at the village and panchayatlevel.

When arranging VWSC meetings:

• Ensure meeting times are convenient for bothwomen and men (e.g. not during mealpreparation).

• Agree locations of meetings to be close tohomes of the least mobile, and in buildingswithout steps.

• Take care that disabled and older people arenot pushed to the back of meetings andarrangements are made for those with difficultyhearing or seeing to be near the front.

• If visual media are used, ensure they aredescribed verbally to those with difficulty seeing,and verbal presentations supplemented withvisuals for those with difficulty hearing.

When arranging additional meetings:

• Consider separate group discussions withpeople who may feel unable to speak incommunity meetings.

• Visit disabled or older people who cannotattend meetings in their homes to ensure theirconcerns are not ignored.

• Share issues raised in these additionalmeetings with the wider community or theirselected representatives.

When arranging meetings with disabled people:(CLTS approach to trigger sanitation demand)

At any time:

• Ask people with disabilities what problemsthey face and how these might be overcome.

• Bring small groups of disabled peopletogether to discuss their experiences withsanitation in a supportive group.

• Convene community meetings and encourageeveryone to listen to what disabled people haveto say.

Pre-triggering:

• Ask who in the community is disabled andwhether they can come to the triggering.

Post-triggering follow up

• Suggest that disabled people are marked onthe monitoring map.

• Facilitate participatory design to suit disabledpeople’s needs. If necessary, feed in ideas.

• Encourage links between disabled people andthose able and willing to support them.

• Make it known that arrangements for disabled



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people are a part of verification.

Triggering

• Ask if disabled people can be marked on themap.

• Encourage and support disabled people tospeak up and be heard when plans are being made.

Verification

• Ask disabled people how they manage -Check that arrangements are adequate, withinthe means of the community.

• Post-ODF check on arrangements andencourage improvement.

How to implement accessible sanitationoptions

Consultation with disabled people

Consult on project design, technology optionsand staff training. Make sure to consult disabledwomen as well as disabled men. Disabilityservice providers can also be a useful source ofadvice and skills

A. Identifying and understandingbarriers to access

Purpose: To identify and analyse the barriers,obstacles and factors that create problems forusers in accessing and using water and sanitationfacilities.

Diversity message: Different groups of users mayexperience different problems and barriers whenusing facilities.

Engineering message: The way infrastructure isdesigned and built can unintentionally excludesome users.

The need for convenient access to sanitation andhygiene is stark and acute for many disabled,older and chronically ill people who have todefecate in their dwellings or in the open. In theirhomes there are problems of smell and disposal.In the open, people with visual impairments haveto rely on a guide or make their own way withdangers of trampling shit.

Problems faced by people with a mobilityimpairment are similar, and if they move on allfours, risk getting filthy crawling among the shit(Wilbur 2010). If the toilets are dirty it is harderfor disabled people to keep themselves clean,especially if they are blind. The dangers ofgetting dirty affect their health, degrade theirself-esteem and can affect how others see andtreat them. This can undermine their confidenceand make them unwilling to express their needs .

Four types of barriers are:

Individual barriersIndividual barriersIndividual barriersIndividual barriersIndividual barriers are those attributes of anindividual that make it difficult for them to accesswater and sanitation. For example,

• if someone is weak because of illness,

• is an older person with weak arms, legs or aninjured back, is very short (child),

• or has limited mobility because of pregnancy.

These are barriers which might be addressed withinterventions that focus on that limitation. Forexample, by providing a wheelchair for someonewho cannot walk, drugs for someone who is sick,or a stick to help guide someone who cannot see.

These barriers are often the focus in the medicalmodel of disability but are notare notare notare notare not u u u u usssssualualualualuallylylylyly the f the f the f the f the focococococuuuuusssssfor WASH programmes.



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Environmental barriersEnvironmental barriersEnvironmental barriersEnvironmental barriersEnvironmental barriers are often easiest toidentify. They include barriers to physicalphysicalphysicalphysicalphysicalaccess:access:access:access:access:

• Long distances to facilities

• Paths that are rough or steep or no paths at all

• Toilets with high steps or narrow doors

• Inside, a lack of space

• Nothing to hold onto, or to raise oneself upfrom squatting

• Nothing to sit on for those who cannot squat

• Access issues are just as significant for thosewith sensory or communication impairmentswhere information is not available in formats theycan understand

Also think about the positioning of latrines – dothey provide privacy and safety for girls?

Do they have to go through unsafe areas to get towater points?

How far do people have to travel?

Is the orientation of latrines important (forexample, some religions do not want to face East)?

InInInInInssssstttttitititititutututututionionionionionalalalalal b b b b barrierarrierarrierarrierarriersssss are some of the mostdifficult to identify. Without a proactive search forthem, they won’t be as immediately evident.That’s because they’re often linked to social andcultural norms and written into policies andlegislation.

Disabled, older or chronically ill people may:

• Be excluded by the way a programme orservice is delivered

• Not hear about a meeting

• Not be able to reach it

• Not be invited or feel able to speak

• Have their opinions dismissed

• Lack of consultation and participation canthen lead to inappropriate designs

• Design or location of facilities, overlookingtheir needs, and limiting or denying their accessto sanitation. Addressing these barriers is crucialthroughout the community mobilisation process

• Implementing staff often lack informationabout low-cost ways of making toilets accessiblefor disabled and older people. Peoplethemselves are often unaware of the optionsavailable, so they do not know how/what to askfor improvements (Jones and Reed 2005)

AttAttAttAttAttitititititudiudiudiudiudinnnnnalalalalal b b b b barrierarrierarrierarrierarriersssss are the most important toidentify – time and time again they are the mainreason prohibiting progress on inclusion ofmarginalised people. Negative attitudes andassumptions have led to many disabled peoplebelieving themselves to be worthless,independent and in need of support. Women aresometimes not respected as decision-makers orconsidered capable of technical skills and tasks.

PPPPPuuuuurporporporporpose:se:se:se:se: To identify and analyse the barriers, obstacles and factors that create problems for usersin accessing and using water and sanitation facilities.DiDiDiDiDiververververversssssititititityyyyy me me me me messssssssssage:age:age:age:age: Different groups of users may experience different problems and barriers whenusing facilities.EnEnEnEnEngigigigigineerineerineerineerineerinnnnng meg meg meg meg messssssssssage:age:age:age:age: The way infrastructure is designed and built can unintentionally excludesome users.



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People who are disabled may be discriminatedagainst and not reported under surveys and olderpeople, especially women, may be shunned byyounger people.

B. Inclusive and accessible designing

1 .1 .1 .1 .1 . Approaches to improving accessibilityApproaches to improving accessibilityApproaches to improving accessibilityApproaches to improving accessibilityApproaches to improving accessibility

• Design and construct facilities that areaccessible for all

• Adapt and modify existing facilities toimprove accessibility

• To provide assistive devices to individuals toenable them to access existing facilities

Preparatory work towards designing options:

• Become better acquainted with disabledpeople in the community to understand theirpersonal challenges and work with them todevelop appropriate solutions to makingWATSAN services more accessible

• Examine current situation of disabledpeople’s access to WATSAN and then reviewdesigns to make them more accessible

• Investigate solutions currently beingimplemented in the community and, whereappropriate, incorporate them into futurework

• Investigate improving specific features suchas the design of taps to improve theiraccessibility to disabled people

• Identify key features that make facilitiesaccessible and incorporate them into minimumstandards

• Produce some practical demonstrations ofaccessible technology

2. Making facilities physically accessible2. Making facilities physically accessible2. Making facilities physically accessible2. Making facilities physically accessible2. Making facilities physically accessible

Getting there: Reaching facilities-

• paths

• ramps

• support rails

• landmarks for blind people

Getting in:

• thresholds

• wide entrance

• flat platform in front of door

• doors

• easy to close, lockable for privacy

Usability:

• hand pump aprons

• internal dimensions - extra space forwheelchair to enter and turn, user +helper, or tomove a seat to one side

• support rails: fixed to the floor, adjustableheight, movable frame, rope

• suspended from a beam overhead

• seating – fixed, movable

• design of equipment

• adapted water lifting mechanism



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Construction

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CCCCCllllleeeeeararararar, l, l, l, l, levelevelevelevelevel p p p p path,ath,ath,ath,ath,lililililinednednednedned w w w w with rith rith rith rith rococococockkkkksssss

LandmLandmLandmLandmLandmarkarkarkarkark po po po po possssstststststsmmmmmaaaaaddddde fe fe fe fe frrrrrom locom locom locom locom localalalalalmmmmmateriateriateriateriaterialalalalalsssss

Advantages

Easy to construct

Simple to maintain

Suitable for userswith visualimpairment

Can be madeaccording to budget

Suitable for userswith visual andphysical impairments,including wheelchairusers

Can be madeaccording to budget

Easy to constructusing local materials

Provides guidance forusers with visualimpairment

Disadvantages

Regular maintenanceneeded

String must be carefullypositioned so it is not ahazard to other users

Rocks are easily movedor dislodged, whichcould cause a trip hazard

Maintenance wouldinclude regular re-positioning of the rocks

Posts must be firm, andpositioned so they arenot a hazard to others

Regular maintenanceneeded to check postsare stable

Improvements/variations

Path could be lined withpainted rocks or landmarkposts

Paint rocks white or abright colour to increasevisibility

Posts can be painted/marked with a bright colourto increase visibility

Use alternative materials,e.g. rocks, or existingfeatures, e.g. trees

Reaching facilities –Paths

How to get there?

Suitable for: everyone, especially users with a visual impairment andwith physical impairments, including wheelchair users



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Ramps

Suitable for: Users with physical impairments, wheelchair users, older people, people carryingheavy loads

Construction

LLLLLooooow-grw-grw-grw-grw-graaaaadientdientdientdientdientccccconconconconconcrete rrete rrete rrete rrete ramp wamp wamp wamp wamp withithithithithrrrrraiaiaiaiaisedsedsedsedsed s s s s sididididideeeeesssss f f f f forororororsssssafetafetafetafetafetyyyyy(me(me(me(me(meaaaaasssssuuuuurementrementrementrementrement1:12 or more)1:12 or more)1:12 or more)1:12 or more)1:12 or more)

Advantages

Smooth, firm, durable

Gentle gradient so achild can propel her/himself up and makea controlled descent

Raised sides preventwheelchairs rolling off

Disadvantages

Monitoring ofconstruction required toensure gradient not toosteep

Maintenance needed tokeep the ground thesame level as the end ofthe ramp


Paint raised sides white orbright colour to increasevisibility



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Construction

WWWWWididididide ce ce ce ce conconconconconcrete rrete rrete rrete rrete rampampampampampttttto ho ho ho ho handandandandandpppppuuuuump aprmp aprmp aprmp aprmp aprononononon

Advantages

The concrete ramponto the apronimproves access foreveryone

Disadvantages

Ramp requires morespace than steps

Drainage must be in theopposite direction tokeep the ramp dry

Monitoring needed toensure masons do notmake it too steep toreduce cost


Paint raised sides white or abright colour to increasevisibility

Cross-hatching on rampwould make it less slipperywhen wet (see page 21'Steps')



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Construction

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Advantages

Flexible - can beplaced whereverneeded

Cheaper thanconcrete

Raised sides preventa wheelchair rollingoff the side of theramp

Disadvantages

Less durable thanconcrete

User needs help to movethe ramp when needed


Paint raised sides white orbright colour to increasevisibility



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How gradient slope of a ramp is measured

“Gradient” describes the change in height over a specified distance.

Example : Gradient 1 : 15

This slope rises 1 unit over a distance of 15 units. If the distance is 15m, the slope will rise 1m.

1:20 is ideal but would require a lot of space. So as a good middle path 1:15 can be done. CertainIndian specifications recommend 1:12m – This is fairly steep but this is the absolute minimum andthe ratio should not go below this.

Depending on the space available, a ramp may be designed as a "Straight Ramp" or "Switch backRamp". The following should be the features/ dimensions of a ramp as per the Universal designconcept.

A Ramp should be smooth, non-slippery, firm and stable and made of a material that is not likely towear away quickly.

A landing may be provided for resting at every vertical rise of 750mm and also between two flightsof a ramp for easy movement. Besides the rest area, it is also required in places where the rampchanges direction.



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Steps

Suitable for: steep terrain; where space is limited; households or communities with no wheelchair users.

Construction

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RecRecRecRecRecommendommendommendommendommendedededededssssstep ditep ditep ditep ditep dimenmenmenmenmensssssionionionionionsssss(f(f(f(f(for referencor referencor referencor referencor reference)e)e)e)e)

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Advantages

Cross-hatching iseasy to apply - theconcrete is scoredwhile wet

Many users canmanage low, evensteps, especiallywhen a handrail isprovided

Steps take up lessspace than a ramp

Disadvantages

No edgeprotection forunstable orvisually impairedusers

Steps excludesome users, e.g.those usingmobility devices


Steps should be ofconsistent height

Install a guard orhandrail

Paint steps white orbright colour toincrease visibility

Cost /labour

Low/medium



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Latrines

Household toilet design principles: For thehousehold level, consider providing informationabout low cost, low tech options to makehousehold latrines easier, more comfortable andsafer for use by everyone in the family, especiallydisabled people.

Accessible design features could include:

• Level, marked paths. A firm, even path clear ofhazards benefits everyone, not only wheelchairand crutch users

• Ramps or low steps with handrail to thelatrine entrance

• Wide entrances to toilets, and enough spaceinside for a person and her/his carer to turn inside

• Simple handrails and movable toilet seatsthat can be placed over pit latrines

• Hand lever to replace a foot lever on ‘tippytaps’ for people with weak legs

• Toilets that are safe (location appropriate) andsecure (e.g. lockable doors)

• Door handles and locks that can be easilyreached by all

• Facilities for menstrual hygiene management,both at the household level and for institutionaland public facilities

Sitting: Latrines should be no more than 15mfrom the household

Accessible Door & Entrance

• The doorway should have a clear width of900mm for a person using wheelchair or thoseusing assistants to get through.

• Door should generally open outside. Slidingdoors are the most preferable.

• A distance of 450mm to 600mm beside andbeyond the leading edge of the door and a safelanding space of 1200mm X 1200mm in front fora wheelchair user to manoeuvre.

• Door Handles should be fixed between 650to 1100mm above the floor level. It should bepreferably Lever shaped or D type handle.

• A 150mm long handle may be fixed on theoutside.

The threshold of the toilet door should be at samelevel without any steps. No door seal or other triphazard should be there.



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Construction

LatLatLatLatLatriririririne wne wne wne wne with lith lith lith lith levelevelevelevelevelccccconconconconconcreteretereteretereteentententententrrrrrancancancancance, we, we, we, we, wididididideeeeeenough fenough fenough fenough fenough for aor aor aor aor awheelcwheelcwheelcwheelcwheelchhhhhaiaiaiaiair ur ur ur ur userserserserser

Advantages

The floor of thelatrine is the samelevel as theoutside


Level flooringcould beachieved withany type ofmaterials, notonly concrete

Entrances

Entrances must be: a) wide enough (e.g for a wheelchair user it needs to be - wheelchair width + 20cm),and b) level enough (minimal or no difference between outside and inside).

It needs to be kept in mind that all people are not wheelchair users.



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Doors

Suitable for: users with mobility devices, a helper, or carrying a small child, or people who areoverweight.

Construction

OutwOutwOutwOutwOutward-openiard-openiard-openiard-openiard-openinnnnng tg tg tg tg tiiiiinnnnndoor on wdoor on wdoor on wdoor on wdoor on woodoodoodoodoodenenenenenfffffrrrrrame. Rame. Rame. Rame. Rame. Raiaiaiaiaisedsedsedsedsedppppplllllatfatfatfatfatform edorm edorm edorm edorm edge actsge actsge actsge actsge acts a a a a asssssa door sa door sa door sa door sa door stttttopopopopop

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Advantages

Outward-openingdoor does notobstruct internalspace

Horizontal woodenstruts can begrasped to closedoor

Easier to close forsome users

Each door is narrowso less obstructiveto passers by

Disadvantages

Pulling a door is harderthan pushing it open

Requires a wide, levelarea in front of door forusers to positionthemselves to open thedoor

Higher cost than a singledoor

Some users find themdifficult to use


Add horizontal handrail

Varnish/paint wood toreduce risk of termitedamage

Move bolt to the inside



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Door handles and closing mechanisms

Suitable: Suitable for everyone including women and girls. Latches are to be on the internal side of thedoors

Construction

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CCCCCarararararvedvedvedvedved w w w w woodoodoodoodoodenenenenenhhhhhandandandandandllllle ne ne ne ne naiaiaiaiailllllededededed t t t t to theo theo theo theo theiiiiinnnnnsssssididididide ofe ofe ofe ofe of the door the door the door the door the door

MMMMMetetetetetalalalalal hoo hoo hoo hoo hookkkkk and and and and and eye eye eye eye eyeon ion ion ion ion innnnnsssssididididide ofe ofe ofe ofe of door door door door door

Advantages

User can easily reach

Door can be bolted toincrease privacy

Large, chunky bolt iseasy to operate

Easy for all users tograsp

Materials locallyavailable

Easy to construct

Ensures privacy

Easy to install


Disadvantages

Door must be solidenough to fix the rail to

Needs monitoring toensure it is securelyfixed and that the boltslides easily

Does not keep the doorclosed

Can be too fiddly forsome users to operate


Rail could be made ofwood (2nd photo, left), GIpipe, chain, or cord

Add a bolt or hook tofasten the door closed

Handle could also be fixedto the door frame forsupport when entering

Instead of a hook, wire canbe looped over a bent nail,or a loop of string woundround a bent nail



26

Internal space

Consider: who will use the toilet, and how muchspace they will need.

Level 1: Space for users who can stand and enterusing support rails, or blind users.

Level 2: Additional space for a carer, to usecrutches/sticks or to park a wheelchair but notturn.

Level 3: Space for a wheelchair to enter, shut thedoor, and turn around inside.

Persons with disability using different types ofassistive devices may require different spaceconsiderations for their safe and free movement.Persons with disability will require space ofdifferent dimensions when moving straight and

also when turning around using different types ofassistive devices

• Ideal clear floor space of 2.0 mt X 1.8 mt(inner dimension) is required for a toilet havingwater closet. A wash basin can be fixed withinthis space.

• This space dimension will also be adequatefor the wheelchair user. Minimum innerdimension of the room may be considered to be1.8 mt X1.5 mt in case of a Wheelchair User

• In case of persons who are using crutches orthose who cannot walk comfortably, thedimension may be considered to be 1.5 mt X 1.2mt. (inner dimension). In this case, the washbasin option in the toilet may be avoided.However, the water taps and the cistern can beeasily fixed.



27

Seating

Fixed seat pan

Suitable for: people who have difficulty squatting, including overweight people, pregnant women, olderpeople and disabled people.

In case of a Wheelchair user, the commode should be placed not in the middle space in the room. Onone side, an unobstructed space of 900 mm from the edge of WC to the side wall should be providedand on the other side, the distance from the centre of the commodeto the next adjacent wall should be 480 mm. There should be a clearspace of 1200 mm in front of commode.

The top of commode may be fixed at a height of 475 to 490 mmfrom the floor or depend on the need and comfort of the user. Incase of commode bought from the market, it is designed so.However, there are also modified/adapted toilets constructed withIndian type squatting pan depending on the type of disability andadaptation needs.

These modified options may be as the examples that follows:

Construction

CementCementCementCementCement bo bo bo bo bowlwlwlwlwl m m m m maaaaadddddeeeeewwwwwith mouith mouith mouith mouith moulllllddddd

Advantages

Comfortable

Durable

Easy to wipe,therefore hygienic

Disadvantages

Requires a mould and ismore difficult toconstruct

Heavy, so needs astrong sanplat


Paint the seat to repel urineand make it easier to clean



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Commode movable seats

Suitable for: people who havedifficulty squatting, includingoverweight people, pregnantwomen, older people and disabledpeople.

Construction

PPPPPaiaiaiaiaintedntedntedntednted w w w w woodoodoodoodoodenenenenenccccchhhhhaiaiaiaiair wr wr wr wr with 'pottith 'pottith 'pottith 'pottith 'potty'y'y'y'y'iiiiinnnnnsersersersersertedtedtedtedted i i i i in hon hon hon hon hollllle ie ie ie ie innnnnseseseseseatatatatat. P. P. P. P. Pottottottottottyyyyy i i i i isssssremoremoremoremoremovedvedvedvedved f f f f forororororemptemptemptemptemptyyyyyiiiiinnnnnggggg

MMMMMetetetetetalalalalal c c c c commodommodommodommodommodeeeeeccccchhhhhaiaiaiaiair wr wr wr wr with pith pith pith pith plllllaaaaasssssttttticiciciciciiiiinnnnnsetsetsetsetset t t t t toioioioioillllletetetetet p p p p pananananan(bought(bought(bought(bought(bought i i i i in locn locn locn locn localalalalalmmmmmarket)arket)arket)arket)arket)

CCCCContontontontontaiaiaiaiainer iner iner iner iner isssss p p p p plllllacacacacacedededededbenebenebenebenebeneath the seath the seath the seath the seath the seatatatatat and and and and andemptemptemptemptemptiediediediedied i i i i intntntntnto theo theo theo theo thelllllatatatatatriririririnenenenene

Advantages

Can be placed in themost convenientplace for the user orcarer, either inside oroutside the house

Fabric straps supporta user with poorbalance

Painted metal andplastic are strong,durable and easy toclean

Can be placed in themost convenientplace for the user orcarer, either inside oroutside the house

Disadvantages

Container must beemptied and cleanedafter every use

A separate private toiletarea might need to becreated

Wood needs regularpainting/varnishing

Container must beemptied and cleanedafter every use

A separate private toiletarea might need to becreated

Metal for some users isuncomfortable - a home-made padded ring couldbe added for comfort

Plank and waist beltadded to provide extrasupport


Padding can be added toback and sides for extracomfort

Seat could be used withoutthe potty, placed over thetoilet hole

A bucket could be usedunder the seat instead of apotty

Car tyre inner tube couldalso be used as a cushion



29

Movable seats

Construction

LLLLLooooow ww ww ww ww woodoodoodoodooden oren oren oren oren orbbbbbamamamamamboo tboo tboo tboo tboo toioioioioillllletetetetet s s s s stttttoooooooooolllllwwwwwith hoith hoith hoith hoith hollllle ie ie ie ie in sen sen sen sen seatatatatat,,,,,ppppplllllacacacacacededededed o o o o over tver tver tver tver toioioioioillllletetetetethohohohohollllle, we, we, we, we, with orith orith orith orith orwwwwwithoutithoutithoutithoutithout f f f f fuuuuunnelnnelnnelnnelnnel a a a a asssss a a a a asssssppppplllllaaaaasssssh guardh guardh guardh guardh guard (see (see (see (see (seeiiiiimmmmmage)age)age)age)age)

StStStStStandandandandandardardardardard vvvvvarniarniarniarniarnissssshedhedhedhedhedwwwwwoodoodoodoodooden cen cen cen cen chhhhhaiaiaiaiair wr wr wr wr withithithithithhohohohohollllle ce ce ce ce cututututut i i i i in the sen the sen the sen the sen the seatatatatat

Advantages

Easy to construct

Materials availablelocally

Height must bedecided based onuser's needs

Can be moved to oneside out of the way ofother users whoprefer to squat

Light and easy tocarry if necessary

Comfortable

Provides backsupport while seated

Materials availablelocally

Varnish makes chaireasier to clean somore hygienic

Disadvantages

Potential for termitedamage

Enough space neededinside latrine to movethe seat away from thepit when not in use

Needs accuratepositioning to reducerisk of splashing orsoiling

Needs extra space in thelatrine so it can bemoved to one side whennot in use

Might be heavy


Painting or varnishing wouldmake it more durable, easierto clean and more hygienic

Add a splashguard to thefront

Add 'runners' - horizontalbars joining the bottom ofthe legs to better distributethe weight on the floor, toreduce damage (see image)



30

Hand Rails and Grab Bars

Hand Rails provide support to the person withdisability to hold and move forward along a rampor stair and even along a straight pathway. Thefollowing are the specifications of hand rails:

• There should be a clearance of at least 45mmfrom the adjacent wall/ surface to which it is fixed

• Hand Rail should be fixed at two levels: one at700mm-750mm and another at 850mm-900mm from the finished floor

• It should be extended by at least 300mmbeyond the head and foot of the flight and ramp

Hand Rails should be circular in section withdiameter of 40 to 45mm

Hand Rails Grab BarsGrab Bars are supportive bars which may be of GIor steel pipes of 40 to 45mm diameter, fixedfirmly to the adjacent walls and floors, so thatpersons with disability can transfer their bodyweight for movement.

• For Wheelchair User - the movable grab bars(U type) are to be provided on transfer side at aheight of 480mm from ground (i.e. at the sameheight as the commode). The L type bar shouldbe fixed on the wall side to get adequate supportduring transferring the body weight

• For others - it depends on the condition ofdisability and preference. Ideally, the bars shouldbe provided on both sides on the wall and maybe fixed to the floor on the transfer side. This maybe of GI pipe and fixed, not movable. The grabbars may be fixed at a height between 450mm to750mm or at a height as suitable to access anduse

• Sometimes, the grab bars are also fixed to thetwo adjacent walls close to commode



31

Construction

BricBricBricBricBrickkkkksssss pr pr pr pr protototototrudirudirudirudirudinnnnngggggfffffrrrrrom wom wom wom wom walalalalallllll f f f f forororororsssssuuuuupppppporporporporporttttt t t t t to a weo a weo a weo a weo a weakakakakakor or or or or vvvvviiiiisssssualualualualuallylylylyly i i i i impmpmpmpmpaiaiaiaiairedredredredredperperperperpersonsonsonsonson

WWWWWoodoodoodoodooden/ ben/ ben/ ben/ ben/ bamamamamamboobooboobooboosssssuuuuupppppporporporporporttttt r r r r raiaiaiaiailllllsssss f f f f fiiiiixxxxxedededededttttto floor either io floor either io floor either io floor either io floor either innnnnfffffrrrrrontontontontont or on either or on either or on either or on either or on eithersssssididididide ofe ofe ofe ofe of t t t t toioioioioillllletetetetet(d(d(d(d(dependiependiependiependiependinnnnng ong ong ong ong onuuuuuser'sser'sser'sser'sser's need need need need needs)s)s)s)s)

MMMMMetetetetetalalalalal b b b b barararararsssss (e.g. (e.g. (e.g. (e.g. (e.g.gggggalvalvalvalvalvanianianianianisedsedsedsedsed i i i i irrrrronononononpppppiiiiipe) fpe) fpe) fpe) fpe) fiiiiixxxxxededededed t t t t to so so so so sididididideeeeewwwwwalalalalall/sl/sl/sl/sl/s of of of of of l l l l latatatatatriririririnenenenene

Advantages

Easy to construct



Easy to construct andmaintain

Allows user totransfer to the toiletfrom the side

Position and height ofrails must involveuser and anassessment of theirneed

Highly durable

Can be added toexisting facility

Easy to clean

Bars to be positionedbased on user needs

Disadvantages

Walls must be strongenough to supportuser's weight

Difficult to add afterconstruction

Regular maintenanceneeded to ensurestability

Rails must be strongenough to bear users'weight

Not possible to fix to aconcrete floor/slab

Might be difficult tokeep clean

Cannot fix to a concretefloor/slab

Walls must be strongenough to fix bars to

Walls must be closeenough for user to reachthe bars


Half bricks in the wall canalso provide mini-ledges fora user to hold on to

Varnish/paint rail to stoptermite damage and foreasy cleaning

For a growing child uselonger vertical poles, so barheight is adjustable

Horizontal bars at differentheights might suit some

For concrete floors, piperails can be cemented induring construction, orscrewed to floor later

Paint bars to reducecorrosion and increasedurability

Several bars at differentheights on each side mightbetter suit some users

Hand Rails



32

3. Accessible design options with cost–3. Accessible design options with cost–3. Accessible design options with cost–3. Accessible design options with cost–3. Accessible design options with cost–working modelsworking modelsworking modelsworking modelsworking models

Planners and service providers need to consultpeople with disabilities at all stages of projectcycle by design. It has been proven that designsdeveloped with user feedback not only results inconstructing user friendly WASH facilities but alsohave a higher acceptance/ usage. People withdisabilities and members from the marginalised/excluded group can play an effective role inWASH committees and in managing communityWASH facilities. The models shared here have

been constructed in Jharkhand and Odisha withcommunity engagement and are examples forreference. There can be better and improvedoptions that can be designed.

*It may be mentioned here that these examples /models have been constructed in 2013 and thecosts are as per the prevailing market rates at thattime in that specific state. This will vary from asper the current market rates in different statesand geographies. The disability accessibleadaptations are in bold.

Do's

1. Provide an access ramp that is firm andsmooth for wheelchairs as well as ambulant-disabled without wheelchairs

2. Ramp should be wide enough toaccommodate a wheelchair

3. Landings or flat surfaces should have an arealarge enough to permit wheelchair to turn

4. Steps can be used if the household does nothave permanently disabled people. These mustconform to the norms provided in this handbook

5. Doors to sanitation facilities should be atleast the width of a wheelchair and openoutwards. The minimum width is 90 cm

6. String or other means of opening fromoutside must be provided that is accessible whileseated in a wheelchair

7. Entrance area should be flat i.e., have alanding before the door so wheelchair users canleave the chair while entering the facility

Do's and Dont's for Accessible Sanitation Facilities for Persons with Disabilities

8. Slope should be as per the norms given inthis handbook

9. Toilet should be large enough toaccommodate wheelchair and allow disableduser freedom of movement

10. Assessment of physically challenged peoplein household must be done before designing thetoilet

11. Disabled people must be brought together todiscuss their specific needs at the planning stage.This may not happen if a general meeting onsanitation is held in the community

12. While planning, households with disabledpeople can be marked with a different colour on amap

13. The disabled person(s) in a household mustbe consulted before designing the toilet orbathroom. This will help understand the barriersand determine the best model

14. Water supply in the toilet must be accessibleto the visually and ambulant disabled



33

15. For visually challenged, contrasting coloursmust be used on the access, railings and inside

16. For visually challenged, tactile cues arenecessary on the railing outside and the supportbars inside the toilet

17. Guideposts with tactile cues painted in brightcolours are necessary to guide visuallychallenged from home to the toilet

18. Local materials must be used to reducecosts. Bamboo, wood or steel may be usedinstead of cement where appropriate andavailable

19. Training to masons must be provided onconstructing ramps for ambulant-disabled andtactile strips to visually disabled

20. Access to toilet must be kept free ofshrubbery and other overgrowth and must be nomore than 15 m from the house

21. Water bucket or pot must be kept at a heightthat is convenient ?

Don'ts

1. Don't make steps on the access ramp. Ifneeded for non-disabled access, steps to thetoilet must be provided separately

2. Don't rearrange the toilet so it is unfamiliar tovisually challenged people

3. Don't leave extra buckets, mugs or otherthings in the toilet

4. Don't place locks or latches for the door atthe top where ambulant-disabled cannot reach

5. Don't have sharp edges or corners onguideposts, railings and inside the bathroom oron the way

6. Don't provide loose ramps that can be movedwhile being used

7. Steps must not exceed measurementsprovided in this handbook

8. Don't keep water source on the ground whereit is hard to reach and use

9. Don't have one type of seat - allow the userto decide if a fixed or moveable seat is preferable

10. Don't have a heavy door that is hard to open



34

Model 1

Name: Kedar SethiPlace: Tentulidihi, OdishaType of Disability: Physical Impairment (Polio)Disability friendly options:(Approach road, Hand rail, Grab bar, commode as WC)

The approach is provided with smooth & wide path with handrails fixed at 750mm height of bamboo and inside the commodefrom market is bought and fixed. At both sides GI grab bars arefixed one side to the wall and other to the floor. A small tank isattached to the toilet where water is stored manually and canflow through the tap connections made in the toilet.

IHHL of Kedar Sethi, TentulidihiTotal cost * 11,19011,19011,19011,19011,190

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of Ked Ked Ked Ked Kedar ar ar ar ar SethiSethiSethiSethiSethi

* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.



35

Model 2

Name: Jitendra TuriPlace: Sirsanunthar in Deoghar districtType of Disability: Multiple (mental disability, blind)Disability accessible options–(Ramp, Hand rail, Grab bar, painting, modified WC)

The boy has mental retardation and also fully blind. So approach road isprepared with compacted earth fill and bamboo railing is put at the side sothat he can access the toilet. Inside the toilet the seat height is raised withbrick masonry and pan is fixed over it. GI grab bars are fixed to the walls.

IHHL of Jitendra Turi, DeogharTotal Cost*Total Cost*Total Cost*Total Cost*Total Cost* 10,90010,90010,90010,90010,900

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of Jitendr Jitendr Jitendr Jitendr Jitendra a a a a TTTTTuuuuuririririri




36

Model 3

Name: Rohit MandalPlace: Jogia Village in Deoghar districtType of Disability: Visual and locomotor disabilityDisability Friendly Options:(Ramp, Hand rail, Grab bar, painting, modified brick masonry WC)

Access to the toilet is a cemented ramp of 1:12 slope with bamboo handrails fixed at 650mm height. The toilet inside is space of 4’-6" X 4’-6" sizewith modified brick masonry commode with space to put legs at both sides.Commode is at a height of 400mm and grab bars in 25mm GI pipe is fixedto the walls.

IHHL of Rohit Mandal, Jogia Village, DeogharTotal Cost *Total Cost *Total Cost *Total Cost *Total Cost * 11,00011,00011,00011,00011,000

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of R R R R Rooooohithithithithit M M M M Mandandandandandalalalalal




37

Model 4

Name: Kalicharan KiskuVillage: Bogli in Dumka, JharkhandType of Disability: Visual Impairment (partial blindness)Disability Friendly Options: Bamboo Hand rail, GI Grab bar,contrast colour

The person is visually impaired. Handrails support him to thetoilet and the bright coloured helps him to see.

IHHL of Kalicharan KiskuTotal cost* 8,560Total cost* 8,560Total cost* 8,560Total cost* 8,560Total cost* 8,560

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of K K K K Kalicalicalicalicalichhhhharararararan Kian Kian Kian Kian Kissssskkkkkuuuuu




38

Model 5

Name: Pintu PaswanPlace: Prandi in Deoghar districtType of Disability: Physical disability (Polio)Disability friendly Options: The toilet was constructed earlier.

The plastic chair was cut to appropriate height and a hole is madeat center. The chair is removed after Pintu uses the toilet so thatother family members can use the toilet.

IHHL of Pintu PaswanTotal cost* 9,100Total cost* 9,100Total cost* 9,100Total cost* 9,100Total cost* 9,100

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of Pi Pi Pi Pi Pintntntntntu Pu Pu Pu Pu Paaaaaswswswswswananananan




39

Model 6

Name: Manoj PanditPlace: Khodkuan in Deoghar districtType of Disability: Physical ImpairementDisability friendly Options: (GI Grab Bar, wooden stool)

The toilet was constructed earlier.

The wooden stool with a hole in the middle is of 320 mm height asappropriate for use by Manoj and after his use the stool is removedand kept outside so that other family members can use the sametoilet without the stool. The grab bars are fixed to the walls inappropriate heights so that Manoj can hold and sit down or get up.

Here a wooden stool is used but one can use a plastic stool or a fibrestool as well or cut a hole in a chair for use depending on convenience,availability and safety.

IHHL of Manoj PanditTotal cost*Total cost*Total cost*Total cost*Total cost* 9,4259,4259,4259,4259,425

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of M M M M Manoj Panoj Panoj Panoj Panoj Panditanditanditanditandit



40

Model 7

Name: Debu TatwaPlace: Pachrodihi in Dumka districtType of Disability: Physical Impairement (Paralysis)Disability friendly Options: (approach road, hand rail, GIGrab Bar, GI frame stool)

The approach road is constructed in cement mortar andhand rails are fixed in bamboo at both sides and GIframed WC sheet is fixed at 350mm height which canbe used and lifted afterwards. The grab bars are Lshaped using 25mm GI pipes.

IHHL of Debu TatwaTotal cost* 11,225Total cost* 11,225Total cost* 11,225Total cost* 11,225Total cost* 11,225

IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of De De De De Debbbbbu u u u u TTTTTatwatwatwatwatwaaaaa




References:

1. Adapted from: Compendium of accessible WASH technologies Hazel Jones and Jane Wilbur (2014)

2. Adapted from: Frontiers of CLTS series - Disability: Making CLTS Fully Inclusive, Jane Wilbur forWaterAid and Hazel Jones for WEDC July 2014 (IDS, SHARE, WaterAid, DFID)

3. Briefing Note: Including disabled people in sanitation and hygiene services, June 2011 by GuyCollender, SHARE, Jane Wilbur, WaterAid, Louisa Gosling, WaterAid


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42

NOTES



43

NOTES



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NOTES


Ministry of DrinKinG WAtEr AnD sAnitAtionGoVErnMEnt of inDiA

WaterAid’s mission is to transform the lives of the poorest and most marginalised people by improving access to safe water, sanitation and hygiene.

WaterAid India – Country Office403, 4th Floor, CNI Bhavan, 16 Pandit Pant Marg, New Delhi -11 0 001 (India)Tel: +91-11-4608 4400 Fax: +91-11-4608 4411Email: [email protected]

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