OPP Six Questions

3.4 The Question of Rectification

In lanes where substandard work has been done, people have carried out major rectifications. These lanes are few and far between, and a few of them belong to the initial period of OPP’s extension work, when the people’s confidence in OPP’s advice had not been established. The majority however were built by the people themselves without OPP technical assistance, in many cases before the OPP was established.

In the majority of cases the defects in the lane are related to levels.. The junction of the line with the secondary drain is higher than the line itself. This makes it impossible for the line to function.

The OPP is contacted for advice in rectification, and the lane residents accept that the reasons for failure are due to

1. Not establishing contact with the OPP at the time of commencement of work, thereby failing to establish correct levels
2. Following the advice of local plumbers and technicians in preference of advice from OPP staff; and
3. Beginning work due to impatience and pressure of lane residents, thereby not waiting for OPP advisors to visit the site and establish bench marks.

A number of case studies for rectifications carried out with OPP advice have been collected, by they have not been published or analysed as yet. However, it is established that people are willing to rectify substandard work even if it means digging up the sewer and relaying it. This is because of the demonstration effect of properly functioning sewerage lines in their neighbourhood.

3.5 The Question of Health

It has frequently been pointed out that though the lanes in Orangi have acquired a sanitation system, there has been no conscious attempt by the sanitation programme to improve personnel hygiene and health of the residents. Whatever improvement has taken place is simply because of the laying of sewers. Consequently one can still find children excreting in the open and garbage being dumped into the lanes.¹

The OPP realized from its very inspection that personnel and domestic hygiene was the key to good health. It also realized that these aims could only be achieved by organizing the women of Orangi. Therefore, in 1981 much time and money was invested in trying to organize women through a programme of home schools and first aid centres. In 1982 again similar attempts were made to form women’s clubs and youth clubs to promote hygiene and sports. The Director’s Annual Report (June 1984 – June 1985) deals at length with the causes for the failure of these programmes. He sums up saying: “by June 1984 we had realized that at present the conditions were too anarchic, and our resources too meager to establish or sustain stable groups or clubs.” However the report continues “by 1984, OPP’s Low Cost Sanitation Programme had spread to hundreds of lanes. In the success of this programme housewives had played a very active role. We realized that they were keenly aware of, the health problem of their home and their lane. Their participation provided us with a clue about the future direction of the women’s programme.” That the women were very conscious of the problems of health and hygiene is borne out by the fact that they paid the sanitation cost from household expenses. The report further says: “We assume that for changing the attitudes and opinions of segregated women access is the main problem. Custom requires them to stay at home. Such women generally go out only for emergencies or in exceptional circumstances”.

It is because of this problem of access that the Welfare Centre approach of government agencies and certain NGOs has proved ineffective. There are 70 to 80 thousand families living in Orangi. Even if 4 of 5 centres were established, women would have to cover long distances to get to them. To accept them to do this, especially when their men are away at work, is quite unrealistic. “In order to serve segregated women, a centre should cover only a small area, not exceeding 20 to 30 lanes.” that means that Orangi would require over 100 such centres!

Keeping the above factors in view, Akhtar Hameed Khan introduced the following systems for organizing women through the Women’s welfare Programme (WWP).

1. Creation of mobile training teamswhich hold meetings in the lane activist’s house: Each team consists of a lady health visitor (LHV), a social organizer, and an expert gardener. Package of advice offered by the team is
   • further training about sanitation and hygiene in the home and the lane
   • leaflets and training about prevention of 12 diseases common in Orangi, like diarrhea, malaria, scabies etc.
   • immunization of children against six diseases
   • instruction for growing vegetables in the homes and free supply of seeds

   Akhtar Hameed Khan calls this approach, ”the street vendors approach”.

2. Selection of women activists or contact persons in the lanes. This selection is undertaken by the team visiting the lane where sanitation work has been carried out and contacting the lane sanitation activist who recommends an interested women resident to the team. This woman becomes an activist for the programme and the women of the lane assemble at her home to meet with the mobile team. The OPP has found no difficulty in finding women activists, in the lanes which have developed their sewers, who are willing to assemble their neighbours in their houses, arrange meetings, and establish a “rudimentary kind of organization”.
3. Regular meetings at the activists home. In the beginning there was only one team and as such only one or two meetings could be held per day. However, with aid from the Population Welfare Division and the Aga Khan Foundation, the OPP was able to purchase vehicles and engage an extra team. Thus the meetings increased rapidly (see table below). Fifteen to thirty women are present in each meeting and now a few men, generally close relatives, also come to listen to the team’s advice.
4. Formation of small groups of neighbours by the activists.

From January 1985, the WWP started giving advice regarding family planning. Initially this advice was given at the health advice meetings. However, it was discovered that there were women who introduced “controversies to brow beat the needy ones”. Therefore separate activists were chosen for the family planning advice and meetings dealing exclusively with family planning were held at their homes. However, by March 1986, the subject of family planning had become non-controversial, and therefore there is no longer a need to have separate meetings, groups or activists for the family planning component. In addition, women who have become adopters of family planning advice are becoming its main promoters.

In addition to access and trust, it was found that for the success of the family planning component, a decentralized system of supplies must be available conveniently and confidentially. The lane activists fulfill this role. Chemists in Orangi have also been enrolled for this purpose.

The tables given in the appendix to this paper give an idea of the development of this programme. In June 1984, 16 health advice meetings were attended by 361 women. In December 1985, 122 meetings were attended by 944 women. The number of activists increased from 90 in January 1985 to 245 in December 1985. Similarly in January 1985, 4 dozen condoms were supplied by the OPP as opposed to 342 dozens in December 1985. There were 272 kitchen garden adopters in May 1984. This figure had arisen to 2725 in September 1980.

Although it is not easy to evaluate a health and hygiene programme, the OPPs monitoring of results has shown

1. Improved sanitation and health education has reduced the incidence of the 12 serious diseases in Orangi.
2. Preliminary investigations through some of the activists in September 1986 revealed that many families had been totally free from disease during the preceding six months.