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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/Jon Spaull
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
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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 ratifies 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 whole of India except the State ofJammu and Kashmir. The Government of Jammu& 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
• 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.
• CCCCCooooosssssttttt effect effect effect effect effectiiiiivenevenevenevenevenessssss. s. s. s. s. 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 minority tobenefit 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 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 guidelines can be used in variousways:
• 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 beyondthe designs 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 12 ).
• 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(WaterAid 2013a).
Four types of barriers are:
IndiIndiIndiIndiIndivvvvvidualidualidualidualidual b b b b barrierarrierarrierarrierarriersssss 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 addressedwith interventions that focus on that limitation.For example, by providing a wheelchair forsomeone who cannot walk, drugs for someonewho is sick, or a stick to help guide someone whocannot 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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EnEnEnEnEnvvvvviiiiirrrrronmentonmentonmentonmentonmentalalalalal b b b b barrierarrierarrierarrierarriersssss are often easiest toidentify. They include barriers to ppppphhhhhyyyyysssssicicicicicalalalalal ac ac ac ac acccccceeeeessssss:s:s:s:s:
• 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. ApApApApApprprprprproooooacacacacachehehehehesssss t t t t to io io io io imprmprmprmprmprooooovvvvviiiiinnnnng acg acg acg acg acccccceeeeessssssssssiiiiibbbbbiiiiilitlitlitlitlityyyyy
• 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
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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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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
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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
Improvements/variations
Paint raised sides white orbright colour to increasevisibility
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Construction
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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
Improvements/variations
Paint raised sides white ora bright colour to increasevisibility
Cross-hatching on rampwould make it less slipperywhen wet (see page 23'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
Improvements/variations
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 up on the space available, a ramp may be designed as a "Straight Ramp" or "Switchback Ramp". The following should be the features/ dimensions of a ramp as per the Universaldesign concept.
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 wheelchairusers.
Construction
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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
Improvements/variations
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 clearof hazards 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)and secure (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 atsame level without any steps. No door seal orother trip hazard should be there.
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Construction
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Advantages
The floor of thelatrine is the samelevel as theoutside
Improvements/variations
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
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OutwOutwOutwOutwOutward-openiard-openiard-openiard-openiard-openinnnnngggggwwwwwoodoodoodoodooden douen douen douen douen doubbbbbllllleeeeedoordoordoordoordoorsssss w w w w with a lith a lith a lith a lith a latatatatatccccch onh onh onh onh onoutsoutsoutsoutsoutsididididide te te te te to keepo keepo keepo keepo keepccccclololololosedsedsedsedsed
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
Improvements/variations
Add horizontal handrail
Varnish/paint wood toreduce risk of termitedamage
Move bolt to the inside
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
25
Door handles and closing mechanisms
Suitable: Suitable for everyone including women and girls. Latches are to be on the internal side of thedoors
Construction
HorizHorizHorizHorizHorizontontontontontalalalalal h h h h handrandrandrandrandraiaiaiaiailllllthe fthe fthe fthe fthe fuuuuullllllllll w w w w width ofidth ofidth ofidth ofidth of the the the the thedoor on the idoor on the idoor on the idoor on the idoor on the innnnnsssssididididide.e.e.e.e.InternInternInternInternInternalalalalal bo bo bo bo boltltltltlt
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
Materials locallyavailable
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
Improvements/variations
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
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
27
Seating
Fixed seat pan
Suitable for: people who have difficulty squatting, including overweight people, pregnant women,older people 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
Improvements/variations
Paint the seat to repel urineand make it easier to clean
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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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
Improvements/variations
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
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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
Improvements/variations
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)
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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 isfixed.
• 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. Thegrabbars 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
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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
Materials locallyavailable
Materials locallyavailable
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
Improvements/variations
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
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
32
3. Ac3. Ac3. Ac3. Ac3. Acccccceeeeessssssssssiiiiibbbbbllllle de de de de deeeeesssssign optign optign optign optign optionionionionionsssss w w w w with cith cith cith cith cooooosssssttttt– w– w– w– w– workorkorkorkorkiiiiinnnnngggggmodmodmodmodmodelelelelelsssss
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 atthat time in that specific state. This will vary fromas per the current market rates in different statesand geographies. The disability accessibleadaptations are in bold.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
33
Do's1. Provide an access ramp that is firm and smooth for
wheelchairs as well as ambulant-disabled without
wheelchairs
2. Ramp should be wide enough to accommodate a
wheelchair
3. Landings or flat surfaces should have an area large
enough to permit wheelchair to turn
4. Steps can be used if the household does not have
permanently disabled people. These must conform to the
norms provided in this handbook
5. Doors to sanitation facilities should be at least the
width of a wheelchair and open outwards. The minimum
width is 90 cm
6. String or other means of opening from outside must
be provided that is accessible while seated in a
wheelchair
7. Entrance area should be flat i.e., have a landing
before the door so wheelchair users can leave the chair
while entering the facility
8. Slope should be as per the norms given in this
handbook
9. Toilet should be large enough to accommodate
wheelchair and allow disabled user freedom of
movement
10. Assessment of physically challenged people in
household must be done before designing the toilet
11. Disabled people must be brought together to
discuss their specific needs at the planning stage. This
may not happen if a general meeting on sanitation is held
in the community
12. While planning, households with disabled people
can be marked with a different colour on a map
13. The disabled person(s) in a household must be
consulted before designing the toilet or bathroom. This
will help understand the barriers and determine the best
model
14. Water supply in the toilet must be accessible to the
visually and ambulant disabled
Do's and Dont's for Accessible Sanitation Facilities for Persons with Disabilities
15. For visually challenged, contrasting colours must be
used on the access, railings and inside
16. For visually challenged, tactile cues are necessary on
the railing outside and the support bars inside the toilet
17. Guideposts with tactile cues painted in bright
colours are necessary to guide visually challenged from
home to the toilet
18. Local materials must be used to reduce costs.
Bamboo, wood or steel may be used instead of cement
where appropriate and available
19. Training to masons must be provided on
constructing ramps for ambulant-disabled and tactile
strips to visually disabled
20. Access to toilet must be kept free of shrubbery and
other overgrowth and must be no more than 15 m from
the house
21. Water bucket or pot must be kept at a height that is
convenient ?
Don'ts1. Don't make steps on the access ramp. If needed for
non-disabled access, steps to the toilet must be provided
separately
2. Don't rearrange the toilet so it is unfamiliar to
visually challenged people
3. Don't leave extra buckets, mugs or other things in
the toilet
4. Don't place locks or latches for the door at the top
where ambulant-disabled cannot reach
5. Don't have sharp edges or corners on guideposts,
railings and inside the bathroom or on the way
6. Don't provide loose ramps that can be moved while
being used
7. Steps must not exceed measurements provided in
this handbook
8. Don't keep water source on the ground where it is
hard to reach and use
9. Don't have one type of seat - allow the user to
decide if a fixed or moveable seat is preferable
10. Don't have a heavy door that is hard to open
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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 thecommode from market is bought and fixed. At both sides GIgrab bars are fixed one side to the wall and other to the floor. Asmall tank is attached to the toilet where water is storedmanually and can flow through the tap connections made in thetoilet.
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.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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, DeogharTTTTTotototototalalalalal C C C C Cooooossssst*t*t*t*t* 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
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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, DeogharTTTTTotototototalalalalal C C C C Cooooosssssttttt * * * * * 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
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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 tothe toilet and the bright coloured helps him to see.
IHHL of Kalicharan KiskuTTTTTotototototalalalalal c c c c cooooossssst* 8,560t* 8,560t* 8,560t* 8,560t* 8,560
IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of K K K K Kalicalicalicalicalichhhhharararararan Kian Kian Kian Kian Kissssskkkkkuuuuu
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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 ismade at center. The chair is removed after Pintu uses the toiletso that other family members can use the toilet.
IHHL of Pintu PaswanTTTTTotototototalalalalal c c c c cooooossssst* 9,100t* 9,100t* 9,100t* 9,100t* 9,100
IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of Pi Pi Pi Pi Pintntntntntu Pu Pu Pu Pu Paaaaaswswswswswananananan
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
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 onconvenience, availability and safety.
IHHL of Manoj PanditTTTTTotototototalalalalal c c c c cooooossssst*t*t*t*t* 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
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
Model 7
Name: Debu TatwaPlace: Pachrodihi in Dumka districtType of Disability: Physical Impairement (Paralysis)Disability friendly Options: (approach rad, 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 TatwaTTTTTotototototalalalalal c c c c cooooossssst* 11,225t* 11,225t* 11,225t* 11,225t* 11,225
IncIncIncIncInclululululusssssiiiiive tve tve tve tve toioioioioillllletetetetet of of of of of De De De De Debbbbbu u u u u TTTTTatwatwatwatwatwaaaaa
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
* The cost of toilet can vary depending on the prevailing market rates at that time in that specific state.
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
42
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
42
NOTES
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
43
NOTES
Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwDs)
44
NOTES
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