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Handbook on

Accessible Household
Sanitation for Persons with
Disabilities (PwDs)

Ministry of DRINKING WATER AND SANITATION


SWACHH BHARAT MISSION (GRAMIN)
GOVERNMENT OF INDIA
DECEMBER 2015
Handbook
Handbookon onAccessible
Household
AccessibleSanitation
Household
Facilities
Sanitation forfor
Persons
Persons with
Disabilities
with (PwDs)
Disabilities (PwDs)

MINISTRY OF DRINKING WATER & SANITATION


SWACHH BHARAT MISSION (GRAMIN)
GOVERNMENT OF INDIA
December 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

Copyright - © WaterAid India, 2015


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

G
overnment of India has made justice and dignity of all individuals and implicitly
proactive legislation to address the need mandates an inclusive society for all including
of basic services for persons with the persons with disabilities. The Constitution in
disability. India is a signatory to the Declaration the schedule of subjects lays direct responsibility
on the Full Participation and Equality of People of the empowerment of the persons with
with Disabilities in the Asia Pacific Region. India disabilities on the State Governments therefore,
is also a signatory to the Biwako Millennium the primary responsibility to empower the
Framework for action towards an inclusive, persons with disability rests with the State
barrier free and rights based society. India Governments.
signed the UN Convention on Protection and
A multi-sectoral collaborative approach, involving
Promotion of the Rights and Dignity of Persons
all the appropriate Governments i.e. Ministries of
with Disabilities on 30th March, 2007, the day it
the Central Government, the State Governments/
opened for signature. India ratified the UN
UTs, Central/State undertakings, local authorities
Convention on 1st October, 2008.
and other appropriate authorities is being
Much before the UN Convention, under Article followed in implementation of various provisions
253 of the Constitution, the Government of India of the Act.
enacted "The Persons with Disabilities (Equal
The Ministry of Drinking Water and Sanitation
Opportunities, Protection of Rights and Full
(MDWS) apart from substantially increasing the
Participation) Act, 1995", in the effort to ensure
Government assistance for household toilets has
equal opportunities for persons with disabilities
also broadened the eligibility beyond BPL1
and their full participation in nation-building. The
categories to firmly include households having
Act extends to the whole of India except the State
Persons with Disabilities (PwDs). The new
of Jammu and Kashmir. The Government of
Swachh Bharat Mission (Gramin) while focusing
Jammu & Kashmir has enacted "The Persons with
on universal sanitation coverage is also looking
Disabilities (Equal Opportunities, Protection of
at better ways of addressing needs of Persons
Rights & Full Participation) Act, 1998". The
with Disabilities.
Constitution of India ensures equality, freedom,

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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Why a handbook for accessible design co-ordination, weak grip, squatting or lifting.
options for PwDs Because of this they experience many of the
same problems as disabled people, although
In spite of the enabling policies and guidelines at
they are not described in this way. Inclusive
national and state level, there has been challenges
planning of water and sanitation services
faced by implementers and service providers
therefore benefits the whole community, and
because of a lack of appropriate and cost effective
often involves only minor adjustments to ordinary
technology options which are PwD friendly, lack of
services.
skills to deal with PwDs, absence of adequate
information on inclusive toilet designs not • Cost effectiveness. It is cost effective and
reaching the district and block functionaries, cheaper to plan from the outset to make services
inherent existing challenges in inter-sectoral inclusive for disabled people, than to provide add
coordination and lack of skilled NGOs. on special services which only a small minority
benefit from. The most cost-effective way to
• Improved knowledge and awareness of
improve access for children with disabilities is to
communities on disability and barriers to access
incorporate accessibility into the design from the
• Inclusion of PwDs in decision making outset (inclusive design) rather than making
processes including platforms like the village expensive changes later.
water and sanitation committees, parent teacher
• EnEnvvironment ffact
actor
orss. However well designed
actor
associations and school management
the latrine, other factors such as location,
committees
distance and approach path affect accessibility
• Improved capacities of service providers and need to be a part of planning and design.
(including PHED functionaries), local government
institutions, disabled people’s organisations and Technical options in this booklet will
CSOs to address inclusive and accessible WASH address the needs of:
programming at households, communities and
• Primary users in communities: Persons with
institutions level
disabilities - Persons with visual disability and
• Barrier free accessible and cost effective locomotor disability including pregnant women
models in WASH for PwDs which can inform and senior citizens/ older people.
inclusive WASH costing in government
programmes leading to a menu of accessible Who can use the handbook?
technical options to address barrier free
sanitation access for PwDs in households This handbook can be used by Government
functionaries, water and sanitation engineers,
representatives of Panchayati Raj Institutions,
Rationale for accessible design options
WASH sector professionals, disabled people's
for PwDs
organisations and disability service providers,
• Benef its of iinc
Benefits nc lu
lussive ffac
nclu ac
aciilit ie
litie s. Many people,
ies. and organisations representing or working with
such as the elderly, pregnant women, girls, other socially excluded groups. This handbook is
parents with small children and people who are expected to serve as a practical guide and have a
injured or sick may have difficulty with balance, better understanding of:

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• The problems facing disabled people, elderly • Improve knowledge of disabled people
people and other vulnerable groups in accessing about how sanitation facilities can be
water, hygiene and sanitation facilities adapted to meet their needs
• Challenges facing the sanitation sector in Technical specifications are not given beyond the
serving vulnerable groups and persons with designs piloted and shared here, because all
disabilities dimensions should be based on users’ needs.
• Possible solutions to address these issues The aim is to provide as much ‘independent
under Swacch Bharat Mission (Gramin) access’ as possible - this means facilities that a
person can use without help, or with minimum
How to use the handbook? help. If possible, try out ideas first to work out:
how high a seat or support rail should be? How
This handbook can be used in various ways:
wide the entrance should be? To work out how
• As a starting point for discussion with much space is needed inside a latrine, mark out
households the area on the ground using rocks or branches.
Ask different users to try moving and squatting/
• As a way of encouraging communities to sitting inside, and adjust if necessary.
consider design options
Costs and materials itemised here are purely
• By disabled people’s organisations suggestive and serve as examples because they
• Capacity building of government and NGO will vary between communities and states.
functionaries implementing Swachh Bharat
Mission (Gramin) Actions at state and district level

• As flashcards - images can be enlarged and • "Key functionaries at the state and district
stuck on card level to take part in a participatory barrier
analysis (see "Who can use the handbook" on
• As posters - images can be printed and used page 10 ).
for group discussions
• Key functionaries at district and block level to
meet representatives from disabled people’s
organisations, and from the health, education,
Capacity building
aging and WASH sectors.
• Training for district level engineers, NGOs
• Key functionaries from the district and state
and PRIs on barriers to access and
level to take part in accessibility and safety
accessible solutions
audits within the community, or at any venue
• Training on conducting accessible audits where meetings are being held.

• Improve knowledge of sanitation and • District Annual Implementation Plans to


hygiene among DPOs so that they can include targets on improving access and use for
advocate more effectively everyone in planning, budgeting, and
monitoring.

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• Include access and use by disabled people as a When arranging additional meetings:
criteria of ODF in national ODF verification
protocols. • Consider separate group discussions with
people who may feel unable to speak in
• District Water Supply and Sanitation community meetings.
functionaries and DPOs collaborate and coordinate
their activities to improve service delivery. • Visit disabled or older people who cannot
attend meetings in their homes to ensure their
• Bring the issues into the public realm through concerns are not ignored.
publications, mass media, meetings and events.
Use available data on the topic from interviews • Share issues raised in these additional
with different people, insights from change meetings with the wider community or their
stories, accessibility audits and the participatory selected representatives.
barrier analysis.
When arranging meetings with disabled people:
• Include accessible sanitation designs in (CLTS approach to trigger sanitation demand)
national standards and protocols.
At any time:
Actions at village and panchayat level • Ask people with disabilities what problems
This set of actions is meant for Swachhata doots, they face and how these might be overcome.
village/GP level motivators, PRIs, WARD members • Bring small groups of disabled people
and NGOs working at the village and panchayat together to discuss their experiences with
level. sanitation in a supportive group.

When arranging VWSC meetings: • Convene community meetings and encourage


everyone to listen to what disabled people have
• Ensure meeting times are convenient for both to say.
women and men (e.g. not during meal
preparation). Pre-triggering:

• Agree locations of meetings to be close to • Ask who in the community is disabled and
homes of the least mobile, and in buildings whether they can come to the triggering.
without steps. Post-triggering follow up
• Take care that disabled and older people are • Suggest that disabled people are marked on
not pushed to the back of meetings and the monitoring map.
arrangements are made for those with difficulty
hearing or seeing to be near the front. • Facilitate participatory design to suit disabled
people’s needs. If necessary, feed in ideas.
• If visual media are used, ensure they are
described verbally to those with difficulty seeing, • Encourage links between disabled people and
and verbal presentations supplemented with those able and willing to support them.
visuals for those with difficulty hearing.
• Make it known that arrangements for disabled

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people are a part of verification. The need for convenient access to sanitation and
hygiene is stark and acute for many disabled,
Triggering
older and chronically ill people who have to
• Ask if disabled people can be marked on the defecate in their dwellings or in the open. In their
map. homes there are problems of smell and disposal.
In the open, people with visual impairments have
• Encourage and support disabled people to to rely on a guide or make their own way with
speak up and be heard when plans are being made. dangers of trampling shit.
Verification Problems faced by people with a mobility
• Ask disabled people how they manage - impairment are similar, and if they move on all
Check that arrangements are adequate, within fours, risk getting filthy crawling among the shit
the means of the community. (Wilbur 2010). If the toilets are dirty it is harder
for disabled people to keep themselves clean,
• Post-ODF check on arrangements and especially if they are blind. The dangers of
encourage improvement. getting dirty affect their health, degrade their
self-esteem and can affect how others see and
How to implement accessible sanitation treat them. This can undermine their confidence
options and make them unwilling to express their needs .

Four types of barriers are:


Consultation with disabled people
Individual barriers are those attributes of an
Consult on project design, technology options individual that make it difficult for them to access
and staff training. Make sure to consult disabled water and sanitation. For example,
women as well as disabled men. Disability
service providers can also be a useful source of • if someone is weak because of illness,
advice and skills • is an older person with weak arms, legs or an
A. Identifying and understanding injured back, is very short (child),
barriers to access • or has limited mobility because of pregnancy.
Purpose: To identify and analyse the barriers, These are barriers which might be addressed with
obstacles and factors that create problems for interventions that focus on that limitation. For
users in accessing and using water and sanitation example, by providing a wheelchair for someone
facilities. who cannot walk, drugs for someone who is sick,
or a stick to help guide someone who cannot see.
Diversity message: Different groups of users may
experience different problems and barriers when These barriers are often the focus in the medical
using facilities. model of disability but are not u
ussually the ffoc
ually ocus
ocu
for WASH programmes.
Engineering message: The way infrastructure is
designed and built can unintentionally exclude
some users.

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Purpo se: To identify and analyse the barriers, obstacles and factors that create problems for users
rpose:
in accessing and using water and sanitation facilities.
Diver
verssit
Diver ityy me
messsage: Different groups of users may experience different problems and barriers when
using facilities.
En gi
Engi neeri
gineeri
neerin ng me
messsage: The way infrastructure is designed and built can unintentionally exclude
some users.

Environmental barriers are often easiest to Disabled, older or chronically ill people may:
identify. They include barriers to physical
• Be excluded by the way a programme or
access:
service is delivered
• Long distances to facilities
• Not hear about a meeting
• Paths that are rough or steep or no paths at all
• Not be able to reach it
• Toilets with high steps or narrow doors
• Not be invited or feel able to speak
• Inside, a lack of space
• Have their opinions dismissed
• Nothing to hold onto, or to raise oneself up
from squatting • Lack of consultation and participation can
then lead to inappropriate designs
• Nothing to sit on for those who cannot squat
• Design or location of facilities, overlooking
• Access issues are just as significant for those their needs, and limiting or denying their access
with sensory or communication impairments to sanitation. Addressing these barriers is crucial
where information is not available in formats they throughout the community mobilisation process
can understand
• Implementing staff often lack information
Also think about the positioning of latrines – do about low-cost ways of making toilets accessible
they provide privacy and safety for girls? for disabled and older people. People
themselves are often unaware of the options
Do they have to go through unsafe areas to get to
available, so they do not know how/what to ask
water points?
for improvements (Jones and Reed 2005)
How far do people have to travel?
Attit
Attit udi
itudinal b
udin arrier
arrierss are the most important to
barrier
Is the orientation of latrines important (for identify – time and time again they are the main
example, some religions do not want to face East)? reason prohibiting progress on inclusion of
marginalised people. Negative attitudes and
In
Insstitut
itut ion
utional b
ional arrier
arrierss are some of the most
barrier assumptions have led to many disabled people
difficult to identify. Without a proactive search for believing themselves to be worthless,
them, they won’t be as immediately evident. independent and in need of support. Women are
That’s because they’re often linked to social and sometimes not respected as decision-makers or
cultural norms and written into policies and considered capable of technical skills and tasks.
legislation.

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People who are disabled may be discriminated 2. Making facilities physically accessible
against and not reported under surveys and older
Getting there: Reaching facilities-
people, especially women, may be shunned by
younger people. • paths

• ramps
B. Inclusive and accessible designing
• support rails
1 . Approaches to improving accessibility
• landmarks for blind people
• Design and construct facilities that are
accessible for all Getting in:
• Adapt and modify existing facilities to • thresholds
improve accessibility
• wide entrance
• To provide assistive devices to individuals to
enable them to access existing facilities • flat platform in front of door

• doors
Preparatory work towards designing options:
• easy to close, lockable for privacy
• Become better acquainted with disabled
people in the community to understand their Usability:
personal challenges and work with them to
develop appropriate solutions to making • hand pump aprons
WATSAN services more accessible
• internal dimensions - extra space for
• Examine current situation of disabled wheelchair to enter and turn, user +helper, or to
people’s access to WATSAN and then review move a seat to one side
designs to make them more accessible
• support rails: fixed to the floor, adjustable
• Investigate solutions currently being height, movable frame, rope
implemented in the community and, where
appropriate, incorporate them into future • suspended from a beam overhead
work
• seating – fixed, movable
• Investigate improving specific features such
• design of equipment
as the design of taps to improve their
accessibility to disabled people • adapted water lifting mechanism
• Identify key features that make facilities
accessible and incorporate them into minimum
standards

• Produce some practical demonstrations of


accessible technology

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Reaching facilities –Paths

How to get there?

Suitable for: everyone, especially users with a visual impairment and


with physical impairments, including wheelchair users

Construction Advantages Disadvantages Improvements/variations

Gu id
Guid e ssttri
ide ng ffrrom
rin Easy to construct Regular maintenance Path could be lined with
hou se tto
house o llat
atri
atri ne and
rine needed painted rocks or landmark
Simple to maintain
bath sshelter
helter posts
String must be carefully
Suitable for users
positioned so it is not a
with visual
hazard to other users
impairment

Clear ar,, llevel


evel p ath,
path, Can be made Rocks are easily moved Paint rocks white or a
lilined
ned w ith rroc
with oc
ockks according to budget or dislodged, which bright colour to increase
could cause a trip hazard visibility
Suitable for users
with visual and Maintenance would
physical impairments, include regular re-
including wheelchair positioning of the rocks
users

Landm ark po
Landmark possts Can be made Posts must be firm, and Posts can be painted/
made ffrrom loc al
local according to budget positioned so they are marked with a bright colour
materi al
alss
aterial not a hazard to others to increase visibility
Easy to construct
using local materials Regular maintenance Use alternative materials,
needed to check posts e.g. rocks, or existing
Provides guidance for
are stable features, e.g. trees
users with visual
impairment

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Ramps
Suitable for: Users with physical impairments, wheelchair users, older people, people carrying
heavy loads

Construction Advantages Disadvantages Improvements/variations

Low-gr
w-graadient Smooth, firm, durable Monitoring of Paint raised sides white or
conc rete rramp
oncrete amp w ith
with construction required to bright colour to increase
Gentle gradient so a
rai
aised id
sed ssid
idees ffor
or ensure gradient not too visibility
child can propel her/
safet
afetyy steep
himself up and make
(me
(meaasurement
a controlled descent Maintenance needed to
1:12 or more)
keep the ground the
Raised sides prevent
same level as the end of
wheelchairs rolling off
the ramp

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Construction Advantages Disadvantages Improvements/variations

Wid e cconc
ide oncrete rramp
oncrete amp The concrete ramp Ramp requires more Paint raised sides white or a
to hand
hand
andppump apr on onto the apron
apron space than steps bright colour to increase
improves access for visibility
Drainage must be in the
everyone
opposite direction to Cross-hatching on ramp
keep the ramp dry would make it less slippery
when wet (see page 21
Monitoring needed to
'Steps')
ensure masons do not
make it too steep to
reduce cost

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Construction Advantages Disadvantages Improvements/variations

Mo ve
Move ab
ablle w
veab ood
wood
ooden en Flexible - can be Less durable than Paint raised sides white or
ramp ffor
or wheelc
wheelch hai
airr placed wherever concrete bright colour to increase
ac
aciilit
acccess ffac
to ac ie
iess
litie needed visibility
User needs help to move
with sstep
tep
tepss
Cheaper than the ramp when needed
concrete

Raised sides prevent


a wheelchair rolling
off the side of the
ramp

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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. Certain
Indian specifications recommend 1:12m – This is fairly steep but this is the absolute minimum and
the ratio should not go below this.

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

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

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

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

Construction Advantages Disadvantages Improvements/ Cost /labour


variations
Low cconc
onc rete
oncrete Cross-hatching is No edge Steps should be of Low/medium
tepss w
step ith ccrross-
with easy to apply - the protection for consistent height
hat
atcchi ng tto
hin o concrete is scored unstable or
Install a guard or
reduc
reduce e the ririssk of while wet visually impaired
handrail
slilip
pping users
Many users can
Paint steps white or
Rec ommend
Recommend
ommended ed manage low, even Steps exclude
bright colour to
step di men
menssion
dimen ionss steps, especially some users, e.g.
increase visibility
(for referenc
(for e)
reference) when a handrail is those using
provided mobility devices
Step
Stepss sshou
hou
houlld be
low and even - al
low alll Steps take up less
of the ssame
ame space than a ramp
height and d epth
depth

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Latrines • Facilities for menstrual hygiene management,


both at the household level and for institutional
Household toilet design principles: For the
and public facilities
household level, consider providing information
about low cost, low tech options to make Sitting: Latrines should be no more than 15m
household latrines easier, more comfortable and from the household
safer for use by everyone in the family, especially
Accessible Door & Entrance
disabled people.
• The doorway should have a clear width of
Accessible design features could include:
900mm for a person using wheelchair or those
• Level, marked paths. A firm, even path clear of using assistants to get through.
hazards benefits everyone, not only wheelchair
• Door should generally open outside. Sliding
and crutch users
doors are the most preferable.
• Ramps or low steps with handrail to the
• A distance of 450mm to 600mm beside and
latrine entrance
beyond the leading edge of the door and a safe
• Wide entrances to toilets, and enough space landing space of 1200mm X 1200mm in front for
inside for a person and her/his carer to turn inside a wheelchair user to manoeuvre.

• Simple handrails and movable toilet seats • Door Handles should be fixed between 650
that can be placed over pit latrines to 1100mm above the floor level. It should be
preferably Lever shaped or D type handle.
• Hand lever to replace a foot lever on ‘tippy
taps’ for people with weak legs • A 150mm long handle may be fixed on the
outside.
• Toilets that are safe (location appropriate) and
secure (e.g. lockable doors) The threshold of the toilet door should be at same
level without any steps. No door seal or other trip
• Door handles and locks that can be easily
hazard should be there.
reached by all

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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.

Construction Advantages Improvements/


variations
Latri
Latri ne w
rine ith llevel
with evel The floor of the Level flooring
conc rete
oncrete latrine is the same could be
ent
entrranc e, w
ance, widid
idee level as the achieved with
enough fforor a outside any type of
wheelc
wheelch hai
airr u ser
user materials, not
only concrete

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

Construction Advantages Disadvantages Improvements/variations

Outw ard-openi
Outward-openi
ard-openinng ttiin Outward-opening Pulling a door is harder Add horizontal handrail
door on w ood
wood en
ooden door does not than pushing it open
frame. R ai
Raised
aised obstruct internal
Requires a wide, level
platf orm ed
atform ge acts aass
edge space
area in front of door for
a door ssttop
Horizontal wooden users to position
struts can be themselves to open the
grasped to close door
door

Outw ard-openi
Outward-openi
ard-openin ng Easier to close for Higher cost than a single Varnish/paint wood to
wood en dou
ooden doubble some users door reduce risk of termite
door
doorss w ith a llat
with at
atcch on damage
Each door is narrow Some users find them
outs id
outsid e tto
ide o keep
so less obstructive difficult to use Move bolt to the inside
closed
losed
to passers by

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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 the
doors

Construction Advantages Disadvantages Improvements/variations

Horiz ont
Horizont al h
ontal andr
handr ai
aill User can easily reach Door must be solid
andrai Rail could be made of
the ffu
ull width of the
width enough to fix the rail to wood (2nd photo, left), GI
Door can be bolted to
door on the iin nsid e.
ide. pipe, chain, or cord
increase privacy Needs monitoring to
Intern al bo
Internal boltlt
ensure it is securely
Large, chunky bolt is
fixed and that the bolt
easy to operate
slides easily

Car ved w
arved ood
wood
ooden en Easy for all users to Does not keep the door Add a bolt or hook to
hand
andlle nai
ailled tto
nai o the grasp closed fasten the door closed
insid
idee of the door
Materials locally Handle could also be fixed
available to the door frame for
support when entering
Easy to construct

Met
etal hookk and eye Ensures privacy
al hoo Can be too fiddly for Instead of a hook, wire can
on iin
nsid e of door
ide some users to operate be looped over a bent nail,
Easy to install
or a loop of string wound
Materials locally round a bent nail
available

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Sanitation for
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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Internal space also when turning around using different types of


assistive devices
Consider: who will use the toilet, and how much
space they will need. • Ideal clear floor space of 2.0 mt X 1.8 mt
(inner dimension) is required for a toilet having
Level 1: Space for users who can stand and enter
water closet. A wash basin can be fixed within
using support rails, or blind users.
this space.
Level 2: Additional space for a carer, to use
• This space dimension will also be adequate
crutches/sticks or to park a wheelchair but not
for the wheelchair user. Minimum inner
turn.
dimension of the room may be considered to be
Level 3: Space for a wheelchair to enter, shut the 1.8 mt X1.5 mt in case of a Wheelchair User
door, and turn around inside.
• In case of persons who are using crutches or
Persons with disability using different types of those who cannot walk comfortably, the
assistive devices may require different space dimension may be considered to be 1.5 mt X 1.2
considerations for their safe and free movement. mt. (inner dimension). In this case, the wash
Persons with disability will require space of basin option in the toilet may be avoided.
different dimensions when moving straight and However, the water taps and the cistern can be
easily fixed.

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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. On
one side, an unobstructed space of 900 mm from the edge of WC to the side wall should be provided
and on the other side, the distance from the centre of the commode
to the next adjacent wall should be 480 mm. There should be a clear
space of 1200 mm in front of commode.

The top of commode may be fixed at a height of 475 to 490 mm


from the floor or depend on the need and comfort of the user. In
case of commode bought from the market, it is designed so.
However, there are also modified/adapted toilets constructed with
Indian type squatting pan depending on the type of disability and
adaptation needs.

These modified options may be as the examples that follows:

Construction Advantages Disadvantages Improvements/variations

Cement bo
bowlwl made
ma Comfortable Requires a mould and is Paint the seat to repel urine
with mou
moulld more difficult to and make it easier to clean
Durable
construct
Easy to wipe,
Heavy, so needs a
therefore hygienic
strong sanplat

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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Commode movable seats

Suitable for: people who have


difficulty squatting, including
overweight people, pregnant
women, older people and disabled
people.

Construction Advantages Disadvantages Improvements/variations

Pai nted w
ainted ood
wood
ooden en Can be placed in the Container must be Padding can be added to
chai
airr w ith 'pott
with 'potty'y' most convenient emptied and cleaned back and sides for extra
inser ted iin
serted n hoholle iin
n place for the user or after every use comfort
se at
at.. P
seat ott
ottyy iiss
Pott carer, either inside or
A separate private toilet Seat could be used without
remo
removed ved ffor
or outside the house
area might need to be the potty, placed over the
empt
emptyying
Fabric straps support created toilet hole
a user with poor
Wood needs regular A bucket could be used
balance
painting/varnishing under the seat instead of a
potty

Met al ccommod
etal ommod
ommode e Painted metal and Container must be Car tyre inner tube could
chai
airr with p
with pllastic plastic are strong, emptied and cleaned also be used as a cushion
inset ttoi
oi
oillet p an
pan durable and easy to after every use
(bought iin n loc al
local clean
A separate private toilet
market)
Can be placed in the area might need to be
Cont
ontaiainer iiss p
ainer pllaced most convenient
aced created
bene
beneathath the seat and place for the user or
se at
Metal for some users is
empt
emptiedied iint
nt
nto o the carer, either inside or
uncomfortable - a home-
latri
atri ne
rine outside the house
made padded ring could
be added for comfort

Plank and waist belt


added to provide extra
support

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Movable seats

Construction Advantages Disadvantages Improvements/variations

Low w ood
wood
ooden en or Easy to construct Potential for termite Painting or varnishing would
bam boo ttoi
amboo oi
oillet ssttoo
ooll damage make it more durable, easier
Materials available
with ho n se
holle iin at
at,,
seat to clean and more hygienic
locally Enough space needed
plac ed o
aced ver ttoi
over oi
oillet
inside latrine to move
ho
holle, with or
with Height must be
the seat away from the
without ffuunnel aass a decided based on
pit when not in use
splash guard (see user's needs
image)
Can be moved to one
side out of the way of
other users who
Needs accurate
prefer to squat
positioning to reduce
Light and easy to risk of splashing or
carry if necessary soiling

Stand
Stand ard varni
andard arnisshed Comfortable Needs extra space in the Add a splashguard to the
wood
ooden en cchhai
airr with
with latrine so it can be front
Provides back
ho
holle ccut
ut iin
n the se at
seat moved to one side when
support while seated Add 'runners' - horizontal
not in use
bars joining the bottom of
Materials available
Might be heavy the legs to better distribute
locally
the weight on the floor, to
Varnish makes chair reduce damage (see image)
easier to clean so
more hygienic

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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Hand Rails and Grab Bars

Hand Rails Grab Bars


Hand Rails provide support to the person with Grab Bars are supportive bars which may be of GI
disability to hold and move forward along a ramp or steel pipes of 40 to 45mm diameter, fixed
or stair and even along a straight pathway. The firmly to the adjacent walls and floors, so that
following are the specifications of hand rails: persons with disability can transfer their body
weight for movement.
• There should be a clearance of at least 45mm
from the adjacent wall/ surface to which it is fixed • For Wheelchair User - the movable grab bars
(U type) are to be provided on transfer side at a
• Hand Rail should be fixed at two levels: one at
height of 480mm from ground (i.e. at the same
700mm-750mm and another at 850mm-
height as the commode). The L type bar should
900mm from the finished floor
be fixed on the wall side to get adequate support
• It should be extended by at least 300mm during transferring the body weight
beyond the head and foot of the flight and ramp
• For others - it depends on the condition of
Hand Rails should be circular in section with disability and preference. Ideally, the bars should
diameter of 40 to 45mm be provided on both sides on the wall and may
be fixed to the floor on the transfer side. This may
be of GI pipe and fixed, not movable. The grab
bars may be fixed at a height between 450mm to
750mm or at a height as suitable to access and
use

• Sometimes, the grab bars are also fixed to the


two adjacent walls close to commode

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Hand Rails

Construction Advantages Disadvantages Improvements/variations

Bric
Brickks pr
protot rudi
otrudi ng
rudin Easy to construct Walls must be strong Half bricks in the wall can
from w al
alll ffor
wal or enough to support also provide mini-ledges for
Materials locally
portt tto
suppor o a we ak
weak user's weight a user to hold on to
available
or visual
uallyly iimp
mp ai
mpai red
aired
Difficult to add after
per son
person
construction

Regular maintenance
needed to ensure
stability

Wood en/ b
ooden/ am
bamamboo boo Materials locally Rails must be strong Varnish/paint rail to stop
suppor
portt rrai
ai
aills ffiixed available enough to bear users' termite damage and for
to floor either iin n weight easy cleaning
Easy to construct and
front or on either
maintain Not possible to fix to a For a growing child use
sid e of ttoi
ide oi
oillet
concrete floor/slab longer vertical poles, so bar
(d ependi
(dependi
ependin ng on Allows user to
height is adjustable
user's need
needs) s) transfer to the toilet Might be difficult to
from the side keep clean Horizontal bars at different
heights might suit some
Position and height of Cannot fix to a concrete
rails must involve floor/slab For concrete floors, pipe
user and an rails can be cemented in
assessment of their during construction, or
need screwed to floor later

Met al b
etal arss (e.g.
ar
bar Highly durable Walls must be strong Paint bars to reduce
galv ani
alvani sed iirron
anised enough to fix bars to corrosion and increase
Can be added to
pipe) ffiixed tto
o ssid
id
idee durability
existing facility Walls must be close
wal l/s of llat
all/s at ri
atri ne
rine
enough for user to reach Several bars at different
Easy to clean
the bars heights on each side might
Bars to be positioned better suit some users
based on user needs

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Sanitation for
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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

3. Accessible design options with cost– been constructed in Jharkhand and Odisha with
working models community engagement and are examples for
reference. There can be better and improved
Planners and service providers need to consult options that can be designed.
people with disabilities at all stages of project
cycle by design. It has been proven that designs *It may be mentioned here that these examples /
developed with user feedback not only results in models have been constructed in 2013 and the
constructing user friendly WASH facilities but also costs are as per the prevailing market rates at that
have a higher acceptance/ usage. People with time in that specific state. This will vary from as
disabilities and members from the marginalised/ per the current market rates in different states
excluded group can play an effective role in and geographies. The disability accessible
WASH committees and in managing community adaptations are in bold.
WASH facilities. The models shared here have

Do's and Dont's for Accessible Sanitation Facilities for Persons with Disabilities
Do's 8. Slope should be as per the norms given in
this handbook
1. Provide an access ramp that is firm and
smooth for wheelchairs as well as ambulant- 9. Toilet should be large enough to
disabled without wheelchairs accommodate wheelchair and allow disabled
user freedom of movement
2. Ramp should be wide enough to
accommodate a wheelchair 10. Assessment of physically challenged people
in household must be done before designing the
3. Landings or flat surfaces should have an area
toilet
large enough to permit wheelchair to turn
11. Disabled people must be brought together to
4. Steps can be used if the household does not
discuss their specific needs at the planning stage.
have permanently disabled people. These must
This may not happen if a general meeting on
conform to the norms provided in this handbook
sanitation is held in the community
5. Doors to sanitation facilities should be at
12. While planning, households with disabled
least the width of a wheelchair and open
people can be marked with a different colour on a
outwards. The minimum width is 90 cm
map
6. String or other means of opening from
13. The disabled person(s) in a household must
outside must be provided that is accessible while
be consulted before designing the toilet or
seated in a wheelchair
bathroom. This will help understand the barriers
7. Entrance area should be flat i.e., have a and determine the best model
landing before the door so wheelchair users can
14. Water supply in the toilet must be accessible
leave the chair while entering the facility
to the visually and ambulant disabled

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15. For visually challenged, contrasting colours Don'ts


must be used on the access, railings and inside
1. Don't make steps on the access ramp. If
16. For visually challenged, tactile cues are needed for non-disabled access, steps to the
necessary on the railing outside and the support toilet must be provided separately
bars inside the toilet
2. Don't rearrange the toilet so it is unfamiliar to
17. Guideposts with tactile cues painted in bright visually challenged people
colours are necessary to guide visually
3. Don't leave extra buckets, mugs or other
challenged from home to the toilet
things in the toilet
18. Local materials must be used to reduce
4. Don't place locks or latches for the door at
costs. Bamboo, wood or steel may be used
the top where ambulant-disabled cannot reach
instead of cement where appropriate and
available 5. Don't have sharp edges or corners on
guideposts, railings and inside the bathroom or
19. Training to masons must be provided on
on the way
constructing ramps for ambulant-disabled and
tactile strips to visually disabled 6. Don't provide loose ramps that can be moved
while being used
20. Access to toilet must be kept free of
shrubbery and other overgrowth and must be no 7. Steps must not exceed measurements
more than 15 m from the house provided in this handbook
21. Water bucket or pot must be kept at a height 8. Don't keep water source on the ground where
that is convenient ? 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

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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Model 1

Name: Kedar Sethi


Place: Tentulidihi, Odisha
Type 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 hand
rails fixed at 750mm height of bamboo and inside the commode
from market is bought and fixed. At both sides GI grab bars are
fixed one side to the wall and other to the floor. A small tank is
attached to the toilet where water is stored manually and can
flow through the tap connections made in the toilet.

IHHL of Kedar Sethi, Tentulidihi


Total cost * 11,190

Inclu
lussive ttoi
Inclu oi
oillet of Kedar Sethi
Kedar

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

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Model 2

Name: Jitendra Turi


Place: Sirsanunthar in Deoghar district
Type 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 is
prepared with compacted earth fill and bamboo railing is put at the side so
that he can access the toilet. Inside the toilet the seat height is raised with
brick masonry and pan is fixed over it. GI grab bars are fixed to the walls.

IHHL of Jitendra Turi, Deoghar


Total Cost* 10,900

Inc lu
lussive ttoi
Inclu oi
oillet of Jitendra Turi
Jitendra

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

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Facilities
Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Model 3

Name: Rohit Mandal


Place: Jogia Village in Deoghar district
Type of Disability: Visual and locomotor disability
Disability 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 hand
rails fixed at 650mm height. The toilet inside is space of 4’-6" X 4’-6" size
with 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 fixed
to the walls.

IHHL of Rohit Mandal, Jogia Village, Deoghar


Total Cost * 11,000

Inclu
lussive ttoi
Inclu oi
oillet of Rohit M
Ro and
Mand al
andal

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

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Model 4

Name: Kalicharan Kisku


Village: Bogli in Dumka, Jharkhand
Type 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 the


toilet and the bright coloured helps him to see.

IHHL of Kalicharan Kisku


Total cost* 8,560

Inc lu
lussive ttoi
Inclu oi
oillet of Kalic
Kalic
alichharan Ki
aran Kissku

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

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Facilities
Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Model 5

Name: Pintu Paswan


Place: Prandi in Deoghar district
Type 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 made
at center. The chair is removed after Pintu uses the toilet so that
other family members can use the toilet.

IHHL of Pintu Paswan


Total cost* 9,100

Inclu
lussive ttoi
Inclu oi
oillet of Pint
Pint uP
ntu asw
Pa an
swan

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

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Model 6

Name: Manoj Pandit


Place: Khodkuan in Deoghar district
Type of Disability: Physical Impairement
Disability 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 as


appropriate for use by Manoj and after his use the stool is removed
and kept outside so that other family members can use the same
toilet without the stool. The grab bars are fixed to the walls in
appropriate 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 fibre
stool as well or cut a hole in a chair for use depending on convenience,
availability and safety.

IHHL of Manoj Pandit


Total cost* 9,425

Inc lu
lussive ttoi
Inclu oi
oillet of Manoj P
Manoj andit
Pandit

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

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Household Sanitation
Sanitation for
Facilities
Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

Model 7

Name: Debu Tatwa


Place: Pachrodihi in Dumka district
Type of Disability: Physical Impairement (Paralysis)
Disability friendly Options: (approach road, hand rail, GI
Grab Bar, GI frame stool)

The approach road is constructed in cement mortar and


hand rails are fixed in bamboo at both sides and GI
framed WC sheet is fixed at 350mm height which can
be used and lifted afterwards. The grab bars are L
shaped using 25mm GI pipes.

IHHL of Debu Tatwa


Total cost* 11,225

Inc lu
lussive ttoi
Inclu oi
oillet of Debu Tatw
Deb a
atwa

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

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Household Facilities for Persons with Disabilities (PwDs)

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 for
WaterAid 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 Guy
Collender, SHARE, Jane Wilbur, WaterAid, Louisa Gosling, WaterAid

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Persons with Disabilities
Disabilities (PwDs) (PwDs)

NOTES

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NOTES

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Sanitation for
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Personsforwith
Persons with Disabilities
Disabilities (PwDs) (PwDs)

NOTES

44
Ministry of DRINKING WATER AND SANITATION
GOVERNMENT OF INDIA

Ministry of Drinking Water and Sanitation


Government of India
C Wing, 4th floor Paryavaran Bhawan,
CGO Complex Lodhi Road,
New Delhi – 110003

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 Office


403, 4th Floor, CNI Bhavan, 16 Pandit Pant Marg,
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Tel: +91-11-4608 4400  Fax: +91-11-4608 4411
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