Rural Health and Environment Programme
The Rural Health and Environment Programme (RHEP) is an integrated rural development
intervention being implemented by Gram Vikas in very backward and poor villages of Orissa.
The mission of RHEP is to improve the quality of life of the rural communities in terms of
both physical conditions of living as well as economic opportunities, to engineer a process of
‘reverse migration’ from urban centres to villages.
In the long-term:
RHEP aims to enable convergent community action through the provision
of services and resources to overcome the inertia that has been caused
by the long spells of marginalisation and deprivation suffered by rural
communities. RHEP also aims to transform the momentum created
through such community action into sustainable community owned and
managed development systems.
RHEP’s primary focus is on adivasi, dalit and poor and marginalised sections like landless,
small and marginal farmers. In every village covered more than 70% population belong to the
category of Below Poverty Line (BPL) families. RHEP was initiated in 1992 in five pilot
villages covering 337 families in the districts of Ganjam and Bargarh. Gaining from this
experience, in the first phase of implementation between 1995-98, all 3,000 families in 40
villages spread over 11 districts of the state were covered. The second phase of
implementation (1999-2001) saw the spread of the programme to 27 villages (2,008 families)
in clusters around first phase villages. Simultaneous identification and motivation of new
villages is underway.
The RHEP concept
The concept of RHEP rises from the aggregation of the experiences Gram Vikas gained as an
implementer of the Biogas programme. During this period Gram Vikas constructed nearly
60,000 biogas plants in around 6000 villages, thus coming into contact with a large number of
poor and backward communities all over Orissa. On examining the reasons behind their
poverty and backwardness, Gram Vikas struck upon a very intriguing factor – the widespread
morbidity and high mortality caused by water borne diseases. On probing deeper it was
found that the people were using the same source of water, normally the village pond, for all
their water needs. Very few villages had access to any safe source of drinking water. The
habit of defecating in the open resulted in large-scale spreading of water-borne diseases.
Altogether, unclean habits of sanitation and absence of protected drinking water were
affecting not just the health of people, but each and every aspect of their life. Gram Vikas
realised that any development intervention in these villages would first have to address these
The core thrust of the RHEP is to harness the physical capital, natural capital, social capital
and human capital in every village/ habitation through convergent community action, to
create a spiralling process of development. The sanitation infrastructure and supply of piped
drinking water for 24 hours, all through the year to all houses is only the entry point and the
May 2001 Rural Health and Environment Programme 9
core rallying element to bring the people together, cutting through barriers of patriarchal
systems, caste and politics. RHEP goes against the prevalent paradigm, which believes that
such interventions can work only through subsidies. The intervention is time bound and has
clear mechanisms of withdrawal of Gram Vikas in a phased manner. As a development
intervention RHEP has distinctive features, based primarily on the following aspects.
RHEP firmly believes that unless all families in a village agree to be part of the programme it
should not be implemented. This is because of the fact that the sanitation aspect can be
addressed only if everybody adopts safe sanitation practices. Without 100% participation
environmental pollution and resultant health hazards cannot be prevented. From the start of
the intervention the insistence is that all adult men and women in the habitation must
subscribe to the programme and participate in it. Women infact have taken the lead in
ensuring that the programme is completed in a time bound manner and is sustainable even
after Gram Vikas withdraws.
2. Articulation of sustainability
The most important factor that governs successful implementation of RHEP is the ‘village
corpus’. The corpus is created with cash and kind contributions from all families in the
village. As a norm, RHEP insists that each family contribute on an average, Rs.1000 to the
corpus, where the better off pay more and the poorer families pay less. Creation of the
corpus is a pre-requisite for Gram Vikas to start contributing to the activities under RHEP.
The corpus is invested, and the interest income is to be used by the Village Executive
Committee (which has equal representation of men and women) to extend the RHEP facilities
to new families that may come up in the village in future, ensuring 100% coverage at all
times to come. Creation of the corpus with the involvement of each family in the village is
the critical test of the eagerness and motivation in the village to undertake the programme.
In the creation of infrastructure itself, of a cost of Rs.7, 000 per unit of toilet and bathing
room, Gram Vikas contributes Rs.2, 500 while people generate the rest through local
materials, their physical labour as well as cash contributions.
3. Maintenance of facilities
Maintaining all facilities created by the programme is the responsibility of the villagers. For
this, systems are built right from the beginning. Villages are encouraged to undertake and
develop community income generation activities like pisciculture in the village pond now
freed from the pressures of catering to household needs and free from pollution as well.
Horticulture plantations, consisting of a mixed variety of timber, fuel, fodder and fruit trees
are raised on village common lands and wastelands. Income from the ponds and plantations
is used for paying electricity bills, repairs and maintenance of pumps and salaries of the
pump operator, balwadi (crèche) teacher, facilitators for day school, etc.
4. The bathing room
The usual understanding of sanitation infrastructure seldom includes a bathing room.
However, in Gram Vikas’ experience, having a bathing room in addition to a separate toilet is
May 2001 Rural Health and Environment Programme 10
very important. Primarily, it provides the women with a private space to bathe. They do not
have to wait for certain fixed hours of the day when the pond will be free for them. Our
studies confirmed the prevalence of a number of gynaecological and reproductive health
problems in women, related to unhygienic sanitation practices. Secondly, a number of skin
diseases spread rampantly during the summer months when the water level in ponds goes
down and people have to bathe in turbid water. The bathing room with protected piped
water supply thus reduces the incidence of skin diseases. An additional advantage is that the
village pond, now free of humans using the water source for washing, cooking, bathing, can
be used for pisciculture.
5. Women and Children
To enable women overcome generations of subjugation in patriarchal systems, a separate
forum is created at the start of the intervention, wherein they are initially encouraged to
save on a regular basis. Once their savings are substantial, they are linked with credit
through financial institutions or government schemes. This gives them an opportunity to gain
confidence and to articulate their views and opinions. Issues related to women’s
gynaecological and reproductive health are also discussed in these fora. Gram Vikas provides
professional support where necessary. Antenatal and postnatal care as well as immunisation
of children is managed by the women's groups. Mothers also play a vital role in motivating
dropout children to go back to school. In some villages special education centres have been
set up to address this need.
6. Enabling infrastructure – Individual
In most RHEP villages Gram Vikas has also supported families to construct better houses. The
traditional houses are of about 100 sq ft, and prone to disasters. We assist people build
permanent disaster proof houses without any subsidy, with people contributing through
labour and local materials about Rs.15, 000 out of an estimated total cost of Rs.46, 500 for a
two-room house with a kitchen and veranda in an area of about 45 sq.m. The remaining
Rs.31, 500 is facilitated by Gram Vikas as a soft loan from housing finance companies. For
the people, building and living in a permanent (disaster proof), spacious and comfortable
home it is a matter of great pride and dignity. It also prompts them to think bigger, gives
them the confidence to move ahead in life and finally come out of the cycle of poverty and
7. Enabling infrastructure – Community
The community is also supported in developing infrastructure like roads, drainage systems,
community hall, grain bank, etc. Here as well the contribution by the people is clearly
defined in the terms of local materials like stone, aggregate, bricks, unskilled labour, etc.
The habitation approach leads to an improvement in living conditions and enhances their
pride as well.
8. Livelihoods support
Limited employment opportunities and dwindling returns from local resources due to
successive droughts are forcing the poor, especially the youth to migrate. To address this,
May 2001 Rural Health and Environment Programme 11
Gram Vikas motivates the community to undertake land and water development measures.
Water harvesting units and irrigation infrastructure are developed to ensure food security and
generate surpluses for better incomes. We focus on the marginally unemployed, seasonally
unemployed and totally unemployed poor in the livelihood interventions. One area of
intervention is skill development - training men and women in masonry, stone cutting, wire
bending, carpentry, etc. Equipped with these skills they command better employment
opportunities, which in turn enhances their pride and dignity. We also promote village
industries involving value addition to local agricultural and forest produce; brick making using
energy efficient technology, etc.
Implementation of RHEP
The motivation process
Given the socio-economic situation of the villages where RHEP is implemented, the time
taken for motivating the communities is quite long. Gram Vikas staff members establish
contact in the village, identify key opinion leaders and work through them to initiate
discussions among all the households. There are certain conditions that the community
needs to agree to at the beginning of the process. These are:
Full participation of all households in the village
Creation of corpus fund with contribution from all families
Developing of monitoring systems to ensure full usage of facilities
1. Village level organizations
Implementation of RHEP in a village begins with the execution of an agreement between the
villagers and Gram Vikas with the norms clearly spelt out. This is followed by organisation of
the village general body. There are separate general bodies of men and women, consisting of
all male and female heads of households in the village. This is essential in the initial stages as
the separate body provides women in the village with a forum to come together and discuss
issues of common interest. In the patriarchal societies that the programme is implemented,
it is difficult to get the women to come forward to sit together with men and discuss common
issues from the beginning of the programme. While in some villages, progress in this regard is
fast, in many others, it is a slow process. The separate General Body of women serve as the
first step in their integration with the larger community. Interactions in this forum provide
women with the necessary confidence and skills to enlarge their scope of interactions.
The two General Bodies nominate/select four men and four women from amongst them to form
the Village Executive Committee. In all villages, the Village Executive Committee is registered
under law, as Societies. This enables the committee to become a legally recognised entity and
this helps in dealing with external agencies, especially government agencies.
The Village Executive Committee assumes all decision-making powers with respect to the
programme in the village. The committee lays down the procedure for collecting the corpus
fund and oversees the collection. It constitutes various sub-committees to oversee the
implementation of various components of the programme. The various sub-committees
formed in a village, and their functions, are the following:
May 2001 Rural Health and Environment Programme 12
Sanitation sub-committee – To ensure timely and proper completion of construction of
facilities, ensure proper use of facilities, detect and punish persons who violate rules set by
the General Body regarding use of toilets and bathing rooms, ensure cleanliness of toilets and
bathing rooms and village surroundings
Water sub-committee – To ensure proper and timely completion of water supply mechanism,
monitor proper use of water, operation and maintenance of the system
Pisciculture / Social Forestry sub-committee – To plan and monitor the utilisation of village
common resources as the case may be. To ensure proper utilisation of the resource and
monitor income flows.
2. Sharing of Costs
The following table provides a picture of Gram Vikas’ and people’s contribution in RHEP
Gram Vikas contribution People’s contribution
Toilet & Bathing room construction
Required quantity of cement, bricks, aggregate, Required quantity of stone for up to the plinth
sand, steel, materials for roof, ceramic pan, level, mud for joining the bricks, centering
water seal, foot rests, door for the toilet, skilled materials and all unskilled labour, door for the
labour. bathing room, construction of two soak pits with
covers and whitewashing.
Construction of water tank & piped water supply
Required quantity of cement, brick, aggregate and Required quantity of stone for the foundation.
steel for the overhead tank. Unskilled labour for the foundation, construction
Pipe for the main pipeline and Motor pump. of overhead tank, laying of water distribution
Part cost of digging well. system and cost of pipes to take water from the
Skilled labour for laying main pipeline and all main pipeline to individual houses, toilets and
construction. bathing rooms.
Required quantity of brick and cement. Required quantity of stone, aggregate, sand.
Skilled labour. All unskilled labour.
Rs.5,000 of the total cost of Rs.9,300 per hectare Raising of nursery, digging of pits, site cleaning
(including nursery raising, plantation and post and planting, watch and ward are the main
plantation activities, over three years) for fuel- activities of the people.
fodder trees. People’s contribution per hectare is Rs.4,300 over
For horticulture plantations, saplings and support 3 years for fuel-fodder trees, and Rs.3,900 for
of Rs.4,500 per hectare (of a total cost of horticulture plantations.
Bank finance is arranged by Gram Vikas for Obtaining long term lease for the pond/ tank is
deepening the pond/ tank, strengthening the responsibility of the community.
embankments and to meet working capital Village community arranges labour for the work,
requirements. Village committee is the loanee. maintenance, watch and ward.
GV arranges training programmes. Proper utilisation of funds and timely repayment
of bank loans
May 2001 Rural Health and Environment Programme 13
The RHEP software
The implementation of ‘software’ aspects of the programme begins simultaneously with the
‘hardware’ activities. Training programmes are conducted for members of the Village
Executive Committee to orient them to the various facets in Rural Health and Environment
Programme and to enhance their capacities in managing the programme. Various leadership
development modules are also conducted for leaders (both men and women) from the
communities. The village societies registered in each village are made active in directly
accessing development funds from the government and banks, bypassing the tradition of
contractors and middlemen. This enhances their self-reliance and self-esteem.
Various economic and capacity development activities, especially for women are important
components of RHEP. Savings groups of women are formed and are encouraged to undertake
collective and individual income generating activities. Gram Vikas facilitates linking up of
these groups with government schemes (like the Development of Women and Children in
Rural Areas Scheme) and banks. To individuals who are not eligible for bank credit, Gram
Vikas provides loans for undertaking small business activities.
To improve the literacy standards of the people Gram Vikas facilitates the running of Non-
formal education centres and adult education centres.
A new phase
After a review of the programme in 1998 we decided to expand the coverage of RHEP into new
villages. In Phase-2 of the programme, the focus was on developing clusters around Phase-1
villages, so that a visible impact and momentum is created at the local level. Phase-1 being
more of experimental in nature, the villages were scattered over a large area. This served
both as learning about how the intervention works in different socio-economic conditions as
well as creating a demonstration impact. In Phase-2, in addition to covering new villages, it
was also decided to strengthen interventions in the livelihood sector in Phase-1 villages.
Having created a conducive atmosphere for collective community action through the process in
the construction phase, it was felt that the same could be utilised for taking up further steps
towards improving the quality of life of the people. The demographic profile of the villages
covered under RHEP is presented at the end of the document.
The way forward
The Rural Health and Environment Programme (RHEP) aims to create an enabling
environment for development processes to take off by establishing a threshold level of
sustainable community owned processes and products, for a critical mass of deprived and
RHEP is designed to utilise and enhance the natural resources of communities whilst
improving the village conditions in an ecologically and environment friendly manner, creating
sustainable, self-supporting and replicable development models. It is focussed towards
making a qualitative improvement in the living standards of communities, enhancing local
economic opportunities and equipping them with the skills to be masters and in control of
their own development.
May 2001 Rural Health and Environment Programme 14
Gram Vikas realises that an isolated intervention in development of health and sanitation
infrastructure alone, is not the most appropriate development strategy. Instead, a holistic
intervention, with Education, Health, Infrastructure development, Secure Livelihoods and
Self-governance as the key sectoral strategies, is critical to enable the rural communities to
realise a threshold level of existence, and to charter sustainable development processes
towards improving their quality of life.
1. Threshold level of quality of life
The “threshold level of quality of life” refers to a situation where communities have satisfied
the most crucial basic needs of life and are in a position to dream of further improvements.
This naturally requires that issues like food and income security, health and medical care,
education and literacy, safe and hygienic habitations, basic infrastructure etc., be addressed
Thereafter, for these communities to move ahead, it is essential to influence the external
environment and gain a favourable bargaining position vis-à-vis the State or the Market. This
position can be gained only if a large number of communities unite and demand it. This
united movement will have the "Critical Mass" necessary to force governments, political
organs, private sector enterprises and other civil society organs to react to communities’
2. Critical Mass
The experience in development action for nearly two decades makes Gram Vikas believe that
to make a significant impact in development interventions and policies, it is essential to
reach out to a larger number of people, over a concentrated geographical area, constituting
a ‘critical mass’. The critical mass is the minimum size required to achieve a given set of
expectations. In the context of Gram Vikas’ work, we could define it as 1% of the total
population of Orissa. We are talking about a time period of from eight to ten years - around
AD 2007-2010; the population of Orissa will then be around 40 million and one percent of the
population will mean 400,000, i.e., about 80,000 households.
Given Gram Vikas’ concentration on the poorer sections of the population, the ‘critical mass’
would constitute about 100,000 households of scheduled tribe, scheduled caste and other
economically backward communities from the poorer regions of Orissa. The advantage of a
‘critical mass’ is that it affords the communities effective bargaining positions, in relation to
plans and policies, directly affecting their socio-economic milieu.
In line with this overall strategy of Gram Vikas, the focus of the second and subsequent
phases of RHEP is to concentrate on poor tribal and dalit communities in the hinterland of
Southern and SouthWestern Orissa. This will be effected through extension of the programme
in clusters of predominantly poor tribal and dalit communities, where Gram Vikas has already
established contacts through interventions in community mobilisation, education and
livelihood development. Gram Vikas also proposes to network with smaller organisations that
have already realised cluster level cohesion in these areas, to extend the outreach of RHEP.
May 2001 Rural Health and Environment Programme 15
3. Networking – forging alliances
Gram Vikas realises that achieving the ‘critical mass’ is not a goal that can be achieved,
single-handedly. It will need to collaborate with a number of organisations that share a
common vision and approach to expand the coverage and reach the Critical Mass. There are
indeed about 100 such organisations working in different parts of Orissa, which were formed
with support from Gram Vikas and who maintain a very healthy relationship with it are the
collaborators who will join Gram Vikas in the quest for the Critical Mass.
Gram Vikas reckons that if each of these organisations can cover, over the eight-ten year
period, about 700-1000 households (which roughly means between 12-15 habitations), in
addition to the 25,000 or 30,000 households Gram Vikas will reach, the target of 80,000 to
100,000 households is very much an achievable one.
In the realm of development interventions addressed at poor and marginalised people, RHEP
defines a new approach to development taking aspects of existential needs of a people. And
growing from that need, slowly and continuously redefining the threshold quality of life, while
making the critical mass definitive and quantum wise more visible through a people's
movement. A movement with political overtones, which aims to create an enabling
environment for a politically assertive community. A people’s movement capable of assuming
an identity where each individual in the community is represented and where they can assert
for themselves in the Panchayati Raj (local self-governance system).
Demographic profile of villages in RHEP Phase 1 (1995-98)
Sl. District Village No. of BPL Category Corpus fund
No. H.H. SC ST GEN (Rs.)
1 Patrapalli 48 40 6 2 40 59,028
2 Chandipalli 50 29 17 2 31 81,935
3 Kujapalli 49 14 1 12 36 70,036
4 Bargarh Old Gouditikira 65 42 2 20 43 111,748
5 New Gouditikira 119 78 3 12 104 172,400
6 Banaharatikira 25 8 1 0 24 66,130
7 Dumerpalli 56 50 4 8 44 110,845
8 Lokapada 50 46 12 24 14 73,392
9 Bangabahal 88 83 20 4 64 90,000
10 Souripalli 50 50 19 0 31 58,339
11 Kumerkelli 71 69 16 9 46 81,674
12 Dimirimunda 50 46 20 3 27 74,472
13 Buruding 45 33 0 45 0 89,136
14 Padmapur 50 50 2 13 35 86,136
15 Anandpur 24 24 0 24 0 65,239
16 Samiapalli 76 76 72 0 4 210,026
17 Sarakumpa 79 79 14 0 65 80,000
18 Gobudi 47 47 0 0 47 64,243
19 Mathakukundapur 60 58 5 0 55 90,422
20 Ganjam Lauput 41 41 0 0 41 50,005
21 Dengapadar 251 130 30 0 221 337,626
22 K. Samantarapur 170 170 5 0 165 241,046
23 Sunamuhi 229 219 6 0 223 391,501
24 Tamana 82 66 0 82 0 90,000
May 2001 Rural Health and Environment Programme 16
Cost Estimate of Toilet and Bathing Room
Sl. Materials Unit Quantity Rate Total (Rs.)
1 Rubble CU.M 1.80 150.00 270
2 Brick Nos.. 1,150 1.00 1,150
3 Cement Bags 9 130.00 1,170
4 Chips CU.M 0.40 325.00 130
5 Sand CU.M 1.80 135.00 243
6 Steel kg 21.00 18.00 378
7 Tile Nos. 47 2.00 94
8 Mason Nos. 15 100.00 1,500
9 Unskilled labour Nos. 33 42.50 1,403
Gram Vikas contribution (Rs.) 2,500
Own contribution (Rs.) 3,838
Plan of Toilet and Bathing Room
Unit Cost of Water Tank – Capacity 80000 ltr.
May 2001 Rural Health and Environment Programme 18
NO DESCRIPTION QUANTITY UNIT RATE AMOUNT (Rs.)
1 Site clearing LS 1000
2 Earth work excavation in hard soil with dressing, 40 cu.m 20 798.34
3 Sand filling in foundation & plinth watered, 5 cu.m 150 748.44
rammed with all materials & labour
4 Providing cement concrete (1:4:8) with graded 5 cu.m 1025 5114.34
stone aggregate 40mm nominal size.
5 Well burnt 1st class brick masonry in cement 79 cu.m 1250 98750.00
mortar 1:6 in super structure with all materials
6 Earth filling inside the basement Watering & 17 cu.m 20.5 348.50
7 Providing reinforced cement concrete (1:2:4) 32.50 cu.m 2450 79625.00
including cost of all materials, centering,
shuttering etc. but excluding cost of steel.
8 Providing cold twisted steel reinforcement bars for 49 Qtl 1780 87220.00
R.C.C work including bending, binding & placing in
9 Fitting & fixing of W.I.Clamps in frames of doors& 60 Nos. 15.5 930.00
windows with all materials & labour complete.
10 Dressed seasoned salwood in frames of doors 0.6 cu.m 15200 9120.00
&windows including all cost of materials & labour
11 Cost of M.S.Grills including labour for fitting& 9.5 sq.m 325 3087.50
tying grills in position complete.
12 Wooden windows glazed including cost of all 9.5 sq.m 750 7125.00
materials & labour complete
13 32 mm thick pia sal in door shutter moulded in 10.9 sq.m 835 9101.50
panels including cost of all materials & labour
14 A.S.Flooring with finishing & punning in floor 95 sq.m 60.5 5747.50
including cost of all materials & labour complete.
15 12mm thick cement sand plastering on wall out 275 sq.m 56 15400.00
side including cost of all materials & labour
16 12mm thick cement sand plastering on under side 149.5 sq.m 69.5 10390.25
of roof including cost of all materials & labour
17 12mm thick cement sand plastering on top roof 73 sq.m 69.5 5073.50
including cost of all materials & labour complete
18 16mm thick cement sand plastering on side of 385 sq.m 52.5 20212.50
room including cost of all materials & labour
19 White washing three coats over a coat of primer on 750 sq.m 10.5 7875.00
wall including cost of all materials & labour
20 Colour washing three coats over a coat of primer 150 sq.m 9 1350.00
on wall inside roof including cost of all materials &
21 Painting synthetic enamel on door grills & windows 10 sq.m 34.5 345.00
including cost of all materials & labour complete
22 Unforeseen items 2556.63
Contingencies 3% 11157.57
GRAND TOTAL 383076.57
May 2001 Rural Health and Environment Programme 19
Plan for Water Tank
May 2001 Rural Health and Environment Programme 20