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Why the International Year of Sanitation is no matter for prudery

Written by Peter Newborne


2007-2008 is going to mark an important initiative

On November 21st, 2007 the UN will launch the International Year of Sanitation (IYS).

What, a year talking about ... toilets?!?

In Europe, we take for granted a toilet on the premises, at home and work. In the developing world, however, almost one in two people doesn’t have one. Imagine having to go to your local park, or the nearest unoccupied land, to defecate. Here it is dog waste we put in plastic bags, but in densely-populated cities in Africa, plastic bags serve for human faeces, the famous flying toilets – that’s ‘flying’ as in thrown away, casually disposed of, by the user. No means of safe disposal are provided.

The ‘IYS’ is designed to put a spotlight on current poor conditions of hygiene in many places in developing countries - to highlight the little progress made to-date towards the Sanitation target under the Millennium Development Goals (MDG 7), and to advocate for the multiple benefits that stem from better sanitation and hygiene.

For me, personally, visiting the Democratic Republic of Congo last year was an unforgettable experience. The rates of access to sanitation in DRC are thought (according to the best available information) to be 8% and 10% in urban and rural areas respectively, i.e. only 1 in 10 Congolese has access to a toilet (of the terrestrial, non-flying kind, that is). Imagine what conditions are like in the slums of DRC. As to solid waste disposal, in the course of the research we carried out with our partners (Tearfund and the Programme de Promotion des Soins de Santé Primaires en Zones de Santé Rurales (PPSSP)), we discovered that, in the capital of DRC, Kinshasa, a city with an estimated population of 6-7 million people (there hasn’t been a census for many years), the public sanitation authority possesses one sole functioning rubbish lorry.

Talking about the S-word
So, how is it that access to a basic service, for a basic need, is so lacking?     

Part of the story is, of course, stigma: defecation is not the stuff of everyday conversation. One of the aims of the IYS is to help remove that stigma around sanitation, so that its importance can be more easily and publicly discussed. Creative work of activists in South Asia has shown how communities can mobilise themselves to stop ‘open defecation’ and that has included (at least amongst the cultures of that region), overcoming the taboo of talking about the ‘S-H-one-T’ word (though I hesitate to write it).

Nor has sanitation been, to-date, a common subject for political speeches - few ministers cut ribbons at latrine blocks, or check the sanitation facilities at the opening of a new school (they should – absurdly, schools are still being built without toilet and washing facilities).
Politicians are missing a trick...
As the UN commented in 2005: "Without strong champions to raise public awareness and generate concern, the sanitation crisis has not been met with anything resembling the kind of response necessary to make substantial and sustainable gains”.

In many countries, overcoming political indifference to sanitation and hygiene (S&H) is still a challenge. That was illustrated by the studies ODI carried out with Tearfund in 2006. Yet, the degree of risk associated with prioritising S&H is less than many politicians think. Instead of large capital outlays on infrastructure (‘hardware’), public investment in S&H can be targeted towards strengthening human resources (‘software’).  Once politicians put those apprehensions aside, they will see they are missing a trick – to strengthen their constituencies. Our work on sanitation has shown that low levels of expressed interest in S&H facilities, relative to other needs (including water supply), are often misleading: where women (particularly) have an opportunity to voice their views, they frequently value improved sanitation facilities and better hygiene in and around the household. Motivations of privacy and individual dignity are important, often more so than public health. Political leadership can help convert this desire for better S&H into perceptible demand.         

Sanitation and hygiene – at the core of the MDGs
As well as being politically feasible and expedient, action to tackle gaps in S&H is key to economic and social development.

Failure to invest in improving hygiene conditions undermines efforts to reduce poverty and promote economic growth. As I expressed for a DFID sanitation ‘policy background paper’ of July 2007 (drafted by a ‘reference group’ of S&H specialists and then widely circulated by DFID to practitioners on e-mail, though not yet published), inaction on sanitation is simply not a viable option. On the other hand, action on S&H can contribute to a wide range of development domains: not only water and environment, but also health, education, housing, urban and rural development – as well as providing means of respecting personal dignity and safety.

But who to talk to, and who will listen?
Despite these needs and opportunities, S&H frequently loses out to other sectors when policy and budget priorities are being set. Although sanitation commonly falls within the sectoral remit of water institutions, the systematic linking of water and sanitation in policy-making is often unhelpful to the cause of sanitation. The dynamics of S&H are, in many, respects, different from water supply. Yet, in most countries promotion of S&H currently revolves around water policies. The case for more investment in S&H needs to be taken beyond water institutions and actors. Katharina Welle and I commented on this in a recent ODI Briefing Paper.

From whom, then, should support be sought?  As Baron Dennis Healey, former UK Chancellor of the Exchequer and Secretary of Defence under a Labour Government reflected in the Guardian recently, all you need is acquiescence (i.e. lack of opposition) from a majority: “I made a mistake. I didn’t only want people to agree with me; I wanted them to share my views. And you don’t need that. All you want in politics is acquiescence”. That’s a piece of wisdom, from a lifetime’s experience in politics, which can surely be adopted in practice for sanitation.

Mainstreaming S&H
S&H ‘mainstreaming’ works through key alliances. Selective arguments for better basic S&H services in poor areas can be made proactively:

  • To officials responsible for education - that school curricula adequately incorporate hygiene education; and
  • For health - that more resources are allocated to district health officers for preventative work on hygiene e.g. to avoid outbreaks of cholera.
At the same time, ministers of finance need to be persuaded of the benefits of investment in S&H, because of the multiple MDG impacts. Without the support of the minister of finance, S&H policies, however well conceived, will not of course receive greater priority in the national budget.  

The ‘RiPPLE Programme’ in Ethiopia - a consortium of partners in Ethiopia, as well as internationally (including the International Water and Sanitation Centre-IRC and WaterAid (UK, Ethiopia)) is looking into an example where S&H has been politically championed: since 2003, efforts to tackle the lack of S&H facilities and practice in rural communities in the Southern Nations region (‘SNNPR’) of Ethiopia have attracted considerable attention, nationally and internationally. Together with the SNNPR Bureau of Health, RiPPLE is looking at how S&H became better mainstreamed within the regional government and how far this exceptional impetus for S&H was (or not, as the case may be) successfully implemented ‘on the ground’.

The full findings of this Ethiopian case study will be available in March 2008.  However, our initial findings do point to some interesting lessons ahead, as they indicate that the Bureau Heads successfully made the case for preventative health care and sanitation to the cabinet of the regional government. How this political leadership was achieved, and how resources and motivation were then mobilised in rural communities is still being studied. More such studies need to be carried out of the political dynamics within the S&H sector - political analysis is all too frequently missing, we believe, in understanding of S&H (and water).

Based on first findings, a market in S&H services seems to be absent in rural SNNPR. In what circumstances the market can positively contribute to ‘stimulating demand’ for S&H in rural Ethiopia merits more study - are current policy debates on S&H overstating the market’s role?      

New mobilisation of energies
The IYS is an opportunity to draw attention to S&H goals. It is also important that we combine this increased attention with in-depth study of how sanitation and hygiene facilities have been successfully improved, in contexts of poverty. From ‘World Toilet Day’ on November 19th, the launch of the IYS on November 21st and the year of activity that follows, development practitioners around the world can expect to witness a renewed and more determined effort to make the case that providing better sanitation & hygiene facilities for poor households is a development priority – especially for the benefit of all the people who are currently without basic means to carry out a basic daily function. We all do it - even if we are coy at talking about it. Or spelling it out in writing.