Bangladesh has received the status of being 99 per cent open defecation free (ODF) according to the UNICEF/WHO Joint Monitoring Programme's 2015 report. This is indeed a grand success for us as we see many South Asian countries are still struggling to achieve ODF status. If we stretch our thoughts a little further to the centre of the problem, which is faecal contamination, we see an array of conditions causing this and the main reason is lack of sanitation with proper excreta disposal function.
A diagram called the 'F-diagram' developed by UNDP explains it further. This diagram clearly elaborates how the contamination takes place and how the excreta are ingested directly or indirectly (through faeces, fingers, flies, fields, fluids, and food). The diagram below shows pathways of faecal-oral disease transmission. The vertical blue lines show barriers to transmission: improved toilets, safe water, hygiene and handwashing.
In the span of 9 long years, BRAC's Water, Sanitation and Hygiene (WASH) programme has built over 1,480,000 latrines (mostly two-pit) through grant and loan support till June 2015. The loan recovery rate has turned out to be very successful, at over 99 per cent.
This goes to show that when a community is motivated enough, they are willing to take ownership of, and implement new ideas for their welfare. The goal is not just to have people switch from open defecation to fixed defecation; it is to facilitate use of hygienic latrines. Just because someone might own a latrine, it does not necessarily indicate that the facilities are indeed hygienic.
With the aim to motivate people to use and maintain hygienic latrines, BRAC engaged over 8,000 field level staff to disseminate WASH messages in 250 upazilas. Moreover, an integrated approach to WASH services has been adopted, since hygienic latrines are not really beneficial without good hygiene practices and access to safe water. Therefore, a community-based integrated approach along with financial support from donors and strong government commitment, are necessary to increase access to safe water, hygienic latrines, and promote good hygiene practices.
Hygienic or improved sanitation is required to break the chain of contamination. According to Bangladesh's National Sanitation Strategy 2005, a hygienic latrine is one which confines faeces, has an intact water seal or other tight pit closure, and is shared by no more than two households. BRAC WASH adheres to this national definition. Similarly, the Joint Monitoring Programme (JMP) counts 'improved' latrines as ones that hygienically separate human excreta from human contact. However, JMP counts only latrines used by single households, not shared ones, as improved.
Thus, a reduction in open defecation does not mean that the sanitation problem has been solved. In fact, 39 per cent of the population, that is over 63 million people, still do not have access to improved sanitation in Bangladesh (WHO/UNICEF Joint Monitoring Programme (JMP) Report 2015 update). So being nearly open defecation free actually means that the road has been paved to be able to move to the next level.
Improved sanitation has proven impacts on health, quality of life and poverty reduction. However, progress in increasing sanitation coverage has been slow for a number of reasons including, lack of knowledge and affordable technology for difficult areas like hoar, char, coastal belt, and hilly areas; extreme poverty and space constraints; the health benefits are not immediately seen or always understood; people living under poverty line often fail to invest in building sanitation facilities, inconvenience of excreta disposal when the pits are full and many more. All these factors accelerate the spread the preventable diseases every day.
Half the hospital beds in developing countries are filled with people suffering from diseases caused by poor water, sanitation and hygiene. (UNDP Human Development Report, 2006).
Only building latrines is not enough, closing the knowledge gap and changing behaviour among the vast majority of the people is important to address the issue and make proper sanitation an in-built practice.
United Nations General Assembly in 2013 designated 19 November as World Toilet Day. It's time to end this fatal crisis and to ensure everyone everywhere has access to a clean, safe toilet.
It's a call for action!
Sabrina Shahidullah is Senior Programme Specialist (Communication), BRAC WASH Programme