Nepal WASH Blog Water, Sanitation and Hygiene (WASH) & Development in Nepal

November 19, 2012

To have or not to have toilet Not enough done

Filed under: Advocacy,Campaigns,Diarrhoea,Nepal,Sanitation — nepalwash @ 9:00 am

Why care whether all Nepalis have access to toilets or not?

From experience, we have learnt that not doing something about ensuring toilet access is likely to lead to people’s deaths, especially those of poor women and children. For evidence, consider what happened in the hills of Doti district in far western Nepal only this past summer.

On the 1st of June, an outbreak of diarrhea was reported in Baglek VDC in Doti. Affected people started visiting the local sub-health post. In a matter of days, it was clear that the diarrheal outbreak was not confined only to Baglek. Patients from adjacent clusters of villages started streaming into the overwhelmed health post, which had neither adequate beds nor enough nurses.

By the time the health post reported 116 cases, including three deaths, to the district health officers, the diarrheal disease had spread to 10 surrounding VDCs and to Dipayal and Silguri, the two towns that lie on the hilly highway. It was clear that what Doti faced was not an ordinary diarrheal ailment that would run its course and die out.

Instead, it was gripped by a disease that was spreading itself and killing terrified villagers. Six weeks after the first reported case, a government investigation concluded that the villages in Doti were in the midst of a cholera outbreak. But by that time, 14 people, 13 of whom were women and young children, were officially reported to have died from cholera.

Looking back, if only the people of Doti had access to something as low-tech, simple and boring as safe, hygienic and private toilets – something which most people reading this article take for granted — that access alone would have helped them separate human waste from drinking water supplies. That separation, which is the cornerstone of modern hygiene practices, would have saved their lives.

But minus the toilets, health risks in our country, especially for the poor and marginalized, only get complicated: the probability of drinking water sources’ getting contaminated becomes high, which then raises the probability of cholera virus or other such water-borne virus striking the nearby population, which, in the absence of a responsive and connected rural health infrastructure, kills innocent, voiceless and anonymous people, most of whom are women, children and the elderly, the most vulnerable sections of our society. These risks are magnified when we consider that up to 16 million Nepalis — a large number, to be sure, regardless of whose data you look at — do not have access to toilets and must defecate in the open.

There are other reasons to care about every Nepali’s access to toilet – at home, at schools and at public places in villages, highways and towns. Besides improving health outcomes, such access matters for other development results such as those related to raising educational achievements and increasing livelihood gains. The government’s stipulation for community schools is that there must be one toilet per 50 students.

Even accounting for the fact that the stipulated ratio is already too high, research shows that the ratio in practice is much higher still: one toilet per 127 community school students. An analysis of the government data that WaterAid did with Federation of Water and Sanitation Users of Nepal (FEDWASUN) found that of 28,000 community-run schools in 75 districts, 17,000 do not have separate toilets for girl students, and only 18,000 have toilets of some sort, mostly for the boys, near their premises.

Indeed, the further west one travels in Nepal, especially in the hills of Mugu, Jajarkot, Rolpa, Jumla, Kalilot, Dailekh, Darchula and Rukum, one hardly sees toilets at schools, let alone separate sanitation facilities for girl students. In Darchula alone, research shows that there is one school toilet for 934 male and female students. Given this reality, it’s not hard to think that bad sanitation at schools not only contributes to poor health outcomes but also to worse educational results.

Despite these problems that exist and affect poor Nepalis and require further investment of time and funds, some progress has been made in spreading the use of toilets across Nepal – in village households as well at schools. In the last two years, thanks to the work of the government, I/NGOs and international agencies, there’s been a momentum across Nepal to declare clusters of villages as Open Defecation Free (ODF) VDCs. Of Nepal’s 3,915 VDCs, more than 400 have already been declared ODF.

On one level, an ODF VDC denotes that all residents of all castes in a community practice basic hygiene behaviours, have access to safe, hygienic and private toilet, and keep human and animal waste separate from drinking water supplies.It signifies that the community’s social competence has improved in that its residents have their act together to sustainably tackle the issue of sanitation, which is the basic building block on which they can stack other developmental goals such as those of education, health and livelihood.

Why care whether all Nepalis have access to toilets or not? Because doing development really does not get simpler and more urgent than caring about this necessary if unglamorous issue.

This article is written by Mr Ashutosh Tiwari, WaterAid’s Country Representative in Nepal and published on The Himalayan Times dated 19 November 2012 – World Toilet Day. The article can be accessed in the link below

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