REPORTS

A silent emergency

ASHA KRISHNAKUMAR

A FEW years ago, readers of the American magazine Focus voted for the greatest invention in history. They chose not the telephone, the steam engine, penicillin or the light bulb, but the humble toilet.

The flush latrine, according to Harvard geneticist Gary Ruvkun, has been the single significant factor that has increased the human lifespan. But, in an age where technicians have invented a toilet that analyses urine and when water and sanitation solutions are becoming cheaper, why are 1.2 billion people in the developing world defecating by rail tracks, in alleyways and in fields before dawn or after dusk? Industrialised societies have reached the ceramic salvation, but diarrhoea is still rampant in most parts of the world.

The Geneva-based Water Supply and Sanitation Collaborative Council (WSSCC) puts diarrhoeal deaths at 6,000 a day, mostly children. Faeces in water supply, in dwellings and in food can be fatal. One gram of human faeces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 worm eggs.

China produces the largest amount of excrement a year, 122.3 million tonnes, and 60 per cent of it is not disposed of safely. In India, 72 per cent of the excreta generated is not disposed of safely, the percentage being next only to Afghanistan, Congo, Ethiopia, Niger and Rwanda. In South Africa, 5.7 million people do not have access to proper sanitation. As many as 769.4 million people in India do not have access to proper sanitation, and for 171 million people safe water supply is a mere pipe dream.

This obviously impacts health. Hygiene-related diseases claim 5,19,500 children every year in India, the highest number in the world; 21,000 children in Bangladesh; and 1,35,000 children in Pakistan. In India, the percentage of children with abnormal growth is 47 per cent, compared to South Africa's 11 per cent.

Sort out waste disposal, and you get hygiene, fuel, energy and good health. The WSSCC estimates that the 4.56 kilograms of nitrogen, 0.55 kg of phosphorus and 1.28 kg of potassium that an average human being's excreta releases each year could be manure enough to help grow crops that produce enough wheat and maize for one person annually. Researchers in China's Yunnan University discovered that one biogas digester saves 0.2 hectare of woodland from the axe for fuel every year. Simple sanitary solutions can halve child malnutrition (often caused by diarrhoea).

On March 22, the WSSCC released a pioneering global report Listening simultaneously in London, Johannesburg, New Delhi and New York on World Water Day. This hard-hitting report, which is an indictment of each one of us, is the voice of about 40 people - engineers, sociologists, doctors, community and non-governmental organisation (NGO) leaders, local government officials, academics and private sector executives - who recount their experiences working with communities in the poor neighbourhoods of Bangladesh, Bolivia, Colombia, India, Kenya, Madagascar, Nepal, South Africa and Uganda. It brings out vividly the `voices' of those with long experience of, and commitment to, the cause of `water, sanitation and hygiene for all'. The report attempts to bring out their frustrations and highlight the failure of the old ways of doing things. It also showcases contributors' path-breaking approaches to tackle water and sanitation problems.

GOAL Seven of the Millennium Development Goals is ensuring environmental sustainability. Under this falls Target Ten - halving the number of people without access to water by 2015. At the World Summit for Sustainable Development in Johannesburg in September 2001, a `sanitation goal' was added - to halve also the number of people without access to adequate sanitation by 2015. The WSSCC is mobilising action-oriented programmes towards reaching both these goals, by spreading knowledge about and the practice of basic hygiene, which Val Curtis and Sandy Cairncross of the London School of Hygiene and Tropical Medicine estimate "could save more than a million lives each year".

The WSSCC, which was set up by a United Nations mandate in 1990, terms sanitation the "biggest failure of the last 50 years". The "silent emergency" of bad water and poor hygiene fills half the world's hospital beds. Though $5 billion in aid is dedicated to the issue, apart from the investments made by governments, about 2.4 billion people still have no access to adequate sanitation.

According to the report, billions of dollars has been spent on the unsuccessful search for weapons of mass destruction in Iraq; yet the deadliest biological weapon of mass destruction ever known, human excrement, continues to wreak havoc. It, along with the lack of potable water, forms the world's number one health hazard. The report questions why this problem, which has been around for ages and known for decades, has not been tackled. Why does a lack of safe water and sanitation continue to kill 6,000 children every day and render half the world's poor ill at any given moment?

The report says: "The main barrier to safe water, sanitation and hygiene for all is not lack of resources, but unwillingness to learn from past failures and to listen to those who have pioneered new approaches in this area."

Gilbert Nkusi, Programme Officer of the United Nations Children's Fund (UNICEF) for Water and Sanitation, based in Antananarivo, Madagascar, has worked with both government and civil society and is a member of the Madagascar `Wash' (water, sanitation and hygiene) committee. He argues that progress towards water and sanitation goals depends on decentralising the responsibility for basic services and, at the same time, building the capacity of local governments.

In Bangladesh's villages, imaginative new techniques that allow communities to see themselves as others see them have succeeded in putting a stop to the age-old practice of defecating in the open. The result has been an increase in the `demand' for water and qualitative sanitation by villagers who were given a chance to share their experiences to develop new approaches to the problem.

One man from Nawgaon district in Bangladesh came up with the slogan, `One fly is deadlier than one hundred tigers' to help people grasp the dangers of faecal contamination. This is now being used all over Bangladesh.

"Once feelings of self-respect are ignited," says Kamal Kar, a consultant in social and participatory development working in Asia and Africa, "the community will carry the project forward with real drive and determination - there is no inertia, no passivity."

"No progress is possible," says Jockin Arputham, president of India's National Slum Dwellers Federation, "until the urban authorities stop trying to hand down Centrally-planned solutions. The urban elite still clings on to the notion that they are the greatest experts in solving problems faced by the poor. This attitude has led to thousands of failed projects."

Gourisankar Ghosh,WSSCC Executive Director, thinks that at the core of the failure is the attempt to `deliver' solutions from outside - usually in the form of installing hardware - to communities that have had no involvement in, or ownership of, the process.

According to the report, which was compiled over two years, the key issue with regard to water and sanitation is not the availability of resources but the unwillingness on the part of those who allocate those resources to learn the lessons of both past failures and current successes.

The WSSCC believes that the greatest contribution it can make towards achieving the Millennium Development Goals for water and sanitation is to listen to and amplify the voices of those who have felt the frustrations of failures and those who have helped pioneer successful approaches.

Almost all the global `voices' recorded in the report reiterate that the main reason for this failure has been the attempt to `deliver' solutions from outside, ignoring local communities. According to Michael Rouse, head of the United Kingdom's Drinking Water Inspectorate and president of the World Water Association, low-tech biogas systems make more sense than unsuitable and expensive sewage solutions of the West. Hygiene remains a neglected area, confined to `water projects' by both government and civil society groups. Hardly 4 per cent of the total budget for the sector is set aside for sanitation and hygiene promotion.

According to the report, India's sanitation systems fall far below global standards mainly because of the myopic approach that does not encourage people's participation. "The average sale of anti-diarrhoea tablets and the continuing high mortality of children below five years are some of the major indicators that sanitary facilities in India leave much to be desired," said Gourisankar Ghosh. He cites the transformation of plague-hit Surat as an example for good sanitation thanks to community effort. Certainly, it was not the lack of resources that was the handicap for good sanitation there, he said.

Over the next six months the WSSCC is planning to work on a "doable report for India that would be presented to the government," says Gourisankar. While there is no one formula for success, the WSSCC report argues that it can be achieved by "trusting local communities, their organisations and those who work with them". It is an approach that "offers dignity, pride, and hope".

In the early 1970s, Dr. Bindeshwar Pathak founded Sulabh International and developed the Sulabh Shauchalaya, a pour-flush waterseal latrine with twin pits. It required very little water and was affordable and clean. It would, Pathak hoped, put thousands of nightsoil carriers - also known as untouchables - out of the demeaning business. It would also put waste to good use in the form of safe manure. But the idea did not take off.

Almost all the `voices' in the report agree that the old approach of providing water and sanitation services is fatally flawed. Increasing the available funds for large-scale, delivery-oriented infrastructure will achieve little without a rethink on how and on whom the funds are spent.

A HALLMARK of the new approach to the problems of water and sanitation is the recognition that women are most likely to be the key factor of a solution. There is widespread consensus that the women of a community are the rock on which real demand and real participation are built. It is women who have to cope with frequent family illness; it is women who have to fetch and manage water; and it is women who have the greatest need for private and safe toilets.

Some measures suggested by the contributors for better and sustained implementation of sanitation programmes in order to attain the Millennium Development Goal of halving the number of people without safe drinking water and basic sanitation by 2015 include community-led water and sanitation programmes, community-led monitoring and feedback, and strict regulation of private enterprise.

The report defines `community participation' essentially as a political process. According to the report, it is about the community organising itself to make decisions and take action; ending dependency; seeing improvements as being within the community's reach and rights; challenging relationships between the poor and their representatives; negotiating to remove political barriers; building the community's confidence and self-esteem; awakening the determination of communities to improve their own lives by their own efforts; and organising to demand that their efforts be supported by local and national political leadership.

The report argues that though the quality and integrity of local governments are critical, it is both the national and local governments that should contribute to the fundamental task of demand creation They should insist that major public institutions such as schools, health centres and other civil institutions become learning and demonstration centres for good hygiene and its benefits. UNICEF and the WSSCC have launched a `Wash in Schools' campaign to promote hygiene education and safe water and sanitation facilities in all primary schools. Donor agencies, the report argues, must support the local authorities working with community organisations.

Laudable, but for any progress a change of attitude will be needed. We are fortunate to be able to flush our waste out of sight, but we are selfish to flush it out of mind, too. As Dr. Bindeshwar Pathak rightly points out, the recognition that the toilet is "the critical link between order and disorder" is long overdue. The sanitation problems should be on the political agenda of every country. What is important is to point out how seriously they affect so many. The report argues that progress towards water and sanitation goals must be measured not by counting the number of taps and toilets and dividing them by the total population served, but by recording changes in use, behaviour and, above all, improvements in health. Undoubtedly, Sulabh's two-pit latrine would be ranked as a significant invention if only sanitation was not a dirty word.

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