By Therese Dooley
UNITED NATIONS, Feb 6 2009 (IPS)

While 2008 – declared by the U.N. as the "International Year of Sanitation" – came and went with 2.6 billion people, including almost one billion children, still living without basic facilities, UNICEF's sanitation and hygiene senior advisor, Therese Dooley, says there is reason for hope.

Therese Dooley Credit: Nergui Manalsuren/IPS

"It is almost like a social movement," she told IPS. "It is about everybody working together."

IPS correspondent Nergui Manalsuren spoke with Dooley at UNICEF headquarters in New York. Excerpts from the interview follow.

IPS: According to recent U.N. statistics, every 20 seconds, a child dies as a result of a poor sanitation. That's 1.5 million preventable deaths each year. How does UNICEF hope to help resolve this global problem? TD: Sanitation is a huge issue for children. On the ground, we've got water, sanitation and hygiene projects in about 96 countries at the moment operational. I'm going to speak specifically on sanitation and hygiene because you can't distinguish sanitation from hygiene – because even by building toilets and latrines, they have to be properly used, so that's when the hygiene component comes in. And, indeed, hand washing by soap after using the toilet is critical because [not doing so] is responsible for about 44 percent of diarrhea diseases.

Some of our great successes is Community-Led Total Sanitation. It's basically following a model where communities work for themselves to improve their own sanitation. We're moving away from the idea of subsidised individual latrines that may or may not be sustainable. We're getting exceedingly positive results in Asia and in Africa.

If I take Zambia for example, it's been introduced in Zambia a year ago, in 12 communities to start with. What happens is the whole process followed by bringing the community together, the one who decides to make a change.

It's not about demonstrating shame to the community, it's about pride, and it's about the community wanting to have a clean, open defecation-free community. Within three months, all 12 communities declared themselves open defecation-free. Which means no one in those communities goes and defecates openly. And, the figures now are about 100 open defecation-free communities in Zambia. It's not just Zambia; it is Sierra Leone, Mozambique and Cambodia.

IPS: How did the International Year of Sanitation help to spotlight the problems of sanitation, mostly in the developing world? TD: The International Year of Sanitation had many achievements. The overall aim was to increase awareness among a number of different target groups. Primarily we were looking at influencing aid administration, governments, and implementers, but also the general public. We have reports that we're currently evaluating, but the preliminary results were really positive.

So, in some countries there were sanitation policies put in place, in some they started looking at strategies, or the development of standards for sanitation. In some countries it meant that it's increased the budget allocation made by government.

We also looked at multilateral and bilateral donors – have they done anything special for sanitation? Have they increased their budget allocations? I think all in all the proof will come in the next six to eight months. I don't think the year is over, I think the year is just started for sanitation.

IPS: Are there any estimates of how much of funding is needed to provide adequate sanitation to the 2.6 billion people suffering from the lack of it? How much of this funding is available now? TD: There's huge difference in opinion because in some cases you have much higher investments needed for urban and urban infrastructure if you like large-scale sewage systems versus rural. But you have to do both. And, the issue is how much then is needed for ongoing maintenance and repair.

How much is currently invested is a very difficult question to answer and how much more is needed. Because one of the problems with sanitation is that it doesn't have its own ministry, or its own investment line. It can be split across the ministry of environment, the ministry of urban development, the ministry of rural development, the ministry of health.

But the reality is there's still not enough investment in sanitation. There's not enough investment at all. We're not coming near anywhere what is needed.

IPS: Are developing countries themselves doing enough to help resolve the problem? What are the success stories in the developing world? TD: There are countries that have really achieved such tremendous coverage. If you take a country like Malawi or a country like Sri Lanka, you've got practically full coverage. If you look at the map, you sort of see that we're not going to achieve MDGs [Millennium Development Goals], but then you've got these jewels in the middle of that map who basically are doing very well, and are achieving success.

I think what you've got to look at is the statistics showing us that people may not be achieving the MDG but they are moving up by the ladder of success. So, the change is really desired, and people are really changing and moving. The whole issue is how we take to the next step.

The International Year of Sanitation has given us motivation and encouragement to do something, and the whole thing now is not to let it stop. And, to keep working with our colleagues and governments in developing world not only to achieve the MDG on water and sanitation, but to get best results for other MDGs. Because, sanitation affects girls, it affects schooling, health, and economy. Improving sanitation has so many benefits, but because it's so basic, people tend to forget about it.

IPS: What role does the private sector and non-governmental organisations (NGOs) have in sanitation? The World Toilet Association (WTA) in Korea is currently funding sanitation projects in several developing nations, including Ghana, South Africa, Cameroon, Mongolia, Indonesia and Laos. What are your thoughts on this? And does UNICEF work with NGOs on the ground? TD: The role of NGOs and private sector is absolutely enormous in this whole process. UNICEF works with governments and through other partners: NGOs, private sector, community-based organisations, faith-based organisations.

I think it is crucial for sanitation because if we talk about sanitation it is almost like a social movement, the role of NGOs is very important. So, we definitely work with many of them. The WTA is one of hundreds of NGOs actively working in sanitation, and without NGOs and community-based organisations, without people who out there on the ground whether governmental or non-governmental, we can't do sanitation alone. It is about everybody working together.

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By Therese Dooley and - -
NEW YORK, Nov 15 2007 (IPS)

Recognising how fundamental sanitation is to children\’s health, social and economic development, and environmental sustainability, The UN General Assembly has declared 2008 the International Year of Sanitation (IYS), writes Therese Dooley, Senior Advisor for Hygiene and Sanitation at UNICEF In this article, Dooley writes that every year, diarrhoea from inadequate sanitation and unsafe hygiene practices kills more than 1.5 million children under five, or one child every 20 seconds. Improved sanitation can also reduce illness due to diarrhoea by 35 percent, averting up to 190 million cases each year. Hand washing with soap, another key issue linked to sanitation, can decrease diarrhoea by over 43 percent. Improved sanitation and hand washing would also have significant impact on cholera, dysentery, worms, and trachoma. The economic cost of not having toilets and not practising good hygiene is also significant. Lost productivity and time, preventable health costs, lost school fees, and the longer term costs of environmental impacts can seriously affect a country\’s growth and economic development. It is estimated that every dollar spent on sanitation yields approximately nine dollars in benefits; thus investing in sanitation makes good economic sense.

Hassina, a 10-year-old girl at Gewane Primary School in northeastern Ethiopia, illustrates the importance of sanitation and hygiene to children: ”Toilets in our school and at home have made a big difference to my life. Before I hated using the old toilet at school or going to the field and I preferred to wait until evening time even if I had to go badly,” Hassina told us. “At first people did not want to talk about toilets and hygiene. They said it was embarrassing and that I shouldn’t be talking about it. But for me it is very important as it will protect my family, so I kept talking and my parents listened to me and now we have a toilet at home.”

A key member of the sanitation and hygiene club, Hassina is an agent of change in her community. ”I want to be a doctor when I grow up, but through what I have learned at the club I can start healing people from today, not only other students but also those people who are not in school.”

Unlike Hassina, almost a billion children around the world still lack access to clean and safe toilets, so IYS is especially significant for UNICEF and its work for children. IYS provides the global community with an opportunity to raise awareness and accelerate actions to achieve the sanitation Millennium Development Goal.

Children under five are most vulnerable to the effects of insufficient sanitation and hygiene. Every year, diarrhoea resulting from inadequate sanitation and unsafe hygiene practices kills more than 1.5 million children under five, or one every 20 seconds.

Diarrhoea is also closely linked to under-nutrition, a condition that is associated with more than half of all under-five deaths, and undernourished children, in turn, have compromised immune systems and are at a higher risk for developing pneumonia, which kills more children than any other disease. The importance of hygiene and sanitation are undeniable when you consider that of the approximately 120 million children born in developing countries each year, half will live in households without access to improved sanitation facilities.

In addition to saving young lives, improved sanitation can reduce illness due to diarrhoea by 35 percent, averting up to 190 million cases each year. Hand washing with soap, another key issue linked to sanitation, can decrease diarrhoea by over 43 percent. Improved sanitation and hand washing would also have a significant impact on cholera, dysentery, worms, and trachoma. Infestation with parasitic worms is another major health problem and children in countries with low sanitation coverage commonly carry up to 1,000 hookworms, roundworms, and whipworms at a time, which can cause anaemia and other debilitating conditions.

Women and girls bear the burden when sanitation is unavailable. Sanitation facilities enhance women’s privacy, dignity, and status. Many women and girls become sanitation prisoners, forced to wait until dark to defecate in a place where they cannot be seen. The presence of adequate school sanitation facilities, which are separate and private, increase girls’ attendance, especially after puberty, improve children’s performance at school, and enhance teacher recruitment, attendance, and retention.

In regions where a large proportion of the population lacks adequate sanitation, sewage flows directly into streams, rivers, and lakes, affecting the environment. Currently about 90 percent of sewage in developing countries is discharged untreated into waterways, often polluting the only usable water supply. One gram of faeces can contain more than 10 million viruses, 1 million bacteria, 1,000 parasite cysts, and 100 parasite eggs. With more than 200 million tonnes of human waste going uncontained and untreated around the world each year, the health of everyone, but especially children, is at risk each day.

The economic cost of not having toilets and not practising good hygiene is also significant. Lost productivity and time, preventable health costs, lost school fees, and the longer term costs of environmental impacts can seriously affect a country’s growth and economic development. It is estimated that every dollar spent on sanitation yields approximately nine dollars in benefits; thus investing in sanitation makes good economic sense.

Sanitation is fundamental to children’s health, social and economic development, and environmental sustainability. By working together in partnership with governments, civil society, faith-based organisations, communities, and children, we can make a difference.

The International Year of Sanitation provides us with a unique opportunity to increase political awareness of sanitation and raise its profile on the development agenda. Like Hassina, we must be prepared to take action about sanitation and spread the message of its importance to everyone. (END/COPYRIGHT IPS)

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