Basic sanitation saves lives, but many countries around the world are still a long way from achieving it.
Much has been written about the South Africa’s hosting of the World Cup, the beauty of its landscapes, and vuvuzelas: less has been said about its sanitation. I visited the country in 2007, while researching my book on sanitation. I remember its glorious views and stunningly good wine. But I also remember that it was my first encounter with a bucket toilet.
I’d been curious to know what a bucket toilet might be. Surely it couldn’t be just a bucket. But it was. This was a shock, even after I’d had to evacuate in a public toilet with no doors (in China); eaten food cooked with latrine-derived biogas (in India); and seen plenty of the second-most common toilet in the world: a roadside, with bare bottoms doing what they must (all over).
But the bucket was still a shock, as were South Africa’s sanitation statistics. Luckily, the country’s current minister for national intelligence, Ronnie Kasrils, became the only cabinet minister worldwide so far to declare his job as “minister for toilets” (the actual title was minister for water affairs and forestry) after a lethal cholera outbreak in KwaZulu Natal in 2000. Money was put into sanitation programmes. Latrines were built. Most importantly though, latrines were talked about.
Kasrils wasn’t ashamed to sit on toilets for publicity shots, or to talk about the importance of safe sanitation, because he’d seen that not providing it cost money as well as lives. When Peru had a cholera outbreak in 1991, it lost $1bn trying to contain it. It could have been prevented with only $100m-worth of sanitation improvements.
Kasrils also knew, as the best sanitation professionals do, that sanitation is never just about latrines. Give a child a decent latrine, and he will stop tramping faecal particles into his living environment on his feet. He will stop dipping faecally smeared fingers into the family rice pot. He will be able to keep his food down. Poor sanitation is linked to malnutrition. There’s little point giving a child a high-protein biscuit when diarrhoea – caused by those faecal particles in water and food – washes it straight out again.
South Africa’s sanitation statistics have improved, but they are not perfect. Nor are those of the planet.
First, the good news. The world is on track to meet a Millennium Development Goal – one of seven on the wishlist – to supply people with clean drinking water by 2015. That’s wonderful news. The trouble is, the MDG is not just about providing clean water. There’s also sanitation. My heart sinks as I write this, as I’ve been writing the same things for years, and still the statistics are woeful: still donors and politicians pour money into water supply and HIV/Aids, while neglecting sanitation, and still children die of diarrhoea. Boring, banal diarrhoea.
A clean water supply reduces disease by 20%, and a latrine by nearly 40%, yet donors continue to pour money into water. It gets more funding. The National Geographic’s recent special issue on water, laudable though it is, took 109 pages to get round to the death toll from diarrhoea caused largely by poor sanitation. The sanitation part of Millennium Development Goal Seven – which was only added after great opposition – is the most off-track of all the goals. Maybe that’s why 883m people may have no access to decent drinking water, but three times that amount have to defecate in the open.
In 2000, according to the Global Water Partnership, the US spent $13bn on water and $1bn on sanitation. Across the world, water gets eight times more funding than sanitation.
If it’s not water kicking sanitation out of the way, it’s something else. Even though toiletlessness, and its accompanying faeces-related diseases, is linked to a quarter of child deaths. Even though diarrhoea kills more children than HIV/Aids. But in Madagascar, where UNAids found there were too few Aids deaths to estimate, Aids receives five times more funding than sanitation. Diarrhoea kills 14,000 Madagascan children every year.
In the same way cities are built on functioning sewer systems, good development is built on sanitation. An off-track MDG on sanitation will knock others off-track too. A girl dying of diarrhoea won’t go to school (MDG 2; achieve universal primary education); or be properly nourished (MDG 1; reduce extreme poverty and hunger) or be alive past the age of five (MDG 4; reducing child mortality).
Many activists are now shouting more loudly about sanitation and safe water provision. Great. But popular pressure is still missing. So today, as you prepare to flush your toilet – as you surely will – imagine doing your business behind a bush, while a farmer spies at you through banana leaves; or watching your child’s life pour out of him with the diarrhoea, the same way your daughter died, or your sister’s children died. Then settle down to watch the football.