Empowering local communities to solve their own problems is the best way to improve health across the continent
The deadline for the world to meet its millennium development goals is now only four years away, yet in sub-Saharan Africa, there are still 570 million people without adequate sanitation, and it will be another 200 years before just half of the population of this region have access to a safe, private toilet.
In Nigeria where I live – alongside one-fifth of the continent’s population – sanitation coverage stands at just 32%.
And while we wait for the pundits, politicians and policymakers to do something about this, our children die at the rate of 4,000 a day. That’s the equivalent of one child dying in the time it takes to read this paragraph.
I have seen many technologies designed to solve our problems parachuted into Nigeria. Some work, most don’t. I am continually amazed at the products thrust at us and the astonishment that then follows when something that we have had no consultation on fails to work in our local context. The lesson should be simple: know the area, know the people.
It is only through talking and listening to the people on the ground that we will be able to make long-lasting and sustainable moves out of poverty. This is especially pertinent when trying to educate people about sanitation and hygiene and bringing about a change in behaviour.
All too often I have seen latrines built and used as broom cupboards or goat sheds while the people carry on the way they have always known – using the great outdoors. Those trying to help scratch their heads and wonder why the latrines aren’t being used. If only it were that straightforward, then we would probably have made a lot more progress on the sanitation MDG target than we have so far.
Local knowledge is everything. WaterAid conducted its own research across west Africa into different ethnic groups’ attitudes to going to the toilet. The results go some way to explaining why simply building a latrine is only half the battle.
In many rural areas in west Africa, the practice of open-air defecation is ritualised and bound in tradition. Beyond individual differences, the members of a group or society are united by similar ways of thinking and behaving, and will react to situations in similar ways. Our research showed that reasons for resistance to using a latrine included beliefs that one might be possessed by demons, lose magical powers or live a shorter life. Some believe a toilet is meant only for wealthy people or that, if somebody feeds you, you should in turn defecate in their field.
For many in so-called modern cultures who take the use of a safe, private toilet for granted, these reasons may sound funny, even ridiculous. However, it soon becomes sobering to think that each of these beliefs may be directly linked to disease, debilitation and death.
WaterAid is adapting an approach known as community-led total sanitation (CLTS) in west Africa. First conceived in Bangladesh, it is a concept that has been sweeping across south Asia with impressive results, and many are hoping that it can bring similar results to Africa. It is based on an understanding that the people themselves have the solutions and are best able to determine which interventions will enable them to attain a self-defined, collective destiny.
Instead of focusing on the supply and installation of sanitation hardware to communities, CLTS focuses on changing attitudes and behaviour through community mobilisation to stop open defecation, and to build and use latrines.
Participants have reported that they find the approach engaging, participatory and, most notably, empowering – putting them in control of their own destiny, in a context in which, more often than not, death by disease is accepted with fatalistic submission to the ‘will of God’ or the hex of an enemy or the local witch.
Empowering local communities – especially women – with information that allows them to make decisions pertaining to their health and wellbeing ensures that they “own” the desired change. It is they who can be credited for the health benefits of safe sanitation and hygiene practices. It is they who commit to the necessary behaviour change, they who hold themselves and their peers accountable.
Here, help is not coming from outside, but from within – and people are in charge of their own destiny.
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