Making hygiene the central issue

I’ve just had the luxury of sitting down and reading a pile of reports that have been accumulating over the last few months.   A group of these relates to the clear links between sanitation and under-nutrition, especially, how the prevalence of open defecation (OD) in India is clearly correlated with stunting in children in that country. The relevant documents, being a report by Dean Spears (How much international variation in child height can sanitation explain) and an article by Robert Chambers and Gregor von Medeazza (Sanitation and stunting in India: undernutrition’s blind spot) are a must-read for all WASH practitioners and child health specialists, and provide ammunition by the bucket load for advocates of better sanitation and hygiene.

One comment in the Chambers/von Medeazza paper, however, stirred up a problem that has been gnawing away at me for a while: “OD is particularly harmful where population density is high”. There is nothing surprising there, we would all agree. So, here is the troubling thought: you might think that the converse applies: perhaps OD is not especially harmful where population density is not particularly high? The situation where someone defecates in a remote field, in a very dry location, and buries the faeces under a desiccating sun is one that has probably occurred to all of us as being not hugely problematic, especially if that person has and uses an effective method of washing his/her hands quickly afterwards.

The particularly troubling thought that follows is that in some places, we are encouraging people to build low cost latrines which may not – in reality – be effective in isolating faecal matter from humans until it is harmless and, therefore, we practitioners actually may be having the unwitting but dangerous impact of bringing faecal matter closer to human contact than it was before.

Maybe this has all been done and dusted somewhere else and I simply didn’t see the debate… but our sector harped on about clean water alone, until it became clear that sanitation was important. Then we agreed that hygiene, particularly hand-washing at key times, was also important, so we invented “WASH”. Perhaps we could be moving more towards simply having hygiene as the key issue – or at least THE entry point. If that was so, then people living in medium-high density locations would naturally look to isolate their faecal matter (build toilets), people everywhere would seek to get their water from safe sources and protect it in their homes, and they would wash their hands at the right times, all as a matter of course.

Of course, having a latrine is about more than solely isolating faecal matter from human contact: the major issues of dignity and particularly safety (for women) are central. But the potential problem of encouraging people to build low cost latrines and therefore possibly having the opposite impact from that intended is worrying.

It seems to me that this is part of a problem of outside agents expecting the poor to have sub optimal infrastructure, mainly because national governments and international donors are simply not giving a high enough priority or enough money to sanitation – which works properly, so sub optimal solutions have to be deployed.
Peter Ryan
Peter Ryan
Consultant to UNICEF WASH Team
Antananarivo, Madagascar

Peter has worked previously for Water and Sanitation for Africa (WSA), IRC International Water and Sanitation and WaterAid

4 responses to “Making hygiene the central issue

  1. Back in the 1990s, ecosan pioneer Uno Winblad attempted to promote the “no cost one-day shallow pit latrine in combination with health education” as an alternative to the “expensive” VIP latrine in Zimbabwe. Understandably, such as pragmatic “primitive” solution never caught on. As you rightly point out, besides health, sanitation solutions need to address dignity and safety issues too.

    Would using hygiene as an entry point solve the problem? Some would argue that adopting a full-chain sanitation service delivery approach is what is really needed. Social entrepreneurs believe sanitation marketing is the Holy Grail, CLTS evangelists stick with CLTS.

    Now there is now more international attention for sanitation than ever before. We had a UN International Year of Sanitation and now there is UN recognition for World Toilet Day; Bill Gates launched his Reinvent the Toilet revolution. When will we see this attention translated into a significant reduction in the 2.5 billion without access to safe sanitation?

  2. Nripendra Kumar Sarma, Guwahati, Assam, India

    Dear All,
    Hygiene is very important, but more importantly the WASH, as a whole, should remain as a focal point. To ensure Hygiene EVERYWHERE, the usage and type of Toilet should remain as one of the important points of FOCUS and which needs redress. Moreover, mere isolation of faecal matter from human is not enough, it should be a Sanitary practice.

    As per the rural situation in Assam (India), there is a large scale practice of using Insanitary Latrines ( called as ‘Kutchcha Latrine’ in Assam ) and the condition of such ‘Kuchcha Latrine’ is as follows :
    (i) Different forms are used as Pan and no Water Seal in the form of Trap is used.
    (ii) The excreta is transferred in most cases to an earthen pit. Such pits are often covered with some locally available materials. Once the pit gets filled up, a new pit is dug out nearby, for this purpose
    (iii) In some cases, excreta is transferred to uncovered pit also.
    ( If required, the Photographs of different types of such Insanitary (Kuchcha) Latrines, as collected from field, can be shared )

    So one of the major challenges remains to convert such Insanitary Toilets into Sanitary one. For this purpose, the basic thrust needs to focus on Awareness and Social Norms on the importance of a Sanitary Toilet at every household levels.

    So our approach is first to ensure Safe Water and Sanitary Toilet and then the simultaneous practice of Hygienic Behaviour. In this connection our slogan remains — “WASH for ALL :: ALL for WASH”.

    Thanking you.
    Nripendra Kumar Sarma
    Guwahati, Assam, India

  3. Thanks for bringing this to light. One thing that I have always strongly believed is that we do not simply want people to use latrines, we want them to use hygenic latrines – latrines that properly cut off all transmission routes (flies, human contact, etc.). Therefore, it is not helpful for an organization to promote the use of any latrine. A dry pit latrine, without a proper seal (that is actually used!!!), is effectively just creating a system of fixed point defecation. It merely collects all the waste, and often brings it closer to the home, making transmission via flies and other methods all the more likely. So I agree with your point, make hygiene a priority in all elements of WASH and lets ensure we are promoting the adoption/use of truly sanitary latrines

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