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.
Consultant to UNICEF WASH Team
Peter has worked previously for Water and Sanitation for Africa (WSA), IRC International Water and Sanitation and WaterAid