World Toilet Day Highlights Global Sanitation and Health Crisis

By Eddy Perez, Global Communities Technical Director for WASH

With billions of people lacking access to the safe, sustainable sanitation essential for public health and for eradicating extreme poverty, World Toilet Day is not a day for celebration, but rather a day to sound the call for action on the global sanitation crisis.

Global Communities embraces sustainable sanitation as essential for public health and for lifting people out of poverty. We recognize the need for a fundamental shift in approach in WASH interventions if the world is to attain the UN’s Sustainable Development Goal 6, which promises progressively more equity of access until sanitation for all is reached in 2030. The world is severely lagging in achieving this goal, especially for the poor. This is true in many parts of the developing world such as sub-Saharan Africa — and it is also true here in the United States where a recent MacArthur Foundation “Genius” award was given to Catherine Flowers for her work in rural Alabama where poor African American families do not have access to safely managed sanitation.

Global data from UNICEF and the World Health Organization paints a grim picture:

• More than half the world’s population — 4.2 billion people — live without safely managed sanitation
• Basic sanitation facilities like toilets and latrines are out of reach for more than 2 billion people and 673 million people still practice open defecation
• Inadequate sanitation is estimated to cause 432,000 diarrheal deaths every year — including 297,000 children under age five — and is a major factor in diseases such as intestinal worms, trachoma, and schistosomiasis
• Children under five years old living in countries affected by protracted conflict are, on average, nearly 20 times more likely to die from diarrheal diseases caused by a lack of safe water, sanitation, and hygiene than by direct violence
• Many countries lose up to 5 percent of their GDP due to lost productivity from incidences of water- and sanitation-related diseases
• More than one in five health care facilities have no sanitation service
• About 80 percent of wastewater is discharged back into natural ecosystems

This year’s World Toilet Day theme — sustainable sanitation and climate change — highlights the way flooding, drought, and rising sea levels damage sanitation systems, such as toilets, pipes, tanks, and treatment plants. These frequent shocks around the world, and intense stressors such as the recent Hurricanes Eta and Iota in Central America, damaged sanitation facilities and set back much of the progress made over the past five years.

Global Communities does WASH differently
WASH is a core technical focus of Global Communities, and a primary plank in its mission to build prosperity and well-being for all — using evidence for inclusive and equitable benefits in health, WASH, nutrition, food security, economic growth, and jobs. Global Communities’ sanitation approach is strongly influenced by the 2030 UN Agenda for Sustainable Development. The SDG 6 goal is a “game-changer” in the global and national WASH sector and calls for a major paradigm shift in how WASH interventions are done by governments, development partners, and donors.

Consistent with this fundamental shift, Global Communities is “doing things differently” from what we have done in the past. Examples include:

• Our rural sanitation programs go beyond stopping open defecation to supporting households to get access to affordable, durable, and hygienic latrines and addressing a wider range of unhealthy behaviors that are fecal-oral pathways
• We are designing programs that go beyond physical construction and counting outputs to strengthening and measuring governance and enabling an environment for service delivery. We measure the capacity of local governments to provide ongoing monitoring of sanitation results and provide support to communities when needed, and we provide technical assistance to national governments to develop new pro-poor sanitation policies and programs
• We bring in researchers and digital experts to strengthen our capacity to collect and analyze data to explicitly target the disadvantaged and monitor progress toward the progressive reduction of inequity
• We are moving toward a dynamic systems approach that looks at all actors and factors in the ecosystem to strengthen local systems based on an understanding of how the system components are interacting with each other
• We moved from implementing NGO-led programs to government-led programs to support national and local systems for sustainable service delivery at all levels
• Our programs go beyond working with small scale local and social entrepreneurs to a market-based approach where Global Communities engages with the formal private sector and helps to facilitate a market-strengthening process with all stakeholders (government, financing institutions, local government, communities, and other development partners) to create an enabling environment for the private sector to contribute solutions to WASH challenges;

For example, Global Communities is doing things differently in Ghana in partnership with USAID under the WASH for Health project. Our market-based approach works with the private sector, the government and communities to design, produce, and market the DigniLoo latrine for the benefit of rural households living in poverty. Also, Global Communities in Ghana partnered with a Swiss University to collect data and assess what factors increased the construction of latrines in rural sanitation programs. This kind of evidence-based learning enables Global Communities and its partners to improve program design and impact.

Global Communities introduced in 2016 the Digni-Loo, a hygienic plastic toilet slab designed with the community’s need for an affordable, durable, practical, and simple solution to their sanitation needs. The Digni-Loo, developed with Ghanaian company Duraplast, can be installed without special tools and is easy to maintain — important factors for rural communities. So far, more than 31,000 units have been sold across Ghana. The Government of Ghana, with support from the World Bank, has purchased more than 25,000 units.

WASH for Health also identified sanitary menstrual hygiene as a challenge for girls’ participation in school, as damaging to their overall self-esteem, and, ultimately, a contributor to gender inequities. Those with limited incomes may have to forego the menstrual supplies available on the market entirely or may rely on inadequate, unsafe alternatives. They also may use money intended for basic household needs to buy expensive disposable products that add to the waste stream. To address this gap, Global Communities partnered with Be Girl, a social enterprise which had developed an improved menstrual product: a sustainable, two-in-one PeriodPanty with built-in menstrual protection. The PeriodPanty uses high-performance fabrics that resist stains, require minimal water to wash, and dry quickly and safely.

With the Digni-Loo, the PeriodPanty, new handwashing facilities, and clean water projects, Ghana WASH for Health is working to ensure that all Ghanaians have sustainable access to dignified, safe, and improved water supply and sanitation. In coordination with its partner The Manoff Group, the project also implemented a behavior change communications strategy to promote the knowledge and behaviors needed to appropriately use these facilities to meet their basic needs and to be healthy.