World Toilet Day 2014: Sustainable Sanitation Can’t Wait

World Toilet Day 2014: Sustainable Sanitation Can’t Wait

{Photo credit: MSH staff, Afghanistan}Photo credit: MSH staff, Afghanistan

In 2013 diarrhea killed 578,000 children under the age of five, 9 percent of all deaths in this age group globally. The tragedy of these deaths is that they are avoidable at many levels. The risk of contracting diarrhea can be drastically decreased through basic hygiene measures, such as consistent and exclusive use of a latrine and washing one’s hands with soap. Once a child becomes ill with diarrhea, most cases can be managed with oral rehydration salts and zinc. But the gap between what is known in the public health community regarding prevention and treatment of diarrhea, and what is practiced in many settings, is wide and deadly.

In Afghanistan, diarrhea killed 13,000 children under the age of five in 2013 and was the third most frequent cause of mortality (after neonatal conditions and pneumonia) in the age group. Many organizations, including Management Sciences for Health (MSH), have worked to improve access to treatment for children with diarrhea, but less attention has been paid to prevention.

 {Photo credit: Mahjan CLTS Facilitator.}Photo credit: Mahjan CLTS Facilitator.

Between 2010 and 2012, however, the US Agency for International Development (USAID)-funded Sustainable Water Supply and Sanitation Project (SWSS), led by Tetratech ARD with MSH and local NGO partners, implemented hygiene and sanitation activities in rural communities of 34 districts in the Nangarhar, Langhman, Logar, Baghlan, Takhar and Badakhshan provinces of Afghanistan to prevent the spread of diarrheal disease.

MSH helped families improve their hygiene using three community-based strategies: implementing community-led total sanitation (CLTS), training families to build or upgrade latrines, and promoting hand washing with soap.

The first strategy, CLTS, is a globally-recognized approach to teaching families and communities about the negative health and social consequences resulting from defecation in open areas. MSH trained facilitators to help communities develop plans to eradicate open defecation, which included peer enforcement. In collaboration with the Ministry of Rural Development and Reconstruction, MSH and its local NGO partners were the first to implement CLTS in Afghanistan on a large scale. In just two years, 611 rural communities were certified to be free of open defecation.

[In Moen Kas, one of the villages where the project introduced community-led total sanitation, officials and villagers celebrate Open Defecation Free (ODF) certification.] {Photo credit: Noorgha CLTS Supervisor/Afghanistan.}In Moen Kas, one of the villages where the project introduced community-led total sanitation, officials and villagers celebrate Open Defecation Free (ODF) certification.Photo credit: Noorgha CLTS Supervisor/Afghanistan.

Secondly, MSH trained families in open defecation free-certified communities to construct or upgrade latrines. Receiving the training motivated families to use their own resources to build or upgrade 42,129 latrines, which benefitted nearly 300,000 people. At the start of the project, less than one-half of one percent of families used latrines. By the end of the two-year program, 39 percent of all households in the targeted districts regularly used a latrine. These family-built latrines enhanced families’ dignity and helped ensure the physical safety of women and girls by removing the need to travel far from their homes to isolated places to defecate.

[Improved latrine with hand washing facility in Baghalak village of the Nahrin district, Baghlan province, Afghanistan.] {Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS}Improved latrine with hand washing facility in Baghalak village of the Nahrin district, Baghlan province, Afghanistan.Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS

Thirdly, in collaboration with community-based women’s groups and schools, MSH educated nearly 574,000 people about hand washing with soap and other hygiene practices. By the end of the project, 60 percent of households had a specific place for hand washing (versus 27 percent in 2010) and soap was present in 80 percent of these places (up from 53 percent in 2010).

[A new hand-washing station in Toghak, Afghanistan.] {Photo credit: Nikmohammad CLTS Facilitator/MSH}A new hand-washing station in Toghak, Afghanistan.Photo credit: Nikmohammad CLTS Facilitator/MSH

In addition to improving the sanitation and hygiene situation for hundreds of thousands of Afghanis, the success of the project led the Government of Afghanistan to include CLTS and hygiene promotion in its National Water and Sanitation Policy and Strategy.

In 2014, two years after these activities ended, MSH asked its local NGO partners (some of whom still have program activities in these districts) to provide an update on the sustainability of the SWSS activities and of the benefits they’ve seen in the communities. They reported that MSH-supported latrines are still used by the majority of families and that hand washing with soap is still a prevailing practice. Most importantly, some of the local NGOs have continued hygiene education activities among women’s groups and schoolchildren using funding from other donors. As a result, there have been 10 to 20 percent fewer cases of childhood diarrhea in the last three years in the districts supported by SWSS, according to the Government’s health information system.

Today, as we commemorate World Toilet Day 2014, MSH reflects on the hundreds of thousands of child deaths that could be prevented by scaling up sanitation and hygiene promotion, not only in Afghanistan but globally. Sustainable sanitation is just one of many ways that MSH is dedicated to ending preventable child and maternal deaths among the world’s poorest and most vulnerable people.

Take action