Monday, 14 June 2010

Toilets: Issues beyond health

Joachim Ezeji

Often, people prefer not to think about what happens to their excreta once they have excreted it, either in the toilets or on the open field; but the earlier this nuisance is tackled the better because it is a serious issue that should no longer be glossed over. The earlier we fully understand the benefits of, and the risks associated with poorly managed or none use of toilets, the better. Some of these are well beyond the traditional health concerns.

People themselves usually improve their sanitation not because of the health arguments but because of social factors such as privacy, dignity, safety, convenience and status. The hundreds of people who must defecate behind bushes, in plastic bags, in roadside ditches face daily assaults to their human dignity. Poor women and girls are hit hardest by the absence of toilets. They care for children and the sick, and they are in greatest physical contact with human waste.

Living in a house without a toilet means going the whole day without relieving oneself and then risking exposure – or even assault – at night. Sexual harassment and rape are also a risk in certain areas, where women often seek privacy in the darkness. These problems take women’s time, imperil their physical well-being, and limit their free and equal participation in the economic and social life of the environment.

Poverty is more than a lack of income or a shortage of material goods. Human poverty, the lack of basic capabilities for participating in the activities of the community, is greatly exacerbated by lack of sanitation or toilets. For people living in households surrounded by human waste and garbage, it is stigmatizing and marginalizing. It creates embarrassment and deprives them of participation, choices and opportunities. Also, children, often will not use pit latrines because they are frightened of falling into the pits, and of what are usually dark, dirty and smelly places etc.

Again, the lack of segregated toilets fuels the discrepancy in primary school completion rates, as fewer girls complete primary school, compared to boys. On community cohesion, when families and influential local figures focus on ending open defecation, the condition of communities can be transformed. Pride in keeping paths and streets unsoiled can help build and maintain community cohesion. The need for sanitation and self respect from a clean environment can provide incentives for a transformation of local governance; sanitary reform has historically been a starting point for civic improvement.

Toilet or sanitation project can also be expected to change people’s relationship with the city authorities and the politicians, shifting from conventional patronage-based relationship with political parties and local governments to relationships that are more transparent and accountable. On poverty eradication, poor sanitation is often correlated directly with poverty; in parts of many Nigerian cities, hardly anyone from the poorest income quintile has a toilet, but 70 percent of those in the richest quintile do. It also causes poverty by making people ill, reducing their productivity and incomes, and by forcing them to use their time unproductively.

The chief asset a poor person has is often his or her physical health and ability to work; illness robs poor people of this asset while also diverting precious resources from critical areas like education. This has been analyzed in due realization of the social constraints that goes with poorly managed environmental sanitation. Both illnesses and diseases expand poverty and shrinks prosperity. While sick, many young children lose precious school hours, their mothers loses income by staying at home to nurse them, while their fathers expend the little resources in seeking medical remedy.

A children-centered view would also be germane in this context, why? In Owerri, under-five mortality rates are around half the national average (at 18.8% per 1000 live births). The deaths of this number of infants and children each year is commonly related to inadequate provision of basic water and sanitary infrastructure. Yet, for those who survive, debilitations of illness, pain and discomfort are common. Their nutritional status is often compromised by water and sanitation related diseases (especially diarrhoea and intestinal worms), and this has impacts not only on their physical development but also on social and mental development.
So, some primary economic benefits of having toilets are ; saving time; reducing direct and indirect health costs; increasing the return on investments in education; and safeguarding water resources etc. The biggest element is saving time. Households without toilets at home spend a great deal of time each day queuing for public toilets or looking for secluded places to defecate. The World Health Organization estimates this time has an economic value of well over US$ 100 billion each year. Many workdays are lost to diarrheal disease –when the worker is ill as well as when she or he is caring for a sick child. Meeting the sanitation MDG target would add more than 3 billion working days a year worldwide, universal coverage more than four times as many.

Thus, improved sanitation can enhance productivity. As to health costs, hygiene and sanitation are among the most cost-effective public health interventions. According to the highly-respected Disease Control Priorities Project, hygiene promotion to prevent diarrhoea is typically the single most cost-effective health intervention in the world, costing just $5 per disability-adjusted life year saved. Basic sanitation costs around $10–100 per disability-adjusted life year saved, which is rather better than the cost effectiveness of HIV/AIDS interventions.

Regarding education costs, Nigerian local municipality governments need to increase education spending to meet the MDG targets for school enrolment. That spending has a greater impact with services such as providing toilets for students and teachers, with separate facilities for girls. The reduction in diarrhoea by meeting the sanitation MDG target would add hundreds of days of school attendance per year globally for children in the community.

Further, healthy children learn better than children suffering from worm infections, which sap nutrients and calories and lead to trouble concentrating. Up to two-thirds of all school children here are infected with parasitic worms. And finally, girls are reluctant to attend schools if there are no safe, private toilets for them to use. This is particularly true once menstruation has begun. Cleaner and safer toilets in schools translate to more girls in school meaning higher rates of female literacy.

Good sanitation can safeguard water resources and maximize the impact of drinking water quality improvements. For example, the risks of water contamination during household storage and handling sharply increase in places that lack toilets. Contamination of local water resources used to supply drinking water can lead to unnecessary investment in more distant and expensive sources. Water resources are an important productive asset. Other economic benefits include the potential for biogas generation, which, as an affordable, cheap and environmentally friendly alternative energy will reduce energy cost for households. Also, organic fertilizers are derivable as it has the potential to enrich farmlands and boost agricultural harvests.

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