Breaking the cycle of diarrhoea in Bangladesh
19 November 2007
On World Toilet Day, we share this story of how improved sanitation is making a positive difference to people's lives in Bangladesh.
Diarrhoeal disease in Bangladesh is estimated to be the fourth biggest killer
of children aged between one and 17. Diarrhoea prevents men and women going to
work, resulting in millions of taka a year being lost in terms of income and
productivity.
Much of this is preventable through good sanitation and hygiene practice.
Incidence of diarrhoea can be halved by washing hands thoroughly after going to
the toilet, or after washing a child’s soiled bottom, and before eating. Being
able to use a convenient, clean and properly maintained toilet means the
prevention of contamination of living, bathing or playing environments with
potentially harmful faecal matter.
Poor sanitation causes suffering for millions
The
poorest members of Bangladesh’s society are hardest hit. Poor working mothers
who have to sacrifice a day’s pay to stay at home to look after their children,
often using scant household resources. People living in slums who have to wash
in the same water that a latrine empties into, exposing themselves to
water-borne disease. A rickshaw driver or a field worker has no access to a
toilet during the day; he or she will have little understanding of the dangers
of defecating openly and exposing others around them to the many diseases spread
through faecal waste.
According to UNICEF, the number of children under five dying from diarrhoea
every year in Bangladesh has been reduced by more than 86% since 1971. Awareness
levels about the consequences of poor hygiene practice and the dangers of
leaving human excreta open to the environment are on the increase. However,
millions of people in Bangladesh still suffer - particularly women, for whom
lack of privacy, safety and dignity are often perceived to be far more severe
consequences of poor sanitation.
In 2003 only 33% of Bangladeshis had access to even a basic toilet facility; the
practice of ‘open defecation’ persisted across the country. Where toilets were
available, they were often crude, unhygienic structures built over water-bodies.
These ‘hanging latrines’ continue to be widely used.
Back to top
Action to improve hygiene
In Bangladesh the Government took a strong lead to improve levels of
sanitation coverage. They hosted the South Asia Conference on Sanitation (SACOSAN)
in 2003, attended by nine other countries from the region, which unanimously
agreed on a people-centred, community-led approach for sanitation and hygiene
development, and committed to accelerating progress in the region. Following the
conference, the Bangladesh Government established a National Task Force for
Sanitation and launched the National Sanitation Campaign. Every October has been
designated the national sanitation month, and continues to be observed at all
levels of society and government.
Bangladesh committed itself to achieving 100% (‘total’) sanitation coverage by
2010. Government organisations, NGOs and donors alike, whilst realising the
considerable challenge, have committed themselves to supporting this national
target through a wide range of projects and programmes; these primarily target
the most vulnerable and the poorest citizens of the country. In rural areas
where lack of coverage has been most acute, 20% of the funds from the
Government’s Annual Development Programme budget for local government have been
allocated as sanitation subsidies for the poorest.
Since SACOSAN, Bangladesh has witnessed a significant increase in availability
of sanitation facilities, particularly in rural areas with reports of up to 85%
coverage. Whilst such reports need verification, recent surveys have shown a
significant move away from 'open defecation' and the use of 'hanging latrines'.
It is evident that Bangladesh has made significant progress towards the MDG
target of halving those without access to improved sanitation by 2015.
However, achieving 100% sanitation coverage is more than just having access to a
toilet. Toilets, together with good hygiene practice, are the main requirements
for a healthy community and a clean environment. Investments are most effective
and will have the most lasting impact when they begin at the household and
community level.
Back to top
DFID: Supporting the UN Year of Sanitation
2008
is the
UN International Year of Sanitation. Bangladesh is in an excellent
position to consolidate the progress made towards reaching 100% sanitation
coverage and can ensure that its achievements are sustained by realising,
throughout all its programmes, that sanitation is about making the conscious
decision and effort to change hygiene behaviour.
There are many excellent examples of good sanitation and hygiene which have been
brought about through Government, NGO and community-led activities. Bangladesh
has gained international recognition for its pioneering of what has become known
as the Community Led Total Sanitation (CLTS) approach. The communities
themselves, however poor, are mobilised to put an end to traditional practices
of open defecation and are shown how to build and maintain even the most
rudimentary type of toilet, sometimes at a cost of no more than Taka 25, which
can still provide a clean and smell-free homemade alternative.
The success of the approach in Bangladesh led the UK Government in 2003 to
support a programme of NGO-led interventions in some of the most challenging
physical and socio-economic areas of the country, including the Chittagong Hill
Tracts. More recently the UK has agreed to support a UNICEF-Government of
Bangladesh partnership programme working in over half the districts across the
country.
During a recent visit to a slum in the Mohammadpur area of Dhaka, where the UK
Government has been supporting local NGO programmes through the International
NGO WaterAid, a group of community women already managing their own community
sanitation facility were able to describe how they were taking responsibility
for the operation and maintenance of their sanitation block. “We collect from 1
to 6 taka from each member of the local user group”, said Roxana, a resident
community health promoter. The poorest people didn’t have to pay; one of the
toilets had even been adapted for use by a number of disabled residents.
Back to top
Sanitation: Vital to development
The United Kingdom is pleased to be supporting the Government’s commitment to 100% sanitation coverage and is working hard to ensure that the programmes of Government, NGOs and other donors in Bangladesh continue to focus their efforts on reaching the poorest and most vulnerable people. DFID considers that “every toilet should be a wanted toilet”. The UK does not want to help just build toilets; it is committed to helping bring about the changes in sanitation and hygiene practice and put the people of Bangladesh at the centre of the development process, which will break the cycle of diarrhoeal disease – the cycle that prevents poor people from participating effectively in the economic growth of the country.