Candid talk about human excrement is making people in rural Niger, where only 2 percent of the population has adequate sanitation, insist on building and using toilets: A project there is showing people from scores of villages the dangers of open defecation.
“We put barely a speck of human waste [from the ground on the outskirts of the village] in a cup of water and ask assembled villagers who would care to drink it - no takers, of course,” Souleymane Atawaten, water and sanitation coordinator with Plan Niger, told IRIN. He and his colleagues demonstrated how flies swarm around human waste and food. “People quickly realize the danger - the link between their waste and illness.”
Plan Niger is one of several NGOs working with the UN Children’s Fund (UNICEF) and government health workers on community-led total sanitation (CLTS). Niger is one of the latest countries in West Africa where the approach is being used, according to Jane Bevan, water, sanitation and hygiene specialist with UNICEF’s West and Central Africa regional office.
This month Sierra Leone - where CLTS began in 2007 - announced its 1,000th open-defecation-free village.
Most West and Central African countries are not likely to meet Millennium Development Goal sanitation targets, according to UNICEF. Child mortality rates are among the highest in the world, with diarrhoea estimated to cause up to 20 percent of these deaths.
But practices that contribute to this can change, Bevan told IRIN. “Once people get [that they are regularly coming into contact with excrement], it’s transformative. The disgust over essentially eating one another’s faeces is universal. Very quickly the people agree they do not want to be doing so… and they see that they all have a responsibility.
“It is about a social norm. Before, the norm was people defecated in the open. This can change quite rapidly.”
Not only were people in the Niger communities OK with open defecation - some thought it was better, villagers told IRIN. Some think many people using the same latrine is somehow less wholesome than everyone finding a spot in the bush.
Beyond that, social taboos dictate that it is disrespectful to use the same latrine as one’s mother-in-law, say, or in the proximity of family members, according to Plan’s Atawaten.
“This is where we must address the cultural side of things,” he said. “There are ways around these taboos; some families build more than one latrine, but usually what happens is a pattern will emerge - families will do a sort of ‘planning’ around who uses the latrine when.”
Photo: Boureima Balima/IRIN
|A woman and her son in the village of Arthé, eastern Niger|
“Before this, I was hesitant to relieve myself with anyone seeing where I was going or knowing about it,” said Rachida Idi, a resident of Arthé village about 900km east of the capital Niamey in Zinder Region. “This is why we women always waited till nightfall and went far away. But now we see that it’s for our own good to have toilets.”
Atawaten said people in the villages where he works - "particularly the women" - are now insisting on latrines.
He said it is critical that people understand the importance of maintaining latrines and keeping them clean. “Otherwise the facilities will pose the same problem as open defecation - just closer to the home.”
Hygiene educators often turn to religion in this predominantly Muslim country, he explained. “People are used to doing their ablutions and they know they must be clean to pray and do so in a clean place,” he said. “We use this to talk about the importance of cleanliness.”
Bevan said once UNICEF and partners have triggered CLTS in a village they follow up for several months to watch for any obstacles to building the necessary number of latrines.
“We make a point of not providing any subsidies,” she told IRIN. “Research has shown that ownership is a strong component of sustainability.”
Atawaten said latrines can be affordable. “People can use all local materials, including recycled tyres, metal or wood,” he said.
“We use clay mixed with straw to make bricks for the latrine,” Arthé resident Souley Abdou told IRIN. But he said if families can afford more solid materials, including cement, a latrine will last longer.
Arthé residents said many families chip in to build latrines for those least able, including widows and disabled people.
At the health centre in the district of Yaouri – where residents of Arthé and other nearby villages go for health services – diarrhoeal illness is down, according to centre director Hamissou el Hadj Issa. Diarrhoea made up 11.13 percent of illnesses seen at the centre in 2010, compared to 19.24 in 2009, he told IRIN. “We are seeing a decrease across villages where CLTS is being applied.”
Experts note that it is difficult to measure precisely the impact of having toilets. “It is difficult to have a causal link - to say that the toilet has improved health,” Bevan said. “Diarrhoea can have a number of various causes. But I think it’s clear that 100 percent elimination of open defecation will be markedly better for communities’ health than 80 percent, which earlier had been accepted as a goal.”
To help illustrate the link UNICEF and partners at the Poverty and Economic Policy research network are undertaking a study of CLTS in Mali funded by the Bill & Melinda Gates Foundation. The study is aimed at measuring the health and socio-economic benefits of the approach over a period of years, Bevan said. “The study will compare indicators of well-being in two districts - one where CLTS is beginning this year, and another where it will start next year.”