The Burmese government declared three villages in western Bago Division open defecation free (ODF), a first in Myanmar, following the first year of a community-led total sanitation (CLTS) effort launched by the UN Children's Fund (UNICEF) and the Ministry of Health.
"This is a major step forward. It proves that communities can discard the practice of open defecation and build latrines on their own initiative," Ramesh Shrestha, the UNICEF country representative in Myanmar, told IRIN. The three villages declared ODF on 4 May were Kywe Ta Paung; Myauk Let Gyi; and Hnget Pyaw Taw.
UNICEF and the government have been working in 20 villages in three townships - Thae Kone, Pyay and Puak Khaung - to mobilize community action against open defecation, with plans to scale up to 15 townships over the next year, using hands-on visual training and demonstrations. Community awareness is an important part of the programme.
Yae Oo, a tiny agricultural community of 300 residents, is also making progress. Until recently, nearly one-third of the residents defecated in the open, using banana groves around the village to relieve themselves.
Ensuring that his community is ODF hasn't been easy, says Thet Naing, a father of two, "Even if a single household doesn't use a toilet, our village is still at risk of diarrhoea." Only two of the 92 homes have yet to build toilets.
Flies used to be a common pest and residents regularly complained of excrement being trampled back into their homes. Bouts of diarrhoea, a major killer of children aged under five, were common, Thet Naing said.
Under CLTS, communities are mobilized and assisted to conduct their own appraisal and analysis of open defecation, and initiate their own strategies to become ODF. "The CLTS approach has the promise to position Myanmar for accelerated progress toward improved sanitation coverage, which is clearly linked to better health," Shrestha said.
The approach also recognizes that merely providing toilets to beneficiaries does not necessarily guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches set high standards and offered subsidies as an incentive.
In the 1980s, much of the Burmese government's efforts focused on encouraging ventilated pit latrines, rather than eliminating open defecation, but recent studies reveal uneven adoption, problems with long-term sustainability, and only partial use by beneficiaries.
It also created a culture of dependence on subsidies, while open defecation and the cycle of faecal-oral contamination continued to spread disease.
Open defecation continues
Despite this week's announcement, there are still huge challenges in stamping out open defecation. A 2012 updated joint report by the World Health Organization (WHO) and UNICEF notes that about 8 percent of Myanmar's rural population still defecate in the open, against 1 percent in urban settings.
A separate UNICEF survey undertaken with the Ministry of Health, covering 6,000 households in 24 townships across nine states and regions in Myanmar, found that more than 7 percent of families defecate in the open, either in the field or in their family compound.
Of these, 62 percent reported having at least one household member working in the field, 85 percent said no latrine was available in the field, and 6 percent said they could not use their latrines at home for an average of four weeks every year, mostly due to flooding.
As a result, almost 42 percent defecated in the open during that period, the survey revealed.
Unsanitary environments allow diarrhoea-causing pathogens to spread more quickly. "Fly-proof latrines are crucial. As the usage of fly-proof latrines was previously low, people in the area were more vulnerable to diarrhoea," said a government health worker.
According to UNICEF, diarrhoea persists as a major cause of child mortality in Myanmar.
The UN estimates that around 40 percent of the world's population engage in open defecation, resulting in some 2 million preventable deaths a year, mostly in children killed by a variety of dysentery-like intestinal ailments that result from ingesting human faecal matter.