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THE limited access to improved sanitation is a serious health risks to billions of people particularly those who live in developing countries. Globally, 2.6 billion people are without access to improved latrines and 1 billion people practice open defecation.

In Tanzania, 91 per cent of rural population and 78 per cent of urban population have no access to improved sanitation.

This translates to approximately 26 million people use unsanitary or shared latrines and 5.4 million have no latrine at all and defecate in the open.

The world is likely to miss the MDG sanitation target if the current rate of acquiring improved facilities continues. Unless enormous efforts are made, the proportion of people without access to improved sanitation will not be halved by 2015. Recent surveys indicated that 18,500 children die every year from diarrhoea diseases, this equates to 50 children dying every day or two children dying every hour.

Concerted efforts both locally and globally are therefore required to expedite the momentum by encouraging the wider population to improve their sanitation facilities. Events such as Global Hand Washing Day (GHWD), World Toilet Day (WTD) and Sanitation Week are quite useful in sensitising the communities to get fully involved in sanitation and hygiene issues.

Although the events are seasonal the impact is potentially magnificent and life serving. The Ministry of Health and Social Welfare (MOSHW) and other partners in 2009 conducted a toilet coverage study with the aim of wanting to find out the standard of toilets that Tanzanians were using both in urban and rural areas.

The findings showed that 9 per cent of rural households own toilets that had a built in hole, is cleanable, has a door and roof and has a facility to wash one's hands while for urban households it was 22 per cent. Mid last year, President Jakaya Kikwete launched the national sanitation campaign which is a four-year campaign that will cost over 25bn/- and will enable 1.3 million households and 700 schools to have quality toilet facilities.

The MOHSW Assistant Director of Environmental Health, Hygiene and Sanitation, Mr Elias Chinamo recently told this paper that since the start of the implementation of the campaign, there has been a slight improvement in the standard of toilets that are being erected and that the number of households in rural areas had increased to 10 per cent and urban areas it was 25 per cent.

"It's slightly over a year and we are already seeing progress. It is my conviction that come 2015, we will meet the target of having 50 per cent of households having standard toilets. Our biggest challenge at the moment is changing people's behaviour such that they attach importance to their toilets because we often see people building mansions but without bothering to have toilets," he said.

Renowned American novelist, philosopher, playwright and screenwriter, the late Ayn Rand once said that 'When man learns to understand and control his own behaviour as well as he is learning to understand and control the behaviour of crop plants and domestic animals, he may be justified in believing that he has become civilised'.

Changing one's behaviour is unusually very difficult, changing another person's is a lot of times a very uphill task. Personally I think after 50 years of independence, sanitation in the country is still pitiful largely because of the national priorities. Earlier this year in April, the National Health Research Priorities (2013-2018) were launched by the Vice-President, Dr Mohamed Gharib Bilal.

In a ranking order of 1 to 15, sanitation, water and hygiene for both Biomedical Research Priorities and Health Systems Research Priorities featured on seventh place while Social Determinants Health Research Priorities put key population behaviours at fifth place from 11 rankings.

If I was ever given a chance to air my views on how to quicken the pace, I would suggest we borrow a leaf or two from Dr Bindeshwar Pathak, a humanist and social reformer of contemporary India who is the founder of the Sulabh International, a sociologist and pioneer in social reform especially in the field of sanitation and hygiene.

In the 40 odd years that the organisation has been in existence, 1.2 million pourflush toilets have been constructed, 7500 public toilet cum bath complexes constructed and maintained, 200 biogas plants erected, 54 million government toilets constructed based on Sulabh design, 10.5 million people using toilets based on Sulabh design daily and has created over 30 million job opportunities.

According to India's recent census of September this year, nearly half of India's 1.2 billion people have no toilet at home, but more people own a mobile phone. Only 46.9 per cent of the 246.6 million households have toilets while 49.8 per cent defecate in the open.

The remaining 3.2 per cent use public toilets. Looking at these numbers, one would be quick to say that Sulabh International's efforts in trying to solve India's sanitation woes have been a drop in the ocean. This may be true depending on which side of the fence you are on but for a local NGO that hasn't taken a single grant from the government, the milestones that they have reached speak volumes.

The Founder through his organisation has been able to pull this near miracle through a simple invention, a twin pit latrine with a steep hole that doesn't require a lot of water to flush. When Sulabh first started, they were serving the lowest caste members who over centuries had to clean people's toilets and carry the load on their heads.

Through this quest, they ended up serving the majority of the India population as well as other countries. Dr Pathak recently said that Sulabh International is in its infant stages of opening up an international arm and plans to build toilets in 50 countries in Asia, Africa and Latin America.

"We are going to construct five public toilets, Sulabh individual toilets in 500 houses and biogas toilets in 100 schools in the respective countries," said Dr Pathak, after receiving the Lifetime Achievement Award instituted by the Rotary Club of Madras, for his outstanding contribution as a humanist and for being a social reformer, who has made a difference in the lives of many.

The Sulabh model has also been adopted by a number of countries, including China, Bhutan, Bangladesh, Afghanistan, Burkina Faso, Ghana, Kenya, Mali, Nigeria, Senegal, Tanzania and Zambia for expansion and promotion of sanitation facilities.

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