African countries, although serious about safe and total sanitation, are likely to miss Sustainable Development Goals by 2030
Djibouti has Africa’s worst sanitation coverage in rural areas; and reported a shocking 17 per cent increase in open defecation during 2000-2015. One in every four persons goes out to defecate; in rural areas, three in four defecate in the open.
But nobody talks about it. The decade-long spell of drought overwhelms discussions on sanitation. For the world outside, the tiny country is talked about for an entirely different reason—3.3 per cent of the country’s population are refugees, from the Yemen war. So the discussions mostly hover around the humanitarian crisis involving migration.
However, the world is discovering the impact of the lack of access to safe sanitation on the humanitarian crisis brewing in the country. Djibouti is facing a health emergency as water-borne diseases have afflicted the entire population, especially children and women. Most of the waterbodies are now contaminated with faecal remains. And this poses a double whammy for the country which is grappling with severe drought for nearly a decade.
As such, Djibouti gets just 200 mm rainfall a year. Only 0.01 per cent of its land is arable. Most of the country’s water sources are either dry or hardly carry any water. According to the United Nations International Children’s Emergency Fund (UNICEF), the limited water supply and stretched services have left nearly 100,000 drought-affected people, living along migration routes, with no access to safe water, and obviously sanitation. The constant flow of refugees in an already safe sanitation-deficit country has made the situation unmanageable.
Djibouti’s capital—also called Djibouti—is home to half of the country’s population. It is only here that one can see the presence of household toilets. But a booming population is making the situation worse. With three-fourths of Djibouti’s population living below the poverty line and more than 50 per cent of rural population food insecure, urban settlements like the capital city are witnessing a deluge of migration of rural inhabitants due to drought. This has increased the demand for basic necessities like water and sanitation. For example, Djibouti city dwellers may have the luxury of having toilets in the houses, but access to sanitation services is still underdeveloped, particularly in the densely-populated southern suburb of Balbala.
Urban areas are finding it difficult to manage wastewater. “Until March 2014, wastewater collected in Djibouti was discharged into the sea without treatment. A sewage treatment plant was commissioned with funding from the European Union (EU),’’ says Radwan Abdillahi Bahdon, Djibouti’s Director of Sanitation. But such initiatives are a drop in the ocean.
The government has been trying to provide financial as well as technical assistance to residents for building mostly primitive and unsafe drop hole toilets. But it is unable to cope with the demand. Djibouti shares a long porous border with Somalia and Ethiopia. There is constant movement of both people and livestock, especially during the lean season (June-September) when nomadic communities often migrate from neighbouring countries to Djibouti in search of pastures for their livestock. Such displaced populations add to the pressure on the already precarious livelihoods in these areas and this is further aggravating food insecurity, as well as overburdening the fragile service delivery systems for nutrition, water and sanitation, health, child protection and education.
Moreover, the rise of acute watery diarrhoea and cholera outbreaks in neighbouring countries has exposed Djibouti to a high risk of epidemics in view of its fragile health systems—low rate of access to safe water and improved sanitation and limited knowledge of key hygiene practices. It is expected the country may well miss its Sustainable Development Goal targets on safe sanitation practices.
But other African countries, with relative advantages, are also finding it difficult to meet this basic target.
Take Nigeria for instance, a relatively prosperous country. Unlike Djibouti, Nigeria has reduced open defecation by 6 per cent during 2000-15. Still about 24 per cent of its population defecates in the open, making Nigeria third-worst in the world in terms of open defecation, after India and China. Notwithstanding this progress, the country typifies Africa’s big challenge: shifting from basic toilets to improved sanitation services. Only 36 per cent of Nigeria’s population has access to improved sanitation.
For the hard-earned economic progress, this is bad news. The World Bank estimates that poor sanitation costs Nigeria US $3 billion annually, or 1.3 per cent of the country’s GDP. The country already attributes the annual deaths of 124,000 children under the age of five to outbreaks of diseases like diarrhoea and cholera linked to lack of sanitation. For 2018, Nigeria has budgeted US $2.7 million for health emergencies and contagious diseases. It also budgeted US $5.5 million for expansion of water, sanitation and hygiene facilities. An Abuja-based independent environment expert, Ayuba Danasabe Umar, says, “Adequate public toilet facilities would rid the country of faecal contaminants that cause enteric diseases and gastroenteritis.”
In 2014, Nigeria took the first steps to be open defecation-free by 2025. But with a change in strategy: involving communities to ensure quality. The National Council on Water Resources (NCWR) partnered with UNICEF to roll out the strategy.
Federal ministries—health, water reso urces, environment, education, housing and urban development and women affairs—converged their activities to attain the target. Alhaji Sidi Abbas, executive director of Sokoto State Rural Water Supply and Sanitation Agency (RUWASSA), says initially Tangaza local government area of Sokoto state was selected for the project. Its success through community-led total sanitation (CLTS) campaigns has prompted the government to expand the strategy to 23 areas in the state.
CELEBRATED WITH CAUTION
As they say, there is no one solution to a crisis that criss-crosses a continent. Ethiopia is an example of winning with a warning. It recorded the highest global reduction rate in open defecation—based on proportion to population. Haimanot Assefa, a rural water supply specialist with UNICEF-Ethiopia, says the country has shown a 53 per cent reduction in open defecation: from 80 per cent in 2000 to 27 per cent in 2015.
Ethiopia is an example of scaling up CLTS along with a much-needed change in strategy—making it a part of the health policy. The country has been successfully implementing its unique Health Extension Programme (HEP) under which water, health and sanitation issues are approached as inter-related concerns. The impressive reduction in open defecation coincided with a similar increase in water supply access coverage, which increased from 14 per cent in 2000 to 82 per cent in 2016 in rural areas.
But this does not mean improved quality of sanitation. The National Hygiene and Environmental Health Strategy confirms that improved toilet coverage in the last 25 years is only 28 per cent. Citing a recent study, Assefa, says that over 90 per cent of urban residents use an on-site sanitation facility, of which nearly 80 per cent are dry pit latrines. He says with less than 3 per cent people having access to a sewer connection, wastewater is continuing to contaminate waterbodies.
Ayantu Taffa, a resident of Kebelein of the Oromia Regional State, says, “Our family has a pit toilet access and a dug well. However, there is no way we can ensure the safety of water.” She adds that her children often suffer from diarrhoea and cannot attend school due to water-borne diseases. Ethiopia is the worst trachoma affected country in the world, with women as well as children aged 1-9 at the highest risk of infection, according to Abireham Misganaw, a public health expert and a member of the Waste Management Team of the Ethiopian Ministry of Health. He cites a national survey stating that the prevalence of active trachoma for children in the age group 1-9 is 40 per cent because of lack of improved access to water and sanitation.
The Ethiopian National Hygiene and Environmental Health Strategy says: “Poor sanitation costs Ethiopia 2.1 per cent of the national GDP. Yet, eliminating the bad practice would require only 6 million improved latrines to be built and used.”
Dagnew Tadesse, director with the Hygiene and Environmental Health (HEH), Directorate of the Ministry of Health, says, “Ethiopia should now turn its face to ensuring improved quality sanitation and water supply schemes.”
TEST OF IMPROVED SANITATION
In Tanzania too people are not reaping the health gains expected through improved levels of sanitation. The case of Mashabani, a 34-year-old resident of Magodani village in Temeke district of Dar es Salaam region, is a testament to this challenge. Mashabani thought that owning a toilet would rid her family of water-borne diseases. “But I and my six children continue to suffer. I spend US $15 every month from our total earning of US $90 on treating water-borne diseases,” she says. She has an open pit toilet. For close to three months, it remains flooded due to rains. “My waste gets mixed up with other water sources and the result is that we consume contaminated water.”
Abdara Juma, the chairperson of the village, says, “We have toilets, but they are of bad quality.” Since August 2015, the country reported 31,291 cholera cases with a death toll of 522. Given the low income of Tanzanians, residents can only afford such basic toilets that costs up to US $44. “Since most residents share toilets, without clean water supply, the women suffer from urinary tract diseases,” says Muamma Muskin, a mother of five children, who herself suffers from an urinary tract infection.
However, Anyitike Mwakitalima, coordinator of the National Sanitation Campaign, a non-profit, says sanitation is not the primary reason for cholera outbreaks; the Ministry of Water has failed to supply clean water to all the regions.
Ali Nyanga, who is with the Ministry of Health Community Development, Gender, Elderly and Children, argues that water supply and sanitation cannot be addressed in a standalone manner, both needs to be safe and sustainable for a healthy country.
Tanzania aims to provide a basic toilet to every household by 2021, says Rowland Titus, who works with UNICEF-Tanzania. In December, 2017 Vice President Samia Suluhu launched a campaign called “Nyumbu Ni Choo” (a house without a toilet is not a house at all). But both UNICEF and the World Bank, who are working with the government on sanitation issues, think it is an ambitious goal. At the current pace of work, the target can be met only by 2027, which is just three years away from achieving the deadline of the Sustainable Development Goal. The Joint Monitoring Programme (JMP) of UNICEF and WHO found in 2015 that around 11.26 per cent of the population practiced open defecation, which was a 2 per cent increase during the 15 years period.
But Anyitike says only 5.8 per cent of the country defecates in the open. He explains that in the first phase of sanitation programme through CLTS in 2012, the open defecation rate was 20.5 per cent. But that does not mean improved sanitation facilities, explains Rwegoshora Rwekaza Makaka, water supply and sanitation specialist with the World Bank group.
Improved sanitation comes with a high price tag. Many of Africa’s relatively prosperous countries find it unaffordable. Take Kenya for example, which aims 100 per cent coverage of safe water and basic sanitation services by 2030. For this, it annually requires US $12.9 billion for water supply, US $4.8 billion for sewerage, US $601 million for basic sanitation and 57 million for basic hygiene. “But, the government budget available for sanitation is only 6.5 per cent,” says Vincent Ouma, of the Kenya Water and Sanitation Civil Societies Network (KEWASNET), a national network of water civil society organisations in Kenya.
Technology options are also limited. According to the Kenya Demographic and Health Survey (2014), over 60 per cent of rural households rely on non-improved sanitation facilities. Different agencies work to promote viable toilet designs. “Most of the toilets are dry pit toilets. The efficacy of such toilets lies in its reusable nature. But due to the lack of acceptance among people for faecal matter to be used as manure, the user usually shuts it down and builds a new toilet or calls the companies to clean it up. The management of faecal matter is our top concern,” says Janet Muse, head, WASH Hub, a dedicated cell of Ministry of Health, Kenya. “The EcoSan Promotion Project is one such pilot project which was implemented in the areas of Nyanza, Western and North Eastern provinces. Despite health, sanitation and economic benefits, this toilets model had very low acceptance among rural households,” adds Janet.
Plan Kenya introduced CLTS in Kenya in May 2007. The idea had instant acceptance. In 2010, Ministry of Public Health and Sanitation embarked a pilot project in the six districts of Nyanza and Western Kenya. Later, the ministry adopted CLTS as a key strategy at national level. This led to the launch of the Open Defecation-Free (ODF) Rural Kenya Campaign in May 2011.
But, meanwhile, it lost the tempo. A study published in East African Medical Journal on assessment of CLTS in rural areas, concluded that it failed to result in open defecation free status as expected. The study cited inadequate monitoring of the process, inadequate funds and conflicting work demands of government officials as the reasons. In 2014, there were only 3,131 certified ODF villages of the 11,641 villages. “Counties need constant support to develop legislations, policies and effectively utilise available financial resources and channelise more resources,” says Kimanthi Kyengo, director, Ministry of Water and Irrigation.
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