Academic journal article Bulletin of the World Health Organization

In the Market for Proper Sanitation: Poor Sanitation Helps Spread Disease, Yet Efforts to Provide Subsidized Toilets Have Been Resisted for Cultural Reasons in Many Developing Countries. to Improve the Rate of Uptake, Some People Are Now Advocating a Market-Based Approach

Academic journal article Bulletin of the World Health Organization

In the Market for Proper Sanitation: Poor Sanitation Helps Spread Disease, Yet Efforts to Provide Subsidized Toilets Have Been Resisted for Cultural Reasons in Many Developing Countries. to Improve the Rate of Uptake, Some People Are Now Advocating a Market-Based Approach

Article excerpt

The main reason so many people are without toilets is because they don't see a need for them, according to Jack Sim, founder of the World Toilet Organization, based in Singapore. Without demand, he says, there is no supply, no distribution network and no interest. "When people talk about sanitation, they usually talk water; it is easier from a social point of view. They even describe human faeces as 'waste water', 'grey water', 'black water', anything but what it is," Sim adds.

Toilets are often regarded with suspicion in parts of the developing world. The relative failure of projects that provided heavily subsidized or free toilets has caused policy-makers to rethink how the United Nations' Millennium Development Goal (MDG 7) on environmental sustainability might be met by 2015.

MDG 7 aims to halve the proportion of people living without access to an improved source of drinking-water and basic sanitation by 2015. Basic sanitation is defined as having access to excreta disposal facilities, such as a sewer or a septic tank, a pour-flush latrine, a simple pit latrine or a ventilated improved latrine. "Improved sanitation" facilities include flush toilets or pit latrines, if they are not shared between households and provide privacy.

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The latest trends reported by the Joint Monitoring Programme (2008) of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) show that the global MDG 7 drinking-water target will be met, but progress towards the sanitation target is significantly off-track.

In 1990, 46% of people worldwide had no access to "improved sanitation". By 2008 this had been reduced to 38% and is projected to fall to 33% by 2015, while the MDG target is to bring this down to 23% of the projected world population of 7.3 billion. Even if this target is met, 1.7 billion people will remain without access. The WHO/ UNICEF programme projects that by 2015, 2.4 billion people will lack "improved sanitation" and 1.1 billion of those people will still defecate in the open.

Jean Humphrey, an associate professor at Johns Hopkins Bloomberg School of Public Health in the United States of America, says that most people involved in the provision of sanitation believe free toilets will not be used. "Some methods (such as the community-led total sanitation projects promoted by UNICEF) do not provide any subsidies. Instead, people are triggered to want a toilet and to build it out of existing sticks, grass, logs, stones, etc.," she says.

Sanitation is central to the Asian Development Bank's development agenda and the organization is keen to improve toilet provision. Anand Chiplunkar, principal water supply and sanitation specialist at the bank, says: "The economic returns of good sanitation have been demonstrated universally. We must find innovative ways of translating them into effective and sustainable solutions to provide environmentally sound sanitation. The task is difficult, as we need to overcome traditions, beliefs, politics and poverty."

An internal evaluation of several projects undertaken by the Water and Sanitation Program, an international partnership led by The World Bank, revealed the most successful projects provided only a small subsidy, equal to about half the cost of the latrine. The more heavily subsidized projects failed. "The reasons for this are interesting; in some cases the subsidies are given as a sort of reward to political leadership for universal toilet construction," says Humphrey. "The leadership, anxious for the money, impose toilets on the most resistant households, who then do not use them because they didn't want them in the first place."

A second reason is that sanitation promotion or behaviour change is essential for success. Programmes that used all or most of their budget on building toilets without using any resources to change people's behaviour have failed. …

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