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Fact of the matter
MAY 10 -
Recently, I visited a public school in Chabahil to enrol one of my distant relatives’ son who hails from Birtamod, Jhapa. While his admission was being processed, I had to use the toilet. As I entered the latrine, I started feeling woozy because of the stink and excreta scattered all about. I immediately rushed out to wash my feet at the school water stand. But the tap yielded nothing. It was dry and dirty. I had this haunting thought: We keep talking about the need to build latrines and water spouts in remote districts like Baitadi, Jumla and Rukum while we are still way behind in maintaining proper hygiene and sanitation practices even in the schools located right here in the capital.
Teachers at this relatively old school have been preaching day in and day out about personal cleanliness and hygienic practices for long, but have themselves failed to practice what they preach. Otherwise, the school latrine would not have been left in such a filthy condition. The irony is that this is the case not only with this school, the sight of similarly maintained toilets is so common in public places like temples, theatres, restaurants, shopping malls, hospitals and even the arrival and departure lounges of the lone international airport. This tells us how negligent we have been — both at the individual and institutional levels — when it comes to maintaining toilets. And I will not be surprised if the Lonely Planet travel guide on Nepal will have a special cautionary mention about it.
It seems teachers in Kathmandu need a special training of trainers (ToT) type of session on the school led total sanitation (SLTS) approach. The key SLTS concept is to empower children to become agents of change within their communities by engaging their families to construct latrines and practice healthier ways of living. SLTS has been instrumental in ending the practice of open defecation in many communities of the developing world. Of course, there are latrines in most of the households in Kathmandu and open defecation is not a usual sight compared to other districts. Following the SLTS strategy and targeting school children as key entry points, the drive can be launched to at least keep their schools and households clean. It has been proven that working with school children is one of the most effective methods of promoting good hygiene and sanitation practices.
If the people living in Kathmandu, where relatively basic public amenities exist, though in limited numbers, can’t internalise and practice simple hygienic behaviour, how can we expect fellow citizens living in Jumla and Rukum to live healthier lives merely because of the implementation of a three-five year long water and sanitation (WATSAN) project.
Various case studies have shown that demand for latrines does not necessarily correlate with a desirable change in sanitation behaviour. The most workable solution to propose improved behaviours is to integrate them with the existing community practices but with greater caution so that the intervention does not appear like something being imposed by outsiders. This means that the solutions have to be worked out in close coordination with the communities, utilising locally suggested ideas and materials where possible so that the communities will feel like owning the interventions and become more committed towards their successful implementation. Under this strategy, the roles of potential change agents such as community health workers, school teachers, social mobilisers, local youth and volunteers will be very crucial.
Analysts argue that rural sanitation projects have, by and large, not enjoyed high levels of success in the developing countries. Although many cases have been documented on what works and what does not based on experiences with numerous discarded, broken, unused and improved latrines worldwide, still the mortality and morbidity rates due to water and sanitation related diseases are high.
According to UNICEF, 17 million people defecate in open areas everyday causing a loss of about 4 percent of the Gross Domestic Product in Nepal. The Millennium Development Goal (MDG) targets on sanitation can be reached only if an additional 14,000 households are served every month. A UNICEF report maintains that proper use of toilets and practice of hand washing can reduce morbidity by 35 percent and 43 percent respectively.
Just because of lack of proper sanitation and hygienic practices and shortage of potable drinking water in many pockets of the Far Western districts, a diarrhoea outbreak claimed more than 200 lives last year alone, and an ugly sign of its resurgence is emerging. Though the District Public Health Offices claim being on high alert to contain a possible outbreak of the disease, the Commission for the Investigation of Abuse of Authority (CIAA) has directed the Department of Health Services on the proper deployment of doctors in the respective regions and to submit a detailed report on the current status of doctors, medicines and strategies for fighting a possible outbreak.
Recently, the Office of the United Nations Resident and Humanitarian Coordinator has also urged the government to take appropriate measures to control a possible outbreak of diarrhoea. It is also good to note that some humanitarian organisations have started social mobilisation work on hygiene promotion and distribution of oral rehydration solution, toiletries and chlorine in last year’s affected pockets.
Though various non-governmental organisations are involved in the implementation of a number of WATSAN projects in the Far and Mid-Western regions and beyond, it is very critical to have effective coordination between these organisations and the government to minimise overlapping and duplication of efforts in setting out a coherent mechanism in place to curb the looming crisis in time.
It is equally important to understand the limitation of the government and service providers because of the long existing weak institutions and regulatory mechanisms in the country. Hence, it is critical to proactively engage community people in the WATSAN projects and programmes with special reference to advocacy and campaign components to raise awareness on sanitation and hygienic practices and behaviours rather than just addressing the seasonal outbreak of diarrhoea. Until the people themselves internalise the consequences of failing to maintain proper sanitation and hygienic practices, outbreaks of water-borne diseases like diarrhoea will occur as a seasonal phenomenon. And the average daily flow of 14 patients with diarrhoea visiting Sahid Shukraraj Tropical Hospital in Teku will only see an upward trend.
Upadhyay_b@yahoo.com
Posted on: 2010-05-11 07:58
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