Report on the WSSCC-WHO Stockholm seminar Sanitation and Hygiene: Approaches for Sustainable Development
In the afternoon of Sunday the 12th of August, WHO and WSSCC jointly organised one of the first seminars of the 2007 Stockholm World Water Week. The seminar, entitled 'Sanitation and Hygiene: Approaches for Sustainable Development', brought together sanitation and hygiene related experiences from Bangladesh, Zimbabwe, Ghana and South Africa.
Under moderation of Stephen Turner, Policy Director of WaterAid, the session kicked off with a keynote speech delivered by Jon Lane, Interim Executive Director of WSSCC. In a tone-setting speech which was quoted throughout the week, Jon Lane explained the main motivations and steps to move from a world that is 'half clean and half shitty', to a world where everyone has safe, basic sanitation. Laying out the main arguments that motivate health professionals, decision makers, and the people themselves to take action, he pushed for the need to scale up existing good ideas, think on a much bigger scale, and achieve unity in the messages that the sector gives out.
Summary of Jon Lane's keynote speech
One of the 'good ideas' out there, is the highly successful Community-Led Total Sanitation (CLTS) programme in Bangladesh, established and piloted by the NGO VERC. Mr. Shaikh Halim, Executive Director of VERC, in a detailed presentation explained the workings of the CLTS, and the reasons for its success. CLTS aims to achieve a 100% hygienic sanitation, which means a total ban on open defecation, hand washing after use of the latrine, good personal hygiene practices, well managed latrines and water points, and so on. The approach uses social capital and peer pressure, recognises and promotes indigenous knowledge, values and tradition, and explores local skills and technologies. Not only has it been very successful in Bangladesh itself, but aspects of CLTS are now also being introduced in Asia (for instance in Nepal and Indonesia) and Africa (Nigeria, Uganda, Mozambique, and more).
Presentation on Community-Led Total Sanitation
Focusing especially on hygiene education and promotion, the second presentation highlighted Zimbabwe's Health Clubs. Set up and run by the communities, these Health Clubs play a vital role in wide-spread community education and behaviour change, on a wide range of health and hygiene related topics. Supported by NGOs and in accordance with Participatory Health and Hygiene Education (PPHE), community groups and schools have established Health Clubs that not only educate their peers and community members, but also provide assistance to those in need, and set overall standards for behaviour and conduct in the community. In a situation where the economic situation is constantly worsening and government service provision becomes more and more scarce, the self-help value of the Clubs is vast, also because the Clubs become hot-beds for income generating activities. This factor draws in the men to the Health Clubs, which is perceived as a positive development as it facilitates their exposure to the health and hygiene messages as well.
Presentation on Zimbabwe Health Clubs
In the third presentation, Robert Abaidoo of the University for Science and Technology in Ghana spoke about the linkages between the lack of sanitation and urban agriculture. In Accra as well as other urban centres in Ghana, the practice of small-scale urban agriculture is widespread. However, the wastewater being used by the farmers to water their crops is almost always contaminated with faeces, which in turn means that the crops get contaminated and those eating them fall ill. Developing better sanitation systems that prevent contamination of the water takes time, so in the mean time the programme tries to raise awareness of the dangers, and educate the farmers as well as the users and consumers of the crops how to adopt certain hygiene behaviours that will reduce the risks involved.
Presentation on Wastewater in Urban Agriculture
The last presentation of the seminar spoke about a large peri-urban programme in the eThekwini metropolitan area (Durban) in South Africa constructing Urine Diversion Toilets (UDTs) for low-income families in the rural areas around the city. Presented from the perspective of the evaluator of the programme, the presentation highlighted the health-impacts the programme has had so far.
Presentation on the eThekwini UDT programme evaluation: Part1, Part2, Part3, Part4, Part5
All presentations proved fruitful grounds for questions and discussion. A challenge raised by Mr. Halim emphasized the often delicate relations between civil society and government, and the issue of subsidy. While CLTS is a non-subsidy approach, the Government of Bangladesh has a subsidy-policy for the poorest families. While the Government supports the premise of CLTS, it also wants to maintain its subsidy stance.
Both the Bangladesh and Zimbabwe presentations once more underlined the need for genuinely people-centred, demand-driven approaches that give people a choice and acknowledge their decision-making power. This formed a contradiction with the eThekwini programme, where households are essentially presented with only one option, namely the UDT. While it can be argued that the UDT is the most appropriate and sustainable technology for the situation and the results of the programme in terms of customer-satisfaction and health improvements have been very good, this doesn't take away the fact that people have not been presented with a choice, and a range of options. This sparked debate as to whether in some cases, slightly top-down approaches are justified.
Similarly, the role of regulation and enforcement was debated. In the past in certain countries, households were obliged by law to have a certain level of basic sanitation, and their compliance with these rules was actively enforced. Would there be value in re-introducing such a system? And what should be the balance between such enforcement, and behaviour change based on education and appreciation?
Other topics discussed included the economic value of excreta, the problem with unreliable coverage data, what to do where civil society is weak, how to ensure that successful approaches are adopted into government policies and programmes without loosing their authenticity and success, and the need to move from these successful projects, to strategic, long-term, national programmes.
In summarizing the discussion, Stephen Turner targeted the role of champions. External champions can drive a process up to a certain point, but when does the championing need to come from within the community -when does a programme or process become really internally driven? And how strong is the role of peer communication, and peer pressure?
Looking forward to the International Year of Sanitation in 2008, Stephen noted that the sector will be embarking on a major advocacy campaign, and it needs to use the many positive lessons learnt from programmes such as discussed in the seminar. There is a need to get other people talking about sanitation. To make them understand that sanitation will make a difference to the environment, to health, and to development.