ENVIRONMENT

"The Taboo of Poo"

Why are we so reluctant to talk about one of the greatest threats to human health?

Text by SEAN MOONEY

Picture this: The setting sun is spreading a warm glow over your small rural village, but you are inside your house doubled over with intestinal pain. All you want is for darkness to fall so you can stagger out into the night, find a relatively secluded spot in the fields and void your bowels. You have been resisting the urge to defecate for most of the day as it is considered disgraceful in your community for a woman to be seen heeding nature’s call. You sometimes suffer from urinary tract infections and constipation, and you have almost been bitten by scorpions and snakes while squatting in the open. You have even suffered sexual violence at the hands of unknown men under the cover of night. You fear for your own health and safety, and for that of your young daughter and disabled mother. Your life is tormented by the taboo of poo.

This sad tale is repeated every day in poverty-stricken regions across Asia. It is estimated that about 1.7 billion people in southern and eastern Asia don’t have the proper means of dealing with their human waste. Many are forced to practise what is known as ‘open defecation’, which involves the use of buckets, plastic bags or simply nothing at all. They might use fields, rivers, railway lines or squalid, foul-smelling unsanitary latrines. This is not only embarrassing and undignified, it is also extremely dangerous, as the majority of the world’s illness is a result of the dispersal of human faeces. Contamination of food and water with faecal matter causes the transmission of deadly diseases such as typhoid and cholera. Every year, 1.5 million children under the age of five die from diarrhoeal diseases. It’s a human tragedy, whichever way you look at it.

So why is it so difficult to get people to talk about defecation and urination? Maggie Black, co-author of The Last Taboo: Opening the door on the global sanitation crisis, says it is primarily a social issue. “From the smallest age, Indian women have had to learn to hold themselves in, in such a way that they often do themselves internal damage,” she says. “If a respectable Indian woman disgraces herself by being in any way identified with having to use a toilet, how can she ever express the misery and indignity she experiences by not having one in the home? Is it surprising that customer demand for toilets is not vocal? I think this kind of social attitude – an extreme form of ‘out of sight, out of mind’ – is the main problem. There needs to be strong social endorsement for things to change.”

Thérèse Mahon runs WaterAid’s country programs in Bangladesh, India, Nepal and Pakistan. She thinks that the absence of discussion about women’s personal matters means that the provision of private toilets is given very low priority. “This paradox results in women living in a constant state of anxiety as they strive to meet their sanitation needs without losing their dignity,” she says. “While men and boys are found squatting by roadsides in broad daylight, similar behaviour for women and girls is unthinkable. If there are no separate latrines for girls at schools this can also prevent girls from attending school particularly once they reach puberty.”

But this is not just a South Asian problem. Sanitation disaster areas exist in that other extremely populous Asian nation, China, as well as many other countries across south and south-east Asia. World Bank Senior Water and Sanitation Economist Guy Hutton estimates that the cost of not investing in sanitation is US$9 billion per year in Cambodia, Indonesia, the Philippines and Vietnam alone. Nor is it simply a rural issue. The Indian co-ordinator for the Swiss-based Water Supply and Sanitation Collaborative Council (WSSCC), Depinder Kapur, believes sanitation is a health time bomb for Asia’s urban areas, where more than 50 per cent of the population lives in shanty towns and slums. “The governments have no accountability to provide for basic services as the people living there are seen as illegal tenants,” he says. “Expensive infrastructure projects for sanitation are being brought in that bypass the slums.” Mr Kapur cites the example of the city of Trichi in south India, where the non-government organisation (NGO) Gramalya, along with other NGOs, has built community-owned and managed toilets for nearly all of the city’s urban slums. “The challenge that they faced was not technology but working with the municipality in slum areas to erect and maintain community sanitation and bathing and washing complexes,” he explains. “To provide for not just sanitation but also all other hygiene facilities for poor slum dwellers.”

In an effort to encourage large-scale action to tackle this problem, the United Nations General Assembly declared 2008 the International Year of Sanitation (IYS), with a stated aim of ‘breaking the taboo’. Thérèse Mahon feels that the IYS “helped to galvanise governments, civil society, communities and other stakeholders around the most neglected Millennium Development Goal”. This goal, declared by the United Nations in 2002, aims to reduce by half by 2015 the numbers of people without access to sanitation in 1990. But judging by current progress, it will take until mid-century to get anywhere near this target.

So what can be done? Ms Mahon suggests that all the goals and declarations that have been made by governments need to translate into urgent action “to ensure lasting results and to realise citizens’ rights to sanitation”. Depinder Kapur says sanitation issues are best addressed by making adolescent girls and women leaders in creating sanitation, drainage and waste-disposal systems. However, Mr Kapur admits that many challenges lie ahead, and that they might require a rethink of current practices. “Making a loo in the rural setting of Asia means creating additional space and finding water to clean the toilets,” he says. “In terms of behaviour, rural people find it easy to go out and defecate and this needs to be addressed by bringing in issues of dignity and behaviour change and not the health imperatives as is being done currently by many agencies. It is difficult for rural people to understand health impacts of safe sanitation.”

This focus on dignity and behaviour change is already being employed in many parts of Asia, and is commonly referred to as community-led total sanitation (CLTS). It was pioneered in the Rajshahi district of Bangladesh in 2000 by Indian development consultant Kamal Kar, together with the Village Education Resource Centre (VERC), a partner of WaterAid Bangladesh. To put it bluntly, this strategy explains to community members that they are eating each others’ faeces. Mr Kar explains it this way: “The method used encourages local communities to visit the dirtiest and filthiest areas in the neighbourhood, appraising and analysing their practices; it shocks, disgusts and shames people. This style is provocative and fun, and is hands-off in leaving decisions and action to the community.” Thérèse Mahon says that these shock tactics create a powerful realisation within the community that collective action is necessary because if any individuals continue to practise open defecation then they will all be at risk. “This process begins to break down the notion that sanitation is not a purely private/individual matter, but is a significant issue for public health,” she says. “Support is then given to show communities how they can build low-cost, hygienic latrines using locally available materials, and technical support is provided.” Guy Hutton adds a note of caution, based on the World Bank’s experiences in Cambodia: “Sometimes [CLTS] works great, where all the preconditions are there. But we are finding that CLTS in Cambodia has many challenges due to weather (after rainy season most of the self-made latrines have broken down), traditional attitudes (preferences for doing your business in nature), and also supply constraints (non-availability of good and cheap materials for constructing a long-lasting but simple latrine). It needs a sustained effort, and close collaboration of all the national and local actors.”

Once a community is aware that it has a sanitation problem, it needs to work out how to fix it. Mr Hutton says that there are as many different solutions as there are types of communities. “Asia varies from poverty-stricken rural areas and slums to first-world mega-cities, so the technology required varies from a cheap basic [but hygienic] pit latrine in rural areas, to public toilets for slum areas, to costly water-based sewerage (with treatment) in cities.” Maggie Black states that the main alternative technology is the pour-flush pit toilet. “This is used in many countries, including India, Bangladesh and Thailand, and has many, many different variations,” she says. The World Health Organization’s A Guide to the Development of on-Site Sanitation outlines a selection of sanitation systems, with indications of their suitability for particular situations, the constraints on their use, and their disadvantages. There’s everything from simple pit, pour-flush and composting latrines, to septic tanks and aqua-privies. Factors to be considered include cost, cultural acceptability, simplicity of design and construction, operation and maintenance, and local availability of materials and skills. The Compendium of Sanitation Systems and Technologies, published by WSSCC and the Swiss Federal Institute of Aquatic Science, sheds even more light on the diversity of sanitary systems and technologies available. It offers a mind-boggling selection of sanitation systems, such as waterless systems with urine diversion, double ventilation pits, aquaculture ponds and dehydration vaults, as well as so-called ecological sanitation systems.

Maggie Black sees an important role for ecological sanitation, which usually separates urine and faeces. The faecal matter can then be treated to make safe fertiliser pellets rich in nitrogen, phosphorus and potassium. Considering that an IYS study estimated that 90 per cent of human excreta in China is used in agriculture, a system that ensures that raw sewage is not put on the fields is extremely useful. One of the great characters of the sanitation movement is Jack Sim, head of the World Toilet Organization. He says that if we recycle our nutrients back to the farms, we can reduce our reliance on energy-intensive chemical fertilisers. “We will also help conserve the depletion of phosphorous mines,” he says. “I think we really need to know that our phosphorous rock mines are depleting at a rapid pace and chemical fertiliser supply will soon face a similar crisis to the oil-depletion problem. Therefore, the sustainable way is to recycle our excreta into fertiliser and soil conditioner.”

This year’s Stockholm Water Prize Laureate Dr Bindeshwar Pathak is the founder of the Sulabh International Social Services Organisation, a non-government group that since 1970 has installed low cost and ecologically sustainable toilets in more than 1.2 million houses across India. Dr Pathak  has also designed biogas technology that allows for the complete recycling and reuse of human excreta from public toilets. Biogas is produced by anaerobic digestion of human excreta in a biogas digester, and is used for cooking, lighting and electricity generation. In addition, biogas plant effluent is treated by a simple method to make it colourless, odourless and pathogen-free, rendering it quite safe for irrigation or discharge into any water body. These facilities are used by 10.5 million people in India and have made a marked difference to the environment, both in urban and rural areas.

Despite the immense challenges facing the fight for better sanitation, with the right technology, implementation and funding, progress has already been made. Now it’s time to tackle the reluctance of many societies even to talk about human-waste management. Jack Sim says that the taboo of poo can be overcome with a concerted effort to be open about the issue. “The problem is people refuse to talk about toilets, and what we do not discuss, we cannot improve,” he says. “If you ask a person how many times he eats a day, he’ll know. If you ask him how many times he visits the toilet a day, that’ll be the first time in his life he starts counting. Just like other taboos such as sex, leprosy, AIDS, women’s liberation and so on, after we are able to speak about it, we will wonder why we were so coy about it before. When public toilets are finally accepted as a lifestyle product, life will be wonderful inside the toilet – it will be a room full of inspiration!”

Sean Mooney is a writer and editor based in Sydney, Australia. He has lived and worked in Europe, North America, the Middle East and Asia. When he isn’t writing about travel and cultural issues, he is editing a group of free magazines for parents that encourage a better understanding of our children.

Did You Know?

Resources available for communities seeking sanitation solutions:

* The Compendium of Sanitation Systems and Technologies can be downloaded free of charge at www.sandec.ch and www.wsscc.org.

* A handbook on Community-led Total Sanitation is available for free download at www.communityledtotalsanitation.org/resources

* Go to www.wateraid.org/splash_out/fun_and_games/7195.asp for The Adventures of Super Toilet, a fun reminder for children of the importance of clean toilets.

* A collection of songs, photos, posters, games, artworks and other advocacy materials promoting sanitation can be found at www.worldtoilet.org/resources.asp?no=2

* The World Health Organization’s catalogue of water, sanitation and hygiene information products is online at www.who.int/water_sanitation_health/en/

* The General Assembly of the United Nations’ International Year of Sanitation website is http://esa.un.org/iys/

In May I passed through the busy Frankfurt airport and what I have always admired about that airport is the way they have tried to place sanitation facilities in almost every corner. Certainly one does not lack access to that facility no matter how needy. However, having come from a meeting of  National Coordinators with the WSSCC who had alluded to the fact that there are some marginalized communities that do not have  access to sanitation and if they do it may not be safe or dignified, I started looking at the facilities at Frankfurt from a different lens. By some stroke of coincidence I was standing with my four old just coming out of the ladies toilet where he had seen some ladies cleaning themselves up when a gentleman rushed in with a six year old girl. He ushered his little girl into the ladies, stood outside hesitantly, urgently called the girl out. Needless to mention the little girl was dancing with the need to use the loo. The father had obviously had second thoughts about leaving an unaccompanied minor alone. This gentleman rushed into the gents with the little girl. I have not used the gents before so I don’t know how it looks like but if it is the standard room that has urinals with lots of men using the toilet, I felt sense of panic for the little girl - what would she see?

When we talk about improved access and coverage for sanitation, it is generally assumed that we are talking about an adult who is able to use a latrine without supervision. In recent years a debate has emerged about meeting the needs of the vulnerable and marginalized communities. This debate looks into the different gender needs, physically disabled and perhaps the elderly, homeless and so forth. Rarely do we consider children or do we see a problem in the provision of sanitation. Children are assumed to be infants generally looked after by their parents and their fecal waste managed by the adults. And yet there are these age groups that are still not adult enough to use the public facilities alone and will need adult supervision. It is not always that adults are traveling with the same sex children, which is posing a problem on deciding which toilet to use. The forgotten or marginalized community here are children who are are still young and need supervision.

Not only do we not have latrines that are child friendly and can be used at public airports, but the technology often does not carter for children. If we look at the toilet seat, most children are unable to use the latrine without having to touch the seat, which compromises their hygiene. Furthermore seating on a large seat designed for adults is uncomfortable and must make the job even more difficult. Secondly most airports and public places are now going for automatic technologies to minimize the risk of transmitting germs; children are unable to touch the sensors that will trigger the flow of water. Thus if a child goes into the toilet alone, he will definitely not wash his hands.

In my country (Zimbabwe) the debate over sanitation and its appropriateness has long been raving. If we look at the Ventilated improved pit that has a squat hole, children are generally unable to use it. Furthermore the toilets are dark in order to control flies and it is this darkness that is a deterrent to them. There are some communities that are still using public shared latrines in some parts of Zimbabwe and again talking to parents in Mutate, they indicated that their children below the age of eight do not use the public latrines but rather use buckets. The fear is that usage of public latrines compromises the safety, hygiene and security of the children.

It seems to me that the writing is on the wall- children are the forgotten community in the provision and design of latrines. The Convention on the rights of the child which has been signed by over 180 countries emphasizes meeting the needs of the child and protecting these minors. Sanitation provision should not therefore place the children in danger (as has been recorded that some abuse takes place in toilets), it should ensure their privacy, safety and dignity. As we strive to meet our sanitation target let us think about this growing population that is sometimes voiceless and is often not given an opportunity to articulate their specific needs.

Noma Neseni, IWSD, Zimbabwe, May 2009

noma[at]iwsd.co.zw

New Steering Committee members elected

WSSCC makes its mark at the 5th World Water Forum

WSSCC Members & Partners

The widening world of WSSCC

Member article - the impact of advocacy workshops

From vision to reality: WASH Coalitions working for safe water and basic sanitation

Reaching out to people in a language they understand

WSSCC in motion May - August 2009

AND MUCH MORE!

Download the newsletter in English, French or Spanish here.

The social mobilization group, a sub-unit of the Health and
WASH clusters, was formed to support scaling up hygiene
promotion nationwide. Oxfam, Unicef and WHO are lead
agencies supporting the Ministry of Health in its efforts to
ensure a cleaner environment for today's and future generations.
The social mobilization team supports a broad scale movement
to engage people’s participation in achieving awareness and
behaviour change to prevent cholera. The team will endeavour
to involve all segments of society; decision and policy makers,
opinion leaders, bureaucrats and technocrats, professional
groups, religious associations, the private sector, communities
and individuals. The principle of community involvement is
critical to empower individuals and groups for action.

This group of sanitation ambassadors is among many other
activities mobilising for the establishment of a National Clean-up
day. Experiences elsewhere have shown that if organized well
and supported at policy level this could be an answer to the
mounting sanitation challenges in most urban areas in Africa.
Those who have travelled to Uganda where a national clean-up
day has been declared report that people take the exercise seriously
and all other essential services stop to pave the way for the clean
up. If as a foreigner you have to travel on the day, you may find
no transport because everyone is expected to be cleaning. One
visitor to that country said they had to book into a hotel close to
the airport so that once the clean up is finished, they could
easily rush to the airport to catch their flight.

This exercise has shifted responsibility for a cleaner
environment to everyone as opposed to just the service
providers. It then means that even individuals take responsibility
of their environment.

We in Harare used to have a “Keep Harare Clean” slogan which
over the years has been relegated to the archives, but we
believe it is time to revive our clean cities campaign. With the
advent of cholera in our cities the call can not be over
emphasized. The social mobilization group is the beginning of
such a movement and the Institute of Water and Sanitation
Development is proud to be part of this process.

Sanitation is dignity, aluta continua.

Read the 2009 third issue of the Institute's of Water and Sanitation Development (Zimbabwe) newsletter here.

The theme for the workshop was “promotion of safe water, sanitation and hygiene”. The objectives were to increase the knowledge of media personnel on basic sanitation and hygiene issues; to develop appropriate information, education and communication materials for sanitation and hygiene promotion and to translate key messages for sanitation and hygiene into four major Nigerian languages. Participants were drawn from the print and electronic media as well as NGOs.

The workshop included lectures, message development and translations, as well as pre-testing of designed materials. At the end of the workshop, the following recommendations were made:

1. The translated key messages should be aired by media houses at appropriate times.
2. Participants should be able to positively change Governments’ perceptions of sanitation and hygiene for positive action.
3. Participants should use these materials to promote sanitation and hygiene issues.
4. Media participants should be supported by Government at all levels, UNICEF, WATERAID and WSSCC as they continue to promote sanitation and hygiene issues in Nigeria.

For more information contact David Trouba at troubad[at]who.int.

Highlights:

- update on the Diorano WASH strategy

- Global Sanitation Fund in Madagascar

- the Diorano WASH and Water Ministry platforms

- the challenges of the sector

- the End Water Poverty campaign

20–22 April 2009

Las Palmas de Gran Canaria, Spain Co-organizers:
Casa Africa / United Nations Office to Support the
International Decade for Action ‘Water for Life’ 2005–2015

• Participants: Ministerial level from eight African countries, intergovernmental cooperation institutions, African Minister’ Council, African Union, United Nations, international non-governmental organizations, international experts, among others.

• Themes: Water governance and cooperation – Reinforcing cooperation tools and mechanisms – Challenges facing the water and sanitation services in Africa.

Objective

The main objective of the meeting is to reinforce cooperation tools and mechanisms that will strengthen the capacities of African countries to achieve the Millennium Development Goals (MDGs) to ‘halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation’.

On current trends sub-Saharan Africa will reach the water target in 2040 and the sanitation target in 2076. What are the main difficulties African States face in extending their water and sanitation services? And what is the current role of international cooperation in relation to water governance issues in Africa? Sub-Saharan Africa, the region most in need of improved access to water supply and sanitation received from 2002-2007 a quarter of worldwide international aid.

This international meeting provides a platform to allow relevant stakeholders to exchange views in a dialogue on the role of international cooperation in the water governance field in Africa. It will provide a forum for identifying and evaluating existing coordination, information exchange and monitoring mechanisms. It will also aim to identify gaps and key obstacles impeding the achievement of water and sanitation targets in the African region; examine actions implemented by cooperating actors on non-covered needs in the areas of water governance, water supply and sanitation in Africa; and better orientate existing cooperation efforts to enhance their effectiveness in the water and sanitation fields.

The meeting is structured around the following themes: water governance and cooperation in Africa, challenges African States face in extending their water and sanitation services, and key aspects for improving the contribution of international cooperation to the achievement of water and sanitation-related MDGs and the ultimate goal of ‘water and sanitation for all’.

Participants

• High-level participants, such as senior government officials, responsible for strategic planning in the water and sanitation sectors and the provision of water and sanitation services for the following African countries: Angola, Cape Verde, Ethiopia, Equatorial Guinea, Mali, Mauritania, Namibia and Senegal.

• Representatives from intergovernmental cooperation institutions from Africa and governmental cooperation institutions from Spain including: the African Ministers’ Council on Water (AMCOW), the African Union (UA), the African Water Facility (AWF), and the Spanish Agency for International Cooperation for Development (AECID), among others.

• Experts from international, African and Spanish non-governmental organizations (NGOs), representing civil society involved in international cooperation efforts in the water and sanitation sectors including: Global Water Partnership (GWP), International Water Management Institute (IWMI), African Civil Society Network on Water and Sanitation (ANEW), the Spanish NGOs Coordination (CONGDE), Oxfam International (OI), the Gender and Water Alliance (GWA), among others.

• Representatives from different United Nations agencies and programmes, including the United Nations Department of Economic and Social Affairs (UN-DESA) and the United Nations Human Settlements Programme (UN-Habitat).

The meeting is open to the media. For further information on registration please contact
Ms. Pilar González Meyaui (gonzalez-meyaui[at]un.org).

About the Organizers

The United Nations Office to Support the International Decade for Action 'Water for Life' 2005–2015 (UNO-IDfA): In 2003, the United Nations General Assembly proclaimed the years 2005–2015 the International Decade for Action ‘Water for Life’. The primary goal of the Decade is to promote efforts to fulfill international commitments made on water and water-related issues by 2015. To facilitate the implementation of the Decade’s agenda, the City of Zaragoza in Spain hosts the UNO-IDfA.

UNO-IDfA aims to contribute to the efforts of the United Nations in coordinating and ensuring follow-up to the implementation of internationally agreed goals in the areas of drinking water, sanitation and Integrated Water Resources Management, raising awareness and creating an enabling environment for achieving the ultimate goal of water and sanitation for all, and strengthening the capacities of Member States and other relevant stakeholders to address key obstacles impeding the implementation of the water and sanitation agenda.

Casa Africa is a public consortium created within the framework of Spain’s Africa Plan. It was established as a result of a joint effort on the part of the Spanish Ministry of Foreign Affairs and Cooperation (MAEC) and the Spanish Agency for International Cooperation for Development (AECID) among others. Casa Africa was created as a space to facilitate open exchange and meetings among citizens of Africa and Spain. Its objectives are to promote awareness of the respective realities of Spain and Africa, and enhance overall Spanish-African cooperation as well as African-European dialogue between both cultures.

Francophone Africa
• Mr. Cheick Tidiane Tandia, General Director of CREPA, Burkina Faso

South Asia
• Mr. Mohammed Moniruzzaman, Executive Director, AID Organisation, Bangladesh

South East  Asia
• Mr. Wilfrido C. Barreiro, Water and Sanitation Engineer and Consultant, The Philippines

Central and Eastern Europe, West and Central Asia
• Mr. Akbar Suvanbekov, Infectious Diseases Specialist, Solution 21, Kyrgyzstan

Open Seats (two elected)
• Ms. Feri G. Lumampao, Social Development Worker, Approtech Asia, Philippines
• Mr. Satish Raj Mendiratta, Senior Water and Environmental Sanitation Specialist, Jupiter Knowledge Management and Innovative Concepts, India

You can read more about each of the newly elected representatives here.

• Message from the Chair
• Your Vote Counts!
• Sanitation Kept High on the International Agenda
• WSSCC People
• Hot Off the Press

News from WSSCC Members & Partners

• Sanitation Week in Burkina Faso for Dignity, Health and Life
• Success Stories from the Inaugural Global Handwashing Day
• From Idea to Reality: The Ethiopia WASH Media Forum
• World Toilet Day in Ukraine: We Deserve Better

WSSCC in Motion, January - March 2009

To access the newsletter in English, French and Spanish please click here.

Read a very thorough article on the "silent emergency" by Barney Jopson, the Financial Times, here. 

A letter to the editor, "better sanitation generates massive economic benefits", by Jon Lane, WSSCC Executive Director, can be found here.

Read more about World Toilet Day in the press clippings below:

• Los Angeles Times: Ode to the commode
• Fox News: Don't laugh - World Toilet Day aims to promote sanitation, rid world of disease
• CNN: Toilet training - taking sanitation seriously
• Daily Monitor, Uganda: The reality of latrine shortage
• L'Express (in French): Pourquoi il faut prendre les toilettes au sérieux
• Le Soleil - Sénégal (in French): Accès aux toilettes - taux de couverture estimé à 17% en milieu rural
• Le Journal du Dimanche (in French): Les toilettes - un défi planétaire
• Le Faso.net (in French): Assainissement - 10 millions de Burkinabés à la recherche de toilettes

More

• 100 Toilets Exhibition in Melbourne, Australia

Please click here to read more about the pre-SACOSAN meeting and the Silent Candlelight Vigil dedicated to all who have died from diarrhoea in the region since 2006 and to see pictures of the event.

• Press release "Civil Society Groups in South Asia to tell Sanitation Ministers: Hurry up! Billions want to use the toilet!"

By presenting an extensive array of available options, this compendium helps promote people-centred solutions to real sanitation problems by providing information to those who are looking for alternatives to the most common offerings.

There are two main sections in the compendium:

• description of different system configurations at the macro scale
• different technology information sheets describing the main advantages, disadvantages, applications and the appropriateness of the technologies required to build a comprehensive sanitation system.

This compendium is primarily addressed to planners, engineers, development experts dealing with sanitation, NGOs and donors.

This is a common publication by WSSCC and EAWAG and can be downloaded here. Read the press release here.

A hard-copy can be ordered by writing to info[at]sandec.ch

Handwashing with soap is one of the most effective and inexpensive ways to prevent diarrheal disease and pneumonia, which together are responsible for approximately 3.5 million child deaths every year.

By washing hands with soap, families and communities can help reduce child morbidity rates from diarrheal diseases by almost 50%.

The inaugural Global Handwashing Day focused on children in schools. After learning about improved sanitation behaviour in schools, children can act as agents of change by taking these messages home to their families and communities. From Afghanistan to Peru, children, school teachers, and parents joined celebrities, government officials, members of civil society and the private sector to raise awareness about handwashing with soap.

Global Handwashing Day is an initiative of the Public Private Partnership for Handwashing (PPPHW), which is spearheaded by UNICEF, USAID, Centers for Disease Control and Prevention, World Bank, Water and Sanitation Programme (WSP), Unilever and Procter and Gamble.

To learn more about the Global Handwashing Day visit www.globalhandwashingday.org.

To read about the events that took place around the world or watch videos visit:

• One million Ethiopian children take part in Global Handwashing Day - Afrique en ligne
• Kids wash hands across Asia - bdnews24.com
• Millions mark UN Handwashing Day - BBCnews
• Global Handwashing Day videos featuring Nelson Mandela, the Wiggles, cricket star Sachin Tendulkar and others - Sanitation Updates

The information is organised by three main themes:

• Water Resources Management
• Water and Wastewater Asset Management
• Water Governance

A resource centre, country profiles and much more can be found on www.pacificwater.org.

Programme participants included:

• Tralance Addy, President and CEO, WaterHealth International
• Jon Lane, Executive Director, Water Supply and Sanitation
  Collaborative Council
• Maria Mutagamba, Minister of State for Water, Uganda
• Rohini Nilekani, Chairperson, Arghyam Trust
• António Guterres, Former Prime Minister, Portuguese Republic, United Nations High Commissioner for Refugees

To view the hour-long programme, please click here.