Editor’s Note: For the last month, the Freshwater Action Network South Asia (FANSA), WaterAid and WSSCC have facilitated national level consultation meetings with marginalized communities to identify key issues and messages to be represented at SACOSAN, the South Asian Conference on Sanitation and Hygiene, which takes place 10-14 April 2018 in Islamabad, Pakistan. While no consultation took place in Bhutan, this blog nonetheless provides insights on the sanitation and hygiene situation in the country.
By Phurpa Thinley, LNW Consulting, FANSA Associates in Bhutan
“I wish for a permanent improved toilet that provides privacy for my two younger daughters and other household members; however, for now, expenses for their education are my priority,” says Mrs. Tshering Choden, a 48-year-old woman from Saling village in Trashigang district. She goes on to say that “within 20 years of our marriage, my husband and I have constructed around five basic pit toilets, each of which had to be relocated to new place after they were filled, which is not only inconvenient but an economic burden too. Until now, other family commitments and financial constraints have deferred our hopes of constructing a good improved toilet.” Such stories are shared by many rural households with basic pit toilets and some households which still practice open defecation.
According to Mr. Rinchen Wangdi, Chief Engineer, Public Health Engineering Department (PHED), Ministry of Health, “Disparities in access to sanitation, hygiene facilities and related services are prevalent in rural Bhutan and these inequalities are due to income, gender, disability and geographic factors which are often correlated.”
Most rural households are remote and scattered on mountainous terrain with limited access, thus posing challenges in access to sanitation. During night time or in rainy seasons, people find it difficult to go out to access toilets which are generally built at a distance from the main house. Sometimes the geographic terrain makes the pits fill so fast that the households have to incur recurring expenditure for constructing new pits. “The quality of construction is also very poor and does not offer privacy for women. For example, the roof is made of banana leaves and the doors are plain sackcloth. “Sometimes, when I use the toilet, I turn on the music on my mobile phone so that people know I am in there and they do not walk in. There is hardly any space to change sanitary napkins when we have our periods,” says Ugyuen Tshom, a 20-year-old young woman from East Bhutan.
Unlike in the towns, there are no issues of faecal disposal as the basic traditional toilet is relocated after it is filled up; but, these unimproved sanitation structures with poor hygiene practices are leading to preventable health problems, such as diarrhoea, dysentery and intestinal worm infections, especially among young children and infants. These health problems are consistently reported as the top ten health problems in the Annual Health Bulletin published by the Ministry of Health.
To improve the sanitation situation and targeting the last-mile population, the Public Health Engineering Department (PHED) under the Ministry of Health, with technical and financial support from donor agencies, has spearheaded a nation-wide sanitation and hygiene advocacy programme. Workshops are held in rural villages with specific objectives of creating good hygiene practices and demand for improved sanitation which can be used by all.
The journey in realizing the expected positive outcomes from the advocacy programme has also had challenges, including poor road connectivity, and difficult mountainous terrain and scattered villages – this makes the issue more acute for the most vulnerable populations. Poor road accessibility to rural villages largely hampers the delivery of sanitation products and services and increases the costs. It is mostly the financially vulnerable population, households with old and infirm members and people living with disabilities that are affected the most. “I have to crawl to the toilet all by myself or wait for a same-gender family member to assist me to use the toilet,” says a 15-year-old girl with a walking disability. The mobile nomadic population are also sizeably affected due to the nature of their seasonal nomadic lifestyle. In addition, maintaining menstrual hygiene is seen as a challenge due to a lack of privacy, inadequate water supply and unavailability or low affordability of sanitary napkins. The challenge is greater for women and girls living with disabilities.
According to a community-elected representative, Mr. Sonam Phuntsho, “Much has been done in sanitation and hygiene sector, but much more is left to be done so that no one is left behind”. This requires more funding to maintain sanitary hardware supply chains as well as to train masons for constructing twin pits. The government can look into providing subsidies and low taxation on sanitation goods for the local small and medium enterprises to make them affordable by the rural population.”
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