Health, safety and dignity: boosting access to safe, clean toilets for women in Pakistan



By Machrine Birungi

Geneva, SWITZERLAND - Pakistan has come a long way in bringing down open defecation. A recent WHO/UNICEF report shows that the phenomenon has been reduced by around 30 percent since the year 2000.

Yet 79 million people still lack access to decent toilets across the country. This poses significant risks to health, livelihoods and long-term prospects for millions of people.

Salman Sufi, a UN Women's Sr Gender Advisor to the Provincial Government of Sindh, has a plan. His ‘Saaf Bath’ (clean toilet) initiative aims to boost access to safe, hygienic toilets for women in public spaces.

We spoke to Salman, a winner of the Mother Teresa Award, member of the Hillary Clinton-led Vital Voices Solidarity Council and founder of the Salman Sufi Foundation, to learn more about his work to solve Pakistan’s dangerous sanitation crisis.

You recently spearheaded a campaign to help women in Pakistan access toilets in public spaces. Can you tell us more about it?
Sanitation and access to clean toilets are big issues for Pakistan. We rank in the top ten countries in the world where open defecation exists. It’s especially tough for women, as most corporate places or public spaces like shopping areas lack clean and sanitized toilets. Women have pressing sanitation needs. Sometimes they also have children with them, and it's very hard for them to go to work and maintain their health as well. I have heard stories of women who don’t eat when they go to public places as there are just no bathrooms for them. Some have also contracted urinary tract infections from dirty bathrooms. So, all this is what inspired me to step in with ‘Saaf Bath’, which literary means a clean toilet.

How does the Saaf Bath initiative work?
First, we find public spaces that need clean toilets. Then we get government permits. Then we seek support from corporate sponsors and donors in building and maintaining the toilets. Our sponsors adopt a steel container that has three to five toilets built in. So, as well as supporting their corporate social responsibility work, they also use their branding on the saaf bath. We install these toilets in areas with heavy pedestrian traffic. In schools and of course the places we know that women go. It's a win-win for sponsors, donors and citizens. Right now, we’re investing in providing the hardware as that is the most pressing need.

We’ve employed staff to clean the toilets, and we’re training them, through an extensive course, to understand how to sanitize toilets and not just to clean them. Through the training, we aim to turn them into master trainers who will then train other sanitation workers. In time, an ecosystem will develop in which sanitation workers will spread the knowledge across the country. I really do think that private-public partnerships, that focus on the dignity of women and other vulnerable groups in public spaces, are key to solving this important challenge for our country.

How is Saaf Bath tackling the crucial issue of menstrual health and hygiene?
Every saaf bath comes with a sanitary compartment filled with sanitary pads. For this, building partnerships with producers and distributors of sanitary pads is so important. We
need them to provide free or discounted sanitary napkins to women who use the saaf baths.

The lack of toilets in schools is a global issue. In 2018 WaterAid reported that 1 in 5 primary schools and 1 in 8 secondary schools worldwide do not have toilets. How is the situation in Pakistan and how do we tackle this challenge?
It's alarming! Toilets in public schools are not given the huge attention they deserve. The crisis only results in more children quitting school, especially teenage girls. In Pakistan, the school dropout rate stands at 69%, starting at grade six. Parents dissuade their daughters from going to school as girls at this age must manage their periods in safe and decent toilets, which many schools just can’t provide.

With safe, clean and sanitized toilets, girls in particular are far more likely to finish their education and of course, stay healthy. So, schools are an important area of work for us. We have asked the Government of Sindh for access to all female colleges and schools in the province so we can install portable toilets. Based on this It is my aim to expand the Saaf Bath initiative the entire country, with support from sponsors and donors.

What frustrates you the most about the state of sanitation and hygiene in Pakistan?
What frustrates me is that the people who have access to clean toilets employ sanitation workers who come from the poorer parts of society. Pedestrians in all these shopping malls and other public areas have no access to public toilets. Yet business owners want these ordinary citizens to spend money on their businesses. They pay taxes, but are not even provided with basic toilets. It's a shame that in Africa, India, Pakistan and Bangladesh this pressing need, which is equal to the need for food, is not met or prioritized.

We need food a number of times a day and we need toilets. Ignoring the need for toilets hampers economic progress, but it also means that many more sick citizens end up in hospital with diarrhea and other diseases related to open defecation.

Looking ahead, what key message would you give the WASH community?
It's s time for real on the ground action.Identify the social entrepreneurs who are trying to change things. Support their efforts to make sure that all public spaces like schools, health care facilities and shopping centres have safe, clean toilets.