Toilets Save Lives: Call for Teaching Tools

Remember that scene from Slumdog Millionaire? That’s what most people in developing country slums have as toilets. Yet at the same time there are thousands of abandoned or barely used household toilets in India and in Africa. Abandoned because they are poorly built, because of a lack of water, or for a lack of maintenance or demand.

Many low-cost toilets become deadly points of environmental contamination. So there is a real need to make sure we build QUALITY toilets – which will be used and appreciated en masse – while working towards the MDG of improving access to safe sanitation.

So what’s the problem? There are plenty of books on sanitation in the market. There’s plenty of information on the internet on sanitation. There are costly workshops that policy makers can attend to learn about this subject, as well as simpler workshops given to masons and field supervisors under less glamorous settings.

There are plenty of training programmes, but what is retained of such programmes? We simply don’t know! The problem is there are no tools to assess people’s knowledge of sanitation.

Representing UNU-MERIT (NL) and FIN (India), I aim to create a tool that will help people who are driving sanitation efforts work out what their team members know or don’t know – and how to rectify this.

In partnership with Gita Balakrishnan of ETHOS (India) and Valentin Post of WASTE (NL), I’m organizing a call for contributions to a ‘Sanitation Question-Answer Bank’ under the aegis of the FINISH programme for sanitation coverage in India.

What does this call for contributions to Sanitation Question-Answer Bank mean? It means if you can think of an interesting question (along with a photo) on how to promote safe sanitation – and can also explain the answer – we want to hear from you!

Expert judges will select 1000 winning entries, each of which will be awarded Rs 75 each (or you can contribute this to repair of toilets!). The concept paper giving detailed explanations about the contest and the answer sheet format is available at Ethos India.

All interesting entries will be acknowledged with the name of the contributor clearly mentioned. These will be compiled into an e-book and put in the creative commons – to be used by any agency teaching about sanitation or anyone who wants to test and improve their knowledge on this subject.

by Shyama Ramani, Professorial Fellow at UNU-MERIT. Image: Flickr / Waterdotorg (Tamil Nadu, India)

Neglected Tropical Diseases and the Austerity Pandemic

Dumdum fever (or visceral leishmaniasis) is caused by a parasite (leishmania) and kills more than half a million people every year. After malaria it’s the world’s deadliest parasitic infection, but little has been done to combat it until very recently.

Dumdum fever is what is known as a Neglected Tropical Disease (NTD). Other NTDs include buruli ulcer, chagas disease, cysticercosis, dengue, dracunculiasis, echinococcosis, endemic reponematoses, helminthiases, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis, trypanosomiasis, and trematode infections.

More than a billion people UN Photo / Sophia Paris are affected by NTDs, yet treatments are rare. On the one hand this is because they are ‘diseases of poverty’, i.e. they mainly affect poor people who can afford neither vaccines nor medical treatments. So there is little incentive for profit-oriented pharmaceutical firms to invest in R&D for treatments.

On the other hand poor-country governments are often fragile states which lack the resources (and often the commitment) to invest in basic amenities which would limit the spread and impact of NTDs, or to provide access to existing medicines. For instance 2.5 billion people still lack proper sanitation and safe water, and 1.5 billion live without electricity.

Continued growth and economic development, coupled with appropriate policies and government investment, is clearly a necessary condition for reducing and eventually eliminating the impact of these diseases. But development takes time, and the benefits of growth are often slow to ‘trickle down’ to the poorest in society.

Moreover, the debilitating effects of these diseases are a contributing factor to poverty. Global intervention is needed to (i) provide access to existing treatments and best practices, but also to (ii) generate, diffuse and use new and more affordable vaccines and other treatments – for many NTDs existing treatments are ‘old, cumbersome to administer, or toxic’ (WHO, 2012:iv).

The World Health WHO NTDsOrganization (WHO) recently announced a Roadmap to deal with NTDs, which is an encouraging step as far as the former (i) is concerned. It aims to control or eradicate most of these NTDs by 2020. The report notes a growing number of contributions by multinational pharmaceutical firms to contribute resources– e.g. donating free medicines – but also notes that more than US$ 2 billion is still needed.

The WHO’s Roadmap also calls for increased R&D for treatments, but doesn’t go into much detail. Hence the question remains, how can we stimulate innovation to control and eradicate NTDs?

In a recent MSM-MGSoG-MERIT Joint Seminar presentation on 16 February 2012, Professor Nicola Dimitri from Maastricht School of Management and the University of Siena argued that from a R&D perspective NTDs are now less neglected than they were before the 2000s.

However much more needs to be done, particularly if the Roadmap’s goals are to be achieved and maintained. Dimitri discussed a number of recent initiatives to stimulate private sector innovation for better treatments.

These initiatives are at the forefront of thinking about public policies, procurement and innovation for socially desirable outcomes, and include push (such as public private partnerships), pull (such as advanced market commitments and priority review vouchers) and hybrid forms of incentives.

Thus (hopefully) in a few years’ time there may be no more ‘neglected’ tropical diseases. The only discordant note was sounded in December 2011 by a G-Finder (Global Funding for Innovation for Neglected Diseases) report which asked ‘is innovation under threat?’ With many rich countries facing high debt burdens and implementing fiscal austerity measures, funding for innovation has been declining.

The report documents that funding for innovation on neglected diseases was slashed by over US$ 100 million in 2010, mostly in European countries. For instance Sweden cut its funding for NTD innovation by 43 per cent, the Netherlands by 39 per cent, Denmark 49 per cent, Spain 30 per cent, Germany 12 per cent and Norway by 20 per cent.  A neglected consequence of the austerity pandemic in Europe is thus the further neglect of NTDs.

Wim Naudé, Professorial Fellow at UNU-MERIT and the Maastricht Graduate School of Governance

Interview: Global Forum on Sanitation and Hygiene

MUMBAI: V.Ganapathy is former Special Correspondent for The Hindu newspaper and now an Advisor to the Friend In Need Trust. We wanted to know why he attended the Global Forum on Sanitation and Hygiene, why these issues are important for India and other developing countries, and what he thought were the highlights of the conference. Read on below for his impressions and insights.

1) What were you personally involved in ?
As a journalist I was keenly interested in sustainable sanitation practices to keep the environment clean and healthy. The problems created by accumulation of bio-degradable and non bio-degradable waste are mounting everyday due to changes in lifestyle and increased consumerism. I was associated with SWM for over a decade and one of its main concerns was disposal of napkins. Hence I am now involved in safe and hygienic disposal of sanitary napkins in my capacity of an Executive Committee Member of the Menstrual Hygiene Management consortium of Tamil Nadu.

2) Why is this work important in India and elsewhere?
Several studies conducted in India have revealed that MHM (Menstrual Hygiene Management) related diseases were high and often it resulted in a high rate of dropouts of girl students in schools during their adolescent period. The Government of India and the Government of Tamil Nadu have recently launched programs for free supply of Sanitary napkins to lakhs of students in schools to promote MHM. Without proper hygienic and environmentally friendly disposal of Sanitary napkins this program would have disastrous impact on health and hygiene. At present only about 30% of the women in India use sanitary napkins and they are concentrated mostly in urban areas. The Government program is focussing on free sanitary napkins in rural areas. Hence I thought that in rural areas people should be also made aware of safe and hygienic disposal of sanitary napkins to prevent any disastrous impact on the environment when the program is fully implemented.

3) What in your opinion were the highlights of the conference?
It is unacceptable that 2.6 billion people in the world are without toilets and are unable to fulfil their daily needs with safety, convenience and dignity. Recent analysis of programs towards the Millennium Development Goals has revealed that the world will miss the sanitation MDG target by more than 500 million people primarily in Africa, Southern Asia and Eastern Asia. The WSSCC(The Water Supply Sanitation Collaborative Council) organized the conference for sharing, learning, strategizing and accelerating the 21st century’s sanitation and hygiene issues. The conference helped the participants in understanding the need for location specific regional approach for changing the mindset of the people who were not having toilets to demand toilets. Though funding is not a major problem globally for the Sanitation sector in reality it was found that enough money was not available for taking all out efforts and suitable IEC(Information,Education & Communication) programs to shift sanitation from a target oriented supply driven program to a demand driven program. The need for a variety of models of toilets to suit different countries and communities as per their traditions and cultural practices was better understood. The experiences shared will result in a change in the focus to make world an open defecation free world.
For the first time MHM was given a high priority sector in the programs for improving sanitation and also ensure that women who constitute 50% of the global population could lead a dignified and healthy life by better MHM practices.


Global Forum on Sanitation and Hygiene: Day Two Snapshot

MUMBAI: The second day of the Global Forum on Sanitation and Hygiene witnessed some compelling themes on behavioural change for sustainable sanitation practices, active initiatives for a pro-poor change in the sanitation and hygiene domain and also about the driving force of leaders in this spectrum. Speakers such as David Kuria (co-founder of Eco Tact, Kenya; presentation on Global Challenges, Local Innovations) and participants alike invoked the need for identification and promotion of social entrepreneurs, for inclusive development in addressing the issues of urban sanitation.

A plenary discussion on the science of behaviour change and social transformation programmes through contemporary case studies (Balbir Pasha-HIV/AIDS) signalled a new dimension of striking social media campaigns in urban sanitation strategies.

I was also drawn to the photo exhibition by the Visual Anthropologist, O. P. Singh on the ‘Urban Right to Water and Sanitation’, which highlighted the urgent need for safe sanitation ‘hardwares and softwares’ in Delhi. He was of the opinion that debates about Community Led Total Sanitation (CLTS) and presentation on behavioural change, marking the key programmes of the second day of the forum, presented sanitation issues in an episodic manner and did not clearly bring out the sundry strata of beneficiaries where each of these issues and associated solutions can be applied.

Lastly, safe sanitation and water go hand in hand, yet the issue of accessibility to water and water management found little prominence today. This should be an essential discussion for later in the conference.

Praveen Kumar, research associate of Professor Shyama Ramani

Changing Behaviour for Safe Sanitation Practices: The Role of the Private Sector

MUMBAI: The exploration of private sector partnerships is clearly important in the drive for behavioural change in safe sanitation and hygiene practices. In this regard, the Global Forum on Sanitation and Hygiene gave a positive impetus through case studies of sanitary napkins and soaps.

Particularly insightful was the Lifebuoy Behaviour Change Journey, a private sector partnership which contributes to tacit behaviour change around core sanitation practices (washing hands, use of soaps for washing hands, and washing hands at important occasions).

Anila Gopalakrishnan, the Lifebuoy Social Mission Manager for UniLever India gave a presentation on ‘Key features on large scale behaviour change programme’ and provided the ‘Big Idea-School of 5 campaigns’. Anila stressed the need to influence children at school, during their formative years, to inculcate sanitation practices as a habit. “Pervading sustainable, robust and safe sustainable practices among children is easier and shows permanence of the same,” remarked Anila.

The Lifebuoy social mission aims to contribute to behavioural transformation of 1 billion people by promoting the use of soap in their handwashing practices.

Praveen Kumar, research associate of Professor Shyama Ramani