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Advocating Sanitation
How, Why and When?

3.3 million people die every year due to diarrheal diseases… Why? because 3,000 million citizens in the developing world lack access to appropriate sanitation according to statistics collected by the Joint Monitoring Programme (WHO/UNICEF, 1997). Who do we blame?… the finger unfortunately points to the donor agencies, the governments and the ordinary person on the street who is not aware of the health burden caused due to in-sanitary conditions. It’s a vicious cycle of ignorance and obvious indifference to the appalling sanitary conditions around the world.

While the emphasis and focus on water supply provision has been increasing, “sanitation” according to the 1996 Joint Monitoring report had been “neglected in the four years, 1990 to 1994” within which time the “number of people deemed to be lacking adequate sanitation rose by 274 million”. UNICEF’s advocacy campaign “Sanitation for All” states that “unless immediate action is taken, the number of people without adequate sanitation will climb to more then 4.5 billion in just 20 years. Hardest hit will be the marginalised poor living in densely populated cities that even today manage to provide only two thirds of their population with sanitation services”.

Ironically such figures fail to shock our governments, since evidently, sanitation is not high on the list of priorities in most developing countries. Safe disposal of excreta accompanied by improved hygiene behaviour appear to contribute more to health than water supply. According to World Development Report 1993 statistics used in a study carried out by WELL (Water and Environmental Health at London and Loughbrough), 40% of the disease burden can be reduced in poor households by feasible interventions in sanitation, water supply and hygiene.

Burden of Disease from Poor Household Environments and Its Potential Reduction.
Data from demographically developing countries, 1990

Principal diseases related to poor household environments	Relevant environmental problem	Burden of disease in developing countries	Reduction achievable through feasible intervention
		millions of DALYs/year	percent	millions of DALYs/ year	DALYs per year/1000 population
Diarrhoea (dysentery, cholera & typhoid)	Sanitation, water supply, hygiene	99	40	40	9.7
Respiratory infections	Indoor air pollution, crowding	119	15	18	4.4
Intestinal worms	Sanitation, water supply, hygiene	18	40	7	1.7
Chronic respiratory diseases	Indoor air pollution	41	15	6	1.5
Tuberculosis	Crowding	46	10	5	1.2
Tropical Cluster (schistosomiasis, Trypanosomiasis, Bancroftian filariasis)	Sanitation, garbage disposal, vector breeding around the home	8	30	2	0.5
Trachoma	Water Supply, hygiene	3	30	1	0.3
Respiratory tract cancers	Indoor air pollution	4	10	*	0.1
All the above		338		79	19.4

Notes:

• Above diseases are ranked by “Burden averted per 1000 population” column
• Demographically developing group includes sub-Saharan Africa, India, China, other Asia Islands, Latin America, the Caribbean and the Middle East Crescent
• Diseases included are those where there is substantial evidence of a relationship with the household environment
• Feasible interventions include: improvements in sanitation, water supply, hygiene, drainage, garbage disposal, indoor air pollution and crowding

In-spite of the apparent benefits marketing sanitation is an uphill battle; marketing water supply seems effortless in comparison. It seems unlikely however that human beings in general prefer to live in filth and disease ridden conditions as long as there’s water. Clearly the problem arises precisely because sanitation is not yet a political issue; too many governments can still argue that demand for sanitation is insufficient to justify increased or improved investment, ignoring the fact that demand remains latent only because other needs are more pressing and the knowledge that there could be a solution does not filter down to poor households. What is urgently required is a concerted effort to promote sanitation at both the political and the household level.

Sanitation promotion is not just about constructing latrines to enable human excreta to disappear unseen by the human eye, its about hygiene behaviour, “it’s the introduction of a whole new way of life through education… and personal hygiene”, as Margaret Catley-Carlsson, Chairperson of the Water Supply and Sanitation Collaborative Council, and President, Population Council, New York, put it. Another UNICEF statistic illustrates the hygiene hazards linked to poor sanitation and its toll on the worlds children.

One Gram of faeces can contain

• 10,000,000 Viruses
• 1,000,000 Bacteria
• 1,000 Parasite cysts
• 100 Parasite eggs.

Diarrhoeal dehydration claims the lives of nearly 2 million children every year and has killed more children in the last 10 years than all the people lost to armed conflict since World War II according to UNICEF.

There is an urgent need therefore to get Governments and society to recognise the appalling toll created by poor sanitary conditions. Serious efforts should be made to develop local, national and international campaigns which:

1. Break down social, political, consumer and technical barriers to sanitation;
2. Provide people with the information to improve hygiene practices;
3. Create incentives to improve the scale and effectiveness of investments in sanitation;
4. Motivate people to demand better sanitation; and
5. Place sanitation to the forefront of development and political dialogue.

Professionals need to become activists, and sanitation activists need to become visible; sanitation should be as pressing as AIDS or Debt Relief in the world of development policy. Untiring advocacy must become a major feature of sanitation initiatives. Current levels of investment in environmental sanitation must rise, and the impact of investments must improve. Serious advocacy for sanitation should be a part of everyday life for professionals and social activists alike.

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