It’s hardly surprising that the building of pit latrines in the poorest countries is one of the least funded and most overlooked areas of health development. A vast amount more sex appeal will be found in other highly worthy public healthcare needs- malaria bed nights, for instance, undoubtedly save thousands of babies lives and are easy to distribute... in addition to lending themselves to great marketing opportunities to photo peaceful sleeping babies. Yet 2.6 billion people do not have access to a safe latrine and this includes half of people in sub Saharan Africa.
4,000 children die daily from preventable water related diseases- more than die from malaria, HIV and measles combined. Diarrhoea is the second biggest killer of children under 5.
Improved sanitation could prevent 1.5 million deaths from diarrhoeal diseases per year. The environmental rewards would also be enormous as currently 200 million tonnes of human waste go uncollected and untreated each year. It is estimated that every dollar spent on sanitation would save nine dollars in days lost from work plus the cost to the local health services. As much as 5% of African GDP is lost to illness and deaths caused by dirty water and lack of basic sanitation.
One of the Millenium development Goals is to halve the proportion of people without access to basic sanitation by 2015. Currently sub Saharan Africa will be at least fifty years late with this MDG unless the health agenda rapidly decided to focus money and effort here.
The added improvement to quality of life is probably larger than any other public health intervention. Whilst a good immunisation campaign will save millions of lives...it does nothing to improve the daily life of its recipients. Yet it doesn’t take much imagination to see that if you offer an adolescent girl an opportunity to use a safe, private latrine you have improved her life beyond measure. Certainly give girls access to education and books... but how many campaigns focus on giving her access to a childhood and adolescence where she can enjoy the basic human right to personal privacy.
Of all the public health interventions we have undertaken this is the most universally popular one with the community. Whilst it is very hard to evaluate whether families using pit latrines are accessing health care less, it is at least easy to assess how much they are used : in every case the take up in use of the latrine amongst school age children and adults is virtually universal: if a latrine is there it is used by all but the youngest children and a few of the very old and infirm. In addition we have not yet come across a manyatta across the group ranches who have turned down the opportunity to have a latrine.
But it is an expensive intervention. After we complete this year’s agreed building programme we will be working with the micro finance project to see if they can help us with low interest development loans for pit latrines and looking to ways of cost sharing with families. But still it will remain expensive ..... and of course it is the poorest families who probably need the latrines most as their family numbers are generally higher and their health education is generally lowest. It is good to see some NGOs also focusing on latrines in Isiolo district- but here the problems remain the same; most NGOs will fund only basic materials, building and adding materials has to be added by families and consequently they are out of the reach of the poorer families. In addition, not unnaturally it is the village ‘centres’ and schools which are generally targeted , where the need is highest, but again the poorest of the poor will miss out.
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