As fate would have it, Sriviliputtur Government Hospital (in Tamil Nadu’s Ramnathapuram district) happened to be one of the first hospitals he reviewed on taking charge. An officer on Pankaj Kumar Bansal’s team drew his attention to a heavily pregnant lady, who was close to panic stricken tears on being referred out, yet again, to another government hospital for emergency obstetric care. That Sriviliputtur itself was a designated CEmONC center (Comprehensive Emergency Obstetric and Neonatal Care Center) mandated to provide every conceivable (except for the very super-specialized) care required for a pregnant mother and her neonate, and yet was incapable of handling the emergency, distressed him deeply.
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The author captured the story of Loyabi, in Chhaor Union Parishad. This is her story of how she provided her family with access to better sanitation and improved their futures.
“I will teach my children how to read and write regardless of my difficulties in doing so.”
My name is Loyabi and I come from a very poor family of Mahadanga village in Chhaor Union Parishad. I was married to Abul Hassan, a man from my own village, at the age of 15. For several years our poverty did not prevent us from being happy. We were blessed with two daughters and two sons. However, when my husband was diagnosed with gallstones, I found I had to raise Taka 50,000/- ($630) for his operation.
We had no land of our own and lived on common land. I was able to collect some money by asking for assistance in different villages. I worked as a mid-wife for humans as well as cattle, bathed dead bodies before their burial and somehow put together the required amount of money to get my husband’s operation done.
We rarely give the toilet a second thought. We use it when we need to, and we flush and forget. We are also able to conveniently wash our hands afterwards. But imagine if you are on a long hiking trip or a bus ride with no stops in sight and had no access to a toilet or running water. It’s a situation most people would dread.
In poorer parts of the world, this is the daily reality for many. The humble toilet—perhaps the most important contributor to improved human health in history—is a luxury item which relatively few people enjoy. Without a toilet, the poor have to go in the open, behind bushes, or next to streams. They cannot flush their waste away or wash their hands afterwards if they wanted to. In poorer countries, managing human waste remains a major challenge, and failure to meet that challenge exposes millions of children and adults to waste-borne diseases that can have deadly consequences.
In Nepal, a country of approximately 26 million people, nearly 40% of the population do not have toilets. In parts the Terai or lowland areas, this number climbs to a staggering 75%. To be sure, the Government of Nepal has achieved remarkable progress in improving sanitation coverage in the last two decades. In 1990, only 6% of Nepalis had access to a toilet. By 2011, 62% had access, with the sanitation Millennium Development Goal (MDG) achieved ahead of the 2015 target. However, that achievement still leaves a large population—more than nine million people—without toilets. So the Government decided to aim for a new and more ambitious target—universal access by 2017. And it may get there.
Last month, I visited Nangkhel, a Newari village near Bhaktapur in the eastern corner of the Kathmandu Valley, to see how one village succeeded in bringing the luxury of a toilet to all 181 households (or about 900 people).
See also: Anniversary of the New Delhi Attack Reminds Us that Tackling Violence is Urgent
December 16, 2012 will in the foreseeable future be remembered as the day in which six men savagely gang raped a 23-year old female student on a bus in New Delhi. The young woman died from her injuries 13 days later. The event shocked the nation and sparked unprecedented uprisings in the Indian capital and across the country. It put the international spotlight on India and reminded us that violence against women remains a leading cause of female mortality worldwide.
Today, on the one-year anniversary of what is simply referred to as the “Delhi Rape”, we are compelled to pause and reflect. Four men were sentenced to death for the crime in September – did this bring closure? Beyond the protests and public appeals for change, has there been meaningful change in India?
Happy belated 1st World Toilet Day! The newly designated UN day embodies the enormous development challenge of providing safe toilets to all. More than 2.5 billion people still don’t have access to adequate sanitation and 1 billion defecate in the open. It brings into sharp focus the need to foster innovation and dialogue on sanitation, especially given our straggler status on the sanitation MDG. From enhancing water management to ending open defecation, the wide ambit of influencing policy and behavior change can seem daunting at times.
Why Sanitation Access Doesn’t Work Unless the Entire Village Buys In
Jitender is a four-year old boy with forward-thinking parents. Although it’s common in his village, in the Indian state of Uttar Pradesh, for most people to defecate in the open, his parents have taken the lessons of the government’s sanitation campaign to heart. They know that open defecation spreads disease—so they construct a private toilet that hygienically isolates their waste from human contact. Nonetheless, a few months later, Jitender develops persistent diarrhea. He is often dehydrated, loses weight, and becomes pale. His immune system is weakened by multiple bouts of disease, and for the next several years he struggles with recurrent illness. He has trouble keeping up with his schoolwork, and, more perniciously, even though he ate more than enough calories each day, the diarrhea eventually caused malnourishment. He remains small for his height and suffers from subtle intellectual deficits that make it difficult for him to follow the teacher’s lessons even during those periods when he does manage to attend. Because of his low marks, his family isn’t able to fulfill their dream of sending him on to university. The village takes note of Jitender’s example and concludes that improved sanitation doesn’t provide much, if any, benefit. This is a fictional story; however, similar stories are being heard every day in South Asia.
NGOs, lending agencies, and the public sector are hard at work in meeting the global sanitation target. But what about the private sector, and what about the families that do not want to wait for the next NGO to knock on their door with a better toilet? Over the past couple of years, the Water and Sanitation Program’s (WSP) Sanitation Marketing strategy in Bangladesh has tried to address these concerns by stimulating the supply and demand of hygienic sanitation facilities through the mobilization of local entrepreneurs. The objective of Sanitation Marketing is for families to have the desire and the agency to move up the sanitation ladder on their own.
In 2009, the pilot program began in five villages in the Jamalpur district, and has now been scaled-up to around 230 villages across Bangladesh with support from the Dutch WASH Alliance, International Development Enterprises, and the Max Foundation. WSP also strategizes and implements the project with Hope for the Poorest (HFP), a local Bangladeshi NGO, and the Association of Social Advancement (ASA), a microfinance institution.
Mohammed Jalal is one of the many sanitation entrepreneurs supported by Sanitation Marketing in the Hobiganj district where WSP has began scaling up the initiative since 2011. Through microfinance loans from ASA and small-business training sessions from WSP, Mr. Jalal was able to open two stores in Hobiganj. Mr. Jalal’s shops are decorated with colorful flags to attract customers and are filled with an assortment of sanitation products such as handwashing stations and off-set pit latrines. With a catalogue in hand, Mr. Jalal markets his products to local villages and gives households the chance to move up the sanitation ladder. Customers are able to choose the materials and colors of their latrine and are most importantly, able to choose the type of sanitation facility that fits into their budget. Products range from Tk 1,600 (US $20) to Tk 20,000 (US $250), and all Sanitation Marketing entrepreneurs offer an installment plan for families to pay for their products over time. WSP additionally connects these entrepreneurs to the local government in order to establish whether any families in the area are eligible for subsidies. In the Hobiganj district alone, Sanitation Marketing has been able to support over 17 entrepreneurs like Mr. Jalal to serve hundreds of happy customers.