Poor sanitation threatens public health

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A man leaves a public toilet at an informal settlement in Soweto, South Africa

Six in 10 Africans countries, which include South Africans, especially in cities and urban areas, still remain without access to proper toilet. Although public-sector leaders may know what they want to deliver—for instance, reliable water and sanitation services, better healthcare services, improved learning outcomes, or more efficient public transportation—and have ideas about how to do it, it sometime takes a lot of time and effort to translate a high-level vision into reality.

It should be worrying that, as we celebrate the International Sanitation Month, there are still people out there struggling to get or find it difficult to have the use of a proper toilet.

Simply stated, 62% of Africans do not have access to an improved sanitation facility — a proper toilet — which separates human waste from human contact, according to the World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) Joint Monitoring Programme for Water Supply and Sanitation.

Preliminary global data reports on the situation in Africa was released yearly as part of World Water Day, shows lack of proper sanitation is experienced by most Africans.  In 2008, The Day, built around the theme that “Sanitation matters,” seeks to draw attention to the plight of some 2, 6 billion people around the world who live without access to a toilet at home and thus are vulnerable to a range of health risks.

“Sanitation is a cornerstone of public health,” said WHO Director-General Dr Margaret Chan. “Improved sanitation contributes enormously to human health and well-being, especially for girls and women. We know that simple, achievable interventions can reduce the risk of contracting diarrhoeal disease by a third.”

Many governments don’t prioritize, spread their efforts across multiple projects, and are always hard-pressed to increasingly function with tighter budgets. The underlying issue, however, is that many governments lack a structured, disciplined process for delivering breakthrough results.

The government’s priority venture, the National Development Plan (NDP) generally is  aimed at ensuring that by 2030 and beyond South Africa has a sufficient reserve of supply to take it safely into the future, that accelerated progress towards meeting Constitutional imperatives is made and that service delivery commitments, such as meeting Sustainable Development Goal 6: Ensure access to water and sanitation for all is achieved.

The plan is drafted by the Department of Water and Sanitation (DWS), in consultation with and considering the input from stakeholders in the entire sector. In general, the National Water and Sanitation Master Plan (NW&SMP) is intended to be a living document, and therefor even after its initial finalization, its content and the achievement of the set targets will be monitored and evaluated. Where necessary, be amended and updated annually based on the inputs from stakeholders and revised government targets and available budgets. This process will provide continuous opportunities for further inputs from all stakeholders.

Sanitation is not a dirty word. Sanitation matters. Although WHO and UNICEF estimate that 1, 2 billion people worldwide gained access to improved sanitation between 1990 and 2004, an estimated 2, 6 billion people – including 980 million children – had no toilets at home. If current trends continue, there will still be 2, 4 billion people without basic sanitation in 2015, and the children among them will continue to pay the price in lost lives, missed schooling, in disease, malnutrition and poverty.

“Nearly 40% of the world’s population lacks access to toilets, and the dignity and safety that they provide,” said Ann M. Veneman, UNICEF Executive Director. “The absence of adequate sanitation has a serious impact on health and social development, especially for children. Investments in improving sanitation will accelerate progress towards the Millennium Development Goals and save lives.”

Using proper toilets and hand washing – preferably with soap – prevents the transfer of bacteria, viruses and parasites found in human excreta which otherwise contaminate water resources, soil and food. This contamination is a major cause of diarrhoea, the second biggest killer of children in developing countries, and leads to other major diseases such as cholera, schistosomiasis, and trachoma.

Improving access to sanitation is a critical step towards reducing the impact of these diseases. It also helps create physical environments that enhance safety, dignity and self-esteem. Safety issues are particularly important for women and children, who otherwise risk sexual harassment and assault when defecating at night and in secluded areas.

Also, improving sanitation facilities and promoting hygiene in schools benefits both learning and the health of children. Child-friendly schools that offer private and separate toilets for boys and girls, as well as facilities for hand washing with soap, are better equipped to attract and retain students, especially girls. Where such facilities are not available, girls are often withdrawn from school when they reach puberty.

In health-care facilities, safe disposal of human waste of patients, staff and visitors is an essential environmental health measure. This intervention can contribute to the reduction of the transmission of health-care associated infections which affect 5% to 30% of patients.

The Department then adopted a Phakisa Programme to help speedy up the realisation of projects implementations. Operation Phakisa is an initiative of the South African government.  This initiative was designed to fast track the implementation of solutions on critical development issues.  This is a unique initiative to address issues highlighted in the NDP 2030 such as poverty, unemployment and inequality. Operation Phakisa is an innovative and pioneering approach to translate detailed plans into concrete results through dedicated delivery and collaboration.

“Phakisa” means “hurry up” in Sesotho and the application of this methodology highlights government’s urgency to deliver.  It plays a crucial role in accelerating the delivery of some of the development priorities. Through Operation Phakisa, Government aims to implement priority programmes better, faster and more effectively.

This approach could help governments to:

– Move from high-level plans to specific priorities underpinned by facts, have committed funding, and with owners mobilized for action.

– Set up systems and build capabilities within the government to implement projects, track outcomes, and achieve results.

– Drive implementation to completion with highly motivated officials and engaged staff.

“The focus on sanitation is fundamental to human beings,” says Pasquale Steduto, UN-Water chairman. “The Millennium Development Goal (MDG) target on sanitation is seriously lagging behind schedule. The entire UN System has a shared responsibility in mobilizing concrete actions towards its achievement; investments must increase immediately.” UN-Water is the coordinating mechanism of the UN agencies, programmes and funds that play a significant role in tackling global water and sanitation concerns.

World Water Day provides an opportunity to draw attention to the International Year of Sanitation, a year in which the UN General Assembly in December 2006 called for a focus on addressing sanitation and hygiene problems. The International Year of Sanitation always aims to raise the profile of sanitation issues on the international agenda and was to accelerate progress towards meeting the Millennium Development Goal target of reducing by half the proportion of people living without access to improved sanitation by 2015.


Ike Motsapi is the Media Liaison in the Department of Water and Sanitation (DWS).