Poor sanitation in rural areas

THE poor sanitation coverage in rural areas remains a big threat to the achievement of the Millennium Development goals sanitation target in Zambia. This is because most rural communities do not have access to any form of toilet facility.

The cost of not having toilets and practicing good hygiene on the country’s growth and economic development is significant. According to document on the state of sanitation in Zambia (2008), lack of toilets and poor hygiene leads to loss of productivity, preventable health costs, low educational achievement, high morbidity and poor social development.

The effect of poor environmental sanitation and hygiene has mainly manifested in diarrhoea and other related diseases. Western province is one region in the country with low sanitation coverage. According to Mongu district director of health, Dr Frank Liywali, the top ten problematic diseases are environmental related. He says the dismal sanitation coverage which stands at 27 percent poses a serious health challenge.

He said the ministry of health continues to record steady cases of diarrhea, dysentery eye infection (trachoma) and skill infections, all resulting from poor hygiene and lack of access to safe water.

Dr Liywali says worse still, access to safe water in the area which previous stood at 26% has drastically reduced to 21%, blaming the situation on the floods which affected most safe water points especially in the plains that are prone to flooding.

“We still have difficulties with environmental manipulated diseases like diarrhoea and dysentery. Out major challenge is changing the attitude of the people despite intensified health education campaigns,” he lamented. “Another challenge has been the cost of equipment like water testing kits. This year, it is in our action plan to buy this equipment but they have been no funds.”

Concerned at this situation, OXFAM international which operating in western province implementing various development programmes wants to reserve the situation by embracing the Community Led Total Sanitation (CLTS) programme.

OXFAM convened a one week workshop recently at Saint Lawrence training centre in Limulunga, Mongu, targeting government officers, chiefs, indunas and civic leaders drawn from Kaoma and Mongu districts.

OXFAM wants the success story of the CLTS campaign piloted in Choma district of southern province by UNICEF replicated in the province to heal surmount the sanitation challenges and the result poor hygiene practices.

OXFAM programmes officer for health Mutinta Chilimboyi says this is because CLTS has shown tremendous success in scaling sanitation coverage in Choma and other parts of southern province. “Our project has a component of review of best international and national practices in terms of public health, water and sanitation options and technologies which should be replaced in areas of our project implementation,” said Mrs Chilimboyi. “Our concern is whether this approach will work in a different cultural context in western province,” she explained.

Mrs Chilimboyi explains the decision to adopt the CLTS approach followed extensive consultations with local authorities and the district Water Health Sanitation Education (D-WASHE) committees on what should be done to address the low sanitation coverage in western province given its unique cultural context.

“The OXFAM project is in western province is phasing out next year but we hope the stakeholders like the councils and the ministry of health will continue with the programme since it is in line with the government road and policy on the National Rural water Supply and Sanitation Programme(NRWSSP),” she said.

Ms Chililmboyi explained that the OXFAM budget line was only able to finance trainings as there is no specific funding for the CLTS. “We are trying to get contingent funds from the donors to ensure the CLTS project become a success in western province.

The CLTS programme thrives on the principal of communities initiating action to stop open defecation through construction of latrines and promotion of good hygiene practices without any hardware subsidies from government or other development agencies.

Presenting a paper on the role of traditional leaders in the CLTS campaign to the OXFAM sponsored workshop of chiefs, Indunas and other stakeholders in Mongu, chief Macha of the Tonga people of Choma warned it would be difficult for the country to achieve some of the millennium development goals unless there were accelerated efforts in the provision of good sanitation and safe water to rural communities.

The chief said more still needed to be done though government through its National Rural Water Supply and Sanitation (NRWSS) policy had put in place a comprehensive programme to attain some of the goals on rural sanitation and water supply.

Chief Macha also paid courtesy call on the Litunga, the paramount chief of Western province, at his Limulunga palace to explain the CLTS programme said improving the low percentage coverage on sanitation and water in rural areas required a concerted effort involving government, traditional leaders and cooperating partners.

He pointed out that the implementation of the NRWSS programme should not be left to government alone because of the mammoth work and limited time remaining in meeting the MDGs.

He said the biggest challenge facing most rural communities was lack of access to latrines and safe water resulting in sanitation related diseases which could be avoided with latrine use and good hygiene practices.

The traditional leader said leadership was needed at the level of chiefs and headmen to spearhead latrines construction without necessary to government for subsidies. “If people are able to build homes on their own without any government assistance, what is so special about a toilet?” he asked.

Chief Macha said since the launch of the Community Led Total Sanitation by UNICEF in Choma district in the year 2007, all the 105 villages in his chief had become open defecation free as all households had built latrines.

“I am happy to inform you that all my villages have latrines and are observing good hygiene through hand washing. This has tremendously improved the health status of my subjects,” he told the Litunga. “This toilet revolution is because of my active and personal involvement in encouraging my subjects.”

Chief Macha said the CLTS approach was unique as there was no need for government handouts but only local resources to put up standard latrines.

He said his decision to become an ambassador of sanitation was because of his concern that rural communities would not be able to reach the MGS targets on sanitation as most of them still answered the call of nature in the bush thereby increasing the disease burden.

CLTS national coordinator Leonard Mukosha explained to the workshop that where CLTS sparks off, there was urgent collective action to stop open defecation. “CLTS focuses on igniting a change in sanitation behavior rather than constructing toilets. It does this through a process of social awakening that is stimulated by facilitators from within or outside the community.”

CLTS, he said, it encouraged the communities to take responsibility and to take its own action.

Mr Mukosha says the concept concentrates on the whole community rather than on individual behaviour. The fundamental thing is that CLTS does not provide individual household hardware subsidy and does not prescribe latrine models.

Social solidarity, help and cooperation among the households in the community are a common and vital element in CLTS.

Mukosha added: “in its fullest sense, total sanitation includes a range of behaviours such as stopping open defecation, ensuring that everyone uses a hygienic toilet, washing hands with soap before preparing and eating food and safe disposal of waste.”

After the three days training at Limulunga, it was time to do practical work, a major principle of the CLTS programme. The participants were put into groups and assigned to various areas in Mongu and Kaoma districts to go and ‘trigger’ CLTS. Triggering is based on stimulating a collective sense of disgust, embarrassment and shame among community members as they confront the crude facts about mass open defecation and its negative impacts on the entire community.

The author was part of the group led by Chief Kandala that assigned to trigger Yuka village, the traditional palace of the lead facilitator. During the trigger, it emerged that Yuka village with 40 households with a total population of 160 people only has to latrines in the entire village.

During the focused group discussion, villagers explained in the presence of the chief that most members of the community were answering the call of nature. Another key thing during the trigger was that traditionally chiefs in western province do not present themselves before their subjects any. This taboo was broken during the CLTS trigger as villagers discussed freely in front of the chief on matter over sanitation.

What then is the way forward for CLTS in western province?

The chiefs and Indunas present at the five days workshop all unanimously affirmed to launch a toilet revolution in their areas. Chief Chiengele of Mongu said CLTS would be nurtured because of the immense benefits but was quick to point out that cultural barriers in Barotseland were still a factor.

But chief Macha said chiefs in western province could take advantage of the strong culture and traditional and integrate CLTS. “Chiefs and headmen should use their structures and authority to spearhead santiation campaign. This is achievable,” he said.

Chief Macha argued that culture should be dynamic and also accommodative to modern innovations meant to improve the health status of the people. It only remains to be seen how OXFAM and other stakeholders will implement the CLTS programme given the unique cultural context of western province.

ZANIS