Out in the openThe state should deliver sanitation services just as it expects its citizens to build toilets
Sanitation is often a neglected topic in academic research, public discussion, media reporting, and in development policies and programmes. It is even more so in the context of Nepal, largely due to the Hindu notions of purity and pollution within which the acts of defecation are treated as ritually impure and the places for defecation are marginal spaces. These notions of defecation (and sanitation) have made it a disgusting topic, discouraging us from talking about it publicly. The mainstream media outlets of the country only find it appropriate to report on people’s sanitation practices when the outbreaks of diarrhoeal diseases hit many impoverished districts of Nepal. Or else, it is during the disasters such as the earthquake when the link between the lack of sanitation and the risk of epidemics becomes a worthy topic of discussion. Otherwise, sanitation issues remain largely invisible.
According to the Joint Monitoring Program (JMP) report of Unicef and World Health Organisation titled ‘Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment’, 2.4 billion people, one third of the total population of the world, do not have improved sanitation facilities (the JMP defines improved sanitation facilities as ones that hygienically separates human excreta from human contact). As many as 946 million people defecate in the open areas—roadside, fields, bushes, river banks, and so forth. This indicates that the Millennium Development Goals (MGD) target on sanitation—that expires this year—to achieve 77 percent people with improved sanitation facilities globally has not
According to the report, 32 percent of the total Nepali population practice open defecation, while only 48 percent of people have improved sanitation facilities. Since the report came out in June, the numbers do not reflect the damages and the loss of toilets caused by the earthquakes. Therefore, it seems is unlikely that the number of people with improved sanitation has increased.
The report points out that regional and class inequalities affect access to sanitation. Most of the people who lack improved sanitation facilities live in rural areas and in impoverished conditions. Unsurprisingly, the South Asian region has the highest number of open defecators, with 40 percent of people lacking improved sanitation. Similarly, there are gender dimensions of sanitation as well; lack of or poor sanitation facilities affects girls and women far more than they do for boys and men. The report also mentions that enhancing the access to sanitation requires addressing the sociocultural, geographical, and economic disparities.
For Nepal, the earthquakes of 2015 have added to the challenge of meeting the goal of ‘sanitation for all’ by 2017. According to the Post-Disaster Needs Assessment (PDNA), about 220,000 toilets have been totally or partially damaged by the earthquakes in the 14 worst-affected districts. The cost to rebuild the damaged toilets in these districts is estimated to be about Rs 1.2 billion. Given the massive damage and loss of sanitation facilities, and a severe halt in economic production, the PDNA also calls for reconsidering the zero-subsidy policy adopted by the current sanitation programs. If subsidies are re-introduced, it will mean two things. First, subsidy models will take the sanitation programme back to the point where it was until a few years ago. Second, it will contradict the basic principles of the Community-Led Total Sanitation (CLTS), an approach—currently adopted by more than five dozen countries worldwide including Nepal—which deals with the water, sanitation, and hygiene sectors. In addition, the CLTS embodies the transformation from subsidy model to behavioural change model. While the former is a top-down approach, where subsidies in toilet materials and finances are provided to the community, the latter is a demand-driven bottom-up approach that focuses on the community’s own realisation of the need of toilets, as a result of embarrassment and shame caused by open defecation.
In Nepal, the ongoing sanitation campaigns focus more on behaviour change, and much less on systematic response to the challenges. Systemic response means that the state should step up to take sanitation not only as a high priority area, but also engage in delivering the required sanitation services as much as it expects from its citizens to build toilets in their houses. It is a false belief that toilet-building in private houses alone will solve the sanitation crisis. Especially in the urban areas, where the everyday mobility of people is high, the state should make sure that there are enough public toilets in the vicinity. It is a shame that one has to pay for using toilets in our government buildings or be denied, as it is locked with a ‘staff only’ notice on its door. Discursively, we may have made progress in rights-centric notions of sanitation, but we are lagging way behind in practice. Recently, a friend of mine could not hold his bowel and dirtied his pants while on the way to a ‘nearby’ pay-for-use toilet in Kathmandu. One may laugh at this incident, but for me, this was a warning call: the public sanitation infrastructure in Kathmandu remains neglected; and our state is naïve for failing to realise that defecation is a bodily requirement as eating or sleeping. Needless to say, building sanitation infrastructures—to which children, the elderly and disabled people have unhindered access to—seems like an idea beyond imagination for the Nepali state.
It is high time that the organisations (governmental, non-governmental and private) engage in bettering the sanitation systems of Nepal, and pay heed to multiple manifestations and implications of sanitation. This requires the realisation that responses to sanitation should be culturally specific, sensitive, and compelling.
The PDNA recognises that the reconstruction and rebuilding process of the water and sanitation sectors will need to take into account the ‘gender sensitivity and social equitability of service delivery that takes human rights-based approach to reach those who are left unserved’. Only time will show whether Nepal has been able to think and do better to ‘build back better’.
Rijal is a PhD Candidate in Anthropology at Simon Fraser University, Canada currently researching on sanitation campaigns in Nepal