Cleaning up Cambodia's toilet problem
Cambodia has the lowest rate of toilet coverage in Southeast Asia, leading to disease, environmental problems and hindering economic development. Tackling its sanitation problems is one the country's biggest challenges.
Deutsche Welle | 18 Nov. 2013
In the village of Damnach Trach, about an hour outside of Phnom Penh,
villagers have gathered to talk about poop. Under a covered shelter to
keep out the blistering tropical sun, Sam Vanna from the sanitation NGO WaterSHED explains how human excrement can pass disease.
Vanna then calls on a local farmer to demonstrate how he takes care of
his business when nature calls. The farmer, Nu Sokhom, promptly squats
as the crowd bursts into laughter.
"We let them have fun," Vanna said. "But I also talk about the reality and what really happens."
What happens in Cambodia is disease and preventable illness resulting
from open defecation, a very common practice in rural parts of the
country, where 80 percent of people do not have toilets. Most people in
the countryside simply defecate in fields or nearby forests, something
they've done for generations.
WaterSHED works on sanitation issues in Cambodia, Laos and Vietnam. For
several years now, the organization has been sending representatives to
rural villages to educate people about the importance of toilet use and
offer them easy ways to get their own household latrines.
Open defecation contaminates the soil, air and water, both above and
below ground. And it leads to serious illness and diarrhea. In Cambodia,
one in eight children won't reach their fifth birthday due to
infectious disease, much of it preventable. Farmer Nu Sokthom, the man
who was pretending to defecate in front of the villager group, knows of
the difficulties first hand.
"I have to go very far from my house [to use the toilet]," he said. "If
it’s raining, I get wet and I get sick. My family also gets sick a lot."
Diarrhea kills more children than malaria and HIV
This is a common refrain heard from both rural folk and sanitation
experts. Diarrheal disease - one of the most common illnesses resulting
from poor sanitation - is one of the basic killers of children under
five years of age worldwide, more so than malaria, tuberculosis and HIV
combined, according to Yi Wei, a sanitation expert from International Development Enterprises (IDE), an international NGO also trying to boost hygiene in the developing world.
"Recently there's been research showing that poor sanitation leads to
stunting and poor growth in children," she added. "That’s an emerging
field that we’re trying to look at as well."
Besides these serious implications for health, poor sanitation can
affect the larger economy. It's estimated that about 7.2 percent of
Cambodia's GDP, or $448 million (332 million euros), is lost due to
sanitation-related problems, such as driving away tourists to hurting
productivity as people have to take off work because of illness.
According to a recent World Bank study, a rural Cambodian family loses
almost $70 a year due to illnesses caused by poor sanitation and
hygiene, more than most make in a month. In urban areas, it's around
$40.
"If a household is earning money but getting sick continuously, it's
like a sieve. You're throwing money but it's continuously draining out,"
said Cordell Jacks, head of IDE's global sanitation program. "Improving
the health of these households is extremely important to poverty
alleviation."
Sanitation helps boost development
The importance of good sanitation management to development can be seen
elsewhere in the region. In Singapore, for example, by 1970, 90 percent
of the country's population had piped water in the homes. By 1990, all
households were connected to the sewage system. Over the next decade,
full sewage treatment came online. Experts say this comprehensive
infrastructure improvement spurred the city-state's economic development
and helped it become the success story it is today.
A WHO study has found that every dollar spent on improving sanitation generates an average economic benefit of $7.
Cambodia, on the other hand, experienced decades of conflict in
the latter half of the 20th century. The genocidal rule of the Khmer
Rouge in the 1970s set the country's development back decades, if not
more. Much of the country lacks basic services, such as electricity and
water. The great majority of rural villages do not have plumbing. And
the government is only recently showing real interest in improving
sanitation. All those factors have resulted in Cambodia having the
lowest toilet coverage in Southeast Asia, according to UNICEF.
But while rural areas in Cambodia are especially hard hit by poor
sanitation, urban areas are struggling as well. In Phnom Penh, raw
sewage is transported through an open canal in a densely populated part
of the city, and it sometimes floods during rainy season. Eventually the
smelly sludge makes it way to a pumping station before passing over a
spillway into a city lake and then emptying into two of the country's
major rivers.
Most Cambodians in the countryside live in traditional houses like this one. Many of them do not have toilets
As the city's population has doubled in the last 15 years, this
antiquated, inefficient system is buckling. The UN has called it a
threat to the urban environment and to human health.
In the Cambodian countryside, the defecation presentation by WaterSHED
is wrapping up. Villagers are handed an information sheet on a simple
latrine that can be installed outside their homes. It costs $50, which
is a significant amount of money for these families. Incomes generally
average around $60 a month.But in the end, 58 people place orders and
they will apply for loans from microfinance institutes or set up payment
plans with the local toilet suppliers.
Toilets aren't given away for free
This market-based approach, asking them to pay local businesses to
install their toilets, is called hands-off sanitation marketing. It has
proven more successful than previous programs, when NGOs would go to a
village and give toilets away for free.
"If people buy [the toilet], they will install it and use it because
they feel ownership of what they pay for," said Phav Daroath,
WaterSHED's marketing manager. He said if they got it for free, that put
less value on it, and perhaps use it for a while, but then go back to
their old ways.
In addition, there's an aspirational aspect to the approach. If one's
neighbor has a toilet, it carries some prestige, especially if a family
can offer guests a sanitary place to relieve themselves. The pride
factor is a key element, sanitation experts say.
While the WaterSHED program has resulted in the installation of 50,000
latrines over the past two years - and several other NGOs are running
similar programs - the majority of Cambodians still live with poor basic
sanitation daily.
The UN's Water of Life Decade, running from 2005 to 2015, has a goal of
reducing by half the proportion of the population without sustainable
access to safe drinking water and basic sanitation. But in Cambodia,
it's not likely that target will be met. And until sanitation
significantly improves, experts say other development goals, such as
education, nutrition, environmental sustainability and a host of others,
will be all that harder to reach.
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