Cash rewards spur poor communities to pay for sanitation projects

The East Meets West Foundation tries cash awards to encourage families and communities in Vietnam and Cambodia to build latrines and hand-washing devices.

By Nicole Wallace, The Chronicle of Philanthropy / September 12, 2012

An international aid charity is taking an unorthodox approach to helping people in Cambodia and Vietnam improve sanitation and hygiene: It asks beneficiaries to help pay for the construction of latrines and hand-washing stations, but then gives them cash rewards when they get results. The effort will now spread, thanks to a $10.9-million grant from the Bill & Melinda Gates Foundation.

The East Meets West Foundation, in Oakland, Calif., works with local groups to provide hygiene education, train masons to build high-quality latrines, and broker low-cost loans that families can use to install latrines and hand-washing devices. Families receive a $10 rebate to help offset construction costs after an independent group has verified that the latrine is in place.

Communities also get incentives: They receive cash awards to be put toward public-works projects, such as roads and sanitation facilities in schools, when the percentage of households that have latrines and hand-washing devices hits 30 percent, and the communities receive more money when those rates reach 95 percent.

Gates Foundation Provides Millions for Sanitation in Cambodia, Vietnam

Bill Gates, accompanied by his wife Melinda speak to students at an appearance at Central Piedmont Community College in Charlotte, North Carolina.

04 September 2012
Men Kimeng, VOA Khmer

WASHINGTON DC - The Bill and Melinda Gates Foundation has provided nearly $11 million to help more than 1 million people establish better sanitation through the construction of latrines.

The funding, provided to the East Meets West Foundation, will help people in Cambodia and Vietnam, where around 17,000 people die each year from poor sanitation, said John Anner, director of East Meets West.

That means the loss of some $1.2 billion a year to medical treatment and absence from work, he said.

“So we see sanitation as not simply being a health issue, but also something that helps families trapped in the cycle of poverty and makes it hard to climb out of poverty,” Anner told VOA in an interview.

Gates Foundation awards $11M to East Meets West

Thursday, August 16, 2012
By Lindsay Riddell, Reporter
San Francisco Business Times

The Bill & Melinda Gates Foundation has awarded a $10.9 million grant to Oakland-based East Meets West Foundation to improve sanitation and hygiene in rural Cambodia and Vietnam.

East Meets West, an international development agency, will use the money to fund its program, which includes sanitation and hygiene education, installing toilets and hand washing devices in homes, and cash payments for use of those facilities within a community.

The Foundation said 50 percent of people living in rural Vietnam and 80 percent in rural Cambodia don’t have access to sanitation facilities. Disease resulting from the unsanitary disposal of human waste kills about 17,000 people a year — most of those younger than five years old — in those two countries every year.

Battle to improve sanitation in Cambodia

Feb 08, 2011
By Laurinda Luffman, SOS Children

Along the border between Thailand and Cambodia, troops have been clashing for four days over a disputed area between the two countries.

An international court ruling gave jurisdiction over the 11th century Preah Vihear temple to Cambodia. However, ownership of land around the temple was never agreed, leading to a number of skirmishes between troops over the past decades. According to the Cambodian government, 5 of its people have been killed in latest fighting, with 45 injured. At least 2 Thai have died. The Cambodian President has called for a buffer zone to be created by the United Nations. However, it is unclear if this will happen and when the conflict might end.

Meanwhile another kind of war is being waged in Cambodia, but the people involved in this battle are confident it will mean the saving of lives. The not-for-profit organisation International Development Enterprises (IDE), which works to provide income opportunities for the rural poor, is campaigning about sanitation. Diseases linked to poor sanitation cause more deaths in Cambodia than HIV/AIDS, malaria and tuberculosis combined. More than 10,000 Cambodians die every year due to lack of proper sanitation, most of them young children.

Rural sanitation a winner for Cambodia's latrine entrepreneurs

August 31, 2010
ABC Radio Australia

Sanitation in Cambodia's rural areas is noticeable mainly by its absence.

The government's target is for 30 percent of rural households to have access to proper sanitation by 2015 - a target it says it will meet - and it aims for the entire country to have access ten years after that. A novel approach from an international NGO that combines the profit motive with sanitation seems to be helping.

Presenter: Robert Carmichael

Click here to listen to the audio program (Windows Media)

CHEA: We empower the community to think about how they can improve sanitation by themselves at the community. So we work with them. FADE///

CARMICHAEL: Dr Chea Samnang heads the department of rural health at the Ministry of Rural Development in Phnom Penh. It is his job to ensure that 30 percent of more than two million rural households have access to proper sanitation and hygiene by 2015. That seems a tall order. Until recently just 16 percent of rural households had access to a latrine. Everyone else uses the "open defecation" method, which simply means waiting until dark, then finding a suitable patch of ground near home. But that leaves large amounts of untreated human waste that contaminate water supplies and spread disease. It is part of the reason Cambodia's under-five mortality rate is among the highest in Asia.

Dr Chea Samnang says the ministry sends teams to rural areas to meet villagers and explain the costs of poor sanitation. Villagers work out how much they spend on medicine, and how many days they lose to illness.

CHEA: And when someone in the family is sick - how much money do you pay? How about the schoolchildren, if they get sick. So this is the situation [that is] analyzed in the community.

CARMICHAEL: The hygiene campaign focuses on three key areas: encouraging people to use latrines; making sure they wash their hands; and educating them about safe drinking water practices. The standard latrine comprises three concrete rings dropped into a six-foot deep pit to provide a reservoir for waste; a concrete slab on top of that; and a pan at ground level. The latrine owner then builds a small structure around that for privacy.

Part of the government's approach to solving the lack of rural sanitation relies on assistance from charities and organizations like the Asian Development Bank. But another part is based on self-reliance. Once the community realises how much poor sanitation costs, villagers will improve matters themselves. However in a country where poverty is widespread, particularly in rural areas, telling people that poor sanitation is expensive is just one part of the solution. The other is providing them with an affordable latrine.

To that end the non-governmental organization IDE Cambodia - whose slogan is: Fighting Rural Poverty with Profit - redesigned the standard latrine and brought its cost down to less than $30. The NGO then trained local manufacturers of cement products in a handful of districts to make and market the toilet - branded the EZ Latrine. It launched in December.

Cordell Jacks heads IDE's water and sanitation program. IDE's philosophy is that subsidies for latrines create an environment in which people wait for others to fund the necessary improvements. The result is often that nothing gets done. Far better, says Jacks, to explain what poor sanitation costs, provide a cost-effective solution, then use local entrepreneurs and the profit motive to solve the problem.

JACKS: In the last nine months it's gone really well. We've sold almost 6,000 latrines and every single one of those latrines has been completely financed by the household. There's been absolutely no subsidy. Not one dollar.

CARMICHAEL: The pay-off for the entrepreneur is a profit of five to ten dollars per latrine. The family benefits because they typically spend far more than $35 annually on related health costs. In fact a World Bank study from 2008 found that poor sanitation and hygiene costs each Cambodian family around $150 per year.

And building the toilet is simple.

JACKS: The family will dig a hole in the ground, place the concrete rings, put the latrine together, and then put a structure - depending on what their income can afford - a superstructure on top of that. And this can all be done in one day. It's completely revolutionized sanitation as an industry here in Cambodia. The Ministry of Rural Development is working with IDE to help spread the message. The EZ Latrine fits the government's concept of self-sufficiency for those who can afford it. Dr Chea Samnang says those who cannot, will get technical help to build the cheapest sort of latrine - a dry-pit. The focus is to ensure every village is 100 percent free from open defecation, so it is essential that the poorest are included. Ultimately the result ought to be better health across Cambodia.

New Effort Brings Latrines to Rural Cambodia

Cordell Jacks, who heads IDE Cambodia's water and sanitation program, stands next to one of the award-winning EZ Latrines that the charity hopes will help improve sanitation in rural Cambodia (Photo: Courtesy: R. Carmichael)
Dr Chea Samnang heads the department of rural health at the Ministry of Rural Development. The government wants 30 percent of rural households to have access to a latrine by 2015, and 100 percent by 2025. Dr Chea says that target is currently on track. (Courtesy: R. Carmichael)

Robert Carmichael, Voice of America
Phnom Penh 30 August 2010

In Cambodia, a new effort is focusing on improving rural sanitation and health by providing toilets to households. A novel way of doing that seems to be paying off, literally.

Latrines – they are humble, necessary, and for the most part lacking in rural Cambodia. Five years ago just one in seven rural Cambodians had access to a toilet.

As in many developing nations, poor sanitation has a cost in Cambodia. In rural communities, where 75 percent of the population lives, most families have no toilets and relieve themselves in fields.

The result is untreated human waste, which can spread disease and death. Poor sanitation is one reason Cambodia has one of the highest child mortality rates in Asia. And, the World Bank says, the lack of toilets costs Cambodia $450 million a year in health care.

Government initiative

Dr. Chea Samnang heads the department of rural health at the Ministry of Rural Development. With the help of international donors, his office aims to provide 30 percent of rural homes, or 720,000 households, with latrines by 2015 – up from half a million now.

The government uses television advertisements and teams of workers sent to villages to explain the benefits of latrines. Chea says the program stresses three areas.

"One is to build toilet and use toilet by their own resources," Chea said. "Second one is hand-washing with soap after defecation and before eating. And the third message is we talk about the safe drinking water at home, and the safe storage of drinking water at home."

Role of IDE Cambodia

An agricultural development charity called IDE Cambodia has joined the effort and says it has found a way to get families to build toilets, and pay for them.

That sounds like a hard sell in a land where poverty is widespread. But Cordell Jacks, the head of IDE's water and sanitation program, says it works – thanks to the EZ latrine.

Knowing the biggest cost of a toilet is concrete, IDE designed one that mixes rice husks in the concrete, reducing the price. And modifications to the concrete slab that is the foundation of the toilet made it easier to install them.

Then IDE trained local entrepreneurs – typically people who already manufacture cement products – to make and market the latrines.

"Latrine producers will load up their trucks with these latrines, go into villages, market and educate about proper sanitation and hygiene, and will sell latrines door to door or at village meetings," said Jacks.

Cost factor

The cost - about $35 dollars, compared with up to $200 if a family tries to buy supplies and build a latrine using traditional methods. The entrepreneur pockets around five dollars, and there is no subsidy. Installing one is simple and speedy.

"The family will dig a hole in the ground, place the concrete rings, put the latrine together, and then put a structure – depending on what their income can afford – a superstructure on top of that," Jacks added. "And this can all be done in one day. It's completely revolutionized sanitation as an industry here in Cambodia.

Government joins IDE

IDE introduced the EZ Latrine, which won an international design award this year, in two provinces in December. Six thousand have been sold and IDE gets regular calls from would-be entrepreneurs wanting to get in on the action.

The Ministry of Rural Development works with IDE to take the EZ Latrine to other provinces.

Chea says latrines will be needed for an additional two million households to ensure 100 percent of the country has toilets by 2025. But Cambodia's poorest can not afford even the EZ latrine.

Chea says the ministry will help such families build dry-pit latrines, which cost only a couple of dollars.

"So we work with them. We try to make them understand that the defecation in the toilet is very useful to improve their income," Chea said. "So we let them to build the dry pit. And then starting from that one, if they understand that it is useful for their family then we can work with them further to improve their sanitation program."

IDE has begun a pilot program to help the poorest buy a latrine. Families pool one dollar a month, and each month the agent builds another latrine. Eventually everyone gets a toilet. Although the program is new, Jacks says the approach seems to work and gradually is helping Cambodia's rural communities fight disease and improve incomes – with the lowly latrine.

CAMBODIA: "Floating toilets" offer hope for river communities

A sideview of the urine diversion pan. The hole on the far right is for urine, the middle for feces and the third for anal washing (Photo: Lien Aid)

PHNOM PENH, 10 July 2009 (IRIN) - A toilet now in the development stage could improve the health of thousands living in Cambodia’s impoverished river communities.

River communities’ homes are typically built on floating platforms and moved seasonally, and rarely have proper latrines. Occupants use the river – the same water they use for drinking, cooking and washing.

The health risks are high: according to Resource Development International–Cambodia, a faith-based NGO, 74 percent of all deaths are due to waterborne diseases, including diarrhoea.

Cambodia has one of the highest infant and under-five mortality rates in the region, at 97 and 141 per 1,000 live births, the UN Children’s Fund (UNICEF) reports.

Many rural Cambodians see latrines as filthy, preferring open defecation as being more natural.

“It’s not a poverty issue. Some wealthy people in the countryside don’t have good sanitation, and some poor families do have it,” Chea Samnan, director of rural healthcare for the Ministry of Rural Development, said. “It’s an issue of access to the right information.”

As part of its "River of Life" profect, Lien Aid, a Singaporean-based NGO, is working on what it describes as a “floating toilet”. The toilets - built on floating platforms and attached to homes – will effectively prevent faeces from entering the water.

“We are still in the preliminary stages of testing out the prototypes,” Sahari Ani, Lien Aid’s head, told IRIN.

Eco-sanitation design

The device has three components - a superstructure, a urine diversion pan, and a space for a removable bucket or container for waste material.

Central to the design is the pan itself, effectively separating urine from faeces. A separate section of the pan allows for anal washing.

Materials such as dry soil, ash and wood chips can be added to excreta, thereby reducing odour and pathogens, while cutting the volume of waste.

The semi-decomposed faeces is then treated at a secondary storage chamber for complete decomposition and pathogen destruction, while the nutrient-heavy urine could be used as fertilizer after removal.

Commenting on the merits of the pan, Judy Hagan, project manager of a different operator, the Tonle Sap Floating Latrine Design Project, said separating the two waste materials reduced the bulk and mass of the faeces that needed to be treated, making it more viable in a floating environment.

Key challenges

But introducing such concepts in a country like Cambodia will not be easy.

As floating river communities exist only in Cambodia and a handful of other Asian nations, latrines designed specifically for their needs are rare and expensive.

Added to this is the country’s lack of qualified engineers, poor sanitation infrastructure and low level of hygiene awareness.

“The more difficult challenge is to help the community build up the human resources necessary to make the venture financially sustainable over the long term,” Sahari Ani said.

According to the World Bank, only 16 percent of rural Cambodians have a proper toilet, the lowest level in Southeast Asia.

Moreover, despite the country’s abundant freshwater rivers and lakes, 60 percent of its population do not have access to safe water and 85 percent are without adequate sanitation, Lien Aid stated.

Cost effectiveness

While an exact price for the device is still being determined, the NGO hopes costs can be kept to a minimum, with families possibly purchasing building material in bulk to keep down costs.

One-third of Cambodians live on less than US$0.50 a day, according to government statistics, making cost a significant factor.

“We will still try to keep costs down by exploring the use of [local] materials and by encouraging local entrepreneurs to manufacture the required parts,” Lien Aid’s head explained.

Although fairly new, villagers in Cambodia have already been learning how to construct cheaper latrines for as little as $15 each from the community-led total sanitation programme, started in 2005 by UNICEF and Cambodia’s Ministry of Rural Development.

And while not of the floating toilet type, the self-built, cost-effective latrines could provide further impetus to the floating toilet prototype once their use becomes more widespread.

Lack of Sanitation Costs Millions: Bank

By Sok Khemara, VOA Khmer
Washington
10 February 2009

Around 10 million rural Cambodians live without proper sanitation and toilets, a major drain of money and resources, a World Bank team has found.

“Based on an economic analysis of sanitation, there’s an annual loss of $190 million, for just a health problem,” Kov Phyrum, a water supply and sanitation analyst for the World Bank said Monday.

Without access to clean water and other sanitation, money is wasted, he said.

“If people urinate and defecate on the ground outside, when the rain comes it drains into water resources, like the ponds, rivers and lakes,” he said, as a guest on “Hello VOA.” That in turn leads to disease, “and if people drink the water, they will become sick with diarrhea and waste a lot of time and money and services.”

Kov Phyrum recommended people use rain water when possible and also wash their hands often to prevent disease.

Cambodian Gov't Calls for Cooperation to Fulfill Sanitation Goals

2008-12-19
Xinhua

Alarming statistics on the state of rural sanitation have led the Cambodian government to call for cooperation at all levels, national media reported Friday.

Only 16 percent of people in Cambodia's rural areas have access to toilets, Chea Sophara, Minister of Rural Development, was quoted by the Phnom Penh Post as saying.

"Cambodian people's understanding of living in a hygienic environment is still low compared to neighboring countries," Chea Sophara said.

He said that the ministry's goal was to ensure that at least 20 percent of the population in the countryside have access to toilets by the year 2010, and 30 percent by 2015, to reach the millennium development goal.

But this would be tough without full cooperation at all levels of government, he added.

"If officials from all departments do not cooperate well with villagers when they are on duty, it will be useless and the development situation will stay the same," he said.

Experts Urge All-Out Toilet Efforts

Fri., Mar. 21, 2008
Marwaan Macan-Markar
Inter Press Service (IPS)

BANGKOK, Mar 20 (IPS) - New technology, religion, and the market must be harnessed to secure basic toilet facilities for Asia's rural and urban poor, sanitation experts from the region said here Thursday.

Currently, over 2.6 billion people across the world have no access to an organized system of toilets, of which some 1.5 billion people live in the Asia-Pacific region, states the Economic and Social Commission for Asia and the Pacific (ESCAP), a regional UN body based in Bangkok, which hosted a conference on sanitation.

And every year, over 200 million tons of human waste go uncollected and untreated globally, adds ESCAP. This not only fouls the environment and spreads diseases, but forces the people with no access to toilets to ''live in deeper poverty and indignity.''

''If you want to solve the problem, you have to talk about the appropriate technology that works,'' said Bindeshwar Pathak, founder of India's Sulabh Sanitation and Social Reform Movement, in a keynote address. ''In many developing countries, due to lack of affordable sanitation technology, sanitation coverage was far below the level of satisfaction.''

And for that, community involvement is a priority, since most of the people who need toilets are from the marginalized lower socio-economic sector, added Pathak, whose organization has built 7,500 community toilets in India. ''It is still not seen as a high priority, resulting in [the] absence of people's participation.''

Other experts, like Jack Sim, founder and current head of the Singapore-based World Toilet Organisation (WTO), called for the poor to be viewed in different light if the current sanitation gap has to be bridged. ''We don't follow the donor model, which requires the poor to be certified as useless to receive assistance.''

His organization has pushed the message for better sanitation using a ''marketing model,'' where the poor have to ''demand'' toilets. That includes ''teaching the poor to be sanitation businessmen,'' said Sim.

The role of religion in influencing change of current toilet habits has to be roped in, he added. ''Religion is a very good tool, because most religions say that when you come to God, you must come clean. We must try and leverage on this.''

Other organizations, like the Seoul-based World Toilet Association, say that for the world to achieve its current sanitation targets, discussion about toilets needs to be part of regular conversation. ''An open dialogue about toilets, a subject often avoided because of unpleasant associations, must be fostered,'' it states. ''Changing people's perceptions and encouraging social action aimed at expanding appropriate toilet facilities around the world is crucial.''

The ESCAP event was part of the program to mark World Water Day, which falls on Mar. 22. The emphasis on sanitation for this year's event stems from 2008 being declared as the International Year of Sanitation.

Ensuring better sanitation, furthermore, is one of the Millennium Development Goals (MDGs) that world leaders agreed at a 2000 UN summit to meet by 2015. Goal Seven of the MDGs' eight goals was a pledge to halve by the deadline the proportion of people without access to safe drinking water and basic sanitation.

The Asian continent offers a major challenge for such an ambitious development program, since it is home to giants like China and India. China accounts for a third of the region's 1.5 billion people without safe sanitation, while India accounts for another third.

During a review of progress made halfway into the MDGs timeline, the UN revealed that China had ''traveled less than half the distance to its target,'' while India's efforts were ''not enough to stay on track.'' Bangladesh, another populous South Asian nation, had also fallen behind, with the UN saying it ''too is off track.''

Even smaller countries like Cambodia and Laos are burdened with few toilets. Currently, only 17 percent of Cambodia's rural population, where the majority of the country's 14.8 million population live, have access to toilets, says Nasir Hassan of the World Health Organisation. In neighboring Laos, only 30 percent of the population have access to basic sanitation.

By contrast, Southeast Asian countries like Singapore and Brunei have 100 percent sanitation coverage, while Thailand has 99 percent coverage and Malaysia, 94 percent.

Yet Thailand's success offered a note of caution, since it was not accompanied by a dramatic drop in waterborne diseases. ''Despite a near 100 percent sanitation coverage, the morbidity rates did not come down,'' Dr. Twisuk Punpeng, a senior advisor at Thailand's ministry of public health, told IPS. ''New toilets alone will not reduce morbidity rates. Good hygiene practices are also essential.''

According to the United Nations, the lack of basic sanitation leaves the world's poor vulnerable to preventable diseases. ''Globally, one child dies every 20 seconds as a result of poor sanitation.''

Diarrheal disease remains the leading killer of children under five years in the East Asia and Pacific region, states the United Nations Children's Fund (UNICEF) in a document circulated at the conference. It is responsible for 187,000 deaths annually.

Poor sanitation in the region also affects education, adds UNICEF. ''School enrollment is also affected as children, especially girls, are less likely to stay in schools without adequate water and safe, private sanitation and washing facilities.''

Cambodia to spend more to guarantee clean water, satiation for rural people

PHNOM PENH, Nov. 13 (Xinhua) -- The Cambodian government will try to make 50 percent of its rural people live with clean water and qualified satiation and 30 percent with toilets at home in 2015, an official said here on Tuesday.

The government will spend over 430,000 U.S. dollars for sanitation and clean water next year, said Chea Samnang, head of the healthcare department for rural areas at the Ministry of Rural Development, while marking the country's first National Sanitation Day.

On the same occasion, Yim Chay Ly, secretary of state at the Ministry of Rural Development, said that currently, some 70 percent of the kingdom's 14 million people, especially those in the rural areas, live without toilet at home, while a large percentage of them have no access to safe water.

This results in the rampancy of diarrhea, typhoid and hookworm intestines, he said.

Lack of sanitation and clean water also led to 20 percent of the death of those under five years old, he added.

Meanwhile, Prime Minister Hun Sen said that this problem has made the Cambodians live in poverty and it is one of the major obstacles in the economic development of the country.

Only 16 percent people live with qualified sanitation and this ratio is far behind other ASEAN (the Association of Southeast AsiaNations) countries, he added.

According to a study by the Economic Institute of Cambodia, theoverall economic loss from poor sanitation and lack of clean waterstands at 448 million U.S. dollars a year in the kingdom, equal to7.1 percent of its GPD, while some 10,000 people die annually due to the problem.

Most Cambodians are in rural areas and 35 percent of them live in poverty.