Serious about sanitation? Listen to the community

According to a 2014 report by the World Health Organization and UNICEF, 1 billion people around the world practise open defecation and 2.5 billion have no access to sanitation services. This is in spite of significant progress towards the Millennium Development Goal of halving, by 2015, the proportion of the population without sustainable access to drinking water and basic sanitation. So, what can be done differently?

It seems as if efforts to increase access to appropriate sanitation facilities have so far misfired. “Progress on rural sanitation has primarily benefited richer people, increasing inequalities,” said Maria Neira, WHO’s director of Public Health and Environment.

There has also been a misguided focus on resource allocation. While there has been no lack of funding or technical know-how to build sanitation facilities, the problem has been how resources are allocated and which strategies are used to carry out an effective worldwide reform in sanitation.

Rolf Luyendijk, a statistician from UNICEF, said earlier this year: “There are so many latrines that have been abandoned, or were not used, or got used as storage sheds. We may think it’s a good idea, but if people are not convinced that it’s a good idea to use a latrine, they have an extra room.”

What this shows is a clear gap between what we as public health professionals think is a good idea and what the communities we’re meant to be working with actually need. If we really want to make progress – not just in sanitation, but on all sorts of issues – we need to start listening to what the community has to say and create partnerships that fully integrate technical experts and community stakeholders.

I speak from experience. After the 2010 earthquake in Haiti, my organization started working in a small community in the municipality of Croix-des-Bouquets. There were two pit latrines, both of which had been clogged since even before the earthquake. As a result, people were forced to defecate in the open.

After the earthquake, international aid organizations proposed building pit latrines in the community. They did so without speaking with community members about what they actually needed. If they had consulted them, they would have discovered that the topography of the area means latrines are unsuitable and could not be used. They get clogged (as the community doesn’t have the financial means to empty them when they’re full), they contaminate the underground water systems and cause diarrhoeal diseases.

When we started working there, we took a different approach. We engaged in constructive dialogue with community leaders, performed a needs assessment and took the time to understand and reflect on their social context. We found out that the area had a high water table, effectively ruling out pit latrines. We also learned how local agriculture had suffered by deforestation and flooding.

Together with community leaders, we explored alternatives to pit latrines, and decided that ecological sanitation (EcoSan) and compost-producing toilets were the best solution. The toilets were built 2 ft off the ground, preventing faecal underground water contamination. Today, the community has toilets, rich compost and an agricultural output of more food than they can consume.

The EcoSan project shows how participatory community development is key to any sustainable development project. Public health professionals and aid organizations need to take the time to understand what a community needs, to earn their trust and make sure they are involved in planning and implementation. Building a toilet should not be something done to them, but something performed with them, making the project more likely to succeed.

As we start to put in place a post-2015 development agenda, we must recognize that communities are not mere recipients of aid. They are key stakeholders and must be involved throughout any projects that will affect their lives. By making community participation central to development projects and strategies, we can get back on track and ensure that each and every one of the development goals is not only reached, but surpassed.

Read about Hati’s fight against cholera
Keeping it clean: the vital role of water and sanitation

Author: Andrea Perez Homar is the founder and executive director of Silent Grace Foundation. She is a doctoral student in global health and the curator of the San Juan hub of the Global Shapers Community. She will be attending the Global Shapers Annual Curators Meeting from 21-25 August in Geneva, Switzerland, bringing together over 325 Curators from around the world.

Image: The first toilet is installed in the Croix-des-Bouquets community, Haiti. Courtesy of Andrea Perez Homar