Improving Sanitation By Placing Value On Toilets

The article below was published in November 2021 in the Zambia Daily Mail Newspaper to commemorate the World Toilet Day. It was relevant then and it is relevant now. 

On 9^th November students from the University of Zambia protested to bring to the attention of government the various challenges the school is facing one of which is the lack of proper sanitation as shown in a video where their Students Union President Gabriel Banda claimed that East Park Mall toilets have been their salvation. 2 days later, on 11^th November 2021, students from the Lusaka Business Technical College (LBTC) staged a protest alleging poor sanitation at the institution.

If situations can be this dire at higher learning institutions, how about the rural areas?

The Toilet Crisis

According to JMP (2021), only 3.2 in 10 Zambians have access to improved sanitation facilities which are not shared with other households. 1.1 in 10 Zambian disposes human faeces in open spaces as they lack any form of toilet. The true picture is that 1.94 million of rural Zambians have no toilet facility, as compared with 128,694 of urban. While toilet access is generally higher in urban areas as compared to rural, sanitary conditions in urban areas are aggravated by high-density living, inadequate septage and solid waste management, and poor drainage.

Poor sanitation undermines human dignity. Access to safe, hygienic, and private sanitation facilities is one of the strongest indicators of dignity. For many women across the country however, inadequate access is a source of shame, physical discomfort, and insecurity. Cultural norms strictly control behaviour in this area, in many cases requiring that women are not seen defecating – a requirement that forces them to leave home before dawn or after nightfall to maintain privacy. Delaying bodily functions is a major cause of liver infection and acute constipation. The loss of dignity associated with a lack of privacy in toilets helps to explain why women attach more importance than men to sanitary provision (UNDP 2006).

Poor sanitation hurt girls’ education. Young girls, particularly after puberty, are also less likely to attend classes if the school does not have proper toilets. UNICEF estimate that about half the girls in Sub – Saharan Africa who drop out of primary school do so because of poor water and sanitation facilities. That helps explain why improving school sanitation can increase the demand for education among girls. Conversely, inadequate provision can retard progress. Toilets at home, school and at work help women fulfil their potential and play their full role in society, especially during menstruation and pregnancy.

Poor sanitation causes child mortality. Of the 123,355 annual deaths in Zambia, 31,500 (26%) are children under the age of five (GBDx). Of these fatalities, 3,754 children won't survive to their 5^th birthday because of diarrhea. These sickness episodes represent the second largest cause of childhood death after acute respiratory tract infection. Globally, diarrhoea kills more people than tuberculosis or malaria – five times as many children die of diarrhoea as of HIV/AIDS. Most deaths from diarrhoea are caused by shigella, or bloody diarrhoea. Unlike other forms of diarrhoea, shigella cannot be treated effectively with simple oral rehydration therapies – it requires more costly antibiotics. Even for households that can afford treatment, shigella is a growing threat because it has rapidly developed resistance to antibiotics. The economic impact of poor WASH is also staggering as health is wealth. Despite all this background, less than 1.4% of 2022 Zambia's national budget will go towards Water, Sanitation and Hygiene.

Poor sanitation and undernutrition reinforce each other. When children are undernourished, their resistance to infection is lowered and they are more susceptible to diarrhetic disease and other infections. Where children regularly suffer from diarrhoea, they are also very likely to be malnourished as a result. For infants, particularly those under six months of age, diarrhoea can cause permanent damage to intestinal development, reducing a child's ability to absorb nutrients leading to stunting, both physical and cognitive. And children who are affected by stunting in their early years have lower test scores on cognitive assessments and activity level (Alderman, Hoddinott and Kinsey, 2006). Ultimately, adults who were stunted as children on average earn 22% less than those who weren’t (Anthony Lake, 2012).

Working with line ministries to contribute to stunting reduction in the Zambia, Scaling Up Nutrition Technical Assistance (SUN TA) is a project supported by USAID being implemented in 13 selected districts of Central, Copperbelt, Luapula, and Northern Provinces. To achieve this goal, SUN TA targets women of reproductive age with at least one child under 2 years of age, and/or a pregnant woman. The project’s sanitation demand creation and sustainable social behaviours change is promoted through Community Led Total Sanitation (CLTS) efforts. Given that recent evidence suggesting that poor sanitation is particularly threatening to early life health, efforts to improve sanitary conditions is therefore of urgent relevance.

2021 World Toilet Day

World Toilet Day - a day set worldwide to raise the awareness and inspire action to intensify the construction and use of toilets – falls on 19^th November every year. This year’s theme ‘Valuing Toilets” draws attention to the fact that toilets - and the sanitation systems that fund them – are often underfunded, poorly managed, or neglected. This has devastating consequences for health, economics, and the environment, particularly in our poorest and most marginalized communities. The use of toilets is a topic that is usually ignored and shrouded in taboos evidenced by the outrage UNICEF faced in 2018 for supporting the erecting of billboards proclaiming the eradication of open defecation in selected districts. It will take us to rightly focus such disgust and outrage at the man in the mirror for allowing our fellow Zambians to have the indignity of not having a toilet.

This World Toilet Day show us support that you care about toilets by joining the #WorldToiletDay conversation on all social media platforms.

Manual Pit Emptiers: Woes and Opportunities

If wealth was a result of hard work and enterprise, every manual emptiers would have been a millionaire. 

Three months ago, our septic tank was full, so we hired a private emptier with a vacuum tanker to empty it. Last week, to our surprise, there was an indication that the septic tank was full again despite it being built based on the standard guideline. The easiest suspicion was that the emptier had pulled a fast one on us and never really emptied the tank. In response, we engaged another emptier four days ago, who, to everyone's surprise, removed as much sludge as the first emptier. In our confusion about how the septic tank could have filled up so quickly, a freelance plumber on a street corner offered a different possibility.

He claimed that over time, sludge tends to block the honeycomb structures used in soakaway, which ultimately affects soil porosity and creates a cement-like structure that hampers water percolation. This revelation blew our minds; we had never seen it that way before. Now, let me expand on this phenomenon.

Fecal sludge is the solid and semi-solid waste generated from onsite sanitation systems like pit latrines and septic tanks. When fecal sludge is improperly managed or disposed of, it can be applied to the soil as a form of fertilizer or contaminant. The composition of fecal sludge includes organic matter, pathogens, and various substances that can affect soil properties. If excessive amounts of fecal sludge are applied, it can lead to soil compaction and reduced porosity. Compacted soil has fewer pore spaces, limiting the movement of air, water, and nutrients essential for plant growth.

Moreover, the organic matter present in fecal sludge can undergo decomposition, consuming oxygen in the soil. This reduction in oxygen levels can further impact soil health and porosity while inhibiting the growth of beneficial soil organisms. Managing fecal sludge properly is crucial to minimize its negative impact on soil quality and promote sustainable agricultural practices. This entails implementing proper treatment, containment, and safe disposal practices. 

The soakaway, also known as a drainfield or leach field, which is an area of soil or gravel specifically designed to receive and disperse the effluent from a septic tank through a pipe buried in the ground had been blocked by soils. Thus, the effluent was not getting distributed to percolate into the surrounding soil, where it was supposed to undergo further biological treatment and filtration. instead of the soil acting as a natural filter, removing pathogens and contaminants before the water eventually reaches groundwater, it compacted limiting percolation. Soak pits are best suited for soil with excellent absorption, rendering clay, hard packed or rocky soil as not appropriate.

Wastewater collected after the soil compacted in the soak away

In non-sewered areas, septic tanks must be emptied whenever they fill up them because of the lack of space to dig new pits. But whenever space permits especially in rural areas with very low population density and more land available, burying the pits and building another one somewhere is an acceptable feacal sludge management practice. Thus, emptiers play a critical role in fecal sludge management (FSM), which encompasses tasks such as emptying pits of fecal matter, transporting the sludge, and facilitating its treatment and safe disposal.

Though they have been providing non-sewered sanitation solutions in every corner of the country, manual emptiers face numerous occupational health issues, ranging from the stigma associated with their work to the challenging environments they operate in. Regrettably, they have been left to self-regulate despite septage being a very infectious material that can cause disease if ingested or if it encounters broken skin. Thus, relying on operators to be responsible for their personal safety and safety on disposal is a significant mistake with serious public health ramifications.

In 2018, the National Water and Sanitation Council (NWASCO), the regulatory body overseeing water and sanitation in Zambia, introduced the Urban On-site Sanitation and Faecal Sludge Management Framework for Provision and Regulation. According to this framework, NWASCO is responsible for regulating onsite sanitation through existing licenses with water and sanitation commercial utilities (CUs) covering their respective service areas. Any private operator, like the two gentlemen who serviced our septic tank within a CU's service area, should have a management contract with the CU that stipulates adherence to the requirements. However, having a regulatory framework in place is one thing, and its actual implementation is another. Zambia generally struggled with enforcement.

Private sanitation workers should be formalized. Promoting the professionalization of masons and emptiers through official licensing and certification processes authorized by the government not only elevates the standing of sanitation personnel but also enhances the overall strength of the sanitation service chain. Alongside improving the competence and expertise of workers, it is crucial to establish mechanisms that ensure their responsibility for the quality of their services. This can be achieved by facilitating consumer accessibility through the establishment of a local authority or CU managed registry of masons and emptiers and prioritizing their safety and protection during work by formulating standardized protocols for occupational health and safety.

Promoting private emptiers is not a zero-sum game but a win–win situation, protecting groundwater against faecal contamination whilst making a livelihood out of it. This is because emptiers can also be trained in hoy to hygienically collect and transform sludge into other products. Thus, all WASH and human and human rights practitioners - including the governments - must be advocating dignified and safe working conditions for private emptiers.