Celebrating Toilets.

This article was published in the Zambia Daily Mail in 2021 to commemorate the World Toilet Day.

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.

Hand hygiene: our future is at hand

This article was initially published in the Zambia Daily Mail Newspaper on 15th October 2021 to commemorate the World Handwashing Day but its relevance hasn't diminished a single bit. 

The COVID-19 era, many public and private institutions had put up handwashing facilities at the entrance of their premises. Standing there to observe the number of people washing their hands as they enter or exit and that gave you a real picture of the battle around social and behaviour change relating to hand hygiene.   

If you took the trouble to check, you may find some of those buckets have not had water in a very long time. Neither is there soap. But for the sake of being seen to be compliant, the buckets still stand.

Handwashing is a simple yet powerful act of hygiene behaviour crucial for the prevention of diseases. Handwashing was important before COVID-19 arrived but has now taken on added importance in view of the pandemic.

According to the Joint Monitoring Programme (JMP, 2021), a UN mechanism that provides regular global reports on water, sanitation and hygiene (WASH) coverage, around 51 percent or over nine million Zambians lack access to any form of handwashing facilities at home.  

Another 82 per cent or over 15 million lack availability of a handwashing facility with soap and water at home. If this sounds farfetched, it may be because you are part of the 18 per cent that have access to a handwashing facility with clean water and soap.

The choice to have a handwashing facility is an investment decision by a household bordering on finance. Hence the reason majority making up the 82 per cent are found in rural areas and poor communities of urban areas.

For the first time in many years, Zambia did not record cholera cases this year. Though an inquiry is needed to establish this, we can argue that there has been a considerable improvement in hand hygiene necessitated by the COVID-19 pandemic. This has broken the fecal–oral route that causes cholera. However, cholera remains a risk unless the underlying WASH vulnerabilities - lack of access to safe drinking water and adequate sanitation - are addressed.

Whilst water and sanitation infrastructure provide the physical conditions for hygiene, it is the sustained good hygiene behaviours that help prevent the transmission of diseases. Handwashing with soap and clean water, together with other public health interventions, has proved key in reducing the transmission of COVID-19.

Caused by poor hygiene, including poor handwashing behaviours, diarrheal diseases are a leading cause of stunting among children under the age of five in Zambia. That is why it is important for all members of the household to ensure they have a clean environment and wash their hands at critical times such as after using the toilet, after changing baby nappies, before breastfeeding, after cleaning a toilet, before preparation and consumption of food, and after coughing, sneezing, or blowing their nose.

Improved hygiene behaviours reduce chances of transmitting diseases, thereby contributing to a disease-free community and the healthy growth of children.

Global Handwashing Day is a day commemorated annually on 15 October to raise public awareness on making handwashing with soap and clean water available globally, especially in public places. It also calls for institutions and individuals to improve hand hygiene efforts in the COVID-19 response that can outlast the pandemic and ensure continued access to clean water and soap.

In 2021, the theme was “Our Future is at Hand – Let’s Move Forward Together”

Since the creation of Global Handwashing Day in 2008, the Government of Zambia began implementing policies and programs that promote handwashing with soap. Handwashing stations have been integrated into the national Community-Led Total Sanitation (CLTS) program, an innovative methodology for mobilizing communities to take leadership in raising sanitation standards in their localities.

One of the organisations supporting the government’s WASH efforts is the Scaling Nutrition Technical Assistance (SUN TA) Project funded by the United States government. By working with District WASH committees in 13 districts (Mumbwa, Chibombo, Kabwe, Kapiri Mposhi, Ndola, Kitwe, Samfya, Nchelenge, Kaputa, Luwingu, Mbala and Kasama), the project has trained government staff and community volunteers to deliver key messages on improved sanitation and hygiene even before COVID-19 arrived.

In addition to providing handwashing facilities to the 390 health centres where it is working in, the project is also rehabilitating 700 and constructing 300 boreholes and 26 water schemes to increase access to clean and safe water, key to the attainment of improve sanitation and hygiene. Also, 390 Area Pump Menders have also been trained and given tools to support their continuous operation and maintenance of these water points.

That year’s commemoration of the Global Handwashing Day offered each one of us an opportunity to spread the word about handwashing and contribute to behaviour change on hand hygiene.

The private sector and donors should invest in national roadmaps, hygiene strategies, and research, as well as programs that are hygiene sensitive, promote sustainable behaviour change and drive hand hygiene habits. Businesses should contribute towards resilient hand hygiene systems through partnerships, financing, and innovative products and facilities and again promote hand hygiene within their workforce.

If there is anything COVID-19 taught us, it is the need for collective actions to address the historic neglect of hand hygiene investments, policies, and programs. Our future is at hand, let us move forward together.

Remember to wash your hands today and every day.