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Lifting the Lid on Africa's Toilet Crisis

Voices emphasising the need for improved sanitation facilities in Africa have grown stronger over the last decade, but now better publicity needs to translate into real progress.
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Relieving rural Africa: a urine diversion dessication (UDD) toilet in South Africa. Photograph by Sustainable Sanitation.

The 12th annual World Toilet Summit has recently concluded in Durban, the first time the event has been held in Africa. It follows in the wake of World Toilet Day, established on November 19, 2001, to raise awareness about numbers of people living without access to proper sanitation – a figure which stands at 2.6 billion worldwide.

The day and the summit are the initiatives of the World Toilet Organisation (WTO), a global non-profit organisation founded in Singapore, which recently derided the UN for failing to adopt World Toilet Day, suggesting they may be “scared of using the word ‘toilet’”. Consequently, the WTO set out to break down toilet taboos and ensure that the provision of improved sanitation facilities (UN nomenclature for ‘toilet’) is no longer overshadowed by its seemingly more wholesome companion cause of providing clean water.

Failure to honour the noble toilet with its own national day aside, accusing the UN of being unconcerned by matters of public sanitation seems unfair. Target 7C of the UN Millennium Development Goals (MDG) was to “Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation”. UN-Water, a coordinating mechanism overseeing all relevant organisations, was endorsed in 2003 to pursue this target. And while sanitation may not be celebrated in the annual manner of World Water Day, the UN saw fit to dedicate an entire International Year of Sanitation in 2008.

Progress so far: a drop in the ocean?

With two organisations championing of the issue, there has been a great deal of discussion on the international stage over sanitation in the last decade. But has this just been hot air or has it led to something more solid? In particular, how has the sanitation situation in Africa developed during this decade of activism? With over 600 million people lacking improved sanitation facilities on the continent, Africa has understandably become a major battleground in the fight to bring toilets to the masses.

Initially promising statistics released in a 2012 report by the African Ministers’ Council on Water (AMCOW), in conjunction with the World Health Organisation (WHO) and UNICEF, quickly become disheartening on closer reading. On the one hand, 189 million more people across Africa gained access to improved sanitation facilities between 1990 and 2010, and the proportion of people with access to improved sanitation facilities has risen from 35% to 40%. On the other hand, however, largely due to the fact there are now 400 million more people in Africa than in 1990, there are 197 million more people without these essential amenities than two decades ago. In proportional terms there has been progress, but in real terms Africa’s exploding population means there are more living without improved sanitation facilities than before.

On a country-specific scale, the situation after over a decade of activism is even more demoralising. Only four sub-Saharan African countries (Angola, Botswana, Rwanda and South Africa) are on track to meet the 2015 targets, while North Africa is the only region that has managed to surpass the targets set at the beginning of the century.

The cost in human lives from continued poor sanitation is staggering, and statistics flagged up by UN-Water make for grim reading. Diarrhoea is the leading cause of illness and death globally, with 88% of these cases originally caused by poor sanitation or inadequate and unsafe water supplies. 12% of the combined health budget across sub-Saharan Africa is consumed by treating diarrhoea. And globally, 1.5 million children die annually from diseases caused by poor sanitation.

Kicking up a stink about sanitation

While tangible results against poor sanitation have been overwhelmed by sheer demographics, organisations have had more success in raising the profile of the cause.

As the pre-eminent Africa-specific organisation concerned with the plight of sanitation, the African Ministers’ Council on Water (AMCOW) has had considerable success in getting the issue noticed by African governments such as through the African Sanitation and Hygiene Conferences (AfricaSan), and the subsequent development of the AfricaSan brand to promote sanitation in Africa.

The first conference, held in Johannesburg in 2002, saw sanitation adopted as a specific target of the MDGs. AfricaSan 2 in 2008 tied participant governments to important commitments to better sanitation, as part of the eThekwini Declaration. And AfricaSan 3, held last July in Rwanda, was the most spectacular conference yet, with 900 attendees from 67 different nations (42 from Africa). The choice of Kigali as a venue was also designed to emphasise the campaign’s continuing success, with Rwanda providing a shining example of how high levels of government involvement can produce positive results (54% of Rwanda’s population now have access to improved sanitation facilities).

AMCOW has devised other media-friendly initiatives alongside the conferences such as the AfricaSan awards, whose past winners include a Mozambican musician who writes about using latrines and washing hands. The World Toilet Organisation has also been active in raising public awareness of the issue, with its aforementioned annual summits and eye-catching events such as ‘Big Squats’ – a form of demonstration also utilised by the charity WaterAid.

But some see the various summits as little more than ineffectual talk shops. Sibusiso Zikode, spokesperson for the South African shack dwellers' movement Abahlali baseMjondolo (AbM), denounced this year’s WTO summit in Durban for being “held without inviting the people who are in need of water and sanitation”, adding “many people want to speak for the poor and about the poor, but very few who will want to speak directly to them”.

Economies going down the toilet

Shunning the gaudier initiatives of award ceremonies or travelling sanitation circuses, other organisations have gone for a hard statistical approach to convincing governments to clean up their acts. This year, the World Bank’s Water and Sanitation Program (WSP) published a detailed survey of 18 African countries detailing the economic disadvantages to letting sanitation remain in such a poor state. The survey represents 554 million people across many of the countries with the worst sanitation records.

The survey claims the 18 countries are collectively losing $5 billion annually due to poor sanitation, each haemorrhaging between 1% and 2.5% of their GDP due to the costs of sickness and high mortality. Providing country-specific data could hopefully push respective governments into action. Ghana, for example, is shown in the survey to be losing $290 million annually – equivalent to 1.6% of its GDP.

The survey also argues that the necessary investment in better sanitation far outweighs the economic losses of the prevailing situation. Most of the 18 countries are currently investing under 0.1% of their GDP in sanitation – only 5 are investing between 0.1% and 0.5%. Solutions proposed by the survey are hardly unachievable – in Ghana, for example, the construction of just 1 million toilets would dramatically reduce the problem.

The international campaigns of the last decade to improve sanitation in Africa have rapidly raised the profile of this often overlooked issue. Global summits, international days and damning reports all contribute to this long overdue furore. But the key is getting African governments to truly commit to investment in sanitation. International conferences, publicity and economic arguments all go some way to achieving this goal. But with mortality rates due to poor sanitation still soaring in Africa – far higher than conflict, or even HIV/AIDS – perhaps it is time we overcame the taboos and were more vocal in championing the cause of the humble toilet.

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