On November 19, 2015, Amref Health Africa joins the rest of the world in marking the UN World Toilet Day. The theme for this year is “Equality, Dignity and the Link Between Gender-Based Violence and Sanitation”, which puts the spotlight on the threat of sexual violence that women and girls face due to the lack of privacy for sanitation activities, as well as inequalities in the usability of available facilities. Toilets generally remain inadequate for populations with special needs, including the disabled and elderly, and for women and girls who need to manage menstrual hygiene.
Sub-Saharan Africa has a mere 30 per cent coverage of safe sanitation facilities, a startling statistic that is only a four per cent increase since 1990. This is a serious concern due to the associated massive health burden. Many people who lack basic sanitation facilities engage in unhygienic practices such as open defecation and inappropriate solid waste and wastewater disposal. The practice of open defecation is the primary cause of fecal oral transmission of disease, with children being the most vulnerable. In Africa, 115 people die every hour from diseases linked to poor sanitation, poor hygiene and contaminated water.
Healthy pregnancies and childbirth
Poor access to water and sanitation is associated with higher levels of maternal mortality. Access to clean water and sanitation is essential for healthy pregnancies and childbirth. Anemia, one of the five major causes of maternal death and disability, is most often associated with malnutrition, but it can also be caused by intestinal worms or malaria, both of which occur when clean water and safe sanitation are lacking. Fifteen per cent of all maternal deaths are caused by infections in the six weeks after childbirth mainly due to unhygienic conditions during delivery at home deliveries and in institutions. Another major cause of maternal death and disability, sepsis, is caused when clean water and adequate sanitation are not available to a woman during childbirth.
“This year’s World Toilet Day presents a critical opportunity for the global community to reflect on this crisis and re-affirm recent Sustainable Development Goals (SDG) commitments towards universal and equitable access to sanitation. Evidence shows that lack of access to proper sanitation has dramatic consequences on human health, dignity and security - including gender-based-violence – the environment, and social and economic development. For instance, Kenya spends US$324 million each year through direct cost of treating sanitation-related illnesses, and indirectly through days lost while seeking treatment. Yet we know that every $1 spent on water and sanitation generates a $4.3 return in the form of reduced health care costs,” observes Dr Githinji Gitahi, global Chief Executive Officer of Amref Health Africa.
Amref Health Africa focuses on the health of women and children, and has been working with communities across Africa for the last 60 years to promote access to health, including safe water, sanitation and hygiene (WASH). “We have learnt that integrating WASH with maternal and child health activities, as well as co-creating WASH business models with entrepreneurs presents limitless opportunities to realize optimal impact and fast-track access to sanitation,” says Dr George Kimathi, WASH Programme Manager in Kenya.
Focus on equity
As we mark World Toilet Day, Amref Health Africa calls upon governments, development partners and the private sector to increase investment in sanitation. High-income countries should allocate no less than 10 per cent of their Gross National Income to WASH financing, including elimination of open defecation. Governments in Africa must also increase their budgetary allocations to sanitation to at least 0.5 per cent of their Gross Domestic Product and ensure a strong focus on equity, sustainability and strengthening of health systems to support development of efficient and scalable sanitation innovations. In addition, stakeholders must explore innovative sources of financing sanitation, including financial transaction taxes, WASH tax rebates, airline ticket levies, special drawing right allocations, carbon taxes and solidarity mechanisms.
The increase in resources must, however, be accompanied by concrete action led by national governments to improve sector performance and to target poor and marginalized communities in rural areas and urban informal settlements.