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Excerpts from Sanitation as a Key to Global Health: Voices from the Field - UN University – Institute of Water,
Environment & Health
1
Implication of Sanitation on MDGs
Goal 5: Improve Maternal Health
Maternal health, child survival and access to sanitation are intricately
linked.
Excerpts from Sanitation as a Key to Global Health: Voices from the Field - UN University – Institute of Water,
Environment & Health
Cambodian Scenario
In Cambodia, a country of 14 million people,
85% of which lives in rural areas, the access to
sanitation in rural areas increased from 9% in
1998 to 23.3% in 2008.
Millennium Development Goal (MDG) for 2015
has been set at 30% coverage. 35% of the
population
p p are reported
p to be below p
poverty
y line.
More than ½ of those without improved
sanitation facilities are non-poor households.
2
Cambodian Scenario (cont’d)
An epidemiological assessment of the health outcomes of
sanitation remains uncertain, however, diarrheal disease and
mal-nutrition are mutually complementary and forms a vicious
cycle with lack of sanitation in poor households.
3
Rural Sanitation Improvement
Programme in Cambodia
In Cambodia, it appears
pp that the various p
programme
g p
partners
who are promoting sanitation, have been able to achieve
significant behaviour change and sanitation demand generation
in pockets, but nationwide, access to sanitation remain
extremely low and the MDG target set by the National Govt. is
rather modest.
Lack of strategic approach for nation wide scaling up of a
sustainable Rural sanitation Programme.
Lack of integrated
g rural development
p p
programme
g at the commune
level incorporating and prioritizing sanitation.
Due to various reasons public finance of sanitation in most
programmes in Cambodia is not effectively addressing rural poor.
Lack of regulatory & institutional framework for rural
housing/sanitation programme.
Impact of CLTS/Sanitation
Marketing
In Cambodia CLTS and sanitation marketing g concept
p
have made significant impact in promoting the behaviour
change in the community and developing demand for
sanitation.
Unfortunately, the CLTS approach adopted Sanitation
technologies which, worked only in dry seasons and its
cost-effectiveness is questionable when one considers
the critical issue of sustainability.
Such technologies are neither sustainable nor
upgradable and promotion of the same in the short term
would be counter-productive in the long term context.
4
Impact of CLTS/Sanitation
Marketing
In Sanitation marketing
g which is basically,
y, a market
based approach, currently being promoted by frontline
NGOs like Lien Aid, IDE, WTO, etc, are putting more
emphasis on training of entrepreneurs on affordable and
sustainable technology options and developing a
delivery mechanism based on demand promotion and
development of supply chain.
However, this is pertinent to note, that given the current
l
levell off rurall poverty iin C
Cambodia,
b di this
hi approach
h too
cannot effectively promote sanitation across all sections
of the rural community, particularly the rural poor.
5
Appropriate Technology Options
It has been observed that even among the economically well-off
section
ti who h can afford
ff d better
b tt quality
lit ttoilets
il t and
d are spending
di more
than US$ 200 for super structure, two pit pour flush/Ecosan design
are not being promoted.
The issues of eco-friendliness and pollution of ground water should
also receive adequate attention.
Present design makes it difficult to recycle the bio-mass from latrine
pits.
Rural consumers should g get multiple
p choices depending
p g on
affordability and sustainability.
SISSO has developed eco-friendly technically appropriate, socio-
culturally acceptable and economically affordable designs of
sanitary toilets in India, cost of which varies from US$30 to US$ 300.
6
The Issue of Subsidy:
Affordability/Sustainability
Divergent opinion is noted in Cambodia for and against subsidy in
rurall sanitation
it ti programme.
In Cambodia the Sanitation sector which is vitally linked with Public
Health & Environment of the Community and closely associated with
the poverty of the people cannot be 100% addressed by the Private
Sector / Market. However, approximately 60% of the non-poor
section of the population could be served by the market.
The Consultant strongly feels that CLTS/sanitation marketing and
Govt. subsidized pprogrammes
g need not be mutuallyy exclusive,,
rather future sanitation programme should draw upon the strengths
of CLTS/sanitation marketing and integrate them into a scaled up
nationwide programme supported by the Govt. and promoted by
sector partners, with provisions of minimal subsidies required by the
poor for having access to sustainable sanitation.
7
Feasibility of Toilet linked Bio-Gas
Technology
30% of rural families have the potential (enough dung to justify) to
h
have d
domestic
ti Bi
Bio-gas plants.
l t
96% of rural Cambodia use firewood for cooking.
There has been impressive growth in the construction of domestic
Bio-gas plants in the country rising from 296 in 2006 to 10,500 by
2010,10% of which are connected to toilets.
Experience in India, China, Vietnam, etc, indicates the potential of
the technology.
There appear to be significant prospect of connecting rural toilets to
the existing Bio-gas plants.
Lack of effective coordination between MRD & the Dept. of
Agriculture.
8
Flow Chart for Rural Bio-Gas System
in Cambodia
Energy
Livestock &
B
Poultry Gas
Y
P
R Input Bio- Output
Farm Agriculture O Digester
Family D
U
I C
N Crops & T Slurry
P Vegetables S
U
T
9
Lessons from India
Supply driven,
driven subsidized Govt
Govt. programme did
not succeed during 80s/90s, primary because:
Lack of Enabling Environment
Lack of Capacity Development at the Community
level
Lack of IEC Support & Awareness among the
consumers
Sanitation was not a perceived need of the
community
10
Lessons from India
Integrating
g g Sanitation into Comprehensive
p Rural
Development Programme of Govt. of India (Bharat
Nirman – Build India)
Rural Health Mission
Rural Sanitation
Rural Water Supply & Water Quality Management
Rural Employment Generation
Rural Education / Mid Day Meal
Rural Roads / Telecommunication
Nodal Dept: Ministry of Rural Development/PRI
Key to success: Capacity building in the Panchayetiraj
Organizations at the District/Block & Village Level.
11
Two Pit Pour Flush Toilet
Multiple Choice
Sulabh has 46 models ranging from US$ 20 to more than US$ 200
12
Community Toilet Complex linked to Bio-Gas Plants
26
13
Lessons from India
A track change - by demand or just willingness to pay?
Physical
y Achievement under TSC For
IHHL (Individual Household Latrine)
7000000
6000000
5000000
4000000
3000000
IHHL BPL
2000000
IHHL APL
1000000
0
Source : Total Sanitation Campaign
14
Lessons from India
Beneficiary contribution?
Expenditure
p under TSC across years
y
16000
14000
12000
Expenditure in Rs. (in millions)
10000
8000
6000
4000
2000
0
15
Epilogue
Investment in Sanitation makes economic
sense. It is possibly the most prudent and
cost effective investment for the promotion
of Health, Environment and productivity of
a nation.
16