Toilets, anyone? World Toilet Day 2017

Today is the World Toilet Day.  The day was officially designated by the United Nations General Assembly in 2013 to inspire action to tackle global sanitation crisis. With this blog post I wish to share some of our fresh emerging findings that we have not published yet. Somebody could say that I am unnecessarily self-critical here, the findings below are from our working communities after all, but this is not my aim. My aim is to draw attention to the fact that even if communities and entire districts have been declared ‘Open Defecation Free’ (ODF), and many places are on the fast track towards ‘Total Sanitation' -status, there is still a lot of work to be done. Sanitation and hygiene crisis is not over. People with toilets are not using them, or they are not using them at all times. The facilities are not accessible to all, they may lack water, hand-washing remains a dream that in theory is supposed to be possible (if you ask about it), but not in practice (if you truly want to wash your hands).

Photo: High-level sanitation at an altitude of 3,700 m. Public toilet at Muktinath bus park, Mustang district, supported by RWSSP-WN

Over the past few years, we have been using a mobile phone based application to map sanitation and hygiene status across our working areas. How can we claim that  some area is ‘Open Defecation Free’ or some cluster qualifies to declare ‘Total Sanitation’ if we do not really know? We do want to know, and we do want to be confident that if we report some area as 'ODF' or 'Total Sanitation declared', it truly is so. We have used this app also to explore the behavioural factors, aiming to sharpen our behavior change techniques accordingly, searching for real and sustainable change in sanitation and hygiene.

RWSSP-WN II has found in its earlier studies (see for instance the study conducted in Baluhawa VDC of Kapilvastu District (RWSSP-WN Brief 11-2016) and Silautiya VDC in Rupandehi (RWSSP-WN Brief 10-2017), that even if the households have a latrine, it may not be used by all family members, or it may not be used at all times, i.e., open defecation continues regardless of the 100% toilet coverage. In September 2017 we conducted a survey on various behavioral factors in a municipality where these clusters had been declared as ‘ODF’.

Mayadevi Municipality is located along the Nepal-India border in Kapilvastu district. The toilet use survey, with the total 161 respondents, was done in three wards, seeking for equal number of those who always use toilet and those who do not.  In practice, the enumerators reported that it was hard to find those who always used their toilets, and that in practice, even if the wards had been declared as ‘ODF’, majority of the toilets were not completed. It was also striking, from the behavior change technique point of view, that out of all female respondents, 90% had no schooling. Out of all female respondents, 71% were illiterate, the corresponding figures for male respondents being 54% no schooling and 34% illiterate. Out of the total sample, more than half are illiterate. This is a strong message for the behavior change communications: there is both the language issue to consider, and literacy. The most literate age group in this sample is 18-29, but even in this group 40% reported ‘no schooling’. Among the three Wards, the Ward 2 has the most poor record with 82% without schooling. Only 3% of all the female respondents reported reading anything at all.

The challenges are not only Tarai specific. For a long time we made a lot of assumptions with regards to hill communities, one of them being that yes, if the community is declared ‘ODF’, it probably does have temporary toilets and those toilets are used. We also assumed that in Western Nepal there would not be a Chhaupadi-type of problems, that this has to do with the remote Mid and Far Western Nepal. We were wrong. This is what we have found from Gulmi, Baglung, Palpa (hill districts) and Rupandehi (Tarai district) by far in total 146 household toilet use surveys – all respondents having a toilet of which 81% were with permanent structure and roof, others missing out roof or having temporary walls, yet all with privacy. Only two cases out of 146 reported ‘no privacy’. This is what else is emerging:

• 54% described the location of the toilet as ‘easily accessible for all? (also for children, elderly, sick, disabled)

• 76% of the toilets described by the enumerators as being clean inside, not smelly

• 77% had water available inside or next to the toilet

• In 72% of the interview locations, the interviewer could wash hands with soap, in other words, the soap and water were actually available by the designated handwashing place

• Question: "In last seven days, how often did you go for OD?" Out all hill district respondents (Baglung, Gulmi, Parbat, Syangja), 78% replied 'never'. This means that even in the hill communities, one of five people would still go for OD at least sometimes!

• Out of total sample, including Rupandehi with the above hill districts, 42% always used the toilet, i.e. reported as ‘never’ going for OD.

• Out of all respondents, male and female, one out of three (32%) would not use the toilet during mourning.

Out of 84 female respondents,

• One third (33%) reported as not using the toilet during menstruation. The responses were equally divided across different ethnic/caste groups.

• Almost one out of four (24%) reported not using the toilet after child birth

Photo: Public toilet in Syangja district, supported by RWSSP-WN, well maintained by the shop & restaurant  keeper, with large number of visitors traveling in between Butwal and Pokhara stopping here for good services

How about Public, Institutional, and School Toilets?             
At the start of RWSSP-WN Phase II, we visited 316 public, institutional and school toilets supported by our Phase I. At that time we found that 9% were not completed; 8% completed but not used or extremely dirty beyond use; 16% used but dirty; 43% used but could be cleaner with minor physical damage; and 13% clean but less used. Only 11% was what all of them should have been, namely used, clean and had water. While 83% were in use, majority (76%) were not clean and/or had issues with their physical condition. (See RWSSP-WN Brief 1-2016).

Over the past year we have been mapping the condition of the public toilets that were constructed in RWSSP-WN Phase I. In total, 31 public toilets in eight districts have been revisited by far:

• Those that are used, are estimated to serve total 12,562 toilet users every week.

• In total, 42% were reported as being "Completed, used, clean and has water – perfect case". This is very encouraging, even if it means that still more than half were not 'perfect cases'.

• One third (29%) were less used (5) or not used at all (4).

• More than half (58%) had water available both inside and outside the toilet, while only third (10) had water and soap for handwashing, yet, another 10 did not have handwashing facility at all.  Two did not have water, seven had water but no soap.

• Majority (94%) were described as ‘gender friendly’ and 58% as 'child-friendly'.

• Since 68% were located at roadsides and bus stops along the road, it is not surprising that only half (52%) were described as 'accessible'. 74% had a maintenance worker.

At the moment, RWSSP-WN Phase II has total 206 Public, Institutional and School toilets in the database. 85% of these are completed and financially cleared, in other words, being used. The following described these 175 cases:

• 90% have handwashing facility (5% no data, 5% no handwashing)

• 72% have caretaker

• 71% had cleaning agents available

• 32% have Operation and Maintenance fund

• 16% charged user fee

• 89% had separate toilets for women and men

• 94% had privacy (two cases ‘no’, nine cases ‘no data’)

• 13% have incinerator

• 16% have side railings (to help elderly and disabled who need support)

• 41% described as ‘accessible for disabled’

• 35% have wide doors that make them accessible for wheel chairs

• 66% handwashing basin reachable for children

Photo: Public toilet in Myagdi district, supported by RWSSP-WN. This toilet has the side railings and ramps, albeit steep ones, but the location itself may not be accessible for wheelchairs. This toilet serves a large number of visitors traveling to and from Mustang.

Further reading:
World Toilet Day, by UN Water: http://www.worldtoiletday.info/
World Toilet Day in Wikipedia with useful f