STOP OPEN DEFECATION SOUTH ASIA HEADLINE RESULTS - 2016 PROGRESS REPORT

  A statistic which baffles me and I was disheartened to know was that 1,600 children die every day because of diarrhoeal diseases.”

Sachin Tendulkar
UNICEF Regional Goodwill Ambassador for South Asia

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There has been a significant reduction in the number of deaths of children
under five years old from 1.5 million in 1990 to 622,000 in 2012. Of these, 361,000
could be prevented with improved water, sanitation, and hygiene practices.

Open defecation puts the health of women and girls at risk. It remains a major cause of child malnutrition, disease and death in many parts of the region.

The primary challenge in reducing open defecation is that it is socially accepted in much of South Asia. There is also a shortage of capacity to implement
community sanitation programmes that focus on changing behaviour.

UNICEF SOUTH ASIA TARGET

120 million fewer individuals practise open defecation by 2017

GLOBAL TARGET

By 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations. (SDG 6.2)

ACHIEVING RESULTS

theory of change

In 2008, UNICEF introduced ‘Community Approaches to Total Sanitation’ (CATS), which provides a local approach to eliminate open defecation globally. CATS provides a framework of nine essential elements that can be easily adapted for sanitation programming in diverse contexts. It emphasizes sustainable, cost-effective approaches and it mobilizes communities to build and use their own sanitation facilities. Local people choose appropriate, affordable designs and building materials to construct facilities that are user-friendly for everyone, including vulnerable groups and people with disabilities.
In South Asia, UNICEF encourages social movements promoting the idea that defecating in the open is degrading, offensive, demeaning and outdated; something that is just not acceptable in any community.

DATA PROFILE

The majority of the world’s open defecators (64%) live in South Asia. The proportion of people who practice open defecation has dropped by 32 percentage points, from 68 percent in 1990 to 36 percent in 2015, a faster rate of reduction than in any other region. India accounts for about 93 percent of the open defecators in South Asia. Afghanistan, Bangladesh, Nepal and Pakistan have much smaller numbers of people without toilets. Open defecation is mostly a rural practice. In India, Nepal and Pakistan, few of the poorest rural households have a toilet. If the current trend continues, the region will not meet the 2017 regional target or the global 2030 target. On current trend, South Asia will reduce the number of open defecators by 50 million over the period 2014-2017, which means that progress must more than double to achieve a reduction of 120 million over the same period.

The majority of the world’s open defecators live in South Asia

In the eight countries in South Asia, there were a projected 610 million people practising open defecation in 2015.


Data Source: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation Data Update with estimates for 2015

It is clear that reducing open defecation in India, where there are an estimated 586 million open defecators in 2014, will accelerate progress in South Asia as a whole.

Five countries bear the largest burden of open defecators


Data Source: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation Data Update with estimates for 2014

ACCELERATING CHANGE IN SOUTH ASIA

1 - INDIA
Government commitment in India to end open defecation

The Indian government has committed to ending open defecation by 2019, which will be the 150th anniversary of Mahatma Gandhi’s birth. In October 2014, it launched a fully funded national hygiene, sanitation and waste management campaign called Swachh Bharat Mission. The campaign aims to transform rural India through community and people-centered strategies that emphasize holistic sanitation approaches.
Sikkim and Kerala are mostly free of open defecation and Himachal Pradesh is making progress through innovative community mobilization.
The campaign has started showing results: Rajasthan, Madhya Pradesh and Odisha, large States with high levels of open defecation have recently seen an acceleration in the rate of reduction in open defecation.

2 - PAKISTAN
Pakistan’s approach to total sanitation

Pakistan achieved its MDG target for sanitation in 2015, five years after Pakistan’s Approach to Total Sanitation (PATS) was launched, following massive floods that hit the country in 2010. Since then, more than 10 million people have eliminated open defecation in their communities, including 6.5 million as a direct result of UNICEF support. In 2015 alone, UNICEF support ensured that more than 1.3 million people were certified to be residing in open defecation free environments and 1.7 million people received hygiene-related information to prevent child illness, especially diarrhea. In Pakistan, 64 percent of the population is now using improved sanitation facilities. The use of PATS has created demand for toilets, facilitating supply side options and enabling duty bearers to take more responsibility. PATS is used by all sanitation sector stakeholders in Pakistan and has spurred government to commit to ending open defecation by 2025. In February 2015, the second Pakistan Conference on Sanitation, inaugurated by the President of Pakistan, resulted in greater ownership for reducing open defecation by the provincial governments. The recent MICS5 survey showed that in rural Punjab, open defecation fell from 32 percent in 2011 to 25 percent in 2014. The Government of Punjab has decided to free the province of open defecation by 2018. Pakistan is preparing to take on challenges of the new ambitious Sustainable Development Goals targets for sanitation. PATS programmes are increasingly focusing on equity, the creation of a sustainable social norm for ‘no open defecation’ and universal use of hygienic toilets. Pakistan has now reached a tipping point, and the use of toilet is fast becoming the new norm.

3 - NEPAL
A social movement in Nepal

In Nepal, open defecation in rural areas has fallen from 93 percent in 1990 to 37 percentin 2015: a remarkable improvement! In 2011, Kaski became the first district in Nepal to be declared open defecation free (ODF). In the four years since, one zone (Dhaulagiri), 34 (of 75) districts, 2,087 Village Development Committees (of 3,157 VDCs) and 85 (of 217) municipalities have achieved ODF status. Five more districts are slated to declare their ODF status before mid-2016. This success is due to a change in approach, earlier based on subsidies for toilet construction, now changed to an approach of ‘reward and recognition’ as envisioned in Nepal’s national sanitation and hygiene master plan of 2011. There is engagement of a wide range of stakeholders, at all levels: including local bodies, government officials, political parties, civil society, mothers groups, forest user groups, child clubs, users committees, and others mobilize and collaborate for reducing open defecation in their communities. As a result, the elimination of open defecation has become a social movement, rather than a programme or a project. Most remarkably, while in the past open defecation was considered to be most common among the poorest, the recent Nepal MICS 2014 showed little difference in sanitation coverage among the poorest and richest quintiles of the population – evidence of an effective social movement!

National averages mask inequities within countries. For example, 2008 figures show that open defecation reduction trends are not consistent across household wealth. In India and Nepal, progress in open defecation levels disproportionately benefit the wealthy. Bangladesh has experienced progress at comparable rates irrespective of wealth although people living in the poorest households are still much more likely to practise open defecation.


Data Source: Special Joint Monitoring Progamme tabulation based on Indian National Family Health Surveys 1996, 2001 and 2006



Data Source: Special Joint Monitoring Progamme tabulation based on Demographic and Health Surveys 1996, 2001 and 2006


Data Source: Special Joint Monitoring Progamme tabulation based on Bangladesh Demographic Health Surveys 1994, 1997, 2000, 2004, 2007

The SDG target 6.2 ‘By 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations’ specifically aims to end the practice of open defecation. As the national governments of all countries in South Asia have adopted the SDGs, it is expected that the reduction of open defecation practices will accelerate in the coming years – as is required to meet the ‘headline result’ of reducing the number of open defecators in South Asia to 500 million by 2017.

RESEARCH, KNOWLEDGE, EVALUATION

Research Institute for Compassionate Economics, Squat Research Brief No.1: Ending Open Defecation Requires Changing Minds, riceinstitute.org, June 2014, accessed 3 April 2015.

United Nations Children’s Fund, Evaluation of the WASH Sector Strategy ‘Community Approaches to Total Sanitation’ (CATS), Final evaluation report, UNICEF, New York, 2014, accessed 3 April 2015.

Robert Chambers and Jamie Myers, Institute of Development Studies, Frontiers of Community Led Total Sanitation: Norms, Knowledge and Usage, Issue 07, January 2016, accessed 20 June 2016.

Siddhivinayak Hirve et al., Psychosocial stress associated with sanitation practices: experiences of women in a rural community in India, Journal of Water, Sanitation and Hygiene for Development, Volume 5, no.1, pp. 115-126, 2015, accessed 20 June 2016.

Ongoing trial study

Three ongoing trials testing the impact of WASH and infant feeding interventions on environmental enteric dysfunction and stunting:
1. WASH Benefits – Bangladesh
2. WASH Benefits – Kenya
3. SHINE – Zimbabwe
Results expected to be available in 2016-2017. Jean Humphrey, November 2014.

Pakistan: evaluation on the effects of a full and a light package of WASH and nutrition interventions on child stunting. Completion: 2020. USAID funding, some districts in Sindh province.

WASH / Nutrition demonstration programme to identify contribution of proven nutrition, hygiene and sanitation interventions on children nutritional status, physical growth, cognitive development, school readiness and educational outcomes.

Afghanistan, Pakistan, India and Nepal: studies of the sustainability of the elimination of open defecation.

REAL LIVES, REAL CHANGE

Teenager fuels revolution, Tumakuru, India

Teenager fuels revolution to build toilets in her village
"Lavanya’s do-or-die attitude is a reflection of her understanding about the importance of using a toilet, and how good hygiene and sanitation practices is the pathway to good health."
By-Avinaash

TUMAKURU, India, 08 March 2016 - What could a 15-year-old want so much that she refused to eat food in protest? If your guess is, a piece of expensive clothing or accessory—like many other teenagers usually fancy—you couldn’t be more wrong. Lavanya, a hardworking ninth grader in school, staged a 48-hour hunger protest to demand a toilet in her home! Her insistence caused a mini revolution in her village, in the Sira Taluk of Karnataka, resulting in not just a toilet being built at her home, but also in inspiring others in the community to get one.
“I was upset with my parents and did not eat for two days because they refused to construct a toilet,” she later said with a smile.
Lavanya’s do-or-die attitude is a reflection of her understanding about the importance of using a toilet, and how good hygiene and sanitation practices is the pathway to good health.
Just like everyone else in the village, the teenager too used to rush to the open fields to answer nature’s call. A perfectly normal, biological process was a source of everyday embarrassment as she would try to defecate without being seen by anyone, or be constantly scared of being bitten by snakes.
An awareness campaign on the Swachh Bharat Mission conducted in Sira, however, changed her perception. As she listened to her teachers asserting the importance of sanitation and hygiene and used the toilet in her school, Lavanya realized the importance of having one at home too.

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Sources:

United Nations Children’s Fund, UNICEF Data – Monitoring the situation of children and women, MICS, accessed 4 April 2015.
United Nations Children’s Fund, Evaluation of the WASH Sector Strategy ‘Community Approaches to Total Sanitation’ (CATS), Final evaluation report, UNICEF, New York, 2014, accessed 3 April 2015.
United Nations, We Can End Poverty – Millennium Development Goals and beyond 2015, End Open Defecation, accessed 4 April 2015.
United Nations, World Toilet Day – 19 November, accessed 4 April 2015.
U.S. Agency for International Development, The DHS Program –Demographic and Health Surveys, accessed 4 April 2015.
World Health Organization, Preventing Diarrhoea through Better Water, Sanitation and Hygiene: Exposures and Impacts in low- and middle-income countries, accessed 4 April 2015.
World Health Organization/United Nations Children’s Fund, JMP – WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2014 update, accessed 4 April 2015.