For three months in 2005-2006, Pacific Institute Program Director Meena Palaniappan will be conducting research in India. This article is part of a series of diary entries in which Palaniappan will elaborate on her experiences abroad.

 

What will it take to prevent the people in the developing world from suffering the ill health of waterborne disease?

Is it greater quantities of safe drinking water?

Is it more toilets?

Is it cheaper water?

The United Nations attempted to answer these questions with a series of Millennium Development Goals (MDGs): targets for the international community to achieve in order to improve the health and well being of all people. In 2002, the Johannesburg Summit added specific objectives on sanitation and hygiene to the MDGs. A main sanitation target was to halve the proportion of people without access to basic sanitation by 2015.

What is critical about these new sanitation goals is that they address a major imbalance in the funding and priority that has been given to drinking water as opposed to sanitation in the past. Sanitation has always been the forgotten child in the water and sanitation family. In fact, the gap in sanitation coverage grew during the 1980s International Water and Sanitation Decade.

But what does access to basic sanitation mean? And how is access to basic sanitation being measured and reported? Are countries being asked how many toilets they have? Whether there is a toilet within 1 km of a residence? Whether people are actually using these toilets?

Since it is primarily self reported, it seems to be up to the national government to decide how to determine how many people have access to basic sanitation. As might be imagined, countries like India who don’t want to be pointed to as a laggard on the indicator of basic sanitation are going out and building tens of thousands of toilets.

But building and disseminating toilets does not guarantee their use. Or use as intended.

Numerous studies demonstrate that lack of involvement by residents in the construction of toilets often leads to toilets being used for numerous purposes, such as store rooms or simply being filled with dirt. Meanwhile, the intended users are still defecating in the open where they are most comfortable.

Recently, the focus in India has been on “open defecation free” villages. By involving residents in mapping where defecation happens, how this impacts their health, and designing a publicity campaign, numerous agencies are creating the demand for toilets and then working with users to design them. This focus on involving the whole community is critical, as it has been found that even if a few residents continue to defecate in the open, there still exist high rates of waterborne diseases

Despite these important transitions in international thinking and local implementation, critical sanitation questions still go unanswered. What if a peri-urban community created a sewerage system that deposited its collected waste into waterway running nearby? What if septic tanks attached to a community toilet bank are overloaded, leaking, and not properly maintained?

There is no point in asking “What if?” in a city like Chennai. While Chennai reports that 100% of its population is covered by underground sewerage, untreated and undertreated sewage flows freely into the waterways. Most underground aquifers, which supply up to 2/3 of the city’s drinking water needs, are polluted by sewage.

Have we solved the waterborne disease problem yet?

If sanitation is the forgotten child in the water and sanitation family, then wastewater and sewage treatment is an even further neglected cousin. In India and other nations with inadequate water systems, untreated sewage flows in urban waterways, serving as a vector for diseases that run right through the community. This surface water pollution and the leaking of underground sewer pipes and septic tanks pollutes groundwater, which is often the only dependable source of drinking water in many areas.

When we measure how well we are doing in providing access to basic sanitation, we shouldn’t count toilets, or even how close people live to toilets. I would propose a different measure: we should conduct independent testing of surface waterways and groundwater for the presence of E. Coli or intestinal bacteria, which would be the best test for the extent of sewage contamination in water and identify the need for better treatment and disposal of human waste.

Improving health and reducing waterborne disease requires more than just toilet construction. People need to use the newly constructed toilets, and the sewage generated needs to be treated, and in areas where water is in short supply, this treated wastewater can be reused for non-potable purposes. If we want to improve health for those that are most affected, a focus on wastewater treatment will be critical in the next leg of our race toward the Millennium Development Goals.