Poor Sanitation Costs Zambia K946 Billion

Since 2008 Plan international Zambia has been implementing Community Led Total Sanitation (CLTS) in Mansa district of the Luapula Province and the programme that promotes use of basic health technologies in sanitation, including use of traditional pit latrines, is already showing signs of a success story that can contribute to reducing colossal economic costs of poor sanitation  

By Innocent Daka

They call it a “wash-to-waste facility”, a stake of sticks that holds a container of water attached with a string that is used as a switch to tilt the container with the foot, making water to flow out for one to wash hands.

The wash-to-waste facility allows for one to wash hands while water runs to the ground after using the latrine, and it replaces the old unhygienic practice where water was placed in a basin in which everyone would wash.

According to experts promoting such basic sanitation practices alongside use of traditional mud-grass-thatched latrines would cost Zambia about US$2 million per year. But the lack of it makes the country to lose a staggering K946 billion annually contending an annual average of 3,200 cases of cholera affecting the country, alongside other consequences as a result of poor sanitation

It is for this reason that in 2008 Plan International started implementing Community Led Total Sanitation (CLTS) in Mansa, to ensure people adopt the use of simple WASH (Water and Sanitation Health) facilities. And now the wash-to-waste facility, alongside dish racks made of sticks, rubbish pits and mud-bricks grass thatched pit latrines are mushrooming everywhere in Fikombo and other villages in the district.

A resident of Fikombo, Dickson Chola says the coming of Plan was like a God-Send. “Before this organisation came, our area was dirty and had a lot of diseases as a result of people defecating in open places and unsafe drinking water. In 2008, it is like it was God coming through when we received an invitation from Plan to go and train in CLTS.

Plan is an International NGO that works to promote the rights of children and has a programme unit in Mansa district of the Luapula Province. It introduced CLTS as part of its contribution to addressing the causes of communicable diseases like diarrhoea that continue to threaten the growth and survival of many children in the district and across the country.

Four years down the line, Fikombo is undergoing changes in its hygiene and sanitation practices. The similar change is also taking places in many villages that in the past did not appreciate basic hygiene practices of washing hands after using a latrine. Apparently, most households did not even have latrines.

“So far, I can say, so good! Considering the resistance that was there and the progress made, I can say CLTS is working out very well in Mansa district,” recounts Simulekwa Sifaya, a Plan International worker who coordinates the water and sanitation activities. “To date we have 167 villagers that have been triggered on CLTS and 68 of those villages, I can confirm, are open defecation free but before 2008, we had nothing”.

Mr Sifaya is also glad that people are appreciating the CLTS concept. “We have a village like Kamelenge, where we are right now. It has 28 households and all the households have latrines, meaning that there are no cases of open defecation in the village. It shows that the level of knowledge on sanitation has increased.”

Mr Chola testifies to the success of CLTS, “what used to happen in our village is that if an area has 50 households, there were only 50 latrines and three households were using one facility. This caused the transmission of communicable diseases like diarrhea easily.”

He chuckles: “even this cleanliness you see in the village now is as a result of the CLTS activities by the team trained by Plan International”.

Transforming people’s attitudes from defecating in the bush and start using pit latrines is not coming easy there are some families that still choose to lag behind.

Mary Mubanga, a trained facilitator of CLTS in Lwingishi ward of Mansa Central constituency, says people at first resist the idea of talking about human waste, “they feel it is disgusting.”

“But in the process of triggering they are led to the bush where they defecate to see how much human waste is there.  Then they are asked what happens when rains wash the waste in the rivers where they draw water or when flies feed on the waste and fly on to their food. This is when they realize that they have been ingesting their faecal waste, which also happens when one does not wash hands after using the toilet.”

Sub chief Kapwewe of Chipete has joined area says he is senstising his subjects on the dangers of open defecation to their health. “I feel human beings should be different from animals and should not dispose faeces anyhow. Where there is open defecation there are also flies which sit on the faeces and come and infect us. Sadly, when I fall ill I will start accusing others of bewitching me,” he said

CLTS concept also uses the children to be whistle blowers against those who defecate in the bush and expose them.

On the day Mr Sifaya was visiting Lwingishi ward in the presence of this reporter, children of Chimba village led the village headman and CLTS community leaders to a household where a family has no latrine and they have been defecating in the bush.  What was found in the nearby bush is more than what anyone had bargained for—human waste deposited everywhere and a disgusting buzz of flies that swarmed the area.

After visiting Chotwe’s home, Beatrice Chama, a community leader on CLTS, started chattering about her experiences and how serious she and other leaders are taking CLTS in the village. “The pit latrine at headman Chimba’s house collapsed and he did not want to construct another one immediately. We went to see him and, since there is no bush nearer, we asked where he was answering the call of nature in the night.  Alas! He pointed us to the cassava field.”

The CLTS did not let the headman scot-free, says Ms Chama. “We gave him a one-week ultimatum failure to which we were going to grab his mattress where he sleeps, as part of the punishment that himself endorsed as penalty for people defaulting on their sanitation.”

Without facilities to dispose human waste, people resort to using the nearby bush and backyard of homes. This is known as Open Defecation, leading to poor hygiene and sanitation.

The Water and Sanitation Programme report of March 2012 reveals that 4 million Zambians use unsanitary or shared latrines while a total of 2.1 million have no latrine at all and defecate in the open. 

Each person practicing open defecation spends almost 2.5 days a year finding a private location to defecate leading to large economic losses, says the report that puts a cost on the loss of time at around US$16 million lost each year in Access Time.

Communities that have poor hygiene and sanitation practices are prone to diarrheal diseases, noting t that treating of these diseases costs government huge sums of money every year.

“Sanitation or lack of it thereof is a public health issue– people are affected by their neighbours and communities’ sanitation status as well as their own, and the costs of open defecation are felt throughout the community,” adds the WSP report.

Mr Sifaya agrees with the report saying social economic costs of poor hygiene and sanitation can have a toll on the economy because government will every year spend a lot of money on diarrhea treatment. “But when people work on their sanitation, government will have enough resources to channel to other developmental projects.”

In the meantime, he says in situations where a school does not have good sanitation facilities “girls just tend miss out because they do not want to go to school and get embarrassed in the midst their peers. To ensure that is curbed, under the project that we are currently implementing supported by the help of the Netherlands government, we are promoting school sanitation through provision of latrines so that as many children as possible can have access.”  

Come the year 2014, Plan International will hive-off its CLTS support, and Grace Mwendapole, Plan International Mansa Programme Unit Manager, helps to answer the bigger question of who will pick up the mantle to ensure the sanitation activities continue and are sustained.

“I want to believe that the community leaders will take up the mantle, the trained natural leaders will take up the mantle, even in schools we have demonstrated through children and they are really very good and positive in maintaining that they have been trained in,” said Ms Mwendapole.

A 66-year-old farmer John Chama says the colonial practice where white district commissioners inspected toilets in villages and punished those found without the facility worked very well as it made every household to construct a latrine.

“If this were to come back so that the DCs work with the village headmen and make it a rule that before one construct a house they must start with a latrine, then every household will have this facility,” Chama said.

Lukola rural health centre environmental health technician Bernard Ndjovu says CLTS will be sustained because of its different approach from other programmes that have gone in the past.

“I can give an example of participatory health sanitation and transformation under which households were given subsidies like cement, iron bars and roofing sheets, it failed as people used the materials for other things,” Ndjovu said

He explains: “In CLTS there are absolutely no subsidies, you need to go into the community so that people take it upon themselves to build their own latrines and set a plan when their community will become ODF (Open Defecation Free)”. 

Ms Mwendapole sees CLTS as one great effort that will help the country to attain the Millennium Development Goal (MDG) No. 7 on water and sanitation.

“We (Plan) are actually delighted that CLTS is building into the MDG No. 7, specifically related to sanitation and falls under ensuring environmental sustainability”. 

“Among the targets under this goal is that a proportion of the population will have access to improved sanitation, increase in proper sanitation to 66 percent of the rural population by 2015. Our Zambian Vision also stipulates that all must have access to safe water and proper sanitation by 2030,” she said.

As Zambia continues to grapple to find solutions to the problem of poor sanitation, it cannot ignore the importance of concepts like CLTS, which require less cost but provides long lasting benefits that can create a huge saving in the cost that go to treating communicable diseases like cholera.