Access to Sanitation:Widening Gap in Nepal

from Media for Freedom

With the increase of sanitation and hygienic coverage in the last one decade, many health-related problems have subsided. However, more than 13,000 children still die due to various water-borne diseases caused by inadequate sanitation facilities. Besides, there is a wide gap between rich and poor as eighty percent of rich population have access to sanitation against 13 percent of poor. As Nepal is celebrating year 2008 as an International Year of Sanitation, the challenge lying ahead is how the sanitation coverage can be increased in rural as well as urban areas. At a time when annual budget allocated by the government towards sanitation is negligible, Nepal's programs rely on the support of international communities as well as local NGOs

By KESHAB POUDEL

For Dhanu Ram, a Dalit of Sunsari district, construction of toilet has brought a new life and prestige in his locality. At the cost of about Rs. 2500 (US$ 35), Ram had constructed a toilet with support from Nepal Water for Health (NEWAH) at his home two years ago.

One of the changes, he has seen in his life in subsequent years is that Ram and his family have not visited nearby sub-health post or a hospital in Biratnagar in the last one year. In the past, Ram used to visit sub-health post almost every day carrying his children to treat various stomach-related ailments, diarrhea and high fever. The toilet has brought a drastic change in the health of his family. Father of three children, Ram's social status has also changed as local people who used to discard him earlier for being a dirty fellow, now embrace him.

For Ram's family, the toilet is now the symbol of pride and dignity in a village where latrine is regarded as a facility preserved for the high cast and affluent families.

"I had hardly realized that cleaning locality and building latrine could transform my social status and make my children healthy and strong," said Ram. Others living in the area also have similar experiences.

Thanks to the implementation of Community-Led Total Sanitation (CLTS) by Water Aid Nepal and Nepal Water for Health (NEWAH), one can see drastic improvement in the sanitation system in villages like Khapte Tole, Baiya, Pachira, Bhalua, Simaborna, Simarriya and other villages of Sunsari district. NEWAH has already implemented such projects in Morang, Banke, Dhading and Gorkha districts.

Similarly, organizations like UNICEF, OXFAM-Nepal, IDS-Nepal, ECARDS-Nepal, and Rural Reconstruction Nepal have implemented this program. According to Millennium Development Goals Needs Assessment for Nepal, there are more than 20 international donor agencies that are active in the water supply and sanitation sector.

According to Department of Drinking Water and Sewerage, annually, 148,000 latrines are constructed in the country or, on average, 405 a day. But, it is still not enough to increase the coverage of sanitation to all by 2017. Nepal needs to construct 879 latrines a day to attain that target.

Negligable Budget

Most of the budget allocated by the government is directed towards drinking water, while increasing sanitation coverage seems to fall under the responsibility of donor agencies, INGOs and local NGOs. According to the red book - Nepal government's budget allocation book 2007-2008 - there is no separate budget for sanitation, though this is one of the major MDGs.

Under the Rural Water Supply and Sanitation Project, the World Bank approved a credit for US$25.3 million in June 2004. The United Kingdom, Asian Development Bank and Water Aid Nepal are currently working on it.

Although Nepal has made some significant improvements in sanitation coverage, Ram is among less than 20 percent of rural population who have access to latrine. The practices of rampant open-air defecation, particularly in terai, has badly contaminated the water poodles and put the public health at stake.

Although Nepal is in a position to achieve the MDG target of sanitation by 2015, there is a need for greater efforts to achieve hundred percent sanitation coverage goal set by the government by 2017. "We can achieve MDGs target. Our national target should be geared towards meeting national target not only for the MDGs" said Umesh Pandey, director of NEWAH.

Implemented by Water Aid Nepal and its partner Nepal Water for Health (NEWAH), the Community-Led Total Sanitation CLTS has made some progress in rural parts of Nepal, particularly in eastern region.

Cause of Concern

A study conducted by United Nation Children Fund in 2005 revealed that 13,000 children under the five years of age, die of diarrhea disease caused due to poor hygiene and sanitation. Nepal continues to bear the loss of some Rs 10 billion each year in terms of health expense, loss of productivity and adverse poor hygiene, and environment sanitation.

Solid waste and waster water problems are growing rapidly as there is massive population influx into urban areas in the recent years. The rate of growth of per capita waste is also growing coupled with poor drainage affecting safe water.

UNICEF reported that a safe water supply can reduce morbidity by 15 percent; latrine use can reduce morbidity by 35 percent. Hand washing practice can reduce morbidity by 43 percent and child mortality by 33 percent.

If present trend is maintained, the sanitation coverage will reach to 60 percent of the total population against the MDG target of 53 percent by 2015. Nepal needs to increase the construction of latrines from 148,000 to 320,000 per year, for the purpose.

Growing Gap

The gap is growing between rich and poor and between urban and rural areas. Only twenty one percent of rural population has access to sanitation against 53 percent of urban population. Eighty percent of rich population has access to sanitation against 13 percent poor.

More than eighty percent of diseases in Nepal are caused by low quality of water and inaccessibility of sanitation. Although only 6 percent of population had access to sanitation in 1990, it has now reached to 46 percent. Nepal is planning to provide sanitation facilities to 53 percent of population by 2015 and to all population by 2017.

"We have set a very good target but we need to do some very hard work to achieve it," said Suman Kumar Sharma, joint secretary at Ministry of Works and Physical Planning. "We can reduce heavy burden on health by increasing sanitation coverage."

Because of inadequate latrines, in public schools, many girl students drop out at early stage. Only 41 percent of schools have toilets and only 26 percent have separate toilets for girl students.

Despite increase in the coverage of sanitation, only 46 percent of the population like Ram use toilets and remaining 54 percent population still use open space for relieving themselves. In urban areas, sewerage and solid waster management is getting worse. As there is a lack of permanent land-fill site, there are frequent cases of uncollected solid waste lying in different parts of cities threatening the public health.

From rural to urban areas, poor are suffering a lot as they have to bear the risk of poor sewerage and sanitation facilities. They are even compelled to drink contaminated water.

"As we are celebrating year 2008 as a sanitation year, we have to set our target to fill gap between rich and poor," said Umakanta Jha, Secretary at the Ministry of Physical Planning and Works.

Thanks to more focus on drinking water, the coverage of sanitation has not expanded. At present, 76 percent population had facilities for drinking water whereas 46 percent of population had sanitation. There is a gap now of about 30 percent. According to a study, less than 20 percent of population has access to sanitation in one third of 75 districts.

"Our experiences have already shown that we can bring tangible change in the life of common people by increasing the sanitation coverage. Our aim must be now on to increase the coverage in the rural and urban areas," said Sanjaya Adhikary, Country Representative of Water Aid Nepal. "Water Aid Nepal has already implemented a number of sanitation programs targeting the poor."

From community to the policy making, hygiene and sanitation is least prioritized. And investment in water and sanitation is inadequate to keep up with the overall rise in global aid.

In a country like Nepal where overwhelming people are at health risk because of not washing their hands before taking food, it is a major challenge to educate the people and generate awareness than increasing the coverage of sanitation.

As sanitation involves all the important institutions of the state, one of the challenges is to have a coordinating body. From Ministry of Health, Ministry of Education, Ministry of Local Development, Ministry of Women, Children and Social Welfare to the Ministry of Works and Physical Planning, all have their own programs on sanitation. What is lacking at present is the coordination among them.

"Coordination is one of the major challenges. The International Sanitation Year 2008 will develop institutional mechanism to coordinate among various organizations working in the sanitation area," said secretary Jha.

In the last one decade, Nepal has achieved tremendous success in increasing the sanitation coverage reducing the health risk. However, the growing gap of coverage between rich and poor and urban and rural areas is a major challenge.

Source:Spotlight.