Happy World Toilet Day!

19/11/2014

Blog Speech BubbleJamie Myers

Today, on 19 November 2014, we are celebrating the fourteenth World Toilet Day, an international day aiming to draw attention to the dire global sanitation problem, inspire action and celebrate the work taking place across the world.

Currently, 2.5 billion people do not have access to sanitation facilities that hygienically separate human excreta from human contact. Out of those 2.5 billion people, 1 billion people practice open defecation.

This problem has been framed in a number of different ways. Rates of diarrhoea, the second highest cause of death amongst children under five, are often discussed. Improved sanitation has been estimated to reduce cases of diarrhoea by more than 33 per cent. When including hand washing with soap this reduction rate is even larger. The United Nations Environmental Programme has claimed that the uncontrolled disposal of human waste is a major source of global water pollution. The Water and Sanitation Program runs the Economics of Sanitation Initiative which highlights the economic burden; it has shown that the lack of access to sanitation costs the world US$260 billion a year. In 2010, the United Nations General Assembly recognised that clean drinking water and sanitation are a human right. Lack of access to sanitation interferes with a person’s right to life, health, education and dignity. The recent rape cases in India have highlighted the specific negative repercussions and dangers that lack of sanitation carries for women. Lack of privacy for defecation, urination and menstrual hygiene, and the shame of being seen, are major gender discriminations in South Asia and elsewhere. And lack of sanitation impacts on school attendance and thus education, especially for girls. It is now also becoming increasingly evident how lack of adequate sanitation impacts the nutrition and the physical and mental development of young children. This month my colleague Robert Chambers, along with Gregor von Medeazza from UNICEF, highlighted the links between inadequate sanitation and undernutrition. In an IDS Working Paper they show how open-defecation leads to stunting due to environmental enteropathy, other intestinal infections and parasites, all of which have been previously overlooked.

CLTS latrine_Malawi_PB

A better understanding of the multiple problems associated with the access and use of improved sanitation has led to the expansion of the sanitation and hygiene field. We now have sociologists, engineers, epidemiologists, behavioural change experts, doctors, religious leaders and even actor Matt Damon, putting in efforts to trying to solve this depressing issue.

This commitment by so many is excellent news. It brings the efforts of more people and different perspectives. However, we also need to make sure that we work together to try and establish a common language. Bringing together people who are traditionally trained separately is not an easy task and will take some time.

Expanding our awareness of the problem does not answer any of the difficult questions we are facing. It adds to the complexity of the issue and calls for conversations between different and sometimes conflicting points of view. However, it can make the answers easier to find. As more work emerges linking the sanitation crisis to a range of devastating problems affecting certain countries, this once hidden issue is brought up the priority list. The numerous reframing’s force policy makers and those in power to put time and effort into dealing with this tragedy. Additionally, it highlights to us, and by us I mean the WASH (water, sanitation and hygiene) community, the need to synergise our work in order to integrate the many different sectors and actors involved. If we are able to leave behind the professional silos we are all comfortable in and co-create multidisciplinary action orientated work, new possibilities and creative solutions may emerge.

So today on World Toilet Day 2014 I expand the call. Visit our website at www.communityledtotalsanitation.org, follow us on twitter @C_L_T_S and join the discussion.

Jamie Myers is a Research Officer at the Institute of Development Studies working on Community-led Total Sanitation.


World Development Report 2015: Congratulations so far. Can you go further?

26/02/2014

Robert ChambersRobert_Chambers200

Robert Chambers was recently asked to provide comments on the forthcoming World Development Report (WDR) 2015. The annual reports are the World Bank’s major analytical publication, each year focusing on a different aspect of development. The WDR 2015 will be on the topic of ‘Mind and Culture’. Below is Robert’s response to Steve Commins, of the Luskin School of Public Affairs at UCLA, and Varun Gauri, Senior Economist at the World Bank. Both are part of the WDR 2015 team at the World Bank. Robert’s response  gives a window onto some of the pressing avenues that participatory thinking should be exploring.

Hi Steve and Varun,

Much stimulated by the video call yesterday. Good to meet again after some time, Steve – I do remember your visit to IDS.

I am excited by the focus and proposed content that you outlined. Both actually and potentially (see below) this WDR promises to take us forward. As background to this, please read the critical piece I wrote about WDR 2000, which was such an achievement by Ravi Kanbur especially. It is in a book Provocations for Development, reprinted from Journal of International Development You are closer to what I advocate in the final paragraphs of that piece than any other WDR has been, to my knowledge, in examining ‘us’. This raises a host of questions (Who? Whose?) which you illustrated, Varun, with the example of Whose indicators? I.e. score cards for health services. How far can you push the envelope in this WDR? Huge opportunity.

My main points:

Reflexivity
(As above, a mirror on ‘us’) Can you, as I suggested yesterday, conclude powerfully with the case for reflexivity, setting an example with your own critical reflections on the framing and content of knowledge in your own WDR?  It would be brilliant, absolutely brilliant, if you could, and would set a wonderful example to all of us who call ourselves development professionals. ‘Belief traps’ is a great phrase and concept. Can you illustrate and elaborate, and show how we are all in them, and how we can recognise them and mitigate them.  Wow! What an opportunity!

Emotion
This is such a significant driver of change in norms and behaviour. In your presentation to us, Varun, you did use the word once, but only once. But is it not almost everywhere, but papered over by our analytical intellectualism? For learning and changing, is it a key element? See John Kotter and Dan Cohen  The Heart of Change: real-life stories of how people change their organizations ,including the critical distinction between see-feel-change and analysis-think-change.  Argues for the transformative power of the former. See also Valerie Curtis Don’t look, don’t touch, don’t eat: the science behind revulsion; also Nick Haslam Psychology in the Bathroom . Both well researched, insightful, entertaining. Haslam pages 9-11 section on emotion points to a dramatic rise in professional attention to disgust and shame.

There is a right hemisphere-left hemisphere dimension here – development in the last decade has lurched into the left hemisphere. But with participation, much of it Bank-led in the now-forgotten 90s, there was a much better balance. See paradigms in Provocations pages 190-4. This links with

Experiential learning
This is implicit in initiatives that give people new experiences. The Bank’s immersions (starting with Wolfensohn in the 90s, and still going on a bit) and similar experiences have been enormously formative. (See pages 171 ff in Provocations). You have experiential learning and change in there – experiences overcoming belief traps. Do we, in development, need to be much more resolute, imaginative and bold in designing experiential learning, as with immersions, into our professional lives? When you talk about horizontal (and by implication vertical) teaching and learning, is the horizontal more experiential in a whole-person and relational sense?

Accelerating change – in every dimension?
Has the perennial challenge of keeping in touch and up-to-date with the realities of people living in poverty – marginalised, vulnerable, weak…. become more acute because of the way in which social and other change has accelerated and continues to accelerate? I recommended the Reality Checks in Bangladesh (pdf). They have done five annual summaries of these. The rate of change they find is astonishing. I have to say that Bangladesh may be an outlier in speed (fertility rate now 2.2!!!), but there are many indications and experiences that suggest that acceleration is the norm. Could you have a box, perhaps combining the experiential learning of immersions with the need to keep in touch and up to date? This could have a big, good, impact. The person best able to advise on this is Dee Jupp who started and has continued this (There is a major review of this in Stockholm this week). In my view all countries should have reality checks – and they are spreading – Indonesia, Mozambique Nepal, Ghana , Dee could tell you.

Blind spots
This is something I am working on just now and links with the points I made about reflexivity above. There have been major areas that have been overlooked or given inadequate attention in the past across a whole range – sexuality and discrimination against LGBTs, canal irrigation at night, group-visual synergy in diagramming on the ground, the potential of participatory statistics, the combined nutritional impact of the many faecally-transmitted infections (perhaps responsible for some half of the undernutrition in the world, certainly in India…remarkable recent research findings by Dean Spears ), environmental enteropathy).These raise the question: what are the characteristics of areas that are blind spots (links with your belief traps, also institutional and professional silos, blinkers)? Why have there been these blind spots? Can you take this on? Open it up as a topic? If we missed these in the past, what are we missing now?

Words and concepts
They frame pretty much everything. We all have our favourites (see the first section of Provocations). The words and concepts here are not as dominated by economics as they might have been, but all the same what are the implications for framing and recommendations of those which come naturally to you and are part of current development speak,  Incentives, Prices, Regulations, information, for example ?

Can you define e.g. belief traps with examples, and cognitive taxes with examples, and explain how the latter overlaps with but goes further than transaction costs (if I understand it right)?

Community-Led Total Sanitation (CLTS)
I will write about this separately. Excellent that you have this in. And it is a good illustration of a number of the points above.

Finally, I would like to congratulate you, the collective you working on the WDR, on your work, but I would also like to challenge you and ask ‘How much further can you go?’ in order to make a real difference.

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS.

Read other blog posts from Robert Chambers:


Top PPSC blog posts in 2013

28/12/2013

Susanne SchirmerSue_Schirmer200

As we’re approaching the end of 2013 I would like to use the opportunity to highlight the top ten posts of the Participation, Power and Social Change blog, as well as some other interesting posts, that you might have missed.

This year we had an interesting array of posts providing commentary on events around the world, such as political change in Egypt, riots in Brazil, tragedies and revolts in Bangladesh, as well as presentations of outputs from some of our main research programmes and initiatives. Bloggers included researchers from the IDS Participation, Power and Social Change team, some of our partners, working with us on a variety of projects and some students associated with the team through our MA course in Participation, Power and Social Change and through our PhD programme.

Welcome to all those that joined our follower-list in 2013. We now have over 450 people following our blog and compared to 2012, we have more than doubled our views, which is excellent news. We hope you have found our posts interesting and even enjoyable. Please feel free to invite others to join our follower-group and find out what we’re up to.

Top 10 blog posts:

1. Participation for Development: Why is this a good time to be alive? By Robert Chambers

2. Bangladesh: Rana Plaza is a parable of globalisation by Naomi Hossain

3. From making us cry to making us act: five ways of communicating ‘development’ in Europe by Maria Cascant

4. The Marriage Trap: the pleasures and perils of same-sex equality by Stephen Wood

5. Bangladesh is revolting, again by Naomi Hossain

6. Storytelling in Development Practice by Hamsini Ravi

7. Missing the pulse of Egypt’s citizens? by Mariz Tadros

8. I’m (still) hungry, mum: the return of Care by Naomi Hossain

9. The crisis of Brazilian democracy, as seen from Mozambique by Alex Shankland

10. Heteronormativity: why demystifying development’s unspoken assumptions benefits us all by Stephen Wood

Other interesting blogs that you might have missed:

To give a different nuance to our commentary and research, we’ve also introduced some visual blog posts this year, showing videos, photographs and cartoons. Have a look:

Finally, on behalf of the Power, Participation and Social Change Team at IDS, we wish all our readers happy holidays (if you’re celebrating) and a good start into 2014. We will be back with more blog posts in early January.

Sue Schirmer works as Communications Coordinator for the Participation, Power and Social Change (PPSC) team at IDS.


World Toilet Day: ‘We can’t wait to improve sanitation’

19/11/2013

Petra Bongartz???????????????????????????????

The 19th November is World Toilet Day. The World Toilet Organization created World Toilet Day (WTD) to break the deadly silence around sanitation and to raise awareness of the struggle of the billions of people in the world who still do not have access to adequate sanitation. It is a day to draw attention to the many challenges this brings to their daily lives and the dire consequences for their health and wellbeing. A day to encourage discussion about what needs to be done in order to tackle the sanitation crisis! It is a call to action, a call for everyone to get involved in changing behaviour and policy in order to end open defecation and thereby change the lives of billions of people for the better.  And it is also an occasion to recognise and celebrate the efforts and achievements of organisations and individuals in bringing about positive change in the area of sanitation and hygiene.

Woman standing outside a latrine in Malawi

Latrine in Malawi, photo by Edson Baptista

This year, the first year of the 19th November being officially designated World Toilet Day by the United Nations (despite it having been ‘unofficially’ honoured since 2001), the theme is ‘We can’t wait to improve sanitation’.  And with 2.5 billion people around the world still lacking appropriate sanitation, the call for action is as urgent as ever!

The Community Led Total Sanitation (CLTS) Knowledge Hub at IDS is marking the occasion with the launch of a new publication series Frontiers in CLTS: Innovations and Insights – a series of short notes offering practical guidance on new methods and approaches and thinking on broader issues. The first issue looks at participatory latrine design. A methodology that can ensure that users participate in creating and selecting sanitation technologies that are appropriate for their needs.

Petra Bongartz is the Coordination, Communication and Networking Officer for the Community Led Total Sanitation (CLTS) Knowledge Hub, based at the Participation, Power and Social Change Team at IDS.

Read more about CLTS:


‘The power is in your hands’ – Global Handwashing Day and Community-Led Total Sanitation

15/10/2013

Susanne SchirmerSue_Schirmer200

Together with improved sanitation handwashing with soap is one of the most effective and inexpensive ways for preventing diarrhoeal, acute respiratory and other infections, which take the lives of millions of children in developing countries each year. The 15th October is Global Handwashing Day and each year about 200 million people are involved in celebrations in over 100 countries around the world. My colleagues from the Community Led Total Sanitation (CLTS) Knowledge Hub at IDS are marking the occasion by promoting handwashing-related publications and resources on the CLTS website.

CLTS is an innovative methodology for mobilising communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free). Handwashing is very much part and parcel of the CLTS approach, as Robert Chambers explains in this online discussion: ‘Handwashing is widely included in triggering or comes soon after. There are ways in which this is facilitated which are not didactic … The main one is likely to be – (if you don’t wash) – the realisation that they are eating their own shit.’

girl washing her hands

‘The Power is in your hands’ photo by Petra Bongartz

There are some innovative ways of triggering handwashing behaviour which UNICEF Malawi researched and collated in this ‘How to Trigger Handwashing with Soap’ Guide – some, for example the ‘scratch and smell method’, are not for the faint-hearted: The facilitator puts his hand inside his trousers and (pretends or actually) scratches his bottom. He then offers his hand to community members to shake. If, as is likely, they recoil and refuse, a discussion on why ensues and leads into conversations about the importance of handwashing.

Visit the CLTS website to find out more and access a number of resources relating to CLTS and handwashing or visit the Global Handwashing Day website to find out about the celebrations around the world.

Sue Schirmer works as Communications Coordinator for the  Participation, Power and Social Change (PPSC) team at IDS. The Community Led Total Sanitation (CLTS) Knowledge Hub is hosted at the PPSC team at IDS. Visit the CLTS website to find out more or follow their blog posts

Read other blogs relating to CLTS


Sanitation and Hygiene: Undernutrition’s Blind Spot

02/05/2012

Robert Chambers

The undernutrition of babies, infants and children is horrible and a disgraceful blot on our human record. It is not just the immediate suffering, anguish and death. It is also the lasting impact: when growth is stunted at age 2 the damage is largely irreversible. Stunted children are disadvantaged for life – their cognition and immune systems impaired, and their education and earning prospects reduced. Stunting leads to a 10 per cent decrease in lifetime earning. Stunted children start school 7 months later and attend 0.7 years less than children who aren’t stunted.

So undernutrition cries out for action and there is plenty of action. The normal, commonsense, humane response is direct and visible – to get more nutrients and food into babies, infants and children. To get it into their mouths. Who could be against that? Not me. It is so obvious, so necessary, so important, so urgent, with such immediate results.

But, and it is a monumental but, has this distracted attention from a major cause, and outside famines and acute seasonal crises, I will dare to venture even the main cause: faecally-related infections(FRIs)? Have I lost my senses? Well….

I recently watched  a video of a presentation made by Dr Jean Humphrey in India, and met her, and heard her speak  at the UK Department of International Development (DFID). She works in Zimbabwe and in the Lancet (19 September 2009) famously argued with convincing evidence that environmental enteropathy (EE) is a more significant cause of undernutrition than diarrhoea. EE is a persistent subclinical condition in which infections damage and reduce the absorptive capacity of the gut and at the same time make it permeable so that nutrient energy has to be continuously diverted to make antibodies to fight the infection. EE is a multisystem disorder, a ‘profound immune system disorder’ which moreover weakens the immune system later in life. That Lancet article stirred things up, and she is now engaged on long-term rigorous field research into EE. She and others are now saying that diarrhoea is just the tip of the iceberg. I agree. But what an iceberg, not just EE!

Here are some bullet points. Are they right?

Diarrhoeas
How significant are the diarrhoeas as causes of undernutrition?

  • Because among faecally-related infections, they are so dramatic, awful, visible and episodic, and so easily measurable, the diarrhoeas have received and continue to receive the major professional attention. Many other conditions are subclinical, continuous, invisible and hard or impossible to measure. The multiple dimensions of EE are a very significant part of this.
  • With oral rehydration therapy, diarrhoeas are less damaging than they were
  • There is rapid recovery between bouts of diarrhoea
  • Studies of the effect of diarrhoeas on linear growth show effects in the range of only 5-20 per cent, and some show none at all
  • In the Gambia where the Dunn Nutrition Laboratory has been doing research for many decades there has been a big drop on the incidence of diarrhoea 1979 – 1993 but no change in stunting. They have found stunting is not explained by inadequate diet or days of diarrhoea!

The misleading conclusion could be drawn that since diarrhoeas are not so much implicated in undernutrition, sanitation and hygiene are not so important either, and that FRIs in general are not so signficiant

Feeding programmes
What is the evidence of the impact of feeding programmes?

  • A review of 42 studies of feeding programmes found that the very best solved only one third of the problem and some had no effect at all
  • No nutrition intervention has ever normalised linear growth

Faecally-related infections (FRIs)
FRIs are much more than the diarrhoeas and EE.

  • The variety and scale of these infections is quite mind-blowing. There are intestinal parasites – bacterial like gardia (extremely widespread), amoebiasis, and worms like ascaris (1.5 billion infected) that steal food and hookworm (over 700 million infected, 200 million in India) which voraciously consumes blood from the host, and tapeworms which come through intermediate hosts. There are hepatitis A, B and E, typhoid fever, polio and other enteroviruses, schistosomiasis (over 200 million, more than half in Africa), liverfluke, trachoma, and various zoonoses from animals (in addition to tapeworms)…..

So there is much, much more to the iceberg of which the diarrhoeas are the tip, than EE. No one so far has been able to point me to a study of how many of these infections are found in any one undernourished infant or child, nor how they interact. So my question to those who work in nutrition and those who work on faecally-related infections, is this: does professional specialisation prevent us seeing the enormity of the whole picture? And is the implication of the whole picture that sanitation and hygiene are not only a huge priority in eliminating undernutrition but even, bar famines and seasonal crises, possibly the main means?

Consider India. The latest data indicate that India has 59.4 per cent, almost three fifths, of the open defecation in the world, a proportion which has risen in the past decade. It also has a third of the undernourished children, a figure which has largely resisted herculean attempts to tackle it directly through the mouth with school meals, ration cards and the like. Imagine if suddenly all FRIs were caught and confined safely just below the anus. How much undernutrition would remain?

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team.

Read other recent blog posts from Robert Chambers:
Ensuring those who are ‘last’ come first: using Reality Checks to inform post-MDGs
Discrimination, duties and low hanging fruit: reflections on equity in CLTS
A passionate family: reflections on the WSSCC Global Forum on Sanitation and Hygiene


Ensuring those who are ‘last’ come first: using Reality Checks to inform post-MDGs

20/04/2012

Robert Chambers

The MDGs picked low hanging fruit.  To achieve them,  the incentive has been to go for those who were closest to thresholds or easiest to help, for instance people close to the poverty line, those who are most accessible and so on.   But this precisely leaves out the last, those who are poorest, least able, most marginalised, women most vulnerable to maternal mortality and babies most likely to die.  What this has meant can be shown by UNICEF’s diagram of sanitation in India.  The  Total Sanitation Programme of subsidised toilets was meant for those below the poverty line, roughly the bottom two quintiles.  But they hardly gained at all.  The biggest gains were by those already better off, the third and fourth quintiles.

Let me propose, and add my voice to others who are proposing, that post-MDG the great need and opportunity is to think and act from the other end, with those who are poorest, weakest, and most excluded and marginalised, those who are disadvantaged and lving with physical, mental and/or social disability.  It means aiming to level up from the bottom with equity as the goal and a radical rethink of policies and priorities.

It also means reviewing and focusing systems of monitoring and learning.  Policy-makers need to be closely in touch with what is happening on the ground to those who are worst off, the conditions they experience and their changing realities. It means finding ways in which there can be flows of honest, accurate, insightful and credible information to those in positions of power. This matters more than ever given the rates of change for all people living in poverty, not least with the rapid transformations of global interconnectedness, the mobile phone revolution, and accelerating changes in social conditions and relationships.   Being out of touch and out of date has always been a problem, and has repeatedly led to misfits between policy and field realities.   More than ever before, those in capital cities are finding it challenging to keep up with developments and changes at the grass roots,. This can be expected to be even more pronounced after 2015.

Fortunately, we have a new means for being in touch and up-to-date.  An approach has been pioneered which all countries can and should adopt.  This is the Sida-supported Reality Checks pioneered in Bangladesh.  This is a brilliant and extraordinarily successful innovation.  Many have still not heard of it, but it is beginning to be recognised and spread.  

The Reality Checks are conducted annually at the same time of year by the same teams.  Outsiders spend several days and nights staying in the homes of people living in poverty. Each year they stay with the same families in the same nine representative areas.  The brief for those who take part in Bangladesh is to listen, observe and understand the perspectives of their host families and others in their communities. The focus has been primary education and primary health care, two sectors which Sida supports, but a great deal else has come to light.  The approach lends itself very well to learning about the realities of those who are poorer, weaker and most marginalised.

The insights repeatedly surprise, not least people’s changing experiences, behaviours and priorities. Unrecognised policy issues are raised. Much more is learnt than just about education and health.  The teams have been struck, even astonished, by how much has changed and how fast it has changed since the first Reality Check was conducted in 2007.   The people who live in poverty in all countries deserve that their governments keep themselves in touch in this sort of way. 

A bottom up focus on equity and on those who are ‘last’, and the approach of Reality Checks, combine and support each other well. Emulating Bangladesh, they could and in my view should be adopted and adapted by all governments.  David Cameron could set an excellent and early example by starting Reality Checks in the UK. Though his stay was brief, the Secretary of State, Andrew Mitchell, can testify to the value of staying overnight in a community from his own experience with a poor family in Ethiopia.

We do not need to wait for 2015.  We could start now.  Experience could then be gained across a range of countries and conditions, ready to inspire and inform extensive adoption post 2015 and to make it more feasible for equity and the wellbeing of those who are ‘last’ to come first.

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS.