About those toilets

Given the increasing level of bigotry witnessed in the last few weeks, the challenges associated with lack of meaningful employment for our youth and the stifling air of frustration, the importance of education could not be understated. When it comes to education emergency in the country, the problem is most acute in rural areas where girls are more likely to drop out than boys. This impacts not only their own lives but the lives of their future families as well. Children born to uneducated mothers are more likely to miss nutritional targets. The cycle continues. One of the drivers in forcing girls to leave school is lack of sanitation. Yes, you heard it right — a functioning toilet may actually help in keeping girls in school. Girls, post-puberty, are much more likely to drop out of schools which have no sanitation or toilets than from schools that do.

Now let us turn our focus on another, independent axis. One of the grandest challenges in health, facing the whole world, is the rise of antibiotic resistance. As our arsenal of antibiotics starts to lose its efficacy due to overuse and abuse of antibiotics, routine surgery and C-section will become challenging to carry out, and common infections will be difficult — and sometimes impossible — to treat and manage. A key driver in our part of the world for infection spread is poor hygiene and lack of toilets. The spread of disease resistant typhoid from Hyderabad to Karachi — and beyond — has become a major news story all over the world. A possible solution to tackle future spread of antibiotic resistant diseases? Yes — functioning and accessible toilets.

The problem of sanitation and hygiene is not just a theoretical one. The report released by the World Bank a couple of weeks ago titled “When Water Becomes a Hazard: A Diagnostic Report on The State of Water Supply, Sanitation and Poverty in Pakistan and Its Impact on Child Stunting” paints a grim picture. While some real gains have been made in the last 10 years — primarily in Punjab and Balochistan — when it comes to sanitation, huge challenges remain, for instance, nearly 80% of the population in rural Sindh and Balochistan has no access to drainage. Worse, in the last 10 years, there has been no policy on fecal waste management. The report says, “Management of drains and treatment of human waste is nonexistent for most rural dwellers, as well as the poor in smaller urban towns and cities, and there has been almost no public-sector effort to regulate toilet quality or monitor water quality.” The report further states that most of the provincial effort has focused on provincial capitals and devolution has, so far, resulted in minimal — if any — impact on rural areas in improving sanitation and hygiene.

Herein lies a challenge in providing safe, affordable and scalable models of sanitation, one that requires innovation in both the product and implementation process. I find it deeply hypocritical that when Bill Gates talks about toilets, and the innovation gap there, we call it cool; but when our public health professionals discuss the need for better toilets, we mock them.

The naysayers may find it silly to focus on toilets — finding it beneath their dignity to discuss the fact that we do not have solutions to deal with fecal waste. But it is not about the supposed dignity of the elite who find it beneath themselves to talk about sanitation. It is about providing dignity to those who are the future of the country. It is about providing a dignified means of education to young girls. It is about ensuring that we do not lose more than we have already lost. It is about a healthier and more educated Pakistan.

Published in The Express Tribune, November 20^th, 2018.

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