Rural Sanitation Risks, Status & Vision South Asia Regional Learning Event Mark Ellery | 10th November, 2016

Activity 1: Identify the Health Risks Rural Sanitation (by Country)

Fecal Rural Ingestion Risks What are the greatest fecal ingestion risks for children <5 in rural areas? Resize the size of the pictures according to the size of the risk!

Correlation of Open Defecation & Nutrition Eradicating Open Defecation has significant health consequences Bangladesh DHS Pakistan DHS Nepal DHS Sri Lanka DHS Source: ICF International, 2015. The DHS Program STATcompiler. Funded by USAID.

Lots of unknowns …. >2 SD below mean Chronic Acute Children <2 Normal Weight & height Wasted Low weight for height Underweight Low weight for age Stunted Low height for age Children <2 Implement sanitation & hygiene interventions with 99% coverage1 Reduce diarrhea by 30% Reduce undernutrition by 2.4% 64.6% Other factors by Implement nutrition interventions with 99% coverage2 Reduce undernutrition by 33.0% Normal height for age 100% Retarded mental & physical development >2 SD below mean Chronic Acute 1 Humphrey J H, Child under-nutrition, tropical enteropathy, toilets, and handwashing; Lancet (2009) 2 Bhutta ZA, Ahmed T, Black RE; Interventions for maternal and child undernutrition and survival. Lancet (2008)

Individual Growth Charts Do all children grow on the normal curve? What about genetics?

Child <5 Growth Trends Average Child Nutrition in Developing Countries Child <5 Growth Trends What is happening at 9 months of age? Why is stunting (chronic) worse than underweight (acute)? Developing Countries (2005) Percentage Child Undernutrition in Bangladesh Bangladesh MICS (2012-13)

Fecal Transmission Risks for Children <5 How can we best protect children from fecal ingestion? Fluids Poor absorption of nutrients Fingers Feces Food Food Flies Unhealthy villi Fields/ floors Infected Intestine No diarrhea

Activity 2: Identify the Bottlenecks Rural Sanitation (by Country)

Where are the Rural Sanitation Bottlenecks? Change the % safe? Right click & then click on “edit data”

Sanitation Bottleneck Analysis Rank 1-8 by scale Sanitation Bottleneck Analysis # Bottleneck Describe why this bottleneck is significant or insignificant Open Defecation Other unimproved Shared facilities Improved Safe (wrt. soap for hands) Safe (wrt. menstrual hygiene) Safe (wrt. fecal effluent) Safe (wrt. fecal sludge)

MoRES in Bangladesh

Do sanitation facilities have the provision for the washing of hands? Handwashing Do sanitation facilities have the provision for the washing of hands? Are handwashing facilities proximate to the latrine? Is there soap or detergent? Is there water? Is the soap & water used? Is there drainage?

Menstrual Hygiene Do sanitation facilities enable the safe management of menstrual hygiene? Do sanitation facilities enable: changing (i.e. space for changing pads within the latrine facility); washing (i.e. water & soap for the cleaning of menstrual rags); drying facilities (i.e. clothes lines & hooks for the drying of menstrual rags); storage facilities (i.e. a place for keeping spare menstrual pads); disposal facilities (i.e. a means for disposing of menstrual pads);

Do sanitation facilities contain effluent? A septic tank without a leach drain doesn’t treat pathogens! Scum Sludge Liquid / Effluent Anaerobic Digestion Aerobic Digestion - Environmental Safety (Chemicals) - Reduces Nitrogen & Phosphorous - Public Safety (Pathogens) - Reduces Fecal Bacteria & Viruses N2 H2 H2S Leach Drain Septic Tank

Is Faecal Sludge Safely Managed? Are there health risks in the containment, emptying, transport, treatment & re-use / disposal of faecal sludge? Dhaka Faecal Flow Diagram

ACTIVITY 3: Country Rural Sanitation Vision

You can change anything in safe sanitation & anything 2020–2030! What are the 2020, 2025, 2030 Targets? You can change anything in safe sanitation & anything 2020–2030! Right click & then click on “edit data”

Describe these Targets In words below provide some description on the nature of the targets (i.e. phasing etc……. ??????

MDG Sanitation Progress JMP Monitoring Source: WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)

MDG Sanitation Status JMP 2015 Update Source: WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)