World Toilet Day = Systems Day = Nutrition Day

By Ron Clemmer, Strategy and Business Development Manager, WASH, FHI 360.

World Toilet Day is about more than toilets! It is about the whole system of the sanitation chain. This whole “system” of household latrines; school and health facility toilets; septage haulers; wastewater and septage treatment, reuse and disposal, has become more and more a focus of international development professionals. As with development practitioners in other sectors, we work in complex social systems that require organizational change, behavioral change, and personal change for transformative social change to result in sustainable impact. A systems lens helps us to see our roles in development programs to understand the impact that is needed in the big picture of the “system.”

FHI 360’s 2015 Challenge Conference Deepening Systemic Engagement addressed an important question for systems thinking: “How do we as practitioners and change agents unify systems theory and practice to bring forth healthy and inclusive human development?”

FHI 360 brought together speakers who are leaders in the area of systems thinking and also practitioners who are implementing a systems approach for international development for the Challenge Conference. The keynote speaker was Otto Scharmer from the MIT Sloan School of Management, who with Katrin Kaufer co-authored, Leading from the Emerging Future: From Ego-System to Eco-System Economies.

Being the pragmatic engineer that I am, some of the presentations that peaked my interest the most were from FHI 360 colleagues discussing the application of systems approaches in their development programs. A systems approach that FHI 360 staff has developed in conjunction with USAID is SCALE (System-wide Collaborative Action for Livelihoods and Environment). Ten years of learning through the implementation of the SCALE systems methodology to accelerate broad stakeholder engagement in sustained collaborative action to address a complex development issues has now resulted in FHI 360’s development of SCALE+.

If you want to explore more of Deepening Systemic Engagement, the Challenge Conference highlight videos and materials can be found here.

World Toilet Day is also about more than toilets because of the significant impact of good sanitation on maternal and child health, neglected tropical diseases, HIV/AIDS, education, and nutrition. World Toilet Day has a special linkage to nutrition this year, and 2015 World Toilet Day was chosen as the day that WHO/UNICEF/USAID are releasing the important publication Improving Nutrition Outcomes through Water, Sanitation and Hygiene: Practical Solutions for Policies and Programmes. My FHI 360 WASHplus colleagues managed the development of this publication in collaboration with the publishing agencies. And the integrated activities in different countries implemented by WASHplus and its partners are contributing practical knowledge and tools that will help guide WASH-nutrition integration in the future.

ABOUT THE AUTHOR: Ron Clemmer joined FHI 360 in May 2015 after working with World Vision as Senior Technical Advisor for WASH for six years. Ron is passionate about building sustainable water and sanitation services through the public and private sectors, hygiene behavior change that becomes habit, and integrated programming of WASH with nutrition, HIV, neglected tropical diseases, education, and women’s empowerment.

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Improving Nutrition, One Latrine at a Time: WASH 1,000 Strategy in Ghana Takes Hold

By Christa Elise Reynolds, Knowledge Management Officer, JSI Research & Training Institute, Inc. with USAID SPRING.

Gmangun Charles, of Kubone community in Ghana, shows off his household’s new latrine. (Photo by David Nunoo, SPRING/Ghana WASH Advisor)
Gmangun Charles, of Kubone community in Ghana, shows off his household’s new latrine. (Photo by David Nunoo, SPRING/Ghana WASH Advisor)

Toilets might not be the first thing you think of in conjunction with basic human nutrition, but inadequate sanitation poses a real danger for 2.5 billion people around the world. When crops become contaminated through open defecation, communities are at risk for disease outbreaks and chronic malnutrition.

This November 19, designated as World Toilet Day, we are reminded of the people lacking access to toilets and improved sanitation. About 1.1 billion people defecate in the open, according to UN-Water. Diarrheal disease, which can prevent nutrients from being absorbed, is a common outcome of improper human waste disposal. This is an issue in Ghana, where approximately 19,000 people die yearly from diarrhea. Nearly 90 percent of those deaths can be attributed to poor water, sanitation, and hygiene (WASH), according to the Water and Sanitation Program.

At the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, funded by the U.S. Agency for International Development’s (USAID), we are working to improve nutrition through our “WASH 1,000 strategy,” a multifaceted approach stresses the importance of key household behaviors during the first 1,000 days, spanning the mother’s pregnancy to the child’s second birthday. Numerous factors influence a child’s well-being during this time. Our WASH 1,000 strategy focuses on four key behaviors: ensuring the child has a safe and clean play space, safely disposing of human and animal feces, handwashing at critical times, and using only boiled or treated water for the child’s consumption.

Mobilizing communities to build latrines is one of the first steps toward improving sanitation. Working with country partners, we facilitated discussions about the importance of latrines and sanitation in communities in the northern and upper eastern regions of Ghana, and participants have been receptive to the ideas. Installing tippy taps, or simple handwashing stations, near latrines and in households promotes handwashing after using the latrine and before meals, another WASH 1,000 goal.

“I am happy that I and my family do not defecate in the open again. I have restored my lost dignity,” said Gmangun Charles, a resident of the Kubone community in the Mion District of Ghana, who recently constructed a latrine for his household’s use.

Since February 2015, 47 household latrines have been built in the Kubone community. After learning about the benefits of using latrines, residents are increasing community awareness of open defecation’s health risks and shaming those who refuse latrines.

The link between open defecation, hygiene, and nutrition is not obvious and many community members may not be aware of the connection. Because people in the northern and upper eastern regions of Ghana often defecate on farm fields and near water sources, crops can become contaminated. Children might be exposed to human and animal feces while playing, which can lead to infection and diarrhea. Eating with unwashed hands can cause further contamination. Properly built latrines and use of tippy taps reduce this health risk. These latrines are a source of pride for the community members who build them, 14-year old Emmanuel Loteba said.

Though the idea of feces getting into our foods is disgusting, I also felt guilty because we all defecate openly in this village. We were told that the best way to avoid contaminating our food and to live healthy lifestyles is to build household latrines,” Loteba commented.

Loteba lives in Boagnab Yare, a community in Ghana’s upper east region, where diarrheal disease and low nutritional absorption are common. He learned about the WASH 1,000 strategy through one of our trainings. In the Kugbar-Bulug community, another of our WASH 1,000 Ghana sites, 19 of 28 households have already built household latrines. Kwame Awin, a local farmer, is happy with his new latrine because he and his family can finally eat fresh beans from their fields without risking contamination.

World Toilet Day highlights the sanitation needs of billions of people around the world who can’t wait for better hygiene. By encouraging a more holistic understanding of nutrition as it is impacted by WASH, our work in Ghana has begun changing perceptions of latrines and sanitation in the country’s northern and upper eastern regions. SPRING continues to promote WASH 1,000 behaviors to communities and trainers so that they may improve sanitation access, nutrition, and health.

ABOUT THE AUTHOR/ PROJECT: Christa Elise Reynolds is a Knowledge Management Officer working on the USAID SPRING project at JSI Research & Training Institute, Inc. Funded by USAID, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project strengthens country efforts to scale up high-impact nutrition practices and policies. To learn more about SPRING visit the project website at www.spring-nutrition.org and follow @SPRINGProject2 on Twitter.

DISCLAIMER: The contents of this blog post are the responsibility of JSI, and do not necessarily reflect the views of USAID or the United States Government. SPRING’s work is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-11-00031 (SPRING), managed by JSI Research & Training Institute, Inc. (JSI).