Safe latrines in Bangladesh

Safe latrines have been promoted in Bangladesh for nearly 30 years - but until the end of the 80s they won little acceptance amongst the majority of the population.

This was in marked contrast to the success in bringing safe water supplies to villages. Safe water covered 80% of the population while sanitation coverage was only 8%.

Cole Dodge, UNICEF representative in Dhaka, set out to find out why the UNICEF and Government sector programme for the previous ten years had used all its available funds, yet failed to meet a single annual target for sanitation.

Between 1964 and 1978 all of Bangladesh was included in a water-sealed latrine programme, with promotion based on the health and germ theory.

However, research showed that, for the 75% of the population who were illiterate, the main attractions of latrines were privacy, convenience, comfort of women and prestige.

To change this mismatch between the sector and the community, a process of social mobilisation was launched.

Advocacy was used to mobilise senior Government staff, Members of Parliament, the media, NGOs and the community.

The phrase 'pathogen overload' was used to described a situation where every sector of society was prone to water borne disease.

Politicians and senior government decision makers were told that sanitation was a top priority in the drive against diarrhoea, which accounts for 300,000 child deaths each year. This advocacy was successful. There was even a report that a cabinet minister had appropriated a whole district's production for his own village.

UNICEF found allies to help promote sanitation.

• The leadership of a village based organisation, Ansars, with four million members, trained its officers in sanitation.
• Islamic clergy allowed a UNICEF communications officer to address 1.5 million people at a religious gathering and to distribute half a millions leaflets on sanitation.
• By 1992 the Prime Minister agreed to launch a logo for the new communication drive at a national rally.
• Sanitation promotional material now highlighted women's preferences and cultural values, rather than simply repeating health messages. A strategy for participatory planning was agreed, and courtyard meetings were used to explain the benefits to 25 or 30 families at a time.
• The popularity of the tubewells programme was exploited. Groups of ten families had to show that they had installed latrines, before a tubewell would be provided.
• At the same time the sector and UNICEF agreed that they would stop promoting the waterseal latrine as the only hygienic option. Although sold at a subsidised price, it was still out of the reach of many families. A smaller version was designed, less than half the price of the original, but suitable for stable soil formations. A do-it-yourself latrine was also introduced as an acceptable option. It has a life about five years and can be produced at little or no cost to the family.
• The new Integrated Approach adopted in Bangladesh will cover the whole country by 1995. Even before national coverage, the percentage of rural families with a sanitary latrine rose from 10% in 1989 to 26% in 1991. A recent survey of 10,000 randomly selected families showed good results, compared to 1985.
• Use of sanitary latrines was up from 4% to 25%.
• Use of tubewell water for drinking reached 92% (up from 80%).
• Hand washing with soap or ash after defecating, up from 5% to 27%.
• Where coverage had been high and more than 70% of families had latrines, use of the latrines was reported at over 90%.
• The survey also showed challenges ahead.
• Hand washing before handling food had remained unchanged at 3%.

The Bangladesh example shows that resources can be used more effectively where the efforts of the sector are closely tuned to the knowledge and beliefs of the community, and where advocacy persuades allies to encourage a real change in people's thinking and behaviour.