Page Content: South Africa is progressively failing in its mission to provide safe sanitation for all, writes Dr Jo Barnes of the Division of Community Health at Stellenbosch University in an opinion article published in the Cape Times on Tuesday (18 November).
The complete article as submitted follows below:
Functioning toilets, clean water reduce health risk
Until the turn of the century, the sanitation crisis was a low priority topic in much of the developed world, but one that affected the quality of life for billions of people globally.
This started to change, albeit slowly, on 19 November 2001 when World Toilet Day was established amid initial amusement and ridicule amongst those who lived in comfort. However, the day gathered support over the years in recognition of the crucial role that sanitation plays in community health. A resolution to this effect was adopted by 122 countries at the 67th session of the United Nations General Assembly in New York on 24 July 2013 and so World Toilet Day, celebrated on 19 November, became an official UN day.
What this day does is to highlight how access to safe sanitation, the practice of good home hygiene and a safe water supply could potentially save the lives of 1.5 million children across the world per year. This amounts to saving the life of a child somewhere in the world every 21 seconds. Unfortunately, in 2010 only 63% of the world population had access to safe sanitation. If current trends continue, 67% (2.4 billion people) will still be without safe sanitation by 2015, the year in which the Millennium Development Goals hoped to achieve a target of 75%.
At this point, it is should be noted that World Toilet Day is not only about the existence or specific type of toilet supplied to mainly poor households. A toilet cannot function on its own without a sanitation infrastructure supporting it. Thus, the focus is also on how sanitation systems, their functioning or lack of it influence the everyday quality of life for so many South Africans.
In South Africa, the backlog of provision of affordable housing and safe sanitation infrastructure is huge. Poor services delivery has become such a bone of contention that dissatisfied poor communities protest regularly to draw attention to their plight with the hope of exerting pressure on local authorities to provide them with proper sanitation facilities.
Adequate sanitation is vital to good health and prevents the spread of diseases such as diarrhoea, cholera, typhoid, intestinal worms and polio.
Provision of safe toilet facilities that are accessible to even the poorest can significantly decrease burdens of disease and therefore health costs. Improved health in turn gives rise to improved education achievements and economic output and thus help to improve the high levels of poverty in our country. With the advent of safe sanitation, the dispersal of sewage into the environment can be significantly reduced, thereby also protecting South Africa's vulnerable water sources.
The second essential link to safe hygiene is the availability of enough clean water for personal hygiene ̶ especially washing hands ̶ safe food preparation and household cleaning. The same communities protesting about poor toilet facilities also often lack sufficient clean water. The country made strides in the provision of safe water, but government's claims about the size of those improvements do not take into account that many of these projects fail after a short time and are no longer functional. The total number of South Africans with access to safe water does not reflect those who have such access at present; only those who had access at one point in the past. This approach needs drastic improvement since the consequences of poor sanitation cannot be managed in the face of misleading management information.
Unfortunately, South Africa is progressively failing in its mission to provide safe sanitation for all. The ratio of numbers of households to a toilet is very poor in many low-income areas, while more than 270 000 bucket toilet systems are still in operation. Toilets that are provided in such areas are often not operational; communal toilets are unsafe, poorly maintained and dangerously dirty. The sewerage systems serving those toilets are blocked in many places and then routinely spew out sewage into the surrounding areas, especially after rains. Living under such conditions are demeaning and contribute to poverty by affecting people's health and ability to earn an income.
In 2013, an investigation by the South African Human Rights Commission highlighted the gravity of situation by revealing that approximately 11% (1.4 million) of formal and informal households in South Africa ̶ predominantly in rural settlements of KwaZulu-Natal, North West and the Eastern Cape ̶ lack formal sanitation services. These households have never received a government supported sanitation intervention. At least 26% of households (3.8 million) within formal areas had sanitation services that did not meet the required standards. This was mainly due to the deterioration of infrastructure caused by lack of technical capacity to ensure effective operation, timeous maintenance, refurbishment and/or upgrading, pit emptying services and/or insufficient water resources.
Based on an assessment of the provision of water services, 23 municipalities (9% of the total) were in a crisis state, with an acute risk of disease outbreak; and a further 38% were at high risk, with the potential to deteriorate into a state of crisis. On a more local note, Cape Town has an estimated 112 000 people without access to safe sanitation.
So what is required to solve our sanitation crisis?
Local and provincial governments need better information on exactly how many persons live in the low-income areas and especially the informal areas under their jurisdiction as well as the real access to properly functioning toilet facilities. Using the minimum emergency guideline of five households per toilet is not an adequate service provision goal.
The maintenance and supervision of communal facilities in low-income areas leave a lot to be desired. Interim toilet facilities that are provided such as chemical toilets are no better than bucket toilets if they are not emptied regularly. Local authorities maintain that they do not get sufficient co-operation from the inhabitants to keep the facilities in working order.
At present, the underserved communities and the local authorities are in conflict, with both sides resorting to blame and unhelpful strategies. The situation needs wise counsel and cool heads to get both parties to change their entrenched positions so that realistic service provision on the one hand can meet sufficient behaviour change on the other hand to make the system work for all. If this can be realised, then South Africa can use this strategy in many spheres to meet social needs on a constructive basis. It can be done!
- Dr Jo Barnes works in the Division of Community Health at the Faculty of Medicine and Health Sciences at Stellenbosch University.