Open defecation

Open defecation (also used in the opposite meaning as open defecation free (ODF)) is the human practice of defecating outside (in the open environment) rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. They do so because either they do not have a toilet readily accessible or due to traditional cultural practices.[1] The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets. The term "open defecation free" (ODF) is used to describe communities that have shifted to using a toilet instead of open defecation. This can happen for example after community-led total sanitation programs have been implemented.

About 892 million people, or 12 percent of the global population, practiced open defecation in 2016.[2] Seventy-six percent (678 million) of the 892 million people practicing open defecation in the world live in just seven countries.[2]

Open defecation can pollute the environment and cause health problems. High levels of open defecation are linked to high child mortality, poor nutrition, poverty, and large disparities between rich and poor.[3](p11)

Ending open defecation is an indicator being used to measure progress towards the Sustainable Development Goal Number 6. Extreme poverty and lack of sanitation are statistically linked. Therefore, eliminating open defecation is thought to be an important part of the effort to eliminate poverty.[4]

Background

Defecating in the open is a very ancient practice. In ancient times, there were more open spaces and less population pressure on land. It was believed that defecating in the open causes little harm when done in areas with low population, forests, or camping type situations. With development and urbanization, open defecating started becoming a challenge and thereby an important public health issue, and an issue of human dignity.[5] With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation.[6]

Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity.[3] The countries where open defecation is most widely practised have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty, and large disparities between the rich and poor.[3]

Waste dumping in a slum of Cap-Haitien

Indiscriminate waste dumping and open defecation, Shadda, Cap-Haitien, Haiti

Open defecation in Tirin Kowt bazaar (4361881653)

Open defecation, Tirin Kowt bazaar, Afghanistan

Open defecation along the river bank (6908382463)

Open defecation along a river bank in Bujumbura, Burundi

Child in open sewer in Nigeria (3150664698)

Child defecating in the open in a canal in the slum of Gege in the city of Ibadan, Nigeria

Drain? Or Toilet? (3683494818)

This drain is used to defecate and urinate in a community in Bangladesh

Terminology

The term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 onwards. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets of the Sustainable Development Goal Number 6.

For monitoring purposes, two categories were created: 1) improved sanitation and (2) unimproved sanitation. Open defecation falls into the category of unimproved sanitation. This means that people who practice open defecation do not have access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time. The term "open defecation" was used in high-level speeches, that helped to draw global attention to this issue (for example, in the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013).[7]

Open defecation free

"Open defecation free" (ODF) is a phrase first used in community-led total sanitation (CLTS) programs. ODF has now entered use in other contexts. The original meaning of ODF stated that all community members are using sanitation facilities (such as toilets) instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation.[8]

The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined ODF as "the termination of fecal-oral transmission, defined by:

  1. No visible feces found in the environment or village and
  2. Every household as well as public/community institutions using safe technology option for disposal of feces".[9]

Here, 'safe technology option' means toilets that contain feces so that there is no contamination of surface soil, groundwater or surface water; flies or animals do not come in contact with the open feces; no one handles excreta; there is no smell and there are no visible feces around in the environment.[10] This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

Reasons

The reasons for open defecation are varied. It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open.[8]

A few broad factors that result in the practice of open defecation are listed below.

No toilet

  • Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.[2][11]
  • Lack of toilets in other places: Lack of toilets in places away from people's houses, such as in schools or in the farms lead the people to defecate in the open.[11]
  • Use of toilets for other purposes: In some rural communities, toilets are used for other purposes, such as storing household items, animals, farm products or used as kitchens. In such cases, people go outside to defecate.[12][13] Another example is a lack of public toilets in cities which can be a big problem for homeless people.[14]

Uncomfortable or unsafe toilet

  • Poor quality of toilet: Sometimes people have access to a toilet, but the toilet might be broken, or of poor quality - Outdoor toilets (pit latrines in particular) typically are devoid of any type of cleaning and reek of odors. Sometimes, toilets are not well lit, especially in areas that lack electricity. Others lack doors or may not have water. Toilets with maggots or cockroaches are also disliked by people and hence, they go out to defecate.[15][16][17][11]
  • Risky and unsafe: Some toilets are risky to access. There may be a risk to personal safety such as - they may be dangerous to access at night due to lack of lights, criminals around them, the presence of animals such as snakes and dogs. Women and children who do not have toilets inside their houses are often found to be scared to access shared or public toilets, especially at night.[17][18] Accessing toilets that are not located in the house, might be a problem for disabled people, especially at night.[19]
  • Presence of toilet but not privacy: Some toilets do not have a real door, but have a cloth hung as a door. In some communities, toilets are located in places where women are shy to access them due to the presence of men.[20][19][11]
  • Lack of water near toilet: Absence of supply of water inside or next to toilets cause people to get water from a distance before using the toilet.[11] This is an additional task and needs extra time.
  • Too many people using a toilet: This is especially true in case of shared or public toilets. If too many people want to use a toilet at the same time, then some people may go outside to defecate instead of waiting. In some cases, people might not be able to wait due to diarrhea (or result of an Irritable Bowel Syndrome emergency).
  • Fear of the pit getting filled: In some places, people are scared that their toilet pits will get filled very fast if all family members use it everyday. So they continue to go out to delay the toilet pit filling up. This is especially true in the case of a pit latrine.[17][19]

Unrelated to toilet infrastructure

  • Lack of awareness: People in some communities do not know about the benefits of using toilets.[21][22]
  • Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open.[8] In some cases, these toilets are provided by the government or other organizations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people are often found to defecate in the open and they are hesitant to change their behavior and go inside a closed toilet.[11]
  • Prefer being in nature: This happens mostly in less populated or rural areas, where people walk outside early in the morning and go to defecate in the fields or bushes. They prefer to be in nature and the fresh air; instead of defecating in a closed space such as a toilet.[4] There may be cultural or habitual preference for defecating "in the open air", beside a local river or stream, or even the bush.
  • Combining open defecation with other activities: Some people walk early in the morning to look after their farms. Some consider it as a social activity, especially women who like to take some time to go out of their homes. While on their way to the fields for open defecation they can talk to other women and take care of their animals.[11]
  • Social norms: Open defecation is a part of people's life and daily habit in some regions (e.g. in India). It is an ancient practice and is hard for many people to stop practicing. It is a part of a routine or social norm. In some cultures, there may be social taboos where a father-in-law may not use the same toilet as daughter-in-law in the same household.
  • Fecal incontinence: This medical condition can result in abrupt 'emergencies' and not enough time to access a toilet.

Prevalence and trends

The practice of open defecation is strongly related to poverty and exclusion particularly, in case of rural areas and informal urban settlements in developing countries. The Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by levels of poverty. This program is tasked to monitor progress towards the millennium development goal (MDG) relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country and results published on a regular basis.[23][2] The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

In recent years, the number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015.[2](p34) Those 892 million people with no sanitation facility whatsoever continue to defecate in gutters, behind bushes, or in open water bodies. Most people (9 of 10) who practice open defecation live in rural areas, but the vast majority lives in two regions (Central Asia and South Asia).[2] Seventy-six percent (678 million) of the 892 million people practicing open defecation in the world live in just seven countries.

In 2017, India was reported to be the country with the highest number of people practicing open defecation: 524 million people or 40% of the total population. These numbers have since then been reduced significantly due to the efforts of the Indian government's Clean India Mission.[2][24] However, some of the government data may reflect only the availability of toilets but not the actual daily use of toilets.

The countries with large numbers of people who openly defecate are listed in the table below.

People practicing open defecation by country - in alphabetical order (use up and down arrows to order by numbers). The figures in column 2 and 3 are from 2015, as reported in 2017 by JMP[2] and made accessible on several websites[25][26]
Country Total country population (in thousands) in 2015 as reported in 2017 by JMP[2][26] Percentage of people who defecate in the open and absolute numbers (data from 2015 as reported in 2017 by JMP[2][26]) More recent estimates of people defecating in the open (not JMP data but government data)
Chad 14,037 68% or 10 million
China 1,376,049 2% or 28 million
Eritrea 5,228 76% or 4 million
Ethiopia 99,391 27% or 27 million
India 1,511,051 42.34% or 524 million

according to NRASS conducted by Independent Verificatiom Agency (IVA) of World Bank[27][28] ---------------- 1.4% or 19 million in January 2019
according to government data[29][30][31]

Indonesia 257,564 12% or 31 million
Niger 19,899 71% or 14 million
Nigeria 182,202 26% or 47 million
South Sudan 12,340 61% or 8 million
Sudan 40,235 27% or 11 million

Impacts

Dirty pit latrine in Mongolia in winter (5321157342)
A dirty pit latrine in Mongolia leading people to choose open defecation instead

Public health

The negative public health impacts of open defecation are the same as those described when there is no access to sanitation at all. Open defecation—and lack of sanitation and hygiene in general—is an important factor that cause various diseases; the most common being diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others.[32][33]

In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days.[32][34] It can also lead to malnutrition and stunted growth among children.[35][36]

Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain flushes feces that are dispersed in the environment into surface water or unprotected wells.

Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death. An average of 2,000 children under the age of five die every day from diarrhea.[37]

Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot, and put things in their mouths without washing their hands. Feces of farmed animals are equally a cause of concern when children are playing in the yard.

Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment (leading to stunted growth in children), high levels of poverty and large disparities between rich and poor.[3]

Research from India has shown that detrimental health impacts (particularly for early life health) are even more significant from open defecation when the population density is high: "The same amount of open defecation is twice as bad in a place with a high population density average like India versus a low population density average like sub-Saharan Africa."[38]

Safety of women

There are strong gender impacts connected with open defecation. The lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education.[39] Women are at risk of sexual molestation and rape as they search for places for open defecation that are secluded and private, often during hours of darkness.[40][39]

Lack of privacy has an especially large effect on the safety and sense of dignity of women and girls in developing countries. They face the shame of having to defecate in public so often wait until nightfall to relieve themselves. They risk being attacked after dark, though it means painfully holding their bladder and bowels all day.[41][42] Women in developing countries increasingly express fear of assault or rape when having to leave the house after dark. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women defecate openly, are common.[41][42]

Prevention

There are several drivers used to eradicate open defecation, one of which is behaviour change. SaniFOAM (Focus on Opportunity, Ability and Motivation) is a conceptual framework which was developed specifically to address issues of sanitation and hygiene. Using focus, opportunity, ability and motivation as categories of determinants, SaniFOAM model identifies barriers to latrine adoption while simultaneously serving as a tool for designing, monitoring and evaluating sanitation interventions.[43][44] The following are some of the key drivers used to fight against open defecation in addition to behavior change:[4]

  • Political will
  • Sanitation solutions that offer a better value than open defecation
  • Stronger public sector local service delivery systems
  • Creation of the right incentive structures

Integrated initiatives

Efforts to reduce open defecation are more or less the same as those to achieve the MDG target on access to sanitation. A key aspect is awareness raising (for example via the UN World Toilet Day at a global level), behaviour change campaigns, increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation by "triggering" the communities themselves into action.[45]

As India has such a high number of people practicing open defecation, various Indian government-led initiatives are ongoing to reduce open defecation in that country. It began as the "Total Sanitation Campaign", which was relaunched as Nirmal Bharat Abhiyan in 2012 and integrated into the wider Swachh Bharat Abhiyan (Clean India Mission) in 2014 - see country section below for more details.

Also in 2014, UNICEF began a multimedia campaign against open defecation in India, urging citizens to "take their poo to the loo."[46]

Simple sanitation technology options

Photo by Ashley Wheaton, May 2011 (6376606733)
Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation

There are some simple sanitation technology options available to reduce open defecation prevalence if the open defecation behavior is due to not having toilets in the household and shared toilets being too far or too dangerous to reach, e.g., at night.

Toilet bags

People might already use plastic bags (also called flying toilets) at night to contain their feces. However, a more advanced solution of the plastic toilet bag has been provided by the Swedish company Peepoople who are producing the "Peepoo bag", a "personal, single-use, self-sanitizing, fully biodegradable toilet that prevents feces from contaminating the immediate area as well as the surrounding ecosystem".[47] This bag is now being used in humanitarian responses, schools, and urban slums in developing countries.[48][49]

Bucket toilets and urine diversion

Bucket toilets are a simple portable toilet option. They can be upgraded in various ways, one of them being urine diversion which can make them similar to urine-diverting dry toilets. Urine diversion can significantly reduce odors from dry toilets. Examples of using this type of toilet to reduce open defecation are the "MoSan"[50] toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL[51] in Haiti.

Country examples

India

PM Modi launches the Swachh Bharat Abhiyaan (1)
India's prime minister Modi launches Swachh Bharat Mission in 2014

According to World Bank report in 2018, 42.34% of Indian population practice open defecation. [52] The Government of India (GoI) has taken up an initiative called Swachh Bharat Mission (Clean India Mission) wherein a large scale drive has been initiated to construct toilets on mass level. The government has increased subsidies on toilet construction to INR 15,000.[53][54] The Government of India claims that the situation has been improving rapidly since 2015, mainly due to the Swachh Bharat Abhiyan campaign. According to Government of India's October 2018 estimate, only 5% of the total population have no access to toilets and are still doing open defecation.[29] As of September 2018, around 93 percent of the rural population had access to proper sanitation, with the number of people defecating in the open reduced to 150 million, down from 550 million in 2014.[53] The goal is to declare India open defecation free (ODF) before 2 October 2019, but the government of India is approaching the initiative much faster and India is likely to achieve ODF status before the deadline.[2][55] Though, some media outlets suggest that open defecation has fallen rapidly but necessarily not as fast as government claims given individual reports of open defecation repoted to be still being practised in some villages.

In an attempt to stop city residents from urinating and defecating in public, a city council in western India is planning to pay residents to use public toilets. In 2015, the Ahmedabad Municipal Corporation announced it will give residents one rupee a visit in a bid to draw them into its 300 public toilets and away from open areas and public walls, which often reek of urine.[56]

In India, the State of Rajasthan became the first state in the country to make a "functional toilet" mandatory in the house of a contestant for contesting elections to Panchayati Raj institutions. The post of village head is called "sarpanch" in Rajasthan, India. A person cannot contest for the post of sarpanch unless they have a functional toilet at their residence.[57]

A number of industries in India are manufacturing affordable toilets using pre-fabrication techniques to meet high demand for toilets created after this new legislation.

Society and culture

Media

The mainstream media in some affected countries have recently been picking up on this issue of open defecation, for example, in India[58][59] and Pakistan.[60][61][62]

Legal status

In certain jurisdictions, open or public defecation is a criminal offense which can be punished with a fine or even imprisonment.[63][64][65][66]

Public defecation for other reasons

In developed countries, open defecation is either due to homelessness, or considered to be a part of voluntary, recreational outdoor activities in remote areas. It is difficult to estimate how many people practice open defecation in these communities.

The Mad Pooper is the name given to an unidentified woman who regularly defecated in public places while jogging during summer 2017 in the U.S. city of Colorado Springs.

See also

References

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External links

Community-led total sanitation

Community-led total sanitation (CLTS) is an approach used mainly in developing countries to improve sanitation and hygiene practices in a community. It focuses on spontaneous and long-lasting behavior change of an entire community. The goal of CLTS is to end open defecation. The term "triggering" is central to the CLTS process. It refers to ways of igniting community interest in ending open defecation, usually by building simple toilets, such as pit latrines. CLTS involves actions leading to increased self-respect and pride in one's community. It also involves shame and disgust about one's own open defecation behaviors.The concept was developed around the year 2000 by Kamal Kar for rural areas in Bangladesh. CLTS became an established approach around 2011. Non-governmental organizations were often in the lead when CLTS was first introduced in a country. Local governments may reward communities by certifying them with "open defecation free" (ODF) status. The original concept of CLTS purposefully did not include subsidies for toilets as they might hinder the process.CLTS is practiced in at least 53 countries. CLTS has been adapted to the urban context. It has also been applied to post-emergency and fragile states settings.Challenges associated with CLTS include the risk of human rights infringements within communities, low standards for toilets, and concerns about usage rates in the long-term. CLTS is in principle compatible with a human rights based approach to sanitation but there are bad practice examples in the name of CLTS. More rigorous coaching of CLTS practitioners, government public health staff and local leaders on issues such as stigma, awareness of social norms and pre-existing inequalities are important. People who are disadvantaged should benefit from CLTS programmes as effectively as those who are not disadvantaged.

Defecation

Defecation is the final act of digestion, by which organisms eliminate solid, semisolid, or liquid waste material from the digestive tract via the anus.

Humans expel feces with a frequency varying from a few times daily to a few times weekly. Waves of muscular contraction (known as peristalsis) in the walls of the colon move fecal matter through the digestive tract towards the rectum. Undigested food may also be expelled this way, in a process called egestion.

Open defecation, the practice of defecating outside without using a toilet of any kind, is still widespread in some developing countries, for example in India.

Emergency sanitation

Emergency sanitation is the management and technical processes required to provide sanitation in emergency situations. This can include man-made or natural disasters. Emergency sanitation is also required during humanitarian relief operations for refugees and Internally Displaced Persons (IDPs).

Emergency situations are classified into three phases which are called the "immediate", "short-term" and "long-term" phases. In the immediate phase, the focus is on reducing open defecation. Toilets provided might include very basic latrines, pit latrines, bucket toilets, container-based toilets or chemical toilets.

Providing showers and handwashing facilities is also part of emergency sanitation during all phases. Fecal sludge management becomes a priority during the long-term emergency management phase.

Fecal–oral route

The fecal–oral route (also called the oral–fecal route or orofecal route) describes a particular route of transmission of a disease wherein pathogens in fecal particles pass from one person to the mouth of another person. Main causes of fecal–oral disease transmission include lack of adequate sanitation (leading to open defecation), and poor hygiene practices. If soil or water bodies are polluted with fecal material, humans can be infected with waterborne diseases or soil-transmitted diseases. Fecal contamination of food is another form of fecal-oral transmission. Washing hands properly after changing a baby's diaper or after performing anal hygiene can prevent foodborne illness from spreading.

The common factors in the fecal-oral route can be summarized as five Fs: fingers, flies, fields, fluids, and food. Analingus, the sexual practice of licking or inserting the tongue into the anus of a partner, is another route. Diseases caused by fecal-oral transmission include diarrhea, typhoid, cholera, polio and hepatitis.

Flying toilet

A flying toilet is a facetious name for a plastic bag that is used as a simple collection device for human faeces when there is a lack of proper toilets (people are forced to practise open defecation). The filled and tied plastic bags are then discarded into ditches, on the roadside, or simply thrown as far away as possible.

Human waste

Human waste (or human excreta) refers to the waste products of the human digestive system and the human metabolism, namely feces and urine. As part of a sanitation system that is in place, human waste is collected, transported, treated and disposed of or reused by one method or another, depending on the type of toilet being used, ability by the users to pay for services and other factors.

The sanitation systems in place differ vastly across the world, with many people in developing countries having to resort to open defecation where human waste is deposited in the environment, for lack of other options. People in developed countries tend to use flush toilets where the human waste is mixed with water and transported to sewage treatment plants.

Children's excreta can be disposed of in diapers and mixed with municipal solid waste. Diapers are also sometimes dumped directly into the environment, leading to public health risks.

Indian states and union territories ranked by availability of toilets

This is a list of Indian states and territories ranked before the availability of toilet facilities per household. Figures are from the Swachh Bharat Mission official data as of 2018-19. In a massive cleanliness drive after the election of Narendra Modi in 2014, over 90 million toilets have been built over the course of 4 years, ferociously taking India towards an open defecation free country. Modi's government also has been building toilets in people's individual households. Google is helping Modi and his government set up toilets across the nation, too.

Indian states and union territories ranked by prevalence of open defecation

This is a list of Indian states and territories ranked by their households with open defecation free in both urban and rural areas. Figures are from ministry of drinking water and sanitation. Below table shows ODF( Open Defecation Free), households with Toilets as percentage of total population.

Kunwar Bai Yadav

Kunwar Bai Yadav (died 23 February 2018) was a supposedly 106-year-old woman who lived in a village in Dhamtari district in the central Indian state of Chhattisgarh. Inspired by the Swachh Bharat Abhiyan (Clean India Campaign), she sold seven of her goats to raise the money to build a toilet at her house. In 2016, the district was declared the first in the state to be free of open defecation, and she was declared a mascot of the campaign and visited by Prime Minister Narendra Modi.

Latrine

A latrine is a toilet or an even simpler facility which is used as a toilet within a sanitation system. For example, it can be a communal trench in the earth in a camp to be used as emergency sanitation, a hole in the ground (pit latrine), or more advanced designs, including pour-flush systems.

The term "latrine" is still commonly used in emergency sanitation situations. Nowadays, the word "toilet" is more commonly used than "latrine", except for simple systems like "pit latrine" or "trench latrine".The use of latrines was a major advancement in sanitation over more basic practices such as open defecation, and helped control the spread of many waterborne diseases

Pit latrine

A pit latrine, also known as pit toilet or long drop, is a type of toilet that collects human feces in a hole in the ground. Urine and feces enter the pit through a drop hole in the floor, which might be connected to a toilet seat or squatting pan for user comfort. Pit latrines can be built to function without water (dry toilet) or they can have a water seal (pour-flush pit latrine). When properly built and maintained, pit latrines can decrease the spread of disease by reducing the amount of human feces in the environment from open defecation. This decreases the transfer of pathogens between feces and food by flies. These pathogens are major causes of infectious diarrhea and intestinal worm infections. Infectious diarrhea resulted in about 700,000 deaths in children under five years old in 2011 and 250 million lost school days. Pit latrines are a low cost method of separating feces from people.A pit latrine generally consists of three major parts: a hole in the ground, a concrete slab or floor with a small hole, and a shelter. The shelter is also called an outhouse. The pit is typically at least three meters (10 feet) deep and one meter (3.2 feet) across. The hole in the slab should not be larger than 25 centimeters (9.8 inches) to prevent children falling in. Light should be prevented from entering the pit to reduce access by flies. This may require the use of a lid to cover the hole in the floor when not in use. The World Health Organization recommends the pits are built a reasonable distance from the house, balancing issues of easy access versus that of smell. The distance from water wells and surface water should be at least 10 meters (32 feet) to decrease the risk of groundwater pollution. When the pit fills to within 0.5 meters (1.6 feet) of the top, it should be either emptied or a new pit constructed and the shelter moved or re-built at the new location. Fecal sludge management involves emptying pits as well as transporting, treating and using the collected fecal sludge. If this is not carried out properly, water pollution and public health risks can occur.A basic pit latrine can be improved in a number of ways. One includes adding a ventilation pipe from the pit to above the structure. This improves airflow and decreases the smell of the toilet. It also can reduce flies when the top of the pipe is covered with mesh (usually made out of fiberglass). In these types of toilets a lid need not be used to cover the hole in the floor. Other possible improvements include a floor constructed so fluid drains into the hole and a reinforcement of the upper part of the pit with bricks, blocks, or cement rings to improve stability. In developing countries the cost of a simple pit toilet is typically between US$25 and $60. Recurring expenditure costs are between US$1.5 and $4 per person per year for a traditional pit latrine, and up to three times higher for a pour flush pit latrine (without the costs of emptying).As of 2013 pit latrines are used by an estimated 1.77 billion people, mostly in developing countries. About 892 million people (12 percent of the global population), practiced open defecation in 2016, mostly because they have no toilets. Southern Asia and Sub-Saharan Africa have the lowest access to toilets. The Indian government has been running a campaign called "Swachh Bharat Abhiyan" (Clean India Mission in English) since 2014 in order to eliminate open defecation by convincing people in rural areas to purchase, construct and use toilets, mainly pit latrines. It is estimated that 85 million pit latrines have been built due to that campaign as of 2018. Another example from India is the "No Toilet, No Bride" campaign which promotes toilet uptake by encouraging women to refuse to marry men who do not own a toilet.

Poo2Loo

"Take Poo to the Loo", commonly shortened to "Poo2Loo", is an ongoing Indian social media campaign led by Unicef to combat the country's problems with open defecation. It has been praised for its innovative approach.

Times of India reported that the idea was developed and initiated in March 2014 after a sanitation conference was organised by Unicef India and the Indian Institute of Technology as part of the larger Total Sanitation Campaign, which the Indian government launched in 1999.Poo2loo calls on Indians to "take the pledge" and show support by signing the following petition addressed to President Pranab Mukherjee:

Hon'ble President of India,

I call on you as Head of State to ensure that India rises to the challenge of ending open defecation. As a citizen of India, I am proud of our country's rich and varied culture; we have a beautiful land. However, over 620 million people do not use a toilet and nearly as many accept this practice. The result is an unacceptable level of filth in our environment. This is why I have chosen to take a stand and raise my voice with that of many other young people. We want our sisters and brothers to survive, grow and develop as healthy individuals in a clean country. We urgently request your help. Together we can change India.

The website of the movement contains many puns and some unusual media, including a simple educational video game called Toilet Trek. The official mascot of the movement is antihero "Mr. Poo", an animated human-sized turd.

Sanitation

Sanitation refers to public health conditions related to clean drinking water and adequate treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems aim to protect human health by providing a clean environment that will stop the transmission of disease, especially through the fecal–oral route. For example, diarrhea, a main cause of malnutrition and stunted growth in children, can be reduced through sanitation. There are many other diseases which are easily transmitted in communities that have low levels of sanitation, such as ascariasis (a type of intestinal worm infection or helminthiasis), cholera, hepatitis, polio, schistosomiasis, trachoma, to name just a few.

A range of sanitation technologies and approaches exists. Some examples are community-led total sanitation, container-based sanitation, ecological sanitation, emergency sanitation, environmental sanitation, onsite sanitation and sustainable sanitation. A sanitation system includes the capture, storage, transport, treatment and disposal or reuse of human excreta and wastewater. Reuse activities within the sanitation system may focus on the nutrients, water, energy or organic matter contained in excreta and wastewater. This is referred to as the "sanitation value chain" or "sanitation economy".Several sanitation "levels" are being used to compare sanitation service levels within countries or across countries. The sanitation ladder defined by the Joint Monitoring Programme in 2016 starts at open defecation and moves upwards using the terms "unimproved", "limited", "basic", with the highest level being "safely managed". This is particularly applicable to developing countries.

The Human Right to Water and Sanitation was recognized by the United Nations (UN) General Assembly in 2010. Sanitation is a global development priority and the subject of Sustainable Development Goal 6. The estimate in 2017 by JMP states that 4.5 billion people currently do not have safely managed sanitation. Lack of access to sanitation has an impact not only on public health but also on human dignity and personal safety.

Swachh Bharat mission

Swachh Bharat Abhiyan (SBA) or Swachh Bharat Mission (SBM) is a nation-wide campaign in India for the period 2014 to 2019 that aims to clean up the streets, roads and infrastructure of India's cities, towns, and rural areas. The campaign's official name is in Hindi and translates to "Clean India Mission" in English. The objectives of Swachh Bharat include eliminating open defecation through the construction of household-owned and community-owned toilets and establishing an accountable mechanism of monitoring toilet use. Run by the Government of India, the mission aims to achieve an "open-defecation free" (ODF) India by 2 October 2019, the 150th anniversary of the birth of Mahatma Gandhi, by constructing 90 million toilets in rural India at a projected cost of ₹1.96 lakh crore (US$30 billion). The mission will also contribute to India reaching Sustainable Development Goal 6 (SDG 6), established by the UN in 2015.

The campaign was officially launched on 2 October 2014 at Rajghat, New Delhi by Prime Minister Narendra Modi. It is India's largest cleanliness drive to date with three million government employees and students from all parts of India participating in 4,041 cities, towns, and rural areas. Modi has called the campaign Satyagrah se Swachhagrah in reference to Gandhi's Champaran Satyagraha launched on 10 April 1917.The mission has two thrusts: Swachh Bharat Abhiyan ("gramin" or 'rural'), which operates under the Ministry of Drinking Water and Sanitation; and Swachh Bharat Abhiyan ('urban'), which operates under the Ministry of Housing and Urban Affairs.As part of the campaign, volunteers, known as Swachhagrahis, or "ambassadors of cleanliness", have promoted indoor plumbing and community approaches to sanitation (CAS) at the village level. Other non-governmental activities include national real-time monitoring and updates from non-governmental organizations (NGOs) such as The Ugly Indian, Waste Warriors, and SWaCH Pune (Solid Waste Collection and Handling) that are working towards its ideas of Swachh Bharat.The government has constructed 86 million toilets since 2014, reducing the number of persons who openly defecate from 550 million to fewer than 150 million in 2018. Many people continue to not use toilets despite having them. The campaign has been criticized for using coercive approaches to force people to use toilets

Toilet

A toilet is a piece of hardware used for the collection or disposal of human urine and feces. In other words: "Toilets are sanitation facilities at the user interface that allow the safe and convenient urination and defecation". Toilets can be with or without flushing water (flush toilet or dry toilet). They can be set up for a sitting posture or for a squatting posture (squat toilet). Flush toilets are usually connected to a sewer system in urban areas and to septic tanks in less built-up areas. Dry toilets are connected to a pit, removable container, composting chamber, or other storage and treatment device. Toilets are commonly made of ceramic (porcelain), concrete, plastic, or wood.

In private homes, the toilet, sink, bath, or shower may be in the same room. Another option is to have one room for body washing (bathroom) and a separate room for the toilet and handwashing sink (toilet room). Public toilets consist of one or more toilets (and commonly urinals) which are available for use by the general public. Portable toilets or chemical toilets may be brought in for large and temporary gatherings.

Many poor households in developing countries use very basic, and often unhygienic toilets, for example simple pit latrines and bucket toilets which are usually placed in outhouses. Globally, nearly one billion people have no access to a toilet at all, and are forced to do open defecation (particularly in India). Diseases transmitted via the fecal-oral route or via water, such as cholera and diarrhea, can be spread by open defecation. They can also be spread by unsafe toilets which cause pollution of surface water or groundwater. Historically, sanitation has been a concern from the earliest stages of human settlements. The Sustainable Development Goal Number 6 calls for "adequate and equitable sanitation and hygiene for all and end open defecation by 2030".

Water and Sanitation Program

The Global Water Security and Sanitation Partnership (GWSP), formerly the Water and Sanitation Program, is a trust fund administered by the World Bank geared at improving the accessibility and infrastructure of water and sanitation for underdeveloped countries. GWSP works in more than 25 countries through regional offices in Africa, East and South Asia, Latin America, the Caribbean, and an office in Washington, D.C.. Heath P. Tarbert is the Acting Executive Director for the United States. The GWSP is best known for its work providing technical assistance, building partnerships and capacity building. GWSP focuses on both regulatory and structural changes and also behavior change projects, such as a scaling up handwashing project and scaling up sanitation project. Another key aspect of GWSP's work is sharing knowledge and best practices through multiple channels. The GWSP has determined five main focus areas: Sustainability, inclusion, institutions, financing, and resilience.

Water supply and sanitation in Mali

Water supply and sanitation in Mali is characterized by serious challenges. Having unclean water can lead to many diseases that can potentially become fatal.

Water supply and sanitation in Zimbabwe

Water supply and sanitation in Zimbabwe is defined by many small scale successful programs but also by a general lack of improved water and sanitation systems for the majority of Zimbabwe. According to the World Health Organization in 2012, 80% of Zimbabweans had access to improved, i.e. clean, drinking-water sources, and only 40% of Zimbabweans had access to improved sanitation facilities. Access to improved water supply and sanitation is distinctly less in rural areas. There are many factors which continue to determine the nature, for the foreseeable future, of water supply and sanitation in Zimbabwe. Three major factors are the severely depressed state of the Zimbabwean economy, the willingness of foreign aid organizations to build and finance infrastructure projects, and the political stability of the Zimbabwean state.

World Toilet Day

World Toilet Day (WTD) is an official United Nations international observance day on 19 November to inspire action to tackle the global sanitation crisis. Worldwide, 4.5 billion people live without "safely managed sanitation" and around 892 million people practise open defecation. Sustainable Development Goal 6 aims to achieve sanitation for all and end open defecation. World Toilet Day exists to inform, engage and inspire people to take action toward achieving this goal.

World Toilet Day was established by the World Toilet Organization in 2001. Twelve years later, the UN General Assembly declared World Toilet Day an official UN day in 2013.UN-Water is the official convener of World Toilet Day. UN-Water maintains the official World Toilet Day website and chooses a special theme for each year. In 2018 the theme is nature-based solutions. Themes in previous years included wastewater, "toilets and jobs" and "toilets and nutrition". World Toilet Day is marked by communications campaigns and other activities. Events are planned by UN entities, international organizations, local civil society organizations and volunteers to raise awareness and inspire action.

Toilets are important because access to a safe functioning toilet has a positive impact on public health, human dignity, and personal safety, especially for women. Sanitation systems that do not safely treat excreta allow the spread of disease. Serious soil-transmitted diseases and waterborne diseases such as cholera, diarrhea, typhoid, dysentery and schistosomiasis can result.

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