Ending open defecation, a toilet at a time

USAID’s Afya Uzazi Nakuru-Baringo Program works with local governments and communities to improve sanitation and hygiene in communities as part of a comprehensive package of interventions to increase access to quality health services, especially for women and children.

An elder observes mapping of homes without latrines during triggering, the first step in community-led total sanitation (CLTS), a participatory process to eliminate open defecation and ensure improved hygiene and sanitation, in Marigat, Baringo County, Kenya.

In Kenya, two in 10 people defecate in the open. In Baringo County, it is almost half of the residents or five of every 10 people. Yet sanitation is a constitutional right in Kenya.

Lack of adequate latrines has a high cost. It is estimated that the county loses over 530 million shillings every year due to access time, premature death, health care costs and productivity.

Poor sanitation and open defecation exposes children to diseases such as diarrhea, measles and pneumonia, affecting their health and school performance.

Afya Uzazi uses the Community-Led Total Sanitation (CLTS) approach to mobilize communities to eliminate open defecation, village by village. The approach encourages people to take small doable actions, like building a simple latrine, to achieve improved sanitation and good hygiene.

A public health officer explains how open defecation leads to contamination of food and water, causing diseases such as diarrhoea.

Zainabu Juma, a mother of an eight-year-old boy, is among thousands of residents of Baringo County who have benefited from CLTS.

In March 2018, Zainabu heeded a call by the local village head, Maureen Kipyegon, and attended a community meeting in an open field at the centre of Ndambul B village in Marigat Sub-County.

During the meeting, local public health officials mapped all homestead without a latrine. Almost 50 homesteads did not have latrines, meaning many of the 500 residents of Ndambul B village either used their neighbours’ toilets or relieved themselves in the bush.

The officials selected a few representatives who walked around the village and found human faeces within a very short time. This was evidence that many people were defecating in the open. The public health officials then used the faeces and fresh bread to show how flies and ground water carry germs from human faeces left in the open to contaminate food.

Zainabu and other villagers were disgusted on realizing that they had been unknowingly ‘eating” faeces because some people were defecating in the bushes.

Village head woman Maureen looks away in embarrassment as a public health officer shows how faeces in the open ends up in food and water.

Led by the local chief, the meeting resolved that home must build a latrine, however simple, and everyone must use a toilet.

Such meetings are called to trigger the community to end open defecation, the first step in the CLTS process.

Zainabu knew she had to act fast. The home she shared with her son and six other relatives inherited from her mother did not have a latrine. They all used a neighbour’s toilet.

After the meeting, Zainabu used some of her savings to buy cement and sand. She hired a couple of young men to dig a latrine and an artisan to build the structure using sand, cement and poles. She is now looking forward to get two iron sheets for the roof.

Zainabu’s new latrine with a cover and hand-washing a simple facility— a plastic container with a hole and a wooden plug.

“Zainabu is one of our role model,” says Priscah Chemubo, the local community health worker.

Zainabu has also erected a dish rack and clothes line, as advised by a committee of volunteers formed to ensure the village is declared a defecation-free zone.

“I used to dry my dishes on a table and chickens or dogs would knock them over,” says Zainabu. “The dish rack now ensures the dishes remain clean as they dry.”

Zainabu’s compound is clean because rubbish is not scattered all over by her dogs and the wind. She dumps all her household waste in a rubbish pit and burns it.

After learning about household hygiene and sanitation, Zainabu now has a dish rack to keep her utensils free of germs, a clothes line and a rubbish pit to keep her compound clean.

Community volunteers now use Zainabu as an example to inspire others to achieve total sanitation in their homes. Two of her sisters impressed by her progress, are already building latrines in their homes.

Due to the efforts of front-runners like Zainabu, all homes in Ndambul B village now have their latrines.

The village has claimed Open Defecation-Free (ODF) status and public officials agree. Next, trained assessor will visit to inspect the village and hopefully certify it to be an ODF zone.

Led by Afya Uzazi Technical officer Benjamin Masila (second right), the sanitation committee traverses Ndambul B village to check progress towards open defecation-free status. All homes now have latrines and the village is set to be certified if inspectors find no evidence of open defecation.

Top, left to right: A sanitation committee members wash hands using a leaky tins near newly built simple toilets; another member examines a latrine pit; teh village head woman in front of one of the new latrines.

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Story: George Obanyi, Senior Technical Officer, Communication, FHI 360|Kenya