Is corruption in sanitation killing Pushpa’s dreams?

Introduction

Globally, in 2015, 2,3 billion people lacked even a basic sanitation service and 892 million people world-wide still practiced open defecation.[1]  The World Health Organization (WHO) defines sanitation as access to and use of facilities and services for the safe disposal of human urine and faeces. A safe sanitation system is a system designed and used to separate human excreta from human contact at all steps of the sanitation service chain from toilet capture and containment through emptying, transport, treatment (in-situ or offsite) and final disposal or end use. Safe sanitation systems must meet these requirements in a manner consistent with human rights.

In 2016, 21% of health care facilities globally had no sanitation service (they had unimproved toilets or no toilets) and the health care facilities serving more than 1.5 billion people had no sanitation service.[2] Half of these unacceptably large numbers of people without access to decent sanitation are female – women and girl children – a group particularly at risk from poor sanitation services.

 

Figure 1: Access to sanitation according to the JMP 2017 report 

Why are women and girl children particularly at risk?

Women and girl children have different sanitation needs from men, not least because of biological differences such as menstruation, pregnancy and the challenges of peeing standing up. During menstruation, pregnancy and in postnatal stages adequate sanitation services are critical. Women and girls often stay home during menstruation if their school or work place does not have adequate sanitation services. Each day, more than 800 million women between the ages of 15 and 49 are menstruating.[3] The school enrolment and success of girls is negatively impacted where safe sanitation services are not provided. Female teachers working in schools without adequate sanitation, or women workers or business owners without access to nearby facilities, face the choice of the indignity, danger and health risks of open defecation or use of unsafe facilities, or leave their work.[4] Pregnant women generally need to urinate more often and dehydration to avoid this is a particular risk. In addition, about 44 million pregnant women have hookworm infections arising from inadequate sanitation[5]. In many places, in the absence of appropriate sanitation facilities, cultural norms mean that women wait until it is dark to go to the toilet. In order to avoid having to go to the toilet too often, women often drink less, resulting in urinary tract infections, chronic constipation and other gastric disorders, and dehydration – as mentioned, particular health threat for pregnant women.

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In addition, as has been well documented across the developing world, women and girl children are most often responsible for cleaning toilet facilities and disposing of human waste.  The cleaning of toilets and the disposal of excreta without adequate health protection or equipment puts the health of these women and girl children at risk. Women are also generally the care givers for family members who are ill as a result of poor sanitation services, hampering their economic productivity.

Women and girls also face physical threats where sanitation services are inadequate. They are vulnerable to violence, including sexual violence, when they use public or open sanitation facilities, especially if they have to use those facilities at night. Such violence has been well documented in many countries, including, for example, Fiji, India, Brazil, Sri Lanka, Philippines, Kenya, Ethiopia, and South Africa, and the tsunami refugee camps of Sri Lanka[7]

For women with disabilities, the challenges are exacerbated significantly. [8]

But what of the connection to corruption?

All of this is known, recorded, and of significant concern in the WASH sector.  The World Bank estimates that close to USD20 billion per annum is required to extend basic sanitation services to all, and close to USD50 billion per annum to meet the SDG target of universal access to safely managed sanitation services[9]. Basic sanitation facilities are essentially the provision of a toilet facility of some form, while safely managed sanitation services are not shared, enable excreta to be safely disposed of in situ or treated off-site, and provide handwashing facilities with soap and water.

According to the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2017 report, countries have increased their budgets for water, sanitation and hygiene at an annual average rate of 4.9% over the last three years. Yet, 80% of countries report that water, sanitation and hygiene (WASH) financing is still insufficient to meet nationally-defined targets for WASH services.[10]

Corruption in the sanitation sector results in a reduction in the availability of already limited financing for the provision of sanitation, or in the delivery of sub-standard facilities and services. Poor and dishonest monitoring of service delivery by governments compound the problem.

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In addition, Pusok has shown how, in the case of public-private-partnerships for the delivery of water and sanitation services in contexts of high levels of corruption, attention is focused on the more lucrative water provision, resulting in low levels of sanitation delivery. She argues that ‘corrupt governments have no incentives to promote coverage in the sanitation sector’. [12]

Building the integrity wall

Corruption in the sanitation sector is widespread, and the impacts are felt most by the poor and the marginalised who lack access to safely managed sanitation. Amongst the poor and the marginalised, women and girl children are hit hardest, given their specific sanitation needs and duties. Corruption in the sanitation sector results in an ongoing violation of the rights to dignity, health, and education of women and girl children. It is a scourge that is insufficiently highlighted, and insufficiently addressed. It is a battle that we have to take on if we want to meet that SDG on sanitation, and enable women and girls to achieve their full potential as active and equal members of thriving societies.

Given the scale of funding that is needed to achieve sanitation for all WIN recommends that anti-corruption measures are embedded into all levels of progamme/project planning and implementation from the start, creating a wall of integrity through a combination of measures that improve transparency, accountability, and participation and reduce corruption  at all levels of planning and  implementation.

Corruption in the sanitation sector should not be treated casually. We have to take it on if we want to meet that SDG on sanitation, and enable women and girls to achieve their full potential as active and equal members of thriving societies.

 

Cover image photo credit: Sudipta Maulik, WIN photo competition 2019

References:

[1] Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), 2017. Licence: CC BY-NC-SA 3.0 IGO.

[2] World Health Organization and the United Nations Children’s Fund, WASH in health care facilities: Global Baseline Report 2019, WHO and UNICEF, Geneva, 2019. Licence: CC BY-NC-SA 3.0 IGO.

[3] http://mirror.unhabitat.org/documents/media_centre/APMC/Sanitation%20-%20A%20womans%20issue.pdf

[4] Needs and Trends in Menstrual Management: A Global Analysis; Ashwini Sebastian and Vivian Hoffmann, University of Maryland and Sarah Adelman, MountHolyoke College;

[5] https://lifewater.org/blog/sanitation-for-women/

[6] https://www.unicef.org/wash/index_womenandgirls.html

[7] https://www.waterpathogens.org/book/gender-and-sanitation

[8] http://www.seri-sa.org/index.php/more-news/818-video-sanitation-for-women-with-disabilities-living-in-informal-settlements-10-august-2018

[9] The Costs of Meeting the 2030 Sustainable Development Goal Targets on Drinking Water, Sanitation, and Hygiene Summary Report Guy Hutton and Mili Varughese, WSP/World Bank 2016 

10] https://www.who.int/news-room/detail/13-04-2017-radical-increase-in-water-and-sanitation-investment-required-to-meet-development-targets

[11] https://www.newsclick.in/glaring-corruption-implementation-swachh-bharat-abhiyan, https://swachhindia.ndtv.com/corruption-swachh-survekshan-survey-assessors-caught-accepting-bribes-aurangabad-4816/, http://www.newindianexpress.com/states/odisha/2018/apr/11/corruption-in-swachh-bharat-raises-a-stink-1799790.html, https://www.indiatoday.in/india/rajasthan/story/swachh-bharat-mission-scheme-narendra-modi-reward-corruption-rajasthan-1054904-2017-09-29, https://www.pratidintime.com/massive-corruption-in-construction-of-swachh-bharat-toilets/, https://en.wikipedia.org/wiki/Swachh_Bharat_mission

[12] Pusok, K 2016: Public-Private Partnerships and Corruption in the Water and Sanitation Sectors in Developing Countries, Political Research Quarterly 2016 Vol 69(4), University of Utah