The big institutes, do they support the Demotech Approach? Part 2 of 4

WASH (WAter, Sanitation, Hygiene) programme UNDP

UNDP Humand Development Report 2006

Because diarrhoeal diseases are of faecal origin, hand washing with soap and water has been identified as a major determinant of reduced child mortality, along with interventions that prevent faecal material from entering the domestic environment of children.11

Evidence from Burkina Faso demonstrates the interaction between sanitation and hygiene. In the mid-1990s the country's second largest city, Bobo-Dioulasso, had a well managed water supply system and most households had pit latrines, but children were still at risk from poor hygiene. The Ministry of Health and Community Groups promoted behavioural changes that reduced the incidence of diarrhoea--for example, by encouraging mothers to wash their hands with soap and water after changing diapers. Over three years the programme averted some 9,000 diarrhoea episodes, 800 outpatient visits, 300 hospital referrals and 100
deaths--at a cost of $0.30 per inhabitant.12 public health changes encouraged through education. Campaigns to promote hand washing, breastfeeding and boiling water for baby bottles increased the returns on investment in public works. What is important is that public policies expand access to infrastructure and unlock the complementarities that operate across the artificial frontiers between water, hygiene and sanitation. Children are among the most effective agents for change (box 3.2). Clean water, the sanitary removal of excreta and personal hygiene are the three foundations for any strategy to enhance public health. Collectively, these are the most potent antidotes and poor sanitation

The classroom is one of the best places for effecting positive changes in hygiene. Teaching children hand washing and other good hygiene habits protects their health and promotes transformations be- yond school. In Mozambique a national campaign trained children to teach other children about hand washing and sanitation-related problems. In China and Nigeria UNICEF-supported school-based hygiene projects report increases of 75%-80% in hand washing with soap.
In some countries hygiene and sanitation have been brought into the national curriculum. In Tajiki- stan more than 11,000 students are engaged in an outreach programme on sanitation. In Bangladesh schools and nongovernmental organizations formed student brigades to take hygiene and sanitation messages from their schools back to their communities.
Such school-based programmes provide adequate water and sanitation and separate facilities for boys and girls.

"By means of water", says the Koran, "we give life to everything." That simple teaching captures a deeper wisdom. People need water as surely as they need oxygen: without it life could not exist.
But water also gives life in a far broader sense. People need clean water and sanitation to sustain their health and maintain their dignity. scarcity at the heart of the global water crisis is rooted in power, poverty and inequality, not in physical availability.

Clean water and sanitation are among the most powerful drivers for human development. They extend opportunity, enhance dignity and help create a virtuous cycle of improving health and rising wealth.

"Not having access" to water and sanitation is a polite euphemism for a form of deprivation that threatens life, destroys opportunity and undermines human dignity. Being without access to water means that people resort to ditches, rivers and lakes polluted with human or animal excrement or used by animals. It also means not having sufficient water to meet even the most basic human needs.

Access to sanitation bestows benefits at many levels. Cross-country studies show that the method of disposing of excreta is one of the strongest determinants of child survival: the transition from unimproved to improved sanitation reduces overall child mortality by about a third. Improved sanitation also brings advantages for public health, livelihoods and dignity--advantages that extend beyond households to entire communities. Toilets may seem an unlikely catalyst for human progress--but the evidence is overwhelming.

Goal 3 Promote gender equality and empower women
Inadequate sanitation is experienced by millions of women as a loss of dignity and source of insecurity.

Nations Children's Fund (UNICEF) suggest a minimum requirement of 20 litres a day from a source within 1 kilometre of the household. This is sufficient for drinking and basic personal hygiene. Below this level people are constrained in their ability to maintain their physical wellbeing and the dignity that comes with being clean. Factoring in bathing and laundry needs would raise the personal threshold to about 50 litres a day.

Undermining human dignity

We feel so dirty and unclean in the summer. We do not wash our clothes for weeks. People say, these Dalits are dirty and they smell. But how can we be clean without water?47
Spoken by a low-caste Indian woman, these words capture the relationship between human dignity and water. Dignity is hard to measure-- but it is at the heart of human development and our sense of well-being, asAdam Smith recognized. Writing in The Wealth of Nations he included it among the "necessities" for well-being, commodities that "the poorest creditable person of either sex would be ashamed to appear in public without".48
Access to safe, hygienic and private sanitation facilities is one of the strongest indicators countries.
The loss of dignity associated with a lack of privacy in sanitation helps to explain why women attach more importance than men to sanitary provision. When asked in surveys about the benefits of latrines, both women and men in Cambodia, Indonesia and Viet Nam said that the main advantage was a clean home and vil-
lage environment free of bad smells and flies.50 But women were more in favour of spending on toilets, rating them far higher on a "value for cost" basis, with a strong emphasis on the benefits of privacy. They were also more likely than men to initiate the process for purchasing latrines (see chapter 3). Underfinancing of sanitation provision in the allocation of household and government resources is thus partly a product of the weak voice of women in setting priorities.

Access to safe water is a fundamental human need and a basic human right. And water and sanitation are at the heart of our quest to enable all the world's people, not just a fortunate few, to live in dignity, prosperity and peace.

Kofi A. Annan