Community Led Total Sanitation: Pakistani Women Take Control of Their Families' Health
By Fatima Raja
KILLA BATEZAI, Pishin District, Balochistan Province, 7 August 2008 – "We did it ourselves," says Khalat Bibi proudly. "Our men didn't have the time as they were working in the orchards and fields. So we, the women of the Saleem family, built our latrines ourselves." She embraces her daughter lightly, one of her ten surviving children. Five others are dead. "They died of diarrhoea," Khalat Bibi recalls sombrely.
"They also had infections of the foot and our home smelled bad because children would defecate in the veranda. We've controlled those problems now."
Her sister-in-law Vilayat Bibi nods. "Before we built our latrine, our children always had diarrhoea and intestinal worms," she adds. "They also had infections of the foot and our home smelled bad because children would defecate in the veranda. We've controlled those problems now."
Asiya Akram is one of the women responsible for this change. A social mobiliser working with UNICEF's local partner SMART, since March 2008 she promotes Community Led Total Sanitation amongst the women of the village. This approach acknowledges that unless all members of a community use adequate sanitation and follow sanitary practices, diseases such as diarrhoea will remain prevalent. By encouraging families to assess their own sanitation and then finance and build their own latrines, stressing their convenience, hygiene and dignity, Asiya and her fellow mobilisers convinced all but two or three of the 100 households in Kila Batezai to give up open defecation.
In a tribal area with a Taliban presence, Asiya had to work hard to get the community's trust. It took several meetings, each lasting five or six hours, to convince each household. Asiya and her colleagues received threats from extremists, one of whom abused her publicly for calling women's gatherings where sanitation was discussed. "We sent them messages saying we are not trying to draw your women away, simply teaching them how to keep themselves and their families clean," she says.
As the women of the Saleem household were persuaded, they took matters into their own hands. With technical help from SMART, they dug pits for six latrines to serve the nine related families who live in the compound. The bad odours disappeared and the children became healthier. The adults also found their lives improving. "We adults used open spaces before," Vilayat Bibi recalls. "It felt unsafe, and if our young girls went outside, their mothers would stand around them holding up sheets to screen their modesty."
Twelve-year-old Selana, who is one of the 25 odd children living in the compound, agrees. "I used to be embarrassed and scared that someone would come by whilst I was relieving myself," she says. "Now, with privacy, there is no fear. Where before I was afraid to go outside by myself, I can use the lavatory whenever I want."Less than a quarter of the people in Pishin District have adequate sanitation facilities; the vast majority defecate in the open. This, along with poor hygiene practices (only 21 per cent wash their hands with soap after defecation) contributes to the province's high child mortality: 158 of ever 1,000 children in Balochistan die before the age of five. Having piloted Community Led Total Sanitation in two districts, Pishin and Kalat, UNICEF has successfully advocated for this approach to become a centrepiece of provincial sanitation strategy. With dedicated workers like Asiya and the women of Kila Batezai, however, entire communities are being slowly transformed so that open defecation and its attendant problems become mere memories.