Sanitation brings health and hope for poorest families

1 March 2024, Kratie – When he was only four months old, little Phanha was always falling sick.

At the time his family were among the 16 per cent of rural Cambodians still practising open defecation, which can contaminate drinking water and spread deadly diseases like diarrhoea^[1]. Without a latrine at home, they would need to walk a hundred metres through dirt and mud.

“It was difficult for me because every time he was sick, I would need to bring him to the hospital,” recalls his father, 50-year-old Mom Soeun. These were hours he could have spent fishing or working at the construction site to help bring much-needed income back home.

Healthcare workers told them Phanha was malnourished. Because the family are IDPoor card holders, they didn’t need to pay for the medical expenses, but the time and money spent on transport and food during hospital stays was a burden that came with other sacrifices.

“Sometimes I would need to borrow money from relatives or neighbours,” says Soeun. They would also often go with less food at home during these periods.

Phanha is now a smiling and lively one-and-a-half-year-old, his health getting better day by day. His father says the turning point was the latrine they built next to their house four months ago. Protected from faecal contamination, it’s the clean and safe environment Phanha needs to prevent his diarrhoea, improve his weight, and grow up strong – and give the family a new lease on life.

In remote northeastern provinces like Kratie, the number of families without access to basic sanitation services goes up to nearly half. Yet this number has steadily decreased over the years, thanks in part to dedicated efforts from community leaders, who work hard to reach families with important messages about handwashing, nutrition, and the health risks of poor sanitation.   

Ey Channak, Koloab village chief, is one of these sanitation champions. A big part of his work in recent years has involved advocating for households to build a latrine at their home. His role is to promote the benefits of the alternating twin pit, a kind of latrine where waste decomposes into reusable soil without needing treatment, reducing environmental contamination risks and providing a safer than the basic type found more commonly across rural Cambodia. Twin pits also provide additional financial benefits for poor families as they do not need to pay for treatment services when the pits are full.

Through Irish Aid, UNICEF has been working with the Provincial Departments of Rural Development (PDRD) in Kratie and Ratanakiri provinces to support the construction of safely-managed and climate-adapted sanitation facilities – including twin pits and sky latrines – in under-served and flood-risk areas. More than 1,200 people have benefited from the pro-poor smart sanitation subsidy.

And in Cambodia, the benefits can be life-saving. Inadequate WASH and the resulting unclean environments are an underlying cause of under-nutrition and preventable illnesses like diarrhoea, which is still a leading cause of death of children under five. Ten per cent of children under five in Cambodia suffer from acute malnutrition, or wasting.

But changing behaviours can take time and effort

“It's not like you do the awareness raising and then they immediately construct the latrine,” says Channak. “Sometimes I need to call them two or three times. And then sometimes they still don’t construct it.”

His messages complement the announcements broadcast through the provincial radio as well as the loudspeakers attached to tuktuks driving through his village, both also supported by UNICEF through Irish Aid, ensuring no one is missed. Almost 130,000 people have been reached with nutrition-sensitive WASH messages across Kratie and Ratanakiri provinces.

“It's good because then people not only hear the information from me, they also hear it from other sources. Because sometimes people don’t believe me,” he says. 

UNICEF’s support specifically targets IDPoor households, especially families with children affected by malnutrition, who Channak says have been the last and hardest to reach through his awareness raising efforts.

He visited Soeun’s family twice before they agreed to build the latrine, followed by additional visits to make sure they followed through with the plans. As IDPoor card holders, they had support for the majority of the construction from UNICEF and the commune. Channak even donated some of the material for the walls and roof himself and collected other bits from other people in the village.

They ended up contributing 100,000 riel (25 USD) of their own money – it took them half a month to save up, relying on eating the fish they catch rather than buying food from the market, but it was worth it.

“I’m happy because now I don’t need to spend money on trips to the hospital. I have more money to put towards food for the family,” says Soeun.

Channak’s hard work has also paid off – because of his commitment to families like Soeun’s, with the support of the PDRD and UNICEF, Koloab Village is now open defecation free (ODF). His village was the first in the commune to reach this milestone. With the other villages following suit shortly after, now, pending review from Chitr Borie district, the whole of Kouleap commune can claim ODF status.

“I feel proud of myself,” he says. “When people use a latrine, they have better health, they reduce health expenses, they have more time to earn money, and they will have a better life.”

It’s the coordinated and comprehensive effort – from the PDRD to the district and commune levels down to village focal points, and from door-to-door awareness raising to mobile loudspeakers – that has helped reach this last mile, says Phun Mom, Commune Council for Women and Children (CCWC) focal point in Koloab commune.

“The final few households that were without latrines are really, really poor,” she says. “In order to speed up our ODF goal, we mobilised resources from different sources, including the commune budget, to add on to the support from UNICEF and support those who were really in need and did not have money to pay for the underground part.”

“Now it's very rare for children to have diarrhoea,” she says. Schoolchildren singing and dancing to the tuktuk loudspeaker jingles are also a good sign that the messages about hygiene and nutrition have stuck.

They have also seen fewer school dropouts thanks to the improved health not only of the students but of their younger siblings too, as the responsibility for taking care of them when parents are working often falls on older brothers or sisters. And with the community’s youngest getting a healthier start in life, she hopes they can get an earlier start in school, too.

Now that Phanha’s weight is getting closer and closer to normal, healthy levels, his father can also dare to hope for a better future for his son.

“I hope that he will be smarter because he can go to school more if he’s not sick much,” he says.

As his family were one of few in his village who didn’t have a latrine, Soeun feels proud that he has caught up with his neighbours.

“Now I can say I have a toilet too.”

^[1] https://www.who.int/news-room/fact-sheets/detail/sanitation