Ending open defecation in Guinea-Bissau: It all starts under a mango tree

QUINARA, Guinea-Bissau ─ Using toilets and washing hands with soap is essential to keep children and families in good health. But in Guinea-Bissau, open defecation remains a deeply rooted practice. 

Going out in open spaces rather than using a toilet is a dangerous challenge: human waste near waterways and homes spreads diseases quickly, putting children and their families at risk. Diarrhoea, which is related to poor sanitation and hygiene, is one of the top killers of children in the country ─ accounting for 9 per cent of children who die before their fifth birthday. 

However, getting rid of open defecation is possible. Take Quinara, a region in the south of Guinea-Bissau.

In 2018, Quinara was recognized as the first region to become 'open defecation free' (ODF) in Guinea-Bissau. This is a remarkable achievement in a country where nearly one in six people still go out in the open. So, how did Quinara do it?

Ask families in a community to identify areas around the home they use as toilets. Use a combination of shock, shame, pride and disgust ─ instead of abstract health messages ─ to trigger behaviour change. And watch the community transform.   

This approach is called Community-Led Total Sanitation (CLTS). It typically takes three to six months for a whole community to give up defecating in the open. And this contributes to a healthier environment for everyone.

 

But how does it actually work? This is what change looked like for Quinara:

#1 Activate the community

It all starts with community mobilization. In Quinara, UNICEF’s partner NADEL was in charge of training facilitators who met with 327 communities across the region.

Facilitators initiated the process by collecting information on the number of families and latrines in each community. Next, they identified community leaders and explained to them how the CLTS approach works. And finally, they met with all community members in an open space, often under a mango tree, for a 'triggering session' to visualize the impact of open defecation. 

#2 Take people on a 'walk of shame'

In Quinara, facilitators used two specific CLTS techniques: asking community members to calculate and map the amount of faeces produced by each family, and then taking them on a so-called ‘walk of shame’.

They used bags of rice as a reference to help people to visualize the volume of faeces produced by each family over a week, a month, or a year. 

Then came the ‘walk of shame’. Facilitators asked community members to take them to the place where most people were relieving themselves in the open. When they got there, after taking a look at the amount of faeces lying around, they asked, “Where does all this poo go?”. This triggered a conversation about how faeces travel back to people’s homes in different ways, including through rain water, flies, and dirty hands. 

#3 Give people ownership

Showing, rather than telling, is key. Facilitators didn’t tell community members to stop defecating in the open. Nor did they tell them to build a toilet. 

Instead, they helped people to understand the implications of open defecation. When community members realized they needed to do something different, they decided to build their own toilets, with local materials and without external funding.

What does it mean to be 'open defecation free'? 

Being recognized as ‘open defecation free’ means that not only did communities in Quinara build toilets and pledge to use them, but also that they incorporated handwashing with soap and other safe hygiene practices into their daily habits.

After the region was declared open defecation free, follow up visits to the communities were organized to verify that, in fact, they had maintained their ODF status. 

“It is a huge relief that I now have this type of toilet at home. Before, I would go into the bush and that was unhygienic and undignified. When the project to end open defecation came to where I live, disease decreased,” said Sadjo Camará, a village chief in Quinara. 

Ending open defecation: It takes a village

In 2018, 1,152 communities were declared ODF across Guinea-Bissau ─ a behaviour change that has benefited an estimated 265,000 people.

On the symbolically appropriate occasion of World Toilet Day, community members and organizations, traditional leaders, and local and national authorities renewed their commitment to maintaining a safe and clean environment.

The benefits of using a toilet are clear. From reducing diarrhoea to preventing malnutrition and stunting in children (which means their brains and their bodies aren’t developing fully), to saving money spent to get treatment for preventable diseases related to poor sanitation.

"If we can stop the practice of open-air defecation, we will save a lot of expenses made to pay for health care, because when a person is in good health, he or she does not need to spend money on healthcare or drugs,” said António Serifo Embaló, the Minister of Energy, Industry and Natural Resources in Guinea-Bissau. “Quinara is not only an example for the other regions of Guinea-Bissau, but for other African countries too,” he added.

And results for children and their families have been tangible. “Since we built a good toilet, there are no more flies bringing diseases to our home,” said village chief Sadjo Camará. “Now we are healthier, we stay clean, we dress clean! No more eating the poo of our neighbours! Congratulations to us! Congratulations to Quinara and to every village chief who didn’t give up!’’