Open ‘bush loos’ are putting people at risk of disease, death

Tuesday May 28 2019

In 2011, Kenya set the ambitious goal to have an open defecation free country by 2013. PHOTO | FILE | NATION MEDIA GROUP


To Ekadeli Loliyak and his family of  eight children, a toilet is a luxury they can ill afford.

“Why should I be so concerned about a toilet when we rarely eat? We survive on black tea … Give me food to eat and I will construct one,” said Mr Loliyak, a resident of Natiir village in Turkana County in northwestern Kenya.

Mr Loliyak, who spends his time working as a labourer at Kakuma refugee Camp, is hardly an exception. In Natiir, toilets are just as likely to be thorny bushes, making this an open defecation zone.

“Here in the village it is easier to go to the bush than to request a neighbour to allow us to use their latrine. Plus, the bush is closer to our home than the neighbour’s toilet,” he said, adding that his children now know how to use a hoe to cover their waste.

This does not come as a surprise given that toilet coverage for Turkana County currently stands at 40 per cent, which, according to James Kooya, the Turkana West sub-county public health officer, is an improvement from 26 per cent recorded during the Kenya Demographic Survey of 2014.

Mr Kooya, who co-ordinates water, sanitation and hygiene (Wash) programmes in the county, has a part-explanation, part-excuse for the low coverage: The soil just isn’t suitable for toilets.


“The existing toilets do not last for long; they collapse and fill up so fast,” he said.


James Kooya, the Turkana West sub-County Public Health Officer, teaches Ekadeli Loliyak and his family about the importance of toilets at their home in Kakuma, Turkana. PHOTO | ANGELA OKETCH


According to data from the Kenya Integrated Household Budget Survey, Turkana is among five counties in the country with poor toilet coverage. The other four are Samburu (74 per cent), Marsabit (52 per cent), West Pokot (51 per cent) and Kwale (48 per cent).

This is despite an ambitious goal set in 2011 to have a Kenya that is open defecation free by 2013. By the end of the campaign, only two per cent or just 1,273 out of 59,915 targeted villages had been certified open defecation free.

However, the goal to halve the number of people living without sanitation still remains just that: A goal.

Across the region, toilet coverage and access to sanitation services remain a challenge even as governments pump resources into economic activities.

Sahr Kemoh, Wash manager at Unicef Somalia Support Centre brought this up at a training of East Africa health reporters.

“Many countries would rather invest on roads and other visible infrastructure and neglect the ‘dirty issue’ of sanitation not knowing that here is where the problem starts. Good sanitation is the bedrock of public health,” he said.

The 2017 Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene report by the World Health Organisation and Unicef estimates that in 2015, about 61 per cent of the global population (or 4.5 billion people) lacked safely managed sanitation services.

These people either used basic toilets or latrines (2.1 billion people), shared toilets among several households (600 million people), poorly constructed latrines or buckets (856 million people) or defecated in the open (892 million).

The JMP report which ranks countries according to the availability of toilets that meet basic hygiene standards notes that almost half (140 million) of the people in the region use unimproved facilities, while 35 million use shared improved facilities.

At the General Assembly of the United Nations in Geneva in 2017, all member states committed to ensuring that everyone has access to basic toilets by 2030, which is one of the 17 sustainable development goals.

SDGs, which build on the successes of the Millennium Development Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.


The current rate of 2.6 million more people per year accessing toilets in East Africa, according to JMP, must increase to 22 million by 2030 in order to achieve SDG Six on clean water and sanitation for all.

The UN defines an improved toilet or latrine as a facility that hygienically separates human waste from human contact. This could be through a mechanical or manual flush that sends the waste matter to a piped sewer system, septic tank or pit latrine. Composting toilets also qualify as improved toilets.

According to the Wash 2017 report, which ranked countries in East Africa according to how difficult it is to find toilets meeting basic hygiene standards, and the population practising open defecation, about 57 million people excrete in the open.

Current open defecation elimination rate in East Africa stands at 2.2 million per year. This must increase to 5.5 million per year in order to end the practice by 2030.

Ethiopia leads in reducing open defecation from 80 per cent in 2000 to 27 per cent in 2015, while there was no change recorded in Burundi. Uganda came second with a 10 per cent improvement rate; Kenya was third with a seven per cent improvement rate, Tanzania (three per cent) while Rwanda had a one per cent reduction.


An illustration on the state of open defecation in East African countries, compiled by Fatma A. Ahmed. SOURCE | WHO AND UNICEF

Although the overall toilet coverage in Uganda has increased, national population and housing census figures released by the Uganda Bureau of Statistics in 2017 show that eight per cent of the population — about 2.7 million people — stays in households with no toilet facilities.

To bring about change in this sector, the State Minister for Primary Healthcare Sarah Opendi proposes amending the Public Health Act, “to include punitive measures for people who will not have toilets.”

In Tanzania, it is estimated that about five million people do not use a toilet at all. National Bureau of Statistics findings of 2016 puts the number for those who have access to quality toilets at 16-19 per cent. Some 15 to 30 per cent use soap to wash their hands after relieving themselves, the data shows.

Such figures worry Mr Kemoh because between 2018 and 2050, it is estimated that with a birth rate of 20 million children every year, the population in the region will soar to 653 million.

Unfortunately, Mr Komeh said the whopping figure does not compare with the slow pace at which proper toilets and sewerage management connections are coming up.

“The alarming population growth would detrimentally reverse the gains made towards assisting households or villages access to clean water and attaining open defecation free (ODF) status over the years,” he said.

This situation, he said, has a negative implication to water and sanitation with a fatal effect on the affected communities.


Inadequate sanitation is a major cause of infectious diseases worldwide, the World Health Organisation notes. It is feared that the high population growth will heighten the communicable diseases burden — including   cholera, typhoid, infectious hepatitis and polio —  most of which spread rapidly and cause sudden death.

“Poor access to safe toilets can lead to faecal matter contaminating water and food, raising the risk of diseases such as diarrhoea — the second leading cause of death among children under five — spreading among vulnerable populations,” said Mr Kemoh.

Diarrhoea caused by contaminated water and poor sanitation kills more than 289,000 children under the age of five every year in East Africa.

In Kenya alone, more than 17,000 children under the age of five die from diarrhoeal diseases directly attributed to poor water, sanitation and hygiene.

Moreover, frequent bouts of diarrhoea, which cause dehydration, make children more vulnerable to other infections and increase cases of malnourishment and stunting due to prolonged undernutrition. A quarter of all stunting is attributed to five or more episodes of diarrhoea during the first two years of life.

These children are also likely to suffer impaired emotional, social and cognitive development. Lives could be saved by a toilet and clean water and soap for hand washing, which is why the world set a goal of universal access to safely managed water and sanitation, as part of the SDGs, to be achieved by 2030.

This means universal access to safe drinking water at home, work or in public places; a private toilet to dispose of faecal waste and soap and clean water to wash hands.

Only 14 per cent of the population (ranging from just one per cent in Ethiopia to 48 per cent in Tanzania) wash their hands with soap at critical times, with 223 million people out of the 260 million not washing their hands with soap and water.

Working together with other international organisations, Mr Kooya said they are advocating more for interventions to discourage open defecation and to make the residents understand more about the importance of having toilets in their homes.

“What we have here is that our people want to be given everything, they normally see the refugees being provided with all the materials, they also want to be given not considering that they are at risk,” Mr Kooya told The EastAfrican.


With the help of World Vision Kenya, the county holds barazaas to educate Turkana residents on the importance of toilets and also helping them use the available resources, for instance, mud and wood to have a toilet.

“It’s an issue of culture and poverty. In-laws cannot share a latrine with their daughters in laws and daughters the same with their fathers cannot share latrines so they go to the bush instead. And for those without latrines, there are thickets for women, men and children to help themselves," notes Henry Kibet, World Vision WASH coordinator Lokichogio, Turkana County.

He said World Vision will be working with community elders to identify homes without toilets and help in constructing one adding that sanitation conditions have to be addressed if livelihoods are to improve.

He encouraged communities to use locally available materials to construct toilets to avoid and curb the rampant diseases adding that there is no worst shame than helping yourself the bush.

“Communities need to start feeling about open defecation and learn to do away with some of the cultural practices which have no basis and geared towards fatal effects in future and this can only be achieved by community-led efforts,” Mr Kibet said.

Ibrahim Kabole, the managing director for Water Aid, an organisation that helps communities implement water and sanitation projects in Tanzania concurs, noting that rudimentary toilets affect the state of water bodies and groundwater in the region, leading to cholera outbreaks.