How Bhutan got two-thirds of its population to use hygienic toilets

Until recently Pema, who lives in Dangchu village in Bhutan’s Wangdue district, shared a pit toilet with a neighbour. It was always embarrassing for her to invite guests home without a toilet, but that has now changed.

An interactive sanitation fair, held by SNV with the Bhutanese Ministry of Health’s Public Health and Engineering Division in her village last year, encouraged Pema to construct one. During the fair the Public Health and Engineering Division emphasised that more people had expensive mobile phones than toilets, “Get your priorities right, invest in a toilet for better hygiene and a healthy life.”

YB Yonzan, an executive engineer with Public Health and Engineering Division told thethirdpole.net that the 2015 annual health household survey showed that 74% of Bhutan now has improved toilets or improved sanitation. By 2018 they are optimistic of reaching the national target of 80% coverage, said Rinchen Wangdi, chief engineer at Public Health and Engineering Division.

This is a big change from earlier, when Bhutan’s health monitoring system did not differentiate between sanitary and unsanitary toilets, nor recorded whether toilets were used. Thus overall coverage was misleadingly high at 95%, said Yonzan. In reality, though, coverage turned out to be only 58% when measured using improved sanitation, an international definition reported for Millennium Development Goals in 2010.

A basic toilet only separates humans from excreta, but not necessarily hygienically, whereas “improved sanitation facilities include those with sewer connections, septic system connections, pour-flush latrines, compost toilet, ventilated improved pit latrines and pit latrines with a slab or covered pit”.

The problem lay in Bhutan’s 2002 Rural Water Supply Sanitation Sector Policy. While it provided a clear pathway to improved access to safe water supplies, it overlooked details on sanitation and hygiene. Recognising this, in 2008 the government began pilot projects in Lhuentse, Pema Gatshel, Sarpang and Gasa districts with technical support from SNV. It was a stunning success. In Lhuentse district alone the improved sanitation increased from 27% to 85% within 2010-2011 without any subsidies. Following its success and positive impact, the ministry endorsed the approach and plans to scale-up the programme as part of the 11th Five Year Plan (2013-2018).

The project is now being implemented in eight districts with support from SNV, UNICEF and Swiss Red Cross Programme.

Health officials said it requires only between BNT 5,000 ($73) to Nu 10,000 ($146) to construct an improved toilet, and the majority of rural households can afford it. The main challenge, however, lies in convincing them of the importance of having improved toilet facilities. This was the focus of commemorating World Toilet Day on 19 November this year.

Around 50 health officials and local leaders from four eastern districts were given certificates and awards for achieving 100% improved toilets in their community on 19 November in Gaselo village of Wangdue. This achieved by the collaborative effort of all, said Karma Sonam Wangdi, a local leader from Mongar district. “Health officials and local leaders even had to provide labour support, as well as conducting advocacy programme to making people understand the importance of having improved toilets,” he told thethirdpole.net.

Changing people’s century-old habit of defecating in the forests and near bushes was the main challenge. This was in addition to mobilising local support to help construct toilets for the elderly people, poor, disabled and single member households.

“However, we didn’t wait for everyone to construct toilet at once, but we encouraged those households who could construct to complete first,” said Karma Sonam, “and came together to construct toilets for those who cannot afford to do so.”

During the World Toilet Day celebrations health officials tried to empower and recognise the gewog (group of villages) leaders and health officials. This was to encourage others to take up such roles in their communities.

Rinchen Wangdi said at least two thirds of the population in the country now have access to improved sanitation toilets. Since funding remains a challenge, he was very happy that these initiatives were done without any additional subsidies. Instead they focussed on helping people prioritise better.

To end open defecation

One of the main aims of the programme is to end open defecation, as this pollutes water sources. In Bhutan people are mostly dependent on spring water and open defecation can easily contaminate the water. Rinchen Wangdi said that diarrhoea always comes in the top 10 causes of death in Bhutan, and open defecation is one of the main contributors.

“Not having proper toilets along the highways is another big issue, and is the standard complaint we receive from tourists,” he said. The govermment is working closely with the Bhutan Toilet Organisation and the Bhutan Tourism Council to deal with it.

“We also have a small forum where people working on water and sanitation come together and discuss issues,” said Rinchen Wangdi. The Bhutan Toilet Organisation has already started managing some of the toilets along the highway. He added that they are now looking for innovative ways to end open defecation along the national highways. One idea is to construct toilets alongside small vegetable sheds along the highway – where the small farmers sell produce – to give the vendors ownership, thus they could collect some charges and manage the toilets.

In this, and other ways, Bhutan has signalled that instead of just focussing on building toilets it will now look at ways to ensure that the core issues of sanitation and hygiene are addressed.

This Article first appeared on The Third Pole.