IDS PRACTICE PAPER 1
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to reflect critically on how this affects how I am treated, where I am taken, what I see, what I am told, what I recollect, how I frame evidence, and the judgements I
make. All the same, biases, misperceptions and misjudgements must surely remain. Disagreements, corrections and qualifications are necessary and
welcome, with ongoing debates from different points of view about policy and practice to help us forward in our collective struggle to do better.
1.2 Rural sanitation: the scale of the problem and opportunity
The orders of magnitude of the sanitation and related health context are striking. Of the 2.2 million people estimated to die each year from diarrhoeas and related
diseases, the great majority are children, with a death rate of 5,000 children a day often being cited. The strong links between these figures and open defecation
OD, lack of access to, or use of, means for the safe disposal of human excreta, lack of hygienic practices and contaminated water, are not in dispute. Urban
sanitation presents massive problems, but of the more than 2.5 billion people estimated to be without improved sanitation more than 7 out of 10, some 1.8
billion, are rural inhabitants WHO and UNICEF 2008: 13, 10.
The rural problem is concentrated most in South Asia and sub-Saharan Africa.
Table 1.1 Population without improved sanitation facilities 2006
Source: WHO and UNICEF 2008: 10.
In these statistics, the simplest improved sanitation facilities are pit latrine with slab.
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There are many gradations of sanitation, and many of those with improved facilities suffer health risks from the OD of others. Many of those in rural areas
who are counted as having improved facilities do not use them or do not use them all the time. Taking this into account, a reasonable estimate may be that in 2009
at least four-fifths of those living in the rural areas affected, the great majority in South Asia and sub-Saharan Africa, are practising OD. This also constitutes a
health risk to those who are using toilets in their communities. This means that the
4 Definitions and statistics are riddled with problems. Improving sanitation is often seen as a ladder, in
which the very bottom rung is digging a hole and covering excreta.
Per cent of total urban population
Per cent of total rural population
South Asia 43
77 Sub-Saharan Africa
58 76
Developing regions 29
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total population adversely affected by rural OD will be more than the roughly 1.8 billion estimated to be without improved sanitation, perhaps of the order of two
billion.
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If the scale of the problem is so huge, so is the scale of the opportunity for gains in physical, social and psychological wellbeing, through convenience, privacy and
self-respect as well as health. If, at a stroke, all rural areas could be ODF and all rural people were to adopt hygienic behaviours, the impact could be massively
transformative. That is the vision to fix in the mind. The question is how big a contribution CLTS can make towards achieving that vision.
1.3 What is CLTS?
