April-May 2008
2015 or bust?

Toilet trouble

WE MAY have heard enough toilet humor and rumors. Now it’s about time to get serious about a simple toilet habit that can save people from many health risks: washing hands.

Health and sanitation experts say this basic hygiene practice after a pee or poo can keep one away from several diseases, diarrhea and worm infections being among the most common and fatal.

Studies have found that human feces are the primary sources of diarrheal pathogens. The human waste is also the most dangerous water pollutant.

To illustrate, Engineer Rolando I. Santiago of the National Center for Disease Prevention and Control notes that a gram of human feces contains 10 million viruses, one million bacteria, 1,000 parasites, and 100 parasite eggs.

So, the next time after a poo (or handling a baby’s poo), make sure you wash your hands, and that you do so with soap. But you don’t just slosh soap and water onto your hands and then rinse. The proper and healthy way of keeping the left and right clean and bright, says former health secretary Jaime Galvez Tan, is to get the bubbles going, and then rinsing only after reciting “The Lord’s Prayer (Ama Namin)” or humming a birthday song.

Dr. Galvez Tan notes that at least 18 Filipinos die each day of diarrheal and other water-borne diseases, many of which can be prevented by, among other things, proper washing of hands after a visit to the toilet, and especially when one is handling food.

In East Asia, the figures run at 190,000 deaths each year from diarrheal disease, involving children aged five and under.

ELEVEN out of 81 provinces, including Pampanga, have the lowest number of households with sanitary toilet facility, reflective of the importance that the Arroyo government attaches to the problem of sanitation.

Not washing one’s hands or doing so improperly may well wash out many of the gains from the Philippines’ expected fulfillment of the water and sanitation target under Millennium Development Goal (MDG) No. 7. According to World Bank water and sanitation specialist Jemima Sy, indications are that the country will reach this target by the 2015 deadline “or soon afterward.”

The MDGs are a United Nations initiative to help the world’s poorest. MDG Number 7 is to “ensure environmental sustainability,” and under it is the target to halve by 2015 the proportion of the population without sustainable access to safe drinking water and improved sanitation.

TO BE deemed as having met this target, the Philippines must have 86.5 percent of its population with “sustainable access to improved water source” and 83.8 percent of its urban population “with access to improved sanitation.” According to the National Statistical Coordination Board (NSCB), three years ago, the country was still 6.3 percentage points away from the former (80.2), but had already overshot the latter by 2.4 percentage points (86.2).

Yet Sy and Santiago do not sound all that impressed. Santiago, for instance, cites a 2003 National Demographic and Health Survey by the Department of Health that showed that although 79.1 percent of Filipinos use flush toilets, there is still an alarming percentage of approximately 10 percent of the population with no access to a sanitary toilet and uses bodies of water as their collective kubeta.

The inclusion of Pampanga, home province of President Gloria Macapagal Arroyo, on the list of 11 out of 81 provinces with the lowest number of households with sanitary toilet facility mirrors the importance the incumbent government attaches to the problem of sanitation.

The other provinces are Sulu, Basilan, Lanao del Sur, Marinduque, Masbate, Zamboanga Sibugay, Maguindanao, Lanao del Norte, and Nueva Ecija.

“It is a totally different picture when we talk of public sewerage coverage,” says Santiago. “Only 10 percent of the 1, 650 towns and cities in the country have sewerage systems of varying degrees of compliance to standards.”

Currently, there are only four public sewerage systems outside Metro Manila. These are in Baguio City, Ilocos Norte, Zamboanga, and Cebu City.

Santiago says the sanitation problem contributes significantly to the health and economic burden in the Philippines. He points out, “Water pollution, sanitation conditions and hygiene practices alone are responsible for nearly one-quarter of all reported diseases and six percent of all reported deaths in the country.”

He cites another study, this time by the World Bank and the United States Agency for International Development (USAID), which pegged the economic cost of poor sanitation at P77.8 billion a year or 1.5 percent of the Philippines’ Gross Domestic Product or GDP.

Santiago laments that the government is not providing enough investments to ensure the supply of clean water and improved sanitation. “The financing gap is not only evident at the national level but equally so at the local level where local chief executives regard sanitation as high capital investments,” he says.

People are also not willing to pay for sanitation services, and he blames poor enforcement of laws and lack of public awareness and education for this.

“When people are rightly informed and educated, parting with even scarce resources should not be a problem,” he asserts.

“There is lack of awareness of and appreciation for sanitation and hygiene resulting in the lack of demand for sanitation services and facilities,” Santiago says. “The low level of community participation in the decision-making processes, which often exclude the marginal and vulnerable sectors, such as indigenous peoples, makes for a total oblivious and unconcerned attitude of the community.”

IT’S A situation the Philippines apparently shares with other countries. In a 2007 World Bank study that covered the Philippines, Cambodia, Vietnam and Indonesia, the economic impact estimates of poor sanitation included health, water resources, land use, sanitation access time, and tourism. Intangible aspects such as aesthetics and quality of life were assessed descriptively by the study called “Universal Sanitation in East Asia,” says World Bank expert Sy.

“Overall in the four countries of population size 400 million people, poor sanitation leads to annual economic loses of $9 billion,” she says. “These losses amount to two percent of (GDP). It is expected that over 70 percent of this — or $6.6 billion — can be averted through improving sanitation.”

Sy also says that “despite the impressive increases in coverage, 40 percent of the world’s population with unimproved sanitation are East Asians. Because of the large population of East Asia, meeting the MDG target still leaves 700 million people without improved sanitation.”

The World Bank study said that 9.1 million Filipinos still went to the toilet in the open — ranking third behind Indonesia and Cambodia, which had 22 million and 9.8 million people, respectively, who relieved themselves on the streets or in the fields. The study also said that 15.2 million Filipinos use public toilets.

Yet even having a sanitary toilet in each home may not really be enough for a country to stake a claim on a “good housekeeping” seal. Sy, for one, notes that close to 80 percent of Filipinos may have access to flush toilets that are connected to private septic tanks. But, she says, the human waste in the septic tank should be desludged at least once every three years. And if these are collected, do we know where the wastes go? If these are just thrown into the river, or in open fields, she argues, then it still contaminates the water and soil, thereby causing damage to the environment and endangering the lives of people.

According to Sy, the World Bank initially estimates that the East Asian region needs to spend at least $12 billion per year in water supply, sanitation, and wastewater treatment.

In the Philippines, the World Bank has committed more than P3-billion assistance for the sanitation sector in its effort to increase access to poor sanitation and to guard against the environmental impact of water pollution in the country.

It includes the Manila Third Sewerage Project and community-based investments activities like the $12.5-million Laguna de Bay Institutional Strengthening and Community Participation project that involves waste treatment facilities in Nagcarlan and Sta. Cruz towns in Laguna.

Still, it’s not enough that international funding institutions and the government pour more money into water and sanitation facilities. Such efforts may be for naught if the people will not observe hygienic practices like washing of hands after defecation and before handling food to avoid contamination.

Talk about having one’s fate in one’s hands.