The Happiest Room in the House, and Ending Open Defecation in India by Mahatma Gandhi’s 150th birthday

Think about it:

When we come out of the bathroom, we are much happier than when we went in (with very few, but notable exceptions). So, according to Jack Sim of the World Toilet Organization, the host of last week’s World Toilet Summit in New Delhi, that makes the toilet the "happiest room in the house!"

Hundreds of delegates at the Summit spent two full days vigorously discussing and debating approaches and steps needed to accelerate progress toward the ultimate goal of universal coverage of sanitation in India and across the developing world. Sanitation is the most off-track of the Millennium Development Goals, and stands to gain the most from the world’s commitment to universal coverage by 2030, as espoused in the draft Sustainable Development Goals.

A key theme throughout the Summit was the balancing act between hardware and software. One cannot have too much hardware/infrastructure and not enough software/behavior change, or vice versa. The balance is important, as is the timing between the two; both tracks need to be pursued simultaneously. On this note, the inventor of Community-Led Total Sanitation (CLTS) and the Founder of the CLTS Foundation Dr. Kamal Kar told a story about the many times he has seen people around the world talking on their cell phones while defecating in the open, then hopping up and riding away on their motorcycles. Clearly these people are not the poorest of the poor, but have rather made a conscious decision to defecate in the open, manifesting the need for behavior change. But once they do change their behavior, or at least express a willingness to do so, the supply chain for sustainable technical solutions to their sanitation challenges needs to be strong enough to respond quickly and appropriately.

This balancing act between hardware and software promises to be prominent in India over the next five years, and I found the World Toilet Summit in New Delhi particularly well-timed for three reasons:

1. The Government of India, led by Prime Minister Narendra Modi, late last year committed loudly and publicly to universal coverage of sanitation in India by October 2, 2019, the 150^th birthday of Mahatma Gandhi. To succeed, this Swachh Bharat Abhiyan (Clean India Campaign) will need to solve the problem of 600 million Indians who continue to defecate in the open, and do so in an appropriate, sustainable fashion.
2. The U.S. Agency for International Development (USAID) and the Bill and Melinda Gates Foundation have recently partnered with the Government of India on capacity-building for sanitation in urban areas across India.
3. And last but not least, sanitation was a key component of the late 2014 summit between U.S. President Obama and Indian Prime Minister Modi, and is likely on the table during President Obama’s current visit to India as the Chief Guest of Prime Minister Modi as India celebrates its Republic Day (January 26, 2015).

So considering the success (and excellent timing) of the recent World Toilet Summit in New Delhi, and the warm relationship between the leaders of the world’s two largest democracies, how about we throw a Global Block Party for Swachh Bharat, just as whole neighborhoods come together to clean up a river on a sunny weekend day: let's all pitch in and help India end open defecation and achieve universal coverage of sanitation by October 2, 2019, and wish Mahatma Gandhi a Happy 150th Birthday. How about a Global Friends of Swachh Bharat to provide additional financial and technical inputs to the Government of India’s already impressive commitment? It won't be easy, but with every single Indian involved, per the suggestion of Prime Minister Modi, and working together with many of us from abroad (perhaps a big push from the Indian diaspora), it is possible. India has killed polio; it's ready to move on sanitation now.

Gates Foundation Grant Opportunities - Create the Next Generation of Sanitation Technologies

From the Gates Foundation below: note their interest in sanitation:

Create the Next Generation of Sanitation Technologies

The Bill & Melinda Gates Foundation is now accepting grant proposals for Round 7 of Grand Challenges Explorations, an initiative to encourage innovative and unconventional global health solutions. Applicants can be at any experience level; in any discipline; and from any organization, including colleges and universities, government laboratories, research institutions, non-profit organizations and for profit companies.

Grant proposals are being accepted online until May 19, 2011 on the following topics:

* Explore Nutrition for Healthy Growth of Infants and Children

* Apply Synthetic Biology to Global Health Challenges

* The Poliovirus Endgame: Create Innovative Ways to Accelerate, Sustain, and Monitor Eradication

* Create the Next Generation of Sanitation Technologies

* Design New Approaches to Cure HIV Infection

* Create Low-Cost Cell Phone-Based Solutions for Improved Uptake and Coverage of Childhood Vaccinations

Initial grants will be US $100,000 each, and projects showing promise will have the opportunity to receive additional funding of up to US $1 million. Full descriptions of the new topics and application instructions are available at:

www.grandchallenges.org/gce/ 

We are looking forward to receiving innovative ideas from around the world and from all disciplines. If you have a great idea, apply. If you know someone else who may have a great idea, please forward this message.

Thank you for your commitment to solving the world's greatest health challenges.

###

Bill & Melinda Gates Foundation

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people's health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people - especially those with the fewest resources - have access to the opportunities they need to succeed in school and life. Based in Seattle, the foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.

Gates Foundation / Grand Challenges Exploration / Sanitation / Nov 2 deadline

Good morning/afternoon everyone - I should have posted this a long time ago - apologies.

For those of you with great ideas about how to solve the world's sanitation challenges, please consider applying for this early-stage Gates Foundation support. Good luck!

__

The deadline for applications to our Grand Challenges Exploration is fast approaching and we want to get as many applications in as possible! Applications need to be received by November 2, 2010.

As you may have heard, the Bill & Melinda Gates Foundation’s WS&H team is currently running a Grand Challenges Exploration for sanitation. Grand Challenges Exploration is a small grants program that is soliciting proposals for the next generation of sanitation technology. From new containment devices to fecal sludge transport, treatment, and reuse, we’re looking for bold, innovative, and risky ideas that have potential to catalyze a transformation in how sanitation is implemented in the world’s rapidly growing cities. The guidelines for the sanitation challenge can be found here:

http://www.grandchallenges.org/Explorations/Topics/WaterSanitation/Pages/Round6.aspx

The application is just 2 pages, and the grant size is $100,000 for a year, to develop the idea further. We’re looking to receive a wide diversity of ideas from a wide diversity of individuals and organizations, so please circulate widely throughout your networks!

One bold idea. That’s all it takes.

Unorthodox thinking is essential to overcoming the most persistent challenges in global health. Vaccines were first developed over 200 years ago because revolutionary thinkers took an entirely new approach to preventing disease.

Grand Challenges Explorations fosters innovation in global health research. The Bill & Melinda Gates Foundation has committed $100 million to encourage scientists worldwide to expand the pipeline of ideas to fight our greatest health challenges. Launched in 2008, Grand Challenge Explorations grants have already been awarded to 340 researchers from 34 countries.

Open to All Disciplines: Anyone Can Apply

The grant program is open to anyone from any discipline, from student to tenured professor, and from any organization – colleges and universities, government laboratories, research institutions, non-profit organizations and for-profit companies.

Agile, Accelerated Grant-Making

The initiative uses an agile, accelerated grant-making process with short two-page applications and no preliminary data required. Applications are submitted online, and winning grants are chosen approximately 4 months from the submission deadline.

Initial grants of $100,000 are awarded two times a year. Successful projects have the opportunity to receive a follow-on grant of up to $1 million.

A link to the press release announcing the launch can be found here: http://www.gatesfoundation.org/press-releases/Pages/grand-challenges-explorations-round-six-100819.aspx

Grand Challenges in Global Health / Gates Foundation

Just making sure you are following Gates’ latest Grand Challenge round. Of particular interest might be their sanitation challenge this year:

Create the Next Generation of Sanitation Technologies

[[The goal of this topic is to generate original and innovative ideas for technologies to support sustainable sanitation services for the excreta of billions of people who are not served by centralized, waterborne sanitation. We are looking for innovations in non-conventional technologies with potential to be adopted due to their affordability, durability, convenience, aesthetic design, and effectiveness. Innovations that leverage nutrient capture, energy reuse or industrial usage may make sense as a means of adding income or reducing costs in the sanitation service delivery chain.]]

Here are the rest of challenges, including the polio eradication challenge which links polio to safe water and sanitation:

http://www.gatesfoundation.org/global-health/Pages/grand-challenges-explorations.aspx

Sanitation jobs at the Gates Foundation - woot woot!

The Gates Foundation has made the big commitment to sanitation we have all been hoping for and are staffing up to prove it:

http://www.gatesfoundation.org/jobs/Pages/job-search.aspx

Search for sanitation and you'll find:

Director, Water, Sanitation & Hygiene

The Director of Water, Sanitation and Hygiene will provide strategic leadership of the WS&H initiative, with a specific focus on non-piped sanitation. The Director will continue to build on the existing strategy and will be responsible for overseeing grant making and grant management, advocacy, people management and reporting of the Water, Sanitation and Hygiene portfolio. The Director of Water, Sanitation and Hygiene will participate in the Global Development Leadership Team and contribute to the entire Global Development team through management and cultural leadership and a willingness to share knowledge as appropriate.

Senior Program Officer - Demand-Led Sanitation

The Senior Program Officer (SPO) will play a pivotal leadership role in the WS&H initiative, taking primary responsibility for developing, executing and managing a portfolio of high-impact grants with the goal of replicating at very large scale a sustainable approach to rural sanitation. This approach triggers demand to end open defecation and improve unsafe latrines, trains local entrepreneurs to offer affordable sanitation products and services, and improves the enabling environment supporting these activities. Reporting to the Deputy Director leading the WS&H initiative, the SPO will also contribute to developing the WS&H strategy, enhancing external and internal relationships, improving team effectiveness, and supervising Program Officers and other staff.

And others... let's get some great sanitation people up to Seattle.

Water, Sanitation, Hygiene and HIV/AIDS

Thought I'd do a little research on the nexus of safe drinking water, sanitation, hygiene and HIV/AIDS tonight. I found a very interesting presentation given recently by USAID staffperson Merri Weinger at AfricaSan 2008 in Durban:

http://www.ehproject.org/PDF/ehkm/weinger-africasan2008_presentation.pdf
(PDF document)

It's a quick, introductory read. I'm not sure if you all will find anything new there but for me it does a good job of laying out the linkages between water, sanitation, hygiene and HIV/AIDS, and of quantifying the positive impact of WASH on HIV+ patients and to a certain extent the larger communities.

Note that Pepfar funds can be used for drinking water and hygiene improvements. Sanitation improvements (latrines) need outside sources of funding.

Page 14 discusses 'small doable actions' that need to be scaled up, out and over.

Then I thought of the ongoing debate (as seen in the recent LA Times article "Unintended victims of Gates Foundation generosity") between vertical (viz. disease-specific) and horizontal (viz. basic public health care) approaches to global public health challenges. The facts are, plenty of financial and political capital is flowing to one individual disease: HIV/AIDS. In my mind, it is premature to determine whether that is a good or bad idea (and there are others: malaria, TB). But how can the global watsan community work within the current situation of HIV getting a lot of attention and water getting relatively less?

Every water development organization (UNICEF, CARE, WaterPartners, WaterAid, Water For People, Living Water, and myriad others) that is working in a community where there are HIV positive people should approach Pepfar and ask for support for drinking water and hygiene promotion. Those water development organizations could make that more attractive to Pepfar by agreeing to provide sanitation facilities from their own funds. Essentially the water community should do a better job of grabbing onto the coattails of the HIV/AIDS juggernaut and get a bigger piece of the pie. The end game? - Every HIV clinic, and perhaps the surrounding families and communities could not only have ARVs and medical professionals trained in treating HIV, but also safe drinking water, sanitation and hygiene, and therefore significantly less diarrheal morbidity and mortality.

I’ll be damned if I’m gonna pay to take a piss

Direct quote from a tourist during a recent trip to Paris: “I’ll be damned if I’m gonna pay half a euro to take a piss. I’m going to McDonald’s!”

So people have a difficult time paying to go to the bathroom in France. Not exactly a newsflash, and I think the same will be said once public toilets start becoming more prevalent in NYC. Tourists will still whistle nonchalantly through hotel lobbies to get away with doing their business for free.

In several woredas (districts) in Ethiopia, however, it’s now the hip thing to not only have your own pit latrine by your home, but to pay for the privilege. How did this happen, and in Ethiopia of all places, where the per capita GDP is $US1,000, and where only 6% (sic) of the population has access to improved sanitation facilities? What’s the secret?

Trachoma is the world’s leading cause of preventable blindness, and is caused by a lack of safe water and inadequate sanitation facilities. Transmission of trachoma can be decreased significantly by using improved sanitation facilities like pit latrines. The Carter Center’s Trachoma Control Program, in cooperation with the Ethiopian Ministry of Health, launched a program in 2002 to catalyze the building of 10,000 pit latrines to stem trachoma. If there is one global public health story over the past few years that deserves to be above the fold in every mainstream periodical, it is this one:

Pit Latrines for All Households: The experience of Hulet Eju Enessie Woreda, Amhara National Regional State, Northwest Ethiopia

The full report (in Amharic) is a bit of a read. The gist of this executive summary (in English) is this:

• 89,000 pit latrines were built (the actual number is now 225,000)
• Ethiopians have for the most part done this themselves
• Most households paid nothing for their latrines; of those who paid anything, the median amount was USD$2.80.
• The secret to success was not throwing money at the problem, or pushing some inappropriate top-down technology or infrastructure.

The secret to success is what the Carter Center calls "community mobilization, the presence of a strong political commitment among local leaders, and integration into the pre-existing community structures and practices." The latin taxonomic name for that is “Ethiopicae grandmae,” less technically “Ethiopian grandmothers,” or “informal village leaders.”

Pit latrines do not sell themselves in most cases, particularly in rural and peri-urban areas where the need to find an unspoiled place to leave a #2 is less urgent because there is simply more real estate. Latrines are frequently expensive to build and maintain, even if the local demand exists. It is often very difficult even to create that demand though, particularly in more rural communities, and difficult to ensure that those latrines are used for their intended purposes, not as homes or as cow-dung storage sheds.

This particular Carter Center program did not have the resources to build latrines themselves, but only to do the community mobilization and training. I spent several years in the late 1990s working for USAID and U.S. Department of State contractors on democracy and governance initiatives throughout Africa. Not infrequently I found that the fewer financial resources we had available for a project, the more successful it turned out to be. This was because less money led to non-financial commitment(s) being provided by local leaders, and by women’s groups in particular. Once those local commitments were made available, the sustainability of our work increased dramatically.

This Carter Center report indicates similar results from a similar approach. If Patty Stonesifer would come to me today with the “How would you spend $5b” question, my answer would be “Scale the sanitation work of both the Carter Center and Sulabh International by customizing their approaches for every country/community in the world, and blow the sanitation MDG out of the water.”

It is not cost-effective to vaccinate a newborn against polio or mumps if that child will die at three years old from a preventable waterborne disease like diarrhea or malaria or be forced into a life of leading a trachoma-blinded adult around for the rest of his/her life.

“Using a pit latrine is freedom, comfort, and honour!” — Villager from Hulet Eju Enessie Woreda