Formidable challenges ahead

October is observed as the National Sanitation Month. Most people have probably not heard of it. However, Sanitation Month has an important role in Bangladesh's track record of success in health and development we need to remember. It began as a way to signal the importance of sanitation as a national priority since 2003, and provides the opportunity every year to look back, review our progress as a nation, and confront new challenges.

The decades-long work that gone into making Bangladesh a pioneer in the field of sanitation is often missing from the public discourse. We have a long history of coordinated, committed action from government, civil society, local government, and citizens themselves. We are the birthplace of Community Led Total Sanitation (CLTS), a unique, people-centred approach that broke with conventional practices of subsidies and hardware support to trigger change in the one place where it matters most — people's mindset.

By using participatory methods to show how we end up eating out own shit when we defecate in the open, CLTS ignited a national change in our sanitation behaviour that persists to this day, and the methodology has now spread across the world. On 30th June 2015, the World Health Organisation (WHO) and Unicef jointly declared open defecation in Bangladesh to be at an astonishing 1% in their Joint Monitoring Progress (JMP) report, a tremendous achievement for a country where the same rate stood at 34% in 1990.

In spite of all of this, we are lagging behind. Bangladesh failed to meet the Millennium Development Goal (MDG) of halving the proportion of population without access to improved sanitation by the deadline of 2015. An estimated 39% of the population, mostly concentrated in hard-to-reach geographical areas or amongst socioeconomically vulnerable populations, are still using unimproved sanitation.

Equally concerning are the challenges we face once we think beyond open defecation — namely, what happens to all the shit? Faecal sludge management — a euphemism for this very question — is a formidable challenge.

Faecal waste ends up in septic tanks or pits that are usually cleaned by manual sweepers, who end up dumping the waste in open water bodies. In some cases, such as is some slum areas or many pavement dwellers, there is no containment of the faeces at all — people defecate in the open or in the hanging latrines above water bodies. With no proper treatment of the vast majority of sludge, waste is being reintroduced in to the domestic environment. We have come far, but we are still, in a very real sense, eating our own shit.

So who does this affect? All of us, in different ways, but it is those who are already most vulnerable that pay the highest price. Bangladesh's worryingly high rate of child malnutrition and stunting can be linked to poor water, sanitation and hygiene (WASH), with strong evidence connecting repeated incidents of diarrhoeal disease to poor nutrition.

Public sanitation facilities in Bangladesh are abysmal — take Dhaka for example, the capital where there is less than 50 toilets to serve a population of 5.5 million on the streets. Women and girls, as well as people with disabilities, suffer the most and are often forced to completely forego any means of relieving themselves while on the road.

Sanitation in schools and healthcare centres — institutions that are central to human development — is another area of concern, with a national survey finding inadequate, unclean facilities in the majority of cases.

Another often neglected issue is that of menstruation, and making sure that women and girls, whether at home, in school or in the workplace, have access to toilets and sanitary materials so they can manage their periods with dignity. These are challenges that threaten to reverse Bangladesh's progress on many levels.

A global report on health status of 188 countries based on the health-related Sustainable Development Goals (SDG) indicators found Bangladesh to be one of the poorest performing countries in South Asia, lagged by only Nepal and Afghanistan. We scored a mere 5 out of 100 on hygiene. This report clearly shows that no country can make sustainable progress on the global health goals without addressing the critical components of water, sanitation and hygiene (WASH). This report clearly shows that no country can make sustainable progress on the global health goals without addressing the critical components of water, sanitation and hygiene (WASH).

Even if we set aside the question of long-term developmental goals, we are already paying the costs of poor sanitation every day. It is estimated that the annual economic impact of inadequate sanitation is Tk. 295.48 billion, or nearly 30,000 crores — equivalent to 6.3 percent of the GDP. In addition, there is the untold and uncountable loss of human dignity and human rights. These are consequences that have not made headlines, but need to be recognised for the crises that they are.

Right now, we are at a unique point in time that could prove to be the next revolution in sanitation in Bangladesh. The state has made a number of commitments on sanitation in SACOSAN VI and the 7th Five Year Plan. SDG 6 provides the opportunity and the impetus to take comprehensive action on ensuring access to sanitation for all, and the recent assessment on health and the SDGs is further evidence that we need to take action immediately if we are to keep pace with the world.

These are not issues that can be easily packaged into attractive solutions. But these are issues that affect the poor, women, children, infants, people with disabilities, the elderly — you and I. They are integral to people's dignity and human development. They matter. Shit matters.

The writers are development professionals, work for WaterAid Bangladesh.