Latrine artisans more important than doctors now [Article]

Approximately 1.21 million households in Ghana do not have access to safe toilets. The majority of these live in rural areas. How do we enable everyone, especially rural dwellers to have, to own, and use a household toilet?  A big part of the answer is latrine artisans. Given the sanitation challenge we face; latrine artisans are currently more important than medical doctors are. This is not hyperbolic.

A good doctor will diagnose your health problems based on your symptoms.  They may also try to treat the cause. Unfortunately, they may only treat the symptoms.  Conversely, a good latrine artisan provides you with an incredible mechanism for preventing illness — a toilet.  However, most people under appreciate the role latrine artisans must play in transforming the liquid sanitation challenge; that is, we fail to realize that a critical mass of latrine artisans are a necessary factor in ensuring that everyone in Ghana has access to a safe toilet.  Consequently, the state of the nation’s toilets is abysmal.

Yet, access to safe toilets for everyone is critical for public health.  This is true for urban as well as rural areas.  People living in urban areas sometimes receive support. Think, for example, of the GAMA project, funded by the World Bank.  There is a bias, however, against rural dwellers. They are usually expected to construct their own toilets without any support.  Generally, there are no enforced standards as to what constitutes a safe toilet in the rural context.  Concomitantly, we largely fail to recognize toilet/latrine construction as a skill.

This is a bit of a paradox.  On the one hand, we want to scale up household toilet ownership and we know one challenge across much of the rural countryside is the collapsing of toilets, especially during the rainy season.  On the other hand, we do not take seriously feedback from rural communities that one of the biggest challenge they have in constructing and using toilets is that they do not know how to build sustainable ones that can last. In my experience, the second most common reason given by communities to explain why they do not have a household toilet is that they lack the technical knowledge in building one. To dismiss this as an excuse is too facile. It also begs us to ask, what is the role of the local government authorities?

In engagements with district assemblies regarding water, sanitation, and hygiene I often ask, “How many communities do you intend to facilitate to become open defecation free”?  I also ask, “How many latrine artisans do you have in the district”?   Then I ask, how many latrine artisans you have trained during the last two years”?  More often than not, the response to the last question is none – no one has been trained.   In a few cases, I learn that an NGO or another entity has supported the training of some latrine artisans.  Then I usually ask another question, “If miraculously, everyone in your district who does not have a latrine decided they wanted one in the next month—how many people do you have who can build them to last”?  If we are going to ensure that everyone has access to safe sanitation by 2025, we need a critical mass of good latrine artisans.

For the purpose of analysis, let us assume that the average district has a population of 100,000 persons. Assuming that the average household size is five (5) per family, then that district should have approximately 60,000 household toilets.  Average sanitation coverage in the region with the lowest coverage is currently about 30%.   However, let us be generous and assume a 40% sanitation coverage. So let us imagine that this district now has 8,000 household toilets.  This means that 12,000 households still require toilets/latrines.  Now let us assume that the district has 100 latrine artisans.  (If there is a district that has more than 100 artisans please identify yourself).  For a simple analysis, this means that each latrine artisan will have to construct 120 latrines. Now let us assume it takes a trained latrine artisan 5 working days to complete the construction of a toilet.  This means that it will take 600 days for the total number of latrines to be constructed.

However, this assumes that artisans are working exclusively in this capacity and doing so 365 days a year.  However, in many rural contexts we can anticipate that artisans as well as the general community will be busy farming for at least half of the year, so expectations of construction during this time is largely misplaced.  Therefore, let us assume that we only have ½ a year for toilet construction.

This means that it will take the imaginary district above three years and four months to build the 12,000 toilets, so that everyone has access to a safe toilet. This is a best-case scenario. This figure does not account for the issue of actual demand for toilets or population growth during that time.  In other words, in a perfect world where every household in our district wanted to own and use a toilet, it would take 100 artisan3 ¼ years to provide them.

Latrine artisans are a critical and necessary component of the multifaceted solutions necessary to transform rural sanitation. To be clear, this is not to suggest that more latrine artisans alone can bring lasting change.  There are many other factors to be considered. There are many assumptions here. For instance, in the above scenario we assume that everyone household wants to own and use a household latrine and they are able and willing to allocate resources to construct one.  Yet, we know that for those living with low-incomes, in a context of growing inequality nationally, access to the resources to construct a sustainable toilet is a luxury for many.  It should not come as a surprise that the areas with the highest rates of poverty depth and severity, as well as high levels of inequality, are also the areas with the highest levels of open defecation.  We may assume that if you, the reader, had to choose between using your limited financial resources to pay school fees or to build a toilet, it is possible you could be found in the bushes or on a beach squatting.  In other words, income inequalities and therefore limited incomes are also a limiting factor in efforts to scale-up household sanitation ownership and use.

For everyone in Ghana to have access to safe sanitation, we have to ensure that all those who want to own and use a toilet can get it as soon as possible.  In other words, supply must be ready to satisfy demand.  There is also a need to discuss demand creation, which I will address in a subsequent article. However, now, I want to focus on supply.

For the rights of everyone to safe toilets to be realized, the state as the primary duty bearer must create and enabling environment for supply.  The starting point of supply are latrine artisans.  However, many districts do not know many latrine artisans they have at present.  Many districts do not budget for the training of latrine artisans and they do not ensure that it takes place.  As a result, a most critical element of supply remains underdeveloped.  For this to change, the state has to play the leading role in creating a critical mass of trained and engaged latrine artisans.

At this historical moment when the state of the nation’s toilets is abysmal, a good latrine artisan is more important than a good doctor.  A good latrine artisan provides you with a toilet; with proper and consistent use of the toilet along with appropriate hand and food hygiene you can prevent most faecal oral diseases. An ounce of prevention is still worth more than a pound of cure.  The nation needs more than a million toilets.  Therefore, Ghana needs skilled and committed latrine artisans in the thousands. Ghana needs them now.

Author: Chaka Uzondu (Ph.D), Policy Manager, WaterAid