“I preferred to sit outside. The compound used to smell bad because of people defecating in the open. Now that we have a toilet, our compound is clean.” says Wubitu Mitiku, a visually impaired woman in Waghimra, Ethiopia.
According to the World Health Organization, 43% of Ethiopia’s population do not have access to an improved water source and 28% practise open defecation. Faecal contamination of water and soil, lack of sanitation facilities and poor hygiene practices lead to serious infectious diseases and thousands of deaths that could otherwise be prevented. The Centers for Disease Control and Prevention estimates that unsafe drinking water, inadequate availability of water for hygiene, and lack of access to sanitation together contribute to about 88% of deaths from diarrheal diseases.
For people with disabilities the challenges are even tougher. Crawling into a dirty latrine increases the risk of disease contamination and transmission. And social stigma further aggravates their situation. It is estimated that around 7% of Ethiopia’s population live with some form of disability. That is around 5 million people in need of appropriately designed WASH services as well as action that addresses social constraints.
Under the 15-country Sustainable Sanitation and Hygiene for All (SSH4A) Results Project funded by DFID, we’re tackling these issues in Ethiopia and are specifically addressing the needs of people with disabilities in six woredas (districts) in Waghimra where in 2016 the incident of acute watery diarrhoea was clearly associated with areas practising open defecation.
What hinders good sanitation & hygiene among people with disabilities?
The formative research we’ve conducted for the project – Behaviours Affecting Sustainable Sanitation and Hygiene Practices – identified two factors that negatively impact the health and well-being of this vulnerable group:
- The use of hands for support during defecation increases the risk of acquiring and transmitting diseases.
- Social isolation and taboos around discussing personal hygiene prevent people with disabilities from attending events that promote good hygiene and sanitation practices.
How does SSH4A address these issues?
Based on the findings of the formative research, the programme has taken the following action to specifically address people with disabilities:
- Trained community mobilisers and facilitators on how to address the key barriers to good sanitation and hygiene among disabled people.
- Disseminated tailor-made behavioural change messages.
- Published a booklet on inclusive design of toilet technologies.
What changes have been observed so far?
A recent survey we conducted among households with people with disabilities shows considerable improvement in access to sanitary and handwashing facilities as well as in the use and maintenance of toilet facilities over the past three years of project implementation.
Access to sanitary and handwashing facilities
A survey that we’ve recently conducted indicates that the rate of open defecation practice decreased from 77.1% in 2014 to 3.3% in January 2017. The report also reveals that use of handwashing facilities next to toilets and kitchens has become an important practice.
Sustained and hygienic use and maintenance of toilet facilities
The findings of our survey also show a considerable decrease in the number of households lacking a (functional) toilet, from 77.1% in 2014 to 3.3% in 2014. In addition, the households are using the toilets sustainably and hygienically, with the regular use of toilets having increased by 78.3% since 2014.
SSH4A is supporting the Government of Ethiopia (GoE) in increasing access to sustainable sanitation and hygiene across the country. In collaboration with the Organisation for Rehabilitation and Development in Amhara (ORDA), SNV is boosting sanitation demand by using a Community Led Total Sanitation and Hygiene approach, strengthening sanitation supply chains, financing and WASH governance and leading behavioural change communications for hygiene promotion.