…was the “mantra” reverberating across the meeting halls of the week-long seventh South Asian Conference on Sanitation, held in Islamabad between 10 to 14 April. Gathering over 500 delegates from eight South Asian countries, sanitation-related achievements shared during SACOSAN VII gave all of us multiple reasons to celebrate… as well, a reality check – that despite this progress, health and nutrition outcomes remain to be seen.
South Asian countries make good sanitation progress
The inaugural event of SACOSAN VII set the stage for reflections and critical analyses prevalent during the rest of the conference. After a warm welcome from the President of Pakistan, Mr. Memnoon Hussain, and the respective minister and secretary of the Ministry of Climate Change (event’s host), speeches from the heads of delegations revealed that:
- country governments have the political will to prioritise sanitation;
- policies and institutional arrangements to support WASH governance are in place; and
- local resources for sanitation access have been mobilised effectively across the region – all resulting in the “South Asian Sanitation Revolution”.
But alongside this progress comes a wakeup call
That progress in sanitation has yet to translate to improved health and nutrition outcomes. A WASH poverty diagnostics initiative of the World Bank conducted in 18 countries – which also covered Pakistan, Bangladesh, and India – found that despite reduction in poverty, improvements in dietary intake, and progress in access to water and sanitation: health and nutrition outcomes remained weak.
Findings showed that faecal-oral contamination – a key contributor to stunting – was still high due to unsafely-managed sanitation and insufficient protection of water supply systems . These findings validate a point that SNV has been making over the years: that “poorly-managed sanitation is just as bad as open defecation”. That even low quantities of faecal sludge contaminate whole waterways, and have negative health impacts on the entire population of an area.
“According to the World Health Organisation, over 525,000 children worldwide die because of diarrhoea alone. Due to these diseases, economic losses are profound, and surely higher than investing in decent sanitation. In Bangladesh alone, the economic loss of poor sanitation is US$14 billion annually, which amounts to 6.4% of their GDP (SNV, December 2017).”
Beyond sanitation facility improvements
Participants in numerous SACOSAN VII sessions also identified the need for the sector to address the issue of equity in health and nutrition outcomes as part of the concrete SDG 6 actions that the region will need to undertake.
This includes tackling the challenge of the “last mile”  especially in mass movements, and adapting services to different population groups: as expressed throughout the conference by women, people with disabilities (PWD) , and transgender people in attendance [Scroll down news item to access latest SNV materials on the last mile and PWDs].
Looking into the future
SACOSAN VII closed with commitments from the heads of delegation to implement the Islamabad SACOSAN-VII Declaration, and from the United Nations to support governments in their respective aims.
In his final words, the Pakistan Minister of Climate Change, Mr. Mushahid ullah Khan hit at many South Asian hearts by proposing to use “green” cricket to promote mass awareness across South Asia on the impacts of climate change and threats to sustainable WASH.
Materials for further reading
 There are, of course, many ongoing efforts to prevent faecal-oral contamination. In Bangladesh, we’re helping develop an urban sanitation blueprint for slum areas. See “Thoughts from the field: Sanitation – the Urban ‘Time Bomb’” by Jason Belanger. Our earlier engagements in Jumla, Nepal also saw the effectiveness of municipal-private sector collaboration, and the use of technical and social data monitoring systems in helping design faecal sludge management business models and enforcement strategies. Read “Establishing a safe FSM system – an endeavour filled with uncertainty and risks” by Nadira Khawaja.
 Learn more about our work on the “last mile”. “Realising sanitation access and usage at anytime, for everyone everywhere,” for example, documents SNV in Nepal’s project experience in engaging people with disabilities (PWDs), and facilitating their meaningful participation in (sanitation and hygiene) decision making spaces. Also read our Learning Brief, “Sanitation and hygiene for all: a comparative study of approaches to leaving no one behind across five countries,” which covers lessons learnt in Bhutan, Nepal, Cambodia, Zambia and Tanzania.
 Understanding the specific WASH needs of PWDs is an important feature in SNV’s collaboration with Australian Aid’s CS WASH Fund. In 2017, SNV in Bhutan published the research titled, “Understanding the impacts of disability on access and use of sanitation and hygiene services in rural Bhutan,” which highlights “the need for systematic inclusion of disability in data collection, monitoring and evaluation to effectively target the needs of people living with disabilities and work towards eliminating the barriers.” In Nepal, the SNV country team contributed to developing the government training manual titled, “Options on Household Toilet Facilities for People with Disabilities and Difficulties.” The training manual was published by Nepal’s National Water Supply and Sanitation Training Center, Department of Water Supply and Sewerage.
SNV in Bhutan WASH Advisor, Thinley Dem, presents the organisation's WASH in Schools initiative experience.