Poo may be the last taboo in Cambodia; but a conversation about good sanitation and sound water management is long overdue
By Sacha Passi
Everyone is doing it, yet nobody wants to talk about it – let alone take responsibility for cleaning up the mess. The luxury of a lavatory, where undesirable contents disappear with the push of a button, is a convenience taken for granted in the West. By 2050 it is estimated that 240 million people worldwide will depend on unsafe water and 1.8 billion will lack basic sanitation.
“Access to improved sanitation facilities – latrines that effectively separate excreta from human contact – are critical to development,” Yi Wei from iDE said. “Low sanitary latrine coverage has serious consequences in terms of health, economics, environment and human dignity.”
Southeast Asia’s water strategy is the world’s second most underinvested and underdeveloped after Sub-Saharan Africa. David Lloyd Owen, a water and waste management expert, estimates that to achieve basic coverage across the region by 2050, capital spending on water sewerage and sewage treatment would cost more than $383 billion. “It is a question of priorities and perceptions. Water may not be a glamorous subject and providing comprehensive water and sanitation services for urban areas may appear to be too costly,” he said. “In fact, people are ready and willing to invest in water when they know that they will benefit from improved services and health.”
In Phnom Penh, the number of households with access to piped water increased nine-fold between 1998 and 2004. Heavy donor funding and loans to the tune of $150m enabled Phnom Penh to transform its utility performance. Now 90% of the city has piped water coverage, with access available 24 hours a day. Across the country, however, water management and sanitation is not faring so well. Despite heavy investments, Cambodia has Southeast Asia’s least developed water management and sanitation sectors, leaving a majority of the ten million people living in rural Cambodia to exist in sub-standard conditions.
The United Nations outlines a daily minimum of 20 litres of clean water per person as a basic threshold, but in rural communities people can have access to less than five litres a day – or one-tenth of the average daily amount of one person’s toilet use in the West. Access to clean water is further compromised due to a high risk of contamination. Eighty-two percent of Cambodia’s rural population still practice open defecation, resulting in the faecal contamination of surface waters such as rivers and ponds, and shallow groundwater, causing waterborne infectious disease and preventable deaths. One in eight Cambodian children won’t live to see their fifth birthday because of diarrhoeal disease, with many more suffering from illnesses that are easily preventable through access to clean water and proper sanitation.
“Although diarrhoeal illnesses kill more children than HIV, malaria and TB [tuberculosis] combined, the resources dedicated to the issue have not reflected this, until recently,” Wei said. Waterborne diseases also result in lost labour productivity for adults, missed school days for children and additional financial burdens for families requiring medical treatment.
One of the biggest challenges facing Southeast Asia’s water and sanitation crisis is government failures to make connections between environment, health and economics. “Many proponents of improved sanitation are working to not only link the issue of inadequate sanitation with public health outcomes, but to demonstrate it as a drag on productivity gains and as a drain on public health spending,” said Geoff Revell from WaterShed, which promotes effective and affordable water and sanitation solutions in the region. The World Bank estimates that Cambodia’s poor sanitation causes an annual economic loss of $448m – equivalent to 7.2% of the country’s gross domestic product, which equates to a yearly loss of $32 per person, or half of one month’s income based on Cambodia’s average national daily wage of just over $2.
Singapore’s proactive water and wastewater management over past decades demonstrates the proven benefits of investment and government initiative. By 1970, more than 90% of the country’s population had household piped water, by 1990 universal household sewerage was standard, and full sewage treatment followed during the next decade. “Singapore developed its water and wastewater at an early stage of its economic development,” Owen said. “It is fair to say that this advanced and comprehensive infrastructure has helped spur the city-state’s economic growth.”
Understanding this link could prove pivotal to implementing a regional solution. Wei argues that at a community level Cambodians already have a good understanding of why sanitation and clean water is significant to improving daily life. She says the next step to finding a solution is getting people to ‘want’ products and services badly enough, and ensuring barriers to access and purchase are minimised. “When you ask people why they get sick, they know it’s because of drinking contaminated water; they know it’s important to use soap to wash hands; they know a latrine reduces diarrhoea frequency,” Wei said. “It’s the same as if you asked a smoker whether they understand the negative effects of smoking. Almost all do, but health reasons are not the reason why people make behavioural changes.”
Stagnant systems are not for lack of innovation or technology, but urban and rural settings provide differing challenges for implementing solutions.
In the urban setting, energy and chemical demands for processing wastewater are costly, and the infrastructure for sewerage requires large capital expenditure, which are not currently accounted for in government budgets.
In rural areas emptying and processing faecal sludge is a major challenge, but environmentalists have widely explored ideas to process waste in ways that result in valuable byproducts such as biogas, compost and fertiliser.
The research is there, and a solution relies on public, private and civil society sectors to take the next step, says Mike Rios from 17 Triggers, a social marketing company that has collaborated on sanitation awareness campaigns.
“Currently the majority of development funds go into expensive research, long reports and education awareness campaigns. This has been going on for several years and no 1,000-page report is going to help a farmer’s need for a cheaper, better toilet. It’s time for a change,” he said.
“If we want to change people’s behaviours at the bottom of the pyramid, we’ll need to change the behaviour of the development community at the top first.”
History shows that progress relies on access to clean water and the ability of societies to harness water as a productive resource to build communities and sustainable livelihoods.
When people are denied access to basic sanitation and water as a productive resource, their choices and freedoms are constrained by ill health, poverty and vulnerability.
“We also know that the negative impacts of inadequate sanitation disproportionately affected the poor,” Revell said. “Therefore, improved sanitation is not only the answer to Southeast Asia’s poverty cycle, it also helps make growth more inclusive as economies expand.”