Coastal Province — Among members of the Mijikenda community of Kenya's Coastal Province, it is taboo for a father-in-law's faeces to mix with those of his daughter-in-law.
Gender-separated open defecation spots are designated to ensure that this taboo is not broken. With such strong cultural edicts, the idea of a pit latrine - or a toilet of any kind for that matter - simply is not acceptable.
In Kilifi District, where many Mijikenda dwell, open defecation is the norm. Dr. Benjamin Tsofa, the district's public health and sanitation officer, said there is a daily battle against the high rate of sanitation-related diseases locally, leaving the youngest children extraordinarily vulnerable.
It is a problem played out across Africa. One of the United Nations Millennium Development Goals (MDGs) involves improving access to affordable clean water on the continent by 50 percent by the year 2015.
But a new report entitled "Off-Track, Off-Target" released this week by the international charity WaterAid, shows that there are more people in the world today lacking adequate sanitation services than in 1990, and there are still 2.6 billion people with nowhere safe, private or hygienic to go to the toilet.
Unless urgent action is taken, nearly all governments in sub-Saharan Africa will fail to meet the MDG pledge they made to halve the proportion of people without sanitation by 2015, WaterAid said. Only 20 countries in the region are on target to meet that goal. Even more alarming, researchers estimate it will take more than two centuries for sub-Saharan Africa to attain the MDG goal.
Diarrhoea kills a child every 20 seconds worldwide. In fact, it kills more children every year than Aids, malaria and measles combined, according to WaterAid. Lack of access to clean water, and poor hygiene practices such as open defecation and lack of hand-washing afterwards, are leading causes of diarrhoea.
In Kilifi district, as across the continent, powerful cultural practices and taboos around personal issues such as defecation pose daunting challenges to public health officials. To address the problem, in 2007 the Ministry of Public Health and Sanitation issued a directive requiring all villagers to cease open defecation and build pit latrines in every homestead.
Tsofa says villagers complied and built the pit latrines. However, "They were never used, as the villagers sarcastically referred to them as the 'chief's toilet.' And then they were eventually converted into stores."
"We stakeholders realised that the use of force would not get us to address the sanitation challenges our district was dealing with," Tsofa said. "Instead, if we hoped to succeed, we needed to have a process that the villagers could identify with and that they could own as theirs; we had to go back to the drawing board."
The solution came from Plan-Kenya, which is affiliated with Plan International. Plan Kenya staffers had just returned from a Community Led Total Sanitation (CLTS) training held in Ethiopia and Tanzania. CLTS was started in 1999 by Kamal Kar in a small village in Bangladesh, and has enjoyed tremendous success in many other Asian and African countries. It emphasizes having the community lead the project.
Tsofa and other stakeholders introduced CLTS in July 2007 in the village of Jaribuni (Swahili for 'let us try'). Led by the Ministry of Public Health and Sanitation and Plan Kenya, this program tapped into the already existing network of community health workers to inspire conversations about open defection and community-led pit latrine construction and usage.
When the project started, only three of the 45 homesteads had a pit latrine. Within three months and with no external funding, pit latrines had been constructed in all homesteads and were used by everyone. By May 2008 in response to the success of this initial CLTS project, all Kilifi public health staff was trained in the CLTS approach.
Community health worker Francis Katana said the CLTS project works where other attempts have failed because it demystifies a deeply held taboo.
"We walk around the village viewing the open defecation sites," he said.
"As we do this, villagers observe that though the sites are segregated, when it rains the faeces do in fact mix, and because of this they are able to deduce that it is not the construction nor the use of a pit latrine that will lead to the breaking of this important cultural taboo - it is already happening."
This was an eye-opening experience for villagers in Katana's Chuda village.
"Once we began to use the latrines, there was a marked decrease in the number of deaths, especially those related to diarrhoea and vomiting," Katana said. "The villagers began to notice this difference and today they not only observe this hygiene, they have begun to teach the use of pit latrines to their children so that the concept is passed on to the next generation."
However, Tsofa said this public education and enlightenment must be vigilantly maintained. CLTS workers capture the attention of villagers during public meetings, and they begin with a rather provocative statement: "Nyinyi mnakula kinyesi chenu." This is Swahili for: "You are eating your own faeces." Tsofa said this always gets the villagers talking.
Next, defecation areas are identified, walks are organized and real faecal specimens are collected. Residents go back to the village, and the CLTS facilitators put food, such as a slice of bread, next to the collected faecal sample and the villagers are asked to observe. Soon, flies swarm, and sometimes a chicken or dog will wander by, step on the faeces then step on or nibble at the bread before moving on.
A sense of disgust is triggered among the villagers as they observe this direct contamination of food and the facilitator will then ask them: "Who wants to stop eating [faeces] in this village?"
By the end of the session, the villagers readily admit they have been unknowingly making themselves sick. They are prepared to commit not only to building pit latrines, but they also vow to use them. Once their homesteads are certified as "open defecation free", celebrations are held in honour of the village and officials from the Ministry of Public Health and Sanitation offer the villagers a certificate.
"This certification works wonders," Tsofa said, "and out of the villages that have so far been certified [as open defecation free], none has lost its status. The push now is to have Kilifi as the first [certified] district - not only on the coast but in the whole of Kenya."