Tamatave — In Madagascar's east coast city of Tamatave, a local taboo against having a toilet in your house or on your land has complicated the task of trying to improve the region's dire sanitation situation.
Nationwide, more than 10,000 people, of whom two thirds are children under five, die prematurely from diarrhoea annually, according to the World Health Organization, which attributes 88 percent of these cases to poor quality water and sanitation.
In the under-developed and flood-prone coastal regions of the country, sanitation is particularly poor and deteriorates even further following a cyclone, a regular event during the rainy season.
"Within three hours, water levels go up so much that everything gets contaminated. In some places, people use traditional pits instead of adequate latrines. When they fill up and overflow, they contaminate the whole environment, including the water wells," said Edwin Joseph of the faith-based organization, Frère St Gabriel, which is working on sanitation projects in the region.
No one needs to convince Joseph of the importance of adequate sanitation. Shortly after his arrival in Madagascar in 2000, the Indian Ocean island was hit by three successive cyclones, and in the aftermath an outbreak of cholera claimed 3,000 lives and hospitalized over 20,000 people.
"The hospitals refused to take in new patients, as they were already too full," he recalled. "Even the verandas of the hospitals were filled with people. In some cases people burnt the dead with all their belongings, as they were afraid of the disease spreading. Our own neighbours - a family of five - died of cholera."
According to the UN Children's Fund (UNICEF), an estimated 7.4 million Malagasy who lack latrines defecate along beaches and rivers. "Sometimes people drink the water from the river," said Joseph. "During the rainy season, all the dirt washes into [that] water."
Overcoming local taboos and convincing people that they need latrines has required some drastic measures. "Our trainers go to the villagers and offer them water with excrement in it to drink. When they refuse, they take them to the river and show them that this is what they drink every day," said Joseph.
Our trainers go to the villagers and offer them water with excrement in it to drink. When they refuse they take them to the river and show them that this is what they drink every day
The NGO also recruits the help of local youth and women's groups. "There was one stretch of beach in Tamatave which was used [for defecation] by 20,000 people. We worked with the youth groups to clean up the place and make it into a soccer field. This way, the young take care others won't use their fields," explained Joseph.
Once a village has decided to be part of the process of improving sanitation, aid workers start a programme called Community-Led Total Sanitation, which encourages households to find their own ways and means of constructing latrines, often by helping them obtain loans from micro-credit institutions.
With UNICEF leading the push for improved sanitation nationally and providing technical assistance, this approach has led to the construction of more than 7,500 latrines in 1,750 villages in Madagascar since 2008.
Campaign with ambitious goal
A nationwide Sandal (Sans Defication Air Libre) 2018 campaign was launched by UNICEF and the Ministry of Water in October 2011. The campaign aims to reduce the 32 percent of Madagascar's population who currently practice open defecation to less than 1 percent by 2018.
Evariste Kouassi-Komlan, water and sanitation manager at UNICEF, told IRIN that reaching this ambitious goal would require 440 villages a year in each of the country's 22 regions to be declared open-defecation free.
"This is a huge job and UNICEF is engaged to push this campaign further," he said.
Frère St Gabriel has already nearly achieved the 1 percent goal on the tiny tourist island of Ile St Marie, off the coast of Tamatave. "They shortly will be the first district in Madagascar to be completely Sandal," said Joseph, adding that he had seen similar campaigns in other African countries achieve impressive results.
"When a government is enrolled, it becomes a mass movement and the whole country stays focused on it. In Madagascar, it's the NGOs that are taking it up. We might not meet the deadline, but it will happen," he said.
[ This report does not necessarily reflect the views of the United Nations ]