Ahead of World Toilet Day, SNV WASH Advisor Raj Kumar Bhattrai joins in the #RuralSanitationMatters call to action by sharing some accounts on how Bhutan’s RSAHP is making a positive impact on the elderly, people with disability, and quality of health care in Bhutan’s sub-districts. Yet again, he writes, Bhutan concludes this year with marked progress in sanitation as almost half of the country’s sub-districts now have access to basic sanitation.
Not so long ago, in the small village of Jangwakha, open defecation practice was the norm. Few households had pit latrines; many were a good distance away from their houses. Said the village’s women, ‘Now, everyone has pour flush toilets, which are either inside, attached or close to the house’. A 75-year old woman added, ‘The best and biggest advantage to having a pour flush toilet is the convenience and privacy that it offers to us women, elderly and children’. Jangwakha village is now open defecation free.
In Samdingkha village, Health Assistant Ms Sonam Choki shared the improvements she had witnessed since the introduction of the government’s Rural Sanitation and Hygiene Programme (RSAHP). According to Ms Sonam Choki, service delivery from the health care facility has improved significantly. She explained the benefits of training personnel in health care facilities. She said that the knowledge and tools cascaded to health care personnel through Community Development for Health (CDH) workshops – Bhutan’s version of Community-Led Total Sanitation  and WASHFIT (WASH in health care facilities) were key drivers behind this improvement. Ms Choki was once trained by SNV and is now a skilled CDH facilitator .
Angay Gyem (F) and Angay Thuji Dem (B), Samdingkha village
Strolling further inside the same village, our team was greeted by two elderly sisters: 75-year-old Angay Thuji Dem and her younger sister Angay Gyem (73) who lives with hearing and speech impairments. Angay Thuji expressed her happiness over owning a toilet very close to her house. Finally, she said ‘a clean, accessible toilet is now attached to my house’. Demonstrating how she can now easily access her toilet without fear and so much of a struggle, she remarked ‘I now wash with water after using the toilet. In the past, I used grass, rags and leaves’. Although Angay Gyem could not utter a word, her face brimmed with the same joy as her sister’s .
Clean and private toilet with water for flushing, Punakha district
Handwashing with soap at facility in close proximity to house, Dagana district
It’s been over a decade of SNV’s implementation of its rural sanitation product – Sustainable Sanitation and Hygiene for All (SSH4A) – in Bhutan. Having had engaged with SNV’s WASH team in different capacities at the start, it has been a privilege to witness these incremental yet life-changing developments. Not so long ago, SNV teams would walk for hours (and even days!) to reach communities. It was a rarity to meet people with access to basic pit latrines, moreover, those who owned a pour flush toilet, within an acceptable distance to its users.
With regular monitoring, we are now able to document these changes. Until last year, 81 sub-districts and two districts had access to 100% improved sanitation . This year, 12 more sub-districts and an additional two districts have achieved ODF taking the total percentage of open defecation free sub-districts and districts with access to 100% improved sanitation to 45% (93 of 205) and 20% (4 of 20) respectively.
It brings me great pride to be part of SNV’s WASH team, a trusted partner of the Government of Bhutan in achieving 100% access to improved sanitation.
 CDH workshop is one method of demand creation that motivates the community to improve their own sanitation and hygiene facilities, and take a concerted interest in maintaining facilities.
 Early this year, SNV Bhutan hosted a learning event on WASH and health care facilities? Access proceedings and summary here: WASH in rural health care facilities, Proceedings of an SNV Sustainable Sanitation and Hygiene for All learning event and WASH in rural health care facilities, E-group discussion summary.
 Read the latest SNV Bhutan WASH research and practice briefs on gender, social inclusion and people with disabilities: Leaving no one behind: National Rural Sanitation and Hygiene Programme of Bhutan and Developing approaches to Do No Harm.
 Within the RSAHP and in Bhutan, improved sanitation is equivalent to the JMP’s basic sanitation level.
Banner photo: Author with Health Assistant Ms Sonam Choki at health care facility in Samdingkha village | All photos by SNV/ Aidan Dockery.