In general, Bhutanese people, like most people, are raised not to talk about poo. As a topic hard to discuss and usually not at the top of people's priority list, it is easy to neglect sanitation and hygiene. People are more interested in buying a television, an expensive mobile phone or a car, rather than having a toilet.
The same can go for leaders and local authorities who may not find investing in sanitation and hygiene as glamorous as, for instance, improving education or constructing roads. The impacts of poor sanitation often seem remote. But sanitation is actually very important in terms of its impact on public health and on stunting in young children. The economic impacts are often overlooked.
Bhutan provides free public health care and education, but the collective costs of treating sanitation related illnesses can be huge, not to mention the lost education opportunities and labour productivity. Poor sanitation accounts for 30% of health cases reported. Poor sanitation and hygiene also perpetuates gender inequity, with girls sometimes missing days of school during their period because they lack access to hygienic toilets and sanitary napkins. And there is an additional burden for women who usually care for the children and the elderly.
In 2008, SNV supported the government of Bhutan in developing a new approach to sanitation and hygiene with the aim of achieving universal improved sanitation coverage in Bhutan. This resulted in the national Rural Sanitation & Hygiene Programme. The integrated approach, which is based on SNV's Sustainable Sanitation & Hygiene for All (SSH4A) programme, focuses on fostering positive hygiene behaviour change, building demand for improved sanitation, encouraging private sector solutions, and developing effective WASH governance at all levels. The programme starts with what the community has already accomplished in other areas and builds on that to create momentum for change.
After seven years, there is wide spread recognition that the approach works really well and has been fully endorsed by the Ministry of Health in 2010. With the help of SNV, UNICEF and the Red Cross, the programme has now reached nine of the twenty districts, mobilizing families and communities to invest in improved sanitation, without subsidies. To date, 24 sub-districts have reached 100% access to improved sanitation.
Mr. Pema Lobzang, Health Assistant from the Mongar district said, "In order to reach the poorest 10%, the whole community came together to help by donating time and money. Getting to 100% wasn’t easy, but we did it. The impact of improved sanitation is clear. We are seeing fewer and fewer cases of diarrhoea, particularly amongst children and the elderly."
Significant gains have been made in improving sanitation, but there is much more to be done. Beyond expanding coverage, we are broadening the focus to include emerging priority areas such as menstrual hygiene management, hand washing, and fecal sludge management. Every effort is being made to ensure that the programme does not leave anyone behind, including the elderly and people living with disabilities.
The Government of Bhutan has now made sanitation and hygiene a priority, committing to increasing rural access to improved sanitation and hygiene from 54% to more than 80% by 2018. While this is a big step in the right direction, there is not enough funding available to support this commitment.
Mr. Rinchen Wangdi, Chief of the Public Health Engineering Division said, "Achieving the goals Bhutan has set will require strong leadership and investment from the government (an investment of $2.7 per person leads to improved sanitation and hygiene practices district-wide). This means prioritising sanitation and hygiene in budgets, in plans, and in the minds of our local leaders." He added, "If we can do that, we can achieve universal access to improved sanitation and hygiene in Bhutan."