Picture this. You are away from home when nature calls and you need to relieve yourself. Within your vicinity are very few public toilets and even so, you would not be allowed to use these rare facilities unless you had money on you.
This is the kind off dilemma that millions of Kenyans continue to face, forcing them to relieve themselves in bushes, trenches or grasslands.
A spot check in urban and rural areas confirms the magnitude of the problem. It is common to spot people relieving themselves along perimeter walls of hedges in most urban centres such as Nairobi.
In the rural areas, open defecation remains a common sight even though health and sanitation campaigns have helped to rein in the problem.
A report the Unicef released in April 2019 showed that and an estimated 5.6 million Kenyans still practice open defecation with about 15.3 per cent in the rural areas.
“Seventy-nine per cent of open defecators are located in 13 counties. Efforts should be concentrated in those high-burden counties to make a significant impact on open defecation,” Unicef Kenya sanitation Manager Julie Aubriot said when he launched the report titled ‘Realising Open Defecation Free Rural Kenya 2018: Achievements and the Road Ahead’.
Turkana County has the highest rate of open defecation at 681 cases, tipping Mandera to second place with 356 cases, followed by Kwale with at 355. West Pokot, Narok, Migori Wajir, Kilifi and Baringo have 341, 332, 254, 233 and 206 cases, respectively. Others are Baringo, Homa Bay, Garissa, Samburu and Marsabit with 195, 190, 186, 185 and 163, respectively.
The Unicef report further showed that only 17 counties had less than one per cent people practising open defecation, representing 64,000 people.
Murang’a, Embu, Kakamega, Kiambu, Mombasa, Vihiga, Meru, Taita Taveta, Nyamira, Tharaka Nithi, Nyandarua and Kirinyanga each have less than 10 cases of open defecation. Only Kitui, Siaya and Busia counties were declared open-defecation-free.
Although they often go unnoticed, public toilets are extremely important in any urban environment. The decline in the public toilet leaves people with no option but to creep into cafe toilets and bars, hoping to avoid the disapproving glare if one is not a customer.
Sanitation, water and hygiene are among the “forgotten foundations of health,” causing hundreds to die every year.
“One gramme of faeces contains 10 million viruses, one million bacteria and 1,000 parasite cysts,” says the Unicef.
World Health Organisation (WHO) and Unicef data reveal that only 29 percent of Kenyans have access to improved sanitation, that is, the use of sanitation facilities that hygienically separate excreta from human contact. This means that about 30 million Kenyans are still using unsafe sanitation methods like rudimentary types of latrines and almost six million are defecating in the open.
The lack of facilities is not only a matter of public health but also touches on issues of safety, women’s rights and human dignity.
To avoid being leered at during the day, some women even hold on for hours until night-time to relieve themselves.
Waiting that long can create health problems, particularly for pregnant women, who are highly susceptible to urinary tract infections.
“Open defecation exposes women to the danger of physical attacks and encounters such as snake bites. Poor sanitation also cripples national development: workers produce less, live shorter lives, save and invest less, and are less able to send their children to school,” says Unicef.
Clean water, basic toilets and good hygiene practices are essential for the survival of children. Water and sanitation-related diseases are one of the leading causes of death for children under five years of age.
Globally, inadequate sanitation is estimated to cause 432,000 diarrheal deaths every year and is a major factor in diseases such as intestinal worms and trachoma.
In July last year, Nairobi Governor Mike Sonko issued a directive scrapping charges on the use of public facilities. However, the directive has not been implemented, with the business said to earn up to Sh6.2 million annually.
Official data reveals that in 2018, diarrheal diseases contributed to 5.5 per cent of total incidents reported in health facilities, while urinary tract infection and intestinal worms accounted for 3.9 percent and 2.1 perecent respectively.
Sanitation in the urban areas is further compounded by the interlinkages with other services including stormwater drainage, solid waste and water supply. For instance, Wajir town has a high groundwater table and shallow water wells, which are the main source of water for domestic and livestock use. This makes the construction of simple pit latrines unfeasible.
Instead, about 68 percent of the 100,000 residents use bucket latrines, a system introduced during the colonial times to protect the groundwater. During the rainy seasons, faecal waste overflow from buckets and is swept away by the stormwater, resulting in contamination of the shallow wells. Consequently, Wajir town suffers from frequent outbreaks of waterborne diseases, especially cholera and diarrhoea.
Analysts say achieving the goal of universal sanitation coverage by 2030, and ending open defecation by 2020 requires a paradigm shift of policies, technologies and mindsets.
“It is estimated that if the current trend of sanitation coverage is maintained, it would take Kenya another 200 years to achieve universal sanitation coverage” Pascaline Wanjiku Ndungu, Water Supply and Sanitation Specialist at the World Bank, observed in an analysis.
The northern counties continue to present very high rates of open defecation, which is also linked to high poverty levels. As the population grows, development takes place and resources become scarcer, the impacts of unsafe disposal of human waste are beginning to bite.
And even as action is taken to provide more toilet facilities, a new joint study by the WHO and partners also urged for protection of sewage workers.
It revealed that millions of sanitation workers in low-income countries are routinely exposed to contagious bugs, powerful chemicals and filthy conditions that can turn out to be deadly.
Researchers focused on cleaners in Bangladesh, Bolivia, Burkina Faso, Haiti, India, Kenya, Senegal, South Africa and Uganda who typically toiled in an “informal economy” lacking basic “rights and protection,” added Dujarric.
Researchers described sanitation workers toiling in sewage pits around the world without safety gear — risking exposure to cholera, dysentery and other killer bugs. Some 432,000 people perish from diarrheal deaths each year, the report said.
They also have to work in tanks with fumes of ammonia, carbon monoxide, sulphur dioxide and other toxic gases that can cause them to lose consciousness and die, or face long-term breathing and eyesight problems.
Few low-income countries have health and safety guidelines to protect sanitation workers, researchers said.
There are no reliable global statistics, but it is estimated that one manhole worker dies unblocking sewers by hand in India every five days.