Did you know that every year, the world marks Global Handwashing Day on October 15 and World Toilet Day on November 19? The former is an international handwashing promotion campaign to motivate and mobilise people around the world to improve their handwashing habits. And the latter, an official United Nations observance day to inspire action to tackle the global sanitation crisis. According to a recent report by the United Nations, worldwide, 4.2 billion people live without “safely managed sanitation” and around 673 million people practise open defecation. ‘Clean hands for all’ was the theme for this year’s Global Handwashing Day and ‘Leaving no one behind’ for World Toilet Day. This year, Rwanda combined the two days and held events in Bugarama sector, Rusizi District, last week. The main objective was to inspire united action in Rwanda to ensure all people benefit from the public health impact of improved toilet use and handwashing with soap. A recent Rwanda Demographic and Health Survey shows that 86 per cent of households use improved latrines. However, only 66 per cent use a toilet that is not shared. Also, over (approximately) one million people in Rwanda still do not have access to an improved toilet. The assessment indicates that only 4.4 per cent have access to a handwashing facility with water and soap in their dwelling. According to officials, this means that the many households in Rwanda are not set up to allow people to wash their hands with soap after they use the latrine, or before they eat food. WHY GOOD SANITATION AND HYGIENE IS CRUCIAL Diarrheal disease, caused by pathogens found in faeces in the environment, is the leading cause of death in children under five years in Rwanda. 2014-2015 RDHS shows that diarrheal morbidity for children under five years accounts for 12 per cent in Rwanda. Diarrheal disease can also compromise children’s physical and cognitive development, mainly due to chronic malnutrition, to which exposure to pathogens from faeces in the environment can contribute. Meanwhile, up to two-thirds of cases of undernutrition are due to inadequate water, sanitation and hygiene. Alphonsine Mukamunana, the environmental health specialist at the Ministry of Health, says toilet use and handwashing with soap helps to break the cycle of diarrhoea and undernutrition. She says toilet use and handwashing with soap at critical moments before handling food and after defecation, are most effective ways to reduce exposure to faeces in the environment which can infect adults and children. 66 per cent of primary schools in Rwanda have handwashing facilities with soap and water (basic hygiene service). On average, 54 primary school students in Rwanda share one toilet with only 53.6 per cent having access to improved drinking water, she says. Mukamunana says lack of hygienic latrines and handwashing stations in schools threatens the education of children, who are at risk of getting sick due to poor hygiene and as a result, miss school. “Hygienic toilets and proper washing stations will help stop the transmission of germs that cause diseases like diarrhoea,” she adds. Globally, 16 per cent of healthcare facilities had no hand hygiene facilities, while 36 per cent of schools had no handwashing facilities, indicating poor handwashing practice everywhere, including schools and health service settings. This endangers lives and prevents healthcare workers from practicing and reinforcing healthy hygiene habits. Anecdotal reports indicate that health facilities in Rwanda are better equipped with basic sanitation and running water and soap for handwashing. However, Mukamunana says equipping health facilities with basic tools to practice and promote good sanitation and hygiene behaviours needs to be a national priority, to continue to improve the health of people in general. At the time of child birth, she says simple acts like hand-washing with soap, sterile equipment and the use of antiseptics can be the difference between life and death. EFFORTS FROM THE MINISTRY The Government of Rwanda is committed to ensuring that every household in Rwanda has its own improved or hygienic toilet by 2020. By 2024, it expects that all people in Rwanda are washing their hands with soap at the critical moments. During Sanitation and Hygiene Week, the Ministry of Health (MoH) with other non-governmental organisations, including UNICEF, launched the National Sub-Strategy for Handwashing with Soap, which is aimed at creating a culture of handwashing with soap for all in Rwanda. MoH is also leading district authorities and partners in a national sanitation and hygiene improvement campaign. In collaboration with other partners, MoH is developing communication tools and materials to share with districts to support these efforts. It is also ensuring that people are using hygienic latrines and handwashing facilities. This, Mukamunana says, is not only because it is imperative for the good health of individuals, but it is critical for the well-being of the community as a whole. WHAT IS THE SITUATION? Globally, over 700 children die every day from diarrheal disease caused by unsafe drinking water, sanitation and hand hygiene. Diarrheal disease is the leading cause of death for children under five years in Rwanda, according to RDHS. The diarrheal disease can undermine children’s physical and cognitive development mainly due to chronic malnutrition by exposure. In 2015, RDHS reported that few households in Rwanda had handwashing facilities with soap and water. This indicated low levels of practicing handwashing. Only 4.4 per cent of households in Rwanda were equipped to enable the practice of handwashing with soap, while 12 per cent had a place for handwashing. Of these, only 37 per cent were equipped with both water and soap, which means 4.4 per cent had a handwashing facility with soap and water. WHAT IS REQUIRED FROM THE POPULATION? MoH urges the public to make sure their household has a hygienic and private latrine, where all members of the family have access. The latrine slab should be solid with no holes that might allow faeces to enter the environment. People should ensure they have a place with water and soap for handwashing in their household area, where all family members can easily access. This place, however, should be near the latrine, so that one can wash their hands after using the latrine. Also, water should be placed near the cooking and eating areas so that one can wash their hands with soap before handling food. It’s also important for parents/adults to teach and support children to use the latrine properly and to wash their hands. “As parents and older siblings, you can be role models by handwashing with soap so that young children grow up with handwashing as a behaviour that is ingrained in their daily habits,” says Mukamunana. Rajat Madhok, Chief, Communication, Advocacy and Partnerships UNICEF Rwanda, says, in an effort to support Sanitation and Hygiene Campaign, they are leveraging its partnerships with the private sector (primarily companies producing sanitation and hygiene products), to promote handwashing with soap at critical times. He says they are also supporting 10 districts to achieve 100 per cent access to household sanitation, by supporting them to plan, monitor and ensure every household, including the most vulnerable, has access to basic hygienic and a safe latrine. Madhok says small investment in building and behaviour to use safe, hygienic and private sanitation and handwashing facilities will yield a large return in terms of child and adult health and survival, thus, building a stronger modern country. Key expectation from the communication effort under the campaign, he says, is that the household decision-makers, including household heads, influential household adults, and youth in both rural and urban settings, will invest their time, finances and effort to ensure that their house has a hygienic latrine and a handwashing facility that always has soap and water. editor@newtimesrwanda.com
