The United Nations children's charity organisation is working in the Pacific to break down the taboo surrounding toilets and ablutions.
UNICEF data shows about a third of Pacific Island people still lack access to toilets and the region's water, sanitation and hygiene specialist says people shy away from discussing them.
World Toilet Day has long been observed on 19 November, but was made an official United Nations Day by a UN General Assembly resolution this year.
Marc Overmars told Annell Husband in Kiribati and Solomon Islands open defecation is still common.
MARC OVERMARS: About 39% and slightly lower than 20% in Solomon Islands. It's really important to provide attention not just on one day, like World Toilet Day, but really throughout the whole development of communities and schoolchildren. So we have methodologies that look at community approaches to total sanitation. And one of them is, for instance, the Community-Led Total Sanitation approach that's been rolled out in Kiribati and in Solomon Islands, that really makes an appeal to communities themselves to take action and to realise they have the future of their health in their own hands. So they're actually being triggered to take action through several participatory methodologies and community mobilisation methodologies. And they're really being triggered for action on sanitation. So some of them have really been succeeding in direct action of people constructing toilets at a very cheap rate just immediately after this triggering exercise.
ANNELL HUSBAND: So what are these triggering exercises? How do they work?
MO: Well, they actually go into communities with facilitators. And these facilitators are very often from the country themselves, but are actually triggering a discussion process within communities to talk about sanitation. As we all know, sanitation has been a taboo in the Pacific to talk about, maybe also elsewhere in the world. But the 'poo taboo' is very hard to break through. So this Community-Led Total Sanitation is really to break through that taboo by opening talking about defecation and indeed talking about faeces and about faecal matter affecting their health. So they really try to break through this faecal oral route of disease transmission. And it's quite an open approach that makes people think about how their practices are having an impact on their health.
AH: So, with it having been a taboo subject, that must be quite an obstacle that people need to overcome within themselves to be able to discuss these issues.
MO: Yes, indeed. There are really a lot of issues that are coming up in this triggering exercise. And they're deliberately designed to really trigger that. For instance, the feeling of disgust and the feeling of shame - shame because they have open defecation that they practice, and disgust to actually realise they're affected by it directly, being exposed to other people's faeces or by their own faeces. And that relation is really important to really get the triggering process in motion, that people want to take action immediately.
AH: And with people having those feelings of shame and disgust, have they had some prior knowledge of the link between ill health and their faecal matter?
MO: Sometimes they do, but sometimes they really have not been exposed to that. And even if you do understand the link, it's not automatically leading to your behaviour change. You could reason why you could get sick of bugs you can't see, but to really change your behaviour from a practice you've been used to since you grew up is maybe quite hard. So it needs this long-term sustained effort. And maybe the disgust aspect and the shame aspect are triggering even more without the reasoning.
AH: So this programme that you're using, how widespread has it gone? How effective has it been so far?
MO: We've just started. This methodology has been developed in Bangladesh quite successfully with a lot of development partners to really go away from supply-driven approaches to improving sanitation to demand improvements. In the Pacific it's quite a recent approach. In the Solomon Islands and in Kiribati, as I mentioned, they have a high rate of open defecation and they just started this last two years, so they have a long way to go to really sustain this. That's why community-led sanitation should be supported over the next decade or so to really get everybody on board and realising that appropriate sanitation is a great way to improve your health. Is UNICEF doing any work or does this programme cover eco-toilets?
AH: Composting or eco-toilets, as mentioned, we'd like to emphasise that this really exists as an option. And certainly on islands where, for instance, your risk of groundwater pollution is very high, you should actually look into non-polluting technologies.
MO: Like Kiribati?
AH: For instance, Kiribati and other islands in the Pacific have shown that composting toilets can be successful, like in Tuvalu. But it's still a long way to get them accepted by everybody because there's still a taboo on handling faecal matter to make good use of that in agriculture.
MO: So it's the digging out of them that's the problem.
AH: The handling, but even the talking about. So the Community-Led Total Sanitation approach at least opens up that debate to get an open discussion. But to really have that follow-through by technology choice, that is something that really needs sustained effort. So it's not only from the communities themselves, but also by the government and by agencies such as UNICEF.
MO: And do you think that governments in those countries that you've mentioned where open defecation is more widely practiced than in other areas, do you think governments have got their eye on this sufficiently?
AH: Yes, I think it's a great breakthrough that in Solomon Islands there's a national policy being developed for rural water and sanitation and, as a core strategy, it implements the Community-Led Total Sanitation approach to go away from supply-led and technology-led approaches to something that really triggers the demand of communities themselves to invest in their future and in their health. In Kiribati even the president has been announcing he would like to see Kiribati open defecation free by 2015. So these are great ways of the government supporting the kind of approaches that are needed to address waterborne disease.
