Ethiopia’s Paradoxical Narratives of Sanitation

Ethiopia’s Paradoxical Narratives of Sanitation


By Mekonnen Teshome Tollera – Ethiopia, through its unique Health Extension Program (HEP), has registered quite impressive results in the promotion of community and household-level hygiene and sanitation. To this end, reports of the Ministry of Water, Irrigation and Energy indicate that the country’s national water supply access “coverage”, has reached 84% during the first phase of One Wash National Program (OWNP), from 2013 to 2015. Its recorded rural and urban water supply access has also been 82% and 91% respectively.

Rural Water Supply Specialist with UNICEF-Ethiopia Mr. Haimanot Assefa, says the country has shown a 53 percent reduction in Open Defecation (OD), from 80% in 2000 to 27 % in 2015, which is the highest in the world when it comes to the population-practice proportion.

Similarly, 18.7 million people gained access to water supply through the construction of 38,336 different types of water supply schemes only from 2014 to 2017.

The country, however, has other paradoxical narratives beyond the successful sanitation stories. The storylines are characterized by impressive results in creating Open Defecation Free (ODF) society but low performance in basic sanitation, remarkable latrine access both in urban and rural areas but these are unimproved facilities and higher risks of diseases the like trachoma.

Ethiopia is the most trachoma affected country worldwide, with women
as well as children aged 1-9 at the greatest risk of infection, according to Mr. Abireham Misganaw, a public health expert and a member of the Waste Management Team of the Ethiopian Ministry of Health.

The expert cited a national survey stating that the prevalence of active trachoma for children in the age group 1- 9 is 40% because of lack of improved access to water and sanitation.

Despite the notable growth repots of the Ministry of Health in the coverage of unimproved latrine and sanitation access which has reached 72 % from only 8 %, the poor quality of the sanitation condition is still negatively affecting people’s health Ethiopia.

Hygiene and Environmental Health (HEH) Directorate Director with the
Ministry of Health Mr. Dagnew Tadesse told Down To Earth that Ethiopia should now turn its face to ensuring improved quality sanitation and water supply schemes. “There is also a huge problem in the management of domestic sewerage in urban areas especially in the Capital Addis Ababa where most residential houses connect their latrine sewerage to nearby small rivers.”

In spite of the huge growth in water supply access and reduction of open defecation, the Sustainable Development Goals (SDG) indicated that the country has witnessed the lowest proportion of population with Basic Sanitation of 7 % as of 2015 while quite remarkable results has been achieved by other African countries like Rwanda that could lift up its improved sanitation to 62% from only 44%.

The experience of Ayantu Taffa, a mother of three, in the rural Kebele of the Sandafa area of the Oromia Regional State corroborates with the situation of increased access to water and latrine facilities but not to the desired quality.

Ayantu says: “Thanks to the Health Extension Program, our family has
now a pit toilet access and to water well dug by a charity organization. However, the water facility frequently fails to work and as the toilet has no disposal system it is now full and we don’t know what to do in getting another toilet. We are also not comfortable with the flies around the over used pit toilet. ”

“As the quality of water we get from the well has some hygienic problems, our children sometimes suffer from diarrhea and I worry when they couldn’t go to school for sometime due to their sickness.”

Admitting the problems of the unimproved pit toilets, Mr. Dagnew indicated that the Ministry of Health is now undertaking various activities to guarantee accessibility of improved toilets in rural Ethiopia through the implementation of the “On-site Household Latrine Technology Option Planning, Design, and Construction Manual” and Sanitation Marketing scheme. The manual comprises recommended options and ides of expanding improved latrines with slab; Ventilated and Twin Alternating vault (pit).

With ambitious and practical steps, the Ethiopia government and its key international partners including UNICEF, WHO, the World Bank and others are implementing the exceptional and exemplary “One WASH National Programme” (OWNP). It is a sector wide approach (SWAp) established with the broad objectives of achieving water, sanitation and hygiene results in Ethiopia following the promulgation of official policies, strategies and development plans.

“The programme has four components of Rural and Pastoral WASH; Urban
WASH; Institutional WASH; and Program Management and Capacity Building with the objective of contributing towards improving the health and
well-being of populations in rural and urban areas of Ethiopia,” OWNP
Review document of the first phase states.

The program is focused on providing water and sanitation service to 382 rural administrative areas (Woredas) and 144 medium and small towns. Phase I of the program has been implemented since 2014 focusing on the four components and financed by its pooling partners GoE, Communities, AfDB, DFID, WB, UNICEF (Embassy of Finland) totaling USD 438.7 million and targeting 5.96 million (3.8 million rural and 2.16 million urban) direct beneficiaries.

From the available USD 1.633 billion for WASH investment for Phase I, USD 766.9 million was invested up to last Ethiopian fiscal year from government capital budget [47% of the available budget for phase 1].

International partners like the World Bank are highly committed to finance the WASH Programme and to jointly design all the programs and implementation plans. The bank provides like “International Development Association (IDA)” financial grants aiming at increasing access to sustainable water supply and sanitation services.

As part of the rural effort to increase access to improved latrine facilities, the Addis Ababa Water and Sewerage Authority is also embarking on the construction of various types of toilets. Mrs. Tsegenet Tesfaye, Authority General Manager and Board Office Head, indicated that a total of 728 standard quality toilets (456 shared, 162 portable and 110 public ones) were constructed by the Authority in Addis Ababa to enhance sanitation and curb open defecation in the capital city.

This situation has now facilitated access to public toilets especially for very low income citizens including homeless in the city. A young homeless boy told this writer: “I now need to have only 1 Ethiopian Birr (less than one US cent) to use a public toilet and avoid Open defecation. I think the government is doing well and this should be strengthened”

Regardless of the notable achievement in the access to sanitation facilities quality is yet to come. National Hygiene and Environmental Health Strategy also confirms that improved latrine coverage in the last 25 years is only 28%. The average annual improved latrine growth rate is sluggish (1.2% per year).

Citing a recent study, Mr. Haimanot Assefa of UNICEF Ethiopia on his part indicated that over 90% of urban residents use an on-site sanitation facility of which nearly 80% are dry pit latrines in Ethiopia.

He said that only less than 3% has access to a sewer connection to remove waste water from households in Ethiopia. This situation has resulted in a severe water bodies’ pollution. When it comes to water body’s pollution, no one compares with the Addis Ababa’s “Akaki River”.

“It has been evident from our findings that, the water quality of the Akaki River shows pattern of behavior linked to anthropogenic sources with the intensity of human pressure associated with industrial effluent, domestic wastes and agricultural activities,” a recent Ethiopian Public Health Institute and Ministry of Health joint study states.

The report further explained about Akaki River, which is also a main tributary of Awash River (a big water body that connects many states of Ethiopia) – “Akaki River uses for irrigation of agricultural land, industrial and municipal waste disposal site, domestic purpose, and as a drinking water sources for the Addis Ababa city (as well field) and 2 downstream population particularly for Adama city, which is the capital city of Oromia regional state.”

Mr. Alemu Biyazine is a resident in the Akaki Kality sub-city of Addis Ababa and earns his living by growing vegetables by the side of Akaki River and using its water for irrigation.

He says: “I know that the river is found at the end of the downstream of the Addis Ababa city and brings all the odds and highly polluted with all sort of pollutant things. But I should continue to grow vegetables using its water to feed my children.”

“Our children and domestic animals usually get sick and it’s stringent odder also affects our lungs and noses. But where should we go?” he added.

Yes, poor sanitation has its own costs. The Ethiopian National Hygiene and Environmental Health Strategy confirms this by stating : “…poor sanitation costs Ethiopia Birr 13.5 billion each year, equivalent to about Birr 170 per person per year or 2.1% of the national GDP.

Yet, eliminating the bad practice would require only 6 million improved
latrines to be built and used.”

Well aware of the challenges of existing unimproved latrines, the government, in its Second Growth and Transformation Plan (GTP-II), 2016-2020, and Phase II of One Wash National Program, set targets to increase households’ access to improved latrine facilities, from less than 28 percent to 82 Percent by the end of 2020; and in ODF kebeles (villages in Ethiopia), from 18 percent to 82 percent.