Bill Gates 

August 23, 2012

 This was the brief given to applicants of Reinvent the Toilet Challenge initiated by the Water, Sanitation & Hygiene programme of Bill & Melinda Gates Foundation in 2011. The mission of this challenge: To bring sustainable sanitation solutions to more than 2.5 billion people worldwide.

From drinking a glass of water made from treated human waste to bringing a jar of human poop to the recent Reinvented Toilet Expo in China, Bill Gates has done it all to raise awareness about the problem. Such acts may seem outrageous to some, but the world needs such commitment as we are running out of time. Today, 4.5 billion people live without a safe toilet and 892 million people still practise open defecation. A single gram of human feces can contain 10 million viruses and one million bacteria, but in most countries of the global south, human faeces, on a massive scale, is not being treated safely. In such a situation, untreated human feces gets into our food chain and degrades ecosystems. To make this crisis worse, extreme weather events which include unprecedented droughts and floods pose a major risk to our fragile sanitation systems.

The good news is, Bill Gates belongs to a rare club of philanthropists with a profound commitment to bring sustainable sanitation to those who don’t have access to it. Financially, this commitment has translated into more than $200 million investments from the Gates Foundation over the last seven years and he plans to invest more to bring these solutions to the mainstream.

 The ‘Reinvented Toilets’

At the recent Reinvented Toilet Expo in Beijing, a range of companies from around the world came together to display a new generation of non-seweredsanitation solutions that could eliminate harmful pathogens and convert human feces into viable by-products – clean water, fuel and fertilizer.In this expo, Indian companies such as, Eram Scientific, Ankur Scientific and Tide Technocrats displayed their reinvented toilets and small-scale waste treatment plants, which are now ready for sale to municipal and private entities.Some of the winning innovations around the globe which have been funded by the Reinvented Toilet Challenge are:

• California Institute of Technology, USA: CalTechh as developed a self-contained, solar-powered toilet and wastewater treatment system. A solar panel produces enough power for an electrochemical reactor that is designed to break down water and human waste. Excess power can be stored to provide energy for night-time operation or for use under low-sunlight conditions.
• Cranfield University, UK: Cranfield developed a prototype toilet that removes water from human waste and vapourizes it using a hand-operated vacuum pump and a unique membrane system. The remaining solids are turned into fuel that can also be used as fertiliser. The water vapour is then condensed and can be used for washing, or irrigation.
• Loughborough University, UK: The team from Loughborough University has been developing a toilet that transforms feces into biological charcoal (biochar) through hydrothermal carbonization (decomposition at high temperatures in water without oxygen) of fecal sludge. The system will be powered from heat generated by combusting the biochar and will recover water and salts from the feces and urine it produces.

To most of us, these innovations sound like expensive gadgets from science fiction movies.  Even Bill Gates admits “it will be at least a decade” before the reinvented toilets reach tens of millions of people in the poorest areas, and they will have to prove both practical and economical.

Which brings us to an important fact. Hardware innovations are not enough to ensure universal sanitation.

CLTS: A proven approach from the global south

While admitting that there has been limited hardware innovations in the sanitation sector, we have to keep in mind that ‘software’ i.e. behaviour change approaches are important for adoption and ownership of toilets. One of the most successful approaches is Community-Led Total Sanitation (CLTS), whichhas been rolled out in more than 70 countries worldwide. Itis one of the most successful approaches in the development sector with roots in the global south.  Pioneered by Dr Kamal Kar in Bangladesh, CLTS is an innovative approachfor empowering communitiesto completely eliminateopen defecation. It focuses on igniting a change in collective sanitation behaviour, which is achieved through a process of collective local action stimulated by facilitators from within or outside the community. As an approach, CLTS has proved that with the right ‘triggers’ and enabling environment communities will take charge and build their own toilets.

The core philosophy of CLTS is : ‘no human being, rich or poor, wants to live in shit’. Affordable reinvented toilets which can be deployed at scale will be successful if they get this basic philosophy right. The Indian story till now has demonstrated that investing millions through a top-down hardware approach to end open defecation is bound to result in failure.There are hopes that Swachh Bharat Mission might have succeeded in building a sanitation movement among the masses, but building toilets for every household is not enough, communities should continue using these toilets without slipping back to old habits.

Thus, reinvented toilets could play a major role when communities which have lived without access to basic sanitation climb up the sanitation ladder and are ready to adopt these new technologies. However, private companies, NGOs,  national and local governments which are/will be involved in rolling out these reinvented toilets must keep in mind that only a toilet that is ‘desired’ will be a toilet used and ‘owned’.

References:

Bill Gates: Complete speech from Reinvented Toilet Expo in Beijing

https://www.gatesfoundation.org/Media-Center/Speeches/2018/11/Reinvented-Toilet-Expo

Water, sanitation & hygiene: Reinvent the toilet challenge fact sheet

https://docs.gatesfoundation.org/Documents/Fact_Sheet_Reinvent_the_Toilet_Challenge.pdf

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Gita Basfore. Photo: Sayantan Roy Chowdhury

Community action to end open defecation empowers women towards better health in Kalyani Municipality – A case story

A resident of Harijan Para, Gita Basfore was one of the women who led the campaign to stop the practice of open defecation in her neighbourhood. She claims that collective community action to build toilets was one of the best changes to have taken place in her community. The benefits were especially large for the women, especially in terms of their health, safety and dignity, she says. Speaking of how women suffered from the lack of access to safe sanitation, Gita recalls how she would join other women from her para to go to the fields, far away from home, to defecate every day. “We would walk about twenty to thirty minutes to get to the fields every morning. Though this used to take a lot of our time and it also felt unsafe, we had no other choice. We would go early in the mornings at dawn, because we did not want to be seen, especially by men. Even then, there would be strange men peeping and trying to catch a glimpse of us. There used to be many goons and drunkards in those areas back then, and we would always be on our guard, thus always hurrying up and not being able to defecate in peace. Each time we would see someone we would get up, and sit again when they passed by. The experience was not only frightening, but also very humiliating.”

What Gita describes above used to be daily life for women in Harijan Para, before 2006, when open defecation was rampant in this slum in Kalyani Municipality, an urban township in West Bengal’s Nadia district in India. Adds Gita, “For the men, practicing open defecation was not as shameful as it was for us women. They would even talk about it openly. The worst thing was when I could not even talk about how I felt to my own husband because this was not something that was to be spoken about. So we women just suffered it in silence.” Gita’s experience resonates with those of other women from the 52 slums in Kalyani at the time. In a recent study conducted by CLTS Foundation Global, it was found that women’s lack of access to clean and safe toilets in Kalyani, made them vulnerable to health consequences that were specific to women due to gender related norms and practices, such as diarrhoea and other infections arising from delayed urination and defecation practices, unhealthy menstrual hygiene management, and severe psychological stress from risks of gender related violence, shame and fear, all of which took a huge toll on their overall well-being.

Gita Basfore. Photo: Sayantan Roy Chowdhury

Describing the various coping strategies that she resorted to in those days, Gita states, “I would eat very little at night, and at times even skip meals, because I did not want to have to ask my husband to take me to the fields at night. This was a practice I developed in my early days of marriage, when I used to be so embarrassed about having to go out to urinate or defecate. I was afraid that my in-laws would get to know and I wondered what they would think of me. Many women like me cope like this. Even if we want to go, we try and hold it in till the next morning. This leads to many problems such as stomach aches, acidity and constipation. During our menstruation, the experience is far more uncomfortable and painful.”

Gita states that participatory exercises involving community mapping was conducted in the community (as part of the Community led Total Sanitation (CLTS) triggering initiated in Harijan Para in the year 2006) which changed women’s lives for the better. “Building our own toilets was one of the best decisions we took for our health. We women saw this as the best chance to solve the problems we were facing. During the exercises, women were actively involved and we learnt that open defecation was the source of the recurrent diarrhoea that we and our children were experiencing, along with other health problems. It was not only about the shame and safety factor anymore. We could not wait even a day longer to protect our health, which for a working class like us, is a very valuable asset. We realized that the starting point was putting an end to open defecation. The men were equally convinced, but it was the added pressure that all of us women put on the men that speeded up the action.”

Gita and her family members, as the others in her community, have been using a toilet since the CLTS triggering in 2006. Harijan Para became Open defecation free (ODF) within 6 months of the CLTS triggering. It was the second slum, after Vidyasagar Colony, to become ODF among the 52 slums in Kalyani Municipality, which became ODF in the 2009. The benefits of the same are significantly evident today according to Gita. “Diarrhoea cases among our children are practically negligible today. For us women, not only has our physical health improved because of adopting timely and hygienic defecation practices, but the very feeling of safety and convenience that having our own toilet brings, has reduced our stress factor drastically and contributed to a feeling of well-being.” Speaking about the impact on the younger generation of girls and women in the community, Gita adds, “I am very happy that my daughter was lucky enough to grow up in a healthier environment. The children in our community are very aware and conscious about cleanliness and hygiene practices. And it goes without saying that we will never allow our daughters to be married into a household that does not have a toilet. This will secure the future generations as well.”

Preetha Prabhakaran is Programme Manager, CLTS Foundation Global

This case story is part of a study titled “The impact of CLTS on women’s health in urban slums – A case study of Kalyani Municipality”, a joint collaborative effort between the Institute of Development Studies, University of Sussex and the CLTS Foundation Global as part of a project within an Accountable Grant funded by UK Aid from the UK’s Department for International Development.

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It is estimated that more than 1 billion people worldwide defecate in the open every day. A staggering 620 million of them are Indians. In a world of instant communication, space travel, nuclear weapons and bio-engineering this is a shocking statistic. More Indians own a mobile phone than use a toilet. Many choose to defecate at night to avoid the indignity of possibly being seen squatting to relive themselves during daylight hours. Fatally, this was the case for the two Indian girls.

Sanitation brings many health benefits, such as reduced diarrhoea, reduced worm infestations and reduced stunting. In a survey of readers of the British Medical Journal in 2007, sanitation was voted as the single most important medical milestone since 1840. Sanitation also brings dignity, it saves time, and it reduces the risk of being of attacked or assaulted, as happened in Uttar Pradesh. The solution to this challenge may seem simple: build toilets for everyone. It should not even cost that much in the scheme of things. However, past projects that did just that failed. High quality toilets were constructed for households but many were never used for their intended purpose; they were used to store firewood or house livestock instead. Essentially, this was because they were provided via top-down initiatives based on ‘educating’ and ‘instructing’ households and communities to use toilets.

In recent years there has been a revolution in the sanitation world, namely Community-Led Total Sanitation (CLTS), which has put the power of development in people’s hands. Now they do not need to wait for charities or governments to come and build toilets for them (many of which they probably would not use anyway), they are enabled to truly understand the importance of sanitation and the fact that they can do something to improve their living conditions by themselves. Subsequently, people who have spent a proportion of every day of their lives shitting behind bushes and shrubs are now building and using their own toilets without financial support. This is not about hand-outs but hand-ups. CLTS is an innovative, imaginative approach which targets emotions rather than intellect. Not only does it enable households to build their own toilets, it also truly empowers them and builds self dependence (see: https://www.cltsfoundationglobal.com/ for more information).

Dr. Kamal Kar, the creator of CLTS, and included in Foreign Policy Magazine’s list of Top 100 Global Thinkers, once told me over a drink (in his typical flamboyant style) that it is the ‘intellectual constipation’ of governments and sector professionals that is holding back this sanitation revolution. Many governments simply do not appreciate the importance of sanitation and its far-reaching effects. Compared to high-tech sectors such as communications, industry and defence, sanitation is just not sexy! However, thanks to the momentum that has been created since the International Year of Sanitation in 2008, sanitation is beginning to receive the attention it deserves. CLTS is now implemented in more than 50 countries worldwide. Interestingly, one of the countries in which CLTS has not been adopted at scale is Kamal’s home country, where half the world’s open defecators reside: India. Perhaps is it true that ‘no prophet is accepted in his own country’. But even here, the shortcomings of the well-intended but misfiring government Total Sanitation Campaign (which some experts have claimed is ‘doomed to fail’) provide an opportunity to get rid of the ‘intellectual constipation’ that leads to top-down and ineffective solutions. Gradually, I believe, we are administering the required laxative.

In my opinion, technology-based solutions such as the Reinvent the Toilet Challenge funded by the Bill and Melinda Gates Foundation are misplaced. It is not technology that will solve the problem but a change in social and cultural norms, which CLTS aims to achieve. Most toilets constructed under CLTS programmes are low-cost, simple facilities located outside the house or dwelling. This is the first step to stop people from defecating in the open. Even in developed nations, where sanitation has had far-reaching impacts on health and well-being over the past century or so, toilets inside the house are still a relatively new development. I recall using an outside toilet at playschool when 3 or 4 years old, and my father tells the story of hearing his young neighbour shout “I need attention!” whenever she had finished her business in the outhouse.

Those unfortunate girls in Uttar Pradesh were not looking for attention at all. All they needed was a toilet.

The author of this blog is Peter Harvey. ( You can view original blog post on  http://peteharvey.net/2014/06/10/in-need-of-a-toilet/)

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