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Poor hygiene costs Kingdom

Cambodia trails neighbours in sanitation coverage, but experts see progress.

CAMBODIA is struggling to meet global goals to boost sanitation levels, according to a UN report released this week, highlighting the Kingdom’s battle to curb deadly and preventable illnesses that stem from poor hygiene.

Cambodia remains one of the only countries in the region not on track to meet a Millennium Development Goal to halve the percentage of the population that lacks access to toilets by 2015, according to the report from the World Health Organisation and UNICEF,
which tracks global progress on introducing basic sanitation and drinking water.

Roughly 29 percent of the population in Cambodia had access to “improved sanitation facilities”, which the report defines as a toilet that hygienically prevents human contact with excrement. The figure, based on data from 2008, represents a 20-percentage-point rise over the 1990 benchmark.

Of particular concern is the number of people who defecate outdoors because they do not have any kind of toilet whatsoever. The report found that 1.1 billion people around the world defecate in the open – a largely rural phenomenon that health experts want to end because it can lead to the spread of dangerous diseases such as cholera.

“It is a known fact that poor sanitation and poor drinking water is the biggest factor leading to diarrhoea and other diseases,” said Nasir Hassan, environmental health adviser for the WHO’s office in Cambodia and Laos.

“Diarrhoea is a disease of poor sanitation.”

Studies have shown poor sanitation and hygiene have a severe impact on both health and the economy. Nearly 10,000 people a year in Cambodia die from diarrhoea and other diseases related to poor sanitation, according to a 2008 study from the World Bank’s Water and Sanitation Programme. The study pegged economic losses at just under US$450 million a year, or the equivalent of 7.2 percent of the country’s GDP.

Chea Samnang, director of the department of rural health at the Ministry of Rural Development, said it has been difficult to convince many villagers of the need for proper toilets.

“In rural areas, people live near bushes and fields. They defecate there because they are not interested in defecating in toilets,” Chea Samnang said. “It is a struggle that has contributed to a low level of toilet use in rural areas because people do not want to change their habits.”

Health experts say many villagers have not viewed the installation of toilets as a priority compared with basic necessities such as clean water.

“Many people do not see the need to build toilets,” said Hilda Winarta, water and environment sanitation specialist with UNICEF.

However, attitudes are changing. Authorities have been active in pushing for rural sanitation improvements, Winarta said, spurred by the realisation in 2005 that Cambodia was the only country outside Africa in which less than 20 percent of the population had access to improved sanitation facilities.

Community education programmes have been implemented and yielded successes, she said.

“Statistics from the WHO show one gram of [human excrement] contains millions of viruses. You can imagine that almost 80 percent of village communities practice open defecation,” Winarta said. “That’s why diarrhoea has continued to be among the three major killers of children under 5 in Cambodia.”

The programmes, she said, prompt villagers to analyse their own situation.

“How many families do not have toilets? How much human waste is produced in a village on a daily basis? Usually, it tends to open the eyes of a community as to how bad the situation is,” she said.

Though the global Millennium Development Goal demands that countries halve the percentage of their population that cannot access toilets, the country has set a target of 30 percent coverage in rural areas by 2015. The government’s current figure, based on 2008 census data, stands at 23 percent, meaning that its own target could be within reach.

Experts point out that strides have been made. Since the benchmark year of 1990, more than 3.3 million Cambodians have gained access to improved sanitation, according to the WHO/UNICEF report.

“First of all, we are impressed with the progress in Cambodia,” said the WHO’s Hassan. “If you compare with the region, yes, we are behind. But I am happy with the intensity of the programme. The national government and, I think, the prime minister himself are very concerned about this issue.”

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