Cotabato鈥檚 quest for public health
TOILETS outside houses in the upland village of Kuya, South Upi, the only municipality in Maguindanao province and in the Autonomous Region in Muslim Mindanao that has achieved zero open defecation. FRINSTON L. LIM
For years, thousands of families in communities in this farming town have “shot-boom” close to their homes.
No, this is not a kind of crude weapon, although it could also have life-altering, if not outright deadly, effects on villagers, particularly children, who use it.
Simply a shallow hole hastily dug on the ground, shot-boom is a convenient but unsanitary method of disposing of human wastes that has been common in many communities in North Cotabato province, where water supply is scarce and good toilet facilities are a rarity.
“You squat on the hole and boom, you’re done in a matter of minutes. No need to flush it down with water,” explained Mila Gumisad, a village health volunteer in President Roxas.
Villagers, particularly farmers, do not even bother to dig a hole when the urge to defecate arises. In fact, in Gumisad’s village of Kamasi, not a few choose to answer nature’s call even in the open, she said.
Article continues after this advertisement“According to them, they can defecate behind trees or bushes, or in the middle of a cornfield, so why bother building a toilet? It was their thinking that their toilet was a vast expanse of grassland or cornfield,” the nutrition scholar for Kamasi told the Inquirer.
Article continues after this advertisementBut it was only later when they realized the high price they had to pay for taking for granted sanitation and hygiene. People were getting diarrhea and children were malnourished.
“People then did not budge. It hadn’t sunk in them yet the correlation between the lack of toilets and the emerging cases of diarrhea affecting children,” Gumisad said in the vernacular.
It took outsiders to jolt the community into realizing that something must be done to prevent disease outbreaks and stem the rise of malnutrition cases. Open defecation must be dealt with resolve, she said.
Globally, the World Health Organization warned that much remains to be done in improving sanitation and hygiene, particularly in developing countries like the Philippines. At least one out of seven people in the planet, or about 1 billion people, practices open defecation. Ninety percent of them, or nine out of 10, come from rural areas. About 2.5 billion people also lack access to improved sanitation, contributing to the spread of infectious and fecal-borne diseases like diarrhea. In the Philippines, at least 7 million people have no access to toilets and thus are more prone to defecation.
The lack of toilets and proper bowel disposal facilities in many areas in North Cotabato had resulted in health problems among residents, local and health authorities said. Diarrhea and other water-borne diseases were prevalent.
“Children got sick and many of them suffered from malnutrition,” said Gumisad. “It was then we realized something must be wrong with the way we looked at cleanliness and sanitation.”
Help came in 2013 when the United Nations Children’s Fund (Unicef), through international humanitarian organization Action Against Hunger (ACF), took notice of the need to educate the people of Kamasi about the importance of having a toilet.
At first, people were slow to accept the new concept and recognize the correlation with having a toilet and a healthy and disease-free environment.
“Some were stubborn. It was difficult to convince people right away,” admitted Angelina Ganancial, the village chief.
With the help of ACF-trained volunteers, community-led total sanitation (CLTS) training programs were conducted, participated by purok (communities) or groups of household representatives, Ganancial said.
Soon, the zero open defecation (ZOD) campaign began to take shape in Kamasi.
‘Shock and eww’
Lectures and seminars were conducted with emphasis on the harmful results of feces-contaminated flies making contact with food being consumed by villagers.
“The lecturers even told us that due to shot-booms and defecating in the open, we run the risk of eating our own feces. It was that gross that many of the listeners almost threw up,” the village official said.
Health officials said the strategy of “show and shame” was an effective way in achieving a 100-percent ZOD in President Roxas and other areas in North Cotabato.
Teogenes Baluma, regional Department of Health chief, said the ZOD campaign has been part of health priorities in the Soccsksargen (South Cotabato, Cotabato, Sultan Kudarat, Sarangani and General Santos) region.
“Defecating anywhere causes infectious diseases as flies attracted by human excreta could land on food. We could cut the source by building toilets,” said Baluma, acknowledging that water-borne and fecal-borne diseases such as diarrhea were a health concern in the region some three years ago.
Baluma said the “shock and eww” technique in advocating ZOD had been effective in winning even the indigenous communities in Malungon, Sarangani province. Malungon was the first local government to be declared 100-percent ZOD in the region.
The regional health official also emphasized the advantage of using water-sealed or flush-type latrines against Antipolo-style or pit toilets in ensuring proper sanitation and hygiene.
“Flies cannot penetrate water-sealed latrines and get on top of feces. Also, the smell cannot escape outside. These toilets are the safest,” Baluma said.
The degree of success in water sanitation and the ZOD campaign in North Cotabato “is a great achievement,” according to Suresh Murugesu, ACF Philippines technical coordinator.
Aside from President Roxas, the town of Arakan was also declared on Nov. 18, the eve of World Toilet Day, 100-percent ZOD.
IPs take the lead
To ensure sustainability, communities in the two municipalities have enacted ordinances related to ZOD. For instance, fines up to P1,000 and hours-long community service are meted out to residents in Kamasi who are caught defecating anywhere. In New Cebu village, also in President Roxas, newlyweds and new families who move in are required to construct their own toilet before they could secure community clearances, village chief Eulogio Embalzado said.
Even in upland communities where majority are members of indigenous peoples (IP), the ZOD campaign was a resounding success. In Arakan, the Manobo-dominated village of Kinawayan was the first to declare as 100-percent ZOD in 2014.
“Our people in the old days consider the entire community their latrine so they defecate anywhere. As a result, many of our tribespeople, particularly the children, got diarrhea,” said Datu Alonzo Suhat, IP representative, referring to the 2013 outbreak that sickened over a dozen people and killed two in Kinawayan.
Suhat said he was happy it took less effort to convince his fellow IPs to discard their toilet custom and embrace the ZOD concept.
“They’re now more informed and educated. We were able to make them understand the importance of having a toilet so our animals like chickens would not feed on feces that could cause diseases if we slaughter and eat these animals,” the tribal chieftain said.
Mayor Rene Rubino said CLTS activities were successful in attaining the Grade 1 —the first in the three-tiered benchmark for total sanitation characterized by the prevalence of toilets in almost all of the households in a community—in Arakan.
“Its impact was the improvement of sanitation and hygiene practices of families. Cases of water-borne diseases are no longer felt especially in upland and IP communities,” Rubino said.
He said the local government had set aside funds in its annual investment plan in the millions for the enhancement of its water, sanitation and hygiene (WASH).
Murugesu, the ACF official, said the assistance given to the two municipalities in water and sanitation was mainly focused on provision of technical assistance as well as small-scale material support toward the attainment of a total ZOD in these areas, such as toilet bowls.
“The biggest challenge (posed by the campaign) is the behavior change of the people, which takes time in part because they cannot see the benefit of this program directly, unlike livelihood activities,” he said. “When you talk about building a toilet, people don’t see a direct benefit in that, especially that they don’t see money out of it.”
Murugesu said ACF was moving toward an integrated approach in implementing WASH projects by supporting people’s livelihood programs.
Aside from toilet facilities, ACF also provided assistance for the setting up of quality, potable water systems in communities, utilizing local sources like springs.
The Unicef has hailed North Cotabato’s campaign on ZOD, calling it “a fantastic achievement.”
“It’s very important that everyone has access to toilets as this will create a clean and healthy environment for the children to grow up in. Children who grow up in a clean and healthy environment have better learning and get sick less often … . [This kind of environment] is a foundation for a healthy life of a child,” said Rebecca Pankhurst, Unicef field office chief.
Dr. Eva Rabaya, provincial health chief, said efforts such as orientation among local and health officials were now under way for the replication of the ZOD campaign in the rest of North Cotabato.
Recently, the two municipalities have been making strides in health and sanitation, with Kamasi being nominated for a national award due to the success of the ZOD campaign. These areas are now poised to raise the level of their health and sanitation practices and programs, officials said.
Part of officials’ sales pitch to communities is to motivate people to participate in their bid to put their areas on the map of public health.
But for Kamasi resident Melody Pagdato, health and sanitation for her family are far more important.
The 24-year-old mother of two said they used to practice shot-boom because they could not afford to build a water-sealed latrine. Her partner is a farmer.
When one of her children got diarrhea, the couple decided it was time to build a toilet.
“I find defecating in a real toilet comfortable. There’s no smell even if it’s built close to the house,” Pagdato said.
ARMM, too
In South Upi, Maguindanao province, five barangays have achieved ZOD, thanks to the efforts of local health workers and ACF.
“We enlisted the help of village chiefs and other local leaders in urging people to build toilets and inculcating in them the importance of proper sanitation, particularly in far-flung communities,” said Rebecca Tenorio, municipal nurse.
Village health volunteers from other barangays are tasked with conducting a lecture in a different barangay to ensure the complete cooperation of residents.
“If people from other areas would tell you to build a toilet or that your toilet was unsanitary, you would feel ashamed. So you comply,” said Tenorio, adding that CLTS volunteers should also have their own toilets already before they’re allowed to conduct lectures to add credibility.
Before the ACF-initiated campaign came to South Upi, cases of malnutrition and water-borne diseases were high there.
“Even the children fell victim to diarrhea, particularly those under 5 years old. Morbidity was high,” said Rommel Erese, municipal sanitary inspector.
“When ZOD came about, the community was capacitated and diarrhea cases reduced drastically. The remaining few cases were in six barangays not yet under the program. There was really a need to change people’s behavior toward health to prevent diseases,” he said.
Erese said diarrhea is the second leading disease in South Upi after pneumonia. Now, it slipped to fifth.
