Access to latrines is not enough to eliminate open defecation and reduce the spread of diseases, such as trachoma, the world’s leading infectious cause of blindness. Rather, latrines must be accessible and acceptable to ensure that they are utilised by communities. Unfortunately, in many settings around the world, latrines are often dark, with poor ventilation and swarming with flies, which reduces the uptake of latrines, particularly among young children who can develop negative attitudes towards them.  

In trachoma endemic settings, open defecation creates breeding grounds for flies and contributes to the spread of dangerous bacteria. Moreover, trachoma endemic settings with poor sanitation often have extremely limited access to other water, sanitation and hygiene (WASH) interventions, including health education, clean water, and soap. 

In 2018, NALA, a non-governmental organization, in collaboration with the zonal health department in Mizan Aman, Ethiopia, developed two experimental latrines to improve the conditions of latrines. The experimental latrine included an attached rain-harvesting system that collected water to be used for improving latrine sanitation, a sloped floor to ease cleaning, and a pipe to improve ventilation and reduce odours. The latrines were built from relatively cheap locally sourced materials, such as corrugated iron sheets, and were well accepted by the zonal health department. Moreover, the latrines have remained in good condition for over five years.  

To further identify innovative solutions to environmental improvement, in 2022, NALA collaborated with researchers through the Masters of Design Program at Shenkar College of Engineering, Design, and Art, Israel. Following engagement between NALA and affected communities, which suggested many school children find latrines to be dirty, scary and inaccessible, the researchers were challenged to identify acceptable new context-specific designs that were clean, bright, and affordable. 

The challenge resulted in several innovative designs that have the potential to improve the uptake of latrines. The researchers designed a new restroom, which used coffee bean husks and wood ash to absorb liquid after defecation in an effort to prevent the breeding of insects and diminish the odour. The method is easy to use and cost-effective, requiring only one scoop of organic material into the pit to reduce odours and help maintain the cleanliness of the latrine. Once the pit has been exhausted and the land is dry, the material serves as compost  which can be used for planting, connotating positive messaging and elevating views on latrines. 

Other designs involved hiring locals to weave leaves together to create latrine walls, leading to more natural lighting and colourful, positive scenery. This has the added benefit of stimulating the economy through the hiring of weavers. Others proposed decorating the latrines like a playground and providing games outside the restrooms for waiting elementary students. 

In 2021, the United Nations estimated that 3.6 billion people globally do not have access to latrines and almost two billion people use a drinking water source contaminated with faeces, contributing to the spread of a range of diseases, including neglected tropical diseases (NTDs). Investments in environmental improvement, including the building of latrines, is essential to improve the health of the world’s poorest, which in turn, will have profound development benefits, by keeping children in school and parents economically productive. 

To achieve Sustainable Development Goal 6: Clean Water and Sanitation, we must harness new technologies and innovations to ensure that clean water and sanitation infrastructure is both available, accessible and acceptable to those in need. This requires cultural sensitivity, but also, forward looking activities to ensure that WASH infrastructure is maintained.  

One solution being implemented by NALA as a pilot project in two regions of Ethiopia is the WASH on Wheels project, which works to restore water in schools through fixing and maintaining inoperable infrastructure. Using a vehicle equipped with tools and technicians which travels to schools fixing infrastructure, the vehicle has reached over 90,000 students in over 100 schools within the first six months of the project, a number it is working to double by the end of 2022. If successful, adaptation of this project has the potential to provide further benefit beyond schools, making clean water and latrines more accessible for entire communities.  

In 2021, the World Health Organization published a global road map for NTDs 2021-2030. The road map recognises that WASH is critical across all NTDs, either in the prevention of disease or through management, rehabilitation and care. Achieving the road map targets, and in particular, the target to eliminate trachoma as a public health problem by 2030, will require increased investment to implement all components of the WHO-endorsed SAFE strategy, including environmental improvement. The building, maintenance and utilisation of latrines will be an essential component of this. 

Investment in facial cleanliness and environmental improvement have long lasting benefits, which is evidenced by the Islamic Republic of Iran being validated for eliminating trachoma as a public health problem despite no national trachoma program to deliver surgery and antibiotics, but only investment in clean water and sanitation among the country’s poorest communities. This World Toilet Day, we recognise the interconnectedness of environmental and human health, and recommit to delivering all components of the SAFE strategy, including the building of latrines, to enable healthy environments and healthy lives for all. 

Disclaimer: This blog was written by representatives of NALA. The contents of this blog are not an endorsement and do not necessarily reflect the views of the International Coalition for Trachoma Control.