In Cambodia, a new effort is focusing on improving rural sanitation and health by providing toilets to households. A novel way of doing that seems to be paying off, literally.
Latrines ? they are humble, necessary, and for the most part lacking in rural Cambodia. Five years ago just one in seven rural Cambodians had access to a toilet.
As in many developing nations, poor sanitation has a cost in Cambodia. In rural communities, where 75 percent of the population lives, most families have no toilets and relieve themselves in fields.
The result is untreated human waste, which can spread disease and death. Poor sanitation is one reason Cambodia has one of the highest child mortality rates in Asia. And, the World Bank says, the lack of toilets costs Cambodia $450 million a year in health care.
Dr. Chea Samnang heads the department of rural health at the Ministry of Rural Development. With the help of international donors, his office aims to provide 30 percent of rural homes, or 720,000 households, with latrines by 2015 ? up from half a million now.
The government uses television advertisements and teams of workers sent to villages to explain the benefits of latrines. Chea says the program stresses three areas.
"One is to build toilet and use toilet by their own resources," Chea said. "Second one is hand-washing with soap after defecation and before eating. And the third message is we talk about the safe drinking water at home, and the safe storage of drinking water at home."
Role of IDE Cambodia
An agricultural development charity called IDE Cambodia has joined the effort and says it has found a way to get families to build toilets, and pay for them.
That sounds like a hard sell in a land where poverty is widespread. But Cordell Jacks, the head of IDE's water and sanitation program, says it works ? thanks to the EZ latrine.
Knowing the biggest cost of a toilet is concrete, IDE designed one that mixes rice husks in the concrete, reducing the price. And modifications to the concrete slab that is the foundation of the toilet made it easier to install them.
Then IDE trained local entrepreneurs ? typically people who already manufacture cement products ? to make and market the latrines.
"Latrine producers will load up their trucks with these latrines, go into villages, market and educate about proper sanitation and hygiene, and will sell latrines door to door or at village meetings," said Jacks.
The cost - about $35 dollars, compared with up to $200 if a family tries to buy supplies and build a latrine using traditional methods. The entrepreneur pockets around five dollars, and there is no subsidy. Installing one is simple and speedy.
"The family will dig a hole in the ground, place the concrete rings, put the latrine together, and then put a structure ? depending on what their income can afford ? a superstructure on top of that," Jacks added. "And this can all be done in one day. It's completely revolutionized sanitation as an industry here in Cambodia.
Government joins IDE
IDE introduced the EZ Latrine, which won an international design award this year, in two provinces in December. Six thousand have been sold and IDE gets regular calls from would-be entrepreneurs wanting to get in on the action.
The Ministry of Rural Development works with IDE to take the EZ Latrine to other provinces.
Chea says latrines will be needed for an additional two million households to ensure 100 percent of the country has toilets by 2025. But Cambodia's poorest can not afford even the EZ latrine.
Chea says the ministry will help such families build dry-pit latrines, which cost only a couple of dollars.
"So we work with them. We try to make them understand that the defecation in the toilet is very useful to improve their income," Chea said. "So we let them to build the dry pit. And then starting from that one, if they understand that it is useful for their family then we can work with them further to improve their sanitation program."
IDE has begun a pilot program to help the poorest buy a latrine. Families pool one dollar a month, and each month the agent builds another latrine. Eventually everyone gets a toilet. Although the program is new, Jacks says the approach seems to work and gradually is helping Cambodia's rural communities fight disease and improve incomes ? with the lowly latrine.