If you are among the two billion people without access to toilets or latrines, the urge to relieve yourself will be accompanied by mounting stress.
While those in urban slums have to hold for hours waiting for dusk to relieve themselves in open trenches, rural folks simply run to the bush.
But is anyone surprised by this situation?
Not really. The United Nations had long warned (in 2015) that 2.3 billion people lack basic access to latrines or toilets.
Of these, 673 million still defecate in the open, for example in street gutters, behind bushes or into open bodies of water.
On Tuesday, the Bill and Melinda Gates Foundation honoured Indian Prime Minister Narendra Modi with the prestigious Global Goalkeeper award for his mission to give all Indians access to toilets through the Clean India Mission (Swachh Bharat Abhiyan).
Modi set the goal in 2014 for the country to be "open defecation free," just in time for Mahatma Ghandi's 150th birthday on October 2, 2019.
So far, 90 million toilets have been built to eliminate open defecation and currently, 98 per cent of India's villages have rural sanitation coverage instead of 38 per cent four years ago.
“Think, less than 40 per cent in 70 years after independence and about 100 per cent in 5 years,” Modi said in his acceptance speech on Tuesday.
Managing human waste is one of the world's oldest and toughest challenges
The Goalkeepers Award has renewed focus on the Sustainable Development Goal 6, which aims to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation by 2030.
The award ceremony took place on the sidelines of the United Nations General Assembly session in New York.
“This campaign was started by our government, but the command was taken by the people themselves,” Modi said.
Bill Gates called Modi’s plan a model that other countries with poor sanitation can follow.
"Managing human waste is one of the world's oldest and toughest challenges," Gates said when he presented the award. "I would say most leaders are not willing to talk about it, in part, because the solutions aren't that easy."
Gates explained that in many parts of the world, an unsafe mixing of human waste and drinking water leads to untold numbers of regrettably preventable deaths by diarrhea, a frequent symptom of illnesses contracted through consuming contaminated water.
According to the World Health Organisation, inadequate sanitation is estimated to cause 432 000 diarrhoeal deaths annually and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition.
Most of these deaths are in developing countries.
If the current trend of sanitation coverage is maintained, it would take Kenya another 200 years to achieve universal sanitation coverage
In his speech, Modi said the lack of toilets hurt his people’s dignity deeply. “You can imagine that from morning till all day, women used to wait for evening. Along with the diseases caused by open defecation, this wait pushed them towards more diseases,” he said.
The change in India gives hope to developing countries like Kenya, where open defecation is still rampant in remote regions.
According to the World Bank, only 30 per cent of Kenyans have access to improved sanitation, that is, the use of sanitation facilities that hygienically separate excreta from human contact.
This means that approximately 30 million Kenyans are still using unsafe sanitation methods like rudimentary types of latrines, and almost six million are defecating in the open.
Data from World Bank shows the rate of increase in access to improved sanitation is worrying. Access to improved sanitation in Kenya increased by only 5 per cent between 1990 and 2015.
“If the current trend of sanitation coverage is maintained, it would take Kenya another 200 years to achieve universal sanitation coverage,” says Pascaline Wanjiku, a World Bank water supply and sanitation specialist.
She advises that the first step for Kenya, like India, is to acknowledge the country faces a huge challenge that calls for rethinking of strategies, and to have champions of change both at the national and local levels.
“Increasing sanitation financing and focus on better targeted and more inclusive interventions will also help Kenya reach its sanitation goals,” she says.
“This includes reviewing the need for targeted subsidies to improve sanitation in rural areas where mostly on-site sanitation is the norm, and embracing city-wide inclusive sanitation that looks beyond sewerage in urban areas.”
During Tuesday’s ceremony, the Changemaker Award was presented to youth activist Payal Jangid for her fight against child labor and child marriage in India.
The Progress Award was presented to Gregory Rockson, co-founder and CEO of mPharma, for his work to increase access to high-quality drugs across community pharmacies in five African countries.
The Campaign Award was presented to Aya Chebbi, the first African Union Youth Envoy, for her work promoting youth empowerment, peacebuilding, and non-violent mobilisation in Africa.
Goalkeepers is the Bill & Melinda Gates Foundation's campaign to accelerate progress towards the SDGs, also called Global Goals.
“By sharing stories and data behind the Global Goals through events and an annual report, we hope to inspire a new generation of leaders—Goalkeepers who raise awareness of progress, hold their leaders accountable, and drive action to achieve the Global Goals,” says the foundation.
