Accelerating Safely Managed Sanitation (SMS) in Ethiopia
Significant progress in reducing open defecation, but a long way to SDG 6.2
Netsanet Kassa, UNICEF Ethiopia, and Dejene Tagesse, Water Aid Ethiopia
Ethiopia achieved the largest reduction of open defecation, from 82 to 29 per cent, of any country over the MDG period (Joint Monitoring Programme (JMP), 2015). However, Ethiopia also has the unflattering distinction of being a country with the lowest proportion of the population with safely managed sanitation, standing at 7 per cent (JMP, 2021). This means that only 7 per cent of the households in Ethiopia have an individual toilet where faecal waste ends up safely disposed of and treated insitu or offsite.
Concerted and urgent action is needed to accelerate the progress towards safely managed sanitation for all by 2030 – the Sustainable Development Goal (SDG) target 6.2.
Thus, high-level officials from the Ministry of Health, Ministry of Water and Energy, the One-WASH National Programme Coordination Office, development partners, and Civil Society Organizations gathered in Adama from 27 February to 1 March, 2023, to contextualize safely managed sanitation in Ethiopia and develop an acceleration plan.
Why is accelerating progress towards safely managed sanitation so important?
Ethiopia is off track to meet SDG 6.2 (JMP 2021). It is therefore required to accelerate current efforts by twenty times to achieve universal access by 2030. Unless we minimize pathogen transmission risks from toilets prior to safe treatment and disposal of faecal wastes, it is difficult for the population to enjoy the health, environmental and economic benefits of safe sanitation.
In Ethiopia, 60 to 80 per cent of communicable diseases are attributed to limited access to safe water and inadequate sanitation and hygiene facilities and services. There are strong links between sanitation and stunting, and open defecation can lead to faecal-oral diseases such as diarrhea, which can cause and worsen malnutrition. Diarrhea is the leading cause of under-five mortality in Ethiopia, accounting for 23 per cent of all under-five deaths – more than 70,000 children per year.
While Ethiopia is progressing well to eliminate open defecation by 2030, the majority of households in rural settings use unimproved onsite sanitation facilities which do not safely contain human excreta. The availability of improved sanitation products and services particularly in rural areas is a long-standing challenge.
where improved sanitation services and products are available, there are issues of affordability, lack of financial mechanisms to support both customers and service providers/suppliers, and means of transportation to ensure access. For example, most small towns do not have emptying services available locally. Moreover, there are limited fecal sludge treatment and disposal sites. It is common that fecal sludge is disposed of untreated in farmlands or open turfs. This is an indirect way of open defecation which creates risks of water-borne diseases as well as environmental contamination.
What is needed to achieve safely managed sanitation in Ethiopia?
Prioritizing sanitation in the country's development agenda
Ensuring safely managed sanitation service provision requires the involvement of multiple stakeholders. It also requires political commitment from the federal to Kebele (sub-district) level. Workshop participants proposed to establish an advocacy group as an immediate action to the highest level of the Government to effectively communicate the importance of safely managed sanitation to Ethiopia’s development.
Policy reform
Sanitation exists in both the health and water sector policies; however, there is no or little mention of safely managed sanitation. Similarly, the current Health Sector Transformation Plan (HSTP) and the National WASH and Environmental Health Strategy (2021-2025) set targets to achieve basic sanitation service level, but do not mention other aspects of the service chain such as emptying, transport, treatment, and disposal or reuse. Currently, the Government is implementing sanitation in phases, starting with access to basic and then safely managed sanitation services. Consequently, most of the existing national sanitation initiatives mainly target basic sanitation services and rarely mention safely managed sanitation apart from a few urban sanitation initiatives such as the Integrated Urban Sanitation and Hygiene Strategy (IUSHS), which is currently under review. Given the focus on the existing policy and national strategies, participants agreed on the need to develop a standalone sanitation policy.
Improved data and monitoring
Since a policy is a system that guides outcomes, it would be important to have it translated into regulations and service delivery on the ground. Data enable us to track whether safely managed sanitation services are provided and if such services are available or not. The existing sanitation monitoring mechanism, which is the District Health Information System 2, doesn’t capture safely managed sanitation data but mainly reports “a proportion of households having sanitation facilities disaggregated by “basic”, and “unimproved facilities”. Indicators for safely managed sanitation services are not included, and the data collection point is limited to a household level. According to UNICEF and WHO’s Joint Monitoring Programme, few data are available on faecal sludge emptying or off-site treatment, but no data exists for transport and wastewater off-site treatment in urban areas. Following the gap analysis, the development of a safely managed sanitation protocol was proposed as a mid-term action to establish a monitoring mechanism and start gathering more relevant and adequate data which feeds into informed planning, budgeting, and future policy and strategy development.
What are the next steps?
The immediate action highlighted in the workshop is developing the action plan to fill the gap until a new standalone sanitation policy is developed. To initiate the process, a small technical working group will be set up, tasked with sharing outcomes of the workshop with government-responsible bodies. The feedback from the consultation made by this group will further be shared with the existing hygiene and sanitation task force to develop the action plan and carry forward the SMS's short-term and long-term actions. The action plan should be aligned with existing guidelines /initiatives, particularly with the African Sanitation Policy Guidelines.
In conclusion, SMS attracted Government’s and other stakeholders’ attention. Ministry of Health and Ministry of Water and Energy as lead ministries clearly pointed out that the government is committed to achieving the SDG target for sanitation.
Mr. Nuredin Mohamed, Lead Executive Officer of sanitation infrastructure in the Ministry of Water and Energy said, “Not only building more toilets is vital but ensuring the whole sanitation service chain improves public health”.
“Strengthening the existing coordination platform that is the OneWASH national programme coordination mechanism, is key to delivering our commitments to SDG 6.2. Moreover, engagement of all the stakeholders is very important to realize this ambitious goal”, said Israel Ataro, Lead Executive Officer of community engagement and primary health care in the Ministry of Health.