TSEDU Ethiopia: Total Sanitation to End open Defecation and Urination

Over the last 80 years, since the first report of the League of Nations Health Organization on Water Supply and Sewage Treatment in 1936, significant progress has been made to improve the water supply and sanitation status in Ethiopia, in line with the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs).

Progress on reducing open defecation

Open defecation rates are a key indicator that basic sanitation services are lacking and as a country we’ve hugely reduced rates, from 79% in 2000 down to 22% in 2017. This reduction significantly contributed to improving the health of children under five. In the same period, under-five mortality reduced from 166 per 1,000 live births to 67.

Despite overall progress, regional states show huge disparities. People who live in rural areas make up 80% of the total population where open defecation rates differ hugely, from less than 1% in Benishangul-Gumuz to 88% in the Afar region. These differences require extensive action, especially in regions like Afar and Gambela.

Poor standards of sanitation remain

While Ethiopia has made significant progress in reducing open defecation, 23 million people still defecate in the open and it remains one of the lowest performing countries for access to basic sanitation. This is because the toilets constructed to reduce open defecation are of poor quality and do not meet the higher standards for basic sanitation contained in the SDGs compared with the MDGs. Only 7.1% of the Ethiopian population has access to flush water toilets, ventilated improved pit latrines, pit latrines with a slab, or composting toilets not shared with other households.

Commonly, the problems encountered while implementing sanitation programs are related to inconsistency of performance, substandard infrastructure, lack of progress in institutional WASH, data inconsistency, and lack of institutional coordination and integration.

The availability of WASH services is also inadequate in health and education institutions. For instance, the Services Availability and Readiness Assessment (SARA), carried out by the Ethiopian Public Health Institute (EPHI) in 2018, shows that on average only 61% of health facilities have improved sanitation services and 34% have improved water respectively. UNICEF’s 2018 sanitation micro-plan shows lower figures with only 47% of health facilities nationally having access to an improved toilet and only 12% having improved water supply services, with variation between regions.

These poor sanitation service levels have adverse health, economic and environmental impacts. The recent Health Sector Transformation Plan (HSTP) and the 2008/9 and 2009/10 Health and Health related Indicators indicated that diarrhea is the second biggest killer of children under five, next to acute respiratory infection. Diarrhea is closely associated with inadequate WASH services. The Economics of Sanitation Initiative Desk Review, conducted by WSP/World Bank in 2013, found that poor sanitation costs Ethiopia Birr 13.5 billion each year, equivalent to 2.1% of the national Gross Domestic Product (GDP).

Overall, more action is required to improve the performance of the sanitation sector because:

  • The huge achievement in reducing open defecation is overshadowed by the abundance of substandard toilets. 
  • The outcome evaluations of the CLTSH program found that the campaign needs to be reinvigorated with only 25% of triggered kebeles becoming open defecation free (ODF) without any guarantee for sustainability.
  • Increased focus on demand creation for sanitation products and sustainable defecation norm changes within communities.
  • There is a clear lack of coordination among concerned ministries and agencies.

The National ODF campaign

The vision of the National ODF Campaign Ethiopia 2024 is to see TSEDU-Ethiopia: a clean Ethiopia where people enjoy a prosperous life with dignity. The overall campaign objective is to eliminate open defecation by creating sustainable behavioral change and provision of at least basic sanitation to declare Ethiopia ODF.

The specific objectives of the campaign are to:

  • Achieve at least sustained basic sanitation infrastructure and hygiene behavior to declare the nation ODF.
  • Create sustainable behavioral change to ensure utilization of basic sanitation and safely managed toilets.
  • Meet post ODF sustainability.

WaterAid Ethiopia’s Role

WaterAid Ethiopia is leading this campaign to deliver results on several major activities. We are focused on developing a campaign logo and guidelines, designing creative content for the media campaign, offering advocacy and campaign training to influencers, government officials and senior citizens and providing support to street shows and competitions intended to raise public awareness.

Key tasks:

  • Create ODF baseline database by woreda.
  • Mobilize stakeholders to one national campaign to eliminate open defecation.
  • Mobilize and utilize sufficient funds and other resources.
  • Carry out capacity building that could ensure the fulfillment of the national target of ODF.
  • Carry out and measure a sustained behavior change campaign through champions, media, and peer-to-peer relationships.

Sustainable behavior change campaign

Effective and sustainable behavior change and evidence-based communication are key to the success of the ODF campaign. The sustainable behavior change components of the campaign will primarily focus on sanitation and hygiene behaviors, including sustainable adoption and use of improved toilets, handwashing with soap, and safe handling and treatment of water at the point of use.

Five key tasks will be carried out to achieve the objectives of the behavior change campaign which include: conducting formative research, designing a comprehensive behavior change intervention package, setting implementation arrangements, preparing modalities of implementation and monitoring and evaluating the intervention including through knowledge, attitude and practice surveys.

Budget and financing

The total estimated cost of the campaign from initiation to completion is Birr 27,700,595,000.00 (US$923 million) over five years. Of this, 76.6% the implementation cost will be for sanitation products and services, 20.1% for resource mobilization, advocacy and the behavior change campaign and 3.3% for capacity building activities. The government and international development partners are expected to cover 40% of this budget and the remaining 60% will be covered by the community.

Get involved

You can help get 23 million Ethiopians currently defecating in the open to use the toilets.