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Water, Sanitation & Hygiene

Tackling Wicked Problems in Ethiopia: Open Defecation

By Dr. Tessie San Martin

This is part one in a two-part series outlining two “wicked problems”: open defecation and enabling girls to attend and stay in school. This series was written by Tessie San Martin during her recent trip to Ethiopia. Part two will be released on March 5, 2014.

Ethiopia is a country on the move. Everything you see from the time you land at the gleaming international terminal and drive into Addis Ababa tells you that things are changing. New buildings are popping up everywhere. A new railway is being built. Road construction is ubiquitous. The country's GDP growth rate (10.7% in 2012) has been among the highest in the world. If Ethiopia continues this impressive growth performance, it could reach middle income status by 2025.

But human capital development has not kept pace with the massive expansion in physical capital being undertaken today. Only 54% of the population has access to improved drinking water supply, in spite of considerable water resources in the country. Only 21% have basic sanitation services.

Ethiopia is ranked 126th out of 127 countries in the Education for All (EFA) development index (measuring things like access to primary school, literacy rates, gender parity, and education quality). Over 70% of Ethiopian women (and 58% of men) aged 15 and over are illiterate, among the lowest literacy rates in the world

Unless basic human needs are addressed, returns on the massive physical infrastructure investments taking place today will fail to materialize. This human development is a daunting task. Building a road or a railroad is a complex problem, but the solution is identifiable and, though technically difficult, it can be worked out. Getting a community to stop open defecation, or enabling girls to attend and stay in school, is another matter.

These are examples of "wicked problems." Wicked problems are difficult to define clearly and are not stable. And because the problems are not stable, neither are the solutions. Tackling these challenges requires constant experimentation, learning, and adaptation.

Plan, like most development organizations, focuses primarily on such wicked problems. In this post, I will focus on one wicked problem, that of open defecation. According to the World Health Organization (WHO), Ethiopia has the 4th highest rate of open defecation in the world (38 million people out of a population of almost 92 million). As a result, the rate of acute watery diarrhea (AWD) is among the highest in the world, a statistic closely linked to the country's low nutritional status. Ethiopian children are at the highest risk for malnutrition, and this in turn contributes to the fact that stunting affects 47% of children under the age of 5.

Addressing the problem in a sustainable manner requires more than building a latrine. Plan’s approach is based on community-led total sanitation (CLTS). Plan introduced CLTS in Ethiopia in 2007; today the Government of Ethiopia (GOE) has adopted it for the whole country. I saw the approach at work in my recent visit to the Dara district in the Southern Nations Nationalities and People's Region (SNNPR) of Ethiopia.

The concept is deceptively simple: inform people of the bad things that can happen to you and your children if you defecate in the open; reinforce the learning through training; discussions with peers and traditional community leaders; and (in an innovation introduced by Plan) dissemination and training through teachers and students in schools.

However, while the concept sounds easy, there is nothing simple about getting people to change behaviors that have been ingrained forever through tradition and common practice. And if you are telling people to stop pooping outside, then you also need to make sure that they have a place where they can defecate. So, they need to learn how to build latrines and mobilize resources to design, build, and maintain the latrines. That is a lot of behavior change and a lot of additional burdens for families and individuals to take on.

Enabling and sustaining this behavior change takes patience and perseverance. And it requires trust, because the investment by the family and the community is made up front, but the payoff in the form of tangible improvements in the health status of families is longer term.

Plan has introduced CLTS in thousands of kebeles (communities) throughout the country. Through Plan's efforts, in collaboration with local authorities and leaders, thousands of these communities have been declared ODF (open defecation free). And when these small achievements take place, significant improvements in health and nutritional status follow. But the challenge is not just to get a community to become ODF, but to stay ODF.

Regression (e.g. returning to old practices) is all too common. In this context, Plan is investing in more rigorous research and partnering with the Gates Foundation and the University of North Carolina's (UNC) Water Institute to better understand what elements of its CLTS programs in Ethiopia lead to more sustainable results. Constant monitoring, adaptation, and learning are the only ways to tackle wicked problems.

In my next post I’ll discuss another wicked problem in Ethiopia: getting girls to attend and stay in school.

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