This report shows that Kenya’s sanitation crisis remains severe, with millions still forced to use the bush, unsafe latrines or other unimproved facilities.
In Makere Village, Tana River County, Salma Hakofagamaro walks home from the bush with a hoe after relieving herself there, a routine that reflects the reality for many rural households without toilets. For her family, the nearest latrine is not always an option, especially after floods destroyed mud-walled toilets during the long rains earlier in the year.
The scale of the problem is large. The article says 5.6 million Kenyans still answer nature’s call in the open, while about 30 million use unsafe sanitation methods. Another nearly six million go in the open altogether. Worldwide, an estimated 1.8 billion people use a source of water that is not protected from contamination with human faeces.
Tana River County has improved compared with 2013, when only 36 per cent of residents had access to toilets. Odha Dae, the county public health officer coordinating water, sanitation and hygiene projects, says the figure has risen to 43 per cent, though more than half of residents still lack toilets. The rest continue to use the bush or the river.
Other counties are in even worse shape. Data from the Kenya Integrated Household Budget Survey places Samburu at 74 per cent without toilets, Turkana at 65 per cent, Marsabit at 52 per cent, West Pokot at 51 per cent and Kwale at 48 per cent.
Kenya’s attempt to end open defecation by 2013 fell far short. A campaign launched in 2011 aimed to free the country from the practice, especially in rural areas, but by the end only two per cent of the targeted villages — 1,273 out of 59,915 — had been certified open-defecation free. Between 1990 and 2013, the share of people using proper toilets rose only from 25 per cent to 29 per cent.
The health consequences are serious. Human waste that is not safely contained contaminates soil and water, then returns to food and drinking sources. That exposure fuels diarrhoea, amoeba, typhoid, cholera, intestinal worms and neglected tropical diseases such as trachoma. Flooded latrines and untreated wastewater make the contamination worse.
The article says open defecation costs Kenya Sh8.8 billion a year, or nearly Sh2,000 per person annually. Eliminating it would require fewer than 1.2 million latrines, but the toilets would need to be improved structures that safely dispose of waste and are not shared by too many people.
Children bear much of the burden. Diarrhoea caused by contaminated water and poor sanitation kills more than 289,000 children under five every year. Repeated illness also contributes to dehydration, malnutrition and stunting, with a quarter of all stunting linked to five or more diarrhoea episodes in the first two years of life.
The global sanitation picture is also weak. A 2017 Joint Monitoring Project update by the World Health Organisation and Unicef estimated that in 2015, 61 per cent of the world’s population — 4.5 billion people — lacked safely managed sanitation services. The report broke that group into people using basic toilets or latrines, shared toilets, poorly built latrines or buckets, and those defecating in the open.
Kenya’s own response has been uneven. The Community Led Total Sanitation campaign was meant to push many areas to open-defecation free status by 2020 and the rest by 2030. Counties such as Vihiga, Nyeri, Nyamira, Kisii and Kiambu, where fewer than one per cent of residents lack toilets, were expected to move faster. Others with higher rates — including Uasin Gishu, Trans Nzoia, Tharaka Nithi, Siaya, Migori, Machakos, Kitui, Kwale, Kilifi, Homa Bay, Kakamega, Busia and Bomet — were also listed as part of the 2020 push.
But a Ministry of Health and Unicef report noted that only 27 per cent, or 16,227 villages, had partnerships for community-level engagement, and many areas still faced operational problems tied to incomplete Community Led Total Sanitation work.
In some places, culture and poverty continue to slow progress. In Kirindon, Trans Mara Sub-county, eight villages with almost 8,000 residents had not been declared open-defecation free despite nearly 10 years of intervention. Only 30 per cent of the population had latrines, and some villages had just three pit latrines. Duncan Sungu, a nursing officer at Kimintent Dispensary, said men sometimes avoid sharing latrines with daughters, while others simply use the bush.
Health workers in the area say the link between open defecation and disease is still poorly understood. Sungu said that for every 20 patients who come to Kimintet Dispensary, two or three are diagnosed with typhoid. He added that public barazas and community health volunteers have been used to push the message about building latrines, but progress has been slow.
Sanitation spending remains low. Kenya allocates less than one per cent of gross domestic product, or 0.2 per cent, to sanitation, below the global target of 0.9 per cent. The money is channelled through the Ministry of Health and other ministries.
World Vision Kenya West Pokot Project Manager Titus Kaprom says communities can be encouraged to abandon open defecation by appealing to shame and disgust, then helping them build toilets from locally available materials. Trans Mara West medical officer in charge of health Dr Timothy Lumarai said during an event earlier this year that families do not need expensive bricks and iron sheets to construct a toilet.
Busia County Deputy Governor Moses Mulomi said improved toilets, not just any latrines, are needed to protect people from their own waste. He also stressed that hand-washing with soap and water must accompany toilet use if sanitation is to improve.
The article also turns to schools, where sanitation gaps affect children’s dignity and attendance. The World Health Organisation recommends one toilet for every 25 girls and one for every 35 boys, yet the national school health policy says 10,000 schools need new toilets and another 10,000 need renovations. A Unicef survey of 343 schools found that while 87 per cent had separate latrines for girls, boys and staff, only 20 per cent met standards for boys’ latrines and 19 per cent met standards for girls’ latrines.
Water Aid’s report released this year found that one in three schools worldwide do not have decent toilets, while one in five primary schools and one in eight secondary schools have none at all. The report said pupils without decent toilets may run home at break time or use bushes on school grounds, and some miss school when they are sick or menstruating.
In Kenya, the article says nearly 20,000 people die every year from diarrhoeal diseases linked directly to poor water, sanitation and hygiene, including more than 17,000 children under five. The broader warning is clear: without safe toilets, clean water and hand-washing, the country will keep paying in disease, lost learning and preventable deaths.
Additional reporting by Ruth Mbula, Oscar Kakai and Anita Chepkoech
By Felista Wangari and Oscar Kaikai
