Jigmi Wangdi, Sherab Lhamo, Yangyel Lhaden

Tul Bahadur Bishwa’s face breaks into a smile as he studies the new toilet. A small structure next to his house, a strong smell of fresh paint fills the air. It has two compartments, one for the bathroom and one for the toilet.

Tul Bahadur Bishwa from Goomsum in Tsirang said that villagers now understand the importance of sanitation and hygiene.

“A good toilet has become a necessity now,” he said. “I had saved some money for the construction.”

Every household in his gewog, Tsholingkhar, today has an improved toilet.

Health ministry declared the country Open Defecation Free in 2022 following the nationwide coverage of access to improved sanitation facilities. The achievement was a result of partnership between the Ministry of Health, Bhutan Toilet Organisation (BTO), SNV, UNICEF and local government administrations.

Access to Water, Sanitation, and Hygiene (WASH) services especially in schools and monastic institutions as in communities are vital for child health, development and educational performance. There are around 263 private and government monastic institutions with students in the country.

Below: A woman in Tsirang helps her child use the toilet

Between 2019 and 2022, six toilets have been installed with heat pumps to support children’s access to hot water for sanitation and hygiene purposes, and from 2020, 42 monastic institutions installed the water filtration system. .

In some monastic institutions, handwashing stations were fitted with water filtration systems, while certain facilities have been constructed to include toilets designed for monks and nuns with disabilities.Work to improve WASH services in monastic institutions  is still ongoing with the support from UNICEF.

“Compared to the past, the WASH facilities in the monastic institutions have drastically changed,” said the Religion and Health manager of the Central Monastic body, Kinley Penjor.

Dechen Phodrang Monastic School in Thimphu with around 300 students faces some challenges regarding its WASH facilities.

UNICEF installed a water filtration system in the school last year. However, one of the most pressing issues is the lack of adequate toilets. Today, four rooms consisting of around 80 monks share four toilets. A senior monk from the school said that it poses hygiene risks, especially for young ones. According to the existing guidelines, the standard is one toilet for 40 boys.

Another challenge for the monastic schools is finding a suitable location. While the practice in the past was to build toilets away from the monastery, monastic schools are now embracing the need to construct toilets near the classrooms and dormitories.

The monastic body has plans to collaborate with UNICEF to gather the necessary data to improve sanitation facilities and make them inclusive.

Schools in every dzongkhag have access to WASH facilities, and schools such as Panbari Middle Secondary School in Samtse, Gonpasingma Primary School in Pemagatshel, and Kengkhar Middle Secondary Schools and others, that face water shortage due to climate change, the education ministry is closely working with the district administrations to find additional and alternative water sources to address the issue.

About 2,800 school toilets were upgraded using SATO pan technology in partnership with BTO and UNICEF. The technology helps prevent the toilets from foul smell and prevent insects and other carriers, curbing disease transmission. Standard guidelines for WASH in schools and monastic institutions are currently being developed while school health coordinators and WASH caretakers are trained to maintain, operate and sustain the WASH systems.

Local leaders said that there is a marked improvement in terms of preventable disease related to sanitation and hygiene such as diarrhoea and typhoid.

Tsholingkhar Gup Pasang Thingh Tamang said that cases related to diarrhoea and typhoid have dropped about 60 percent and to around 12 percent respectively.

“With improved sanitation, we could see there is a drastic improvement in the health of residents,” the gup said.

Health ministry reports also show a marked improvement in WASH. Since 2003 diarrhoea dominated the top-10 list of morbidity in the country and was followed by a  gradual decline over the years, diarrhoea and dysentery cases were no longer among the top-ten morbidity by 2019.

Cases of diarrhoea, one of the leading causes of morbidity among Bhutanese, have decreased so much that it slipped out of the top 10 list of morbidity in the country by 2020, according to health ministry’s annual report 2021. Six people each died of diarrhoea in 2018 and 2019, and the disease claimed two lives in 2022, while Bhutan reported 24,500 cases of diarrhoea in 2022.

Besides preventing the spread of Covid-19, handwashing is a proven public health measure to avert diseases like diarrhoea and other communicable diseases, according to public health officials.

Between January and October, 2022, the education ministry installed almost 11,500 new water taps, increasing the number of handwashing tap-points in schools across the country by 77 percent. At the national level, from one tap-point for every 17 students, the access then increased to one tap-point for every nine students.

Similarly, at the dzongkhag level, excluding the four thromdes, the tap-to-student ratio more than doubled from one tap for 19 students to one tap point for nine students.

According to the Bhutan Living Standard Survey report (BLSS) 2022, almost all households (99.1 percent) in the country are using improved sanitation facilities. About 97 percent of households use flush toilets, 1 percent use ventilated improved pits and almost 1 percent use pit latrine with a slab.

However, there are some issues. While, the BLSS 2022 revealed that almost all households (99.9 percent) have access to improved water sources only about 83 percent of households have 24 hour access to drinking water.

The national survey report also states that households, both in urban and rural areas, mentioned water supply was on the top of the list when asked what the government should do to improve their welfare.

Meanwhile, villagers in Seru Tar, Tsirang, blame climate change as some springs and water sources have gradually dried up. Farmers like Tul Bdr have been at the receiving end as the shortage impacts sanitation at home and their surrounding areas.

“We’re adopting various methods like rainwater harvesting, and water reservoirs, among others  to provide sufficient water to all,” Gup Pasang Thingh Tamang said.

In partnership with UNICEF, Kuensel will publish a series of stories on children’s and young people’s issues as part of the new Country Programme Cycle and emerging priorities.