Ending open defecation in Guinea-Bissau: It all starts under a mango tree

ABSTRACT

Using toilets and washing hands with soap is essential to keep children and families in good health. But in Guinea-Bissau, open defecation remains a deeply rooted practice. Going out in open spaces rather than using a toilet is a dangerous challenge human waste near waterways and homes spreads diseases quickly, putting children and their families at risk. Diarrhoea, which is related to poor sanitation and hygiene, is one of the top killers of children in the country ─ accounting for 9 per cent of children who die before their fifth birthday. However, getting rid of open defecation is possible. Take Quinara, a region in the south of Guinea-Bissau. In 2018, Quinara was recognized as the first region to become 'open defecation free' (ODF) in Guinea-Bissau. This is a remarkable achievement in a country where nearly one in six people still go out in the open. So, how did Quinara do it? Ask families in a community to identify areas around the home they use as toilets. Use a combination of shock, shame, pride and disgust ─ instead of abstract health messages ─ to trigger behaviour change. And watch the community transform. This approach is called Community-Led Total Sanitation (CLTS). It typically takes three to six months for a whole community to give up defecating in the open. And this contributes to a healthier environment for everyone.