Today, Monday, November 19th is World Toilet Day – a special date to provoke conversation about a place and an act people don’t always want to talk about.

Vietnam is not alone in Asia in avoiding such a subject. In Indonesia people refer to “going to the back” and in Cambodia they say “folding legs”. In many cultures people will ask for the bathroom rather than the toilet, despite obviously wanting to use a toilet, not take a wash. Toilet can be a dirty word.

For those working in development the concept of “open defecation” – ie, going to the toilet outdoors is a topic of key importance but not always something people are happy to talk about. More than one billion people around the world still practice open defecation, the practice of defecating outdoors. Of this number, more than 60 percent live in Asia, according to a World Health Organization/UNICEF Joint Monitoring Program report.

Excreta, ie the product of defecating, causes diarrhoea and other deadly infectious diseases. WHO statistics show that more than one in ten child deaths (about 800,000 per year worldwide) are caused by diarrhoea. Among other negative consequences, open defecation can cause contamination of water, food and soil and increase the number of flies and insects carrying excreta and spreading disease. When people do not wash their hands before meals and after defecating, this further increases the risk of disease.

The economic impact of sanitation is enormous. A World Bank study on the Economic Impact of Sanitation in Southeast Asia found that poor sanitation brought economic losses of at least US$9 billion per year, with communities suffering from illness, loss of life, high medical costs and time away from work. For the millions of boys and girls who miss school every year due to illnesses resulting from poor sanitation the implications are far-reaching, affecting their ability to learn and fully participate in their education.

Among the underlying problems that perpetuate open defecation, there is a wide acceptance of this long-entrenched habit in many communities, and a lack of leadership at different levels, from communities to local and national governments. In many countries sanitation improvement is still considered the main responsibility of the water and sanitation sector, which is often fragmented and lacking the necessary resources to undertake significant initiatives.

We need to talk about open defecation! Global sanitation advocates are leading the way this year for the 19 November ‘World Toilet Day’, with the Water Supply and Sanitation Collaborative Council and its partners encouraging people to talk in plain language. Water Aid is drawing attention to the fact that 1 in 3 women worldwide risk shame, disease, harassment and even attacks because they have nowhere safe to go to the toilet. 1) Work together to amplify the message and increase impact. Governments and development partners can combine efforts to highlight how improved sanitation is benefitting communities, particularly girls, boys and women. At all times we should focus on the powerful effects of collaboration, involving development partners, governments and communities in creating sustainable solutions that benefit everyone. 2) Make sanitation a community-wide issue! By enlisting the support of mass organizations active in many countries in Asia we can build on experience and expertise from within and outside the water and sanitation sector. This engagement needs to be long term as previous ‘on and off’ efforts in some countries have proved ineffective in creating and sustaining the momentum needed to bring about lasting change. 3) Empower those who work at the front line. Health and sanitation facilitators need to be better equipped to motivate communities to take part in collective action to improve sanitation, drawing on the best available evidence and skills necessary to bring about change. These critical front-line change agents also need to be able to convey upwards the community’s expectations and aspirations. At the decision-making level, local governments need to be better resourced to facilitate community-based activities and to plan, implement and monitor local sanitation improvements. Spearheaded by its water and sanitation teams in 13 countries, Plan has been participating in collective efforts to enable communities, particularly women and children, across Asia to lead a healthier and safer life with dignity. To date, approximately 10,000 communities, including those in Pakistan, Indonesia, Bangladesh, Nepal, Cambodia, Vietnam, Philippines and Laos, have been supported to stop open defecation through the Community Led Total Sanitation (CLTS) approach. CLTS does not involve provision of materials but focuses on triggering communities to eradicate open defecation practices. Plan has worked in Asia for more than 50 years, working directly with communities to bring about positive change. On this critical issue Plan is working to find ways to motivate, engage and empower communities to lead change and end open defecation. World Toilet Day offers a timely reminder that we have a long way to go – and that the humble toilet is one of the key tools in the fight to create healthier, safer and more dignified living conditions for all. This story is contributed by Hilda Winartasaputra, Water, Sanitation and Hygiene specialist at Plan International’s Asia Regional Office.