15 February 2018, General Santos City – Stories of communities finally eliminating open defecation are aplenty in the Province of Sarangani, but the work is not yet over, according to the Provincial Health Office.

“We have adjacent barangays along the Pangi River working together to eradicate open defecation and promote our White Water river cruise. Or the Muslim barangay captain brave enough to dump human feces in front of a resisting household. Or the story of how a whole barangay wept when their leader, an advocate, died,” Provincial Health Officer Dr. Arvin Alejandro shared at an orientation of health officers and media on Zero Open Defecation (ZOD) Program.

Access to sanitary toilets in the province increased from 72% in 2016 to 78% in 2017. “This is a result of our commitment to contribute to the national goal of 100% ZOD by 2022.”.

“The work, however, is not yet over,” said Dr. Alejandro. “We still want to understand the connection of poor sanitation with soil-transmitted infections and stunting of children.”

Sarangani’s progress, however, is not representative of the whole Region 12. According to data from the Department of Health (DOH), sanitation coverage decreased from 85% in 2014 to 81% in 2017. Dr. Vivian Saspene, regional programme manager of the agency’s Environmental and Occupational Health (EOH), committed to accelerate the ZOD program in the region.

“We will definitely include a significant portion for ZOD program in the 2018 budget,” Dr. Saspene said.

DOH and the United Nations Children’s Fund (UNICEF) launched this week a national health promotion and communication campaign about flies and feces with a roll-out training for health promotion and education officers (HEPO) and sanitary engineers.

Called “Goodbye, Dumi! Hello, Healthy!”, the campaign supports the Zero Open Defecation Program of DOH. Using different communication strategies and tools, DOH trains frontline health workers in bringing messages on safe water, sustainable sanitation and proper hygiene to children and adults in communities.

“The aim is to help fathers and mothers, especially in rural barangays, to finally construct a sanitary toilet for their own families,” said Dr. Aristides Tan, regional director of DOH Region 12.

According to the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), approximately six million Filipinos, mostly in rural areas, still do not have sanitary toilets, as of 2015.

Roll-out in pilot areas

In Region 12, the campaign was piloted in North Cotabato and Sultan Kudarat. In the Municipality of Antipas in North Cotabato, sanitary toilet coverage in five pilot barangays increased from 60% to 91% in only six months. Municipal Mayor Elpidio Cadungon advocated for  a 1:1 household to toilet ratio and  procured a garbage compactor as part of his vision for a sustainable solid waste management in Antipas.

A municipal ordinance on Zero Open Defecation was issued. “Having a sanitary toilet is now one of the requirements in securing a barangay clearance,” Mayor Cadungon said.

“Our goal now is to make the whole of Antipas a Zero Open Defecation municipality by 2019,” said Cadungon.

According to Dr. Tan, the practice of giving toilets to residents has not resulted in actual construction and use of toilets. “People need to know and understand the dangers of having no toilets and open defecation. This is what ‘Goodbye, Dumi! Hello, Healthy! provides — making people understand the relationship of feces, flies, diarrhea, disgust and danger.”

A priority of the DOH

Health Secretary Dr. Francisco Duque III stressed the importance of having a basic toilet facility to achieve universal health, during the World Toilet Day celebration at the Department of Health (DOH) central office in Manila, last November.

“Our target is 100 percent coverage by 2022. Let us not wait till 2022. Nothing is stopping us to achieve this earlier than planned,” Duque said, citing his agency’s National Sustainable Sanitation Plan.

Eliminating open defecation by 2022 is one of the goals of the Philippine Health Agenda. “But giving away toilets alone will not solve our problem,” said Duque.

“Achieving zero open defecation is not easy. Households and communities need to be aware and prepared. We cannot just give toilets for free. All our efforts will be for naught if families are not willing to invest their time and resources in building and maintaining their own toilet facilities,” said Duque.

Scale-up of campaign

DOH is working with other government agencies, local government units, non-government organizations and the private sector to promote its ZOD Program and scale-up “Goodbye, Dumi! Hello, Healthy!”.

First implemented in the Province of Masbate in 2014, the campaign will now be rolled out in all regions in 2018. The campaign is composed of different communication platforms, including a community play, health classes, and engaging information materials for children and adults.

In communities where the campaign was first implemented, toilet coverage increased from 58 to 85 percent on the average in a six-month period in 2016, according to UNICEF.

“We have seen that toilet distribution programs by themselves are not effective in achieving change. By investing in the Zero Open Defecation Program and the Goodbye, Dumi! Hello, Healthy! communication campaign, the Department of Health can  mobilize and empower communities to change their behaviors  and to find solutions to their sanitation problems.,” said UNICEF country representative Lotta Sylwander.

Designed by a non-government organization, the Center for Health Solutions and Innovations Philippines, Inc. (CHSI), the campaign was cited by the Public Relations Society of the Philippines (PRSP) as one of the country’s top communication programs at the 52nd Anvil Awards in 2017.

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