PHNOM PENH, 25 September 2008 (IRIN) - At the rate rural communities are gaining access to sanitation, it will take Cambodia 150 years to achieve a government goal of universal coverage in 2025, specialists warned.

According to a recent report by the World Bank-sponsored Water and Sanitation Programme (WSP), only 16 percent of rural Cambodians have access to toilets.

In some areas, such as the southeastern Prey Veng and Svay Rieng provinces, that number is only 2 percent, the WSP report stated.

"To speed up progress, one thing that would be required would be investment, either in a programme of promotion, marketing and supply chain development, and investment in actual construction," Jan Willem Rosenboom, WSP country director for Cambodia, told IRIN.

"The Ministry of Rural Development [MRD] has never yet had any investment budget for RWSS [Rural Water Supply and Sanitation]," she added. "It is entirely dependent on external aid. The annual budget for the ministry is about 1.25 percent of the government budget, or roughly US$8 million per year."

Scores of people continue to defecate in fields and forests, prompting a host of public health concerns. Every day, 2,000 metric tonnes (MT) of waste are disposed of indiscriminately in the countryside.

"Many people in these areas are under the false impression that they need $100 or more to buy a toilet," Chea Samnang, MRD's director of rural healthcare, said. About 33 percent of Cambodians live on less than $0.50 a day, according to government statistics.

Educational barriers

In 2005, the UN Children's Fund (UNICEF) and the MRD initiated the Community Led Total Sanitation (CLTS) programme, aimed at teaching villagers to construct cheap latrines and practise good hygiene.

In conventional latrine promotion projects, a single toilet can cost up to $200, whereas CLTS only requires $15 per latrine.

"It's a big emphasis on letting communities do it themselves instead of us buying it for them," said Hilda Winarta, UNICEF project officer for water and environmental sanitation, noting its efficiency and self-sustainability.

Since 2005, eight villages of 800 families each have been declared open-defecation-free, a major achievement as 2008 is designated the International Year of Sanitation by the UN.

But despite such progress, huge challenges remain.

Toilets continue to remain taboo in many parts of Cambodia, with villagers often seeing open defecation as more natural.

"When I need to do it, I usually go to the bushes right outside the village," Sam Than, who lives in the countryside in northwestern Battambang province, said. "I don't understand why anyone would spend money on a toilet. They don't need it when they have bushes."

NGOs are looking for ways to get around behavioural differences in the countryside, where people often question the need for sanitation. Samnang contends that sanitation coverage is more a matter of education than poverty.

In neighbouring Vietnam and Thailand, with similar rural poverty levels, access to latrines is high at 68 and 99 percent respectively.

"It's not a poverty issue. Some wealthy people in the countryside don't have good sanitation, and some poor families do have it," he said. "It's an issue of access to the right information."

Sanitation as second priority

The MRD has not yet gathered enough data to fully measure the overall impact of CLTS, which began in 2005, when the government released its last official sanitation report. The next one is set for 2010.

At the same time, there still remains a lack of widespread recognition of the problem.

"Water has been funded together with sanitation and because water is more visibly demanded, it always takes priority," Jack Sim, founder of the World Toilet Organization (WTO) in Singapore said. "Politicians tend to shy away from the subject."

Some point to a lack of coordination between sanitation groups as another shortfall.

As many as 20 NGOs conduct sanitation activities in Cambodia, but there is little coordination between them, according to the 2007 WSP report.

CLTS may alleviate that problem as the project integrates the government, UNICEF, Pact Cambodia and several other organisations in sanitation awareness projects.

Children at risk

Children are especially at risk from sanitation-related diseases. According to UNICEF, 12,600 under-fives die every year from diarrhoeal diseases in Cambodia, accounting for 21 percent of all deaths in that age group.

Sanitation also correlates with education levels in most villages.

"We've found that villages with better sanitation coverage also have more children in school," Winarta said. "Obviously, if they aren't sick with diarrhoea, they're more likely to be at school."

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