The Power of Toilets, Simple Medicines, and Strong Policies to Stop Diarrhea

Children outside of the health center in Kampong Thom province in Cambodia, where oral re-hydration therapy is provided to children who have diarrhea. / PATH/Heng Chivoan

More than 2.5 billion people still do not have access to a toilet. As we #CelebratetheToilet on this World Toilet Day, we should remember that universal access to toilets is one of the many necessary steps to ending preventable death.

Day in and day out, I’m reminded of the power of innovation to save the lives of women and children. Often,we forget how successful low-cost innovations and solutions—and the policies that support them—have been in advancing health progress. Like the toilet.

It might seem like an odd thing to celebrate, but the invention of the toilet has been a critical contribution to modern-day public health. Access to toilets, safe water, vaccines and simple interventions like oral rehydration solution (ORS) and zinc have the power to stop deadly diarrhea and save lives. But like all health innovations and interventions, toilets need more champions and complementary policies to reach their full lifesaving potential.

Children and their families attend community health education sessions in Kampong Cham Province. Diarrheal disease is a leading infectious killer of children under 5 years old. / PATH/Heng Chivoan

Around the globe, local leaders and advocates are playing a critical role in bringing innovations, interventions and policy together to accelerate health gains within their countries. It was heartening to see India’s new prime minister, Narendra Modi, embracing innovative thinking and advocacy to solve the health problems caused by open defecation. As a result, he has the country talking about toilets. Diarrheal disease is devastating in India—as well as other parts of Asia and Africa—where it is one of the leading causes of death among children under the age of 5.

India is not the only country making progress in the fight against deadly diarrhea. Another example is in the Mekong Delta, where my organization, PATH, has helped policymakers in Vietnam and Cambodia evaluate and refocus their policy efforts to stop diarrheal disease—a leading killer of children in their region as well.

About 10 years ago, when new formulations of ORS and zinc, the two cornerstone interventions for severe diarrhea, were recommended for widespread use by the World Health Organization (WHO) and UNICEF, it became clear that the diarrheal disease policies needed to be updated in both Vietnam and Cambodia. Unfortunately, making these updates was not a government priority at the time. Local health workers, NGO advocates and scientists knew more needed to be done to prioritize diarrheal disease so that lifesaving medicines could reach the children dying in their local communities.

Latrine in Cambodia. One in three people worldwide–or 2.5 billion–lack access to a toilet, and open defecation is a major culprit behind the tragic number of diarrhea–related deaths. PATH/Anne Aumell

Using our unique advocacy model, PATH worked with these local champions to help them assemble a compelling case to present to the ministries of health in each country, which included a package of strong evidence based on the WHO’s global policy recommendations, more effective treatments, the high burden of disease, and support among communities and potential partners. This informed the governments’ policies and compelled action to increase access to ORS and zinc, better equipping health workers to deal with the scope of the diarrheal disease problem in both countries.

As the global health community, including USAID, works to end preventable maternal and child deaths in a generation, country leadership and collaboration for stronger advocacy is key. At PATH, we are always gratified to help local communities and technical experts take action to achieve policy improvements that will save lives.

Students learn healthy hygiene habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. / Ivan Sarenas

I am confident that we can continue to expand toilet use, improve water and sanitation, and advance diarrheal disease policies around the world if we equip and empower more local leaders and experts to be champions of health innovations, interventions and policies. Together, we can bring the basic essentials of our everyday lives to the rest of the world.