Poor sanitation is one of the leading causes of diarrhoeal diseases, which kill hundreds of people including children around the world everyday. The story in Bhutan is not any different either. The sanitation coverage in terms of presence of toilet in Bhutan is 91% and in the case of water supply, 84.5% of households had access to water supply in 2009, and 80.1% of the households had functional piped water schemes. However despite these good figures, the incidence of illness due to water and sanitation-related diseases is still high and the figure for under-five child mortality is one of the highest in South Asia (85/1000 live birth).
This is thought to be due to continued poor hygiene practice and in particular the poor state of latrines and associated facilities. Although the construction coverage of latrines is relatively high, the conditions are thought to be very poor and the amount of use low.
The Rural Sanitation and Hygiene Programme (RSAHP) co-ordinated by Public Health Engineering Division (PHED) under the Ministry of Health with technical assistance from SNV Netherlands Development Organisation had been assisting the primary client in rural areas by developing new approaches to improving the overall sanitation and hygiene practices in the rural communities in Bhutan. The initial programme area starting in 2008 was in the four pilot Geogs of Nanong (Pemagatshel), Hiley (Sarpang), Laya (Gasa) and Jarey (Lhuentse). The programme was later upscaled to the whole Dzongkhag of Lhuentse covering 7 more Geogs (Kurtoe, Khoma, Gangzur, Metsho, Menbi, Minjay and Tsenkhar) in June 2010.
There were two primary objectives under the RSAHP. Firstly, to explore, adapt and pilot best international practices to develop a model that can be rolled out country-wide. The model to be explored and piloted included an approach termed Community-Led Total Sanitation (CLTS), of which the outcome is measured in a complete end to open defecation and unsanitary conditions for entire communities rather than in terms of individual household latrine construction coverage. Secondly to study, explore and pilot sustainable, affordable and appropriate sanitation technologies in the programme areas. This handbook is a result of this second primary objective of the programme.