COLOMBO — A researcher and passionate advocate of school sanitation and catchment conservation, Kusum Athukorala is a community water practitioner who works closely with water-stressed communities, promoting conservation of the precious resource and better irrigation. At times she also battles against river pollution and river sand mining, while also engaging with children to promote school sanitation and hygiene.

Known as Sri Lankan’s “woman in water,” Athukorala is chair of the Network of Women Professionals (NetWwater), founder member of the Sri Lanka Water Partnership, or Lanka Jalani, and the 2012 recipient of the prestigious Women in Water Award from the London-based International Water Association (IWA) — a global network of more than 15,000 professionals covering all facets of the water cycle. She was awarded in recognition of her long association with, and deep commitment to, gender-related issues in water.
Athukorala served on the first steering committee of the Global Water Partnership (GWP) and has co-founded two other international organizations: SaciWATERs, based in Andhra Pradesh, India, and Women for Water Partnership (WfWP), based in The Hague.

An active advocate of women’s participation in the water sector and a former trustee of the National Community Water Trust set up by the Ministry of Urban Development and Water Supply, Athukorala spoke to Mongabay on the inclusion of gender in Sri Lanka’s COVID-19 response, the importance of the WASH (water, sanitation and hygiene) approach in the community, and why school sanitation is critical to prevent the disease from spreading.

Mongabay: The Sri Lankan government has taken strict measures to contain the spread of COVID-19 in the Indian Ocean island. There is strong emphasis on handwashing as the first step in prevention. At present, is there enough focus on WASH in Sri Lanka?

Kusum Athukorala: There is renewed emphasis on handwashing and social distancing as we battle against the COVID-19 pandemic, but the full scope of WASH is much more than that.

WASH is a combination of water, sanitation and hygiene and is linked to an entire cluster of Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs).

To wash hands, you need clean water. It also means the provision of safe drinking water and water for sanitation and hygiene. To supply uninterrupted clean water, Sri Lanka needs to conserve catchments and keep the rivers clean.

Living through a global pandemic, we appear to forget our recent priority was climate change and that’s not going to change. Climate change is going to intensify and impact our natural resources more, including water. Disease and extreme weather events go hand in hand, so part of the response should be to effectively combat climate impact.

Dry spells also mean water shortages. This year we will feel it more as health authorities constantly remind us to ensure good personal hygiene to fight the disease.

As a nation, we have failed to look after our rivers and our catchment conservation is equally poor. Unless we have a holistic approach and an integrated plan, fighting COVID-19 by just washing hands with soap and social distancing will come a cropper.

COVID-19 is a powerful call to refocus on groundwater protection, catchment conservation and preventing river pollution. In a climate of disaster, this becomes a greater priority.

How can Sri Lanka address climate realities through a COVID-19 containment strategy?

Good sanitation and hygiene are key to fighting the disease, both directly linked to water.

Water is not an infinite resource and Sri Lanka’s groundwater is being depleted. For example, there is depletion of groundwater in the island’s northern Jaffna Peninsula, where conservation of the region’s limestone aquifers is a top priority. There is enough scientific knowledge now to show that Sri Lanka is among the most vulnerable countries to climate risk. Our dry spells are getting longer and wet spells, typically shorter. The impacts are being felt everywhere.

Sri Lanka has 42 ecological zones, hence the island’s enchanting diversity. This also calls for diversity in solutions.

In our long- and mid-term COVID-19 response, we should include conservation plans that cater to specific ecosystems and the community that forms a part of each ecosystem. To do that, we need to study the climate vulnerability profiles of these regions.

As our sanitation and hygiene best practices are linked to our water resources, we should build greater collaboration between the community and state agencies. Community action is key to conservation efforts and fighting disease and mitigating climate impact.

If we have a large urban population and a pandemic, the one resource that can shield the community is water.

Despite the lockdown, I have seen ongoing river pollution with factories directly releasing raw sewage into rivers. This shows we have poor solid waste disposal mechanisms in place, which is quite alarming.

Our water resources are our biggest buffer against epidemics of any kind and preaching about handwashing will get us nowhere if our natural water is polluted, or worse, contaminated. We need a holistic approach and this means factoring in climate change.

Which groups are more vulnerable to COVID-19 at this point?  

Older persons staying at home with little disposable incomes and single-parent families. Babies and school-going children. Pregnant mothers, vendors and those engaged in delivery services at present, garbage collectors and sewage workers, persons living with minimum sanitation infrastructure or living in communities such as slums are exposed to higher levels of risk.

Any COVID-19 response must specifically address the sanitation needs of these groups.

The need for better sanitation is heightened during disease. How can the high-risk groups be serviced with an increasing demand?

Social distancing is a reality only when there is that luxury called space. Not everyone has it.

I have been to homes of low-income families in the nation’s capital, Colombo, and sectors such as the plantations in the island’s Central province where basic sanitation infrastructure is poor. Efforts have been made but there is a lot more to be achieved.

In places where people sleep in rotation in highly congested homes, imagine one person being infected by a contagious disease. During my many visits to Colombo’s slums, areas in the central districts of Kandy and Nuwara Eliya and in parts of the east, I have discovered ghettos. They should be treated as high-priority communities.

You can lock down these communities, but the congestion itself will give rise to infectious diseases.

Then, there are moves to expand Colombo. That should not happen, especially now. There should be better housing for lower-income groups but the answer is not to expand slums. It is not a question of city beautification but about measures to reduce stress on natural resources like water and preventive programming.

Our national housing policy should no longer plan for tightly bound clusters. The state instead should plan for this kind of pandemic from repeating and add improved sanitation facilities to new housing models as our post-COVID-19 housing response.

The World Health Organization (WHO) recognizes children as a group highly vulnerable to COVID-19. Sri Lanka is now gradually opening up the country. What practical measures are necessary to prevent the disease from spreading among children?

We must first look at what makes children more vulnerable and how do they get exposed to risk.

It is impractical to imagine how children can be made to practice social distancing in a school setup. They naturally interact more. So it’s quite risky to reopen schools just yet, especially for the younger kids. When reopening, it is best to avoid a common break.

The lockdown offers an opportunity to upgrade school sanitation facilities and ensure cleanliness. Gutters can be cleaned, broken doors and taps be fixed. This will reduce exposure to risks when schools reconvene.

A huge problem in school sanitation is poor cleaning, maintenance and regular water supply. In our sanitation surveys, we have discovered even urban schools have toilets that don’t flush, or without a latch. These two issues impact girls more, because of menstrual hygiene and privacy. If this is the reality, how can children handwash, considered the first line of defense in fighting disease?

Unfortunately, children hardly have voices and their needs are not always prioritized. NetWwater and the Sri Lanka Water Partnership have for years raised the issue of marginalized schools, particularly in the island’s plantation sector. What they have in terms of facilities and what other schools have are worlds apart.

As the monsoon approaches, it will be good to find out whether more schools can adopt rainwater harvesting systems.

As a water professional, what possible health and environmental consequences can there be if WASH goals are not well met?

Ongoing hygiene issues are likely to increase exposure.

For example, if a primary school has 3,000 kids, how do you ensure social distancing? How do we know which kid comes from where and the possible exposure to risk within his home or at community level? Schools will be ripe for infection spreading!

The lockdown cannot be brought to a sudden and ill-advised end for expediency either. If not carefully contained, we could have a second cycle of COVID-19 at the community level. So here, we advocate WASH at all levels, targeting adults and children.

How can future public health initiatives cater to school-aged children?

In the long term, we need to prepare our children to deal with epidemics and educate them on health, hygiene and keeping their school and home environment clean.

My suggestion is a nationwide school education program to educate them on vital public health concerns and to address myths and barriers especially around sanitation and menstrual hygiene.

Currently these programs are run by some of us as community-level interventions but we need to upscale this and have community water specialists, sanitation practitioners, epidemiologists and teachers advocating for WASH.

Let’s spend the lockdown to clean school premises, improve sanitation facilities and reduce the possibilities of poor hygiene contributing to the spreading of COVID-19 at school level.

How can the global pandemic impact women and girls differently? What are the likely concerns?

Women bear a disproportionate amount of unpaid caregiver responsibilities at any given time. This increases exponentially in a pandemic situation.

Then you have women health care workers fighting COVID-19. WHO has quite correctly recognized 2020 as the year of the nurse and midwife, to mark Florence Nightingale’s death anniversary. Look at the emphasis on women in our global battle against the pandemic. WHO’s South-East Asia director in a recent statement called for the expansion of their nurses’ and midwives’ cadre by 1.9 million to achieve health for all by 2030.

By 2018, the region had 3.5 million nurses and midwives, 18 per every 10,000 persons, according the WHO. These are women absorbed into the formal health care services, and while they bear the burden of battling against a pandemic, they have their additional sanitation and hygiene requirements. Their hygiene is key to ensuring global health and effective fighting off the pandemic.

How can the gender lens be effectively incorporated into policy and programs, capturing all levels?

The gendered sanitation and hygiene response needs to be multi-layered. There are the health care workers, communities including vulnerable segments, people with special health care needs and girl children. Our initiatives must capture all of them.

Women run higher risk of infection but are placed low in decision-making. This immediately creates an imbalance, despite the heightened caregiver roles of women in the current context.

Policies and programs that gloss over gender will fail, causing a sanitation crisis beyond COVID-19 if we give no thought to catering to 50% of humanity.

Sri Lanka’s sanitation achievements are considered impressive, yet there are many gaps and communities that are not well serviced.

These good sanitation indicators are linked to an established tradition of good health care practices.

The problem is, policymakers often fail to consider the link between gender and epidemics.

We also have not seen any gender analysis of the outbreak by global health institutions or governments in affected countries in preparedness phases, and the same goes for natural disasters. This needs to be nationally addressed and become part of our national planning. It’s more about preventive measures than post-crisis response.

Such planning will help us in good stead, when natural disasters and epidemic outbreaks happen.

It’s not just about COVID-19; Sri Lanka does not have detailed vulnerability profiles. Gender hardly is a consideration when setting policy priorities, hardly going beyond sex disaggregated data. We can learn from the Ebola and Zika experiences and see what needs to be done locally.

What we lack in terms of a gender lens to global health is a consistent problem, found in many countries. We also have a global health system that consistently glosses over gender dimensions.

For Sri Lanka, benefits can be enormous when we improve on our already robust health care system.

To ensure an effective country response, we should have greater focus on vulnerable groups and have supplementary programs to prevent disease spread, contributing to the success of our COVID-19 medium- and long-term response.

At the national level, the government’s COVID-19 response themes are prevention, detection and recovery. Do you find sufficient gender focus there?

In our living memory, there had been no pandemic of this magnitude. The last recorded epidemic was exactly a hundred years ago, in 1920. So we cannot draw from memory in response preparation.

As a first-time response to a global pandemic with national impact, our approach appears gender neutral. But soon, it is going to visit us, just like when the country was in post-tsunami recovery phase.

Our contingency programs must begin to reflect the diversity of health and hygiene response requirements, with sufficient focus on vulnerable and marginalized groups. Otherwise, initiatives run the risk of failure.

Sri Lanka is relying heavily on our well-recognized health care systems and sanitation standards, at 92% coverage, recognized as South Asia’s best. Inclusion of gender focus will improve the quality of our response and overall performance.

Do we have gender disaggregated data to inform the kind of programs you propose?

In Sri Lanka, this is a data-deficient area. It will be a useful research topic in the future and can specially strengthen WASH initiatives.

As part of the immediate response, what gender-specific needs should be addressed by the government? 

All health issues need to be gender specific, not gender neutral.

When you consider health and hygiene needs of people under lockdown, there are special groups and special needs.

Those living with disabilities, terminally ill persons, elderly persons, girls and women of menstruating age, or persons living in close communities are special groups. In this, gender plays an important role.

If gender is not a factor, then we will fail to address, for example, menstrual hygiene during the pandemic. Menstrual hygiene is not a Cinderella issue. What programs do we have at the multiple quarantine centers to cater to gender-specific sanitation needs?  The need for sanitary pads is not something women will openly discuss with the military who are currently operating the quarantine centers. These centers are efficiently run but there are issues that are not been catered to, like women-specific sanitation.

Sri Lanka now has a grocery delivery mechanism in place, both at the urban and rural level. Grocery lists contain mostly food items. These packs do not contain soap, which should be an essential item. Needless to say that no delivery package contains sanitary pads.

We propose to Sri Lanka’s excellent health care people to recognize different sanitation needs. Start small. Introduce health care packs catering to women’s sanitation needs. Ensure that our garbage disposal mechanisms now have specific plans to deal with solid and clinical waste both.

Countries are likely to take many months to return to normalcy. Where are the main challenges in reaching sanitation goals?

There will be significant loss of livelihood and this would result in reduced investment in several sectors. Despite its extreme importance, unfortunately, safe sanitation is one area that may suffer a slash globally.

But the actual need is to invest in safe sanitation, both at homes and institutions. If not, poor sanitation will exacerbate our health issues, amplifying the multipronged impact of COVID-19 and other infectious diseases.

Sri Lanka, for its part, has a strong community perspective in health care and we should strengthen that. We have traditionally invested in public health care and education and our COVID-19 response reflects the results of early investments made. We should build on that.

What should be Sri Lanka’s sanitation roadmap to keep not just COVID-19 but also other infectious diseases at bay?

As happens with all disasters in general, we have witnessed a powerful resurgence of the community spirit due to COVID-19. We should build on it, understanding that new roles will emerge and community health practitioners will have a bigger role to play in future.

Sri Lanka also has a history of applying community practices to tackle infectious diseases, including an age-old tradition in social distancing and reliance of native preventive medicine.

We must prioritize WASH in schools as a key investment. Then also look at waterborne diseases.

Next, invest in preventive, not curative, health. Catering to the marginalized communities and upgrading their sanitation facilities will reduce our risks in the future and make our future national responses more manageable.

Also, let’s keep our environment clean and our water resources healthy. They are our lifeline.

Banner image of school children in Sri Lanka, courtesy of UNICEF Sri Lanka.

Dilrukshi Handunnetti is a staff writer at Mongabay. Find her on Twitter: @DilrukshiH

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Dilrukshi Handunnetti Editor

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