There is no toilet at Siev Phalla’s house. The 47-year-old farmer from Pursat province, along with her husband and seven children, head to the edge of their rice field when they need to relieve themselves. They dig a small hole and cover their excrement with dirt when they are finished.
“I understand that having a toilet and sanitation is very important,” said Ms. Phalla. “But for us, we don’t have enough money to build it.”
Ms. Phalla is among the 66 percent of the rural population who still openly defecate outdoors, according to a new report released last month by the Rural Development Ministry and Unicef.
The continued lack of access to improved sanitation facilities, defined by the World Health Organization (WHO) as facilities that separate human excreta from human contact, is costing the government more than $400 million in health costs annually, the report says.
“The improper containment of feces, coupled with a lack of hygiene practices, can be harmful to the health of the wider population,” according to the report, which details the national strategy for sanitation and hygiene up to 2025.
While the government set a target in 2003 to reach universal access to proper latrines by 2025, only 28 percent of the population currently has access to one, the report states, adding that it is “unlikely” the government will reach its 100 percent target on time.
“Even though there are some difficulties, we will work our best [to reach the 2025 goal],” said Chea Samnang, director of the Rural Development Ministry’s rural health care department.
“At the moment, the government is facilitating and working with NGOs and we have a meeting every month,” he said.
The national plan for sanitation and hygiene calls on the government to direct more funding to sanitation, but also encourages the private sector to invest in sanitation projects and cooperate in research and improving human resources in the sector.
Kong Bunleang, country director for the World Toilet Organization, a global body that promotes proper sanitation, said the reason so many people in the country still don’t have toilets is because there are still many people living under the poverty line. He also said there is a tendency to focus more on irrigation and drainage programs rather than sanitation.
“I would like the local government in villages and communes to pay more attention to toilets and sanitation because now they only focus on water and drainage,” he said, adding that his organization had sold more than 20,000 toilets across the country.
Defecating in the open, where bacteria and parasites can contaminate water resources, poses a real public health risk, according to Steven Iddings, an environmental engineer with the WHO in Cambodia.
Every year, about 2,300 children die from diarrheal diseases in Cambodia, according to a 2011 report from PATH International. And “a high proportion of childhood illnesses—especially diarrheal diseases—are linked to quality of water and water-related hygiene,” said Mr. Iddings.
But while universal access to improved sanitation may not be reached by 2025, a number of organizations have joined the government to bring more toilets to rural areas.
Increasing access to proper toilets, according to the report from the Rural Development Ministry, is not only a matter of building toilets, but of changing behavior and marketing toilets so that families understand their value and buy them.
Making, marketing and encouraging the use of toilets has been one of the aims the international non-profit iDE since it began research on its sanitation marketing project in 2006, according to Mike Roberts, iDE’s country director.
In 2008, iDE hired a product designer who created the Easy Latrine, a low-cost cement toilet that iDE has trained local businesses to make. Since the Easy Latrine’s launch in 2009, 150 cement businesses in rural Cambodia have sold about 30,000 latrines to villagers, according to Mr. Roberts.
For people like Ms. Phalla, who can’t afford a toilet—Mr. Roberts at iDE said the Easy Latrine costs about $35 for the toilet and a bit more for an accompanying shelter—iDE is also encouraging microfinance institutions to provide loans for interested families.
The Rural Development Ministry as well as firms such as iDE have also been pushing the importance of proper latrines in meetings with rural villagers.
To encourage people to use a toilet, firms such as 17 Triggers, a social advertising and marketing firm based in Cambodia, have created campaigns for both iDE and the Rural Development Ministry meant to convince people without toilets to buy one.
In one image, feces is shown next to a roast chicken leg, with a swarm of flies going between the two.
Another image in the Rural Development Ministry’s “Sanitation and Hygiene Behavior Change Toolkit” shows a man with his pants around his ankles defecating next to a dog doing the same. The accompanying text reads “Animals don’t use toilets, but you do.”
The images, which are both humorous and shocking, are meant to change people’s perceptions of sanitation, said Mr. Roberts.
“Until it is a shameful thing to poop in rice fields, people are going to do it,” he said.