Sustainable Sanitation in rural Haiti

Now retired, I worked as a Family Nurse Practitioner for 40 years in inner-city Milwaukee, Wisconsin and Tel Aviv, Israel. I have always served the disadvantaged community. Raised in New Rochelle, N.Y. by an activist teacher mother, I have always been motivated to look for solutions to problems that face me. When I travelled to rural Haiti in 2006 on a medical mission I saw the futility of treating preventable diseases with one month of medicine and leaving until the mission returned in a year. My nursing background always focused on prevention and sought the source of the problems. I looked for practical solutions that would fit the resources of local families. Research led me to learn about composting toilets and share what I had learned with my new friends.  From that moment the work was born.

In rural Haiti up to 85% of people have no access to improved sanitation. Open defecation leads to increased contamination of water sources and water-borne diseases.  Since 2008 Youthaiti has been building urine-diverting ecological toilets at schools in rural Haiti and promoting a marketing approach to household Arborloo composting latrines. All sanitation projects are accompanied by instruction in or demonstration sustainable organic gardens recycling nutrients back into the soil. This helps protect and improve health with increased access to food and nutrition. Youthaiti's education programs in both hand hygiene and menstrual hygiene reach students in 18 local schools. Youth are the future of Haiti and providing them with education and resources gives them hope.

Lack of sanitation is a global problem. In 2017, 2 billion people lacked access to improved sanitation and over 650 million practiced open defecation (UNICEF).  This is both an urban and a rural problem.

Much attention is paid to crowded urban centers, but people in rural areas are often ignored.  Lack of sanitation leads to contaminated water sources, which leads to serious water borne diseases and contributes largely to a 6.5% childhood mortality rate in Haiti (UNICEF 2018). In rural Haiti there are entire communities that have neither running water nor toilets and are not touched by either government or NGO interventions. Since 2008 Youthaiti has worked with some of the most remote villages providing both education and access to simple ecological toilets that are acceptable and affordable. By developing a marketing strategy that encourages 'buy-in' we do not just give away our services but teach the value.

Youthaiti provides multiple services to communities. We partner with schools to build urine-diverting toilets with facilities for boys and girls. Every school must provide 8-10% of the cost (in-kind) in construction and sign a contract taking responsibility for ongoing maintenance. We then provide extensive and repeated education for the students in sanitation and hygiene that they can share with their families. Individual families are invited to purchase a household arborloo composting latrine with regular surveillance by Youthaiti staff. Purchases are made with small monthly payments which allows the funds to recirculate back into the community. Staff support is subsidized by Youthaiti.

Because most residents are subsistence farmers, Youthaiti provides education in sustainable methods of agriculture that utilize recycled nutrients from urine and composted feces. Youthaiti's tree nursery provides fruit trees for planting in full arborloo pits and helps augment a family's income. 

Youthaiti's staff is entirely local Haitians.  They not only understand the lives of the people they serve, they live it. Since our inception our projects are locally conceived and driven. 

The population and the community leaders are very involved in the project. Decision making is done in consultation with the community. Due to limited financing, projects have required buy-in and in-kind contributions from participants. This has created increased value to the participants. The farmers have set up an association to facilitate reflection on various other practices that can be associated with the use of human excreta compost and also for community dissemination. The farmers become less dependent on chemical fertilizers, which are very expensive and difficult to obtain. In addition their garden production has increased and they have usable toilets!

Not only is Haiti the poorest country in the Western Hemisphere, but those living in rural Haiti are the poorest of the poor.  With underdeveloped infrastructure, a dysfunctional government and limited (NO) real resources, rural folks suffer from general neglect.  Youthaiti makes people in small, isolated communities feel like they count and their voice is important to how we develop our projects. Sanitation is not high on most donor's radar, but $1 spent on sanitation saves $9 in health care and increased productivity and combined with use of compost improves livelihoods and nutrition.  

I first travelled to Haiti in 2006 as a Nurse Practitioner on a medical
mission.  When I learned that so many people had preventable disease but no access to clean water or sanitation. I sought to learn more. Extensive research led me to consider eco-sanitation as a viable alternative in remote areas without access to piped water.  After conversations with local partners, we decided to try to build our first arborloo in January 2007.  After reaching out to friends and family to raise funds, I returned in May of 2007 to build the first urine-diverting toilet at the public grade school in Duchity. Working together with young people in the village we decided to launch an ongoing sustainable sanitation project, and in 2008 Youthaiti was born.  

Our U.S. board and staff are all volunteer.  Initially our Haitian partners were mostly high school students and some of their teachers.  Many of them have gone on to obtain university degrees or join Youthaiti as staff. Our 12 paid Haitian staff are local.  The project has evolved organically to meet the needs of local sanitation and sustainability. We integrated hygiene, and later menstrual hygiene education.  Sustainable gardening and tree nurseries are another natural outgrowth.

As a Nurse Practitioner, prevention has always been one of my core beliefs.  Yet medical missions never adequately address this and disaster relief even less.  When I first started working in Haiti, one in twelve children were dying before the age of five, many from water-borne disease.  Yet the answers could be so simple.

I wasn’t planning on starting a non-profit, but I found the young people in rural Haiti anxious to learn about alternative sanitation methods that were sustainable and could improve health and agricultural output.  Eighty-five percent of rural Haitians are subsistence farmers.  Methods to increase crop yield that wouldn’t cost them money could increase their security and send their children to school.  It was a win-win! Their enthusiasm was contagious and Youthaiti has continued to increase its impact with ties between sanitation, health and agriculture in the community.

Since 2006 I have developed relationships not only with Youthaiti staff, but with the communities of rural Haiti where we work.  Our current staff of 12 are well versed in the methods we promote and highly motivated to see change happen in their communities. It has been exciting to see these young adults develop into respected community leaders.

My background as a Nurse Practitioner helps me understand both the need and the science behind the importance of prevention and I have been able to share this with our partners.  I have been able to network with both local and U.S. based experts in ecological sanitation and sustainable agriculture and bring them to the community as teachers.  

We also network with other local organizations and government authorities. This has helped us expand and promote our tree nurseries and reforestation work.  Youthaiti is seen as a community resource throughout the region. 

The work in Haiti has not been easy, ever.  First, raising money for a project in sanitation for the poorest country in the Western Hemisphere doesn’t easily move people.  I had to reach beyond my comfort level to ask people to give.  I learned Creole to be able to communicate directly with Haitians, and I learned about the culture to understand decisions that were made at the local level. When we were building our Center for Sustainable Development I was working with people who betrayed my trust and fiscal responsibility was lacking. I not only had to let people go, but I had to take responsibility and report back to the Youthaiti board on the losses.  I am responsible
both to donors and to the community in which we work.  In a small Haitian community this had both personal and political repercussions. 
But despite that, I persisted and built on the relationships I could
trust. In 2013 we completed construction of a Center where locals can gather
for education and visitors can stay to volunteer.  In 2014 we finally had enough money to hire a local Program Director and many of those issues have been resolved.

Youthaiti is my brain-child, my baby.  From the beginning I shared my ideas with local Haitians in the village of Duchity and elicited their feedback. When I learned about ecological sanitation I sought to know if local Haitians would accept and adopt these methods.  We sat as a group listening to input from the youth. I believe in a participatory style of leadership.  In every project I always encourage the input and ideas of participants.

I encourage U.S. volunteers to visit with me and share their expertise – in organizational development, agronomy, solar engineering, even weaving and tennis!  And so we have developed local leaders, agronomy experts and staff who can maintain our solar electric system. By becoming fluent in Creole I have increased the trust that people have in me.  I can speak with villagers in remote communities and understand their needs, so that I can research resources or ideas to help them help themselves.  I believe in order for a project to be sustainable recipients have to have buy-in, both intellectual and financial.  This often means goods or labor ‘in-kind’, but it makes us true partners and not ‘giver’ and ‘receiver’.

Our solution is based on a known problem in the community, which is the need for toilets, to turn it into a strategy to have several lasting effects. In concrete terms, our solution solves two crucial problems: access to toilets which reduces open defecation in the area and therefore contamination, and enriches the soil with nutrients to increase agricultural production. This aspect of toilet use is not widely known in rural Haiti and is a key solution in communities. 

Generally, community-based interventions do not encourage people to contribute to development, they are often spontaneous and limited in time.  Our solution has been developed with local people, and in addition to meeting targeted needs, it also energizes people to commit to the provision of toilets.  This promotes sustainability.

The spread of diseases such as diarrhea and pneumonia, and hunger due to low agricultural productivity are the main problems identified in the community. Contamination of water by fecal matter is one of the main causes of disease. Our solution of building ecological toilets addresses this problem and then links it to agricultural production. As many toilets as there are built, there will be fewer cases of open defecation, and it will be easier to collect these excreta to make compost for soil fertility improvement.

(1) Farmers will be provided with a place for defecation.

(2) Improvement of sanitary conditions, with less contamination.

(3) Obtaining cheap compost rich in nutrients such as Nitrogen, Phosphorus and Potassium for crops

(4) Increasing soil productivity

(5) Conservation of the soil resource by maintaining chemical fertility

Our solution will have lasting impacts for the following reasons:

(1) It was the result of an inclusive and participatory community diagnosis and therefore reflects the needs of the population.

(2) Our solution has been implemented on several locations internationally and has yielded good results

(3) Our solution supports support and monitoring at all levels of the implementation and composting activities. Dialogue and constructive sharing are also favoured.

(4) Emphasis is placed on outreach to community and state bodies. 

Youthaiti has built urine-diverting toilets in 34 schools and 320 households have built arborloo toilets with the help of the project's technicians. We follow-up with them in terms of maintenance, sanitation and hygiene education, and integration of compost into garden production.  Each year we reach 18 schools and over 4000 school children with education in hygiene and reproductive health (menstrual hygiene).  Our public education on sanitation, hygiene and recently COVID prevention has reached over 7,000 additional adults. 

Next year we will build 100 arborloos for households who have already been identified on the basis of certain vulnerability such as the practice of open defecation, the number of dependent children, the ages of family members and the amount of land available.  Small family plots are a factor of poverty, as it does not allow the householders to be economically self-sufficent.  Priority is given to families with small plots of land. In some cases families will share a toilet located between households. 

We will continue to build 2 school-based toilets next year and continue our education program in 18 schools.

With adequate financing, in five years we will have expanded our community outreach capacity and will reach 500 families per year or 2500 additional families, five times our current capacity. We will build 5 school-based toilets yearly and continue our outreach to all of the 50,000 people in the Commune of Pestel.

Haiti has a population of approximately 11 million people, two-thirds of whom live in rural areas which are the poorest and lack infrastructure. Our long-range vision is to reach communities in all 10 of Haiti's departments who live without proper sanitation and engage in agriculture.  These communities will learn how to use local materials to build ecological toilets and improve agricultural productivity. Over the next five years we will have strengthened our network at the local and regional level with over 5000 households with new toilets and new skills.  This can then be expanded to other regions through our network of experts and government contacts.

Our Center for Sustainable Development will serve as an education hub for people from throughout the Departments of Grande'Anse and Sud (the western part of Haiti). By sharing ideas and developing a 'train the trainer' program we will be able to expand our outreach many fold.

In the time of COVID, it is difficult to know how much expansion will be possible across geographical areas, or what impact the virus may have on local populations and our ability to work in the field and for how long.  As markets for goods shrink due to people out of work, families who sell agricultural products may also suffer from decreased income and have less of an ability to contribute to the purchase of a household arborloo.  Yet the importance of sanitation and hygiene could not be more important.

In addition, due to the contracted economy, organizational donation income is at risk.  We hope that we will be able to continue supporting our staff of 12 to do the important work of community outreach and education.

Other barriers in Haiti include the weather and the political climate.  Our only transportation currently is by foot or motorcycle.  In the mountains where we work there is frequent rain, making travel treacherous, and therefore outreach and education can often be delayed.   Because of Haiti's political instability, local governments also do not have funds to help support or promote our work, despite the acknowledged need.  As a matter of fact, it is not unusual for the local officials to come to us seeking help financing local projects.

We continue to seek funding partners both individual and foundations.  With adequate funding we could purchase a truck that could more easily travel in inclement weather.

We hope that increased agricultural productivity, both gardens and fruit trees, will at least help feed families who live always on the margins.  We continue to look for less expensive methods of construction that are even more affordable.

We continue to collaborate with local officials, despite the financial constraints.

We currently partner with Despagne Felix Vocational school in Duchity, Haiti.  They train local Haitian youth in all fields of construction.

We also partner with the local government authorities in planning educational outreach and distribution of hygiene materials.

Currently the majority of our funds come from individual donors and a small amount from grants.  We continue to seek larger grant funding to expand our work.

In addition, our model of 'sanitation marketing' seeks to reinvest all fees received back into the project and the community to provide more toilets to more families.

We are currently partnering with the Ministry of Agriculture on a coffee tree seedling program that provides income to Youthaiti and the beneficiaries of the trees.  We hope to expand this program going forward.

We have received a variety of grants in the past, however in 2019-2020 our only institutional funder was High Winds Association with a $5,000 grant for general operating expenses.

Our current 2020 budget is $99,785, however to date we have raised just over 20% of anticipated funds. We have several outstanding grant applications, but are concerned due to global pandemic concerns funders priorities have changed focus. We anticipate having to curtail several projects if additional funding is not received.  We will use our reserves to make up the difference and keep our staff employed in 2020.

Youthaiti has struggled in the last two years especially to meet our budget with individual donations and grants.  The Elevate Prize would initially enable us to have a more secure financial footing to expand our work to meet the local need.  We need to update our motorcycles, some of which are over 5 years old and have travelled many miles on rocky mountain roads and paths. Currently we do not even have one motorcycle for each field staff, they often need to ride together.  We need a truck to transport materials from the nearest city to our Center and then out to isolated communities for construction of projects, as well as to provide safe transportation in inclement weather.  In order to expand our outreach as so desperately needed in this area, we need to increase our staff and compensate them fairly.

In addition, the Elevate Prize would provide us with mentoring and coaching in capacity building and connect us to a wider range of donors and funders. Ultimately we would like to reach out to and train a new cadre of young Haitians to assume ultimate leadership and management of Youthaiti.  

We currently have no real 'staff' in the U.S.  I am a volunteer Executive Director with a background in healthcare.  We have 2 volunteers who help with some grant writing, but could use a professional Development Director to help expand our revenue base including individual donations, grants and expanding our marketing/media presence.