The Indian state of Maharashtra has declared itself “open defecation-free” after installing nearly 5.5 million toilets since 2014. The state’s chief minister, Devendra Fadnavis, has described this as a win for women’s dignity. But what does eliminating open defecation mean for women’s economic advancement?
Camilla Hagen Sorli, a Norwegian philanthropist, says the potential is great.
Without a toilet, “women have to defecate in the open, they have to go really far and they have to get up at night. And there is the issue of menstruation. All of this hinders them from getting out and being able to live and work,” says Sorli, owner and project executive at Canica, one of the largest privately owned investment companies in Norway.
She supports a project in Vietnam that hires local masons – men and women – to build affordable, hygienic toilets and works with the Vietnamese government to make sure low-income families can afford to buy and install one.
By creating a commercial market for hygienic toilets in Vietnam’s rural areas, she says she hopes to give more women the chance to participate in the economy and make decisions for their families.
Sorli is a member of the Maverick Collective, a community of women philanthropists created by Population Services International. Another member of the collective, English Sall, is also investing in the link between women’s physical health and their economic well-being.
Sall, a board member of the Sall Family Foundation and a specialist in humanitarian work psychology, is working on creating an electronic information tool for Zimbabwe’s community healthcare system. She believes community health workers, most of whom are women, are the key to making the system work.
“They’re like human databases, the details they know about their patients that truly allow them to provide quality care are amazing,” she says. “If we can do anything to make their job easier and help them provide this high level of quality care, we’re excited to do it.”
Women’s Advancement Deeply spoke with Sall and Sorli about their projects and how women’s health has an impact on their economic progress.
Women’s Advancement Deeply: You’re transforming community health in Zimbabwe. And you’re using something called industrial organizational psychology. Can you start off by explaining what that is?
English Sall: It‘s the psychology of the workplace and the workforce. My specialty is humanitarian work psychology. So, it’s this idea of how people interact with their work, especially focused on social impact and humanitarian aid organizations and initiatives.
One of the reasons I am so excited about this project … is really understanding the community health worker and how they’re the backbone of this system we are trying to strengthen. Being able to understand how this person interacts with this work in a very informal economy, and yet still maintains the motivation to get up every day and treat the members of her community and keep these extremely detailed, meticulous records of the different patients she treats.
Women’s Advancement Deeply: You say this is informal work. What does that mean?
Sall: In a lot of these spaces where you and I operate, we operate in a formal economy. We operate in a system that provides the infrastructure for us to provide services or goods where we get paid and there’s equal information between demand and supply, provider and patient. They’re structures we can count on.
A lot of times, especially when it comes to community health workers, not just in Zimbabwe but throughout the world, they’re operating in an informal economy. There’s not a lot of structure that they can count on to elevate and enhance their work. So, that’s what we’re really trying to do by strengthening this system, [is] provide the empowerment to a lot of these community health workers to do the job to the best of their ability and giving them the tools to do that.
Women’s Advancement Deeply: What’s the economic situation of the community health workers? Are they well remunerated for their work?
Sall: It’s a really interesting topic, because it’s something that is somewhat debated – whether or not a community health worker should be paid. There’s a fair number who do this on a voluntary basis or do it in exchange for something like a bicycle. I’m of the mind that community health workers should absolutely be paid.
First of all, all of the data says that if they are paid, then the quality of healthcare outcomes are improved. Also, we live in the 21st century and this is an important job, and they should be paid for doing it. The community health workers that we were talking with were paid maybe $5 a month. Some hadn’t been paid in a year and they were still doing their job, very motivated, and just hoping that at some point they would get paid what they were owed.
Women’s Advancement Deeply: These are very trusted people and, as you say, they are highly motivated. Is your work about formalizing that role, hoping we can get those women paid regularly and fairly to raise the overall standard of care?
Sall: That’s definitely a huge component of it. One of the reasons I am so passionate about this project is that it has a lot of moving pieces. It’s a systems-level project starting with community health workers as the foundation. If we were to look at how a community health system operates, it’s going from a patient to the community health worker, to the Ministry of Health. And we’re trying to implement processes that bring all of those together and put into play connective tissue that allows all of the people in that equation to have access to the information they need in order to make strategic decisions and provide high-quality care.
Formalizing this role of a community health worker – ensuring that the training is issued to provide quality care and that the pay for this role is fair – is really important and would be a huge success, especially for women.
Women’s Advancement Deeply: Why is sanitation in rural Vietnam important?
Camilla Hagen Sorli: When you look at the issue of sanitation, you have to look at the whole picture. It’s not just about handing out the toilets and saying, “Use it.” You really have to look at the complete value chain and work with consumer behavior, access, affordability and the whole production line. That is what we’re doing in Vietnam.
Vietnam still has 17 million people in rural areas who do not have access to proper sanitation. This, of course, affects women especially, who have no choice but to defecate in the open or in open-air toilets, and a process that has subjected them particularly to shame, embarrassment and risk of assault.
We are looking to provide women and communities with the tools, ideas and education to create sustainable solutions for sanitation within their societies. With proper sanitation, we will promote gender equality, empower women and reduce child mortality.
Women’s Advancement Deeply: Rather than giving out toilets, you’re focusing on selling them to families. Are you finding that the more effective way of increasing buy-in?
Sorli: Yes, for sure, because it’s a much more sustainable solution. Both in Vietnam and also in India, governments were handing out toilets. But it was really the lowest standard toilets, which were very difficult to keep clean. It ended up with no one using them. It’s much better to empower the communities and the women to build a good economic value chain of their own.
Women’s Advancement Deeply: How are you working with women down the value chain and making sure it’s something that can also be used for women’s economic advancement?
Sorli: We’re empowering women with tools and ideas to become community champions, to engage with the retailers, and also become masons.
We haven’t had a focus on actually recruiting female masons. It’s more male masons. But we do see an increase, and it’s a way of empowering the women to be able to work within their own communities and earn money for themselves.
This conversation has been edited for length and clarity.