More cell phones than toilets: Mobile technology emerges as the new lifeline for the world’s poor

A report on inadequate sanitation, released by the UN University, made waves earlier this year when it reported that while 45% of India’s population owned cell phone, only 31% of them had access to improved sanitation in 2008.1  Headlines proclaiming “India has more cell phones than toilets” found their way into several of my e-mail news digests.  “It is a tragic irony to think that in India, a country now wealthy enough that roughly half of the people own phones, about half cannot afford the basic necessity and dignity of a toilet,” said Zafar Adeel, Director of United Nations University’s Institute for Water, Environment and Health (IWEH), and chair of UN-Water.  With the focus on the Millennium Development Goals growing more acute as the deadline approaches, people were understandably astonished.  

It is shocking to think that so many of the world’s poor cannot access appropriate sanitation.  However, the widespread use of cell phones should not be juxtaposed against the conditions of poverty, but should rather be seen as a way to empower the poor to improve their conditions.  The cell phone market has seen explosive growth in the last decade: 90% of the world’s population will soon be within the coverage of wireless networks,2 and there are already an estimated five billion cell phones used globally.3  Villages without running water or electricity often have at least one mobile phone, and people can switch out their own SIM cards for access.  They are being adopted faster than basic services such as routine medical care and schools.2  When a basic toilet costs 15 times more than a basic cell phone ($3001 compared to $203), it becomes easier to understand the discrepancy between access to sanitation vs. mobile technology.  If mobile penetration is so widespread, then, should it not be viewed as a tool and an opportunity for innovation?  

A man holds a cell phone in front of a woman with four children.
Photo taken from mHealth Alliance Executive Director David Aylward's blog entry in the Global Health Magazine.

Some governments and organizations have already caught on.  In Rwanda, for example, the government provides free cell phones to rural health workers to register expectant mothers, get answers to their questions from a health expert, and send monthly status reports to doctors.2  Other programs send reminders to HIV-positive pregnant women to take ARVs and work to reduce stock-outs of drugs in rural clinics.  Pharmaceutical companies are also working with application developers to fight drug counterfeiting: customers will be able to submit a numeric code on drug packaging via SMS and get a reply that states whether the drug is “NO” or “OK,” along with the drug’s name, expiration date, and other information.4  And I have already featured Tostan’s Jokko Initiative, which applies their literacy lessons to cell phone usage and includes a lesson on the health-related utility of SMS.  Other applications include facilitating electronic banking and providing information on crop disease and weather to farmers.2  

Progress on the MDGs should not be overlooked, and the importance of access to sanitation is should certainly not be downplayed at all.  With an expected return between $3-34 for every dollar spent on sanitation, it is absolutely worthwhile to stress the importance improving people’s access to this need.  Now, if only we could develop an app to improve sanitation – that would be perfect.

Rohingya Refugees: Where do you go when everyone just wants you to go away?

Rebel groups in the Congo.  Religious radicals in Iraq.  Mercenaries in Darfur.  Starvation in North Korea.  Natural disasters in Haiti and Chile.  Every region in the world has something to run from, and the people running from them are dispersed far and wide.  Refugees, while pitied, are often treated with a mild neglect, or sometimes with disdain or outright hostility.  Still, many of them find the means to survive in less dangerous conditions.  Some try to make a life for themselves by emigrating, while others do their best to scrape a life together in refugee camps dotting the borders of their more peaceful neighbors.  The public health and medical challenges in refugee camps are many and daunting: unsanitary conditions, no running water, little to no food security, scant medical care. 

A Rohingya woman collects rain water.
From "Rohingya in Bangladesh: Unrecognized, Unprotected, and Unassisted," a slideshow by MSF

The Rohingya are suffering from these conditions perhaps more acutely than most.  They are an ethnic Muslim group from Myanmar, but they are not recognized as one of the country’s 135 “national races” by the military junta.  About 750,000 currently live in Myanmar, where they are oppressed by the military and not allowed to own property, vote, travel, or marry; one million have fled persecution and emigrated to other parts of the world.1  There are refugees in each of the country’s five neighbors – China, India, Laos, Thailand, and Bangladesh – with the largest refugee camps in Bangladesh.2  While 28,000 in the official Kutupalong camp have recognized refugee status in Bangladesh,3  another 220,000 are illegal immigrants with no official status and no assistance.3,4  Many live in a makeshift camp just down the road from Kutupalong with no water, power, schools, or medicine.1  When Médecins sans Frontières (Doctors without Borders) made its initial assessment of the camp in March of 2009, they found that 90% of the more than 20,000 residents were severely food-insecure; malnutrition and mortality rates were past emergency thresholds; and people had little access to safe drinking water, sanitation, or medical care.3,5  MSF immediately began offering basic health care and treating malnourished children and has now established a primary health care program for the refugees.  MSF and Action contre la Faim (Action against Hunger) are the only international NGOs working at the makeshift camp.5The treatment the Rohingya face in Bangladesh and elsewhere isn’t much better than in Myanmar.  The Bangladeshi government has been accused of blocking food aid, conducting arbitrary arrests, beating and harassing the unrecognized refugees.3,4  Reports have come in of the Thai military conducting “pushbacks” – rounding up Rohingya, putting them on a boat, and pushing them out to sea.1  But the truth is that no one wants them.  Bangladeshi officials, denying allegations of abuse, insist that “[w]e are the victims. The Burmese people have been kicked out of their country and we gave them shelter.”4 

More information on the Rohingya and refugee health
Rohingya in Bangladesh: Unrecognized, Unprotected, and Unassisted (MSF slideshow)
The United Nations High Commissioner for Refugees
Forced Migration Review – published three times a year in English, Arabic, Spanish, and French by the Refugee Studies Centre of the Department of International Development, University of Oxford. 

Rotavirus—the most common and lethal form of diarrhea—deadly for children

Rotavirus—the most common and lethal form of diarrhea—is one of the most deadly diseases facing children

By Dr. John Wecker, director of the Vaccine Access and Delivery Global Program at PATH

Whether you have heard of rotavirus before or not, it may surprise you to know that you’ve probably had it. Nearly everyone in the world will have at least one rotavirus infection by age 3.

In wealthy countries, ready access to medical care means that few children will die from rotavirus. And with the recent availability of vaccines, the risk of dying, or of ever having to be hospitalized because of rotavirus, has dropped dramatically.

In the developing world, the situation is completely different. Rotavirus—the most common and lethal form of diarrhea—is one of the most deadly diseases a child will face.

This global health crisis can be solved by making rotavirus vaccines widely available in the developing world. The World Health Organization recommends that these vaccines be included in every country’s immunization program. What is lacking is the political will at all levels to make this happen.

Raising awareness about the toll of this disease and the promise that vaccines hold to save lives is critical for building political will. Recently, the scientific Journal of Infectious Diseases released a special supplement on rotavirus, Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines. It provides a comprehensive review of the latest information about rotavirus disease and the role that vaccination can play.

Not only is rotavirus not well known as a major killer of children worldwide, but the fact that diarrheal disease is responsible for the death of 1.5 million young children each year in developing countries is lost on a world that takes for granted access to sanitation, clean water and basic health services. In a recent New York Times story the chief of health at UNICEF, Mickey Chopra, was quoted as saying, “All the attention has gone to more glamorous diseases, but this basic thing has been left behind. It’s a forgotten disease.”

Included below is a short release on the special rotavirus supplement.

To access the supplement, please visit:

For more information on rotavirus, read: Common Virus and Senseless Killer: Briefing Paper on Rotavirus

Learn more at or

Continue reading “Rotavirus—the most common and lethal form of diarrhea—deadly for children”

Water and Public Health


The theme of APHA’s annual meeting is Water and Public Health. During the opening general session Dr. Mirta Roses Periago, Director of the Pan American Health Organization (PAHO) underlined the effects of climate change on human health, the new challenges faced by global health and the importance of access to safe water. Dr. Periago reinforced that combining water, sanitation and hygiene interventions can reduce up to 80% of the preventable water borne and related disease. The Millennium Development Goal target for 7c is to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Dr. Periago stated that a one dollar investment in water and sanitation provides a $46 savings in social and development cost. The ideal would be to have water, climate change and equity addressed in a combined sustainable approach.

Celine Cousteau reinforced the importance of the connection between people and the environment. Ms. Cousteau is a story teller whose passion preserving our natural resources is equaled by her passion to bring health care to the indigenous people of the Vale do Javari reserve in Brazil. The film Amazon Promise is a celebration of one organization’s goal to bring health care to those in need…. the same passion found in so many of our public health workers around the globe.

VIDEO about Community-led Total Sanitation in Indonesia – PCI

Solihin asks the crowd whether anyone wants to drink a cup of feces-contaminated water.
Solihin asks the crowd whether anyone wants to drink a cup of feces-contaminated water.

Project Concern International (PCI) is the first NGO in Indonesia to fully implement Community-led Total Sanitation (CLTS) and offer no subsidies to communities. Watch the video here (and listen to some cool music):

View or download VIDEO here (MPEG4)
Download high-quality video (MPEG2, 700MB)

This video is about 18 minutes in length and shows how CLTS gets started in a community. The CLTS method emphasizes the importance of “natural leaders,” community members who emerge during the triggering session and demonstrate strong motivation and resolve to help their village become “open defecation free.” Continue reading “VIDEO about Community-led Total Sanitation in Indonesia – PCI”