“With all the attention given to AIDS, malaria and TB in Africa, are we losing sight of other basic services?” Azad Essa, an online producer at Al Jazeera, asks in the news service’s “Africa” blog. He highlights a meeting between journalists and “the Chief Macha of Choma, leader of the Tonga speaking people in southern Zambia,” noting, “The Choma district, made up of 260,000 people, heaves heavily under the burden of HIV, malaria and TB. But like every other region in the country, the district has made significant gains against the triad of disease in recent years.” Essa writes, “Here we were, intent on bringing out the usual set of questions related to HIV, malaria and TB: peoples’ behavior, the role of culture and tradition and empowerment of women. Instead, he challenged our basic assumptions of what mattered most to him, or his people” — sanitation.

“More than 600 million or 70 percent of people on the continent still do not have access to a clean toilet. Poor sanitation is the cause of hundreds of thousands of deaths in Africa each year,” Essa continues, adding, “Poor sanitation lays hidden behind the big names of malaria, HIV and TB, as the primary killers on the continent.” He writes, “But under conditions of poor or no sanitation, millions live in constant risk of a myriad of diseases: The soiled hands feeding children medication and the contaminated water that carries typhoid and causes diarrhea, contribute to economic dysfunction, and even fatalities.” He states, “There remains a fixation on HIV and to a lesser extent TB as illnesses that impose a particular violence on human beings, requiring dramatic intervention,” adding, “The Gods of global health policy appear merely intent ‘on keeping people alive,’ but not necessarily transforming their lives.” He writes, “And while toilets and clean water won’t solve the challenges related to AIDS, or TB, it certainly does illustrate a severe shortcoming of global health policy” (7/22).