TOILETS are a private concern for most people in rural China, except when they become a major health concern. Gong Yidong looks at the reality of bad smells and good living.

For a Chinese farmer like Gao Zhiping living in a backward, mountainous region, talking about toilets is like talking about sex - it's a private concern and impolite to discuss.

For him, going to the toilet is part of life, but not nearly as important as the happiness of a good corn harvest or the benefits from subsidy policies.

But a national campaign to improve toilets and sanitation by the Chinese government on the basis of the United Nations Children's Fund's pilot program in the 1990s is changing Gao and his fellow Chinese peasants' ideas and actions.

Having lived in Gaojiagou Village, Xiangyuan County in northern China's Shanxi Province, for more than half a century, Gao is accustomed to the dirty environment of his toilet.

"When the summer comes, the toilet stinks, driving off passers-by. Flies are everywhere, over the roof, in the kitchen, you name it," Gao points to the shabby open toilet constructed by his grandfather in the early 1950s.

In Gao's village and the larger Shanxi Province, open toilets are common. Farmers build a simple toilet using flagstones, and most latrine pits are up to 2 meters high.

In some places, the villagers don't have a personal toilet and share an open toilet. But these large toilets can be dangerous for children - some have slipped into the pit and drowned, 53-year-old Gao says.

More alarming is the health threat from this type of open toilet. In the past when tap water was not available, Gao had to go far to fetch water from the Sishui River at the foot of the mountain. Underground water was polluted by the open toilets, which also leaked into the river. "We were worried, but no one knew how to deal with the situation."

Gao's village is not on its own. In the adjacent Dongchangyi Village, diarrhea was commonly reported in the past and there was a high incidence of cancer, says villager Wang Xianzhong.

One of the reasons behind the high occurrence of diarrhea, according to Wang, was that children had easy access to dung. "They liked to play games with it."

Game-playing like this is not funny. UNICEF reports that there are 190 million Chinese children suffering from roundworm and 70 million tormented by whipworm infections.

"These bowel infections can result in retarded growth and malnutrition," says Lei Jun, an official from UNICEF.

Gao Shenghua, director of Shanxi Provincial Committee of Patriotic Health Campaign, says the neglect of toilets is not just an issue of personal hygiene, but a challenge to public health. A recent case was the outbreak of cholera in southern China's Hainan Province late October.

When torrential rain hit Xinying Town of Danzhou City, 51 cases of cholera were reported. A major reason, according to Bai Zhiqin, the head of Hainan Provincial Department of Health, was that villagers did not build sanitary toilets in the village and the water was polluted when the rainy season arrived.

To help the sanitation, UNICEF launched a pilot program aimed at the rural areas of northwestern China in 1996, with a focus on building a new type of double-urn latrines.

The science behind this type of toilet is quite simple, but it is effective, says Lei. The first urn, filled with water, is used for storing dung. Within three months, bacteria carried by dung are nearly all killed in an anaerobic environment, and the dung will be automatically transferred to the second urn through a tunnel linking the two.

Then, the dung in the second urn continues the process of fermentation before eventually being disposed of.

Wang Xianzhong, one of the pilot program's beneficiaries, is happy to see that he is no longer bothered by flies and the new toilet no longer smells badly.

Apart from a cleaner environment, the fermented dung in the second urn can be used as high-quality organic fertilizer.

Clean environment

Li Tuying, an orchardist in Zhanghu Village, Jinzhong City, says the fermented dung complements the chemical fertilizers she buys on the market. On average, she spends 4,500 yuan (US$658) per year on 10 tonnes of fertilizer - the fermented dung can make up to 600 kilograms of organic fertilizer.

Another part of UNICEF's pilot program is the emphasis on health awareness, as UNICEF integrates the construction of toilets with clean water and personal hygiene under its WES (water, environment and sanitation) model.

"Now, everyone in my village has accepted the idea that washing hands with soap is an effective means to prevent communicable diseases," says Wang.

In the past decade, UNICEF's practice was gradually absorbed into the policy-making process at the top level. Starting from 2007, the central government of China decided to improve sanitation in the rural areas by renovating the old-style toilets into five new varieties: double-urn, three-chamber, bio-gas, urine-diversion and water-flushed toilets.

"Keeping a clean environment is an important element of building a new socialist countryside," says Gao Shenghua.

Central government's spending on toilet renovations has risen from 107 million yuan in 2004 to 300 million yuan in 2008. The target is to raise the penetration of sanitary toilets to 65 percent by 2015. Right now, the spread of sanitary toilets in the rural areas of Shanxi is 16 percent.

Both officials and villagers have to counter a series of challenges.

The most troublesome is funding. Without sufficient funding from outside, says Gao Zhiping, he cannot renovate the toilet himself as the expense is not a small amount for his family of four, who earn less than 3,000 yuan a year from his one hectare of land.

On average, it costs nearly 1,000 yuan to renovate a toilet, but the central government only sets aside 350 yuan per toilet, and provincial and local governments are obliged to contribute.

But most of the local governments of Shanxi are short of revenue, especially after tax reforms in the 1990s. Some officials believe that clean toilets are less important than introducing investment.

More embarrassing is the position of the Patriotic Health Campaign Committee, which has the responsibility of overseeing the sanitation work.

In the mid-1950s, Chairman Mao Zedong initiated a movement to "pay attention to the sanitation, fight against the bacteria and improve health," and the Patriotic Health Campaign Committee was thus founded.

Throughout the 1950s, the Chinese were engaged in cleaning up their homes and communities, and both the countryside and cities took on a new look in a short time.

But the committee's functions have been sidelined over the past decades, and it has become an institution with no substantial power. For example, there are no specially assigned personnel on many lower-level committees, says Gao Shenghua.

But Gao, who has worked on the provincial committee for 26 years, is determined to push ahead. "A person can hardly be deemed healthy if a single cell is ill, and the new socialist countryside won't be realized without clean toilets in the backyard," she says confidently.