Overview
Some 829 000 people in low- and middle-income countries die as a result of inadequate water, sanitation, and hygiene each year, representing 60% of total diarrhoeal deaths. Poor sanitation is believed to be the main cause in some 432 000 of these deaths and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition.
In 2020, 54% of the global population (4.2 billion people) used a safely managed sanitation service; 34% (2.6 billion people) used private sanitation facilities connected to sewers from which wastewater was treated; 20% (1.6 billion people) used toilets or latrines where excreta were safely disposed of in situ; and 78% of the world’s population (6.1 billion people) used at least a basic sanitation service.
Diarrhoea remains a major killer but is largely preventable. Better water, sanitation, and hygiene could prevent the deaths of 297 000 children aged under 5 years each year.
Open defecation perpetuates a vicious cycle of disease and poverty. The countries where open defection is most widespread have the highest number of deaths of children aged under 5 years as well as the highest levels of malnutrition and poverty, and big disparities of wealth.
Benefits of improving sanitation
Benefits of improved sanitation extend well beyond reducing the risk of diarrhoea. These include:
- reducing the spread of intestinal worms, schistosomiasis and trachoma, which are neglected tropical diseases that cause suffering for millions;
- reducing the severity and impact of malnutrition;
- promoting dignity and boosting safety, particularly among women and girls;
- promoting school attendance: girls’ school attendance is particularly boosted by the provision of separate sanitary facilities;
- reducing the spread of antimicrobial resistance;
- potential recovery of water, renewable energy and nutrients from faecal waste; and
- potential to mitigate water scarcity through safe use of wastewater for irrigation especially in areas most affected by climate change.
A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US$ 5.50 in lower health costs, more productivity and fewer premature deaths.
Challenges
In 2013, the UN Deputy Secretary-General issued a call to action on sanitation that included the elimination of open defecation by 2025. The world is on track to eliminate open defecation by 2030, if not by 2025, but historical rates of progress would need to double for the world to achieve universal coverage with basic sanitation services by 2030. To achieve universal safely managed services, rates would need to quadruple.
The situation of the urban poor poses a growing challenge as they live increasingly in cities where sewerage is precarious or non-existent and space for toilets and removal of waste is at a premium. Inequalities in access are compounded when sewage removed from wealthier households is discharged into storm drains, waterways or landfills, polluting poor residential areas. Globally, approximately half of all wastewater is discharged partially treated or untreated directly into rivers, lakes or the ocean.
Wastewater is increasingly seen as a resource providing reliable water and nutrients for food production to feed growing urban populations. Yet this requires regulatory oversight and public education. Inadequately treated wastewater is estimated to be used to irrigate croplands in peri-urban areas covering approximately 36 million hectares (equivalent to the size of Germany).
In 2019 UN-Water launched the SDG6 global acceleration framework (GAF). On World Toilet Day 2020, WHO and UNICEF launched the State of the world’s sanitation report laying out the scale of the challenge in terms of health impact, sanitation coverage, progress, policy and investment and also laying out an acceleration agenda for sanitation under the GAF.
WHO response
In 2010, the UN General Assembly recognized access to safe and clean drinking water and sanitation as a human right and called for international efforts to help countries to provide safe, clean, accessible and affordable drinkinAnitg water and sanitation. Sustainable Development Goal target 6.2 calls for adequate and equitable sanitation for all.
As the international authority on public health, WHO leads global efforts to prevent transmission of diseases, advising governments on health-based regulation and service delivery. On sanitation, WHO monitors global burden of disease and the level of sanitation access and analyses what helps and hinders progress. Such monitoring gives Member States and donors global data to help decide how to invest in providing toilets and ensuring safe management of wastewater and excreta.
WHO works with partners on promoting effective risk assessment and management practices for sanitation in communities and health facilities through the WHO Guidelines on sanitation and health, safe use of wastewater, recreational water quality and promotion of sanitation safety planning and sanitary inspections. WHO also supports collaboration between WASH and health programmes such as neglected tropical diseases, cholera, polio and antimicrobial resistance. Aspect of climate resilience are incorporated in all WHO sanitation guidance documents.
