Water for Life Decade >> Access to sanitation

Access to sanitation

The United Nations estimates that 2.6 billion people still lack access to improved sanitation and around 1.2 billion practice open defecation. An estimated 1.6 million people, mostly children under the age of 5, die each year from water and sanitation-related diseases.

In 2006, only 62 per cent of the world's population had access to improved sanitation - that is, uses a sanitation facility that ensures hygienic separation of human excreta from human contact. A further 8 per cent shared an improved facility with one or more households, and another 12 per cent uses an unimproved sanitation facility - one that does not ensure hygienic separation of excreta from human contact. Open defecation is declining in all regions and has decreased worldwide from 25% in 1990 to 17% in 2008.

The state of sanitation remains a powerful indicator of the state of human development in any community. Access to sanitation bestows benefits at many levels. Cross-country studies show that the method of disposing of excreta is one of the strongest determinants of child survival: the transition from unimproved to improved sanitation reduces overall child mortality by about a third. Improved sanitation also brings advantages for public health, livelihoods and dignity-advantages that extend beyond households to entire communities.

Sources:

• Progress on sanitation and drinking water: 2010 update. Joint Monitoring Programme (JMP), 2010
• Progress on Drinking Water and Sanitation: Special Focus on Sanitation. Joint Monitoring Programme (JMP), 2008
• Human Development Report 2006. United Nations Development Programme (UNDP), 2006

Sanitation and the MDGs

The Millennium Development Goal's (MDGs) Target 10 is to halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation. At the current rate of progress, the world will miss the MDG target by 13 percentage points. Unless huge efforts are made, the proportion of people without access to basic sanitation will not be halved by 2015. Even if we meet the MDG target, there will still be 1.7 billion people without access to basic sanitation. If the trend remains as currently projected, an additional billion people who should have benefited from MDG progress will miss out and by 2015 there will be 2.7 billion people without access to basic sanitation.

What is "basic sanitation"?

Basic sanitation is improved sanitation. Facilities that ensure hygienic separation of human excreta from human contact. They include:

• Flush or pour-flush toilet/latrine to a piped sewer system, a septic tank or a pit latrine;
• Ventilated improved pit latrine;
• Pit latrine with slab;
• Composting toilet.

Did you know?

• Nearly 40% of the world's population have no access to hygienic means of personal sanitation
• Most countries that are not on track to meet the MDG sanitation target are in Sub-Saharan Africa and in Southern Asia
• In 2006, the world's population was almost equally divided between urban and rural dwellers. Nevertheless, more than 7 out of 10 people without improved sanitation were rural inhabitants.

UN initiatives that are helping to raise the issue...

2008: International Year of Sanitation 2008 was declared International Year of Sanitation. It helped to put sanitation in the spotlight and led to the launch of several initiatives to more vigorously address the current sanitation crisis

UN-Water Task Force on Sanitation
Established in 2007, the UN-Water Task Force on Sanitation aims to increase the effectiveness of global efforts to reach the sanitation targets of the Millennium Development Goals (MDGs). The Task Force operate until the end of 2010.

To know more

Identifying the Potential for Results-Based Financing for Sanitation [ - 817.17 KB]
World Bank Water and Sanitation Program (WSP). November 2011

This working paper aims to identify practical ideas for advancing the use of innovative financing mechanisms focused on results and performance, with a view to supporting the delivery of sustainable sanitation services. To this end, the document reviews: (1) The rationale for examining Results-Based Financing (RBF) instruments for sanitation; (2) Current issues with sanitation, where "misaligned incentives" mean that inadequate services are being provided or demanded; (3) How public funding, if allocated based on results, could help with realigning incentives; and (4) Common issues and challenges with the design of RBF instruments.

Introductory Guide to Sanitation Marketing
[ - 4.01 MB]
World Bank Water and Sanitation Program (WSP). September 2011

This document seeks to contribute to the field of sanitation marketing by sharing practical guidance on the design, implementation, and monitoring of rural sanitation marketing programs at scale in India, Indonesia, and Tanzania, plus additional projects implemented in Cambodia and Peru. The goal of the guide is to (1) Define sanitation marketing and the key components of a sanitation marketing initiative; (2) Provide an overall framework for scaling up rural sanitation programs and the justification for using a sanitation marketing approach; (3) Explain the steps needed to design, implement, and monitor sanitation marketing programs at scale; (4) Provide practical guidance on implementation; (5) Share concrete examples and lessons learned based on WSP's experiences to date; and (6) Highlight key challenges and recommend solutions.

Facilitating 'Hands On Training' Workshops for Community-Led Total Sanitation: A Trainers' Training Guide. Water Supply and Sanitation Collaborative Council (WSSCC), CLTS Foundation. 2010
[ - 1.62 MB]

Community-Led Total Sanitation (CLTS) is spreading fast in many countries in different regions, and there is growing demand for facilitators and trainers of facilitators. This guide, produced by WSSCC and the CLTS Foundation, and authored by Kamal Kar, fulfils the need for a resource that will support the creation of a strong cadre of trainers for front-line CLTS work.

Hygiene and Sanitation Software: An Overview of Approaches. Water Supply and Sanitation Collaborative Council (WSSCC). 2010 [ - 3.44 MB]

Since the 1970s, sanitation and hygiene professionals have strived to find ways to engage target groups (individuals, households, communities, institutions or even organisations) in development programmes that facilitate sanitation and hygiene behaviour change, or create a demand for related services. These are 'software' methods or approaches, as opposed to 'hardware' such as toilets and pipes. This new resource presents in one place the latest thinking and most common software approaches for improving the political, legal, institutional, financial and economic, educational, technical and social conditions within which hygiene and sanitation programmes operate.

The MDG target on Water and Sanitation - Reader. UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC). 2010 [ - 149 KB]

This reader is intended for all those interested in getting familiar with issues related to the achievement of target 7c of the Millennium Development Goals (MDGs). The reader provides basic references for easy reading and some of the latest and most relevant United Nations publications on issues related to the accomplishment of the Millennium Development Goals (MDGs) as they relate to water and sanitation. Link is provided when the publication is available online.

Sanitation as a Key to Global Health: Voices from the Field. United Nations University Institute for Water, Environment and Health (UNU-INWEH). 2010
[ - 2.4 MB]

In October 2008 the United Nations University Institute for Water, Environment and Health invited international representatives from NGOs, government, academia and the UN to a meeting to discuss barriers and to identify breakthroughs to providing sanitation for all. This document has been compiled to summarize these discussions, place them within the current global context, illustrate them with stories from the field and provide recommendations for addressing the global sanitation crisis.

Progress on sanitation and drinking water: 2010 update. World Health Organization (WHO), United Nations Children’s Fund (UNICEF), Joint Monitoring Programme (JMP). 2010 [ - 2.3 MB]

This report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society.

10 Things you need to know about sanitation. United Nations Children’s Fund (UNICEF), World Health Organization (WHO), Water Supply and Sanitation Collaborative Council (WSSCC). 2008 [ - 84 KB]

This document responds to 10 basic questions on sanitation.

Core questions on drinking-water and sanitation for household surveys. World Health Organization (WHO), United Nations Children’s Fund (UNICEF). 2006
[ - 284.9 KB]

This document is intended for use in comprehensive surveys that include questions on drinking-water and sanitation. If national and subnational household surveys use the questions and response categories in this guide, this will help to improve survey comparability over time and harmonize them with international monitoring programmes.

Human Development Report 2006. Chapter 3 - The vast deficit in sanitation. United Nations Development Programme (UNDP). 2006 [ - 434.6 KB]

This chapter of the Human Development Report, highlights the scale of the global deficit in sanitation. After briefly outlining the contours of the sanitation deficit, it asks why progress in reducing that deficit has been so slow, and it identifies some of the structural factors that explain why advances in sanitation have lagged behind those in water. The chapter explores some of the policies and strategies that have created an environment for accelerated progress.

The Sanitation Challenge: Turning Commitment into Reality. World Health Organization (WHO). 2004
[ - 549 KB]

The provision of sanitation is a key development intervention. Despite its importance, achieving real gains in sanitation coverage has been slow. Scaling up and increasing the effectiveness of investments in sanitation need to be accelerated to meet the ambitious targets agreed at Johannesburg. This document summarises the key thinking about how these targets can be met. It suggests actions that can be taken at different levels and by different actors to change the pace of sanitation improvement.

Access to sanitation around the world

(The) political economy of sanitation: How can we increase investment and improve service for the poor? Operational experiences from case studies in Brazil, India, Indonesia, and Senegal World Bank Water and Sanitation Program (WSP). February 2011
[ - 1.49 MB]]

This report presents the results of a Global Economic and Sector Work Study on the Political Economy of Sanitation in Brazil, India, Indonesia, and Senegal that was conducted by the Water and Sanitation Program (WSP) and the World Bank. The purpose of the study was to help WSP and the World Bank—through a better understanding of the political economy of sanitation—in their efforts to support partner countries and development practitioners in the de¬sign, implementation, and effectiveness of operations that aim to provide pro-poor sanitation investments and services to improve health and hygiene outcomes. This Synthesis Report is based on the findings from the secondary literature review and the results of primary research in the four case study countries, which examined how each had identified and managed political economy risks and opportunities in its sanitation interventions.

Africa

Pathways to Progress. Transitioning to Country-Led Service Delivery Pathways to Meet Africa's Water Supply and Sanitation Targets [ - 2.8 MB]
World Bank Water and Sanitation Program (WSP), African Ministers' Council on Water (AMCOW). August 2011

This document is the regional synthesis of the 32 country status overviews which collectively account for 95 percent of Sub-Saharan Africa's population and over 90 percent of GDP. The report highlights the most important trends, challenges, and proposed actions for achieving improved water supply and sanitation services across Sub-Saharan Africa. The opportunities for progress are identified based on:
1. Understanding trends: The report analyzes regional performance, the relative progress of individual countries, and progress of groups of countries classified by a combination of political and economic factors. The report considers separately the four water and sanitation subsectors in each country: rural water supply; urban water supply; rural sanitation; and, urban sanitation;
2. Identifying the challenge: For each country and subsector, Country Status Overviews explore the links between inputs (finance) and outcomes (coverage) through the lens of a 'service delivery pathway', which is systematically assessed to identify the major barriers that still constrain performance in each subsector;
3. Prioritizing action: The report builds on the insights from the Country Status Overviews scorecard to provide senior managers in the sector and their development partners with proposals on prioritizing reform and investment options that match the relevant stages of subsector evolution in each country.

Africa's Water and Sanitation Infrastructure. Access, Affordability and Alternatives
International Bank for Reconstruction and Development (IBRD), World Bank. January 2011
[ - 5.18 MB]

This publication integrates a wealth of primary and secondary information to present a quantitative snapshot of the state of the water supply and sanitation (WSS) sectors in Africa. It explains the sectoral institutional structures and utility performance and articulates the volume and quality of financing available over time. The authors also evaluate the challenges to the WSS sectors and explore the factors that govern the expansion of coverage over time. Finally, the authors estimate spending needs for WSS, arriving at a funding gap for meeting the MDGs. The proposed directions for the future draw on lessons learned from best practices and present the menu of choices available to African countries, bearing in mind that the challenges differ to a significant extent among countries and solutions must be tailored to national or regional conditions.

A Snapshot of Sanitation in Africa. World Health Organization (WHO), United Nations Children's Fund (UNICEF) – Joint Monitoring Programme (JMP). 2008
[ - 1.82MB]

This tabulation has been prepared by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) as its contribution to the Second African Conference on Sanitation and Hygiene, held in Durban, South Africa in February 2008. It contains a new set of sanitation coverage estimates for Africa for the year 2006 based on preliminary JMP estimates. The estimates presented in this document originate from data collected by national statistics offices along with other relevant institutions through national censuses and nationally representative household surveys, including Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and World Health Surveys among others.

Asia and the Pacific

Long Term Sustainability of Improved Sanitation in Rural Bangladesh
World Bank Water and Sanitation Program (WSP). April 2011 [ - 1.68 MB]

This research brief summarizes some of the key findings and main lessons extracted from the Bangladesh experience with the Community-Led Total Sanitation (CLTS) approach. The document also provides some insights for future programming which includes considerations for governments and sector professionals to sustain sanitation programming and behaviour change at scale.

Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Madhya Pradesh, India World Bank Water and Sanitation Program (WSP). March 2011 [ - 919 KB]

The goal of the WSP Global Scaling Up Rural Sanitation project is to reduce the risk of diarrhea and therefore increase household productivity by stimulating demand for sanitation in the lives of people in India, Indonesia, and Tanzania. This report summarizes the findings of the baseline and community surveys conducted in Madhya Pradesh, India, and is part of a series of papers analyzing the baseline data from all countries where the program has been implemented.

(The) Economic Impacts of Inadequate Sanitation in India World Bank Water and Sanitation Program (WSP). December 2010 [ - 1.59 MB]

This study from India analyzes the evidence on the adverse economic impacts of inadequate sanitation at the national level using information on health (deaths and diseases) and other impacts. The study underlines that not only are substantial investments needed but that these can become effective only when they result in reducing morbidity and mortality, mitigating impacts on drinking water, improving welfare, and reducing impacts on tourism, and so on, which are associated with inadequate sanitation. The study recommends a new monitoring framework at the national and local levels—one that measures not just toilet coverage and use, or coverage of sewerage and number of wastewater treatment plants, but also the improvements in the overall health, water-related, environmental, and welfare indicators that are caused by inadequate sanitation.

Managing the Flow of Monitoring Information to Improve Rural Sanitation in East Java World Bank Water and Sanitation Program (WSP). December 2010 [ - 1.83 MB]

Global Scaling Up Rural Sanitation is a WSP project being implemented in India, Indonesia, and Tanzania. Working with local governments and the private sector in 29 districts of East Java province in Indonesia, WSP’s approach combines generating demand from local governments prior to initiating project interventions and demand from consumers for improved sanitation facilities and behaviours prior to making a greater range of sanitation products and services available through local markets. This demand responsive approach combines Community-Led Total Sanitation (CLTS), behaviour change communication, and sanitation marketing approaches to help villages become open defecation free (ODF). WSP’s experience with participatory monitoring in East Java has shown that communities are fully able and highly motivated to monitor progress toward ODF and that they can regularly track changes in community access to improved sanitation. However, during 2009 the project team observed that while monitoring data was being generated regularly in the communities, much of this data was not reaching sub-district, district, or higher levels for regular consolidation. With a focus on implementing sustainable approaches, WSP focused on integrating innovations with existing monitoring mechanisms used by local governments. This working paper documents how this system works and shares insights based on implementation to date.

Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia World Bank Water and Sanitation Program (WSP). November 2010 [ - 1.70 MB]

WSP’s Global Scaling Up Rural Sanitation Project, known as Sanitasi Total dan Pemasaran Sanitasi (SToPs) in Indonesia, aims to improve the sanitation practices in Indonesian rural communities, reaching a total of 1.4 million people in 29 rural districts in East Java by project end. This report summarizes the findings of the baseline survey conducted in Indonesia and is part of a series of papers presenting and analyzing descriptive findings from the baseline impact evaluation surveys conducted in 2008 and 2009 from all countries where the project has been implemented.

Institutional Changes required to achieve the MDG target on Sanitation: Survey and Experiences from the Asia-Pacific Region. United Nations Economic Commission for Asia and the Pacific (UNESCAP). 2009 [ - 582.46 KB]

This report presents the institutional progress made in selected member countries towards achieving sanitation goals. Institutional progress consists of changes in administrative, legal and financial rules and practices that have been made with sanitation goals in mind. It also includes the "slow-moving" institutions, which are social norms and practices, general awareness of the public and the ensuing demand for sanitation services. In terms of administrative changes, the survey revealed that nine out of thirteen countries have created a sanitation coordination mechanism at the national level. Many governments have also undertaken legal reform, integrating sanitation into existing development plans or introducing decentralization laws that pass authority for sanitation to local governments. Few countries, however, have taken the needed step of providing adequate financial resources to local authorities, so that they can start investing in their jurisdictions.

Economic Impacts of Sanitation in Southeast Asia. World Bank. 2008 [ - 2.64 KB]

This study examines the major health, water, environmental, tourism and other welfare impacts associated with poor sanitation in Cambodia, Indonesia, the Philippines and Vietnam. The study is based on evidence from other investigations, surveys and databases. By examining the economic impacts of poor sanitation, and the potential gains from improved sanitation, this study provides important evidence to support further investment in sanitation. The goal of this report is to show decision-makers at the country and regional levels how the negative impacts of poor sanitation can be mitigated by investing in improved sanitation.

Latin America and the Caribbean

Drinking water supply and sanitation services on the threshold of the XXI century. United Nations Economic Commission for Latin Amercia and the Caribbean (UNECLAC). 2004 [ - 347 KB]

The objective of this paper is to analyse the status of drinking water supply and sanitation services in the countries of Latin America and the Caribbean. The study is divided into two parts. The first section consists of an analysis of access to services and their quality. The second section of the study contains an analysis of the reforms carried out in recent years by the countries of the region.