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Sanitation for all? Households are just half the story

Thu, 2015-11-19 16:50
Sarah Dickin and Caspar Trimmer

If we are to truly fulfill the Sustainable Development Goals' (SDGs) vision of universal sanitation access, then governments, businesses and civil society need to recognize the value of sanitation outside the household – not only in fulfilling rights but also in boosting labour force participation, economic productivity and health and well-being. 

Photo shows an ecosan toilet block at a school in Tamil Nadu, India

Eco-sanitation at a secondary school in Tamil Nadu, India, image from S.Paramasivan / David Crossweller /SuSanA Secretariat /Flickr, creative commons licence, some rights reserved.

The Sustainable Development Goals (SDGs) reaffirmed the ambition of providing “access to adequate and equitable sanitation and hygiene for all”. But what does that mean?

While attention is often paid to toilets and sanitation services at the household level – including in the monitoring system being discussed for the SDGs – most people spend a good chunk of their lives outside the home. Universal access to sanitation – for all people, all of the time – means ensuring services are available in schools, health centres, refugee camps and all types of formal or informal workplaces.

For all children

Access to toilets in schools and day-care centres is critical to providing a safe and healthy learning environment.  Young children are particularly vulnerable to health risks associated with unsafe sanitation, including infectious diseases such as cholera, worms and trachoma. Diarrhoea is a leading cause of morbidity and mortality in children under five years of age in developing countries, imposing a significant global health burden.

Undernutrition is frequently connected to diarrhoeal disease and this pernicious challenge is the focus on this year’s World Toilet Day events. Diarrhoea makes it harder for children to absorb and use nutrients, and can leave them with long-term cognitive deficits, with poorer school performance and lower economic productivity as adults.

Healthier health facilities

Considering the well-known links between sanitation and health, it is disturbing that safe access to sanitation in healthcare facilities is also lacking in many countries. A WHO/UNICEF assessment found that 38 per cent of healthcare facilities in low- and middle-income countries lack access to even basic levels of water, sanitation and hygiene (WASH) services. This further threatens the health vulnerable patients, and has particularly serious implications for pregnant women and infants, contributing to maternal, neonatal and infant mortality.

The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) has said that it will monitor WASH services in schools and healthcare facilities as well as households. This monitoring will hopefully help to raise awareness among governments and donors of these important gaps that have been overlooked in planning water and sanitation services.

Caught short at work

But people also spend large amounts of their time at recreational facilities, in public spaces, and, particularly, at work. This has serious implications not just for health and well-being but also for the rights of women or vulnerable groups such as the homeless and those with disabilities. Having to walk long distances to use a latrine during working hours and a lack of facilities for menstrual hygiene management can result in missed work days, lost productivity, narrower job opportunities, exclusion from aspects of cultural and political life – or can encourage people to use the nearest bush or quiet corner.

A growing challenge: sanitation in refugee camps

Camps for refugees and internally displaced people (IDPs) bring huge numbers of people together, often in places with minimal infrastructure. This amplifies the problems associated with poor WASH provision; worldwide, around 30 per cent of camps don’t have adequate waste disposal and toilet facilities for the populations they house. And while they facilities are designed as temporary settlements, the camps often end up being longer-term, even permanent. In a short time, lack of toilets will degrade scarce water resources, further raising the risk of epidemics of diseases like typhoid.

For the safety, well-being and dignity of refugees and IDPs, as well as camp workers and the surrounding communities, we need to move beyond emergency solutions. Sustainable WASH services should be built in at the planning stage, and provided as early as possible.

Real costs, real benefits

It’s tempting to think that limited sanitation, water and hygiene provision outside homes is largely a matter of budget priorities: people see it as a cost, a corner that can be cut. But it’s a false economy. The consequence of not providing toilets is a drag on livelihoods opportunities and economic development, not to mention sustainability ambitions. Companies, humanitarian agencies, government authorities from national down to local levels need to consider the real costs of a small saving, and their vital role in providing true sanitation for all.


Sarah Dickin is a Research Fellow at the Stockholm Environment Institute (SEI), focusing on sustainable sanitation issues. Caspar Trimmer is a Science Writer and Editor at SEI.



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