3 hard truths about the global sanitation crisis


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Martin Gambrill, Lead Water Supply & Sanitation Specialist, World Bank 
Rebecca Jean Gilsdorf, Water Supply & Sanitation Specialist, World Bank
Ndeye Awa Diagne, Young Professional, World Bank

Today when you go to the toilet, be it in someone’s basic latrine in a rural village you might be visiting, in a public toilet where you work, or on a comfortable water-flushed ‘loo’ at home, take a moment to think about those not as fortunate as yourself.
As you sit (or squat) and contemplate, consider these three hard truths about sanitation:

  1. One quarter of the world’s population do not have access to a decent toilet.  At present roughly 1.8 billion people use unsafe toilets/latrines or lack access to any facility. In cities alone, over 80 million people practice open defecation. If lined up, these people without toilets in cities and towns, would stretch around the world 29 times! Despite significant gains — over 2.1 billion people gained access to improved toilets or latrines since 1990 — sanitation was one of the most off-track Millennium Development Goals.
  2. Only 39% of human waste is ‘safely managed’ globally, with only 2.9 billion people using a safely managed sanitation service  –  that is an improved sanitation facility which is not shared with other households, and where excreta are disposed of in situ or transported and treated off-site. The resulting diarrheal and related diseases lead to the deaths of thousands of people every day, and countless other negative impacts, including the stunting of children.
  3. The total global costs of inadequate sanitation are estimated at US$ 260 billion per year – that is, on average, 1.5% of a country’s GDP.  In order to meet the Sustainable Development Goals, capital investment in urban sanitation alone will require at least US$46 billion every year, with an additional US$ 25 billion a year for sanitation in rural areas. To help our client countries address the funding issue directly, over the past 25 years the World Bank has committed over US$ 13 billion to sanitation, reaching millions of people across the world. 
Inadequate sanitation has dire impacts on families, on communities and on society more widely. In total, around 1.6 million people die every year due to poor sanitation and hygiene – that’s more than 4,500 people every day. For sanitation alone, the death toll is nearly 900,000 people per year, or around 2,460 people every day. For households, there can be tremendous economic impacts from a lack of sanitation, including time spent looking for a safe space ‘to go’ or queuing at public toilets, impact on productivity due to sickness, and long-term impact on health, especially for children. For economies, a lack of sanitation affects tourism and sectors dependent on water quality, such as fisheries and agriculture. From an environmental perspective, the impact on water resources can be damaging, ranging from groundwater resource contamination, through surface water pollution, to negative impacts on biodiversity. Clearly, the benefits of thinking through sanitation challenges are worth it – whether you’re doing so sat on your toilet or elsewhere.
These daunting numbers should motivate us to do our part in exploring innovative approaches for meeting the needs of the unserved. To address these sanitation challenges, and to better respond to the realities faced in developing countries, we need to embrace a diversity of technical solutions that are adaptive, mixed and incremental and which combine both onsite sanitation and sewerage solutions in either centralized or decentralized systems. Effective resource recovery and re-use should be considered, as should complementary services, including water supply, drainage, greywater and solid waste. These comprehensive approaches to sanitation improvements will require long-term planning, technical and service delivery innovation, institutional and regulatory reforms, and new and creative ways of mobilizing funding for the sector.
Moving from inadequate sanitation to citywide inclusive sanitation
– an example of appropriate sewerage from São Paulo, Brazil
Moving from inadequate sanitation to citywide inclusive sanitation
– an example of onsite sanitation and fecal sludge management from Maputo, Mozambique
There is no single solution to poor sanitation, and toilets are but one part of the sanitation service chain. To meet the needs of those without toilets, we need to rethink toilets and rethink how to provide sanitation as a service in new, adaptable and customer-centric ways.  Such rethinking should consider a menu of options, from condominial sewers and appropriate wastewater treatment, through fecal sludge management serving onsite sanitation services, to appropriately managed shared sanitation facilities and emerging approaches such as container-based sanitation and other waterless solutions. We need to find ways to broaden the discussion to nurture experimentation and help solve these complex sanitation challenges.
As we commemorated World Toilet Day this week, we hope you feel inspired to take action – solving the global sanitation crisis depends on collective action by each of us and our communities. There’s something to think about next time you’re sat on the loo.


Seema Thomas

Consultant, World Bank Water Global Practice

Join the Conversation

Raul Millara Bernal
November 21, 2018

This is indeed a good read. Thanks for sharing.
I am currently stationed here in the Philippines and the organization I am working with provides services on the design and build of water and wastewater treatment plants. We were operating here for more than 15 years now. And I can easily understand the challenge or the struggle in the sanitation management.
I hope you can allow me to share this with my colleagues.
Thank you.
Raul/JFE Engineering Corp. - Philippine Branch

Naim Ahamed
November 25, 2018

Very unfortunate, we all are working but still we can't make it over...

Francis Musinguzi
November 26, 2018

Hard truth about sanitation, and need to rethink sanitation. The narrative supports rallying evidence for countries. The need to prioritise sanitation into national budgets and policies. Households will have to play a lead role. I see the place of blended financing. More innovation and thinking needed

David A. Bates, P.E., Ph.D.
November 26, 2018

great article on serious subject, with some light hearted humor very the clever graphic - an APP to find a latrine (lol)

Alexio Maseka
November 29, 2018

Let's encourage the Implementation of ISO 30500 International Standard on sanitation.

November 29, 2018

HI decentralized water and Sanitation will save water and methane gas from the sludge used for green gas energy,,,biomass for vermicompost,,,,, Aerobic toilet,,, system for Rural Areas,,,,
Thanking you in anticipation
Shadrack Moloi

Stephen Phiri
November 30, 2018

Great news