Published on Africa Can End Poverty

Toilets missing in action

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Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

Tanzania is ranked the second lowest in terms of access to improved sanitation worldwide out of 171 countries that reported statistics for 2010. The details read as follows:
- Only 1 in 10 Tanzanians has access to an improved sanitation facility, such as a flush toilet connected to a sewage system or septic tank or a covered pit latrine not shared with other households.
- The above access to improved sanitation for Tanzania is well below the average for sub-Saharan Africa (31 percent), and also much lower than in Kenya (32 per cent), Uganda (34 per cent) and Malawi (51 per cent).
- Urban residents are three times more likely to use an improved toilet facility than their rural counterparts (20 per cent vs. 7 per cent).
- A staggering 5.4 million Tanzanians do not have access to any toilet facility, and answer nature’s call in the open. This burden falls most heavily on the poorest quintile.

This lack of improved toilet facilities has a range of social and economic consequences. Sanitation is vital for public health as it limits the spread of diarrhea and other infectious disease and reduces malnutrition, morbidity and mortality. Economically, insufficient access to sanitation results in premature deaths, in an increased burden on health care systems, and in time and productivity losses.

Other adverse effects on society are less tangible but nonetheless important: Women and girls are afraid of sexual harassment when using public toilets, especially at nighttime. Open defecation, in particular, is associated with feelings of shame, loss of dignity and privacy.
Despite a general appreciation of these negative impacts there is very little investment in sanitation:
- Current investment in sanitation stands at less than 0.1 per cent of GDP, which is inadequate to significantly improve access.
- Most public resources are geared towards urban sewage systems. Private spending on sanitation is also heavily concentrated amongst urban neighborhoods. 
- While urban access to improved sanitation increased from 10 to 20 per cent over the last two decades, there was no corresponding progress in rural areas (where access to improved sanitation stagnated at 6-7 per cent over the period 1990-2010).

An important lesson learned from sanitation interventions in Tanzania and around the world is that health and economic benefits only accrue if household spending on latrines is accompanied by  efforts to improve hygiene practices, especially hand-washing. Improving sanitation and hygiene may be more about effective awareness raising and social marketing to promote behavior change than it is about traditional public investment.
And access to toilet facilities alone is not enough to improve sanitation and hygiene. Just as important is the safe disposal and treatment of human waste, especially in urban areas.

All of this raises the following questions:
- Should there be more public investment in sanitation? Or would it be more effective to promote private spending on toilet facilities through community awareness campaigns and hygiene education?
- Should the Government subsidize latrine construction in rural areas where access to improved sanitation is lowest? Or should public investment focus on densely populated urban areas?
- How should communities be engaged more effectively in emptying latrines and maintaining the existing infrastructure?

Note: The statistics above are based on the World Development Indicators (WDI) and a 2012 desk study on the Economic Impacts of Poor Sanitation in Africa by the Water and Sanitation Program (WSP).  All are publicly available.


Jacques Morisset

Lead Economist and Program Leader, World Bank

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