To share or not to share sanitation facilities: A coronavirus conundrum

Slums and overcrowded informal urban settlements, where social distancing is physically impossible and infrastructure services are limited, are emerging as hotspots for COVID-19.  Due to inadequate access to water, sanitation and hygiene services, these neighborhoods, which are home to some of the poorest urban dwellers, often bear a disproportionate burden of infectious diseases. 

Globally, 3 billion people do not have access to household handwashing facilities, and in Sub-Saharan Africa, 63 percent of urban dwellers (nearly 258 million people) lack access to handwashing facilities at home. For these households, communal taps or shared sanitation facilities serve as a primary site for their handwashing needs.  

Although many people living in informal settlements or slums would prefer individual household toilets, individual household solutions are not always feasible due to lack of space and other factors. Consequently, an estimated 627 million people around the world rely primarily on a sanitation facility shared with at least one other household. 

Now consider these shared service points in the context of the ongoing COVID-19 pandemic. Even under lockdown or stay-at-home conditions, people have little option but to use these shared sanitation facilities together with many other users, thus increasing their risk of contracting coronavirus, which is primarily spread through airborne and contact transmission (e.g., via contaminated taps, doors, knobs, toilets and handwashing surfaces). Given the critical role that these facilities play in providing sanitation services to underserved people, we must promote ways to minimize the risks to users during the COVID-19 pandemic.  

Well-managed shared sanitation facilities can benefit urban communities and help households meet their basic handwashing and sanitation needs. Lessons from Addis Ababa and Maputo suggest that public/community toilets can be effective responses to ending open defecation in low-income urban neighborhoods. They can also create jobs for vulnerable groups and cater to the needs of women and girls, if designed in a “female-friendly” way. 

Through its work on Citywide Inclusive Sanitation (CWIS), the World Bank’s Water Global Practice has developed resources, informed by global experiences, on the design, operation and maintenance of shared sanitation facilities.  The team has also curated guidance on the measures that can be taken more broadly in the sector to mitigate the risks of COVID-19 transmission, including guidance on safely managing shared sanitation. 

Here are some key recommendations: 

• Invest in quick solutions to increase access to critical hygiene services: Service providers will need to increase the availability of handwashing materials (e.g., soap, water, alcohol-based hand rubs), and provide appropriate waste bins for the safe disposal of tissue/disposable hand towels. Where piped supplies aren’t available, alternative sources of water for handwashing will need to be provided (such as water tanks/mobile water points/kiosks/’water ATMs’/mobile handwashing stations). It is also important to establish a more frequent and more thorough cleaning protocol for the facilities, using appropriate soap or alcohol-based disinfectant. 

• Increase user-focused communication and messaging related to COVID-19: For public and community toilets, as well as institutional shared sanitation facilities (such as those serving hospitals, health care facilities, workplaces or schools), service providers should share clear guidance regarding COVID-19 and good hygiene etiquette for minimizing transmission, including: the importance of proper handwashing and other hygiene practices; the need for ‘social distancing’ measures in and around the facility; and clear instructions on the rules for use of the facilities by symptomatic/infected persons. Such messaging can be achieved through posters, radio announcements and other multimedia communication channels. 

• Implement electronic/digital payment mechanisms: To avoid the spread of the virus through cash or money exchange, it is recommended that, wherever possible, mobile/e-payment mechanisms should be employed, especially for ‘pay and use’ public toilets. Where cash payment is the only option, it is important to allow toilet attendants to use a jar/lockbox into which users can drop cash/coins when paying. Then operators should wait for a period (ideally 72 hours) before touching the deposited money. 

• Increase protective measures for sanitation workers: Sanitation workers who provide essential services – such as toilet attendants and fecal sludge/septic tank emptiers– must continue to be provided with appropriate personal protective equipment (PPE), especially gloves and masks. Though the use of PPE is always important, it is even more important during a pandemic. Service providers also need to strengthen support for frontline sanitation workers who need healthcare services, including COVID-19 related health insurance and/or hazard pay, as appropriate; training on occupational risks associated with COVID-19 and corresponding mitigation measures; as well as access to emergency helpline numbers, if they exist.  

In the immediate term, minimizing the spread of the virus at shared sanitation facilities, especially in dense low-income and informal neighborhoods, is key to containing the spread of the virus in these communities. As countries lift lockdowns and reopen their public spaces, such measures will continue to be important. For the over 600 million people using shared sanitation facilities, we need to ensure that the users are safe in seeking access to this most basic of services, which provides health protection, human dignity and so much more. 

To learn more about Shared Sanitation and what the World Bank is doing on this important topic, check out: 

Shared and Public Toilets: Championing Delivery Models That Work 

How many people can share a toilet? 

Videos on Citywide Inclusive Sanitation 

To learn more about the critical WASH interventions for COVID-19 pandemic response, please refer to: 

Water Knowledge Note: Water Supply, Sanitation and Hygiene (WASH) and COVID-19