Shared toilets as the path to health and dignity

This post is co-authored with Tim Wainwright, Chief Executive, WaterAid and Neil Jeffery, Chief Executive Officer, Water & Sanitation for the Urban Poor and was originally published on the Financial Times’ BeyondBrics Blog.  

Mollar Bosti is a crowded slum in Dhaka, Bangladesh, home to 10,000 people: garment workers, rickshaw drivers, and small traders, all living side-by-side in tiny rooms sandwiched along narrow passageways.

With the land subject to monsoon flooding, and no municipal services to speak of, the people of Mollar Basti have been struggling with a very real problem: what to do with an enormous and growing amount of human faeces.

Traditionally, their ‘hanging latrines’ consisted of bamboo and corrugated metal structures suspended on poles above the ground, allowing waste to fall straight down into a soup of mud and trash below. Residents tell stories of rooms flooded with smelly muck during monsoons; outbreaks of diarrhoea and fever would quickly follow.

But conditions have improved for much of the slum. With help of a local NGO, the residents negotiated permission for improvement from a private landowner, and mapped out areas of need. Today, they proudly show visitors their pristine, well-lit community latrines and water points. They report fewer problems with flooding and disease.

With neither the space nor money for a toilet for each household, these well-cared-for latrines have provided an effective solution on the way to good sanitation  for everyone. But we fear these kinds of community latrines are under threat from dwindling investment, as governments and city planners focus efforts on neighbourhoods and populations that are easier to reach.

How to effectively provide sanitation in fast-growing slums and informal settlements is a growing problem worldwide. More than half the world’s population now live in towns and cities; by 2050, it will be two-thirds. An estimated 668 million city dwellers around the world do not have access to decent, private toilets; in many cities, options include the use of plastic bags as ‘flying toilets’, or using a comparatively isolated place like a railway track at dusk.

Given this urgent need – and given that 369 million urbanites already depend upon shared latrines of varying quality as their only option – we are calling on governments, donors and development partners to agree on criteria for acceptable shared latrines, to prioritise investment in new ones, and to improve those that already exist, as the essential stepping stone to better public health and prosperity for those living in poverty.

The wider vision for the global sanitation crisis is in the UN Sustainable Development Goals, which include a goal to deliver access to a decent toilet for every household by 2030.

The severity of the challenge is clear. The crises of Ebola and Zika show us that in this globalised world, poor sanitation only exacerbates public health emergencies .

The question is how to address it. Ultimately, everyone deserves that gold standard of a toilet for each household. However, city planners, policymakers, and donors should not now succumb to the temptation of focusing efforts and funding on those who are easiest to reach, rather than tackling the greater challenge of serving the poorest and most marginalised.

This cannot be a job left to individual communities and grassroots NGOs alone. The economic returns and public health gains felt from these interim solutions for the world’s ‘bottom billion’ who are currently without sanitation will be far greater than delivering gold-standard service to a few, most of whom already have another, if less than perfect, option.

It’s true that shared toilets are not all good toilets . Built badly and managed poorly, they are dirty, smelly, fill up quickly, and may be unsafe to use. But well-managed shared toilets create cleaner, healthier spaces, and are designed, cleaned, and maintained in a way that ensures safety and dignity, particularly for disabled people and for girls and women: properly lighted, in well-planned locations, with stalls that lock.

Decent shared toilets, along with the provision of clean water and good hygiene practices, provide dignity, create healthier, more productive communities, improve children’s attendance at school, and ultimately improve economic growth.

They also save lives. An estimated 289,000 children under five die around the world each year – that is one child every two minutes – from preventable diarrhoeal illnesses linked to dirty water, poor sanitation and poor hygiene. As much as 50% of child malnutrition is linked to chronic infections which could be prevented with clean water, decent toilets, and handwashing with soap.

The ambition of the Goals to deliver safe water running from household taps and safely managed private toilets is clear, and is intended to drive the political will and financing required.

But little more than a century ago, before household toilets became the norm in New York, London, Paris and many other cities, they had tenement outhouses and neighbourhood privies. While these were far from a perfect solution, they played an important role in helping to prevent diseases spreading throughout these ambitious, fast-growing cities, and were a step toward further improvements.

We are asking governments, planners and donors in today’s equally ambitious and fast-growing developing cities to borrow a page from that history book: recognising that where private toilets aren’t yet an option, well-managed shared sanitation can set cities up for further progress. We cannot let the perfect be the enemy of the good. The health and wealth of these nations depends upon it.