In 2010, the UN General Assembly recognized access to safe and clean drinking water and sanitation as a human right, and called for international efforts to help countries to provide safe, clean, accessible and affordable drinking water and sanitation.

Sustainable Development Goal target 6.2 calls for adequate and equitable sanitation for all. The target is tracked with the indicator of “safely managed sanitation services” – use of an improved type of sanitation facility that is not shared with other households and from which the excreta produced are either safely treated in situ, or transported and treated off-site.

Sanitation and health

Some 827 000 people in low- and middle-income countries die as a result of inadequate water, sanitation, and hygiene each year, representing 60% of total diarrhoeal deaths. Poor sanitation is believed to be the main cause in some 432 000 of these deaths.

Diarrhoea remains a major killer but is largely preventable. Better water, sanitation, and hygiene could prevent the deaths of 297 000 children aged under 5 years each year.

Open defecation perpetuates a vicious cycle of disease and poverty. The countries where open defection is most widespread have the highest number of deaths of children aged under 5 years as well as the highest levels of malnutrition and poverty, and big disparities of wealth.

Benefits of improving sanitation

Benefits of improved sanitation extend well beyond reducing the risk of diarrhoea. These include:

reducing the spread of intestinal worms, schistosomiasis and trachoma, which are neglected tropical diseases that cause suffering for millions;

reducing the severity and impact of malnutrition;

promoting dignity and boosting safety, particularly among women and girls;

promoting school attendance: girls’ school attendance is particularly boosted by the provision of separate sanitary facilities; and

potential recovery of water, renewable energy and nutrients from faecal waste.

A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US$ 5.50 in lower health costs, more productivity, and fewer premature deaths.

Challenges

In 2013, the UN Deputy Secretary-General issued a call to action on sanitation that included the elimination of open defecation by 2025. Achieving universal access to a basic drinking water source appears within reach, but universal access to basic sanitation will require additional efforts.

The situation of the urban poor poses a growing challenge as they live increasingly in mega cities where sewerage is precarious or non-existent and space for toilets and removal of waste is at a premium. Inequalities in access are compounded when sewage removed from wealthier households is discharged into storm drains, waterways or landfills, polluting poor residential areas.

Limited data available on this topic suggests that a large proportion of wastewater in developing countries is discharged partially treated or untreated directly into rivers, lakes or the ocean.

Wastewater is increasingly seen as a resource providing reliable water and nutrients for food production to feed growing urban populations. Yet this requires:

management practices that ensure wastewater is sufficiently treated and safely reused;

institutional oversight and regulation; and

public education campaigns to inform people about wastewater use.

WHO response

As the international authority on public health, WHO leads global efforts to prevent transmission of diseases, advising governments on health-based regulations.

On sanitation, WHO monitors global burden of disease and the level of sanitation access and analyses what helps and hinders progress. Such monitoring gives Member States and donors global data to help decide how to invest in providing toilets and ensuring safe management of wastewater and excreta.

WHO works with partners on promoting effective risk assessment and management practices for sanitation in communities and health facilities through the WHO Guidelines on Sanitation and Health, Safe Use of Wastewater, Recreational Water Quality and promotion of Sanitation Safety Planning. WHO also supports collaboration between WASH and health programmes such as neglected tropical diseases, cholera, polio and antimicrobial resistance.