2.5 billion people live without access to improved sanitation.

This is a consequence of failed service delivery, and results in sanitation as one of the most off track Millennium Development Goals (MDG) globally. Lack of safe sanitation has significant negative externalities on health and human capital, and has real economic consequences.

Lack of access to improved sanitation costs countries up to 7% of their GDP annually.i

At the national and global levels, the human cost manifests in huge economic losses. These losses are mainly driven by premature deaths, health care treatment, lost time and productivity seeking treatment, and finding access to sanitation facilities in urban areas, or the bush in rural areas. In 2012, the World Health Organization (WHO) estimated that the global economic return on sanitation spending is US$5.5 dollar for every one dollar invested, more than double the economic return on water spending (US$2.0)ii . However, the UN 2012 Global Analysis and Assessment of Sanitation and Drinking Water indicates that only 10 out of 75 countries who participated in their survey reported to have more than 75% of the funds needed for sanitation .iii

Improving access to sanitation contributes to health, education, gender equality, and poverty reduction.

Lack of access to sanitation has real human costs leading to about 700,000 premature deaths annually. Recent analysis shows a stronger link between open defecation and childhood stunting, which is important for cognitive development and future economic productivity iv. With respect to education, it is estimated that 443 million school days are lost every year due to water, sanitation, and hygiene related diseases. And women who lack access are forced to go out in open areas, and are more susceptible to sexual harassment and violence v. Access to sanitation is undeniably a fundamental pillar in development.

What will it take to make measurable improvements in access to sanitation?

Urban centers need to prioritize investment in a mix of sanitation options to address ever growing challenges of rapid urbanization.

The world’s urban population is expected to increase by 72 per cent by 2050, from 3.6 billion in 2011 to 6.3 billion in 2050 vi. Asia and Africa are projected to have the highest urban growth rates of all regions. This requires urgent attention by countries to find innovative financing approaches to incentivize municipalities and utilities to undertake policy and institutional reform, investing in capacity building, city-wide sanitation planning, and cost-effective approaches (not only conventional networked sewerage systems) to ensure adequate sanitation service delivery, and livable cities for all.

Rural areas require investment in demand creation.

Households often do not prioritize investing their own resources in sanitation, and society pays the consequences. Therefore, investment for demand creation in rural areas is most cost effective when targeted for behavior change interventions (stopping open defecation); capacity building for community outreach, and output based financial incentives for local governments vii. Public funds may also be needed for demand responsive subsidies for the poorest households who have real financial constraints to invest in sanitation.

Private sector participation is essential to meet the needs of all citizens.

To realistically accelerate access to 2.5 billion people, governments need to leverage the private sector’s professional capacity and investment. Partnering with the private sector can tap into their capacity to innovate new affordable and aspirational products for poorer households, strengthen distribution and supply chains, and apply the best social and commercial marketing practices to change behavior, which is absolutely essential for sanitation. Through these partnerships, governments can maximize their investment by leveraging investment from both households and the private sector to achieve economies of scale.

Billions of people are willing to invest but cannot do it by themselves.

They need political courage, financing, and commitment from governments, and a willingness to take bold decisions on partnering with the private sector. Combining public and private sector resources can affect country-wide social change, which can reap massive social and economic benefits. This is feasible and achievable; it just needs to be done.

Related:

World Bank Live: A Matter of Life: Investing in Sanitation

i Hutton, G. (2011). Economics of Sanitation Initiative What are the economic costs of poor sanitation and hygiene?. Washington DC, World Bank’s Water and Sanitation Program

ii Hutton, G. (2012). Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and

universal coverage. Geneva, World Health Organization

iii World Health Organization, and UN Water. (2012). UN-Water Global Analysis and Assessment of Sanitation and Drinking Water. The Challenge of Extending and Sustaining Services. Geneva

iv Spears, D.,(2012). How much international variation in child height can sanitation explain?. Rice Institute

v Lennon, S (2011) Fear and anger: perceptions of risks related to sexual violence against women linked to water and sanitation in

Delhi, India. SHARE Briefing Note.

vi United Nations (2012). World Urbanization Prospects The 2011 Revision. New York, Department of Economic and Social Affairs Population Division

vii Tremolet, S., Perez. E, Kolsky, P.,(2010) Financing On-Site Sanitation for the Poor A Six Country Comparative Review and Analysis. Washington DC, World Bank