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Sanitation

Fact sheet N°392
July 2014

Key facts

  • In 2012, 64% of the world’s population had access to improved sanitation facilities including flush toilets and covered latrines, compared with 49% in 1990.
  • 2.5 billion people still do not have basic sanitation facilities such as toilets or latrines.
  • Of these, 1 billion defecate in the open, for example in street gutters, behind bushes or into open bodies of water.
  • At least 10% of the world’s population is thought to consume food irrigated by wastewater.
  • Poor sanitation is linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio.
  • Inadequate sanitation is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition.

Introduction

Hygienic sanitation facilities are crucial for public health. Since 1990, the number of people gaining access to improved sanitation has risen from 49% to 64% but some 2.5 billion people still do not have toilets or covered latrines.

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.

Despite progress, the 2015 Millennium Development Goal target to halve the proportion of the population without access to improved sanitation facilities will most likely be missed.

Sanitation facilities

Despite big improvements, inequalities between and within countries and regions persist. In Southern Asia, 42% of the population was using improved sanitation facilities in 2012 compared with 23% in 1990. Sub-Saharan Africa has made slower progress, with sanitation coverage rising from 24% to 30% in 2012. In 46 countries, less than half the population has access to a toilet or an improved latrine.

Some 14% of the global population is forced to defecate in the open. Nine out of 10 people who do this live in rural areas. However the number defecating in the open in towns and cities is gradually increasing as urban populations grow without a corresponding expansion of sanitation facilities.

More than 80% of people forced to defecate in the open live in just 10 countries. In India, 597 million people practise open defecation: in rural India, 65% of the population practises open defecation, down from 90% in 1990.

Sanitation and health

More than 840 000 people in low- and middle-income countries die as a result of inadequate water, sanitation and hygiene each year, representing 58% of total diarrhoeal deaths. Poor sanitation is believed to be the main cause in some
280 000 of these deaths.

Diarrhoea remains a major killer but is largely preventable. For example, better water, sanitation and hygiene could prevent the deaths of some 360 000 children aged under 5 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 under-5s 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;
  • potential recovery of water, renewable energy and nutrients from faecal waste.

A WHO study in 2012 calculated that for every $1 invested in sanitation, there was a return of $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.

There is not much reliable data but estimates suggest that up to 90% 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. But there needs to be:

  • management practices that ensure wastewater is sufficiently treated and safely reused;
  • institutional oversight and regulation;
  • public education campaigns to inform people about wastewater use.

WHO's 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 and is preparing guidance on Sanitation Safety Planning for Safe Wastewater Use and Sanitation and Health Guidelines.

WHO is also working with UNICEF on a global action plan for ending preventable child deaths from pneumonia and diarrhoea by 2025. This aims to meet several prevention and treatment targets, including promoting universal access to drinking water, sanitation and hygiene in health care facilities and homes by 2030.

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