Decent toilets for all: five ways to accelerate progress towards safely managed sanitation
With just six years to the 2030 deadline for Sustainable Development Goal 6, the world is far from achieving universal access to safely managed sanitation. This blog delves into the key challenges and strategies needed to accelerate progress, drawing insights from a recent global summit on safely managed sanitation.
The second target of Sustainable Development Goal (SDG) 6 is to reach universal safely managed sanitation services by 2030. But with only six years left to the deadline, almost half the global population still lives without these services. At the current pace of progress, universal access will not be achieved until 2060. And this is just the global projection; for many of the least-developed countries, the goal is centuries away.
One key barrier to progress is confusion over what safely managed sanitation is and what it entails in different contexts. Does it mean having sewers everywhere? What if that is too expensive for a district or country? We have to dispel these misconceptions. And we need to do it now because, every day, almost 4,000 people die from diseases that can be attributed to inadequate water, sanitation and hygiene – nearly 1,000 of them children under five.
For this reason, more than 120 delegates from governments and partners from over 20 countries attended the first ever global summit on safely managed sanitation in Kathmandu, Nepal, in June 2024. They came together to demystify safely managed sanitation, build consensus on what is needed to progress towards the SDG target, and foster greater collaboration.
Here are five things that will help countries accelerate progress towards safely managed sanitation.
1. Safe toilets + safely managed waste = better public health and cleaner environments
Safely managed sanitation is about stopping the spread of faecal pathogens and safely managed services could avoid up to 6 billion cases of diarrhoea and 12 billion cases of parasitic worms between 2021 and 2040. But toilets alone won’t do this; we need safety "downstream" – in other words, safe sanitation services and behaviours – to keep the whole environment free from human waste.
Solutions may look different in each context, but it is possible to leapfrog from open defecation to safely managed sanitation. In rural areas, for example, a pit latrine made from durable material that is easy to clean with a tight-fitting lid can be considered “safely managed” if the waste is safely contained in the ground. Once it’s full, the pit is closed and another one is dug. Twin-pit toilets – two pits which are used alternatively – can also be a good way to safely manage waste if they are well operated i.e. time is allowed for the waste to decompose fully before emptying the pit.
Ethiopia, for example, is one of several countries that has conducted a national workshop to understand what safely managed sanitation means there, and to identify actions to accelerate progress in line with the WHO’s Sanitation and Health Guidelines.
Today, more people are using on-site sanitation facilities and services than sewers, so safely managing the waste from them is an urgent issue.
2. Infrastructure needs to be supported by “systems” for sustainable service delivery.
We often hear: “Let’s build more sewers and treatment plants!”. These types of infrastructure are critical, but they need to be supported by systems – a skilled workforce, management models, regulations and financial resources – to keep them running in the long term.
To make this happen, national and local governments need to conduct a thorough analysis of the strengths and weaknesses of these supporting systems, involving all the stakeholders from the sanitation service chain. This helps identify priority actions for improvement, tailored to specific contexts.
Kenya, for example, has reviewed its national policy using the African Sanitation Policy Guidelines and set clear national targets based on a situation analysis. This allows incremental progress towards universal access to safe sanitation services in all settings. And in towns and municipalities in Bangladesh, Ethiopia (PDF) and Nepal, mayors are leading the way by developing and implementing city-wide inclusive sanitation plans with time-bound targets.
3. Sanitation is a public good, so public finance is essential.
Many believe that achieving safely managed sanitation is too expensive. There are simple and cost-effective options for rural sanitation where space is more available. But in dense urban settings, more costly septic tanks or emptiable pit latrines may be needed. The problem is that households are left to bear most of the costs, in contrast to wealthier neighbourhoods where publicly funded or heavily subsidised sewerage systems are more common. What is more expensive though is the social, health and economic costs resulting from poor sanitation – such as the time and expense of caring for sick families and school absences – especially for marginalised communities.
A significant increase in public finance for non-sewered (or “on-site”) sanitation is critical to cover a fair share of the costs for inclusive and equitable services, which delivers public health benefits for the entire community. To do this, governments and service providers must understand the financial flows and cost of delivering sanitation first, using tools like WASH Accounts, as done in Nepal.
Indonesia recently launched a costed roadmap for safely managed sanitation, and others are exploring different financial mechanisms, such as revolving funds, private finance, and funding from taxes, tariffs and transfers (3Ts).
4. Climate resilient sanitation and safely managed sanitation should be pursued together.
Floodwater can cause human waste to overflow from pit latrines, resulting in the spread of diseases and the pollution of communal water sources. And so safely managed sanitation can only be achieved if sanitation systems are resilient to climate risks – that is, they continue to function or are restored quickly after climate-related events and other shocks.
Safely managed sanitation services can also reduce health and pollution risks that impact ecosystems, biodiversity and communities’ livelihoods, while reducing greenhouse gas emissions.
5. Data and monitoring systems need to track the greatest risks to human health along the sanitation chain.
The WHO/UNICEF Joint Monitoring Programme monitors “global” progress with core indicators for safely managed sanitation based on national data. National and local governments should use an expanded set of indicators to understand the “local” health risks to communities and sanitation workers from faecal-related diseases.
Tools like the WHO's Sanitation Safety Planning can help with such analyses and prioritisation. The government of Cambodia, for example, recognised that unsafe containment of human waste was one of the biggest risks to public health and so decided to develop a sanitary inspection process for routine monitoring, while harmonising sanitation indicators across various national surveys.
For service delivery, municipalities and utilities can use data to plan, budget, monitor and report on the performance of the services they provide. Regulators can also use this data to report on overall sector performance and hold service providers accountable. The Eastern and Southern Africa Water and Sanitation Regulators Association is one such organisation that provides support to strengthen sanitation data collection and management systems.
Safely managed sanitation is for everyone
The key thing to remember is that safely managed sanitation is for everyone, everywhere – not just for urban areas or for those with sewers. Minimising exposure to human waste at every step of the sanitation chain requires context-specific and risk-based solutions, including infrastructure, behaviour change, and local systems strengthening. The needs of marginalised groups, such as women and people with disabilities, must be met and their voices heard in the planning and delivery of services.
- Andrés Hueso González is Senior Policy Analyst – Sanitation for WaterAid
- Maya Igarashi Wood is WaterAid's Sanitation Lead
- Andrew Narracott is WASH Specialist – Sanitation for UNICEF
Top image: Bishakha, 35, stands outside the new water, sanitation and hygiene facilities in Satkhira, Bangladesh. December 2022.
