The sanitation situation

Today we’re writing about a sh*tty subject to draw attention to one of the biggest public health threats across the globe: sanitation. That’s right, today we’re talking toilets. 

Excreta is inescapable. The human body produces waste to eliminate the matter it does not require; regular bowel movements are the sign of a healthy digestive system, necessary for the human body to function properly.  Shockingly, the amount of poop produced by all humans on earth calculates to about 290 billion kilograms (640b pounds) each year. Regardless of where you live on this planet, your economic standing, your nationality, your ethnicity or your gender, you poop.

In a society or country where toilets are widely dispersed and properly functioning, you simply flush that poo farewell and never think of, or see it again. But, for the  2 billion people on Earth who don’t have basic sanitation service s or clean water, their lives are more than just affected, they’re at risk.  Every year, 775,000 lives end prematurely because of poor sanitation, and we’re on a mission to decrease that. 

​Wateroam’s vision to increase clean water access is intrinsically linked to this world wide battle against poor sanitation, and today, World Toilet Day, we’re focusing on the role sanitation plays in helping children to thrive, economies to develop, and communities to feel empowered.

The problem with poop

2 billion people globally lack safe water in their homes; people travel long distances, pay extortionate amounts for bottled water or use nearby rivers or lakes to meet this basic need. In fact, 160 million people drink water directly from surface water sources. In an environment where there is no potential cross-contamination, those water sources may not put someone at risk of death.

But in a world where over 890 million people defecate openly, surface water sources are in tremendous danger of contamination. Open defecation is defined as the disposal of human faeces in fields, forests, bushes, open bodies of water, beaches or other open spaces. Because ⅓ of the world doesn’t have access to a toilet, people go where they can. When it rains or floods, faecal matter then washes into water sources, agricultural fields and even areas where children play.  Unintended victims end up consuming bacteria and viruses spread through teeny tiny particles of faecal matter, causing dangerous illnesses, severe dehydration, and even death. 

This grave injustice led to the founding of World Toilet Day in 2001 to tackle the mountainous task of spreading awareness about this understated killer and assist in the progress towards achieving improved sanitation world wide. 

United Nations Development Goals

​In 2000, the Millenium Development Goals (MDGs) were created in an effort to make development progress in 8 broad areas, with clean water and sanitation sitting under Goal 7 (Ensuring environmental sustainability). At this time, half of the world’s population were not using a source of improved sanitation, and the goal by 2015 was to halve this figure.  

Improved sanitation was then defined by a facility that ‘hygienically separates human excreta from human contact.’  This is clearer defined by a household having one of the following types of toilets:

• Flush toilet
• Connection to a piped sewer system 
• Connection to a septic tank
• Flush / pour-flush to a pit latrine 
• Pit latrine with slab
• Ventilated improved pit latrine (VIP latrine)
• Composing toilet 

Sanitation doesn’t only account for the method by which excreta is contained and disposed of, but extends to include considerations of whether individuals have privacy, dignity and accessibility. With this in mind, sanitation facilities that are one of the above may not be considered ‘improved’ if they are shared among more than one household. Just imagine if you had to knock on your neighbor’s door every time you had to do number 2…or worse, you had to walk to the middle of town because the entire neighborhood shared a single toilet. Today, 600 million people live with limited sanitation, sharing their facilities with individuals outside of their household. 

For this reason, sanitation facilities are considered ‘unimproved’ if they: 

• Are a public or shared latrine (used by more than one household)
• Flush or pour flush to elsewhere (not into a pit, septic tank, or sewer)
• Are a pit latrine without slab 
• Are bucket latrines, or hanging toilets / latrine
• Do not exists, leading to open defecation or flying toilets

Despite the global effort directed at conquering this colossal challenge, the progress fell significantly short. ​​

A report by the Joint Monitoring Programme cited that the populations without improved sanitation were actually the hardest to reach, and the ones that would benefit from it most: "families living in remote rural areas and urban slums, families displaced by war and famine, and families mired in the poverty-disease trap."  

​Meeting the sanitation targets didn’t just mean installing toilets everywhere you could, it meant identifying and reducing disparities between rural and urban communities, disparities of wealth, and even disparities of gender. ​

 Despite falling short overall, some regions did successfully attain their desired sanitation coverage, with East Asia accomplishing the largest increase of 40% more sanitation coverage between 1990 and 2011.  
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​During this time, 1.9 billion people worldwide gained access to some type of improved sanitation, demonstrating that success was possible, it just required a different and more systemic approach.

Unicef

The challenges and disparities mentioned above are still widespread issues today, representing a broader set of circumstances that hinder success towards not only sanitation goals, but many other development goals.
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Recognition of this issue skyrocketed in the last decade, and major organisations like the Gates Foundation hosted global initiatives to ‘reinvent the toilet’ in an effort to innovate a more sustainable sanitation system. As the Millenium Development Goals morphed into the Sustainable Development Goals, clean water and sanitation received its own indicator (SDG6) and its own dedicated attention. Organisations that worked behind the scenes to tackle WASH related issues took the forefront and de-stigmatised the talk of toilets. ​

The world is making progress, just not fast enough

In 2015, 68% of the world’s population had access to improved sanitation facilities, and that number today is roughly 74%. Despite continued progress, there are still 2.0 billion people without basic facilities; because of this, nearly 300,000 children under the age of 5 die every year because of illnesses that could have been prevented by improved sanitation and hygiene. 

​Today, only half the global population, use safely managed sanitation services; simply installing a latrine doesn’t mean it can be safely managed, therefore these additional systems and infrastructures must be planned and implemented in a sustainable and methodical manner to operate within the confines of each and every household.

Safely managed means: (1) access to facilities for the safe disposal of human waste and (2) the ability to maintain hygienic conditions through garbage collection, industrial or hazardous waste management, or wastewater treatment and disposal.

Complete data for ‘safely managed sanitation’ is very challenging to come by, and estimates are used at a regional level to gain a better idea of the situation on the ground.  The range of terminology used to categorize the types of sanitation also leaves room for inconsistencies, so a sanitation ladder has been created to help identify the shifts of progress for communities transitioning from the lower rungs upwards. ​​

washmatters.wateraid.org

Moving communities up the ladder

While the ultimate goal is universal access to safely managed sanitation services by 2030, there are other extremely important goals that contribute to this. The commitment to end open defecation and ensuring that there are safe and hygienic toilets for girls to use in school are two of them.
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​Once a girl hits puberty and begins menstruating, she must have access to toilets during her school day so she can change her menstrual pads. Because many rural schools in developing countries don’t have toilets, adolescent girls must stay home or even drop out of school due to their feminine needs. 

This biological difference between males and females has led to severe inequities in the opportunities for a young girl to get an education. In sub-saharan Africa, 1 in 10 girls miss school during their period, while in Bangladesh, 40% of girls missed an average of three days per month. 

​Sub-Saharan Africa is home to all 10 of the world’s worst countries for basic sanitation, where on average only 28% of the population has access to a toilet. These countries are also the locations where open defecation is commonly accepted and practiced; therefore independent campaigns to reduce open defecation have been diligently promoted and highly effective.  Over the last 20 years, open defecation has decreased from 80% to 27%, citing successful public health endeavors to provide education, encourage behaviour change, and create access to sanitation facilities. This is a victory itself, but there is much more progress to be made.

India, the country with the world’s second largest population, is also the country where the most people don’t have access to a toilet. Although, by proportion, only 56% of India’s population don’t have basic sanitation, this figure equates to over 700 million people. That is more than double the entire population of the US!

The situation in India and in many countries around the world is enhanced by the growth of populations and urbanisation that increase these inequalities. As populations boom and move to cities where space for toilets, sewer systems, and treatment facilities simply do not exist, the accumulation of waste overlaps into the living spaces and neighborhoods of the poor.  In fact, over 80% of wastewater from all human activities is discharged into rivers or seas without any pollution removal.  As access to affordable clean water is still a major issue across the globe, the improper containment and treatment of wastewater can lead to widespread contamination, increasing the likelihood of  illness, disability and death. This vicious cycle has brought us back to the paramount importance of having a clean water supply.

WaterAid has said ‘diseases attributable to poor sanitation currently kill more children globally than AIDS, malaria and measles put together, and diarrhoea is the single biggest killer of children in Africa.’ ​

We’ve written an entire blog on common infectious diseases related to poor water quality, unsanitary conditions and improper hygiene, but those only cause a fraction of the true negative impact of improper sanitation. In addition to the tropical diseases, trachoma-induced blindness and worm-like parasites that affect billions worldwide while malnourishment and stunting hinder a child’s ability to grow. The effects can be long-lasting and detrimental to an individual, a family or an entire community's ability to thrive. The World Bank states that ‘poor sanitation and water supply result in economic losses estimated at US$260 billion annually in developing countries, or 1.5% of their GDP.  

Singapore is one of only a few countries with 100% rates of safely managed sanitation.

 The benefits of improved sanitation severely outweigh the costs; in fact it’s believed that for USD$1 invested in water and sanitation services, there would be a USD$4.30-$5.50 return due to greater productivity and attendance in the workplace, reduced health care costs, and decreased premature deaths. 

Investing in sanitation reduces the impact of malnutrition, helps decrease the disparity between males and females, promotes school attendance, and can even contribute to a sustainable and renewable system for energy, waste water, and faecal matter. ​

How do we achieve universal sanitation coverage?

To accomplish the goal of universal sanitation coverage, a systematic approach to implementing and maintaining toilets is required. Rigorous data collection on a household level is needed to properly understand each family’s situation and needs, while a broader understanding of how sanitation can fit within a community context is also crucial. The movement of communities up the sanitation ladder requires a people-led approach with community participation at its core. Public awareness campaigns to educate on the matters of wastewater, its proper treatment and other safety measures are essential to ensure sustainability is ingrained within the progress. There must also be accountability, oversight and enforced regulation to ensure the necessary treatment and disposal occurs. Simply criminalizing activity that doesn’t fit within these regulations isn’t the solution however, and there absolutely must be a multifaceted approach to ensuring sanitation facilities are widespread and available for use.

These elements combine to create an approach known as Community-Led Total Sanitation, which focuses on mobilising communities to take matters into their own hands; this participatory approach encourages behavioural change at its core and addresses the systematic challenges on a community level that simply installing hardware will not. Local and international organisations such as WaterAid, UNICEF, and World Vision have become champions for this approach, and much of the world wide sanitation progress has been attributed to it. 

While we aren’t heavily involved in the field of sanitation, Wateroam believes that working cohesively with the local community is the single most important factor in a clean water project’s success. The CLTS approach reinforces that belief, demonstrating that the most effective way to enact change is to empower people to be able to make a difference in their own lives. Part of our core mission is to help communities be their own heroes, and we’re proud to partner with organisations that uphold that same attitude.

There is still a lot of effort to be made in the realm of improved water and sanitation, but we and our partners are working diligently to continuously fight for all humans to have access to the same basic rights. Click the button below to learn about how Wateroam's products are specifically designed to help rural and remote populations to meet their basic needs by visiting our Rural Development page. ​

Rural Development Solutions

Blog Author: Michelle Falcone 

Sources:
https://www.youtube.com/watch?v=bPsiPc_ZKO8&feature=youtu.be
https://www.youtube.com/watch?v=U5TxygvcmU8
https://ourworldindata.org/sanitation#access-to-safe-sanitation
https://ourworldindata.org/sanitation#access-to-safe-sanitation
https://www.communityledtotalsanitation.org/resources
https://www.undispatch.com/water-is-an-mdg-success-story-sanitation-is-most-certainly-not-why/
https://thelogicalindian.com/story-feed/awareness/india-worst-sanitation-toliets-open-defecation/?infinitescroll=1
https://www.unwater.org/
https://www.who.int/data/gho
https://water.org/our-impact/water-crisis/global-sanitation-crisis/