Make toilets and safe sanitation services accessible to all

All people everywhere should have access to safe sanitation services, including hygienic toilets that are connected to quality sewage systems. 

For many people across the WHO South-East Asia Region, as across the world, access to these services nevertheless remains a problem, with 900 million region-wide lacking basic sanitation, and more than 500 million practicing open defecation. This leads to increased human-faeces contact and the transmission of a range of diseases, from cholera to typhoid and hepatitis A and E to tapeworm.  

In recent years Member States have made significant progress. Region-wide, urban coverage of basic sanitation is now close to 70%. In a majority of countries rural coverage exceeds 50%. The share of the region’s population practicing open defecation has meanwhile been reduced from more than 50% to less than 30%, while several Member States have achieved more than 90% coverage of basic sanitation services. 

These advances are to be commended. More than that, however, they must also be built on: The return on every dollar invested in safe sanitation is estimated to be nearly six times, due in large part to lower health costs, increased productivity and fewer premature deaths.

As outlined in WHO’s recently launched Guidelines on Sanitation and Health, there are several ways Member States can sustain their many gains, accelerate progress and make safe sanitation services accessible to all.

First, health authorities should work across sectors to ensure all communities have access to toilets that adequately contain excreta. Of key importance is targeting communities in hard-to-reach areas, as well as those living informally in cities or urban zones. India’s Swaachh Bharat campaign is a good example of how this can be done to rapid effect and on a large scale, with household sanitation coverage increasing at a rate of 13% annually between 2016 and 2018. 

Second, authorities should ensure all toilets are connected to services that provide safe sewage treatment and disposal. This means conducting health-risk assessments of sanitation systems on an ongoing basis, with issues or gaps remedied as a matter of priority. It also means engaging planning authorities at the local level to ensure this process is sustainable and that the environment remains free of human waste.

And third, health facilities themselves must provide safe and functional water, sanitation and hygiene services. Region-wide, too many facilities still lack these basic services, representing a missed opportunity to drive down health care-associated infections, reduce the length of hospital stays and decrease maternal and newborn deaths among other benefits.

WHO is committed to supporting Member States as they strive to make toilets and safe sanitation services accessible to all. Doing so will help achieve several of the Region’s own Flagship Priorities, as well as the wider Sustainable Development Agenda, including Sustainable Development Goals 3 and 6 (on health and sanitation respectively). 

Indeed, as World Toilet Day highlights, the benefits of access to toilets and safe sanitation for all are many and must be harnessed to maximum effect.

(The writer is WHO Regional Director for South-East Asia.)