Sanitation Overview

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Context
Strategy
Results

Globally 2.4 billion people live without access to improved sanitation: Almost 1 billion of these people practice open defecation. Despite significant gains — almost 2.1 billion people gained access to toilets or latrines since 1990 — sanitation was one of the most off-track Millennium Development Goals (MDG) globally. Only 68% of the world’s population has access to improved sanitation, but 70% of the Sub-Saharan Africa population and 53% of South Asia still lack access. The world missed the MDG target for sanitation by almost 700 million people.
Sanitation lies at the root of many other development challenges, as poor sanitation impacts public health, education, and the environment. Almost 1,000 children under five die each day from diarrhea caused by inadequate water, sanitation and hygiene. Without sanitation girls are more likely to drop out of school or are vulnerable to attacks while seeking privacy. Recent analysis shows that ending open defecation can save children’s lives by reducing disease transmission, stunting, and under-nutrition, which are important for childhood cognitive development and future economic productivity.
Lack of sanitation also holds back economic growth. Poor sanitation costs billions to some countries, amounting to the equivalent of 6.3% of GDP in Bangladesh, 6.4% of GDP in India, 7.2% of GDP in Cambodia, 2.4% of GDP in Niger, and 3.9% of GDP in Pakistan annually. The economic losses are mainly driven by premature deaths, the cost of health care treatment, lost time and productivity seeking treatment, and finding access to sanitation facilities. Pollution resulting from improper disposal and treatment of wastewater and domestic fecal sludge also affects both water resources and ecosystems. At the same time, fecal sludge and wastewater can provide valuable resources (water, nutrients, and energy) and economic opportunities, especially in urban areas and in water-scarce environments.

Last Updated: Apr 04, 2017
The World Bank Group (WBG) has been addressing water and sanitation issues globally with large-scale finance and technical assistance to countries.
With its impact on so many aspects of human and economic development, sanitation will be one of the key drivers to ending extreme poverty by 2030. For this, the World Bank Group is committed to using innovative approaches to meet the sanitation challenges: ending open defecation, improving service delivery, and closing the loop from access to sanitation facilities to sustainable disposal of wastewater and sludge management. Currently sanitation represents almost half of the Water Supply and Sanitation (WSS) lending portfolio, and a large share of non-lending technical assistance and knowledge development activities.
A major change in the past year has been a significant growth in the sanitation component of the WSS portfolio, in large part due to the considerable influence of the WBG Water and Sanitation Program (WSP)’s long-term engagement in this area, particularly in the rural sanitation sub-sector. Through advocacy, innovative approaches, and policy dialogue, WSP engagements are now yielding impact at scale in large rural and urban sanitation projects in countries such as India, Vietnam, Egypt, Mozambique, Tanzania, Ethiopia, and Ghana.
The World Bank Group sees the need for urban centers to prioritize investment in a mix of sanitation options to address ever-growing challenges of rapid urbanization. In addition to access to facilities, significant efforts are made to improve fecal sludge and wastewater management to minimize water pollution and other environmental damage. Meanwhile, rural areas require different investments; such as efforts on behavior change that create demand for improved sanitation and hygiene promotion among the poorest.
Another tenet of the strategy to expand access to sanitation is the recognition that private sector participation is essential to meet the needs of all citizens. To accelerate access to 2.4 billion people, governments need to leverage the private sector’s professional capacity and investment. Partnering with the private sector can tap into its 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, a particularly crucial consideration for sanitation. Private sector participation is also tapped in the collection and proper disposal of fecal sludge and wastewater.

Last Updated: Apr 04, 2017
By combining global knowledge with country investments, the World Bank Group generates more firepower for transformational solutions to help countries grow sustainably into the 21st century. These are some highlights from our work on sanitation:
In Lao PDR, the Community-Led Total Sanitation (CLTS) approach, combined with sanitation marketing tools, led to a 32% increase in sanitation access in 266 villages, eight times faster than the national rural average of 2.6% per year from 2014 to 2016. Through this support, 113 villages were declared open defecation free and almost 40,000 people gained access.
In Haiti, the National Direction of Water and Sanitation (DINEPA) launched a roadmap to raise awareness and encourage households to build or improve their own latrines. As part of this strategy, DINEPA doesn’t grant any direct subsidies to households for buying a toilet; instead, it provides them with consulting ser vices for the construction of latrines.
In India, a US$1.5 billion World Bank loan is supporting the Government of India’s Swachh Bharat Mission in its efforts to ensure that all citizens in rural areas have access to improved sanitation with the goal of ending the practice of open defecation in the country by 2019. The program incentivizes latrine and toilet construction through a focus on changing behaviors and stimulating demand.
In Egypt, the US$550 million Sustainable Rural Sanitation Services Program for Results is enhancing access to sanitation services for poor people in small towns while addressing the pollution of the Nile from untreated sewage. The Program aims at empowering local service delivery and connecting the rural and small town poor to working sanitation systems in the Delta governorates of Daqahliya, Sharqiya, and Beheira in Lower Egypt.
In Mozambique, at the request of the Maputo Municipal Council, inclusive sanitation options have been identified for households not connected to the limited sewerage system. This pilot has led to a request for World Bank financing for urban sanitation projects which will promote sustainable solutions to on-site sanitation. Projects which similarly address the challenges of on-site sanitation at scale are either under implementation or preparation in Ghana, Bangladesh, Benin, Tanzania, Indonesia and Ethiopia, among other countries.
In Bangladesh – As part of a broader technical assistance program, the Water and Sanitation Program is working with leading microfinance institutions to develop specialized sanitation loan products. These can help the many households in rural Bangladesh which do not have sufficient cash on hand to upgrade to improved sanitation, but can afford the cost if they are able to spread it over time. Following initial successes, the approach is now being expanded through a US$3 million GPOBA grant.

Last Updated: Apr 04, 2017