Sanitation crisis: It’s time to talk about solutions

Development Policy19 Mar 2013Bekele Geleta

Setting achievable and sustainable sanitation goals and solutions must have top priority in formulating the post-2015 development agenda.

Toilets are something that people are often embarrassed to talk about, making it easy to ignore the issue. While most of us can find a bathroom or toilet with little difficulty, for over thirty percent of the world’s population—2.5 billion people— it is not easy at all.

This is not only a matter of dignity. It is a problem that can have devastating health and environmental consequences. Diarrhoea is the second leading cause of death in children under 5 years old in sub-Saharan Africa. Chronic diarrhoea can also hinder child development by impeding the uptake of essential nutrients that are critical to the development of children’s minds, bodies, and immune systems.

Are these reasons not enough to talk less about statistics and more about sanitation solutions?

Even in urban areas, where household access to sanitation is higher, too often the contents of people’s toilets are emptied into the streets or even into nearby streams and rivers, which then serve as drinking water for the population, with devastating health consequences.

Creating sanitation solutions that work for everyone, including poor people, and that keep waste out of the environment is a major challenge. But the answer is not to invest in western-style flush toilets and centralized sewage systems that use far too much land, energy and water—and that are expensive to build and maintain.

The above scenario can change and there are already innovative solutions to the problem of improving sanitation in the poorest parts of the world. However, we must go beyond the traditional charitable notion of giving development aid and open a serious discussion about economies of scale, marketing approaches, private sector solutions, pour-flush, eco-san (ecological sanitation) and other decentralized waste-treatment technologies.

The return on investment in sanitation can be incredibly high. Water and sanitation interventions have been shown to produce economic benefits ranging from US$ 5 to US$ 46 per US$ 1 invested.1

The Red Cross Red Crescent has been supporting eco-san projects in Asia-Pacific. In China, for example, this ecological way of disposing human waste in the world’s most populated country has yielded a 30 per cent reduction in diarrhoeal diseases in the last few years.

The private sector has a critical role to play in sanitation, which has often been neglected by governments and aid agencies. In addition to addressing the needs of the most vulnerable populations, there is also a business opportunity to provide toilets to those willing and able to pay for them.

In Ivory Coast, the Red Cross builds toilets in public places like markets and bus stations and then contracts private individuals to run them as small businesses. One of the most common reasons a facility is not used is lack of cleanness. The contractors know that if the toilets are unappealing they won’t get customers, so there is a clear incentive to keep them clean. Increasingly, we are also seeing the value of sanitation marketing to scale up the supply and demand for improved sanitation facilities. The private sector has a lot to offer us in terms of new solutions and can contribute to make sanitation products attractive to consumers and available on a mass scale.

However, bringing the solutions to the people without involving them is pointless.

As one of the major providers of water, sanitation and hygiene services in emergencies, one of the most common activities we have to undertake, unfortunately, is to rehabilitate water and sanitation facilities that are not functioning. Disaster-affected populations without access to such facilities prior to an emergency are more vulnerable to the negative consequences, less inclined to practice hygiene, and take longer to recover.

Community engagement and behaviour change initiatives that address people’s beliefs and motivations are key to sustainable sanitation solutions. If people are consulted and involved in the construction of facilities they will value them more and care for them better. If they are enabled to maintain a water supply or toilet they can ensure they are repaired when necessary. If they understand the benefits, they will save the money to build their own toilets. Working with a community to achieve this takes time, effort and resources.

As we debate the development goals ‘beyond 2015’, we will certainly fail miserably if we cannot increase the emphasis on setting achievable and sustainable sanitation goals and solutions.

The International Federation of Red Cross and Red Crescent Societies (IFRC) is the world’s largest volunteer-based humanitarian network, reaching 150 million people each year through its 187 member National Societies. Together, the IFRC acts before, during and after disasters and health emergencies to meet the needs and improve the lives of vulnerable people. It does so with impartiality as to nationality, race, gender, religious beliefs, class and political opinions. For more information, please visit

  1. Hutton G, Haller L , Bartram J. 2007. Global cost-benefit analysis of water supply and sanitation interventions. J Water Health 2007:5.4;481-502.