Sanitation

Globally 3.5 billion people lack access to safely managed sanitation services.  Almost 8% of the global population practices open defecation. Despite significant gains — 2.4 billion people gained access to improved toilets or latrines between 2000 and 2020 — sanitation was one of the most off-track Millennium Development Goals (MDGs) globally. Today, 1.7 billion people still lack even basic services. Among those, 580 million shared improved sanitation facilities with other households, counted as “limited” services and 616 million used “unimproved” facilities. The data reveal pronounced disparities, with two thirds of people who still lacked even basic services lived in rural areas. Nearly half of them lived in sub-Saharan Africa. The world missed the MDG target for sanitation by almost 700 million people.

In addition to the challenges of providing many millions of rural households with adequate sanitation, the world continues to urbanize, and cities and small towns will increasingly bear the burden of poor sanitation — with an estimated 57% of urban dwellers lacking access to toilets that provide a full sanitation service, 16% of urban dwellers lacking access to basic sanitation services, and almost 100 million urban residents practicing open defecation.

The benefits of tackling the challenges of sanitation are manifold. Improved sanitation leads to lower disease burden, improved nutrition, reduced stunting, improved quality of life, increased attendance of girls at school, healthier living environments, better environmental stewardship, increased job opportunities and wages, improved competitiveness of cities, and economic and social gains to society more broadly.

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. Without adequate sanitation facilities, girls are more likely to drop out of school or are vulnerable to attacks while seeking privacy.

A 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 (2007), 6.4% of GDP in India (2006), 7.2% of GDP in Cambodia (2005), 2.4% of GDP in Niger (2012), and 3.9% of GDP in Pakistan (2006). The economic losses are mainly driven by premature deaths, the cost of health care treatment, lost time and productivity seeking treatment, and lost time and productivity 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, soil conditioner, briquettes and energy) and economic opportunities, especially in urban areas and in water-scarce environments.

Last Updated: Nov 10, 2023

The World Bank Group (WBG) has been addressing water and sanitation issues globally with large-scale finance and technical assistance to countries across the world.

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, as it will be an important input to the World Bank’s Human Capital Index. The World Bank Group is committed to using innovative approaches to help meet the sanitation challenges of ending open defecation, improving service delivery, and closing the loop from access to sanitation facilities through to sustainable disposal or reuse of wastewater and fecal sludge.

To date, the World Bank has committed US$10 billion to sanitation and water services, which will reach 132 million people. 

Earlier work by the Bank on advocacy, innovative approaches and policy dialogue, has led to large scale impact in rural and urban sanitation projects in countries such as India, Vietnam, Egypt, Haiti, Mozambique, Tanzania, Ethiopia, Bangladesh, Bolivia and Ghana.

The World Bank Group has also partnered with other core development partners in the sector to launch the Citywide Inclusive Sanitation (CWIS) initiative, which is intended to encourage a radical shift in the way urban sanitation challenges are tackled in a rapidly urbanizing world. CWIS aims to ensure that: everyone benefits from adequate sanitation service delivery outcomes; human waste is safely managed along the whole sanitation service chain; effective resource recovery and re-use are considered; a diversity of technical solutions is embraced for adaptive, mixed, and incremental approaches; and onsite and sewered solutions are combined, in either centralized or decentralized systems, to better respond to the realities found in cities across the globe. CWIS further aims to help cities develop comprehensive approaches to sanitation improvement that encompass long-term planning, technical innovation, institutional reforms and financial mobilization. Meanwhile, the provision of sustainable rural sanitation services requires differentiated approaches, including efforts on behavior change, on demand creation for sanitation and hygiene, on strengthening supply chains for sanitation products/services, on hygiene promotion, on fecal sludge management in dense rural areas, and on creating an enabling environment in government and with other key stakeholders to facilitate, promote, scale up, and learn from such approaches.

Another tenet of the strategy to expand access to sanitation — in both urban and rural locations — is the recognition that private sector participation will be key in helping us meet the needs of all citizens. To accelerate access to basic sanitation services for 3.6 billion people, and access to safely managed services for an additional 2 billion people, governments will need to further 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 and service delivery for poorer households, strengthen distribution and supply chains, increase responsiveness to customer demand, and apply the best social and commercial marketing practices to change behavior, a particularly crucial consideration for sanitation. Private sector participation can also be tapped into for the efficient collection, conveyance, treatment and proper disposal/reuse of fecal sludge and wastewater.

Last Updated: Oct 06, 2022

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.

Some examples of what we are doing to provide safely managed urban sanitation to our clients includes the Citywide Inclusive Sanitation initiative, incorporating a Call to Action and ongoing engagement with core development partners, including The Bill & Melinda Gates Foundation, Emory University, The University of Leeds, WaterAid and Plan International.  As part of the implementation of these principles, the World Bank’s Water Global Practice is developing a suite of tools and other material to support Bank teams and their clients when engaging in CWIS. One of the aims of this work is to explore innovative approaches to providing safely managed sanitation services along the whole service chain and to support clients in identifying when such options might make sense. 

Fecal sludge management (FSM) is now a more prominent part of our urban sanitation portfolio; we have FSM activities under implementation or planned in our projects in Bangladesh, Bolivia, Ethiopia, Ghana Angola, Benin, Mozambique, Tanzania, India, Zambia, Indonesia, among others. 

Further as part of the initiative, the Water Global Practice has been undertaking advocacy and capacity building work through CWIS knowledge and learning (K&L) events for Bank task teams and their government counterparts.

The following represent some highlights from the World Bank’s work on sanitation:

• In Egypt, the US$550 million Sustainable Rural Sanitation Services Program for Results (results based financing program) is enhancing access to sanitation services for poor people in small towns and creating channels for citizens to engage with their service providers 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, Beheira, Gharbiya, Damietta, and Menoufiya in the Nile Delta in Egypt.
• In Ghana, to tackle the challenges of sanitation in the Greater Accra Metropolitan Area, the World Bank is supporting a multifaceted sanitation intervention. The project includes: subsidies for poor households to buy toilet facilities, construction of a new fecal sludge treatment plant, engagement with private sector financial institutions to encourage creation of loan products for household sanitation, sanitation marketing, mobile money platforms for households to save towards the cost of a toilet, and support to local private contractors to build their capacity to deliver toilets at larger scales.
• In India, a US$1.5 billion World Bank Program for Results (results based financing program) 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 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 a new urban sanitation project which is currently under preparation and will promote sustainable solutions to onsite and reticulated sanitation in cities throughout the country. 
• In Bangladesh, a sanitation micro-finance program has received much attention in the country and has led to a request from the Ministry of Finance for a US$300 million project to scale up micro-finance for rural sanitation and water supply. Also, in Bangladesh, the US$ 330 million Dhaka Sanitation Improvement Project is now under preparation which will address the challenges of urban sanitation through both reticulated and non-network solutions, as is the Municipal Water Supply and Sanitation project which will provide fecal sludge management and treatment in 30 small towns across the country.

Last Updated: Oct 06, 2022