Progress towards the sanitation target within the Millennium Development Goals (MDGs) has been extremely disappointing. Defined as a facility which removes excreta from the risk of human contact, “safe” sanitation encompasses covered pit latrines as well as flush toilets. Since its belated addition to the MDGs in 2002, the sanitation target has been the Cinderella of the cause, attracting little over 10% of funds available for water and sanitation programmes.

Risky sanitation for children in Nepal © Mark Naftalin

Development agencies must accept some responsibility, their publicity cameras preferring to linger on happy children working the pump handle. Latrines offer less inspiring images and copy. Even the UN’s declaration of the period 2005-2015 as the “International Decade for Action - Water for Life” betrayed neglect of sanitation, in presentation if not intent.

The consequence is that global access to safe sanitation increased only from 54% to 62% in the period 1990-2006, leaving 2.5 billion people without access, a figure which has barely changed in recent years. In sub-Saharan Africa progress from 26% to 31% extrapolates to arrive at the target sometime during the 22nd century. About half of the population of South Asia continues to suffer the indignity of open defecation.

The development industry has recently taken great strides to redress its lopsided focus on drinking water. The UN corrected its earlier omission by proclaiming 2008 as the Year of Sanitation and the development agencies have overhauled their presentations.

For example, the suggestion that diarrhoea is caused by drinking contaminated water presents an incomplete picture and more attention is now given to the link with unsafe sanitation and poor hygiene practices which ultimately are a major contributor to child mortality. The specialist international agency, WaterAid, has been referring to “sanitation and water” in its communications, inverting the more familiar phrase.

Within village projects too there has been much greater determination to overcome years of failure to convince households of the value of safe sanitation and improved hygiene. Offering government subsidies for latrine construction has been notoriously unsuccessful. More promising results have recently been achieved in an approach known as “community-led sanitation” which promotes behaviour change through peer group condemnation of open defecation as an anti-social habit.

The right to safe sanitation has played a relatively minor role in the protracted debate about the right to water. An alternative pragmatic approach has been articulated by Catarina de Albuquerque, the UN Independent Expert on human rights, water and sanitation. She has pointed out that “those who do not have access to adequate sanitation will not be served by years of political negotiations over a new international treaty.”

A further important output of this fresh approach has been the calculation that sanitation projects deliver highly impressive economic returns of $9 for each $1 of investment, thanks to lower healthcare costs and less disruption to school and work attendance.

This result reinforces the 2006 UN Human Development Report which estimated that failure to invest in water and sanitation was costing sub-Saharan Africa $28.4 billion per annum, about 5% of GDP. This compares with the relatively modest estimate of $10 billion per annum to achieve the sanitation MDG target for all developing countries.

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