Sanitation investment in poor countries would yield $9-to-1 benefits in productivity, health and other benefits

Mar 24 2008

Experts estimate that $9 in productivity, health and other benefits are returned for every dollar invested installing toilets for people in countries that today are off-track in meeting the UN Millennium Development Goal (MDG) for sanitation.

Some argue that meeting the sanitation MDG is also a prerequisite to the goals of reducing global poverty.

Achieving the sanitation goal - to simply halve the number of people without access to a toilet by 2015 – would cost $38 billion, less than 1% of annual world military spending. That investment, however, would yield $347 billion worth of benefits - much of it related to higher productivity and improved health.

According to UN figures, meeting the sanitation MDG target would add 3.2 billion annual working days worldwide. Universal coverage would add more than four times as many working days.

Some 2.6 billion people – over a third of humanity – lack access to adequate sanitation. Each of those devotes a conservatively estimated 30 minutes a day queuing for public toilets and / or seeking seclusion. The cumulative time involved equals about two working days per month.

A more drastic consequence, however, is the number of workdays lost to diarrhoeal disease – either by ill workers or when she or he is caring for a sick child or relative.

In addition, many women avoid workdays during menstruation when workplaces have no toilets.

Diarrhoeal disease is a leading cause of death and illness, killing 1.8 million people each year. Poor hygiene and lack of access to sanitation together contribute to 88 per cent of all deaths from diarrhoeal disease, with children paying the highest price: 5,000 deaths a day. Hundreds of millions of other children suffer reduced physical growth and impaired cognitive functions due to intestinal worms.

Improved access to sanitation would also lead to very high avoided health sector costs, according to UN research.

On a typical day in sub-Saharan Africa, for example, half the hospital beds are occupied by people afflicted with faecal-borne disease. Treating preventable infectious diarrhoea consumes 12 percent of the region's total health budget.

Globally, $552 million in direct treatment costs would be avoided by meeting the MDG sanitation target.

Around the world, an estimated 200 million tons of human waste and untold millions of tons of wastewater are discharged uncontained and untreated, into watercourses every year. As a result, humans are regularly exposed to bacteria, viruses and parasites – spread through direct or indirect contact with these watercourses. Such exposure is the leading cause for diarrhoeal disease (including dysentery and cholera), parasitic infections, worm infestations and trachoma.

Healthy children learn more than children suffering from worm infections, which sap nutrients and calories and lead to listlessness and trouble concentrating. Up to two thirds of all schoolchildren in some African countries are infected with parasitic worms.

Schools without private and separate sanitation facilities for boys and girls have higher incidence of diarrheal disease but also lower attendance and a higher dropout rate, especially for girls whose parents may remove them from the education system when they start menstruating. This fuels the discrepancy in primary school completion rates: one in four girls do not complete primary school, compared to one in seven boys.

More girls in school means higher rates of female literacy -- for every 10 percent increase in female literacy, a country's economy can grow by 0.3 percent.

UN experts estimate the reduction in diarrhea engendered by meeting the sanitation target would add an estimated 272 million days of school attendance.

Many UN studies have shown that public- and private-sector investment into sanitation can lead to economic benefits for communities. In particular, small entrepreneurs can benefit from infrastructure development. That, in turn, requires enabling policies to be in place.

Many sectors are already impacted by sanitation-triggered illnesses of their workers, including agriculture, fish-farming, energy production, large-scale industrial processes, small-scale industry, transport and recreation.

Health, safety and comfort standards for sanitation as well as aesthetic considerations also heavily influence the choice of tourist destinations.

Between 1990 and 2004, an estimated 1.2 billion people gained access to improved sanitation, an increase of 10 percent. To meet the Millennium Development Goals' sanitation target, however, over 1.6 billion more will need to be reached by 2015, with developing countries facing the biggest challenge. Globally, this translates into 626,000 people per day being given access to an improved sanitary facility.

While many regions are on track to meet the MDG sanitation target, we will miss this global target by a wide margin.

The East Asia/Pacific region recorded the largest improvements, with sanitation coverage increasing from 30 per cent in 1990 to 51 percent in 2004, putting it on track to reach its target of 65 percent. The Middle East/North Africa and Latin America / Caribbean are also generally on track to meet their MDG sanitation targets.

The areas with the least access are West and Central Africa (36 per cent coverage), South Asia (37 per cent) and Eastern and Southern Africa (38 per cent). In terms of absolute numbers, the greatest improvements have been in South Asia, which more than doubled its coverage from 17 per cent in 1990 to 37 percent in 2004. Yet the increase is still not sufficient for the region to meet its MDG sanitation target of 58 per cent by 2015.

Access to improved sanitation was more than twice as high in urban areas than in rural areas in 2004 (80 per cent in urban areas versus 39 per cent in rural areas). Of the 2.6 billion people currently without access to improved sanitation, 2 billion (77 per cent) live in rural areas. The urban-rural disparity is largest in South Asia, where only 27 per cent of the rural population is served, compared to 63 per cent in urban areas. Only in industrialized countries is urban and rural coverage comparable

According to UN experts, key steps needed to accelerate progress on this issue include:

Sanitation is a political and institutional orphan, an under-funded sector with no voice at the policy or service delivery ‘high table'. Establishing one national coordinating body, formulating a single, country-wide sanitation plan, and putting into place a transparent monitoring framework could spur and drive progress.

Market sanitation and hygiene and focus on long-term behaviour change

Health-oriented information campaigns have been less successful at driving demand than using commercial techniques and appealing to consumer preferences for convenience, comfort, safety, cleanliness and prestige. Building community consensus that open defecation and other environmental hazards are actually serious health problems – that can be solved by toilets – has proved successful in a number of countries. Supporting health departments and community health workers to focus on long-term behaviour changes and educating children through school-based programs are both necessary for sustaining demand and helping new behaviours stick.

Significant professional business development support for small-scale sanitation providers is required, as is greater training of sanitary engineers, to meet the demands of the massive scaling up of efforts required for universal coverage. It needs to be made easy for lower income families to build and maintain toilets, washrooms and wastewater disposal systems whose benefits they understand, and whose domestic convenience they actively seek.