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Sanitation refers to the provision of facilities and services for the safe disposal of human waste .  Basically, we're talking about toilets, or versions of toilets such as latrines.  Most developed countries are well-equipped with flush toilets, however in developing countries, sanitation is based around much more basic facilities that are often little more than a hole in the ground.  Design is not important, as long as the facilities in question dispose of waste in a hygienic way.  2.5 billion people - over one third of the world's population - lack access to sanitation facilities.  That's almost twice the number of people living in extreme poverty .  Sanitation is also one of the world's leading cause of disease and child death.

"Sanitation, despite being perhaps the 'dirtiest' theme in aid and development, is undeniably a life-saving one."

Why is it important?

Sanitation is crucial to global health. 

Human waste is full of dangerous bacteria that can cause diseases like cholera, typhoid, infectious hepatitis, polio, cryptosporidiosis, and ascariasis. When waste is not properly managed, it can come into contact with skin, water, insects and other things that ultimately transfer the bacteria back into the human body where it can make people sick. 

The most common illness associated with poor sanitation is diarrhea.  In developed countries, diarrhea is little more than a nuisance, but for millions of children in the developing world, it's a death sentence. 

The primary purpose of good sanitation is health (through disease prevention).  Despite the overwhelming importance of sanitation, the world is far behind in providing universal access to safe and hygienic toilets, and the poor are the overwhelming majority of those who miss out.

• 1.2 billion people do not have a toilet .
• Not all toilets are sanitary: 2.5 billion people do not have somewhere safe, private or hygienic to go to the toilet.
• Appropriate sanitation is driver of good health and human development, which can enable pro-poor economic growth.
• In fact, a recent survey conducted by the British Medical Journal identified sanitation as the greatest medical invention in the last 150 years.
• One gram of faeces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 parasite eggs.
• Poor sanitation is most likely the single biggest contributing factor to child mortality in the developing world . About 5000 children die from diarrhoea-related diseases every day.
• Sanitation is the single most cost-effective major public health intervention to reduce child mortality. The simple act of washing hands with soap and water after going to the toilet can reduce the likelihood of contracting diarrhoeal diseases by over 40%.
• Improvements in sanitation have strong flow-on effects to other aspects of human development.
• Poor sanitation disproportionally affects women, impacting their health, dignity and opportunities for education.
• Sanitation in urban areas is nearly double that of rural areas.

Getting sanitation right can have a positive effect on economic growth. In parts of Africa, half the hospital beds at any one time can be filled with people suffering from diarrheal diseases. Because of the high financial burden of poor sanitation, on individuals, businesses and healthcare systems, adequate investments in sanitation could provide an estimated additional 3% economic growth in sub-Saharan Africa.

Dignity

Sanitation represents a basic human right.  Most people who live in 'developed nations' such as Australia, Canada or the UK could never imagine themselves using the kind of toilet facilities that are the norm for so many people around the world.  Decent sanitation facilities bring not only increased health to a community; they bring a much-deserved dignity.  All human beings deserve privacy, clean facilities and the right to go to the bathroom with dignity.

Sanitation and the Millennium Development Goals

	Target 10. Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation. Despite the overwhelming importance of basic sanitation, the world is not on track to meet the sanitation target unless there is a drastic increase in commitment and progress on sanitation coverage . With our current progress, we will miss the goal by over 700 million people. Yet without sanitation, disease control and poverty eradication are impossible, which undermines progress towards all of the other MDGs, and in particular the following:
	Goal 1: Eradicate Extreme Poverty and Hunger. Diarrhoea is major contributor to malnutrition as it means that people’s bodies are unable to process the food that they have consumed.
	Goal 2: Universal Primary Education. Sickness related to sanitation means that millions of children miss time at school either because they are or a member of their family is sick, and they are required at home.
	Goal 4: Reduce Child Mortality. WaterAID (2008) estimates that appropriate sanitation would dramatically reduce child mortality by almost 2.4 million or a quarter – by preventing the following fatalities - 910,000 from diarrhea, 900,000 from pneumonia and 560,000 lives from malnutrition.

Challenges

Sanitation suffers from political neglect at every level. There is a sense of shame and stigma attached to the issue that prevents it from being a high profile political issue. Unlike more attractive issues like water, or issues like HIV/AIDS which have overcome their stigma, sanitation still largely a hidden issue.

What's being done? 

On the international level, there is increasing international support and advocacy for sanitation. On 19 November, the international community celebrates World Toilet Day.  On the community level, sanitation projects can be very simple and have a major impact throughout the community. Girls in Bagamoyo, Western Tanzania are turning up to school in huge numbers due to the improved school buildings and sanitation. Through support from NGO ActionAid, the school now has three new classrooms and eight toilets at the school so that girls who in the past feared sharing toilets with boys could be comfortable being at school. “Enrolment at the school has gone up by one hundred percent because the girls now have their own toilets. They are free to use them without fear of being victimised by boys”, says Anna Ngordya, the Schools Headmistress.

Improved sanitation in developing countries typically yields about USD $9 worth of economic benefit for every USD $1 spent, an impressive ratio.  The benefits include saving time, reducing direct and indirect health costs, increasing the return on investments in education, and safeguarding water resources. The first element, saving time, should not be underestimated in its contribution to economic benefits in the developing world. People without toilets at home spend a great deal of time each day queuing for public toilets or looking for secluded places to defecate. The World Health Organization estimates this time has an economic value of well over USD 100 billion each year. So addressing sanitation does not only bring about valuable health benefits, it frees up individuals' time so they can do more productive things, like earning income, than searching for a quiet spot to relieve themselves.