Sanitation refers to public health
conditions related to clean drinking water
and adequate treatment and disposal of human excreta
human contact with feces
is part of sanitation, as is hand washing
with soap. Sanitation systems aim to protect human health by providing a clean environment that will stop the transmission of disease
, especially through the fecal–oral route
Towards more sustainable sanitation solutions
Sustainable Sanitation Alliance (SuSanA)
For example, diarrhea
, a main cause of malnutrition
and stunted growth
in children, can be reduced through adequate sanitation. There are many other diseases which are easily transmitted in communities that have low levels of sanitation, such as ascariasis
(a type of intestinal worm infection or helminthiasis
, and trachoma
, to name just a few.
A range of sanitation technologies and approaches exists. Some examples are community-led total sanitation
, container-based sanitation
, ecological sanitation
, emergency sanitation
, environmental sanitation, onsite sanitation
and sustainable sanitation
. A sanitation system includes the capture, storage, transport, treatment and disposal or reuse of human excreta and wastewater
. Reuse activities within the sanitation system may focus on the nutrients, water, energy or organic matter contained in excreta and wastewater. This is referred to as the "sanitation value chain" or "sanitation economy". The people responsible for cleaning, maintaining, operating, or emptying a sanitation technology at any step of the sanitation chain are called "sanitation worker
[World Bank, ILO, WaterAid, and WHO (2019)]
Health, Safety and Dignity of Sanitation Workers: An Initial Assessment
World Bank, Washington, DC.
Several sanitation "levels" are being used to compare sanitation service levels within countries or across countries.
The sanitation ladder defined by the Joint Monitoring Programme
in 2016 starts at open defecation
and moves upwards using the terms "unimproved", "limited", "basic", with the highest level being "safely managed
This is particularly applicable to developing countries
The Human Right to Water and Sanitation
was recognized by the United Nations (UN) General Assembly
in 2010. Sanitation is a global development
priority and the subject of Sustainable Development Goal 6
[WHO and UNICEF (2017]
Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines
Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), 2017
The estimate in 2017 by JMP
states that 4.5 billion people currently do not have safely managed sanitation
Lack of access to sanitation has an impact not only on public health
but also on human dignity
and personal safety.
There are some variations on the use of the term "sanitation" between countries and organizations. Sanitation is not an easy concept to understand.
Lived Realities of Women Sanitation Workers in India: Insights from a Participatory Research Conducted in Three Cities of India
Participatory Research in Asia, New Delhi, India
The World Health Organization
defines the term "sanitation" as follows:
Sanitation includes all four of these technical and non-technical systems: Excreta management systems, wastewater management systems (included here are wastewater treatment plants
), solid waste management
systems as well as drainage systems for rainwater, also called stormwater drainage
. However, many in the WASH
sector only include excreta management in their definition of sanitation.
Another example of what is included in sanitation is found in the handbook by Sphere
on "Humanitarian Charter and Minimum Standards in Humanitarian Response" which describes minimum standards in four "key response sectors" in humanitarian response
situations. One of them is "Water Supply, Sanitation and Hygiene Promotion" (WASH
) and it includes the following areas: Hygiene
promotion, water supply
, excreta management, vector control
, solid waste management and WASH in disease outbreak
s and healthcare
[Sphere Association (2018]
The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response
fourth edition, Geneva, Switzerland, 2018.
promotion is seen by many as an integral part of sanitation. The Water Supply and Sanitation Collaborative Council
defines sanitation as "The collection, transport, treatment and disposal or reuse of human excreta
, domestic wastewater and solid waste, and associated hygiene promotion."
Despite the fact that sanitation includes wastewater treatment, the two terms are often used side by side as "sanitation and wastewater management".
Another definition is in the DFID
guidance manual on water supply and sanitation programmes from 1998:
Sanitation can include personal sanitation and public hygiene. Personal sanitation work can include handling menstrual waste
, cleaning household toilet
s, and managing household garbage
. Public sanitation work can involve garbage collection, transfer and treatment (municipal solid waste management
), cleaning drains, streets, schools, trains, public space
s, community toilets and public toilet
, operating sewage treatment plants
Workers who provide these services for other people are called sanitation workers
The overall purposes of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water
), and to provide safety, security and dignity
for people when they defecate
The Human Right to Water and Sanitation
was recognized by the United Nations (UN) General Assembly
It has been recognized in international law
through human rights treaties
, declarations and other standards. It is derived from the human right
to an adequate standard of living.
Effective sanitation systems provide barriers between excreta and humans in such a way as to break the disease transmission
cycle (for example in the case of fecal-borne diseases). This aspect is visualised with the F-diagram where all major routes of fecal-oral disease transmission
begin with the letter F: feces, fingers, flies, fields, fluids, food.
One of the main challenges is to provide sustainable sanitation
, especially in developing countries
. Maintaining and sustaining sanitation has challenges that are technological, institutional and social in nature. Sanitation infrastructure has to be adapted to several specific contexts including consumers' expectations and local resources available.
Sanitation technologies may involve centralized civil engineering
structures like sewer systems
, sewage treatment
, surface runoff
treatment and solid waste landfill
s. These structures are designed to treat wastewater
and municipal solid waste
. Sanitation technologies may also take the form of relatively simple onsite sanitation systems. This can in some cases consist of a simple pit latrine
or other type of non-flush toilet
for the excreta
Providing sanitation to people requires attention to the entire system, not just focusing on technical aspects such as the toilet
, fecal sludge management
or the wastewater treatment
[Tilley, E., Ulrich, L., Lüthi, C., Reymond, Ph. and Zurbrügg, C. (2014)]
Compendium of Sanitation Systems and Technologies. 2nd Revised Edition
Swiss Federal Institute of Aquatic Science and Technology (Eawag), Duebendorf, Switzerland
The "sanitation chain" involves the experience of the user, excreta and wastewater collection methods, transporting and treatment of waste, and reuse
or disposal. All need to be thoroughly considered.
The benefits to society of managing human excreta are considerable, for public health as well as for the environment. As a rough estimate: For every US$1 spent on sanitation, the return to society is US$5.50.
For developing countries, the economic costs of inadequate sanitation is a huge concern. For example, according to a World Bank study, economic losses due to inadequate sanitation to The Indian economy are equivalent to 6.4% of its GDP.
Most of these are due to premature mortality, time lost in accessing, loss of productivity, additional costs for healthcare among others.
Inadequate sanitation also leads to loss from potential tourism revenue.
This study also found that impacts are disproportionately higher for the poor, women and children. Availability of toilet at home on the other hand, positively contributes to economic well-being of women as it leads to an increase in literacy and participation in labor force.
Types and concepts (for excreta management)
The term sanitation is connected with various descriptors or adjectives to signify certain types of sanitation systems (which may deal only with human excreta
management or with the entire sanitation system, i.e. also greywater, stormwater and solid waste management) – in alphabetical order:
In 2017, JMP
defined a new term: "basic sanitation service". This is defined as the use of improved sanitation
facilities that are not shared with other households. A lower level of service is now called "limited sanitation service" which refers to use of improved sanitation facilities that are shared between two or more households.
Community-led total sanitation
The term "dry sanitation" is not in widespread use and is not very well defined. It usually refers to a system that uses a type of dry toilet
and no sewers to transport excreta. Often when people speak of "dry sanitation" they mean a sanitation system that uses urine-diverting dry toilet
[Platzer, C., Hoffmann, H., Ticona, E. (2008)]
Alternatives to waterborne sanitation – a comparative study – limits and potentials
IRC Symposium: Sanitation for the urban poor – partnerships and governance, Delft, The Netherlands
[Flores, A. (2010)]
''Towards sustainable sanitation: evaluating the sustainability of resource-oriented sanitation''
PhD Thesis, University of Cambridge, UK
Environmental sanitation encompasses the control of environmental factors that are connected to disease transmission
. Subsets of this category are solid waste management, water and wastewater
treatment, industrial waste
treatment and noise pollution
Improved and unimproved sanitation
Lack of sanitation
Lack of sanitation refers to the absence of sanitation. In practical terms it usually means lack of toilets or lack of hygienic toilets that anybody would want to use voluntarily. The result of lack of sanitation is usually open defecation
(and open urination but this is of less concern) with associated serious public health issues.
It is estimated that 2.4 billion people still lacked improved sanitation
facilities including 660 million people who lack access to safe drinking water as of 2015.
[WHO and UNICEF ]
Progress on Sanitation and Drinking-water: 2015 Update
', WHO, Geneva and UNICEF, New York
Onsite sanitation (or on-site sanitation) is defined as "a sanitation system in which excreta and wastewater are collected and stored or treated on the plot where they are generated".
The degree of treatment may be variable, from none to advanced. Examples are pit latrine
s (no treatment) and septic tank
s (primary treatment
of wastewater). On-site sanitation systems are often connected to fecal sludge management
(FSM) systems where the fecal sludge that is generated onsite is treated at an offsite location. Wastewater (sewage
) is only generated when piped water supply
is available within the buildings or close to them.
A related term is a decentralized wastewater system
which refers in particular to the wastewater part of on-site sanitation. Similarly, an onsite sewage facility
can treat the wastewater generated locally.
Safely managed sanitation
Safely managed sanitation is the highest level of household sanitation envisioned by the Sustainable Development Goals
. It is measured as defined under the Sustainable Development Goal 6.2, Indicator 6.2.1 “Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water”.
The operation definition of indicator 6.2.1a is the following: The proportion of population that is using an improved sanitation facility, which is not shared with other households, and where the excreta produced is either
* treated and disposed in situ,
* stored temporarily and then emptied and transported to treatment off-site,
* or transported through a sewer with wastewater and then treated off-site.
In other words, safely managed sanitation is a basic sanitation service where in addition excreta are safely disposed of in situ or transported and treated offsite.
In addition, under SDG Indicator 6.2.1, safely managed services include handwashing facilities with soap and water measured separate under Indicator 6.2.1b.
Other terms used to describe certain types of sanitation include:
* Community-based sanitation (often related to decentralized wastewater treatment
Other types, concepts and systems
Wastewater management consists of collection, wastewater treatment
(be it municipal or industrial wastewater
), disposal or reuse of treated wastewater. The latter is also referred to as water reclamation
Sanitation systems in urban areas of developed countries usually consist of the collection of wastewater
in gravity driven sewers, its treatment in wastewater treatment plants
or disposal in rivers, lakes or the sea.
In developing countries
most wastewater is still discharged untreated into the environment. Alternatives to centralized sewer systems include onsite sanitation
, decentralized wastewater system
s, dry toilet
s connected to fecal sludge management
Sewers are either combined with storm drain
s or separated from them as sanitary sewer
s. Combined sewer
s are usually found in the central, older parts or urban areas. Heavy rainfall
and inadequate maintenance can lead to combined sewer overflows or sanitary sewer overflow
s, i.e., more or less diluted raw sewage
being discharged into the environment. Industries often discharge wastewater into municipal sewers, which can complicate wastewater treatment unless industries pre-treat their discharges.
Solid waste disposal
Disposal of solid waste
is most commonly conducted in landfill
s, but incineration, recycling
ing and conversion to biofuel
s are also avenues. In the case of landfills, advanced countries
typically have rigid protocols for daily cover
with topsoil, where underdeveloped countries
customarily rely upon less stringent protocols. The importance of daily cover lies in the reduction of vector contact and spreading of pathogen
s. Daily cover also minimizes odor emissions and reduces windblown litter. Likewise, developed countries typically have requirements for perimeter sealing of the landfill with clay-type soils to minimize migration of leachate
that could contaminate groundwater
(and hence jeopardize some drinking water
For incineration options, the release of air pollutant
s, including certain toxic
components is an attendant adverse outcome. Recycling and biofuel conversion are the sustainable
options that generally have superior lifecycle costs, particularly when total ecological
consequences are considered. Composting value will ultimately be limited by the market demand for compost product.
Sanitation within the food industry means the adequate treatment of food-contact surfaces by a process that is effective in destroying vegetative cells of microorganism
s of public health
significance, and in substantially reducing numbers of other undesirable microorganisms, but without adversely affecting the food or its safety for the consumer (U.S. Food and Drug Administration
, Code of Federal Regulations
, 21CFR110, USA). Sanitation Standard Operating Procedures
are mandatory for food industries in United States
. Similarly, in Japan, food hygiene has to be achieved through compliance with food sanitation law.
In the food and biopharmaceutical
industries, the term "sanitary equipment" means equipment that is fully cleanable using clean-in-place
(CIP) and sterilization-in-place (SIP) procedures: that is fully drainable from cleaning solutions and other liquid
s. The design should have a minimum amount of deadleg, or areas where the turbulence
during cleaning is insufficient to remove product deposits. In general, to improve cleanability, this equipment is made from Stainless Steel
316L, (an alloy
containing small amounts of molybdenum
). The surface is usually electropolish
ed to an effective surface roughness of less than 0.5 micrometre
to reduce the possibility of bacteria
In many settings, provision of sanitation facilities alone does not guarantee good health of the population. Studies have suggested that the impact of hygiene practices have as great an impact on sanitation related diseases as the actual provision of sanitation facilities. Hygiene promotion is therefore an important part of sanitation and is usually key in maintaining good health.
Hygiene promotion is a planned approach of enabling people to act and change their behavior in an order to reduce and/or prevent incidences of water, sanitation and hygiene
) related diseases. It usually involves a participatory approach of engaging people to take responsibility of WASH services and infrastructure including its operation and maintenance. The three key elements of promoting hygiene are; mutual sharing of information and knowledge, the mobilization of affected communities and the provision of essential material and facilities.
A video shedding light on the unsafe and undignified working conditions of many sanitation workers
Sanitation is a necessity for a healthy life. Health impacts of the lack of safe sanitation systems can be grouped into three categories: Direct impact (infections), sequela
e (conditions caused by preceding infection) and broader well-being.
It was estimated in 2002 that inadequate sanitation was responsible for 4.0 percent of deaths and 5.7 percent of disease burden worldwide.
Lack of sanitation can result in feces-contaminated drinking water
and cause life-threatening forms of diarrhea
to infants. In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days.
It can also lead to malnutrition
and stunted growth
Numerous studies have shown that improvements in drinking water and sanitation (WASH
) lead to decreased risks of diarrhea.
– or lack of sanitation – is a leading cause of diarrheal death.
Approximately two billion people are infected with soil-transmitted helminths
worldwide. This type of intestinal worm infection is transmitted via worm eggs in feces. It happens in environments where there is no effective separation of humans and feces due to lack of sanitation.
When analyzing environmental samples, various types of indicator organism
s are used to check for fecal pollution of the sample. Commonly used indicators for bacteriological water analysis
include the bacterium ''Escherichia coli
'' (abbreviated as ''E. coli)'' and non-specific fecal coliforms
''.'' With regards to samples of soil
, sewage sludge
or fecal matter from dry toilet
eggs are a commonly used indicator. With helminth egg analysis, eggs are extracted from the sample after which a viability test is done to distinguish between viable and non viable eggs. The viable fraction of the helminth eggs in the sample is then counted.
can have negative impacts on existing sanitation services in several ways: damage and loss of services from flood
s and reduced carrying capacity of waters receiving wastewater.
The sanitation sector is already affected in many different ways by "weather and climate-related phenomena such as variability, seasonality and extreme weather
events". Extreme weather events, such as floods and droughts
, are increasing in frequency and intensity due to climate change. They affect the operation of water supply
, storm drainage
infrastructure, and wastewater treatment plants
A publication by WHO
provides guidance on how adaptation policies
should consider these risks from extreme weather events.
Technical solutions for climate change adaption for sanitation systems can include separate systems (storm water pipes kept separate from sewer pipes), backflow valves on sewers (backflow prevention devices
), dry toilets
instead of flush toilets, locating sanitation infrastructure outside of flood zones if possible.
Water and sanitation services contribute to greenhouse gas emissions
. It has been estimated that sanitation services produce roughly 2–6% of global man-made methane
, one of the greenhouse gases. Septic tanks, pit latrines, anaerobic lagoons
, anaerobic digesters
are anaerobic treatment processes and thus emit methane which may or may not be captured (usually not captured in the case of septic tanks).
To reduce those emissions, the following can be done: Choice of wastewater treatment technologies, improved pumping efficiency, use of renewable sources of energy
, and within-system generation of energy offer potential for reducing emissions.
systems can lead to reductions in greenhouse gas emissions by producing renewable energy in the form of biogas
, heat recovery or directly from excreta. These options have additional mitigation
Researchers at the International Institute for Sustainable Development
(IISD) have found in 2017 that "nearly all National Adaptation Plans published by the UN Framework Convention for Climate Change
identify improving sanitation and hygiene as a priority".
Global development goals
Sustainable Development Goal Number 6
In the year 2016, the Sustainable Development Goals
replaced the Millennium Development Goals. Sanitation is a global development
priority and included Sustainable Development Goal 6
The target is about "clean water and sanitation for all" by 2030.
One indicator for the sanitation target is the "Proportion of population using safely managed sanitation services, including a hand-washing facility with soap and water".
The current value in the 2017 baseline estimate by JMP
is that 4.5 billion people currently do not have safely managed sanitation
JMP is the Joint Monitoring Programme by UNICEF and WHO to monitor SDG6 progress. It is estimated that 660 million people still lacked access to safe drinking water as of 2015.
Since the Covid-19 pandemic
in 2020, the fight for clean water and sanitation is more important than ever. Handwashing is one of the most common prevention methods for Coronavirus, yet two out of five people do not have access to a hand-washing station.
Millennium Development Goal Number 7 until 2015
The United Nations
, during the Millennium Summit in New York in 2000 and the 2002 World Summit on Sustainable Development
in Johannesburg, developed the Millennium Development Goals
(MDGs) aimed at poverty eradication and sustainable development. The specific sanitation goal for the year 2015 was to reduce by half the number of people who had no access to potable water
and sanitation in the baseline year of 1990. As the JMP and the United Nations Development Programme
(UNDP) Human Development Report in 2006 has shown, progress meeting the MDG sanitation target is slow, with a large gap between the target coverage and the current reality.
In December 2006, the United Nations General Assembly
declared 2008 "The International Year of Sanitation
", in recognition of the slow progress being made towards the MDGs sanitation target.
The year aimed to develop awareness and more actions to meet the target.
There are numerous reasons for this gap. A major one is that sanitation is rarely given political attention received by other topics despite its key importance. Sanitation is not high on the international development agenda, and projects such as those relating to water supply
projects are emphasised.
The Joint Monitoring Programme for Water Supply and Sanitation
(JMP) has been publishing reports of updated estimates every two years on the use of various types of drinking-water sources and sanitation facilities at the national, regional and global levels. The JMP report for 2015 stated that:
* Between 1990 and 2015, open defecation
rates have decreased from 38% to 25% globally. Just under one billion people (946 million) still practise open defecation worldwide in 2015.
* 82% of the global urban population, and 51% of the rural population is using improved sanitation facilities in 2015, as per the JMP definition of "improved sanitation
In 2011 the Bill & Melinda Gates Foundation
launched the Reinvent the Toilet Challenge to promote safer, more effective ways to treat human waste. The program is aimed at developing technologies that might help bridge the global sanitation gap.
A study was carried out in 2018 to compare the lifecycle costs of full sanitation chain systems in developing cities of Africa and Asia. It found that conventional sewer systems are in most cases the most expensive sanitation options, followed, in order of cost, by sanitation systems comprising septic tank
s, ventilated improved pit latrine
s (VIP), urine diversion dry toilets
and pour-flush pit latrines.
The main determinants of urban sanitation financial costs include: Type of technology, labour, material and utility cost, density, topography
, level of service provided by the sanitation system, soil
condition, energy cost and others (distance to wastewater treatment
facility, climate, end-use of treatment products
, business models, water table
Some grassroots organizations have trialled community-managed toilet blocks whose construction and maintenance costs can be covered by households. One study of Mumbai informal settlements
found that US$1.58 per adult would be sufficient for construction, and less than US$1/household/month would be sufficient for maintenance.
Major human settlements could initially develop only where fresh surface water was plentiful, such as near rivers or natural springs
. Throughout history people have devised systems to get water into their communities and households, and to dispose (and later also treat) wastewater. The focus of sewage treatment at that time was on conveying raw sewage to a natural body of water, e.g. a river
, where it would be diluted and dissipated.
The Sanitation in the Indus Valley Civilization
in Asia is an example of public water supply and sanitation during the Bronze Age
). Sanitation in ancient Rome
was quite extensive. These systems consisted of stone and wooden drains to collect and remove wastewater
from populated areas—see for instance the Cloaca Maxima
into the River Tiber
in Rome. The first sewers of ancient Rome were built between 800 and 735 BCE.
[Farnsworth Gray, Harold. "Sewerage in Ancient and Mediaeval Times." Sewage Works Journal Vol.12.5 (1940): 939-46]
Society and culture
There is a vast number of professions that are involved in the field of sanitation, for example on the technical and operations side: sanitation workers
, waste collector
s, sanitary engineers
* List of abbreviations used in sanitation
* List of water supply and sanitation by country
* Environmental health
* Water pollution
* Self-supply of water and sanitation
* Sustainable Sanitation Alliance
* World Toilet Day
Sustainable Sanitation Alliance
Category:Articles containing video clips