Lack Of Access To Improved/Basic Sanitation, Hygiene & Open Defecation

Lack Of Access To Improved/Basic Sanitation, Hygiene & Open Defecation

Availability of, and access to clean, safe water is an issue of it’s own.

But, it is closely linked to and also a cause of lack of sufficient and safe sanitation, and hygiene.

Open defecation is also an issue related to lack of sanitation.

In this guide we look at what these issues are, examples of them, why they happen, and what might be done to improve them.


Summary – What To Know About Sanitation, Hygiene & Open Defecation

Much of the world’s worst issues with sanitation, hygiene and particularly open defecation occur in developing (or under developed) countries in the lower GDP brackets (particularly in rural areas).

There’s dangerous human health and disease consequences because of these issues – particularly with young children.

Investing in access to clean water infrastructure, as well as human waste and hygiene facilities is obviously the big solution.

Having and directing the funds on the government and individual levels are the big barrier to making this happen.

Minimising water pollution and contamination will help, as well as finding better ways to spend external funding, and finding ways to stimulate the economy.

Access to clean water (that isn’t contaminated or polluted) is also important to sanitation, hygiene and human waste systems.


What Are The Lack Of Access To Improved/Basic Sanitation, Hygiene & Open Defecation Issues?

Lack Of Access To Basic Sanitation, & Improved Access To Sanitation

The lack of access to basic sanitation issue is essentially the percentage of people that do not have access to sanitation conditions or facilities to dispose of their waste safely and hygienically.

For places with a lack of access to sanitation, there is an aim for improved access to sanitation.


  • “An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.
  • Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.”

– WorldBank & WHO/UNICEF, via


  • Improved sanitation facilities include: flush or pour-flush to piped sewer system, septic tank or pit latrine; ventilated improved pit latrine; pit latrine with slab; and composting toilet.
  • Unimproved sanitation facilities include: flush or pour–flush to elsewhere; pit latrine without slab or open pit; bucket; hanging toilet or hanging latrine; no facilities or bush or field. 
  • The word ‘sanitation’ also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal. 



Open Defecation

  • “Refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste.”



Types Of Sanitation

According to

  • Basic sanitation – refers to the management of human feces at the household level. Basic sanitation is the same as improved sanitation. This is facilities that ensure hygienic separation of human excreta from human contact. They include:
    • Flush or pour-flush toilet/latrine to a piped sewer system, a septic tank or a pit latrine.
    • Ventilated improved pit latrine.
    • Pit latrine with slab.
    • Composting toilet.
  • On-site sanitation – the collection and treatment of waste is done where it is deposited. Examples are the use of pit latrines, septic tanks, and Imhoff tanks.


Causes Of Lack Of Access To Basic Sanitation, & Open Defecation

Some of the overall causes of lack of access to sanitation, lack of access to improved sanitation and open defecation are:

  • Lack of access to clean, safe, fresh water (which is linked to sanitation because sanitation uses water)
  • Pollution or contamination of accessible freshwater sources
  • Not enough money to build sanitation facilities and infrastructure, and keep them maintained
  • Being a low income, poverty stricken, low GDP or less developed country or region (note that due to the health effects of poor sanitation and hygiene – poverty and lack of access to improved sanitation can be a cause of each other, which is a vicious cycle)
  • Living in rural areas as opposed to urban areas


Consider these findings from (

  • There is a general link between income level/GDP of a country and freshwater access
  • In addition to the large inequalities in water access between countries, there are can also be large differences within country
  • [rural areas compared to urban areas tend to have a lower share of sanitation facilities]
  • [The provision of sanitation facilities tends to increase with income]
  • [open defecation is mainly a rural issues] … Open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. 


Effects Of Lack Of Access To Basic Sanitation, & Open Defecation

There’s many effects, both direct and indirect, from not having access to sanitation, not having access to improved sanitation, and open defecation. Some of these include:

  • Overall lower human health and hygiene
  • Disease – transmission of infectious diseases such as diarrhoea, cholera, dysentery, typhoid, and polio.
  • Higher mortality rates, especially of children
  • Higher poverty rates, or lack of improvement in poverty rates
  • Severe impacts on malnutrition
  • In particular with open defecation, this can increase the rate of pathogens, toxins, nitrates and phosphates in the environment and harm the natural environment and ecosystem


Some more findings from & WHO in the impacts are:

  • The WHO estimates that in 2015, the deaths of 361,000 children under 5-years-old could have been avoided by addressing water and sanitation risk factors.
  • There are a number of important contributing factors to child mortality, including nutrition, healthcare and other living standards … But, in countries where open defecation is greater than 10 percent, typically more than 20 children per 1,000 die before their 5th birthday.
  • Contaminated drinking water, poor sanitation facilities and open defecation contribute to the transmission of infectious diseases such as diarrhoea, cholera, dysentery, typhoid, and polio, and can also have severe impacts on malnutrition.
  • Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of chronic malnutrition … [but is also linked to poor sanitation and hygience]


Other stats and findings on the effects of lack of sanitation are:

  • discusses a case study of lack of sanitation in Cape Town settlements –
  • Poor water and sanitation is the leading cause of diarrhoea, which is the second biggest cause of death among children under five, killing 760,000 each year. –
  • Poor water and sanitation can severely erode health and wellbeing gains made by food and nutrition programs. –
  • Illness and time spent collecting water also reduces school attendance and adults’ capacity to work and earn income. A 2012 World Bank study of 18 African countries found they lose 1-2.5 percent of GDP – around US$5.5 billion – every year due to poor sanitation. –
  • 272 school days are lost each year due to water related diseases –
  • 80% of childhood disease is related in some way to unsafe drinking water, inadequate hygiene and poor sanitation –
  • Every 20 seconds a child dies as a result of poor sanitation. –


How Many People Lack Of Access To Improved/Basic Sanitation, & Progress On The Issue

From (which has great charts and data on access to sanitation and open defecation + water access):

  • The total number of people without access to improved sanitation has remained almost constant from 1990 to 2015: in 1990 this figure was 2.49 billion, and in 2015 it reduced to 2.39 billion.
  • Total world population has of course grown in total though over this period
  • This means the % of the population without access has decreased (which is an improvement)
  • This population growth also means the total number with access has increased from 2.8 billion in 1990 to nearly 5 billion in 2015.
  • From 1990-2015, a share of 29 percent of the global population gained access to sanitation.
  • But, share of people gaining access to improved sanitation is growing at different rates in different countries and regions and better effort needs to be made that countries and areas lagging behind are helped out


From –  844 million people lack access to safe water, while 2.5 billion people live without improved sanitation. have a good fact sheet on access to sanitation and open defecation – 


Access To Safe Sanitation By Country, & Regions


  • Of the total number of people without access to improved sanitation facilities by region, over 90 percent of those without access in 2015 resided in Asia, the Pacific or Sub-Saharan Africa.
  • The largest region share was from South Asia, accounting for 40 percent and nearly one billion without access. This was followed by Sub-Saharan Africa with nearly 30 percent (706 million), and East Asia & Pacific with around 22 percent (520 million).
  • There remains large inequalities in levels of access to improved sanitation across the countries in the world
  • In 2015, the total share of the population with access to improved sanitation across Europe, North America, North Africa and some of Latin America is typically greater than 90 percent (and in most cases between 99 and 100 percent).
  • Between 80 and 90 percent of households in Latin America and the Caribbean have improved sanitation.
  • Access is slightly lower across Central and East Asia, typically between 70 and 80 percent.
  • In South Asia, progress has been varied. Sri Lanka has achieved a 95 percent access rate; Pakistan and Bangladesh both have access of over 60 percent; whereas India lags behind in this regard with just under 40 percent.
  • Regionally, access is lowest in Sub-Saharan Africa where most countries have less than 40 percent access rates.
  • In South Sudan, only 6-7 percent of the population had improved sanitation in 2015.
  • Within each country, rural areas generally have lesser access to sanitation than urban areas


In Which Countries Are Open Defecation Rates Highest?


  • In 2015, 15 percent of the world’s population were still practicing open defecation, presenting a reduction of approximately half since 1990
  • Prevalence was highest in South Asia where the average share is 36 percent. India in particular still has high rates, with nearly 45 percent still using open defecation.
  • In Sub-Saharan Africa, this rate was 23 percent. However, some countries in particular — such as Niger, Chad, South Sudan and Eritrea — still have a prevalence between 60-80 percent.


According to, in 2011, 1.04 billion people still practiced open defecation. 


Potential Solutions To Lack Of Access To Improved Sanitation, Hygiene & Open Defecation Issues

Potential ways to increase access to improved sanitation and decrease open defecation are:

  • To increase access to safe freshwater
  • To manage water usage in water stressed countries more efficiently
  • To develop technology or develop plans in water stressed countries, or countries where water security is poor, to increase the amount of available and usable freshwater
  • To minimise water pollution and contamination of freshwater in countries where this is a problem
  • To develop, invest in and aid low income/low GDP countries economically so they can afford new water and sanitation facilities and infrastructure, and so they can maintain it. According to the United Nations World Health Organization (2014), every dollar invested in water and sanitation results in a $4.30 return in the form of reduced healthcare costs. –
  • Place specific focus on rural areas who lag in both sanitation and open defecation rates says:

  • “Reaching the Sustainable Development Goal (SDG) of access to safely managed water and sanitation services by 2030 will require countries to spend $150 billion per year. A fourfold increase in water supply, sanitation, and hygiene (WASH) investments compared to what is spent today, this is out of reach for many countries, threatening progress on poverty eradication.”


  • An example of an organisation helping with the sanitation issue is UNICEF. UNICEF’s water, sanitation and hygiene (WASH) team works in over 100 countries worldwide to improve water and sanitation services, as well as basic hygiene practices.
  • In one year, UNICEF’s efforts provided nearly 14 million people with clean water and over 11 million with basic toilets.




1. Hannah Ritchie and Max Roser (2018) – “Water Access, Resources & Sanitation”. Published online at Retrieved from: ‘’ [Online Resource]








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