Photo credit: RTI International/Nabin Baral

How important is the toilet?

In your daily life, you may not think about this much. But something that might surprise many, especially those in more developed communities, is the fact that 3.6 billion people still lack access to safely managed sanitation services.

As we recognize World Toilet Day on November 19, we must reflect on the reality that the seemingly fundamental right to defecate in a safe, private space is limited, if not nonexistent, for these millions of men, women, and children around the globe.

While the number declined in recent years, there are still 494 million people defecating in the open as of 2021. That is more than the population of the U.S., Canada, and Australia combined.

Open defecation is an affront to the dignity, health, and wellbeing of those impacted. Women and girls are particularly vulnerable and at risk due to the potential for increased sexual exploitation during long walks to sanitation facilities, negative health impacts due to “holding it,” and decreased school attendance during menstruation.

Why do billions still lack this crucial access to a toilet?

The short answer—it’s complicated. Reasons vary from country to country, stemming from challenges at the individual level, others at the community level, and yet others from a lack of governmental prioritization of sanitation as a crucial component of societal health and development.

What governments can do

Some may consider toilet access an individual or household responsibility, but it becomes a societal problem when the numbers grow so much that it affects the health and wellbeing of communities and countries. And, as it turns out, there is a great deal that governments can do to improve toilet access and use.

First, governments can prioritize sanitation infrastructure (human excreta management as opposed to solid waste management), by increasing institutional accountability and clear policy guidelines. Second, they can increase funding to the sanitation sector. Not prioritizing these obstacles can contribute to the reality we currently see in developing countries, which suffer disproportionately from a lack of proper sanitation. And yet, the root cause is not only governmental; culture also plays a crucial role.

What communities can do

Years ago, I worked with a community in India to implement something called the Community-Led Total Sanitation (CLTS) approach. One of most substantial barriers in ending the practice of open defecation was camaraderie, as men would agree to travel to the defecation field at specific times to hold discussions surrounding topical issues while undertaking their business. And yet, the power of culture can also be harnessed to achieve the opposite end. As an advocacy tool, the CLTS approach uses peer pressure to sway popular and personal opinions against open defecation.

CLTS has become a common methodology, leveraging community and even peer pressure to ignite a change in sanitation behavior. This is achieved through facilitated community engagements instead of just constructing toilets. It relies on the power of social cohesion and peer pressure to target whole communities rather than individual households or behaviors to help the community realize the benefits of ending open defecation.

This approach has been widely used in many countries in Africa and Asia and was a great tool in ending open defecation in India under the Swachh Bharat Mission, a nationwide campaign launched in 2014.

What the private sector can do

Another promising approach for scaling sustainable access to sanitation is the market-based sanitation (MBS) framework. MBS facilitates private ownership and use of sanitation facilities. Leveraging the private sector not only empowers local enterprises to become key players in the construction of infrastructure, but it also increases community self-reliance by strengthening local actors rather than relying on external entities.

Private ownership also ensures that individual households take responsibility over facility maintenance, and that sanitation entrepreneurs within the community have a vested interest in overseeing the businesses that sell toilets, toilet components, or sanitation services. As a system reliant on customers purchasing and overseeing the construction, operation, and maintenance of facilities, MBS utilizes a more sustainable, free-market approach at the crux of which intersects the right product system, an effective sales and marketing approach, and a viable and efficient delivery model. This complex market ecosystem is inherent to the ability of MBS to not only succeed independently in the long term, but also benefit those most in need.

While some adjustments may be required to scale up this approach, if properly implemented, MBS will address the problem of open defecation and also increase the production of safely managed sanitation systems.

Integrated approaches to achieve sanitation and hygiene goals

RTI is working with partners to implement the MBS framework and other sanitation solutions as part of the collaborative, global effort to achieve UN Sustainable Development Goal 6.2 – Adequate and equitable sanitation and hygiene for all and end open defecation. The MBS framework has already been embraced by organizations ranging from international development institutions such as UNICEF, USAID, and GIZ (the German Agency for International Cooperation), to governments and NGOs at the local level.

In our work, we recognize that in order for market-based efforts to succeed, they must go hand-in-hand with an enabling policy environment fostered by governments as well as social norms that can be supported by approaches such as CLTS.

In other words: Mere access to a toilet is not enough to solve the sanitation problem; we need long-term, locally implemented, and integrated solutions to ensure that waste is safely removed and treated, and that communities continue to work toward a safter, cleaner, more self-reliant future.