Number of people forced to go to the toilet in the open cut by half

Anne Gulland
A row of portable toilets at an informal settlement in Khayelitsha, Cape Town - AFP

The number of people around the world forced to go to the toilet in the open has halved since 2000, according to new data. 

A report by the World Health Organization and Unicef that tracked household access to water, sanitation and hygiene services found that in 2017 the number of people who practise “open defecation” has reduced from 1.3 billion people in 2000 to 673 million in 2017.

Going to the toilet in the open puts children and adults at risk of picking up and spreading a host of diseases such as diarrhoea, cholera, typhoid and hepatitis A. Diarrhoea alone killed around half a million children under five in 2015.

Ensuring that everyone has access to a toilet is a top priority for the world’s poorest countries and is closely associated with wider efforts to end extreme poverty. 

The practice of open defecation is mainly concentrated in “high burden” countries - that is, those where at least five per cent of the population still have no access to a toilet at home.  

And the WHO/Unicef report says that efforts will need to be concentrated in these countries if the world is to achieve the Sustainable Development Goal target of ending open defecation by 2030.

The biggest fall in open defecation has been in Central and Southern Asia where nearly two thirds of the population - 58 per cent - went to the toilet in the open in 2000. This fell to 20 per cent in 2017. In sub Saharan Africa the number fell from 32 per cent to 20 per cent.

Some 23 countries have reduced open defecation to less than one per cent and have been classed as reaching near elimination.

In India, ending the practice of open defecation has become a political goal, with prime minister Narendra Modi pledging in 2014 to eliminate the practice by October this year by launching a country-wide mission to build toilets.

The report does not capture the latest data on the country’s progress but Andrés Hueso, policy analyst for sanitation at charity WaterAid, said that Mr Modi’s intervention was a good example of how political commitment at the highest level was important.

“The prime minister made it a top priority and invested lots of resources - not just money but human resources, for example putting people with the right skills at ministry level. He made an ongoing effort - he didn’t just launch it and forget about it but talked about sanitation every few months.

“If you prioritise and invest you can made a big acceleration of progress,” he said.

The report also showed that there are wide disparities in access to toilets between countries. In Namibia, just four per cent of the poorest people had basic access to toilets, compared to 87 per cent of the richest people.

Tom Slaymaker, senior statistics and monitoring specialist at Unicef, said that while building toilets was important there were other important factors. 

“It’s better to have some kind of facility than no facility at all. But what we would want is somewhere that is hygienic and separates faeces from human contact, such as a pit latrine. Toilets that are shared with other households are less than ideal, especially for women and girls who may face harassment or lack privacy,” he said.

He added: “As more and more people have basic toilets the focus has shifted towards what’s happening to waste. Is it being treated in any way or is it just going onto the street or the field? It’s important in all settings but if you have untreated waste in densely packed urban areas it can be a real problem."

The report also showed that 1.8 billion people have gained access to basic drinking water but there are still vast inequalities in accessibility, availability and quality.  And 144 million people still drink untreated surface water, putting themselves at risk of picking up a host of diseases.

A further 3.1 billion do not have basic handwashing facilities at home.

Dr Maria Neira, director in public health at WHO, said: "If countries fail to step up efforts on sanitation, safe water and hygiene, we will continue to live with diseases that should have been long ago consigned to the history books: diseases like diarrhoea, cholera, typhoid, hepatitis A and neglected tropical tropical diseases including trachoma, intestinal worms and schistosomiasis.

"Investing in water, sanitation and hygiene is cost effective and good for society in so many ways." 

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