World Toilet Day 2018

Message from Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region on the occasion of World Toilet Day 2018

World Toilet Day is a unique occasion for a universal need: safe sanitation services. As the theme of this year’s World Toilet Day – ‘When Nature Calls’ – underscores, ensuring those services are accessible to all is vital to advancing health and wellbeing and achieving WHO South-East Asia Region’s Flagship Priorities. It is also fundamental to fulfilling the 2030 Sustainable Development Agenda.

The need for safely managed sanitation is straightforward. When latrines and the systems supporting them are inadequate or non-existent, human waste is neither effectively captured or treated. This turns the environment into an open sewer, increasing human-feces contact and the transmission of a range of diseases, from cholera to typhoid and from hepatitis A and E to tapeworm. More often than not, newborns and children are at greatest risk. The most recent estimates put the number of people Region-wide lacking access to a basic sanitation service at more than 900 million, with more than 500 million practicing open defecation. Apart from contaminating food and water sources and increasing the spread of disease, open defecation also puts girls and women at risk of abuse and sexual assault. That is unacceptable.

In recent years Member States have made significant progress. Region-wide, urban coverage of basic sanitation services is now close to 70%. In a majority of countries rural coverage exceeds 50%. The share of the Region’s population practicing open defecation has meanwhile been reduced from more than 50% to less than 30%, while several Member States have achieved more than 90% coverage of basic sanitation services. These advances are to be commended. More than that, however, they must also be accelerated: The return on every dollar invested in safe sanitation is, after all, estimated to be nearly six times, due in large part to lower health costs, increased productivity and fewer premature deaths.

As outlined in WHO’s recently launched Guidelines on Sanitation and Health, there are a number of ways countries can achieve these outcomes and provide safe sanitation for all, including by facilitating and promoting hand-washing and menstrual hygiene management.

A key starting point is ensuring all communities have access to toilets that adequately contain excreta, and that proper services for treatment and disposal are provided. That includes for communities in rural and hard-to-reach areas, as well as those living informally in cities or urban zones. As part of this, health-risk assessments of sanitation systems should be conducted on an ongoing basis, with issues or gaps remedied as a matter of priority. Making this happen sustainably requires input and planning at the community level, with multisectoral involvement – including from the health sector – vital. However robust, high-level commitment requires full local buy-in to achieve maximum impact.

Crucially, health facilities themselves must provide safe and functional water, sanitation and hygiene services as a cost-effective and immediate means of enhancing quality. This is particularly important as the Region pursues universal health coverage as part of its own Flagship Priorities, as well as the wider Sustainable Development Agenda. Region-wide, too many facilities still lack these basic services, representing a missed opportunity given their capacity to drive down health care-associated infections, reduce the length of hospital stays and decrease maternal and newborn deaths among other benefits.

Our forward momentum nevertheless continues. WHO South-East Asia remains committed to providing guidance and operational support to Member States to ensure the full impact of safely managed sanitation is realized, the Region’s Flagship Priorities are achieved, and Sustainable Development Goals 3 and 6 (on health and sanitation respectively) are fulfilled. As World Toilet Day highlights, though the need for safe sanitation may be straightforward, the benefits of achieving it are many, and are uniquely powerful.

Dr Poonam Khetrapal Singh
Regional Director