Investments aligned with this strategic goal aim to increase access to safely managed non-sewered sanitation services, including toilets, safe transport of waste, waste management, and waste reuse.
The sections below include an overview of the strategy for achieving desired goals, supporting evidence, a starter kit of metrics that help measure performance toward goals, and a curated list of resources to support collecting, reporting on, and using data for decision-making.
In 2017, just 45% of the world’s population had access to safely managed sanitation services (1). Safe sanitation improves people’s health, well-being, and dignity (2). Exposure to excreta as a result of inadequate household or community-wide access to sanitation harms human and environmental health, increasing disease and pollution (3, 4).
In many locations, however, constructing sewered systems is infeasible given population density and costs or unsustainable given the high volume of water required. Non-sewered sanitation options can fill this gap (5). For example, comparing the capital expenditure and operating costs required for sewered versus non-sewered treatment systems in Dakar, Senegal, one study found that a sewered system would cost 10 times more (6). Non-sewered solutions will become increasingly important as the urban population grows as projected over the coming decades.
In addition, regarding global greenhouse gas emissions, the sanitation and waste sector contributed approximately 5% of non-carbon emissions in 2010, making it the fifth-largest contributor. Innovative sanitation solutions can reduce emissions and transform waste into a reusable resource that is potentially valuable for agricultural production, energy, or carbon capture (4).
Investments aiming to increase access to non-sewered sanitation services can :
As of 2017, more than four billion people lack access to safely managed sanitation (7). One study of low- and middle-income countries estimated that 63% of all households (approximately 1.8 billion people) use sanitation facilities that require fecal sludge management (8).
Low-income households: Typically the target market, households in the poorest wealth quintile, one study found, were almost 170 times more likely to require fecal sludge management than were households in the richest wealth quintile (8).
Rural, urban, and peri-urban communities: While all communities need safely managed sanitation service, strategies for achieving this level of service differ by location. Eighteen percent of the rural population still practices open defecation as of 2017, and this practice is much more common among poorer people (1). For these populations, household latrines are particularly important. The urban and peri-urban poor typically use limited sanitation facilities, such as toilets shared among multiple households, along with unimproved sanitation, such as buckets. Fecal sludge management is particularly important in the urban and peri-urban settings. Finally, all densely populated or fast-growing urban communities without a complete sewered network can benefit from safely managed non-sewered sanitation, which reduces the risk of water contamination from untreated waste regardless of its source (9, 10).
Women and girls: Women and girls especially benefit from toilet facilities that increase their privacy and safety, whether an in-home latrine or higher-quality shared sanitation (11). Inadequate access to indoor sanitation and the need to travel to outdoor toilet facilities are major risk factors for gender-based violence (12). Women in India who practice open defecation are twice as likely to experience non-partner sexual violence as women with a household toilet (13).
The environment: Adequate fecal sludge management prevents the eventual discharge of excreta without treatment into bodies of water. Discharge of untreated waste depletes oxygen in water bodies, reduces water quality, and damages aquatic ecosystems (4).
Certain geographic areas have higher need for non-sewered sanitation than others. Sixty-one “high-burden” countries, where more than 5% of the population practices open defecation, are located primarily in sub-Saharan Africa, South Asia, and East Asia Pacific. Just 31% of the population in sub-Saharan Africa and 61% of the population in Eastern and South-Eastern Asia have at least basic sanitation services (7).
In addition, unlike in North America and Europe, where industrial pollution is the primary concern, urban wastewater is the main source of nutrient pollution in the coastal waterways of South America, Asia, and Africa (4).
Organizations investing in projects that improve access to and use of nonsewered sanitation can contribute toward solutions by:
As of 2017, more than 4 billion people lack access to safely managed sanitation (7). This includes two billion without access to even basic sanitation facilities, for whom access to in-home toilet facilities is a priority. The remainder have access to a toilet in the home, but waste is not adequately treated.
Positive change associated with investments expanding options for non-sewered sanitation depends on the context of the investment. Examples of change associated with investments in this strategy include the following:
Impact risk factors identified by experts as material for this Strategic Goal include:
These risk factors could prevent achievement of the benefits of safely managed sanitation, including improvements to human and environmental health.
Sanivation is a Kenya-based social enterprise that provides waste-to-energy sanitation services for local governments and refugee camps, turning fecal sludge into environmentally friendly fuel alternatives to charcoal and firewood. Secondary cities in developing countries struggle to manage sewage because they lack the resources to build and run traditional sanitation infrastructure. The Sanivation model turns waste treatment from a cost burden into a revenue source for communities. After successfully deploying sanitation solutions in the Kakuma refugee camp, Sanivation partnered with the Naivasha, Nakuru, Kisumu, and Malindi municipal governments, operating waste-treatment plants, installing and servicing container-based toilets, and providing private-sector technical expertise to these governments on long-term sanitation plans. FINCA Ventures, an investment initiative of FINCA International, is an early investor in Sanivation.
Sanergy is a social enterprise in Kenya that builds bold sanitation and waste management solutions for emerging cities, starting with Nairobi. In their full-value-chain model, the company builds high-quality sanitation units branded Fresh Life, which are distributed in non-sewered urban areas to landlords and entrepreneurs via a monthly subscription model. Sanergy regularly and safely removes all generated waste that would otherwise contribute to disease and pollute the environment, transports the waste to their recycling factory, and converts it into a portfolio of valuable products, predominantly organic fertilizer, high-protein insect-based animal feed, and briquettes used as fuel. As of June 2019, Sanergy had more than 2,700 toilet facilities managed by 1,900 ‘Fresh Life Operators,’ half of whom are women. This has enabled 100,00 people each day to access safe sanitation, with 26,069 metric tons of waste cumulatively removed. The company received early-stage investments from impact-first investor Global Partnerships’ Social Venture Fund.
Biomass Controls PBC is a U.S.-based public benefit corporation whose mission is to deliver innovative and transformative technologies in response to the world’s water, sanitation, and environmental challenges. Biomass Controls’ biogenic refinery is a decentralized, small-scale, thermal process that remediates any organic waste, including fecal, food, and agricultural waste (such as manures and crop residues). De-watered waste streams are input into the system, processed thermally, and output pathogen-free in the form of nutrient-rich carbon. An optional integrated, combined heat and power technology generates positive electrical energy; the system can therefore be operated off-grid, and any excess energy may be stored or used for other applications. In 2019, WaterEquity provided a loan for Biomass Controls to expand its deployment of biogenic refineries in India, Cambodia, Indonesia, and the Philippines.
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UNICEF and the World Health Organization. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on Inequalities. New York: United Nations Children’s Fund (UNICEF), 2019.
Guy Hutton and Claire Chase. “The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene.” International Journal of Environmental Research and Public Health 13, no. 6 (May 2016): 536.
Jennyfer Wolf, Annette Prüss‐Ustün, Oliver Cumming, Jamie Bartram, Sophie Bonjour, Sandy Cairncross, Thomas Clasen, John M. Colford Jr., Valerie Curtis, Jennifer de France et al. “Assessing the Impact of Drinking Water and Sanitation on Diarrhoeal Disease in Low‐and Middle‐Income Settings: Systematic Review and Meta‐Regression.” Tropical Medicine & International Health 19, no. 8 (August 2014): 928–42.
Kim Andersson, Arno Rosemarin, Birguy Lamizana, Elisabeth Kvarnström, Jennifer McConville, Razak Seidu, Sarah Dickin, and Caspar Trimmer. Sanitation, Wastewater Management and Sustainability: From Waste Disposal to Resource Recovery. Nairobi: United Nations Environmental Programme and Stockholm Environment Institute, 2016.
Sarah Cairns-Smith, Haley Hill, and Emmanuel Nazarenko. Urban Sanitation: Why a Portfolio of Solutions Is Needed. Boston: The Boston Consulting Group, 2014.
Pierre-Henri Dodane, Mbaye Mbéguéré, Ousmane Sow, and Linda Strande. “Capital and Operating Costs of Full-Scale Fecal Sludge Management and Wastewater Treatment Systems in Dakar, Senegal.” Environmental Science & Technology 46, no. 7 (March 2012): 3705–11.
World Health Organization. “Sanitation.” Fact sheet, June 14, 2019. https://www.who.int/en/news-room/fact-sheets/detail/sanitation.
David M. Berendes, Trent A. Sumner, and Joe M. Brown. “Safely Managed Sanitation for All Means Fecal Sludge Management for at Least 1.8 Billion People in Low and Middle Income Countries.” Environmental Science & Technology 51, no. 5 (January 2017): 3074–83.
David Berendes, Amy Kirby, Julie A. Clennon, Suraja Raj, Habib Yakubu, Juan Leon, Katharine Robb, Arun Kartikeyan, Priya Hemavathy, Annai Gunasekaran et al. “The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children.” The American Journal of Tropical Medicine and Hygiene 96, no. 6 (June 7, 2017): 1404–14.
James A. Fuller, Eduardo Villamor, William Cevallos, James Trostle, and Joseph N.S. Eisenberg. “I Get Height with a Little Help from My Friends: Herd Protection from Sanitation on Child Growth in Rural Ecuador.” International Journal of Epidemiology 45, no. 2 (April 2016): 460–69.
Joanna Pearson and Kate McPhedran. “A Literature Review of the Non-Health Impacts of Sanitation.” Waterlines 27, no. 1 (2008): 48–61.
Gregg S. Gonsalves, Edward H. Kaplan, and A. David Paltiel. “Reducing Sexual Violence by Increasing the Supply of Toilets in Khayelitsha, South Africa: A Mathematical Model.” PLoS ONE 10, no. 4 (April 29, 2015): e0122244.
Apoorva Jadhav,Abigail Wetizman, and Emily Smith-Greenaway. “Household Sanitation Facilities and Women’s Risk of Non-Partner Sexual Violence in India.” BMC Public Health 16 (November 8, 2016): 1139.
Samantha C. Winter and Francis Barchi. “Access to Sanitation and Violence against Women: Evidence from Demographic Health Survey (DHS) Data in Kenya.” International Journal of Environmental Health Research 26, no. 3 (2016): 291–305.
G. D. Sclar, G. Penakalapati, B. A. Caruso, Eva Annette Rehfuess, J. V. Garn, K. T. Alexander, M. C. Freeman, S. Boisson, K. Medlicott, and T. Clasen. “Exploring the Relationship between Sanitation and Mental and Social Well-being: A Systematic Review and Qualitative Synthesis.” Social Science & Medicine 217 (November 2018): 121–34.
Guy Hutton. Global Costs and Benefits of Drinking-Water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage. Geneva: World Health Organization, May 2012.
OECD. Making Blended Finance Work for Water and Sanitation: Unlocking Commercial Finance for SDG 6. OECD Studies on Water. Paris: OECD Publishing, August 2019.
This mapped evidence shows what outcomes and impacts this strategy can have, based on academic and field research.
Bisung, Elijah, and Susan J. Elliott. “Psychosocial impacts of the lack of access to water and sanitation in low-and middle-income countries: a scoping review.“ Journal of Water and Health 15, no. 1 (2016): 17-30.
Berendes, David, Amy Kirby, Julie A. Clennon, Suraja Raj, Habib Yakubu, Juan Leon, Katharine Robb et al. “The influence of household-and community-level sanitation and fecal sludge management on urban fecal contamination in households and drains and enteric infection in children.“ The American journal of tropical medicine and hygiene 96, no. 6 (2017): 1404-1414.
Biran, A., M. W. Jenkins, P. Dabrase, and I. Bhagwat. “Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India.“ Tropical medicine & international health 16, no. 7 (2011): 854-862.
Peprah, Dorothy, Kelly K. Baker, Christine Moe, Katharine Robb, Nii Wellington, Habib Yakubu, and Clair Null. “Public toilets and their customers in low-income Accra, Ghana.“ Environment and urbanization 27, no. 2 (2015): 589-604.
Berendes, David M., Amy E. Kirby, Julie A. Clennon, Chantal Agbemabiese, Joseph A. Ampofo, George E. Armah, Kelly K. Baker et al. “Urban sanitation coverage and environmental fecal contamination: Links between the household and public environments of Accra, Ghana.“ PloS one 13, no. 7 (2018): e0199304.
Wolf, Jennyfer, Richard Johnston, Paul R. Hunter, Bruce Gordon, Kate Medlicott, and Annette Prüss-Ustün. “A Fecal Contamination Index for interpreting heterogeneous diarrhea impacts of water, sanitation and hygiene interventions and overall, regional and country estimates of community sanitation coverage with a focus on low-and middle-income countries.“ International journal of hygiene and environmental health 222, no. 2 (2019): 270-282.
Jadhav, Apoorva, Abigail Weitzman, and Emily Smith-Greenaway. “Household sanitation facilities and women’s risk of non-partner sexual violence in India.“ BMC public health 16, no. 1 (2016): 1139.
Sahoo, Krushna Chandra, Kristyna RS Hulland, Bethany A. Caruso, Rojalin Swain, Matthew C. Freeman, Pinaki Panigrahi, and Robert Dreibelbis. “Sanitation-related psychosocial stress: a grounded theory study of women across the life-course in Odisha, India.“ Social science & medicine 139 (2015): 80-89.
Winter, Samantha C., and Francis Barchi. “Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya.“ International journal of environmental health research 26, no. 3 (2016): 291-305.
Krause, Ariane, and Vera Susanne Rotter. “Linking energy-sanitation-agriculture: Intersectional resource management in smallholder households in Tanzania.“ Science of the Total Environment 590 (2017): 514-530.
Laramee, Jeannette, Sebastien Tilmans, and Jennifer Davis. “Costs and benefits of biogas recovery from communal anaerobic digesters treating domestic wastewater: Evidence from peri-urban Zambia.“ Journal of environmental management 210 (2018): 23-35.
O’Keefe, Mark, Luthi, Christoph, Kamara, Innocent T., Tobias, Robert. “Opportunities and limits to market-driven sanitation services: evidence from urban informal settlements in East. Africa.” Environment & Urbanization (2015)
Seck, Alsane, Moritz Gold, Seydou Niang, Mbaye Mbéguéré, Cheikh Diop, and Linda Strande. “Faecal sludge drying beds: increasing drying rates for fuel resource recovery in Sub-Saharan Africa.“ Journal of Water, Sanitation and Hygiene for Development 5, no. 1 (2014): 72-80.
Muspratt, A. Murray, T. Nakato, C. Niwagaba, H. Dione, J. Kang, L. Stupin, J. Regulinski, M. Mbéguéré, and L. Strande. “Fuel potential of faecal sludge: calorific value results from Uganda, Ghana and Senegal.“ Journal of Water, Sanitation and Hygiene for Development 4, no. 2 (2013): 223-230.
Gold, Moritz, Daniel Isaac Waya Ddiba, Alsane Seck, Patrick Sekigongo, Alassane Diene, Serigne Diaw, Seydou Niang, Charles Niwagaba, and Linda Strande. “Faecal sludge as a solid industrial fuel: a pilot-scale study.“ Journal of Water, Sanitation and Hygiene for Development 7, no. 2 (2017): 243-251.
Narayanan, Sriharini, A. Thillai Rajan, Paul Jebaraj, and M. S. Elayaraja. “Delivering basic infrastructure services to the urban poor: a meta-analysis of the effectiveness of bottom-up approaches.“ Utilities Policy 44 (2017): 50-62.
Wolf, Jennyfer, Paul R. Hunter, Matthew C. Freeman, Oliver Cumming, Thomas Clasen, Jamie Bartram, Julian PT Higgins et al. “Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta‐analysis and meta‐regression.“ Tropical medicine & international health 23, no. 5 (2018): 508-525.
World Bank. 2019. “Evaluating the Potential of Container-Based Sanitation.” World Bank, Washington, DC.
Sclar, G. D., G. Penakalapati, B. A. Caruso, Eva Annette Rehfuess, J. V. Garn, K. T. Alexander, M. C. Freeman, S. Boisson, K. Medlicott, and T. Clasen. “Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis.“ Social Science & Medicine 217 (2018): 121-134.
Garn, Joshua V., Gloria D. Sclar, Matthew C. Freeman, Gauthami Penakalapati, Kelly T. Alexander, Patrick Brooks, Eva A. Rehfuess, Sophie Boisson, Kate O. Medlicott, and Thomas F. Clasen. “The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis.“ International journal of hygiene and environmental health 220, no. 2 (2017): 329-340.
Each resource is assigned a rating of rigor according to the NESTA Standards of Evidence.
(Percent of all residents who rank themselves “likely to recommend” product or service) – (Percent of all residents who rank themselves as “unlikely to recommend” product or service)
Average monthly bill / Average monthly income