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Sanitation refers to the provision of facilities and services for the safe disposal of human urine and feces. Progress in improving sanitation has lagged behind clean water due to a number of complicating factors, including an unrealized demand for sanitation services, the challenge of behavior change, and the complex value chain of sanitation systems.

Size/Magnitude of Problem

Poor water and sanitation environments lead to suboptimal health conditions (e.g. infections, physical disorders, diarrhea, malnutrition) and even death. The poor health resulting from such conditions places excessive burden on those affected as well as those around them. Additionally, the lack of improved sanitation facilities disproportionately affects women and girls, who experience a lack of dignity and safety when practicing open defecation. This in turn contributes to higher school dropout rates for girls. The estimated annual global economic loss due to water and sanitation-related issues is $260 billion.i

  • 2.5 billion people lack access to improved sanitation. 1 billion people worldwide still practice open defecation.ii
  • 842,000 people die each year from water-related diseases.iii 42% of these are children under five.iv
  • 50% of all girls worldwide attend schools without toilets, a large contributor to the female dropout rate.v
Desired Equilibrium

Universal, equitable access to sanitation services, from toilets to waste management services. Governments, utilities, and service providers see the value in extending robust sanitation services to low-income communities. The poor understand the benefits of sanitation and fully utilize available infrastructure, eliminating open defecation and promoting strong hygiene and environmental standards.

Ways Skoll social entrepreneurs are addressing the issue:
  • Working directly with utilities and service providers to improve the quality, quantity, and cost of service (Ciudad Saludable, Water for People, Water and Sanitation for the Urban Poor)
  • Securing finance from governments, multilaterals, and private sector sources to implement and sustain services (Ciudad Saludable, Gram Vikas,, Water for People, Water and Sanitation for the Urban Poor)
  • Organizing community members a to pool resources for community-wide solutions (Gram Vikas, Slum Dwellers International)
  • Tracking the use and capacity of water and sanitation systems to inform operations and maintenance (Water for People)

i WaterAid (link)
ii World Health Organization (link)
iii National Institutes of Health (link)
iv World Health Organization (link)
v (link)

Critical Geographies
Access to Improved Sanitation Facilities

As defined by SPI (< 20% of population)
Niger, Togo, Madagascar, Chad, Sierra Leone, Ghana, Republic of Congo, Tanzania, Liberia, Papua New Guinea, Uganda, Benin, Burkina Faso