Inadequate sanitation is impacting health and economies of countries in South-East Asia. Improving sanitation is the most effective way of reducing these losses. Every dollar spent on sanitation yields about US$ 9 in savings on treatment, health-care costs and gains from more productive days.
The current Ebola crisis in West Africa demonstrates the enormous importance of adequate sanitation, water and hygiene services in preventing disease outbreaks and infection control. We must learn from this tragic crisis.
A major study of 2006 data estimated that in India, inadequate sanitation amounted to a loss equivalent to about 6.4% of India’s gross domestic product (GDP) – greater than the GDP of all but five of the states in India. These losses and economic impacts disproportionately affect the poor.
Good sanitation is proven to prevent water sources being contaminated, protect the environment, prevent infectious diseases and help reduce malnutrition, stunting and mental stress.
A recent WHO study indicates that in 2012 in WHO’s South-East Asia Region, 123 300 diarrhoea deaths were estimated to be caused by inadequate sanitation and 131 500 by inadequate hand-washing practices. Good sanitation contributes hugely to poverty reduction and enhances the security, dignity and wellbeing of women and girls, since poor sanitation hits them the hardest.
In 1990, only 25% of the population of the South-East Asia Region had access to improved sanitation. The countries in the Region have put in immense efforts to meet the MDG sanitation targets and by 2012, the proportion of the Region’s population with access to improved sanitation had risen to 45%. However, the Region is likely to miss its MDG on sanitation. Open defecation has been reduced by 25% across the Region between 1990 and 2012 with Nepal (86% to 40%) and Bangladesh (34% to 3%) being the most successful.
A striking feature of sanitation coverage (and changes in coverage) is the inequity. The rich have much greater access in all areas, whilst 70% of people without improved sanitation and 90% of people practising open defecation live in rural areas. Communities with higher levels of education have better access to sanitation than illiterate ones.
Whilst reducing open defecation and ensuring access to toilets in every home is essential, it is time to think more broadly of improving ‘environmental sanitation’ to include management of all types of wastes. With rapid population growth and industrialization, the amount of wastes from human settlements, industries and other settings is increasing exponentially.
WHO’s global assessment of sanitation and drinking water in 2013 highlights the lack of policies for improving water, sanitation and hygiene in health-care facilities. The MDG goals for sanitation and water are almost exclusively focused on households and communities, while outside the home where a significant amount of time is spent, institutions such as schools and health-care facilities are ignored.
In 2013, the United Nations officially recognized November 19 as World Toilet Day to draw attention to this important issue and to make sanitation a global development priority. On this day, I urge all countries, stakeholders and development partners to work together and make sanitation for all a reality.