Untreated and Unsafe: Solving the Urban Sanitation Crisis in the Global South

Cities must ensure universal access to safe, reliable and affordable sanitation so that all urban residents can lead productive, healthy and thriving lives. Globally, the number of urban residents who lack safely managed sanitation has increased from 1.9 billion in 2000 to 2.3 billion in 2015, costing $223 billion a year in health costs and lost productivity and wages. When households cannot afford safe sanitation services, they often resort to unsafe practices, putting the entire city at risk.

This paper presents new sanitation data from 15 cities in the global south that shows almost two-thirds of sewage and human waste is unsafely managed, with access to safe sanitation lowest in South Asia and sub-Saharan Africa. For these households, sanitation services are too expensive or unsafe.

The paper argues that global monitoring efforts have resulted in an underestimation of the urban sanitation crisis. They do not adequately consider urban density and affordability from the perspective of low-income households. The new analysis confirms that the provision of sanitation infrastructure has inflexible, high, one-time costs, disincentivizing households to use safe practices.

The paper explores what cities can do to ensure more equitable access to safe, reliable and affordable sanitation, while facing climate change and population growth. It highlights four key action areas for cities to improve sanitation access: extend the sewer and simplified sewer networks to household, communal and public toilets; support and regulate on-site sanitation in the absence of sewer systems; support citywide settlement upgrading; and make sanitation services affordable for all.

This is the seventh and last thematic paper of WRI’s flagship World Resources Report (WRR), Towards a More Equal City, a series of 15 papers that examines if equitable access to core urban services can help achieve higher economic productivity and better environmental quality for the city. Visit citiesforall.org for more information.


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