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

by Victoria A. Beard, Jillian Du, David Satterthwaite and Diana Mitlin - December 2019

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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Key Findings

  • Cities must ensure universal access to safe, reliable and affordable sanitation so that all urban residents can lead productive, healthy and thriving lives. New analysis of 15 cities in the global south shows that on average, 62% of sewage and fecal sludge is unsafely managed somewhere along the sanitation service chain.
  • Global monitoring efforts have resulted in an underestimation of the urban sanitation crisis and the risks to public health, the economy and the environment. New data and analysis at the city and sub-city level is needed to galvanize action.
  • Sewers are convenient, safe, sanitary and work well in dense urban environments and multistory buildings. From the perspective of the household, sewer connections and services are often less expensive than on-site sanitation options.
  • In the absence of universal access to sewers, cities need to find an optimal combination of off-site and on-site sanitation options. On-site sanitation systems place enormous responsibility on households and private providers, requiring strong government capacity to regulate and enforce sanitation standards to ensure public health and safety.
  • Citywide upgrading of informal settlements can improve low-income households’ access to urban sanitation. City governments should work with community organizations, nongovernmental organizations, and federations to improve and extend sanitation to informal settlements and address affordability.

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