No sanitation: public health implications and private-sector solutions

Going to the toilet might not strike some as a development priority, but social enterprises in India and Kenya have demonstrated the immense social and health benefits of cleaning up this most basic human function. Amira Aleem investigates.


Drain? Or Toilet?

This open watercourse in Malgudam, Bangladesh, serves as both drain and toilet. © Sustainable Sanitation Alliance/Creative Commons license

Today, 2.5 billion people globally lack access to a toilet that adequately separates human excreta from human contact. This includes over 1 billion people who defecate in the open, or nearly fifteen per cent of the world’s population. These statistics are incredibly alarming considering that we are only one year away from the deadline for the Millennium Development Goals, three of which – to reduce child mortality, improve maternal health, and combat malaria by 2015 – are contingent on better sanitation facilities for the world’s poorest.

Apart from the obvious aesthetics of open defecation, it encourages the spread of diseases such as diarrhea, malaria and hepatitis A, which are overwhelmingly responsible for child mortality in the developing world. Research suggests that 1.2 million people die of malaria each year, 90 per cent of whom are children under the age of five.

Lack of sanitation in the rapidly growing slums of the developing world, in particular, is of increasing concern to public health. Too often, urban authorities’ inability to manage an ever more dense population means that water resources are stretched thin and the poorest often go without. In fact, it is estimated that four per cent of the global disease burden could be prevented by improving water and sanitation facilities for the 1 billion people who live in urban slums without access to safe drinking water.

Lack of organised toilet facilities also translates into insecurity, and crime over access to resources is a common threat. As Melinda Gates has pointed out, reinventing the toilet is in many ways a girls’ issue, with women risking rape and sexual harassment by being in vulnerable positions when they are forced to defecate in the open, often in the middle of the night, far away from their homes in open fields.

While governments and local bodies struggle to develop, plan and maintain sanitation facilities, it is increasingly the private sector that has stepped in to address the problem in innovative ways.

In Pune, India, Samagra has designed a new system of ‘loo rewards’ to increase toilet usage for people living in slum communities. Indian conceptions about dirt and purity make the concept of using an indoor toilet seem unhygienic, smelly and anti-social for large numbers of people. For many women, going to the bathroom is a chance to be away from the running of a house, meet with friends and spend time in nature.

The entrance to a Samagra toilet block in Pune, India. Image courtesy of Samagra.

In response to this, Samagra works with local communities to design toilets that are aesthetically pleasing and that incorporate local designs and preferences – open roofs and communal chatting spaces, for example. Each time a user visits a Samagra toilet complex, they accumulate rewards that can then be exchanged for discounts at local stores, mobile phone top-up credit and government family schemes. Stores pay Samagra to attract new customers and build loyalty for their goods and services. In their own words, ‘Samagra’s paradigm shifting model has proven its ability to attract and retain users to the toilet facility, promote hygienic behavior, and still achieve profitability.’

Sanergy provides training to ensure that pupils attending schools with a Fresh Life installation learn how to properly use the toilet and handwashing stand. Image courtesy of Sanergy.

Elsewhere, Kenyan-based social enterprise Sanergy approaches the issue in an entirely different way. By working with engineers, it has designed an affordable and efficient toilet that is micro-franchised to local slum residents. Each day, the waste is collected by Sanergy and converted into renewable energy and organic fertiliser, which is then sold to local farmers. This reduces the cost of fertiliser for farmers (normally imported at expensive rates), combats urban sanitation problems and provides an income for the hundreds of local entrepreneurs who are franchise partners in their ‘Fresh Life’ model. In developing this kind of joined-up solution, social enterprises like Sanergy are helping to redesign the landscape of access to essential facilities through bold new innovation.

Entrepreneurs like those at Samagra and Sanergy are increasingly turning to innovative business models and game-design thinking to make solutions to social problems more appealing. In many ways, this highlights the greater trend towards capacity building and for-profit ventures as opposed to the traditional charity model for combating poverty issues. To truly design changes in a system, inability to access a toilet has to be seen as a greater human rights issue. We must look beyond the health and crime figures and recognise it as a problem that is fundamentally about people not having the ability to lead a safe, clean and private life. And that’s really quite shit.

The views expressed in this article are those of the author and do not necessarily represent the views of Development in Action.


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