Learning from history: Sanitation for prosperity

The disposal and treatment of human waste has been an integral part of human civilization for thousands of years. From Mesopotamia’s first clay sewage pipes in 4000 BCE, to indoor plumbing in ancient Rome, to flush toilets in the Industrial Revolution, sanitation has helped human health, development and economic prosperity.

Sanitation is a human right

But today, billions of people still do not enjoy the right to sanitation. Despite progress, over half of the world’s population, 4.2 billion people, use sanitation services that leave human waste untreated, threatening both human and environmental health. Approximately 673 million people have no toilets at all and practice open defecation, while 367 million school-age children lack a toilet at school. The consequences of poor sanitation are devastating to public health and social and economic development.

With only 10 years left until 2030, the rate at which access to sanitation is increasing will need to quadruple if the world is to achieve the Sustainable Development Goal (SDG) sanitation target of sanitation for all. Yet at the current rate of progress, it will have been the twenty-second century before sanitation for all is a reality. Clearly this is too slow. In the meantime, while investment in sanitation is delayed, the higher costs to the health system, to economy through lost productivity and to a degraded environment mount up.

While the challenge often seems insurmountable, history shows that it is possible – sanitation can be a success story. Many countries have made rapid progress in sanitation coverage within a generation, transforming lives, the environment and the economy. In the 1960s and 1970s, Malaysia, the Republic of Korea, Singapore and Thailand produced rapid and remarkable results to achieve total sanitation coverage. More recently, countries such as Ethiopia, India and Nepal have dramatically reduced open defecation and made progress towards universal access to basic sanitation – to name just a few.

What can we learn from these sanitation champions?

For starters, every country that has made rapid progress has had strong political leadership, with governments playing an important role in policy, planning, mobilizing investment and regulating services. And there is a good reason that governments are so interested in this topic:

History shows that no country has achieved high income status without first investing in sanitation.

Many governments have also realized that though achieving universal access to safe sanitation will be expensive, inaction brings even greater costs. Without sanitation, recurrent and preventable healthcare costs increase, income and educational opportunities are squandered, productivity is lost, and environmental pollution grows. Investments in sanitation – particularly safely-managed sanitation services – avert these costs and generate positive externalities across society. The economic benefits of sanitation have been estimated at about five times the cost.

A mother looks on as a child washed his face at a water source in Indonesia.
© UNICEF/UN0353556/IjazahWahyu watches her son Rizki, 4, wash his face in a newly built clean water and sanitation facility in their home in Tlogopakis village, Central Java province, Indonesia.

To accelerate progress, sanitation must be defined as an essential public good. When governments take this view and accelerate investment in sanitation services, they can help to ensure that all of society reaps the benefits rather than just the privileged few. 

What does this look like in practice? Success comes through investment in five key ‘accelerators’:

  • Good governance, beginning with strong political leadership, effective coordination and regulation
  • Smart public finance to lay the foundation for safe sanitation services, support the most vulnerable and attract private investment
  • Capacity building across the sanitation sector, including training, human resources development, organizational development, research and innovation.
  • Reliable data for better decision-making and stronger accountability
  • Innovation to unlock better approaches and meet emerging challenges like urbanization and climate change


These accelerators are defined in detail in the new UNICEF-WHO ‘State of the World’s Sanitation report’. Through this report, we aim to draw attention to the sanitation crisis, bring together lessons from high-achieving countries, and presenting a vision of what is needed to deliver universal access to safe sanitation. We are calling on Member States, the United Nations system and partners to urgently rise to these challenges.

The world has come so far since ancient civilizations discovered the criticality of sanitation. With just ten years to go until the SDG target of 2030, we must continue to work together towards achieving universal access to safe sanitation for the children of today and the generations to come.


Kelly Ann Naylor is the Associate Director of Water, Sanitation and Hygiene at UNICEF
Bruce Gordon is the Unit Head of Water, Sanitation and Hygiene at WHO.

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