Sanitation Access

First published in September 2019.

Access to improved sanitation

What share of people have access to improved sanitation?

There remains large inequalities in levels of access to improved sanitation. The maps below show the total share of the population with improved sanitation facilities, as observed through time from 1990. Also shown in the maps which follow is this share for rural and urban populations of a given country.

Access across Europe, North America, North Africa and some of Latin America is typically greater than 90 percent (and in most cases between 99 and 100 percent). Between 80 and 90 percent of households in Latin America and the Caribbean have improved sanitation. Access is slightly lower across Central and East Asia, typically between 70 and 80 percent.

In South Asia, progress has been varied. Sri Lanka has achieved a 95 percent access rate; Pakistan and Bangladesh both have access of over 60 percent; whereas India lags behind in this regard with just under 40 percent. Regionally, access is lowest in Sub-Saharan Africa where most countries have less than 40 percent access rates. In South Sudan, only 6-7 percent of the population had improved sanitation in 2015. 

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How many people don’t have access to improved sanitation?

The chart below shows the total number of people with and without access to improved sanitation facilities from 1990 [note that this data can also be viewed by country and region using the “change country” function].

Over this 25-year period, the total number of people without access to improved sanitation has remained almost constant: in 1990 this figure was 2.49 billion, and in 2015 it has reduced to 2.39 billion. Total population has of course grown over this period, meaning the number with access has increased from 2.8 billion to nearly 5 billion in 2015. This means that although the total number without access has remained almost constant, the share of the population without access has fallen.

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Number of people without access to improved sanitation facilities by region

The chart below shows the total number of people without access to improved sanitation facilities by region. Over 90 percent of those without access in 2015 resided in Asia, the Pacific or Sub-Saharan Africa. The largest region share was from South Asia, accounting for 40 percent and nearly one billion without access. This was followed by Sub-Saharan Africa with nearly 30 percent (706 million), and East Asia & Pacific with around 22 percent (520 million).

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Number of people without access to improved sanitation facilities by country

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Access to safe sanitation

What share of people use safely managed sanitation facilities?

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How many people use safely managed sanitation facilities?

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Sanitation facilities coverage

Breakdown of sanitation coverage

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Open defecation

What share of people practice open defecation?

Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence — particularly for women and girls.1

The charts below detail the share of people practicing open defecation from 1990 onwards, as a percentage of the total population, rural and urban population. In 2015, 15 percent of the world’s population were still practicing open defecation, presenting a reduction of approximately half since 1990. Regionally, prevalence was highest in South Asia where the average share is 36 percent. India in particular still has high rates, with nearly 45 percent still using open defecation.

In Sub-Saharan Africa, this rate was 23 percent. However, some countries in particular — such as Niger, Chad, South Sudan and Eritrea — still have a prevalence between 60-80 percent.

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Access to handwashing facilities

What share of people have access to basic handwashing facilities?

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What determines levels of sanitation access?

Access to sanitation facilities increases with income

Similarly to improved water access, the provision of sanitation facilities tends to increase with income. In the chart below we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.

Overall, we see a strong relationship between the two. However, the typical ‘threshold’ for reaching 90-100 percent sanitation provision is notably higher than that of improved water sources. Even countries with an average GDP per capita greater than $25,000 have rates of access below 75 percent.

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Rural households often lag behind on sanitation access

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Open defecation is mainly a rural issue

As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.

In the chart below we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.

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Health impacts of poor sanitation

The World Health Organization highlights the contribution of poor water and sanitation access to health, disease and mortality2,3

Contaminated drinking water, poor sanitation facilities and open defecation contribute to the transmission of infectious diseases such as diarrhoea, cholera, dysentery, typhoid, and polio, and can also have severe impacts on malnutrition. The WHO estimates that in 2015, the deaths of 361,000 children under 5-years-old could have been avoided by addressing water and sanitation risk factors.4

In the chart below we see rates of child mortality (measured as the number of children who die before their 5th birthday per 1,000 live births) versus the share of the population practicing open defecation — a key measure of poor sanitation and hygiene. There are a number of important contributing factors to child mortality, including nutrition, healthcare and other living standards. However, overall we see that countries with very low child mortality rates tend to have negligible shares of open defecation.  In countries where open defecation is greater than 10 percent, typically more than 20 children per 1,000 die before their 5th birthday.

However, this relationship is not directly related: several countries with very low rates of open defecation still have very high child mortality rates (close to 1-in-10). Sanitation is therefore just one of many contributing factors to health and disease prevention.

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Stunting is higher where access to improved sanitation is low

Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of chronic malnutrition.5

Although, linked to poor nutritional intake (which we cover in our entry on Hunger and Undernourishment), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.

In the chart below we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below  the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. 

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Definitions

Improved sanitation facilities: “An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.

Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.” 6

Safely managed sanitation facilities: “Safely managed sanitation” is defined as the use of an improved sanitation facility which is not shared with other households and where:
• excreta is safely disposed in situ or
• excreta is transported and treated off-site.

The definitions of categories of sanitation facilities coverage include:

  • Basic service‘: Private improved facility which separates excreta from human contact;
  • Limited service‘: Improved facility shared with other households;
  • Unimproved service‘: Unimproved facility which does not separate excreta from human contact;
  • No service‘: open defecation.

Open defecation: “People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste.”

Data Sources

World Development Indicators – World Bank
  • Data: Access to improved water sources, improved sanitation facilities, open defecation, water consumption by sector and related health indicators
  • Geographical coverage:  Global – by country and world region
  • Time span: 1990 onwards
  • Available at: https://data.worldbank.org/indicator

WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation
  • Data:Water and sanitation sources access
  • Geographical coverage: Global – by country and world region
  • Time span: 2000 onwards
  • Available at: https://washdata.org/