Sanitation Matters

March 21, 2008—Good sanitation and hygiene—clean toilets, easy access to clean water, proper sewage removal—are basic health needs and much more.

Yet some 2.6 billion people, including 980 million children, don't have access to sanitation, meaning they live without access to adequate toilets.

And each year, some 1.7 million people, most of them children, die from poor sanitation and hygiene, and lack of access to safe water. Poor sanitation makes it easier for various illnesses to spread, such as diarrhea, dysentery, cholera, and typhoid. Diarrhea is one of the leading causes of death for children under 5 in the world.

All this means that access to safe water and sanitation is crucial to staying healthy and being well. It is one of the Millennium Development Goals.

"Sanitation is a cornerstone of public health," said Dr. Margaret Chan, Director-General of the World Health Organization.

While more than 1 billion people have gained access to sanitation over the last 14 years, it's not enough. If current trends continue, 2.4 billion people will still live without basic sanitation in 2015, according to WHO.

Children will be affected most—getting sick, missing school, becoming malnourished and poor.

Sanitation in Schools Is Often Lacking

Providing better sanitation—adequate toilets and sinks—can improve school attendance, according to the School Sanitation website.

In most developing countries, sanitary and hygienic conditions in schools are appalling—bathrooms, if they exist, are often dirty or don't work. Often there is nowhere to wash hands.

Students don't want to use these facilities but rather chose not to go to the bathroom.  There are also cases where the new, spotless bathrooms go unused because there is no water supply. Sometimes teachers keep the bathrooms under a lock for their use, because separate facilities for teachers don't exist.

With working sanitation facilities—getting and maintaining clean toilets and sinks—students will get sick less often and miss fewer school days. This will make it more likely that more children will finish and advance in school.

Providing Separate Toilets for Girls

In addition to making sure toilets are clean and working, it's equally important to provide separate facilities for girls.

But these are often more expensive to build. Often in schools with no separate toilets for girls, parents refuse to send girls to school for safety and cultural reasons. Or girls go the entire day without using the bathroom.

As a result, once girls reach puberty and start menstruating, they would rather not go to school than deal with the lack of privacy.

This means that a girl will miss some four days of school each month. These absences add up, making it harder to keep up with schoolwork and much easier to drop out.

Girls often don't want to use bathrooms that are in isolated locations because it increases the risk of being harassed, which means that girl toilets should be near the school building. However, in some cultures it's unacceptable for girls to be seen going to a toilet, which makes it tricky to find a good location for the facilities.

Washing Hands Is Also a Must

If students don't have access to adequate facilities, they can't practice good hygiene—such as washing hands after using the toilet—which makes it easier for diseases to spread.

Washing hands with soap is one of the most effective ways to prevent the spread of diseases, according to the World Bank's Handwashing Handbook.

Yet not many people worldwide use soap when washing hands—many wash their hands with water, but only a small percentage use soap after going to the bathroom.

While soap is present in many households in the world, it is commonly used for bathing and laundry, not handwashing.

Studies show that the main reason why people don't use soap to wash hands is because it's not a habit.

Schools and general public education can help make that simple action a habit.