The scale of the challenge

2. The scale of the challenge • 2.6 billion people – four in ten people in the world – do not have access to a toilet. • Every day, diarrhoeal disease kills 5,000 children. Every week, it kills 42,000 people. Every one of these deaths is tragic – and preventable. • Without concerted action, the lack of sanitation will continue to impact the lives of billions of people and impede progress on development.

3. The global picture Total Sanitation Coverage 2006 Less than 50% 50 – 75% 76 – 90% 91 – 100% No or Insufficient data Note: The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

4. The good news (1) Regions on track to achieve their MDG sanitation target: • Latin America and the Caribbean • Western, Eastern and South-eastern Asia • Northern Africa Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

5. The good news (2) • Coverage in South-eastern and Eastern Asia increased with 17 percent. • Coverage in the developing world has increased from 41 percent (1990) to 53 percent (2006) => 1.1 billion people gained access! Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

6. The good news (3) Many countries are making rapid progress, despite initial low coverage and rapid population growth: • Vietnam: 47 percent of the population gained access to sanitation (1990-2006). • Philippines: 43 percent of the population gained access to sanitation (1990-2006). • Pakistan: 40 percent of the population gained access to sanitation (1990-2006). Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

7. The good news (4) Many countries are making rapid progress, despite initial low coverage and rapid population growth: • Benin: 30 percent of the population gained access to sanitation (1990-2006). • Cameroon and Mali: 29 percent of the population gained access to sanitation (1990-2006). Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

8. The bad news (1) Regions not on track to achieve their MDG sanitation target: • Southern Asia • Sub-Saharan Africa Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

9. The bad news (2) • Sub-Saharan Africa recorded the least progress – only 5 percent: from 26 (1990) to 31 percent (2006). • Southern Asia recorded moderate progress – 12 percent: from 21 (1990) to 33 percent (2006). Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

10. The bad news (3) • The majority of people without sanitation live in Asia (70 percent) and Sub-Saharan Africa (22 percent). • The world is not on track to meet the MDG sanitation target. At the current rate, we will miss the target by over 700 million people. (see next slide). Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

11. The bad news (4) Sanitation coverage trend 1990-2015: Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

12. Coverage in 2006 was less than 5% below the rate it needed to be for the country to reach the MDG target, or coverage was higher than 95%. Coverage in 2006 was 5 to 10% below the rate it needed to be for the country to reach the MDG target. Coverage in 2006 was more than 10% below the rate it needed to be for the country to reach the MDG target, or the 1990–2006 trend shows unchanged or decreasing coverage. Data were unavailable or insufficient to estimate trends. Progress towards the MDG sanitation target 2006 On track Progress but insufficient Not on track No or insufficient data Sources: World Health Organization and United Nations Children's Fund Joint Monitoring Programme on Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: special focus on sanitation. UNICEF, New York, and WHO, Geneva, 2008.

13. The International Year of Sanitation in five key massages • Sanitation is vital for human health • Sanitation generates economic benefits • Sanitation contributes to dignity and social development • Sanitation protects the environment • Improving sanitation is achievable

14. Sanitation is vital for human health (1) Lack of sanitation is one of the biggest causes of illness and death in the developing world: • One gram of faeces can contain 10 million viruses, one million bacteria, one thousand parasite cysts and 100 worm eggs. • More than half the hospital beds in Sub-Saharan Africa are currently occupied by patients with preventable diarrhoeal disease; improving sanitation and hygiene would free up money and resources to tackle other health issues.

15. Sanitation is vital for human health (2) Lack of sanitation is one of the biggest causes of illness and death in the developing world: • Access to a toilet can reduce child diarrhoeal deaths by over 30 percent. • Diarrhoea coupled with pneumonia kills more children than any other disease. • Children infested by worms lose up to one-third of the nutrient value of their food.

16. Sanitation generates economic benefits (1) • Meeting the Millennium Development Goal for sanitation would cost about $10 billion every year, but yield benefits upwards of nearly $200 billion per year. • Sanitation is among public health’s most cost-effective policy interventions. • Around 12 percent of the health budget in countries of Sub-Saharan African is currently spent treating preventable diarrhoeal diseases.

17. Sanitation generates economic benefits (2) • Investing in sanitation makes investments in education more effective; girls are more likely to go to school and stay in school when girls-friendly toilets are available. • Investments in sanitation also protect water resources, make investments in water supply more effective, and increase tourism revenues.

18. Sanitation contributes to dignity and social development (1) • Many of the 2.6 billion people without basic sanitation defecate in the open, exposing themselves to ridicule, shame, and, for women and girls, the risk of attack. • Within thirty years, UN-Habitat estimatesthan one in three people in the world will live in a slum. Without adequate sanitation,they will live surrounded by human filth.

19. Sanitation contributes to dignity and social development (2) • Girls are nearly twice as likely as boys to fail to complete primary education. Improving sanitation with girls-friendly toilets at schools can help them catch up.

20. Sanitation protects the environment Investments in sanitation protect vital natural resources, keep rivers and coastal seas clean, and reduce degradation of productive land and fisheries: • Worldwide, every year more than 200 million tonnes of human waste and vast quantities of solid waste and wastewater remain untreated. • In Southeast Asia 13 million tons of faeces are released to inland water sources each year, along with 122 million m3 of urine and 11 billion m3 of gray water.

21. Improving sanitation is achievable (1) • Malaysia and Thailand achieved almost universal coverage through concerted programmes delivered over thirty years – well ahead of the Southeast Asian economic boom. • The Southern region of Ethiopia has seen a quiet revolution led by health extensionistswho have supported behaviour change andmoved to eliminate open defecation.

22. Improving sanitation is achievable (2) • Almost 10,000 villages in Bangladesh and countless others in more than 15 countries have become “open-defecation-free” through Total Sanitation approaches led by the community.

23. We’ve got what it takes – a global consensus There is a surprisingly high level of consensus about what is needed: • approaches that respect and respond to people’s actual needs, preferences and demands; • suppliers of sanitation and hygiene services to meet those demands; • hard work and sustained funding over the long run; • plain talk about sanitation; • an inspiring vision of the future.