Improved Sanitation for Rural Public Health

Sanitation refers to the provision of facilities and services for the safe disposal of human urine and feces. An improved sanitation facility hygienically separates human excreta from human contact, typically involving physically enclosed latrines or toilets connected to a sewer system, septic tank, or pit latrine, alongside reduced waiting times and safer waste disposal methods (WHO, 2021). Improved facilities may also include engineered components such as ventilated improved pit latrines, composting toilets, and flush/pour-flush systems linked to onsite or offsite treatment.

Poor sanitation contributes significantly to the global disease burden. Diseases linked to inadequate sanitation and unsafe water account for nearly 10% of the global disease burden, encompassing diarrheal diseases, acute respiratory infections, undernutrition, and neglected tropical diseases such as helminthiasis and schistosomiasis (WHO, 2023). Diarrheal illnesses alone cause severe dehydration and nutrient loss, particularly among children under five, undermining growth and cognitive development. Furthermore, inadequate sanitation exacerbates environmental contamination, affecting water bodies used for drinking, bathing, and irrigation, which in turn perpetuates disease transmission within communities.

Despite progress, a staggering 3.5 billion people (43% of the global population) still lack access to safely managed sanitation services, meaning facilities that are not only improved but also ensure excreta are safely handled, transported, and treated (WHO, 2023). Approximately 1.7 billion people continue to practice open defecation or rely on unsafe sanitation facilities, with the vast majority residing in low- and middle-income countries (LMICs) (World Bank, 2022). This lack of access is most acute in sub-Saharan Africa and South Asia, where rural populations often contend with limited infrastructure, cultural barriers, and financial constraints. Diarrheal diseases caused by poor sanitation, hygiene, and unsafe drinking water result in 297,000 child deaths annually, equating to over 800 children under five dying each day (UNICEF, 2023). Beyond mortality, poor sanitation imposes economic burdens through healthcare expenditures, lost productivity, and diminished educational outcomes, as children frequently miss school due to illness. Achieving universal access to improved sanitation by 2030, an objective embedded within Sustainable Development Goal 6, remains critical for reducing disease, fostering economic growth, and protecting human dignity worldwide.

Sanitation as a Human Right and Public Good

Sanitation is enshrined as a fundamental human right under United Nations Sustainable Development Goal 6, which mandates that everyone, everywhere, must have access to safe, private, and affordable sanitation services (UN, 2010). Ensuring equitable sanitation access is not merely a matter of infrastructure; it affirms dignity, privacy, and basic health standards for all individuals. As a public good, improved sanitation delivers collective benefits, reducing disease transmission, bolstering economic productivity, and fostering social development (Hutton & Varughese, 2016). When communities are equipped with safely managed toilets and waste treatment, outbreaks of diarrheal diseases and parasitic infections decline, freeing households from avoidable medical expenses and children from preventable school absences.

The economic costs of poor sanitation are staggering, particularly in regions such as Sub-Saharan Africa and South Asia, where infrastructure gaps are most acute. Direct healthcare expenditures amount as households pay for consultations, medications, and hospital stays to treat sanitation-related illnesses. Indirect costs manifest through lost productivity: adults miss workdays due to illness, and premature deaths erode the workforce, undermining household incomes and national economic output. Environmental degradation compounds these burdens, as untreated human waste contaminates water sources; communities must then rely on alternative, often costlier, water supplies or invest in energy-intensive purification systems (World Bank, 2021).

At the macroeconomic level, inadequate sanitation drags on GDP. A 2021 WHO study estimated that poor sanitation costs low- and middle-income countries between 0.5% and 6.3% of GDP. In Ghana and Pakistan, malnutrition stemming from waterborne diseases adds 40% to the financial burden of child mortality, inflicting long-term consequences on educational attainment and labor productivity (Hutton, 2018). In India, sanitation-related health impacts account for a loss of approximately 6.4% of GDP annually (World Bank, 2020). These figures underscore that investments in sanitation infrastructure, behavior-change campaigns, and regulatory frameworks not only save lives but also yield substantial economic returns by reducing healthcare costs, improving workforce participation, and preserving environmental resources. Ensuring universal access to improved sanitation is therefore both a moral imperative and a sound economic strategy for sustainable development.

Ecological Sanitation and Rural Improvements

Ecological sanitation integrates sanitation infrastructure with nutrient recycling to create sustainable, low-cost solutions tailored to underserved rural areas. By treating human waste through composting toilets or urine-diverting dry toilets, nutrients become safe, valuable fertilizers that enhance soil fertility and food security (Strande et al., 2014). In resource-limited settings, such closed-loop systems reduce reliance on chemical fertilizers, lower costs for smallholder farmers, and promote healthier crops. Moreover, ecological sanitation facilities often require fewer water resources, making them particularly suited to regions facing water scarcity.

However, rural sanitation faces significant challenges. In many villages, 72.4% of households rely on community dumping spots because waste collection systems are inadequate or nonexistent (National Statistical Office, 2022). These open dumps lead to environmental contamination, heightening the risk of waterborne diseases. Additionally, maintenance issues frequently undermine sanitation projects: without regular upkeep, toilets break down, and composting pits overflow, prompting communities to revert to open defecation (UNICEF, 2022). Sustainable rural sanitation, therefore, demands robust community engagement from the outset, training local caretakers, establishing management committees, and providing simple maintenance tools to ensure long-term functionality.

Investments in improved sanitation yield substantial economic benefits. According to WHO (2021), every $1 invested in sanitation generates $5.50 in economic returns by preventing illness and increasing productivity. Families save an average of 1,000 hours per year by avoiding long walks to distant water sources or open defecation sites, freeing time for education and income-generating activities (World Bank, 2020). In schools, the presence of gender-segregated, functioning toilets correlates with higher attendance rates, especially among adolescent girls, and improves overall educational outcomes (UNESCO, 2022). Protecting water supplies from contamination also lowers costs for water treatment systems and reduces public spending on healthcare and emergency interventions (UN-Water, 2023).

In Pakistan, the Water Supply and Sanitation (WSS) sector has made strides, but rural coverage remains limited. Public Health Engineering Departments (PHEDs) prioritize large-scale piped water schemes, which often bypass small villages and remote communities (World Bank, 2022). As a result, only 48% of rural Pakistanis have access to improved sanitation facilities (Pakistan Bureau of Statistics, 2023). Introducing ecological sanitation can help bridge this gap by offering low-cost, decentralized alternatives that communities can manage and maintain. Scaling up such initiatives, coupled with hygiene education campaigns and small grants for local maintenance, can transform rural sanitation, improve public health, and stimulate lasting social and economic development.

Conclusion

Access to improved sanitation is a cornerstone of rural public health and economic resilience. By hygienically separating human excreta from communities, improved sanitation prevents diarrheal diseases, undernutrition, and neglected tropical illnesses that together comprise nearly 10% of the global disease burden. Despite global progress, 43% of people still lack safely managed sanitation, with 1.7 billion practicing open defecation, most in low- and middle-income countries. These gaps impose staggering costs: healthcare expenditures, lost productivity, environmental cleanup, and macroeconomic losses amounting to up to 6.3% of GDP in some nations.

Sanitation is not only a fundamental human right under SDG 6 but also a critical public good; investments in infrastructure and behavior-change yield high economic returns, every dollar spent can generate $5.50 in societal benefits. Ecological sanitation offers a sustainable, low-cost model for rural contexts by recycling nutrients, conserving water, and promoting food security. Yet maintenance challenges and limited coverage, only 48% of rural Pakistan has improved sanitation, underscore the need for community engagement, capacity building, and supportive policies.

Moving forward, scaling up decentralized ecological solutions, strengthening waste management systems, and integrating hygiene education will drive down disease, enhance workforce participation, and foster long-term rural development. Ensuring universal sanitation access is thus both a moral imperative and an economically sound strategy for protecting health, boosting productivity, and advancing sustainable growth in rural communities.

References: Hutton, G.; WHO; UNICEF; World Bank; UN-Water; Hutton & Varughese; Hutton; Strande et al.; National Statistical Office; UNESCO; Pakistan Bureau of Statistics

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writer is affiliated with the Department of Epidemiology and Public Health, Faculty of Health and Pharmaceutical Sciences, University of Agriculture, Faisalabad, Pakistan.

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