WHO Sanitation Guidelines 2018

WHO - Sanitation Guidelines 2018

Introduction and scope

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Safe sanitation is essential for health, from preventing infection to improving and maintaining mental and social well-being. The lack of safe sanitation contributes to diarrhoea, a major public health concern and a leading cause of disease and death among children under five years in low- and middle- income countries; poor sanitation also contributes to several neglected tropical diseases, as well as broader adverse outcomes such as under-nutrition. Lack of access to suitable sanitation facilities is also a major cause of risks and anxiety, especially for women and girls. For all these reasons, sanitation that prevents disease and ensures privacy and dignity has been recognized as a basic human right.

Sanitation is defined as access to and use of facilities and services for the safe disposal of human urine and faeces. A safe sanitation system is a system designed and used to separate human excreta from human contact at all steps of the sanitation service chain from toilet capture and containment through emptying, transport, treatment (in-situ or offsite) and final disposal or end use. Safe sanitation systems must meet these requirements in a manner consistent with human rights, while also addressing co-disposal of greywater, associated hygiene practices and essential services required for the functioning of technologies.

The purpose of these guidelines is to promote safe sanitation systems and practices in order to promote health. They summarize the evidence on the links between sanitation and health, provide evidence-informed recommendations, and offer guidance for encouraging international, national and local sanitation policies and actions that protect public health. The guidelines also seek to articulate and support the role of health and other actors in sanitation policy and programming to help ensure that health risks are identified and managed effectively.

The main audience for the guidelines is national and local authorities responsible for the safety of sanitation systems and services, including policy makers, planners, implementers and those responsible for the development, implementation and monitoring of standards and regulations. This includes health authorities and, since sanitation is often managed outside the health sector, other agencies with responsibilities for sanitation. The guidelines were developed in accordance with the processes set out in the WHO Handbook for Guideline Development.

Recommendations

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The below recommendations are provided for action by national and local authorities.

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• Recommendation 1: Ensure universal access and use of toilets that safely contain excreta

• a) Universal access to toilets that safely contain excreta and elimination of open defecation should be prioritized by governments, ensuring that progress is equitable and in line with the principles of the human right to water and sanitation.
• b) Demand and supply of sanitation facilities and services should be addressed concurrently to ensure toilet adoption and sustained use and enable scale.
• c) Sanitation interventions should ensure coverage of entire communities with safe toilets that, as a minimum, safely contain excreta, and address technological and behavioural barriers to use.
• d) Shared and public toilet facilities that safely contain excreta can be promoted for households as an incremental step when individual household facilities are not feasible.
• e) Everyone in schools, health care facilities, workplaces and public places should have access to a safe toilet that, as a minimum requirement, safely contains excreta.

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• Recommendation 2: Ensure universal access to safe systems along the entire sanitation service chain

• a) The selection of safe sanitation systems should be context specific and respond to local physical, social and institutional conditions.
• b) Progressive improvements towards safe sanitation systems should be based on risk assessment and management approaches.
• c) Sanitation workers should be protected from occupational exposure through adequate health and safety measures.

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• Recommendation 3: Sanitation should be addressed as part of locally delivered services and broader development programmes and policies

• a) Sanitation should be provided and managed as part of a package of locally-delivered services to increase efficiency and health impact.
• b) Sanitation interventions should be coordinated with water and hygiene measures, as well as safe disposal of child faeces and management of domestic animals and their excreta to maximize the health benefits of sanitation.

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• Recommendation 4: The health sector should fulfill core functions to ensure safe sanitation to protect public health

• a) Health authorities should contribute to overall coordination of multiple sectors on development of sanitation approaches and programmes, and sanitation investment.
• b) Health authorities must contribute to the development of sanitation norms and standards.
• c) Sanitation should be included in all health policies where sanitation is needed for primary prevention, to enable coordination and integration into health programmes.
• d) Sanitation should be included within health surveillance systems to ensure targeting to high disease burden settings, and to support outbreak prevention efforts. 

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