Water Currents: World Toilet Day 2019


Toilets are more than a household necessity—they save lives, protect dignity, and create economic opportunity. This November 19, join the annual celebration of World Toilet Day to raise awareness of the importance of sanitation to lift people out of poverty. This year’s theme “Leaving No One Behind” emphasizes the importance of expanding sanitation access to the more than 4.2 billion people living without safely managed sanitation options.
USAID goes beyond toilet construction to address weak demand and low capacity for sanitation improvements. The Agency’s comprehensive approach includes engaging the private sector to develop aspirational and affordable products, unlocking financing, and strengthening sanitation governance, coupled with behavior change to encourage use and maintenance. To learn more about USAID’s sanitation activities, follow us @USAIDWater or visit

This Water Currents contains recent studies and resources related to the sanitation issues facing marginalized or special populations, such as people with disabilities, refugees, sanitation workers, and the urban poor.

World Toilet Day 2019: Leaving No One Behind – This year’s World Toilet Day (WTD) theme emphasizes that a toilet is not just a toilet. When a person does not own or have access to a toilet, he or she is vulnerable and can be “left behind” in terms of health, dignity, and opportunity. The official advocacy day website provides resources, including factsheets in multiple languagesposters, and social media messages.

World Toilet Summit 2019 – The World Toilet Summit takes place each November to coincide with World Toilet Day celebrations. This year’s summit will be held in Sao Paulo, Brazil, November 18–19, 2019.

Sanitation FactsheetWorld Health Organization, June 2019. Inadequate sanitation is estimated to cause 432,000 diarrheal deaths annually and is a major factor contributing to several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition.

Scaling Market-Based Sanitation: Desk Review on Market-Based Rural Sanitation Development ProgramsUSAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) Project, 2018. This desk review investigates the current state of knowledge in market-based sanitation (MBS) and establishes a framework to analyze, design, and improve MBS interventions. A webinar summarizes the report findings.

Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)World Development, December 2019. This paper, produced with support from the USAID WASHPaLS Project, uses a qualitative approach to analyze the reasons and processes that drove the wide diffusion of CLTS, showing that CLTS was embraced because it was perceived as a fast and effective solution to the problem of open defecation.

Toward a Hygienic Environment for Infants and Young Children: A Review of the LiteratureUSAID WASHPaLS Project, 2018. This literature review examines the health risks to infants and young children from fecal exposure in their home environments. A webinar and blog summarize the report’s findings.

Safely Managed Sanitation in High-Density Rural Areas: Turning Fecal Sludge into a Resource Through Innovative Waste ManagementWorld Bank, September 2019. This report explores the challenges of fecal sludge management (FSM) in densely populated rural areas and it presents some typical current practices, examples of financially sustainable FSM services, and global innovations in waste management with potential replicability for FSM.

Guidance on Programming for Rural SanitationWaterAid, February 2019. Guidance is provided on the design of large-scale sanitation programs in rural communities, with a focus on the achievement of sustained household and collective sanitation and hygiene outcomes.

Smart Sanitation City: The Sanitation Economy at City ScaleToilet Board Coalition, 2018. Smart Sanitation Cities present a significant opportunity to design future sanitation systems leveraging smart city growth trends to address the global sanitation crisis.

People with Disabilities 
Systematic Review of Menstrual Hygiene Management Requirements, Its Barriers and Strategies for Disabled PeoplePLoS One, February 2019. This review assessed the menstrual hygiene requirements of disabled people—a population often discriminated against and facing its own taboos—identified the barriers they face, and cataloged interventions to help them manage their menstruation hygienically and with dignity.

Support Mechanisms to Strengthen Equality and Non-Discrimination (EQND) in Rural Sanitation (Part 2 of 2)CLTS Knowledge Hub, July 2019. This issue of Frontiers of CLTS examines the potential of support mechanisms designed to help disadvantaged groups access and use hygienic toilets in driving more equitable rural sanitation outcomes. It covers the latest thinking on the opportunities and challenges of support mechanisms and explores what work remains to be done.

Equality and Non-Discrimination (EQND) in Sanitation Programmes at Scale (Part 1)CLTS Knowledge Hub, September 2017. This issue looks at who should be considered potentially disadvantaged, how they can effectively participate, and what should be done to address diverse needs to make processes and outcomes sustainable and inclusive.

Are Current Approaches for Measuring Access to Clean Water and Sanitation Inclusive of People with Disabilities? Comparison of Individual- and Household-Level Access Between People with and without Disabilities in the Tanahun District of NepalPLoS One, October 2019. People with disabilities face substantial challenges to meeting their water, sanitation, and hygiene (WASH) needs, particularly in using services autonomously, consistently, hygienically, with dignity and privacy, and without pain or fear of abuse. These challenges are not captured through household-level data, and so individual-level WASH access data are needed to monitor progress toward universal WASH access.

A Mixed-Methods Study of Women’s Sanitation Utilization in Informal Settlements in KenyaPLoS One, March 2019. Women living in informal settlements, in particular, are disproportionately affected by lack of access to sanitation. A majority of women in this study used an unsafe method of disposal at least once in a 24-hour period that increased their risk of direct exposure to waste and harmful pathogens.

Not Just Any Toilet: Women’s Solutions to Sanitation in Informal Settlements in NairobiJournal of Development Practice, September 2018. The purpose of this study was to provide women with an opportunity to share their perspectives and solutions to sanitation in informal settlements. The most common solution was to build more toilets, but women had a variety of suggestions—including gender-specific solutions.

Water, Sanitation and Hygiene: Measuring Gender Equality and EmpowermentBulletin of the World Health Organization, June 2019. Inequalities in access to WASH services have been measured between rural and urban areas and across country wealth quintiles, as well as by sex. However, past studies have not adequately measured the burdens placed on women and girls, the opportunity costs of these burdens, and female empowerment related to WASH decision-making and autonomy.

Female-Friendly Public and Community Toilets: A Guide for Planners and Decision MakersWaterAidWater and Sanitation for the Urban Poor (WSUP)UNICEF, October 2018. The guide explains why toilets must be female-friendly before detailing the essential and desirable features needed to make them so. It also suggests ways to increase gender sensitivity in town planning on sanitation.

Engaging Men and Boys in Sanitation and Hygiene ProgrammesCLTS Knowledge Hub, August 2018. This review focuses on men and boys: how to engage them (or not), how to mobilize them as allies in the transformation of sanitation and hygiene outcomes, and the problems they contribute to and experience.

Humanitarian WASH 
Rapid Review of Disability and Older Age Inclusion in Humanitarian WASH InterventionsElrha, May 2019. People with disabilities and older people make up significant population groups, however, they are disproportionately affected by and among the most marginalized in humanitarian response.

Sani Tweaks: Guide to Best Practices in Humanitarian Response SanitationOxfam, February 2018. Research has shown that humanitarian agencies are failing to properly consult the users of the latrines they build, leading many people—especially women and girls—to stop using those latrines as they find them inaccessible, unsuitable, and/or unsafe. To address this, the Oxfam WASH team has developed a series of communications tools that seek to promote best practices in sanitation.

Tiger Worm Toilet Manual: Globally Relevant Learnings from MyanmarElrha, March 2019. Tiger Worm Toilets contain composting worms inside the pit that digest feces in-situ, replacing the build up of raw sludge with vermicompost. This removes the need for traditional desludging. To date, more than 900 Tiger Worm Toilets have been built and trialed across four countries by Oxfam in a range of settings, including urban, peri-urban, and camps. They have been shown to work in both household and shared communal camp settings.

Urban Poor 
The Use of Research in Participatory Planning of Sanitation and Hygiene: Lessons from Babati, TanzaniaWaterAid, October 2019. This policy brief captures learnings from research in Babati Town in Tanzania to inform the development of a sanitation and hygiene plan and pro-poor town-wide planning.

Review of Drivers and Barriers of Water and Sanitation Policies for Urban Informal Settlements in Low-Income and Middle-Income CountriesUtilities Policy, October 2019. This study identifies donor prioritization and collective action as key drivers of water and sanitation policy, and social exclusion, lack of land or dwelling tenure status, the political economy of decision-making, and insufficient data as key barriers.

Anchoring Innovations in Oscillating Domestic Spaces: Why Sanitation Service Offerings Fail in Informal SettlementsResearch Policy, February 2020. Newly provided and improved basic services are not maintained by users despite seemingly superior functionality and user convenience. One major reason for this is an insufficient understanding of the context in which users have to manage their daily lives.

Assessing the Market for Safe Faecal Waste Emptying Services in Low-Income Areas of Kisumu, KenyaWSUP, June 2019. Results from this study indicate that future interventions need to address the price barrier between formal (safe) and informal (unsafe) fecal sludge emptying.

Evaluating the Potential of Container-Based SanitationWorld Bank, February 2019. Container-based sanitation consists of an end-to-end service—that is, one provided along the whole sanitation service chain—that collects excreta hygienically from toilets designed with sealable, removable containers and strives to ensure that the excreta is safely treated, disposed of, and reused.

Experiences of Shared Sanitation–Towards a Better Understanding of Access, Exclusion and ‘Toilet Mobility’ in Low-Income Urban AreasJournal of Water, Sanitation and Hygiene for Development, May 2019. This study examines shared sanitation access and use by using innovative mapping methods in compound house units in Fante New Town, Kumasi, Ghana.

Challenges of Governing Off-Grid 'Productive' Sanitation in Peri-Urban Areas: Comparison of Case Studies in Bolivia and South AfricaSustainability, June 2019. A comparison of two initiatives in Bolivia and South Africa offers valuable insights for introducing functional off-grid “productive” sanitation systems relying on urine-diverting dry toilets in peri-urban settlements. Findings suggest that household acceptance of these toilets largely depends on consistent awareness raising and capacity building, in addition to adapting to local needs and creating a sense of ownership over the toilet system.

Sanitation Workers 
Guaranteeing the Rights of Sanitation Workers: Links between SDG 8 and SDG 6WaterAid, June 2019. Despite their vital role in urban sanitation service provision and the occupational risks that accompany their profession, sanitation workers are often overlooked in health protection and sanitation program design, and are typically employed informally.

The Health, Safety and Dignity of Sanitation Workers: A Blind Spot in Safely Managed SanitationWater Blog, May 2019. Sanitation workers often suffer terrible working conditions and are generally taken for granted in sanitation programs. Yet, without them, the sanitation service chain can’t function.

USAID Water, Sanitation and Hygiene Partnerships and Learning for Sustainability Project – WASHPaLS is working to improve water supply, sanitation, and hygiene programming by identifying, researching, and sharing best practices for the delivery of WASH services and sustained behavior change.

Toilet Board Coalition – The coalition has the ambition to address the global sanitation crisis by accelerating the sanitation economy. To do so it enables private sector engagement; connects large and small companies; and ensures close collaboration among private, public, and nonprofit sectors with the purpose of achieving Sustainable Development Goal 6—universal access to sanitation.

Sanitation Updates – USAID’s WaterCKM project and IRC maintain this news and opinion blog on sanitation. Sanitation Updates was originally set up to promote the 2008 International Year of Sanitation and continues to provide news, information, and resources in support of achieving the goal of sanitation for all.


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