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The poorest have the most to gain from sanitation improvements in developing countries

05 March 2012

Slums exist in the shadows of new high-rise buildings in Dhaka, Bangladesh. Photo credit: Rick RheingansNew SHARE research shows the poorest are suffering the most from inadequate sanitation as they are more exposed to human waste and are more susceptible to disease. The findings from the study of 10 low-income countries in sub-Saharan Africa and South Asia have far-reaching implications for the better targeting of future sanitation investments.

Lead author Associate Professor Rick Rheingans said: “We already know that sanitation is critical to human health and yet 2.6 billion don’t have access to even a basic toilet. What this research shows is that the health impact of this problem hits the poorest hardest and yet we continue to fail to deliver sanitation to those most at risk.”

Researchers from the SHARE consortium, which is led by the London School of Hygiene and Tropical Medicine, analysed the number of child deaths caused by diarrhoea across wealth groups within national populations. Their results suggest the health burden of poor sanitationfalls disproportionately on children living in the poorest households. This is because of greater exposure to infection and also increased susceptibility among children in these households, largely because of undernutrition. Children in the poorest households are less likely to have access to a private toilet, are most likely to have to use shared facilities, and are most likely to live among others without sanitation.

Other findings from this research are:

• Whether it’s rural or urban, children in poor households consistently suffer disproportionately
• While rural populations generally have lower levels of access, the sanitation associated health risk may be greater for the urban poor due to factors such as population density
• Improvements in sanitation for households in the poorest quintile bring significantly greater health benefits than improvements in the richest quintiles
• We can do better to monitor whether investments are targeted the most at the risk and whether the potential returns are being realised

The results of the study have important implications:

• We need to monitor progress on reaching the most at risk
• We need to target investments at those who need it most

In conclusion, Rick Rheingans said: “At a time when every pound counts, we need to do more to ensure that aid gets to where it can deliver the biggest impact. Value for money is all about targeting money at areas which offer the biggest returns; we show that targeting sanitation investments at children in the poorest households is more than a fair deal, it’s smart economics.”

The study was based on data from Bangladesh, Ethiopia, Ghana, India, Kenya, Malawi, Nigeria, and Tanzania Zambia, and Zimbabwe. It was led by SHARE’s Rick Rheingans, Associate Professor at the University of Florida. The co-authors are Oliver Cumming, of LSHTM, John Anderson and Julia Showalter, both of University of Florida.

Read Research Report: Exploring inequities in sanitation-related disease burden and estimating the potential impacts of pro-poor targeting

Read Policy Briefing

Read Policy Briefing (French translation)

Listen to podcast interview with lead author Associate Professor Rick Rheingans