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A silent urban sanitation crisis is underway.
It’s time to clean up our acts!

A successful city is one where all citizens live productive, healthy and digni ed lives in an environment free from fecal contamination. Human waste must be managed in ways that safeguard the urban environment, including water and food supplies. Far from being a reality, this vision is under increasing threat. With limited nancial and human resources, a changing climate and rapid, unplanned urbanization, cities are struggling to cope. ‘Business as usual’ is not working. However, the Sustainable Development Goals provide new impetus to ensure access to sustainable water and sanitation services, to keep cities safe and resilient, and to ensure citizens’ health and well-being.

Citywide inclusive sanitation means that: everybody bene ts from adequate sanitation service delivery outcomes; human waste is safely managed along the whole sanitation service chain; effective resource recovery and re-use are considered; a diversity of technical solutions is embraced for adaptive, mixed and incremental approaches; and onsite and sewerage solutions are combined, in either centralized or decentralized systems, to better respond to the realities found in developing country cities. Cities need to develop comprehensive approaches to sanitation improvement that encompass long-term planning, technical innovation, institutional reforms and nancial mobilization. They will need to demonstrate political will, technical and managerial leadership, to focus on durable drivers for innovation, and to manage funding for sanitation in new and creative ways.

Poor sanitation is stifling economic growth

With neighborhoods and public spaces turning into open sewers, many cities struggle to manage human waste. Currently, some 60 million new residents move to urban areas every year. One in four lives in slums, amounting to 1 billion people with inadequate housing, limited access to basic services and usually lacking land tenure security.2 As a result, urban population growth dramatically outpaces gains in access to safe sanitation. Only 37% of urban excreta is safely managed globally.3 Evidence shows that even where piped water networks exist, sewerage and septic tank connections lag far behind.4

The resulting environmental degradation and public health impacts lead to high child mortality and morbidity, poor school attendance and performance, especially for girls, and low productivity. They also contribute to the vicious cycle affecting the delivery of other key urban services such as housing, potable water, solid waste and drainage. All these factors ultimately limit economic growth, urban development and city competitiveness. A silent urban sanitation crisis is sti ing the realization of the urban transformation called for in the Sustainable Development Goals.

In 2007, readers of the British Medical Journal chose the “sanitary revolution” as the greatest medical advance since 1840. This 19th Century revolution must become a 21st Century reality for everyone. Acknowledging the importance of urban sanitation and its intrinsic link to appropriate land use planning and the need for affordable housing is fundamental in the transformation of cities becoming clean, livable and productive.

Why ‘business as usual’ is not working

‘Business as usual’ in urban sanitation primarily focuses on centralized/conventional infrastructure, which only bene ts a small percentage of the population. It fails to shift politi- cal priorities, funding allocations, institutional coordination, as well as the planning, design and management prac- tices needed to achieve services for all. It fails to consider the tradeoffs between sanitation investments and doesn’t consider incrementalism. Only a radical shift in mindsets

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