Affordable Sanitation Systems and Their Role in Inclusive Public Health

Abstract

Affordable sanitation systems are foundational to inclusive public health because they reduce exposure to fecal pathogens, protect dignity and safety, and narrow health inequities that disproportionately affect low-income households, women and girls, persons with disabilities, and informal-settlement residents. Despite progress, sanitation gaps remain vast: in 2022, 57% of the world (≈4.6 billion people) used safely managed sanitation, while about 3.5 billion still lacked it; 419 million people continued to practice open defecation. These deficits translate into preventable illness and lost productivity; diarrhoeal disease alone kills ~443,832 children under five annually, and a significant proportion is preventable through safe water, sanitation, and hygiene (WASH). This paper synthesizes evidence on “affordable sanitation” (low-capex and low-opex options appropriate to local context) and explains how well-designed, inclusive sanitation services—paired with behavior change, fecal sludge management, and governance—advance public health, equity, and progress toward SDG 6. We propose a practical framework for selecting affordable systems (technical feasibility, life-cycle cost, inclusion/safety, climate resilience, and service-chain performance) and outline policy and program actions to accelerate equitable sanitation outcomes.