Stop the Cycle

Diarrheal Disease Solutions


Poor access to water, sanitation, and hygiene—collectively known as WASH—is responsible for more than half of diarrhea cases . Exposure to enteric pathogens in the environment due to poor WASH can lead to long-term gut damage, compromising a child’s physical and cognitive growth. Good health is simply not possible without WASH.

WASH in institutional settings, such as health centers and schools, is critically important and is generally agreed to be one of the key integrated interventions for preventing infectious disease, stunting, and drug resistance. Health facilities, like diarrhea wards, are an especially crucial setting for improving WASH because of the risk of spreading infections. However, an expansive study of 54 countries and 66,101 facilities revealed that 38 percent of health care facilities do not have a clean water source, 19 percent do not have improved sanitation, and 35 percent do not have water and soap for handwashing. Visit the WHO/UNICEF WASH in Health Care Facilities website to find resources and learn how your organization or country can make a commitment and develop an advocacy strategy.

“Safe water, sanitation and hygiene at home should not be a privilege… These are some of the most basic requirements for human health, and all countries have a responsibility to ensure that everyone can access them.”

– Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (WHO)
in a WHO statement

“Modest efforts to marginally improve environments are not going to be sufficient. If we want children in the lowest-income, most resource-constrained environments to thrive, we’re going to need to make their environments radically cleaner.”

– Stephen Luby, lead of the groundbreaking WASH Benefits Study in Bangladesh. The results from the studies in Bangladesh and Kenya, which looked at the impact of WASH and nutrition interventions on child stunting, is prompting important conversations among practitioners about the need for more robust coverage of WASH programs. Read WaterAid’s data analysis.

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Everyone needs water to survive. But it must first be safe to drink and use.

World Water Day


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Safely collecting, treating, and disposing of human waste reduces exposure to the causes of enteric disease.

“Giving people access to toilets isn’t enough. You also have to persuade them to use the toilets.”
– Bill Gates, Co-Chair, Bill & Melinda Gates Foundation
Gates Notes

  • Problem: lack of sanitation exposes people to enteric disease

    Billions of people do not have basic sanitation facilities, such as toilets or latrines, and defecate in the open in fields, streets, gutters, or open bodies of water.

    Lack of basic sanitation (e.g., open defecation) creates serious health risks, including endemic diarrhea and the spread of diseases like cholera, diarrhea, and dysentery. It is also linked to transmission of hepatitis A, typhoid, and polio. In 2017, 673 million people still practiced open defecation.

    Evidence shows a total community approach to sanitation coverage is needed in order to have a meaningful impact. Estimations show that 60 to 65 percent coverage in a community is required before any impact can be seen. A study in India showed that 25 percent of the effect of diarrheal disease reduction was due to a child’s access to his/her own sanitation facility; by contrast, 75 percent of the effect came from having a high level of sanitation in the village.

    The lack of access to basic sanitation facilities can also have serious safety implications, especially for women at night, and undermine feelings of self-dignity.

    The vast majority of people without access to proper sanitation live in sub-Saharan Africa, East Asia, and South Asia. Unless addressed, the problem will only continue, with rapid urbanization and climate change presenting growing threats.

  • Solution: safely dispose of human waste

    Sanitation can be improved by addressing user-, product-, and market-related challenges that inhibit uptake and use of sanitation technologies. Leading sanitation solutions engage and create incentives for all actors across the sanitation value chain.

    Everyone needs a safe place to go. Proper sanitation means that people are separated from and do not come into contact with human waste. This requires proper fecal sludge management – a process for which countries recently met to discuss lessons learned. Squat pan or seated pour-flush toilets, onsite biodigesters, or public latrine blocks are all appropriate for varying contexts. However, it is important to recognize there is no “one size fits all” solution to sanitation. The right intervention depends on the community’s needs, culture, and environment. And a critical element of an intervention is ensuring that facilities are used and maintained. This can sometimes mean taking on cultural norms.

  • Impact: infections prevented, lives saved

    Sanitation could substantially reduce diarrheal disease frequency and malnutrition indicators. Safely disposing of human waste impacts not only health, but also social and economic development. In fact, every US$1.00 invested in sanitation yields a return of US$5.50 in decreased health costs and increased productivity.

    Durability, privacy, and security
    These were among the key user requirements for a joint Population Services International (PSI) and PATH sanitation project in rural India. The collaboration helped build a market for the sale of 150,000 toilets that are designed to be cost-effective and user-friendly. Addressing supply chain challenges, creating user-centered designs, and providing financing options for families to purchase their own toilets have been core components in the program’s success in Bihar.

  • Global Guidance: sanitation

    The SDGs call for progress in sanitation by 2030.

    Goal 6: Ensure availability and sustainable management of water and sanitation for all.

    6.2: Achieve access to adequate and equitable sanitation and hygiene, and end open defecation, paying special attention to the needs of women, girls, and those in vulnerable situations.

    6.2.1: Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water. Learn more.

    UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2017-2020 Strategy
    The UN-Water GLAAS strategy responds to the new demands of the SDGs and sets a course for GLAAS actions at the country level. Learn more.

    WHO Joint Monitoring Programme (JMP) Report: Progress on Household Drinking Water, Sanitation and Hygiene 2000-2017: Special focus on inequalities 
    This report includes national, regional, and global estimates for WASH in households for the period 2000-2017. It also assesses progress in reducing inequalities in household WASH services and identifies the populations most at risk of being left behind. Learn more.

World Toilet Day


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Handwashing with soap is a simple and effective way to prevent diarrhea. Hygienic practices like handwashing maintain health and prevent the transmission of diseases.

  • Problem: limited access to soap and water, knowledge, or good hygiene practices

    Contaminated hands are one of the main ways diarrhea is spread.

  • Solution: handwashing with soap can prevent the transmission of illnesses

    Since diarrheal diseases are transmitted through the fecal-oral route, routine handwashing with soap can prevent the transmission of the bacteria and viruses that cause diarrhea, particularly when regularly practiced after using the toilet or changing a baby’s diaper and before preparing food.

    Handwashing with soap is one of the most cost-effective investments in public health. Handwashing prevents diarrhea and a host of other infections that can be extremely costly to individuals, health care systems, and countries.

    Washing hands in schools and health care facilities can have a significant impact.

    It is critical to educate both parents and caregivers on the importance of correctly washing hands. For children, schools provide ample opportunities for promoting healthy habits.

    Since improving handwashing requires behavior change, it works best as part of a broader package of solutions.

  • Impact: infections prevented, lives saved

    Handwashing with soap could eliminate nearly half of all diarrhea infections.

    Without good hygiene practices like handwashing with soap, efforts to improve drinking water and sanitation will be undermined and unsustainable. The SDGs are monitoring the percentage of people with facilities in their homes to wash their hands with soap and water. Access varies immensely, from 15 percent of the population in sub-Saharan Africa to 76 percent in West Asia and North Africa.

Global Handwashing Day


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