According to a new WHO/UNICEF report, entitled Progress on drinking water and sanitation: 2014 update, the number of people practicing open defecation is declining steadily in most areas of the world, but is still increasing in 26 of 44 countries in sub-Saharan Africa.
Contaminated water and poor sanitation are linked to the transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A and typhoid. In addition, inadequate or absent water and sanitation services in health care facilities put already vulnerable patients at additional risk of infection and disease according to the report.
Those with no access to a sanitation facility continue to defecate in gutters, behind bushes or in open water bodies, with no dignity or privacy. Nine out of 10 people who practice open defecation live in rural areas.
"The vast majority of those without improved sanitation are poorer people living in rural areas. Progress on rural sanitation - where it has occurred - has primarily benefited richer people, increasing inequalities," Dr Maria Neira, WHO Director for Public Health, Environmental and Social Determinants of Health, said.
"Too many people still lack a basic level of drinking water and sanitation. The challenge now is to take concrete steps to accelerate access to disadvantaged groups. An essential first step is to track better who, when and how people access improved sanitation and drinking water, so we can focus on those who don't yet have access to these basic facilities," she added.
Overall, the world is not on track to meet the sanitation target in the Millennium Development Goals; 69 countries were not on track in 2012, 36 of them were located in sub-Saharan Africa.
According to the call to action on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013, "open defecation perpetuates the vicious cycle of disease and poverty. Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty and large disparities between the rich and poor.
"There are also strong gender impacts: lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education".
In addition to the disparities between the rich and poor, and between urban and rural areas, there are often also striking differences within towns and cities. People living in low-income, informal or illegal settlements on the outskirts of cities or small towns are less likely to have access to an improved water supply or better sanitation.
"When we fail to provide equal access to improved water sources and sanitation we are failing the poorest and the most vulnerable children and their families," Sanjay Wijesekera, UNICEF Chief of Water, Sanitation and Hygiene, said. "If we hope to see children healthier and better educated, there must be more equitable and fairer access to improved water and sanitation."
As we approach the 2015 Millennium Development Goals deadline, the lessons, successes and remaining challenges are becoming increasingly clear. Although sub-Saharan Africa is not on track to meet the MDGs drinking water target, progress has still been made.
"Since 2000, almost a quarter of the current population gained access to an improved drinking water source - that is, on average, over 50 000 people per day, every day, for 12 years in a row," states the report.
"In 1990, 95 percent of people in urban areas could drink improved water, compared with 62 per cent people in rural ones. By 2012, 96 per cent people living in towns and 82 per cent of those in rural areas had access to improved water".
In 2012, over 50 per cent of sub-Saharan Africa's population is now using improved drinking water sources. Despite progress, more progress is needed - much more.
Ed.'s Note: Dr Cory Couillard is an international health columnist that works in collaboration with the World Health Organization's goals of disease prevention and control. The views expressed in this article do not necessarily reflect the views of The Reporter. He can be reached at