Most of us take our toilets for granted. We certainly do. Do you? Yet this year on World Toilet Day – a United Nations international observance day to inspire action on the global sanitation crisis –  1.2 billion people across Asia-Pacific do not have even basic sanitation services, and 453 million people still practice open defecation. Even for many with access, the facilities remain rudimentary and unsafe.

As a result, 80% of wastewater flows back into the ecosystem without being treated or reused, creating unhealthy, smelly and polluting conditions, locally and in the wider environment, as well as the spread of diarrhea, cholera, dysentery, skin diseases and other ailments.

Lack of access to safe, adequate and affordable water, sanitation, and hygiene (WASH) facilities has a devastating effect on the health, dignity, and prosperity of billions of people across Asia and the Pacific. The COVID-19 pandemic is a painful reminder of this. The absence is most noticeable for vulnerable and poor people living in informal urban areas and settlements.

How did we get here? Investments in the sanitation sector continue to favor large centralized systems in the larger cities, leaving behind people living on the edges of cities, in informal settlements, and rural communities who must make their own arrangements, at their own cost.

There is little evidence that these substantial investments have improved sanitation services, and subsequently improved public health for those who need them the most. Recent studies showed that many completed wastewater treatment plants have never been commissioned, or have been disconnected, or are not operated well.

Lack of access to safe, adequate and affordable water, sanitation, and hygiene (WASH) facilities has a devastating effect on the health, dignity, and prosperity of billions of people across Asia and the Pacific.

While inappropriate technology choices, poor design, lack of household connections are often the culprits, the failures are also caused by focusing too much on the investment, and not enough on developing policy and regulations; operations and management capacity, revenue structures, and staffing, in order to ensure sustainability. The end result is vast amounts of money spent with limited impact.

The citywide inclusive sanitation approach aims to shift how we think, design, and implement urban sanitation projects. It focuses on achieving sanitation service delivery, not just on building “grey” infrastructure. This is being done to “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation,” as called for in Sustainable Development Goal 6.2.

This means alongside the infrastructure, we need to strengthen the policy, institutional and regulatory systems, build institutional capacity and using a mix of sewered and non-sewered sanitation services and business models that can address the different types of settlements found in urban and peri-urban areas – from small towns to mega cities.

The citywide inclusive sanitation concept can be defined as the provision, financing and equitable distribution of sanitation services; prioritizing public health and safety with reliable services continually delivered based on the effective management of human, financial, and natural resources; and the presence of a responsible and accountable sanitation authority to execute a mandate of ensuring safe, equitable, and sustainable sanitation for all.

The authorities’ performance against their mandate has to be monitored and managed with data, transparency, and incentives. And all resources must be effectively managed to support the execution of the authorities’ mandate across time and space.

There is still much to learn and navigate in designing and implementing more inclusive sanitation projects. For example, how to support institutionalizing the citywide inclusive sanitation principles into practical policies? How do we build capacity and provide systems that will be responsive to better data? How can governments work with the private sector to improve service delivery, while also monitoring progress?

But one thing is clear: the status quo has to change. Sanitation investments must be sustained and result in improved services and a less polluted environment for everyone. This includes you and I, but more importantly the most disadvantaged people most in need of better services.