Sanitation and hygiene

UNICEF works with governments to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

Children wash their hands


Poor sanitation and high-risk hygiene behaviors confine the poor in a vicious cycle of poor health, environmental degradation, malnutrition, reduced productivity and loss of incomes. For women and adolescent girls, the lack of privacy and dignity has deleterious impacts on health and safety, self-esteem, education and well-being.

More than 70 per cent of the population in Eastern and Southern Africa (340 million people) have no access to basic sanitation services.

Among these, 98 million people (19 per cent) practise open defecation, 179 million use unimproved facilities and 63 million shared sanitation facilities. Ethiopia, Uganda, Kenya and Tanzania, have by far the largest number of people in the region with no access to basic sanitation services, while countries like Eritrea, South Sudan and Ethiopia have the largest proportions and numbers of people practising open defecation.

The numbers who don’t have access to basic hygiene services are even higher (386 million) as more than per cent of the population in the region don’t wash hands with soap and water. In schools, for example, over 50 million (27 per cent) school-age children have no access to sanitation services while 117 million (62 per cent) have no access to handwashing facilities in schools.

Two students in Uganda mop the floor outside a lavatory
Students of a primary school in Uganda clean latrines, a practice that was introduced by the school’s water, sanitation and hygiene club to improve sanitation and hygiene for a better learning environment.

The greatest concern in the region is the pace of increase in access on basic sanitation services. Access to basic sanitation services in communities has only increased by 6 per cent since 2000 and projections showing that only 36 per cent of the population will be having access to basic sanitation services by 2030. While efforts to eliminate open defecation in many countries are on course, too many households are too low on the sanitation service ladder, with every risk of being stuck there. Those in rural areas start using unimproved sanitation facilities, while those in urban areas, start using sharing facilities. The need to move populations along the service ladder – not just away from open defecation – is paramount. In institutions, programming in WASH needs to go to scale, as so far it has been limited.

Sanitation sector financing has been identified as the greatest obstacle in efforts to accelerate the pace in sanitation service delivery. In addition, current approaches used in creating demand for sanitation need to be better adapted to changing economic and demographic shifts, to make them more effective.

The WASH SDG sanitation ambition goes beyond containment to other parts of the sanitation supply chain (see Figure 1). These other parts largely characterize urban and small towns sanitation systems. Unlike rural areas where access to a good toilet largely equates to good sanitation, in urban areas, more infrastructural investments are needed to ensure that faecal matter is emptied, transported, treated and reused/disposed safely. This only needs development of service and management models to ensure sustainable functionality of these systems. Urban areas and small towns have been identified as epicenters for cholera due to poor sanitation and hygiene practices. In addition, the region is experiencing an increasing shift of populations from rural to urban areas and an exponential growth of small towns, which has great implications on UNICEF programming, which has been mainly rural.


UNICEF works across the sanitation management chain in promoting and supporting a range of technologies and systems from containment to re-use and disposal. UNICEF stresses on demand creation in communities where open defecation is still common; improve supply of sanitation products and services in communities where open defecation is low but there are high proportions of unimproved latrines (i.e. where demand exists but the availability of affordable and aspirational sanitation solutions are limited); and promote innovative financing solutions in communities where basic sanitation coverage is high, but some households (often the poorest and marginalized) have yet to be reached. This is done in all contexts – urban or rural, development or humanitarian – targeting the most vulnerable.

Sanitation service chain graphic

Some specific solutions include:

Implementation of open defecation game plan

UNICEF has developed a global game plan for ending open defecation by 2030. The game plan, aligned with SDG 6.2, which also aims to end global open defecation by 2030, seeks to reach ‘the furthest behind first’, namely the 892 million people who practised open defecation by 2015. ESAR is home to 8 of the 26 ‘high-burden’ countries for open defecation in the world. The game plan outlines UNICEF’s programmatic focus and approaches in sanitation. It will help ensure that ending open defecation receives the deliberate and sustained attention required to succeed. To end open defecation, UNICEF is targeting these eight countries (Angola, Eritrea, Ethiopia, Kenya, Madagascar, Mozambique, South Sudan and Tanzania) with additional support to accelerate or sustain the annual reduction rates in open defecation. There is a clear emphasis on sustainability issues in the support.

Strategic public-private partnerships to move populations up the sanitation ladder

UNICEF has in providing guidance and support to governments in the region on how to better engage with the private sector on sanitation and hygiene. For example, UNICEF has partnership with Lixil, a global sanitation products company, to reach millions of people with sanitation products in the region.  This market shaping partnership aims to increase the availability of affordable sanitation products and services in the region. In institutions, UNICEF advocates for national policies that ensures that schools have sex-separated sanitation and hygiene facilities, which also have a strong inclusion component to taken care of special needs such as disabilities and adolescent girls.   

Ending high-risk hygiene practices

UNICEF is working with governments to improve good hygiene practices such as handwashing with water and soap in households, communities and institutions. UNICEF employs a wide range of behavior change and communication approaches to reach to the most vulnerable populations. In schools, for example, school hygiene clubs, are playing a critical role in increasing awareness and knowledge as well as fostering good hygiene practices in schools.

Mainstreaming menstrual health and hygiene (MHH) in schools

UNICEF is working with the education and gender teams to mainstream MHH in schools across the region. Efforts include strengthening national policies on MHH, increasing awareness and knowledge of MHH in schools and communities, implementation of gender-sensitive designs of WASH facilities in schools and strengthening the supply chain of MHH products. The aim is to create conducive learning environments for adolescent girls to boost school attendance and performance. 

Improving urban sanitation systems and services

Unlike rural sanitation, urban sanitation systems especially transportation and treatment, requires heavy capital investments. UNICEF is working with other partners like UN Habitat and funding agencies like World Bank, DFID, European Investment Bank and KfW, to define entry points and make high value investments in the urban sanitation sector. Methodological approaches and behavior change strategies are also being reviewed to better adapt to urban populations. To comprehensively address public health epidemics, including cholera, in the region, UNICEF in ESAR is increasingly involved sanitation and hygiene programming in urban areas and small towns, which has been identified as sources of these epidemics. In addition, the region’s has many settlement camps for displaced populations (IDPs and refugees), like in Somalia, northern Uganda, Ethiopia and Southern Sudan, which have turned to be ‘small towns’ due to protracted crises, hence need similar programmatic approaches for typical development context urban programing.