Doing Your Business – Toilets and Health

Nisa PatelNews

by Ian Matthews, Director, GBCHealth

World Toilet Day is November 19th. Hopefully you are reading this sitting… at your desk. This year, I found myself recalling an unforgettable campaign UNICEF launched a few years ago in India to encourage kids to use toilets. The Poo2Loo initiative headlined by Mr. Poo and his Poo Dabba Dance was meant to raise awareness of the dangers of open defecation. Along with its cuddly cast of characters, Poo2Loo built a smartphone app that allowed users to tag sightings of human feces which were then plotted on a map to chart the highest offending areas.

Poo2Loo attempted to reduce stigma, start a conversation and build momentum for behavior change. Despite improvements, India still has close to 650 million people who have no choice but to practice open defecation because they don’t have a toilet. In a recent survey by The Hindu newspaper, 52 percent of people in rural India opt for open defecation. By some estimates, as many as 275,000 children under-five in India die every year from dehydration and malnutrition linked to diarrhea, caused by contaminated water, inadequate sanitation and hygiene.  Open defecation is also linked to higher risk of stunting from malnutrition and a further 61.7 million are left moderately to severely stunted. Stunting in young children hinders optimal growth and cognitive development with long-term consequences for school performance and future earnings.

The problem is not confined to India. Globally, 2.4 billion people live without proper sanitation. Loss of productivity due to illness caused by lack of sanitation and poor hygiene practices is estimated to cost countries as much as 5 percent of their GDP. In short, open defecation is a genuine and severe threat to human health and economic development.


Photo courtesy of

Global Sanitation Efforts
Early international efforts to combat the practice of open defecation have focused primarily on issues of access. The “build and they will come” mantra has driven donor agencies and governments to invest heavily in latrine construction often without regard for community demand or plans for maintenance. Unsurprisingly, millions of latrines have been built, greatly increasing access, while corresponding declines in open defecation and disease burden have progressed more slowly. Travelling in South Asia, particularly in India and Nepal, it is commonplace to see latrines being used as chicken coops or as storage (not to be confused with the odd trend in the US of building chicken coops that look like outhouses…Seriously!). Around the world, latrines are dilapidated and cannot be repaired because they have not been constructed with locally-sourced materials.

Since the mid-2000s, the international community has sought to focus less on ‘hardware’ and more on ‘software’. By creating demand for better hygiene through education and collective decision-making, communities are being empowered to make their own claims and hold one another to account. This principle forms the basis for Community-led total sanitation initiatives (CLTS), a structured attempt to galvanize communities to find local solutions for sanitation challenges and build open defecation free zones.


World Toilet Day 2016

Business and Sanitation
The theme for this year’s World Toilet Day is ‘Toilets and Jobs’ – replete with a set of likeable toilets dressed up in different work uniforms. The theme is appropriate given the key role workplace programs can play in the CLTS approach referenced above. Disease transmission at work caused by poor sanitation and hygiene is a main contributing factor to workplace deaths. Businesses risk daily losses due to absenteeism, attrition, reduced concentration, exhaustion and decreased productivity amongst their workforce. Furthermore, lack of safe water and toilets can result in reduced employee skills, stunted consumer spending, inadequate infrastructure including limited water supply, and higher water treatment costs.

Businesses have the opportunity to address the sanitation crisis at three levels: in the workplace, in the community and through their core operations. In the workplace, business can work to ensure safe water and basic sanitation services are provided throughout the value chain. In the community, business can promote good hygiene and sanitation practices through partnerships with governments and civil society. And finally, through its core operations, business can drive the development of new solutions and revenue models focused directly on providing sustainable sources of water and sanitation. Mitigating risk and contributing meaningfully to the realization of global sanitation goals –e.g. SDG Goal 6 and Global Compact LEAD company 2020 commitments— can result in a wide range of positive outcomes for business and society.

The Business Case for Improved Sanitation

Direct Societal Effects
of Improved Sanitation

Business Benefits
of Improved Sanitation


Fewer people ill or caring for sick family Improved productivity due to reduced absenteeism at work and school and a healthier workforce


Increased school attendance More capable workforce,
more effective talent recruitment


Poverty alleviation Increased consumer purchasing power


Stronger economies More public money to maintain infrastructure, support governance, etc. that lead to a robust business climate


Less pollution in waterways
and the environment
Reduced water treatment costs

(Chart adapted from: The CEO Water Mandate. “Exploring the Business Case for Corporate Action on Sanitation.” September, 2014)

Workplace Programs
The 2007 Manual on the Right to Water published by the World Water Council, a multisector policy network, stipulated that water and sanitation services and facilities must be accessible within the immediate vicinity of each workplace and that these services are safe, adequate and conducive to the protection of public health and the environment. Further, in the case of employers, workplace standards need to ensure that this access is free. In 2015, 193 UN Member states recognized that access to clean water and appropriate sanitation was a human right. Beyond simply providing clean facilities, business can create momentum for progress by considering the unique needs of women, particularly in the garment manufacturing and textile industries, and by requiring each of its business partners throughout the supply chain to conform to clear codes of conduct on water, sanitation and hygiene –known informally as WASH.

Gap Inc. has been a leader in this field by incorporating WASH guidelines into their PACE program and requiring business partners to provide access to clean drinking water and safe sanitation facilities in their factories. To date, 25,000 women have been covered by the PACE program, which focuses primarily on building job skills and helping women achieve their goals at home and in the workplace, in Bangladesh, Cambodia, Haiti, India, and Indonesia.

Community Programs
Businesses can expand their programs beyond the workplace to promote behavior change and build infrastructure at the community level. Working together with community coalitions, businesses can improve sanitation by financing the provision of sustainable services, promoting hygienic behavior through education, advancing capacity for maintaining or building sanitation facilities, joining civil society groups to advocate for better local sanitation policies, supporting social entrepreneurs with innovative business models, and by investing in R&D for new technologies that deliver sanitation services cost-effectively.

The Coca-Cola Company, through RAIN (Replenish Africa Initiative), has committed US$30 million over six years to improve access to water and sanitation, and promote better hygiene practices for two million people in 35 African countries. The program, implemented in partnership with USAID, WaterHealth International, UN Habitat and other community-based partners, has had remarkable success providing clean, sustainable access to water for one million people and access to sanitation for 350,000 people, often for the first time. Last month, Coca-Cola announced it would provide an additional US$35 million and lend its expertise to a Pan-African partnership dedicated to reaching an additional four million people by 2020.

Social Businesses
In addition to a business focus on workplace and CSR activities, social entrepreneurs have started to think about how they can create businesses with the sole purpose of providing access to better sanitation. Each business is different. However, they share an approach to solving problems and a commitment to creating financial and environmentally sustainable delivery models.

One company SOIL, has been transforming wastes into resources in Haiti since 2006. Using ecological sanitation, SOIL is working to create a revolutionary social business model for providing access to safe, dignified sanitation that produces rich, organic compost as a natural resource for Haiti’s badly-depleted soils, while also creating economic opportunities in some of the world’s most under-resourced communities. SOIL utilizes EcoSan toilets to convert human waste into compost critical for agriculture and reforestation efforts. The organization has grown to become one of the largest waste treatment operations in the country.

The Loo
At work and in our communities, business plays a vital role in shaping our collective experience each and every day. As such, businesses have the potential to act as tremendous forces for good in the way that they interact with their employees, communities and customers. The business case for investing in sanitation is clear. Fewer sick people means fewer insurance payments, less absenteeism at school and work, and higher productivity. Poverty alleviation and stronger economies means more consumers, better infrastructure and better governance. Business is an essential part of this discussion, and we are glad to see the focus this World Toilet Day on Toilets and Jobs. At the very least, it gives us the opportunity to watch that Poo2Loo video again.

Nisa PatelDoing Your Business – Toilets and Health