Unlocking the sanitation dividend: Health, dignity, prosperity

By Saroj Kumar Jha and Doulaye Kone

Behind every thriving city, healthy workforce, and growing economy lies something we rarely acknowledge: Sanitation systems that quietly protect productivity, safeguard natural resources, and keep people healthy. When these systems function well, societies prosper. Where they remain out of reach, as is the case for 3.4 billion people, the impacts are immediate and profound.

This World Toilet Day reminds us of sanitation’s power to strengthen human capital, advance equity, and foster more resilient, healthy and prosperous communities.

A foundation for people—and their potential

Safe sanitation is one of the most effective public health investments a country can make. It prevents diseases that keep children out of school, weaken their immune systems, and contribute to malnutrition and stunting, all of which can curb learning and lifetime earnings. Today, one in five people still drink water contaminated with human waste, driving preventable illnesses and widening social disparities. These burdens fall disproportionately on low-income communities with limited services and high vulnerability.

These impacts extend well beyond households. Nearly 367 million children attend schools without toilets, affecting attendance, safety, and dignity, especially for adolescent girls during menstruation. Improving sanitation in schools is one of the simplest ways to support learning, promote inclusion, and enable children to reach their full potential.

Sanitation fuels economic growth

Sanitation is not only a public good; it is an economic necessity. Countries lose an estimated 2–4 percent of gross domestic product (GDP) each year to inadequate sanitation through lost productivity, higher health costs, pollution, and reduced competitiveness. 

When countries invest, the economic benefits are immediate and sustained.

Every $1 million spent on sanitation can generate around 40 jobs in low- and lower-middle-income countries. In Africa, for instance, adequate funding could raise GDP by up to 5 percent. Tackling diarrheal disease alone could save $86 billion globally each year. Stronger sanitation systems lead directly to healthier workers, more competitive economies, and better-functioning cities.

What progress can look like

Cities that prioritize sanitation as core infrastructure show how quickly benefits can accumulate. In Cape Town, South Africa, for instance, measures to improve utility performance, manage wastewater safely, and expand reuse are expected to deliver hundreds of millions of liters of additional water per day by 2030, strengthening service reliability for vulnerable communities and building resilience to climate shocks. The experience highlights a broader lesson: When sanitation is integrated into water resource management, the gains are widespread.

India’s Swachh Bharat Mission demonstrates what’s possible when sanitation becomes a national priority. In just five years, the campaign improved sanitation for more than 500 million people, enabled the construction of over 100 million household toilets, and reduced open defecation at an unprecedented scale. Rural toilet coverage rose from around 40 percent to nearly universal. The initiative has also saved thousands of young lives annually. Districts with increased toilet access experienced a reduction in infant mortality by more than 5 deaths per 1,000 births, showing how improved sanitation is essential not only for dignity but also for survival. Independent assessments find that every dollar spent yields a return of over four dollars. Few public health initiatives have propelled human development this quickly. 

How countries can capture the sanitation dividend

Realizing the social, economic, and environmental benefits of sanitation depends on how countries plan, finance, and manage their systems. Three areas are central:

1. Stronger governance and smarter financing.  Clear regulatory frameworks, robust investment plans, and smart financing models that combine public resources with private capital create the conditions needed for sustainable sanitation services. By blending public funds with private capital, leveraging climate finance, and using tools like microcredit, green bonds, and results-based financing, countries can mobilize resources and make sanitation projects both bankable and sustainable. 
2. Rethinking sanitation to invest in inclusive system-wide solutions.  Implementing resilient, citywide inclusive sanitation solutions—combining sewers, on-site systems, and safe fecal sludge management—alongside scaling innovative technologies, efficient supply chains, and service models offer practical, affordable pathways to expand equitable access across cities. By integrating sanitation with water supply, drainage, and solid waste planning, and embracing circular practices like wastewater reuse and resource recovery, cities can turn waste into opportunity, boosting efficiency, strengthening health outcomes, and enhancing climate resilience. 
3. Investing in people, new skills, and breakthrough innovation  Expanding sanitation requires a capable workforce and modern tools. Data, technology, safe reuse, and circular approaches can help countries meet rising demand while protecting the environment. Sanitation is a key contributor to climate resilience and sustainable development. As water resources face increasing stress from climate change, water and sanitation systems must evolve and promote next generation solutions that address water scarcity, environmental pollution, and the circular economy. This reframing opens the door for industry leaders to design ubiquitous solutions that recover resources, reduce waste, and create new business models. By positioning sanitation as a driver of innovation and economic opportunity, we can accelerate the adoption of transformative technologies and build a skilled workforce ready to meet future challenges.

A partnership for stronger systems

The World Bank Group and the Gates Foundation share a deep commitment to expanding access to safe, inclusive sanitation. Through the Global Water Security & Sanitation Partnership  and other collaborations, we have partnered to support countries to strengthen institutions, generate evidence, test new approaches, and mobilize financing to scale what works. 

If countries invest now in modern, inclusive sanitation, the benefits will be far-reaching: healthier families, more productive economies, more resilient cities, and cleaner waterways. By elevating sanitation in national development agendas and sustaining investments in strong systems, countries can unlock a powerful sanitation dividend that will support people and prosperity for generations to come.