Providing adequate sanitation facilities for the poor remains one of the major challenges in all developing countries. An estimated eighteen (18) million South Africans or three (3) million households do not have access to adequate sanitation facilities. Those who have inadequate sanitation may be using the bucket system, unimproved pit toilets or the veld. In addition there is a disturbing increase in poorly designed or operated water-borne sewerage systems, especially in urban areas.



When sanitation systems fail, or are inadequate, the impact on the health of the community, on the health of others and the negative impact on the environment can be extremely serious as witnessed by the 1.5 million cases annually of diarrhoea in children under the age of 5 and the recent outbreaks of cholera.
Inadequate sanitation facilities and infrastructure combined with unhygienic practices represent South Africa’s sanitation problem. The unhygienic practices are clearly the results of:


lack of health and hygiene awareness;

  • lack of sanitation facilities
  • inadequate water supplies;
  • poor facilities for the safe disposal of waste water and other domestic waste; and
  • inadequate toilet and hand washing facilities.

In the past, sanitation has been seen primarily as a technical issue (toilet building, providing sewer systems, maintenance etc.) whilst other aspects have been given secondary consideration. It is now recognised that toilets are just one element in a range of factors that make up good sanitation. Community participation in decision-making, improved health of millions of people, safer living environments, greater knowledge of sanitation-related health practices and improved hygiene are just some of the factors that are central to the development of good sanitation services.
For the purpose of this policy it is necessary to define sanitation and also to give guidance on the minimum acceptable basic level of sanitation:      

“Sanitation” refers to the principles and practices relating to the collection, removal or disposal of human excreta, household waste water and refuse as they impact upon people and the environment.  Good sanitation includes appropriate health and hygiene awareness and behaviour, and acceptable, affordable and sustainable sanitation services.

  • The minimum acceptable basic level of sanitation is:
    (a) appropriate health and hygiene awareness and behaviour;
    (b) a system for disposing of human excreta, household waste water and refuse, which is acceptable and affordable to the users, safe, hygienic and easily accessible and which does not have an unacceptable impact on the environment; and
    (c) a toilet facility for each household.

This policy will focus mainly on the improvement of health and hygiene and the provision of adequate sanitation facilities in households, schools and clinics as well as the collection, removal and disposal of human waste and the related health and hygiene practices.

Health problems associated with poor Sanitation

The most common health problems associated with poor sanitation are:

  • diarrhoea and dysentery;
  • typhoid;
  • bilharzia;
  • malaria;
  • cholera;
  • worms;
  • eye infections and skin diseases; and
  • increased risk from bacteria, infections and disease for people with reduced immune systems due to HIV/Aids.

Significant investments are being made in the provision of safe water supplies for all. However, the health benefit of this investment is limited where inadequate attention is paid to sanitation and to health and hygiene promotion. International experience shows that once people’s basic needs are met (especially the provision of clean water), sanitation improvements together with health and hygiene promotion results in the most significant impact on their health.

Sanitation programmes can have these dramatic health benefits because many of the infective organisms are spread from hand to mouth or from hand to food to mouth rather than through drinking contaminated water. Improving hygiene practices and providing sanitation facilities could have a direct influence on a number of important public health problems besetting South Africa. Thus, understanding how infections are transmitted and how to break the cycle of infection are important public health messages.

Most faecal-oral infections are transmitted on hands and during food preparation, rather than through drinking contaminated water directly, as shown in this diagram



In short, faeces provide food for many organisms that cause diseases in humans. Any action that prevents these organisms from getting to the faeces or from getting onto or into human bodies will help to break the cycle of infection.

Most human activity impacts on the environment.

Sanitation systems involve the disposal and treatment of wastes. A lack of adequate sanitation or inadequately maintained or inappropriately designed systems can therefore constitute a range of pollution risks to the environment, especially the contamination of surface and ground water resources:

Although water systems are able to tolerate a certain degree of pollution there is a limit to the amount that can be assimilated without causing the water quality to deteriorate to such an extent that the water cannot be used.

Factors that affect the impact of sanitation systems on water quality are:

  • size and density of the settlement being served;
  • sensitivity (or Class) of the receiving water resource;
  • type of sanitation system;
  • capacity of the service provider to manage the system; and
  • depth to ground water and the soil type.

Pollution resulting from failed or inadequate sanitation systems is associated with:

  • water borne disease caused by direct contact with faecal contaminated water and other health risks such as blue baby syndrome in bottle fed infants;
  • the growth of aquatic plants (mostly algae), which in turn results in increased treatment costs, reduced recreational value of the water body, possible growth of toxic algae and loss of bio-diversity; and
  • depletion of the oxygen in the water column which can also result in a loss of bio-diversity and a complete shift in the natural biota of the stream.

Recent work internationally and in South Africa suggests that in spite of the potential for groundwater pollution from on-site sanitation systems, the concerns about this risk may at times have been overstated. The current view is that geo-technical conditions will seldom justify a change to water-borne sewerage. Very few soils will create problems that cannot be solved by lining a pit. Even where excavation of rock is necessary, it would still usually be cheaper and more practical to construct Ventilated Improved Pit (VIP) latrines than it would be to install and maintain water borne sewerage.

An aim of the national sanitation policy is to promote the environmental sustainability of sanitation systems. To ensure that sanitation systems are designed, constructed and operated in such a way that contamination caused by sanitation systems is restricted to acceptable levels throughout the life cycle of the system, regardless of the chosen technology option.

Social and Psychological problems associated with poor sanitation

Toilets placed at a distance from the home, inadequate communal facilities, inadequate disposal of waste and other poor sanitation practices result in loss of privacy and dignity, exposure and increased risks to personal safety.

It is especially women and the elderly who are the most inconvenienced

Although the school attendance of girls in schools in South Africa is high compared to other developing countries, it is internationally recognised that poor sanitation facilities at schools can be one of the main reasons for girls to drop out.