Sanitation and hygiene: the water, health and education trio

We hear a great deal about access to water, and far less about toilets. That's understandable: the subject is less photogenic and more awkward. Yet without sanitation, clean water can't deliver on its promise. Here's why these three elements, water, sanitation and hygiene, only work together.

The situation today: 3.4 billion people without safe toilets

The figure is staggering, yet little known. According to the WHO/UNICEF Joint Monitoring Programme (2025 data), 3.4 billion people, nearly half the world's population, still live without safely managed sanitation services.

Of these, 354 million people have no toilet at all and practise open defecation: in bushes, ditches, fields or near water points. And the problem is overwhelmingly rural: according to the WHO and UNICEF, 66% of people without basic sanitation facilities live in rural areas.

In Africa the situation is especially critical: according to the JMP, 779 million people there lack basic sanitation services, including 208 million who practise open defecation.

Why water alone isn't enough

This is the heart of the matter, and the point people rarely grasp straight away. You might think a well solves a village's health problems. In reality, it doesn't.

Here's why. Waterborne diseases spread along a specific route: faeces contaminate the water, the contaminated water is drunk, and pathogens attack the digestive system. So if a village has clean water but people defecate in the open, faeces eventually return to the environment and contaminate water sources, including through run-off into shallow water points.

In other words, giving a village clean water without tackling latrines is like filling a bath without putting the plug in. The cycle closes and disease persists.

That's why people in the sector always talk about the trio of water, sanitation and hygiene, never water on its own. The three building blocks hold each other up: water protected at source, latrines to stop contamination, and hygiene to block transmission by hand.

Hygiene: the best-value act in public health

The third pillar is the simplest and cheapest: washing your hands. And yet, according to the WHO and UNICEF (2025), 1.7 billion people have no basic hygiene service at home, including 611 million with no facility whatsoever.

Yet the impact of this simple act is huge. As we explain in our article Water and health: how access to water reduces childhood illness, handwashing with soap reduces diarrhoeal disease by more than 40%, according to UNICEF and the WHO. Few medical interventions deliver such results at so little cost.

But there's an obvious condition that's often forgotten: to wash your hands, you need water to hand. A handwashing station with no water point nearby is useless. So we're back to the well. The circle is complete: each building block depends on the others.

The little-known link between toilets and girls' education

This is the most invisible side of the issue, and one of the most unjust. A lack of toilets doesn't just make people ill: it deprives girls of an education.

As UNICEF stresses, when children, and girls in particular, have no access to private, decent sanitation facilities at school, their right to education is under threat. In practice, many girls are forced to miss school during their periods because there are no toilets offering enough privacy.

These repeated absences, month after month, end up causing them to fall behind and then drop out. Something as simple as latrines thus shapes the schooling, and so the working future, of millions of girls.

On top of this comes a question of dignity and safety: open defecation exposes women and girls to harassment and assault, especially at night.

An investment with an exceptional return

If the health case weren't enough, the economic case is overwhelming. According to a WHO study, every dollar invested in sanitation returns 5.5 dollars, thanks to lower healthcare costs, productivity gains and fewer premature deaths.

That's even higher than the return on clean water alone, estimated by the UN at 2 dollars per dollar invested. Our article Donating clean water: the best value for impact sets out these calculations.

So the problem isn't the return, it's the pace. The WHO estimates that the current rate of progress would need to increase fivefold to achieve universal access to safely managed sanitation services by 2030. Without speeding up, the goal will remain out of reach.

How to take practical action

The approach that works is never to treat water in isolation, but to make it part of a complete chain.

That's the thinking behind LIFE's water programme. A village well, dug to around 20 metres and fitted with a pump, serves around 500 people. Its specifications include a concrete surround to prevent contamination of the water point, laboratory testing of water quality and, above all, training for a village management committee, which also leads awareness-raising on good hygiene practices.

Funding one costs €2,650 in Africa, or around €901 after 66% French tax relief. To understand the work in detail, our article Building a well in Africa: steps, costs and real impact follows the 7 steps, and our article How much does a well in Africa cost? breaks down the budget. LIFE's donor relations team is always happy to answer any questions about ongoing projects.