Toilets for all: The beautiful benefits of sanitation

"It was very difficult when nature called—we had to run into the nearby forest,” says Chanh. “It was even harder when the rainy season came.”

Chanh, 29, is raising five children in a very rural part of northern Laos. Her babies range from 18 months to 11 years. Each time her children went to the bush to relieve themselves, she fretted.

“I worried an insect or snake would bite them during the night,” she explains.

Most families in Chanh’s area lived this way. The practice of “open defecation”—going in bushes, fields or roadsides—was all they had known. They didn’t have a toilet or latrine at home and didn’t know how hygiene and sanitation (or a lack of it) could affect their health.

They used water from the river for drinking and washing dishes, not knowing it was contaminated by the run-off. Chanh had been worried about insects and snakes, but a few years ago, tragedy came in a different form.

“Done, my three-year-old son, had diarrhea, and we could not cure him because we did not have money to bring him to the hospital,” she says. “After a few days, he passed away. It was an excruciating period for our family."

Little Done was certainly not the only child to die from waterborne illness in the area. The high rate of open defecation—combined with financial struggles and limited knowledge around hygiene—was hurting other families, too.

It was time to launch a community campaign for widescale sanitation.

What is sanitation and why is it important?

Sanitation means having the facilities and services needed to get rid of human urine and feces safely. Good sanitation helps prevent diseases that are spread from human waste.

Access to sanitation is a basic human right—essential for people’s dignity, safety and health. But we still have a way to go in achieving our global goals. According to the World Health Organization and UNICEF, nearly half of the world’s people (3.4 billion) do not have safely managed sanitation. That includes 354 million people who still practice open defecation.

Toilets and latrines are needed for healthy families and strong communities. This massive gap is creating cycles of poor health, heartbreaking loss, and poverty, especially in the world’s impoverished rural communities.

What happens when a community has no toilets or safe latrines?

1. Water sources become contaminated.

Without toilets, human waste ends up in fields, rivers, ponds and soil. When it rains, runoff carries fecal matter into water sources—contaminating the water families rely on.

Philip Makutsa is World Vision Canada’s specialist for water, sanitation and hygiene (together, known as WASH). “Most times, if there's poor sanitation, then access to safe water becomes a challenge,” he says. “Those two issues, when they're combined, put the community health at risk.”

2. Diseases spread quickly, hurting children the most.

Exposure to fecal pathogens spread by flies or water runoff leads to parasites and other preventable illnesses, like diarrhea—which remains the third leading cause of death for children under five.

3. Malnutrition goes up.

Poor sanitation contributes to chronic malnutrition and stunting in children. ”Because they can eat,” says Philip, “But they can’t keep the nutrients in.”

4. Women and children are less safe.

Without private facilities nearby, people walk longer distances, go to the bush, or wait until dark to relieve themselves. This puts women and children especially at risk of harassment, sexual assault and violence. The lack of safe sanitation strips away dignity and increases daily stress.

5. Children miss school—especially girls.

Schools without latrines and toilets have lower enrolment and attendance. Girls, in particular, stay home during menstruation or drop out altogether once they reach puberty. Poor sanitation makes children sick, which keeps them away from class and reduces their ability to learn.

6. Poverty deepens across the community.

When families are constantly battling illness, time and income are drained by medical care. Parents—especially moms—spend more time caring for sick children and less time in earning or participating in community life. Poor sanitation undermines transformational development, trapping families in vicious cycles of poverty.

How does World Vision support communities in addressing sanitation issues like open defecation?

Thankfully, there’s an approach that does wonders to improve a community’s sanitation—one that is low-cost, owned by the community and sustainable in the long term: community-led total sanitation.

Through the process, communities are empowered to assess their sanitation challenges and tackle them together. The result? Habits change around toilet use and hygiene, and communities pave their own way to being certified “open defecation free.” The results are transformative.

Over the last six years, 1,228 communities have been certified “open defecation free” through World Vision Canada’s programs—another community certified every two days, on average.

How does “open defecation free certification” work?

We begin without judgement

“Most of the areas where we are working—especially in low developing countries—don’t know the concept of safe fecal disposal,” says Philip. “They don’t quite understand the link between health and sanitation.”

World Vision staff talk about this with care and respect. People cannot be blamed for information they never had, but teams are still honest and clear about the dangers.

Demand grows through education

The work begins by teaching local leaders and community health workers, who then become instrumental in influencing change and dismantling inaccurate beliefs. They lead teaching sessions and walks through the community, helping map out where sanitation is a problem. They visit homes and share information about the dangers of open defecation and the importance of good hygiene. As families learn the truth, concern increases and demand for better sanitation grows.

The community leads the efforts

Sanitation action groups, WASH committees and/or community health clubs are established. These groups lead the process of improving latrine or toilet coverage and becoming open defecation free.

“They might give themselves a timeline,” says Philip. “For example, ‘In the next six months we will make sure we do this, and then we will report back to the community.’”

These groups raise awareness, inspect latrines and handwashing stations, track and report progress and identify especially vulnerable families who need extra support.

Practical demonstrations build local skills

Capable builders are identified and trained to construct safe latrines, while having their concerns addressed.

Philip explains: “They might tell you, ‘Oh, we cannot put in a latrine because the soils are collapsing, so that's why we don't dig. If we dig, we don't dig deep.’”

The demonstrations teach methods like:

• Interlocking brick to prevent the soil from collapsing inward
• Concrete platforms for cleanliness and safety
• Installing ventilation pipes that control smell and eliminate flies
• Privacy wall construction

The trainings are planned strategically where the need is great, like schools and households that are child-headed or have members with disabilities.

Holistic water and hygiene education supports the process

Alongside sanitation training, families receive hygiene education. They learn the importance of handwashing—especially after using the latrine, and before eating or preparing food—and other hygiene measures like using drying racks for dishes. These habits contribute to a culture of sanitation as behaviours and attitudes begin to change.

Government collaboration helps sustain the change

Local and national governments are essential partners in the work, involved from the beginning. World Vision staff help to establish connections between the community and their government health and water experts. This means even when our programs come to an end, the committee will continue getting the technical support they need to maintain their gains.

Certification and celebration

When the health and sanitation committee confirms that latrine coverage is 100 per cent, the community is ready to be certified. An independent team of stakeholders visits to verify compliance, inspecting every household for functional latrines, handwashing facilities and good adoption of hygiene practices.

This is a huge milestone! Often, this calls for community celebrations, which are graced by local dignitaries.

Being “open defecation free” is a designation that the community will own and maintain with pride going forward.

“A community that is certified—when you go back there, you find that the children are better nourished because of reduced incidences of diarrhea,” says Philip. “You find that the health of school children is good. Kids are not missing school because of diarrhea. You find that even the teachers are happy because the kids are able to concentrate. It contributes to many things. And that's why it's very important.”

Sibongumusa Ncube is an area program manager for the Menyezwa community in Zimbabwe, where Canadians sponsor children.

“When I look at communities that have achieved open defecation free status, I see a sense of achievement and celebration,” she says. “There is a sense of relief that they have made it together as a community.”

Every five minutes, another case of diarrhea is prevented for a child under five through World Vision Canada’s water, sanitation and hygiene programs.

Chanh’s progress in Laos

At the time of writing, Chanh’s district was still on their journey to becoming open defecation free.

The district health office and World Vision were running training sessions—nearly 7,000 people had already learned about hygiene and sanitation and been encouraged to construct latrines.

Chanh and her husband Bounkham had fully bought in and were budgeting toward it.

“I see the importance of hygiene and sanitation more now—our family wants to build a toilet after rice harvesting by the end of this year,” she says. “We will do our best because our children’s life is more important.”

Chanh, Bounkham, and Done’s siblings have faced an unbearable loss. As their community works together, they’re helping to spare their neighbours from similar heartbreak.

Answering your questions about sanitation

What is the difference between sanitation and hygiene?

Sanitation refers to the systems, services and infrastructure that safely manage human waste—things like toilets, latrines, sewage systems and waste disposal. Hygiene is about the behaviours that keep people healthy, such as handwashing with soap, safe food preparation and menstrual hygiene practices. Both are essential: sanitation keeps harmful germs away from people, and hygiene prevents them from spreading.

What is the difference between a toilet and a latrine?

A toilet typically uses running water to flush waste into a sewer system or septic tank and usually refers to a more modern fixture. A latrine is a simpler, on-site facility, not connected to a major sewage network. This is a broader term that includes many low-cost or rural sanitation options.

What is a “safe” latrine?

A safe latrine is one that prevents human waste from contaminating soil, water, hands and food. It is:

• Built at a safe distance from water sources
• Properly ventilated and covered
• Designed to contain waste securely
• Accessible, private and safe for everyone—including women, girls and people with disabilities

Safe latrines protect families from disease, offer dignity and privacy, and help create healthier communities.

Why would anyone practice open defecation?

It’s rarely a choice—most often, it’s the only option available.

• The vast majority of people who practice open defecation live in rural areas, where sanitation systems are limited or non-existent.
• People in the world’s least developed countries are more than twice as likely to lack basic drinking water and sanitation services, and more than three times as likely to lack basic hygiene.

When families don’t have toilets, cannot afford to build them, or live in places where toilets are unsafe, poorly designed, or unfamiliar, open defecation becomes the default.

Why is it so challenging to stop open defecation?

Open defecation has been practiced for generations. In some communities, it is an ingrained cultural norm—with people having never known any other system.

Changing that requires more than just building toilets. It requires behavioural changes, infrastructure, maintenance and sustained investment. This is a long-term shift, but the health, safety and economic benefits are profound.

How effective are World Vision’s WASH programs?

Research shows that World Vision’s water, sanitation and hygiene work doesn’t just improve health—it transforms futures.

• Every $1 invested generates more than $14 in economic benefits for local communities, through reduced illness and death and increased productivity.
• Since 2019, more than 3.1 million people have gained access to safely managed toilets and latrines through World Vision Canada programs—more than the population of Metro Vancouver.

How can I support World Vision’s sanitation work?

You can help families gain access to safe, dignified sanitation by giving a gift that helps communities build more latrines.