Exploring inequities in sanitationrelated disease burden and estimating the potential impacts of pro-poor targeting

There is growing attention to disparities in global and national progress in improving access to sanitation. Recent work by UNICEF and the WHO/UNICEF Joint Monitoring Programme (JMP) has shown significant variation in progress in improving access to sanitation across quintiles in many low-income settings. UNICEF has argued that this is not only ‘unfair’ but also potentially acts as a ‘brake’ to progress across all the MDGs. Others have considered the role of international aid flows and national policy and planning in securing progress on poor people’s access to sanitation services. Work in this area has suggested that certain groups are being marginalized by the targeting of current strategies and investments. Less work though has been carried out to understand how the health burden and potential benefits associated with sanitation vary across sub-populations in low-income settings. Research based on other interventions has shown significant variance in disease burden and
impacts across socio-economic groupings. A stronger understanding of how sanitationrelated risks are distributed across sub-populations offers the potential to improve both the effectiveness and efficiency of investments through better targeting. [authors abstract]