Clean Team toilet cartridges being loaded onto a truck before delivery to customers in Kumasi, Ghana on 17 October 2013.

Why the world can’t wait for sewers

Achieving equitable sanitation for all by 2030 depends on scaling new models that reach the places conventional sewerage can’t.

To mark World Toilet Day, we’re revisiting EY research on container-based sanitation models and highlighting a new study in development, which aims to show how the potential of a transformative sanitation economy can be realized. Conducted in collaboration with Water & Sanitation for the Urban Poor (WSUP) and the Toilet Board Coalition (TBC), these studies illustrate our shared belief in the vital role of impact entrepreneurs in tackling inequality and accelerating progress toward the UN Sustainable Development Goals (SDGs).

A global challenge — and a global opportunity

Next time you go to the bathroom, consider this: 2 billion of your fellow human beings still don’t have access to the basic amenity of a toilet or latrine,¹ and 4.5 billion don’t have access to any form of safely managed sanitation.²

Of these people, 673 million still defecate in the open,³ which contributes to the spread of disease, malnutrition and environmental contamination. Some 827,000 people in low- and middle-income countries die each year because of poor water, sanitation and hygiene, and poor sanitation is believed to be the primary cause of more than half of these deaths.⁴ Combined with lost economic productivity and increased health care costs, this is estimated to have cost the global economy close to US$225b in 2015.⁵

Compounding these costs is a massive lost opportunity. Trillions of liters of valuable toilet resources (the TBC’s preferred term for human waste) go lost and untreated every year. Safely capturing, treating and using those resources, and leveraging the huge amounts of data on health and consumer behavior that can be gleaned from use of sanitation facilities, could generate a multi-billion-dollar economic bounty.

With a global economic return of US$4.30 for every dollar invested in water and sanitation services,⁶ the TBC estimates that, in India alone, the sanitation economy could be worth US$62b a year by 2021.⁷

In short, the business case for accelerating progress toward SDG target 6.2 — access to adequate and equitable sanitation and hygiene for all by 2030 — could hardly be stronger. The sanitation economy presents vast potential for global economic growth, while addressing one of the most urgent social challenges of our time.

The question should no longer be about why we should seek to accelerate progress. The why is clear. What matters now, more than ever, is how scale can be achieved. With the UN suggesting that achieving universal access to even basic sanitation by 2030 would require doubling the current rate of change,⁸ we need to go further, faster. In particular, we need to go further, faster in scaling the impact enterprises whose innovative business models are reaching the parts that conventional sewerage, waste treatment and processing can’t.

Illuminating practical pathways to scale

Helping these enterprises plot a path to greater scale and true sustainability is precisely the purpose of collaborations with WSUP and the TBC.

A service-based business model — built around stand-alone toilets that store waste in sealable, removable cartridges — container-based sanitation (CBS) is uniquely suited to the needs of densely populated urban slums, where sewered sanitation remains a pipe dream. But the challenges of building a self-sustaining CBS enterprise are many — from achieving a sufficient level of gross margin to finding appropriate and affordable means for the transport and off-site treatment of waste, which is essential to gaining recognition as a “safely managed” form of sanitation.

EY analysis with WSUP clearly establishes the prerequisites for scale, with a particular focus on unit economics. While our report shows it is possible for CBS models to achieve a sustainable level of profitability, it also illustrates how public-private partnerships could dramatically improve their chances of achieving their full potential, by lowering up-front capital costs of toilets, creating stronger linkages to city-wide waste management and making it easier to establish a viable customer base.

Now, in collaboration with the TBC, we are applying a wider lens. Drawing on the experiences of past and present enterprises in the TBC’s Toilet Accelerator program — several of which have benefitted from EY support to enhance their resilience, productivity and capacity to scale sustainably — a forthcoming report aims to show how the potential of a transformational sanitation economy can be realized.

From bundling sanitation with other services to create a better, broader user experience, to creating demand for transformed toilet resources, to becoming asset light to make invested capital stretch further, Toilet Accelerator enterprises are illuminating multiple pathways to greater efficiency, profitability and scale.

They are proving that better answers to the global sanitation crisis already exist. They just need to be scaled. In sharing their stories, and practical insights that others can follow, we hope to accelerate progress toward the sanitation economy, by encouraging more entrepreneurs to take up the challenge and stimulating the investment that can help make it happen.

If not now, when?

We sit at a critical inflection point in the pursuit of access to adequate and equitable sanitation and hygiene for all by 2030. The business case has already been made — powerfully. And better answers to the global sanitation crisis already exist. But unless and until the debate meaningfully shifts from why a transformational sanitation economy is a good idea toward how to rapidly scale and replicate these answers, the prize is likely to remain elusive.

That prize deserves greater attention and commitment to act. It deserves greater attention and commitment from governments and municipal authorities who can rid themselves of the unaffordable public costs of sewered sanitation, while reaping huge cost-avoidance advantages in improving community health.

And it demands greater attention and commitment from entrepreneurs and impact investors who can unearth huge value, not only from serving the 4.5 billion people still lacking access to safely managed forms of sanitation today, but also helping to tackle related goals for sustainable development, such as safe water, food security, renewable energy, and good health and well-being.

Building a profitable, sustainable sanitation business serving low-income customers is hard, but it can be done. Innovative enterprises are already bringing dignity and a better quality of life to millions of people. With the right support, the EY organization, WSUP and the TBC believe that they, and others like them, can bring affordable, sustainable and safely managed sanitation to hundreds of millions more of the people who so desperately need it.


Meeting the United Nations Sustainable Development Goal of equitable sanitation for all by 2030 offers vast potential for global economic growth, while addressing one of the most urgent social challenges of our time. In India alone, the potential annual value of a transformational sanitation economy is estimated to be US$62 billion by 2021.

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