By Christopher Burke
Urbanization is accelerating across Africa, but basic sanitation infrastructure remains dangerously underdeveloped. Over 700 million people still lack access to improved sanitation. Traditional pit latrines, poorly managed septic systems and rampant open defecation pollute water sources, degrade environments and expose populations to disease.
The lack of effective sanitation is not just a health issue, but a tangible threat to sustainable urban development, economic growth and environmental stability.
As traditional official development assistance (ODA) stagnates or declines, infrastructure investment continues across Africa led by China’s Belt and Road Initiative, sovereign funds from the Middle East and new entrants such as the US with the Lobito Corridor in Southern Africa. The majority of these initiatives prioritize transportation and energy.
Sanitation infrastructure forms the backbone of a healthy urban environment, but remains chronically underfunded.
Poor sanitation is a root cause of waterborne diseases, including cholera and typhoid that still claim thousands of lives annually across Africa. Sanitation systems rarely generate direct revenue–toilets and treatment plants do not pay for themselves, but their value is realized in human capital, cleaner cities and sustainable growth. According to World Health Organization every US$1 invested in sanitation returns US$5.50 in lower health costs, improved productivity and fewer premature deaths.
Water contamination is a vicious cycle. Wastewater containing human waste and chemicals enters rivers and groundwater, carrying bacteria such as Vibrio cholerae and Salmonella typhi. People rely on shallow wells that draw from polluted aquifers in towns and villages across the continent, exposing families to recurring illnesses and compounding environmental harm.
Soil degradation is another consequence. In Kampala, Uganda, a study by Makerere University found 39 percent of pit latrines had cracks and seven in every ten were either full or overflowing. Further research showed nitrate levels 1.7 times higher, ammonium 10.5 times higher and phosphate 49 times higher downstream from pit latrines—evidence of serious nutrient pollution. These imbalances reduce crop yields and pollute water systems deepening food insecurity.
Lakes and rivers are being choked by harmful algal blooms. Excess nutrients feed rapid algae growth that depletes oxygen and suffocates aquatic ecosystems. Dead zones are expanding in Lake Victoria and other water bodies, impacting millions dependent on fishing. One global study found nearly half of nitrogen pollution caused by human waste originated from just 25 major watersheds including Africa.
Methane emissions from poorly managed sanitation systems also represent a hidden climate threat. Toilets not connected to sewers, including pit latrines, release greenhouse gases. It has been estimated these systems contribute 2–6 percent of all human-made methane emissions.
Methane is 28 times more potent than carbon dioxide at trapping heat in the atmosphere, according to the U.S. Environmental Protection Agency (EPA).
Yet sanitation is often overlooked in climate mitigation plans. We cannot talk about climate resilience or sustainable cities without integrating sanitation systems explains Christopher Cripps, a physical planner and advisor on spatial, economic and climate-smart infrastructure with DT Global, FCDO and the World Bank in Uganda and Ghana. It requires massive mindset change, but we need to explore ways to provide urban sanitation, water, waste, energy, food, greening and wellness as a single, affordable urban eco system submits Cripps.
Coastal and beach pollution is worsening, impacting health, tourism and livelihoods. In Cape Town, South Africa, the Milnerton Lagoon receives 28 million liters of partially treated sewage each day leading to fish die-offs and beach closures. In Accra, Ghana, the Odaw River and Korle Lagoon are contaminated with untreated sewage and domestic waste producing foul odors, degrading ecosystems and depleting fish stocks.
These examples show that when sanitation infrastructure fails, the ripple effects can be severe and far-reaching. Waste from informal settlements flows into rivers and oceans without treatment. In Dar es Salaam, Maputo and Lagos, sanitation systems, where they exist, are outdated, poorly maintained and overwhelmed by rapid urban growth. Infrastructure upgrades have not kept pace.
As the global development landscape shifts, African governments must consider self-financing models. Innovative strategies that leverage rising property values through land value capture, public-private partnerships and community land trusts can help finance sanitation infrastructure. There is growing recognition that aligning sanitation investments with environmental, social governance (ESG) principles can attract impact-oriented capital, drive accountability and embed sustainability into infrastructure planning.
Green finance is a promising avenue. The World Bank reported the value of green, social, sustainability and sustainability-linked (GSSS) bonds issued in the market reached US$5.7 trillion in 2024. Development banks and climate funds are increasingly interested in sanitation as a form of climate-resilient infrastructure.
International investors are watching closely. Sanitation experts such as Prit Salian, a Partner and Principal Consultant at i-san based in Nairobi Kenya, emphasize the sector’s potential to reduce healthcare costs, boost productivity and enhance urban resilience. While sanitation does not yield direct profits, it delivers measurable social and economic returns. Blended finance approaches where public and private investments share risk can make the sector more attractive to institutional investors.
Politically, sanitation is a high-impact, visible improvement that strengthens trust in public institutions. Countries that expand access to sanitation report better school attendance—especially among girls—lower disease burdens and stronger economies. Tourism, agriculture and fisheries all benefit when waste is managed properly.
Sanitation must be seen as a legal and institutional responsibility, not just a service says Edgar Tayebwa, Principal Legal Officer at Uganda’s National Water and Sewerage Corporation (NWSC). Without clear mandates, enforcement and accountability, even the best infrastructure plans risk falling apart.
Africa’s youthful population heightens the urgency. With over 60 percent of the population under 25, demands for jobs, housing and services are rising fast. Sanitation infrastructure presents a critical opportunity to tap into the continent’s demographic dividend and secure gains in health, education and productivity.
Scalable solutions exist. City-wide Inclusive Sanitation (CWIS) integrates sewer systems, on-site sanitation and fecal sludge management. This flexible approach ensures that all residents benefit regardless of location or income. Governments and development partners can invest in solutions tailored to local contexts, not default one-size-fits-all models.
Sanitation solutions that leave women and girls behind are unlikely to be sustainable highlights Margaret Maina, Executive Officer of the Women in Water and Sanitation Association in Kenya. Inclusive planning that ensures women's voices are heard in infrastructure design and service delivery is essential for dignity, safety and long-term success.
Community-led models have proven very effective. In Ethiopia’s Oromia Region, Community-Led Total Sanitation (CLTS) halved open defecation rates at a cost of only US$6–US$11 per person. Zambia’s CLTS programs enabled over 75 percent of participating villages to achieve Open Defecation Free (ODF) status in under two years. The success of programs relies on political will, local ownership, peer monitoring and behavior change–not heavy infrastructure.
Sanitation deserves the same priority as roads, energy and other foundational infrastructure. It may not generate immediate profits, but the indirect returns in reduced disease burdens, increased productivity, better education outcomes and more resilient cities are clear and undeniable.
With traditional aid flows under pressure and new financing models emerging, now is the time for governments and development partners to reframe sanitation as a core driver of inclusive growth. The longer sanitation is neglected, the more costly the consequences will become for people, economies and ecosystems.
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