Access to basic sanitation

The National Sanitation Policy 2016 defines basic sanitation as infrastructure that “considers natural resource protection, is safe (including for children), reliable, private, socially acceptable, with skills and capacity available locally for operation and maintenance, protected from the weather and ventilated, keeps smells to the minimum, is easy to keep clean, minimises the risk of the spread of sanitation-related diseases by facilitating the appropriate control of disease carrying flies and pests, facilitates hand washing and enables safe and appropriate treatment and/or removal of human waste and wastewater in an environmentally sound manner”.[1] 

This definition differs from the previous Strategic Framework for Water Services in that it includes more specific reference to environmental considerations. It also specifically mentions that sanitation should be safe for children, and that basic sanitation includes access to handwashing facilities.[2]

Adequate sanitation prevents the spread of disease and promotes health through safe and hygienic waste disposal. To do this, sanitation systems must break the cycle of disease. For example, the toilet lid and fly screen in a ventilated pit latrine stop flies reaching human faeces and spreading disease. Good sanitation is not simply about access to a particular type of toilet. It is equally dependent on the safe use and maintenance of that technology; otherwise, toilets break down, smell bad, attract insects and spread germs. 
 
Good sanitation is essential for safe and healthy childhoods and for reducing inequalities for children.[3] It is very difficult to maintain good hygiene without water and toilets. Poor sanitation is associated with diarrhoea, cholera, malaria, bilharzia, worm infestations, eye infections and skin disease. These illnesses compromise children’s health and nutritional status. Using public toilets and the open veld can also put children in physical danger. The use of the open veld and bucket toilets is also likely to compromise water quality in the area and to contribute to the spread of disease. Poor sanitation undermines children’s health, safety and dignity.
 
The data shows a gradual and significant improvement in children’s access to sanitation since 2002, although the number of children without adequate toilet facilities remains worryingly high. In 2002, less than half of all children (46%) had access to adequate sanitation at home – services defined as “adequate” include a flush toilet connected to a bulk infrastructure disposal or a septic tank, or a ventilated pit latrine. By 2018, the share of children with adequate toilets had risen to 79% and the share has remained at that level since. Around 3.9 million children still use unventilated pit latrines, buckets or other inadequate forms of sanitation, despite the state’s reiterated goals to provide adequate sanitation to all and to eradicate the bucket system. The majority of these children (3.6 million) use unventilated pit toilets, while 280,000 children have no sanitation facilities at all (open defecation or buckets). Children (21%) are slightly more likely than adults (18%) to live in households without adequate sanitation facilities.
 
As with other indicators of living environments, there are great provincial disparities. In provinces with large metropolitan populations, like Gauteng and the Western Cape, over 90% of children have access to adequate sanitation (mostly in the form of flush toilets), while provinces with large rural populations tend to have the poorest sanitation. Provinces with the greatest sanitation improvements in numeric terms are the Eastern Cape (where the number of children with access to adequate sanitation more than tripled from 626,000 to over 2.1 million, resulting in an increase in access for 1.5 million children), KwaZulu-Natal (an increase of 7 million children) and Gauteng (an increase of 1.8 million children with adequate sanitation facilities on site). In the Free State, the share of children with sanitation improved from 53% in 2002 to 86% in 2024). 

The dramatic improvement in access to sanitation from 21% in 2002 to 85% in 2024 in the Eastern Cape is largely due to increased provisioning of ventilated pit latrines, which may be provided by the state or built by households themselves. In other words, the achievements in sanitation access have not necessarily been accompanied by improved or more extensive bulk infrastructure. Of the nearly 90% of children in this province who are defined as having adequate sanitation, 60% have pit latrines while only 40% have flush toilets. Similarly, the substantial improvements in levels of access to ‘adequate’ sanitation in KwaZulu-Natal and Limpopo have been achieved without corresponding expansion of bulk infrastructure to rural households but rather through increased access to ventilated pit latrines. Expansion of waterborne sewerage systems into deep rural areas is probably not feasible given that South Africa is a water-scarce country and that the costs of installing and maintaining bulk infrastructure to remote low-density areas is prohibitive. Small urban municipalities and even well-resourced metros are struggling to maintain sanitation infrastructure and sewerage treatment works.

All sanitation infrastructure needs to be maintained to be safe and hygienic, and pit toilets need to be emptied regularly and safely to avoid health hazards and environmental contamination. Across the country, 6 million households still used pit toilets in 2024, and of these 88% reported that their toilets had never been emptied. Eight million children live in these households, depending on un-serviced pit toilets.

Although there have also been significant improvements in sanitation provision in Limpopo, this province still lags behind the other provinces, with only 57% of children living in households with adequate sanitation. It is unclear why the vast majority of children in Limpopo are reported to live in formal houses, yet access to basic sanitation is the poorest of all the provinces. Definitions of adequate housing such as those in the UN-Habitat and South Africa’s National Housing Code include a minimum quality for basic services, including sanitation.
 
The statistics on basic sanitation provide yet another example of persistent racial inequality: 100% of Indian and White children had access to adequate toilets in 2024 and 95% of Coloured children had adequate sanitation, while only 76% of African children had access to adequate basic sanitation. This is, however, a marked improvement from 37% of African children in 2002.

Children in relatively well-off households have better levels of access to sanitation than poorer children. Among the richest 20% of households, 98% of children have adequate sanitation, while 71% of children in the poorest 20% of households have this level of service.