Tackling Toilet Loss
Technical annex:
methodology note

Supported by

Contents
3

Methodology note

4

Defining Toilet Loss

4

Data definitions

5

Analysis scope

8

Detailed methodology and assumptions

16 Limitations and data requirements

Tackling Toilet Loss

3

Methodology note

The findings from this research are based on
analysis conducted by Economist Impact,
supported by Unilever, to quantify Toilet Lossand assess the costs and benefits of alternative
investment pathways towards providing
all children with access to clean and usable
toilets in schools. The findings are based on
insights gathered from a literature review,expert interviews and a custom economic
impact model developed by Economist
Impact. This technical annex details themethodology used in conducting the analysis.
Developing the methodology
The methodology was developed basedon research conducted through a literature
review, expert interviews and a data audit.
Combined, this research has informed a
methodology that is robust and relevant to
the research question, while also feasible
based on the availability of data.
Literature review. The findings from ourliterature review fed into the development ofour definition of “Toilet Loss”; overall theory ofchange and the potential channels through which
Toilet Loss could emerge; model methodology;
and pilot country selection. We consulted
existing global, regional and country-specificstudies published by academia, governments,
international organisations and the private
sector. These broadly covered: the state of accessto maintained sanitation services in schools;
the costs associated with the construction,
operation and maintenance of toilets; the direct
benefits to children from access to toilets inschools; and the indirect benefits to societies
from improved outcomes for children.

1
2
3

Expert interviews and consultations. In
developing the methodology and conducting theanalysis, we conducted one-on-one interviews
with 15 individuals. The experts we spoke with
provided input into and validated our theory ofchange and model methodology, and guided
us towards relevant datasets. In addition,
we engaged experts in wider roundtablediscussions to input on the methodology andprovide validation of the findings. The full listof experts consulted through the programme
is included in the “about the report” section.
They come from a diverse range of professional
backgrounds across academia, government
agencies, international organisations, and nonprofits with expertise in water, sanitation andhygiene (WASH) in schools, as well as WASH
financing, infrastructure and monitoring.
Data audit. The data audit of available data on
WASH and toilets in schools contributed to thedevelopment of our model methodology andthe selection of the four focus countries. As partof the data audit, we consulted the following
key databases and tools amongst others:• WHO/UNICEF Joint Monitoring Programme( JMP), a global database for data on thecurrent state of access to sanitation services
in schools.1 Data points explored include
the percentage of children with access tono, limited and basic sanitation services.
• Fit for School App (GIZ) for data on
the costs involved in constructing,operating and maintaining a toilet.2• WASHCost Share Tool and Guide (IRC)for data on costs involved in constructing,operating and maintaining a toilet.3

https://washdata.org/data
http://www.fitforschool.international/
https://www.ircwash.org/news/washcost-share-quick-start©Economist Impact 2023

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Defining Toilet Loss
Toilet Loss is the economic and societal cost of neglected toilets. Toilets can become unusable
through neglect from:a) lack of investment in operations and maintenance;b) lack of appropriate school-level management policies to enable toilet use (e.g. safety
policies, school policies on routine O&M); andc) lack of provision of essential resources (for example, water and sanitary products).

The analysis conducted for this report
estimates the losses that are incurred fromconstructing toilets that are not fit foruse, or Toilet Loss. Based on our review ofliterature and engagement with experts,
we define Toilet Loss as follows:This definition of Toilet Loss informs
our approach to the analysis, discussed
below. Specifically, our analysis focuseson Toilet Loss in schools through lack ofinvestment in O&M. It seeks to quantify:• The costs incurred in constructing toilets inschools that become unusable as a result of
insufficient investment in O&M (Toilet Loss)• The future financial costs and socioeconomic
benefits under alternative policy scenarios,
to explore options for addressing Toilet Loss
In doing so, the analysis is designed to both:
1. provide a backward-looking view on
the cost of historic inaction and thelosses that have already been incurred
as a result of neglecting toilets; and2. provide a forward-looking viewon the impacts of different policy
options to guide decision-making inminimising future Toilet Loss
The definition of Toilet Loss is intentionallybroad to cover the occurrence of Toilet Lossacross a broad range of contexts, including
within schools, homes and other settings. The
objective of this analysis is to quantify the scaleof the loss arising specifically: (a) from lack4
5

of investment in O&M; and (b) in the context
of schools. Subsequent analysis can draw on
a similar methodology to explore how theissue of Toilet Loss is being addressed acrosscountries in different contexts and monitor
progress towards tackling Toilet Loss.

Data definitions
The analysis draws on data from the JMP asa basis.4 The JMP classifies toilets as one of
the following, in the context of schools:• No service: The infrastructure for toilets or
latrines does not exist, or the facilities that exist
are unimproved (pit latrines without a slab orplatform, hanging latrines, bucket latrines).
• Limited: The infrastructure for improved
facilities exists (flush/pour-flush toilets,
pit latrine with slab, composting toilet),but it is either not single-sex or usable• Basic: The infrastructure for improved
facilities exists and is single-sex and usable.
Improved facilities are defined as those that
use technologies designed to hygienicallyseparate excreta from human contact.5
A fourth level of service—advanced
services—incorporates additional elementsof toilet usability such as student per toilet
ratios, facilities for menstrual hygiene
management and toilet accessibility for allusers. However, data on advanced services
is not currently collected across schools.

See JMP service definitions for sanitation in schools: https://washdata.org/monitoring/schools
See JMP service definitions for sanitation in schools: https://washdata.org/monitoring/schools©Economist Impact 2023

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FIGURE A1. Interpreting the JMP’s data on basic, limited and no sanitation services

Basic sanitation services

Limited sanitation services

No sanitation services

The infrastructure for
improved facilities exists andis single-sex and usable.

The infrastructure for improved
facilities exists, but it is not
single-sex and/or usable

The infrastructure for toilets or
latrines does not exist, or the facilities
that exist are unimproved

Constructed
toilets

Regular
O&M

Constructed
toilets

No
O&M

No
construction

No
O&M

Based on the JMP’s definitions, our analysis assumes that toilets that are defined as“limited service” exist, but are not usable because they have not received sufficient andregular O&M. Meanwhile, toilets defined as “basic service” both exist and are usable.

Analysis scope
Country selection
The objective of the analysis is to estimate
Toilet Loss and the options for addressing
it in four selected countries: Ecuador, India,
Nigeria and the Philippines. These countries
were selected based on a number of criteria:
1. Geography. We have selected countries toprovide wide geographic representation todemonstrate the scale of toilet loss acrossdifferent global regions. We therefore include
one Latin American country (Ecuador), two
Asian countries (India and the Philippines)
and one African country (Nigeria). The
spread of geographies provides insight into
where Toilet Loss is the most pronounced,
and the different policy responses that may
be required across regions to address it.

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2. Availability of data. The availability ofdata formed an important criterion incountry selection to ensure that current
levels of availability and usability can be
determined to then estimate the gap
that needs to be filled. The four selected
countries all have the most recent data
available on the JMP database.6
3. Gaps in access to toilets. We want
to look at the countries that have thebiggest gaps in toilet access to assess themagnitude of the potential gains fromovercoming toilet loss (see Figure A2).
4. Child population. The number of children
in the selected countries represents almost
26% of the global child population. This
provides greater validity of the findings thatemerge from the analysis (see Figure A3).

The most recent data points are for 2021.

©Economist Impact 2023

Tackling Toilet Loss

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FIGURE A2. Percentage of children covered by sanitation services in sample countries7
59.2

Ecuador

30.1

10.7

86

India

37.5

Nigeria

5.9
19.6

42.9

73.8

Philippines
Basic

Limited

8.1

18.3

7.8

No service

Source: JMP; Economist Impact analysis.

FIGURE A3. Percentage of child population in sample countries compared to the rest of the world
1.5%
3.8%

20.3%

Rest of the world
Philippines
Nigeria

0.3%
74.1%

India
Ecuador

Source: World Bank; Economist Impact analysis.

7

JMP data on limited and no service shares for India have been adjusted from published data based on consultations with experts toaccount for data collection challenges.

©Economist Impact 2023

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Scenarios
Construction alone scenario: All
additional sanitation investment isdirected entirely towards the constructionof new toilets to achieve full sanitation
coverage by 2030

The analysis looks both at the backward-looking
costs that have been incurred based on past
investment decisions related to school sanitationand identifies a forward-looking pathway bycomparing the future costs and benefits ofdifferent levels of investment in the construction,
operations and maintenance of school toilets.
The future investment scenarios assessed areoutlined in Figure A4.

O&M alone scenario: All additional
sanitation investment is directed
entirely towards the O&M of existing
dysfunctional infrastructure to convert all
limited service toilets into basic service
toilets
Construction & O&M scenario: “Bestcase” scenario with investment in bothconstruction and O&M to achieve fullcoverage of basic sanitation facilities inschools

FIGURE 20. Future investment scenarios for school sanitation
FIGURE A4. Future investment scenarios for school sanitation
100%
Construction
alone scenario

Limited services

BY 2030:
0% no services
Some children without access tobasic service toilets at school

Basic services

All investment is assumed towards constructing new toilets

100%
O&M alone
scenario

No services

0% limited services
Some children without access to any
sanitation facilities at school

Basic services

All investment is assumed towards maintaining existing toilets

100%
Construction andO&M scenario

Basic services

100% basic services
All school children with accessto clean and usable toilets

All investment towards both constructing new toilets and maintaining new and existing ones

©Economist Impact 2023

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Detailed methodology andassumptions
As a starting point, the analysis uses datafrom the JMP on the level of access totoilets that children have in school andthen builds on it in a number of ways tocalculate, both historically and in the future:
the availability of toilet infrastructure inschools; investment in sanitation in schools;
and the benefits of sanitation investment.
1. Toilet infrastructure in schools: We
calculate the number of toilets thatexist across schools, split by those thatare usable and those that are not.
a. Backward-facing analysis: We estimate
the growth in toilet infrastructure ineach country since 2015, when the
UN Sustainable Development Goals(SDGs) were first introduced.
b. Forward-facing analysis: We estimate therequired growth in toilet infrastructure tomeet the SDGs and provide all children
with access to toilets in school by 2030.
2. Investment in sanitation in schools:
We use a bottom-up approach to quantify
the financial costs of providing sanitationin schools, including costs incurred inconstruction, operation and maintenance.
a. Backward-facing analysis: Based on ourestimates of existing toilet infrastructure,
we assess and quantify the investment
levels that are expected to have gone into
providing this infrastructure. Toilet Loss isestimated as the investment in constructing
toilets that are currently unusable.
b. Forward-facing analysis: For eachscenario, we estimate the required
investment in construction, operations andmaintenance in closing sanitation gaps.
3. Benefits of sanitation investment:
We quantify the socioeconomic impactsof sanitation investment in schools thatemerge through reduced healthcare
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payments, increased family income
and increased economic output.
a. Backward-facing analysis: We quantify
the lost benefits from constructing toilets
that are unusable by children in school.
b. Forward-facing analysis: For eachscenario, we estimate the futuresocioeconomic gains that could be madefrom investing in closing sanitation gaps.
The remainder of this section discusses the
specific methodology used in the analysis,
including the assumptions made. The
methodology is designed to draw on nationallycollected and publicly available data using
standardised methodologies that can be
replicated over time and across countries.
Estimating toilet infrastructure in schools
The analysis draws on JMP data as a starting
point on the percentage of children in schools
with: no sanitation services; limited sanitation
services; and basic sanitation facilities.8 It
should be noted that JMP data on limited andno service shares for India have been adjusted
from published data based on consultations
with experts to account for data collection
challenges. Using these data, we assume thataccess to limited sanitation services denotes theavailability of infrastructure that is not usable,
while access to basic sanitation services denotes
infrastructure that is available and usable (thatis, investments in O&M have been made).
We convert data on access into estimatesof toilet infrastructure using the standards
outlined by the World Health Organization(WHO) in the document Water, sanitationand hygiene standards for schools in low-costsettings.9 This document states a requirementof at least one toilet per 25 girls, and one toilet
and one urinal per 50 boys. If, for example, anestimated 25,000 girls have access to toilets by
the JMP’s estimates, we therefore assume that
1,000 toilet units are available. An underlying
assumption in this analysis, validated throughour expert interviews, is that the required
guidelines for toilet-to-student ratios are met.

https://washdata.org/monitoring/schools
https://apps.who.int/iris/bitstream/handle/10665/44159/9789241547796_eng.pdf?sequence=1&isAllowed=y©Economist Impact 2023

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Using this approach, we estimate thetotal required number of usable toilets,
based on JMP estimates of the size ofthe school-age population, split by:• the number of toilets that are available
and usable (basic service toilets);• the number of toilets that are available but
not usable (limited service toilets); and• the number of toilets that are notcurrently available (no services).
In the present, this analysis provides an estimateof the current gap in access to toilets in schools.
In the future, we account for population growth
to estimate the number of toilets that will be
required and the gaps in meeting those needs.
Estimating investment insanitation in schools
Having estimated the current availability of
toilets in schools and the gaps in access, theanalysis quantifies the investment costs—
including both those that have been incurred andthose that need to be incurred to close gaps.
We use a bottom-up country-specificapproach to estimating the costs involvedin providing sanitation services in schools,
including the costs of construction and O&M.
We assume that the following costs are
incurred for each type of sanitation service:• Basic sanitation services: Costs are
incurred in both construction and O&M.
• Limited sanitation services: Costs are
incurred only in construction. We assume
that limited toilets are unusable and,
therefore, no costs are incurred in O&M.
• No sanitation services: No costs are
incurred in either construction or in O&M. It
is recognised that the “no service” categoryof toilets under JMP definitions includes“unimproved toilets” which will also haveincurred some construction costs; however,these are not captured in the analysis.
10

11
12

From a backwards-looking perspective,
the analysis estimates the investment thathas been made between 2015 and 2021
based on the existing toilet infrastructure
and the split of basic and limited service
toilets currently available across schools. We
estimate Toilet Loss as the investment madein constructing limited service toilets thatare unusable as a result of lack of O&M.
From a forward-looking lens, we estimate
the investment that is required between
2021 and 2030 to close the gaps in sanitation
access. All future costs are discounted
at a rate of 3.5% to estimate the present
value of future required investments.10
It should be noted that rehabilitation costs—orthe costs incurred if an existing toilet has beenleft unmaintained for an extended period oftime and, therefore, requires rehabilitation
to bring it back to a basic service level before
it is available for use again—are not included
in our analysis. These costs may be incurredin closing sanitation gaps; however, they vary
substantially across countries and depend on
the type of toilet constructed, and the extent
of disrepair. The existing data do not allow for
an assessment of how many toilets require
rehabilitation. As a result, our estimated overall
cost requirements for closing sanitation gaps
will be lower than they are likely to be in reality.
Construction costs. Our estimates of
construction costs are based on:• The cost of different sanitation
technologies in each country: In theabsence of country-level data, we use
estimates of construction costs from India
in 2011. We update these estimates for thepresent local context using two adjustments:(1) the costs are adjusted for inflation
between 2011 and the present using a GDP
deflator to estimate real prices;11 and (2) thecosts are adjusted for purchasing power
parity (PPP) between countries using a PPP
adjustment factor.12 Table 1 below summarises

https://www.gov.uk/government/publications/the-green-book-appraisal-and-evaluation-in-central-governent/the-green-book2020#valuation-of-costs-and-benefits
https://data.worldbank.org/indicator/NY.GDP.DEFL.ZS?end=2021&start=2000
https://www.google.com/url?q=https://data.worldbank.org/indicator/PA.NUS.PPP&sa=D&source=editors&ust=1695833328157045&usg=AOvVaw2eKBkfmvOJpyNFT9yeoz8T©Economist Impact 2023

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the base costs assumed before countrylevel adjustments have been applied.

predominantly used in each country. The
shares assumed for each country are listed
in Table 2 below. In the case of urinals (notincluded in Table 2), a 100% share is assumed
for urinals for boys, drawing on the WHO
requirements of one urinal per 50 boys.

• The share of toilets by technology in eachcountry: We estimate a weighted average costof constructing a toilet in each country basedon the cost of each sanitation technology andestimates of the share of different technologies

Table 1. Estimating toilet construction costs by country: cost by technology in India
Sanitation technology

Cost (2011 prices)

Simple-pit latrine

US$ 2613

Pour-flush

US$ 35814

VIP-latrine

US$ 35815

Cistern flush

INR 39,86616 (equivalent to US$ 880)

UrinalINR 8,333 (2014 prices)17 (equivalent to US$ 137)

Table 2. Sanitation technology shares by country
Ecuador

India

Nigeria

Philippines

Simple-pit latrine

32%

1%

38%

7%

Pour-flush

2%

43%

0.5%

43%

VIP-latrine

1%

8%

29%

7%

Cistern flush

65%

48%

32.5%

43%

Source: Economist Impact based on multiple country-specific sources.

Based on assumptions of the cost by sanitation
technology, and the shares of each, weestimate the cost per toilet constructed ineach country. Different estimates are used
for male and female toilets, given additional
requirements for urinals for male children.
O&M costs. We assess a range of costs requiredin the annual O&M of toilets. Assumptions on
the required units of each type of expenditure
per school toilet have been obtained fromavailable literature, as outlined in Table 3
below. We convert all required units into
requirements per toilet per school year,
and apply unit costs to estimate the annual
investment needed. Country-specific unit
costs have been estimated through a scan of
consumer data on online marketplaces. In cases
where country-specific data are unavailable forcertain countries, we use data from alternative
countries as a proxy and adjust for PPP.

https://www.ircwash.org/sites/default/files/IRC-2012-Cost.pdf
https://www.ircwash.org/sites/default/files/IRC-2012-Cost.pdf
https://www.ircwash.org/sites/default/files/IRC-2012-Cost.pdf
16
https://www.ircwash.org/sites/default/files/Jharkhand-2004-Layout.pdf
17https://www.indiawaterportal.org/articles/cost-effective-urinals-established-musiri-boys-high-school-trichy-case-study-unicef-iit
13

14
15

©Economist Impact 2023

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Table 3. Annual O&M requirements
O&M cost category

Annual requirements*

Water for flushing

Estimated as a weighted-average based on sanitation technology:18
simple pit: 0 litrespour flush: 3 litres per student per day
VIP latrine: 0 litres
cistern flush: 7 litres per student per day
urinal: 2 litres per student per day

Water for handwashing

1.5l per student per day

Water for cleaning latrines

10l per toilet per day

Rubbish bin with cover

1 per toilet per year

Toilet brush

1 per toilet per year

Dipper/mug

1 per toilet per year

Floor mop or brush

1 per toilet block per year19

Bucket1 per toilet block per year

Broom

2 per toilet block per year

Hand gloves

5 per toilet block per year

Face mask

2 per toilet block per year

Cleaning cloth

2 per toilet block per year

Rubber boots

1 per toilet block per year

Detergent powder

53g per toilet per day

Bleach30 ml per toilet per day

Hand washing soap

2.5g per student per day

Cleaning staff

2 people per block per year20

Latrine pit emptying

Once every year21

Repairs to sanitation hardware

Once every year22

Screwdriver

1 per toilet block per year

Toilet pump

1 per toilet block per year

Hammer1 per toilet block per year

Pipe wrench

2 per toilet block per year

https://sswm.info/sites/default/files/reference_attachments/TILLEY%20et%20al%202014%20Compendium%20of%20Sanitation%20
Systems%20and%20Technologies%20-%202nd%20Revised%20Edition.pdf
We assume that one toilet block contains three toilets.
20
https://www.google.com/url?q=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409642/&sa=D&source=editors&ust=1695834438043590&usg=AOvVaw3R-n4Huuxgk1Q0UKyH8kwn
21
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409642/
22
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409642/
18

19©Economist Impact 2023

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Hook locks

2 per toilet block per year

Can sealing agent

1 per toilet block per year

Teflon tapes

3 per toilet block per year

Extra faucets

1 per toilet block per year

Paint

1 per toilet block per year

*Unless otherwise specified, assumptions on the unit requirements for O&M expenditure draw on the Fit for School O&M manualdeveloped in the Philippines.23

Using the assumptions above on construction and O&M costs, we estimate countrylevel costs per toilet. The estimated values are presented in Table 4 below.

Table 4. Estimated investment costs per toilet, by country (US$, 2021 prices)

Construction costs(one-time cost per
toilet)O&M costs (annual
costs per toilet)

Ecuador

India

Nigeria

Philippines

Female

1,600

1,010

1,000

1,070

Male

1,860

1,160

1,200

1,260

Female

560

350

390

390

Male

680

410

440

470

Source: Economist Impact estimates.

Estimating the benefits of sanitation investment
Although there are financial costs incurred in expanding access to sanitation in schools, there are also
large socioeconomic benefits of investment. We estimate these benefits to demonstrate the returns
on investment into sanitation.
From a backwards-looking perspective, we estimate the opportunities lost between 2015 and2021 from not providing complete access to usable sanitation services in school for all children,
comparing outcomes based on current levels of access to full access.
From a forward-looking perspective, we estimate the potential gains to 2030 from investment
under each investment scenario. All future benefits are discounted at a rate of 3.5% to estimate thepresent value of future required investments, with the exception of health-related benefits, which arediscounted at a lower rate of 1.5%.24
There are a number of channels through which lack of adequate sanitation creates socioeconomic loss.
Lack of adequate sanitation spreads infectious diseases, including diarrhoea and worm infections.25
These diseases cause nearly 4,000 daily deaths globally.26 Inadequate sanitation also impacts morethan health. It can impede access to education—studies have shown impacts on both enrollment andhttp://www.fitforschool.international/wp-content/ezdocs/WASH_in_Schools_Operation_and_Maintenance_Manual_2017.pdf
https://www.gov.uk/government/publications/the-green-book-appraisal-and-evaluation-in-central-governent/the-green-book2020#valuation-of-costs-and-benefits
25
https://www.who.int/news-room/fact-sheets/detail/sanitation#:~:text=Poor%20sanitation%20is%20linked%20to,the%20spread%20
of%20antimicrobial%20resistance.
26
https://www.unicef.org/media/137206/file/triple-threat-wash-EN.pdf
23
24©Economist Impact 2023

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FIGURE A5. The lifetime journey of potential impacts from inadequate sanitation

Loss of societal
employment
opportunities

Loss ofsocietalincomeReducedeconomic
demandHealthcareburden on
families

Inadequate
sanitation inchildhoodPresence andtransmissionof diseases

Loss of labour
supplyDeath

Reducedschoolenrollment
and/orattendance

Reducedlearning
outcomes

Loss of humandignity

Reducedself-worth

Reduced future
employment
opportunities

Reducedfuture earningpotential

Reducedproductivity

Societal impacts

Individual impacts
Short-term impacts

Reducedeconomic
outputLong-term impacts

attendance, with more pronounced impacts
for girls.27,28 This has knock-on implications forlearning outcomes and wellbeing and, over the
longer term, on employment opportunities
and earning potential. Across communities andsocieties, these individual-level impacts havewider societal and economic impacts, ranging
from lower productivity to the perpetuationof social inequalities (see Figure A5).29
Although the longer-term benefits of investingin Toilet Loss can be substantial, the evidence on
impacts is inconclusive.30 As such, longer-term
impacts cannot be robustly quantified and ouranalysis. In addition, some short-term benefits
such as higher self-worth and improved learning
outcomes cannot be quantified in monetary
terms and hence are not included in the analysis.
Instead, the analysis focuses on the immediate
quantifiable impacts that arise through three key

channels: healthcare benefits, increased family
income and increased economic output. Benefits
across each of these channels are aggregated toprovide an overall estimate of socioeconomic
impact from sanitation investment.
Healthcare benefits. We estimate thehealthcare benefits of investment in sanitation
based on assumptions of reductions indiarrhoeal infections and resulting costsavings from treatment. Drawing on existing
literature, we assume the rate of diarrhoeal
infection in children drops from 69% without
access to a toilet to 49% with access.31 Using
these assumptions, we estimate the change
in diarrhoeal infections from investment
in sanitation in schools, assuming that
this reduction only arises from access to abasic service toilet (and not from limitedservice toilets). We draw on the following

https://www.mdpi.com/1660-4601/9/8/2772
https://iwaponline.com/washdev/article/8/1/53/38065/Sanitation-and-water-supply-in-schools-and-girls
https://www.who.int/news-room/fact-sheets/detail/sanitation30
https://www.mdpi.com/1660-4601/9/8/2772
31https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437198/
27

28

29

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cost estimates, adjusted for inflation
and PPP to estimate resulting countryspecific reductions in healthcare costs:

assessed, the benefits from increased family
income account for a small share of the overall
benefits from investment in sanitation (lessthan 10%). As in the case of healthcare benefits,
the benefits from increased family income
only arise from additional access to basic
service toilets that are usable by children.

• Cost per case of diarrhoea requiring
inpatient treatment: US$140 (2015
prices), applicable to 0.5% of cases32,33• Cost per case of diarrhoea requiring
inpatient treatment: US$37 (2015
prices),applicable to 99.5% of cases34,35
Increased family income. We estimate
increased family income from reduced days
taken off work by adults to care for sick children.
We assume that parents need to take days
off work or find alternative care for children
for 50% of the time that children are sick, foran estimated 1.3 days per episode.36 Applying
country-specific data on average earnings
per day, we estimate the additional incomethat could be earned from a reduced needto take these days off.37 Across the countries

Increased economic output. Increased
investment in construction and O&M generate
additional local economic activity throughthe creation of employment and, therefore,
income. We estimate these impacts by applying
economic multiplier estimates drawing on therelevant literature. Unlike healthcare benefits andincreased family income, increased economic
output benefits arise regardless of where theinvestment in sanitation is made—construction
or O&M. Table 5 below summarises the multipliereffects assumed for every US$1 invested inconstruction and O&M across countries.

Table 5. Assumed economic multipliers for every US$1 invested in construction or O&M,
by country
Ecuador38

India39

Nigeria40

Philippines41

Construction

1.5

2.0

1.5

1.5

O&M

1.4

1.3

2.1

1.6

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201538/
https://pubmed.ncbi.nlm.nih.gov/22480268/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201538/
35
https://pubmed.ncbi.nlm.nih.gov/22480268/
36
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437198/
37
https://data.worldbank.org/indicator/NY.ADJ.NNTY.PC.KD38
https://contenido.bce.fin.ec/documentos/PublicacionesNotas/Catalogo/CuentasNacionales/Anuales/Dolares/PR_MatrizInsumoProducto10.pdf
39
https://www.adb.org/what-we-do/data/regional-input-output-tables
40
https://www.eajournals.org/wp-content/uploads/Assessment-of-Nigerias-Economic-Sectors.pdf
41
https://www.adb.org/what-we-do/data/regional-input-output-tables
32
33

34

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Tackling Toilet Loss

15

Limitations and data requirements
The analysis conducted for this researchadds to the existing data and literature bydemonstrating the losses incurred from lack ofadequate investment in school sanitation andthe socioeconomic benefits on offer. However,there are limitations that should be taken into
account and serve as a call for additional data tofurther develop our understanding of the current
state of access to sanitation across schools.
Estimating toilet availability andrequirements. The analysis makes simplifying
assumptions to utilise data collected by the
JMP. Specifically, it assumes that toilets thatare defined as “limited service” exist, but are
not usable because they have not received
sufficient and regular O&M. Meanwhile, toilets
defined as “basic service” both exist and areusable. However, these assumptions are likely tooverestimate current levels of access in two ways:
1. The number of existing toilets isoverestimated. We assume that WHO
guidelines on student-to-toilet ratios—one
toilet per 25 girls, and one toilet and one
urinal per 50 boys—are met in all schoolsthat have access to “basic services”; however,the JMP assigns “basic service” levels to any
school that has at least one toilet facility.42
2. The number of usable toilets is also
overestimated. We assume that all “basic
service” facilities are usable in practice.
The JMP’s definition of “basic service”
accounts for school toilets being accessible,
functional and private. Other measures ofusability—such as cleanliness—are captured

42

in “advanced services” for which data are notyet collected at the country level. Therefore,
the analysis does not distinguish between“basic” and “advanced” levels of service.
As a result, we expect that estimates fromthe analysis of infrastructural and financial
requirements to close access gaps—aswell as the benefits that could arise
from doing so—are underestimated.
Going forward, there is an urgent need for more
standardised frameworks to guide data collection
on not only levels of access to school toilets, butalso the quality of this access. Without these
data, we will continue to remain in the dark onlevels of access to adequate usable facilities inpractice, and we will be unable to fully grasp
the scale of the challenge that lies ahead.
Estimating the socioeconomic returns
from investment in sanitation. The study
focuses on quantifying the short-term tangible
impacts from investing in providing children
with sanitation at school. These short-term
impacts can translate into much larger longerterm impacts. These have not been assessedin this study for two key reasons: (a) the time
horizon for the analysis extends only to 2030,
as the focus is on the requirements to meet theSDGs—this is too near in the future to observe
tangible longer-term impacts as the children who
benefit grow into adults; and (b) the literature
available is inconclusive on the magnitude ofthese longer-term impacts. Future research
could further explore these impacts to build
a more comprehensive understanding of themultifaceted impacts of sanitation investment.

https://apps.who.int/iris/bitstream/handle/10665/44159/9789241547796_eng.pdf?sequence=1&isAllowed=y©Economist Impact 2023

Tackling Toilet Loss

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©Economist Impact 2023

Tackling Toilet Loss

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While every effort has been taken to verify the accuracy of thisinformation, Economist Impact cannot accept any responsibility
or liability for reliance by any person on this report or any of
the information, opinions or conclusions set out in this report.
The findings and views expressed in the report do
not necessarily reflect the views of the sponsor.

©Economist Impact 2023

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