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This working paper describes sanitation access challenges in cities of the global south that have been overlooked in global indicators. In analyzing 15 cities, we found that almost two-thirds of urban residents lack access to safely managed sanitation, with access lowest in South Asia and Sub-Saharan Africa. For these households, sanitation services are too expensive or unsafe. This paper highlights four key action areas for cities to improve sanitation access: extend the sewer and simplified sewer networks to household, communal and public toilets; support and regulate on-site sanitation in the absence of sewer systems; support citywide settlement upgrading; and make sanitation services affordable for all.


This case study in the World Resources Report, Towards a More Equal City, examines transformative urban change in Kampala, Uganda, by following its sanitation reforms. The research follows the political process that created favorable conditions for the implementation of innovative solutions to sanitation service provision. The unfolding change remains vulnerable to shifting fiscal priorities and local political instabilities, however, with continued support from all stakeholders, it seems likely that the urban change in Kampala will be sustained.

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