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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.

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