Toilets provide an important health function by separating users from faecal material that can be the source of many waterborne illnesses, including cholera and diarrhoea, and soil-transmitted diseases, such as intestinal worms.

A lack of hygienic toilet facilities has detrimental consequences for humans. The World Health Organisation estimates that inadequate sanitation causes 432,000 diarrhoeal deaths, with mainly young children among the victims.

Lack of sanitation also contributes to malnutrition, lost educational opportunities and a lack of dignity. Knock-on effects on a country can be significant and it is estimated that in 2015 poor sanitation cost the global economy about $222-billion (R3-trillion) – a 22% increase on 2010 – mainly through mortality, loss of productivity, the burden on healthcare for preventable diseases and the time used in gaining access to a toilet.

Despite the many societal benefits of providing hygienic sanitation, about two billion people in the world do not have basic facilities, with nearly 700 million having to relieve themselves in bushes, in water and in streets.

These are eye-opening statistics for many of us for whom a hygienic toilet is one of every building’s standard fixtures.

World Toilet Day serves a reminder and an inspiration for the world to tackle the global sanitation challenge. The theme for World Toilet Day 2019 is “Leaving no-one behind” and is linked to the UN’s Sustainable Development Goals, specifically Target 6, which is to eliminate defaecating in the open and to ensure everyone has access to sustainable toilet services by 2030.

It has been 50 years since the first manned Apollo 11 mission to land on the Moon and there have been massive technological advances since then. Yet, as a global community, we have not figured out how to achieve universal toilet access – a basic human need. Why do we struggle with this and what are the challenges?

There are two main ways to tackle the challenges: full-flush devices linked to sewers and dry sanitation in the form of latrines.

Full-flush toilets connected to sewers are mainly found in urbanised areas within South Africa. It may be surprising to hear that the basic design of the flush toilet has not changed considerably since the late 1700s. The S-shaped pipe that you find at the bottom of toilet and connecting to the wall of your home and a sewer system is the same design that has been used for nearly 300 years.

The water inside the toilet bowl of your flush toilet serves as an odour trap, while the flushing water is used a transport medium to remove the faecal waste into sewer systems. In urban South African homes, about six to nine litres of potable water – water that is safe for human consumption – is used to do this.

Globally, the flush strategy has resulted in a significant reduction in waterborne illnesses. But, in South Africa, which experiences uneven rainfall distribution and water stress in various parts, the model might not be viable in the long-term.

At the moment, many parts of the country are experiencing heatwave conditions and there is concern over water supply. Requests have been by water utilities to use water more sparingly – especially as water consumption tends to increase in heatwave conditions.

People can conserve water by reducing or recycling water for flushing. Flushing makes up about 30% of household water use and it seems illogical that we flush away so much clean, drinkable water of limited supply. Would one use six to nine litres of cooldrink or fruit juice to flush faecal waste? Probably not – indicating how little we consider the value water.

With high urbanisation trends and population growth, more and more people want to be connected to the sewer system – resulting in more potable water flushing and increasing pollution load volumes to be treated. The main reasons South Africa cannot install sewers throughout the country is that it is too costly and there’s not enough water available.

On the opposite side of the technical spectrum are on-site sanitation systems. These systems are not connected to a sewer and are common outside urban centres. Septic tanks are one example, but by far the most common option in rural and peri-urban settlements are latrines – commonly called “long drops”. Faecal waste drops into a hole in the ground.

The best attribute of latrines is that they do not require water – or sewerage pipes. The downsides are that they are a temporary solution and need to be periodically moved to new ground. Depending on the number of users, relocation can be frequent. With chemical-treatment latrines – often in the form of plastic cubicles – the cost of disposal of the viscous, sticky paste called faecal sludge can be significant.

With limited options available, municipalities have little choice but to implement such costly solutions, but they are not sustainable over the long-term.

There is a need for new and innovative toilets that close the gap between the aspirational flush-style and rudimentary pits.

The Water Research Commission (WRC) based in Pretoria was established in terms of the Water Research Act (Act No 34 of 1971) with one of its mandates to stimulate and fund water research according to priority. Together with national and international stakeholders, the WRC has focussed on developing sanitation solutions that fill the gap dictated by South Africa’s technical constraints.

This includes development of water-efficient flush toilets like the Arumloo, which uses less than three litres per flush. The hydrodynamic features of the Arumloo bowl were copied from the arum lily plant, using biomimicry. The product has been tested according to international flush standards and compares well to conventional toilets.

This product is innovative, but there is a need to create a market for such water-efficient products within South Africa – and policies that allow for their development and rollout.

A similar strategy was used by the US Environmental Protection Agency (EPA) develop water-saving flush toilets. In 1992, the US Energy Policy Act 1992 was enacted to lower flush volumes from 13 to 19 litres per flush to eight litres. Manufacturers came on board and there were significant toilet water usage savings (of over 50%), while indoor water use also declined (by 16%). In 2007, through the US EPA WaterSense Programme, toilet manufacturers were prompted to greater flush efficiencies (six litres per flush). Products achieving the WaterSense Programme flush standard could be marketed as water-efficient.

The South African Sanitation Technology Enterprise Programme (Sastep), driven by the WRC and involving national and international partners, aims to achieve similar results. However, the programme is not only about conventional toilets and embraces new, innovative ideas. Sastep says it will support and accelerate the application and uptake of the latest cutting-edge toilets through evidence-based policy adjustments, demonstration, testing and science-based improvements towards localisation and industrialisation. This includes technologies supported by the Bill and Melinda Gates Foundation’s “Reinvent the Toilet” programme.

Such revolutionary toilet systems have water-saving or water-recycling features, are aspirational in design and, more importantly, can eliminate pathogens and sludge production at point-of-source without the need for sewers.

For informal areas or areas with constrained water supply, these solutions could be central to providing sanitation services and saving countless lives.

South Africa is a test-bed for developing and demonstrating these solutions, with a few of them recently highlighted in the Netflix docuseries “Inside Bill’s Brain”, which highlights the drive of Bill Gates, Microsoft’s co-founder, to find creative and innovative solutions to sanitation.

An important cog upscaling these new solutions is having appropriate process performance standards to ensure that the new toilets are able to meet a specific public health and environmental standard. This will ensure product durability and reliability and manufacturability. Globally, process standards for these technologies have been adopted by the International Standards Organisation (ISO).

On World Toilet Day, the American National Standards Institute (ANSI) hosts a Non-Sewered Sanitation ISO training programme, together with Department of Water and Sanitation and the WRC, that aims to facilitate understanding of the new technology standard. Further training courses are planned with innovators, the building industry and municipalities.

It is anticipated that the new toilet standard will provide impetus for creative and innovative thinking to develop appropriate sanitation solutions and services for South Africa and the region and thereby save many lives. MC

Sudhir Pillay and Akin Akinsete work at the Water Research Commission.