Hesperian Health Guides

Toilets for Health (Sanitation)

Cleanliness in the community is just as important as cleanliness for individuals and families. Sanitation means public cleanliness — using clean and safe toilets, keeping water sources clean, and disposing of garbage safely (see Garbage, Medical Waste, and Pollution - in development). Poor sanitation causes a great deal of unnecessary sickness and death.

 men and women of different ages, some with children, one with crutches, having a group discussion

Any community effort to improve sanitation must help people overcome the challenges they face in their daily lives. Poverty and lack of access to enough water often make it difficult for people to improve sanitation.

Experts may offer technical solutions, such as flush toilets or complex sewage treatment systems. These kinds of technical solutions may work in some places, but that does not mean they will solve the problems of your community or that people will use them. A health worker who knows and listens to the needs of the people will have important information the expert does not have. Experts and community members should work together to solve problems.

Include women in the discussions about the community’s needs and possible solutions. Women often care for children and the home, so they may recognize sanitation and water issues that the men do not see. When everyone is involved in making decisions and works together to improve sanitation, everyone benefits.

Use toilets to manage human waste

When human waste (feces) is not managed well, it pollutes water, food, and soil with germs, and leads
to diarrhea and other serious health problems. Using toilets prevents germs from getting into the environment, and protects the health of the whole community.

 woman washing her hands at a tap close to a toilet shelter

Health is not the only reason to build and use toilets. People also want:

  • Privacy: A toilet can be as simple as a deep hole in the ground. But the need for privacy makes it important for a toilet to have a good shelter with a door or curtain. Shelters can be made from local materials,or they can be made from concrete.
  • Safety: For a toilet to be safe it must be well built and in a safe place. No one will use a toilet if they are worried about it collapsing. And if the toilet is far from the home, or in an isolated place, women may not feel safe using it.
  • Comfort: People will more likely use a toilet with a comfortable place to sit or squat, and a shelter large enough to stand in. They will also be more likely to use a toilet that is nearby the house and is sheltered from wind, rain, or snow.
  • Cleanliness: If a toilet is dirty and smelly, no one will want to use it. A toilet also must be clean to prevent the spread of germs. Sharing the task of cleaning will help make sure that toilets are properly used and cared for.
  • Respect: A well-kept toilet brings status and respect to its owner. This can be what motivates people to spend the money and effort to build one.

Where to build a toilet

When deciding where to build a toilet, make sure it will not pollute any water sources such as rivers, wells, or springs. A toilet should be at least 20 meters from all water sources.

Also be sure the toilet will not pollute the groundwater. Groundwater flows at different depths underground in different places. The risk of groundwater pollution depends on the type of soil, the amount of rain or moisture in the area, and the depth of the groundwater. Keep in mind that water levels are much higher in the rainy season than in the dry season. But some general rules include:

  • The bottom of the pit should be at least 2½ meters above the groundwater.
  • If you dig a pit for a toilet and the soil is very wet, or if the pit fills with water, this is a bad place to put a toilet. Germs from the human waste will contaminate the groundwater.
  • Do not build pit toilets on ground that gets flooded.
  • When there is a risk of groundwater pollution from pit toilets, consider building an above-ground toilet. If there is no choice but to build a toilet in a place where there is a risk of groundwater pollution, place the toilet downhill from nearby wells so the germs will flow away from the wells.
showing depth of well deep enough to reach groundwater, compared to toilet which is much shallower than groundwater
Groundwater is water that has soaked into the earth and flows underground. When building a toilet, make sure the pit is not so deep that it will pollute the groundwater.

Types of toilets

There are many kinds of toilets, and no one kind is right for every community or household. When deciding what kind of toilet to build, think about the needs of those who will be using it and the kind of space you have for it. Also think about whether you and your family will want to use and maintain a composting toilet; if not, then the pit toilet may be best for you. All 3 types use no water

There is no perfect toilet. Each has its drawbacks. But the 3 types of toilets described in this chapter are good at keeping communities clean and healthy, with the least harm to the environment and to people. All 3 types use no water.

Most water flush toilets only move the problem (feces and germs) from one place to another, they contaminate a lot of water while doing so (see below), and they do not make human waste safe. To use water to clean after passing stool, there are safe toilets you can build that do not contaminate the environment, for example, the pour-flush toilet. To learn how to make this toilet, see chapter 7 of
A Community Guide to Environmental Health

 hotel dumping sewage next to village stream where people and animals are washing and carrying the water for use

Flush toilets and
sewage systems

Flush toilets use water to carry waste away through pipes called a sewage system. They improve health, especially in crowded urban areas, and are often the kind of toilets people want.

But flush toilets have a lot of problems that may not be obvious. The sewage must be treated to remove germs from the water before it returns into waterways or for reuse. This is costly, so often sewage is dumped into rivers, lakes, or the ocean without being correctly treated. This spreads the germs from the sewage into our water systems or those of our neighbors.

Many of the chemicals used to treat sewage contaminate sources of drinking water and land where people live and farm. Flush toilets also waste fresh water that is needed for drinking and farming. While so many people lack enough water to drink, it is wrong to flush so much water down the drain.

Closed pit toilet

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A closed pit toilet has a platform with a hole in it and a lid to cover the hole when it is not in use. The platform can be made of wood, concrete, or logs covered with earth. Concrete platforms keep water out and reduce health problems because they are easy to clean. A closed pit toilet should have a lining or concrete ring beam to prevent the platform or the pit itself from collapsing.

Adding a vent pipe to reduce smells and flies (called a “ventilated improved pit,” or VIP, toilet) is an improvement that makes pit toilets much more pleasant to use.

A closed pit toilet that is 2 meters deep will last a family of 5 people about 5 years.

A problem with pit toilets is that once the pit is full, the toilet can no longer be used. However, you can easily take advantage of the waste in a full — but unlined — pit by moving the shelter somewhere else and planting a tree on the site. Or, with only slightly different daily maintenance, you can build a composting toilet to turn the waste in a lined pit toilet into useful compost. A composting toilet can be quite simple.

To make a closed pit toilet

 two men using stones to reinforce a pit
 two men making a platform on top of the pit
  1. Choose a location that will be easy for people to get to and does not risk contaminating water sources.
  2. Dig a hole less than 1 meter across and at least 2 meters deep. If the soil is very sandy, you can line the pit with empty oil drums stacked on top of each other or cement bricks, so the pit does not collapse.
  3. Line the top of the pit with logs, stones, brick, a concrete ring beam, or other material that will support a platform and prevent the walls of the pit from falling in.
  4. Make a platform and a shelter to put over the pit. The platform can be made from concrete or local materials like logs or a mix of bamboo and mud. If you make a platform from logs, use wood that does not rot quickly.

How to make a concrete toilet platform and ring beam

A well-made concrete platform and ring beam will prevent a pit toilet from collapsing. A concrete platform also makes it easier to keep the toilet clean.

One 25 kilo bag of cement is enough to make 1 platform and 1 ring beam. It is easiest to make them both at the same time. You will also need reinforcing wires, bricks, and boards to form the mold, and a piece of wood cut to the shape of a keyhole to mold the hole. The platform and ring beam shown here are square, but you could make round ones.

1. Lay down a plastic sheet or used cement bags on flat ground. On top of this make a mold of bricks
or boards.
Toilet Platform Ring Beam
 illustration of the below: mold for a toilet platform
 illustration of the below: mold for a ring beam
Make the toilet platform about 120 cm long, 90 cm wide, and 6 cm high. Place a wooden “keyhole” mold, or a few bricks in the center to shape the toilet hole. Make the ring beam 130 cm long and 1 m wide on the outside, and 1 m long and 70 cm wide on the inside.
2. Make a concrete mix of 1 part cement, 2 parts gravel, 3 parts sand, and water. Pour the concrete into the mold until it is half-way to the top.
 man shoveling concrete into toilet platform mold
 shoveling concrete into ring beam mold
3. Place 3 mm thick reinforcing wires on top of the wet concrete.
 arrows showing placement of wires for handles in concrete for toilet platform
Make handles from wire 8 to
10 mm thick and set them in the concrete near the corners.
For the platform:
use 4 to 6 wires in each direction.
 arrow showing placement of wire in concrete for ring beam
For the ring beam:
lay wire on each side of ring beam.
4. Pour the rest of the concrete and level it with a block of wood.
 adding more concrete and smoothing for toilet platform
 adding more concrete and smoothing for ring beam
5. Remove the keyhole mold from the platform when the concrete begins to harden (after about
3 hours). If you used a brick mold, remove the bricks and form the hole into a keyhole shape.
6. Cover the concrete with wet cement sacks, damp cloth, or a plastic sheet. Wet it several times a day to keep it damp for 7 days. Keeping it damp makes the concrete dry more slowly and become stronger.
 man and woman carrying hardened ring beam
7. When the concrete is completely hardened, carry the ring beam to the toilet site. Level the ground, place the ring beam and dig a pit inside of it. Pack soil around the outside of the ring beam to set it in place. Then place the platform over the pit.
8. Make a cover for the hole from concrete or wood. It can have a handle, or can be made to be moved by a person’s foot, to avoid getting germs on the hands.
 Three women moving a toilet shelter to a new pit

Composting toilets

A composting toilet stores human waste until it breaks down and becomes compost. The mix will heat up and over time will kill the harmful germs, including roundworm eggs which are the hardest to kill. Composting toilets may seem like a strange idea at first, but when used properly they are a very safe way to manage human waste and improve soil quality at the same time.

Dig a pit 1 meter deep, and less than 1 meter across. Line the pit and build a platform as you would for any other pit toilet. But make the structure moveable.

To use and maintain a composting toilet

  • Before using, put dry leaves or straw in the pit. This will help feces decompose.
  • Add a handful of soil mixed with ashes or dry leaves after every use. This reduces smells and helps the waste to break down.
  • Do not put plastic, tins, or other garbage in the toilet.
  • Sweep and wash the platform often. Be careful not to get much water or cleaning chemicals in the pit.
  • When the hole is nearly full, remove the shelter, platform, and ring beam. (It will take about 1 year for a family of 5 to nearly fill a composting toilet that is 1 meter deep.)
  • Fill the hole with 15 cm of soil mixed with plant matter. After several weeks, the waste will settle.
  • Add more soil and plant matter, water, and plant a tree. Fruit trees grow well and bear abundant fruit that is safe to eat.

 a woman planting a seedling next to a pit toilet and three larger fruit trees

  • Alternatively, the compost can also be dug out and used to fertilize other trees or food crops, but only if it is completely broken down. So let it decompose for at least 1 year and only use it if it has become an odorless, crumbly soil.
  • Move the shelter, platform, and ring beam to another place, dig a hole, and do it again.

A composting toilet for places with little land

This toilet is useful for places where people live very close together and do not have extra outdoor space for pit toilets. It can even be built inside a home and should not smell much if it is maintained and cleaned regularly.

For this toilet, you must separate urine so feces can dry out and turn into compost more quickly. Separating urine also reduces the smell.

  1. Build a wood box that is large enough to fit a 5 gallon bucket inside. The top will need a hole with a seat and the side of the box can be hinged so that the bucket can be taken out.
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  3. Put in a urine diverting toilet bowl. You may be able to buy this, or make one by cutting the bottom and side from a plastic jug, and then attaching it to the front of the hole.
  4. Attach one end of a tube to the part of the toilet bowl (or spout of the plastic jug) that diverts the urine. Put the other end of the tube in a jug to collect the urine.
  5. Put a 5 gallon bucket under the toilet bowl to collect feces.
  6. A lid will keep flies away and reduce the smell.
 wooden box toilet
 bucket under toilet bowl and jug to collect urine

To use and maintain this toilet

It is important that everyone who uses the toilet is taught how to use it correctly.

  • Before using, put a layer of dry leaves or straw in the bucket. This will help keep the bucket clean.
  • Add a handful of soil mixed with ashes or dry leaves to the bucket after every use. This reduces smells and helps break down the feces. Do not put garbage such as plastic or tins in the toilet. Keep liquids, including urine, out of the bucket. If the bucket contents get wet, add more soil or ash.
  • The urine will flow through the tube to be collected in a container. Pour the urine out somewhere away from homes or the urine can be mixed with water and used as fertilizer. For fertilizer, use 3 parts water to 1 part urine and add to plants up to 3 times a week.
 man emptying bucket of feces into large container
  • When the bucket is filled with feces (about 2 weeks for a family of 5) empty it into a large container with a lid. This is where the waste will be stored. When this container is full, store it for 1 year (in a sunny place, if possible) until the waste has turned into compost. After 1 year, the compost can be added to fields, gardens, or potted plants. A family may need several large containers to store all the waste.
  • After each time you empty the bucket, clean it with water mixed with chlorine to kill the germs.
  • When the toilet is not in use, close the lid of the box. This will reduce smell.

Composting toilets like these take work to maintain. But when used properly, they are a great way for communities without a lot of space to manage their human waste, and even make a valuable product
from it.

Composting toilets for urban areas

A lot of people in a small area means a lot of human waste, and often a lot of sickness caused by germs from human waste.

 child sitting on toilet

A group in Haiti called Sustainable Organic Integrated Livelihoods (SOIL) works in urban communities to transform wastes into resources. SOIL has developed a program that (for a small fee) rents out composting toilets to families, and collects the waste from each home every week. The waste is transported to a site where it is turned into valuable compost which is then sold or used to grow food.

Much of SOIL’s work is educating people about the safety of composting toilets. One of the best ways they do this is to show the final product from the toilets. Once people see for themselves that what was once human waste has now become nutrient-rich compost, they soon become excited to transform something that was making them sick into a resource that helps them and their environment.

Toilets should work for everyone in the community

Talk with everyone who will use the toilet to find out what might make it easier for them to use. This picture shows ways to adapt a toilet for a wheelchair rider.

 woman in wheelchair in toilet shelter that has been adapted for her
shelter big enough so that a wheelchair can fit inside
bell or something to make noise, if help is needed
backrest to support seating
hand rail to make moving from wheelchair to toilet easier
toilet seat and wheelchair on same level
wide door that opens outward for easy access
door handle with pull cord
path to the toilet is level and easy to get to from the house
Remember, a person with a disability feels the same need for privacy as anyone else and should get the privacy he or she needs.

This page was updated:26 Jul 2018