Delivering Safe Sanitation and Better Health in Mozambique

STORY HIGHLIGHTS

• Urbanization, recurring disasters, and years of underinvestment created a sanitation crisis in Mozambique, driving waterborne diseases and childhood stunting.
• IDA financing is helping expand sanitation infrastructure by building wastewater treatment plants and enabling low-income families to install affordable household toilets.
• Investing in sanitation builds the human capital that drives growth, improving health, increasing school attendance, and creating the foundation for better jobs and higher incomes.

For the first time, Jordina has a safe, private toilet.

Standing outside the small green structure in the Filipe Samuel Magaia neighborhood of Tete, her baby in her arms, she smiles with pride. Unlike the makeshift latrine her family once relied on, it does not flood during heavy rains or force them to leave home in search of safer alternatives. It may look simple but for Jordina it represents dignity, safety, and peace of mind.

Jordina's story is becoming increasingly common. Across five of Mozambique's fastest-growing cities, Maputo, Beira, Nampula, Tete, and Quelimane, the Mozambique Urban Sanitation Project, financed by a grant from the International Development Association (IDA) with support from the Global Water Security and Sanitation Partnership and Gates Foundation, and implemented by the Government of Mozambique, is expanding access to improved sanitation and transforming living conditions for more than 265,000 people.

A Crisis Long in the Making

A decade ago, Mozambique's cities were struggling to keep pace with rapid growth. Urbanization, expanding informal settlements, recurring natural disasters, and years of underinvestment had pushed sanitation infrastructure to its limits. In most cities, less than 10 percent of residents were connected to sewerage networks, leaving the majority dependent on latrines and septic tanks. Untreated wastewater and fecal sludge often flowed into rivers and coastal waters. In cities such as Quelimane and Tete, more than one in five residents still practiced open defecation.

Tete resident Jenifer Vontade says she had no choice but to relieve herself outdoors. “It often meant waiting until the area was safe to avoid snakes and other dangers.” Beyond the embarrassment, she adds, "the conditions left people constantly exposed to contamination and disease.”

The health consequences were severe. According to Pedro Martinez, a neighborhood secretary in Tete, the city experienced cholera outbreaks almost every year because of inadequate sanitation. Poor sanitation was estimated to cost the economy $125 million each year - $75 million in urban areas and $50 million in rural areas. Government estimates placed the investment needed to achieve universal access to safely managed sanitation by 2030 at over $1 billion, far beyond what domestic resources alone could finance.

A Different Kind of Solution

The Mozambique Urban Sanitation Project was designed to do more than build infrastructure. It was the first in a series of investments supporting Mozambique's National Urban Water and Sanitation Strategy.

Its approach was based on the principles of Citywide Inclusive Sanitation, recognizing that no single solution can meet the needs of an entire city. Instead, it combines sewerage networks with well-managed on-site sanitation and fecal sludge management, ensuring that services reach low-income communities as well as formally planned neighborhoods.

Inclusion was built into the project from the outset, with a goal of ensuring that at least half of those benefiting are women and at least 40 percent come from the poorest households.

From Household Toilets to Citywide Systems

In Tete, the approach translated into 4,400 improved household toilets across eight low-income neighborhoods. The toilets were delivered through a sanitation marketing initiative known as Casa de Banho Verde ("Green Toilet"), which encouraged households to co-invest in their own toilets and take ownership of the solution.

Maria Ernesto was among the beneficiaries. She says that when she heard she could finally have a toilet of her own, "my heart beat faster." Her family contributed 2,000 meticais toward the construction cost, a symbolic amount, she says, compared to what they received.

The response exceeded expectations. More than 11,500 households applied for a Green Toilet in Tete alone, far surpassing the 4,400 toilets that could be delivered.

Carla Jose, another Tete resident, says the benefits extend individual households. "The project brought something incredibly valuable to our community. Today we live with more dignity, in a healthier environment where we can better care for ourselves and protect our children."

But toilets were only part of the solution. A new fecal sludge treatment plant now ensures that waste from thousands of household toilets is safely collected, transported, and treated. Together, these investments created a complete sanitation service chain, from household toilet to treatment. They have also opened new opportunities for the private sector to reuse treated fecal sludge as fertilizer, with municipal sanitation utilities developing business plans to support a circular economy.

Quelimane adopted a different approach. In Mapiazua, one of the city's poorest neighborhoods, the project built a condominial sewer system - a simplified, community-scale network that enabled densely populated, low-income communities to connect affordably to the city's sewerage system for the first time.

The network feeds into Quelimane's first wastewater treatment plant, designed to treat both wastewater and fecal sludge. The project also rehabilitated 29 kilometers of sewer lines, including 4.7 kilometers of condominial sewers, built three pumping stations, and connected nearly 3,000 households. During construction, the project created jobs for more than 500 people recruited from local communities, providing income and supporting the local economy.

The project also invested in healthier learning environments. Improved sanitation facilities, water supply, and handwashing stations were introduced in schools, benefiting more than 160,000 students. The facilities were designed with girls in mind, including menstrual hygiene management amenities and awareness programs to help reduce absenteeism and ensure that schools provide safe, dignified spaces for learning.

Health, Jobs, and Economic Returns

The World Bank's latest urban sanitation report makes a compelling case: sanitation is not a cost - it is one of the smartest investments countries can make in human capital. Better sanitation improves health, keeps children in school, and boosts future earnings. Each additional year of quality education is associated with about an 8 percent increase in lifetime income, while every $1 million invested in sanitation can generate around 40 direct jobs in low- and lower-middle-income countries.

Mozambique shows what those investments can achieve. Families have gained access to safer sanitation, cities are better equipped to manage waste, and local jobs have been created along the way. The project demonstrates how investing in sanitation strengthens human capital, supports economic growth, and builds healthier, more resilient cities.

As part of the Water Forward initiative, the World Bank Group aims to improve water security for 400 million people by 2030 by helping countries scale solutions that strengthen water and sanitation services, create jobs, and improve lives.