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BRIEF June 16, 2020

Citywide Inclusive Sanitation


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World Bank  Support to CWIS

CWIS In Action



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The Global Sanitation Crisis

Urban population growth dramatically outpaces gains in access to safe sanitation. As the world continues to urbanize, the challenges of sanitation will only grow. Not surprisingly, sanitation was an off-track Millennium Development Goal – the target was missed by almost 700 million people. The World Bank helps countries address the sanitation challenges: ending open defecation, improving service delivery, and closing the loop from access to sanitation facilities to sustainable management of wastewater and sludge.

Globally, 2.4 billion people still live without access to basic sanitation services, and 4.5 billion people lack access to safely managed sanitation. Lack of sanitation causes an estimated 1.6 million deaths each year, or 4,500 deaths every day.. Today, 17 percent of the world’s urban dwellers do not have access to basic sanitation (i.e., an improved toilet or latrine), and only 43 percent of urban residents have access to safely managed sanitation (i.e., their waste is safely contained, conveyed and ultimately treated). In addition to the millions of unnecessary deaths each year, a lack of proper sanitation causes diarrhea and related diseases, leading to countless negative impacts, including the stunting of children. Approximately 58 percent of diarrheal deaths of children under 5 are due to inadequate sanitation and hygiene. The economic impacts from a lack of sanitation on health and mortality are compounded by negative impacts on the environment and, ultimately, on economic growth. The total global costs of inadequate sanitation are estimated at US$260 billion per year or, on average, 1.5% of a country’s GDP.

At present, over 50 percent of the world’s population live in urban areas. By 2045, the number of city dwellers is projected to increase by 50 percent from 4 to 6 billion, with much of this growth occurring in low-income and lower middle-income countries. In cities across the globe, it is the norm that, even where piped water networks exist, sewerage and septic tank coverage lags far behind. This lack of sanitation service delivery also contributes to the vicious cycle affecting the delivery of other key urban services, such as housing, potable water, solid waste and drainage. To reach the urban sanitation SDGs, over US$45 billion will be needed annually to meet the capital costs alone.


Moving from the Millennium Development Goals (MDGs) to achieving the Sustainable Development Goals (SDGs) requires thinking out of the box!

The SDGs’ Target 6 has drastically changed the focus from access to a household sanitation facility (as was prioritized under the MDGs) to consideration of the full sanitation service chain. Despite 2.1 billion people gaining access to improved toilets or latrines since 1990, we have a long way to go to meet the new SDG target of safely managed sanitation for all. At present, however, the SDGs only consider individual household toilets as being part of a safely managed sanitation solution: sanitation solutions for use outside the home (e.g., at work, school, markets) are not included, nor are toilets/latrines that are shared between neighboring households. As part of addressing the world’s urban sanitation challenges, these shared sanitation solutions must also be considered, where appropriate, to see improvements in public health and environmental quality.

The World Bank’s Water Global Practice (WGP), in partnership with sector development partners (including The Bill & Melinda Gates Foundation, Emory University, The University of Leeds, WaterAid and Plan International), have jointly developed and advanced an approach to tackling urban sanitation challenges, termed Citywide Inclusive Sanitation (CWIS).  

How is CWIS promoting ‘Business as Unusual’?

‘Business as usual’ in urban sanitation—where conventional sewerage and wastewater treatment are considered as the only solution—will not get us to universal safely managed sanitation. Citywide Inclusive Sanitation (CWIS) looks to shift the urban sanitation paradigm, aiming to ensure everyone has access to safely managed sanitation by promoting a range of solutions—both onsite and sewered, centralized or decentralized—tailored to the realities of the world's burgeoning cities. CWIS means focusing on service provision and its enabling environment, rather than on building infrastructure.

This shift in paradigm to CWIS requires a shift in mindsets. Governments and development agencies increasingly recognize that historic approaches to urban sanitation have not always worked and new approaches are required. Consulting firms need to think differently, and not simply replicate approaches found in high-income countries. Engineering curricula should include the design and management of non-conventional systems and should explore opportunities for leapfrogging to solutions that take full account of the public health and environmental imperatives of urban sanitation. We should rethink the way sanitation infrastructure is funded and challenge approaches that subsidize sewers but not onsite sanitation, that do not embrace innovation and do not consider running costs. CWIS, or ‘business as unusual’, requires awareness raising and capacity building, capturing best practices, working in coordination with complementary city services, and the development and use of tools that help better design and implement sustainable urban sanitation services for all.

At the World Bank, we see an important emerging global movement to engage on CWIS by governments and development partners, which provides an unprecedented opportunity to shift the urban sanitation paradigm in the pursuit of universal safely managed sanitation.


What is CWIS?

A CWIS project is where…

  • Everybody benefits from adequate sanitation service delivery outcomes that meet user aspirations and that protect the health of users.
  • Human waste is safely managed along the whole sanitation service chain ensuring protection of the environment and of human health.
  • A diversity of appropriate technical solutions is embraced, combining both on-site and sewered solutions, in either centralized or decentralized systems, with consideration of resource recovery and re-use.
  • Cities demonstrate political will, technical and managerial leadership, and identify new and creative long-term funding options for sanitation.
  • Institutional arrangements and regulations, with well-aligned incentives, are in place for the operation and maintenance of the full sanitation service chain.
  • Funding is allocated for non-infrastructure aspects of service delivery, such as capacity building, household engagement and outreach, and sanitation marketing.
  • Complementary urban services, including water supply, drainage, greywater management and solid waste management, are incorporated into sanitation planning.
  • Activities are included to target specific unserved and underserved groups, such as women, ethnic minorities, the urban poor and people with disabilities.

What is a good example of CWIS?

Learn about good practices of CWIS in these country examples:


Cochabamba, Bolivia – Decentralized Wastewater Collection and Treatment


Manila, Philippines – Mixed wastewater and fecal sludge responses



El Alto, Bolivia – Dry Sanitation


Durban, South Africa – Services for All


Kenya & Haiti – Container-Based Sanitation


Brasilia, Brazil – Condominial Sewers and Appropriate Wastewater Treatment


Brazil & Colombia – Connecting the Unconnected

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As part of the implementation of the CWIS principles, the WGP provides support to World Bank project teams and their government counterparts at different stages of the project cycle, from preparation through to implementation. The CWIS team provides technical inputs to operational teams around the world – through the leveraging of technical experts (both internal to the Bank and external specialists), safe space reviews, support missions, the review of documents, the provision of resource materials such as operational guidance documents and generic TORs, and more. While primarily intended for use by World Bank task teams and their government counterparts, the guidance and related resources may also be of use to non-World Bank project teams working on sanitation challenges in urban areas around the world.

The CWIS team also supports project-, country- and region-specific advocacy and knowledge and learning activities to advance the CWIS operational agenda.

Below are some examples of the types of technical and operational support materials that the CWIS team has to offer:

Guidance Notes and Manuals




Generic and Example Terms of Reference

Good Practice Documentation


Knowledge and Learning Events


Guidance Notes and Manuals 


Shared and Public Sanitation: Championing Delivery Models That Work

A guide to the design and implementation of shared, community and public sanitation facilities, with a focus on operation and management models that support long-term service provision. The document draws on good experiences from across the globe and provides guidance for service providers (whether private or public sector entities) and service authorities (i.e., those who regulate/oversee the service providers), as well as consideration of the user perspective, including special needs for people with disabilities, women, the elderly, etc.


Fecal Sludge and Septage Treatment: A Guide for Low- and Middle-Income Countries

This engineering design manual responds to the urgent need to provide guidance to engineers on how to design treatment works to appropriately handle the increasing volumes of faecal sludge and septage (i.e., waste from pit latrines and septic tanks) collected in the rapidly expanding towns and cities of the world. It discusses the urban contexts that influence treatment requirements and the different septage/fecal sludge treatment processes available. The book includes detailed design recommendations and design standards for a range of appropriate fecal sludge and septage treatment technologies.


Evaluating the Potential of Container-Based Sanitation:

Over the past decade, container-based sanitation (CBS) approaches have emerged as an alternative service delivery modality for the urban poor without access to other onsite or sewered solutions. Existing CBS approaches focus on delivering a sanitation service along the whole sanitation service chain – from containment through to treatment and reuse – rather than only providing a traditional infrastructure intervention. This report assesses existing CBS providers around the world, with a focus on evaluating their safety, reliability, affordability and financial viability, as well as identifying circumstances in which CBS approaches are most appropriate.



The CWIS Costing & Planning Tool:

This free-to-use, open-database online tool allows planners to compare the capital and running costs of different types of sanitation solutions along the whole sanitation service chain at the component, system, and city levels – for both sewered and onsite interventions.

Fecal Sludge Flow Diagrams (SFDs):

The SFDs depict the movement of fecal sludge/septage and wastewater across a city with the objective of providing impactful visualizations of the status of sanitation in a city, in order to assist planners, decision-makers and other stakeholders in better understanding the bottlenecks, gaps and ‘leakage’ of waste in the city.

Urban Sanitation Rapid Assessments:

The Urban Sanitation Rapid Assessment tool is designed to guide task teams and their government counterparts to understand the sanitation context of the city and to recommend short-term priority interventions that are in line with the project’s development objective as well as the Sustainable Development Goals

Strategic Sanitation Planning:

The City-level Strategic Planning for Urban Sanitation Guidance Note is intended for use by World Bank task teams and their government counterparts, as well as other teams/organizations who are in the early stages of designing a new sanitation intervention or a new approach to providing sanitation services within a city.

Countywide Inclusive Sanitation Planning Guide:

The Kenya Countywide Inclusive Sanitation (COWIS) approach was initiated as part of a World Bank Technical Assistance to the Government of Kenya to address sanitation challenges. A methodology was developed in collaboration with Nakuru County and relevant national government representatives to address sanitation challenges in a county-wide manner in Nakuru. This note summarizes said methodology to encourage its application in other counties in Kenya.

Urban Sanitation Implementation Indicators:

These indicators have been developed to guide Bank teams and their government counterparts in the development of results frameworks for urban sanitation projects and programs.

Generic and Example Terms of Reference and Related Documents

We have developed generic terms of reference (TORs) for assisting task teams and their government counterparts in the design and implementation of key urban sanitation interventions, as well as having example terms of reference from some Bank operations, including:

●        The Design of Fecal Sludge Management Interventions – considering their technical, institutional, social, financial and business dimensions.

●        Example TOR for Consulting Services for the Preparation of Participatory Sanitation Master Plans and Technical Specifications for Bidding Documents (Angola)

●        Example TOR for the undertaking of Countywide Inclusive Sanitation Planning

Good Practice Documentation

Health, Safety and Dignity of Sanitation Workers: An Initial Assessment

The World Bank, World Health Organization (WHO), International Labour Organization (ILO) and WaterAid have joined forces to shed light on the neglected issue of sanitation workers. This report, the most extensive global exploration of the topic to date, analyzes the problems, explores good practices, and sets out actions to improve the health, safety and dignity of sanitation workers.

CWIS good practice videos:

The World Bank has produced a series of videos showing good practice approaches to Citywide Inclusive Sanitation, from Brazil to South Africa, Haiti to the Philippines, in order to help disseminate good experiences of providing urban sanitation services to all. 

Knowledge and Learning Events

The Bank’s CWIS team designs and implements knowledge and learning (K&L) exchanges and facilitates regional and cross-regional experience sharing for Bank staff, government counterparts, and development partners through tailored events and workshops across the globe. Here is a list of some of our recent events:

  • Africa Regional K&L event, Durban, South Africa, December 2016
  • Kenya National CWIS K&L event, Nairobi, March 2017
  • LAC Regional K&L event, Brasília, Brazil, March 2018
  • Ethiopia National CWIS K&L events
  • MENA Regional workshop on sanitation/CWIS, Lebanon, May 2018
  • West Africa Regional Anglophone K&L CWIS event, Accra, Ghana, May 2018
  • India National Workshop on CWIS, New Delhi, India, February 2019
  • Bangladesh national workshop on CWIS, Dhaka, Bangladesh, February 2019
  • Indonesia national workshop on sanitation/CWIS, Jakarta, Indonesia, February 2019
  • Anglophone & Lusophone Africa K&L event, Kampala, November 2019

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At the World Bank we find that there is appetite for moving towards the principles of Citywide Inclusive Sanitation in our existing and our new urban sanitation investment projects, in low- and middle-income countries alike and, increasingly, we see government and service provider counterparts interested in adopting CWIS approaches. We currently have engagements in a diversity of countries around the world in which we are advancing CWIS principles, at both large and small scale, be it in single or multiple cities in a given country. The World Bank’s CWIS team provides expertise in support of Bank and government project teams in operationalizing and embedding CWIS principles within their urban sanitation investments. 


The table below presents a list of the countries where the Bank has supported, or is currently supporting, differing degrees of CWIS engagement.








Cote d’Ivoire









●        In Ethiopia, the WB is supporting a US$505 million project that focuses on expanding access to urban sanitation services for 2.5 million people, while strengthening the institutions that provide these services. The project, which includes activities in 23 cities across the country, supports sewered and onsite solutions and incorporates consideration of the full sanitation service chain. The project also supports shared household facilities for the poorest households and those living in particularly dense areas and will scale up access to public toilets, which are currently run by economically marginalized groups such as women and people with disabilities, for use in busy urban centers. The CWIS team has supported the project in the development of the Urban Sanitation Rapid Assessment Tool and developed Design-Build-Operate (DBO) bidding documents for Fecal Sludge Treatment Plants.

●        In Tanzania, through a USD$225 million project, the Government is using CWIS principles to expand sanitation services and treatment of human waste for over 1 million people, combining both onsite sanitation and fecal sludge management interventions, in addition to sewerage and wastewater treatment. The CWIS team has supported the design of the Wastewater Treatment Plant DBO contract and the associated sewerage interventions.

●        In Ghana, the World Bank is supporting a multifaceted sanitation intervention to tackle the challenges of sanitation in the Greater Accra Metropolitan Area. The project includes: subsidies for poor households to buy toilet facilities; construction of new fecal sludge treatment plants; engagement with private sector financial institutions to encourage creation of loan products for household sanitation; sanitation marketing; mobile money platforms for households to save towards the cost of a toilet; support to local private contractors to build their capacity to deliver toilets at larger scales; and other related initiatives. The project aims to provide over 110,000 people with access to improved sanitation.

●        In Angola, the World Bank is supporting the Government to undertake a city-level sanitation master planning process for nine secondary cities and to pilot innovative sanitation service delivery models to benefit 35,000 people. The activities are all aligned with CWIS principles.

●        In Bolivia, GWSP and the CWIS team have supported the government in advancing its urban sanitation agenda, including on CWIS strategic planning, on fecal sludge management, on piloting the use of condominial/smart sewers and on connecting the unconnected to sewer systems.

●        In Uruguay, the World Bank has been supporting the National Water Directorate (DINAGUA) in advancing the operationalization of its recently approved National Sanitation Plan, particularly in identifying institutional, legal and regulatory gaps in Uruguay’s sanitation sector. This Plan recognizes the need to use a wide menu of sanitation options, including sewerage networks, fecal sludge management and on-site sanitation solutions, and recommendations on how to adapt the current legal and regulatory framework to this new concept will feed into the discussions on a new Sanitation Law

●        In Kenya, the World Bank is helping the Government of Kenya address their sanitation challenges and is engaging in strategic planning activities in Nakuru county through the Countywide Inclusive Sanitation initiative.

●        In Cote d’Ivoire, the World Bank is supporting the government to develop a National Sanitation Strategy that will bridge the mandates of multiple institutions. The project will also finance the Government’s investments in sanitation master planning in a number of urban centers as well as WASH investments in schools and health centers in parallel with hygiene campaigns.

●        In Bangladesh, the World Bank is supporting the improvement of sanitation services in Dhaka and in small towns. The Dhaka project is the first, large, standalone sanitation project in the region. The team has also been supporting the preparation of sanitation programs in the country and has been informing the design of the Dhaka sanitation project.

●        In Yemen, the World Bank is conducting sanitation assessments in Sana’a and Aden, including assessment of access and infrastructure in households, cholera- affected areas, internally displaced persons (IDP) camps, shared sanitation facilities in public institutions and sanitation service delivery models. The Bank also supporting the preparation of a new water and sanitation project by prioritizing sanitation investments in several urban centers in Yemen.

●        In Mauritania, the World Bank is supporting investments across the sanitation service chain in peri-urban areas as well as in densely populated refugee camps.

●        In Mozambique, the team has been supporting the development of sanitation services improvement plans in five municipalities, the design of wastewater treatment plants, and trainings on condominial sewers design and management. The team is also supporting development of management models for public and school sanitation facilities, including activities on menstrual hygiene management.  

●        In Nigeria, the WB is preparing a US$700 million program for results (PforR) which aims to increase access to water, sanitation, and hygiene services through the development of infrastructure, institutions, and policies in select states of Nigeria. The program will support the “Clean Nigeria: Use the Toilet” campaign to achieve an open defecation free Nigeria by 2025. Sanitation activities will be implemented in urban and rural areas as well as small towns and will align with the principles of local government area-wide (‘LGA-wide’) inclusive sanitation. Preparation is ongoing and the program is expected to be approved by the WB Board of Directors before the end of the calendar year 2020.

●        In Malawi, the World Bank is supporting the development and design of onsite sanitation facilities, including fecal sludge treatment plants, public sanitation facilities, and also supporting the development of sanitation master plans.

●        In Turkey, the World Bank is adapting innovative solutions from Africa, and applying them in project design in order to deliver sanitation services in refugee camps in Turkey.

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Partnerships between governments and the World Bank are at the heart of our work and of our modus operandi during both project preparation and implementation. In addition, we are also working across the world with several other key partners in the sector to advance the concepts of Citywide Inclusive Sanitation, including with other multilateral development banks, bilateral donors and various other development partners.

We are partnering with the Bill & Melinda Gates Foundation under a new Urban Sanitation Innovation Partnership which leverages the comparative advantages of both organizations in support of their government counterparts in working towards ‘proof of scale’ for innovative sanitation delivery services for all, with a focus on sustainable services for the poor. We are also working with a number of bilateral organizations: in Angola, for example, we are co-financing a project with the Agence Française de Développement (AfD) that will support strategic sanitation planning in nine secondary cities and will pilot sanitation service provision for 35,000 people.

We are collaborating with WaterAid, GIZ and other development partners on the shared, community and public sanitation agenda; with WaterAid, WHO, ILO and SNV on the challenges and realities facing sanitation workers; with pS-Eau on non-conventional approaches to designing and implementing sewers; with Eawag-Sandec and the Gates Foundation on training material for a new generation of urban sanitation sector professionals; and with other non-governmental organizations, think tanks and research entities on various CWIS-related initiatives.

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More About Urban Sanitation

Onsite Sanitation/Fecal Sludge Management



Wastewater Treatment


Sludge and Greywater Management and Reuse


Wastewater Reuse


Financing and Subsidies


Monitoring and Evaluation


Policies, Intuitions and Regulations






More about Urban Sanitation:

-          Fecal Sludge Flow Diagrams (SFDs) => link to SuSanA SFD generator page

-          Compendium of Sanitation Systems and Technologies, 2nd Edition (2014), EAWAG

-          Sanitation 21: A Planning Framework for Improving City-wide Sanitation Services , IWA (2016)

-          Sanitation Safety Planning: Manual for safe use and disposal of wastewater, greywater and excreta, WHO (2015)

-          Achieving total sanitation and hygiene coverage within a generation: lessons from East Asia,  WaterAid (2016)

-          Low Cost Urban Sanitation by Duncan Mara (1996)

-          Planning and Design of Sanitation Systems and Technologies MOOC by Eawag-Sandec

Onsite Sanitation/Fecal Sludge Management:

-          Faecal Sludge Management: Systems Approach for Operation and Implementation, IWA (2014)  

-          Business Models for Fecal Sludge Management, IWMI (2016)

-          Faecal Sludge and Septage Treatment: a guide for low- and middle- income countries , Kevin Taylor (The World Bank/Gates Foundation 2018)

-          Introduction to Fecal Sludge Management by CAWST (the Centre for Affordable Water and Sanitation Technology) and Eawag- SANDEC (2016)

-          Evaluating the Potential of Container-Based Sanitation, World Bank (2019)

-          Market Driven Approach for Selection of Faecal Sludge Treatment Products by Eawag- Sandec

Online Courses:

-          Fecal Sludge Management by the Asian Institute of Technology

-          Fecal Sludge Management by UNESCO-IHE Delft

-          Introduction to Fecal Sludge Management by École Polytechnique Fédérale de Lausanne and Sandec


-          PC-based Simplified Sewer Design, University of Leeds (2001)

-          Non-conventional sewerage material, pS-Eau (2014)

Wastewater Treatment:

-          Domestic Wastewater Treatment in Developing Countries, pS-Eau (2004)

-          Tecnologías alternativas para la provisión de servicios de agua y saneamiento en pequeñas localidades, World Bank (2005)

-          Wastewater Engineering: Treatment and Reuse, Metcalf & Eddy, Inc. (2002)

-          Biological wastewater treatment in warm climate countries, IWA (2005) Volume 1 and Volume 2  

-          Co-treatment of Septage and Fecal Sludge in Sewage, IWA (2020)

Sludge and Greywater Management and Reuse:

-          WHO: Volume 4: Excreta and greywater use in agriculture (2006)

-          Örmeci: Shaped by regulation: Current and future trends in sludge mgmt., Water 21, IWA (2014)

Wastewater Reuse:

-          Water Reuse for Irrigation, CRC press (2004)  

-          Wastewater Irrigation and Health, IWMI and IDRC (2010)

-          Sustainable Treatment and Reuse of Municipal Wastewater, IWA (2012)

Financing and Subsidies:

-          Doing More with Less: Smarter Subsidies for Water Supply and Sanitation, World Bank (2019)

-          Public Funding for Sanitation: The many faces of sanitation subsidies, WSSCC (2009)

Policies, Intuitions and Regulations

-          Aligning Institutions and Incentives for Sustainable Water Supply and Sanitation Services, World Bank (2018)

-          Capacity Development for Inclusive Urban Sanitation Video Series for consultants by Eawag-Sandec

Monitoring and Evaluation:

-          Urban Sanitation Sample Indicators

-          Sanitation mapper, WaterAid


-          Health, Safety and Dignity of Sanitation Workers: An Initial Assessment by the ILO, WaterAid, WHO and World Bank (2019)

-          Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals: Synthesis Report of the WASH Poverty Diagnostic Initiative by the World Bank (2017)

-          Poor-Inclusive Urban Sanitation: An Overview, WSP (2013)

-          Women in Water Utilities: Breaking Barriers, World Bank (2019)

-          The Rising Tide: A New Look at Gender and Water, World Bank (2017)

-          Menstrual Hygiene Management

-          Making sustainable sanitation inclusive for persons with disabilities, GIZ (2011)

-          Shared and Public Sanitation: Championing Delivery Models That Work, World Bank (2018)

-          Female-friendly public and community toilets: a guide for planners and decision makers, WaterAid, WSUP and UNICEF (2018)


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Martin Gambrill

Lead Water and Sanitation Specialist