For many people, the idea of having a global day dedicated to the humble toilet is quite an amusing one. Going to the toilet is something we generally don't talk about after all, and owning one just seems bog standard.
But this World Toilet Day (19 November), there are 2.6 billion people across the world who have nowhere safe to go to the toilet. That's two out of five people for whom a toilet is an unimaginable luxury. Meanwhile, almost 900 million people are forced to risk their lives on a daily basis by drinking dirty water because they have no other option.
At the turn of the century, world leaders made a set of promises under the Millennium Development Goals (MDGs) to dramatically cut poverty worldwide. Among these was a commitment to halve the proportion of people without access to sanitation by 2015; but with just three years to go, this target is wildly off track.
Our report Off-track, off-target, which we have published to mark World Toilet Day, shows that aid is repeatedly not reaching the people who need it the most. In Sub-Saharan Africa, this goal won't be reached for another 200 years. That's a long wait for a toilet!
Dirty water and inadequate sanitation cost sub-Saharan Africa around 5% of its gross domestic product (GDP) every year. In 2009, this meant the region missed out on $47.7 billion, which was more than the amount provided in development aid to the entire continent in the same year ($47.6 billion).
The human cost of this denial of human rights is even starker - 4,000 children under the age of five die every single day because of diarrhoeal diseases caused by drinking dirty water and having nowhere safe to go to the toilet. That's one child dying needlessly every 20 seconds.
Dr Eumu Silver is the only doctor in a health clinic in Amuria, Uganda, serving a population of 350,000. He says improving access to clean water and toilets would reduce the number of admissions by 80%.
"We cannot afford to have our people die from illnesses that can be stopped," he says. "It is not like we need to bring water from heaven, it is already there."
Investing in water and sanitation not only saves lives, it also makes sound economic sense. According to the United Nations Development Programme, every $1 invested in water and sanitation provides a return of $8 in increased productivity.
So, what's the problem then?
Our report shows that a vicious cycle of poor performance and low investment plagues the water and sanitation sector. Finance ministers, donors and the private sector are reluctant to invest in water, hygiene and improved sanitation in areas most in need due to concerns over the money being used effectively. Meanwhile, a lack of money undermines existing weak performance.
And how do we break this cycle? The solutions are stronger leadership to ensure better targeting and sustainability.
"Off-track, off-target" argues that to get the sanitation and water MDGs back on track, countries in Sub-Saharan Africa need to spend at least 3.5% of their GDP on sanitation and water while off track countries in South Asia need to spend at least 1% of GDP on sanitation.
Donor governments need to step up to the mark and double the aid they dedicate to these services by an additional $10 billion per year.
Over the past decade, the least developed countries have received only 30% of total global water and sanitation aid, with middle income countries receiving between 50% and 60%. With poor people in Africa being five times less likely to have access to adequate sanitation and over 15 times more likely to practise open defecation than Africa's rich communities, increased investment needs to be directed to the poorest, most excluded communities if any real progress is to be made in reducing poverty.
A serious shift in approach is needed to stop millions dying every year for lack of a toilet. Ending the global water and sanitation crisis is not an impossible dream; it is a joint endeavour that requires immediate action through collaboration and commitment. You too can be part of this process by supporting WaterAid's new Water Works campaign.