In many health-care facilities in developing countries, patients have no access to sewer-based sanitation facilities.
In these places, human sanitation is often by pit latrines or something similar, and at worst by open defecation in
the grounds of the health-care facility or nearby. Excreta collected from patients is usually disposed of via the same
routes, creating a risk of infection to other people. This underlines the prime importance of providing access to
adequate sanitation in every health-care facility. Sufficient toilets should be available; the recommended minimum
is one toilet per 20 users for inpatient medical areas, and at least four toilets per outpatient location (one each for
male and female staff, one for female patients, one for male patients) (WHO, 2008). Ideally, the toilets should be
connected to a sewerage system. Where there are no sewerage systems, technically sound onsite sanitation should
be provided. Guidance on this is available in a number of publications (e.g. Franceys, Pickford & Reed, 1992;
Mara, 1996). These cover both simple techniques, such as the basic pit latrine, ventilated pit latrine and pour-flush
latrine, and more advanced options, such as a septic tank with soakaway or an aqua-privy. Waterless systems and
composting toilets are also now available.1