The Last Mile of Sanitation: The Campaign Ended, the Service Never Began

Executive Summary. Bangladesh finished the sanitation campaign and never built the sanitation service. Open defecation fell from 15.69% of the population in 2000 to 0% in 2024, and 98.78% of people now use at least a basic drinking water source, second of the six countries compared here behind Thailand's 100%. One rung up, the country is last. A basic sanitation facility, meaning an improved one the household does not share with another, reaches 67.62% of Bangladeshis, the lowest of the six against a peer median of 88.2%, a shortfall of 20.6 points that leaves 56.2 million people below the rung. A handwashing facility with soap and water at home reaches 71.82%, again the lowest of the six and 17.3 points under the peer median, leaving 48.9 million without. The outcomes that travel by the enteric route are where Bangladesh still trails: under-five mortality of 30.5 per 1,000 live births is the second-highest of the six and 1.7 times the peer median, and stunting at 23.6% of children under five is the highest of the four countries reporting.

The rung Bangladesh cleared

Take the achievement first, because it is real and it is unusual.

Open defecation in Bangladesh stood at 15.69% of the population in 2000. In 2024 the series records 0%, a fall of 15.69 points and a reduction of 100%. Thailand and Vietnam also record 0%. India is at 6.73%, Pakistan at 8.17%, Indonesia at 2.29%. Whatever combination of campaigning, subsidy, social pressure and local government did this, it worked on a population of 173.6 million people living at high density on a delta, and it started from a 2000 level above every one of those 2024 peer rates.

Drinking water tells a similar story. 98.78% of Bangladeshis use at least a basic source, second of the six behind Thailand's 100% and 3.1 points above the peer median of 95.72%. Vietnam is at 98.76%, India 95.72%, Pakistan 90.69%, Indonesia 89.01%. These are the two indicators a national campaign can close, and Bangladesh has closed them.

The rung it did not clear

Now the same country on the next step up.

Basic sanitation reaches 67.62% of the population, the lowest of the six. Thailand is at 99.35%, Vietnam 95.45%, Indonesia 88.2%, India 83.38%, and Pakistan, the nearest peer, 71.88%. The peer median is 88.2%, so Bangladesh sits 20.6 points below it and at 77% of it. In people, 56.2 million Bangladeshis are below the basic rung, close to a third of the population.

Source: World Bank World Development Indicators, people using at least basic sanitation services (SH.STA.BASS.ZS), 2024.

The definition is what makes this figure interesting rather than merely bad. The WDI series follows the JMP service ladder, on which a facility counts as basic only when it is improved and not shared with other households. A shared improved latrine is classified one rung down, as limited. So the gap between Bangladesh's 0% open defecation and its 67.62% basic coverage is not a gap between defecating in the open and not doing so. That question is settled. It is the gap between having somewhere to go and having somewhere that is built to standard and belongs to one household.

That is a different kind of problem, and it costs a different kind of money. Ending open defecation is a one-off act with a visible endpoint, enforceable by neighbours, and cheap per household. Moving a household onto the basic rung requires capital per household, land or floor space that dense settlements and insecure tenure do not always allow, and construction that survives flooding and a high water table. It is bought house by house, and it stays bought only if it is maintained.

The half that costs money every week

The handwashing figure carries the same signature and is harder to explain away.

A handwashing facility with soap and water available at home reaches 71.82% of Bangladeshis, the lowest of the six. Thailand is at 94.63%, India 89.69%, Vietnam 89.11%, Pakistan 84.77%, Indonesia 79.78%. The peer median is 89.11%, putting Bangladesh 17.3 points below it, at 81% of the median, with 48.9 million people in households without one.

Source: World Bank World Development Indicators, people with basic handwashing facilities (SH.STA.HYGN.ZS), 2024.

Two things are worth noticing in those rankings. Indonesia is second-lowest on handwashing at 79.78% while sitting at 88.2% on sanitation, and Pakistan is above Bangladesh on handwashing at 84.77% while ranking below every other comparator on sanitation at 71.88%. The two ladders do not move together, which means neither is a proxy for the other and neither is simply a proxy for income.

What the handwashing indicator measures is a recurring purchase and a fixed point of use: soap bought again every month, water delivered to the place where hands are washed rather than carried to it. There is no campaign that closes this once. A country can hold a national hygiene week every year and the measured share will still be governed by whether soap is affordable in the poorest quintile and whether the water point is inside the dwelling.

Why the campaignable half was the half that got done

Source: World Bank World Development Indicators, people practicing open defecation (SH.STA.ODFC.ZS), Bangladesh against comparators, 2000-2024.

Put the three indicators side by side and a pattern shows up that is not about sanitation at all.

Bangladesh is level with Thailand and Vietnam at 0% open defecation and second of the six on drinking water, the two things a campaign can finish. It is last of the six on the two things that require a per-household asset or a per-month purchase, and that need somebody to maintain, empty, repair or resupply them afterwards. This is the same shape as the country's wider record in health: strong on campaigns, weak on services.

The data has a hard limit here that should be stated rather than glossed. The basic rung asks only whether the household's facility is improved and unshared. It says nothing about where the contents go: emptying, transport and treatment belong to the safely managed rung, which this comparison does not carry for these six countries. So this essay cannot tell you how much of Bangladesh's faecal load is treated. It can tell you that the country falls short on the cheaper and weaker of the two measures, which leaves little room for optimism about the harder one.

The same caution applies to the water figure. The basic drinking water rung counts the type of source and the time taken to collect from it, not the quality of what comes out. A tubewell carrying arsenic and a source contaminated between the well and the cup both count as basic, so the 98.78% is a statement about access, not about what is in the water.

What it shows up in, and what it does not prove

Bangladesh's under-five mortality was 30.5 per 1,000 live births in 2024, the second-highest of the six behind Pakistan's 56. India is at 26.6, Indonesia 17.7, Vietnam 17.3, Thailand 9. The peer median is 17.7, so Bangladesh is 12.8 deaths above it and at 1.7 times the median rate. Stunting among children under five was 23.6% in 2022, the highest of the four countries reporting, against 21.6% in Indonesia, 18.9% in Vietnam and 12.4% in Thailand. India and Pakistan have no comparable 2022 observation in this series, so that comparison rests on four countries, not six.

Both outcomes have a documented route through sanitation and hygiene: repeated enteric infection in early childhood, which kills some children and stunts others through chronic gut damage and nutrient loss even when diets are adequate. Bangladesh being last of the six on both WASH indicators, second-worst of the six on child mortality and worst of the four reporting on stunting is consistent with that route.

Consistent is all it is. This is a cross-section of six countries in one year, and it identifies nothing. Three specific reasons to hold the association loosely.

First, the group itself refuses to line up. Pakistan is ahead of Bangladesh on both basic sanitation (71.88% against 67.62%) and handwashing (84.77% against 71.82%), and its under-five mortality is 56 against Bangladesh's 30.5, which is the wrong way round for a story in which WASH coverage does the heavy lifting. Indonesia has lower handwashing coverage than India (79.78% against 89.69%) and lower child mortality (17.7 against 26.6). If WASH coverage were doing most of the work, those pairs would not look like that.

Second, everything that moves child mortality and stunting also correlates with sanitation coverage across countries: household income, maternal education, birth spacing, dietary quality, vaccination, and access to care. Six observations cannot separate them, and nothing in this comparison tries to.

Third, Bangladesh's own history argues against a simple sanitation story. Under-five mortality fell from 146.5 per 1,000 live births in 1990 to 30.5 in 2024, a drop of 116 per 1,000 live births, or 79.18%. No account of the last mile of sanitation explains a fall of that size on its own, and any argument that sanitation is now the binding constraint has to concede that it plainly was not the binding constraint on the decline already achieved.

What would change this conclusion

The claim here is narrow: Bangladesh's remaining WASH deficit is concentrated in the recurring, per-household half of the ladder, and that is where the money should go. A checkable test: if basic sanitation closes most of its 20.6 point gap to the peer median by 2030, and handwashing most of its 17.3 point gap, and stunting is still near its 2022 level of 23.6%, then the deficit was not the constraint this argument treats it as, and the case for spending there weakens. If coverage is still near 67.62% and 71.82% in 2030, nothing will have been tried and the test will not have been run.

Three moves, with owners and signals.

1. Publish the shared-facility share as a separate national statistic. The single most useful unknown in the 20.6 point gap is how much of it is households using an improved latrine they share, and how much is households with no improved facility at all. Those two shortfalls need different money. Owner: Bangladesh Bureau of Statistics, with the Department of Public Health Engineering, inside the existing survey cycle. Success signal: a published series splitting limited from unimproved sanitation, so the gap can be costed rather than described.
2. Fund the recurring half, not only the construction half. Soap and a water point at the place of washing is the cheapest item on this list and the one where Bangladesh is furthest behind. Owner: Local Government Division and the Department of Public Health Engineering. Success signal: handwashing coverage above 79.78% in a later WDI vintage, which is today's lowest peer value and would end Bangladesh's position at the bottom of this group.
3. Buy emptying and treatment, not only pits. A programme that funds construction and not desludging moves households onto the basic rung and leaves the faecal load in the settlement. Owner: city corporations and pourashavas, under the Local Government Division. Success signal: Bangladesh reporting on the safely managed sanitation rung, which this comparison currently cannot use for any of the six.

The counterargument

The strongest objection is that the 67.62% is an artefact of the ruler. Sharing an improved latrine between two households drops both out of basic coverage without a single gram of excreta reaching the open, and Bangladesh's 0% open defecation is proof that containment worked. On this reading the indicator is measuring housing density and land tenure in a delta of 173.6 million people, and Bangladesh is being marked down for being crowded.

Three answers, one of which is a concession.

Every country in the group is measured against the same rung, and Vietnam clears it at 95.45% and Indonesia at 88.2%. For the definition alone to explain a 20.6 point gap, Bangladeshi households would have to be sharing at far higher rates than their peers, which is a housing and service failure rather than a measurement error, and it is exactly the thing move 1 above would make visible.

Sharing is not neutral either. A facility that no household owns is the one no household pays to empty or repair, which is why the ladder treats it as a lower rung rather than a labelling quirk.

The concession is that the objection is right about what the outcome data can carry. Under-five mortality of 30.5 and stunting of 23.6% are consistent with the sanitation reading and equally consistent with an income reading, in an economy of US$450.1 billion growing at 4.2% in 2024. Nothing here separates them. What the objection cannot do is turn last of six into an acceptable result, on an indicator that measures a latrine, in a country that already proved it can change the behaviour of an entire population inside a generation.

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Data sources: World Bank World Development Indicators, retrieved from the BDPolicyLab data lake, 2026-08-10. Comparators are India, Pakistan, Indonesia, Thailand and Vietnam; "peer median" is the median of the comparators reporting in the stated year, excluding Bangladesh. WASH and mortality figures are 2024 and stunting 2022, being the latest years with comparable coverage. WASH coverage figures are WHO/UNICEF JMP modelled annual estimates fitted to household surveys, not a direct enumeration in the stated year, and revisions between vintages are normal.

Sources

1. World Bank WDI, People using at least basic sanitation services (% of population), SH.STA.BASS.ZS: https://data.worldbank.org/indicator/SH.STA.BASS.ZS
2. World Bank WDI, People with basic handwashing facilities including soap and water (% of population), SH.STA.HYGN.ZS: https://data.worldbank.org/indicator/SH.STA.HYGN.ZS
3. World Bank WDI, People using at least basic drinking water services (% of population), SH.H2O.BASW.ZS: https://data.worldbank.org/indicator/SH.H2O.BASW.ZS
4. World Bank WDI, People practicing open defecation (% of population), SH.STA.ODFC.ZS: https://data.worldbank.org/indicator/SH.STA.ODFC.ZS
5. World Bank WDI, Mortality rate, under-5 (per 1,000 live births), SH.DYN.MORT: https://data.worldbank.org/indicator/SH.DYN.MORT
6. World Bank WDI, Prevalence of stunting, height for age (% of children under 5), SH.STA.STNT.ZS: https://data.worldbank.org/indicator/SH.STA.STNT.ZS