At USD 5 per DALY (disability adjusted life years, a unit measuring the amount of health lost due to a disease or a condition) averted, hygiene promotion is a veritable bargain. By comparison, a DALY costs an average of USD 10 for insecticide-treated bed nets to prevent malaria; around USD 100 for condom promotion and distribution to prevent transmission of HIV/AIDS; and from USD 80 to USD 800 for directly observed short-course chemotherapy for endemic, infections or non-infectious tuberculosis. With the burden of disease costing the world USD 4.1 trillion each year, such simple hygiene acts as hand washing, safe disposal of shit, and good general hygiene around food, domestic animals, and sick family members, are the world's most cost-effective health interventions.

England's Stratford-upon-Avon, where the Bard of Avon, William Shakespeare, was born around 1560, was not the kind of place one would choose to enter this world. The putrid conditions in the village led to an infant mortality rate that was so high that surviving past the age of 5 was often a matter of random chance. As notable figures go, Shakespeare was not alone in being a random childhood survivor. Nelson Mandela (b. 1918, Mvezo, South Africa), Martin Luther King Jr. (b. 1929, Atlanta, USA) , Mohandas Gandi (b. 1869, Porbandar, British India), Mother Teresa (b. 1910, Skopje, Ottoman Empire), Eva Peron (b. 1919, Los Toldos, Argentina), and Kofi Annan (b. 1938, Kumasi, Gold Coast) are but a few of history's greats whom the world can thank for surviving past the age of five. Today, two million children die each year before the age of 5 because of diarrhea.

One of the best feel-good stories in the effort to end open defecation and help more people to be served by sanitation is the ascendance of CLTS, community led total sanitation. CLTS represents a shift from centralised top-down supply-driven approaches to decentralised, people-centred demand-driven approaches. Developed in Bangladesh, the approach takes advantage of the knowledge and opinions of rural people in the planning and management of sanitation programmes in their own villages, and success are being seen as the approach spreads into India and Africa.

Poor women and girls are hit hardest by the absence of toilets. They care for the  sick and are in greatest physical contact with human waste. Lacking toilets in overcrowded slums means going the whole day without relieving oneself and then risking exposure – or even assault – at night, a humiliating daily routine that can damage health. Menstruation adds considerably to the need for sanitary facilities. Sexual harassment and rape are also a risk in rural areas, where women often seek privacy in the darkness, and in refugee camps, which all too often fail to provide safely located, women-only toilets. These realities absorb women’s time, imperil their physical well-being, and limit their free and equal participation in the economic and social life of their societies.

Access to sanitation services has enormous potential to improve and save lives. What is lacking is the means to achieve this; the aim of the Global Sanitation Fund, launched by WSSCC in 2008, is thus a major development response and will help provide the means. The GSF aims to support national efforts to help larger numbers of poor people attain sustainable access to basic sanitation and good hygiene practices. Already, the GSF has some USD 50 million committed from the governments of Sweden, Switzerland, the Netherlands and the United Kingdom, and implementation is beginning in Madagascar, Nepal and Uganda. The intention is for this new global fund to disburse USD 100 million annually to support programmes that have been developed through decision-making processes involving local communities and will concentrate on hygiene education, raising awareness and creating demand.

The Global Water Partnership estimated in 2000 that, while USD 13 billion was spent by donors on water, just USD 1 billion was committed to sanitation. More recent figures from the Joint Monitoring Programme of WHO and UNICEF suggest a proportion of eight to one. With 2.5 billion people lacking sanitation, but 894 million lacking good drinking water, more investment is needed in sanitation. Why has sanitation been the "orphan child" in WATSAN (water and sanitation) funding and programmes?

Improved sanitation in developing countries typically yields about USD 9 worth of economic benefit for every USD 1 spent. That is an impressive ratio, though it is still relatively unknown outside of the sector. These benefits are mainly: saving time, reducing direct and indirect health costs, increasing the return on investments in education, and safeguarding water resources. The biggest element is the first one, saving time. People without toilets at home spend a great deal of time each day queuing for public toilets or looking for secluded places to defecate. The World Health Organization estimates this time has an economic value of well over USD 100 billion each year.

In our multimedia world, news reports inundate us everywhere and at any time. For example, as of 2007, there were 2.5 billion mobile phones in use. The same year, iTunes music sales exceed 2.5 billion. For its Olympic effort, China planted 2.5 billion trees in 2008. Carbon dioxide emissions from US power plants are now at roughly 2.5 billion tonnes per year. The "Idol" franchise is worth USD 2.5 billion. Sadly, 2.5 billion is also the number of people unserved by sanitation around the world. Of these roughly 0.7 billion are in India, 0.7 billion in China, 0.7 billion in Africa and the remainder in other places, including the Caribbean. In reality, "unserved" means that 2.5 billion people wake up every morning with nowhere to go to shit. 2.5 billion is a shockingly large number. Of people.

2008 is the UN-mandated International Year of Sanitation; for sector professionals, it is an all-out advocacy effort to get sanitation issues higher on the international agenda - and to get more people to demand good sanitation and hygiene. Success in the water and sanitation sector depends not only on technological know-how, but involves as well dealing with a complex process of social and political dynamics. Examples of on-going large-scale advocacy campaigns are WSSCC's WASH (Water, Sanitation and Hygiene) campaign and WaterAid's End Water Poverty Now campaign. Do such campaigns convince media, politicians and those without toilets of the need for sanitation and hygiene?