Every rung counts–A retrospective analysis of global sanitation progress across the service-level ladder under the MDGs

<jats:p>The household sanitation target during the Millennium Development Goal (MDG) period used a binary “Improved”/”Unimproved” metric to evaluate progress. The “Unimproved” category was divided into three service levels: Shared Sanitation (facilities acceptable), Unimproved Facilities, and Open Defecation (no facility). Despite these data being publicly available, no analysis of country-level progress across these sanitation service levels during the MDGs has been published. We propose that retrospective analysis of progress across service levels can illuminate the diverse approaches used to address particular urban and rural sanitation deficits, and may provide insight to national and global actors in their ongoing efforts to address household sanitation. Additionally, we propose that a Sanitation Ladder Score, weighted to ascribe full, partial, and no credit to use of improved, shared and unimproved, and open defecation, respectively, is essential for concise communication of progress. Our analysis required gap-filling of data missing from the Joint Monitoring Programme (JMP) dataset; our final dataset consists of 190 countries representing 99.8% of global population. 149 countries achieved greater progress on the Sanitation Ladder Score than on the MDG metric. Using the four JMP progress categories, 144 countries fell into the same progress category and 41 achieved a higher category of Ladder Score progress. Countries with large gains in shared sanitation tended to have much greater progress on the Sanitation Ladder Score than on the MDG metric. A more detailed analysis is reported for six countries, with insight from the literature into their approaches. This Sanitation Ladder Score could be modified to incorporate the new “Safely Managed” service level tracked under the Sustainable Development Goals (SDGs) and likewise could be modified for other SDG targets for which multiple levels of service/achievement are reported. We encourage others to build upon our analysis; our complete dataset is freely available online (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://melliott.people.ua.edu/data.html" xlink:type="simple">https://melliott.people.ua.edu/data.html</jats:ext-link>).</jats:p>