More than 761 million people rely on shared sanitation facilities. These have historically been excluded from international sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. Prompted by a proposed change in such policy, this review was undertaken to identify and summarize existing evidence that compares health outcomes associated with shared sanitation versus individual household latrines.

The reviewed studies show a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines. Therefore, evidence to date does not support a change of existing policy of excluding shared sanitation from the definition of improved sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.

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Heijnen M, Cumming O, Peletz R, Chan GK-S, Brown J, et al. (2014) Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes. PLoS ONE 9(4): e93300. doi:10.1371/journal.pone.0093300