Access to adequate sanitation is a human right and applies to everyone. Sanitation services and facilities and particularly on-site facilities and user interfaces are far too often designed in a standard way, without taking into account the diversity of needs of different user groups. Particularly in the rapid response phase where time and money are limiting factors simple, uniform and easy to implement designs are a preferred option. However, there is a wide range of different abilities and needs in any affected community. Consequently, if this range of abilities and needs is not properly addressed during the assessment, planning and design stage, people will be excluded from otherwise well-intentioned sanitation facilities and services.

An inclusive and equitable (or universal) design approach considers people’s diversity as a normal part of every society where the needs and rights of different groups and individuals are of equal value and properly balanced. Inclusive design aims to identify and remove potential barriers and create facilities and environments that can be used by everyone, irrespective of age, gender, disease or disability. It helps improve one’s sense of dignity and self-reliance, health and well-being, it supports caregivers and counteracts misunderstanding and ignorance. Often only minor adaptations or design improvements are needed to make sanitation facilities more inclusive. If considered in the design stage, additional costs of 3–7 % support barrier-free systems.

In order to be inclusive all potential user groups need to be adequately considered in the design of sanitation facilities. This includes people with long-term physical, mental, intellectual or sensory impairments, people with reduced mobility, people of different ages, sick or injured people, children, pregnant women, women and girls with specific requirements regarding safety and safe menstrual hygiene management among others. People may belong to different user groups at the same time (intersectionality) and some of the potential user groups may be hidden or less visible. Hence it is crucial to identify user groups and their potential barriers already during the initial assessment phase X.1. It is essential that facilities are built from the perspective of the persons concerned and they should be consulted and actively involved in the later program design and implementation process. Depending on anticipated users the interventions, adaptations and design improvements may include:

Assessment and monitoring

• Collecting data from each user group and ensuring that data are disaggregated by gender, age and, if applicable, type of impairment.
• Conducting focus groups and other direct consultations involving all relevant user groups in gender separated groups with trained facilitators of the same gender as the group members.
• Consulting different user groups about their needs, in order to inform the location, accessibility, design and use of all sanitation services and facilities.
• Involving organisations of persons with disabilities and older people’s organisations in sanitation responses and seeking advice from specialist organisations on how to ensure that sanitation facilities are accessible.
• Ensuring that all relevant user groups are represented in community WASH committees and WASH program evaluation.
• Training staff, outreach workers and partners in inclusive design, disability- and age-awareness and recognition of specific needs of different user groups.
• Monitoring the sanitation response to ensure inclusion of all user groups.

Planning availability of accessible sanitation and washing facilities:

• Consideration of a minimum of 15 % of all public latrines to be inclusive with other latrines built as barrier-free and as accessible as possible.
• Consideration of individual inclusive latrine units or inclusive units in blocks of latrines.
• Ensuring that all accessible facilities are labelled with large access symbols.

Reaching the facility

• Minimising distance of public or shared facilities to homes and shelter and locating accessible sanitation facilities and shelters so that people with physical limitations, reduced mobility or security concerns can be accommodated close to accessible latrines and other WASH facilities.
• Improving access to public facilities through wider paths, a handrailed slope or steps, string-guided paths or ground surface indicators and additional landmarks for people with visual impairments.
• Providing ramps with a low slope (no steeper than 1 unit height per 12 units length) with a minimum width of around 1.5 m and handrails at either side (preferably on both) and side kerbs.
• Providing brightly coloured visual signs that show accessible public or shared facilities.
• Providing mobile or household devices like bedpans, potties, buckets, bags or diapers for people with reduced mobility, people with incontinence or people who are bedbound.
• Ensuring that all hazardous areas are marked and fenced.

Entering and circulating inside the facility

• The recommended base area of a transitional or mobile latrine during the initial phase of emergency response is at least 120 × 120 cm and ideally 180 × 180 cm.
• For wheelchair users, the entrance area should be large enough to manoeuvre and should allow enough space to open the door. There should be minimal/no difference in floor level between outside and inside.
• The door should be at least 90 cm wide and open outwards with a large lever handle (no round handle) and a rope or rail at the inside to pull door closed and secure door fastening.
• Locks should be easy to handle for persons with grip difficulties, for example a sliding or revolving metal or wooden bolt could be used.
• Space inside the latrine should be sufficient for wheelchair-manoeuvre with a turning cycle of around 1.5 m (depending on wheelchair-models, check sizes and shapes of wheelchairs in emergency areas) and 1 m space to latrine for transfer. Additionally, there needs to be space for a caregiver to stand.
• Surfaces need to be slip-resistant.

Using the facility

• Providing handrail or rope for support when sitting/ squatting and standing up. Handrails should be installed at a height of around 80 cm above the floor and be strong enough to support body weight.
• Providing accessible handwashing devices (reachable height, easy-to-use taps, for people with limited grip/strength) and locating accessible handwashing facilities close to accessible latrines.
• Providing fixed or movable seats and sitting aids (commode chair, chair/stool with hole, cleanable seat, fixed or removable, different dimensions for children/adults).
• The toilet seat or type of latrine can be shaped differently according to customs and habits and should be decided on in consultation with the concerned population, including people with disabilities

Information dissemination

• Ensuring that all relevant WASH information and hygiene promotion messages are disseminated using appropriate and various communication means (e.g. using large print, loudspeakers, simple language, illustrations).

Gender-Friendly Design

Adaptations and design improvements to make sanitation facilities more gender and menstrual hygiene management-friendly include:

• Public or shared facilities that are accessible, well- maintained and gender-segregated
• Provision of privacy and security (latrines with solid walls, lockable doors, roof coverage in terraced areas, lighting at night, screened-unit blocks)
• Access to sustainable supply of locally acceptable menstrual hygiene materials including information on correct use (appropriate, affordable, produced by local supplier if possible). If they are not reusable,correct disposal options must be provided and communicated.
• Provision of disposal bins for discrete disposal of menstrual hygiene materials
• Provision of washing facilities with water and soap inside the cabin and/or possibilities for discreet washing and drying of reusable menstrual hygiene products with discreet drainage so that water with menstrual blood cannot be seen.

Culturally Appropriate Design

When designing and implementing sanitation infrastructure, special consideration needs to be given to culturally appropriate design of the facilities. This is particularly the case if people from different cultural, ethnic and/or religious groups are living together. People have the choice to use a toilet facility or not and may not use it if it is considered inappropriate, is not convenient or does not correspond to the user’s customs and habits. Culturally appropriate design therefore considers aspects such as an appropriate user interface (for sitters or squatters), the type of anal cleansing material that users find acceptable (e.g. toilet paper, water, sticks or stones), gender aspects and privacy (e.g. gender-segregated facilities for women and men), that different cultural groups may not be willing to use the same latrines or existing taboos related to toilet use, handling of waste or potential reuse options. Cultural beliefs and norms may also affect the siting (people may not want to be seen when going to a toilet) and the orientation of facilities (e.g. religious rules that the toilet should face away from the prayer point) and may limit technology options (e.g. reuse-oriented technologies may not be considered in contexts where handling and reuse of excreta is culturally not acceptable or the implementation of urinals in Muslim societies may not be an option). Cultural issues can be manifold and need to be addressed during the assessment stage X.1 in order to understand and respond adequately to people’s needs, habits and practices.