A lack of understanding at the individual, community and societal level regarding adequate sanitation is at the heart of this issue.

Although most people are aware that poor sanitation has an adverse health impact, there is a lack of awareness as to its extent. Improving sanitation is often low on the list of priorities for governments due other pressing needs i.e., food supply, education, medical treatment and dealing with war and conflict.

While sanitation is usually paired together with safe water as a single development goal, water has traditionally received greater emphasis and more resource allocation. Financing for sanitation comprises 37 per cent of total aid funding for sanitation and drinking water. The breakdown of country expenditures between sanitation and drinking water shows that funding for drinking water is often 3 or more times higher than that for sanitation.[2]

Sanitation and hygiene education is especially difficult to place as a priority area due to the lack of clear identification of institutional roles and responsibilities for sanitation, resulting in the merging of sanitation with drinking water services and the perception in some countries that sanitation is mainly a household issue.

Additionally, society regards the issue of untreated excreta with either deep disgust, as culturally unacceptable, or at best with indifference.

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