About two in every five people have no access to a proper toilet, said the World Health Organisation and the UN Childrens Fund (UNICEF), warning that the lack of sanitation is putting 2.6 billion people at risk of disease.

"In the world today, there are 15 million deaths caused by infectious diseases," said David Heyman, WHO's assistant director general for health security and environment.

"If we had good sanitation today, and good water supplies, we could decrease that immediately by two million -- those children who are dying unnecessarily from diarrhoea diseases."

The United Nations has declared 2008 the International Year of Sanitation, and it made use of International Water Day -- Thursday -- to highlight the issue.

"People don't like to talk about sanitation," said Jon Lane, executive director of the Water Supply and Sanitation Collaborative Council, a UN-mandated organisation that works for better sanitation in poor communities.

"It's a subject that is not spoken about in conventional polite society -- and that's been a problem for a long time."

In a survey by the British Medical Journal of 11,000 health professionals, sanitation was cited as the most important medical advancement since 1840, ahead of vaccines and anaesthesia.

But Lane said that some governments approach the issue in the wrong way.

"They've been a using top-down, centralised, supply-driven, subsidy-driven approach," he said. "They've been building toilets for people who don't want them and use them as bicycle stores and cow sheds and so forth."

Too much time was also being wasted on trying to get the private sector involved in sanitation facilities.

"The big multinational companies who were perceived as coming into the water sector don't want to come and manage utilities in developing countries because they have a profit motive which cannot be met in those countries," he said.

As a result, in Africa, six in 10 people have no access to what development agencies call "an improved sanitation facility which separates human waste from human contact".

Lack of sanitation not only increases the risk of disease, but also gives rise to safety issues, particularly for women and children who "risk sexual harassment and assault when defecating at night and in secluded areas".

Between 1990 and 2004, sanitation access improved for 1.2 billion people. But if current trends continue, there will still be 2.4 billion people without toilets in 2015.

UN-Water chairman Pasquale Steduto said: "The entire UN system has a shared responsibility in mobilizing concrete actions towards its achievement; investments must increase immediately."

The WHO estimates that, on average, one US dollar spent on sanitation will wind up 9.10 dollars later.

In Peru, it cost 800 million dollars to respond to a cholera outbreak in 1991 -- far more than the amount needed to improve sanitation and thus prevent such an outbreak from occurring.

UN Secretary General Ban Ki-moon reminded world leaders that one of the Millennium Development Goals that they signed up to in September 2000 was to halve the number of people living without basic sanitation by 2015.

"We are nowhere near on pace to achieve that goal," said Ban in a statement that bemoaned a global lack of political will to tackle the issue.

"Experts predict that by 2015, 2.1 billion people will still lack basic sanitation. At the present rate, sub-Saharan Africa will not reach the target until 2076."

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