WaterAid India is calling on central and state governments to commit to delivering universal access to sanitation after a report said India has most people lacking sanitation.
WaterAid's report reveals the hardest places in the world to find a toilet, where one can find the most people waiting, and which developed nations are facing their own challenges on sanitation.
The world's youngest country, South Sudan, has the worst household access to sanitation in the world, followed closely by Niger, Togo and Madagascar the report reveals.
Access to safe sanitation, and ensuring that everyone in a community uses a toilet, was key to better health and an important measure in addressing undernutrition linked to chronic diarrhoeal illnesses, it said.
India now has 60.4 percent of its people without access to safe, private toilets.
India, it said, holds the record for the most people waiting for sanitation (774 million) and the most people per sq km (173) practising open defecation.
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Since 1990, access has improved by 22.8 percentage points, putting it at seventh out of eight countries for improvement in South Asia, of countries for which data is available, the report said.
WaterAid India's Chief Executive Neeraj Jain said: "As we observe yet another World Toilet Day, more than 140,000 children younger than five years continue to die each year in India from diarrhoea and nearly 40% of our children are stunted.
"The Swachh Bharat Mission has the highest political commitment driving it but lot needs to be done still to make India truly open defecation free.
"The commitments need to go beyond just the construction of toilets to focus on other critical aspects like collective behaviour change, hygiene and technology intervention.
"Education to change people's attitudes towards sanitation is crucial if we are to realise the full health and economic benefits of sanitation," Jain said.
In South Asia, Nepal saw the most improvement, followed by Pakistan and Bhutan.
The report highlights the plight of more than 2.3 billion people in the world who do not have access to a safe, private toilet.
Of these, nearly one billion have no choice but to defecate in the open - in fields, at roadsides or in bushes. The result is a polluted environment in which diseases spread fast.
An estimated 314,000 children under five die each year of diarrhoeal illness which could be prevented with safe water, good sanitation and good hygiene.
Many more have their physical and cognitive development stunted through repeated bouts of diarrhoea, blighting their life chances, the report said.
The tiny South Pacific island of Tokelau has made the most progress on delivering sanitation since 1990.
Nigeria has seen a dramatic slide in the number of people who have access to toilets since 1990.
Not everyone in the developed world has toilets. Canada, Britain, Ireland and Sweden are among nations with measurable numbers still without safe, private household toilets.
Russia has the lowest percentage of household toilets of all developed nations, the report said.