By Richard Black
Environment Correspondent, BBC News website, New York
"The problem is," Hilde Johnson told me, "that toilets are not sexy."
Women making latrines in Bangladesh
Self-evident perhaps; but in the context of breaking down the walls of poverty, it is a crucial fact.
"Imagine seeing people out in the streets with signs saying 'we want toilets'", Ms Johnson continued, "when they could be talking about HIV/AIDS or vaccines.
"It's quite clear which issue their attention will be on, and often the money follows the attention."
The "un-sexiness" of sanitation, its lack of donor-appeal, is one of the reasons why Norway's Minister for International Development calls it the "neglected Millennium Goal."
Five years ago, world leaders vowed to halve the proportion of people in the world without access to safe drinking water and basic, hygienic toilet facilities.
And as joint leader of a new initiative aimed at realising this aim, Ms Johnson believes that success or failure will have a significant impact on other issues also covered in the Millennium Goals, particularly health, education and the promotion of gender equality.
Children crossing over the sewage flow in Karachi
"In a school, for example, it's more difficult for girls than boys without a proper toilet," she said.
"Girls feel really awkward when they get their periods, and if they have to go out in the fields they may get attacked.
"It's actually a major reason why more girls than boys leave education."
Girls and women may also be more vulnerable to diseases associated with poor sanitation than boys and men.
Water and sanitation are linked in the Millennium Goals as they are in reality; but they do not appear to receive equal attention from the donor community.
According to United Nations data, water projects receive about eight times as much funding as those dealing with toilets.
Globally, the UN says that 1.1 billion people lack access to safe drinking water, while 2.6 billion do not have adequate sanitation.
The charity WaterAid calculates in its report Dying for the Toilet that at current rates of progress, the global Millennium Goal on water and sanitation will be met in 2026 rather than 2015. The delay, according to the charity, will result in 10 million extra child deaths.
But global figures hide regional trends; the most striking is how Africa is being left behind on both issues.
WaterAid shows Africa achieving its Millennium target only in 2105 - 90 years behind schedule - with more than 100 million additional child deaths over that period.
Women leaders vital
The initiative which Hilde Johnson hopes may bring sanitation and water into focus is called Women Leaders for Wash, the acronym spelling out Water, Sanitation and Hygiene.
It aims to take messages about the importance of water and sanitation to women leaders in Africa, the continent which above all others is failing on the Millennium Goals.
WHY TOILETS MATTER
A child dies every 15 seconds from diarrhoeal disease, attributable mainly to poor water supply and/or sanitation
443 million schooldays are lost each year from diarrhoeal disease
Failure to meet the MDG on water and sanitation is costing poor countries US$84bn per year
36% of Africans have access to an adequate toilet
19% of women in rural Africa spend more than one hour on every trip to fetch water
Investments in sanitation can bring a 14-fold return
"Diarrhoea is the second biggest child killer in Africa," another of the project's leaders Maria Mutagamba, Uganda's Minister of State for Water, told a meeting on the fringe of the World Summit.
"Only 58% of people have a supply of clean, safe water within one kilometre of their home.
"And the amount of time which it takes people to go and fetch that water has been calculated to cost Africa US$4bn in lost working hours each year, which it can ill afford."
WaterAid's policy officer David Redhouse believes that economic arguments alone should ensure investment in water and sanitation.
"Governments of both developing and developed countries are failing to prioritise sanitation in their development strategies," he said.
"These failures are not only an abuse of peoples' rights, they are economic illiteracy."
Clearly, some African countries are taking the issue seriously.
Ms Mutagamba mentioned Senegal, Ethiopia, Madagascar and her own Uganda as nations that are making progress.
According to Unicef's water and sanitation chief, Vanessa Tobin, one key issue is to use appropriate technology that can be looked after by local people.
Latrines on the bank of a stagnant pond in Bangladesh
"Bore-holes, rainwater harvesting, which we've set up in India and Bangladesh; for example, gravity-flow systems - and that's with training of local mechanics with networks of spare parts," she said.
"On the sanitation side, [there are] latrines with hygienic slabs, and bio-ecological systems."
These are not sexy terms; in fact, let's be honest, they are low-tech, hands-dirty grunt material.
But whether they begin to turn donor governments on more than they have in the past could largely determine the pace of human development in the poorest regions of the world - which is, after all, what the entire Millennium Goals process is supposed to be about.