DEMAND FOR SANITATION

What We’re Learning: To end the age-old practice of public defecation, it’s not enough to give away toilets.

Half the people in the developing world—2.5 billion people—don’t have safe sanitation. The consequences of this state of affairs include the spread of deadly disease, weak economic growth, and the loss of personal dignity. Partly because sanitation can be an uncomfortable topic, the problem hasn’t received the attention it deserves. When people have tried to address it, they’ve often done so by providing toilets. The assumption is that if people have toilets, they’ll use them. But evidence shows that many people who are given toilets don’t actually use them. In short, supplying toilets doesn’t work unless people also want to use them.

We made a grant to the Water and Sanitation Program, an organization affiliated with the World Bank, to help fund the Total Sanitation and Sanitation Marketing project. The project addresses the demand side of the sanitation equation as well as the supply side. The project’s goal is to reduce the number of people who defecate outside to zero in four different areas (one in Tanzania, one in Indonesia, and two in India) of about 1 million people each. And in the process, it is testing whether this approach can succeed on an even bigger scale in the future.

Total Sanitation is a participatory process. The goal is to secure an agreement from everybody in a given community to stop the practice of defecating in the open. In many cases, the people the project is targeting have been defecating outside for their whole lives. Encouraging them to change their ways takes a careful grassroots effort.

The project works with local NGO staffers and government officials who travel from village to village. They work with community leaders to organize a series of face-to-face meetings to make sure the message filters down. Oftentimes, emphasizing the health reasons for sanitation is not the most effective way to build consensus. Some of the educators explain the goal in terms of reducing the smell or the potential danger and shame of public defecation.

At the same time, the project addresses the issue of supply by training local masons to offer a range of latrines that are affordable to every segment of their market, including the poorest people in their communities. And, except for the very poorest families, each household pays for its own toilet, minimizing the need for subsidies and, most importantly, maximizing each family’s commitment to actually using it.

The Total Sanitation approach has already been tested on a large scale in one country, Bangladesh. But there isn’t enough evidence about the extent to which Total Sanitation is improving the lives of poor people and how sustainable it will be over the long term.

Our grant aims to test this approach on a large scale and in different countries to get hard data on how it impacts people’s health, economic, and social condition; whether it can be sustained over the long term; and whether it can be replicated at an even larger scale. If it succeeds, the grant could spur the widespread use of an effective solution to a very old problem.