India’s recently ended Kumbh Mela festival, which attracted 10 million Hindus to a short stretch of the Ganges River over 55 days, was a reminder of the perils of poor sanitation. With pilgrims using leaky latrines and defecating on open ground, fecal sludge flowed toward the water they bathed in and sipped, risking diarrheal disease.

For many of those visitors, the situation at home isn’t much better. Some 37 percent of the world’s population, 2.5 billion people, don’t have so much as a composting toilet or a covered pit latrine. Almost half this group practices open defecation.

In the early 1990s, world governments committed themselves to halving the proportion of people without access to safe drinking water and basic sanitation by 2015. The water goal was reached last year, yet the toilet gap has narrowed by just 27 percent. At this point, there’s no chance of meeting the deadline.
This isn’t merely a matter of dignity. Inadequate sanitation leads to fecal contamination of food, water and living spaces, and this in turn causes diarrheal diseases, the second largest killer in the developing world, claiming 2 million lives a year.

The disappointing progress on sanitation is partly because only about a third as much money is spent on sanitation as is devoted to clean water. Although 884 million people still lack decent water, the needs in sanitation are now larger, so allocating funds more evenly makes sense.

Unused Toilets

Another reason sanitation has gotten less traction is that toilets aren’t as universally appreciated as clean water is. Thousands of toilets installed across the developing world at government or donor expense gather cobwebs.
These failures offer a lesson in how to expand good sanitation: Rather than build toilets, governments and donors must build demand for them.

In India, Indonesia and Zimbabwe, among other places, pilot projects run by government authorities and nongovernmental organizations have begun to demonstrate the value of this approach. Understanding that people don’t automatically want toilets, they begin with a campaign lauding them. It has proved essential that a trusted member of the community lead such efforts. In one approach, people are shown how their current habits allow feces to get into fluids and fields, onto fingers, flies, floors and food, and then into mouths.
It takes more than a health lesson to sell people on toilets, however. In surveys of targeted communities, people say they care more about other qualities, such as privacy and the reduction of flies. This shouldn’t be entirely surprising. Think of how soap makers in wealthy countries often extoll their products’ smell rather than germ-killing potential.

Certain communities respond to more targeted messages. In Tanzania, where heads of household said they wanted to be seen as modern but thought toilets were too expensive, posters feature a happy family showing off its latrine with the caption, “A good toilet is possible! We’ve taken development all the way to the toilet!”

Some programs offer toilet-installation subsidies. In India, a number of communities have been given grants after they have become 100 percent open-defecation free. Many campaigns have achieved that outcome without offering households financial assistance. Once demand was sufficient, the free market ensured households got affordable toilets.

At the same time, the private sector needs support to ensure local masons are trained to build toilets. In a program in Indonesia’s East Java province, some households preferred no latrine to a smelly one. So it proved important that craftsmen learned to produce pleasant, water-sealed models that even poorer households could afford. Authorities will need to offer builders access to credit and business skills coaching so they can meet rising demand.

These pilot efforts can guide the many other communities that still suffer from a lack of toilets. The World Bank estimates that poor sanitation costs Tanzania the equivalent of 1 percent of its gross domestic product annually. For India, the figure is 6 percent. If a greater share of global aid is dedicated to sanitation, the investments are certain to pay off.