Focus on Poverty: Using disgust to stop open defecation
A community-led approach gets local people to realise they must end the problem
The World Bank thinks it is more important to provide subsidised toilets
But disgust backed up by evidence is likely to be more potent than cheap loos
The government of Narendra Modi came to power in 2014 with a clear commitment to ending open defecation, wanting the job done by 2019. The campaign invoked the memory of Mahatma Gandhi, who thought sanitation was even more important than his country’s independence. The 2019 deadline is the 150th anniversary of his birth, and eradicating the practice would be a fitting tribute.
Modi’s plan was to construct 800 million toilets and a modern sewage system nationwide. But in March the central government announced budget cuts and a decision to push responsibility for delivering the scheme to state level — news that some commentators think means the dream is even further away than before the plans were first announced.
India is the country with the greatest prevalence of open defecation. But comb the internet and it’s not hard to find stories of it elsewhere — for instance, there are fears tourists could be deterred by turds on Ghana’s beaches (see video below).
One movement tackling the issue head on — or perhaps I should say ‘cutting through the crap’ — is Community-Led Total Sanitation (CLTS), which prioritises community organisation as a way of halting the practice.
The method is brutally frank. CLTS gets communities to discuss the patterns of open defecation in the village. The trigger for taking action comes when someone voices the realisation: “We are eating each other’s shit.” That trigger is visceral enough to get the community to organise itself, to do the work and bear the cost of the new sanitary arrangements, to make it work and to put a sustainable social infrastructure in place to keep it working. The approach is starkly different to those NGOs that fly in latrines in an effort to combat open defecation — indeed CLTS advocates say that subsidised toilet technology undermines their process.
The latest Global Food Policy Report contains a chapter, The power of WASH, which stresses the links between water, sanitation and hygiene (WASH), including the latest scientific evidence on the connection between open defecation and child stunting. In particular, comparison between Bangladesh and India indicates that reduction in open defecation levels is among the factors (also including nutrition, general economic condition and other WASH measures) improving average child height. 
It is therefore particularly regrettable that advocates of CLTS have had to challenge the World Bank’s use of their data in the World development report 2015, which looks at changing behaviours in the developing world (see pages 17 and 152-3). 
The report claims that systematic reviews have shown CLTS can reduce open defecation, but when the approach is paired with subsidies for toilets its benefits are “much higher”. Yet an open letter written by CLTS advocates says this is a wrong interpretation of the data. The authors of the letter (including Institute of Development Studies expert Robert Chambers, who the World Bank consulted while writing the report) argue that providing subsidised toilets to individual families undermines the community resolve and the approach of this dynamic movement. The correspondence is worth reading in full.
The World Bank report is an important and valuable attempt to summarise what we know about incentives and changing behaviour for development purposes. It would be tragic if it were to undermine efforts to end open defecation. There is a clear case here for independent experts reviewing the existing evidence.
I am confident that both the World Bank and the CLTS advocates are committed to evidence as the basis for policy. So it is important that this issue is resolved.
If evidence can prove advocates of CLTS are right — as I think they are — then this would be a clear case where the alliance of disgust and scientific evidence could provide a much stronger motivator for ending open defecation than the financial incentive of a cheap toilet.
Roger Williamson is an independent consultant and visiting fellow with both UNU-WIDER (UN University World Institute for Development Economics Research) and the Institute of Development Studies at the University of Sussex, United Kingdom. Previous positions include organising nearly 80 international policy conferences for the UK Foreign Office and being head of policy and campaigns at Christian Aid.