Open defecation is unsanitary. It leads to an estimated 280,000 deaths in impoverished communities each year, according to a study published in the journal Tropical Medicine & International Health in April 2014, and it can stunt the growth of children, who risk becoming infected with fecal bacteria while playing outdoors.
The United Nations has made it part of its eight Millennium Development Goals, to be achieved by this year, to reduce outdoor defecation significantly by increasing access to clean latrines. The U.N. says the goal will also reduce sexual violence against women who defecate outdoors.
The sanitation target includes provision of uncontaminated water to the world’s impoverished people. That goal, of providing potable water to 50 percent of those who need it, has been achieved.
But Mushfiq Mobarak, an economist at Yale University in New Haven, Connecticut, said that "we are far behind the stated goal" for reducing outdoor defecation. He noted that more than 1 billion people, or about 15 percent of the world's population, continue the practice, "and our ultimate goal is the bring that number down to zero.”
Toward that aim, Mobarak and co-researchers from the University of Maryland wanted to see whether financial aid would reduce open defecation. They provided vouchers to thousands of villagers in Bangladesh to cover 75 percent of the cost of installation of clean toilets, and coupled that with an information and motivation campaign called the Latrine Promotion Program, or LPP. Other villagers participated only in the LPP. The researchers also ensured that more latrines were available for purchase.
In 380 rural communities of more than 18,000 households, researchers compared the impact of the LPP with and without vouchers. They found that the combination of educating people about sanitation and offering them subsidies to install toilets was more successful than the motivational campaign alone, or simply increasing the supply of latrines that people could pay for out of pocket.
In a study published in the journal Science, investigators reported that vouchers for toilets resulted in a 22 percent reduction in open defecation, while the other two strategies had little or no impact.
Mobarak noted that some economists and politicians, concerned that the offering of subsidies can undermine interest and motivation in a project, are opposed to providing vouchers as an incentive to install clean toilets. But the toilet subsidies have proved "necessary and very useful" in combination with an information campaign, he said.
Mobarak said subsidies are offered by charitable organizations, like the Bill and Melinda Gates Foundation, and some governments have money to help people purchase toilets.