India has a problem with toilets: Every second person relieves themselves outdoors, a centuries-old practice that contributes to child malnutrition, economic loss and evenviolence against women.
It’s a problem that India’s Prime Minister NarendraModi wants to fix by making sure every home in the country has a toilet of its own by 2019.

The answer though, sanitation experts say, doesn’t lie only in building more bathrooms. First, people need to learn to love using the latrine.

“Many people regard open defecation as part of a wholesome, healthy, virtuous life,” a recent study conducted in Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh found.  Researchers at the New Delhi-based Research Institute for Compassionate Economics added that the practice is “not widely recognized among rural north Indians as a threat to health.”

Those five northern Indian states account for 45% of the country’s households without a toilet, according to data from the 2011 census. But even in homes where toilets were installed, many people still prefer to go outside.

The RICE study found that out of 3,235 rural homes, 43% had a working toilet. Of those, over 40% had at least one member of the household who nevertheless opted to defecate in the open. When asked why, almost 75% said they did so because it was pleasurable, comfortable and convenient.
The government says it has recognized that it needs to address this mindset making it “top priority” while setting out to build 110 million new toilets across swathes of rural India in the next few years.
The full policy has so far not been published but will include a door-to-door campaign similar to that used in the eradication of polio.

When you get down to brass tacks though, the picture looks slightly less positive.
To build toilets across India’s cities and villages, over $30 billion has been earmarked, a large chunk of it provided by the federal government.

But only 8% of this money will go towards what the government calls “information, education and communication,” or IEC.

Experts say that’s too little.

“I would spend at least half of the money on IEC,” said SantoshMehrotra, a professor of economics at New Delhi’s Jawaharlal Nehru University.

“The IEC strategy is the heart and soul of a sanitation scheme to bring real change on the ground,” he added.
Previous sanitation programs in India have failed to spend all the money allocated.

SangitaVyas, one of the authors of the RICE study, said this is partly because of the red tape involved in getting education campaigns approved. She worries it will be the same for Mr. Modi’s new mission.

When the money is spent, it’s not all being put to good use: Researchers point out that the government has failed to inform people about the adverse health effects of open defecation as it has done in campaigns to reduce tobacco and alcohol consumption.

In the past, India has also relied on subsidies to get people to embrace toilets and handouts will play a big part in the new program, Mr. Mehrotra added.

The result? “Toilets that are not being used for what they are meant for and instead are made into storage rooms,” he said. “With subsidies, they go back to their bad habits after they have received the prize.”

India could learn from its neighbor Bangladesh when it comes to eradicating open defecation without relying on incentives.

In 2000, that country introduced a program in which health workers would encourage communities to identify the consequences of poor sanitation, spurring them to want to build toilets for themselves. The focus was to alter behavior before building the infrastructure to accommodate the change.
Known as community-led total sanitation and pioneered by Indian-born development consultant Kamal Kar, it is now in place in more than 50 countries, including in parts of India.

The method has reduced the number of people in Bangladesh defecating in the open from 19% in 2000 to 3% in 2012.

But it’s not perfect. CLTS does not define what makes a good toilet and regards access to a toilet, even a poorly built one, as better than not using one at all. Often in Bangladesh, a toilet can be just a shallow pit covered by two wooden planks. This pit is able to store human waste, but is often washed away during heavy rains and floods, increasing the risk of contracting diseases like diarrhea and cholera. That’s why the focus there has now shifted to manage the disposal of waste collected in the country’s toilets.

In India, the challenge remains to get people to use them at all.