This looks like a great opportunity for some competent group to follow after the failed projects in developing countries for the benefit of the citizens. From World Economic Forum:
A recently published Lancet paper looks at the impact of the erstwhile Total Sanitation Campaign in the coastal Puri district in Odisha. The study finds that the government’s rural sanitation programme, implemented by NGOs and community-based organisations, was unable to reduce exposure to faecal matter. As a result, this sanitation programme had no impact on the incidence of diarrhoea and malnutrition. The authors of the paper conclude that in order to realise concrete and sustainable health benefits, sanitation programmes need to increase both the coverage and use of toilets, as well as improved hygienic practices.
Here’s the data:
Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.
…without total coverage, the gains from improved sanitation cannot be realised in a community. Even before one begins to debate the balance of priorities between sound construction and behaviour change communication, implementers need to acknowledge that sanitation programmes follow an ‘all or nothing’ logic. Unless all families adopt hygienic sanitation practices, we will not make a dent on the incidence of disease prevalence.