Sanitation marketing programs are part of Community-Led Total Sanitation (CLTS), a growing social science–based technique pioneered in Bangladesh in 2000. CLTS creates a demand for improved sanitation—one villager at a time, if necessary—and is successful only when 100 percent of the targeted population has abandoned open defecation.
It shares some tactics with previous efforts, such as creating an ally of a village's leader before approaching the group. But the differences are significant. CLTS teams, which can be outsiders, regional converts or both, use sanitation marketing to render the status quo disgusting. A team might ask residents to create a large map of the village in a clearing and then have everyone pour a bright powder where they relieve themselves. The resulting image shows how much land is despoiled. Another approach is to point out that another local village held in high esteem does not defecate in the open, playing again on feelings of shame as well as aspirational sentiment.
Aspirational motives play in the next phase as well, when the team prompts villagers to design latrines that can be built with locally found or purchased materials. If latrines cannot be produced locally, replacements will not be built when the original toilets break down and are abandoned.
Perhaps most counterintuitive is the importance of ownership. "Toilets need owners," says Jack Sim, founder of the World Toilet Organization, an information and advocacy group based in Singapore. Sim, who has been involved in improving sanitation since 1998, is not talking just about conceptual ownership, as in who takes care of a latrine. He and others have found that people should purchase a toilet with their precious money to give it value. "People often revert to open defecation when there is no ownership."
David Winder, CEO of the nonprofit WaterAid America, says that whenever possible, the toilet must bestow status on those using it. Something as seemingly minor as a coat of paint on a latrine's concrete slab encourages its use and care.
The only objective measure of progress in the fight to give everyone on Earth a safe, sanitary and private toilet is the United Nation's Millennium Development Goals, which call for halving the proportion of people living in poverty by 2015. The sanitation goal seeks to halve the proportion of people living without basic toilets by the same year.
The hope is that efforts such as sanitation marketing and the Gates Foundation's challenge will have an impact on sanitation problems worldwide, but the reality of what they face is daunting. "Of the Millennium Goals, sanitation is the one that's most off track," according to Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters, (Metropolitan Books, 2008) which makes the case for universal toilets. Indeed, WaterAid estimates that at the present rate of progress, sub-Saharan Africa will not hit the mark for centuries.*
*Editor's Note (2/21/12): Rose George requested that the wording of her quote be changed to indicate the sanitation portion of the Millennium Goals is the one that is most "off track," as opposed to being the most "out of line," as the quote originally indicated.