Sanitation dynamics: toilet acquisition and its economic and social implications

Poor sanitation is an important policy issue facing India, which accounts for over half of the 1.1 billion people worldwide that defecate in the open [JMP, 2012]. Achieving global sanitation targets, and reducing the social and economic costs of open defecation, therefore requires effectively extending sanitation services to India's citizens. The Indian Government has shown strong commitment to improving sanitation. However, uptake and usage of safe sanitation remains low: almost 50% of Indian households do not have access to a private or public latrine (2011 Indian census). This highlights the need for novel approaches to foster the uptake and sustained usage of safe sanitation in this context. This study contributes to addressing this need in two ways: First, we use primary data collected in both rural and urban contexts in two states of India, to understand determinants of toilet ownership and acquisition. A theoretical model is presented accompanying our empirical findings. Second, while ours is not a randomized control trial, we are able to offer a rich picture on the main determinants and potential outcomes of sanitation uptake. Contrary to many studies on sanitation, our focus is not primarily on health outcomes but we emphasize economic and social status considerations. Further, toilet acquisition is analyzed in the context of an intervention that alleviated one of the major constraints to acquisition - financial resources - which allows us to highlight the importance of attending this constraint. These three contributions have important implications for the design of strategies to promote sanitation, a major focus of many governments of developing countries and international organizations at present.