Toilet Use in Developing World Not a Simple Decision

The case for using toilets—less fecal pollution leads to better health—might seem self-evident, but 2.5 billion (according to United Nation’s estimates) of the world’s poorest still don’t have them.  And it’s harder to press that case than might be imagined. After all, the causal link between fecal contamination and human health is a scientific fact while the decision to buy or use a toilet is governed more by such variables as cost, tradition, and culture than by science. When it comes to behavior change, effective outcomes depend wholly on recipients’ decision-making—a process that’s rarely understood, much less taken into account in project design.

Scientific laws are universal, but individual decision-making is context specific; a project that worked in one context may not work in another without adjusting for the new project recipients’ decision-making.  Even if project approaches are tested in a pilot, all that can be determined is what is effective in that specific context. Replication requires additional testing to see what works in the new context. 

As a recent 3ie blog explained,  the failure rate of taking Water and Sanitation Hygiene (WASH) programs to scale is high. A knot of contextual, psychosocial, and technological factors influence decision-making around the use of toilets, making more research into understanding these factors imperative and essential to improving program design. 

One way to understand how decisions are made is to articulate the intended beneficiary’s decision-making process or “decision space.”  Building on the latest work in applying behavioral economics to development, decision space is an understanding of a person’s range of options and their likely consequences. One indication of the idea’s currency is the 2015 World Development Report, which was devoted entirely to understanding decision-making processes to better leverage behavior change. 

So let’s unpack a hypothetical decision space for deciding whether to join the ranks of toilet-users. Cost is one factor, certainly, since in households earning less than $2 a day toilets connected to sewer networks can utilize up to 35% of a household’s annual income. As the 3ie blogger noted, other factors include everything from the nature and frequency of communication campaigns to the skepticism of influential household members or the relationship between landlord and tenant.   

Once these factors are identified, weighted, and mapped out, the project designers target each with a solution that becomes part of the initiative. Here’s a hypothetical example of how challenges might be paired with project components:

Decision Space

Corresponding Project Design

Local civic leaders are extremely influential and hesitate to openly advocate for toilet use due to cultural sensitivity

Recruit local religious leaders to work with civic leaders to try to de-stigmatize talking about toilet use and help hold community meetings  

Labor is very seasonal and at times bills go unpaid and dependence on informal credit networks grows

Schedule loan repayments for toilets with income seasonality in mind

Low literacy rates complicate  loan applications and lending outside of informal networks is intimidating since unfamiliar

Use Informal networks to help explain and manage lending processes


Traditional formative research tools like willingness to pay surveys, focus group discussions, etc., have been used to study similar WASH projects.  Many fail because results from pre-design work are erroneously treated as definitive.  In other words, using the results from focus groups to scale up an information, education, and communication campaign is premature when what is needed is a pilot to test focus group discussion findings to fine tune the campaign. 

Given the complexity of the decision space—many more than the three factors charted here could be involved—work on the triggers of behavior change in each project setting is needed before project design is fixed and final.  Without pilot testing different approaches to see what works and what doesn’t in a particular environment, the decision space will be murky and the project probably won’t succeed.

Bringing program recipients and other stakeholders squarely into project design is an idea whose time has come.  Making good on this promise means articulating the decision space, using it to guide project design, and, more fundamentally, rethinking strategy for engaging project recipients in project design. 

Going forward, project success will hinge less on deliverables and timelines and more on defining the nature of the relationships between project communities and project funders in articulating and testing the decision space.  

Michael Cooper is a Senior Researcher at AIR.