Building Toilets not Really Useful?

Left, right, and toilets:

Most people in India defecate in the open. Most people worldwide who defecate in the open live in India. The diseases spread by open defecation kill hundreds of thousands of Indian children each year and stunt the physical and cognitive development of those who survive....The importance of removing faecal germs from children’s environments follows clearly from economists’ growing understanding of early-life human capital accumulation. Study after study is showing that exposure to disease and other health insults in the critical first months of life translate into quantitatively important lost productivity as adults (for a recent review, see Currie and Vogl, 2013). If children exposed to more open defecation grow up to be adults who earn less and pay less tax, open defecation is not only a health disaster but an economic one too.

Remember that 35% of Indian population is under 18. For this cohort time has nearly run out to make any meaningful intervention. So the "economic disaster" has largely already happened. The issue is reducing its severity and preventing its future occurrence.

Open defecation has been declining by only about one percentage point per year for a very long time. Intensifying business as usual is not enough.... 

First, even without our survey, it is clear that there are many developing countries that are much poorer than India where open defecation rates are low and falling fast. Only 4% of people in Bangladesh and a small fraction of people in sub-Saharan African countries such as Rwanda, Burundi, Malawi, Kenya and the Democratic Republic of Congo (DRC) defecate in the open. People in these countries do not buy the expensive latrines with enormous pits that people in India insist on. Instead, these other countries are eliminating open defecation by switching first to using simple pit latrines that most people in India could already afford to make—affordable latrines which would save infant lives and prevent the spread of disease. 

Second, we found that many people defecate in the open even though they live in a household with a working latrine—and we know the latrine is working because somebody is using it. Over 40% of households with a working latrine have at least one person who defecates in the open. This figure includes both privately constructed and government latrines, which are much less likely to be used. Most people living in households with a fully government constructed latrine defecate in the open—indeed, even most young women in their 20s do. In these cases, the problem is clearly not latrine access....

We find that two-thirds of new latrine recipients would defecate in the open, and that even if the government were to build a latrine for every rural household in these states, without changing anybody’s preferences, a majority of people would still be defecating in the open. 

In fact, this result reflects two optimistic assumptions—that existing latrine owners are not more likely to be latrine users for unobservable reasons, and that the government’s attempt to build a latrine for every household indeed translates into a latrine on the ground for every household. So, it is clear that mere latrine construction is simply not enough. Instead, the Swachh Bharat Mission must be built on promoting latrine use: building demand for latrines.