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Where open defecation remains prevalent, the policy focus needs to be on education to encourage people to build and use a latrine

Populations accustomed to open defecation may require a substantial change in cultural values and behavior to use a fixed-point facility. Without such change, people may not use latrines at all or may use them in a way that undermines the potential health benefits. Therefore, behavior change through hygiene education programs must be the central policy focus in these settings.


It is important to understand what stimulates people’s interest in hygiene and sanitation. Health is one factor, but convenience, dignity, and social status may provide a stronger motivation. Once behaviors are recognized by a community, there is a pressure to conform, and social structures and leaders begin to contribute.

A successful example is the Regional Health Bureau’s Sanitation Advocacy Campaign, launched in 2003 in southern Ethiopia. That campaign increased latrine coverage from 13 percent of the population to 78 percent in just two years (see figure). This experience shows that relatively modest government expenditure to promote hygiene education can raise awareness and leverage significant household investment in traditional latrines.

Ethiopia’s successful experience of getting people onto the first rung of the sanitation ladder