In Indonesia, the World Bank workedwith the government to develop new approaches to discourageopen defecation and increase the number of toilets in poor,rural areas. An impact evaluation of a program to fosterdemand for toilets by raising awareness (instead of buildingsanitation facilities and hoping people would use them)showed a boost in toilet construction and a drop indiarrheal illness. Proper sanitation reduces the spread ofillnesses such as diarrhea and typhoid, which can betransmitted through fecal matter. In countries where peoplepractice open defecation in rivers, fields and forests,these illnesses are harder to stop. Fecal matter is trackedinto homes and into food, causing life threatening disease,particularly among infants and children under the age offive. Development practitioners and policymakers seeking toimprove sanitation and reduce open defecation are stillsearching for the most effective programs. Financialconstraints, inadequate water systems and habit of behaviorall play a role in slowing the end of open defecation. ThisEvidence to Policy note was jointly produced by the WorldBank Group, the Strategic Impact Evaluation Fund (SIEF), andthe British government's Department for International Development.
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