This 21-page report on sanitation promotion strategies, written by M.S. Candidate Jennifer McConville for the requirements of a graduate course, examines reasons behind the "disappointing" results to date of large-scale latrine promotion efforts around the world, offers some examples of projects that have had concrete impacts, and proposes a model for continued change in this area of environmental and health development. The premise of this report is that "Current sanitation promotion tactics needs to be reevaluated in order to develop new techniques that meet with wider public appeal."

Despite studies (which McConville cites) showing that latrine coverage must reach 90% of a population to have an impact on community health, 40% of the total world population lack the sanitation that could help prevent the deaths of children from diarrhoeal disease. Barriers to latrine adoption, McConville notes, are largely economic and socio-cultural ("Latrines themselves may be viewed as dirty and evil places....In many cultures women need separate facilities from the men....Cultures may be resistant or reluctant to change. This is especially true when foreign aid workers are responsible for promoting change. There may be feelings of resentment and/or fear of outsiders and their ideas.")

McConville shares a set of case studies that "give examples of success and failure in sanitation promotion around the world" - Guinea, Burkina Faso, China, Bangladesh, and India - gleaning impact data and lessons learned from each. For instance, "The key to sanitation promotion in India has been balancing the technical and social aspects of sanitation services. Since the introduction of community based promotion methods, rural India has seen sanitation coverage increase from nearly zero to 14% while total sanitation coverage increased to 31%. Community involvement and self-financing methods lead to the construction of more than 350,000 latrines in one county alone. An impact evaluation in 1999 showed consistently better excreta disposal practices in communities participating in the promotion programs. The study indicated that future sanitation promotion efforts should focus on social marketing techniques and community management of latrines." Drawing on such examples, McConville finds that "The most common element to successful latrine promotion appears to be community outreach and involvement."

Based on this assessment, she then proposes a 3-step strategy for a successful latrine promotion programme:

1. background study - conducting interviews can help determine users' likes and dislikes as well as identify current hygiene practices and potential reasons for resistance
2. planning phase:
   
   
   • select key messages - "The key messages need to be based on existing ideas, because it is much harder to introduce radical or rapid changes in a population. The core ideas should be kept simple and to the point."
   • select appropriate technology
   • develop a social marketing approach that works to increase the social desirability of latrine use

3. project implementation:
   
   
   • conduct education/outreach - person-to-person visits have been found to be most effective; radio and television programming, discussion groups, and the use of school curricula are other options for encouraging participation
   • work to reduce the user costs of the new technology. "It is also important that operation and maintenance costs remain the responsibility of the user. This requires that the user take ownership of the project and increases the sustainability of the latrine."
   • work with in partnership with institutions ("Care must be taken not to duplicate efforts or damage the working relationship between the partner institutions.")

In short, knowledge of the local area and people, selection of appropriate messages and technology, and community involvement are, for this author, key strategies for increasing and sustaining use of latrines in developing countries.