Beyond the pilot project: a review of the diffusion of ecological sanitation toilets

Over 2.6 billion people lack safe sanitation. EcoSan toilets are an affordable technology that, used appropriately, minimize environmental and health problems associated with waterborne sewerage and pit latrines. A challenge for population health is how to encourage widespread adoption, known as diffusion or scale-up. This paper employs Diffusion of Innovations constructs to illuminate EcoSan toilet adoption factors in diverse settings. EcoSan toilets were found in 55 countries. Experiences in seven countries are compared. Findings include: a tendency for greater proliferation in federally-driven sanitation programs; successes in surmounting traditional disgust with excreta; a relationship between utilization and follow-up; and the importance of user acceptance before attempting to routinize construction. Included is a theoretical framework of EcoSan diffusion as a two-tiered, parallel innovation-decision making process, where the decisions of implementers and administrators and intended beneficiaries overlap and interact. Maximizing adoption from both groups is key for scaling up pilots to nations.