DAVID GREENE, HOST:
Millions of people in the developing world lack toilets. And that can have serious consequences. Human waste out in the open is a major cause of stomach illnesses and child mortality. From Nepal, Danielle Preiss reports on one unconventional way to deal with this.
DANIELLE PREISS, BYLINE: I'm walking through Jiling Village in central Nepal with a group of villagers on the hunt. We cut narrow paths around rice fields and yield to goats with our eyes peeled to the ground until someone calls out, found some.
CHANDRA KUMARI: (Foreign language spoken, laughter).
PREISS: "It's poop," laughs 40-year-old Chandra Kumari - human poop. Leading the expedition is Sanjay Devkota, who works with U.N. Habitat through the Global Sanitation Fund. He asks who's responsible for the offending pile. The group calls a woman from a nearby house. And Devkota grills her.
SANJAY DEVKOTA: (Foreign language spoken).
PREISS: "When there's poop out in the open like this, how do you feel?" he asks. "Do you feel good about that? And the flies on it - do they only stay at your house? Or do they go to your neighbor's house, too?"
The woman looks really embarrassed. And the whole thing feels kind of icky. But that's the point.
ALISON BRADLEY: It's specifically for people to feel that what they're doing is dirty or unhealthy or not right for their communities.
PREISS: Alison Bradley is with the Water Supply and Sanitation Collaborative Council, a U.N. member organization that advocates this behavior change strategy to hygiene. It's called community-led total sanitation or CLTS.
BRADLEY: The notion that one family is defecating outside and that, you know, it's pretty gross is part of the process of helping the whole community realize that they need to take charge of their sanitation needs.
PREISS: CLTS emerged in Bangladesh about 15 years ago as a new way to combat open defecation. As late as 1990, just 10 percent of homes in Nepal had toilets, according to the World Health Organization and UNICEF.
And by toilet, I don't mean your standard porcelain bowl. A toilet here often means an outdoor squat latrine with some type of cover to keep flies out. Now about 70 percent of Nepali homes have toilets. But the millions of people who still defecate outside are a huge health problem.
CLTS upends the idea that building toilets for people is the solution. Bradley says such subsidy-based approaches have built a lot of toilets. But that doesn't mean people use them.
BRADLEY: So travel across India, and you see empty toilets being used as chicken coops or, sometimes, even as temples.
PREISS: Instead of subsidies, CLTS tries to make people want to build toilets themselves through the strong motivators of disgust and social shaming.
SHANTA BAHUDAR TAMANG: (Through interpreter) I built a toilet. If I can do it, why can't other people? If my neighbors defecate outside and the chickens eat it and walk in it, they come over and infect my house, too.
PREISS: Sixty-nine-year-old year old Shanta Bahadur Tamang is pretty worked up after walking around the village. If CLTS works perfectly, he'll use his anger to pressure the households in Jiling without toilets to build them, meeting the village's goal of being open defecation-free by September. The Nepal government wants the whole country using toilets by 2017.
DEVKOTA: Progress was very encouraging before earthquake.
PREISS: Sanjay Devkota worries victims of last year's earthquake will hesitate to spend money on toilets when they're still struggling to rebuild houses. He says aid dispersed after the earthquake has also made people expect handouts.
But he hopes that those who are already convinced to prioritize toilets will continue to do so even if the methods might seem a little harsh. I asked Chandra Kumari, the woman we met at the start of this story, if being called out on her community's hygiene practices bothers her.
KUMARI: (Through interpreter) I'm not ashamed. I think this is good. If we're staying in a dirty place, and people come to remind us not to do that, it's a good thing.
PREISS: For NPR News, I'm Danielle Preiss in Kathmandu. Transcript provided by NPR, Copyright NPR.