Although improved public health and the generation of real economic returns to society (Evans et al. 2004) are the main societal reasons for investing in sanitation, they contrast greatly with the reasons that motivate private a householder’s desire for improved sanitation.
The society/public reasons for ensuring latrine use include,

- reduced excreta-related disease burden (morbidity and mortality) leading to:

- reduced public health care costs
- increased economic productivity
- increased attendance by girls at school (for school sanitation) leading to broad development gains associated with female education
- reduced contamination of ground water and surface water resources
- reduced environmental damage to ecosystems
- increased safety of agricultural and food products leading to more exports
- increased nutrient recovery and reduced waste generation and disposal costs (for ecological sanitation)
- cleaner neighbourhoods
- less smell and flies in public places
- more tourism
- national or community pride

Overwhelming evidence and common sense clearly show that households decide to change their sanitation practices to gain a variety of different benefits, these include:

- increased comfort
- privacy
- convenience
- prestige (se Household motivations for adopting improved sanitation.doc) [Paul can this title please link to the document]

These reasons have little to do with avoiding excreta-related diseases for good reason. Other faecal-oral transmission routes operate both inside and outside the home, thus emphasising the health benefits of improved sanitation are the least reliable when encouraging household to change their sanitation practices.

The private vs. public dimension of sanitation demand shows that both households and the public sector (government) clearly have good, but different reasons for wanting sanitation improvements. Trying to motivate private behaviour using these public interests usually doesn’t work. This partly explains why health education campaigns achieve little permanent change in sanitation and hygiene behaviours. Cholera outbreaks are notorious for gaining short-term changes in household behaviour but rarely seem to motivate sustained changes once the threat has passed. Moreover, many of the societal public benefits may be difficult to achieve without high levels of coverage which raises important programmatic and policy considerations.

The supply-led model pays little, if any, attention to understanding and stimulating the householders demand for sanitation improvements. Motivating messages designed to stimulate sanitation behaviour change are usually based on the pubic health reasons for latrine use and are tacked on to (and regarded as secondary to) the construction process.