Campaign improves childhood cognitive skills. The direct role of sanitation on educational outcomes suggests that lack of access to sanitation is a threat to human capital formation, which is an important driver of long-term growth and development. Despite its benefits, governments in developing countries have not provided sufficient investment, administrative support, and continuous oversight for the substantial provision of basic sanitation services.

Table 1 provides a first look at the progress made in access to electricity and water compared to sanitation services in low-income countries. Over the 2010 to 2019 period, access to electricity and water services increased by 14.07 and 7.97 percentage points, respectively. Meanwhile, access to sanitation services increased by only 0.68 percentage points in low-income countries. This marginal increase in access to sanitation may be partly driven by the fact that there is less public awareness of, and perhaps, lower priority given to, the sanitation problem— i.e., sanitation is a “low visibility good” in developing countries— compared to electricity or water services.

**Table 1:** The change in access to basic public goods in low-income countries, 2010-2019

|Publicgood/service|2010|2019|Change(% Points)|
|---|---|---|---|
|Electricity (% of population)|26.85|40.92|14.07|
|Water services (% of population)|49.85|57.80|7.95|
|Sanitation services (% of population)|44.56|45.24|0.68|

Source: Authors’ calculation of World Bank’s World Development Indicators. Access to electricity is the percentage of population with access to electricity. Water services (% of population) is the percentage of people using at least basic water services. This indicator encompasses both people using basic water services as well as those using safely managed water services. Basic drinking water services is defined as drinking water from an improved source, provided collection time is not more than 30 minutes for a round trip. Improved water sources include piped water, boreholes or tubewells, protected dug wells, protected springs, and packaged or delivered water.

Access to sanitation is both a demand and supply problem. Specifically, households demand to use sanitation services, and governments have a key leadership and facilitating role (e.g., partnering with the private sector) in providing sanitation services. Households may be able and willing to pay for improved sanitation services, but the government’s supply of public infrastructure is required to facilitate the final provision of these services. Without government provision of sanitation infrastructure, household demand for, and use of, sanitation may not be possible. In several rural areas in low-income countries, households may not be able to afford sanitation services— i.e., demand is nonexistent simply because income is too low. In such a case, the government can provide sanitation services (e.g., public toilets) as public goods to serve the poor at little to no cost.<sup>6</sup> On the other hand, if the supply of sanitation service is available, people will have the incentive to access and use these necessities. For several people in the developing world, however, the immediate and long-term benefits of accessing and using quality sanitation services and the facilitating role of government in providing these services are not well-communicated. Hence, the demand, and consequently, the supply for basic sanitation services might be low partly because of low awareness from lack of information. Moreover, even if there is awareness of the sanitation problem, the suppression of discussions and media campaigns around it can keep the problem hidden and hence, make it less visible as a priority policy issue. These may be attributed to weak institutions related to voice and accountability.

Using average years of schooling in 1900 as an instrumental variable to identify the exogenous component of voice and accountability, we estimate the latter’s impact on access to sanitation in 73 developing countries over the period 2002-2020. Our empirical analysis uncover the following results: First, we find that higher levels of _Voice_

> 6In situations where building sanitation infrastructure can generate positive externalities on the demand side, the empirical study by Gautam (2023) shows that a price subsidy is more effective than a targeted cash transfer in increasing the average sanitation adoption rate.

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