YAOUNDÉ, Cameroon – Access to toilets is not something that captures the imagination of celebrity activists, but it is one of the most important health issues facing the developing world.

The statistics are disturbing. 88 percent of the 7.3 million people of Togo—over 6 million people—do not have toilets in their homes, according to UNICEF. If they do, it is very often an outdoor pit latrine, which are also scarce.

The United Nations estimates over half of the Togolese population defecates in the open.

“Access to toilets is a major problem in Togo: 23 percent of people in urban population and 78 percent of people in rural areas lack access to a toilet,” Samson Nzayisenga, Catholic Relief Services Country Manager in Togo told Crux.

And this comes at a cost. Nzayisenga said the lack of toilets means “people will defecate in the open, which leads to exposure to diseases like diarrhea, infections with intestinal worms, typhoid fever, cholera and problems with menstruation.”

He said poverty and rapid urbanization were some of the major issues at the root of the problem.

CRS is in partnership with Caritas Dapaong to the north of  Togo, and with support from the Togolese Department of Hygiene and Basic Sanitation and UNICEF has stepped in with a project to help.

Since 2011, the project that uses an approach called ‘Community-Led Total Sanitation’, or CLTS has reached well over 177,000 individuals.

“This is an approach that provokes a collective effort in communities to take independent action to end open defecation and maintain better sanitation practices in their community over the long-term. CRS is also helping masons build latrines using materials available in their areas. This is done with the funding from Global Fund for Sanitation through UNICEF and the Ministry of Health in Togo,” Nzayisenga, told Crux.

Faouziatou Ali, the social worker facilitating the project has been effective in sparking change in the communities she has visited.

It all starts with Faouziatou leading a group of villagers into the surrounding bushes. They look around the overgrowth and behind trees, and the hum of flies draws their attention to what they were looking for: a mound of human waste.

“I ask them to look at the feces and tell me what they see, and they always mention the flies,” she said.

She would then proceed to ask them where the flies move to afterwards.

“Some mention that they find flies near their homes, others are more specific and say they often see flies in their kitchen when food is being prepared.”

‘The walk of shame,’ as the visits to the bushes are now called, created the spark for change. As Faouziatou explained the health implications, and illustrated the lessons with a community mapping activity and cost analysis of a family’s loss of income each time a child falls ill with diarrhea, community members suddenly came to terms with just how much they had been risking their lives through not using toilets.

“Before this project, no one had a toilet,” farmer Ichakou Koami told CRS. “I think the nearest one was in the next village over.”

“We thought we lived in a clean environment,” says one villager, “but that is not the case.”

With this new realization, Faouziatou would tell people to start digging a toilet the very next day.

“When your health is on the line, you wait for no one.” And she follows up to make sure the villagers are on track: In the village of Tchanfieri in northern Togo where the project has been so successful that the social worker now says the people “were in a hurry to use their latrine.”

In a country with one of the highest mortality rates for children under age 5, with 9 percent of the deaths caused by diarrheal diseases according to the World Health Organization, the development could potentially save thousands of children’s lives.

CRS has been motivating people across Togo to adopt the new habits of using toilets. Significant progress has been made, and 90 percent of the population in the targeted villages now have access to their own private latrine.

“Through a network of 75 local facilitators like Faouziatou, all 211 rural villages across northern Togo have been reached, with special attention to students at 181 primary schools. So far, 10,500 new latrines have been constructed benefiting over 100,000 individuals—many of whom now reside in villages that are certified open defecation free,” CRS said on its website.

“It is not a bad thing that we are asking people to do. This is a good thing for their health and for the community. I see it as the work of God,” said Faouziatou.