Don't know about cities but villages in Pakistan have showed an enviable statistics. 5.8 million people living in 5000 villages have been declared free of open defecation. I think villagers are much cleaner than the city dwellers.What are bases of 43 million figure? AFAIK - even villager have toilets in their houses these days - and in cities in almost every 2nd street have mosque where toilet facility is available than why one will defecate in public place?