Determinants of toilet ownership among rural households in six eastern districts of Indonesia

Abstract

In 2012, the Government of Indonesia and UNICEF launched a project within eastern provinces of Indonesia to scale up and strengthen a national hygiene and sanitation program called ‘Sanitasi Total Berbasis Masyarakat’. A formative study prior to the project was conducted to characterize sanitation and hygiene knowledge, attitudes, and practices (KAP) among 1,700 households in six rural Indonesian districts in 2014. Separate multivariate analyses for toilet ownership (outcome 1) and improved sanitation (outcome 2) were conducted with generalized linear models to assess the association between potential determinants and sanitation outcomes. Respondents who agreed that most people do not have a toilet in their community were associated with lower levels of toilet ownership compared to respondents who disagreed with the statement (p < 0.001). The perception that building a toilet is expensive was also associated with reduced toilet ownership in contrast to respondents without this perception (p < 0.001). Embarrassment and convenience were associated with ownership of improved sanitation versus those with shared or unimproved toilets. The study suggests that social norms play an important role in changing sanitation behaviors. Future research should aim to clarify the extent to which norms and other psychosocial factors can be used to influence sanitation practices.

Enabling Factors for Sustaining Open Defecation-Free Communities in Rural Indonesia: A Cross-Sectional Study

“…This suggests further efforts might be needed to introduce culturally-acceptable latrine options with lower water use requirements together with strengthening water access provision by local governments. Our findings around respondents’ perceptions on their community-level latrine ownership as a predictor of both consistent latrine use and private latrine ownership were in line with previous studies [ 13 , 14 , 21 ]. These findings suggest both normative and empirical expectations could be strengthened by reaching a tipping point of and/or gradual increasing sanitation coverage and use within their communities.…”

“…For challenges around water access, a pit latrine option might be more suitable in settings like the Alor district, where water is scarce during the dry season. However, strong preference to flush or pour-flush latrine and aspirations for higher levels of sanitation provision have been reported among households without latrines in rural Indonesia [ 21 ]. This suggests further efforts might be needed to introduce culturally-acceptable latrine options with lower water use requirements together with strengthening water access provision by local governments.…”

“…Conversely, other studies report opposite findings that women were more likely to use a latrine when they have access to a private latrine in rural India [ 39 ]. Further work is needed to better understand gender-related cultural dynamics around latrine use behaviour in rural Indonesia, but in this context, privacy, pride, and convenience were found to be important drivers for women in respect for building a latrine [ 21 ].…”

“…To examine the impact of strength of social norms on (1) slippage (i.e., sub-optimal use of a private and neighbour’s latrine as well as reversion to OD usually) among all of the sampled households, and (2) slippage among households owning their private latrine, two separate multivariate analyses were performed. In multivariate model construction, all social norms-related variables, as described earlier, were included in addition to socio-economic factors (i.e., gender, age of respondents, education level, presence of a child under five years old, wealth quintile, size of household, and all year round water access for household needs) (based on the approach previously described [ 21 ]).…”

“…Enumerators recorded each response in one of 13 pre-determined reasons (“to prevent disease”, “to be clean and healthy living in their home”, “convenience”, “to have privacy in using the facility”, “to be modern”, “to be accepted well by others (i.e., pride/status)”, “to avoid sharing the facility with others”, “to avoid disturbing others in using a shared facility”, “to avoid embarrassment/humiliation”, “to follow what everybody is doing in the community”, “was told it was a right thing to use the facility”, “don’t know”, and “others”), accordingly. Each motivation factor was then treated as a binary variable (“Mentioned” or “Not mentioned”), and was used for constructing multivariate logistic regression models as described elsewhere [ 21 ]. Furthermore, in order to better understand challenges to building a private latrine, we examined factors that were associated with latrine ownership, where both social norms and socio-economic factors were included.…”