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

Abstract

Community Approaches to Total Sanitation (CATS) programmes, like the Sanitasi Total Berbasis Masyarakat (STBM) programme of the Government of Indonesia, have played a significant role in reducing open defecation though still little is known about the sustainability of the outcomes. We assessed the sustainability of verified Open Defecation Free (ODF) villages and explored the association between slippage occurrence and the strength of social norms through a government conducted cross-sectional data collection in rural Indonesia. The study surveyed 587 households and held focus group discussions (FGDs) in six ODF villages two years after the government’s ODF verification. Overall, the slippage rate (i.e., a combination of sub-optimal use of a latrine and open defecation at respondent level) was estimated to be 14.5% (95% CI 11.6–17.3). Results of multivariate logistic regression analyses indicated that (1) weaker social norms, as measured by respondents’ perceptions around latrine ownership coverage in their community, (2) a lack of all-year round water access, and (3) wealth levels (i.e., not being in the richest quintile), were found to be significantly associated with slippage occurrence. These findings, together with qualitative analysis, concluded that CATS programmes, including a combination of demand creation, removal of perceived constraints through community support mechanisms, and continued encouragement to pursue higher levels of services with post-ODF follow-up, could stabilize social norms and help to sustain longer-term latrine usage in study communities. Further investigation and at a larger scale, would be important to strengthen these findings.

Open defecation-free slippage and its associated factors in Ethiopia: a systematic review

“…The analysis revealed that the open defecation-free slippage rate in Ethiopia was 15.9% (95% CI 12.9–19.4%). This slippage rate was higher than a study conducted in Nepal 3.5% [ 40 ], in Ghana 8.8% [ 41 ], and in Indonesia 14.5% [ 42 ], consecutively. Similarly, the slippage rate was higher than the average slippage rate of some African countries, which was 10–13% [ 2 , 43 ], in contrast, lower than East Timor 16.4% [ 44 ], Benin 17.5%, Mali and Mauritania 24% [ 41 ], Kenya 22% [ 2 ], Eritrea 27% [ 45 ], and Mozambique 31% [ 46 ] (Fig.…”

Achieving Equitable Uptake of Handwashing and Sanitation by Addressing Both Supply and Demand-based Constraints: Findings From a Randomized Controlled Trial in Rural Bangladesh 

“…Programs like CLTS may have improved coverage, but improved coverage may not equate to improved levels of usage in the context of large-scale programs (48). The poorest commonly revert back to open defecation due to low-quality sanitation structures that are prone to collapse, or ll with no provision for emptying (52)(53)(54). Many latrines built as part of CLTS are unimproved and shared; they do not effectively remove waste from the environment and are not sustainable (55).…”

Development and external validation of a logistic regression derived algorithm to estimate a 12-month post open defecation free slippage risk

“…A correlation in lack of handwashing with soap and ODF slippage was established at 8% (Shivanarain & Nancy, 2015). A cross sectional study to ascertain the association of ODF slippage and the strength of social norms in Indonesia for 587 households after a two-year ODF period estimated the slippage rate at 14.5% (Odagiri, et al, 2017).…”

“…ODF slippage occurs when one or more toilet adequacy parameters are no longer present for one or more toilets in a community (Galan, et al, 2013;Njuguna & Muruka, 2017). It is increasingly recognised that maintaining ODF status is challenging due to uncertainties in social cohesion, implementing agencies and government priorities, sustainability of toilet and handwashing technologies, sanitation financing, governance, monitoring and sanitation markets (Bongartz, 2016;Odagiri, et al, 2017). Faced with the challenge of ODF slippage, there is limited scientific evidence to guide a systematic approach on mitigating ODF slippage risk factors and covariates.…”