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.
Highlights
An estimated 892 million people still practice open defecation [1]
Looking at the association between social norms factors and private latrine ownership, we found evidence that respondents’ perceptions around latrine ownership, the perceived costs associated with latrine construction, acceptance of open defecation near to a water body, and latrine use behaviour in their communities were associated with latrine ownership (Table 4)
We examined the sustainability of Open Defecation Free (ODF) village status that was achieved through the national sanitation programme, Sanitasi Total Berbasis Masyarakat (STBM), in six ODF verified villages in rural Indonesia, using the government-collected data
Summary
An estimated 892 million people still practice open defecation [1]. Poor sanitation leads to various infectious diseases such as diarrhea, soil-transmitted helminth, schistosomiasis, and trachoma. The STBM programme follows the principles of CATS (i.e., demand creation for sanitation in communities to stop open defecation within a broader enabling environment), and consists of five pillars: to stop open defecation, promote handwashing with soap, improve household drinking water and food management, and manage solid and liquid waste [17]. These efforts have resulted in over 9000 verified ODF villages (i.e., achievement of the first pillar, to stop open defecation) in Indonesia [18].
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