End Open Defecation Research Articles

Policy Brief: Ending Open Defecation in Nigeria

The purpose of this paper is to present a policy brief on ending open defecation in Nigeria. The briefing notes the burden of open defecation (OD) in Nigeria, its causes, the impact of OD practices, successes achieved so far, as well as the failures encountered and offers recommendations to end the practice in order to achieve the sustainable development goal (SDG) 6.2 of ending open defecation globally by 2030 as proposed by the United Nations.
 Key Recommendations:
 
 Strong Political Will to uphold and implement policies on sanitation
 Building more latrines
 Establishing monitoring team
 Capacity building
 Sustainable job creation
 Improved communication strategy

What noise matters? Experimental evidence for stochastic deviations in social norms

Social norms interventions are increasingly used in applied policy-making such as to end female genital mutilation or open defecation. Amongst the reasons for why policy-makers rely on social norms intervention tools is that the relevant underlying theory, which is concerned with dynamic-stochastic deviations processes, has matured substantially over the past three decades. In this article, turning to behavioral evidence, we investigate which of the models proposed in this strand of theory are supported regarding individual human behavior. Specifically, we identify which assumptions regarding individual-level adjustment behavior in terms of optimal play (‘best response’) and deviations thereof (‘noise’) are supported. In doing so, we move the focus of research from the theoretical and modeling question ‘How Noise Matters?’ (Blume, 2003) to the behavioral and empirical question ‘What Noise Matters?’.

A Legal Approach to Winning the ‘Wash’ War in Nigeria

Open defecation has continued to pose serious health and environmental challenges globally. This practice affects almost 1 billion people worldwide and is said to contribute significantly to an estimated 842,000 deaths resulting from sanitation related diseases. A survey conducted by UNICEF ranks Nigeria as the African country with the highest population practicing open defecation and the second next to India globally. To tackle this and to prevent an environmental and health crisis, a state of emergency was declared in the water supply, sanitation and hygiene services (WASH) sector that led to the signing of an executive order to end open defecation by 2025. The objective is to eliminate open defecation and also ensure that SDG 6 is achieved especially in the rural areas. This paper posits that achieving an open defecation free status has and still remains a primary target for the government in Nigeria at all levels and the machinery of law be deployed as a viable tool to achieve this target. It submits that for this target to be met, there is the need to recognize the right to sanitation as one of the key ways to address sanitation issues especially open defecation. Articulating this right in a way that respects equity, human rights and environmental sustainability will effectively aid in the realization of the goal of ending open defecation by 2025.

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

BackgroundThe most ambitious sanitation campaign to end open defecation (OD) in India came to a close on 2 October 2019 and there are limited independent, robust data to measure its...

Understanding Open Defecation in the Age of Swachh Bharat Abhiyan: Agency, Accountability, and Anger in Rural Bihar.

Swachh Bharat Abhiyan, India’s flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents’ preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and “behavior change” campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts.

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection.

Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection.

Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)

Worldwide, 892 million people practice open defecation, most of whom live in rural areas of South Asia and Sub-Saharan Africa. Community-Led Total Sanitation (CLTS) is the most widely deployed approach to generate demand for, and use of sanitation facilities. CLTS relies on behavioral change and community self-enforcement to end open defecation. Since its genesis in Bangladesh in 1999, CLTS has spread to approximately 60 countries, mostly in Asia and Africa, and is employed by the majority of development organizations operating in rural sanitation. This paper uses a qualitative approach to analyze the reasons and processes that drove the wide diffusion of CLTS. We show that CLTS was embraced because it was perceived as a fast and effective solution to the problem of open defecation, one which was in line with the decentralization and community participation paradigms, at a time when donors and governments were looking for strategies to meet the MDG for sanitation. CLTS spread under the leadership of influential donors, NGOs, persuasive practitioners, and academics. Face-to-face interactions among members of this network and local governments at conferences and workshops played a central role in the diffusion of the approach. The use of experiential learning during study tours and workshop field visits has been crucial to persuade government actors at different levels, NGOs, and donors to use the CLTS approach. Notably, robust scientific evidence played little role in the diffusion of CLTS. We conclude by making suggestions to strengthen the evidence base for rural sanitation policies.

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Urban and rural sanitation in the Solomon Islands: How resilient are these to extreme weather events?

The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 (“by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation”). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative cross-sectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders.

On consortium driven sanitation interventions to end open defecation: insights from an Indian village study

ABSTRACT Under the present global agenda of striving to attain the Sustainable Development Goals (or SDGs), it is necessary to reinforce the diffusion and adoption of inclusive innovations like toilets. SDG6 has created business opportunities for private actors to contribute to sanitation coverage in novel consortia involving public agencies, private actors, international bodies and social enterprises. Can there be tension between the pursuit of public welfare and private interests in such consortia? If so, how can they be managed to eliminate open defecation? To contribute to answering these questions, we study the evolution of sanitation coverage in Kameshwaram village in India via interventions by two consortia and their impact in the short and medium terms. Our case study highlights five sources of challenges: disconnect with evaluation of innovation by beneficiary, partner risks, stakeholder risks, systemic risks and missing institutions. Private incentives can be aligned for social welfare, only if payoffs to consortium actors are based not only on the attainment of implementation targets, but also on the impact produced. Thus, incentive design must only reward toilet installations that are of quality construction, safe, functional, long-lasting and being used.

Ending Open Defecation - Evidence from Survey of Rural Punjab

Ending Open Defecation - Evidence from Survey of Rural Punjab

Prevalence of open defecation among households with toilets and associated factors in rural south India: an analytical cross-sectional study.

India's National Sanitation Mission aims to end open defecation by changing social norms and behaviours coupled with financial subsidies to build toilets. An earlier evaluation in the rural Dharmapuri district of Tamil Nadu reported poor use of household toilets constructed with government assistance. Our objectives were to estimate the prevalence of adults with a household toilet practicing open defecation and determine the factors associated with it. We conducted a cross-sectional survey in 251 villages of the Dharmapuri district. We randomly selected households with toilets from the government register. We interviewed one adult member per household. We used multiple logistic regression to determine factors associated with open defecation. Of the 493 respondents, 270 (54.8% [95% confidence interval 50.2 to 59.2]) practiced open defecation despite having a household toilet. Inadequate design and incompletely constructed toilets, poor accessibility and availability of water, preference for open defecation, personal beliefs, sociocultural behaviours, family dynamics and lack of recognizing the health benefits of toilet use were significantly associated with open defecation. Exposure to government propaganda promoting safe sanitation practices was associated with toilet use. Open defecation is common despite the presence of household toilets in the Dharmapuri district of Tamil Nadu. Toilet use is influenced by several structural and sociocultural determinants. The mission needs to shift its emphasis from toilet construction to sustainable functioning and use of toilets.

A Review of In-Situ and Remote Sensing Technologies to Monitor Water and Sanitation Interventions

The United Nations Sustainable Development Goals (SDGs), announced in September 2015, present a vision of achieving a higher level of human health and well-being worldwide by the year 2030. The SDG targets specific to water and sanitation call for more detailed monitoring and response to understand the coverage and quality of safely managed sources. It is hoped that improved monitoring of water and sanitation interventions will reveal more cost-effective and efficient ways of meeting the SDGs. In this paper, we review the landscape of approaches that can be used to support and improve on the water and sanitation targets SDG 6.1, “By 2030, achieve universal and equitable access to safe and affordable drinking water for all”, and SDG 6.2, “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations”.

Public finance at scale for rural sanitation – a case of Swachh Bharat Mission, India

Abstract In 2014, the Indian Government embarked on a major programme to end open defecation. The government allocated significant public funds to ensure that the goal is reached by the year 2019. The Swachh Bharat Mission (SBM) programme for rural sanitation is ambitious and probably no government has ever attempted to tackle sanitation at this scale and with such a large financial commitment. The main objectives of this paper are to assess sufficiency of financial commitments for SBM and to review efficiency and effectiveness in fund utilization against its stated objectives. In a large country like India, the programme achievements are not even. Some states are on track while others will need more attention and more funds to ensure that the goal is reached by 2019. An important challenge is to ensure sustainability of open defecation free (ODF) villages and communities. Supplementing public finance with innovative financing is needed to ensure that lack of finance does not become a constraint in achieving the ODF status and to ensure sustainability.

Ending Open Defecation: A Review of Community-Led Sanitation Programs.

Ending Open Defecation: A Review of Community-Led Sanitation Programs.

To shame or not to shame—that is the sanitation question

AbstractThe Community‐Led Total Sanitation (CLTS) programme aims to end open defecation through facilitating activities that evoke a sense of shame, shock and disgust. The programme's initial success and low‐cost design has seen it become hegemonic in donor‐supported rural sanitation. However, the theoretical basis of the use of shame has not been critically evaluated. Supporters claim that shame helps form and maintain social relationships, yet contemporary psychosocial literature highlights that it is a volatile and often harmful emotion, particularly in conditions of poverty. Using a case study of Cambodia, which rejected the coercive elements of shame in CLTS, we explore the problems of shame and limits of local ownership of development.

Sanitation and the commons: The role of collective action in sanitation use

A lack of safe sanitation threatens human wellbeing and has overlooked implications for environmental sustainability. There is a growing need to understand community-level drivers of sanitation use, as poor sanitation in a few households can create risks for neighboring households and contaminate the surrounding environment. This paper considers sanitation in the context of common-pool resources, focusing on processes of collective action and sustainable sanitation use, and draws on a case study conducted in Koassanga, Plateau-Central, Burkina Faso, where an ecological sanitation system intervention was implemented. Using a qualitative study design, 26 semi-structured interviews were conducted with residents using a social capital framework for water, sanitation and hygiene. Data were thematically analyzed to understand how collective action played a role in sustaining use of the sanitation system. The case study findings indicated that social capital characterized by membership in local groups and associations may have contributed to successful implementation of the intervention and ending open defecation, through normalization and monitoring of the use of ecological sanitation systems. In addition, community leaders played prominent roles in ensuring that collective management of the sanitation systems was sustained. These findings highlight potential for further examination of sanitation systems from a common pool resources perspective to identify other factors that contribute to long-term sustainability. With growing interest in community-led sanitation approaches, this understanding can inform more effective strategies for governments and NGOs to promote the health of entire communities to achieve SDG targets for universal coverage.

Assessment of the implementation of community-led total sanitation, hygiene, and associated factors in Diretiyara district, Eastern Ethiopia.

Based on the sustainable development goals, the United Nations plans to achieve equitable sanitation and hygiene for all and to end open defecation by 2030. In Ethiopia, 60% to 80% of health problems are due to communicable diseases attributable to unsafe water supply, unhygienic and unsanitary waste management, which are directly linked to the practice of open defecation. This study has aimed at assessing the implementation of community-led total sanitation and hygiene (CLTSH) and associated factors. A community-based cross-sectional study design involving 420 of the 7,225 households found in Diretiyara district was conducted in June 2014. Both quantitative and qualitative data were collected. Using Logistic Regressions, bivariate and multivariate analyses were computed. This study showed that 66% of the respondents have knowledge of CLTSH. Eighty-nine percent of the respondents have latrine, of which 78% were constructed after the introduction of CLTSH. Eleven percent of the respondents reported to have defected in the open field and 15% of them reported that they had been recently exposed to diarrhea diseases. The occurrence of diarrheal disease was significantly associated with the extent of latrine ownership [AOR = 2.48; 95% CI 1.00, 6.12]. Attitude and perception parameters were significantly associated with consistent latrine utilization. Respondents who agreed that "Open defecation is preferred due to the unpleasant smell and heat from the Latrine'' [COR = 0.58; 95% CI 0.34, 0.99] were 58% less likely to use the latrine consistently. In conclusion, CLTSH has increased the extent of latrine ownership and decreased practice of open defecation, and yet, intermittent latrine use and poor hygienic practice were reported. Although some fundamental misconceptions were reported, the majority of the respondents have accepted CLTSH approach as a means to ending open defecation in their village. Health extension workers and local authorities should give emphasis to achieving sustainable behavioral change on improved sanitation and good hygiene practices.

For toilets, money matters

New work suggests that subsidies to the poor to buy latrines could help end open defecation.

Ending Open Defecation in Rural Tanzania: Which Factors Facilitate Latrine Adoption?

Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95–11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063–0.75; p < 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities.