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Cited by 68Child Nutrition and Water AccessWater Resource Management and QualityEnergy and Environment Impacts

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

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Odagiri, Mitsunori, Muhammad, Zainal, Cronin, Aidan, Gnilo, Michael, Mardikanto, Aldy, Umam, Khaerul, Asamou, Yameha·2017·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph14121572PMC PMC5750990
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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.

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  • Factors linked to reversion to open defecation include financial constraints, lack of water access, rocky or unstable soil conditions, and large household size.

    “Factors that may be linked to reversion to open defecation include financial constraints, lack of water access, rocky or unstable soil conditions, and large household size [9, 13]”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [9]

    Discussion §4.2 identifies economic barriers, limited dry-season water access, and households with seven or more members as factors associated with slippage or reversion to open defecation. Our copy does not identify rocky or unstable soil conditions as a factor, so that part of the claim is unsupported. No page numbers are available in the indexed passages. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In prior studies, a fraction of the population (ranging from 4% to 39%) may revert to open defecation in the years following ODF verification.

    “the limited data available indicate that a fraction of the population (ranging from 4%-39% in prior studies) may revert to open defecation in the years following ODF verification [6, 8–12].”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [9]

    The Discussion (§4.1; page unavailable) reports slippage one to two years after sanitation programmes, supporting the general point that some people may revert to open defecation. It does not report the claimed 4%–39% range, and cautions that the studies used different definitions of slippage and follow-up methods. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In some areas, the majority of open defecators may own a toilet but choose not to use it because they dislike its poor construction quality, lack of privacy, or unpleasant smell.

    “In some areas, the majority of open defecators may own a toilet but choose not to use it because they dislike its poor construction quality, lack of privacy, or unpleasant smell [9, 11].”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [9]

    Results §3.1 reports that 64.7% of households classified as having slipped back owned a private latrine, but this group is not equivalent to people who usually practise open defecation. Discussion §4.2 links dissatisfaction with poor construction to inconsistent latrine use, though the association was only nearly significant. It does not establish lack of privacy or unpleasant smell as reasons these Indonesian households chose not to use their toilets; the smell example concerns a study in Ethiopia. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Other studies in areas where sanitation markets are stronger have not identified toilet collapse as a major threat to ODF sustainability.

    “In fact, other studies in areas where sanitation markets are stronger have not identified toilet collapse as a major threat to ODF sustainability [9, 26].”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [9]

    The Discussion (§4.2; page unavailable) identifies wealth, water access and perceptions of latrine ownership as key drivers of slippage, rather than toilet collapse. But it does not establish that sanitation markets in the study area were stronger; it suggests sanitation marketing might be needed to improve poorly constructed latrines. That market comparison is unsupported. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The levels of open defecation observed in this study were higher than those reported in Asia, such as in Nepal (4%-8% at least one year after ODF achievement) and Indonesia (15% two years after ODF achievement).

    “The levels of open defecation observed in this study were higher than those reported in Asia, such as in Nepal (4%-8% at least one year after ODF achievement [6, 11]) and Indonesia (15% two years after ODF achievement [9]).”

    From Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana (2022) · cites this paper as [9]

    The citation to this paper is attached to the Indonesia figure, not the Nepal figures. The Results (§3.1; page unavailable) report 14.5% household slippage, approximately 15%, and the Methods (§2.1) place the survey more than two years after ODF verification. But slippage includes inconsistent latrine use; the paper reports only 2.7% of households as usually practicing open defecation, so 15% overstates that specific measure. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Odagiri, M., Muhammad, Z., Cronin, A., Gnilo, M., Mardikanto, A., Umam, K., & Asamou, Y.
Affiliations
  • United Nations Children's Fund (US)
  • United Nations Children's Fund India (IN)
  • National Development Planning Agency (Bappenas), Government of Indonesia, Jl. Taman Suropati No. 2, Menteng, Jakarta 10310, Indonesia
  • Planning, Research and Development Agency (Bapelitbang), Government of District of Alor, Jl. Bukit Doa Ayalon, Petleng, Alor Tengah Utara, Kabupaten Alor 85871, Nusa Tenggara Timur, Indonesia
  • Alor District Health Office, Government of District of Alor, Jl. Profesor W.Z. Yohannes, Subo, Alor Selatan, Kabupaten Alor 85871, Nusa Tenggara Timur, Indonesia
Corresponding author
Odagiri, Mitsunori
ORCID
Umam, Khaerul
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2017-12-14
Volume
14
Issue
12
Pages
1572
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph14121572
PMC
PMC5750990
OpenAlex
W2771581328
Cited by
68
References
1
Citations by year
2026: 2 · 2025: 9 · 2024: 8 · 2023: 8 · 2022: 12 · 2021: 10 · 2020: 12 · 2019: 4 · 2018: 2 · 2017: 1
FWCI
4.32
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Bill and Melinda Gates Foundation (OPP1029822)
  • UNICEF
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
  • Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
Keywords
total sanitation, community-based sanitation, program sustainability, social norms, latrine use, water access, household wealth, rural sanitation, Indonesia
MeSH terms
Adolescent, Adult, Cross-Sectional Studies, Defecation, Family Characteristics, Female, Government Programs, Humans, Indonesia, Male, Middle Aged, Ownership, Perception, Surveys and Questionnaires, Rural Population, Sanitation, Toilet Facilities, Focus Groups, Young Adult, Social Norms

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