Assessing the sustainability of an integrated rural sanitation and hygiene approach: A repeated cross-sectional evaluation in 10 countries

Abstract

AbstractIntroductionWhile many studies have implemented programs to increase sanitation coverage throughout the world, there are limited rigorous studies on the sustainability of these sanitation programs.MethodsBetween 2014 and 2018, the rural Sustainable Sanitation and Hygiene for All (SSH4A) approach was implemented by SNV in Sub-Saharan Africa and Asia. Repeated cross-sectional household surveys were administered annually throughout program implementation, and 1-to-2-years following completion of program activities. We characterize to what extent sanitation coverage was sustained 1-2 years after implementation of this SSH4A intervention.ResultsSurveys were conducted in 12 program areas in 10 countries, with 22,666 households receiving a post-implementation survey. Six of 12 program areas (Bhutan, Ghana, Kenya, both Nepal sites, and Tanzania) had similar coverage levels of basic sanitation 1-to-2-years post-implementation, whereas there were varied levels of slippage in the other program areas (both Ethiopia sites, Indonesia, Mozambique, Uganda, and Zambia), ranging from a drop of 63 percentage points in coverage in Ethiopia to a drop of only 4 percentage points in Indonesia. In countries that experienced losses in the coverage of household sanitation, generally sanitation sharing among neighbors did not increase, whereas open defecation did increase. In each of the areas where slippage occurred, the sanitation coverage levels at the final time point were all still higher than the initial time point before SNV started working in these areas. We found a number of factors to be associated with the sustainability of sanitation coverage, including household socio-economic status, having household members with disabilities, baseline sanitation coverage levels of the program areas, and rate of change of coverage during program activities.ConclusionsData revealed sustained gains in sanitation coverage in some program areas, yet slippage in other areas. This work may serve to benchmark sustainability of sanitation interventions in Sub-Saharan Africa and Asia.