UNICEF Indonesia, World Trade Center 6 (10th Floor), Jalan Jenderal Sudirman Kav. 31, Jakarta 12920, Indonesia.
UNICEF Indonesia, Kupang Field Office, Gedung NTT Satu Data, Jl. Polisi Militer No. 2, Kupang 85111, Nusa Tenggara Timur, Indonesia.
Int J Environ Res Public Health. 2017 Dec 14;14(12):1572. doi: 10.3390/ijerph14121572.
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.
社区环境卫生整体推动方案（CATS），例如印度尼西亚政府的社区参与环境卫生整体推动方案（STBM），在减少露天排便方面发挥了重要作用，尽管对于成果的可持续性仍知之甚少。我们评估了已验证的无露天排便村庄的可持续性，并通过印度尼西亚农村的政府进行的横断面数据收集，探讨了滑降发生与社会规范强度之间的关联。该研究调查了 587 户家庭，并在政府进行无露天排便验证两年后，在六个无露天排便村庄进行了焦点小组讨论（FGD）。总体而言，滑降率（即受访者层面上厕所使用不理想和露天排便的组合）估计为 14.5%（95%CI 11.6-17.3）。多变量逻辑回归分析的结果表明，（1）较弱的社会规范，如受访者对社区内厕所拥有率的看法，（2）缺乏全年的水供应，以及（3）财富水平（即不属于最富有五分位数），与滑降发生显著相关。这些发现，结合定性分析，得出结论，CATS 方案，包括需求创造的结合、通过社区支持机制消除感知到的限制，以及在无露天排便后继续鼓励追求更高水平的服务，可能稳定社会规范，并有助于维持研究社区的长期厕所使用。进一步的调查和更大规模的调查将有助于加强这些发现。
