As sanitation and hygiene programmes mature, the challenge shifts from helping communities achieve open defecation free (ODF) status to sustaining this status. In this context, many programmes are confronted with ‘slippage’ – the return to previous unhygienic behaviours, or the inability of some or all community members to continue to meet all ODF criteria. How should slippage be understood and addressed? A new report – primarily based on experiences from the Global Sanitation Fund (GSF)-supported programme in Madagascar, provides comprehensive insights.
Download the complete paper or read the feature article below.
Slippage is intricate because it is hinged on the philosophy and complexity of behaviour change. Moreover, the definition of slippage is linked to the definition of ODF in a given country. The more demanding the ODF criteria are, the more slippage one can potentially experience.
In most programmes, one can discern two levels of slippage: output-level slippage and impact-level slippage. The former relates to the strict application of all ODF criteria, such as the elimination of open defecation and the availability of fly-proof latrines and handwashing facilities with evidence of use. The latter relates to negative impacts on overall health and wellbeing, such as a return to a high prevalence of diseases and epidemics related to poor sanitation and hygiene.
When identifying slippage patterns and addressing their resulting behavioural variations one has to remember that the journey towards mature ODF status is a community-driven process. Throughout this process the community continuously tests and consolidates new behaviours.
Sanitation and hygiene behaviour change is a non-linear process where it seems that becoming ODF is just the first step in a community learning process to reach behaviour change maturity. In Madagascar it was found that the typical community learning process to reach this level of maturity might look like this:
- A community is triggered, endeavors to reach ODF, and is eventually declared ODF
- The community slips back to non-ODF status repeatedly due to various regression factors (climatic events, challenging geology, life events and socioeconomic shifts)
- Interventions are carried out using so called ‘advancement factors’ to regain ODF status.
A common trend seems to be that the more often interventions are repeated and follow-up support is provided, the less dramatic the slippage will be, until eventually the community reaches behaviour change maturity.
With high-quality, dynamic community-led total sanitation (CLTS) facilitation, ODF becomes a state of mind as opposed to being attributed to physical, visual or infrastructural aspects only. There is a clear distinction in mentality between an ‘ODF state of mind’ community, a basic ODF community, and a community that is still practicing open defecation. Communities that demonstrate the ODF state of mind are more prone to steadily advance towards maturity than a community that displays a superficial internalization of ODF.
Identifying slippage patterns
As slippage is related to behaviour change we must assume that it is dynamic, highly varied and context specific. Slippage depends on factors internal to the community as well as external factors over which communities have little or no influence. The GSF has identified various slippage patterns:
- Slippage due to non-compliance with ODF criteria
- Community-wide slippage
- Seasonal slippage
- Slippage of convenience
- Externally induced slippage
- Institutional slippage
Slippage is a highly context-specific phenomenon and can be caused by a multitude of factors, either occurring separately or interacting with each other. Addressing slippage therefore calls for localized solutions, building on the creativity of the community but also the quality of facilitation throughout the CLTS process.
The time-bound measurement of slippage according to visual observations of technical and infrastructural criteria is an important management tool for programming and monitoring. The rigour and zero tolerance for failure to meet ODF criteria must not be compromised if we want to ensure the robustness of sanitation and hygiene programmes. However, it is crucial to find a way to combine this with an analysis of the level of collective behaviour change and health outcomes in a particular community. This will ensure programmes fully capture the intricacies and multifaceted nature of slippage.
In assessing slippage, external verifiers far too often rely on visual indicators only, without incorporating qualitative community perceptions and quantitative health impacts. To ensure all of these aspects are incorporated, three ODF verification pillars can be used:
The growing experience of GSF-supported programmes in monitoring and evaluation shows that adherence to ODF status over time is not linear, but rather a ‘two steps forward, one step back’ type of process. Slippage should therefore not be considered nor monitored as a ‘yes’ or ‘no’ matter, but rather as a sliding scale, and not at one-off events but periodically.
Addressing and mitigating slippage
As the GSF-supported programme in Madagascar matured, significant effort was put into finding strategies to address and pre-empt slippage, while building community resilience and capacity during the entire CLTS process. The following strategies have been used by the programme, through high-quality CLTS facilitation:
- In-depth Pre-Triggering
- Follow-up MANDONA
- Local Community Governance
- Creating a sanitation movement
- Institutional Triggering
- the U Approach for scaling up
- Behaviour Change Communication
- Participatory technology development
- Sanitation Ladder Triggering
- Sustainability indicators in ODF monitoring and verification
Some of these strategies have also been incorporated and refined within other GSF-supported programmes.
The way forward
Given the complexities of slippage across GSF-supported programmes, some areas for further exploration include:
- Measuring the impact of visual/observable slippage on behaviour change and health indicators.
- Assessing the impact of slippage on community health status: is there a critical tipping point when output-level slippage no longer has a bearing on impact-level slippage?
- Exploring slippage patterns, community dynamics and maturity trajectories, and behaviour reinforcement and sustainability factors, to better understand contextual factors.
- Understanding what strategies and tools there are/can be further developed, to empower people to take further steps on the ‘behaviour change ladder’. Moreover, how can programmes assess the depth of the behaviour change? Reaching ODF is perhaps the first rung on the behaviour change ladder. What are the subsequent rungs, and how can they be facilitated and monitored?
- Determining how to use slippage/ODF verification data to improve programmes and advance sector learning. What are the programming implications in terms of planning, implementation and evaluation?
- Establishing vigorous, harmonized and participatory monitoring/verification systems with reasonable financial and human resource implications. These should include agreed definitions that take into consideration aspects of slippage beyond one-time ‘snap-shots’ of visual slippage. Is there such a thing as an ideal standardized methodology, given that slippage is context-specific and variable?
- Determining how to effectively design systems for monitoring at scale, while acknowledging sustainability, quality and scale as inseparable elements that constantly reinforce each other.
- Exploring the correlations between the quality of Sub-grantees and/or the involvement of (local) governments and slippage rates.
- Considering the quality of Pre-Triggering, Triggering, follow ups and most importantly, CLTS facilitation.
The GSF is committed to supporting sustainable sanitation and hygiene behaviour change. To this end, the Fund will continue to deepen its understanding of slippage and sustainability factors, patterns and measurement, and further develop, innovate and assess potential mitigation methodologies and approaches.
Download the complete paper on the WSSCC website: bit.ly/2dxM1SL