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Sanitation and Hygiene Behaviour Change at Scale: Understanding Slippage

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This Reflection Paper is primarily based on experiences from the Global Sanitation Fund-supported programme in Madagascar. As sanitation and hygiene programmes mature, the challenge shifts from bringing communities to ODF status to sustaining this status. In this context, many programmes are confronted with the issue of slippage. This concept refers to a return to previous unhygienic behaviours, or the inability of some or all community members to continue to meet all ODF criteria. 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.


Date: 20 October 2016