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Many sanitation and hygiene programmes are confronted with slippage, which refers to a return to unhygienic behaviour, or the inability of community members to continue to meet all open defecation free (ODF) criteria.
In the first of a seven-part series for water, sanitation and hygiene (WASH) practitioners, WSSCC introduces slippage and how it should be understood.
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 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 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:
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:
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.
In the second article of our seven-part series, we explore the nuances of slippage and its impact on communities.