The sanitation arc: an alternative examination of WASH behavior change

A primary goal of the WASH sector is to facilitate transitions from open defecation to improved sanitation. Many residents of low-income countries desire improved sanitation but lack the resources to obtain or maintain access to toilets. For such persons, describing the goal as ‘behavior change’ implies a deficiency in mindset, failing to capture contextual factors affecting sanitation access. Furthermore, household circumstances affect movement both up and down the sanitation ladder, a phenomenon that the sector tends to overlook. This study, based on interviews with 308 former subscribers to Haitian container-based-sanitation service EkoLakay, tracks household sanitation access at four points in time: prior to subscribing, during the subscription period, immediately upon unsubscribing, and at the time of interview. We describe this movement through time as the ‘sanitation arc’. Prior to subscribing, households were more likely to practice open defecation or rely on non-household sanitation, and less likely to have private improved sanitation than the average urban Haitian. This distribution is reversed among former subscribers. Nearly half of former subscribers, however, could not afford continuous access to EkoLakay; 80% of involuntary terminations resulted in loss of access to private improved sanitation, and over one-third of these households reverted to open defecation. HIGHLIGHTS Measuring behavior change omits perspective on resource availability.; Movement on the sanitation ladder is not always upward.; The ‘sanitation arc’ describes household movement up and down the sanitation ladder over time.; Many households rely on container-based sanitation for sanitation while amassing means to invest in permanent infrastructure.; Households with economic challenges revert to open defecation when no alternative sanitation is available.;