RT Journal Article SR Electronic T1 Assessing the Sustainability of an Integrated Rural Sanitation and Hygiene Approach: A Repeated Cross-Sectional Evaluation in 10 Countries JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2100564 DO 10.9745/GHSP-D-21-00564 VO 10 IS 4 A1 Apanga, Paschal A. A1 Freeman, Matthew C. A1 Sakas, Zoe A1 Garn, Joshua V. YR 2022 UL http://www.ghspjournal.org/content/10/4/e2100564.abstract AB Key FindingsThe Sustainable Sanitation and Hygiene for All (SSH4A) approach was designed to increase sanitation and hygiene coverage with the premise that by working with local government to plan and budget for the intervention, access and uses would be sustained.In 6 of the 12 program areas where SSH4A was implemented, we found sustained basic sanitation coverage 1–2 years post-implementation; all program areas, including those with slippage, had higher sanitation coverage than at baseline.Community, household, and structural factors were associated with higher toilet sustainability, including higher household socioeconomic status and living in communities with higher baseline sanitation coverage.Key ImplicationsPolicy makers, program managers, and funders should continue prioritizing the sustainability of sanitation and hygiene programs. Our findings can help benchmark sanitation sustainability and its predictors in sub-Saharan Africa and Asia.Introduction:While many studies have implemented programs to increase sanitation coverage throughout the world, there are limited rigorous studies on the sustainability of these sanitation programs.Methods:Between 2014 and 2018, the rural Sustainable Sanitation and Hygiene for All (SSH4A) approach was implemented by SNV in sub-Saharan Africa and Asia. Repeated cross-sectional household surveys were administered annually throughout program implementation and 1 to 2 years following completion of program activities. We characterize to what extent sanitation coverage was sustained 1 to 2 years after implementation of this SSH4A intervention.Results:Surveys were conducted in 12 program areas in 10 countries, with 22,666 households receiving a post-implementation survey. Six of 12 program areas (Bhutan, Ghana, Kenya, both Nepal sites, Tanzania) had similar coverage levels of basic sanitation 1–2 years post-implementation, whereas there were varying levels of slippage in the other program areas (both Ethiopia sites, Indonesia, Mozambique, Uganda, Zambia), ranging from a drop of 63 percentage points in coverage in Ethiopia to a drop of only 4 percentage points in Indonesia. In countries that experienced losses in the coverage of household sanitation, sanitation sharing among neighbors generally did not increase, whereas open defecation did increase. In each of the areas where slippage occurred, the sanitation coverage levels at the final time point were all still higher than the initial time point before SNV started working in these areas. We found several factors to be associated with the sustainability of sanitation coverage, including household socioeconomic status, having household members with disabilities, baseline sanitation coverage levels of the program areas, and rate of change of coverage during program activities.Conclusions:Data revealed sustained gains in sanitation coverage in some program areas, yet slippage in other areas. This work may serve to benchmark the sustainability of sanitation interventions in sub-Saharan Africa and Asia.