Community-Led Total Sanitation Program Attain to Increase Knowledge, Attitude and Intention but Fail to Change the Community's Behavior; Case Study in Urban Slum Area in Bandung Municipality

Abstract

Environment-based diseases in developing countries mainly caused by poor sanitation and low hygienic behaviour. Community-Led Total Sanitation (CLTS) as government effort to change community's behavior concerning campaign of open defecation free, hand washing, household water treatment and domestic waste disposal is implemented through triggering activities. This study intended to analyze implementation process and outcome of CLTS in urban-slum area in Bandung municipality. It was sequential explanatory mixed-methods study among 53 urban-slum dwellers in Taman sari sub-district during Oct-Nov 2016. Quantitative data through self-administered questionnaires was collected to compare level of knowledge, attitudes, and intentions of community pre-post triggering activities and analyzed using paired t-test analysis. Qualitative data was collected by observations, in-depth interviews, and document studies to reveal, explain, and strengthen the results. Follow-up observation was conducted after one year to gain CLTS outcome. Results showed knowledge, attitude and intention significantly different before and after triggering activities (p=0.006; p=0.021; p=0.001, respectively). Qualitative analysis explained that predisposing-factors were constructed by community knowledge, attitudes, intentions, and habits. Enabling-factors consisted of environmental conditions, officer capability, resources, enabler agents, accessibility, appropriate technology, and sanitation facilities. Reinforcing-factors consisted of officer knowledge and attitudes, regulations, policies, and external support. However, follow-up one year after triggering activities proved that the change on knowledge, attitude, intention were not accomplished by community's action without any supervision by strong local ledership, government's facilitation and family support. Triggering activities on CLTS programme can increase knowledge, attitude and intention but intensive monitoring-evaluation and supervision should be carried out after implementation.