BARRIERS AND MOTIVATORS FOR MAINTENANCE OF OPEN DEFECATION FREE COMMUNITIES IN ABIM DISTRICT, UGANDA
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Introduction: Lack of access to improved sanitation facilities is still a serious threat to public health affecting billions of people globally. Consequently, people are compelled to practice open defecation which responsible for several health complication. Despite the resources invested by the government and development partners to enable communities become Open Defecation Free (ODF), some communities have relapsed to Open Defecation (OD). One of the limitations could be the limited understanding of the barriers and motivators influencing the maintenance of ODF communities at multiple levels which this study explored. Objective: The main purpose of the study was to identify the motivators and barriers to maintenance of ODF status communities in Abim District, Karamoja region. Methods: This was a qualitative study that used Focus Group Discussion (FGDs) and Key Informant Interviews (KIIs). The study area was Abim district located in Northern Karamoja region of Uganda. A total of Eighty (80) community members from ODF and OD villages were selected purposively to participate in FGDs basing on their capacity to provide information which was relevant to the study. Key informants included community leaders, technocrats and civil society. Directed content analysis guided by the socio-ecological model was used to derive themes emerging from the FGDs and KIIs. Results: Several motivators and barriers to maintenance of ODF were revealed by the study. Motivators at individual level included; perceived benefits, personal dignity and level of education. Incentives, dignity and perceived health benefits were cited at household level. At organizational level; stakeholder coordination and funding of ODF campaigns, at community level; availability of facilities, and policy level; availability of bye-laws. Barriers to maintenance of ODF status at individual level were; attitude, readiness to behaviour change and structural barriers, at household level; financial challenges, physical barriers and shared latrines, at organizational level; community engagement and financial challenges, at community level; socio-cultural practices, physical barriers and limited access to latrines. Lack of ordinances and weak enforcement of bylaws were reported at policy level. Conclusion: Maintenance of ODF status was influenced by a cascade of motivators and barriers within the socio-ecological framework. In order to achieve sustainability of ODF communities in Abim district, there is a need to consider sanitation interventions that address OD challenges at multiple levels of influence.