Achieving zero open defecation status through a community-based programme in Cavite, Philippines, 2013-2019: a field review.

PROBLEM: Open defecation is practised in several communities in the Philippines. Achieving zero open defecation (ZOD) certification in the Philippines has been shown to reduce disease burden and improve overall community health and well-being. CONTEXT: Philippine communities are guided by the Department of Health to achieve ZOD status through verified municipal inspections. The Barangay Anahaw II administrative unit was selected as a site for implementing sustainable, community-based health programmes aimed at achieving ZOD. ACTION: In 2013, a community diagnosis was conducted in the barangay to assess sanitation and health needs. In 2016, a multisectoral water, sanitation and hygiene committee, guided by a Community-Led Total Sanitation campaign, focused on improving the barangay's sanitation status and promoting behavioural change. By 2017, the campaign's activities had been implemented to prepare for and support ZOD verification and certification. OUTCOME: The community diagnosis in the barangay identified improper waste management, including limited access to toilets, as one of its top health concerns. The community-led campaign included strategies such as household inspections, assessments of the knowledge of heads of households, clean-up drives and incentives to encourage toilet construction. While an initial attempt at certification in May 2017 was unsuccessful, the barangay achieved provincial ZOD certification in July 2019. DISCUSSION: A coordinated approach involving an initial community diagnosis, a multisectoral sanitation programme supported by local officials and the community, and continuing household engagement through activities and incentives enabled the achievement of ZOD certification.