Evaluating a Community-Led Total Sanitation Model with Hardware Subsidies: A Qualitative Study on Open Defecation and Childhood Diarrhoea in Oromia, Ethiopia

Community-Led Total Sanitation (CLTS) is an established approach for eliminating open defecation. The integration of hardware subsidies within this model remains a contested issue in water, sanitation and hygiene (WASH) programming. This study explores a modified CLTS intervention incorporating targeted subsidies in rural Ethiopia. This qualitative study aimed to evaluate the implementation and perceived effects of a subsidised CLTS model on open defecation practices and childhood diarrhoea in selected communities of the Oromia Region, Ethiopia. An exploratory qualitative design was employed. Data were collected through in-depth interviews and focus group discussions with programme implementers, community health workers, and caregivers of children under five. Thematic analysis was used to analyse the data. The subsidised model was generally well-received. Subsidies for vulnerable households were seen to improve community cohesion and participation in sanitation activities. However, perceptions of inequitable subsidy distribution generated some social tensions. Many caregivers reported a perceived decrease in childhood diarrhoea, which they linked to increased latrine access and shifting community norms around sanitation. Integrating targeted hardware subsidies within CLTS can improve latrine coverage and is perceived to reduce childhood diarrhoea. Nevertheless, meticulous management of subsidy targeting is essential to preserve community trust and the collective action principle central to CLTS. Programme designs must incorporate clear, transparent criteria for identifying subsidy beneficiaries. Ongoing support is required for sustained latrine maintenance and the reinforcement of hygiene behaviours beyond the initial construction phase. Community-Led Total Sanitation, open defecation, diarrhoea, child health, qualitative research, Ethiopia, WASH This study offers qualitative evidence on the nuanced social dynamics of integrating hardware subsidies into a community-led sanitation approach, contributing to practical discourse on WASH programme design from an implementation perspective.