Zeta, A. O. (2017). Achieving zero-open defecation using the hygiene improvement framework (Unpublished master's thesis). Graduate School of Public and Development Management, Development Academy of the Philippines.

Graduate School of Public and Development Management Health Systems and Development Batch 7 Thesis (MPM-HSD)--Development Academy of the Philippines.

Diarrhea remains as a top cause of death among children under face tears of age worldwide. The burden of this disease is linked to poor sanitation practices and contaminated water. In the Philippines, about 1.3 million families are without access to sanitary toilet and 3.4 million have no access to safe water. The geographically isolated and disadvantaged (GIDA) sixth class municipality of Talalora in the Province of Samar burdened by the same poor sanitation situation with the rest of the country was hit by a recent diarrhea outbreak. Water sample examination from drinking water sources revealed positive contamination from E. coli and Coliform. As a public management response, this inquiry was conducted with the aims of reducing high diarrhea incidence by addressing high open defecation. Specifically, this study determined the socio economic review and service delivery network profiles of respondents determined the factors that contribute to open defecation practice, and the strategies that may be used to implement a zero open defecation (ZOD) program through a series of face to face unstructured interviews of key informants from the health demand side and supply side. The study showed that households practicing open defecation had low socio economic status and factors that contribute to open defecation and the strategies which may be used to implement a ZOD program can be grouped as access to sanitation hardware, enabling environment, and hygiene promotion core elements of the Hygiene Improvement Framework (HIF). Open defecation is a three pronged problem of behavior, financing, and regulation. Thus, a three pronged approach should be implemented instead of tackling these three problems singly. Hygiene promotion activities included community led total sanitation (CLTS), intensive information and education campaigns during family development sessions (FDSs), and food handlers training. Enabling environment interventions included policy development and ZOD institutionalization, and organization and activation of barangay health boards (BHBs). Access to sanitation hardware included the planned distribution of toilet bowls and construction materials. A financing scheme is yet to be developed to sustain the access of households to sanitation hardware.