Alliance Model for Increasing Access to Sanitation and Improving Hygienic Practices in the Remote Community of Dhading District, Nepal

Abstract

Background: Access to adequate sanitation and hygiene is an important global health issue and remains a serious problem in Nepal. Objective: This study aimed to apply the alliance model to manage a sanitation and hygiene project. The project sought to increase sanitation access and improve households’ basic knowledge of sanitation and hygiene, as well as the hygiene practices of household members, in Dhading District, a remote area of Nepal. Methods: A mixed-method design was applied for data collection. The study sample included 18 alliance members and 492 household respondents. The alliance model consisted of three steps: (1) Preparation, including a situation assessment, formation of the alliance, and baseline measurement of study variables; (2) Action research using a one-group pre-test–post-test design to strengthen the management capacity of alliance members through planning, implementation, and evaluation of the sanitation and hygiene project; and (3) Reinforcement of capacity strengthening through a one-day review and reflection workshop with key alliance members and a final evaluation of post-alliance outcomes. Results: Six months after implementing the model, the overall management capacity of alliance members increased significantly (p < 0.001). Households’ access to sanitation, basic knowledge of sanitation and hygiene, and hygiene practices also increased significantly (p < 0.001). The prevalence of diarrhea in the project area significantly decreased (p < 0.05) nine months after implementing the model. Discussion: The model addressed key management issues within the alliance, fostered collaboration among major stakeholders, established a clear goal and action plan, mobilized resources, and secured the active participation of local residents in improving sanitation and hygiene in the Village Development Committee. Conclusions: The model can be applied to strengthen alliance members' management capacity, thereby improving the effectiveness of rural sanitation and hygiene practices.