Long-term usage, condition, and cultural acceptability of the BALatrine project – findings from a subsidised sanitation improvement intervention in rural Central Java, Indonesia

Background Much work remains to achieve the sustainable development goals for improved sanitation access for all. Subsidised sanitation interventions are often criticised due to the possibility of the infrastructure being neglected or culturally inappropriate for target communities. The BALatrine intervention is a novel approach consisting of a community-wide subsidised recipient-aided installation of an improved latrine with septic tank (‘BALatrine’) and education package. The overarching study in rural Central Java, Indonesia, aimed to investigate whether this intervention could reduce soil-transmitted helminth infections, and the present study aimed to investigate elements of acceptability and long-term usage of the BALatrine. Methods We conducted a cross-sectional follow-up study of 88 households who received BALatrines in two villages 4—6 years following their installation. Quantitative and qualitative interviews with the household head and members were conducted to understand BALatrine usage and perceptions. Results The BALatrines were still in excellent condition with 89% still functional as initially intended corresponding to 95% of participants regularly passing a bowel motion in the BALatrine. Participants held high opinions of the BALatrine intervention, expressing their appreciation for the convenience it offered. A 77% reduction in reported open defecation was achieved. Participants expressed concerns towards the prospect of having to empty the septic tanks. Interviews with key village stakeholders demonstrated participants desire for aid and financial difficulties in obtaining and maintaining such improved sanitation. Conclusion Follow-up results of the BALatrine intervention demonstrate that BALatrine’s are a viable, practical and long-term solution for improving sanitation coverage in poor rural communities where there has been some behaviour change communication and emphasis on the importance of safely managed sanitation.