Despite increased promotion, sanitation programmes have varying degrees of success partly because of limited consideration of the wider context beyond individual factors in programme design. Although a recent model, Integrated Behaviour Model for Water Sanitation and Hygiene (IBM-WASH) comprehensively addresses this gap, the model focuses on the initial adoption factors and lacks emphasis on the functioning of the entire sanitation system from toilet usage to the safe disposal of the waste. Hence application of the model is limited, to some degree, in achieving the Sustainable Development Goals for sanitation which have broadened the scope for sustainable sanitation service. Based on a review of available frameworks, this paper proposes an alternative comprehensive framework using an ecological public health approach to health determinants but does so through application across the spectrum of sanitation stages. A systematic literature review on sanitation adoption factors and comparative analysis of the proposed framework and the IBM-WASH framework was conducted to analyse the benefits of the framework. The findings show that different factors operate differently for each sanitation service stage, requiring a different set of actions for each stage. Our alternative framework can better address factors across sanitation stages and encourage collaboration among stakeholders with different disciplinary backgrounds.

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