Lasting results: A qualitative assessment of efforts to make community-led total sanitation more inclusive of the needs of people with disabilities in Rumphi District, Malawi.

In low-income countries, like Malawi, approaches aimed at improving access to household sanitation for persons with disabilities have been limited, and often do not include post-intervention process evaluations. 6% of Malawi's population reports defecating outside rather than in a sanitation facility, and 4% of its population live with a disability; these groups of individuals live predominantly in rural areas.This article describes a post-program evaluation of an inclusive Community-Led Total Sanitation program that specifically responds to household-level needs of people with disabilities in Rumphi District, Malawi.Data collected from safety and accessibility audits of household latrines used by persons with disabilities and interviews with implementers at 18 months post-intervention were used to determine sustainability.The household latrine audit results show that existing conditions for sanitation access are still not optimal for persons with disabilities and that changes may require more time to be implemented. Some of the training program steps had more lasting impact on the implementers than other steps, such as the squatting exercise. There was limited evidence implementers had made additional changes or innovations or had transferred their knowledge more widely to other implementers. There is also a need to ensure local vernacular is available to mitigate the social stigma associated with people with disabilities.Implications for future replication show the need to invest in training a wider group of people to assist with implementation and to keep the program simple and focused on more active learning methods to make sustainable behavioral changes.