Sanitation access and satisfaction in northern Haiti: Insights from a quasi-census survey

Lubeck-Schricker M, Felix-Jean W, Schelling M, Bauza V, Sklar R, Fanor Pierre M, et al. (2026) Sanitation access and satisfaction in northern Haiti: Insights from a quasi-census survey. PLOS Water 5(4): e0000510. https://doi.org/10.1371/journal.pwat.0000510

Abstract

Between 2015 and 2024, global open defecation declined, yet fragile contexts continue to lag behind this trend. In Haiti, urban access to safe sanitation fell from 34% to 32%, with dense housing and frequent flooding limiting the potential of conventional solutions like sewers, septic tanks, and pit latrines. SOIL, a non-profit container-based sanitation provider in northern Haiti, offers an alternative, but high operational costs exceed many households’ ability and willingness to pay. In October 2023, SOIL launched a results-based financing pilot with the Inter-American Development Bank Lab’s Outcomes for Change Fund, targeting the installation of 900 new customers and a>10% increase in improved sanitation coverage throughout selected communities.

To benchmark progress, we conducted a baseline survey using a cross-sectional quasi-census approach across eight target communities. Enumerators collected household GPS coordinates and data on socioeconomic status, demographics, and sanitation behaviors. Multivariate logistic regressions explored associations between wealth, spatial factors, and sanitation outcomes, including open defecation and private toilet ownership.

Between October and November 2023, we surveyed 4,008 households. Most households owned their home and a private toilet, while 19% reported practicing open defecation. Using the Equity Tool, 38% of households were in the poorest quintile, and only 4% in the wealthiest.

Open defecation was more common among households whose neighbors practiced it and in lower-density areas. Lack of private toilet ownership was largely due to prohibitive costs, particularly among poorer households, and was associated with lower sanitation satisfaction.

Logistic regression of 3,983 households confirmed higher odds of open defecation among poorer households and those with neighbors practicing open defecation. These findings highlight persistent challenges in expanding safely managed sanitation in northern Haiti. Even among households with basic facilities, dissatisfaction suggests strong demand for services that are accessible to the most vulnerable while also providing dignity and aspirational quality for all.