Policy promises and sanitation realities: analysing WASH practice constraints in a South African peri-urban settlement

1 Introduction

Access to safe water, sanitation and hygiene (WASH) services remains fundamental to human health, dignity and social development (1). Globally and within South Africa, WASH policies increasingly emphasise universal access, equitable service delivery and sustainable hygiene practices in line with Sustainable Development Goal (SDG) 6. These policy aspirations reflect a commitment to ensuring that all communities can reliably access and utilise safe WASH services. However, translating such aspirations into sustained everyday practices remains a persistent challenge in many peri-urban settlements, peri-urban settlements, including Nompumelelo in East London (2). Despite substantial investments in WASH infrastructure, inequalities in service access and reliability persist, particularly in peri- areas affected by rapid urbanisation, informal settlement growth and complex governance arrangements (3). Consequently, residents often aspire to reliable water supply, adquate sanitation and improved hygiene conditions, yet these aspirations are frequently constrained by interconnected infrastructural, institutional and socio-economic challenges. Nompumelelo exemplifies this reality. Despite infrastructure development and public health campaigns, inconsistent water supply, inadequate sanitation facilities and irregular hygiene practices continue to expose residents to avoidable and preventable health risks (2). These challenges highlight a broader gap between WASH policy aspirations and lived realities, raising important questions about how governance systems, social conditions and everyday practices shape sanitation outcomes.

Peri-urban areas refer to settlements situated at the urban-rural interface that are often only partially integrated into formal planning and municipal service systems (4), while informal settlements are typically characterized by unplanned housing and insecure land tenure (5). Nompumelelo exhibits characteristics of both. Understanding why WASH aspirations remain unrealised is important because these gaps have implications for public health, gender equality (SDG 5), environmental justice and community resilience. Existing studies have documented infrastructural deficiencies, resource constraints, service-delivery failures and behavioural challenges across African peri-urban settlements (6, 7). More recent WASH governance research has highlighted the importance of participatory governance, co-production, accountability and inclusive decision-making for improving service sustainability and equity (2). However, these dimensions are often examined in isolation. Infrastructure studies frequently focus on service deficits, behavioural studies emphasise individual practices, while governance research concentrates on institutional performance. Consequently, limited attention has been given to how behavioural, socio-cultural, material and governance factors interact to shape everyday WASH practices and influence the translation of aspirations into sustained action. This knowledge gap is particularly important in peri-urban settings, where infrastructure, governance arrangements and social practices intersect in complex and dynamic ways.

To address this gap, the study integrates the Theory of Planned Behaviour (8) and Social Practice Theory (SPT) (9) as complementary analytical frameworks. Together, these perspectives enable examination of both individual decision-making processes and the broader social, material and institutional contexts that shape WASH practices. Combining these frameworks provides a more holistic understanding of why positive sanitation intentions do not always translate into practice, particularly where infrastructural limitations and governance challenges restrict opportunities for action. The integrated framework informed both data collection and analysis, enabling a multi-dimensional examination of the factors shaping the gap between WASH aspirations and practices. In doing so, the study moves beyond predominantly descriptive accounts by generating empirically grounded evidence from household surveys, interviews, focus group discussions and participatory engagement processes centred on the lived experiences, aspirations and constraints of community members.

Guided by this framework, the study addresses the following questions, (a) What socio-cultural, behavioural, economic and infrastructural factors contribute to the persistent gap between WASH aspirations and practices in Nompumelelo? (b) How do residents and key stakeholders perceive the barriers and opportunities for effective WASH behaviour change? (c) How do material conditions, infrastructure and governance systems interact with everyday WASH routines? And (d) What lessons can be drawn for designing context-sensitive, sustainable and empowering WASH interventions in peri-urban settlements? Using a mixed-method case study design, the study contributes empirical evidence on the interaction between governance, infrastructure and behavioural factors shaping WASH outcomes. The findings provide practical and theoretically informed insights to support policy development, participatory governance approaches and community engagement strategies for improving WASH service delivery in South Africa and other peri-urban contexts.

2 Materials and methods

2.1 Study area

Nompumelelo, in Ward 15, East London, is a township with a predominantly isiXhosa speaking population and a mix of low to middle income households (10). This study area was preferred due to its high population density, documented limitations in access to basic services and persistent socio-economic challenges (10). In addition, its cultural and demographic characteristics, including the co-existence informal and formal settlements and active community structures provide an appropriate context for examining WASH service delivery and behavioural practices in a peri-urban setting (2). Nompumelelo is bounded by the N2 motorway to the north, Mdantsane township to the south, the Buffalo River to the east and Amalinda township to the west and display urban characteristics including limited green space and variable access to basic services (10). It is situated in the peripheries of East London, Eastern Cape province, SA (Figure 1). The area provides an appropriate case study context for examining households and stakeholder perspectives regarding the gap between WASH policy intentions and everyday practices.

This township was selected because of its potential representativeness of the challenges confronting sustainable access to WASH services in SA's Peri-Urban Areas (PUAs) and its documented vulnerability to persistent shortages of potable water (2). The area also has a socio-economically diverse population (10, 11) which makes it suitable for a stratified household survey and stakeholder interviews aimed at capturing varied experiences and perspectives. Its history of community engagement with local governance further provides a relevant context for examining behavioural practices, institutional constraints and opportunities for viable WASH interventions, as proposed by Magwaca (11).

2.2 Design

This study employed a convergent parallel mixed-methods design. Quantitative and qualitative data were collected concurrently, analysed separately, and integrated during interpretation. The quantitative component consisted of a household survey that generated numerical evidence on sanitation conditions, water access and hygiene practices. The qualitative component comprised key informant interviews, focus group discussions (FGDs) and a participatory ranking exercise designed to capture stakeholder perceptions of WASH-related challenges. Analysing each dataset separately before triangulation enabled comparison, corroboration and contextual interpretation of findings across multiple sources, thereby strengthening the validity of the study.

2.3 Study population and sampling methods

The quantitative component included 264 adult residents from Nompumelelo Township. The study population comprised 423 adults residing in formal residential yards recorded within the study area, excluding occupants of informal dwellings and makeshift structures. A multistage sampling procedure was employed. First, Nompumelelo Township was purposively selected due to persistent WASH challenges and its relevance as a peri-urban settlement. Second, residential sections were identified and mapped to ensure spatial coverage of the study area. Third, households were systematically selected within each section. Finally, one adult household member (18 years or older) who was available and willing to participate was selected from each sampled household.

The qualitative component included 24 purposively selected key informants and six stakeholder focus groups. Key informants were selected based on their expertise and involvement in WASH governance, public health, community development and local service delivery. Focus groups were organised to represent key stakeholder categories within the community, namely adult women, adult men, youth (18–25 years), elderly residents (60 years and above), community health workers/WASH practitioners and municipal officials responsible for WASH services.

The sample size was determined using Yamane's (1967) finite population formula at a 95% confidence level and a 5% margin of error:Where: The minimum recommended sample size was therefore 206 respondents. A total of 264 respondents were ultimately surveyed, exceeding the minimum requirement and thereby improving the representativeness and precision of the quantitative findings.

n=N1+N(e)2

• n = required sample size
• N = population size (423 adults)
• e = margin of error (0.05)

2.4 Data collection

Data were collected through household surveys, key informant interviews, focus group discussions and participatory ranking exercises. The household survey was administered to 264 adult respondents and collected information on water access, sanitation conditions, hygiene practices and perceived barriers to WASH service utilisation. Twenty-four semi-structured key informant interviews were conducted with municipal officials, environmental health practitioners, community leaders, ward representatives and healthcare personnel. Interviews continued until thematic saturation was achieved, meaning that no substantively new themes emerged from successive interviews. Additional interviews were conducted to confirm the consistency and completeness of the identified themes. Six focus group discussions were conducted with different stakeholder categories to explore collective experiences and perceptions regarding WASH challenges. Following thematic discussion, participants engaged in a participatory ranking exercise. Identified WASH-related challenges were presented to each stakeholder group and independently ranked using a ten-point scale, where 1 represented the lowest perceived importance and 10 represented the highest perceived importance.

2.5 Data analysis

Qualitative interview data were transcribed and analysed using ATLAS ti.24 software (12). Thematic analysis was employed, involving systematic coding, categorisation and theme development. Codes were generated from participant responses and organised into broader themes reflecting behavioural, infrastructural and governance influences on WASH practices. To enhance analytical transparency, coding decisions and theme development were documented throughout the analysis process. Quantitative survey data were checked for completeness, coded and entered into a spreadsheet for cleaning and verification. Descriptive statistics, including frequencies, percentages, means and rankings, were used to summarise respondent characteristics, WASH conditions and perceptions. Matrix-based analysis was applied to compare performance across key WASH indicators and identify priority intervention areas. Scores were aggregated and converted into percentages, with higher values indicating stronger performance and lower values indicating areas requiring improvement. As the study was primarily descriptive and exploratory, the analysis focused on identifying patterns, trends and priority concerns rather than testing causal relationships. Qualitative and quantitative findings were subsequently integrated during interpretation to provide complementary insights into the factors influencing WASH practices and service delivery.

2.6 Validity, reliability and ethical consideration

Content validity was enhanced through the development of data collection instruments based on the study objectives, relevant literature and theoretical framework. The instruments were reviewed by two independent subject specialists to ensure clarity, relevance and alignment with the research questions. Reliability was strengthened through the use of standardised data collection procedures, consistent coding practices and systematic verification of survey responses. For the qualitative component, an audit trail of coding and theme development was maintained to enhance dependability. Ethical principles were observed throughout the study. Participants were informed about the purpose of the research, their right to withdraw at any stage and measures taken to ensure confidentiality and anonymity. Written informed consent was obtained from all participants prior to data collection. Personal identifiers were excluded from the dataset, and all information was used solely for research purposes.

3 Results

This section begins by presenting the study's key findings in the form of a flowchart diagram (see Figure 2). Although only a limited number of verbatim quotes are included, they have been purposefully selected to reflect the broader perspectives observed across the full sample. These quotes serve to highlight recurring themes and shared experiences among participants. The subsequent discussion critically engages with these findings, exploring both their convergence and divergence with existing literature and theoretical frameworks.

Table 1 presents the results of a participatory matrix-ranking exercise conducted with six stakeholder groups involved in the FGDs: adult women from the peri-urban community (A), adult men (B), youth aged 18–25 years (C), elderly residents aged 60 years and above (D), community health workers/WASH practitioners (E), and local government officials responsible for WASH services (F). Following thematic analysis of the FGD transcripts, key water and sanitation challenges were identified and presented to each stakeholder group for assessment. Using a ten-point participatory ranking scale (1 = lowest importance; 10 = highest importance), participants within each group collectively assigned a consensus score to each issue based on its perceived significance. The values reported in columns A–F therefore represent stakeholder-assigned importance rankings rather than frequencies, prevalence estimates, or statistically weighted measures.

Table 1. Participatory matrix-ranking scores and percentages for perceived WASH challenges across stakeholder groups in Nompumelelo.

Descriptive label that reflects the group's composition, characteristics, or setting.

Total scores were calculated by summing rankings across the six stakeholder groups, yielding a maximum attainable score of 60 per issue. Percentages were derived by dividing the total score by the maximum possible score and multiplying by 100. Equal weighting was applied because the purpose of the exercise was to compare perspectives across stakeholder categories rather than estimate population-level prevalence. Accordingly, each stakeholder group was treated as an analytical unit of equal importance, ensuring that less represented groups were not overshadowed by larger or more influential stakeholders. The resulting scores indicate the perceived importance of each issue across stakeholder groups and should be interpreted as comparative stakeholder assessments rather than statistically representative measures.

Data indicates that water access issues are primarily due to irregular delivery, affecting 72% of users, rather than scarcity, which impacts 60%. This highlights a problem of unreliability rather than a lack of resources (see Table 1). In terms of sanitation, weak social norms (65%) and a lack of collective action support (45%) exacerbate the situation. Infrastructure failures are prevalent, with nearly half of the sample reporting broken toilets (58%), inadequate facilities (52%) and aging pipes (48%), reflecting systemic decay (see Table 1). Resource barriers are more closely linked to entrenched inequalities (55%) than to funding shortages (43%). As shown in Table 1 hygiene issues arise from chronic exposure (52%) and overcrowding (48%). Governance challenges are significant, including low community engagement (70%), slow repair processes (67%), unresponsive councils (65%) and a heavy reliance on top-down solutions (60%) that marginalize community voices (55%).

The Spearman correlation analysis revealed varying levels of agreement among stakeholder groups regarding the prioritisation of WASH challenges. The strongest positive association was observed between youth participants (Group C) and municipal officials (Group F) (ρ = 0.706), followed by adult men (Group B) and youth participants (Group C) (ρ = 0.609), suggesting relatively similar perceptions of WASH priorities across these groups (see Table 2). Moderate agreement was also observed between adult men and municipal officials (ρ = 0.595). In contrast, community health workers/WASH practitioners (Group E in Table 2) exhibited weak or negative correlations with several community groups, particularly adult women (ρ = −0.269) and elderly residents (ρ = −0.175), indicating differences in how challenges were prioritised. Overall, the findings suggest that while some stakeholder groups shared broadly similar perceptions of WASH challenges, notable differences remained across community and institutional actors, reinforcing the value of incorporating multiple stakeholder perspectives in participatory WASH planning.

Table 2. Spearman rank correlations between stakeholder groups.

Correlations are based on stakeholder rankings of 16 WASH-related challenges. The correlation analysis is presented as an exploratory assessment of stakeholder agreement and should not be interpreted as evidence of causal or statistically representative relationships.

The scores therefore represent stakeholder-assigned importance rankings rather than frequencies, prevalence estimates, or statistically weighted measures. Total scores were obtained by summing rankings across stakeholder groups, and percentages were calculated relative to the maximum attainable score. Equal weighting was applied because the objective was to compare stakeholder perspectives rather than estimate population-level prevalence. Accordingly, each stakeholder group was treated as an analytical unit of equal importance irrespective of group size. This approach is consistent with participatory matrix-ranking methods but may obscure differences in group composition and size; therefore, findings are interpreted as indicative stakeholder perceptions rather than population-level estimates.

3.1 Practical water-access reality

Disaggregated analysis across focus groups (A–F) reveals that elderly residents (Group D) and community health workers (Group E) reported the highest levels of perceived loss of control over water access, suggesting that vulnerability intensifies with age and frontline service exposure. This pattern is consistent with the broader household survey's findings (n = 264; March 2025) which reveal a marked disjuncture between sanitation attitudes and everyday practice. The majority of respondents described toilet use and hand washing as “very important,” reflecting positive attitudes and indicated that “most neighbors expect these practices,” indicating supportive subjective norms. Despite these favourable attitudinal and normative conditions, 72% reported that they do not wash their hands with soap after every toilet visit (see Table 1). This substantial intention-behaviour gap may be associated with low perceived behavioural control, as participants consistently reported limited influence over water availability and sanitation conditions. Community members rated their environmental control such as access to water at a mean score of 60%, indicating low perceived control. As one resident explained “We don't really have much say or control over our water situation. Most times, we just wait and hope it returns when it's gone” (see Figure 2). This perception is reinforced by findings from key informant interviews, which indicate that water supply interruptions exceed 48 h per week. In addition, 58.3% of survey respondents classified communal toilets as “non-functional” (see Table 1), further limiting the feasibility of routine hygiene practices.

Spatial disparities within the settlement compound these challenges. Households located in areas characterised by informal housing structures reported significantly higher frequencies of water interruptions than those in formal dwellings, highlighting intra-community inequality in service reliability. The survey findings indicate a notable divergence between positive sanitation attitudes and reported handwashing behaviour, suggesting the presence of an intention-behaviour gap consistent with the Theory of Planned Behaviour (TPB). The existing gap can be analytically explained through the Theory of Planned Behavior (TPB), which connects behaviour to attitudes, subjective norms and perceived as well as actual behavioral control (13). While attitudes and norms in Nompumelelo appear largely supportive of hygienic practice, both perceived and material control remain weak. Consistent with TPB, the findings suggest that supportive attitudes and subjective norms alone may be insufficient when perceived and actual behavioural control remain constrained by inadequate infrastructure and unreliable water access. In this context, policy responses must therefore extend beyond awareness campaigns and combine behavior-change communication with practical solutions, such as ring-fenced funding for rapid toilet repairs, decentralized water kiosks and community-led maintenance committees. By enhancing perceived control and eliminating material constraints, these interventions can make sanitation “wishes” both technically and psychologically attainable.

3.2 Subjective norms shape sanitation practices

Another key finding explaining why sanitation wishes are rarely translated into action is the significant influence of subjective norms on sanitation behaviors. Matrix scores reveal important demographic variations. Women participants (Group A) reported stronger perceived social pressure to uphold hygiene standards than men (Group B) yet simultaneously indicated lower perceived behavioural control. Women in the study reported increased responsibility for securing and managing household water, especially during periods of scarcity, yet they remained largely excluded from decision-making structures governing water access and infrastructure. These findings suggest that gendered divisions of labour may increase women's responsibility for household water management while simultaneously limiting their participation in local governance processes. From a Sustainable Development Goals (SDGs) perspective, the findings highlight a critical intersection between Goal 6 (Clean Water and Sanitation) and Goal 5 (Gender Equality), suggesting that progress toward SDG 6 (Clean Water and Sanitation) may be constrained where women remain underrepresented in decision-making processes central to SDG 5 (Gender Equality). Therefore, addressing this imbalance requires institutional mechanisms that actively include women in community water governance and planning processes, thereby aligning water security interventions with gender-transformative outcomes.

This tension highlights a gendered burden of sanitation responsibility, where expectations are high but enabling conditions remain weak. In contrast, youth participants (Group C) expressed comparatively greater willingness to adopt new hygiene norms, suggesting generational differences in openness to behavioural change. Taken together, these patterns demonstrate that social conformity functions not merely as passive acceptance of prevailing practices, but as an active mechanism that sustains collective behavioural inertia. This dynamic is particularly true in contexts such as Nompumelelo, where community expectations often discourage deviation from existing unhygienic practices. Consistent with the TPB, individuals are less likely to act on positive intentions if their actions lack social support (13). In Nompumelelo, entrenched communal routines and the pressure to conform create a climate of behavioral inertia. As one informant explained, “Even if a family tries to stay clean, if the neighbor dumps their waste outside or the toilets are dirty, you eventually give up” (see Figure 2). This testimony illustrates how collective inaction fosters a sense of futility, reinforcing a self-perpetuating cycle of neglect. Figure 3 should be interpreted as a conceptual synthesis of the qualitative and quantitative findings, illustrating potential interactions among infrastructure constraints, governance challenges, and sanitation practices rather than empirically verified causal pathways.

Figure 3 presents a conceptual interpretation derived from the convergence of qualitative narratives, matrix-ranking results, and household survey findings. The figure is intended to illustrate perceived interactions among governance, infrastructure, resource constraints and sanitation practices and should not be interpreted as an empirically validated causal model. Consequently, residents lack reliable access to safe water, often undertaking long and physically demanding walks to collect water from distant sources. Limited and irregular water access restricts households' ability to maintain adequate sanitation and cleanliness, resulting in poor hygiene practices. These conditions increase exposure to pathogens, leading to higher incidences of illness and disease within the community. Deteriorating health outcomes manifest as broader community health issues, including sickness and absenteeism from work and school, which further weaken the community's capacity to maintain or advocate for infrastructure improvements. As a result, the system remains trapped in a cycle of neglect and vulnerability, where failing infrastructure, limited access, poor hygiene and declining health continuously reinforce one another. As argued by Bicchieri et al. (14), unchallenged social expectations can override personal motivation, making it essential to transform norms for sustainable WASH behaviour. Lasting sanitation improvements therefore require integrated strategies that address both the socio-normative context and strengthen the material conditions necessary for hygienic choices. Interventions should include community-wide norm-shifting campaigns in conjunction with sustained investments in infrastructure and affordability.

3.3 Unstable sanitation infrastructure

The results of this study indicate that one of the factors perceived by participants to constrain the translation of sanitation aspirations into everyday practice in peri-urban areas is the chronic failure of basic infrastructure, which systematically hinders the adoption of desired hygiene behaviours. Despite widespread awareness and positive attitudes towards sanitation, many residents encounter daily challenges, including broken communal toilets, inadequate sanitation facilities and fragile, old pipes (see Tables 1, 3). These infrastructural deficiencies are not marginal concerns but widespread realities: “broken communal toilets” (58.3%), “inadequate facilities” (51.7%) and “old pipes” (48%) collectively highlight systemic deterioration. These conditions may substantially reduce opportunities for routine hygiene practices and increase the difficulty of maintaining recommended sanitation behaviours. This pattern aligns with arguments by Shrestha et al. (15), who point out that hygiene promotion efforts initiatives are unlikely to succeed in the absence of an enabling environment and by Muchaku and Zhou (2), further contend that Inadequate infrastructure in low-income and peri-urban settings significantly restricts community members from adopting better sanitation practices, particularly in many peri-urban areas. In Nompumelelo, these insights are reflected in both narrative and numerical data. One respondent captured the frustration succinctly: “The government says we must wash our hands and keep clean, but with broken toilets and no water for days, they make it impossible for us to do that” (see Figure 2). Such testimonies suggest broader concerns regarding environmental justice and unequal access to basic WASH services. This perception is reinforced by survey results, which show that 72% of participants identified unreliable infrastructure as the primary obstacle to WASH adherence. Cross-tabulation further reveals that households reporting broken communal toilets also reported higher levels of inconsistent handwashing behaviour, suggesting an association between infrastructural conditions and sanitation practices that is consistent with Social Practice Theory. Key informant interviews support these findings, confirming that maintenance backlogs in several areas of the settlement extend beyond three months. This indicates systemic infrastructural stagnation rather than isolated technical failures. The convergence of narrative accounts, percentage scores and comparative analysis thus enhance the internal validity of the infrastructural constraint theme and underscores a critical conclusion; without reliable foundational provision, behaviour change interventions are unlikely to succeed, regardless of community willingness.

Table 3. Stakeholder groups represented in the focus group discussions and their average participatory ranking scores.

Columns A–F represent six stakeholder groups participating in the FGDs. The scores indicate how often each issue was identified and prioritised across the groups, which included adult women (A), adult men (B), youth (C), elderly residents (D), community health workers/WASH practitioners (E), and local government officials (F). Following thematic coding of the qualitative data, each group independently assessed the relative importance of identified sanitation and water-related challenges using a five-point participatory ranking scale (1 = very low importance to 5 = very high importance).

3.4 Government imposed decision-making

A critical challenge identified in Nompumelelo is the perceived exclusion of community voices from water and sanitation planning and decision-making processes. Participants frequently described interventions as externally imposed, top-down initiatives that are insufficiently aligned with local priorities and lived realities. This concern was reflected in the views of a youth representative during in-depth interviews who stated: “People are tired of promises. We need solutions that come from our situation, not ideas from people who don’t live here” (see Figure 2). Such accounts suggest a disconnect between institutional planning processes and community experiences. Survey findings reinforce this perception, with respondents ranking weak community engagement (70%), “delayed repairs” (66.7%) and an “unresponsive municipality” (65%) as the most pressing concerns (see Tables 1, 3). Similarly, dissatisfaction with top-down approaches exceeded 60% across all stakeholder groups, indicating broad concern regarding limited participation in local WASH governance.

Municipal officials (Group F) also acknowledged challenges associated with budget approval processes and procurement delays, suggesting that some service-delivery constraints may be rooted in broader institutional and administrative structures rather than individual performance. Taken together, the findings suggest a potential cyclical relationship in which governance inefficiencies may contribute to community disengagement, while reduced community participation may further weaken accountability mechanisms and responsiveness. These patterns indicate that sanitation challenges extend beyond infrastructure provision and may also reflect structural inequalities in decision-making power and access to services. Similar concerns have been documented in other peri-urban contexts, where centralized governance arrangements have been associated with reduced community ownership and weaker accountability mechanisms.

These findings align with the Behaviour Centred Design (BCD) framework (16), which emphasises the importance of interventions that are participatory, context-sensitive and responsive to users lived realities. The results suggest that when communities perceive themselves primarily as recipients rather than active participants in service planning, sustained adoption of sanitation practices may become more difficult. From an environmental justice perspective, the findings further indicate that unequal participation in decision-making can influence how sanitation services are experienced and distributed across communities. Consequently, improving WASH outcomes may require greater emphasis on participatory governance, inclusive planning processes, and mechanisms that strengthen accountability between service providers and residents. While infrastructure improvements remain essential, the findings suggest that their effectiveness is likely to be enhanced when combined with approaches that support local agency, community ownership, and meaningful stakeholder engagement.

3.5 Lack of financial and material resources

A significant barrier identified in the study that hampers the achievement of sanitation goals in peri-urban communities is the chronic lack of financial and material resources. Survey results indicate that resource constraints, especially those stemming from structural inequalities, are perceived as more burdensome, scoring 55%, compared to a simple “lack of financial resources,” which scored 43.3%. This finding may indicate that respondents perceive structural inequalities and unequal access to resources as important constraints alongside direct financial limitations. From an environmental justice perspective, the findings suggest that resource deprivation is not distributed evenly across households, with vulnerable residents bearing a disproportionate burden of inadequate sanitation conditions. While community members often recognize the importance of hygienic practices, they struggle to afford essential items such as soap, disinfectants, or safe water storage containers (17). This challenge reflects not just logistical issues but also deep-rooted structural inequalities and systemic neglect of public health investment. As one resident noted, “We know it's important to keep the toilet clean and wash hands, but sometimes even buying soap or toilet paper is a struggle when there's no money for bread” (see Figure 2). This statement underscores the tension between health awareness and economic survival.

In such environments, poverty limits individuals' agencies, rendering hygiene a luxury rather than a fundamental right. Many incomes are unstable or informal, leading to recurring hygiene expenses being deprioritized in favor of immediate necessities like food and rent (7). Over time, this normalization of inadequate sanitation perpetuates poor health outcomes and intergenerational poverty (18). Chirgwin et al. (19) argue that WASH initiatives often fail when they neglect the economic vulnerabilities of the communities they aim to help. To address these challenges, WASH interventions must incorporate economic considerations into their design. This could involve subsidizing hygiene products, creating community cooperatives for bulk purchasing and aligning sanitation support with social protection programs. By tackling the material constraints imposed by poverty, we can turn sanitation aspirations into consistent, health-promoting practices. Such an approach not only enhances public health but also restores dignity and equity in access to basic hygiene.

3.6 Normalization of poor hygiene practices

Social barriers have emerged as a significant constraint to improving hygiene, particularly due to the normalization of poor sanitation practices in overcrowded living environments. This normalization, shaped by prolonged exposure to substandard conditions, may gradually reduce motivation to adopt or sustain recommended hygiene practices (see Figure 2). Nevertheless, the findings indicate a latent capacity for change rooted in social influence and communal action. Participants were asked to rank the severity of poor hygiene practices and how issues such as “prolonged exposure” to unsafe conditions and “overcrowded environments” affect wash practices. They scored these factors at 52% and 48.3%, respectively (see Tables 1, 3). This interpretation aligns with Social Practice Theory, which views sanitation behaviour as emerging from the interaction of material conditions, social meanings, and practical competencies rather than from individual choice alone. Community members consistently emphasised the critical role of local leadership and peer modeling, suggesting that visible behavioral changes among respected individuals or households can trigger broader collective change, a dynamic supported by social learning theory (20).

Residents expressed a strong preference for participatory approaches to WASH interventions, advocating for their involvement in planning, management, and monitoring of services. This preference aligns with the principle of co-production, which highlights the importance of community engagement in enhancing accountability and service uptake (21, 22). One participant noted, “If a few households start something and it works, others will follow suit,” underscoring the community's belief in the diffusion of innovation through peer-led efforts (23). While infrastructural and socio-economic constraints remain, these insights reflect not only a willingness to improve hygiene but also a vision of dignity and shared responsibility. Future interventions should therefore be context-sensitive, prioritise local agency and strengthen enabling environments for change in behavior, thereby restoring both material access and social pride in hygiene and counteracting the effects of normalized neglect.

3.7 Government efficiencies in shaping daily practices

Unresponsive municipal systems, delayed repairs and weak community engagement were consistently identified by participants as factors influencing the ability of households to maintain desired sanitation practices, as described in Social Practice Theory (SPT) (24). One community informant shared, “We have been reporting broken toilets for months, but unless someone important complains, nothing gets done. People lose hope and stop bothering” (see Figure 2). Participants perceived prolonged service delays as contributing to frustration and reduced confidence in institutional support, which may discourage sustained engagement with sanitation initiatives, ultimately undermining the meaning attributed to sanitation, which begins to feel futile in the face of institutional indifference (2). This issue is supported by questionnaire findings, which revealed that the “exclusion of community voices” accounts for a significant 55% of the scoring. Additionally, the prevalence of “top-down solutions” received the highest score in the entire dataset at 60.0% (see Table 1). This indicates that technocratic approaches are predominant and may undermine locally driven WASH improvements. Such systemic failures disrupt the essential feedback loop between service users and providers, undermining trust and shared responsibility (25, 26).

Instead of encouraging adaptive or resilient behavior, the lack of timely responses leads to disengagement and the normalization of unsanitary conditions. Addressing these challenges requires more than just technical solutions. Municipal systems must prioritize community-responsive mechanisms, such as transparent reporting platforms, regular feedback sessions and accountability channels, to restore the social fabric that supports WASH behavior. Additionally, infrastructural investments should be paired with participatory maintenance models that empower communities to co-manage sanitation resources. Without these dual reforms, the motivation to uphold hygienic norms will remain fragile, particularly in marginalized settings (2, 27, 28).

3.8 Design of context-sensitive WASH interventions in peri-urban settlements

Several important lessons emerge for this study for designing context-sensitive, sustainable and empowering WASH interventions in peri-urban settlements such as Nompumelelo. Firstly, WASH behaviors are deeply embedded in material realities; without reliable infrastructure, such as a constant water supply, functioning toilets and effective waste disposal, even well-designed behaviour change campaigns are unlikely to have a lasting impact. The findings suggest that behavioural intentions alone cannot compensate for structural deficiencies. Equally critical is the need to move away from top-down implementation models towards participatory, community-owned systems. The evidence indicates that sustainability is likely to depend not only on infrastructure provision but also on inclusive governance arrangements that position residents as planners, monitors and decision-makers rather than passive beneficiaries. Experience from Nompumelelo shows that motivation to maintain WASH facilities declines rapidly when residents feel excluded or marginalized by administrative processes. Therefore, strengthening local leadership structures, accountability mechanisms and community feedback platforms is essential for rebuilding trust and sustaining engagement.

Interventions must also incorporate insights from social practice perspectives, recognising that behavior change is not merely about “teaching” new habits. Instead, sustainable change requires alignment between material conditions, social meanings and practical competencies. For example, investments in micro-infrastructure such as household water storage tanks or decentralized sanitation facilities should be implemented alongside community dialogue forums that enable residents to collectively redefine hygiene standards and expectations. This integrated approach ensures that new routines are materially feasible, socially supported and practically achievable. Finally, WASH systems in peri-urban settlements must be designed with flexibility and responsiveness in mind. Settlements like Nompumelelo are characterised by migration, informal tenure arrangements and changing livelihood patterns. Rigid, centrally planned models are ill-suited to these dynamic contexts. Instead, adaptable, modular and resilient systems are needed to accommodate ongoing change. Evidence from both quantitative and qualitative sources converges on a critical insight: behavioural willingness is not the primary deficit. Rather, sustained sanitation practice is undermined by a systemic misalignment between infrastructure provision, governance processes and prevailing social norms. The integrated findings suggest that strengthening rapid-response maintenance systems and expanding participatory governance structures may enhance perceived behavioural control and institutional trust. These changes could create more favourable conditions for improved sanitation practices, although further longitudinal and inferential research would be required to establish the magnitude and direction of these relationships.

4 Study limitations

Although Spearman correlation analysis was conducted to examine patterns of agreement across stakeholder groups, the findings should be interpreted cautiously because the rankings were derived from participatory assessments rather than independent population-based observations. Consequently, the results are exploratory and do not imply causality or statistical generalisability.

5 Conclusion

The findings of this study demonstrate that the gap between WASH policy and everyday sanitation realities in Nompumelelo is shaped by the interaction of behavioural, infrastructural, socio-economic and governance factors. Although residents generally recognise the importance of safe sanitation and hygiene practices, the findings suggest that positive intentions alone are insufficient when access to reliable infrastructure, material resources and supportive institutional arrangements remain constrained. The persistence of sanitation challenges therefore reflects not simply individual behavioural choices, but the broader structural conditions within which WASH practices are embedded. By integrating the TPB and SPT, the study shows that sanitation behaviours are influenced simultaneously by individual perceptions and by the material, social and institutional environments that enable or constrain action. The findings indicate that limited perceived behavioural control, inadequate infrastructure, weak community participation and persistent socio-economic inequalities collectively reduce the likelihood that sanitation.

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Footnotes

Edited by: Jiangtao Du, University of Liverpool, United Kingdom

Reviewed by: Mhlalisi Gavu Mndzebele, University of Johannesburg, South Africa

Mohamed Said, The University of Dodoma College of Humanities and Social Sciences, Tanzania