Barriers to sewer connection in urban Dhaka: individual and organizational challenges

Access to safe sanitation remains a challenge in urban areas globally, particularly in low- and middle-income countries. In cities like Dhaka, Bangladesh, despite efforts to expand sewer connections, uptake among households remains low. This study investigates both the psychological and administrative barriers to household sewer connections. We conducted a mixed-methods cross-sectional study in five Dhaka zones operated by the Dhaka Water and Sewerage Authority (DWASA). We surveyed 384 households, conducted 5 Key Informant Interviews, and 10 In-Depth Interviews. Survey participants included households with toilets connected to the foul-water sewer or to open drainage. We used the risks, attitudes, norms, abilities, and self-regulation (RANAS) framework to examine socio-demographics, and psychological factors determining connection behaviour. Individual-level barriers included the lack of knowledge about connection procedures and perceived low risks of disease transmission among those who had not connected to the sewer. Organizational-level barriers included complex administrative processes, high installation costs, bureaucratic delays, inadequate support from DWASA, and outdated infrastructure. Addressing the global urban sanitation crisis requires interventions that simultaneously tackle administrative barriers (such as streamlining processes and enhancing financial support) and psychological factors (including raising awareness about the benefits and procedures of sewer connection and fostering a sense of ownership).