Objective: Primarily aimed to achieve better sanitation and Sustainable Open-Defecation Free (ODF) villages in DFSA targeted areas of Amahara and Oromia region.

Method: This study used Positive Deviance (PD) approach to understand and describe its application as a strategy to increases sustainable ODF villages in DFSA targeted areas of Amhara and Oromia regions. It used the three steps of the positive deviance methodology and utilized a purposive sampling method in selecting key informants, position and significance of individuals in society and involvement in other past health programs. Field data were collected through semi-structured in-depth audio-taped interviews, and observations checklists.

Analysis: Descriptive statistics was compiled, analyzed and described in the form of frequency tables and graphs and the qualitative data was analyzed by MAXQDA software to analyze transcribed text data.

Result: Altogether 220 households for the direct observation, 7 FGD and 12 KII were included in the study. The information collected were environmental and home sanitation using observation checklist. In areas with high prevalence of OD most of the households have latrine but almost all study participants do not dare to declare their practice to defecate in the open fields despite having access to their own latrine. Most of the PD and non PD households reported that there is age and gender difference on open defecation practice and reported that male adult individuals and under five children observed to defecate out of toilet. Negligence and ignorance remain the main factors associated with OD as reported by most study participants. Using PD model and emphasizing the community engagement to solve their problem by themselves was recommended.