Community-led total sanitation


Community-led total sanitation is a participatory approach used primarily in developing countries to improve sanitation and hygiene practices within communities. CLTS aims to achieve behavior change with a "trigger" that leads to spontaneous and long-term abandonment of open defecation practices, thereby improving community sanitation and overall health. The term "triggering" is central to the CLTS process. It refers to methods of igniting community interest in ending open defecation, usually by building simple toilets such as pit latrines. The effect of CLTS is two-fold: actions that increase self-respect and pride in one's community and actions that promote shame and disgust about one's open defecation behaviors. CLTS takes an approach to rural sanitation that works without hardware subsidies by facilitating communities to acknowledge the problem of open defecation, taking collective action to become "open defecation free," and improve sanitation.
The concept was developed around 2000 by Kamal Kar for rural areas in Bangladesh. CLTS became an established approach around 2011. Local governments may reward communities by certifying them with "open defecation free" status. The original concept of CLTS purposefully did not include subsidies for toilet installations, as they might hinder the process.
CLTS is practiced in at least 53 countries and has been adapted to the urban context. It has also been applied to post-emergency and fragile states settings.
Challenges associated with CLTS include the risk of human rights infringements within communities, low standards for toilets, and concerns about usage rates in the long term. CLTS is, in principle, compatible with a human rights-based approach to sanitation, but there are examples of bad practices in the name of CLTS. Rigorous coaching of CLTS practitioners, government public health staff, and local leaders on issues such as stigma, awareness of social norms, and pre-existing inequalities are important. Disadvantaged people should benefit from CLTS programs as effectively, as those who are not disadvantaged.

Definitions

is the practice of defecating out in the open rather than using a toilet or other receptacle.
"Open defecation free" is a central term for community-led total sanitation programs. It primarily means the eradication of open defecation in the entire community. However, ODF can also include additional criteria, such as:
  • Household latrines or toilets are hygienic, provide the safe containment of feces, offer privacy, a roof to protect the user, and have a lid to cover the hole or a water seal for toilets.
  • All household and community members use these latrines or toilets.
  • A handwashing facility with water, soap, or ash is nearby and used regularly.
Even more stringent criteria which may be required before a community is awarded "ODF status" might include:
CLTS focuses on community-wide behavioral change rather than merely toilet construction. The process aims to spread awareness about the issues associated with open defecation. It highlights the fact that a community is put at risk of disease even if just a minority continues defecating in the open. CLTS uses community-led methods, such as participatory mapping and analyzing pathways between feces and the mouth, as a means of teaching the risks associated with open defecation.
The concept originally focused on provoking shame and disgust about open defecation. It also involved actions leading to increased self-respect and pride in one's community. With time, CLTS evolved away from provoking negative emotions to educating people about how open defecation increases the risk of disease. Currently, CLTS-triggering events focus more on promoting self-respect and pride.
CLTS prioritizes personal responsibility and low-cost solutions. Rather than facilitating improved sanitation only to selected households, CLTS aims to eliminate open defecation within a community by making the entire community acknowledge the associated severe health impacts. CLTS employs individual pressure to enforce sanitation principles such as using sanitary toilets, washing hands, and practicing good hygiene. To introduce sanitation principles, low-cost toilets financed by each household are built with local materials.

Use or non-use of subsidies

Before CLTS, most traditional sanitation programs relied on subsidies to construct latrines and perform hygiene education. Under this framework, the subsidized facilities were expensive and often did not reach all community members. In addition, the subsidies may have reduced the feeling of personal responsibility for the toilets.
The original concept of CLTS did not include subsidies for toilets. CLTS proponents at that time believed that provoking behavior change in the people alone would be sufficient to lead them to take ownership of their sanitation situation, including paying for and constructing their toilets. This was not always the case.
Kamal Kar and Robert Chambers stated in their 2008 CLTS Handbook:
In time, NGOs and governments began to see the value of the approach and ran their schemes in various countries, some with less aversion to subsidies than Kamal Kar.

Phases

Pre-triggering

Pre-triggering identifies which communities are suitable for CLTS intervention. This involves visits and criteria to identify communities likely to respond well to triggering. During pre-triggering, facilitators introduce themselves to community members and begin to build a relationship.

Triggering

"Triggering" is a technique used to propel people into taking action and often takes place over a day with a team of facilitators. The team visits a community identified as practicing open defecation and encourages villagers to become aware of their sanitation situation. This aims to cause disgust in participants, and the facilitators help participants to plan appropriate sanitation facilities.
Using the term "shit" at triggering events or presentations – rather than feces or excreta – is a deliberate aspect of the CLTS approach, as it is meant to be a practical, straightforward approach rather than a theoretical, academic conversation.
The "CLTS Handbook" from 2008 states there is no "one way" of triggering in CLTS. A rough sequence of steps is given in this handbook which could be followed. Facilitators are encouraged to modify and change activities depending on the local situation.
The UNICEF manual approved for the use of CLTS in Sierra Leone suggests the following steps for the triggering process:
  • Visit the community, to learn about its sanitation situation
  • Facilitate "Kaka Mapping" – drawing a map of important locations in the village, then adding common sites for defecation by asking the community
  • Pretend to leave the community because you cannot believe how bad defecation sites are, which will encourage the community to offer to show you, especially children
  • Facilitate a "Walk of Shame" to sites with frequent open defecation
  • Collect a piece of feces in a bag
  • Put feces on the ground where all present can see it, and discuss how flies move between food and feces
  • Wait for the people's shock that they are indirectly eating each other's feces
  • Put some feces into a water bottle and ask if anyone would drink it
  • Calculate how much feces is produced each day and ask where it goes
  • Ignition
  • Wait for the emergence of "natural" leaders to work with to develop a plan of action.
The "ignition" phase occurs when the community becomes convinced that there is a real sanitation problem and is motivated to do something about it. Natural leaders are community members engaged in the process and able to drive change.
The goal of triggering is to let people see the problem first-hand and evoke disgust. However, it has been reported that communities that respond favorably tend to be motivated more by improved health, dignity, and pride than by shame or disgust.

Post-triggering

After a positive response to the ignition phase, NGO facilitators work with communities to deliver sanitation services by providing information and guidance relevant to the local situation.
Many challenges occur in the post-triggering phase. These are mainly related to the supply of durable and affordable latrine hardware and technical support for their construction. Toilet owners may need advice on upgrading and improving sanitation and handwashing facilities using local materials.

Applications and scale

Millions of people worldwide have benefited from CLTS, which has reduced open defecation and increased latrine coverage in many rural communities. Practitioners have declared many villages as "ODF villages", where ODF stands for "open defecation free".
CLTS is practiced in at least 53 countries. CLTS has spread throughout Bangladesh and to many other Asian and African countries with financial support from the Water and Sanitation Program of the World Bank, DFID, Plan International, WaterAid, CARE, UNICEF and SNV. Large INGOs and many national NGOs have also been involved. Many governments have in the meantime initiated CLTS processes or made it a matter of national policy.
The idea of CLTS has grown beyond its founder and is now often being run in slightly different ways in different countries, e.g. in India, Pakistan, Philippines, Nepal, Sierra Leone and Zambia. Non-governmental organizations were often in the lead when CLTS was first introduced in a country. India was an exception – there, the government led the somewhat similar "Total Sanitation Campaign" which has been turned into the "Clean India Mission" or Swachh Bharat Abhiyan in 2014.
The idea of CLTS has many supporters around the world, with Robert Chambers, co-writer of the CLTS Foundation Handbook, describing it this way:
The Institute of Development Studies coordinated research programme on CLTS since 2007 and regards it as a "radically different approach to rural sanitation in developing countries which has shown promising successes where traditional rural sanitation programmers have failed".
Today there are many NGOs and research institutes with an interest in CLTS, including, for example, the CLTS Knowledge Hub of the Institute of Development Studies, the CLTS Foundation led by Kamal Kar, The World Bank, WaterAid, Plan USA and the Water Institute at UNC, SNV from the Netherlands and UNICEF.