How can Community-Led Total Sanitation (CLTS) be scaled up to address open defecation (OD) and its resulting health problems? This paper, published by the Institute of Development Studies, draws on cases from Bangladesh, India, Indonesia, Pakistan, Ethiopia and Kenya to highlight learning points. A crucial component in bringing this revolutionary, participatory approach to more of the 2 billion people living with OD involves finding, supporting and multiplying champions.
Widespread OD has continued despite decades of rural sanitation programmes, many of them centred on the concept of hardware subsidies. For example, governments and NGOs have provided free toilets in many communities, despite indications that as many as half of them are not being used. CLTS, barely a decade old, provokes communities into making their own analyses and appraisals, and charges them with the goal of declaring themselves OD-free (ODF). Communities come to understand through participatory mapping, transect walks and other methods that OD leads to poor health, triggering community resolve to change the situation. The potential benefits of CLTS are particularly significant for women and children, whose health is the most adversely affected by OD.
A number of best practices can be identified by the array of ongoing CLTS experiments. Initial start-up variables are crucial, including proper training and facilitation at an early stage and an emphasis on promoting teamwork and leadership. Fruitful approaches have also included: conducting campaigns and encouraging competition; inspiring and empowering children, youth and schools; making use of the market and promoting access to hardware; and verifying and certifying ODF status. Other findings include the following:
- The obstacles to CLTS implementation and spread include the opposition of influential leaders and the continued use of hardware subsidies for individual households. Institutional factors such as bureaucratic inertia, budgetary issues and vested interests are also hindrances.
- CLTS has however spread rapidly and widely. Credible evidence of major improvements comes from subdistricts of northwest Bangladesh, East Java in Indonesia and elsewhere in India, Pakistan and Cambodia. In Africa, Ethiopia has made the most progress, followed by Kenya and Zambia.
- On the other hand, there are few accurate statistics about the scale and impact of CLTS, due to the speed of its spread and inflated community claims about ODF status.
- There has been a great deal of variation in the implementation of CLTS in different countries. In Bangladesh, where the approach originated, NGOs have led in partnership with local governments, while India and Indonesia have taken more state-led approaches.
To spread CLTS well requires continuous learning, adaptation and innovation, plus major institutional, professional and personal paradigm shifts. CLTS methodologies should keep evolving, particularly through action learning. Some concerns include helping the most vulnerable, water contamination and sustaining project support. Further recommendations are that:
- Creativity and critical awareness are needed and require a certain degree of reflexivity. CLTS practitioners have to gauge their own mindsets and assumptions, and adopt a pragmatic attitude. The fundamental test of CLTS is whether the behaviours, attitudes and processes it encourages bring about sustainable, positive outcomes.
- Learning and action alliances, as well as other forms of networking and communications across communities, will be a key way forward.
- CLTS needs to be perceived and advanced as a light-touch, self-spreading movement which embraces complementarities with other approaches.
