Globally, CLTS has been widely embraced as a strategy to end open defecation, and dozens of countries have incorporated the approach as part of national policy for rural sanitation. Though the “total sanitation” focus of CLTS is laudable, there is reason to believe that the poor and more vulnerable segments of the community do not benefit equally, as they are more likely to construct lower-quality toilets and revert to open defecation. Beyond the equity concerns this raises, there may be a public health cost associated with these households being left behind: there is increasing evidence that health protection from sanitation is a function of the herd protection of community-wide coverage.
USAID’s Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (USAID/WASHPaLS) project is partnering with UNICEF in Ghana to examine if and how subsidies targeted at the most vulnerable may serve to improve the sustainability and equity of behavior change and sanitation coverage gains from CLTS. This study is the first of its kind in Africa and will contribute to build the evidence base on targeted subsidies in rural sanitation.