Water Currents: Community-Led Total Sanitation

Water Currents is produced biweekly by USAID’s E3 Water Office. Each issue contains recent news and articles on water sector issues, partner and donor updates, latest sector research, and a special focus on one topic. Please provide your feedback and suggestions by contacting the waterteam@usaid.gov.

This issue highlights community-led total sanitation (CLTS), including selected 2017 reports and articles on the subject, as well as coverage on open defecation, behavior change, and recent CLTS videos. Our “In the News” section features recent articles on household water treatment, WASH training materials, and other water matters.​

Water Currents - In Focus

Articles and Reports

Keeping Track: CLTS Monitoring, Certification and Verification. IDS, January 2017. These critical elements of the CLTS process ensure the sustainability of open defecation free achievements and support the behavior change education necessary to improve CLTS implementation.

Local Governance and Sanitation: Eight Lessons from Uganda. Global Sanitation Fund (GSF), April 2017. This case study presents eight lessons learned from the GSF-supported Uganda Sanitation Fund on coordinating, planning, and implementing CLTS at scale through a decentralized government system.

A Mobile Platform Enables Unprecedented Sanitation Uptake in Zambia. PLOS Neglected Tropical Diseases, January 2017. Akros, in partnership with Zambia’s Ministry of Local Government and Housing, and UNICEF, layered a unique mobile-to-web application over traditional CLTS delivery methods, resulting in an innovative service delivery and monitoring system that uses mobile phones, automated data feedback loops, and engagement of traditional leaders to provide communities with a clear view of their progress toward sanitation goals.

Scaling Up Sanitation: Evidence from an RCT in Indonesia. Monash University, March 2017. This paper evaluates a randomized controlled trial (RCT) of the effectiveness of a CLTS intervention conducted across rural Java, resulting in increased toilet construction, reduced roundworm infestations, and decreased community tolerance of open defecation. The trial also examined the program’s scale-up process, and results suggest that all of the sanitation and health benefits accrue from villages where development resource agencies implemented the program. Local government implementation produced no discernible benefits.

The Impact of Sanitation Interventions on Latrine Coverage and Latrine Use: A Systematic Review and Meta-Analysis. International Journal of Hygiene and Environmental Health, April 2017. This literature review analyzes how different sanitation interventions, including CLTS, impact latrine coverage and use. Results indicate that most sanitation interventions only have a modest impact.

Effects of Neighbourhood and Household Sanitation Conditions on Diarrhea Morbidity: Systematic Review and Meta-Analysis. PLoS One, March 2017. In this first systematic review and meta-analysis of the distinct effect of neighborhood and household sanitation conditions on diarrhea morbidity, findings suggest that in addition to household sanitation provision, dual emphasis on neighborhood sanitation through public sanitation infrastructure and community-wide sanitation adoption is advisable.

Exploring ‘The Remote' and 'The Rural': Open Defecation and Latrine Use in Uttarakhand, India. World Development, May 2017. This study explores the question, “What is the role of remoteness in sustaining open defecation in rural India?” Using ethnographic methodology, 70 participants in four villages were interviewed and observed over a three-month period. The study asserts that remoteness in general, and its lived nuances, form a context for prevalent open defecation.

Short-term WASH Interventions in Emergency Response: A Systematic Review. International Initiative for Impact Evaluation, February 2017. This review assesses the outcomes and impacts of short-term emergency WASH interventions in low and middle-income countries. Within the scope of WASH, 13 specific interventions were identified, including water source treatments, household water treatment, sanitation, hygiene promotion, and environmental hygiene. Twelve of these interventions were found to be theoretically able to improve WASH conditions and reduce the risk of disease transmission.

WASH Interventions in Disease Outbreak Response. Oxfam, February 2017. This synthesis evaluates the existing evidence on the efficacy of WASH interventions in disease outbreaks in 19 low and middle income countries. One of the findings was that a long-running CLTS intervention implemented before and during an Ebola outbreak recorded a large and significant reduction in disease risk.

Water, Well-being, and the Prosperity of Future Generations. World Bank, March 2017. This discussion paper provides an overview of the poverty-related impacts of inadequate WASH services, and highlights policy challenges that have emerged in a more populated, polluted, and urbanized world with finite water resources. It discusses CLTS successes in Bangladesh, and points out that there is limited understanding of why CLTS works better in some countries and circumstances than in others.

Active Trachoma and Community Use of Sanitation, Ethiopia. WHO Bulletin, April 2017. In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.

Latrine Utilization and Associated Factors Among Kebeles Implementing and Non-Implementing Urban Community-Led Total Sanitation and Hygiene in Hawassa Town, Ethiopia. African Journal of Environmental Science and Technology, March 2017. This study compares latrine utilization rates in neighborhoods implementing and not implementing urban community-led total sanitation and hygiene.

Sanitation Articles from USAID’s Global Waters on Medium


Webinar on Monitoring, Verification and Certification of CLTS, May 4, 2017. The CLTS Knowledge Hub will host this webinar, which will begin with an overview of global practice, followed by case studies from UNICEF’s Kenya and Mali programs. Presenters will explore successes as well as the issues and challenges emerging around monitoring, verification and certification of CLTS.


Using a CLTS Approach in Peri-Urban and Urban Areas. CLTS Knowledge Hub, October 2016. This webinar looks at CLTS in urban areas, and drawing on global experience, concludes that urban CLTS does not strictly follow the processes and tools that have been used in rural areas.

Community-Led Total Sanitation: Sustainable Sanitation Beyond Just Toilets. CLTS Foundation, October 2016. The film provides a global sanitation overview and discusses the role of community-led total sanitation in fast-tracking open defecation free nations.

CLTS in Post Emergency and Fragile States Settings. CLTS Knowledge Hub, August 2016. Frank Greaves from Tearfund discusses lessons learned from CLTS projects in Pakistan and other countries.


Community-Led Total Sanitation (CLTS). The CLTS website is a global hub, connecting the network of practitioners, communities, NGOs, agencies, researchers, governments, donors and others involved or interested in CLTS.

Institute of Development Studies (IDS) – Community-Led Total Sanitation. The IDS program on CLTS works globally to ensure that CLTS goes to scale with quality and in a sustainable and inclusive manner. IDS has published a series of CLTS reports on urban CLTS, women’s health and CLTS, partial or non-use of toilets, menstrual hygiene and CLTS, and others.

UNC Water Institute – Testing CLTS Approaches for Scalability. In collaboration with Plan International, this project aims to advance rural sanitation efforts in Kenya, Ethiopia, Ghana and worldwide by improving the cost-effectiveness and scalability of the CLTS approach. Two of the key reports include Lessons from CLTS Implementation in Seven Countries, and Creating Better, Evidence-Based Policies and Plans for Sanitation Interventions: Policy Findings.


Water Currents - In the News

UN Water GLAAS 2017: Financing Universal Water, Sanitation and Hygiene under the Sustainable Development Goals. UN Water; WHO, April 2017. This report presents an analysis of the most reliable and up-to-date data from 75 countries and 25 external support agencies on issues related to financing universal access to water and sanitation.

Development Malpractice in Ghana: How Stuff That Doesn’t Work Can Screw Up Stuff That Does. Stanford Social Innovation Review, April 2017. This article discusses how a nonprofit’s efforts to set up successful water chlorination entrepreneurs were negatively affected by the actions of another NGO distributing inferior but free desalination filters in the same area.

When It Comes to Water Access We Keep Doing the Same Thing, and Failing. The Guardian, April 2017. Many water and sanitation services are unreliable and sub-standard. The article asserts that NGOs must change their way of working and be accountable when projects fail.

Advancing the Global Dialogue on the Value of Water. World Bank Water Blog, April 2017. The author of this blog calls for a fundamental shift in how water is valued and managed.

Powering Frontline Health Workers announces new WASH training resources. The ORB website connects health workers with training materials on topics related to maternal and child health, including water, sanitation, and hygiene. ORB WASH resources include a mobile course on Urban WASH and a handwashing video to promote healthy behaviors in communities. Additional training resources that meet the ORB criteria can be added to this site.

If you would like to feature your organization's materials or suggest other content for upcoming issues of Water Currents, please send them to Dan Campbell, Knowledge Creation/WASH Specialist, at dcampbell@waterckm.com.


Water Currents
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