In what has been termed a revolution of sorts, community-led total sanitation (CLTS) introduced a new approach to eliminating open defecation when it was pioneered by Kamal Kar 17 years ago. Since its introduction, approximately 60 countries have adopted CLTS, a technique which triggers communal disgust to change defecation behaviors and expand sanitation coverage in mostly rural communities. A good number of governments have even embraced CLTS as their national policy.
Interventions don’t tend to achieve this level of scale unless they are effective. But what is the evidence of how well CLTS works in different contexts and the degree to which it contributes to nationwide open defecation free (ODF) achievement? Do the populations receiving the CLTS intervention become healthier? Are reductions in open defecation sustained? What factors enable these achievements to be sustained over time?
On December 13, 2017, the USAID-funded Water, Sanitation and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) Project held a webinar to present key findings from a soon-to-be released desk review assessing the knowledge base on CLTS program performance. WASHPaLS Deputy Director Jeff Albert began the discussion with an overview of CLTS and an explanation of the breadth of the WASHPaLS exploration—his team consulted several hundred CLTS studies, spanning the peer-reviewed and “gray” literature, and conducted 23 key informant interviews. Among the challenges the WASHPaLS team noted: data availability and reliability in such studies can be uneven, different organizations/governments measure open defecation differently and implement CLTS in different ways, and few health studies focused on sanitation consider community-level interventions like CLTS.
That being said, the research team identified topline findings related to latrine coverage, quality, sustainability, and health. The main takeaways were that, while extraordinarily promising, CLTS does not work everywhere, for everyone, or all the time. In selected deployments, CLTS is reported to dramatically decrease open defecation and increase private latrine ownership though quality and durability may be limited. Who executes CLTS and how the technique is executed appear to matter significantly. And while studies haven’t captured improved health effects related to diarrhea, some observed decreases in stunting and intestinal worm infection are encouraging.
Caroline Delaire, research program manager with Aquaya Institute, a WASHPaLS research partner, picked up the conversation on how the findings will inform WASHPaLS’ research agenda for subsequent years of the project. Two areas emerged in the course of the desk review. One area involves addressing the issue of latrine quality, durability, and equity, which all leads back to affordability. WASHPaLS plans to study how smart subsidies can improve CLTS outcomes and what amounts, modality, and timing yield the best results—the project is currently looking for a partner and country to help conduct this research. The second area of research is likely to explore what elements make CLTS effective, in other words what factors are more or less important for CLTS performance. The webinar concluded with a lively Q&A.
Interested in learning more? Listen to the webinar recording here.
By Wendy Putnam, Communications Lead for the USAID/E3 Bureau Water Office’s Water CKM Project.