Community-Led Total Sanitation

Community-Led Total Sanitation
Name	Community-Led Total Sanitation
Abbreviation	CLTS
Formation	2000s
Purpose	Sanitation and hygiene promotion
Region served	Global

Community-Led Total Sanitation Community-Led Total Sanitation is an approach to ending open defecation through collective behavior change and community empowerment, advocated by organizations such as the WaterAid, UNICEF, and the World Bank. Originating in responses to sanitation crises in Bangladesh and promoted in programs by World Health Organization campaigns, the approach has been adopted by national governments like India and Ethiopia and by NGOs including Oxfam and Plan International. It emphasizes triggering collective action through participatory methods developed by practitioners associated with the Institute of Development Studies, SNV Netherlands Development Organisation, and the London School of Hygiene & Tropical Medicine.

Overview

Community-Led Total Sanitation positions communities as agents of change rather than recipients of hardware subsidies, drawing on facilitation models used by CARE International and Save the Children. The method aims to mobilize households in villages, towns, and peri-urban settlements similar to initiatives by Bill & Melinda Gates Foundation funded projects, seeking rapid elimination of open defecation observed in programs supported by UNICEF country offices in Nepal, Mozambique, and Kenya. It links to public health priorities highlighted by the Global Handwashing Partnership and follows monitoring frameworks used by the Joint Monitoring Programme between UNICEF and the World Health Organization.

History and Development

The approach evolved from community sanitation experiments in Bangladesh in the late 1990s and early 2000s, influenced by practitioners associated with BRAC, Centre for Development Innovation, and researchers at the University of Sussex. Early dissemination occurred through networks such as the Water and Sanitation Program of the World Bank and conferences at the Stockholm World Water Week and the International Water Association. National scale-ups occurred in programs coordinated by ministries in India, Nepal, Zambia, and Ethiopia, often with technical assistance from UNICEF, USAID, and DFID (now Foreign, Commonwealth & Development Office).

Principles and Methodology

Core principles include triggering, no hardware subsidy, community verification, and sustainability, reflecting facilitation approaches used by Participatory Rural Appraisal practitioners linked to Oxfam workshops and training modules developed by the Institute of Development Studies. Methodology uses tools such as transect walks, mapping, and participatory scorecards similar to tools promoted by Asian Development Bank programs and curriculum modules at the London School of Hygiene & Tropical Medicine. Monitoring relies on community-led verification and declarations modelled on campaigns by UNICEF and reporting conventions used by the Joint Monitoring Programme.

Implementation and Practice

Implementation typically involves local facilitators trained by NGOs like WaterAid or by municipal bodies in collaboration with donors such as the World Bank, Asian Development Bank, and USAID. Practice includes triggering sessions that employ behavior-change communication techniques used in public health initiatives by WHO and mass mobilization strategies seen in programs by CARE International and Plan International. Scaling requires coordination with national ministries of health and sanitation ministries in countries such as India (including state programs), Ethiopia, and Bangladesh, and often engages community-based organizations like BRAC and faith-based NGOs linked to Caritas.

Outcomes and Impact

Evaluations by researchers at institutions including the London School of Hygiene & Tropical Medicine, University of Oxford, and the World Bank report reductions in open defecation and improvements in latrine coverage in settings across Nepal, Bangladesh, Kenya, and Ethiopia. Reported health impacts intersect with studies on diarrhoeal disease and child growth by scholars associated with Harvard University, Johns Hopkins Bloomberg School of Public Health, and the International Food Policy Research Institute. Programmatic impact has influenced national sanitation campaigns such as Swachh Bharat Abhiyan in India and inspired components of Sustainable Development Goal 6 implementation tracked by UNICEF and WHO.

Criticisms and Limitations

Critiques from academics at University College London, Brown University, and Institute of Development Studies focus on issues including social exclusion, sustainability of behavior change, and measurement validity; similar concerns have been raised by commentators in The Lancet and reports by Human Rights Watch. Debates involve comparisons with hardware subsidy models promoted historically by the World Bank and analyses by the International Initiative for Impact Evaluation and Evidence Aid regarding evidence strength and unintended consequences documented in case reviews from India and Ethiopia.

Case Studies and Regional Applications

Regional applications span South Asia, East Africa, and Southeast Asia with documented cases in Bangladesh, Nepal, India, Kenya, Ethiopia, and Cambodia, often evaluated by consortia including the World Bank, UNICEF, and research teams from University of Oxford and LSHTM. High-profile national rollouts include links to campaigns led by ministries in India (including coordination with NITI Aayog), municipal programs in Kathmandu, and county-level initiatives in Kenya supported by USAID. Comparative studies draw on datasets assembled by the Joint Monitoring Programme and on impact syntheses published by the World Bank and research partners such as the International Initiative for Impact Evaluation.

Category:Sanitation