Community-led total sanitation: Difference between revisions

"CLTS" redirects here. For the seminary, see Concordia Lutheran Theological Seminary.

Community-Led Total Sanitation (CLTS) is an approach to bring about sustained behavior change in mainly rural people by a process of "triggering" leading to spontaneous and long-term abandonement of open defecation practices. It was first applied by Kamal Kar in Bangladesh in around the year 2000. The concept involves provoking shame and disgust about poor sanitation in order to bring about change. It has spread throughout Bangladesh and to many other Asican, African and Latin American countries with support from the World Bank, UNICEF and other large NGOs.

An important difference between CLTS and other kinds of sanitation intervention is that it does not involve NGOs or governments giving hardware subsidies and building toilets like pit latrines for the villagers, because of a perception that these kinds of projects are not sustainable in the longer term. Instead, those supporting CLTS believe that provoking behavior change in the people will ensure that they take ownership of their own sanitation situation, construct their own toilets (often pour flush pit latrines) and pay for necessary improvements themselves.

History

Kamal Kar presenting about CLTS at a meeting of the Sustainable Sanitation Alliance in Sweden in 2010

In 2000, Kamal Kar was working in a village called Mosmoil in Rajshahi and decided that a system of attitudinal changes by villagers might have a longer-lasting effect than the existing top-down approach involving subsidies from NGOs and government. According to a report written about the early development of CTLS in Bangladesh, the Bangladeshi government began a programme of installing expensive latrines in the 1970s, but this was eventually seen as too costly and many of the original latrines were abandoned. In the 1990s, a social mobilisation scheme was begun to encourage people to demand and install better sanitation systems, but early successes were not seen in the longer term. Dr Kamal Kar, a participatory development expert from India, was brought in by Wateraid and concluded that the problem with previous approaches was that local people had not "internalised" the demand for sanitation. He then suggested a new approach: abandoning subsidies and appealing to the better nature of villagers and their sense of self-disgust to bring about change. The CTLS Foundation, the organisation set up by Kar to promote these ideas, stated this in their 2008 handbook.

It is fundamental that CLTS involves no individual house-hold hardware subsidy and does not prescribe latrine models.

— Kamal Kar, CLTS Foundation Handbook, 2008 page 8

In time, NGOs and governments began to see the value of the approach and ran their own schemes in various countries, some with less aversion to subsidies than Kamal Kar. By 2015, Community-led Total Sanitation as an idea had grown beyond its founder and was being run in slightly different ways in many different contexts.

CLTS as an idea now has many supporters around the world, with one sanitation expert describing in this way:

"We have so many "revolutions" in development that only last a year or two and then fade into history. But this one is different. In all the years I have worked in development this is as thrilling and transformative as anything I have been involved in."

— Robert Chambers from Institute of Development Studies, The Guardian, 30 May 2011

Today there are many NGOs with an interest in CLTS, including the CLTS Foundation led by Kamal Kar, the Institute of Development Studies, The World Bank, Wateraid, Plan USA and UNICEF.

Overview

At the heart of CLTS is a process described as triggering. The official handbook used by the CLTS Foundation explains that this takes place over a day in a community with a team of facilitators. The team visits a community which is identified as practicing open defecation and encourages villagers to become aware of their own sanitation situation. This tends to cause disgust in participants, and the faciliators help participants to plan appropriate sanitation facilities.

Using the term "shit" (or other locally used crude words) during the conversations - rather than feces or excreta - is a deliberate aspect of the CLTS approach, as it is meant to be a practical, straight forward approach rather than a theoretical, academic conversation.

Pre-triggering

Pre-triggering is the process by which communities are assessed to be suitable for CLTS intervention. This may involve visits and a number of different criteria to use to identify communities likely to respond well to triggering.

Triggering

The UNICEF manual approved for use in CLTS in Sierra Leone suggests the following steps for the triggering process:

• Visit the community, emphasising that it is for learning about their sanitation situation
• Facilitate 'Kaka Mapping' - which involves drawing the main sites in the village then the main sites for defecation
• Pretend to leave
• Facilitate the 'Walk of Shame' - walking with community to the sites of Open Defecation
• Take a piece of faeces in a bag
• Put faeces on the floor in front of the community and discuss the way flies move between food and faeces
• Wait for the shocked understanding that the community is 'eating' the faeces
• Put some faeces into a water bottle and ask community if they would drink it
• Calculate how much faeces is produced each day and asks where it goes
• Ignition
• Wait for the emergence of "Natural Leaders" to work with to develop a plan of action.

The idea of the triggering process is to stimulate disgust in the villagers by physical demonstration of the sanitation problems. At the 'ignition' phase, the villagers are expected to realise that there is a real sanitation problem and that they need to do something about it. Natural Leaders are people from the community who are engaged by the process and who are seen to be people who can drive change.

Post-triggering

After a positive response to the ignition phase, NGO facilitators work with communities to deliver sanitation services by providing information and guidance relevant to the local situation.

Positive outcomes

The positive outcomes are usually measured in the declarations of "ODF villages", where ODF stands for "open defecation free". A positive outcome would be if the village stays as ODF for many years after the initial triggering and if it may even "move up" on the sanitation ladder.

Recent developments

More recently, CLTS has also been adapted to the urban context (for example in Kenya by the NGO Plan) and even to schools and the surrounding pupil and parent communities, where it is sometimes referred to as "school-led total sanitation".

Increasingly, there is also discussion about how CLTS could be adapted to post-emergency settings and there has been some experience with this in Haiti, Afghanistan and Indonesia.

Criticisms

Human rights

CLTS’s behavioral changes process is based on the use of shame. This is meant to promote collective consciousness-raising of the severe impacts of open defecation and trigger shock and self awareness when participants realize the implications of their actions. There is quite some evidence now that the triggering process has seen practices utilized which infringe the human rights of recipients even if this was not intended by the original concept. There have been cases of fines (monetary and non-monetary), withholding of entitlements, public taunting, posting of humiliating pictures and even violence. Some researchers have called it the "dirty truth" that CLTS is based on coercion.

Toilet standards

CLTS does not specify technical standards for toilets. This is a benefit in terms of keeping the costs of constructing toilets very low and allowing villagers to start building their own toilets immediately. However, it can produce two problems: first in flood plains or areas near water tables poorly constructed latrines are likely to contaminate the water table and thus represent little improvement. Second, long-term use of sanitation facilities is related to the pleasantness of the facilities, but dirty overflowing pits are unlikely to be utilised in the longer term. A related issue here is that CLTS does not address the issue of latrine emptying services or where they exist, how they dispose of waste. This has led some researchers to say that the success of CLTS is largely down to the cultural suitability of the way it is delivered and the degree to which supply-side constraints are addressed.

Alternative toilet options

If villagers do not know about alternative toilet options (like urine-diverting dry toilets or composting toilets), and are not told about these options by the facilitators of the CLTS process, they may opt for pour flush pit latrines even in situations where groundwater pollution is a significant problem.

Longer-term usage rates

There is also concern about the number of people who go back to open-defecation some months after having been through the CLTS process. A Plan Australia study from 2013 investigated 116 villages considered Open Defecation Free (ODF) following CLTS across several countries in Africa. After 2 years, 87% of the 4960 households had fully functioning latrines - but these were considered the most basic and none of the communities had moved up the sanitation ladder. 89% of households had no visible excreta in the vicinity, but only 37% had handwashing facilities present. When broader criteria for declaring communities ODF were used an overall "slippage rate" of 92% was found.

Reviews of effectiveness

Another problem relates to the lack of rigorous review about the effectiveness of CLTS. A recent study looking at reports released by NGOs and practitioners (the so-called 'grey' literature) which itself was not in a peer reviewed journal found that there was little review of the impact of local Natural Leaders, that anecdotes were used without assessing impacts and claims were made without supporting evidence. It concluded that these kinds of reports focus on the 'triggering' stage of CTLS instead of the measurable outcomes.

Reuse of excreta

Feces are given a strong negative connotation in the CLTS approach, which is also obvious by calling it "shit". This can cause confusion for villagers who are already, or could be in future, using treated human excreta as a fertiliser in agriculture - a process known as reuse of excreta in agriculture.

See also

• Farmer Field School
• Orangi Pilot Project

• Nirmal Bharat Abhiyan

External links

• Community-led total sanitation at Appropedia.org
• CLTS Knowledge Hub at Institute for Development Studies (IDS) in the UK
• CLTS Foundation by Kamal Kar
• Publications on CTLS in the library of the Sustainable Sanitation Alliance