Where it has been introduced, CLTS has been integrated with other development initiatives. Besides ending open defecation, the focus is on a more comprehensive package which includes wastewater management, solid waste disposal, overall hygiene and more. The approach has also been modified in some countries to ‘School-led Total Sanitation (SLTS)’, whereby schools are the prime drivers in achieving ODF status. This has widened the spread of CLTS and its impact, both among adults and children. Plan, Water Aid and UNICEF have become important disseminators and champions of CLTS. Today, it is present in many countries in Asia, Africa, Latin America, the Middle East and Africa. In sub-Saharan Africa, it has taken root in 28 countries and gained the support of decision makers and professionals, who have recognised it as a successful, cost-effective approach and have issued a declaration to urge governments to take more decisive steps to ensure ODF environments among local communities.
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