WASHplus Weekly: Focus on Community-Led Total Sanitation

Issue 149 | June 6, 2014 | Focus on Community-Led Total Sanitation (CLTS)

This issue updates the December 2013 Weekly on CLTS with 2014 studies, reports, and videos. Included are a May 2014 video of Dr. Kamal Kar discussing CLTS challenges, an article criticizing CLTS, a UNICEF evaluation of its Community Approaches to Total Sanitation program, and other reports and videos. washplusweekly

The June 13th issue of the Weekly will focus on cookstove issues and the next issue of the Weekly on WASH-related issues will be on June 27, 2014.


The Potential of Community-Led Total Sanitation (CLTS) in Achieving an Open Defecation Free World, 2014. Institute of Development Studies. (Video)
(NOTE: The actual presentation begins at about 4 minutes into the video.) Dr. Kamal Kar, the pioneer of CLTS, speaks about the potential of the CLTS approach in achieving the sanitation Millennium Development Goals with a special focus on Africa. He also discusses second and third generation challenges of CLTS such as sustainability, waste containment, and the politics of scaling up.


Shaming and Sanitation in Indonesia: A Return to Colonial Public Health Practices?Development and Change, Jan 2014. S Engel. (Link)
CLTS involves more than just education and encouragement; it uses social shaming and punishment. The authors argue that this is not only an inadequate approach but one that echoes coercive, race-based colonial public health practices. This article thus integrates extant historiography on Indonesian colonial medicine with contemporary scholarly literature and field research on CLTS using case studies of a 1920s hookworm-eradication program funded by the Rockefeller Foundation, and the current World Bank Water and Sanitation Program, both in Java.


Evaluation of the WASH Sector Strategy “Community Approaches to Total Sanitation” (CATS), 2014. UNICEF. (Link)
In the context of the recent evolution of the sanitation sector, CATS can be seen in a twofold way: as a move from technically based, supply-driven approaches toward behavior change, demand-driven approaches; and also as a recognition of the centrality of the adoption of a new social norm around ending open defecation as a key issue to be addressed, with impact on and linkages with other sectors.

Testing CLTS Approaches for Scalability: Systematic Literature Review, 2012. V Venkataramanan. (Link)
This report presents findings from a systematic literature review conducted by The Water Institute at UNC as part of the Plan International USA project: “Testing Community-Led Total Sanitation (CLTS) Approaches for Scalability.” Despite widespread implementation of CLTS and many claims of success, no systematic review has been carried out on the effectiveness and impact of CLTS programs. The objectives of the systematic review of the grey literature were to characterize the breadth of grey literature on CLTS and to describe the role of key internal actors—natural leaders, teachers, and local government—on sanitation and hygiene outcomes.

Towards Sustainable Total Sanitation, Key Findings from the Workshop, Cotonou, 2013. IRC. (Link)
This brochure summarizes the key findings agreed upon by participants in this workshop organized by the IRC International Water and Sanitation Centre with the objective of further sharing and engaging with the sector to set the ground for rural sanitation services that work. The findings are broken into four categories, covering the four conditions that trigger a service, namely strengthening the enabling environment, demand creation and advocacy to change behavior, strengthening the supply chain, and offering appropriate incentives and financial arrangements.


How to Trigger for Handwashing with Soap, 2014. J Maulit, UNICEF.  (English) |(French)
CLTS provides an excellent opportunity to facilitate hand washing behavior change. The purpose of this document is to outline several practical tools that can be used as a part of CLTS in order to trigger realization among communities of the importance of hand washing with soap, as well as eliminating open defecation.

Sanitation and Externalities: Evidence from Early Childhood Health in Rural India, 2014. L Andres, The World Bank. (Link)
This paper estimates two sources of benefits related to sanitation infrastructure access on early childhood health: a direct benefit a household receives when moving from open to fixed-point defecation or from unimproved sanitation to improved sanitation, and an external benefit (externality) produced by the neighborhood’s access to sanitation infrastructure.


Association Between Social Network Communities and Health Behavior: An Observational Sociocentric Network Study of Latrine Ownership in Rural IndiaAm Jnl Public Health, May 2014. H Shakya. (Link)
Three levels of social contacts (direct friends, social network community, and village) significantly predicted individual latrine ownership, but the strongest effect was found at the level of social network communities. In communities with high levels of network cohesion, the likelihood was decreased that any individual would own a latrine; this effect was significant only at lower levels of latrine ownership, suggesting a role for network cohesion in facilitating the non-ownership norm. Although many international health and development interventions target village units, these results raise the possibility that the optimal target for public health interventions may not be determined through geography but through social network interactions.

Freedom from Open Defecation: Role of the CommunityEconomic & Political Weekly, May 2014. N Dhaktode. (Link)
Sarola, a village in Maharashtra, was able to become open defecation free with effective community participation through the Sant Gadgebaba Gram Swachhata Abhiyan program. Toilets were built in every house, and the systematic management of solid waste was implemented. The success in the village testifies to the larger social benefits that can come from the efforts of a group of determined youth.


Community Led Total Sanitation (CLTS) Training of Trainers in the Solomon Islands (with Kamal Kar), 2014. UNICEF. (Video)
The Ministry of Health and Medical Services, with support from UNICEF and other partners, is introducing CLTS in the Solomon Islands. The first trials began in 2012, and Dr. Kamal Kar, chairman of the CLTS Foundation, led the first national training of trainers. This video gives an overview of the training, narrated by Dr. Kar, and shows community action following CLTS triggering by the newly trained facilitators.

A Qualitative Comparative Analysis of Well-Managed School Sanitation in BangladeshBMC Public Health, Feb 2014. C Chatterley. (Link)
The authors identified distinct pathways sufficient to support well-managed school sanitation services. Two of these are applicable to both government and nongovernment schools: (1) quality construction, financial community support, and a champion; and (2) quality construction, financial government support, a maintenance plan, and school management committee involvement. Ongoing financial support for operations and maintenance was also identified as necessary, however, financial support was determined to be insufficient on its own.

Incentives for Enterprise Engagement in Indonesia: Private and Social Enterprise Engagement in Water and Sanitation for the Poor, 2014. J Murta. (Link)
CLTS triggering of communities prior to sanitation marketing plays a key role in generating demand for sanitation products and services. In Grobogan and East Java, most sanitation entrepreneurs work primarily in rural communities that have been CLTS triggered and demand within such communities is generally expected to grow spontaneously once they have been triggered.


Community-Led Total Sanitation – (Website)
The CLTS website aims to be a global hub for community-led total sanitation, connecting the network of practitioners, communities, NGOs, agencies, researchers, governments, donors, and others involved or interested in CLTS.

Institute of Development Studies (IDS) – (CLTS Program)
IDS has been working on the research, learning, and networking aspects of CLTS for close to a decade.

CLTS Foundation – (Website)
The CLTS Foundation was formed by the pioneer of CLTS, Dr. Kamal Kar, to meet the growing demand for a common global platform for practitioners, trainers, and users of CLTS.

Plan International – (Website/handbook)
Plan’s handbook on CLTS enables communities to analyze their sanitation conditions and collectively understand the impact of open defecation on public health and their environment.



Dec  13: Focus on Community-Led Total Sanitation
May 10: Focus on Community-Led Total Sanitation


Dec 14: Focus on Community-Led Total Sanitation
July 6: Focus on Community-Led Total Sanitation
Jan 20: Focus on Community-Led Total Sanitation

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