Tag Archives: CLTS

Accelerating and sustaining behaviour change: New handbook launched at GSF learning event

This week, the Global Sanitation Fund (GSF) and the GSF-funded ‘Fonds d’Appui pour l’Assainissement’ (FAA) in Madagascar launched a new handbook on accelerating and sustaining the end of open defecation.

The handbook was launched during the GSF Learning Event in Antananarivo, Madagascar, inaugurated by Madagascar’s Minister of Water Sanitation and Hygiene, Roland Ravatomanga.

A community celebrating the creation of their ‘model latrine’ for others to replicate during a FUM session in Madagascar. Credit: WSSCC

A community celebrating the creation of their ‘model latrine’ for others to replicate during a FUM session in Madagascar. Credit: WSSCC

The ‘Follow-up MANDONA’ (FUM) handbook is a field guide for practitioners of Community-Led Total Sanitation (CLTS) – an empowering approach for improving sanitation and hygiene through collective behaviour change, rather than external subsidies or prescription. FUM aims to systematically engage communities after they have been initially ‘triggered’ and committed to ending open defecation.

‘Mandona’ is a Malagasy word which means ‘to push’. FUM brings the entire community together for a self-analysis of their sanitation situation, which then helps them immediately create models that prevent the ingestion of faeces. The approach harnesses the power of Natural Leaders to replicate these models across the community, which includes helping those that are least able, in order to advance to ODF status. By focusing on sustainable behaviour change, FUM is also a useful tool for addressing issues surrounding ‘slippage’, which relates to returning to previous unhygienic behaviours.

FUM was developed and refined by MIARINTSOA NGO, a sub-grantee of the FAA programme. Given the success of FUM in Madagascar and elsewhere, the GSF and FAA created the FUM handbook to provide a practical guide for how CLTS practitioners can implement the approach in their own contexts.

Download ‘Follow-up MANDONA: A field guide for accelerating and sustaining open defecation free communities’ (English/French)

The weeklong global event where the handbook was launched brings together implementing partners, WASH experts, and high-level government representatives from GSF-supported programmes. These actors are exchanging ideas and sharing best practices for achieving improved sanitation and hygiene behaviour at scale.

During the launch, WSSCC Executive Director Chris Williams highlighted how FUM is engraining the sustainability of sanitation and hygiene behaviour change in Madagascar and beyond. “Once a village, or an entire commune, has reached ODF status, the story isn’t over. In fact, the work continues. This important publication documents the innovations that Madagascar has put together to systematically follow-up with villages. FUM aims to ensure that the change in attitudes and creation of convictions that my ‘sanitation problem is your sanitation problem’ – ‘or my shit is your shit’ – is dealt with as a collective community effort.”

WSSCC Executive Director holds up the Follow-up MANDONA handbook at GSF Learning Event opening ceremony. Credit: WSSCC/Okechukwu Umelo

WSSCC Executive Director holds up the Follow-up MANDONA handbook at GSF Learning Event opening ceremony. Credit: WSSCC/Okechukwu Umelo

FUM has become one of FAA’s most important tools for empowering over 1.6 million people to live in open defecation free environments on their own terms. Due to its success in Madagascar, FUM has recently become a core strategy for national sanitation and hygiene programmes in Uganda, Nigeria, Benin, and Togo.

Community members in Nigeria agreeing to trigger their neighbours and help those who don’t have the means to build their own latrine. Credit: WSSCC

Community members in Nigeria agreeing to trigger their neighbours and help those who don’t have the means to build their own latrine. Credit: WSSCC

Kamal Kar, the Chairman of the CLTS Foundation, which has extensively supported the FAA programme to develop their CLTS approach, emphasized the importance of the handbook in sharing proven approaches to practitioners around the world: “I am glad that the Malagasy NGO, MIARINTSOA, with the help of the FAA programme, WSSCC and the GSF, has systematically documented their experience of post-triggering follow-up from their implementation of CLTS over the last 4-5 years. Publication of this Follow-up MANDONA handbook is indeed a step forward towards country-wide scaling up of good practice of CLTS in Madagascar and beyond.”


Eugène De Ligori Rasamoelina, Executive Director of MIARINTSOA NGO, which developed and refined Follow-up MANDONA. Credit: WSSCC

“I must say that the emergence of thousands of ODF villages in Madagascar, starting with my multiple support visits to the country since 2010 to strengthen the approach, is a brilliant example of quality CLTS implementation with its central philosophy of local empowerment. I believe that this handbook will be useful in understanding and ensuring post-triggering follow-up in CLTS for sustained behaviour change.”

Find out more about the Global Sanitation Fund on the WSSCC website.

Topic of the week: Community-Led Total Sanitation

Financing sanitation for low-income urban communities: Lessons from CCODE and the Federation in Malawi, 2016. Wonderful Hunga, IIED.

Like many other countries in the Global South, Malawi has failed to meet Millennium Development Goal (MDG) targets to improve access to sanitation. It has been estimated that only 25 per cent of the country’s population has gained access to improved sanitation since 1990 and access to it is a meagre 41 per cent, according to the latest Joint Monitoring Programme (JMP) Report (2015).

By utilising social capital and promoting ecological sanitation, CCODE (an SDI affiliate), has enabled thousands of urban poor households, who could not afford better toilets, to live a dignified life. This study shows that the CCODE model could do this for most of Malawi’s urban poor.

Beliefs, Behaviors, and Perceptions of Community-Led Total Sanitation and Their Relation to Improved Sanitation in Rural Zambia. Am J Trop Med Hyg. 2016 Jan 19. Authors: Lawrence JJ, Yeboah-Antwi K, et al.

Inadequate hygiene and sanitation remain leading global contributors to morbidity and mortality in children and adults. One strategy for improving sanitation access is community-led total sanitation (CLTS), in which participants are guided into self-realization of the importance of sanitation through activities called “triggering.” This qualitative study explored community members’ and stakeholders’ sanitation, knowledge, perceptions, and behaviors during early CLTS implementation in Zambia.

We conducted 67 in-depth interviews and 24 focus group discussions in six districts in Zambia 12-18 months after CLTS implementation. Triggering activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and handwashing stations. New sanitation behaviors were also encouraged by the hierarchical influences of traditional leaders and sanitation action groups and by children’s opinions.

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Norms, Knowledge and Usage: Frontiers of CLTS: Innovations and Insights

Chambers, R. and Myers, J. (2016) ‘Norms, Knowledge and Usage’, Frontiers of CLTS: Innovations and Insights Issue 7, Brighton: IDS.

The partial or total non-use of toilets, with some or all in a household defecating in the open, is a growing concern. Although all households may have a toilet, communities cannot remain open defecation free unless they are always used by everyone. clts

This is not just an issue of maintenance and accessibility but also of social norms, mind-sets, and cultural preferences. The problem is widespread but most evident in India.

This issue of Frontiers of CLTS asks how serious the problem is, why it occurs, what can be done about it, and what more needs to be known.

It is an attempt to summarise current knowledge as a first step in exploring and learning about this growing obstacle to attaining and sustaining ODF status in some parts of the world.

New Video Offers Five Lessons for Sanitation Policy and Practice

A new video from Plan International and the Water Institute at UNC offers a preview of five exciting lessons on sanitation policy and practice, based on findings from operational research on community-led total sanitation (CLTS). These lessons relate to CLTS planning at the national and local levels, its place in national sanitation systems, and the importance of involving local actors. In particular, government officials, teachers, and natural leaders can play important roles in improving access to basic sanitation, and their involvement can ensure sustainable outcomes over time.

Learning, progress and innovation: Sanitation and hygiene promotion in Madagascar

Learn how the Global Sanitation Fund-supported programme in Madagascar is promoting sustainability and achieving strong sanitation and hygiene results trough a cycle of learning, progress and innovation.

Download the complete case study or explore the sections below:

The national context

Photo: Members of a local sanitation and hygiene advocacy group in the fokontany of Anjalazala celebrate achieving open defecation free status. Credit: FAA/Nirina Roméo Andriamparany

Photo: Members of a local sanitation and hygiene advocacy group in the fokontany of Anjalazala celebrate achieving open defecation free status. Credit: FAA/Nirina Roméo Andriamparany

The latest report from the Joint Monitoring Programme of the United Nations Children’s Fund and World Health Organization highlights revealing statistics on Madagascar’s sanitation and hygiene situation. Approximately 12 percent of the country’s population have access to improved sanitation, while 18 percent have access to shared sanitation that is unimproved, and 30 percent have access to other types of unimproved sanitation. Furthermore, 40 percent defecate in the open. Ensuring improved sanitation and hygiene for all remains a major challenge in the country, but innovations from local partners supported by the Global Sanitation Fund (GSF) are vigorously helping to transform this situation.
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The CLTS journey

Photo: ‘Triggering’ children in the commune of Mangarano, using the open defecation mapping tool. Credit: FAA/Fano Randriamanantsoa

Photo: ‘Triggering’ children in the commune of Mangarano, using the open defecation mapping tool. Credit: FAA/Fano Randriamanantsoa

In rural Madagascar, CLTS is the preferred approach for eliminating open defecation, and these actions also drive overall improvements in sanitation and hygiene. CLTS was introduced in the country in 2008, following its success in Asia. The crux of the approach lies in creating an enabling environment in which communities become self-reliant and improve their own sanitation and hygiene situation without external help.

Video: CLTS ‘triggering in action

CLTS focuses on igniting change in sanitation and hygiene behavior within whole communities, rather than constructing toilets through subsidies. During this social awakening, or ‘triggering’ process in Madagascar, the community looks for visible faeces in their environment. When people realize they are eating faeces this provokes disgust, shame and impacts on dignity. The community then makes and immediate decision to end open defecation. These steps are highlighted in the above video.
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Innovations in sanitation and hygiene behaviour change methods
As the first GSF programme, the Fonds d’Appui pour l’Assainissement (FAA) was the testing ground for various approaches based on the essence of CLTS, which helped to drive the programme’s learning and sharing culture. Sub-grantees have utilized a range of approaches within local communities, sharing their challenges and success with the larger FAA team. Through FAA’s strong learning and sharing system, many of these approaches have been evaluated for their potential to be implemented on a larger scale, and some have become best practices, both within and outside of Madagascar. This case study highlights three best practice approaches evaluated and utilized by the FAA programme: Follow-up MANDONA, local and institutional governance and sanitation marketing.

Follow-up MANDONA
Inspired by CLTS triggering approaches, Follow-up MANDONA is aimed at helping communities speed up their achievement of open defecation free status and initiate the development of local governance mechanisms for sustainability.
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Read the full article on the WSSCC website.

WASHplus Weekly: Focus on Community-Led Total Sanitation (CLTS)

Issue 202 | August 14, 2015 | Focus on Community-Led Total Sanitation (CLTS)

This issue updates the March 6, 2015 Weekly on CLTS. Studies and resources in this issue include a webinar series on what constitutes success for CLTS, new reports from the UNC Water Institute and the Institute of Development Studies, a presentation by Kamal Kar on CLTS and scaling up, and a UNICEF report on CLTS in fragile and insecure contexts. Also included are recent studies on the health impacts of open defecation in India and Nepal and a Waterlines review on the safety of burial or disposal with garbage as forms of child feces disposal.


What Constitutes Success for CLTS? Measuring Community Outcomes and Behavior Changes, 2015.
The webinar had a chat show format where, following a panel interview, the audience will have the chance to interact with the panelists. This webinar was organized under the Knowledge Management initiative of the Building Demand for Sanitation (BDS) program of the Bill & Melinda Gates Foundation. Organizers included Euforic Services, the SuSanA secretariat and the Stockholm Environment Institute.

  • Introduction by Pippa Scott, Link to recording on YouTube
  • Chat show. Speakers: Ada Oko Williams, Technical Support Manager, Sanitation and Hygiene, WaterAid UK; Darren Saywell, Senior Director, Water, Sanitation and Health, Plan International USA and others, Link
  • Feedback from breakout rooms, Link
  • Closing panel, Link
  • More information and links to audio files are available on the SuSanA discussion forum

Seminar: CLTS at Stockholm World Water Week, August 23rd, 9:00 – 10:30, FH 202. Link
In this 90-minute event, speakers from Plan International and the Water Institute at UNC will discuss with the audience the results of an operational research program on the role and potential of local actors to sustain CLTS outcomes. Highlights will be shared from activities in 10 countries across Africa, Asia, and the Caribbean.

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Can WASH deliver more than just sanitation?

Through successful WASH intervention, communities access a new service that improves their quality of life, and also learn about equity and inclusion.

Blog by development expert Suvojit Chattopadhyay

The abysmal state of access to safe water and sanitation facilities in the developing world is currently a major cause for alarm; 580,000 children die every year from preventable diarrheal diseases. This is due largely to the 2.5 billion people around the globe who do not have access to safe sanitation. Not only can an effective WASH intervention save lives, it can also engineer changes in the social fabric of communities that adopt these behavioural changes. This points to a key attribute of a successful WASH intervention – that through these programmes, communities not only access a new service that improves their quality of life, but they also learn from being part of a concrete intervention that emphasises equity and inclusion.

Let me explain how. Safe sanitation is essentially ‘total’. In a community, even one family practising open defecation puts the health of other families at risk. Also, unsafe sanitation practices pollute local potable and drinking water sources in the habitations. Together, this can undo any gains from partial coverage of WASH interventions. This much is now widely accepted by sanitation practitioners around the world. However, there remains a serious challenge when it comes to the implementation of this concept.

When a community is introduced to a WASH-focused behaviour change campaign, there are often variations in the levels of take-up in different families. This could be because of several barriers – financial ability, cultural beliefs, education levels, etc. In response, external agencies have many options. They can focus more on families in their behaviour change campaigns, offer them material and financial support or incentives, or exert peer pressure (which may in some cases become coercive, etc).

However, the best approach – whether facilitated by an external agent or not – is for a community to devise a collective response. The issue should be framed as a collective action problem that requires solving for the creation of a public good. In many instances, communities have come together to support the poorest families – social engineering at its finest. At its best, recognising the needs of every member of a community will lead to a recognition of the challenges that the typically marginalised groups face. It is this recognition that could prompt a rethink of social norms and relationships.

Read the full article on the WSSCC Guardian partner zone.