Sanitation in Bangladesh: Revolution, Evolution, and New Challenges

Sanitation in Bangladesh: Revolution, Evolution, and New Challenges, 2016. CLTS Knowledge Hub Learning Paper.

• Full text

Author: Dr Suzanne Hanchett.

Our 2015 discussions with people at all levels of Bangladesh society reveal both pride in sanitation achievements and concern about meeting future challenges. A combination of approaches – subsidies, non-subsidies, micro-credit, sanitation market improvements, programming at various scales, motivating of individuals and groups – has resulted in a majority of households’ using latrines rather than defecating openly.

Policy documents have created frameworks to guide activities in diverse areas. Issues such as quality, faecal sludge removal, and appropriate subsidies for very poor households remain, however. Hard-to-reach geographical areas lag behind the rest of the country. As Professor Mujibur Rahman’s 2009 overview pointed out, failing to address these challenges will threaten the sustainability of achievements.

Unique characteristics of the Bangladesh sanitation situation include the focus on its local government institution (the union), its long history of NGO-sponsored community mobilisation, and its high population density. Donor involvement has been a regular feature of the sanitation scene for more than three decades. It is a relatively small country, the size of only one of India’s states. All of these special conditions and characteristics have supported its achievements to date.

Teachers and Sanitation Promotion: An Assessment of Community Led Total Sanitation in Ethiopia

Teachers and Sanitation Promotion: An Assessment of Community Led Total Sanitation in Ethiopia. Env Sci Tech, May 2016.

• Full text, pdf

Authors: Jonny Crocker, Abiyot Geremew, Fisseha Atalie, Messele Yetie, and Jamie Bartram

Community-led total sanitation (CLTS) is a participatory approach to addressing open defecation that has demonstrated success in previous studies, yet there is no research on how implementation arrangements and context change effectiveness. We used a quasi-experimental study design to compare two interventions in Ethiopia: conventional CLTS in which health workers and local leaders provided facilitation and an alternative approach in which teachers provided facilitation.

In 2012, Plan International Ethiopia trained teachers from 111 villages and health workers and leaders from 54 villages in CLTS facilitation. The trained facilitators then implemented CLTS in their respective villages
for a year. Latrine ownership, use, and quality were measured with household surveys.

Differences between interventions were explored using surveys and interviews. The decrease in open defecation associated with teacher-facilitated CLTS was 8.2 percentage points smaller than for conventional CLTS (p = 0.048). Teachers had competing responsibilities and initially lacked support from local leaders, which may have lessened their success.

Teachers may be more appropriate for a supporting rather than leading role in sanitation promotion because they did demonstrate ability and engagement. Open defecation decreased by 15.3 percentage points overall but did not change where baseline open defecation was below 30%.

Ownership of a latrine with stable flooring increased by 8.7 percentage points overall. Improved latrine ownership did not change during the intervention. CLTS is most appropriate where open defecation is high because there were no significant changes in sanitation practices or latrine upgrades where baseline open defecation was low

Global Waters Radio: Piet deVries on Sanitation Behavior Change in Liberia

Global Waters Radio: Piet deVries on Sanitation Behavior Change in Liberia | Source: Global Waters, June 2016 |

Piet deVries is Senior WASH Specialist and Liberia Country Director for Global Communities, a Maryland-based NGO with programs in more than 20 countries around the world. In his recent sit-down with Global Waters Radio, deVries discussed his experiences in Liberia promoting community-led total sanitation (CLTS) over the past several years, as former chief of party for USAID/Liberia’s Improved Water, Sanitation, and Hygiene (IWASH) program.

Photo Credit: Global Communities

CLTS is a methodology originally pioneered in Bangladesh that seeks to create sustainable improvements in community sanitation by prioritizing public education and equipping communities with the skills needed to build and maintain their own improved sanitation facilities. CLTS also encourages community members to support the behavioral changes necessary to eliminate the public health threats posed by open defecation — a common practice in much of rural West Africa.

Link to the podcast/complete article.

A Community Approach to Better Public Health in Rural Liberia

A Community Approach to Better Public Health in Rural Liberia. Global Waters, June 2016

Liberia is no stranger to difficult times, having weathered a devastating Ebola outbreak and now struggling through a slow economic recovery. Lost amid the headlines from these events is the story of Liberia’s quiet public health victories.

Residents of Lofa County’s Vahun district in Liberia gather to discuss strategy for sustaining recent local sanitation improvements. Photo Credit: Global Communities

Half of Liberia’s 4.5 million people live in the countryside and roughly the same amount practice open defecation.

This practice has jeopardized public health by facilitating the spread of diseases that cause diarrhea, Liberia’s sixth leading cause of death and the primary cause of childhood morbidity and mortality.

However, thanks to two programs that championed community-led sanitation improvements, USAID has now helped 1,500 Liberian communities achieve open defecation-free (ODF) status — fueling optimism about continued public health improvements in the near term

Read the complete article.

Impact of Community-led Total Sanitation on Women’s Health in Urban Slums: A Case Study from Kalyani Municipality

Impact of Community-led Total Sanitation on Women’s Health in Urban Slums: A Case Study from Kalyani Municipality, 2016.

• Full text

Authors: Prabhakaran, P., Kar, K., Mehta, L. and Chowdhury, S.R. Institute of Development Studies.

This Evidence Report seeks to understand the health and other impacts of slum women’s access to sanitation through the Community-led Total Sanitation (CLTS) approach. It also examines the process through which open defecation free (ODF) status was attained in two different slum colonies, the resulting health impacts and the collective action that took place around both sanitation and other development benefits.

The study was conducted in the slums of Kalyani, a Municipality town located 55km north of Kolkata, the capital city of West Bengal state in India. From an area plagued with rampant open defecation, the slums of Kalyani were transformed into the first ODF town in India in 2009. This was achieved through the CLTS model that focused on motivating the community to undertake collective behaviour change to achieve ‘total’ sanitation and an ODF environment. This was in sharp contrast to earlier, top-down approaches to the provision of toilets, which had failed to ensure ownership or usage by the community.

The benefits of CLTS to the community were not limited to changed sanitation behaviour and an end of open defecation – there were significant development and health gains beyond sanitation. Women’s health in this study has been viewed not just in terms of the presence or absence of disease burden on the physical health of women but also in terms of their socio-psychological wellbeing resulting from reduced risks and a wide range of benefits accruing from better sanitation and hygiene practices and facilities.

The study also focused on exploring the extent to which the CLTS process can be said to have empowered women. As experiences of good health and wellbeing are affected by factors in the external environment, namely the role of the local government, women’s access to health services and the involvement of multiple sectors, these issues were also considered, in order to understand the overall health status and experiences of women in Kalyani slums.

WASHplus – A Surprise Inoculation Against Cholera

A Surprise Inoculation Against Cholera, 2016. WASHplus.

• Full text 

Communities that embraced the WASHplus and Kenya Ministry of Health community-led total sanitation-plus approach appear to have protected themselves against cholera during a recent epidemic.

An Update of Themes and Trends in Urban Community-Led Total Sanitation Projects

An Update of Themes and Trends in Urban Community-Led Total Sanitation Projects, 2015. 38th WEDC International Conference, Loughborough University, UK, 2015.

• Full text

This briefing paper identifies common themes and trends of Urban Community-Led Total Sanitation (UCLTS). The study relies on literature from 14 different projects across India and Africa alongside articles that focused on UCLTS and participation in urban sanitation projects.

The hope is to provide an overview for those working in the field by identifying common characteristics, problems and opportunities.

The paper ends with a list of recommendations for those currently working on UCLTS projects and those interested in transferring the CLTS model to urban environments.