Community-led total sanitation

The aim of CLTS is to achieve behavior change with a 'trigger' that is meant to lead to spontaneous and long-term abandonment of open defecation practices, thereby improving community sanitation and overall health.

It refers to ways of igniting community interest in ending open defecation, usually by building simple toilets, such as pit latrines.

[4] Challenges associated with CLTS include the risk of human rights infringements within communities, low standards for toilets, and concerns about usage rates in the long term.

[5] More rigorous coaching of CLTS practitioners, government public health staff and local leaders on issues such as stigma, awareness of social norms and pre-existing inequalities are important.

CLTS uses community-led methods, such as participatory mapping and analyzing pathways between feces and the mouth (fecal–oral transmission of disease), as a means of teaching the risks associated with OD.

With time, CLTS evolved away from provoking negative emotions to educating people about how open defecation increases the risk of disease.

CLTS employs individual pressure to enforce sanitation principles such as using sanitary toilets, washing hands, and practising good hygiene.

[8][9] Prior to CLTS, most traditional sanitation programs relied on the provision of subsidies for the construction of latrines and hygiene education.

[2] CLTS proponents at that time believed that provoking behavior change in the people alone would be sufficient to lead them to take ownership of their own sanitation situation, including paying for and constructing their own toilets.

[10] The team visits a community which is identified as practicing open defecation and encourages villagers to become aware of their own sanitation situation.

The UNICEF manual approved for use of CLTS in Sierra Leone suggests the following steps for the triggering process:[11] The "ignition" phase occurs when the community becomes convinced that there is a real sanitation problem, and motivated to do something about it.

However, it has been reported that communities which respond favorably tend to be motivated more by improved health, dignity, and pride than by shame or disgust.

[1] 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.

[1] Millions of people worldwide have benefited from CLTS which has reduced open defecation and increased latrine coverage in many rural communities.

[1] CLTS has spread throughout Bangladesh and to many other Asian and African countries with financial support from the Water and Sanitation Program of the World Bank, DFID, Plan International, WaterAid, CARE, UNICEF and SNV.

[1] CLTS as an idea had grown beyond its founder and is now often being run in slightly different ways, e.g. in India, Pakistan, Philippines, Nepal, Sierra Leone and Zambia.

[6] To be successful in the longer term, CLTS should be treated as part of a larger WASH (water, sanitation and hygiene) strategy rather than as a singular solution to changing behavior.

[2] Reviews about the effectiveness of CLTS to eliminate open defecation, reduce diarrhea and other gastrointestinal diseases, and decrease stunting in children are currently underway.

[citation needed] A cluster-randomized controlled trial in rural Mali conducted during 2011 to 2013 found that CLTS with no monetary subsidies did not affect diarrhea incidence,[spelling?]

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.

[5] More rigorous coaching of CLTS practitioners, government public health officials and local leaders on issues such as stigma, awareness of social norms and pre-existing inequalities are important.

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.

A Plan Australia study from 2013 investigated that 116 villages were considered Open Defecation Free (ODF) following CLTS across several countries in Africa.

[38] Some researchers suggest that this means support is needed for communities to upgrade facilities in ODF villages which have been triggered by CLTS.

[39] In the 1990s, a social mobilisation plan was put in place to encourage people to demand and install better sanitation systems, but early success did not last, according to Kar.

At that point Kar, a participatory development expert from India, was brought in by Wateraid and he concluded that the problem with previous approaches was that local people had not "internalised" the demand for sanitation.