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Community Led Total Sanitation: a stunning sanitation solution for Africa?

Two thirds of Africa’s population do not have access to improved sanitation, and 224 million practice open defecation. Only 4 of 44 sub-Saharan African countries are on track to meet the MDG of halving the proportion of people without access to sanitation. In this context, Community Led Total Sanitation (CLTS) has been described as “radical” and “revolutionary” as it offers the international development fraternity a way to quickly increase sanitation access. While it started as a small NGO type approach, engaging with the specific dynamics of each community, CLTS is now being adopted at scale by African countries as their sole household sanitation programme. What is CLTS and is it something that we should advocate?

CLTS was developed and implemented in Asia in the late 1990s. It is a response to donors pouring funds into sanitation hardware, with poor involvement and take up by communities and little change in health statistics. Instead CLTS passes the responsibility for sanitation to communities themselves. It tries to remove the role of outsiders and relies on facilitators to “trigger” community responses, for households to build their own toilets using their own resources, and for “natural leaders” to emerge to monitor and help sustain progress.

Facilitators use participatory methods that are well respected and established in the development world, like transect walks, community mapping and venn diagrams. What is particularly distinctive about CLTS is that it forces participants to confront their “shit” by using this word, visiting places where people openly defecate, and tracing the faecal to oral transmission route to the glass of water on the table. The message is: “As long as any household in the community is practicing open defecation, we are drinking each other’s shit.”

While it has “worked”, measured by an increasing number of communities that certify themselves as having achieved “open defecation free” (ODF) status (with signs erected that note this on entrance to the area), there are a number of critiques that can be considered:

1. Is this pure neo-liberalism under the guise of good community development? Does it allow governments to abrogate responsibility, which is taken on by communities themselves?

2. Who is really calling the shots? While the entire approach is premised on communities taking control of their own lives in terms of sanitation and health, the approach is formulated and introduced by outsiders. Outsiders include international organisations that often are the drivers—the Water and Sanitation Programme of the World Bank, UNICEF, and Dfid and large NGOs including PLAN and WaterAid. Communities may be driving, but the roads have been built by these organisations.

3. Are the benefits of CLTS sustainable? Once the initial shock triggers community action, such simple toilets can collapse— will people rebuild them? If there are problems with toilets, will people revert to previous behaviour of open defecation? Sustainability depends on natural leaders as well–will they continue to play this role and do this work without pay?

4. Does CLTS place households at the bottom of the sanitation ladder without an ability to climb further? CLTS is a no-subsidy approach that governments are adopting, so how can poor households gain a standard of sanitation that is technically sound and provides a higher standard?

5. What impact do the methods used for triggering and sustaining progress have on communities? CLTS triggering actively invokes shame, and community members call the attention of the community to anyone they see practising open defecation. How does CLTS influence relations between youth and elders, men and women, and rich and poor? Does it damage the very “social fabric” or “social capital” that development organisations claim to support?

In her book on good practices in realising the right to water and sanitation, Catarina de Alburquerque commends CLTS’ application in rural Bangladesh, and that it has been introduced with “varying degrees of success” into other countries in Asia and Africa. She adds: “Observers have also recognised that incentives for encouraging behaviour change and the construction of latrines are sometimes unacceptable, and include public shaming, including photographing, of those who still practice open defecation.”

The key question here is: What other human rights do we compromise in meeting people’s right to sanitation? On one hand, CLTS offers the prospect of radically decreasing child mortality and improving the health of rural African people by eliminating the open defecation practiced by 224 million people. CLTS is indeed a powerful method to ensure that people understand the health impacts of their behaviour. On the other hand, we must question international agencies working with governments to shame poor people into digging their own pits to shit in, while stopping subsidies that assist them to build a proper toilet.

In what ways is CLTS a stunning solution to poor people’s sanitation dilemmas?