Tag Archives: Community-Led Total Sanitation

Benefit‐Cost Analysis of Community‐Led Total Sanitation: Incorporating Results from Recent Evaluations

Benefit‐Cost Analysis of Community‐Led Total Sanitation: Incorporating Results from Recent Evaluations. Prepared for the Benefit‐Cost Analysis Reference Case Guidance Project; Funded by the Bill and Melinda Gates Foundation, January 2019.

We analyze the costs and benefits of “Community-Led Total Sanitation” (CLTS), a
sanitation intervention that relies on community-level behavioral change, in a hypothetical rural region in Sub-Saharan Africa with 200 villages and 100,000 people.

The analysis incorporates data on the effectiveness of CLTS from recent randomized control trials (RCTs) and other evaluations. We value reduced mortality benefits by adjusting estimates for the value of statistical life (VSL) from high income countries to reflect incomes in Sub-Saharan Africa.

Reduced morbidity benefits are calculated using a cost of illness (COI) approach based on recent studies quantifying the cost of diarrheal disease in Sub-Saharan Africa. Time savings from owning a latrine are valued using estimates for the shadow value of time based on a proportion of the average local wage. Costs include the cost of intervention implementation and management, households’ time costs for participating in the community behavioral change activities, and the cost of constructing latrines.

We estimate the net benefits of this intervention both with and without the inclusion of a positive health externality, which is the additional reduction in diarrhea for an individual when a sufficient proportion of other individuals in the community construct and use latrines and thereby decrease the overall load of waterborne pathogens and fecal bacteria in the environment.

We examine the sensitivity of the results to changes in the effectiveness of the CLTS intervention. A probabilistic sensitivity analysis using Monte Carlo simulation is used to examine the sensitivity of the results to changes in all of the parameters in the benefit-cost model.

We find that CLTS interventions would pass a benefit-cost test in many situations, but that benefit-cost metrics are not as favorable as many previous studies suggest. The model results are sensitive to baseline conditions, including the income level used to calculate the VSL, the discount rate, and the time spent traveling to defecation sites.

We conclude that many communities will have economic investment opportunities that are more attractive than CLTS, and recommend careful economic analysis of CLTS in specific locations.

The Nakuru Accord: failing better in the WASH sector

The Nakuru Accord: failing better in the WASH sector. CLTS website, December 20, 2018.


Things can, and do, go wrong in water, sanitation and hygiene.

In July 2018, an event at the Water Engineering Development Centre (WEDC) Conference in Nakuru, Kenya, ‘Blunders, Bloopers and Foul-ups: A WASH Game Show‘ inspired a call for WASH professionals to publicly commit to sharing their failures and learning from one another.

Read the ten principles in the Nakuru Accord asking WASH professional to commit to creating a culture based on transparency and accountability. Be inspired and sign up yourself!

Determining the effectiveness and mode of operation of Community-Led total Sanitation: The DEMO-CLTS study

Determining the effectiveness and mode of operation of Community-Led total Sanitation: The DEMO-CLTS study. EAWAG, December 2018.

The final report of a project in which CLTS was analyzed using the RANAS approach is now out.

In the project funded by BMGF two cross sectional studies in Cambodia and Mozambique (see News June 8, 2018) and one big field experiment with 3120 households in northern Ghana was conducted. The following research question were addressed in this study:

  • How do CLTS participants perceive different activities of the CLTS triggering event?
  • Which factors of the CLTS implementation process are most predictive for CLTS achievements in terms of community’s latrine coverage?
  • Does CLTS successfully provoke latrine construction and stop open defecation (compared to a control group)?
  • What are the mechanisms that lead CLTS to success? In terms of psychological determinants and potential moderating factors?
  • Can CLTS be improved by combining it with evidence-based, behavioral change strategies based on the RANAS-model of behavior change?
  • Which characteristics of communities describe a fertile ground for CLTS to be most effective in stopping open defecation?

Rapid monitoring and evaluation of a community-led total sanitation program using smartphones

Rapid monitoring and evaluation of a community-led total sanitation program using smartphones. Environmental Science and Pollution Research, September 2018.

India accounts for around 50% of the world’s open defecation, and under a World Bank initiative, a rural district was selected to be the first open defecation-free (ODF) district in Punjab. Considering this, the current study aims to evaluate the application and impact of a smartphone-based instant messaging app (IMA) on the process of making Fatehgarh Sahib an ODF district. smartphone

The District Administration involved the Water Supply and Sanitation Department, Non-government Organizations, and volunteers to promote the process of a community-led total sanitation. Proper training was provided to the volunteers to spread awareness about the triggering events, health impacts of open defecation, and monetary benefits of building new individual household latrine (IHHL).

IMA was used as an aid to speed up monitoring and for the evaluation of a sanitation program. All the volunteers were connected to an IMA. This helped in providing a transparent and evidence-based field report on triggering events, follow-up activities, validation of existing IHHL, and monitoring of construction of new IHHL.

IMA is a cost-effective tool as it is already being used by the volunteers and requires no additional cost (on the user or on the project) but requires a training on ethical uses of mobile and data safety.

Engaging men and boys in sanitation and hygiene programmes

Engaging men and boys in sanitation and hygiene programmes. IDS, August 2018.

Discussions of gender in sanitation and hygiene often focus on the roles, positions or impacts on women and girls. Such a focus is critical to improving the gendered outcomes in Water, Sanitation and Hygiene (WASH), as women and girls bear the greatest burden of WASH work yet are often excluded from planning, delivery and monitoring community WASH activities as a result of having less power, resources, time and status than their male peers.

However, current efforts to improve sanitation and change social norms may not always actively engage men and boys in the most effective way. There is more to learn about how the roles men and boys actually play out in improving use of safe sanitation and improved hygiene practices and – if necessary – how the engagement strategies can be modified to make efforts more successful.

This issue of Frontiers of CLTS shares and builds on the learning from a desk study that explores examples of men’s and boys’ behaviours and gender roles in sanitation and hygiene. Of particular interest is the extent to which the engagement of men and boys in S&H processes is leading to sustainable and transformative change in households and communities and reducing gendered inequality.

The review focuses on men and boys: how to engage them (or not), how to mobilise them as allies in the transformation of S&H outcomes and the problems they contribute to and experience.

Innovations for Urban Sanitation: Adapting Community-led Approaches

Innovations for Urban Sanitation: Adapting Community-led Approaches. Practical Action, June 2018. innovations

Authors – Jamie Myers, Sue Cavill, Samuel Musyoki, Katherine Pasteur and Lucy Stevens

Over half the world’s population now lives in urban areas and a large proportion of them lives without improved sanitation. Efforts to tackle open defecation in rural areas has been led by the Community-led Total Sanitation (CLTS) movement. But how can the community mobilization techniques of CLTS be adapted to the more complex situations and transient populations in urban areas? How can landlords as well as tenants be motivated to provide and use safely managed sanitation?

Innovations for Urban Sanitation has been developed in response to calls from practitioners for practical guidance on how to mobilize communities and improve different parts of the sanitation chain in urban areas. Urban Community-Led Total Sanitation is potentially an important piece of a bigger puzzle. It offers a set of approaches, tools and tactics for practitioners to move towards safely managed sanitation services. The book provides examples of towns and cities in Africa, South Asia and South-East Asia which have used these approaches.

The approach has the potential to contribute not only to Sustainable Development Goal (SDG) 6 on water, sanitation and hygiene and SDG 11 on cities but also those concerning the reduction of inequalities and the promotion of inclusive societies. As a pro-poor development strategy, U-CLTS can mobilize the urban poor to take their own collective action and demand a response from others to provide safely managed sanitation, hygiene and water services which leave no one behind.

Gaining new insights into CLTS and rural WASH from field visits to Babati and Karatu districts, Tanzania – CLTS Knowledge Hub

Gaining new insights into CLTS and rural WASH from field visits to Babati and Karatu districts, Tanzania – CLTS Knowledge Hub, June 2018. clts

CLTS and WASH in the East and Southern Africa region
A five-day regional workshop was held by the CLTS Knowledge Hub in Arusha, Tanzania, in order to foster sharing of knowledge and learning, ideas and innovations, challenges and approaches to CLTS and rural WASH among 36 sanitation practitioners working for international NGOs, cooperation agencies, research centres and at different government levels across eight countries1 from east and southern Africa.

Based on SNV and GoT’s work in the districts, one of the main goals from the visits to Babati and Karatu was to understand and further discuss how CLTS and WASH programming are responding to the need to make the approaches more equitable and inclusive as well as more sustainable in order to deal with the lack of access, the slippages and the low rates of improvement of sanitation facilities which make rural communities strive to reach and maintain Open Defecation Free (ODF) status.

Experiences from the field
The trips started with an early morning visit to a health centre where women with their children were being triggered about hygiene promotion by a local health worker. When we sat down in Magugu Health Centre in Babati, a common scenrio was being acted out by a young mother – she changes her baby’s nappy in front of the group but when she is finished doesn’t go to wash her hands – which prompted the audience to discuss what the problem with this was and what could have been done better. The triggering session then focused on the other critical moments for handwashing throughout the day. During the process the participants learnt about of the main hygiene hazards and procedures, and the health worker emphasised the importance of sharing these messages with the rest of the community.

Read the complete article.