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Social Dynamics of CLTS: Inclusion of Children, Women and Vulnerable
Abstract
After experimenting different approaches Plan Bangladesh introduced CLTS in several villages of Dinajpur District in 2002. Present study was conducted to understand intensity and significance of participation of women and children in CLTS process and to identify the extent of inclusion of the extreme poor and marginalised in the process and their experience over time. Data collection took place during February and March 2008 in a village of Dinajpur District. Various participatory methods were employed for data collection. Additionally narratives of twelve case-studies were recorded and ten key informants were interviewed. The result revealed that children were enthusiastic in motivational activities, developing indicators for monitoring and preventing people from practicing open defecation. However, mostly the outspoken women were involved in awareness raising activities but the role of ordinary women was prominent at household level. Powerlessness and compulsion of earning livelihood obstructed the inclusion of the extreme poor in CLTS process. Due to various pressures they undertook measures to install latrine. The experience of the marginalised suggested the need to develop a prior strategy to include them in collective action. Their situation also manifested how the declaration of a government grants could hamper the spirit of a collective action like CLTS.
... Therefore, we used to follow it often in the sessions (Mahbub, p12). 9 In our own anthropological work, we have identified that people across culturally diverse sites make similarly consistent cognitive connections between disgust reactions and stigmatising the person associated with what disgusts. 10 This means such efforts as disgust-triggering should be expected to shift a reaction towards to a disgusting object (faeces) onto 'disgusting people'. ...
... Perhaps more crucially, leveraging concerns around people's desire to maintain social standing and avoid social judgments can potentially act to reinforce social-structural divisions. Mahbub (2008) describes the case of a single rural farming-fishing village in Bangladesh. In the wake of CLTS interventions, the poorest families had been forced by the wealthier families to install latrines they just couldn't afford, because the village elites were strongly motivated by the externally-oriented prestige of being an ODF village. ...
Community sanitation interventions increasingly leverage presumed innate human disgust emotions and desire for social acceptance to change hygiene norms. While often effective at reducing open defecation and encouraging handwashing, there are growing indications from ethnographic studies that this strategy might create collateral damage, such as reinforcing stigmatized identities in ways that can drive social or economic marginalization. To test fundamental ethnographic propositions regarding the connections between hygiene norm violations and stigmatized social identities, we conducted 267 interviews in four distinct global sites (in Guatemala, Fiji, New Zealand, USA) between May 2015 and March 2016. Based on 148 initial codes applied to 23,278 interview segments, text-based analyses show that stigmatizing labels and other indices of contempt readily and immediately attach to imagined hygiene violators in these diverse social settings. Moral concerns are much more salient at all sites than disease/contagion ones, and hygiene violators are extended little empathy. Contrary to statistical predictions, however, non-empathetic moral reactions to women hygiene violators are no harsher than those of male violators. This improved evidentiary base illuminates why disgust- and shame-based sanitation interventions can so easily create unintended social damage: hygiene norm violations and stigmatizing social devaluations are consistently cognitively connected.
... Nevertheless, communities encompass many levels of differentiation in terms of power and privilege. Full-community CLTS processes can risk by-passing some groups due to their lesser status unless facilitators are aware of community divisions and address these during triggering and follow-up (see Mahbub 2011). ...
Open defecation is the norm in rural and urban Africa – only about a third of the population uses improved sanitation facilities – and this contributes in various ways to a heavy disease burden. Community-led Total Sanitation (CLTS), an approach to sanitation which focuses on community-wide behaviour change to completely stop open defecation, began to go to scale in Africa in 2006. Since then, it has spread dramatically and in many countries very successfully, and is now used at some level in at least 26 African countries.
This paper draws on the extensive involvement of Kamal Kar with the spread of CLTS in Africa to describe the early stages of the process, to elaborate on its developments and to outline insights into the circumstances and features which have facilitated its rapid spread. Taking a broadly comparative approach which draws on the somewhat earlier experience of the spread of CLTS in Asia, it identifies aspects of the institutionalisation process and circumstances, including key individuals, that have contributed to the success of the approach in Africa. It also discusses challenges, however, noting several issues which may limit its impact and hinder its dissemination. In particular, the paper discusses some of the many adaptations made to CLTS in response to a wide range of pressures, varying country circumstances and strategy choices. These adaptations, it is claimed, should be made with a clear picture of what may be lost and gained by adopting them. As CLTS progresses further, it will be important to continue to grapple with these issues, to acknowledge the lessons from adaptations that have had little success, and to retain a vision of the potential of CLTS to bring fundamental transformations in sanitation, health and rural lives.
Gender equity is an important element of health promotion and is vital to ensuring that the benefits and burdens of participation in health promotion activities are fairly distributed. Yet, the gendered consequences of participatory interventions are often overlooked. This is particularly relevant for water and sanitation initiatives, given that women are generally responsible for maintaining domestic hygiene and procuring water. This study uses a qualitative approach to assess the gender dynamics of participation in community-led total sanitation (CLTS) activities in Mpwapwa District, Tanzania. We used semi-structured interviews and focus-group discussions to investigate men’s and women’s involvement in health promotion initiatives and their key motivators for and challenges to participation. We interviewed 77 community members from four villages and analysed the responses using qualitative content analysis. The study supports the notion that participation reinforces gender inequity and reproduces gendered norms due to activity-specific participation, women’s passive participation within activities, and their limited opportunities for decision-making. However, there were also indications that participation provided a platform to increase the status of women, prioritise women’s needs and demand a stronger position in decision making within the household and the community. CLTS organisers should, therefore, harness the opportunity to address gender inequalities within the community.
Community-Led Total Sanitation (CLTS) involves creating community health awareness, changing behaviours, generating a demand for sanitation, and finally the design and construction of sanitation solutions (e.g. latrines). The CLTS approach intentionally avoids any up-front external subsidies or technical support throughout the process. By excluding technical support, the CLTS philosophy argues that people innovate and develop a sense of ownership for the latrines that they build, which in turn leads to sustainable use of the latrines. This article questions this exclusion of technical support. Specifically, the article summarises the CLTS approach, identifies innovative designs that have been implemented by CLTS communities, discusses the technical weaknesses of some of these designs, and reports the responses from a survey of leading sanitation experts and practitioners regarding the potential need for technical support in CLTS. The study findings suggest that community innovations resulting from CLTS are not always satisfactory in terms of hygiene and quality of physical construction and may impede the pathway to sustainable improved sanitation. The article also suggests how and when technical support may be included in the CLTS process, without compromising the core principles of the approach.
This article examines what attention to subjectivity and emotion can bring to understandings of participatory resource governance. This focus highlights limitations of common participatory governance approaches, as well as possible ways forward. Attention to these dynamics makes it clear that for participatory governance interventions to be equitable and sustainable they must attend simultaneously to structural and institutional dynamics, as well as an individuals’ experience of participation. Moving forward, we offer some suggestions of new tools and approaches (e.g. emotion work, participatory performance, and spatial tools) that emerge from explicit consideration of emotional and subjective dimensions of participatory resource governance.
The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.
Good participatory approaches are premised on the argument that communities know their own situations and can work out their own sustainable solutions. Community-Led Total Sanitation (CLTS) uses participatory tools so that communities can actively and collectively realise and change the realities of their sanitation and hygiene situation. When 'triggering' this process in communities, flexibility and innovation is encouraged. Good practice requires CLTS facilitators to adapt to the particular cultural and religious context, and to innovate and share new tools amongst practitioners. CLTS was first introduced in Zimbabwe in November 2008 and this article explores how passionate facilitators and community members (natural leaders) have developed a number of new tools for triggering communities to end open defecation.
Community-Led Total Sanitation (CLTS) is a radically different way to help rural villages become and stay safe from the dangers of their own shit. CLTS requires field staff to become both provocative and participatory facilitators of complex individual and collective behaviour change processes. They are no longer simply disseminating leaflets and health messages prepared by experts in the capital city. For field staff to develop into skilful CLTS facilitators, they will require different training and ongoing support from their local managers than they have traditionally been provided with. The directive management style that has historically dominated must evolve into a more conducive coaching management style. But will front-line managers come to recognise this need to work differently with their field staff? Can they independently develop the attitudes and skills required to be more participatory and strategic managers? This article seeks to engage people who provide technical support to field-level CLTS managers, as a means of enhancing their capacity for management of their facilitators and programmes more broadly. The article shares the author's own trial and error experience providing technical support to 12 local government CLTS management teams in Malawi. If successful, the article might facilitate other technical support providers to be ignited with a desire to change their own style of support for the better.
In this article, the authors discuss how Community-Led Total Sanitation (CLTS) is helping to revolutionise sanitation coverage in rural Zambia. According to UNICEF/WHO, more than a third of rural Zambians defecate in the open. Past approaches to sanitation promotion were inadequate, even with subsidies. In 2007, the Government of Zambia and cooperating partners sought new strategies to meet the Millennium Development Goal for sanitation target of 66%. A zero subsidy CLTS approach was introduced in Choma district with great success. Sanitation coverage has increased to 67% and the government now plans to scale up the CLTS programme throughout Zambia. Lessons from Zambia include ensuring flexibility in terms of structures, timescales and funding and adapting CLTS to local conditions. Multi-sectoral buy-in, mass media participation and the role of local traditional leadership have also been key to success. The authors conclude that successfully scaling up CLTS requires rigorous monitoring, documentation and dissemination.
This article discusses findings from research designed to encourage practitioners and community members to explore the extent and effects of child and youth involvement in the community level changes crucial for the success of Community-Led Total Sanitation (CLTS). The main argument is that triggering equips children and youth with the desire and ability to contribute to these changes, but practical constraints, as well as cultural and social factors, shape the nature of each individual child?s ability to do so. There are indications that youth and child involvement in CLTS may, in some circumstances, contribute to shifting relationships between adults and young people, providing a pathway to child and youth empowerment. But findings indicate challenging power relations is never without risk of harm. The author concludes on a cautionary note, posing questions requiring further consideration by practitioners interested in the potential of CLTS to effect more meaningful youth and child participation in community development and governance.
In this article, the author draws on his experience with Engineers Without Borders Canada. From February 2008 to October 2009, he was seconded to WaterAid Burkina Faso when the NGO decided to adopt Community-Led Total Sanitation (CLTS). Here, he analyses the practical implications of adopting CLTS for facilitators, managers and organisations. It is particularly relevant to development managers who have heard of CLTS and would like to implement, support or finance the approach. The author argues that not every organisation is ready to adopt CLTS without reassessing its organisational culture, field-level practices, organisational processes and institutional context. The argument is developed by first discussing the reasons that can motivate - or discourage - development agencies to drop their previous approaches to sanitation and take up CLTS. The author then analyses the different implications of CLTS on how development agencies operate.
As Community-Led Total Sanitation (CLTS) continues to gain prominence in Africa many organisations increasingly want to go to scale. This has sharply increased the demand for training and supporting facilitators to ensure that quality is not lost in the process of scaling up. Going to scale is necessary if CLTS is to make a significant contribution to the lives of many millions in sub-Saharan Africa. The quality of training and support is essential for effectively scaling-up CLTS. This note provides some tips on what to look out for. The tips are simple and provide a brief 'menu' of dos and don'ts: what has been found to work and what does not. It is based on the author's personal experience as a CLTS trainer, facilitator and manager.
Responding to the need for improved access to sanitation may seem extremely daunting in Kenya. For many years Plan Kenya, like many development agencies, constructed latrines. Yet this subsidy-led approach failed. So Plan Kenya changed tactics and now uses Community-Led Total Sanitation (CLTS). CLTS seems key to transforming communities' attitudes and behaviour towards good hygiene and sanitation. From one open defecation free (ODF) village in Kilifi District in November 2007 there are now over 200. As of May 2010, nearly 400 villages have been triggered across the country. The approach has gained recognition by the Ministry of Public Health and Sanitation and others in the sanitation sector. There is increased demand from government, NGOs and UN agencies to scale up CLTS. This article shares insights for those thinking of introducing and/or scaling up CLTS. It first presents the Kenyan sanitation context and makes a case for CLTS, shares Plan Kenya's CLTS journey and experiences and highlights opportunities, challenges and lessons that institutions and individual practitioners should consider when implementing CLTS.
Here, the author discusses how Community-Led Total Sanitation (CLTS) is challenging perceptions and sanitation policy in Zimbabwe. Its zero subsidy approach has met with mixed reactions. Since the 1980s the government has adopted sanitation standards, with a heavily subsidised National Sanitation Programme. However, the government lacked the resources to support it and latrine designs are unaffordable for most rural communities without subsidies. In contrast, CLTS was piloted in Zimbabwe in 2008, during a time of devastating economic meltdown and widespread cholera. The dramatic decrease in development assistance and subsidies in Zimbabwe led many communities to seek their own sanitation solutions. CLTS provides the flexibility to do this, and at district and community levels it has been widely embraced. However, at national government levels the approach has been contested. Existing policies, institutional incapacity and uncoordinated approaches to sanitation interventions are major challenges. Yet CLTS has boosted the confidence of many communities to find their own solutions. The author concludes that it is not about prescribing sanitation structures - it is about changing mindsets.
Community-Led Total Sanitation (CLTS) is a radically new participatory approach to rural sanitation. In this overview article the guest editors explore how CLTS has shown promising results where previous rural sanitation programmes in Africa have failed. Although the approach has only been rolled out in Africa in the last three years, the pace with which it has been taken up and developed is astonishing. Over 2.6 billion of the world's population do not have proper toilet facilities. As a result, diarrhoea and disease kill around 1.8 million people every year, mainly children under the age of five. Yet CLTS has started to encourage people to break the silence around sanitation and bring shit out into the open. It does so by explicitly talking about and making visible the shit that is normally hidden beneath taboos and polite language. Past approaches to rural sanitation were mostly based on subsidised hardware. Unlike traditional sanitation approaches, CLTS works without subsidies for individual households. Instead, CLTS uses PRA tools to mobilise communities' collective action to become open defecation free - literally shit free. This does not happen through education, force or monetary incentives, but through the facilitation of a participatory process called 'triggering' that raises awareness and mobilises collective action for change. CLTS emphasises, as long as even a minority still defecates in the open, all members of the community are 'eating each others' shit' and are at risk of disease. CLTS is about people, their attitudes and behaviour, rather than hardware or structures. However, it is not only communities whose behaviour change is required - facilitators, institutions, governments and development practitioners, too, are challenged to think and act differently. Here, the authors look at some of the issues, challenges and lessons learnt. The article examines how CLTS has developed: how it differs from other sanitation approaches, its key elements and conditions for success, and emerging issues and questions in Africa and elsewhere. It looks at community-level processes in CLTS, from innovative forms of triggering, to the importance of language, building on an understanding of local taboos, and the potential of CLTS to empower children and youth. It identifies challenges when scaling up and considers some of the management and organisational changes needed for CLTS to be effective as well as the opportunities, challenges and lessons for taking CLTS to scale, based on experiences so far in Africa. The authors also discuss the importance of quality training and facilitation, identifying CLTS champions and natural leaders, engaging with government and ensuring multi-sector involvement. Issues around verification, certification and follow-up activities that ensure sustainability, and ongoing activities to mobilise further community development are also examined. The authors conclude that documentation and sharing of experiences amongst practitioners needs to be encouraged so that lessons will not be lost but will instead help to continuously improve CLTS practice and policy.
Ten years after Community-Led Total Sanitation (CLTS) was first introduced in Bangladesh, there is a strong, vibrant and continuously growing global network of people working together to end open defecation. Networking, sharing and learning activities such as those coordinated by the Institute of Development Studies (IDS) play a crucial role in supporting CLTS as it goes to scale. Ensuring that practitioners learn from each other and share lessons and challenges can help improve practice and influence policy. Here, the author describes how linking people through email, via the CLTS website and bringing them together in person can be effective tools for change.
This article explores the power of language in Community-Led Total Sanitation (CLTS). The author discusses facilitators' experiences in talking about shit with communities in Sierra Leone and shows the hidden cultural blocks which can hinder total sanitation in communities - but which can also be turned into advantages. The author explores the role of songs, humour, religion and children in stopping open defecation (OD). She also shows how the language, words, fables and adages community people themselves use continue to influence their sanitation and hygiene behaviour after attaining open defecation free (ODF) status. The article explores the challenges of maintaining a 'high level' of total sanitation in communities. Furthermore, it brings out the challenges associated with breaking the obstacles which trivialise discussions about shit and actions at government and institutional level.
Of 44 countries in sub-Saharan Africa only four are currently on track to meet the Millennium Development Goal (MDG) 7 target on sanitation. Diarrhoea is a major cause of death in sub-Saharan Africa and is clearly linked to inadequate sanitation, hygiene and water supply. There are an estimated 565 million people in sub-Saharan Africa without access to improved sanitation and, worse, 224 million who practice open defecation - the riskiest sanitation practice of all. Here, the authors describe how the United Nations Children's Fund (UNICEF) has been working with partners to implement Community-Led Total Sanitation (CLTS) in several countries in sub-Saharan Africa. Community-led approaches to sanitation have been demonstrated to rapidly improve sanitation coverage in Asia and have recently been introduced in Africa. This positive South-South transfer is showing great promise in terms of accelerating coverage. It has real potential, when scaled up, to make a strong impact on the appalling figures cited above. This article examines some of the many opportunities and challenges met during the introduction of CLTS in Africa to date, both by UNICEF and its partners - and considers key issues for scaling up and sustainability.
Community-Led Total Sanitation (CLTS) was introduced in Kilifi district, Kenya by Plan Kenya in 2007, working with the Kenyan Ministry of Public Health and Sanitation. Since that time, there has been a steep uptake in the construction and use of latrines by local communities. From only one in 2007, there are now over 200 open defecation free (ODF) villages. The number of latrines increased from 300 in 2007 to over 4,550 in 2009. The success of CLTS benefited from local sanitation practices, which hinge on cultural beliefs that affect all aspects of the villagers' day-to-day activities. These helped trigger the communities' desire to end open defecation and embrace CLTS. This article examines the link between those local sanitation practices and the success of CLTS in Kilifi.
Perhaps as many as 2 billion people living in rural areas are adversely affected by open defecation (OD). Those who suffer most from lack of toilets, privacy and hygiene are women, adolescent girls, children and infants. Sanitation and hygiene in rural areas have major potential for enhancing human wellbeing and contributing to the MDGs. Approaches through hardware subsidies to individual households have been ineffective. Community‐Led Total Sanitation (CLTS) is a revolutionary approach in which communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation‐free).
In six of the countries where CLTS has been spread – Bangladesh, India, Indonesia, Pakistan, Ethiopia and Kenya – approaches differ organisationally with contrasting combinations of NGOs, projects and governments.
Practical elements in strategies for going to scale have included: training and facilitating; starting in favourable conditions; conducting campaigns and encouraging competition; recruiting and committing teams and full‐time facilitators and trainers; organising workshops and cross‐visits; supporting and sponsoring Natural Leaders and community consultants; inspiring and empowering children, youth and schools; making use of the market and promoting access to hardware; verifying and certifying ODF status; and finding and supporting champions at all levels.
To spread CLTS well requires continuous learning, adaptation and innovation. It faces challenges. Paradigmatically, it requires major institutional, professional and personal shifts. Opposition at senior levels, pressures to disburse large budgets, demands to go to scale rapidly, and programmes to subsidise hardware for individual rural households, have been and remain threats and obstacles. Issues for review, reflection and research include: diversity, definition and principles; synergies with complementary approaches; scale, speed and quality; creative diversity; and physical, social and policy sustainability. In seeking constructive ways forward, four key themes or thrusts are: methodological development and action learning; creative innovation and critical awareness; learning and action alliances and networks, with fast learning across communities, districts and countries; and seeking to seed self‐spreading or light touch movements. A key to good spread is finding, supporting and multiplying champions, at all levels, and then their vision, commitment and courage.
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