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Is CLTS considered a sustainable way to provide sanitation?

Community led total sanitation seems to be very effective, however, it is very time consuming. Does anyone know if this is considered a sustainable way to provide sanitation? I.e. if CLTS was the only way to get people to change their sanitation habits, how many people would have to be employed (and how much money would be required) to sensitize everyone in the world. I think that CLTS will not work as the only solution. Hopefully it has some compounding effect and once sensitizing reaches some threshold, people will start to see for themselves that sanitation is essential.

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Concerns about CLTS were addressed in a paper by Christine Sijbesma:

Sanitation and hygiene in South Asia : progress and challenges : summary paper of the South Asian Sanitation & Hygiene Practitioners' Workshop organised by IRC, WaterAid and BRAC in Rajendrapur, Bangladesh, 29-31 January 2008.

In 2009 WaterAid published a review of CLTS programmes in Bangladesh, Nepal and Nigeria.

WSP’s Global Scaling Up Rural Sanitation Project is testing Community-Led Total Sanitation (CLTS) and Sanitation Marketing approaches in Tanzania, India, and Indonesia. The project web site includes numerous studies on the use of the these approaches in these countries.

In 2009 UNICEF published a field note “Community Approaches to Total Sanitation (CATS)” , reviewing experiences in Sierra Leone, Zambia, Nepal, and in India.

Originally posted on 21 January 2011

For more on CLTS see:

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An independent review of the sustainability of Plan CLTS programmes in Africa uncovered a slippage rate of 92%. The study report provides an analysis of factors that lead households to revert to open defecation (OD) and factors that motivate people to remain open defecation free (ODF) + six focus areas for improving CLTS approaches.

A link to the study plus a discussion on its findings can be found on the SuSanA forum.

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Cor - I'm sorry, but you have misrepresented the findings of this study in this comment. I was one of the peer reviewers for this study, so I know the findings well. The main finding was that "87% of the households surveyed still had a latrine and thus that if ODF status was equated with a household having a functioning latrine then the rate of reversion to OD (or slippage) was a remarkably low 13%." It is true that far fewer households met the wider definition of ODF (which meant that few communities could be re-verified as ODF), but the figure of 90% slippage refers to the number of households that managed to meet every one of the wider ODF criteria (including some, such as having a lid over a dry latrine, which are not required by the WHO definition of a hygienic sanitation facility). In fact, as I'm ...(more)

Andyroxhat gravatar imageAndyroxhat ( 2014-03-06 03:20:50 -0600 )edit

Sorry: I couldn't post the whole of my comment for some reason: here's the rest ... handwashing was a major problem, with only 37% found to have handwashing facilities; and many latrines lacked lids over the squat holes. So the intervention was weak in handwashing, and some OD persisted; but the main aim of the interventions, which was to reduce open defecation and promote the use of hygienic toilets, was highly successful, with lower slippage (13% average across the 4 countries and 116 villages surveyed) than anticipated! This is a far more impressive finding than in most other large-scale rural sanitation interventions, and achieved with a low cost per household/community covered. It's really a shame that you choose to highlight the most negative (and partial) finding of the study, and ignore the other useful and important findings! Best regards - Andy Robinson, Independent Water and Sanitation Specialist

Andyroxhat gravatar imageAndyroxhat ( 2014-03-06 03:23:02 -0600 )edit

Dear Andy, You cannot equate having infrastructure (often of poor quality) in place with a sustainable sanitation service that will provide health benefits. In 2010, Sandy Cairncross et al "found very little rigorous evidence for the health benefit of sanitation", .i.e excreta disposal alone, while handwashing did - If you don't wash your hands properly after defecation or cleaning babies, you will not stop disease transmission. The 87% figure is misleading because it did not consider safe disposal of latrine contents - unsafe disposal or "delayed open defecation" is a serious (environmental) health problem. Was evdidence of OD only checked in the direct vicinity of latrines? What about the rest of village environment?

C Dietvorst gravatar imageC Dietvorst ( 2014-03-08 02:58:28 -0600 )edit

Comment cont.: The so-called wider criteria are the actual criteria used at the beginning of the CLTS programmes to award ODF status. You infer that these may have been too strict, but they still do not include safe disposal and a check for OD in the wider village environment. It is true as you said that there is little evidence for the sustainability of other large large-scale rural sanitation either, but I am not convinced that the resuts for CLTS are any better. The report provides excellent recommendations to improve the sustainability of CLTS but if they implemented CLTS may no longer be a low-cost solution. Adding to this are growing concerns about human rights issues and coercive tactics applied in some CLTS programs, see and

C Dietvorst gravatar imageC Dietvorst ( 2014-03-08 03:19:56 -0600 )edit
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