The Community-Led Total Sanitation (CLTS) approach facilitates communities to conduct their own appraisal and analysis of open defecation, mobilising people to identify and find solutions to their sanitation and hygiene needs. CLTS encourages people to improve their situation by utilising local knowledge, technology and innovation.

CLTS’s focus is on behaviour change and collective community action. The process uses participatory methodologies and activities, such as Community Mapping T.7 and Transect Walks T.52, to facilitate communities to analyse their sanitation practices and faecal-oral pathways. CLTS involves a series of steps from pre-triggering to triggering, post-triggering, follow-up, open defecation free (ODF) verification and monitoring. During ‘triggering’, communities come to realise that they are eating each other’s shit, motivating them to become ODF. The word shit is deliberately used to create an emotional response to generate community action. Triggering often takes between three and five hours and is supported by a team of facilitators. Although triggering is central to the approach, CLTS also requires substantial ‘pre-triggering’ (e.g. meeting with local leaders and gathering information) and follow-up activities. Post-triggering and post-ODF activities include technical support, follow-up visits, verification and certification of ODF status, celebrations and ongoing Monitoring M.2, Evaluation M.3 and Learning [M.6, M.7, M.8]. Although focused initially on open defecation, CLTS has since been integrated with complementary approaches such as market-based programming P.8, financing and other approaches in this Compendium, including handwashing and Menstrual Health and Hygiene P.7 programmes. For example, triggering tools adapted for handwashing with soap are often included as criteria in ODF certification.  

School-Led Total Sanitation (SLTS) is a CLTS adaptation to improve sanitation and hygiene in the school environment and the school’s catchment communities. The approach uses schools, as respected institutions in the community, as entry points. School communities are triggered, including learners, teachers, parents, school management committees, school administration staff and village heads. The process, approach and resources are similar to CLTS. Children may play an active role as agents of change throughout the process, but pre-triggering analysis should carefully assess when and how to involve them, adhering to the ‘do no harm’ principle. 

Tools and Methods used

Pre-triggering

• Observation T.28
• KAP Survey T.24
• Involvement of Local Champions T.22

Community Assessment and Triggering

• Transect Walks T.52
• Community Mapping T.7
• Transmission Routes and Barriers T.53
• Social Norms and Shame and Disgust T.45
• Involvement of Local Champions T.22
• Public Commitment T.37

Post-Triggering

• Social Support T.46
• Rewards and Incentives T.40 through ODF certification process
• Participatory Monitoring M.5
• Accessibility and Safety Audit T.1
• Exchange Visits T.12

Post-ODF

• Participatory Monitoring M.5
• Involvement of Local Champions T.22

Applicability

CLTS initially emerged and is most widely used in rural communities. Although examples are relatively few, CLTS has been adapted to post-emergency and fragile contexts and urban environments and refugee settlements (e.g. in Bidibidi, Uganda and Cox’s Bazar, Bangladesh). It is more often recommended for the recovery phase when community needs are less acute. Due to the collective nature of the approach, CLTS is not recommended for communities with underlying conflict and low social cohesion. Triggering disgust can also lead to feelings of shame that, if unaddressed, may lead to stigma and bullying of vulnerable individuals and groups T.45. It has been adapted for fragile areas, especially those with limited access, by using a decentralised approach where local leaders and community health workers facilitate the process with remote support and (or) follow up by phone. 

Main Requirements / Investments Needed

Time should be taken to understand the social context and physical environment before implementation, especially in post-emergency and fragile contexts. As no subsidies are offered, CLTS is often seen as very cost-effective. However, it is heavy on human resources and requires frequent visits to the community at each step. Facilitators for these community-level activities require training and ongoing support. Resources are also needed for monitoring, ODF verification and certification. 

Evidence of Effectiveness

There are a limited number of research studies on CLTS and their findings are mixed, often because the interventions and their contexts are different. Questions also remain about the sustainability of outcomes. Findings suggest CLTS is most effective in villages that are small, remote, cohesive and have strong local leadership, high levels of open defecation and social cohesion and - rare in prolonged crises - no prior history of subsidies. In post-emergency situations and fragile contexts, its effectiveness is increased when it is part of an integrated health services approach.

Do

• Ensure that the necessary pre-triggering, post-triggering and post-ODF follow-up is done

• Ensure facilitators have the required skills, attitudes and behaviour and follow ‘do no harm’ principles to avoid victimisation and stigma

• Encourage people to undertake tasks themselves and support each other to empower and build self-confidence

Don't

• Do not rely solely on triggering (triggering alone is unlikely to produce sustainable outcomes)

• Do not disrespect communities, be rude or tell people what to do

• Do not assume all communities are the same: tailor the response to the local context and needs of different groups

Practical Example

In Afghanistan, Tearfund implemented CLTS in returnee villages, focusing its efforts on facilitation, promotion, marketing and training of WASH Committees T.55 and leaving the construction, production and distribution of latrines to the local community, households and tradespeople. Follow-up was conducted through Radio T.38 and community-level promotion. Hygiene practices were further embedded through working closely with mullahs T.22 who incorporated hygiene messages into community teachings. 

In the Philippines, UNICEF introduced a Phased Approach to Total Sanitation following the Haiyan Typhoon. CLTS, Sanitation Marketing F.21 and Mass Communication C.5 were used to create demand with Zero Open Defecation (ZOD) declared once all households in a community used a hygienic toilet with soap and water nearby. Some implementers provided poor and vulnerable households with in-kind subsidies and vouchers to assist latrine construction. Once ZOD was achieved, communities were provided with financial rewards to further develop facilities.