An examination of CLTS's contributions toward universal sanitation

This desk review examines the refereed and gray literature on Community-led Total Sanitation (CLTS) to assess best practices and identify evidence gaps to inform the research agenda of USAID's Water, Sanitation and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project (2016-2021). The review describes  the CLTS intervention, tracing its evolution in theory and practice from Southeast Asia to its current place as a global phenomenon. It explores the open defecation free (ODF) concept (including varying definitions from country to country) and analyses its strengths and weaknesses. It also highlights the disconnect between the independent monitoring and analysis of CLTS programme results on the one hand and internal performance reports released by implementing organisations or their donors on the other. This review also seeks to assess (1) circumstances in which CLTS works best, (2) the most promising implementation modalities, and (3) instances where CLTS may not be suitable. CLTS should not be judged as a stand-alone intervention, but rather as a powerful option among an array of sanitation interventions whose limitations in selected circumstances must be recognized to best adapt it to diverse contexts and optimize its integration with other measures. Main findings include: (1) there is not enough reliable information on CLTS performance with respect to open defecation (OD) reduction and latrine adoption; (2) the behavior change brought about by the best of the CLTS deployments, even when short of the installation of hygienic latrines, may be sufficient to improve health; however, further research is needed; (3) CLTS works, but not necessarily for everyone, everywhere, or all the time; (4) CLTS can and should be integrated with other measures, and that integration can be done in a careful way that avoids disrupting the collective action process; (5) CLTS is less expensive than programs that provide full subsidy of hardware, but its costs are generally comparable with market-based approaches or targeted subsidies; and (6) We must be clear about the original goals of CLTS and be careful about critiquing it for failing to achieve goals for which it was not initially intended. Further research is needed to understand why CLTS does not always lead to sustained behaviour change and if this is related to a failure to create permanent facilities and improved levels of service. The report proposes that the sanitation sector's focus should be on sustaining behaviour change combined with driving movement up the sanitation ladder.