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17 Junio 2019

Community-Led Total Sanitation (CLTS)

Autor
Stefanie Keller (seecon international gmbh)
Resumen ejecutivo

Community-Led Total Sanitation (CLTS) is an approach which helps rural communities to understand and realise the negative effects of poor sanitation and empowers them to collectively find solutions to their inadequate sanitation situation. CLTS is focused on igniting a change in sanitation behaviour rather than constructing toilets. This is done by a process of social awakening that is stimulated by facilitators from within or outside the community. This approach concentrates on the entire community rather than on individual behaviours. The first significant step of CLTS is to end open defecation as an entry point while changing sanitation behaviour. It starts by enabling people to do their own sanitation profile through appraisal, observation and analysis of their practices of open defecation and the effects these have.

Ventajas
CLTS does not rely on sanitation subsidies or service delivery from external agencies.
The approach encourages people to change their hygiene behaviours without prescribing how they should do it.
Empowering the households and enabling them to get onto the sanitation ladder at the level that they can afford.
CLTS also empowers natural community leaders and facilitators who then move on to other communities to spread the effect or use the momentum of collective action and social cohesion to address other livelihoods issues in the community (adapted from PEAL at al. 2010).
Desventajas
CLTS relies on the quality of the facilitators.
The selection process, their training and their motivation level are critical factors for success.
Where previous interventions have offered subsidies or prescribed certain standards the community tends to have reservations and be sceptical about CLTS and wait for handouts (adapted from PEAL at al. 2010).
The sustainability of CLTS approaches is sometimes questionable, given that the technologies chosen are usually cheap.
Factsheet Block Title
What is Community-Led Total Sanitation (CLTS)?
Factsheet Block Body
Community members from a small village in Nepal receive an award for achieving the “open defecation free status” after a successful CLTS Campaign. Source: KROPAC (2009)
Community members from a small village in Nepal receive an award for achieving the “open defecation free status” after a successful CLTS Campaign. Source: KROPAC (2009)

 

(Adapted from KAR and CHAMBERS 2008; WSP 2007)

Community-Led Total Sanitation (CLTS) is an approach which is based on the principle of triggering collective behaviour change. In this approach, rural communities are facilitated to take collective action to adopt safe and hygienic sanitation behaviour and guarantee that all households have access to safe sanitation facilities. CLTS focuses on instigating a change in sanitation behaviour rather than constructing sanitation infrastructure. This change in sanitation behaviours is accomplished through a process of social awakening that is stimulated by facilitators from within or outside the community (see also awareness raising). The CLTS approach concentrates on the whole community rather than on individual behaviours. Collective benefit from stopping open defecation can encourage a more cooperative approach. People decide together how they will generate a clean and hygienic environment that benefits everyone. It is essential that CLTS involves no individual household hardware subsidy and does not prescribe latrine models.

The CLTS approach concentrates on ending open defecation as a first significant step and entry point to changing behaviour. It starts by enabling people to do their own sanitation profile through appraisal, observation and analysis of their practices of open defecation and the effects these have.

In its fullest sense, total sanitation includes a range of behaviours such as: stopping all open defecation; ensuring that everyone uses a hygienic toilet; washing hands with soap before preparing food and eating, after using the toilet, and after contact with babies’ faeces, or birds and animals; handling food and water in a hygienic manner; and safe disposal of animal and domestic waste to create a clean and safe environment.

Factsheet Block Title
The Beginning and Spread of CLTS Approach
Factsheet Block Body

(Adapted from WSP 2007)

In Bangladesh (Rajshahi district) a unique community mobilisation approach was piloted in the year 2001 by the Village Education Resource Centre in Bangladesh, a local NGO and partner of WaterAid Bangladesh. The main goal was to achieve total sanitation coverage. The approach aimed to make the community realise how important it is to totally ban open defecation within the village, without any external subsidy, and based entirely on community mobilisation. The communities used their own resources, created action committees, developed innovative low-cost technologies, monitored progress, and ensured that all households adopted fixed-point safe and hygienic defecation practices. External agencies were only facilitating the process. The Rajshahi initiative demonstrated a paradigm-shift in promoting improved sanitation practices through a community-based strategy. However, the approach to scaling up was modest and only a village-by-village upscale was attempted.

The Rajshahi project had raised interest in India, leading to visits by policy makers facilitated by the Water and Sanitation Program-South Asia. Based on the visits to Bangladesh and dissemination of lessons in workshops, Maharashtra formulated a strategy to end open defecation in the state. The Bangladesh visits and Maharashtra initiative also assisted in revising the national sanitation guidelines in India and contributed in introducing the concept of the need to create open defecation-free villages. Within South Asia, there are efforts in Pakistan and Nepal to take up the approach, while CLTS has been introduced as a national program in Indonesia and Cambodia.

Factsheet Block Title
How to the Implement CLTS Approach?
Factsheet Block Body

(Adapted from RCNN 2007)

In the beginning of the process, the community is approached to build rapport, clarify the objective of the programme and convince the community members why they should implement a no subsidy programme led on their own. Once the community understands the objectives, you have to make them realise and accept how open defecation creates problems and affects their lives. Then participatory rural appraisal (PRA) methods are adopted (see planning and process tools in general).

PRA methods are used to bring instant change in the understanding and behaviour of the people by igniting sparks of awareness in their minds. This process is adopted to motivate community members through their won involvement and initiative to build and use latrines as well as bring positive changes in their hygiene and sanitation behaviour. This method helps to change people’s perception allowing them to start thinking from a new dimension and perspective.

The following tools are used:

  • Shameful walk: A shameful walk, an adapted version of a classic “transect walk”, is called the process of collectively visiting the places of open defecation by members of the community and representatives of the facilitating organisations.
  • Faeces mapping: Faeces mapping is the process of preparing the community map indicating the places of defecation through community participation. 
  • Faeces calculation: Once people realise that there is a lot of faeces lying around in the area, you should raise the questions such as: How much on an average does an individual defecate in a day?
  • Faeces mobility mapping: In this exercise community members should realise how dangerous open defecation is by getting to know the five different faecal-oral contamination ways in order to avoid the transmission of diseases like diarrhoea and improve the health and hygiene situation. This is called the five-F-diagram. Faecal-oral contamination can happen through: 1. Food, 2. Fingers, 3. Flies (and all kind of insects), 4. Fields (agriculture field), 5. Fluids (e.g. water).
Faecal-oral transmission routes include: Fingers, flies (and other insects), fields (agriculture), food, and fluids, e.g. contaminated water. Source: HESPERIAN & UNDP (2004)
Faecal-oral transmission routes include: Fingers, flies (and other insects), fields (agriculture), food, and fluids, e.g. contaminated water. Source: HESPERIAN & UNDP (2004)

 

Community members decide and plan where to build new latrines in their area. Source: KAR & CHAMBERS (2008)
Community members decide and plan where to build new latrines in their area. Source: KAR & CHAMBERS (2008)

 

After having used these exploring methods and tools, the facilitator should ask the community who and by when the community will stop indirectly ingesting faeces or within how many days they will end open defecating practices. The names of the people will be listened down who commit that they will stop open defecation. Ask the person who commits to construct a toilet in the shortest span to step forward. Give a round applause to the individual and applause the rest one by one.

After the community members have expressed their commitment not to defecate in the open, it has to be decided by whom and how these commitments will be monitored. For this purpose it can be useful to form a committee (see also decision making section).

This committee should also decide the duration within which to declare the community an “open defecation free” area. Set the date for this and accordingly facilitate to develop an action plan.

Factsheet Block Title
The Principles of CLTS Approach
Factsheet Block Body

(Adapted from KAR and CHAMBERS 2008; WSP 2007)

  • Focusing on outcomes, not on hardware inputs.
  • Collective action: Mobilising the community rather than establishing household contacts.
  • Local choice: Providing a variety of technological options and getting people to access affordable technologies.
  • Setting up proper institutional frameworks institutional framework: Giving local governments a central role in scaling up and sustainability.
  • Incentives: Directing incentives to the community and rewarding outcomes, rather than subsidising household toilets.
  • Market development: Promoting the availability of sanitary materials and allowing private suppliers to respond to the demand (see privatisation).
  • Communities construct their own latrines or toilets with their own resources. Those people who are better off help those who are too weak or poor to help themselves.
  • No standardised top-down designs: People decide for themselves.
  • Facilitation, not teaching or preaching: Appraisal and analysis are facilitated. But after triggering information media campaigns and encouragement can be provided.
  • Spontaneous emergence of Natural Leaders (NLs) as a community proceeds towards Open Defecation Free (ODF) status.
  • Local innovations of low cost toilet models using locally available materials.
  • Community-innovated systems of reward, penalty, spread and scaling-up.

 

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Factsheet Block Title
Potential of CLTS Approach
Factsheet Block Body

(Adapted from CHAMBERS 2009)

CLTS entails with it the potential for further benefits beyond those of previous partial sanitation programmes:

  • Speed. The speed of going total, meaning that the community is claiming to be Open Defecation Free (ODF), can be remarkable. In best-case scenarios communities declare themselves or are declared ODF in a matter of weeks.
  • Totality. ODF conditions provide a public and not just a private good. CLTS has shown a spotlight on this aspect. A question is to what degree achieving total or degrees of total ODF status increases these benefits for the community. Claims of dramatic drops in diarrhoeas and other diseases following the achievement of ODF conditions are numerous. People in ODF communities do again and again report sharp drops in diarrhoea and medical expenses. Anecdotal evidence is so widespread, and seems such commonsense, that it is easy to believe.
  • Social solidarity leading to other actions. The community solidarity and sense of achievement from a successful CLTS process can be an entry point for other initiatives. The Social Development Unit of CARE Bangladesh has pioneered here, and there have been examples of communities coming together to build embankments to prevent flooding and crop loss, following CLTS triggering and action. They have also tackled the annual hunger season in other ways, with the aim of achieving hunger-free communities.
  • Local leadership, self-confidence and livelihood. Linked with social solidarity, the emergence and growing confidence of local leaders ― in a CLTS context usually described as Natural Leaders (NLs) ― is often reported. This provides opportunities for people with leadership potential and can also apply pressure on the existing leadership. The voluntary work and commitment of NLs can contribute to the sustainability of CLTS and other activities beyond the life of any external project.

 

Aplicabilidad

A CLTS approach has been applied not only in rural regions but also in urban areas. The first known case is Kalyani, a slum north of Kolkata, where exceptional political leadership galvanised people to achieve ODF conditions without subsidies (CHAMBERS 2009). In July 2008, a CLTS training of government staff based in the town of Kilifi on the Kenya coast provoked meetings and action to install and improve facilities and strive for total sanitation in the town. In other cases, for example in Panipat District in Haryana, large semi-urban areas have been declared ODF.

Referencias

Going to Scale with Community-Led Total Sanitation: Reflections on Experience, Issues and Ways Forward

This document gives a good overview of the background and the context of CLTS. Furthermore, it describes practices which are found to be very effective related to the approach as well as some obstacles which are often occurring.

CHAMBERS, R. (2009): Going to Scale with Community-Led Total Sanitation: Reflections on Experience, Issues and Ways Forward. (= Practice Paper , 1 ). URL [Visita: 18.06.2019]

Sanitation and Cleanliness for a Healthy Environment

This book contains well-written information about both personal and public cleanliness including instructions on how to build safe toilets that respect the principles of sustainable Sanitation. The book is also available in Spanish and Creole.

HESPERIAN FOUNDATION ; UNDP (2004): Sanitation and Cleanliness for a Healthy Environment. Berkeley: The Hesperian Foundation URL [Visita: 18.06.2019]

Hygiene and Sanitation Software. An Overview of Approaches

In sanitation and hygiene programme and service delivery, several methods are used to engage target groups in development programmes to enable behavioural change and/or create a demand for services. These methods or approaches are generally referred to as ‘software’, to distinguish them from the provision of ‚hardware‘. This publication takes an in-depth look at the various hygiene and sanitation software approaches that have been deployed over the last 40 years in all types of settings – urban, informal-urban and rural, and aims to address such issues as what a particular approach is designed to achieve, what it actually comprises, when and where it should be used, how it should be implemented and how much it costs, etc.

PEAL, A. EVANS, B. VAN DER WOORDEN, C. (2010): Hygiene and Sanitation Software. An Overview of Approaches. Geneva: Water Supply & Sanitation Collaborative Council (WSSCC) URL [Visita: 16.06.2019]
Lecturas complementarias

Going to Scale with Community-Led Total Sanitation: Reflections on Experience, Issues and Ways Forward

This document gives a good overview of the background and the context of CLTS. Furthermore, it describes practices which are found to be very effective related to the approach as well as some obstacles which are often occurring.

CHAMBERS, R. (2009): Going to Scale with Community-Led Total Sanitation: Reflections on Experience, Issues and Ways Forward. (= Practice Paper , 1 ). URL [Visita: 18.06.2019]

Hygiene and Sanitation Software. An Overview of Approaches

In sanitation and hygiene programme and service delivery, several methods are used to engage target groups in development programmes to enable behavioural change and/or create a demand for services. These methods or approaches are generally referred to as ‘software’, to distinguish them from the provision of ‚hardware‘. This publication takes an in-depth look at the various hygiene and sanitation software approaches that have been deployed over the last 40 years in all types of settings – urban, informal-urban and rural, and aims to address such issues as what a particular approach is designed to achieve, what it actually comprises, when and where it should be used, how it should be implemented and how much it costs, etc.

PEAL, A. EVANS, B. VAN DER WOORDEN, C. (2010): Hygiene and Sanitation Software. An Overview of Approaches. Geneva: Water Supply & Sanitation Collaborative Council (WSSCC) URL [Visita: 16.06.2019]

A Decade of the Total Sanitation Campaign (TSC), India: Rapid Assessment of Processes and Outcomes

This report analyses primary and secondary data on the TSC to arrive at an understanding of the processes, outputs, and outcomes at a national level and across the states, which are compared to program inputs. The analysis is useful in tracking the efficiency of the states in terms of time taken to achieve total sanitation and the financial expenditure put forward to achieve outcomes.

WSP (2011): A Decade of the Total Sanitation Campaign (TSC), India: Rapid Assessment of Processes and Outcomes. Washington, D.C.: Water and Sanitation Program (WSP) URL [Visita: 06.02.2012]

Revitalising Community-led Total Sanitation: A Process Guide

After observing how CLTS was changing lives in Bangladesh, WaterAid introduced the approach in Nigeria in 2005. Over time it became clear that the practice would need to be adapted to be effective in another country and continent with its own challenges. Drawing on the findings from evaluations and research on CLTS in the country, WaterAid in Nigeria has progressively revitalized the CLTS process. This document is a practical guide to implementing the revitalized CLTS approach and covers the main barriers and triggers to progress likely to be encountered along the way.

WATERAID (2011): Revitalising Community-led Total Sanitation: A Process Guide. London: WaterAid URL [Visita: 18.06.2019]

Community-Led Total Sanitation in East Asia and Pacific

The publication provides an up-to-date summary of CLTS status, lessons and experiences from the region, and highlights some of the key areas that require further attention and better quality uptake of CLTS at country level, and as such guide in accelerating efforts for reaching open defecation free (ODF) status and overall sanitation and hygiene improvements at scale.

UNICEF (2013): Community-Led Total Sanitation in East Asia and Pacific . Progress, Lessons and Directions . Bangkok: UNICEF East Asia and Pacific Regional Office, Plan, WaterAid and Water and Sanitation Program (WSP) URL [Visita: 18.06.2019]

Developing and Monitoring Protocol for the Elimination of Open Defecation

This paper reviews process and protocol for defining, reporting, declaring, certifying ODF (Open Defecation Free) and sustaining ODF, highlighting where the process varies between countries and potential determinants of sustainability within the process itself.

THOMAS, A. BEVAN, J. (2013): Developing and Monitoring Protocol for the Elimination of Open Defecation. (= ODF Protocol ). Nairobi: UNICEF URL [Visita: 18.06.2019]

Exploring Changes in Open Defecation Prevalence in Sub-Saharan Africa Based on National Level Indices

This study estimates the changes in open defecation prevalence between 2005 and 2010 across countries in Sub-Saharan Africa. It also explores the association between national level indices and changes in open defecation prevalence and assesses how many countries can achieve “open defecation free status” by 2015.

GALAN, D.I. ; KIM, S. ; GRAHAM, J.P. (2013): Exploring Changes in Open Defecation Prevalence in Sub-Saharan Africa Based on National Level Indices. Entradas: BMC Public Health: Volume 13 , 1-12. URL [Visita: 28.08.2013]

Sustainability and CLTS: Taking Stock

Sustainability is without doubt one of the most burning subject matters that subsumes many of the issues that we are seeing in CLTS and wider WASH practice. There have been several useful studies on sustainability that have highlighted some of the different aspects as well as the complexities involved. However, it is unclear how much of the learning from these studies has been built into current and future programming and practice. Based on existing research and our own understanding, this issue of Frontiers of CLTS is an attempt at an up to date synthesis of where we are at the beginning of 2015. In the issue, we identify some priority areas for learning: How to phase in sanitation marketing; Post-ODF engagement of government, NGOS, donors and others; How to ensure equity and inclusion; How to transform social norms; Monitoring, learning, changing

CAVILL, S. CHAMBERS, R. VERNON, N. (2015): Sustainability and CLTS: Taking Stock. (= Frontiers of CLTS: Innovations and Insights , 4 ). Brighton: Institute of Development Studies URL [Visita: 18.06.2019]
Estudios de caso

Children’s Involvement In Community-Led Total Sanitation (CLTS). A Case Study Of Oboyambo Community In Central Region Of Ghana

This document is about the involvement of children in the CTLS approach in the Oboyambo community in central region of Ghana.

SARPONG, D. (2010): Children’s Involvement In Community-Led Total Sanitation (CLTS). A Case Study Of Oboyambo Community In Central Region Of Ghana. URL [Visita: 17.04.2012]

Sustainability and equity aspects of total sanitation programmes. A study of recent WaterAid-supported programmes in three countries

This report is a synthesis of three individual country studies carried out in Bangladesh, Nepal and Nigeria in 2008-2009. The purpose of the study was to contribute to the global understanding of community-wide open defecation-free approaches, with a focus on the extent to which these approaches result in sustained and equitable improvements in sanitation behaviour.

WATERAID (2009): Sustainability and equity aspects of total sanitation programmes. A study of recent WaterAid-supported programmes in three countries. (= Global synthesis report ). London: WaterAid URL [Visita: 17.06.2019]

Revisiting the Midnapore Model after Ten Years of Total Sanitation Campaign (TSC) in India

This paper discusses the Midnapore model of sanitation, adopted by the Indian government as a role model of Total Sanitation Campain (TSC). In doing so, the paper examines the factors behind the success of the model, which during the process of replication were probably overlooked. The paper also tries to address some policy level problems in the implementation of TSC.

BANERJEE , T. MANDAL, K. (2011): Revisiting the Midnapore Model after Ten Years of Total Sanitation Campaign (TSC) in India. New Delhi: Jawaharlal Nehru University URL [Visita: 06.02.2012]

Sustainability of Total Sanitation Campaign at Kambalwadi Village in Maharashtra, India

The Total Sanitation Campaign has achieved considerable success in the State of Maharashtra in India. The village of Kambalwadi voluntarily participated in the campaign and succeeded in adapting the model and achieving sustained growth with people’s active participation. This paper provides the details of these achievements.

CHAVAN, B.L. ; RASAL, G.B. ; KALSHETTI, M.S. (2011): Sustainability of Total Sanitation Campaign at Kambalwadi Village in Maharashtra, India. Entradas: Journal of Education and Practice: Volume 2 , 42-44. URL [Visita: 06.02.2012]

Community-Driven Sanitation Improvement in Deprived Urban Neighbourhoods

There is an international consensus that urban sanitary conditions are in great need of improvement, but sharp disagreement over how this improvement should be pursued. Both market-driven and state-led efforts to improve sanitation in deprived communities tend to be severely compromised, as there is a lack of effective market demand (due to collective action problems) and severe barriers to the centralized provision of low-cost sanitation facilities. In principle, community-driven initiatives have a number of advantages. This report investigates these challenges and opportunities.

MCGRANAHAN, G. (2013): Community-Driven Sanitation Improvement in Deprived Urban Neighbourhoods. Research Report. London, Bangladesh: London School of Hygiene and Tropical Medicine (LSHTM), International Center for Diarrhoeal Disease Research (ICDDR), International Institute for Environment and Development (IIED), WaterAid, Sanitation and Hygiene Applied Research for Equity (SHARE) URL [Visita: 17.06.2019]

Get to Scale in Urban Sanitation!

Taking urban sanitation to scale requires ‘scaling out’ models that work for poorer communities, and at the same time ‘scaling up’ sustainable management processes. This short note reports scale-out and scale-up experience from Maputo and Antananarivo.

WSUP (2013): Get to Scale in Urban Sanitation!. (= Practice Note , 10 ). London: Water and Sanitation for the Urban Poor (WSUP) URL [Visita: 22.04.2019]

Self-Supply as a Complementary Water Services Delivery Model in Ethiopia

Self-supply, where households invest to develop their own easily-accessible water supplies, is identified as an alternative service delivery model that is potentially complementary to more highly subsidised community-level provision. The approach is widespread in Ethiopia with family wells bringing additional benefits that are in line with wider government objectives, such as supporting small-scale irrigation. However, two recent studies show the current performance of traditional or family wells to be far below potential with most sources providing unsafe water in the absence of adequate protection.

BUTTERWORTH, J. ; SUTTON, S. ; MEKONTA, L. (2013): Self-Supply as a Complementary Water Services Delivery Model in Ethiopia. Entradas: Water Alternatives: Volume 6 , 405-423. URL [Visita: 08.03.2019] PDF

Factors associated with achieving and sustaining open defecation free communities: Learning from East Java

The study goals were, first, to identify the factors that influence the achievement and sustainability of collective behavior change by communities to become ODF; and second, to understand what these findings might imply for improving program implementation effectiveness at scale.

MUKHERJEE, N WSP Factors associated with achieving and sustaining open defecation free communities: Learning from East Java. WSP URL [Visita: 01.12.2015]

Community-led Total Sanitation in Nepal

This learning brief shares key findings from a case study of communityled total sanitation (CLTS) implementation in Plan International Nepal program areas, focusing on the roles and responsibilities of local actors. Several implications are relevant for consideration by Plan International Nepal and other sanitation practitioners.

VENKATAMARANANAN, V. et al. (2015): Community-led Total Sanitation in Nepal. Findings from an Implementation Case Study. Chapel Hill, NC, USA: The Water Institute at UNC URL [Visita: 11.05.2016]
Material de capacitación

Training of Trainers’ Manual on Community-driven Total Sanitation. Module 1: Guidance Note

This manual is made for resource agencies engaged in training potential master trainers to facilitate and scale up community-driven total sanitation. This document facilitates the understanding of key concepts of community-driven total sanitation.

WSP (2007): Training of Trainers’ Manual on Community-driven Total Sanitation. Module 1: Guidance Note. Washington, DC: Water and Sanitation Program URL [Visita: 20.08.2010]

Training of Trainers’ Manual on Community-driven Total Sanitation. Module 2: Trainers’ Note

This manual is the second part of the manual described above. This manual provides curriculums and guidance to trainers on how to facilitate a five-day Training of Trainers’ Program on community-driven total sanitation.

WSP (2007): Training of Trainers’ Manual on Community-driven Total Sanitation. Module 2: Trainers’ Note. Washington, DC: Water and Sanitation Program URL [Visita: 17.06.2019]

Training in Community-Led Total Behavior Change in Hygiene and Sanitation: The Amhara Experience in Line with the Health Extension Program

This manual provides a comprehensive training to build capacity of health extension workers (HEWs) and development agents to support total behavior change in hygiene and sanitation. Complete with exercises, facilitators notes, and tools.

WSP ; USAID-HIP (2009): Training in Community-Led Total Behavior Change in Hygiene and Sanitation: The Amhara Experience in Line with the Health Extension Program. Facilitators Guide. Bahir Dar, Ethiopia: Amhara National Regional State Health Bureau, World Bank Water and Sanitation Programme (WSP), USAID Hygiene Improvement Project (USAID-HIP) URL [Visita: 24.06.2019]

Community Led Total Behavioural Change in Hygiene and Sanitation (CLTBCHS)

This document is grounded in the values and principles laid down by the Community Led Total Behavioural Change in Hygiene and Sanitation approach. It is an attempt to compile all possible formation on the subject into a single publication.

GOUDEL, C. (2011): Community Led Total Behavioural Change in Hygiene and Sanitation (CLTBCHS). Lead TBC facilitator’s training manual. Pokhara: Rural Water Supply and Sanitation Project in Western Nepal (RWSSP-WN)
Material de sensibilización

Factors Associated with Achieving and Sustaining Open Defecation Free Communities: Learning from East Java

This research brief discusses what it takes to bring about sustainable sanitation behavior change, cost-effectively, and at scale. Some of the findings: open defecation free (ODF) communities represent the most efficient model for scaling up sustainably; ODF outcomes that materialize late, after many months of triggering, should be subject to intensive verification and periodic recheck; and sanitation behavior change is difficult to ignite in riverbank and waterfront communities and special strategies are needed.

WSP (2011): Factors Associated with Achieving and Sustaining Open Defecation Free Communities: Learning from East Java. Washington, D.C.: Water and Sanitation Program (WSP) URL [Visita: 06.02.2012]

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