About the Project

The Challenge: Improving Access to Toilets

Worldwide, about 2.5 billion people do not have safe toilets and as many as 1 billion people practice open defecation due to the absence of sanitation facilities. Compounded with lack of access to safe water and poor hygiene practices, these conditions contribute to the spread of disease, which kills about 1.5 million people per year. Despite the huge health benefits, enabling universal access to sanitation infrastructure will be a difficult and lengthy process. In the interim, innovative approaches for improving access to sanitation have emerged which could help fill the gap and improve people’s health and quality of life.

A Solution: Community-led Total Sanitation

Community-led total sanitation (CLTS) is an approach to sanitation promotion that has spread to countries across South Asia, Latin America and Africa over the past 15 years.  This approach seeks to eliminate open defecation and encourage the construction and use of sanitation facilities through “triggering” or grassroots mobilization of communities. When successful, triggering promotes a community-wide commitment to becoming open-defecation free (ODF).

The Research Issue: Working with Local Actors

Successfully mobilizing communities to become ODF appears to depend greatly on the skills of local facilitators. Research is needed to understand the essential aspects of the facilitation and mobilization process and how it could be scaled to national level and/or replicated in other countries.

Plan International USA’s Testing CLTS Approaches for Scalability project aims to advance rural sanitation efforts in Kenya, Ethiopia, Ghana, and worldwide by improving the cost-effectiveness and scalability of the CLTS approach, with a particular focus on the role of local actors, such as teachers, local government staff, and natural leaders.

In collaboration with The Water Institute at the University of North Carolina, this goal will be achieved by collecting, critically evaluating, and disseminating lessons about overcoming common challenges to implementing CLTS at scale, based on applied research from interventions in Kenya, Ghana, and Ethiopia. This website will share the project findings and allow visitors to download related publications.

Funding for the project is provided by the Bill & Melinda Gates Foundation.

In Kenya

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In Kenya, our study takes place in two counties, one located on Lake Victoria and the other located in the Indian Ocean coastal area. We selected four sub-counties and identified a number of government officials to receive our capacity-development program. The program consists of a 1-week training, followed by mentoring and support for their CLTS-related duties. Using qualitative research methods, we will evaluate changes in individual knowledge, attitudes and practices relating to the management and monitoring of CLTS. We expect to complete our activities in Kenya in May 2015.

In Ghana

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In Ghana, we are working in the Volta, Central and Upper West regions of the country. Plan Ghana and their partners implemented conventional CLTS in 20 communities from each region, for a total of 60 communities. We randomly assigned 30 of the communities to receive additional training. In these 30 communities, we identified natural leaders to receive training and mentoring in a variety of topics. Natural leaders are community members who demonstrate commitment to making their communities ‘Open Defecation Free’. We will evaluate how the training affected household- and community-level outcomes. Our activities in Ghana are expected to complete by October 2014.

In Ethiopia

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In Ethiopia, we are working in the Oromia and the Southern Nations, Nationalities and Peoples’ (SNNP) regions of the country. We selected six kebeles in these two regions. Four kebeles received CLTS led by teachers and two kebeles received CLTS led by health extensions workers (HEWs). We will evaluate and compare household, village, and kebele level outcomes in both the teacher and HEW groups. Our activities in Ethiopia will conclude in October 2014.


This website is managed by the Water Institute at UNC and aims to provide a source of information and updates about the project, and aid in the dissemination of research findings to all sectors interested in improving access to sanitation through the promotion of CLTS. Unless otherwise specified, the information or findings available on this website are a result of a sub-agreement to the University of North Carolina at Chapel Hill from Plan International USA, which was a recipient of a grant from the Bill & Melinda Gates Foundation.