Capacity Building for CLTS: Lessons in Engaging Local Actors

Water and Health Side Event Summary • October 27, 2015 • Chapel Hill, NC, USA

“One of the key goals of this grant was to invest in understanding what other organizations have done before us, and how we could build on that work to ensure that we reach the outcomes we want to see. With that goal in mind, our [first] question going in was: what works in delivering rural sanitation services at scale?”

Jan Willem Rosenboom, Bill and Melinda Gates Foundation

At the UNC Water and Health Conference, Plan International USA and The Water Institute at UNC convened a half-day event to share findings and implications of operational research on community-led total sanitation (CLTS) across ten countries. This research is part of Plan International USA’s Testing CLTS Approaches for Scalability project, funded by the Bill & Melinda Gates Foundation, which aims to advance rural sanitation efforts by improving the cost-effectiveness and scalability of CLTS. In particular, this research was focused on the role of local actors in CLTS, such as teachers, local government staff, and natural leaders. The session was presented to a packed audience representing governments, non-governmental organizations, academic institutions, businesses, and development organizations, who were keenly interested in how these lessons can be translated into their water, sanitation, and hygiene work. Most importantly, this research has helped identify settings where CLTS is most effective.

In regards to setting, we know that local conditions influence the cost, scale, and sustainability of CLTS. Pilot evaluations in Ghana, Ethiopia, and Kenya incorporated new data collection and analysis tools to understand the cost of CLTS, challenging a misconception that CLTS is a low-cost approach. This project also reveals the impact that training local actors can have on achieving CLTS outcomes. In Kenya, Plan trained local government officials to improve CLTS management. The training improved both the way that staff worked in partnership (across ministries), and their supervision of field staff. In Ghana, training natural leaders demonstrated the potential they have to improve CLTS outcomes, but it also added a large cost that varied strikingly across different regions. In contrast to the project in Ghana, in Ethiopia project staff focused their attention on training local facilitators, which required more time than was used to actually facilitate CLTS in communities.

CLTS Side Event Session at UNC’s Water and Health Conference, 2015
Photo by Tom Fuldner

Complementary to the three pilot evaluations, the team also conducted rapid evaluations in seven countries across Africa, Asia, and the Caribbean and found that CLTS does not offer predictable results. Across the seven countries, 36% of communities had been declared open defecation free after Plan’s interventions. However, it is important to note that latrine coverage tended to vary considerably across countries, further highlighting that the effectiveness of the approach is unique to the setting in which it is implemented. The approach may need to be adapted for certain communities, in which case it is also important that policy makers consider targeting appropriate communities. The approach has, however, been most successful in the very communities most neglected by public health interventions – specifically those which are smaller, more remote, have stable popualations, and which do not have a history of receiving financial assistance from government or NGO programs.

Researchers also found that monitoring and reporting the effectiveness of CLTS has been compromised by a focus on open defecation free (ODF) achievement, an indicator that is difficult to standardize and more difficult to measure. Additional findings point to the fact that the complexity of CLTS arrangements in various countries is largely dependent on government support (e.g. through national policies and mandates), capacity of local actors to participate in the implementation process, and the length of time that CLTS has been implemented to date.

The partnership between UNC (a research institution) and Plan USA (an international NGO with a global practice footprint) has proven valuable and is generating recommendations for improving sanitation policy and practice. Findings from the Testing CLTS Approaches for Scalability project from several countries are already available and will be shared through public and private events and online communications in coming months. For further details, visit the project website at: https://waterinstitute.unc.edu/clts/.

Key Highlights

CLTS, as an approach, can have a positive impact on sanitation outcomes.

CLTS works best under very specific conditions; thus, policy makers and practitioners need to consider targeting appropriate communities.

Budgeting for CLTS should account for the full cost of the approach, including facilitator training and follow-up by local actors and community members.

Standardized monitoring approaches that extend beyond ODF achievement can enable comparisons between triggered communities.

Local actors are important catalysts for sanitation behavior change, and careful engagement with them can enhance CLTS outcomes.


The Testing CLTS Approaches for Scalability project involves The Water Institute at UNC working with Plan International USA to evaluate whether capacity strengthening of local actors influences CLTS outcomes. Our activities span 10 countries in Africa, Asia, and the Caribbean. More information, project resources, and news are available at the project website.