New Video Offers Five Lessons for Sanitation Policy and Practice

Project Video • November 16, 2015

CLTS Triggering in Ghana
Photo/Video by Diana Mrazikova

Worldwide, an estimated 2.4 billion people live without access to an adequate sanitation facility, of which nearly 1 billion have no option other than open defecation. This poses a major public health risk for people and especially women and children. One potential solution is community-led total sanitation (CLTS), a behavior change approach promoted in up to 50 countries which aims to mobilize communities to take action and end the practice of open defecation.

A new video offers a sneak peek at 5 lessons for policy-makers and practitioners interested in scaling up CLTS. These lessons relate to CLTS planning at the national and local level, its place in national sanitation systems, and the importance of involving local actors.

The research is based on four years of collaboration between Plan International staff in Ethiopia, Ghana, and Kenya and researchers at the Water Institute at UNC. Our work in these countries has produced considerable, high quality evidence about approaches to implementing CLTS.

We found that local actors such as local government officials, schoolteachers, and natural leaders can play important and effective roles in improving basic sanitation access and related behaviors and that certain conditions can make or break the success of CLTS. Since these local actors tend to be invested in the community over the long-term, their involvement may improve sustainability.

The five main lessons from our work are:

  1. CLTS does have a major impact on latrine adoption and ODF achievement.
  2. CLTS is not a silver bullet which works everywhere but it does work well under known conditions.
  3. Local actors are vital for CLTS effectiveness and reaching scale but this varies by setting.
  4. CLTS costs are misrepresented and misunderstood.
  5. For CLTS to reach its potential, it should be viewed as one tool in a larger sanitation toolbox.

This new research is being prepared for publication in peer-reviewed journals in 2016. For continuing news about project findings, please stay tuned to this project website.


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.