Going to Scale?
The Potential of Community-
Led Total Sanitation
Lyla Mehta
Institute of Development Studies
Shit happens and shit matters!
• Around 4,000 people, mainly children under five, die every day due to poor sanitation, hygiene and water.
• WHO estimate: health sector could save over US $11 billion in treatment costs; people could gain 5.5 billion productive days due to reduced diarrhoeal disease
• Sanitation as neglected issue in development –main focus usually on water
• Past interventions have tended to be technical, top-down paying scant attention to people’s actual needs and wants
Shit happens and shit matters!
• Sanitation and the MDGs: Target 7 (watsan); MDG 4 (reduce child mortality); MDG 5 (maternal health); and MDG 6 (combat major illnesses – diarrhoea/ malaria etc.);
• More recently receiving increasing attention - in 2007, the British Medical Journal voted for sanitation as the greatest medical advance in the last 166 years
What is CLTS• Pioneered by Kamal Kar, a development consultant working with the Village Education Resource Centre (VERC) , CLTS began as an experiment in Bangladesh in 1999.
•Powerful participatory approach that analyses and unpacks the sanitation profile in a community and the spread of faecal-oral contamination
•Strong emotions (disgust/ shame); humour and self analysis that everyone is ingesting each other’s ‘shit’
•Collective decision to stop open defecations, build and use toilets without upfront hardware subsidies
Transect walks Walking through the
bush to find the
stuff! Rural
community near
Awassa, Ethiopia
leading a OD
transect team.
Slums in the outskirts of
Ulaanbaatar in Mongolia –
locations where sources of water
get contaminated with human
excreta are important points to
stop during a defecation area
transect and discuss with the
community.
Mapping
‘Who shits where?’
Community members
in Tororo, Uganda, map
places used for open
defecation. Photo:
Philip Otieno, Plan
Kenya.
In a well facilitated CLTS
triggering, villagers in Tanzania
calculating household shit, the
ignition point is often reached
while they are doing this
Where is CLTS now
ASIA
• Bangladesh (WaterAid, VERC, Dhaka Asahnia Mission, PLAN, CARE, NGO Forum)
• India (Government-driven)
• Indonesia (government-driven)
•Cambodia
• Nepal
• Pakistan
• (introduced in China, Mongolia, Sri Lanka)
AFRICA
• Plan Regional East and Southern Africa is rolling out CLTS in Egypt, Kenya, Uganda, Sudan, Zambia, Zimbabwe; Ethiopia and Tanzania;
•WaterAid in Ethiopia/ Nigeria
•Sierra Leone
LATIN AMERICA
• Bolivia (UNICEF, Plan and WSP)
• Brazil, Chile and Peru participated in workshop
MIDDLE EAST
•Yemen
Challenges around scaling up
• Socio-technological dynamics
• Quality v/s maximising impact
• Impacts on poorest and women?
• How sustainable?
• Scaling up
• Citizenship and rights
Group characteristics
Demographics
Power relations
Gender relations
Cultural practices
Religious norms
Perceptions of shit
Sentiments/needs/desires
Health problems
Mindset
Creativity
Materials
Supply networks
Maintenance
Infrastructure
Cost
Traditions for masonry
Availability
Marketing
Architechture
Social Technological
Ecological
Climate conditions
Landscape changes
Settlement patterns
Wet/arid
Floods/droughts
Soil types
Water/groundwater table
Vegetation cover
Presence of pathogens
Actors, institutions and
processes • Kamal Kar, Pioneer; WSP; UNICEF:
DFID; WaterAid; Plan
• Learning and exchanges – 2002 BD workshop; exchange visits for officials
• Regional processes (Sacosan; Africasan)
• Research, Action learning and networking
Diverse pathways of spread
and going to scale • Diverse experiences – BD, India, Indo
• Role of trainers and facilitators
• Role of champions
• Different institutional homes (MoH v/s RD)
• Different experiences with subsidies
Challenges of scaling up
diversity v/s uniformity
Institutional challenges and
scaling up
Inclusion/ exclusion
Sustainability issues
Gender, empowerment, rights
Technology matters
Conclusions
• CLTS challenges conventional mindsets
regarding financing/ help/ subsidies and
the role of communities
• People as agents of change, rather than
institutions, things or bureaucracies
• Scaling up through process and people
• Challenges of sustainability and inclusion
• the right to sanitation
• Lessons from history
(www.communityledtotalsanitation.org)