How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana (original) (raw)
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Global Health: Science and Practice
Innovative construction approaches, local government commitment, and adequate resource allocation can help address geographic and environmental challenges, including soil type and heavy rains that cause low-quality toilets to collapse, that hinder sustainability of household sanitation coverage. n Community health worker programs, which represent local capacity for implementing demand generation and behavior change programming, enabled the sustainability of household sanitation coverage improvements through adapting programs based on cultural norms and dynamics. Community health workers were supported by tailored trainings led by SNV and local governments.
Community based solutions for sustainability of rural sanitation behavior change in Kenya
WEDC, Loughborough University, 2018
Kenya loses USD 324 million per year due to poor sanitation (World Bank, 2012), and 19,500 Kenyans, including 17,100 children under 5 die each year due to diarrhea. Communities' knowledge on desirable behaviors and their willingness to adopt these desired practices are greatly influenced by their surroundings. Certain aspects and conditions must be met for these communities to adopt desired behaviors and also to ensure that they do not relapse. This paper seeks to demonstrate how through simple community based solutions the Kenya Sanitation and Hygiene Improvement Programme (K-SHIP) has been able to identify hindering factors to collective behavior change and how to remedy these factors. KSHIP is funded by Water Supply & Sanitation Collaborative Council (WSSCC) through Global Sanitation Fund (GSF) and implemented by Amref Health Africa in Kenya. Description of context Rural sanitation continues to present a significant service delivery challenge related to poverty alleviation, disease burden reduction and sustainable development in Kenya. In the recent years, there have been innovations and approaches towards service delivery to reach the unserved in the rural areas with a policy shift to community based approaches and initiatives that attempt to overcome the supplyled complex solutions of the past decades. Following the Millennium Development Goals, the world has set a collective Sustainable Development Goal of universal access to basic sanitation services by 2030 which is more ambitious and more nuanced, aiming at universal access and with specific references to ending open defecation, moving up the sanitation service ladder, and improving equity and inclusion. Kenya has committed itself to progressively meet the Sustainable Development Goals. Even with the commitment, in Kenya basic sanitation services are not accessible to the majority of the population. The result is that the poor are deprived of decent and dignified lifestyles leading to deterioration of health, wellbeing and human environment. The Joint Monitoring Programme (2013), estimates that only 32 percent of the rural population had access to improved sanitation of which 72 percent predominantly consisted of simple pit latrines providing varied degrees of safety, hygiene and privacy. Overall, the national open defecation rate is about 14 percent, which masks massive regional disparities.
American Journal of Tropical Medicine and Hygiene, 2016
Inadequate hygiene and sanitation remain leading global contributors to morbidity and mortality in children and adults. One strategy for improving sanitation access is community-led total sanitation (CLTS), in which participants are guided into self-realization of the importance of sanitation through activities called "triggering." This qualitative study explored community members' and stakeholders' sanitation, knowledge, perceptions, and behaviors during early CLTS implementation in Zambia. We conducted 67 in-depth interviews and 24 focus group discussions in six districts in Zambia 12-18 months after CLTS implementation. Triggering activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and handwashing stations. New sanitation behaviors were also encouraged by the hierarchical influences of traditional leaders and sanitation action groups and by children's opinions. Poor soil conditions were identified as barriers to latrine construction. Taboos, including prohibition of different generations of family members, in-laws, and opposite genders from using the same toilet, were barriers for using sanitation facilities. CLTS, through community empowerment and ownership, produced powerful responses that encouraged construction and use of latrines and handwashing practices. These qualitative data suggest that CLTS is effective for improving sanitation beliefs and behaviors in Zambia.
Community-led total sanitation in rural areas: an approach that works
Water and Sanitation Program (WSP)South Asia, …, 2007
The Water and Sanitation Program is an international partnership for improving water and sanitation sector policies, practices, and capacities to serve poor people Sanitation programs have, for some time now, incorporated the need to raise awareness and emphasize the benefits of toilet usage. This has been most effectively undertaken by empowered communities motivated to take collective action, with the local governments and other agencies performing a facilitating role.
Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)
World Development, 2019
Worldwide, 892 million people practice open defecation, most of whom live in rural areas of South Asia and Sub-Saharan Africa. Community-Led Total Sanitation (CLTS) is the most widely deployed approach to generate demand for, and use of sanitation facilities. CLTS relies on behavioral change and community self-enforcement to end open defecation. Since its genesis in Bangladesh in 1999, CLTS has spread to approximately 60 countries, mostly in Asia and Africa, and is employed by the majority of development organizations operating in rural sanitation. This paper uses a qualitative approach to analyze the reasons and processes that drove the wide diffusion of CLTS. We show that CLTS was embraced because it was perceived as a fast and effective solution to the problem of open defecation, one which was in line with the decentralization and community participation paradigms, at a time when donors and governments were looking for strategies to meet the MDG for sanitation. CLTS spread under the leadership of influential donors, NGOs, persuasive practitioners, and academics. Face-to-face interactions among members of this network and local governments at conferences and workshops played a central role in the diffusion of the approach. The use of experiential learning during study tours and workshop field visits has been crucial to persuade government actors at different levels, NGOs, and donors to use the CLTS approach. Notably, robust scientific evidence played little role in the diffusion of CLTS. We conclude by making suggestions to strengthen the evidence base for rural sanitation policies.
International journal of environmental research and public health, 2017
Community Approaches to Total Sanitation (CATS) programmes, like the Sanitasi Total Berbasis Masyarakat (STBM) programme of the Government of Indonesia, have played a significant role in reducing open defecation though still little is known about the sustainability of the outcomes. We assessed the sustainability of verified Open Defecation Free (ODF) villages and explored the association between slippage occurrence and the strength of social norms through a government conducted cross-sectional data collection in rural Indonesia. The study surveyed 587 households and held focus group discussions (FGDs) in six ODF villages two years after the government's ODF verification. Overall, the slippage rate (i.e., a combination of sub-optimal use of a latrine and open defecation at respondent level) was estimated to be 14.5% (95% CI 11.6-17.3). Results of multivariate logistic regression analyses indicated that (1) weaker social norms, as measured by respondents' perceptions around la...
Improving Uptake and Sustainability of Sanitation Interventions in Timor-Leste: A Case Study
International Journal of Environmental Research and Public Health
Open defecation (OD) is still a significant public health challenge worldwide. In Timor-Leste, where an estimated 20% of the population practiced OD in 2017, increasing access and use of improved sanitation facilities is a government priority. Community-led total sanitation (CLTS) has become a popular strategy to end OD since its inception in 2000, but evidence on the uptake of CLTS and related interventions and the long-term sustainability of OD-free (ODF) communities is limited. This study utilized a mixed-methods approach, encompassing quantitative monitoring and evaluation data from water, sanitation, and hygiene (WASH) agencies, and semi-structured interviews with staff working for these organizations and the government Department of Environmental Health, to examine sanitation interventions in Timor-Leste. Recommendations from WASH practitioners on how sanitation strategies can be optimized to ensure ODF sustainability are presented. Whilst uptake of interventions is generally ...
Journal of Water, Sanitation and Hygiene for Development
Finite storage capacities of household pit latrines make safely managing fecal sludge a recurring challenge for 2.7 billion people globally. Frequently without guidance from standards or regulation, rural latrine owners choose how to manage their own fecal sludge. However, their intentions – what behavioral science says are the best predictors of future behaviors – when pits fill are poorly understood, inhibiting the development of safe fecal sludge management (FSM) solutions and deteriorating public and environmental health. Using survey data commonly measured by development practitioners, we analyze response frequencies and their associations with contextual factors, such as location, month that the survey was administered, and poverty level. We also use binomial logistic regression to determine if contextual factors can be used to predict the intentions of rural Cambodian latrine owners when pits fill. We found that four in ten rural latrine owners intend to manage their fecal sl...
Texila International Journal of Public Health, 2024
Community-led total sanitation (CLTS) is a widely used method to tackle health issues related to open defecation within the community. Research indicates successful CLTS in arid and semi-arid areas, but lacks understanding of its implementation, engagement of Community-Based Health Workers, and their expertise. The study aimed to assess the influence of Community-Based Health Workers on the implementation of a Community-Led Total Sanitation approach in Turkana County, Kenya.The survey utilized a community-based cross-sectional design, with 200 community-based health workers and 430 households recruited using multi-stage sampling as participants, and 21 key informants selected purposively. Excel and STATA version 17 were utilized for data management, analysis, and presentation of quantitative results, while NVivo was utilized for qualitative analysis. Quantitative data was analyzed using descriptive and inferential statistics, while qualitative data was analyzed using thematic methods. The study revealed a positive trend in sanitation infrastructure, with 69.93% of households owning latrines. Facing challenges using latrines demonstrated a highly significant association with both latrine ownership (p < 0.001) and open defecation (p < 0.001), indicating that household members encountering difficulties with latrine usage are less likely to own one and more likely to practice open defecation. CBHWs playing a role (p < 0.001) are all significantly associated with both latrine ownership and reduced open defecation, underlining the influential role of CBHWs in promoting improved sanitation practices and infrastructure within households in Turkana County, Kenya. The study revealed that Community-Based Health Workers significantly enhance households' sanitation infrastructure and support decreases in open defecation practices.
Desalination, 2009
Despite all efforts and significant investment in the sanitation sector; sub-Saharan Africa is far behind its Millennium Development Goal (MDG) target. Community led total sanitation (CLTS) is a concept that revisits all the past approaches, particularly the promotion of household sanitation within the context of basic human dignity. CLTS emphasises community facilitation to assess their sanitation situation and promotes natural