An estimated 2.5 billion people worldwide do not have access to safe, hygienic toilets and as many as 1 billion people practice open defecation. This practice leads not only to sanitary issues within the immediate environment, but has repercussions on the health, safety, education, and economy for individuals and communities. For 15 years, community-led total sanitation (CLTS) has been a rapidly spreading, widely-accepted, gold standard sanitation intervention applied in the developing world to eliminate open defecation. CLTS uses community-wide behavior change approaches to “trigger” community members to take on ownership of the elimination of open defecation. Plan has been a pioneer of the approach worldwide.
As a recognized leader in CLTS, Plan was invited by the Bill & Melinda Gates Foundation to implement a rigorous evaluation of the approach in 10 countries, in partnership with the University of North Carolina’s Water Institute. The resulting four-year Testing CLTS Approaches for Scalability project analyzed the cost-effectiveness and scalability of the CLTS approach, while implementing three different interventions in Kenya, Ethiopia, and Ghana that focused on the role of local actors, such as teachers, local government staff, and natural leaders.
On October 15, Plan held a half-day event at the National Press Club in Washington, D.C. to present the findings and their implications for the Water, Health, and Sanitation (WASH) community of practitioners and policy makers. The dialogue, entitled “Local Solutions in WASH: New Evidence and Policy Implications,” featured two panels of well-respected experts.
The first panel, moderated by Ann Hudock, Vice President of International Programs at Plan, included Martin P. Gambrill, Lead Water and Sanitation Specialist, The World Bank; Jamie Bartram, Director of The Water Institute, University of North Carolina; Liz Warfield, Local Solutions Coordinator, USAID; and Kumar Ranganathan, Global Practice Leader for Water & Sanitation, Millennium Challenge Corporation. This panel focused on the implications of the research findings on policy and program design.
The panelists reacted to edited highlights of the main research findings by drawing conclusions relevant for policy makers within donor organizations, governments, or other development actors. Foremost amongst these points was recognition that the role of local government – and thus the capacity of staff – was fundamental to the long-term success of sanitation approaches, including CLTS. Management training, and a focus on the institutional conditions under which capacity strengthening could flourish, were critical. Secondly, the panel reached consensus that no single approach to sanitation should define a national strategy; rather each country needed a set of tools within a broader toolbox that would allow practitioners to be responsive to the specific context in which sanitation behavior change occurred. Lastly, the panel turned to the issue of targeting, equity, and inclusion – agreeing that in order to reach the 2030 Sustainable Development Goals, implementing partners need to be careful in targeting approaches like CLTS to the conditions and contexts in which they could optimally influence sanitation coverage and Open Defecation Free (ODF) status.
To complement the policy-level discussion, the second panel, moderated by Darren Saywell, Senior Director for Water, Sanitation, and Health at Plan International USA, focused on a more detailed technical review of findings. This panel featured Jonny Crocker, The Water Institute, University of North Carolina (the primary researcher on the project); Eddy Perez, Center for Global Safe Water, Sanitation, and Hygiene, Emory University; and Jay Graham, School of Public Health, George Washington University. Jonny Crocker’s presentation focused attention on the impact that CLTS had on ODF, leading to 20 percent and 13 percent reductions in open defecation rates in Ghana and Ethiopia, respectively. The dialogue in this panel focused more on details and implications of the research for practice, including issues such as what other approaches should be used when CLTS fell outside its “performance envelope,” the impact on community members from time leveraged for facilitating CLTS, or the relative enabling or constraining factors that worked on local actors as agents of change in sanitation coverage. Throughout, a particular recurring theme was interest in how a partnership between a research institute and an implementing partner had been able to work effectively, maintaining both relevance and rigor throughout the life of the project.
The event was the first in a series of continuing discussions on the research findings and results over the next six months. Reactions will be sought from the wider community of practice both internationally and in the three pilot countries of Ghana, Ethiopia, and Kenya. Follow the conversation on social media using #triggeringchange and via Plan’s website or dedicated project page.