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)