Community-led total sanitation

Community-led total sanitation (CLTS) is an approach used mainly in developing countries to improve sanitation and hygiene practices in a community. The approach tries to achieve behavior change in mainly rural people by a process of "triggering", leading to spontaneous and long-term abandonment of open defecation practices. It focuses on spontaneous and long-lasting behavior change of an entire community. The term "triggering" is central to the CLTS process: It refers to ways of igniting community interest in ending open defecation, usually by building simple toilets, such as pit latrines. CLTS involves actions leading to increased self-respect and pride in one's community. It also involves shame and disgust about one's own open defecation behaviors. CLTS takes an approach to rural sanitation that works without hardware subsidies and that facilitates communities to recognize the problem of open defecation and take collective action to clean up and become "open defecation free". The concept was developed around the year 2000 by Kamal Kar for rural areas in Bangladesh. CLTS became an established approach around 2011. Non-governmental organizations were often in the lead when CLTS was first introduced in a country. Local governments may reward communities by certifying them with "open defecation free" (ODF) status. The original concept of CLTS purposefully did not include subsidies for toilets as they might hinder the process. CLTS is practiced in at least 53 countries. CLTS has been adapted to the urban context. It has also been applied to post-emergency and fragile states settings. Challenges associated with CLTS include the risk of human rights infringements within communities, low standards for toilets, and concerns about usage rates in the long-term. CLTS is in principle compatible with a human rights based approach to sanitation but there are bad practice examples in the name of CLTS. More rigorous coaching of CLTS practitioners, government public health staff and local leaders on issues such as stigma, awareness of social norms and pre-existing inequalities are important.