Community-Led Total Sanitation

I’ve somewhat avoided this topic, because it’s something that I feel incredibly frustrated about. But it keeps haunting me, whether it’s in The Last Taboo, The Big Necessity,  UNICEF’s website, or the Copenhagen Consensus.

As a brief introduction, I’ll let WaterAid and its snazzy video give you a summary:

This is a variation on Community-Led Total Sanitation (CLTS), an approach to tackling open defecation first brought up by Kamal Kar, an agriculturalist, in the early 200s in Bangladesh with the support of Plan International. As the above video indicates, the basic model is this:

(1)   “trigger” disgust in a community at open defecation by mapping out where shit is deposited in the community, calculating how much shit is produced, and/or illustrating how it spreads to food

(2)   The community reacts with disgust and is motivated to build latrines. The community pressures late adapters into abandoning open defecation via spontaneous pressures or more programmatically proscribed means.

(3)   The community can then declare themselves ODF free and post a sign.

Sounds good, yes? A lot of groups have thought so. It’s been adopted by UNICEF, WaterAid, Gates Foundation, Plan International, and many other organizations as their official approach.

What’s the number one catch?

We just don’t know.

And that’s the catch.

(Say what?)

There has never been an evaluation of CLTS. That’s right. We’re scaling up and vaunting a means of change that has, in fact, never been scientifically evaluated beyond a few months of the triggering event. There are no follow-ups, no long-term evaluations, no critical reflexivity. Papers on it that do appear in Google Scholar searches are predominantly written by or co-written by Kamal Kar and his colleagues.

But what’s wrong with it? What’s the worst that can happen?

Here are a list of things right off the top of my head:

• The latrines are ineffective at containing waste.
• As the “disgust trigger” fades, people are left with an increased resentment towards outside influences who basically came in and told them they’re disgusting. (Let’s perpetuate neocolonialism and resentment towards Westerners even more, shall we?)
• The social pressure to not defecate openly is applied differentially to people and groups who are already stigmatized. (One means that I have heard CLTS facilitators use is to give children whistles to blow at people they see openly defecating. Who are they more likely to blow a whistle at—the chief of their village or the Untouchable kid?)
• People who don’t have the means to construct latrines still can’t.
• Instead of shame causing people to improve their habits, it instead makes them angry, less cooperative, and resentful of the meddling of outside influences.

And think about it, put yourself in the place of these communities—how would you feel if someone came and told you that what you’ve been doing is disgusting?

Disgust has been used to motivate public health behavior in other contexts. It was used quite effectively in this effort at a hospital in LA , where they took swabs from doctors’ hands, cultured the bacteria, and subsequently posted the pictures of the incredibly disgusting dishes and posted them everywhere: every screen saver on every computer screen in the hospital featured these pictures with the reminder to wash your hands after using the bathroom.

 
What are the difference between CLTS and triggering disgust amongst doctors in a hospital? The doctors already know why they should wash their hands. As they’re doctors, they’ve already bought into the belief system—specifically, Western biomedical understandings of germ spread. The posters and pictures reminded them of values they ostensibly already have; they’re just being prodded to taking the actions to match.

CLTS, on the other hand, does not necessarily work in the framework. It is attempting to incite disgust that is not necessarily based on a belief or knowledge system that is already in place. Yes, most people agree that shit is disgusting, but what value system is being reinforced with CLTS?

I’m not necessarily saying that CLTS is a bad thing. I’m really not. What I am saying is that it needs to be researched more. A lot more.