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745:, Bangladesh, and decided that a system of attitudinal changes by villagers might have a longer-lasting effect than the existing top-down approach involving subsidies from NGOs and government. The Bangladeshi government began a programme of installing expensive latrines in the 1970s, but the government decided this was too costly, and many of the original latrines were abandoned. In the 1990s, a social mobilisation plan was begun to encourage people to demand and install better sanitation systems, but early success did not last, according to Kar. At that point Kar, a participatory development expert from India, was brought in by
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poorly constructed latrines are likely to contaminate the water table and thus represent little improvement. Second, long-term use of sanitation facilities is related to the pleasantness of the facilities, but dirty overflowing pits are unlikely to be utilised in the longer term. A related issue here is that CLTS does not address the issue of latrine emptying services or where they exist, how they dispose of waste. This has led some researchers to say that the success of CLTS is largely down to the cultural suitability of the way it is delivered and the degree to which supply-side constraints are addressed.
215:
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severe health impacts of open defecation. Since individual carelessness may affect the entire community, pressure on each person becomes stronger to follow sanitation principles such as using sanitary toilets, washing hands, and practicing good hygiene. To introduce sanitation even in the poorest households, low-cost toilets are promoted, constructed with local materials. The purchase of the facility is not subsidized, so that every household must finance its own toilets.
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but only 37% had handwashing facilities present. When broader criteria for declaring communities ODF was used, an overall "slippage rate" of 92% was found. Some researchers suggest that this means support is needed to support communities to upgrade facilities in ODF villages which have been triggered by CLTS.
717:
Free (ODF) following CLTS across several countries in Africa. After two years, 87% of the 4960 households had fully functioning latrines – but these were considered the most basic and none of the communities had moved up the sanitation ladder. 89% of households had no visible excreta in the vicinity,
652:
of recipients, even if this was not intended by those promoting CLTS. There have been cases of fines (monetary and non-monetary), withholding of entitlements, public taunting, posting of humiliating pictures and even violence. In some cases CLTS successes might be based on coercion only. On the other
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CLTS shifted the focus on personal responsibility and low-cost solutions. CLTS aims to totally stop open defecation within a community rather than facilitating improved sanitation only to selected households. Combined with hygiene education, the approach aims to make the entire community realize the
262:
The original concept of CLTS did not include subsidies for toilets. CLTS proponents at that time believed that provoking behavior change in the people alone would be sufficient to lead them to take ownership of their own sanitation situation, including paying for and constructing their own toilets.
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about open defecation. It also involved actions leading to increased self-respect and pride in one's community. With time, CLTS evolved away from provoking negative emotions to educating people about how open defecation increases the risk of disease. Currently, CLTS triggering events focus more on
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One small study compared different CLTS programmed. Participants from NGOs involved in delivering CLTS reported that although they included some of the activities described in the guidance materials, they often omitted some and included others depending on the local situation. Some reported that
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There are many challenges that occur in the post-triggering phase. These are mainly related to the supply of durable and affordable latrine hardware and technical support on latrine construction. Toilet owners may need advice how to upgrade and improve sanitation and handwashing facilities using
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CLTS does not specify technical standards for toilets. This is a benefit in terms of keeping the costs of constructing toilets very low and allowing villagers to start building their own toilets immediately. However, it can produce two problems: first in flood plains or areas near water tables,
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Pre-triggering is the process by which communities are assessed to be suitable for CLTS intervention. This involves visits and a number of different criteria, which are used to identify communities likely to respond well to triggering. During pre-triggering, facilitators introduce themselves to
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and he concluded that the problem with previous approaches was that local people had not "internalised" the demand for sanitation. He suggested a new approach: abandoning subsidies and appealing to the better nature of villagers and their sense of self-disgust to bring about change. The CLTS
572:
There is currently a lack of scientific review about the effectiveness of CLTS, although this has been changing since 2015. A study in 2012 reviewed reports by NGOs and practitioners and found that there was little review of the impact of local
Natural Leaders, that anecdotes were used without
226:, rather than merely toilet construction. The process raises the awareness that as long as even a minority continues to defecate in the open, everyone is at risk of disease. CLTS uses community-led methods, such as participatory mapping and analyzing pathways between feces and the mouth (
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Catarina de
Alburquerque, the former United Nations Special Rapporteur on the Right to Water and Sanitation, is quoted as saying that "Observers have also recognized that incentives for encouraging behavior change and the construction of latrines are sometimes unacceptable, and include
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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.
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hand, 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 officials and local leaders on issues such as stigma, awareness of
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Millions of people worldwide have benefitted from CLTS which has resulted reductions in open defecation and increases in latrine coverage in many rural communities. Practitioners have declared many villages as "ODF villages", where ODF stands for "open defecation free".
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for the construction of latrines and hygiene education. Under this framework, the subsidised facilities were expensive and often did not reach all members of a community. In addition, the subsidies may have reduced the feeling of personal responsibility for the toilets.
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The goal of the triggering process is to let people see the problem first-hand, thereby evoking disgust. However, it has been reported that communities which respond favorably tend to be motivated more by improved health, dignity, and pride than by shame or disgust.
332:
The "CLTS Handbook" from 2008 states that there is no "one way" of doing triggering in CLTS. A rough sequence of steps is given in this handbook which could be followed. Facilitators are encouraged to modify and change activities depending on the local situation.
467:(IDS) coordinated research programmed on CLTS since about 2007 and regards it as a "radically different approach to rural sanitation in developing countries which has shown promising successes where traditional rural sanitation programmers have failed".
445:"We have so many "revolutions" in development that only last a year or two and then fade into history. But this one is different. In all the years I have worked in development this is as thrilling and transformative as anything I have been involved in."
60:
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
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The "ignition" phase occurs when the community becomes convinced that there is a real sanitation problem, and motivated to do something about it. Natural
Leaders are members of the community who are engaged by the process, and able to drive change.
506:
and
Practical Action have implemented a form of urban CLTS. CLTS has also been used in schools and the surrounding communities, which is referred to as "school-led total sanitation". The school children act as messengers of change to households.
209:
School-led total sanitation "triggering" event: These school children in West Bengal, India are looking at a glass of water and fresh feces. Flies will pass from the water to the feces and back, which demonstrates how water can get polluted with
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assessing impacts, and that claims were made without supporting evidence. It concluded that these kinds of reports focus on the 'triggering' stage of CTLS instead of the measurable outcomes. A peer-reviewed article considered the
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There is also concern about the number of people who go back to open defecation some months after having been through the CLTS process. A Plan
Australia study from 2013 investigated that 116 villages were considered
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of 200 studies concluded in 2018 that the evidence base on CLTS effectiveness is still weak. This means that practitioners, policy makers, and program managers have little available evidence to inform their actions.
141:(ODF) is a central term for community-led total sanitation (CLTS) programs. It primarily means the eradication of open defecation in the entire community. However, ODF can also include additional criteria, such as:
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It eventually became standard practice for NGOs to leave the community quite soon after "triggering" activities. When communities took the lead, change in sanitation practices was more longer term and sustainable.
77:
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
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588:(TSC) when assessing the effectiveness of the approach. However, this comparison may be invalid, as the presence of subsidies in the TSC process may fundamentally change the effectiveness of the CLTS process.
426:
Community-led Total
Sanitation as an idea had grown beyond its founder and is now often being run in slightly different ways, e.g. in India, Pakistan, Philippines, Nepal, Sierra Leone and Zambia.
1843:
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of CLTS in the longer term: It found that there was little monitoring or evaluation of the impacts of CLTS, even though large international organizations were involved in funding the process.
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A tool called "triggering" is used to propel people into taking action. This takes place over a day with a team of facilitators. The team visits a community which is identified as practicing
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After a positive response to the ignition phase, NGO facilitators work with communities to deliver sanitation services by providing information and guidance relevant to the local situation.
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in rural Mali conducted during 2011 to 2013 found that CLTS with no monetary subsidies did not affect diarrhea incidences, but substantially increased child growth (thereby reducing
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In time, NGOs and governments began to see the value of the approach and ran their own schemes in various countries, some with less aversion to subsidies than Kamal Kar.
1021:
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and pre-existing inequalities are important. People who are disadvantaged should benefit from CLTS programmes as effectively as those who are not disadvantaged.
407:
CLTS is practiced in at least 53 countries. CLTS has spread throughout
Bangladesh and to many other Asian and African countries with financial support from the
615:
A health worker (centre) gets villagers to draw a map of the area, showing the main features like the road and the river (a village near Lake Malawi, Malawi).
329:– is a deliberate aspect of the CLTS approach, as it is meant to be a practical, straight forward approach rather than a theoretical, academic conversation.
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1002:
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Villagers making a transect walk or 'walk of shame' to the open defecation places, singing 'let us end open defecation' (village near Lake Malawi, Malawi)
1510:"The Effect of India's Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial"
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and many national NGOs have also been involved. Many governments have in the meantime initiated CLTS processes or made it a matter of national policy.
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infringements within communities, low standards for toilets, and concerns about usage rates in the long term. CLTS is in principle compatible with a
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The CLTS behavioral change process is based on the use of shame. This is meant to promote collective consciousness-raising of the severe impacts of
434:
was an exception – here the government led the somewhat similar "Total
Sanitation Campaign" which has been turned into the "Clean India Mission" or
1713:"Commentary on community-led total sanitation and human rights: Should the right to community-wide health be won at the cost of individual rights?"
688:), and are not told about these options by the facilitators of the CLTS process, they may opt for pour flush pit latrines even in situations where
441:
CLTS as an idea now has many supporters around the world, with Robert
Chambers, co-writer of the CLTS Foundation Handbook, describing it this way:
648:
and trigger shock and self-awareness when participants realize the implications of their actions. The triggering process can however infringe the
1401:, implemented by Practical Action and Umande Trust in collaboration with County Government of Nakuru, health services department, CLTS Foundation
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Feces are given a strong negative connotation in the CLTS approach. This can cause confusion for villagers who are already using treated human
1631:"Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial"
537:
People who are disadvantaged should benefit from CLTS programmers as effectively as those who are not disadvantaged. This is referred to as
1508:
Patil, Sumeet; Arnold, Benjamin; Salvatore, Alicia; Briceno, Bertha; Ganguly, Sandipan; Colford Jr., John; Gertler, Paul (26 August 2014).
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420:
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https://www.theguardian.com/global-development/poverty-matters/2011/may/30/mdg-sanitation-offtrack-but-community-led-approach-is-working
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Reviews about the effectiveness of CLTS to eliminate open defecation, reduce diarrhea and other gastrointestinal diseases, and decrease
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1413:
Beyond construction : use by all - a collection of case studies from sanitation and hygiene promotion practitioners in South Asia
1563:
1360:
1232:
483:
416:
1059:
2898:
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1910:
977:
1327:
1298:
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Today there are many NGOs and research institutes with an interest in CLTS, including for example the CLTS Knowledge Hub of the
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2191:
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1420:
1045:
1085:
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2923:
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2444:
2032:
1140:
887:
Galvin, M (2015). "Talking shit: is
Community-Led Total Sanitation a radical and revolutionary approach to sanitation?".
773:
113:
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Facilitate "Kaka Mapping" – drawing a map of important locations in the village, then adding common sites for defecation
1948:
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2464:
2047:
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950:
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It is fundamental that CLTS involves no individual house-hold hardware subsidy and does not prescribe latrine models.
336:
The UNICEF manual approved for use of CLTS in Sierra Leone suggests the following steps for the triggering process:
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Black, M. and B. Fawcett (2008) The Last Taboo: Opening the Door on the Global Sanitation Crisis. London: Earthscan
1037:
471:
464:
451:
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but there are bad practice examples in the name of CLTS. More rigorous coaching of CLTS practitioners, government
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2209:
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1877:
734:
558:
223:
53:
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998:
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Even more stringent criteria which may be required before a community is awarded "ODF status" might include:
90:
631:
619:
611:
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1178:
408:
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reported positive outcomes with CLTS in fragile and insecure contexts, namely in Somalia and South Sudan.
197:
149:, offer privacy and a roof to protect the user, have a lid to cover the hole, or a water seal for toilets.
2700:
2593:
2504:
2317:
2305:
2214:
1903:
596:
227:
69:. CLTS involves actions leading to increased self-respect and pride in one's community. It also involves
56:
in mainly rural people by a process of "triggering", leading to spontaneous and long-term abandonment of
721:
A study in 2018 has found little evidence for sustained sanitation behavior change as a result of CLTS.
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More debate is still needed regarding human's rights consequences of post-triggering punitive measures.
205:
2770:
2695:
2600:
2136:
1827:
681:
21:
1087:
IDS Working Paper 184: Subsidy or self-respect? Participatory total community sanitation in Bangladesh
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2755:
2454:
2161:
2119:
2083:
1990:
1311:
585:
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2429:
2141:
2037:
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in participants, and the facilitators help participants to plan appropriate sanitation facilities.
1629:
Pickering, Amy J; Djebbari, Habiba; Lopez, Carolina; Coulibaly, Massa; Alzua, Maria Laura (2015).
3001:
2928:
2760:
1361:
Field notes: UNICEF Policy and Programming in Practice - Community Approaches to Total Sanitation
538:
1470:
Systematic Literature Review (Grey Literature) of Publications on Community-led Total Sanitation
1194:
3024:
2996:
2775:
2499:
1985:
1896:
1060:
Lessons Learned from Bangladesh, India, and Pakistan; Scaling-Up Rural Sanitation in South Asia
833:"Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality"
310:
and encourages villagers to become aware of their own sanitation situation. This aims to cause
182:
1442:
933:
Myers, Jamie; Cavill, Sue; Musyoki, Samuel; Pasteur, Katherine; Stevens, Lucy (15 June 2018).
374:
Wait for the emergence of "Natural Leaders" to work with in order to develop a plan of action.
321:" (or other locally used crude words) during triggering events or presentations – rather than
2981:
2765:
2300:
2201:
2094:
1943:
778:
689:
435:
1472:" The Water Institute at the University of North Carolina at Chapel Hill Accessed 2015-02-16
1459:, UNICEF WASH Field Note, Eastern and Southern Africa Sanitation and Hygiene Learning Series
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2740:
2605:
2571:
2519:
2344:
2339:
2285:
2241:
2131:
2069:
1958:
1953:
896:
768:
362:
Wait for the shocked realization that the community is indirectly eating each other's feces
1712:
1482:
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8:
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2961:
2735:
2534:
2524:
2359:
1968:
1873:
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Villagers go to the place where meals are prepared to observe how flies are attracted to
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Visit the community, emphasizing the purpose of learning about their sanitation situation
201:
A facilitator and the community during a triggering in Malda District, West Bengal, India
900:
214:
2588:
2171:
2020:
1801:
1774:
1536:
1509:
1430:
956:
912:
853:
832:
662:
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in children are currently underway. In some cases, CLTS has been compared with India's
41:
1647:
1630:
1022:
Equality and non-discrimination (EQND) in sanitation programmes at scale', Part 1 of 2
3075:
2750:
2745:
2673:
2622:
2396:
2376:
2364:
2324:
2295:
2263:
2181:
2074:
2042:
1938:
1806:
1734:
1662:
1611:
1590:"Analysis of behavioral change techniques in community-led total sanitation programs"
1541:
1416:
1094:
1041:
960:
946:
916:
858:
685:
565:
152:
All household members and all members of the community use these latrines or toilets.
79:
1682:"Shaming and Sanitation in Indonesia: A Return to Colonial Public Health Practices?"
729:
592:
subsidies were included, and some offered specific design and construction options.
16:
Approach to improve sanitation and hygiene practices, mainly in developing countries
2915:
2668:
2627:
2439:
2414:
2226:
2156:
2000:
1796:
1786:
1724:
1693:
1652:
1642:
1601:
1531:
1521:
938:
904:
848:
840:
701:
1415:. Delft: IRC International Water and Sanitation Centre and WaterAid. p. 181.
2976:
2678:
2481:
2474:
2409:
2349:
2231:
2221:
2151:
2124:
2109:
2064:
2054:
2005:
1847:
1791:
1526:
1367:
1334:
1104:
714:
645:
307:
132:
57:
30:
1841:"Community Led Total Sanitation in Bangladesh:Chronicles of a People's Movement"
553:
To be successful in the longer term, CLTS should be treated as part of a larger
2663:
2449:
2386:
2371:
2354:
2312:
2114:
1995:
1166:
Philip Vincent Otieno - Defecation mapping in progress CLTS FIRE IGNITED IN DRC
831:
Venkataramanan, Vidya; Crocker, Jonathan; Karon, Andrew; Batram, Jamie (2018).
649:
600:
581:
574:
557:(water, sanitation and hygiene) strategy rather than as a singular solution to
542:
493:
254:
Prior to CLTS, most traditional sanitation programs relied on the provision of
188:
Provision of toilets for schools, markets, clinic or visitors to the community.
85:
The concept was developed around the year 2000 by Kamal Kar for rural areas in
1457:
CLTS in Fragile and Insecure Contexts: Experience from Somalia and South Sudan
1312:
Community-based Sanitation lessons learned from Sanimas Programme in Indonesia
3064:
2971:
2850:
2658:
2632:
2509:
2469:
2434:
2424:
2404:
2146:
2104:
2079:
2027:
2015:
2010:
1919:
1862:
763:
654:
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and carry diseases by landing on the food (village near Lake Malawi, Malawi).
511:
121:
117:
102:
1606:
1589:
145:
Household latrines or toilets are hygienic, provide the safe containment of
2991:
2419:
2268:
2258:
2236:
2166:
2059:
1973:
1810:
1738:
1710:
1666:
1615:
1545:
862:
430:(NGOs) were often in the lead when CLTS was first introduced in a country.
170:
135:
is the practice of defecating out in the open, rather than using a toilet.
109:
66:
1301:
Institute of Development Studies (IDS) In Focus Policy Brief 10 July 2009.
942:
2986:
2683:
2381:
2290:
2253:
665:, including photographing, of those who still practice open defecation."
624:
527:
519:
322:
156:
97:
CLTS is practiced in at least 53 countries. CLTS has been adapted to the
1729:
1265:
1093:. Brighton, UK: Institute of Development Studies, University of Sussex.
704:
in agriculture and can, in fact, discourage the reuse of human excreta.
2612:
2334:
1697:
1657:
1040:', Frontiers of CLTS: Innovations and Insights Issue 4, Brighton: IDS,
741:
In 1999 and 2000, Kamal Kar was working in a village called Mosmoil in
499:
475:
218:
This is what CLTS tries to stop: Open defecation in rural Bihar, India.
98:
86:
45:
1883:
1347:
1057:
908:
355:
Put feces on the ground where all present can see it, and discuss how
2710:
2529:
2099:
1980:
750:
Foundation is the organisation set up by Kar to promote these ideas.
176:
844:
2576:
2329:
1963:
1933:
1752:
Time to Acknowledge the Dirty Truth Behind Community-led Sanitation
1323:
746:
742:
523:
479:
368:
Calculate how much feces is produced each day and ask where it goes
365:
Put some feces into a water bottle and ask if anyone would drink it
349:
Facilitate a "Walk of Shame" to sites with frequent Open Defecation
1399:
Lessons in Urban Community Led Total Sanitation from Nakuru, Kenya
266:
Kamal Kar and Robert Chambers stated in their 2008 CLTS Handbook:
230:
of disease), as a means of teaching the risks associated with OD.
2248:
1868:
1711:
Bartram, J; Charles, K; Evans, B; O'Hanlon, L; Pedley, S (2012).
1560:"An Open Letter in response to the World Development Report 2015"
326:
311:
255:
238:
74:
49:
1888:
1772:
1299:'Beyond Subsidies - Triggering a Revolution in Rural Sanitation'
830:
680:
If villagers do not know about alternative toilet options (like
2543:
1628:
1381:"The Addis Agreement: Using CLTS in urban and peri-urban areas"
1024:, Frontiers of CLTS: Innovations and Insights 10, Brighton: IDS
980:', Frontiers of CLTS: Innovations and Insights 9, Brighton: IDS
733:
Kamal Kar presented information about CLTS at a meeting of the
531:
487:
120:
staff and local leaders on issues such as stigma, awareness of
62:
1587:
159:
facility with water, soap or ash is nearby and used regularly.
2705:
999:"CLTS and the Right to Sanitation, Frontiers of CLTS issue 8"
515:
431:
234:
146:
70:
26:
1328:
Revitalising Community-led Total Sanitation: A process guide
1156:- UNICEF and Sierra Leone Government, Freetown, Sierra Leone
494:
Applications to urban situations, schools and other settings
2831:
Committee on the Environment, Public Health and Food Safety
2637:
1507:
784:
554:
503:
412:
318:
932:
707:
695:
356:
1222:"Field Notes: UNICEF Policy and Programming in Practice"
101:
context. It has also been applied to post-emergency and
52:
practices in a community. The approach tries to achieve
1179:
Tales of shit: Community-Led Total Sanitation in Africa
514:
settings. There has been some experience with this in
1058:
Water and Sanitation Program; World Bank (May 2005).
298:
community members and begin to build a relationship.
1865:
at Institute for Development Studies (IDS) in the UK
1036:
Cavill, S. with Chambers, R. and Vernon, N. (2015) '
671:
603:), particularly in children under two years of age.
108:
Challenges associated with CLTS include the risk of
1410:
996:
233:The concept originally focused mainly on provoking
89:. CLTS became an established approach around 2011.
978:CLTS in Post-Emergency and Fragile States Settings
1679:
510:CLTS has also been applied to post-emergency and
415:, Plan International, WaterAid, CARE, UNICEF and
3062:
1773:Mara, D; Lane, J; Scott, BA; Trouba, D (2010).
1346:Plan USA and The Water Institute at UNC (2014)
498:Since about 2016, CLTS has been adapted to the
82:to clean up and become "open defecation free".
606:
249:
25:CLTS triggering process: Community members in
1904:
1020:House, S., Cavill, S. and Ferron, S. (2017) '
657:and pre-existing inequalities are important.
1501:
1397:Kath Pasteur and Preetha Prabhakaran (2014)
1143:Plan UK and Institute of Development Studies
474:, the CLTS Foundation led by Kamal Kar, The
1826:Tyndale-Biscoe, P, Bond, M, Kidd, R (2013)
1822:
1820:
1588:Sigler, R; Mahmoudi, L; Graham JP. (2015).
1189:
1187:
2866:Centers for Disease Control and Prevention
1911:
1897:
1213:
1181:. Vol. 61. IIED, 2010. Accessed 2015-02-26
1141:Handbook on Community-led Total Sanitation
1032:
1030:
2826:Centre for Disease Prevention and Control
2816:Center for Disease Control and Prevention
1800:
1790:
1728:
1656:
1646:
1605:
1583:
1581:
1535:
1525:
1411:ed. by James Wicken; et al. (2008).
886:
852:
398:
114:human rights based approach to sanitation
1850:IDS Conference paper Accessed 2015-02-27
1817:
1184:
1154:CLTS Training manual for natural leaders
882:
880:
878:
876:
874:
872:
728:
630:
618:
610:
502:context. For example, in Kenya the NGOs
213:
204:
196:
20:
2871:Health departments in the United States
1884:Testing CLTS Approaches for Scalability
1348:Testing CLTS Approaches for Scalability
1135:
1133:
1131:
1129:
1127:
1125:
1027:
3063:
2876:Council on Education for Public Health
1578:
1289:by Robert Chambers Accessed 2015-02-27
1219:
1005:from the original on 10 December 2020.
889:Wiley Interdisciplinary Reviews: Water
708:Long-term usage rates (sustainability)
696:Reuse of treated excreta as fertiliser
38:Community-led total sanitation (CLTS):
2934:Professional degrees of public health
2841:Ministry of Health and Family Welfare
1892:
1387:from the original on 23 January 2021.
1177:Bongartz, Petra et al. (eds) (2010) "
1038:Sustainability and CLTS: Taking Stock
869:
826:
824:
822:
820:
192:
3031:
2924:Bachelor of Science in Public Health
1340:
1122:
1016:
1014:
1012:
992:
990:
988:
986:
972:
970:
928:
926:
818:
816:
814:
812:
810:
808:
806:
804:
802:
800:
3043:
2192:Workers' right to access the toilet
2033:Human right to water and sanitation
1083:
937:. Practical Action Publishing Ltd.
774:Self-supply of water and sanitation
597:cluster-randomized controlled trial
13:
1462:
1391:
1373:
1304:
1077:
386:
242:promoting self-respect and pride.
14:
3092:
2465:Commercial determinants of health
1918:
1856:
1754:by Liz Chatterjee in the Guardian
1489:. Sustainable Sanitation Alliance
1009:
983:
967:
923:
837:Environmental Health Perspectives
797:
672:Toilet standards and toilet types
352:Collect a piece of feces in a bag
292:
3042:
3030:
3019:
3018:
2048:National public health institute
935:Innovations for Urban Sanitation
548:
482:and the Water Institute at UNC,
472:Institute of Development Studies
465:Institute of Development Studies
452:Institute of Development Studies
167:Safe drinking water and storage.
2445:Open-source healthcare software
2187:Sociology of health and illness
1878:Sustainable Sanitation Alliance
1833:
1766:
1757:
1745:
1704:
1673:
1622:
1552:
1475:
1449:
1404:
1353:
1317:
1292:
1280:
1250:
1171:
1159:
1146:
787:(Water, sanitation and hygiene)
735:Sustainable Sanitation Alliance
639:
222:CLTS focuses on community-wide
2806:Caribbean Public Health Agency
2618:Sexually transmitted infection
2515:Statistical hypothesis testing
2276:Occupational safety and health
2177:Sexual and reproductive health
2090:Occupational safety and health
1199:Community-Led Total Sanitation
1139:Kal, K and Chambers, R (2008)
1051:
428:Non-governmental organizations
277:CLTS Foundation Handbook, 2008
263:This was not always the case.
127:
91:Non-governmental organizations
40:is an approach used mainly in
1:
2460:Social determinants of health
1648:10.1016/s2214-109x(15)00144-8
1084:Kar, Kamal (September 2003).
791:
301:
2520:Analysis of variance (ANOVA)
2281:Human factors and ergonomics
1869:CLTS Foundation by Kamal Kar
1792:10.1371/journal.pmed.1000363
1680:Engel, S; Susilo, A (2014).
1527:10.1371/journal.pmed.1001709
997:Musembi and Musyoki (2016).
409:Water and Sanitation Program
275:Kamal Kar, Robert Chambers,
7:
3071:Rural community development
2701:Good manufacturing practice
2505:Randomized controlled trial
1717:Journal of Water and Health
1483:"Research projects on CLTS"
757:
682:urine-diverting dry toilets
607:Challenges and difficulties
359:move between food and feces
250:Use or non-use of subsidies
10:
3097:
2771:Theory of planned behavior
2696:Good agricultural practice
2601:Public health surveillance
2493:epidemiological statistics
2137:Public health intervention
1468:Venkataramanan, V (2012) "
724:
692:is a significant problem.
3014:
2949:
2908:
2893:World Toilet Organization
2888:World Health Organization
2795:
2784:
2721:
2646:
2562:
2490:
2455:Public health informatics
2395:
2200:
2162:Right to rest and leisure
1991:Globalization and disease
1926:
586:Total Sanitation Campaign
486:from the Netherlands and
287:
2939:Schools of public health
2731:Diffusion of innovations
2430:Health impact assessment
2142:Public health laboratory
2038:Management of depression
1846:27 February 2015 at the
1828:ODF Sustainability Study
1635:The Lancet Global Health
1065:(Report). pp. 65–66
839:. 026001–1 (2): 026001.
530:and Indonesia. In 2014,
3002:Social hygiene movement
2929:Doctor of Public Health
2761:Social cognitive theory
2563:Infectious and epidemic
2345:Fecal–oral transmission
1775:"Sanitation and Health"
1262:www.phwashresources.com
702:excreta as a fertiliser
228:fecal–oral transmission
2997:Germ theory of disease
2776:Transtheoretical model
1876:in the library of the
1686:Development and Change
738:
636:
628:
616:
461:
399:Applications and scale
282:
219:
211:
202:
183:Solid waste management
139:"Open defecation free"
34:
2881:Public Health Service
2766:Social norms approach
2756:PRECEDE–PROCEED model
2202:Preventive healthcare
2095:Pharmaceutical policy
1944:Chief Medical Officer
1607:10.1093/heapro/dau073
1337:. Accessed 2015-03-04
943:10.3362/9781780447360
781:(Clean India Mission)
779:Swachh Bharat Abhiyan
732:
690:groundwater pollution
634:
622:
614:
450:Robert Chambers from
443:
436:Swachh Bharat Abhiyan
268:
217:
208:
200:
29:are drawing a map of
24:
2957:Sara Josephine Baker
2856:Public Health Agency
2741:Health communication
2606:Disease surveillance
2572:Asymptomatic carrier
2554:Statistical software
2242:Preventive nutrition
2070:Medical anthropology
1959:Environmental health
1874:Publications on CTLS
1366:2 April 2015 at the
1333:2 April 2015 at the
976:Greaves, F. (2016) '
769:Orangi Pilot Project
371:Ignition (see below)
42:developing countries
33:for their community.
2967:Carl Rogers Darnall
2962:Samuel Jay Crumbine
2736:Health belief model
2589:Notifiable diseases
2525:Regression analysis
2360:Waterborne diseases
1949:Cultural competence
1730:10.2166/wh.2012.205
1370:Accessed 2015-03-04
1350:Accessed 2015-03-04
1314:Accessed 2015-03-04
1195:"The CLTS approach"
1168:Accessed 2015-02-16
901:2015WIRWa...2....9G
411:of the World Bank,
2565:disease prevention
2500:Case–control study
2172:Security of person
2021:Health care reform
1863:CLTS Knowledge Hub
1698:10.1111/dech.12075
1441:has generic name (
739:
737:in Sweden in 2010.
686:composting toilets
637:
629:
617:
220:
212:
203:
193:Aims and rationale
35:
3058:
3057:
3010:
3009:
2920:Higher education
2751:Positive deviance
2746:Health psychology
2722:Health behavioral
2649:safety management
2623:Social distancing
2397:Population health
2377:Smoking cessation
2325:Pharmacovigilance
2296:Injury prevention
2264:Infection control
2182:Social psychology
2132:Prisoners' rights
2075:Medical sociology
2043:Public health law
1939:Biological hazard
1839:Ahmed, SA (2008)
1641:(11): e701–e711.
1594:Health Promot Int
1422:978-9937-2-0472-9
1046:978-1-78118-222-2
1001:. Brighton: IDS.
909:10.1002/wat2.1055
566:systematic review
559:changing behavior
543:nondiscrimination
395:local materials.
224:behavioral change
80:collective action
3088:
3046:
3045:
3034:
3033:
3022:
3021:
2916:Health education
2793:
2792:
2647:Food hygiene and
2628:Tropical disease
2440:Infant mortality
2415:Community health
2291:Controlled Drugs
2227:Health promotion
2157:Right to housing
2001:Health economics
1913:
1906:
1899:
1890:
1889:
1851:
1837:
1831:
1830:, Plan Australia
1824:
1815:
1814:
1804:
1794:
1785:(11): e1000363.
1770:
1764:
1761:
1755:
1749:
1743:
1742:
1732:
1708:
1702:
1701:
1677:
1671:
1670:
1660:
1650:
1626:
1620:
1619:
1609:
1585:
1576:
1575:
1573:
1571:
1562:. Archived from
1556:
1550:
1549:
1539:
1529:
1505:
1499:
1498:
1496:
1494:
1479:
1473:
1466:
1460:
1453:
1447:
1446:
1440:
1436:
1434:
1426:
1408:
1402:
1395:
1389:
1388:
1377:
1371:
1357:
1351:
1344:
1338:
1321:
1315:
1308:
1302:
1296:
1290:
1284:
1278:
1277:
1275:
1273:
1264:. Archived from
1258:"PHWash | PhaTS"
1254:
1248:
1247:
1245:
1243:
1237:
1231:. Archived from
1226:
1217:
1211:
1210:
1208:
1206:
1191:
1182:
1175:
1169:
1163:
1157:
1150:
1144:
1137:
1120:
1119:
1117:
1115:
1109:
1103:. Archived from
1092:
1081:
1075:
1074:
1072:
1070:
1064:
1055:
1049:
1034:
1025:
1018:
1007:
1006:
994:
981:
974:
965:
964:
930:
921:
920:
884:
867:
866:
856:
828:
459:
346:Pretend to leave
317:Using the term "
280:
3096:
3095:
3091:
3090:
3089:
3087:
3086:
3085:
3061:
3060:
3059:
3054:
3006:
2977:Margaret Sanger
2945:
2904:
2788:
2786:
2780:
2723:
2717:
2689:Safety scandals
2648:
2642:
2564:
2558:
2492:
2486:
2482:Social medicine
2475:Race and health
2410:Child mortality
2391:
2350:Open defecation
2232:Human nutrition
2222:Family planning
2210:Behavior change
2196:
2152:Right to health
2065:Maternal health
2055:Health politics
2006:Health literacy
1922:
1917:
1859:
1854:
1848:Wayback Machine
1838:
1834:
1825:
1818:
1771:
1767:
1762:
1758:
1750:
1746:
1709:
1705:
1678:
1674:
1627:
1623:
1586:
1579:
1569:
1567:
1566:on 2 April 2015
1558:
1557:
1553:
1520:(8): e1001709.
1506:
1502:
1492:
1490:
1481:
1480:
1476:
1467:
1463:
1454:
1450:
1438:
1437:
1428:
1427:
1423:
1409:
1405:
1396:
1392:
1379:
1378:
1374:
1368:Wayback Machine
1358:
1354:
1345:
1341:
1335:Wayback Machine
1322:
1318:
1309:
1305:
1297:
1293:
1285:
1281:
1271:
1269:
1268:on 8 March 2022
1256:
1255:
1251:
1241:
1239:
1238:on 2 April 2015
1235:
1224:
1220:UNICEF (2008).
1218:
1214:
1204:
1202:
1193:
1192:
1185:
1176:
1172:
1164:
1160:
1152:UNICEF (2010).
1151:
1147:
1138:
1123:
1113:
1111:
1107:
1101:
1090:
1082:
1078:
1068:
1066:
1062:
1056:
1052:
1035:
1028:
1019:
1010:
995:
984:
975:
968:
953:
931:
924:
885:
870:
845:10.1289/EHP1965
829:
798:
794:
760:
727:
715:Open Defecation
710:
698:
674:
646:open defecation
642:
609:
551:
496:
460:
449:
401:
389:
387:Post-triggering
308:open defecation
304:
295:
290:
281:
274:
252:
195:
133:Open defecation
130:
58:open defecation
54:behavior change
31:open defecation
17:
12:
11:
5:
3094:
3084:
3083:
3078:
3073:
3056:
3055:
3053:
3052:
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3012:
3011:
3008:
3007:
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3004:
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2979:
2974:
2969:
2964:
2959:
2953:
2951:
2947:
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2943:
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2941:
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2931:
2926:
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2912:
2910:
2906:
2905:
2903:
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2890:
2885:
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2883:
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2873:
2868:
2860:
2859:
2858:
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2845:
2844:
2843:
2835:
2834:
2833:
2828:
2820:
2819:
2818:
2810:
2809:
2808:
2799:
2797:
2790:
2785:Organizations,
2782:
2781:
2779:
2778:
2773:
2768:
2763:
2758:
2753:
2748:
2743:
2738:
2733:
2727:
2725:
2719:
2718:
2716:
2715:
2714:
2713:
2708:
2698:
2693:
2692:
2691:
2686:
2681:
2676:
2671:
2666:
2661:
2652:
2650:
2644:
2643:
2641:
2640:
2635:
2630:
2625:
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2560:
2559:
2557:
2556:
2551:
2550:
2549:
2541:
2532:
2527:
2522:
2512:
2507:
2502:
2496:
2494:
2491:Biological and
2488:
2487:
2485:
2484:
2479:
2478:
2477:
2472:
2467:
2457:
2452:
2450:Multimorbidity
2447:
2442:
2437:
2432:
2427:
2422:
2417:
2412:
2407:
2401:
2399:
2393:
2392:
2390:
2389:
2387:Vector control
2384:
2379:
2374:
2372:School hygiene
2369:
2368:
2367:
2362:
2357:
2355:Sanitary sewer
2352:
2347:
2342:
2332:
2327:
2322:
2321:
2320:
2313:Patient safety
2310:
2309:
2308:
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2288:
2283:
2273:
2272:
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2179:
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2092:
2087:
2077:
2072:
2067:
2062:
2057:
2052:
2051:
2050:
2045:
2035:
2030:
2025:
2024:
2023:
2018:
2008:
2003:
1998:
1996:Harm reduction
1993:
1988:
1983:
1978:
1977:
1976:
1971:
1961:
1956:
1951:
1946:
1941:
1936:
1930:
1928:
1924:
1923:
1916:
1915:
1908:
1901:
1893:
1887:
1886:
1881:
1871:
1866:
1858:
1857:External links
1855:
1853:
1852:
1832:
1816:
1765:
1756:
1744:
1723:(4): 499–503.
1703:
1692:(1): 157–178.
1672:
1621:
1577:
1551:
1500:
1474:
1461:
1455:UNICEF (2014)
1448:
1421:
1403:
1390:
1372:
1359:UNICEF (2009)
1352:
1339:
1316:
1303:
1291:
1279:
1249:
1212:
1183:
1170:
1158:
1145:
1121:
1110:on 28 May 2008
1099:
1076:
1050:
1026:
1008:
982:
966:
951:
922:
868:
795:
793:
790:
789:
788:
782:
776:
771:
766:
759:
756:
726:
723:
709:
706:
697:
694:
673:
670:
663:public shaming
641:
638:
608:
605:
575:sustainability
550:
547:
512:fragile states
495:
492:
447:
400:
397:
388:
385:
376:
375:
372:
369:
366:
363:
360:
353:
350:
347:
344:
341:
303:
300:
294:
293:Pre-triggering
291:
289:
286:
272:
251:
248:
194:
191:
190:
189:
186:
180:
174:
168:
161:
160:
153:
150:
129:
126:
103:fragile states
15:
9:
6:
4:
3:
2:
3093:
3082:
3079:
3077:
3074:
3072:
3069:
3068:
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3051:
3050:
3041:
3039:
3038:
3029:
3027:
3026:
3017:
3016:
3013:
3003:
3000:
2998:
2995:
2993:
2990:
2988:
2985:
2983:
2980:
2978:
2975:
2973:
2972:Joseph Lister
2970:
2968:
2965:
2963:
2960:
2958:
2955:
2954:
2952:
2948:
2940:
2937:
2935:
2932:
2930:
2927:
2925:
2922:
2921:
2919:
2917:
2914:
2913:
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2879:
2877:
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2872:
2869:
2867:
2864:
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2857:
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2852:
2851:Health Canada
2849:
2848:
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2842:
2839:
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2836:
2832:
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2821:
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2796:Organizations
2794:
2791:
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2772:
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2759:
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2660:
2657:
2656:
2654:
2653:
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2645:
2639:
2636:
2634:
2633:Vaccine trial
2631:
2629:
2626:
2624:
2621:
2619:
2616:
2614:
2611:
2607:
2604:
2603:
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2533:
2531:
2528:
2526:
2523:
2521:
2518:
2517:
2516:
2513:
2511:
2510:Relative risk
2508:
2506:
2503:
2501:
2498:
2497:
2495:
2489:
2483:
2480:
2476:
2473:
2471:
2470:Health equity
2468:
2466:
2463:
2462:
2461:
2458:
2456:
2453:
2451:
2448:
2446:
2443:
2441:
2438:
2436:
2435:Health system
2433:
2431:
2428:
2426:
2425:Global health
2423:
2421:
2418:
2416:
2413:
2411:
2408:
2406:
2405:Biostatistics
2403:
2402:
2400:
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2388:
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625:human feces
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520:Afghanistan
157:handwashing
128:Definitions
44:to improve
3081:Sanitation
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2679:Processing
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2535:Student's
2335:Sanitation
1969:History of
792:References
476:World Bank
302:Triggering
210:pathogens.
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