There are doubts that Community-led Total Sanitation (CLTS) works in Africa, as culturally the 'Walk of Shame' is not acceptable and there is no evidence that targets set are realistic. HEART were asked to research the CLTS application in Africa to find evidence to support or reject this position.
Evidence and comments suggest that CLTS has been successful in some cases in Africa, however it is difficult to find strong data to support this.
Claims to have achieved Open Defecation Free (ODF) status have often been exaggerated and estimates of numbers of ODF communities inflated. Verification systems need to be improved. Another problem is that ODF is an absolute condition, important as a community objective but unlikely to be strictly achieved. This does not mean that significant progress has not been made. Most studies identified for this report were observational.
This report presents evidence of improved hygiene and sanitation, and impact on diarrhea, together with comments from experts on CLTS, and a discussion on the use and meaning of the term 'shame' in the context of the report.
Bolton, L.; Kanguru, L. Helpdesk Report: Community-led Total Sanitation in Africa. Health and Education Advice and Resource Team (HEART), Oxford, UK (2013) 24 pp.