I recently came across this very interesting article which was published by Jamie Bartram et al., in the Journal of Water and Health.
It is such an important and well written article on an important topic that I approached IWA Publishing if they could make an exception and allow me to place the pdf file in the SuSanA library. I am happy to announce that they agreed so now I can share this article with you in the SuSanA library! See library link below.

Bartram, J., Charles, K., Evans, B., O'Hanlon, L., Pedley, S. (2012). Commentary on community-led total sanitation and human rights: Should the right to community-wide health be won at the cost of individual rights?. Journal of Water and Health, Vol 10 No 4 pp 499–503 © IWA Publishing 2012, doi: 10.2166/wh.2012.205.

www.susana.org/lang-en/library?view=ccbk...p;type=2&id=1695

Jamie pointed out in an e-mail to me:

Summary:



After having gone through the trouble of obtaining this pdf file, obtaining permission for copyright waver and uploading it in the library, I hope that it will be useful for some of you and that those people who are interested in CLTS, or who have experiences with it, will comment here.

Regards,
Elisabeth

Dear Ms. Elisabeth,

It was great on your part to have obtained the IWA permission and, placing the article in the library. It is very useful and interesting paper. Dr.Jamie was kind to send me the paper, few days back. I wish, Kamal Kar, whom I met at the 6th World Water Forum in Marseille, could comment on the Dr. Jamie's paper and; on the growing criticism on CLTS vis-a-vis human rights violations.

F H Mughal

Thanks, Elisabeth for inviting us to comment.

Of course, I and indeed, I think, most CLTS practitioners, condemn practices that entail human rights abuses. However, as the article itself states, these are isolated examples. And, since CLTS is an approach not owned or controlled by anyone, and relies on humans to facilitate, train, implement,... and as such , like any other approach is always open to abuse, that's just the nature of an approach that depends on human beings...So apart from speaking out against bad practice, and constantly encouraging good practice and sharing examples of it, I wonder what there is to do? Seen in context, these examples of bad practice are far and few between the mostly inspiring, well done cases of CLTS which support the basic human right to a life lived in dignity.

The assumption that CLTS encourages ‘shaming’ that is behind this and some similar publications puzzles me since a) none of the key materials on CLTS support this and b) we and others have repeatedly written to emphasize that CLTS is not about shaming and that there are also different understandings of shame – in many cultures and languages, shame is the same as embarrassment, and the shame that some practitioners talk about is not so much about outsiders shaming community members, but about people feeling shame within themselves when they realise what the implications of their own behaviour are (so it’s more about dignity and self-respect for me!) - see for example

Emotional triggers: Shame? Or shock, disgust and dignity
Is shame a bad thing?
The shame question in CLTS

I also think that perhaps rather than blaming the approach for human rights infringements, it would be good to look at the specific contexts in which CLTS is being used in that way and ask what (traditions, norms, hierarchies) leads to the approach being used in this way? Eg in India where the caste system may very much encourage extreme social sanctions...

Apart from repeatedly emphasising what CLTS is and is not about, it's impossible to police the approach, especially at community level- and, if it's really about handing over the stick to communities, it raises the question about who really leads the process if outsiders decide how it can and cannot be used? Who is it that makes a judgement about what is (in)appropriate in a community context, what qualifies as an infringement of human rights and what is really the local community policing what is important to them? I suspect that this is not just the case with CLTS but a broader question with all sorts of participatory interventions and approaches? Does this concern over what the community does with the approach mean that 'we' outsiders once again decide what the community should or should not do?

I do not feel like I want to write a defensive response because I do not feel there is a need to defend CLTS, with all the evidence out there to support that in the majority of settings it is creating very positive changes. Nor do I feel that I or we here at IDS should be the people to do it. I will ask some of our colleagues who are involved at field level to add to the discussion if they like. And it would be good to hear from Kamal, as I am sure he has some strong points to make in response.

Best wishes,
Petra

Petra Bongartz
Coordination, Communication and Networking Officer for
Community-led Total Sanitation (CLTS)
CLTS Knowledge Hub @ the Institute of Development Studies (IDS)
www.communityledtotalsanitation.org

This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Institute of Development Studies at the University of Sussex
Brighton BN1 9RE
www.ids.ac.uk

One of the key resources on the IDS CLTS web site, the 2008 "Handbook on Community-Led Total Sanitation", lists many do's and do'nts for CLTS implementers. In the light of ongoing discussions, it would be advisable for future CLTS handbooks to provide examples of unacceptable bad practices, such as those listed by Bartram et al.

Also in the same light, I wonder whether the (Ethiopian) excerpt below, taken from the above mentioned Handbook, really is an example of "good practice" that the CLTS promoters think should be shared:

"I found four men at different times defecating in open fields in our village. I ordered
them to shovel it with their hands and take it into the nearby toilet. As I caught them with their trousers down, they didn’t resist; they only begged me to allow them to handle their shit with leaves. I allowed them and they shoveled it with leaves into the toilet.”

Cor Dietvorst, Programme Officer, Global Team
Information Specialist and Editor E-Source
IRC International Water and Sanitation Centre
PO Box 82327
2508 EH The Hague
The Netherlands

Tel.: +31-70-3044014
Fax: +31-70-3044044
E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Twitter: @dietvorst
Web: www.irc.nl

Dear Elisabeth and all-

Thanks for this opportunity to comment. The JWH article raises important issues for WASH practitioners. The allegation that significant human rights violations may have taken place under CLTS or other sanitation campaigns is a concern that should not be dismissed or ignored. However, there is not a lot of evidence presented in the article for these violations; most were sourced from blog posts or workshops, at least one of which (Chatterjee’s blog post), generated widespread disagreement at the time.

What is the context in which “social coercion” rights violations allegedly occur? Does anyone understand the range and magnitude of human rights violations experienced in poor communities? Or how incidents supposedly related to CLTS fit into this context? How do local government officials, village police, or other authority figures normally treat people in these communities? I ask because I wonder if strong-arm tactics are originating from within (poorly supervised) sanitation campaigns, or if they are creeping into sanitation campaigns from social and governance systems which may have low respect for human rights in general? Even Chatterjee admits that social coercion used under the TSC was “often community-backed”. This does not justify such techniques, but it may signal that we poorly understand day-to-day (human rights) realities in such communities.

I’m also not clear on the point being made about involving children. The article references examples from Bangladesh where children whistled at open defecators, or ‘flagged’ piles of shit. I’m unclear how this constitutes a serious violation of human rights. I personally visited Bangladesh recently, and virtually all adults I interviewed spoke memorably and highly of the roles that children had played in sanitation campaigns, whether it was ‘flagging’, whistling, or otherwise. If children are violating the rights of adults in the community, what are the adults doing about it? Who’s minding the children?

The article expresses concerns with ‘social sanctions’, ‘fines’, and ‘taunting’ (cited as “effective” by the JWH article’s source). Other approaches used under the TSC allegedly included stone-throwing, women’s photographs displayed, threats to cut off water and electricity, and a ‘handful’ of toilets constructed without owner consent. These practices should not be ignored or condoned (though others working in India commented they did not believe such practices were common). This goes back to the question of how much do we really know about social sanctions in the TSC, or in CLTS campaigns? As Petra from IDS pointed out in her posting, development agencies have encouraged decentralized programs, and are generally thrilled when efforts like CLTS spread (replicate) on their own, or through government-led initiatives. Supervising or policing a rapidly expanding effort that is largely carried out beyond the view of development practitioners is going to be difficult, if not impossible. However, we do have an obligation to know more about these issues, and the JWH article is fair to point this out.

The JWH article cites an incident in Bangladesh where a local official reportedly told fathers that if their wives or daughters were raped because they had to leave the family compound to defecate, the official would not convene an ‘arbitration’ to confront the perpetrator. The JWH article cites this threat as evidence of “the extreme end of the scale” of CLTS rights violations. If such a denial of justice has ever occurred, it would indeed be cause for concern and action. However, the reader also is left wondering if this threat was ever really carried out, or if local residents even considered the ‘threat’ to be credible. The assertion in the article that ‘the right to justice has… been withheld’ therefore seems to be an overstatement.

On the other hand, accounts of women being abused because they have to defecate in the open are continuing to come in, and what is being done about it? The IPS news service reported that in Bangladesh, of 109,621 complaints of various forms of violence against women (VAW) lodged during 2010-2012, only 6,875 cases were deemed ‘genuine’ and fit for further proceedings. The Inspector-General responsible for VAW crimes told IPS, “On many occasions our investigations showed that the law was used to harass the accused. It does seem that not all complaints are genuine.” The IPS article goes on to quote the executive director of Nari Unnayan Shakti, a women’s rights NGO, who said “Due to better awareness female victims have learnt to raise their voices, but stop short of seeking police help. During our 20 years of experience on VAW we have found that police often do not cooperate with victims and favour the accused.”

Based on information and comments like this, one has to wonder how frequently a victim of rape or abuse would actually report such an incident, whether the incident took place on the way to defecate, or under other circumstances. And if reported, would it result in any legal action? The point being – does a ‘threat’ by a local official that he would not convene a rape case arbitration have any real credibility? One has to wonder how significant these alleged CLTS ‘rights violations’ are, in comparison to what appears to be a massive problem of sexual violence against women and children in South Asia and elsewhere. Given the recent and horrifying case in New Delhi, we have to ask ourselves how to ensure the rights of women and girls everywhere. Given the scale and scope of the gender violence problem, what should we be most outraged by, and taking action against?

In many communities where CLTS has been carried out, the social norms that had once freely allowed the practice of open defecation (which in and of itself has human rights implications) appear to have irreversibly changed. Were all of the techniques used to achieve this outcome perfect? Possibly not, as the JWH article points out. Were they sanctioned by the community members themselves? Possibly yes, as Chatterjee might assert. Ultimately, was the greater good (and the human right to survival, and to live a healthy life in a clean environment) served? Perhaps these and related questions should be the focus of the more “systematic analysis that the JWH article calls for.

When women and girls are still being abused and raped because their households have no toilets, or because their status in society is still so unequal to that of men, or because the criminal justice system is essentially deaf and blind to the problem of gender-based violence – what are the most pressing human rights issues that call for our attention?

In spite of my many questions and concerns about the article, I believe the authors have done the sanitation and hygiene community a good service by writing the thought-provoking piece, and I hope it leads to greater attention to human rights issues in WASH (and other development) programming. And though the issues raised by the JWH article deserve attention, I also hope that the development community does not lose sight of the many well-documented human rights issues faced due to the lack of access to WASH services, and also to the basic human rights of equality, justice, and freedom from gender-based violence.

Peter Feldman
Seattle, Washington, USA

Hi everyone,

I just wanted to point out the similarities between the cycle of world fame followed by hard critics that CLTS is facing just like microcredit a year ago.

After his nobel prize in 2006, Muhamad yunnus and all the microcredit institutions have been hardly critizized from 2010 till nowdays, including accusation of "sucking blood from the poor" and "pushing poors to commit suicide" from high rank world officials.

So what's next, sanitation marketing ? Public Private Partnership ?
All these concepts, when they get global, will always have dark sides, bad implementation, sad stories ... you can be sure there will be always a journalist to point it out.

Every implementation concept in Water and Sanitation has to be analysed and adapted to the local context. Let's bring back responsabilities to the implementers, wherever they're from, NGOs as much as local leaders. No-one should be just a parrot applying to the coma what Kamal Kar is preaching, I think his concept is very interesting and that everyone has to pick in what ever he finds usefull. No one can deny that the shame approach is very powerfull, obviously it will never be the only catalyst for behavior change.

Thanks for bringing up the discussion,

Ben

I asked others to contribute their opinions and experiences to this forum and received a few interesting responses from Asia which I am sharing here on the writers' behalf:

Wahyu, WASH Advisor, Plan Indonesia

Wahyu shared his opinion that any approach implemented at the community level, where people are brought together both among villagers as well as between villagers and “outsiders” may always run into the risk of human rights abuse. This is because the boundary of human relationship under such a situation is too thin and can easily be transgressed. CLTS, which relies on intensive people interaction, has similar risks to violate human right. And it DID happen.

I’m referring to the undesirable triggering sessions where some sort of “pressure” was applied by external facilitators, community (internal) facilitators, and perhaps the natural leaders. At the point when the so-called triggered people write down their action plan, in few cases I found that some people were pushed to do so, or participated based on “being followers” spirit rather than voluntarily commit themselves to stopping open defecation. It happened due to the pressure nuances during the session. It is proven by our research that such a pressure won’t result in a sustainable ODF status. They slipped back to OD. In this instance I think we need to recognize that CLTS might have violated human rights.

What about shame?

I have never come across a case where shame was put upon the communities by external facilitators or outsiders. The shame came to the surface as the communities realized that open defecation was something bad, and it is something that came to their mind as they are engaged during the triggering process. This is surely debatable, especially for those who have never had a hands-on experience of CLTS triggering. But my point is we’re outsiders who come to the village with the objective of discussing with the community if open defecation is bad practice. If they say it is, then people will feel the shame. But when the people say nothing is wrong with open defecation, please do remember that, as recommended in the Handbook, we’re free to leave them. No shaming as part of our intention, definitely not in the good triggering process.

Nilusha, WASH Adviser, Plan Srilanka

The application of the CLTS approach in different cultures brings diverse interpretations, impacts and experiences. Having a latrine definitely contributes to the dignity and social status of a person and it has been proved in several social research works in our country. Dignity and avoiding shame are like two sides of the same coin. Implementing the CLTS approach by giving/promoting dignity among the people and communities especially those who continue the OD is a good strategy rather stressing on shame. It’s about the interpreting the same thing in different ways to reach same target.

Jorge Álvarez-Sala Torreano, Senior Advisor/ Programme Leader WASH, SNV in Vietnam

CLTS has been successfully introduced in many countries and contexts. Millions of people globally have changed their behaviour and are stopping open defecation. Of course there could be exceptional cases where CLTS has not been applied properly and has created problems, but again, I think that those cases are really exceptional.

Nitish Jha, Staff Consultant, ADB Vietnam

Open defecation occurs because it has long received public sanction, and CLTS tries to eradicate it by altering the public mood against supporting such a practice. However, any "shame" experienced is watered down because the embarrassment is shared by all members of the community and does not single out an individual or household. From what I have observed, it does not (or should not) try to insult or demean -- intentionally or otherwise -- either the target community or individuals within it.

But, as with everything, this answer depends on the context. [...] In one case of "autonomous" CLTS in India (although I hesitate to call it CLTS because no external trigger or agency was involved), a community's leaders carried the message to all members and, with the help of cross-subsidies from richer to poorer households, managed to achieve total sanitation in the village. The community also agreed and instituted its own rules for "shaming" and fines for those who continued to defecate in the open rather than use their newly built toilets. But in practice, the few caught doing this were always spoken to privately rather than in a public meeting or forum, and fines were rarely levied. If they continued to offend perhaps a public meeting would have been called to address the issue but this had not yet happened at the time I came across the village, which was probably 6-8 months after total sanitation had been achieved. Public shaming was held out as a last resort sanction or punishment, and it appears that the mere threat of it was enough.

But if a community shames its own members in public interest, can we argue that it is a breach of individual rights? Consider that in many urban settings, people are encouraged not to litter, urinate or even spit in public areas. I think it hardly constitutes an infringement of their individual rights if they are shamed into not doing these things, or if a fine is levied on them if they do. Open defecation is comparable. By its very definition, it almost always occurs in public areas or negatively affects a public good (e.g., a water source, or community health).
[...]
The practice of "shaming", in and of itself, is not the culprit. Instead one should ask questions like WHO is doing the shaming, and HOW is it being done?

Dear all,

First of all, thank you Elizabeth for making this article available to those of us who do not have regular access to journal articles. Also thank you to Petra and others for providing some counter arguments.

I will start by saying that I would probably be put in the CLTS critical group by most people, but I also realize that there have been significant impacts. One thought that struck me reading the article and the responses was the wider question of "being relativist about human rights". This is a difficult discussion, mainly focusing on the issue of how universal human rights really are and should be? I think we see a sort of pragmatism/realism versus a more "principled" approach in the discussion here.

Another thing that happened to me reading the article was that I found a word for something that has made me feel uneasy about CLTS for a longer time: "conflict sensitive development" also know as the "Do no harm" framework. As usual I write this post from a perspective of working in Nepal, which is a post conflict country. In Nepal,unfortunately, one of the legacies of the conflict is that in some communities and regions using violence and other forms of coercion have become acceptable to an unhealthy degree as ways of "forcing decisions". Also in many of the larger population centers (district head quarters, etc.) there tend to be groups of young man that can be used by local "strong man" (either from political parties or outside them)to show strength and use violence. These groups tend to be mobilized when existing power balances are disturbed and or challenged. Obviously I am not writing this post to defend these practices .

My question to Petra (or other CLTS community members) is the following:
"Has there been a critical self examination of the CLTS framework through the lens of conflict sensitive development/Do no harm? And if that has been done, is there also a set of guidelines/recommendations resulting from this process?"

A second, only partly related, question that I emailed to the CLTS website once but was not answered:
"Are there any case studies following-up CLTS triggered communities (5 years on), which do show that the impacts are sustainable, the communities still ODF and that communities have moved up the "sanitation ladder?"

Kind regards

Marijn Zandee

I'd like to add to Marijn questions:

1. Is there any evidence of progression of communities up a sanitation ladder?

2. Is there any evidence of measurable improvements in Open Defecation Free villages (such as cleaner water or health improvements)?

3. Are villages which have taken the initiative to build their own facilities discriminated against when agencies look for communities to work with (given that they may be said to have some sanitation)?

The shame question is an interesting philosophical point. On the one hand it does appear to involve some level of embarrassment and lowering of human dignity. But then I don't know that you can truly say that other WASH interventions are not also based on the same idea. To suggest to a community that a new latrine or water system might be appropriate is also to imply that the options they have are inferior. Given that communities are unlikely to understand the reasons behind sanitation and hygiene messages, there is ends-justify-means thinking in operation. In western countries with full sanitation, there is definitely a level of compulsion (involving fines, taxes and legal action) that encourages users to engage with the system rather than living without it. The vast majority of Western users co-operate with sewers because it is far easier than the alternatives/penalties, rather than because they have full knowledge of the benefits and have made a rational choice.

Shame, as far as most people in most INGOs are concerned, is a valuable emotion - otherwise they would not use advertising that appealed to shame, disgust and anger to attract donations.

That being the case, why should those involved in CLTS not use shame? What is so special about users of the interventions which means that they are protected from the same methods that are used routinely on the donors of the same project - both for their own sanitation and for the donations?

I think the answers to those questions come back to the ones I pointed to at the beginning. If there is little obvious progression on a sanitation ladder, if the interventions triggered are poor, if there are no obvious benefits, then I think that changes the nature of the shaming act. And it becomes extremely problematic to read of community members in triggered communities who rejected the process because their 'aspirations are too high' or because they have (possibily legitimate) reasons to believe that doing something themselves will mean they are bypassed when better interventions are distributed in the area in the future.

I don't believe that anyone in a community that prior to triggering was unaware of the importance of sanitation is able to build themselves anything that can be considered useful sanitation. The knowledge level is too low. Hence the systems are almost bound to fail.

Another very problematic issue is what users are supposed to think of interventions they are offered when they know that other, better, interventions exist. Rationally individuals should accept anything as being better than what they have. However in practice communities may reject these interventions (as happened recently in South Africa) and claim that they are being treated as second class citizens and second class humans.

As far as I am concerned, that feeling is not only understandable, it is right.

joeturner wrote:


Most people are not aware of the importance of sanitation and rather evaluate available sanitation solutions according to their convenience and cost factor (case in point: open defecation is more convenient that other options when individual costs are taken into account for most people that practice it).
Obviously it requires knowledge and skill to construct a worthwhile sanitation system out of "sticks & stones", but if there is a market available for affordable and appropriate (and hopefully convenient) sanitation components, people can easily construct useful sanitation systems themselves.

joeturner wrote:


I disagree.
This basically comes back to the long discussion of water (&sanitation) as a human right. While it sounds logical at first, it really is a completely different thing than other human rights which (except in special cases) need to be actively violated instead of just neglected.
However, I can understand that people complain (in special cases) to their elected leaders that promised certain level of sanitation interventions to "keep their promises" (and efficiently use the tax-generated funds), but often people that are doing so are just spoiled by donor handouts or cross-subsidies.

JKMakowka wrote:


Thanks for this. I disagree that this is a 'rights' discussion, my final phrase was to suggest that those who feel that they're being offered something (which they perceive to be) inferior are correct to feel that they are being treated as second class citizens - what else can they feel if they live in a place where 80% of other people have flush toilets? That to me is a perfectly logical conclusion when offered a bucket toilet.

I don't think that is quite the same as a 'human rights' discussion. And I reject the idea that someone who aspires to more than a bucket toilet has been spoiled by anything.

To me this underlines a problem with the way we talk about sanitation - as if some intervention that is objectively totally inadequate should be welcomed because it is 'better' than some really horrible alternative. People don't think like that. If you offer them something that sounds like a cut-price and poorer alternative, why should they not be upset?

And moreover, why should everyone else not be upset on their behalf that they only thing they're being offered is something which we all know is totally inadequate?

The article you linked was not very specific in details. However was there some specific thing actively preventing them from building an flush toilet themselves? If not I don't quite understand your issue.
From a regulators point of view it is correct to force people to have *some* sort of sanitation solution for public health reasons, so either they build themselves what they consider adequate, or they have to accept what is being offered.
Of course a smart offer would include a cash subsidy equal to what the offered solution would cost, but not in every case that is really feasible or anywhere near of what people would need to pay for the flush toilet.

Now a different case would be if they were offered an expensive but inadequate solution, like done in a case with a badly designed vacuum toilet system in South Africa etc. (edit: well designed vacuum sewers are a good idea in many cases though).

Besides (but I guess you know that) a properly designed and operated waterless toilet is not inferior to a flush toilet (I wouldn't mind switching myself, and have used one for longer periods in the past).