Comprehending practitioners’ assessments of community-led total sanitation

  • pepino
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Comprehending practitioners’ assessments of community-led total sanitation

Although far from representative, let me share our small attempt to examine selected practitioners’ views and assessment of CLTS. Our recently published paper should be accessible through this link (if not I will be happy to share it) - academic.oup.com/heapro/advance-article/...55-aacb-94e3e1748fec

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Comprehending practitioners’ assessments of community-led total sanitation
František Ficek Josef Novotný
Health Promotion International, day070, doi.org/10.1093/heapro/day070
Published: 19 September 2018

Abstract

Around 2.3 billion people in developing countries still lack access to improved sanitation facilities and almost one billion practice open defecation (OD). The Community-Led Total Sanitation (CLTS) has recently become a particularly popular approach used in more than 60 countries. CLTS is a behavior-change approach that aims to ignite community action and make OD socially unacceptable without providing any external financial or material support to individual households. CLTS is sometimes perceived as a revolutionary approach that has proven to be highly cost-effective in abolishing OD. However, it has been criticized for its use of unethical practices and questioned with respect to the sustainability of its outcomes and the limited health benefits it can generate. Based on semi-structured interviews with development workers experienced in the implementation of CLTS in 14 different countries, this paper seeks to examine practical views on the issues surrounding this approach. We found that despite acknowledging some of the controversies and the possibly limited sustainability of results, CLTS is generally considered an effective and satisfactory tool for improving sanitation conditions. Practitioners first of all accentuate the normative importance of the elimination of OD attained through CLTS without weighting on (the absence of) evidence on the longer term effects or impacts on health. However, a need for various modifications of CLTS according to local social and natural environments was strongly expressed, including changes that go against the core principles of CLTS like no subsidies and no technical assistance principles.
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Re: Comprehending practitioners’ assessments of community-led total sanitation

Dear Josef,

That's a very interesting paper that you published there. Interesting methodology. You wrote:

The material utilized in this qualitative study comes from semi-structured interviews with practitioners experienced in the implementation of CLTS. [...] Eventually, 19 practitioners from 6 different organizations (plus 2 freelancers) with experience across 14 different countries were interviewed.


It seems to me that CLTS tends to evoke quite a binary response: people either think it's really good or they think it's really bad. Of your 19 interviewees, would they all fall into the camp of "CLTS supporters" or do you think you had a cross-section there, or it didn't matter because the questions flushed all the issues out anyhow? Could the 19 interviewees have been biased (e.g. because they earn their living by conducting CLTS related work)?

I found this information from your conclusions very interesting:

In general, understanding the* processes operating behind the CLTS intervention has been limited, both theoretically and empirically, which exacerbates a risk of its mechanistic application.

* it said "to" in the paper but I think that was a typo

With your in-depth knowledge on CLTS, is there any chance I could interest you in adding some of your research results to the Wikipedia article on CLTS? See here: en.wikipedia.org/wiki/Community-led_total_sanitation

Regards,
Elisabeth

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  • pepino
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Re: Comprehending practitioners’ assessments of community-led total sanitation

Dear Elisabeth,
I apologize for the late reply.
To answer your first question: I think that most informants were generally positive about CLTS based on their experiences but realistic and not naive supporters... Yes, they can be biased in several ways including due to their selection (largely based on initial contacts by email, while those with more negative experiences with CLTS might be more reluctant to agree with interview), but this was a qualitative research and should not be generalized in a statistical way.

To your second comment: Yes, I do believe that understanding to processes is important and still not much studied empirically (and more common impact evaluations mostly do not address this). As far as I know, CLTS has no clearly defined and corroborated theory of change (draws on multiple theories / assumptions) so that empirical research may show which of the individual and social parameters it actually addresses/manipulates (and which not) in a given context. In my opinion, this type of empirical results may be similarly or more important for practice like, for example, findings on CLTS outcomes from evaluations. That is why I like two recent papers by prof. Mosler´s group: journals.plos.org/plosone/article?id=10....journal.pone.0197483 , bmcpublichealth.biomedcentral.com/articl...86/s12889-018-5287-y )

As for the CLTS Wikipedia page. I think it is informative, congrats to that. However, I do hope that people using CLTS do not rely on solely information from Wikipedia. In fact, I do think that there is no shortage of "grey-literature" information on CLTS, the opposite is more likely. But, as the recent systematic review by Venkataramanan et al concludes, there is a great need for more information from rigorous research.
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