CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF STUDY

Community led total sanitation is a sanitation behavior change intervention that was developed by Kamal Kar in Bangladesh in the late 1990s (Kar and Chambers, 2008). It was developed in response to unsustainable supply-driven sanitation programs. Traditionally, CTLS activities are intended for small, rural villages with socially and culturally homogenous populations (Kar and Chambers, 2008). The guiding principle of CLTS consists of empowering communities to take their own initiative and come up with their own solutions to become open defecation free (ODF) (Kar and Chambers, 2008). While, providing monetary or hardware subsidies go against its core principle (Kar and Chambers, 2008).

This is an integrated sanitation promotion approach to achieving and sustaining an Open Defecation Free (ODF) status. CLTS entails the facilitation of the community’s own observation, appraisal and analysis of their sanitation profile, their practices of defecation and the consequences, leading to collective action to become open defecation free (ODF).

It focuses on igniting a change in sanitation behavior to ensure real and sustainable improvements. It invests in community mobilization instead of hardware, and shifts the focus from latrine construction for individual households to the creation of “Open Defecation-Free” villages. It raises awareness that as long as even a few people continue to defecate in the open everyone is at risk of disease. It emphasizes a community sense of shame, fear and disgust about Open Defecation (OD), and ignites the desire to stop it and clean up their neighborhood. CLTS discourages target- oriented approaches. This is because such approaches degenerate into counting latrines and meeting targets for their construction, instead of assessing with rigorous standards the numbers of communities that truly achieve an ODF status.

Community led total sanitation recognizes that only providing latrines neither guarantees their use nor results in improved sanitation and hygiene. Therefore it concentrates on ending OD as a first significant step and entry point to changing sanitation and hygiene behavior. CLTS doesn’t prescribe high standards nor offer subsidies because this leads to uneven adoption, problems with long-term sustainability and only partial use of sanitation facilities.

An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas (UNICEF and WHO 2015). Open defecation adversely affects human health, contributing to diarrheal diseases and childhood stunting (Clasen et al. 2014; Spears et al. 2013; Vyas et al. 2016). Poor sanitation also has an adverse economic impact (DeFrancis 2011), and disproportionately affects the safety, health, and dignity of women (Hulland et al. 2015; Jadhav et al. 2016; Khanna and Das 2016; Kulkarni and O’Reilly 2014).

For decades, governments and nongovernmental organizations (NGOs) provided free or subsidized latrines to households, but practitioners widely believe that this approach was unable to guarantee regular latrine use. This recognition led to a focus on hygiene and health education programs, often combined with latrine subsidies, such as the Participatory Hygiene and Sanitation Transformation approach (WHO 1997). Lessons learned from implementing these programs led many sanitation professionals to conclude that while the infrastructure-heavy approach may have increased access to latrines and educational approaches may have increased awareness of health benefits, these strategies were largely insufficient to generate demand for latrines and change sanitation behavior (Jenkins and Sugden 2006).

As a response, the community-led total sanitation (CLTS) approach was developed, aiming to create open defecation–free (ODF) communities (Kar and Chambers 2008). This approach signified a fundamental shift from a focus on individual or household sanitation to a community-level concern for open defecation. CLTS facilitators attempt to trigger collective behavior change by encouraging and motivating people to confront the impact of community-wide open defecation. CLTS comprises three stages:

• Pretriggering: selecting communities, training facilitators, collecting baseline information, and coordinating community entry.
• Triggering: organizing a community-wide meeting where facilitators conduct participatory exercises intended to trigger shame and disgust. Attendees are expected to be motivated to change their sanitation situation.
•  Post triggering: conducting routine follow-up visits, with the goal of verifying and certifying ODF status in communities.

Since the first pilot projects in Bangladesh in 2000, CLTS has been adopted by many international NGOs involved in rural sanitation and has been incorporated into national policy by many governments. It is arguably now the predominant rural sanitation behavior change approach.

Most literature on CLTS is contained on websites and knowledge bases in the form of gray literature, primarily produced by practitioners to share insights from their implementation experiences. It has often been noted that there is limited rigorous evidence on CLTS impacts. Governments and organizations implementing CLTS face the challenge of navigating a vast and cluttered body of literature to inform their decisions.

Most study the impact of sanitation on health outcomes. A handful look at behavior- or demand-related topics, such as factors affecting sustained adoption of water and sanitation technologies (Hulland et al. 2015), behavioral research relating to point-of-use-water treatment technologies (Fiebelkorn et al. 2012), behavioral models for water and sanitation (Dreibelbis et al. 2013; Dwipayanti et al. 2017), and water, sanitation, and hygiene (WaSH) social marketing approaches (Evans et al. 2014

Community-Led Total Sanitation (CLTS) focuses on igniting a change in sanitation behaviour rather than constructing toilets. It does this through a process of social awakening that is stimulated by facilitators from within or outside the community.

It concentrates on the whole community rather than on individual behaviours. Collective benefit from stopping open defecation (OD) can encourage a more cooperative approach. People decide together how they will create a clean and hygienic environment that benefits everyone. It is fundamental that CLTS involves no individual household hardware subsidy and does not prescribe latrine models. Social solidarity, help and cooperation among the households in the community are a common and vital element in CLTS. Other important characteristics are the spontaneous emergence of Natural Leaders (NLs) as a community proceeds towards ODF status; local innovations of low cost toilet models using locally available materials, and community-innovated systems of reward, penalty, spread and scaling-up. CLTS encourages the community to take responsibility and to take its own action.

In its fullest sense, total sanitation includes a range of behaviours such as: stopping all open defecation; ensuring that everyone uses a hygienic toilet; washing hands with soap before preparing food and eating, after using the toilet, and after contact with babies’ faeces, or birds and animals; handling food and water in a hygienic manner; and safe disposal of animal and domestic waste to create a clean and safe environment. CLTS concentrates on ending open defecation (OD) as a first significant step and entry point to changing behaviour. It starts by enabling people to do their own sanitation profile through appraisal, observation and analysis of their practices of OD and the effects these have. This kindles feelings of shame and disgust, and often a desire to stop OD and clean up their neighbourhood.

Around the world, achieving total sanitation in communities has proved an ongoing challenge for sanitation stakeholders. It requires whole communities to commit to stop defecating in the open and hygienically contain all faecal matter. In recent years, sanitation programming has evolved dramatically. Increasingly, sanitation programming is focused on engaging communities, creating demand for sanitation, and supporting the development of sustainable systems and appropriate technologies – all of which are rooted in catalysing community behaviour and social change.

Hygiene and sanitation promotion has been gaining momentum in Ethiopia, where the number of people with access to a latrine has been improving (access reached 60 percent in 2011). However, the use and management of available latrines remains poor. Many international agencies and non-governmental organizations have been working to improve the hygiene and sanitation situation by constructing latrines using various kinds of subsidies. But even after such efforts, it remains difficult to find a single village in the country that is completely sanitized and free from open defecation. Success has generally been measured on the basis of the number of latrines constructed within a given period of time instead of on the extent to which people continue to practice open defecation even when latrines are available.

A new approach pioneered by Dr. Kamal Kar through the Village Education Resource Centre (VERC) (a partner of WaterAid Bangladesh), concentrates on empowering local people to analyze the extent and risk of environmental pollution caused by open defecation and to construct toilets without any external subsidies. The methodology is now being adopted in most regions of Ethiopia and elsewhere in Asia and Africa.

Similarly, in 2007, the Federal Ministry of Health’s Environmental Health Department asked the Water and Sanitation Program/World Bank-Africa and the USAID/Hygiene Improvement Project to assist with the implementation of the National Hygiene and Sanitation Strategy. Following this, CLTS, combined with innovative household behavior-change approaches and capacity building, was implemented as CommunityLed Total Behavior Change in Hygiene and Sanitation in the Amhara Regional State.

More recently, a hygiene component has been added to CLTS (now CLTSH). The CLTSH approach combines the basic principles of Community-Led Total Sanitation with intensive interpersonal communications (such as community Conversation and Family Dialogue) to foster improvements in hygiene practice through problem solving and collective action. Political commitment to CLTSH is reflected in a standardized national implementation guideline designed to harmonize the work of sector partners and community leaders in implementing the program. The strengthened CLTSH initiative is envisaged to accelerate the rate of achievement in various health-related programs, including the Universal Access Plan and the fourth Health Sector Development Plan. The pace at which the national Health Extension Program is achieving sanitation and hygiene targets throughout the country has also improved.

Community-Led Total Sanitation (CLTS) has in recent years been the preferred approach to promoting sanitation. The strategy centers on eliminating the practice of open defecation in rural and peri-urban areas. It is now being implemented nationwide by government and non-governmental actors.

1. STATEMENT OF THE PROBLEM

In its fullest sense, total sanitation includes a range of behaviours such as: stopping all open defecation; ensuring that everyone uses a hygienic toilet; washing hands with soap before preparing food and eating, after using the toilet, and after contact with babies’ feces, or birds and animals; handling food and water in a hygienic manner; and safe disposal of animal and domestic waste to create a clean and safe environment. Unhygienic living  kindles feelings of shame and disgust.

However, most communities in and around the world suffer a lot of diseases from unhygienic living. Many researchers have written on the need for proper hygiene and the negative effect of open defecation and unclean environment. But from the various research work done , non has researched on community led total sanitation, factors that that lead or contribute to the unhygienic living of these communities and ways to help them maintain proper hygiene. It’s on this premise that this study is carried out.

1. AIMS AND OBJECTIVES

The main aim of the study is to examine community led total sanitation a case study of Pantami in Gombe State. Other specific objectives of this study include:

1. To examine the need for community led total sanitation in Pantami Gombe State.
2. To determine the impacts of community led total sanitation.
3. To identify factors affecting community led total sanitation’s implementation and effectiveness in pantami Gombe State.
4. To determine the effects of unhygienic living to the residents of Pantami Gombe State.
5. To proffer solution to many diseases caused by unhygienic living and lack of environmental sanitation in Pantami Gombe State.
   1. RESEARCH QUESTION

1. What is the need for community led total sanitation in Pantami Gombe State?
2. What are the impacts of community led total sanitation?
3. What are the factors affecting community led total sanitation’s implementation and effectiveness in Pantami Gombe State?
4. What is the effect of unhygienic living?
5. What is the solution to many diseases caused by unhygienic living and lack of environmental sanitation in Pantami Gombe State?
   1. STATEMENT OF RESEARCH HYPOTHESIS

1. HO: there is no need for community led total sanitation in Pantanmi Gombe State.
2. H1: there is need for community led total sanitation in Pantami Gombe State.
   1. SIGNIFICANCE OF STUDY

Community led total sanitation concentrates on ending open defecation (OD) as a first significant step and entry point to changing behaviour. It starts by enabling people to do their own sanitation profile through appraisal, observation and analysis of their practices of OD and the effects these have on most communities. The study will bring awareness to the understanding of what community led total sanitation is especially to resident of Pantami in Gombe State, its importance and possible effects of unhygienic living.

It will further bring awareness to various agencies of Humanitarian services on enlightening these communities (Pantami in Gombe State) on the need for proper Hygiene and environmental sanitation as well as render help to them if need be.

Finally it will bring to the notice of the government of Gombe State to make and implement policies on thorough environmental sanitation and apply sanctions to defaulters.

1. SCOPE OF STYDY

The study will cover community led total sanitation (CLTS) using Pantami in Gombe State as a case study.

1. LIMITATIONS  OF STUDY

1. Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
   1. DEFINITION OF TERMS

Community-Led Total Sanitation (CLTS)

CLTS refers to Community-Led Total Sanitation. This is an integrated approach to achieving and sustaining open defecation free (ODF) status. CLTS entails the facilitation of the community’s analysis of their sanitation profile, their practices of defecation and the consequences, leading to collective action to become ODF. Approaches in which outsiders “teach” community members are not CLTS in the senses of this handbook. CLTS processes can precede and lead on to, or occur simultaneously with, improvement of latrine design; the adoption and improvement of hygienic practices; solid waste management; waste water disposal; care; protection and maintenance of drinking water sources; and other environmental measures. In many cases CLTS initiates a series of new collective local development actions by the ODF communities.

Open defecation(OD)

 OD means defecating in the open and leaving the stuff exposed. ODF means open defecation free, that is, when no faeces are openly exposed to the air. A direct pit latrine with no lid is a form of open defecation (fixed point open defecation), but with a fly-proof lid (with or without the use of ash to cover the faeces after defecation) qualifies as ODF. Defecating into a trench and covering the faeces can be part of the transition from OD to ODF.

Latrine and toilet:

A latrine is typically a direct pit, and a toilet is typically an arrangement with a water seal. In this handbook latrine is sometimes used to include both. Toilet is used where a water seal is likely to be more common than a direct pit.