39669 The Water and Sanitation Program February 2007 is an international partnership for improving water and sanitation sector policies, practices, and capacities to serve poor people Field Note Community-Led Total Sanitation in Rural Areas An Approach that Works Sanitation programs have, for some time now, incorporated the need to raise awareness and emphasize the benefits of toilet usage.This has been most effectively undertaken by empowered communities motivated to take collective action, with the local governments and other agencies performing a facilitating role. At the heart of this approach lies a paradigm shift to collective behavior change in creating open defecation-free environments. Executive Summary Why is Rural Sanitation a Sanitation remains one of the biggest development challenges in all developing countries. Improving sanitation is the key to achieving the Concern in South health-related Millennium Development Goals (MDGs) of reducing child Asia? mortality and combating disease. However, these outcomes will remain pressing and persistent concerns for many nations even as they Despite significant progress in approach the goal of halving the number of the world's poor by 2015, Bangladesh, and some improvement which in turn will have considerable bearing on the progress of attaining in India in recent years, sanitation this goal by itself. A focus on appropriate outcome-oriented approaches coverage in the rural areas of South to rural sanitation is critical, given that a majority of poor households continue to live in rural areas. Asia continues to be a matter of concern. It was estimated in 2003 that Conventional approaches in South Asia have attempted to tackle the approximately 653 million people issue of poor sanitation by trying to improve coverage and access with (76 percent of the total population of financial support for constructing toilets. However, for many years it has the region) still lack access to been evident that providing subsidies for construction of individual toilets adequate sanitation.1 alone does not necessarily translate into usage. Behavior change is a key ingredient for this to occur. Sanitation programs have, for some time The practice of open defecation by now, incorporated the need to raise awareness and emphasize the the majority of people in this region benefits of toilet usage. Even this marketing of sanitation, in order to is one of the most serious create individual demand (often combined with subsidies linked to toilet environmental threats to public construction by households) has not necessarily resulted in significant health. Open defecation and the progress in securing the desired outcomes from sanitation programs in failure to confine excreta safely are theregion. primary factors that contribute to the spread of disease and infection It is in this background that the significant results demonstrated by a through the bacteriological recent approach adopted in South Asia have drawn attention. At the contamination of water sources and heart of this approach is a shift away from the provision of subsidy-led the transmission of pathogens toilets for individual households and emphasizing not merely behavior through the fecal-oral route. Improved change by individuals in general but of an entire collective, to achieve hygiene practices by entire 'open defecation-free' villages.The objective is to reduce incidence of communities, including the use of diseases related to poor sanitation and manage the public risks--posed sanitary toilets, can effectively break by the failure to safely confine the excreta of some individuals--at the this cycle of disease transmission. community level.This has been most effectively undertaken by Policy intervention to help achieve empowered communities motivated to take collective action, with the this objective could reduce the government and other agencies performing at best a facilitating role. disease burden by as much as There is a growing recognition that this evolving approach, often referred 50 percent.2 to as Community-LedTotal Sanitation (CLTS), offers tremendous potential not only for achieving, but even for surpassing, the relevant 1Joint Management Programme 2004. 2Planning Commission of India, Mid-Term Appraisal of the Tenth MDG targets set for 2015. Plan, 2005. 2 Urban Water Sector inSanitation Community-Led Total South Asia: Benchmarking Performance in Rural Areas: An Approach that Works Box 1:What are the Outcomes of Hardware-Driven Programs? The Government of Andhra Pradesh has, over the past few years (post-2001), committed considerable funds to a statewide sanitation program providing subsidies for the construction of toilets in rural areas (under the program, each household is given approximately US$ 16 and 100 kg rice coupons). Substantial coverage has been achieved under the program, and some 2.95 million household toilets have been constructed during this period. However, random concurrent evaluation shows that an estimated 50 percent of these subsidized toilets remain unused or are being used for purposes other than sanitation. Similarly, in Maharashtra, 1.6 million Preferred usage of subsidized toilets. subsidized toilets were constructed during 1997-2000 What has Been the Approach So Far? India, till recently, the national but concurrent evaluation by the government provided financial government puts usage at Traditionally, sanitation programs in assistance to identified poor (below around 47 percent. In the small the region have focused on providing poverty line) families for state of Himachal Pradesh, over toilets, usually on a subsidized basis, constructing toilets of a specified 0.3 million toilets have been built rather than on motivating their usage. design. In addition to this through a subsidy-driven Evidence now overwhelmingly points assistance, many state and program in the 1990s, but to the fact that providing subsidized provincial governments across the random evaluation in 2003 toilets does not necessarily lead to South Asia region had introduced showed usage of less than enhanced usage or ensure behavior their own schemes of providing 30 percent. change for all the households or the subsidy, often covering an even entire community.The focus mostly wider segment of the population. Sources: WSP-supported Rural Water Supply and Sanitation Sector Assessment Study in Andhra remains on construction of toilets in For example, in Bangladesh, early Pradesh, 2004; Unpublished reports/official statements from the Government of Maharashtra; WSP-supported rural areas either directly by the initiatives in sanitation focused on study on Rapid Assessment of Rural Sanitation in government or by providing a high the distribution of fully-subsidized Himachal Pradesh, 2003-04. level of subsidy to beneficiaries. In sanitation hardware. 3 The reason why people defecate in the open is not necessarily due to lack of toilets. Key Issues Does Subsidized Construction of Recent studies of statewide sector Can Health Outcomes be Toilets Lead to Usage? assessments in India show that Achieved if Only Some Households most people continue to defecate in UseToilets? While investment in toilet construction the open not due to a lack of access through the provision of generous to toilets but primarily because they It has been observed that even where subsidies for hardware to households see no reason to change their higher access and usage of sanitation has, to some extent, increased the behavior because awareness of facilities by several households has reported coverage of sanitation in the associated health risks is limited or been reported, improved public health region, subsidy-driven programs do ignored. In fact, usage of toilets is outcomes have not necessarily been not generate motivation for use of the highest where households achieved.This is because even if some facility. Indeed, subsidized toilets are recognize the need for toilets people still continue to practice open often not used or lie abandoned, or and therefore, construct them on defecation, the surroundings are not are being put to alternative uses. their own.3 free from fecal contamination.Public health outcomes can be achieved only Table 1: Individual Sanitation Practices Affect the Entire Community when the entire community adopts improved sanitation behavior, the area is 100 percent open defecation-free, Category Users of Prevalence of and excreta is safely and hygienically toilet (%) diarrhea (%) confined. This is possible only when Open defecation­prevalent villages 29 38 the collective is made aware of the negative effects of poor sanitation, Almost open defecation-free villages 95 26 sensitized about the fecal-oral transmission route, understands the Open defecation-free villages 100 7 link between sanitation and health, The table shows that rural households in Himachal Pradesh with limited abandons the traditional practice of toilet coverage reported a high diarrhea recall (up to 38 percent). Even open defecation for ever, and every villages with close to 100 percent household toilet coverage showed a member of the community has access significantly high recall of diarrhea incidence. Only villages declared to be to, and uses a, sanitary toilet ensuring open defection-free, with 100 percent toilet usage, reported a significant safe disposal of fecal matter. drop in diarrhea recall to 7 percent. What are the Limitations of the In effect, even if a small segment of the population continues to practice Generally Practiced Approach to open defecation, the risk of bacteriological contamination and disease Behavior Change? transmission may continue to be high. The general practice is to focus on Source: Formative research by WSP-Knowledge Links for IEC Manual in Himachal Pradesh, 2005. inducing behavior change in 3Rapid Assessment of Rural Sanitation in Himachal Pradesh (WSP) in 2003-04 and Andhra Pradesh RWSS Sector Assessment (WSP), 2004. 4 Urban Water Sector inSanitation Community-Led Total South Asia: Benchmarking Performance in Rural Areas: An Approach that Works individual households (often along key message--the public health sanitation. It may also result in the with hardware support) with the idea impact of sanitation--is subsumed construction of unsanitary toilets that that these efforts would gradually within these concerns. This can lead fail to confine excreta safely. include the entire community. to toilets being constructed and even However, this approach does not being used by those who need them, In order to negate the adverse recognize the fact that till the entire but does not necessarily result in consequences of poor sanitation and community adopts the required instilling sustained behavior change to secure the benefits envisaged from behavior change, there would be no by all members in the entire improved sanitation, it is imperative to real benefit from improved sanitation. community, which is what will lead to ensure collective action motivated significant improvement in the primarily by the need to change The attempt is to promote toilet usage environment and achieve the public behavior. This change can only be by highlighting advantages such as health outcomes that are the sustained if collective action is the convenience, privacy, and dignity. The fundamental objective of improved result of self-realization by the community of the adverse consequences of prevailing practices. Figure 1: Increased Access May Not Translate into Improved Igniting self-realization in the Public Health Outcomes community about the negative effects of open defecation along with the adoption of improved and hygienic practices that ensure a safe, sanitary, and open defecation-free NoToilet environment is another critical 23.2% element lacking in traditional SanitaryToilet 40.1% approaches. · Bacteriological loading of ground water `Pig'Toilet in Goa is 1,000 times the permissible Rather than being driven by targets 22.7% drinking water limit. for the construction of toilets in · Sample surveys indicate that 90 `OpenDrain' individual households, as in percent of the wells in Kerala are toilet, 13.9% bacteriologically contaminated. traditional approaches, sanitation programs must shift their focus to measuring outcomes based on In India, the states of Goa and Kerala have the highest access to toilets (over 80 stimulation of effective demand in percent), which has been driven by the urbanized nature of these states and the communities as a whole. The lack of convenient space for open defecation. However, studies indicate that the Community-Led Total Sanitation bacteriological contamination of water in these two states remains high as a result (CLTS) approach seeks to address of the continuance of poor sanitation practices and the use of inappropriate toilet the various lacunae in traditional designs or technology. approaches highlighted in the Source: RWSS Sector Assessment of Goa and Kerala (WSP), 2005. foregoing discussion. 5 Pilots evoked interest among policy makers in South Asia to strengthen sanitation programs. What is Village Education Resource Centre (VERC), a local nongovernmental Community-Led organization (NGO) and partner of Total Sanitation? WaterAid Bangladesh, to achieve total sanitation coverage. The approach 'triggered' the community to Community-Led Total Sanitation achieve a total ban on open (CLTS) is based on the principle of defecation within the village, without triggering collective behavior change. any external subsidy, and based In this approach, communities are entirely on community mobilization. facilitated to take collective action to Communities used their own adopt safe and hygienic sanitation resources, established action behavior and ensure that all committees, developed innovative Community triggering process. households have access to safe low-cost technologies, monitored sanitation facilities.This approach progress, and ensured that all Government of Maharashtra had helps communities to understand and households adopted fixed-point safe already launched the Sant Gadge realize the negative effects of poor and hygienic defecation practices. Baba Clean Village Campaign, an sanitation and empowers them to External agencies only facilitated innovative scheme to reward local collectively find solutions to their the process.4 governments, and was looking at sanitation situation. In the process, ways to strengthen sanitation the community is sensitized of the The Rajshahi initiative demonstrated a outcomes and take forward the consequences of poor sanitary paradigm shift in promoting improved program in the state. practices, commits itself to finding sanitation practices through a own solutions, and finally is liberated community-focused strategy.However, Based on the visits to Bangladesh and from open defecation.This helps in the approach to scaling up was dissemination of lessons in creating a receptive environment for modest and only a village-by-village workshops, Maharashtra formulated a the adoption of improved practices in upscale was attempted. strategy to end open defecation in the personal hygiene, safe handling of state. It was recognized that food and water as well as safe Widening the CLTS Base: Scaling replicating the Rajshahi model in confinement and disposal of excreta up from Pilot to Program totality would have limitations for and waste. scale up. Accountable institutions The Rajshahi pilot evoked interest in would need to be involved to provide The CLTS Approach: India, leading to visits by policy the necessary support mechanisms to TheBeginnings makers from that country facilitated by sustain the change process for long- Water and Sanitation Program-South term benefits.The key features of the In Rajshahi district, Bangladesh, a Asia (WSP-SA). Representatives from Maharashtra approach were to bring unique community mobilization the state government of Maharashtra local governments to the fore, provide approach was piloted in 2001 by the were among these visitors. The fiscal support to the poor through the 4This process has been documented in Jal Manthan, 5 and 7, (2002), available online at www.wsp.org. Also Dr Kamal Kar, 2003, `Subsidy or Self Respect', Institute of Development Studies, University of Sussex, United Kingdom. 6 Urban Water Sector inSanitation Community-Led Total South Asia: Benchmarking Performance in Rural Areas: An Approach that Works collective post facto achievement of Box 2: Key Principles of the CLTS Approach: an open defecation-free environment, The Maharashtra Experience and link the state reward scheme to collective outcomes to ensure credible and transparent monitoring Igniting behavior change and eliminating open defecation, not just and evaluation of outcomes. Program building toilets. implementation was visualized in a campaign mode with a strong Focusing on outcomes, not on hardware inputs. emphasis on information, education · Collective action: Mobilizing the community rather than establishing and communication activities, household contacts. exposure visits to best performing · Local choice: Accommodating a variety of technological options and villages, and handholding workshops getting people to access affordable technologies. to help in the dissemination of · Setting up appropriate institutional frameworks: Giving local lessons and sharing of experiences. governments a central role in scaling up and sustainability. · Incentives: Directing incentives to the community and rewarding The Bangladesh visits and outcomes, rather than subsidizing household toilets. Maharashtra initiative also assisted in · Market development: Promoting the availability of sanitary materials and revising the national sanitation allowing private suppliers to respond to the demand. guidelines in India and contributed in introducing the concept of the need to create open defecation-free villages. Box 3: Involving Local Government in Scale up To support the development of open defecation-free villages, a national- level fiscal instrument, the Nirmal The 'public good' dimension of sanitation requires government intervention Gram Puraskar (NGP), was launched given its reach and mandate, ideally at the local level. In CLTS, local in 2004.This rewards local governments play a vital role in facilitating the mobilization of communities governments on achieving open for collective action.They also help to develop local action plans including defecation-free areas within their planning mobilization strategies, thinking of low cost technology options, administrative jurisdiction (see Box 4). providing incentives, developing the supply market, monitoring the Similarly, Bangladesh learnt from implementation process, and achieving sanitation outcomes. Local India, especially from Maharashtra, governments are well positioned to ensure long-term benefits and sustained the approach of involving local collective behavior change through local monitoring processes.While governments, incentives directed at nongovernmental organizations' (NGOs) initiatives have been successful in communities, and rewards to local demonstrating the CLTS approach, experience shows that the involvement governments on post-achievement of of the local government legitimizes local action and accelerates scaling up. open defecation-free areas. An NGO's actions are strategically utilized by local governments for mobilizing communities. 7 Providing fiscal incentives demonstrates a substantial shift in sanitation financing. Box 4: India: Scaling up Sanitation Nationwide Through Nirmal Gram Puraskar The Nirmal Gram Puraskar (meaning `Clean Village Prize') was introduced by the Government of India in 2004. The scheme offers cash rewards to local governments that achieve 100 percent sanitation (that is, that are open defecation-free and have also tackled the issues of liquid and solid waste). Providing fiscal incentives demonstrates a substantive shift in intergovernmental fiscal transfers--from financing sanitary inputs, such as household toilets, to an approach that emphasizes demand creation and rewards communities for collectively achieving sanitary outcomes. By providing incentives to community efforts to meet collective gains in sanitation, the scheme helps to raise the status of the village, create peer pressure Children's brigade in action:No more open among neighboring villages, and foster competition defecation, stop polluting water! among all tiers of governance within and across states. The response to the scheme has been tremendous. In February 2005, for The Spread of the instance, 38 gram panchayats (the lowest tier of elected rural local government) received the Nirmal Gram Puruskar and in February 2006 this CLTS Approach in number went up to 760 gram panchayats and 9 block panchayats (an intermediate tier of elected rural local government). Maharashtra and Beyond State Performance for Nirmal Gram Puraskar: 2005 and 2006 The Government of Maharashtra introduced the CLTS approach in two pilot districts in 2002 and encouraged other districts to learn from these experiences. In 2005, the state formally decided to scale up its efforts across the state. The success of combining local government participation and community-led initiatives is evident from the results of rapid scale up. From a situation of constructing 1.6 Source: Rajiv Gandhi National Drinking Water Mission, Department of Drinking Water, Government of India, March 2006. million toilets with state government support and not having a single 8 Urban Water Sector inSanitation Community-Led Total South Asia: Benchmarking Performance in Rural Areas: An Approach that Works open defecation-free village in Accelerating sanitation.The national government 2002, Maharashtra had reached also instituted a reward for open more than 3,800 open defecation- Sanitation defecation-free union parishads free villages by the middle of 2006. Coverage (elected rural local government The state now has over 5 million bodies). Over the past two years, 10 households living in open in Bangladesh percent of union parishads in the defecation-free villages, and based country have achieved open on the current growth rate, the state defecation-free status. CLTS has been Based on the home-grown approach of government is set to achieve an able to address the challenge of CLTS in Bangladesh, the Maharashtra eradicating open defecation in open defecation-free environment experience of the effectiveness of Bangladesh, with over 70 million by 2008 for its entire rural involving local government, as well people adopting safe sanitary population of more than 50 million. as the introduction of a national practices in just over five years. reward scheme in India, the Other Indian state governments Government of Bangladesh The scale up of this community-based have begun to exhibit an interest in formulated a national strategy to approach and the involvement of the approach. Himachal Pradesh accelerate sanitation promotion by local governments have resulted in a has formally adopted a strategy to local government involvement and phenomenal growth in sanitation pursue the CLTS approach, and facilitate the process of scale up. coverage. With over 70 percent Madhya Pradesh and Haryana are coverage now, the Millennium set to follow.Within South Asia, there In 2004, the Government of Bangladesh Development Goal target for are efforts in Pakistan and Nepal to made a marked shift in policy by sanitation in Bangladesh has already take up the approach, while CLTS allocating 20 percent of the annual been achieved and the country is has been introduced as a national development budget to local ahead of its target to achieve 100 program in Indonesia and Cambodia. governments for the promotion of percent sanitation coverage by 2010. Figure 2: Growth in Open Defecation-free Gram Figure 3: Sanitation Coverage in Bangladesh Panchayats 4000 100 RequiredBangladesh 3500 3561 90 (>5 million Trend 3000 population) 80 (%) GPs 70 2500 60 ODF of 2000 Coverage 50 1688 Actualcoverage 40 1500 Required MDF Number 1146 30 Trend 1000 Households20 10 500 515 2 13 39 0 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Sep'03 Sep'04 Sep'05 Source: Bangladesh Bureau of Statistics, UNICEF National Sanitation Secretariat. Source: Government of Maharashtra, March 2006. Prepared by Shafiul Azam Ahmed, WSP-SA. 9 Communities and local governments are the key stakeholders in Community-Led Total Sanitation. How Does CLTS Address Critical Elements environment for CLTS to succeed in matters like channeling fiscal support in Implementing a Sanitation Program? for inducing collective behavior change for improved sanitation and rewarding outcomes.In addition, higher tiers of government or external agencies also have a role in implementation.They are expected to play a facilitating role that assists in both mobilizing communities and stimulating demand for awakening collective action as well as enabling the community to make informed choices on issues like assisting the Although CLTS is showing remarkable advocates that these issues are best poor, choosing between technologies, results on the ground, there is tackled not through a prescriptive top- arranging supplies, and related skepticism about whether this down approach but by relevant matters. approach can address various institutions undertaking appropriate elements critical in implementing roles. CLTS requires communities and Supporting collective behavior sanitation programs. Issues of building local government on the one hand and change at scale: It is generally awareness on a mass scale, higher tiers of government or external perceived that as CLTS requires affordability by poor people, agencies on the other to assume effective and in-depth facilitation to appropriate technology for difficult different roles in the implementation of enable communities to work together, hydro-geological and topographical a sanitation program.Communities this approach can only be effective situations (availability of water, high and local government are the key (a) where government programs are water tables, hard rock terrain, and so stakeholders in CLTS. Once the need committed to support capacity on), supply chain arrangements, and for the collective to change its development;and (b) where availability of necessary skills in rural behavior is realized and established, committed NGOs are available. In the areas have all been central in devising the collective are facilitated to find absence of committed NGOs, there sanitation strategies over the years. ways to resolve any problems posed may not be adequate capacity to The question often posed is: How can by affordability, technology, physical mobilize communities. However, CLTS, with its emphasis largely on environment, and the like.The higher these gaps are to be filled by creating igniting collective behavior change tiers of government are expected to a cadre of skilled and committed through interpersonal communication, design policy and render trainers (by drawing on committed address these concerns? implementation support in a manner personnel even from within the that facilitates and does not dilute the government system as well as The question is based on an process of self-realization by the drawing on resources from civil inadequate appreciation of CLTS as it community and its desire to undertake society, engaging para-professionals, has evolved since it was first piloted. collective action to become open and so on) to ignite behavior change The CLTS approach takes into defecation-free. Policy and strategies and mobilize communities. Various account these core issues. It are expected to create an enabling support groups can be identified and 10 Urban Water Sector inSanitation Community-Led Total South Asia: Benchmarking Performance in Rural Areas: An Approach that Works involved as motivators to facilitate defecation-free environment is Creating a supply chain: Key to the community mobilization and assist in achieved. In villages in Bangladesh success of this approach is the demand stimulation. For example, in and Maharashtra, poor households establishment of an effective system Rewa district in the Indian state of have been supported to achieve the to meet demand for the range of Madhya Pradesh, the district collective goal of creating an open technologies that may be appropriate administration created a band of 600 defecation-free environment in a for the local household profile. In motivators to fan out to all the villages variety of ways. In practice, richer Bangladesh, a range of low-cost in the district, by designing households have provided financial technologies and sanitary products appropriate training modules and assistance to poorer households, self- have been developed with local imparting training through master help groups have provided innovation, and private entrepreneurs trainers. Similarly, in Bangladesh, the microfinance for the purchase of are making inroads in marketing their decentralized total sanitation project sanitaryware, panchayats have products and meeting consumer creates an army of trained local level provided interest-free loans, and demand. In Maharashtra, there are motivators and sets up area level task panchayats and landed families have examples of local governments forces for community action. made land contributions.With the facilitating the availability of material stimulation of demand and the close to villages and encouraging Addressing the needs of poor internalization of improved sanitary private entrepreneurs to set up people: The CLTS approach requires habits, low-income communities are retail outlets. that every household in the even exercising a choice in favor of community, including those of poor more expensive design options and Ensuring sustained behavior people, should participate in this graduating up the sanitation ladder. change: The CLTS approach movement. Implicit in this is a facilitates peer monitoring at the local recognition of the need for the Overcoming physical constraints: level to ensure that villages remain community to deal with issues of CLTS has demonstrated that scarcity open defecation-free. A sense of affordability and the concerns of the of water, adverse hydro-geological pride and recognition is created poor households.Information on low- conditions or topographical terrain are within the community when their cost technology options and their not insurmountable obstacles to village is officially declared open application on how these can be securing a collective resolve to change defecation-free. Rewards from the implemented allow each behavior. Once ignited to achieve an national government and from socioeconomic group to choose a open defecation-free environment, competitions among best performing toilet based on its affordability.These communities find local solutions to villages have conferred a higher tools facilitate the community's address the situation. For example, in status to open defecation-free approach on these issues. drought-prone villages in Ahmednagar communities. The recognition has district in Maharashtra, drought brought a sense of pride in their Communities get together to cross- mitigation and management systems achievement and a desire to protect subsidize the poor households and have been developed to ensure that that status, resulting in a close make microfinancing arrangements, or the minimal needs of water for monitoring of household behavior by local governments come forward to sanitation are not compromised communities. Self realization, peer support the participation of poorer and there have been no reported pressure, and recognition come households so that the collective instances of people going back to together to play an important role in objective of creating an open open defecation. sustaining behavior change. 11 be secured, is easy to grasp.The Water and Sanitation Program- CLTS approach has demonstrated the South Asia ABOUTTHE SERIES: ability to best meet this objective but The World Bank 55 Lodi Estate, New Delhi 110 003 the principles that underlie its WSP Field Notes describe and India successful implementation are not as analyze projects and activities in easily accepted.The legacy of Phone: (91-11) 24690488, 24690489 water and sanitation that provide traditional approaches and thinking Fax:(91-11) 24628250 lessons for sector leaders, constantly weigh down CLTS. E-mail: wspsa@worldbank.org administrators, and individuals Web site: www.wsp.org Subsidies and motivation linked to tackling the water and sanitation toilets for individual households challenges in urban and rural compromise this approach and the areas.The criteria for selection of achievement of collective behavior stories included in this series are change is still not widely appreciated. large-scale impact, demonstrable The fact that even outcome-based sustainability, good cost recovery, rewards can trigger toilet construction replicable conditions, and targets, unless adequate safeguards leadership. are in place, is not always realized. Analytical studies of the situation on February 2007 the ground, workshops to disseminate WSP MISSION and share findings as well as To help the poor gain sustained access to exposure visits to dispel skepticism water and sanitation services. and build acceptance of what is TheWay Ahead possible are all still essential for the WSP FUNDING PARTNERS successful implementation and spread The Governments of Australia, Austria, With the formulation of appropriate of CLTS even in its home ground in Belgium, Canada, Denmark, France, Ireland, guidelines, demand-responsive Luxembourg, the Netherlands, Norway, South Asia. Sweden, Switzerland, the United Kingdom, the strategies, and inclusion of fiscal United States of America; the United Nations incentives, the foundation has been However, enough ground has been Development Programme, The World Bank, laid for achieving overall sanitation covered and success demonstrated to and the Bill and Melinda Gates Foundation. goals in countries such as India and be able to send out a strong message Bangladesh.Policy decisions by about the promise that CLTS holds. AusAID provides WSP-SA programmatic central and state governments on support. Devising appropriate institutional adopting outcome-focused frameworks by keeping the local ACKNOWLEDGMENTS approaches are a positive step government at centre-stage, This publication is prepared based on a series towards scaling up and sustaining formulation of effective information, of policy discussions, workshops, consulations, behavior change for meeting education and communication and interaction with national, provincial, and sanitation outcomes. However, policy strategies, providing of technology localgovernmentsinSouthAsia.Documentation makers need to be continuously know-how and choices, ensuring inputs from Deepika Ganju (Consultant), Shafiul Azam Ahmed (Water and Sanitation Specialist, informed to ensure that policies and monitoring mechanisms and WSP-SA), and C. Ajith Kumar (Water and strategies remain on track. developing the capacity of a cadre of Sanitation Specialist, WSP-SA) helped in motivators to trigger mindset change finalizing the publication.This publication has The logic of focusing on behavior in different settings could go a long been peer reviewed by Shekhar Shah change of an entire collective, if the way in meeting the health- and (Economic Advisor, South Asia Region, World public health objective that underlies sanitation-related Millennium Bank) and Eduardo Perez (Senior Water and Sanitation Specialist, WSP). the search for improved sanitation is to Development Goals. PREPARED BY Deepak Sanan and Soma Ghosh Moulik The findings, interpretations, and conclusions expressed are entirely those of the authors and should not be attributed in any manner to The World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the companies they represent. Editor:AnjaliSenGupta The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, Pictures by: Shafiul Azam Ahmed, C. Ajith Kumar and other information shown in this work do not imply any judgement on the part of The World Bank concerning the legal Created by: Roots Advertising Services Pvt Ltd status of any territory or the endorsement or acceptance of such boundaries. Printed at: PS Press Services Pvt. Ltd., India