Community-led total sanitation (CLTS) is an approach used in developing countries to improve sanitation and hygiene through spontaneous behavior change in communities. The goal of CLTS is to end open defecation and achieve "open defecation free" communities through raising awareness of the risks of disease transmission from fecal matter and participatory activities. Nepal began implementing CLTS in 2003 and has since made progress in expanding coverage, establishing national plans and committees to coordinate sanitation efforts. Challenges remain in fully implementing a community-led approach and maintaining outcomes after communities achieve open defecation free status.

1. Presented by:
MohammadAslam Shaiekh
Master of Public Health (MPH)
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Community Led Total Sanitation
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2. Introduction
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Community-led total sanitation (CLTS) is an
approach used mainly in developing countries to
improve sanitation and hygiene in a community.
focuses on spontaneous and long-lasting behavior
change of an entire community.
The goal of CLTS is to end open defecation.
Open defecation free" (ODF) is a central term for
community-led total sanitation (CLTS) programs.
 Primarily means the eradication of open defecation
in the entire community.
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3. Cont…
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CLTS focuses on community-wide behavioral
change, rather than merely toilet construction.
The process raises the awareness that as long as
even a minority continues to defecate in the open,
everyone is at risk of disease.
CLTS uses community-led methods, such as
participatory mapping and analyzing pathways
between feces and the mouth (fecal-oral
transmission of disease), as a means of teaching the
risks associated with OD.
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4. History of CLTS
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 In June 2003, Water Aid Nepal (WAN), Plan Nepal, Nepal
Water for Health (NEWAH) and other government and civil
society stakeholders travel to Bangladesh to visit the work
of Village Education Resource Centre (VERC) in relation
to sanitation promotion.
 The team were given some initial orientation on the
Community Led Total Sanitation (CLTS) approach and
shown the impact on the ground
 First pilot CLTS projects in Karki Danda, Dhading District,
Nepal, in October 2003.
 In the preceding two years, WAN and Plan supported a
number of local NGOs, including NEWAH, to implement
WaSH project using the CLTS approach on a pilot basis.
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5. Cont…
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 During this time a sector coordination committee
on CLTS was established to support dissemination of
experiences and the sharing of the approach with a wider
set of actors in the sector.
 The coordination committee organized further training to
other interested agencies on the CLTS approach, with the
support of Plan International.
 NICEF took a keen interest in the approach and decided to
pilot a modified CLTS approach, called School Led Total
Sanitation (SLTS).
 This approach took the school as the lead institution in
stimulating and promoting changes in sanitation, and
worked to cover the whole school catchment area.
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6. Cont…
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 The use of CLTS and SLTS approaches for promoting
sanitation were incorporated into a Government-led
programme to achieve total sanitation coverage in the
District of Chitwan
 The use of the CLTS approach have been implemented in
WaSH projects by at least 10 local NGOs in over 30 of the
75 districts in Nepal, with support of 6
International NGOs.
 However community-led approaches in Nepal are still not
mainstreamed and although some agencies,
including WAN, NEWAH, UNICEF and Plan, have made
moves in recent years to implement these approaches
across their programmes
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7. Sanitation related facts
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In Nepal, annually 10500 children below five years of
age die of diarrhea related disease ( Water Aid, 2008)
1.8 million children die every year as a result of disease
caused by unclean water and poor sanitation. (Water
Aid, 2008)
The simplest act of washing hands with soap and water
can reduces incidence of diarrhea by 44% (Unicef,
2009)
About 2.6 billion people half the developing world-
lack even a simple improved latrine (WHO,2009)
About 1.1 billion people have no access to any type of
improved drinking source of water (WHO,2009)
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8. Status of ODF in Nepal
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 1st ODF district : Kaski
 1st ODF municipality : Dharan & Ratnanagar
 Gaupalika : 393 out of 460
 Municipality : 205 out of 293
 District: 49 out of 77
 Province: 3 out of 7 ( 4,6,7 have 100% coverage)
 National sanitation coverage: 96.3%
(Source: ESS/DWSS,NSHCC)
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9. Province level status of sanitation
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10. National Hygiene and Sanitation Master
Plan
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 In 2011, Nepal Government developed a National Sanitation
and Hygiene Master Plan (2011-2017), which sets an
ambitious target of achieving 100% Community‐Led Total
Behavior Change in Hygiene and Sanitation (CLTBCHS)
status across all 75 Districts by 2017.
 The Master Plan established a decentralized system for
sanitation programming, recognizing the “leadership of the
local government bodies,” setting the VDC and
municipalities as the basic planning unit for sanitation.
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11. Cont…
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Subsequently sanitation coverage has risen from
6% in 1990 to 62% in 2012.
Largely focuses to Open Defecation Free (ODF)
with universal access to toilet in both the urban and
rural context through the total sanitation approach.
It has recognized the improved toilet facilities as
defined by the Joint Program Monitoring (JMP)
Report of UNICEF and WHO.
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12. National Hygiene and Sanitation
Master Plan
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 To achieve TBC status each community must
achieve the following 12 conditions:
1. All households use hygienic latrines
2. Latrines are kept clean
3. Hands are washed with cleaning agent at critical
times
4. Food kept covered
5. Drinking water kept covered
6. Household environment kept covered
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13. Cont…
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7. Footwear worn in the latrine
8. Water sources kept clean
9. Roads and paths kept clean
10.Waste (including faecal matter) is disposed of
appropriately
11.Personal hygiene kept up
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14. National Sanitation and Hygiene
Master Plan
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Action Plan
Phase I: Institutional Building
Phase II: Planning and Programming
Phase-III:ODF Campaigning and Behavior Change
Phase IV: Post ODF Campaigning (Total Sanitation)
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15. National Sanitation and Hygiene Master
Plan
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 The Master Plan sets mile stones for sanitation
coverage to achieve on a yearly basis
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16. Key features of CLTS on Hygiene and
Sanitation
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Main strategy
 ODF declaration in a community through facilitators/
local committee
 Wider application of PRA tools for instant community
action
 Promotion of locally appropriate low cost toilet
Support mechanism
No subsidy for household toilets; reward after ODF
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17. Cont…
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Coverage targets
Community or cluster
Tools and techniques
Specially PRA tools for triggering communities
Strength/success
 Communities/ clusters declared ODF
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18. Coordination
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 The Department of Water Supply and Sewerage (DWSS) in
the Ministry of Urban Development (MoUD) is primarily
responsible for sanitation.
 MoUD works closely with other ministries, the primary
partner being the Ministry of Local Development (MoLD),
which houses the Department of Local Infrastructure
Development and Agricultural Roads (DoLIDAR).
 National Sanitation and Hygiene Steering Committee
(NSHSC): coordinates with relevant ministries; reviews
policies, plans, and budgets.
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19. Cont…
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National Sanitation and Hygiene Coordination
Committee (NSHCC): responsible for national
planning of sanitation activities; implements decisions
of NSHSC;
supports regional and district coordination committees;
monitors ODF performance; organize ODF Compaigns
WaSH coordination committees (WASHCCs) exist at
the regional, district, VDC levels.
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21. Monitoring and Evaluation
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 For monitoring of school/ community level activities, a
rural municipality/ municipality level monitoring team is
formed, whereas, for rural municipality/ municipality level
activities, a district monitoring team is formed.
 Similarly, a province or national level or combination of
both levels team is formed for district level activities.
 These teams will facilitate the process for ODF declaration
and it’s verification at respective levels.
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22. Challenges
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 Practice of subsidizing of the latrines by the partners
 Overlap of latrine construction period and the onset
of the rainy season.
 Persistence of negative view on women leadership in
some communities.
 Time between triggering and reaching ODF
 Water points in CLTS communities
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23. References
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 NEPAL, G. O. 2011. SANITATION AND HYGIENE
MASTER PLAN
 OUSMANE, T. 2015. plan African CLTS programme.
 ASSOCIATES, A. Dec, 2014. Evaluation of the UNICEF
Sanitation Programme at Scale in Pakistan (SPSP) – Phase
1
 http://www.communityledtotalsanitation.org/country/nepal
 Sanitation Status of Nepal, March 2018 :: Ministry ofWater Supply
[Internet]. [cited 2019 Jan 29].Available from:
http://mowss.gov.np/article/112/sanitation-status-of-
nepal.html
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