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Access to improved sanitation and clean drinking water in Madagascar is severely limited: just 12% of the population has access to improved sanitation facilities (9% in rural areas), and 52% has access to improved water sources (35% in rural areas) (JMP, 2015). Whilst water provision has increased moderately since 1990, progress in the sanitation sector has been slow. Open defecation remains widespread and, combined with poor hygiene practices and a severely limited diet, results in high levels of diarrhoeal disease and malnutrition. This in turn exacerbates levels of poverty through a reduced ability to work (WHO, 2012).

Since 2008, however, the situation has shown signs of change. The implementation of CLTS in over half of Madagascar’s 22 regions is making positive progress, motivating communities to eliminate open defecation and build their own latrines. Whilst the number of communities which have become open defecation free (ODF) across the country is somewhat disputed (claims range from 767 to 9,049), there is little doubt that the approach is stimulating change where none has been seen for years.

History and stakeholders

CLTS was introduced to Madagascar by UNICEF in 2008 and is now supported by a number of major technical and financial partners at the national level (including Global Sanitation Fund, WaterAid and USAID) as well as a host of implementing partners working at the regional, district, commune and fokontany (village cluster) levels. In March 2010, Madagascar became the first country to start using the Global Sanitation Fund (GSF) funding mechanism to address sanitation. Since this time, Madagascar has pioneered GSF’s objectives to scale up sanitation work and its principles of zero subsidy; put focus on the poor and rural populations; and, in line with CLTS, give a strong focus on achieving behaviour change rather than on building latrines. In addition to being implemented at scale in rural areas, CLTS is also being implemented in urban settings by the NGO Azafady in the south east of the country. Coordination between CLTS stakeholders is facilitated through Madagascar’s Diorano WASH network as well as GSF’s CLTS Programme Coordinating Mechanism.


No single unified CLTS approach is promoted in Madagascar and implementers are encouraged to adapt the triggering, ODF verification and follow-on processes to best suit their locality. Given the environmental, cultural and economic diversity across the country, this flexibility is seen as a vital component of CLTS’s success. Some CLTS projects are training community health workers to initiate CLTS and provide follow-on support in their constituencies, some are supporting Ministry of WASH staff to take the lead, and others are supporting community and/or natural leaders to run activities.

Another successful element of Madagascar’s approach to CLTS is its stakeholders’ willingness to embrace learning and change. CLTS processes in Madagascar are constantly adapting as new techniques are tried and results are shared with others through the Diorano WASH and Programme Coordinating Mechanism platforms, which are becoming increasingly well established. GSF’s FAA CLTS initiative is the largest CLTS programme in the country and convenes workshops between its implementing partners to share best practice and learning, particularly on how to achieve results at scale. UNICEF meanwhile has facilitated training from experienced Malian practitioners in order to develop the skills of a core group of 68 expert CLTS practitioners in Madagascar.

An outcome of this willingness to adapt has been the widespread introduction of “institutional triggering”, using CLTS techniques to mobilise government officials, community leaders, elders and other influential figures ahead of communities. This has resulted in a positive enabling environment in many parts of the country, with an increase in political will to address sanitation issues.


Despite the progress made by CLTS in Madagascar, however, a number of challenges to the long-term country-wide elimination of open defecation remain. The sustainability of ODF claims has been questioned and it is clear that some communities have returned to open defecation following their certification as ODF. Linked to this are questions concerning people’s ability to move up the sanitation ladder, beyond the often poor quality latrines they begin by building immediately following triggering. Private sector engagement in Madagascar remains limited and the majority of the population have extremely low purchasing power. As a result, an emerging theme across CLTS projects in Madagascar has been the provision of support for local artisans to design and promote improved latrines made from locally available materials at little cost once communities have been declared ODF. Perhaps the biggest challenge though is the accurate monitoring of ODF claims and sustainability. With poor infrastructure and limited government capacity at local levels, collecting and verifying this data is a huge task. As a result, a number of key CLTS results are disputed. Whilst there are certainly signs that CLTS is making significant progress, until realistic and regular monitoring can be conducted, the scale of the achievements across the country will remain uncertain.

(September 2015)