The CLTS approach

What is CLTS?

Community Led Total Sanitation (CLTS) is an innovative methodology for mobilising communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free).

At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease.

In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilisation instead of hardware, and shifting the focus from toilet construction for individual households to the creation of open defecation-free villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for collective change, propels people into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.


In 2010, some 1.1 billion people were practicing open defecation and 2.5 billion lacked access to improved sanitation, almost all in developing countries and predominantly in rural environments. Access to toilets is sharply skewed, with the lowest income quintiles having by far the least access and the least improvement over recent decades. In addition, lack of privacy for women for defecation, urination and menstrual hygiene, and the shame of being seen, are major gender discriminations in South Asia and elsewhere.


CLTS was pioneered by Kamal Kar (a development consultant from India) together with VERC (Village Education Resource Centre), a partner of WaterAid Bangladesh, in 2000 in Mosmoil, a village in the Rajshahi district of Bangladesh, whilst evaluating a traditionally subsidised sanitation programme. Kar, who had years of experience in participatory approaches in a range of development projects, succeeded in persuading the local NGO to stop top-down toilet construction through subsidy. He advocated change in institutional attitude and the need to draw on intense local mobilisation and facilitation to enable villagers to analyse their sanitation and waste situation and bring about collective decision-making to stop open defecation.


CLTS spread fast within Bangladesh where informal institutions and NGOs are key. Both Bangladeshi and international NGOs adopted the approach. The Water and Sanitation Programme (WSP) of the World Bank played an important role in enabling spread to neighbouring India and then subsequently to Indonesia and parts of Africa. Over time, many other organisations have become important disseminators and champions of CLTS, amongst them Plan International, UNICEF, WaterAid, SNV, WSSCC, Tearfund, Care, World Vision and others. Today CLTS is in more than 50 countries in Asia, Africa, Latin America, the Pacific and the Middle East, and governments are increasingly taking the lead in scaling up CLTS. At least 16 national governments have also adopted CLTS as national policy.

CLTS and the MDGs

CLTS has a great potential for contributing towards meeting the Millennium Development Goals, both directly on water and sanitation (goal 7) and indirectly through the knock-on impacts of improved sanitation on combating major diseases, particularly diarrhoea (goal 6), improving maternal health (goal 5) and reducing child mortality (goal 4).

CLTS and health

Open defecation is implicated in a formidable range of endemic infections – not just diarrhoeas, but also tropical enteropathy, malabsorption of nutrients in the gut, ascaris, tapeworms and other intestinal parasites, hookworm, the hepatitises, liver fluke, schistosomiasis, trachoma and zoonoses. As a result of these, infant and child undernutrition and stunting are also aggravated. CLTS opens up the possibility of tackling and mitigating all of these bad effects simultaneously, the more so by focusing on the total of total sanitation, and contributing to and enhancing the dignity and wellbeing not just of the better off, but of all women, children and men.

CLTS and livelihoods improvements

In addition to creating a culture of good sanitation, CLTS can also be an effective point for other livelihoods activities. It mobilises community members towards collective action and empowers them to take further action in the future. CLTS outcomes illustrate what communities can achieve by undertaking further initiatives for their own development.

More information

You can read in more detail about CLTS in the CLTS Handbook. In addition, in order to learn more about the approach, look at the highlighted Key Resources. They provide a good starting point for your reading. If you are interested in the implementation and progress of CLTS in a particular country, take a look at the Where section. To get an impression of CLTS in action, check out the many films from different countries that depict triggering in communities, as well as discussing some of the successes and challenges of implementation. If you are interested in a specific topic, please search the Resources by key word or topic (eg monitoring an sustainability, urben etc).