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May 30, 2011

The biggest Oxfam campaign ever launches tomorrow (but it's a secret)

May 30, 2011

Inspiring action on shit (getting rid of it) – guest post from Robert Chambers

May 30, 2011
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Robert Chambers is a participatory development guru with a nice line in modesty. The one line bio he sent for this post reads ‘Robert Chambers is CLTS workshop in Mombasa_P Bongartza research associate at the Institute of Development Studies, Sussex, currently working on Community-Led Total Sanitation’. Well OK, but he’s also author of books that have changed the way we see development, such as Whose Reality Counts? and Revolutions in Development Enquiry. In his late 70s, he remains an extraordinarily energetic and influential voice across the development world, his achievements discussed in a new book about his work  ‘Revolutionising Development‘. So I was excited and honoured when he agreed to write this:

“CLTS is Community-Led Total Sanitation. It does not sound such a big deal, but it is revolutionary.  Hype?  We have so many ‘revolutions’ in development that only last a year or two and then fade into history.  But this one is different.  In all the years I have worked in development this is as thrilling and transformative as anything I have been involved in.  Let me explain.  

First, sanitation and scale.  2.6 billion people today lack improved sanitation.  1.1 billion defecate in the open.  The MDG for sanitation is badly off track in most countries. All the other MDGs are affected.

Second, sanitation and hygiene matter much more than most people realise. Where they lack, the effects are horrendous.  Faecally-related infections are many.  Everyone has heard of the diarrhoeas and feels outrage at over 2 million children killed by diarrhoea each year. We hear about cholera outbreaks.  But  who hears about the guts of 1.5 billion people hosting greedy parasitic ascaris worms, about 740 million with hookworm voraciously devouring their blood,  200 million with debilitating schistosomiasis or 40 to 70 million with liverfluke? And what about hepatitis, giardia, tapeworms, typhoid, polio, trachoma…?  On top of all these, many millions are likely to be affected by tropical enteropathy with damage to the gut wall reducing nutrient absorption (in effect wasting food) and diverting nutritional energy to make antibodies. All these can be dealt with through safe disposal of excreta and hygienic behaviour.  We give undernourished children more and better food.  Let that continue.  But we can reasonably ask whether attacking undernutrition through sanitation and hygiene may not in many cases be more effective and more lasting?

Worldwide the traditional approach to hygiene has been education – people have to be taught, and hardware subsidy – poor people cannot afford toilets and have to be given them. Rural areas in developing countries are littered with the results: toilets not used, put to other purposes as stores, hencoops, a shrine and the like, or dismantled and the materials used elsewhere. Or the toilets go to those who are better off, not the poor.  The dollars wasted must run into billions; and in some countries like India very large sums continue to go, so to speak, down the drain. 

CLTS turns these failed approaches on their heads.  There is no standard design, no hardware subsidy, no teaching, no special measures for people unable to help themselves, and no use of polite words – shit is shit.  India leads in the international glossary of words for shit with Kenya runner up.  Communities are triggered, facilitated to do their own analysis of their behaviour – through making their own participatory social and shit maps, inspecting the shit in the areas of open defecation (OD), and analysing pathways from shit to mouth.  Often children are facilitated in parallel with adults and then present their findings to them.  Throughout, there is a cocktail of embarrassment, laughter and disgust.  When people realize that ‘We are eating one another’s shit’ it can ignite immediate action to dig pits and construct latrines with their own resources. 

CLTS 2A follow up of encouragement, emphasising handwashing and hygiene as well as construction, is important.  Ideally and often, those unable to dig and build for themselves are helped by others. It is in the common interest.  When a community can declare itself ODF (open defecation free), external verification takes place, with subsequent celebration.

CLTS was pioneered in 2000 by Kamal Kar in Bangladesh.  Since then he and now many others have been energetically spreading it round the world.  Plan International, Unicef, the Water and Sanitation Programme of the World Bank, and Water Aid are among the organisations behind it.  It is happening in over 40 countries.  In a few it has stalled, but in most it is spreading, even exponentially. It is widespread in parts of South and Southeast Asia. In Africa, Sierra Leone, Mali, Kenya, Ethiopia, Zambia and Malawi stand out.  The scene changes fast.  In more and more countries CLTS has been adopted as Government policy and hardware subsidies to individual households have been stopped, sometimes facing down donors.  Worldwide, after discounting heavily for misleading reports of targets achieved, probably over 10 million people are now living in communities that have credibly been declared ODF.

CLTS is not a magic wand.  It faces serious obstacles – entrenched (and large) budgets for hardware subsidies; professional and bureaucratic sceptics and vested interests; training facilitators in classrooms when it needs to be hands-on in real time in communities; programmes with targets that are then reported ‘achieved’;  myths of success; donor and lender agencies insisting on subsidies; and the corruption that so often goes with hardware programmes.

But it is driven by passionate champions. And they multiply.  They emerge at all levels.  Once they have experienced the power of CLTS, many become energetically committed.  They realise how it enhances human wellbeing.  They see what a difference having a toilet makes to women and girls in particular – issues of privacy, menstrual hygiene, self-respect, and the bodily wellbeing of being able to defecate during daylight, which is such a transformation for women in South Asia.

CLTS has spread initially in rural areas.  But in India, Kenya, Mauritania and Nigeria it has been pioneered in urban slums. Watch this space.  And it has applications too for solid waste and liquid waste management, and perhaps other domains.

So, yes, it is thrilling.  It is an international movement, itself a community of like-minded people who are inspired by what they recognise as a vast potential.  The MDG for sanitation is badly off-track in almost all countries.  With CLTS it need not be.  After a slow but steady start, Kenya is rolling out a big programme and has set itself the target of making all rural areas ODF by 2013.  Others are doing likewise.  The questions now are how well it can be taken to scale, and whether enough people at all levels – from policy-makers to local leaders and facilitators –  have the vision, guts and commitment to make it happen widely and well. 

By 2020, say, could it be not ten million but hundreds of millions who benefit? Is it hyperbole to say that the opportunity is brilliant?  What do you think?”

And here’s the 3 minute intro video featuring Kamal Kar (many more videos from Mali, Mozambique, India etc here)

7 comments

  1. CLTS is indeed a remarkable approach, and one that has delivered some impressive results. But it is not a comprehensive and universally applicable approach, as many of its advocates (though thankfully not the author of this post) claim it to be.

    I have seen CLTS in action in Bangladesh and Tanzania, and it can be just as Robert Chambers describes here – thrilling and inspiring. That was what I saw in Bangladesh. But in the wrong context it can be a waste of time and resources.

    CLTS works by provoking a powerful sense of shame, first among communities that some of their members don’t have or don’t use latrines, and second in individuals who are defecating openly. People are essentially shamed into building simple latrines.

    That works well when open defecation is common, as was the case where I saw CLTS at work in rural Bangladesh, as well as parts of rural Africa and in many urban slum settings.

    But in most of Tanzania, the vast majority of households (typically over 95% in most areas) have their own pit latrine – the legacy of a very effective health promotion campaign 40 years ago. Where I saw CLTS mobilisers trying to provoke shame at open defecation in this setting, the only shame present was the community’s embarrassment at the mobilisers’ lack of understanding of the local context.

    Tanzania’s challenge is to persuade people to upgrade from very basic latrines, which are often very ineffective barriers against the spread of disease, to something more lasting and effective. Nobody has yet found a way to do this.

    CLTS is very effective at getting people in other countries away from open defecation to where Tanzania already is. But it has proved unable to take people a step higher, to persuade people to construct latrines that will prevent the spread of disease.

    With some of CLTS’s main advocates not willing to accept any criticisms of the approach, we need to guard against the danger of overlooking its weaknesses and assuming the sanitation problem is solved. Tanzania’s experience shows that getting people away from open defecation, while important, is only a first step, and one that leaves people still at serious risk of diarrhoeal disease.

    Finally, I should add that the possibility of CLTS contributing to putting the sanitation MDG back on track is very small. The MDG monitoring for sanitation rightly specifies “improved sanitation”. The full definition of an “improved” latrine is complicated, but for pit latrines it essentially boils down to whether the latrine has a washable slab – i.e. one made of ceramic, plastic or cement.

    In my experience the majority of latrines constructed as a result of the CLTS process don’t have washable slabs and are therefore not classed as “improved”, since CLTS leaves households and communities to design their own latrines.

    This final point is not strictly a criticism of the CLTS approach, just a clarification that it’s impact on the MDG for sanitation is likely to be very small.

  2. @Mtega: excellent point. You are right that one of the key questions is what role CLTS (or other approaches) have in encouraging people to move further up the ‘sanitation ladder’ – there is some positive evidence e.g. http://www.irc.nl/page/40591, and interestingly some of WaterAid’s partners in Mali have started using CLTS to encourage this step from unimproved to improved latrines as well.

  3. It’s great to hear of new bottom up approaches like this. I have a question about roll out which links to Mtega’s point about the CLTS process building on feelings of shame. I can see how this kind of approach could work at a pilot level with well-trained *sensitive* facilitators. But what about when it is scaled up? How do communities react when a local govt health official comes along and shames them all? From my experience I can see how the whole approach might suffer from institutionalization – and the different relationship people tend to have with officialdom – but seek enlightenment from my cynicism.

  4. Hallo,we are a company that specialises in low technology water and waste water solutions.The small scale villiage approach using(hopefully)locally sourced materials and people is perfect for us to help with.If we try to bring first world to third world too quickly the result will be failure.

  5. I understand that Oxfam have been working with SOIL in Haiti. I sincerely hope that waste can be viewed in the future as livestock farmers view it – as valuable manure. Save purchase of fertilisers, improve soil condition, safeguard health and give dignity and employment opportunities, while allowing the combination of other organic wastes and natural processes to sanitise it.

  6. I’ve just written a reply piece to Robert Chambers on this: http://www.guardian.co.uk/global-development/poverty-matters/2011/jun/09/dirty-truth-behind-community-sanitation

    Improved sanitation is an unqualified good (if, as Mtega points out, it really is ‘improved’), but I don’t think we should pretend that CLTS is some participatory revolution – it’s neither brand new nor necessarily all that democratic.

    As a friend bluntly puts it, “If the intended outcome [of CLTS] is shitting indoors then great, but let’s not pretend it’s teaching anything else around participation, empowerment, democracy and equality.”

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