Department Environmental Social Sciences

Determining the effectiveness and mode of operation of Community-led total sanitation (CLTS): The DEMO-CLTS study

Project description

One billion people still practice Open Defecation (OD), a practice that poses significant risks to public health. The problem especially affects the poor, and is closely associated with extreme poverty. Therefore, a proposed post-2015 target is the full elimination of OD by 2030. Community-led total sanitation (CLTS) is a widely used approach to tackle OD. However, the considerable grey literature on CLTS does not provide sufficient scientific evidence that CLTS is effective in changing behavior to avoid OD or in achieving the ODF status within communities. The reasons for success or failure are unknown and some researchers have raised concerns that CLTS might have adverse effects. Several implementing organizations apply a “light” version of CLTS, in which some elements of the original system are omitted; many of these organizations have reported success. It is, therefore, unclear which CLTS elements are indispensable and which are not. It might also be the case that some elements of CLTS are simply unnecessary for success.


This project will assess the impact of CLTS on OD, both in its entirety and individually for its key elements; moreover, it will determine the mechanisms of CLTS for behavioral change. The study will also compare the effectiveness of the CLTS approach against that of an evidence-based approach.

Main objectives:

The project’s overall goal is to improve the behavioral change strategies used to eliminate OD.
In a first phase of the project taking place in Mozambique, Lao PDR and Cambodia elements of the broad CLTS canon fostering or constraining the success of CLTS will be identified.
In a second phase in Ghana a randomized controlled trial will be conducted, mainly to address the following objectives:

  • Assessment of the effectiveness of CLTS interventions on Open Defecation
  • Determination of the impact of CLTS as entirety and of its key elements on behavior change
  • Comparison of CLTS with an evidence-based behavior change intervention targeting psychological factors determined by a baseline survey

General information

  • Theoretical background: RANAS model (Mosler, 2012)
  • Applied topics: Health behavior models; behavior change techniques; water, sanitation, and hygiene interventions
  • Countries: Mozambique, Cambodia, Ghana
  • Cooperation: USAID, Plan International, Pathfinder International, Global Communities