This document discusses collective behavior change as the key to enhancing large-scale investment efficiency in sanitation and public health. It explains that behavior change is a human process that cannot be induced through subsidies or incentives alone. The Community-Led Total Sanitation (CLTS) approach triggers behavior change through community participation and empowerment. The document also discusses how CLTS can be combined with other sanitation approaches to further progress along a "sanitation ladder" and provide improved facilities over time. It emphasizes the need to institutionalize CLTS through "Institutional Triggering" to drive behavior change beyond the village level and achieve Open Defecation Free (ODF) status at a national scale.

1. In cooperation with:
Dr. Kamal Kar
Collective behaviour change: Key to enhance large-scale
investment efficiency in sanitation and public health
Chairman, CLTS Foundation (India)

2. Attitude &
Behaviour
Change
CLTS Tools &
Techniques
Enabling
Environment
Institutional
Professional
Personal
Triggering
Policy
Context
National
Protocol/
Budget
Essential
Convergence
Inter-
Institutional
Coordination
Pre-triggering
Post ODF
actions
Post Triggering
Follow-up
The key elements of CLTS

3. 3
Collective Behaviour Change – The Engine
Subsidy
Free toilet
I will be fined
and punished There is not
enough space
to build a
toilet
Toilets are
expensive
Safe sanitation is a
healthy practice
Who will empty the
toilet pit?
My ration card will be
blocked
My children will be
safe from diarrhoea
We are ingesting
each other’s shit
and that has to
be stopped!

4. 4
We are ingesting
each other’s shit
and that has to
be stopped!
Collective Behaviour Change – The Engine
Subsidy
Free toilet
I will be fined
and punished There is not
enough space
to build a
toilet
Toilets are
expensive
Safe sanitation is a
healthy practice
Who will empty the
toilet pit?
My ration card will be
blocked
My children will be
safe from diarrhoea
Collective
Behaviour
Change

5. 5
• Behaviour change is a 100% humane element or a thought process.
• It cannot be allured / attracted / pushed by free subsidy and pressures of
incentives.
• It is THIS behaviour change process which is agreed and accepted by all – the main
theme of CLTS.
• The question of mismatch with local context arises only when there is a policy of
large scale subsidy in place.
Contd...

6. 6
Movement along the Sanitation Ladder
6

7. 7
• It is, however, the other way around.
• Other sanitation approaches can take the extra mileage of the opportunity and
platform of community empowerment created by CLTS to further the goals.
• Piggybacking on the success of CLTS and sense of community solidarity.
• Embarking upon “movement along the sanitation ladder”.
How CLTS can be best combined with other sanitation
approaches and institutionalised?

8. 8
FINISH Mondial programme in Busia County, Kenya since 2013
– In partnership with Amref, WASTE and Aqua for all; supported by the Dutch MoFA
– to scale up the public-private partnership model for moving up the sanitation ladder
– has been instrumental in enabling households obtain safe and improved sanitation
facilities, paid for through micro-credit initiatives.
– The success of the programme is based on the fact that Busia County is the only
county in Kenya to be ODF in 2015, the journey of which started with CLTS in July
2010.
Examples

9. 9
CLTS Foundation in Benin (2014-15)
– Development support by the Netherlands to the Beninese WASH sector started in
2004
– In 2013, the rural sanitation situation in Benin was dire: it was fourth in the global
list of countries ranked by percentage of population defecating in the open
– In the period following 2013, CLTS was implemented and it was proved that there
were no cultural barriers to CLTS, and a system for developing capacity was created,
involving local NGOs and output-based contracting.
– In 2016, Benin celebrated its first certified ODF village and 300 ODF localities.
Examples

10. 10
• The success of ODF achievement has remained limited to the village level.
• The strength and ability of the village community to be locally empowered to
transform the sanitation situation needs to be recognised by higher level institutions.
• Political will, capacity of the Government and the enabling environment are major
factors driving the journey of ODF achievements from village to nation.
• Innovative tools to fast track institutionalization of behaviour change through
Institutional Triggering.
From Village to Nation

11. 11
Institutional Triggering is a methodology to trigger institutional actors to take
ownership and responsibility for the state of poor sanitation in the
country/state/region and mobilise immediate action to support the implementation
and scaling up of CLTS in the respective area.
• It aims to address limiting factors in the institutional environment that hinder
CLTS implementation
• This is done through illustration of glittering examples of success within the
country where the community members have shown potential for collective
behaviour change to achieve tangible health outcomes.
Institutional Triggering

12. 12
• The Dutch WASH policy has so far mostly invested in rural sanitation interventions
at the community level.
• In order to harness the best health outcomes, the Dutch policy should also focus on
institutionalisation of the home-grown success of the local communities to fast
track achievement of ODF nations.
Potential of the Dutch Policy

13. 13
“Collective behaviour change brought about by CLTS
is the engine which drives the bogies of success of
other sanitation programmes”

14. Except where otherwise noted, this work is licensed under
http://creativecommons.org/licenses/by/4.0/
These materials were developed and/or made available under the project Accelerating the Impact of Education and Training on Non-
sewered Sanitation (OPP1157500) funded by the Bill & Melinda Gates Foundation (BMGF). The content is subject to free unlimited
access and use, consistent with BMGF’s commitment to ensure the open access to information and knowledge. Therefore, sharing (to
copy and redistribute the material in any medium or format) and adapting (transforming, and building upon the material for any purpose)
under condition that appropriate credit to author(s) is provided is allowed. Although care was taken to ensure the integrity and quality of
these materials and information, no responsibility is assumed by the author(s) or IHE Delft for any damage to property or persons as a
result of use of these materials and/or the information contained herein.
Dr. Kamal Kar
Thank you!
Chairman, CLTS Foundation (India)