Community-Led Total Sanitation: A “New Frontier” for ... · Community-Led Total Sanitation: A...
6
Community-Led Total Sanitation: A “New Frontier” for International Social Work Practice Terry A. Wolfer Currently, some 2.5 billion people lack adequate sanitation, including 1 billion who practice open defecation. Because inadequate sanitation is both a cause and effect of ex- treme poverty, it deserves inclusion on the international social work agenda. This article introduces community-led total sanitation (CUTS), a recent and highly effective innovation for mobilizing whole communities to address their sanitation problems. Keywords: CUTS, community-led total sanitation, extreme poverty, participatory rural appraisal, sanitation Calling it a “silent global crisis,” UNICEF (2008) asserted that inadequate sani- tation “constitutes an affront to human dignity on a massive scale causing widespread damage to human health and child survival prospects; social mis- ery especially for women, the elderly and sick; depressed economic productivity and human development; and pollution to the living environment and water resources. Lack of sanitation is one of the single biggest challengesfacing the world to- day”(p. 1; italics added). Likewise, the World Health Organization (WHO, 2011) describes lack of sanitation as “a serious health risk and an affront to human dig- nity” and notes that it particularly affects the poor and disadvantaged (para. 1). In 2008, an estimated 2.6 billion people—four of ten people in the world— did not have access to adequate sanitation (UNICEF, 2008). Nearly half of those people, especially those living in rural areas, practiced open defecation (i.e., defe- cation in fields, forests, bushes, plastic bags, streams, lakes, or other open spaces; Sanitation Drive 2015,2013). The most recent data indicate that there are still 2.5 billion people in the world—one in three—who lack adequate sanitation, and the number of people practicing open defecation has decreased but remains above 1 billion (UNICEF, 2013). The problem is most widespread and severe in Southeast Asia and Sub-Saharan Africa (Sanitation Drive 2015,2013). Terry A. Wolfer, PhD, MSW, is a professor in the College of Social Work, University of South Carolina ([email protected]). © 2014 International Consortium for Social Development 6 8 Social Development Issues 36 (1) 2014 Associated with extreme poverty, inadequate sanitation affects the lives of individuals, families, and communities in various ways (UNICEF, 2008). Most tragically, inadequate sanitation is the major cause of preventable diarrheal and other diseases (e.g., cholera, dysentery, typhoid, hepatitis A, polio, cryptospo- ridiosis, ascariasis), which kill five thousand children and another one thou- sand adults per day (Sanitation Drive 2015,2013; UNICEF, 2008; WHO, 2011). Worldwide, diarrheal diseases are the second leading cause of child death (Glau- siusz, 2002). Even when diarrheal diseases do not kill, they leave hundreds of millions more people seriously ill. Such diseases cause many children and adults to miss school and work. In addition, inadequate sanitation contributes to the spread of other diseases, increases malnutrition, and deters children (especially girls) from attending school at all. In these and other ways, the lack of sanitation both directly increases poverty and deters social development, and thus it poses a major challenge to human well-being. Although recognized as a root cause of extreme poverty (UnitedNations, 1995), sanitation was not originally included in the UN Millennium Development Goals (MDGs; UN General Assembly, 2000). However, it was subsequently added to the MDGs, and 2008 was declared the International Year of Sanitation to rectify the omission and to supplement other MDGs (UN General Assembly, 2005; UNICEF, 2008). Indeed, Robert Chambers (2008) first argued that providing adequate sani- tation will substantially contribute to achieving all the MDGs by eradicating ex- treme poverty and hunger, improving maternal health, reducing young child mor- tality, reducing major diseases, increasing primary education, increasing gender equality and female empowerment, and ensuring environmental sustainability. Remarkably, the International Federation of Social Workers (2012) does not mention sanitation as part of the social work profession’s agenda for global poverty eradication, despite noting that the Copenhagen Declaration defined absolute poverty as “a condition characterized by severe deprivation of basic human needs, including food, safe drinking water, sanitation facilities, health, shelter, education and information” (United Nations, 1995, p. 41). Nevertheless, there is growing public recognition of the magnitude and se- verity of the problems posed by inadequate sanitation (e.g., Black, 2008; George, 2008; Sanitation Drive 2015,2013). Promoting sanitation may never have the appeal of promoting clean water, but there is growing recognition that the two are inextricably linked. Indeed, readers of British Medical Journal selected “clean water and sewage disposal” as the most important medical advance since that journal began publishing in 1840 (Ferriman, 2007). Despite the consequences and prevalence of inadequate sanitation in im- poverished communities, both government and nongovernment organization (NGO) leaders have tended to ignore it. When the problem could not be avoided, the conventional response was to build public latrines and then provide finan- cial incentives to promote their use (Kar & Pasteur, 2005). Despite the commit- ment of significant resources and efforts, these approaches have not succeeded in many parts of the world (Chambers, 2008; Sanan & Moulik, 2007).
Transcript of Community-Led Total Sanitation: A “New Frontier” for ... · Community-Led Total Sanitation: A...
Com
mun
ity-L
ed T
otal
San
itatio
n: A
“New
Fro
ntie
r” fo
r In
tern
atio
nal S
ocia
l Wor
k Pr
actic
e
Ter
ry A
. Wol
fer
Cur
rent
ly, s
ome 2
.5 b
illio
n peo
ple l
ack a
dequ
ate s
anita
tion,
incl
udin
g 1
billi
on w
ho
prac
tice o
pen
defe
catio
n. B
ecau
se in
adeq
uate
sani
tatio
n is
both
a ca
use a
nd ef
fect
of e
x-tr
eme p
over
ty, i
t des
erve
s inc
lusi
on o
n th
e int
erna
tiona
l soc
ial w
ork a
gend
a. T
his
artic
le in
trodu
ces c
omm
unity
-led
tota
l san
itatio
n (C
UTS)
, a re
cent
and
hig
hly
effe
ctiv
e in
nova
tion f
or m
obili
zing
who
le co
mm
uniti
es to
add
ress
thei
r san
itatio
n pro
blem
s.
Key
wor
ds: C
UTS,
com
mun
ity-le
d to
tal s
anita
tion,
ext
rem
e pov
erty
, par
ticip
ator
y ru
ral a
ppra
isal,
sani
tatio
n
Cal
ling
it a
“sile
nt g
loba
l cris
is,”
UN
ICEF
(20
08)
asse
rted
that
inad
equa
te s
ani-
tatio
n “c
onst
itute
s an
aff
ront
to h
uman
dig
nity
on
a m
assi
ve s
cale
cau
sing
w
ides
prea
d da
mag
e to
hum
an h
ealth
and
chi
ld s
urvi
val p
rosp
ects
; soc
ial m
is-
ery
espe
cial
ly fo
r wom
en, t
he e
lder
ly a
nd si
ck; d
epre
ssed
eco
nom
ic p
rodu
ctiv
ity
and
hum
an d
evel
opm
ent;
and
pollu
tion
to th
e liv
ing
envi
ronm
ent a
nd w
ater
re
sour
ces.
Lac
k of s
anita
tion
is on
e of t
he si
ngle
big
gest
chal
leng
es fa
cing
the w
orld
to-
day”
(p. 1
; ita
lics a
dded
). Li
kew
ise,
the
Wor
ld H
ealth
Org
aniz
atio
n (W
HO
, 201
1)
desc
ribes
lack
of s
anita
tion
as “
a ser
ious
hea
lth ri
sk a
nd a
n af
fron
t to
hum
an d
ig-
nity
” and
not
es th
at it
par
ticul
arly
aff
ects
the
poor
and
dis
adva
ntag
ed (p
ara.
1).
In 2
008,
an
estim
ated
2.6
bill
ion
peop
le—
four
of t
en p
eopl
e in
the
wor
ld—
di
d no
t hav
e ac
cess
to a
dequ
ate
sani
tatio
n (U
NIC
EF, 2
008)
. Nea
rly h
alf o
f tho
se
peop
le, e
spec
ially
thos
e liv
ing
in ru
ral a
reas
, pra
ctic
ed o
pen
defe
catio
n (i.
e., d
efe-
catio
n in
fiel
ds, f
ores
ts, b
ushe
s, p
last
ic b
ags,
stre
ams,
lake
s, o
r oth
er o
pen
spac
es;
Sani
tatio
n D
rive
2015
,201
3). T
he m
ost r
ecen
t dat
a in
dica
te th
at th
ere
are
still
2.
5 bi
llion
peo
ple
in th
e w
orld
—on
e in
thre
e—w
ho la
ck a
dequ
ate
sani
tatio
n,
and
the
num
ber o
f peo
ple p
ract
icin
g op
en d
efec
atio
n ha
s dec
reas
ed b
ut re
mai
ns
abov
e 1
billi
on (U
NIC
EF, 2
013)
. The
pro
blem
is m
ost w
ides
prea
d an
d se
vere
in
Sout
heas
t Asi
a an
d Su
b-Sa
hara
n A
fric
a (S
anita
tion
Driv
e 20
15,2
013)
.
Ter
ry A
. Wol
fer,
PhD
, MSW
, is a
pro
fess
or in
the
Col
lege
of S
ocia
l Wor
k, U
nive
rsity
of S
outh
Car
olin
a (te
rry.
wol
fer@
sc.e
du).
© 2
014
Inte
rnat
iona
l Con
sorti
um fo
r Soc
ial D
evel
opm
ent
6 8
Soci
al D
evel
opm
ent I
ssue
s 36
(1) 2
014
Ass
ocia
ted
with
ext
rem
e po
verty
, ina
dequ
ate
sani
tatio
n af
fect
s th
e liv
es o
f in
divi
dual
s, fa
mili
es, a
nd c
omm
uniti
es in
var
ious
way
s (U
NIC
EF, 2
008)
. Mos
t tra
gica
lly, i
nade
quat
e sa
nita
tion
is th
e m
ajor
caus
e of
pre
vent
able
dia
rrhe
al an
d ot
her
dise
ases
(e.
g., c
hole
ra, d
ysen
tery
, typ
hoid
, hep
atiti
s A
, pol
io, c
rypt
ospo
- rid
iosi
s, a
scar
iasi
s), w
hich
kill
five
tho
usan
d ch
ildre
n an
d an
othe
r on
e th
ou-
sand
adu
lts pe
r day
(San
itatio
n D
rive
2015
,201
3; U
NIC
EF, 2
008;
WH
O, 2
011)
. W
orld
wid
e, d
iarr
heal
dis
ease
s are
the
seco
nd le
adin
g ca
use
of c
hild
dea
th (G
lau-
si
usz,
200
2). E
ven
whe
n di
arrh
eal d
isea
ses
do n
ot k
ill, t
hey
leav
e hu
ndre
ds o
f m
illio
ns m
ore p
eopl
e ser
ious
ly il
l. Su
ch d
isea
ses c
ause
man
y ch
ildre
n an
d ad
ults
to
mis
s sc
hool
and
wor
k. I
n ad
ditio
n, in
adeq
uate
san
itatio
n co
ntri
bute
s to
the
spre
ad o
f oth
er d
isea
ses,
incr
ease
s mal
nutr
ition
, and
det
ers c
hild
ren
(esp
ecia
lly
girls
) fro
m at
tend
ing
scho
ol a
t all.
In th
ese
and
othe
r way
s, th
e la
ck o
f san
itatio
n bo
th d
irect
ly in
crea
ses p
over
ty a
nd d
eter
s soc
ial d
evel
opm
ent,
and
thus
it p
oses
a
maj
or c
halle
nge
to h
uman
wel
l-bei
ng.
Alth
ough
reco
gniz
ed as
a ro
ot ca
use o
f ext
rem
e pov
erty
(Uni
tedN
atio
ns, 1
995)
, sa
nita
tion
was
not
orig
inal
ly in
clud
ed in
the
UN
Mill
enni
um D
evel
opm
ent G
oals
(MD
Gs;
UN
Gen
eral
Ass
embl
y, 2
000)
. How
ever
, it w
as s
ubse
quen
tly a
dded
to th
e M
DG
s, an
d 20
08 w
as d
ecla
red
the
Inte
rnat
iona
l Yea
r of S
anita
tion
to re
ctify
the
omis
sion
and
to s
uppl
emen
t oth
er M
DG
s (U
N G
ener
al A
ssem
bly,
200
5; U
NICE
F,
2008
). In
deed
, Rob
ert C
ham
bers
(200
8) fi
rst a
rgue
d th
at pr
ovid
ing a
dequ
ate s
ani-
tatio
n w
ill s
ubst
antia
lly c
ontr
ibut
e to
ach
ievi
ng a
ll th
e M
DG
s by
erad
icat
ing
ex-
trem
e pov
erty
and
hung
er, i
mpr
ovin
g m
ater
nal h
ealth
, red
ucin
g yo
ung
child
mor
-ta
lity,
red
ucin
g m
ajor
dis
ease
s, in
crea
sing
pri
mar
y ed
ucat
ion,
incr
easi
ng g
ende
r eq
ualit
y an
d fe
mal
e em
pow
erm
ent,
and
ensu
ring
envi
ronm
enta
l sus
tain
abili
ty.
Rem
arka
bly,
the
Int
erna
tiona
l Fe
dera
tion
of S
ocia
l Wor
kers
(20
12)
does
no
t men
tion
sani
tatio
n as
par
t of t
he so
cial
wor
k pr
ofes
sion
’s ag
enda
for g
loba
l po
vert
y er
adic
atio
n, d
espi
te n
otin
g th
at th
e C
open
hage
n D
ecla
ratio
n de
fined
ab
solu
te p
over
ty a
s “a
con
ditio
n ch
arac
teri
zed
by s
ever
e de
priv
atio
n of
bas
ic
hum
an n
eeds
, inc
ludi
ng fo
od, s
afe
drin
king
wat
er, s
anita
tion
faci
litie
s, he
alth
, sh
elte
r, ed
ucat
ion
and
info
rmat
ion”
(Uni
ted
Nat
ions
, 199
5, p
. 41)
.N
ever
thel
ess,
ther
e is
gro
win
g pu
blic
reco
gniti
on o
f th
e m
agni
tude
and
se-
veri
ty o
f the
pro
blem
s pos
ed by
inad
equa
te sa
nita
tion
(e.g
., Bla
ck, 2
008;
Geo
rge,
20
08; S
anita
tion
Driv
e 20
15,2
013)
. Pro
mot
ing
sani
tatio
n m
ay n
ever
hav
e the
ap
peal
of p
rom
otin
g cl
ean
wat
er, b
ut th
ere
is g
row
ing
reco
gniti
on th
at th
e tw
o ar
e ine
xtri
cabl
y lin
ked.
Inde
ed, r
eade
rs o
f Bri
tish
Med
ical
Jour
nal s
elec
ted
“cle
an
wat
er a
nd s
ewag
e di
spos
al”
as th
e m
ost i
mpo
rtan
t med
ical
adv
ance
sin
ce th
at
jour
nal b
egan
pub
lishi
ng in
184
0 (F
erri
man
, 200
7).
Des
pite
the
cons
eque
nces
and
pre
vale
nce
of i
nade
quat
e sa
nita
tion
in im
-po
veri
shed
com
mun
ities
, bot
h go
vern
men
t and
non
gove
rnm
ent o
rgan
izat
ion
(NG
O) l
eade
rs h
ave
tend
ed to
igno
re it
. Whe
n th
e pr
oble
m co
uld
not b
e av
oide
d,
the
conv
entio
nal r
espo
nse
was
to b
uild
pub
lic la
trin
es a
nd th
en p
rovi
de fi
nan-
cial
ince
ntiv
es to
pro
mot
e th
eir u
se (K
ar &
Pas
teur
, 200
5). D
espi
te th
e co
mm
it-m
ent o
f sig
nifi
cant
reso
urce
s an
d ef
forts
, the
se a
ppro
ache
s ha
ve n
ot su
ccee
ded
in m
any
part
s of
the
wor
ld (C
ham
bers
, 200
8; S
anan
& M
oulik
, 200
7).
Wol
fer
69
Com
mun
ity-L
ed T
otal
San
itatio
n
This
art
icle
intr
oduc
es c
omm
unity
-led
tota
l san
itatio
n (C
LTS)
, a r
ecen
t an
d hi
ghly
eff
ectiv
e in
nova
tion
for m
obili
zing
who
le c
omm
uniti
es to
add
ress
san
i-ta
tion
prob
lem
s (K
ar, 2
005,
200
8; K
ar &
Pas
teur
, 200
5). I
n sh
arp
cont
rast
to
prev
ious
effo
rts to
bui
ld a
nd in
cent
iviz
e the
use
of p
ublic
latr
ines
, CLT
S “t
rigg
ers
the
com
mun
ity’s
desi
re fo
r col
lect
ive
chan
ge, p
rope
ls p
eopl
e in
to a
ctio
n an
d en
-co
urag
es in
nova
tion,
mut
ual s
uppo
rt a
nd a
ppro
pria
te lo
cal s
olut
ions
, thu
s lea
d-in
g to
gre
ater
ow
ners
hip
and
sust
aina
bilit
y” (
Inst
itute
of D
evel
opm
ent S
tudi
es,
2011
, par
a. 3
). K
amal
Kar
(200
5), t
he o
rigi
nato
r of C
LTS,
exp
lain
s tha
t it i
s
base
d on
stim
ulat
ing
a co
llect
ive
sens
e of
dis
gust
and
sham
e am
ong
com
-m
unity
mem
bers
as t
hey
conf
ront
the
crud
e fa
cts
abou
t mas
s op
en d
efec
a-tio
n an
d its
neg
ativ
e im
pact
s on
the
entir
e co
mm
unity
. The
bas
ic a
ssum
p-tio
n is
that
no
hum
an b
eing
can
sta
y un
mov
ed o
nce
they
hav
e le
arne
d th
at
they
are
inge
stin
g ot
her p
eopl
e's f
aece
s, (p
. 3)
By
evok
ing
a co
llect
ive
sens
e of
dis
gust
, CLT
S ap
pare
ntly
taps
into
a u
nive
rsal
an
d vi
scer
al e
mot
ion
that
is k
ey fo
r hum
an s
urvi
val (
Gla
usiu
sz, 2
002)
. Rob
ert
Cha
mbe
rs (2
009)
, the
est
eem
ed d
evel
opm
ent s
chol
ar a
nd p
ract
ition
er, c
onsi
d-er
s CL
TS “
a re
volu
tiona
ry p
artic
ipat
ory
appr
oach
to ru
ral s
anita
tion”
(p. 9
).Se
vera
l ba
sic
prin
cipl
es d
istin
guis
h CL
TS (
Cha
mbe
rs,
2009
; K
ar,
2005
; Sa
nan
& M
oulik
, 200
7): c
omm
unity
self-
help
act
ion
(i.e.
, gra
ssro
ots,
or b
otto
m
up ra
ther
than
top
dow
n), h
ands
-off
trig
geri
ng, f
acili
tatio
n th
roug
h qu
estio
ns
rath
er th
an in
stru
ctio
n, n
o st
anda
rd la
trin
e de
sign
(i.e
., le
tting
peo
ple
choo
se
thei
r ow
n de
sign
s, a
nd a
llow
ing
priv
ate
supp
liers
to m
eet l
ocal
dem
and)
; pro
mo-
tion
of c
omm
unity
assi
stan
ce to
poo
rer a
nd w
eake
r com
mun
ity m
embe
rs, n
o pr
o-vi
sion
of a
hou
seho
ld h
ardw
are
subs
idy
(foc
usin
g in
stea
d on
com
mun
ity-l
evel
ou
tcom
es).
Of
thes
e, r
efus
ing
to p
rovi
de e
ither
ove
rt in
stru
ctio
n or
fina
ncia
l su
bsid
y re
pres
ents
the
mos
t sig
nific
ant d
epar
ture
s fro
m c
onve
ntio
nal p
ract
ice
in
sani
tatio
n.C
ham
bers
(200
9) id
entif
ied
five b
enef
its o
f CLT
S ov
er tr
aditi
onal
app
roac
hes
to s
anita
tion:
the
unu
sual
spe
ed o
f su
cces
s; t
he c
omm
unity
-wid
e sc
ope
of it
s su
cces
s; th
e re
sulti
ng s
ocia
l sol
idar
ity, w
hich
may
lead
to o
ther
initi
ativ
es; t
he
deve
lopm
ent o
f loc
al le
ader
ship
, con
fiden
ce, a
nd li
velih
oods
; and
its a
pplic
atio
n in
oth
er c
onte
xts,
suc
h as
sch
ools
and
urb
an c
omm
uniti
es.
Rec
ently
, sys
tem
atic
rese
arch
on
CLTS
out
com
es h
as b
egun
to c
onfir
m a
n-ec
dota
l rep
orts
of i
ts e
ffec
tiven
ess.
For
exa
mpl
e, a
larg
e, m
ultic
ount
ry s
tudy
in
Wes
t and
Cen
tral
Afr
ica f
ound
impo
rtan
t but
frag
ile p
rogr
ess o
n sa
nita
tion
goal
s ac
ross
eig
htee
n co
untr
ies
(UN
ICEF
, 201
1). A
mul
timet
hod
stud
y in
Cam
bodi
a co
mpa
red
CLTS
and
con
vent
iona
l sub
sidi
zed
sani
tatio
n ap
proa
ches
(Kun
thy
& C
atal
la,
2009
). I
n ca
mps
with
CLT
S, i
t fou
nd g
reat
er u
se o
f la
trin
es,
grea
ter
equi
ty a
cros
s in
com
e le
vels
, be
tter
cost
-eff
ectiv
enes
s (b
oth
shor
t an
d lo
ng
term
), an
d m
ore
attit
udin
al a
nd b
ehav
iora
l cha
nge,
but
som
e pr
oble
ms
with
su
stai
nabi
lity.
Muk
herj
ee (
2011
) fo
und
that
com
mun
ities
tha
t bec
ame
open
-
70
Soci
al D
evel
opm
ent I
ssue
s 36
(1) 2
014
defe
catio
n-fr
ee (O
DF) m
ost q
uick
ly w
ere
also
mos
t lik
ely
to s
usta
in th
ose
gain
s an
d th
at s
anita
tion
beha
vior
cha
nge
was
mor
e di
fficu
lt to
initi
ate
in ri
verb
ank
and
wat
erfr
ont c
omm
uniti
es. G
iven
ade
quat
e tri
gger
ing,
acc
ordi
ng to
Muk
her-
je
e(20
11):
Ope
n D
efec
atio
n Fr
ee (O
DF) a
chie
vem
ent a
nd su
stai
nabi
lity
are
hast
ened
by
: (a)
com
mun
ity’s
soci
al c
apita
l and
the
invo
lvem
ent o
f lea
ders
hip
in th
e ch
ange
pro
cess
, (b)
loca
l ava
ilabi
lity
and
affo
rdab
ility
of l
atrin
e at
tribu
tes
desi
red
by p
oor a
nd n
on-p
oor c
onsu
mer
s, (c
) abs
ence
of e
xter
nally
pro
-vi
ded
subs
idie
s to
a fe
w h
ouse
hold
s, an
d (d
) pos
t-trig
gerin
g m
onito
ring
and
follo
w-u
p by
ext
erna
l age
ncie
s tog
ethe
r with
com
mun
ities
, (p.
1)
In su
mm
ary,
the
emer
ging
evid
ence
dem
onst
rate
s tha
t CLT
S is
no p
anac
ea, b
ut
it m
ay b
e si
gnifi
cant
ly m
ore
effe
ctiv
e th
an p
revi
ous
appr
oach
es. I
n m
any
parts
of
the
wor
ld, i
t has
gen
erat
ed si
gnifi
cant
pro
gres
s tow
ard
the
MDG
s.
CL
TS
Too
ls
The C
LTS i
nter
vent
ion
cons
ists
of s
ever
al to
ols f
or p
rom
otin
g co
mm
unity
mem
-be
rs’ c
ompr
ehen
sive
anal
ysis
of s
anita
tion
in th
eir c
omm
unity
. Dra
wn
from
par
-tic
ipat
ory
rura
l app
rais
al (B
ar-O
n &
Prin
sen,
199
9; C
ham
bers
, 199
4a, 1
994b
, 19
94c)
, the
tool
s are
“sim
ple,
vis
ual,
and
prac
tical
” (Ka
r, 20
05, p
. 5).
The t
ools
ar
e ac
com
pani
ed th
roug
hout
by
Socr
atic
que
stio
ning
to p
rom
ote
com
mun
ity
mem
bers
’ ana
lysi
s and
refle
ctio
n. U
nles
s ind
icat
ed o
ther
wis
e, th
e fo
llow
ing
de-
scrip
tions
are
dra
wn
from
seve
ral k
ey so
urce
s (K
ar, 2
005,
2008
; Kar
& P
aste
ur,
2005
) and
per
sona
l exp
erie
nce.
Get
ting
Star
ted
The
first
ste
p is
gain
ing
entr
ance
to a
com
mun
ity a
nd b
uild
ing
rapp
ort w
ith
com
mun
ity le
ader
s an
d m
embe
rs (
Kar
, 20
05).
The
appr
oach
to t
his
varie
s fr
om in
form
al to
mor
e fo
rmal
. In
som
e si
tuat
ions
, CLT
S fa
cilit
ator
s sim
ply
visit
co
mm
uniti
es a
nd b
egin
ask
ing
peop
le a
bout
san
itatio
n is
sues
whi
le w
alki
ng
thro
ugh
the
com
mun
ity. I
n ot
hers
, the
y co
ntac
t com
mun
ity of
ficia
ls in
adva
nce
to re
ques
t for
mal
per
mis
sion
to c
ondu
ct sa
nita
tion
anal
ysis
. In
eith
er c
ase,
the
goal
is to
recr
uit a
s man
y co
mm
unity
mem
bers
as p
ossib
le fo
r the
inte
rven
tion
(e.g
., te
n to
mor
e th
an o
ne h
undr
ed).
At t
he o
utse
t, fa
cilit
ator
s al
so d
eter
min
e th
e cr
ude l
ocal
wor
d fo
r fec
es (i
.e., t
he e
quiv
alen
t of s
hit i
n En
glish
) and
pro
ceed
to
use
that
term
inol
ogy
thro
ugho
ut th
e in
terv
entio
n.
Tran
sect
Wal
k
The
CLTS
usu
ally
beg
ins w
ith a
tran
sect
wal
k—a
tour
of t
he c
omm
unity
with
th
e as
sem
bled
com
mun
ity m
embe
rs—
to v
isit
and
disc
uss a
reas
of o
pen
defe
ca-
tion
and
all t
ypes
of l
atrin
es. A
t eac
h lo
catio
n, f
acili
tato
rs p
ause
to s
mel
l and
Wol
fer
71
view
the
effe
cts
of o
pen
defe
catio
n an
d po
or la
trin
e m
aint
enan
ce. A
lthou
gh
com
mun
ity m
embe
rs fi
nd it
em
barr
assi
ng to
hav
e vi
sito
rs v
iew
thes
e pa
rts
of
thei
r com
mun
ity, t
hey
ofte
n ga
in a
fres
h pe
rspe
ctiv
e on
cond
ition
s to
whi
ch th
ey
have
gro
wn
accu
stom
ed. T
he s
ight
of
a la
rge
grou
p vi
sitin
g op
en-d
efec
atio
n si
tes
ofte
n at
trac
ts a
dditi
onal
par
ticip
ants
. Fac
ilita
tors
take
tim
e to
ask
que
s-tio
ns a
t eac
h st
op (e
.g.,
Whi
ch fa
mili
es u
se th
is a
rea?
Do
peop
le c
ome
at n
ight
? D
o w
omen
and
chi
ldre
n fe
el sa
fe h
ere?
Do
peop
le c
ome
here
whe
n it’
s rai
ning
? W
hen
they
are
sic
k? W
hat a
re th
e fli
es d
oing
her
e? D
o th
ese
flies
sta
y he
re o
r go
to th
e ca
mp?
How
long
hav
e pe
ople
bee
n us
ing
this
are
a?).
The
tran
sect
w
alk
and
ques
tions
are
inte
nded
to st
imul
ate
fran
k co
nver
satio
n an
d re
flect
ion
abou
t ope
n de
feca
tion
amon
g co
mm
unity
mem
bers
and
to p
rovo
ke v
isce
ral
disg
ust.
Com
mun
ity M
appi
ng
In th
e nex
t ste
p, fa
cilit
ator
s enc
oura
ge p
artic
ipan
ts to
dra
w a
map
of t
heir
com
-m
unity
on
the g
roun
d at
a ce
ntra
l loc
atio
n. T
he m
appi
ng o
ften
begi
ns b
y not
ing
land
mar
ks in
the
imm
edia
te v
icin
ity. A
fter p
artic
ipan
ts h
ave
draw
n th
eir o
wn
hom
es a
nd k
ey si
tes
on th
e m
ap, f
acili
tato
rs o
ffer f
lour
, bon
emea
l, or
a si
mil
ar
pow
dery
subs
tanc
e for
mar
king
ope
n-de
feca
tion
area
s on
the m
ap. A
gain
, fac
ili-
tato
rs u
se q
uest
ions
to g
uide
the
exer
cise
(e.g
., W
here
are
the
open
-def
ecat
ion
sites
that
we
visit
ed?
Whe
re e
lse d
o pe
ople
def
ecat
e in
the
open
? W
here
is th
e ru
bbis
h sit
e? D
o pe
ople
ever
go
ther
e? W
here
is th
e di
rties
t nei
ghbo
rhoo
d? W
ho
lives
ther
e? W
hy is
it th
e di
rties
t nei
ghbo
rhoo
d? D
o pe
ople
from
oth
er n
eigh
bor-
hood
s go
ther
e?).
Bui
ldin
g on
the
tran
sect
wal
k, th
e co
mm
unity
-map
ping
exer
-ci
se h
elps
peo
ple
visu
aliz
e th
e sc
ope
of th
e sa
nita
tion
prob
lem
in th
eir c
omm
u-ni
ty a
nd p
rovo
kes r
efle
ctio
n ab
out i
ts u
neve
n di
strib
utio
n.
Goo
Cal
cula
tion
Afte
r the
map
ping
exer
cise
, fac
ilita
tors
ask
par
ticip
ants
to e
stim
ate t
he a
mou
nt
of f
eces
an
adul
t pro
duce
s ea
ch d
ay (
abou
t 0.5
pou
nds,
or
0.25
kilo
gram
s).
On
the
basi
s of
this
est
imat
e, fa
cilit
ator
s as
k pa
rtici
pant
s to
cal
cula
te th
e to
tal
amou
nt o
f fec
es a
n ad
ult p
rodu
ces
per w
eek,
per
mon
th, a
nd p
er y
ear.
Subs
e-qu
ently
, fac
ilita
tors
ask p
eopl
e to
calc
ulat
e the
tota
l am
ount
of f
eces
pro
duce
d by
a ty
pica
l fam
ily p
er d
ay, w
eek,
mon
th, a
nd y
ear.
Fina
lly, t
hey
ask
abou
t the
size
of
the
entir
e lo
cal c
omm
unity
and
repe
at th
e qu
estio
ns. I
n ad
ditio
n, fa
cilit
ator
s se
ek to
hel
p pa
rtici
pant
s vi
sual
ize
the
tota
l am
ount
s by
sel
ectin
g a
loca
lly fa
-m
iliar
con
tain
er a
nd a
skin
g pa
rtici
pant
s to
calc
ulat
e th
e nu
mbe
r of c
onta
iner
s re
quire
d fo
r eac
h am
ount
. Sam
ple
ques
tions
may
incl
ude
the
follo
win
g: H
ow
man
y ba
sins
(buc
kets
, bag
s) w
ould
that
be? H
ow m
any
whe
elba
rrow
s (w
agon
s, bo
ats,
truc
ks)
wou
ld th
at fi
ll? T
he g
oo c
alcu
latio
n dr
amat
izes
the
cum
ulat
ive
volu
me
of fe
ces g
ener
ated
by
a co
mm
unity
and
rais
es fu
rthe
r que
stio
ns a
bout
its
disp
osal
.
7 2
Soci
al D
evel
opm
ent I
ssue
s 36
(1) 2
014
Dia
gram
min
g Fe
cal-O
ral C
onta
min
atio
n
In th
e di
agra
mm
ing
phas
e of
the
inte
rven
tion,
fac
ilita
tors
ask
wha
t hap
pens
to
all
the
fece
s an
d th
en in
vite
par
ticip
ants
who
resp
ond
to d
raw
a p
ictu
re o
r w
rite
the
wor
d on
a c
ard
(Gov
ernm
ent o
f U
gand
a, M
inis
try o
f Hea
lth, n
.d.).
W
ithou
t eve
r lec
turin
g or
inst
ruct
ing,
faci
litat
ors
ask
ques
tions
that
lead
par
-tic
ipan
ts to
iden
tify
feca
l-ora
l tra
nsm
issi
on ro
utes
. Bas
ic q
uest
ions
incl
ude
the
follo
win
g: H
ow d
o fe
ces g
et fr
om o
pen-
defe
catio
n ar
eas t
o w
ater
sour
ces?
How
do
fece
s get
into
the
mou
th?
Parti
cipa
nts t
ypic
ally
vol
unte
er th
at d
omes
ticat
ed
anim
als
(e.g
., pi
gs, d
ogs,
chic
kens
) eat
fece
s or
car
ry it
aw
ay o
n th
eir f
eet,
that
ve
hicl
es (e
.g.,
bicy
cles
, car
s) c
arry
it o
n th
eir w
heel
s, an
d th
at p
eopl
e als
o ca
rry
it on
thei
r fee
t and
han
ds. B
ut th
e sh
eer v
olum
e of
fece
s lea
ds to
the
real
izat
ion
that
ani
mal
s an
d pe
ople
can
not d
ispos
e of i
t all,
and
that
rain
was
hes m
uch
of
it in
to th
eir w
ater
supp
ly (e
.g.,
wel
ls, s
tream
s, la
kes)
. Afte
r gat
heri
ng re
spon
ses
to th
ese
ques
tions
, fac
ilita
tors
ask
a c
omm
unity
mem
ber t
o or
gani
ze th
e ca
rds
to d
emon
stra
te fe
cal-o
ral t
rans
mis
sion
rout
es. T
he p
roce
ss le
ads p
artic
ipan
ts to
re
aliz
e th
at th
ey o
ften
and
inev
itabl
y in
gest
hum
an fe
ces.
Med
ical
Exp
ense
Cal
cula
tion
Even
with
out u
nder
stan
ding
the
heal
th ef
fect
s of i
nade
quat
e sa
nita
tion,
peo
ple
know
the
cost
s of
med
ical
car
e. F
acili
tato
rs c
an a
sk a
bout
the
loca
l cos
ts o
f m
edic
al ca
re, i
nclu
ding
med
icat
ions
, tre
atm
ent,
and
hosp
italiz
atio
ns. T
hey
can
also
ask
abo
ut th
e co
sts
of tr
ansp
orta
tion
for m
edic
al c
are
and
of w
ages
lost
be
caus
e of
illn
ess (
by p
atie
nts a
nd th
eir c
areg
iver
s). F
or p
eopl
e in
pove
rty, t
hese
co
sts a
lway
s com
poun
d th
e ha
rdsh
ip o
f illn
ess a
nd a
ll to
o of
ten
bloc
k ac
cess
to
med
ical
care
. The
se q
uest
ions
rem
ind
peop
le o
f the
ir v
ulne
rabi
lity.
Trig
gerin
g
The C
LTS
inte
rven
tion
clim
axes
with
dem
onst
ratio
ns d
esig
ned
to tr
igge
r stro
ng
emot
iona
l res
pons
es (e
.g.,
sham
e, d
isgu
st, f
ear).
Dur
ing
the
tran
sect
wal
k, f
a-ci
litat
ors
surr
eptit
ious
ly c
olle
ct a
sam
ple
of fr
esh
fece
s an
d a
sam
ple
of fr
eshl
y co
oked
food
. With
out e
xpla
natio
n, th
ey p
ut th
ese
item
s on
sepa
rate
pla
tes
and
plac
e th
e pl
ates
in c
lose
pro
xim
ity a
t a p
rom
inen
t spo
t dur
ing
the
prec
edin
g ex
erci
ses.
The
clas
sic
trigg
er in
volv
es (1
) of
ferin
g pa
rtic
ipan
ts a
drin
k of
saf
e w
ater
bro
ught
alo
ng fo
r thi
s pu
rpos
e, (
2) to
uchi
ng a
sing
le h
uman
hai
r to
the
fece
s sam
ple
and
dipp
ing
it in
the
drin
king
wat
er, a
nd (3
) off
erin
g pa
rtici
pant
s an
othe
r dr
ink
of w
ater
. Whe
n pa
rtici
pant
s re
fuse
(as
they
con
sist
ently
and
st
renu
ousl
y do
), fa
cilit
ator
s as
k, “
How
man
y le
gs d
oes
a fly
hav
e?”
(bec
ause
fli
es c
ould
pic
k up
mor
e fe
ces
than
the
hair)
. At t
his
poin
t, a
parti
cipa
nt o
ften
excl
aim
s, “T
hat m
eans
we’
re e
atin
g ea
ch o
ther
’s sh
it!”
and
the
faci
litat
ors
sit
dow
n an
d tu
rn th
e m
eetin
g ov
er to
com
mun
ity le
ader
s. Th
ese l
eade
rs o
ften
ask
the
faci
litat
ors w
hat t
hey
will
do
to a
ssis
t the
com
mun
ity w
ith th
eir p
robl
em o
f
Wol
fer
73
open
def
ectio
n, a
nd fa
cilit
ator
s re
min
d co
mm
unity
lead
ers
and
mem
bers
that
th
ey c
ame
only
to a
sk q
uest
ion,
not
to p
rovi
de s
ubsi
dies
or
othe
r as
sist
ance
. Th
is m
omen
t ofte
n st
imul
ates
the
emer
genc
e of n
atur
al le
ader
s eag
er to
addr
ess
the
prob
lem
of o
pen
defe
catio
n, ty
pica
lly b
y vo
lunt
eerin
g to
imm
edia
tely
bui
ld
latri
nes f
or th
eir o
wn
fam
ilies
.
Ope
n-D
efec
atio
n-Fr
ee P
lann
ing
Onc
e co
mm
unity
mem
bers
and
/or l
eade
rs h
ave
deci
ded
to a
ddre
ss th
e pr
oble
m
them
selv
es, f
acili
tato
rs m
ay pr
ovid
e gen
eral
gui
danc
e and
enco
urag
emen
t for
the
deve
lopm
ent o
f a sa
nita
tion
com
mitt
ee a
nd a
n ac
tion
plan
. The
goa
l is t
o es
tab-
lish
and
rein
forc
e com
mun
ity o
wne
rshi
p of
the s
olut
ion,
and
thei
r ini
tiativ
e mus
t be
resp
ecte
d. P
ossib
le a
ctiv
ities
may
incl
ude
listin
g or
map
ping
hou
seho
lds
and
thei
r cur
rent
san
itatio
n st
atus
, dig
ging
pits
or m
akes
hift
latri
nes,
mak
ing
plan
s an
d ac
quiri
ng re
sour
ces t
o bu
ild p
erm
anen
t lat
rines
, pla
nnin
g ou
treac
h to
oth
er
mem
bers
of t
he c
omm
unity
, est
ablis
hing
pen
altie
s to
enfo
rce
com
mun
ity-w
ide
parti
cipa
tion,
and
esta
blis
hing
ODF
goal
s. In
shor
t, fa
cilit
ator
s enc
oura
ge n
atur
al
lead
ers t
o pl
an fo
r mob
ilizi
ng th
eir c
omm
uniti
es to
take
colle
ctiv
e act
ion.
Follo
w-U
p
At t
he c
oncl
usio
n of
the
inte
rven
tion,
fac
ilita
tors
sch
edul
e re
turn
vis
its to
ob
serv
e th
e co
mm
unity
’s pr
ogre
ss to
war
d OD
F. I
t app
ears
that
ear
ly a
nd re
-pe
ated
visi
ts to
the
com
mun
ity (e
.g.,
mon
thly
) ser
ve to
stim
ulat
e an
d re
info
rce
follo
w-th
roug
h on
act
ion
plan
s an
d in
crea
se th
e lik
elih
ood
that
com
mun
ities
w
ill a
chie
ve O
DF (G
over
nmen
t of U
gand
a, M
inis
try o
f Hea
lth, n
.d.).
ODF
Dec
lara
tion
and
Cel
ebra
tion
The
ultim
ate
goal
of
CLTS
is d
ecla
ratio
n an
d ce
lebr
atio
n of
ODF
sta
tus.
Al-
thou
gh s
ucce
ss a
nd ti
min
g va
ry b
y co
mm
unity
, in
man
y ca
ses
com
mun
ities
ac
hiev
e OD
F st
atus
with
in w
eeks
or m
onth
s of
the
initi
al in
terv
entio
n. W
hen-
ever
it o
ccur
s, su
cces
s is g
reat
caus
e for
cele
brat
ion
and
com
mun
ity pr
ide.
Ofte
n,
the
sens
e of
em
pow
erm
ent a
nd s
olid
arity
that
resu
lts fr
om C
LTS
may
insp
ire
com
mun
ities
to ta
ckle
oth
er p
robl
ems
toge
ther
. Fac
ilita
tors
som
etim
es re
crui
t na
tura
l lea
ders
from
succ
essf
ul c
omm
uniti
es to
ass
ist w
ith C
LTS
inte
rven
tions
in
nei
ghbo
ring
com
mun
ities
.
Impl
icat
ions
for S
ocia
l Wor
k
It ap
pear
s tha
t the
pro
blem
of i
nade
quat
e sa
nita
tion
dese
rves
gre
ater
atte
ntio
n on
the
inte
rnat
iona
l soc
ial w
ork
agen
da a
nd th
at C
LTS
is a
pote
ntia
lly u
sefu
l ap
proa
ch fo
r soc
ial w
orke
rs w
ho w
ork
in c
omm
uniti
es w
here
peo
ple
prac
tice
open
def
ecat
ion.
74
Soci
al D
evel
opm
ent I
ssue
s 36
(1) 2
014
Crit
ical
Rol
e of
San
itatio
n in
Wat
er, S
anita
tion,
and
Hyg
iene
Eff
orts
Ove
r the
pas
t tw
o de
cade
s, a
n em
phas
is o
n sa
fe w
ater
has
gra
dual
ly g
iven
way
to
a m
ore
com
preh
ensi
ve e
mph
asis
on
wat
er, s
anita
tion,
and
hyg
iene
(WA
SH).
Safe
wat
er a
nd a
dequ
ate
sani
tatio
n ar
e es
sent
ial f
or h
uman
wel
l-bei
ng, a
nd th
e tw
o ar
e in
extr
icab
ly li
nked
and
rela
ted
to h
ygie
ne. F
urth
erm
ore,
uns
afe
wat
er
and
inad
equa
te s
anita
tion
both
con
trib
ute
to e
xtre
me
pove
rty. W
hile
gov
ern-
men
t and
NG
O le
ader
s ha
ve tr
aditi
onal
ly p
refe
rred
to a
ddre
ss w
ater
and
hav
e do
wnp
laye
d or
eve
n ig
nore
d sa
nita
tion,
it is
incr
easi
ngly
cle
ar th
at s
anita
tion
play
s a
criti
cal r
ole
in in
tegr
ated
wat
er, s
anita
tion,
and
hea
lth (W
ASH
) eff
orts
. A
ddre
ssin
g in
adeq
uate
san
itatio
n go
es a
long
way
tow
ard
addr
essi
ng w
ater
pr
oble
ms,
esp
ecia
lly w
hen
inad
equa
te s
anita
tion
invo
lves
ope
n de
feca
tion.
As
UN
Sec
reta
ry G
ener
al B
an K
i-moo
n as
sert
ed re
cent
ly,
‘Ade
quat
e sa
nita
tion
is cr
ucia
l for
pov
erty
redu
ctio
n, c
ruci
al fo
r sus
tain
able
dev
elop
men
t, an
d cr
ucia
l fo
r ach
ievi
ng a
ny a
nd ev
ery
one o
f the
Mill
enni
um D
evel
opm
ent G
oals
" (Sa
nita
-tio
n D
rive
2015
, 201
3).
Ref
ocus
on
Bas
ic N
eeds
of t
he M
ost V
ulne
rabl
e C
omm
unity
Mem
bers
In g
ener
al, a
ttent
ion
to sa
nita
tion
is a
n es
sent
ial c
ompo
nent
of a
hol
istic
focu
s on
pove
rty, a
nd in
clud
ing
it in
the
soci
al w
ork
agen
da w
ill li
kely
cont
ribu
te to
gre
ater
su
cces
s in
addr
essi
ng po
verty
. Mor
e spe
cific
ally
, san
itatio
n is
an
espe
cial
ly si
gnifi
-ca
nt p
robl
em fo
r the
dis
adva
ntag
ed m
embe
rs o
f im
pove
rishe
d co
mm
uniti
es w
ho
soci
al w
orke
rs o
ften
cham
pion
(e.g
., w
omen
, chi
ldre
n, o
lder
adu
lts, p
eopl
e w
ho
are
ill, p
eopl
e w
ith d
isab
ilitie
s, r
ural
resi
dent
s). I
nade
quat
e sa
nita
tion
is b
oth
a si
gnif
ican
t sou
rce
and
a co
nseq
uenc
e of
hea
lth a
nd e
cono
mic
dis
parit
ies,
and
th
us it
shou
ld re
pres
ent a
sign
ifica
nt c
once
rn fo
r soc
ial w
orke
rs.
Pote
ntia
l Rol
e as
Tra
iner
or F
acili
tato
r
Soci
al w
orke
rs w
ith ex
peri
ence
in p
artic
ipat
ory
rura
l app
rais
al, c
omm
unity
or-
gani
zing
, and
Soc
ratic
que
stio
ning
may
be
wel
l sui
ted
for l
earn
ing
to fa
cilit
ate
CLTS
inte
rven
tions
. Fac
ilita
tor t
rain
ing
is o
ffer
ed th
roug
h m
ultid
ay w
orks
hops
, an
d nu
mer
ous
trai
ning
res
ourc
es a
re a
vaila
ble
at th
e C
omm
unity
-Led
Tot
al
Sani
tatio
n w
ebsi
te (h
ttp://
ww
w.c
omm
unity
ledt
otal
sani
tatio
n.or
g), h
oste
d by
th
e In
stitu
te o
f Dev
elop
men
t Stu
dies
at t
he U
nive
rsity
of S
usse
x an
d fu
nded
by
the
Bill
and
Mel
inda
Gat
es F
ound
atio
n.
Follo
w-U
p w
ith L
ivel
ihoo
d an
d C
omm
unity
Dev
elop
men
t Ini
tiativ
es
Of
sign
ific
ant i
nter
est f
or s
ocia
l wor
kers
, CLT
S in
terv
entio
ns o
ften
stim
ulat
e co
mm
unity
-wid
e co
llabo
ratio
n an
d su
cces
ses
that
cre
ate
oppo
rtun
ity fo
r an
d in
tere
st i
n ot
her
pove
rty
alle
viat
ion
initi
ativ
es (
Dea
k, 2
008;
Kar
& P
aste
ur,
2005
). I
n sh
ort,
they
ser
ve to
em
pow
er a
nd b
uild
sol
idar
ity in
com
mun
ities
.
Wol
fer
75
The c
omm
unity
dev
elop
men
t and
live
lihoo
d in
itiat
ives
that
emer
ge in
the
wak
e of
CLT
S in
terv
entio
ns p
rovi
de a
mor
e fam
iliar
role
for s
ocia
l wor
kers
in p
over
ty
alle
viat
ion.
It is
nec
essa
ry o
nly
that
soci
al w
orke
rs b
e al
ert f
or th
ese
oppo
rtuni
-tie
s or s
eek
to a
ctiv
ely
part
ner w
ith C
LTS
faci
litat
ors.
Part
of S
ocia
l Wor
k’s E
nviro
nmen
tal A
gend
a
Fina
lly, i
t see
ms
clea
r tha
t wor
k in
san
itatio
n fit
s with
soc
ial w
ork'
s em
ergi
ng
envi
ronm
enta
l ag
enda
. In
adeq
uate
san
itatio
n ha
s gr
ave
cons
eque
nces
for
hu
man
s an
d fo
r the
env
ironm
ent m
ore
broa
dly.
With
con
tinui
ng g
loba
l pop
u-la
tion
grow
th, a
dequ
ate
sani
tatio
n is
incr
easi
ngly
criti
cal f
or su
stai
nabi
lity.
Ad-
dres
sing
inad
equa
te s
anita
tion
as a
mat
ter o
f env
ironm
enta
l deg
rada
tion
and
soci
al ju
stic
e con
stitu
tes a
noth
er li
nkag
e fo
r soc
ial w
orke
rs.
Con
clus
ion
Des
pite
the
early
pre
cede
nt s
et b
y Ja
ne A
ddam
s (N
obel
Fou
ndat
ion,
n.d
.), th
e so
cial
wor
k pro
fess
ion
has g
ener
ally
ove
rlook
ed sa
nita
tion.
But
inad
equa
te sa
ni-
tatio
n re
mai
ns a
sign
ifica
nt c
ontri
buto
r to
pove
rty in
man
y pa
rts o
f the
wor
ld,
and
thus
it is
an
appr
opria
te ta
rget
for p
rofe
ssio
nal c
once
rn a
nd in
terv
entio
n.
Bey
ond
the
dire
ct, i
mm
edia
te, a
nd s
ever
e he
alth
con
sequ
ence
s of
inad
equa
te
sani
tatio
n, th
ere
are
sign
ifica
nt c
onse
quen
ces
for e
duca
tion
and
empl
oym
ent.
As
with
man
y ot
her
prob
lem
s, th
ese
cons
eque
nces
dis
prop
ortio
nate
ly a
ffec
t w
omen
, chi
ldre
n, o
lder
adu
lts, a
nd p
eopl
e with
disa
bilit
ies.
For t
hese
and
oth
er
reas
ons,
it s
eem
s ap
prop
riate
that
the
soci
al w
ork
prof
essi
on b
egin
to a
ddre
ss
inad
equa
te s
anita
tion.
As
a po
tent
ial a
ppro
ach,
CLT
S ap
pear
s to
be
high
ly ef
-fe
ctiv
e an
d la
rgel
y co
nsis
tent
with
soci
al w
ork
valu
es, k
now
ledg
e, a
nd sk
ills.
Ref
eren
ces
Bar-O
n, A
. A.,
& Pr
inse
n, G
. (19
99).
Plan
ning
, com
mun
ities
and
empo
wer
-m
ent:
An
intro
duct
ion
to p
artic
ipat
ory
rura
l app
rais
al. I
nter
natio
nal
Soci
al W
ork,
42(3
), 27
7-29
4.Bl
ack,
M. (
2008
). Th
e las
t tab
oo: O
peni
ng th
e doo
r on
the g
loba
l san
itatio
n cr
isis.
Lond
on, U
K: E
arth
scan
.C
ham
bers
, R. (
1994
a). T
he o
rigin
s and
pra
ctic
e of
par
ticip
ator
y ru
ral a
p-pr
aisa
l. W
orld
Dev
elop
men
t, 22
(7),
953-
969.
Cha
mbe
rs, R
. (19
94b)
. Par
ticip
ator
y ru
ral a
ppra
isal
(PRA
): A
naly
sis o
f exp
e-rie
nce.
Wor
ld D
evel
opm
ent,
22(9
), 12
53-1
268.
Cha
mbe
rs, R
. (19
94c)
. Par
ticip
ator
y ru
ral a
ppra
isal
(PRA
): C
halle
nges
, po-
tent
ials
and
par
adig
m. W
orld
Dev
elop
men
t, 22
(10)
, 143
7-14
54.
Cha
mbe
rs, R
. (20
08, N
ovem
ber 1
9). "
Shit"
mat
ters
: Com
mun
ity-le
d to
tal s
ani-
tatio
n an
d th
e MD
Gs.
Ret
rieve
d fr
om h
ttp://
ww
w.id
s.ac
.uk/
go/n
ews/
ne
ws-
at-id
s-sh
it-m
atte
rs-c
omm
unity
-led-
tota
l-san
itatio
n-an
d-th
e-m
dgs.
76
Soci
al D
evel
opm
ent I
ssue
s 36
(1) 2
014
Cha
mbe
rs, R
. (20
09).
Goi
ng to
scal
e with
com
mun
ity-le
d to
tal s
anita
tion:
Ref
lec-
tions
on
expe
rienc
e, iss
ues a
nd w
ays f
orwa
rd (P
ract
ice P
aper
No.
1).
Brig
hton
, UK:
Inst
itute
of D
evel
opm
ent S
tudi
es.
Dea
k, A
. (20
08).
Takin
g com
mun
ity-le
d to
tal s
anita
tion
to sc
ale:
Mov
emen
t, sp
read
an
d ada
ptat
ion
(Wor
king
Pap
er N
o. 2
98).
Brig
hton
, UK:
Inst
itute
of D
e-ve
lopm
ent S
tudi
es.
Ferr
iman
, A. (
2007
, Jan
uary
18)
. BM
J rea
ders
cho
ose
“san
itary
revo
lutio
n”
as g
reat
est m
edic
al a
dvan
ce si
nce
1840
. BM
J, 33
4(11
1.2)
. Ret
rieve
d fr
om h
ttp:/
/ww
w.b
mj.c
om/c
onte
nt/3
34/7
585/
111.
2.G
eorg
e, R
. (20
08).
The b
ig n
eces
sity:
The
unm
entio
nabl
e wo
rld o
f hum
an w
aste
an
d w
hy it
mat
ters
. New
Yor
k, N
Y: M
etro
polit
an B
ooks
.G
laus
iusz
, J. (
2002
, Dec
embe
r). T
he b
iolo
gy o
f ..
. dis
gust
: War
ning
: Thi
sar
ticle
cou
ld m
ake
you
sick
to y
our s
tom
ach.
Disc
over
. Ret
rieve
d fr
om
http
://di
scov
erm
agaz
ine.
eom
/200
2/de
c/fe
atbi
olog
y#.U
jR56
D9o
JX8.
Gov
ernm
ent o
f Uga
nda,
Min
istry
of H
ealth
, (n.
d.).
Com
mun
ity-le
d to
tal s
anita
-tio
n: F
acili
tato
r’s fie
ld gu
ide.
Ret
rieve
d fr
om h
ttp://
ww
w.c
omm
unity
led
tota
lsan
itatio
n.or
g/si
tes/
com
mun
ityle
dtot
alsa
nita
tion.
org/
files
/ Fa
cilit
ator
s_Fi
eld_
Gui
de.p
df.
Inst
itute
of D
evel
opm
ent S
tudi
es. (
2011
). Th
e CLT
S app
roac
h. R
etrie
ved
from
ht
tp://
ww
w.c
omm
unity
ledt
otal
sani
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itsco
nten
tm
ayno
tbe
copi
edor
emai
led
tom
ultip
lesi
teso
rpos
ted
toa
lists
erv
with
outt
heco
pyrig
htho
lder
'sex
pres
swrit
ten
perm
issi
on.H
owev
er,u
sers
may
prin
t,do
wnl
oad,
orem
aila
rticl
esfo
rin
divi
dual
use.
