Two million children die every year from diarrhoea, caused by inadequate water and sanitation infrastructure and unhygienic practises. Half of these deaths occur in India[i] [ii] [iii].
Globally 1.1 billion people, including an estimated 638 million in India alone, practice open defecation (OD). This is inextricably linked to the very low availability and use of toilets. In India, the 2011 census indicated that less than half (46.9%) of households have latrines within their premises.
In 2014, the Government of India made Open Defecation Free (ODF) status a national mission. India aims to achieve ODF status by 2019 through a mix of strategies that include financial incentives for household toilet construction, recognition and rewards for villages that become ODF, and community led initiatives to mobilise behaviour change.
Community Led Total Sanitation (CLTS) uses community empowerment to raise awareness and change defecation practices with the goal of entire villages becoming ODF.
In Odisha, one of the least developed states in the country with a population of 42 million, the 2011 census found only 22% of households have their own latrines. Following the change in national policy, the Government of Odisha (GoO) implemented an adapted CLTS approach to improve sanitation practices and achieve ODF status. This adapted approach, named Community Led Sanitation (CLS) draws on CLTS methodologies of community empowerment, but also provides government subsidies and enables communities to access affordable and high quality materials for toilet construction.
A technical management and support team, led by Options, supported local NGOs to implement CLS in over 800 villages across five blocks of Odisha from high burden districts, identified by the State Government. CLS was implemented in stages between October 2014 and February 2016.
Following the intervention, more households have an improved sanitation facility, with the greatest increase among the most vulnerable groups.[iv]
The final 2016 survey found 44.1% of households had improved sanitation facilities (shared and unshared) compared with only 13.9% in the 2014 baseline survey.
Increased access to improved facilities has also progressed for scheduled tribe households, the social group with the lowest health and nutrition outcomes in the state. In 2014, just 3.7% had access to an improved facility, compared to 29.7% in 2016.
Although more people had access to improved toilet facilities, more than half of households at the end of the programme did not yet own an improved sanitation facility. Lack of land for construction of household toilets and lack of water to sustain use of toilets are the two main factors that hinder achievement and sustainability of ODF status with poor people being most at risk.
The overall findings of the evaluation show that CLS is an effective, pro-poor intervention that considerably increased access to and use of improved sanitation facilities in a short period of time and progressed the ODF movement in the state. Linking community mobilisation efforts with provision of government subsidies and materials to households to construct a toilet was key to achieving results. Responsive district administrations helped overcome bottlenecks in access to supplies of rural pans, ensured the smooth flow of funds from the district to the local government body and undertook regular monitoring of toilet construction. Community institutions also played a major role in promoting and reinforcing messages, providing credit to village members that were left out of government subsidy beneficiary lists, and monitoring the flow of subsidies and construction.
[i] Wang L. Determinants of child mortality in LDCs: empirical findings from demographic and health surveys. Health Policy 2003;65:277-99.
[ii] Borooah VK. On the incidence of diarrhoea among young Indian children. Econ Hum Biol2004;2:119-38.
[iii] Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2005;5:42-52.
[iv] Improved facility: Flush or pour/flush facilities connected to a: piped sewer system, septic system, pit latrine; pit latrines with a slab; composting toilets; Ventilated improved pit latrines.