Livelihood Impacts of a Community-Led Total Sanitation Approach in Kenya.

1. Background
“Sanitation is more important than political independence” is a quote by Mahatma Gandhi that captures the
quintessential positioning of sanitation in the hierarchy of human rights. The Joint Monitoring Programme
(JMP) report on the progression of water sanitation and hygiene (WASH), estimates that 2 billion people still
do not have basic sanitation facilities such as toilets or latrines and of these, 673 million still defecate in the
open, for example in street gutters, behind bushes or into open bodies of water (WHO and UNICEF, 2017).
Without proper sanitation infrastructure such as toilets or latrines, many people practice open defecation,
which is a major contributor to the global burden of disease (Pruss-Ustun and Corvalan, 2006). For decades,
governments and nongovernmental organizations (NGOs) provided free or subsidized latrines to households,
but practitioners widely believe that this approach was unable to guarantee regular latrine use. This
recognition led to a focus on hygiene and health education programs, often combined with latrine subsidies,
such as the Participatory Hygiene and Sanitation Transformation approach (WHO 1997). Lessons learned
from implementing these programs led many sanitation professionals to conclude that while the
infrastructure-heavy approach may have increased access to latrines and educational approaches may have
increased awareness of health benefits, these strategies were largely insufficient to generate demand for
latrines and change sanitation behavior (Jenkins and Sugden 2006).
As a response, the community-led total sanitation (CLTS) approach was developed, aiming to create open
defecation–free (ODF) communities (Kar and Chambers 2008). This approach signified a fundamental shift
from a focus on individual or household sanitation to a community-level concern for open defecation. CLTS
facilitators attempt to trigger collective behavior change by encouraging and motivating people to confront
the impact of community-wide open defecation. In the initial phase, pre-triggering, each community is
visited, and information is gathered about the population and their readiness for behaviour change. In the
second phase, triggering, this information is used to adjust participatory behaviour change techniques (BCTs).
These techniques are then applied during a community event such as community mapping or a transect walk
along which the community is confronted with faecal contamination. The optimal outcome of this community
meeting, also called the triggering event, is an increase in community members’ awareness that “they are
eating their own faeces” (Kar and Chambers, 2008).
This realization should lead to a change in sanitation conditions by constructing latrines (Kar and Chambers,
2008). Third, during the post-triggering phase, facilitators support the community in achieving the status of
an “open defecation free community,” by helping in the construction of latrines. The original CLTS process
works without any subsidies (Kar, 2003).

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 2. Statement of the Problem
Despite 15 years of concerted efforts to end open defecation under global action plans like Millennium
Development Goals (MDGs), poor sanitation remains one of the biggest development challenges in the
country and costs Kenya Ksh27 billion (US $324 million) each year. Approximately 5 million rural dwellers
practice open defecation and since poverty is heavily weighted towards rural areas, the health and social cost
of poor sanitation falls disproportionately on the poorest, with open defecation costing more per person than
any other type of unimproved sanitation. (WSP Sanitation Baseline, 2014).
Today, there remains a large number of sanitation approaches which range from the original CLTS focusing
on behavioural changes to other traditional and hybrid approaches which focus more on market based
solutions. Given the wide adoption of CLTS (Cavill, 2018), its effectiveness has still rarely been scientifically
investigated. The few rigorous scientific studies of CLTS's effectiveness have produced diverse and ambiguous
findings (Pickering et al., 2015; USAID, 2018; Venkataramanan et al., 2018).
Whatever sanitation approach is implemented, in many cases slippage is an issue. Slippage refers to failure to
sustain new facilities and behaviours over time. Without a policy and regulatory environment that enables
maintenance, pit emptying, replacement or upgrading of facilities or support behaviours over time,
households are likely to go back to their former habits. And as basic infrastructure is provided at larger scale,
coverage risks stagnating at around 60-80% if necessary financial, institutional and logistical arrangements
are not in place. This has an implication on the livelihood of the people living in the rural areas. (Carrasco &
Dube, 2014).
This study therefore aims to investigate the relation between sanitation and livelihoods in the context of
poverty reduction, health improvements, increased levels of education and environmental protection. The
main question to be explored in this study is, how can human excreta disposal, management and re-use
improve poor people’s livelihoods in rural areas? This contribution is important because it will add evidence
to a relatively sparse literature on how sanitation improvements can have large and significant impacts on
livelihood outcomes particularly when accounting for the strong link between cognitive development and
future earnings (Orgill-Meyer & Pattanayak, 2017).

3. Objectives of Study
The general objective of this study is to investigate how CLTS Approach has impacted the livelihood of
the people in Kenya.

3.1. Specific Objectives

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 2. To examine the influence of social norms in livelihood enhancement in Kenya
3. To examine the role of capacity building in SMEs on livelihood enhancement in Kenya
4. To analyze the influence of Physical Environment on livelihood improvement in Kenya.
5. To establish the role of financial support on livelihood improvement in Kenya

4. Theoretical Framework.
4.1 Sustainable Livelihoods Approach

This theory relates to the ability of a social unit or system to enhance or maintain its livelihood on a
sustainable basis, using its assets and capabilities in the face of shocks and stresses over time (Carney 1998).
The theory identifies key livelihood assets as well as the nature and impacts of environmental, economic and
social shocks and stresses on these assets. Carney (2002) defines livelihood as comprising the capabilities and
assets required for a means of living. In Carney’s view, a livelihood should be sustainable by being able to
cope with and recover from stresses and shocks and maintain or enhance its capabilities and assets both now
and in the future, while not undermining the natural resource base. In line with Carney’s conception, Safe
sanitation will lead to improved health which makes it more possible for people to take initiatives and utilize
their assets for improved livelihoods. According to Borba et al. (2007) without safe sanitation and its
resultant safe physical environment and improved health, the people might lack the energy and productivity
to initiate and sustain relevant action to improve their living conditions at the individual, household and
community levels, which will invariably affect their livelihoods.

4.2 Multi-Dimensional Poverty Index (MPI)

The MPI was developed in 2010 by the Oxford Poverty & Human Development Initiative (OPHI) and the
United Nations Development Programme and uses health, education and standard of living indicators to
determine the degree of poverty experienced by a population. It has since been used to measure acute
poverty across over 100 developing countries. The Global MPI is released annually by OPHI and the results
published on its website. It replaced the Human Poverty Index. The MPI is composed of three dimensions
made up of ten indicators. Associated with each indicator is a minimum level of satisfaction, which is based
on international consensus (such as the Millennium Development Goals or MDGs). This minimum level of
satisfaction is called a deprivation cut-off. Two steps are then followed to calculate the MPI: Step 1: Each
person is assessed based on household achievements to determine if he/she is below the deprivation cut-off
in each indicator. People below the cut-off are considered deprived in that indicator. Step 2: The deprivation

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of each person is weighted by the indicator’s weight. If the sum of the weighted deprivations is 33 per cent or
more of possible deprivations, the person is considered to be multidimensionally poor.

To link household environment to sanitation impacts, first is that the health of the population is linked to
determinants of health such as improved sanitation, drinking water and cooking fuel. A poor household
environment affects the health and productivity of the population adversely. Second, the multidimensional
poor are likely to be living in a poor household environment, unaware of the adverse effects of a challenging
environment caused by sedentary lifestyle, and they may suffer from poor health as a result. Hence,
multidimensional poverty has a direct bearing on the health and productivity of the population and
consequently their livelihood.

4.3 Diffusion of Innovation Theory

Diffusion of innovations is a theory that seeks to explain how, why, and at what rate new ideas and
technology spread. Everett Rogers, a professor of communication studies, popularized the theory in his book
“Diffusion of Innovations”; the book was first published in 1962 (Ryan and Gross, 1995). Rogers argues that
diffusion is the process by which an innovation is communicated over time among the participants in a social
system. The origins of the diffusion of innovations theory are varied and span multiple disciplines.

Rogers proposes that four main elements influence the spread of a new idea: the innovation itself,
communication channels, time, and a social system. This process relies heavily on human capital. The
innovation must be widely adopted in order to self-sustain. Within the rate of adoption, there is a point at
which an innovation reaches critical mass. Since its genesis in Bangladesh in 1999, CLTS has spread to
approximately 60 countries, mostly in Asia and Africa, and is employed by the majority of development
organizations operating in rural sanitation (Zuin et.al, 2019). This theory will aid in analyzing the reasons and
processes that drove the wide diffusion of CLTS.

4.4 Behaviour Change Theory

One theoretical framework that explains changes in mindsets in the sector of water sanitation and hygiene
(WASH) is the risks, attitudes, norms, abilities, and self-regulation (RANAS) model of behaviour change
(Mosler, 2012; Mosler and Contzen, 2016). It combines existing theoretical models of behaviour change, such
as the health action process approach (Schwarzer, 2008) and the theory of planned behaviour (Ajzen, 1991).
The core concept of the RANAS model is that behaviour change is driven by various psychosocial
determinants that need to be in favor of a new behaviour (Mosler, 2012).

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These determinants are clustered in five factor blocks: 1) Risk factors include individuals' health knowledge,
its perceived severity, and their vulnerability to it; 2) attitude factors include feelings about the new
behaviour and the perceived costs and benefits of performing it; 3) norm factors include people's perceptions
of others' behaviour and their perceived (dis)approval when an individual shows the new behaviour; 4) the
ability factor block includes the knowledge of how to perform the behaviour and confidence in starting a
behaviour, continuously performing it, and recovering it after relapse; and 5) the self-regulation factor block
contains the individual's action plans for the behaviour, how he or she deals with barriers, self-monitoring
(e.g., action control) and remembering the new behaviour and the commitment to performing the behaviour.

These psychosocial factors are used to develop theory- and evidence-based behaviour change interventions.
Differences are observed between the psychosocial determinants of people who already show the new
behaviour and those who do not yet show it. The determinants that show the greatest differences are those
targeted in behaviour change campaigns.

Reference
Chambers, R. (2009). Going to scale with community-led total sanitation: reflections on experience, issues
and ways forward. IDS Practice Papers (Vol. March). Brighton, UK: Institute of Development Studies at the
University of Sussex.

Kar, K. (2010). Facilitating ‘‘Hands-on” Training Workshops for Community-Led Total Sanitation, a Trainers’
Training Guide. Geneva.

Kar, K., & Chambers, R. (2008). Handbook on Community-led total sanitation. Brighton, UK: Plan
International.
Kar, K., & Milward, K. (2011). Digging in, Spreading out and Growing up: Introducing CLTS in Africa. IDS
Practice Paper 8.

Mukherjee, N., & Shatifan, N. (2008). The CLTS Story in Indonesia Empowering communities, transforming
institutions, furthering decentralization.

Musyoki, S. M. (2007). Sceptics and Evangelists: Insights on Scaling up Community Led Total Sanitation (CLTS)
in Southern and Eastern Africa.

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Pickering, A.J., Dentz, H.N., Arnold, B.F., Arnold, C.D., BenjaminChung, J., Clasen, T., Dewey, K.G., Fernald,
L.C.H., Hubbard, A.E., Kariger, P., Lin, A., Luby, S.P., Mertens, A., Njenga, S.M., Nyambane, G., Ram, P.K.,
Colford, J.M., (2018). ‘Effects of water quality, sanitation, handwashing, and nutritional interventions.
International Journal of Hygiene and Environmental Health, 28 (4), 477-498.

Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De
France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D.,
Medlicott, K., Neira, M., Stocks, M., Wolf, J., Cairncross, S., (2014). Burden of disease from inadequate water,
sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145
countries. Tropical Medical International Health.19 (8), 894–905.

Rogers, Everett (16 August 2003). Diffusion of innovation, 5th Edition. Simon and Schuster.

United Nations Children’s Fund (UNICEF) and World Health Organization (WHO). (2019). Progress on
household drinking water, sanitation and hygiene 2000-2017. Special focus on inequalities.

USAID. (2018). An Examination of CLTS’s Contributions Toward Universal Sanitation. Washington.

Venkataramanan, V. (2017). Review of Rural Sanitation Approaches. Venkataramanan, V., Crocker, J., Karon,
A., & Bartram, J. (2018). Community-led total sanitation: A mixed-methods systematic review of evidence and
its quality. Environmental Health Perspectives, 126(02).

World Health Organization (2017). Financing universal water, sanitation and hygiene under the sustainable
development goals.

WHO, UNICEF, (2017). Progress on Drinking Water. Sanitation and Hygiene, Geneva.