The Government of India launched a Swachh Bharat Mission (SBM) in October 2014 to achieve Clean India by 2019 (Ravindra and Smith, 2018). SBM aims to improve the levels of cleanliness in rural areas through solid and liquid waste management activities and making village communities (Gram Panchayats) ODF, clean and sanitized (MDWS 2014). The application of IMA in CLTS activities is innovative and as shown in Table 1, it helped to achieve rapid progress (within 1 year) to make ODF villages in Fatehgarh Sahib. Table 1 also shows that clustering of villages declared as ODF but that happened due to administrative approval, as the authorities normally clear the cases together. A comparative assessment of traditional and IMA approach in CLTS is shown in Table 2, which highlights the importance of IMA in planning, monitoring, evaluating and validating a community-led total sanitation program. Application of IMA for sharing multimedia files was felt as the most useful feature by District Administration to observe daily progress and plan further. Hence, the ease of attaching multimedia files like audio, video, and image makes IMA more comprehensive and authentic for public service delivery. This also expedited the process of CLTS to make Fatehgarh Sahib as ODF district.
Community Led Total Sanitation Pdf Download
The study showed that the level of latrine utilization in CLTSH implemented and that of CLTSH non-implemented kebeles was low. Therefore, concerted efforts should be made by local and national governmental and non-governmental organization to should be used to promote behavioral change in the communities to implement community-led total sanitation and hygiene for improving latrine utilization.
Citation: Gebremariam B, Hagos G, Abay M (2018) Assessment of community led total sanitation and hygiene approach on improvement of latrine utilization in Laelay Maichew District, North Ethiopia. A comparative cross-sectional study. PLoS ONE 13(9): e0203458.
Considering the devastating consequences of poor sanitation, in recent years sanitation programs including Community-Led Total Sanitation and Hygiene (CLTSH) have evolved dramatically most of them in which focused on engaging communities, creating demand for sanitation, and supporting the development of sustainable systems and appropriate technologies in which all of which are rooted in catalyzing community behavior and social change [4].
CLTSH is based on the principle of triggering collective behavior change with basic principles of no toilet subsidy and no financial reward when the community reaches 100% Open Defecation Free (ODF). In this approach, communities are simply facilitated to take collective action to adopt safe and hygienic sanitation behavior and ensure that all households have access to safe sanitation facilities [5]. In the process, the community is sensitized to the consequences of poor sanitary practices, commits itself to find own solutions, and finally is liberated from open defecation. This helps to increase a receptive environment for the adoption of improved practices in personal hygiene, safe handling of food and water as well as safe confinement and disposal of excreta and waste[4, 6, 7].
Community-led total sanitation and hygiene approach implementation were started in different parts of Ethiopia; nevertheless, the assessment of CLTSH approach on the utilization of latrine was not assessed, particularly in the study area. Therefore, the objective of this study is to assess the Community-led Total Sanitation and hygiene approach on the improvement of latrine utilization in the rural community of Laelay Maichew district, Central zone, Tigray, Northern Ethiopia.
The sample size was calculated assuming two population proportion formula using rate of latrine utilization 50% for the two study sets, 95% Confidence level, 5% margin of error and 10% of non-response rate. The study subjects were selected using multistage sampling procedure, where the kebeles first divided into community-led total sanitation and hygiene implemented and community-led total sanitation and hygiene non-implemented, then three kebeles were selected from each total kebelles by lottery method. Then, to draw a sampling frame the total number of households in the kebelles were obtained from the respected Health Extension workers of each kebele. The sample size was allotted to each selected kebele by probability proportional to size sampling method. Using systematic random sampling every 9th household)in the selected kebelles were included in the study. The final sample size included in the study was 776 (388 from CLTSH implemented and 388 from CLTSH non-implemented kebeles).
The study showed that the extent of latrine utilization in CLTSH implemented was greater than that of CLTSH non-implemented kebeles. In this study coverage of hand-washing facility near the latrines in both CLTSH implemented kebeles and CLTSH non-implemented kebeles was very low. The study also indicated that from those households with latrine the habit of hand-washing after defecation in CLTSH implemented and non-implemented kebelles was similar and have no significant association in the bivariate and multivariate analysis in both kebelles. Thus, even though the CLTSH implementation seems almost the same in both the CLTSH implemented and non-implemented kebelles, it can be concluded that it is possible to increase latrine utilization rate through the effective and sustainable implementation of the CLTSH approach. Therefore, it is possible to increase latrine utilization with the sustainable implementation of the community-led total sanitation and hygiene approach.
Community-led total sanitation (CLTS) is a widely used, community-based approach to tackle open defecation and its health-related problems. Although CLTS has been shown to be successful in previous studies, little is known about how CLTS works. We used a cross-sectional case study to identify personal, physical, and social context factors and psychosocial determinants from the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) model of behavior change, which are crucial for latrine ownership and analyze how participation in CLTS is associated with those determinants.
In recent years, one form of intervention to reduce or eliminate open defecation has gained attention worldwide: community-led total sanitation (CLTS). This set of community-based activities was first introduced by Kamal Kar in Bangladesh in 2000 [1]. It is designed to engage individuals in action to eliminate open defecation and recognize health as a common good, worth fighting for as a whole community. It has the potential to replace a top-down approach to subsidizing toilet facilities. The good news is that CLTS is successful in evoking change: people in a variety of cultural settings have started building latrines after participating in CLTS [2,3,4,5,6], for example in Mali [7] and Tanzania [8]. But in the case of Mozambique, the results of CLTS are not encouraging so far: Pendly et al. [9] reported 24% of communities failed to adopt latrine construction after CLTS implementation and Godfrey et al. [10] reported 29% of communities losing the gained status of an open defecation free community.
Globally, 2.0 billion people lack improved sanitation and 946 million practice open defecation (OD).1 Between 2000 and 2017, the net reduction in the global population practicing open defecation decreased by 647 millions.1 However, there were disparities in the reductions with countries in Central and South Asia recording the largest reduction of 496 million, whereas sub-Saharan Africa reduced open defecation by 5 million people.1 A report released by the WHO in 2012 indicated that about 1.5 million children younger than 5 years die each year from sanitation-related diseases such as diarrhea, which could be prevented by community-led total sanitation (CLTS).2 Uganda was not able to meet its 2015 millennium development goal of increasing sanitation and hygiene coverage to 75%.3 The country has generally experienced stagnation in progress in achieving better sanitation and hygiene4 with 18% of the population without access to at least basic sanitation, 18% had limited (shared) sanitation, and 58% had unimproved sanitation in 2017.1 Moreover, 6% of the population was estimated to still be practising OD by 2017.1
The Uganda Ministry of Health with support from Global Sanitation Fund recognized and implemented the CLTS approach in selected districts including Pallisa. The approach is considered an effective and low-cost mechanism to promote better sanitation and hygiene at the household level. The focus of CLTS is to trigger the community to generate sustained behavioral change leading to spontaneous and long-term abandonment of open defecation practices and to stimulate demand for safe sanitation and hygiene facilities without provision of any facilities or subsidies.5 Indeed, in Pakistan, effective CLTS implementation resulted in improved latrine coverage in all the target districts, which reduced open defecation practices in the communities.6 In rural Zambia, CLTS activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and hand-washing facilities.7 Previous findings have also indicated that the prevalence of childhood diarrhea was significantly higher in communities where CLTS was not implemented than in the intervention areas.8,9
Quantitative data on sociodemographic factors and knowledge about sanitation and hygiene were collected using a semi-structured questionnaire, whereas observational checklists were used to collect data on ODF latrine and handwashing status. The data collection instruments (Supplemental Information) were adapted from the previous literature on sanitation13 and pretested in a similar community and necessary adjustments made. Data were collected by a team of research assistants who underwent a 2-day training on the study aspects before being deployed. At least one eligible respondent, who was an adult member in their households, was identified and interviewed. Where more than one adult was present in a selected household, preference was given to the household head, their spouse, or the next adult member. Data collection took place in May 2018. 2ff7e9595c
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