Today it is widely accepted that Community Led Total Sanitation (CLTS) is one of the most effective and successful approaches to achieving open defecation free communities. Pioneered in Bangladesh in 1999-2000 by Dr. Kamal Kar, the approach is now being implemented in 43 countries in Asia, Africa and Latin America.

When triggered the feeling of ‘disgust’, ‘shame’, ‘self-respect’ and ‘fear’ prompts a self-realization amongst the individuals as well as the entire community of the negative consequences on health, environment and economy such as chronic illness, poor drinking water quality, workdays lost, medical expenses and consequent impact on livelihood. CLTS is triggered through  hands-off facilitation and  participatory analysis of a community’s  sanitation profile , which stimulates the basic  desire to avoid contact with human excreta. Self-respect, shame, disgust and fear of contamination drive communities towards an urgent collective local action to get out of the filth. These considerations then drive women, men and children to collectively work to create Open Defecation Free (ODF) communities. 

One of the major contributions of CLTS has been to illustrate that externally imposed ‘hardware’ prescriptions do not work. Hardware prescriptions emphasize toilets, rather than safe confinement of excreta, and therefore divert attention from the self-realization process that is essential to achieve collective behavior changes. Further, studies have revealed that subsidy schemes to ‘provide’ latrines do not lead to the desired outcomes, as these are often inappropriate or create divisions between the ‘have’ and ‘have-not’ communities. Moreover, they nurture the mentality of dependency through hand-outs which is contrary to transformative social processes.