Open defecation is the norm in rural and urban Africa – only about a third of the population uses improved sanitation facilities – and this contributes in various ways to a heavy disease burden. Community-led Total Sanitation (CLTS), an approach to sanitation which focuses on community-wide behaviour change to completely stop open defecation, began to go to scale in Africa in 2006. Since then, it has spread dramatically and in many countries very successfully, and is now used at some level in at least 26 African countries.
This paper draws on the extensive involvement of Kamal Kar with the spread of CLTS in Africa to describe the early stages of the process, to elaborate on its developments and to outline insights into the circumstances and features which have facilitated its rapid spread.
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