Evaluating the Impact of Community led Total Sanitation Programs in Mali

Behavioral change is a key ingredient for successful adoption of better sanitation practices in rural Africa. Sanitation programs have, for some time now, incorporated the need to raise awareness and emphasize the benefits of toilet usage. These endeavors, often combined with subsidies linked to toilet construction by households, seek to create a demand for sanitation goods. Yet, progress in securing the desired outcomes from sanitation programs has been slow. Moreover, the benefits of sanitation largely take the form of externalities, which individuals do not take into account when making their own investment decisions. This makes sanitation promotion at the household level particularly challenging.

An approach adopted in South Asia has drawn attention. This approach shifts away from the provision of subsidies for toilets for individual households and towards a promotion of behavioral change at the individual level. It emphasizes collective decision-making in order to produce 'open defecation-free' villages. The objective of the intervention is to reduce the incidence of diseases related to poor sanitation and manage public risks posed by the failure to safely confine the excreta of some individuals. The way to achieve this objective is by empowering communities that are motivated to take collective action. Local governments and other agencies perform at best a facilitating role. There is a growing recognition that this approach, referred to as Community-Led Total Sanitation (CLTS), may help with the reduction of open defecation practices. However, no rigorous impact evaluation of CLTS has been conducted so far. This study presents the results of the baseline analysis of a randomized controlled trial for studying the effect of CLTS in rural Mali. It produces sound evidence that can be used to evaluate the extent to wich CLTS improves health outcomes and help determine what drives collective action, in order to increase sanitation coverage.

The direct recipients of the intervention are members of rural communities in Mali who aspire to live in a cleaner environment. The donor community includes international organizations and governments in developing countries. They will benefit from having simple and clear evidence on the effectiveness of an innovative program for improving sanitation in rural areas. They will learn whether the program has worked or failed to achieve its objective of eradicating open defecation, and the key factors explaining success and failure. This evaluation aims to provide useful information to help guide decisions on how to help meet the MDG sanitation target. 

This research was recognized in the 2015 Best of UNICEF Research competition as Outstanding research.
Pickering, A. J., Djebbari, H., Lopez, C., Coulibaly, M., & Alzua, M. L. (2015) Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial. The Lancet Global Health, 3(11), e701-e711. 

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