Evaluating the performance and the sustainability of the community- led total sanitation (clts) programme in Ghana

Abstract

Community-led total sanitation (CLTS) is a widely used sanitation intervention in ending open defecation through a community-wide behavioural change towards latrine construction and use, resulting in certified open defecation-free (ODF)communities. However, the effects of its implementation activities on improving the performance of the programme and the factors that significantly drive sustainable, long-term behavioural change, are yet to be ascertained. To achieve the aim of this study, which was to evaluate the performance and sustainability of the CLTS programme in Ghana, a sequential, exploratory, mixed-methods approach that allowed the integration of qualitative and quantitative data was adopted. Data collected from semi-structured interviews with CLTS practitioners and implementers, focus group discussions and direct observations in 25 selected cases in certified ODF communities across eight regions in Ghana were analysed thematically. The results were used to develop a conceptual framework and questionnaire which were administered to CLTS practitioners and implementers. The quantitative data, analysed using the partial least square structural equation modelling, were used to validate the conceptual framework developed from the qualitative data. A confirmatory factor analysis showed the inter-relationship between variables. The framework showed that, for CLTS to achieve improved performance and long-term behavioural change in sanitation practices, implementers, practitioners, and governments should prioritise leadership, ownership, motivation and commitment, financial and behavioural change factors of sustainability, which were found to influence improved performance and sustainability of the programme significantly. Thus, through active and supportive leadership, and ownership of the CLTS programme by top-management of the sanitation sector and the CLTS beneficiary communities; readily available financial support for effective application of CLTS implementation resources and post-implementation activities, such as follow-ups, maintenance and reconstruction of improved latrines, beneficiary communities would be motivated to commit to long-term behavioural change in sanitation practices that provide comfort, convenience and prestige culminating in improved performance and sustainability of the CLTS programme. The results showed further that, when combined with school-led total sanitation, and sanitation marketing and support in the form of targeted subsidies, CLTS yielded sustainable outcomes. The findings of the study showed that the framework developed could be used by sanitation donors, governments and organisations to sustain long-term behavioural change in sanitation practices.