Community-Led Total Sanitation: A solution to Nairobi's Sanitation Struggles?

In light of the challenges women face raised by inadequate water, sanitation, and hygiene (WASH) facilities in my last blog post, I have dedicated this blog post to the Mathare 10 project: a Community-Led Total Sanitation (CLTS) initiative in Kenya, aimed at eliminating open defecation. 

The City Council of Nairobi enforced the Environmental Sanitation and Hygiene Policy in 2007 to improve universal access to sanitation via a participatory, people-centred approach. As part of this law, Plan Kenya, an international, humanitarian development organisation introduced CLTS to ten villages in Mathare, Kenya, in June 2010. The Mathare 10 project is a participatory approach that aims to achieve open defecation communities, replace ‘flying toilet’ practices through the use of a night bucket system, and encourage landlords to agree to construct latrines for their tenants. Non-government organisations (NGOs) and community-based organisations (CBOs) are the primary sanitation and solid waste management providers to Nairobi’s informal settlements and have been at the forefront of this initiative.  

When successful, CLTS has the potential to achieve an open defecation free (ODF) community through a process of ‘social awakening’. This involves triggering and encouraging a collective sense of disgust and shame once locals have realised they have been ingesting each other’s faeces. It is crucial that programmes like these target collective behaviours and sanitation practices within communities, rather than purely focus on the increased provision of WASH infrastructure. Constructing latrines is of little value without a mindset change about living in a hygienic and sanitised environment. 

Natural leaders then emerge after the triggering process, especially women, as they are more motivated to create change due to their much greater need for a cleaner and safer sanitation environment. While I was unable to find data on Mathare specifically, a study found that two years after the nearby community Nambale, Busia County, gained ODF status, average monthly diarrhoeal cases declined by 38.3%. The lack of data for Mathare has been one of the main challenges behind my research, but we can infer the benefits of these WASH programmes through observing results in other Kenyan counties. CLTS therefore effectively motivates change through the community’s own realisation and collective engagement, rather than being instructed on what to do by a foreign party.

This process adopts the following approach:

• Mapping: To show where people live and defecate. In Mathare, for example, local youth engaged in participatory digital mapping to construct a sanitation map, which provided them with knowledge about their own community and empowered them to effect social change through a policy-influencing process. As shown in Figure 2, GIS technology has been used for informing and visualising community development efforts.

Figure 1: Sanitation map of Mathare 10 illustrating open drains, toilets, toilet users, buildings and open defecation sites.

Figure 2:  Defecation mapping session taking place in Kenya; ‘triggering’.   

• Transect walks: ‘Walk of shame’ to visit open defecation areas. 

• Faeces calculation.

• Identifying oral-faecal contamination pathways (Figure 3).

Figure 3: Faecal-oral transmission route.

To reiterate, inadequate WASH facilities disproportionately affect women, thus, the introduction of CLTS particularly benefits women. There are examples of women, who for the first time in their lives, now have the opportunity to become community leaders and engage in key decision-making processes, making them feel empowered and confident, especially as their collective efforts benefit women’s health as a whole, and women report a greater sense of security and safety with the presence of toilets by or within their homes. Decreased medical expenses have allowed women to channel their income towards school fees and personal items. 

However, CLTS does not adopt a clear gender-sensitive approach. Other than the fact that two women facilitators are necessary for CLTS triggering sessions, gender mainstreaming needs to be adopted into the process. The data collected from CLTS in Kenya is not segregated by sex, therefore it is challenging to understand whether CLTS is equitably successful. Just 20% of the community in Nairobi County has been triggered through CLTS, suggesting that the vast majority is still without CLTS knowledge, let alone the urban village of Mathare. Furthermore, CLTS must go beyond the goal of simply ending open defecation in order to be successful. For instance, it could address broader concerns related to solid waste management and upkeep, and guarantee that women are not burdened with the job of cleaning latrines.