Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, 128 43 Praha 2, Czechia.
Health Promot Int. 2019 Dec 1;34(6):e129-e138. doi: 10.1093/heapro/day070.
Around 2.3 billion people in developing countries still lack access to improved sanitation facilities and almost one billion practice open defecation (OD). The Community-Led Total Sanitation (CLTS) has recently become a particularly popular approach used in more than 60 countries. CLTS is a behavior-change approach that aims to ignite community action and make OD socially unacceptable without providing any external financial or material support to individual households. CLTS is sometimes perceived as a revolutionary approach that has proven to be highly cost-effective in abolishing OD. However, it has been criticized for its use of unethical practices and questioned with respect to the sustainability of its outcomes and the limited health benefits it can generate. Based on semi-structured interviews with development workers experienced in the implementation of CLTS in 14 different countries, this paper seeks to examine practical views on the issues surrounding this approach. We found that despite acknowledging some of the controversies and the possibly limited sustainability of results, CLTS is generally considered an effective and satisfactory tool for improving sanitation conditions. Practitioners first of all accentuate the normative importance of the elimination of OD attained through CLTS without weighting on (the absence of) evidence on the longer term effects or impacts on health. However, a need for various modifications of CLTS according to local social and natural environments was strongly expressed, including changes that go against the core principles of CLTS like no subsidies and no technical assistance principles.
发展中国家约有 23 亿人仍然无法获得改良的卫生设施，近 10 亿人仍在露天排便。社区主导的整体卫生运动（CLTS）最近成为一种在 60 多个国家使用的特别流行的方法。CLTS 是一种行为改变方法，旨在激发社区行动，使露天排便变得不被社会接受，而不给个别家庭提供任何外部财政或物质支持。CLTS 有时被视为一种革命性的方法，在消除露天排便方面已被证明具有很高的成本效益。然而，它因其使用不道德的做法而受到批评，并对其结果的可持续性和所能产生的有限健康益处提出了质疑。本文基于对在 14 个不同国家实施 CLTS 的发展工作者进行的半结构化访谈，旨在探讨围绕这一方法的实际问题。我们发现，尽管承认存在一些争议，以及结果可能的可持续性有限，但 CLTS 通常被认为是改善卫生条件的有效和令人满意的工具。从业者首先强调通过 CLTS 消除露天排便的规范重要性，而不重视（缺乏）对长期影响或对健康影响的证据。然而，强烈表达了根据当地社会和自然环境对 CLTS 进行各种修改的需求，包括违背 CLTS 的核心原则，如不提供补贴和不提供技术援助的原则的修改。
