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How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana

Author

Listed:
  • Jessica Tribbe

    (The Aquaya Institute, San Anselmo, CA 94960, USA)

  • Valentina Zuin

    (Division of Social Science, Yale-NUS College, Singapore 138527, Singapore)

  • Caroline Delaire

    (The Aquaya Institute, San Anselmo, CA 94960, USA)

  • Ranjiv Khush

    (The Aquaya Institute, San Anselmo, CA 94960, USA)

  • Rachel Peletz

    (The Aquaya Institute, San Anselmo, CA 94960, USA)

Abstract

Community-led Total Sanitation (CLTS) is a popular intervention for eliminating open defecation in rural communities. Previous research has explored the contextual and programmatic factors that influence CLTS performance. Less is known about the community-level conditions that sustain latrine coverage and use. We hypothesized three categories of community conditions underlying CLTS sustainability: (i) engagement of community leaders, (ii) follow-up intensity, and (iii) support to poor households. We evaluated these among communities in Cambodia and Ghana, and applied fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify combinations of conditions that influenced current latrine coverage and consistent latrine use. In Cambodia, latrine coverage was highest in communities with active commune-level leaders rather than traditional leaders, and with leaders who used casual approaches for promoting latrine construction. Latrine use in Cambodia was less consistent among communities with intense commune engagement, higher pressure from traditional leaders, high follow-up and high financial support. In Ghana, by contrast, active leaders, high follow-up, high pro-poor support, and continued activities post-implementation promoted latrine coverage and consistent use. The different responses to CLTS programming emphasize that rural communities do not have homogenous reactions to CLTS. Accounting for community perceptions and context when designing community-led interventions can foster long-term sustainability beyond short-term achievement.

Suggested Citation

  • Jessica Tribbe & Valentina Zuin & Caroline Delaire & Ranjiv Khush & Rachel Peletz, 2021. "How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana," Sustainability, MDPI, vol. 13(10), pages 1-23, May.
  • Handle: RePEc:gam:jsusta:v:13:y:2021:i:10:p:5440-:d:553654
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    References listed on IDEAS

    as
    1. Maria Laura Alzua & Amy Janel Pickering & Habiba Djebbari & Carolina Lopez & Juan Camilo Cardenas & Maria Adelaida Lopera & Nicolas Osbert & Massa Coulibaly, 2015. "Impact Evaluation of Community-led Total Sanitation (CLTS) in Rural Mali," CEDLAS, Working Papers 0191, CEDLAS, Universidad Nacional de La Plata.
    2. Paul Gertler & Manisha Shah & Maria Laura Alzua & Lisa Cameron & Sebastian Martinez & Sumeet Patil, 2015. "How Does Health Promotion Work? Evidence From The Dirty Business of Eliminating Open Defecation," NBER Working Papers 20997, National Bureau of Economic Research, Inc.
    3. Myles Bateman & Susan Engel, 2018. "To shame or not to shame—that is the sanitation question," Development Policy Review, Overseas Development Institute, vol. 36(2), pages 155-173, March.
    4. Cameron, Lisa & Olivia, Susan & Shah, Manisha, 2019. "Scaling up sanitation: Evidence from an RCT in Indonesia," Journal of Development Economics, Elsevier, vol. 138(C), pages 1-16.
    5. Crocker, Jonny & Shields, Katherine F. & Venkataramanan, Vidya & Saywell, Darren & Bartram, Jamie, 2016. "Building capacity for water, sanitation, and hygiene programming: Training evaluation theory applied to CLTS management training in Kenya," Social Science & Medicine, Elsevier, vol. 166(C), pages 66-76.
    6. Cameron, Lisa A. & Olivia, Susan & Shah, Manisha, 2015. "Initial Conditions Matter: Social Capital and Participatory Development," IZA Discussion Papers 9563, Institute of Labor Economics (IZA).
    7. Zuin, Valentina & Delaire, Caroline & Peletz, Rachel & Cock-Esteb, Alicea & Khush, Ranjiv & Albert, Jeff, 2019. "Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)," World Development, Elsevier, vol. 124(C), pages 1-1.
    8. Dale Whittington & Mark Radin & Marc Jeuland, 2020. "Evidence-based policy analysis? The strange case of the randomized controlled trials of community-led total sanitation," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 36(1), pages 191-221.
    9. Jenkins, Marion W. & Scott, Beth, 2007. "Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana," Social Science & Medicine, Elsevier, vol. 64(12), pages 2427-2442, June.
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