Learning What Works: Sanitation Partners
Workshop, Phnom Penh, January 2013
Demonstration by the football player Frederic Oumar Kanouté
Overview of the CLTS Impact Study in Mali
Nicolas Osbert, UNICEF, nosbert@unicef.org
CLTS Impact Study Mali– CLTS Mali 11/12
Study takes place in 120
villages of Koulikoro
Region (pop.: 2,4
million)
CLTS Impact Study Mali – WHAT IS IT?
 Randomized controlled trial (RCT)
allow: comparison of relevant
indicators between “treated” and
“control” communities  better
estimate of the causal effects (having
a randomly selected control group allows
observing the outcomes that would have
been experienced in the absence of the
intervention)
CLTS Impact Study Mali – WHAT IS IT?
 Randomized controlled trial (RCT) design – implying random
selection of communities: 60 communities to receive the
“treatment” (CLTS intervention) + 60 Control communities.
 An international and multidisciplinary team of 10 scientific
experts + Local team of more than 60 enumerators
 Funding from the Bill & Melinda Gates Foundation: $
900,000
 UNICEF coordinates the study with the government +
partners
 2 comprehensive household and community surveys,
 Water quality testing, 2 campaigns (baseline / final)
 Observational data collection on sanitation practices, health
indicators and community decision-making.
CLTS impact study Mali - INDICATORS
 Psychological outcomes:
knowledge, risk perceptions, self-efficacy;
 Community outcomes: level of
cooperation, level of trust, social cohesion, wealth
disparities, leadership, speed of diffusion of latrine use
within social networks;
 Intermediary sanitary
outcomes: building latrines, quality of latrines
built, usage frequency of latrines, building of hand
washing stations, hand hygiene behavior, water quality,
quantity of flies, outdoor presence of fresh feces;
 Final sanitary outcome: community status towards becoming ODF;
 Health outcomes: diarrheal illness for children under 5, child anthropometrics
(stunting and wasting), reports on community disease rates by traditional healers and health
clinic staff, out-of-pocket health expenditures, etc.;
 Non-health outcomes: school attendance, time use, women's safety
CLTS Impact Study Mali – PURPOSE
1. Understand the determinants of
behavioral change
• social dynamics, leadership, social cohesion or pressure, adoption of
better sanitation practices –
• understand the sustainability of impact (whether the ODF status and
positive outcomes are maintained over time),
• cost-effectiveness, potential scalability and spillover effects (in
neighboring communities) of the CLTS program.
2. improve the future of sanitation
programs
• Identify bottlenecks that may impede adoption of better sanitation
practices;
• Identify the most relevant strategies to develop in ODF communities in
order to sustain the results achieved, as well as community
engagement in improving sanitation practices
3. Transparency, accountability show
that we try sound evidence analysis, neutral/external
monitoring
4. If possible: show the positive
impacts of Sanitation on health and
other outcomes and advocate
CLTS impact study Mali – 1st RESULTS from baseline
SANITATION (JMP 2012, Rural Mali: access 14% / OD = 20%)
 93% of children under five, 62% of children age 5-10 years,
56% of adult women and 44% of adult males practice OD.
 34% with access to a private latrine (improved or unimproved)
and 29% with access to a neighbor’s latrine
 On average, households have to walk 3.6 minutes to the
location where they most often practice open defecation.
 54% of respondents: OD area was located outside the village.
 28% of respondents reported that women do not have privacy
when practicing OD + 4% reported harassment/assaults
 Most latrines were unimproved pit latrines.
 85% of households reported that they did not have a specific
place in their household to wash their hands.;
CLTS impact study Mali – 1st RESULTS from baseline
WATER SUPPLY (JMP 2012, Rural Mali: access 51%)
CLTS impact study Mali – 1st LESSONS LEARNT
 Great Buy-in from government:
 Crucial: Gov. involved since early start of the
study; creation of a technical working group
(MoS, MoH, MoWS, WHO, UNICEF,
INGOs…)
 Sees opportunity:
(i) to increase visibility of sanitation
sector / of Mali,
(ii) to improve efficiency of interventions
(iii) to build capacities (implementing
surveys, water quality monitoring,
statistic calculation…)
CLTS impact study Mali – 1st LESSONS LEARNT
 Improve CLTS strategy:
 Follow-up phase between triggering and
certification: understand all the areas on which
de teams can focus to achieve better results:
 Hand Washing,
 Household water storage and use,
 community empowerment,
 latrine construction,
 institutional framework
 waste management…
CLTS impact study Mali – 1st LESSONS LEARNT
 Improve CLTS strategy:
 monitoring per village  now per household (with focus
on hand washing, water and food storage and use)
 identification of efficient leaders and formalizing hygiene
committees
 improve construction techniques and how to promote
them (without breaking the ownership / creativity of
communities) : site selection, coating of slabs, roofs,
lateritic mud walls …
 Improving the institutional framework: intensification of
follow-up by districts and communes and establishing
post-certification follow-up
 Learn from external experts; i.e. have more focus on
children who more persistently practice OD  Mobilize the
schoolteachers: involve them to involve the children
Cleansing of public spaces by the women in
Konosoro, Koulikoro Region (next step: put
men on board)
Lateritic mud wall
consolidated by adding
straw (Sallé Village,
Koulikoro Region)
Latrine in the
Village of
Touloumadjo
Villagers
digging pits, the
day of the
triggering
“This is the Family Coulibaly; Nothing is
better than sanitation;
Cleanliness protects us”
Certificate given to the hygiene
committee + Certification board at
the entrance of Tienra village
inaugurated on 14 August 2012