Community Led Total Sanitation (CLTS) in The Gambia: Using a social norms perspective to
target and address local disparities to accelerate coverage and reach national ‘Open
Defecation Free’ status by 2015
Jane Bevan, WASH Specialist, UNICEF West & Central Africa Regional Office, July 2012.
I.
Description of the challenge
The Gambia is a small country in West Africa with a population of less than 2 million, and is unusual
in the region as the sanitation coverage is already very high, standing at 76.3%, with only 2.8% of the
population – predominantly rural - practicing open defecation (MICS, 2010). In population terms
this is approximately 48,500 people, a very ‘reachable’ number – these 48,500 are however
scattered throughout the country, and Gambia’s CLTS strategy, aimed at reaching 100% open
defecation free status (ODF) by 2015,
Fig 1. Open Defecation by Region (MICS 2010)
intends to target the regions/zones
15,000
with the highest open defecation
(OD) statistics – the MICS data shows
10,000
this to be the two Central (Kuntaur &
5,000
Janjanbureh) and North Bank
(Kerewan) Regions (Fig 1), with chiefly
0
rural populations from the lowest
wealth quintile.
II.
Critical Evaluation of the Work so far
The CLTS approach makes strong use of the principle of social norms. It concentrates on creating
both personal and collective empirical and normative attitude shifts through collective discussion and
the change of factual beliefs (with good reasons provided about the health risks of OD) and attitudes
(disgust at current practices) to build a new social norm of toilet use, based on common knowledge
and cooperative behavior for the public good.
Once a community has agreed to become ODF, a communal ‘pledge’ or promise is made that all
households will commit to build toilets by a certain date. This equates to the rule of commitment in
the social norm theory, making it much less likely that the group will go back on their promise.
Natural Leaders often emerge from the triggering event to promote and advocate for latrine
building. Follow-up visits are made by community health workers (CHWs), whilst the new norm is
still fragile, to reinforce the factual beliefs and to assist with technical concerns.
This model has been very effective in communities where the use of toilets is already a mild social
norm (eg Mandinka groups). However, the approach has not been found to be working so well with
traditionally nomadic groups (eg the Fula), or with communities living near to forests or along the
river banks, where there is no tradition of toilet use and some technical challenges in building toilets.
As the Mandinka are the majority ethnic group in the country, it is possible that the current level of
follow up has been based on their perceived needs to become ODF, rather than the stronger needs
of the minority of communities where toilet use is not a social norm. Furthermore, the tools in the
current CLTS triggering do not directly deal with the issue of defecation in or next to water bodies.
Although strong gains are being made with CLTS , the current strategy, working from village to
village, will take many years to reach and trigger all communities in the country, and a fully ODF
Gambia is a distant prospect. The following proposed strategies, based on the principles of social
norms, aim to more effectively target our CLTS interventions to the OD population, making the
realization of the 2015 ODF goal a genuine possibility.
III.
Change in Practices
The following steps are proposed to target the most significant OD populations in The Gambia, and
to aim for an ODF national social norm – that is to say that everyone thinks that everyone should use
a toilet, throughout the country.
a)
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In the field:
Concentrate our resources on the 3 central regions where OD rates are clearly the highest.
In these regions, conduct a more detailed ‘mapping’ of OD zones and social networks.
Concentrate on primarily triggering in places where OD is the custom. For now, we do not trigger
the communities where sanitation coverage is already over about 75%. In each region, select
‘central’ OD communities (those with the most network connections) to be triggered first.
Once ODF status is achieved, support the natural leaders of the central communities to spread
the approach to neighbouring communities, schools, churches etc.
Following the triggering of central villages, the CHWs should move to the more isolated OD
communities, or those with the least dense network connections, as these will be subject to the
least social influence (gossip) and so will benefit more from factual information sharing.
The post-triggering phase should include more frequent follow-up visits to ensure ODF adoption
and to assist with technical challenges such as high water-table latrines.
Support the successful natural leaders to diffuse the message of total sanitation in neighbouring
communities. Invite the chiefs to attend ODF celebrations to increase the organized diffusion.
Research and develop new triggering tools for river bank and forest communities. For example
we can trigger 3 adjacent villages together to better communicate OD contamination effects.
Develop School-led total sanitation (SLTS) in regular and Quranic schools, starting in those where
the most reference networks overlap.
Support local entrepreneurs to make and market a range of toilet parts to encourage upgrading,
and the development of credit schemes to assist the poor.
Rely (at first) on the diffusion and social influence across networks for the total sanitation
message to reach high coverage communities, and for normative expectations to change.
b) In parallel with this, work on the upstream or enabling environment:
 Develop a national advocacy campaign promoting total sanitation as a social norm on several
levels – mass media, roadshows, etc.
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Identify and promote national public figures as sanitation and ODF champions.
Explore the expansion and promotion of the ‘Set Setal’ – the monthly ‘clean up’ day, to also
build and maintain toilets. This would be a very public reinforcement of the social norm.
Consider the advance promotion of and publicity for future legislation (ie by 2015 every
household must have a toilet) to harmonise with the developing national social norm. To start in
Banjul, where ODF is already more of an accepted norm (perhaps with a very mild sanction).