Kamal Kar and Katherine Pasteur (2005). IDS Working Paper 257 The CLTS approach was first pioneered in 1999 by Kamal Kar working with the Village Education Resource Centre (VERC) and supported by Water Aid, in a small community of Rajshahi district in Bangladesh. The background to the approach, the methodology and details of early experience were documented in ‘Subsidy or Self-Respect: Participatory Total Community Sanitation in Bangladesh’ (IDS Working Paper 184 – reprinted in this volume from page 15). Since then the approach has continued to spread within Bangladesh and has been introduced in a number of other countries in Asia and in Africa. Interest among different institutions is growing, particularly as it becomes apparent that CLTS has the potential to contribute towards meeting the Millennium Development Goals (MDGs), both directly on water and sanitation (Goal 7) and indirectly through the knock-on effects of improved sanitation on combating major diseases, particularly diarrhoea (Goal 6), improving maternal health (Goal 5) and reducing child mortality (Goal 4). The purpose of this document is to update the 2003 Working Paper, describing recent developments, and highlighting emerging innovations, lessons and challenges. First, experiences in Bangladesh are brought up to date and some of the lessons from the scaling-up process are captured. Innovations and some emerging sustainability issues are discussed. The spread of CLTS beyond Bangladesh has been notable, and this spread is documented and some of the contributing factors are analysed. Institutional take-up of CLTS has been encouraging, but has raised several dilemmas and challenges, not least of which is the need for changes in the attitudes and mindsets of donors who wish to support and promote CLTS.