USAID’s Water, Sanitation and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) is a five year project that supports the agency’s goal of reducing morbidity and mortality in children under five by ensuring USAID programming employs high-impact, evidence-based environmental health and WASH interventions. The project identifies and shares best practices for achieving sustainability, scale, and impact by generating evidence to support the reduction of open defecation and movement of communities up the sanitation ladder while also focusing on novel approaches for reducing faeces exposure to infants and young children.

This desk review examines literature on community led total sanitation (CLTS), with the central objective of assessing the knowledge base on best practices and identifying evidence gaps to inform the project’s research agenda (to generate findings that improve policy and practice). The review offers a description of the CLTS intervention, tracing its evolution in theory and practice from Southeast Asia to its current place as a global phenomenon. It explores the open defecation free concept (including varying definitions from country to country) and analyses its strengths and weaknesses. It also highlights the disconnect between the independent monitoring and analysis of CLTS programme results on the one hand and internal performance reports released by implementing organisations or their donors on the other. The report considers the challenges of measuring open defecation and suggests potential solutions that may lie in the more straightforward measure of private latrine ownership.