Community Led Total Sanitation (CLTS) in The Gambia Using a social norms perspective to target and address local disparities in sanitation practices to accelerate coverage and reach national ‘Open Defecation Free’ status by 2015 Kerewan Janjanbureh Kuntaur Basse Mansa Konko Brikama

Community Led Total Sanitation (CLTS) in The Gambia: Background Sanitation coverage across the country is high: 76.3% (MICS, 2010) The Gambia aims to reach full open defecation free (ODF) status by 2015 Only 2.8% of the population (about 1.75 million) – predominantly rural and in the poorest quintile – practice open defecation (OD) These 48,500 people are mostly concentrated in the 3 central regions In many communities – including urban areas - the use of toilets is already a social norm (ODF); in others, open defecation is a cultural custom which can be modified to a positive social norm – the use of toilets - using the CLTS approach

Community Led Total Sanitation (CLTS) in The Gambia CLTS from a Social Norms Perspective: CLTS concentrates on creating both personal and collective (empirical and normative) attitude shifts through collective discussion and change of factual beliefs (by providing good reasons about the health risks and costs of open defecation) and attitudes (disgust at current practices) A new social norm of toilet use is built or reinforced, based on common knowledge and cooperative behavior for the public good (clean environment/less disease/healthier children) A commitment through a communal ‘pledge’ or promise is made by all households to build toilets by a certain date (to become ODF) Follow-up visits are made by community health workers (CHWs) after ‘triggering’, whilst the new norm is still fragile, to reinforce the factual beliefs and to assist with technical concerns (enabling environment) of latrine building. Natural Leaders emerge in the community to promote CLTS

Community Led Total Sanitation (CLTS) in The Gambia Local variations in latrine use: a)Majority of population has a tradition of latrine use, although defaulters are not sanctioned – a weak social norm – there is a normative expectation that all use toilets b)More historically ‘nomadic’ ethnic groups have a cultural custom of open defecation (OD) c)Populations that live by the river and oyster harvesting sites or the forest have a cultural custom or preference for open defecation The current CLTS approach is working village by village across each region. Traditional Mandinka latrine

Community Led Total Sanitation (CLTS) in The Gambia Riverside Community Proposed Strategies for the scaling up of CLTS (rural Gambia): Concentration of CLTS resources in the 3 regions where OD is high, triggering primarily those communities where OD is the custom Mapping of the zones of highest open defecation, and networks within these populations – prioritise central or ‘hub’ OD communities Development of specific CLTS strategies/tools to tackle local challenges (eg living by the river/forests) Stronger and more frequent follow- up to ensure adoption of norm and to assist with technical challenges Sanitation marketing of toilet parts in central communities (cement slabs etc) to encourage the upgrading of traditional toilets

Community Led Total Sanitation (CLTS) in The Gambia Diffusion Strategies: Develop programme of School-led total sanitation (SLTS) for greater diffusion across reference groups, targeting schools where ethnic communities overlap to achieve maximum benefit of child to child peer pressure (wider/different reference group) Support Natural Leaders to promote CLTS in nearby communities (community diffusion or outreach) Rely on social influence across networks, media campaigns and sanitation marketing for high % coverage communities Media campaign for Total Sanitation to develop common knowledge

Community Led Total Sanitation (CLTS) in The Gambia A new ‘CLTS’ latrine Proposed Strategies for the Scaling- up of CLTS (Upstream): National advocacy campaign on the benefits of Total Sanitation – creation of a national ODF social norm Expansion and promotion of the ‘Set Setal’ – the national monthly ‘clean up’ day to also build/maintain toilets Identify and promote national public figures as sanitation/ODF champions Consider the longer term introduction of ODF legislation to harmonise with norm adoption (start in urban areas)

Community Led Total Sanitation (CLTS) in The Gambia A lot of hard work remains to be done! With 76% sanitation coverage, and a strongly targeted CLTS strategy to introduce ODF as a national social norm, The Gambia has the unique opportunity to become the first fully ODF country in Africa

Community Led Total Sanitation (CLTS) in The Gambia