More than 2.5 billion people lack improved sanitation, with nearly 30 per cent residing in urban areas and the rest in rural areas. Improving sanitation is often a low priority for development professionals, and it may require uncomfortable discussions and difficult behaviour changes. Traditional approaches rely on hardware subsidies to individual households, but community-led total sanitation (CLTS) has recently encouraged more flexible methods of provision. While diverse, these participatory approaches consistently prioritize community needs and facilitate locally driven sanitation innovations. This paper reviews international experiences since 1999 and identifies challenges in scaling up. Future research directions are discussed, and although Robert Chambers seeks greater diffusion of CLTS, he also urges increased critical awareness and creative innovations.

The paper provides a concise introduction to CLTS and then discusses several contrasting cases that highlight effective practices and identify obstacles to scaling up. Chambers summarizes experiences across Asia and Africa, where CLTS has spread through various combinations of non-governmental and governmental support. After being “triggered” to reassess local sanitation practices, rural communities conduct their own appraisals and design appropriate solutions. The goal is to become “open defecation free” and some areas have developed complementary hygienic or ecological initiatives. Kolkata’s political leadership recently spurred an informal settlement to become “open defecation free” without employing subsidies, indicating the possibilities in urban areas as well. Scaling up CLTS hinges upon careful training and facilitation, supporting natural leaders, using the market and promoting access to hardware. Finding champions at all levels remains crucial, as the nascent movement must overcome official opposition or donor preferences for large budgetary disbursements.

In the two final sections, Chambers reflects on research directions and advocacy challenges, particularly on ensuring sustainability and good practice. As CLTS continues to spread rapidly, supporters must strive to balance the need for scale, speed and the quality of the initiatives. He sees parallels between CLTS today and participatory rural appraisal in the mid-1990s, with a proliferation of creative approaches as well as bad practices. He argues for enhanced research networks, critical awareness and alliances to help advance the CLTS movement. Several topics for methodological development and action learning are identified, such as helping marginalized households or minimizing water contamination. Through reflexive research and constant adaptations, CLTS may find new ways to revolutionize sanitation in ever more settings.