The implementation of sanitation and hygiene interventions remains a cornerstone of public health strategies in low- and middle-income countries. A recent process evaluation conducted in Malawi examined the effectiveness of Community-Led Total Sanitation (CLTS) in driving behavioral change. While these programs aim to eliminate open defecation, researchers found that success depends heavily on the specific methods of engagement and implementation fidelity.

Effectiveness of Sanitation and Hygiene Interventions

Specifically, the study analyzed the reach and dose of various community-based activities. The results demonstrated that combined exposure to both community triggering sessions and direct household visits significantly improved outcomes. Consequently, the odds of latrine ownership increased by 63% (OR = 1.63). Furthermore, the presence of handwashing facilities (HWF) saw a 39% increase among exposed households. However, the researchers noted that intervention reach was often suboptimal. For example, less than half of the households recalled specific hygiene campaigns.

Challenges in CLTS Implementation

Despite the delivery of all planned activities, fidelity varied across different stages. Training delivery exhibited low fidelity, whereas household engagement showed much higher consistency. Additionally, environmental factors like extreme weather posed significant barriers to the sustainability of sanitation facilities. Therefore, future sanitation and hygiene interventions must integrate climate-resilient designs. They should also prioritize strengthening household-based engagement to ensure long-term behavioral maintenance and public health impact.

How do sanitation and hygiene interventions like CLTS work?

CLTS focuses on empowering communities to take collective action against open defecation through triggering sessions that highlight health risks and encourage the construction of local facilities.

What factors improve the success of these programs?

Success significantly increases when community-wide activities are paired with direct household visits. This combined approach ensures better recall and higher adoption of latrines and handwashing stations.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Panulo M et al. Community-Led Total Sanitation implementation in Malawi: process evaluation of a sanitation and hygiene intervention. Glob Public Health. 2026 Dec 31. doi: 10.1080/17441692.2026.2638018. PMID: 41764035.

World Bank. Community-Led Total Sanitation in Rural Areas: An Approach That Works. World Bank Documents and Reports.

UNICEF. A decade of India's transformative Sanitation Mission. November 2024.