I originally submitted this essay as the Mid-Term Assignment for my class ‘Introduction to Community Development’ at the American University in Cairo. As several months have passed, I hope it is fine to upload this work now and share my findings with the world 🙂
1. Introduction
Globally, governments and non-governmental agencies alike are on a quest to improve the living conditions of people in the most remote areas of the planet. The Sustainable Development Goals (SDGs), drafted and passed by all United Nations member states in 2015, is an agenda that is clear in providing concrete goals for such endeavours. SDG 3, for instance, aims to “ensure healthy lives and promote well-being for all at all ages” and advises stakeholders to consider, for instance, the “mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene […] services”. The importance of sanitation is reiterated in SDG 6, which calls to “ensure availability and sustainable management of water and sanitation for all.” When turning this guiding principle into an actionable policy goal, the SDGs highlight the importance of ending open defecation, a practice that is perpetuated by poverty and is a leading cause of various health concerns such as diarrhoea, intestinal worms, typhoid, cholera, and associated child mortality (UNICEF 2018). Not only do the SDGs seek to eradicate open defecation due to its health concerns, but also because of the specific associated risk for women who face increased vulnerability to sexual violence and rape if they defecate in the open at night. Development practitioners, in combatting open defecation, must focus both on “human development”, that is health issues, but also on “interpersonal development” by fostering a consciousness that the health and well-being of one community member should also be of concern to the other (Matarrita-Cascante and Brennan 2012).
This paper argues that the contemporary community development approach to eradicating open defecation must involve not only those who represent the community traditionally or on a political level, but must be truly inclusive of all community members. To come to this conclusion, the paper first reviews Community Led Total Sanitation as an approach and assesses it suitability to end open defecation through the lens of collective action theory and Asset Based Community Development. Second, the paper considers the case study of Eritrea, where the government launched the above-mentioned approach in 2008 in collaboration with UNICEF. Finally, the case study of Eritrea is used to understand how gender and power issues ought to be better integrated into eradicating open defecation.
2. Community Led Total Sanitation
Any literature review on open defecation reveals that the most common approach to combatting it is through “Community Led Total Sanitation” (CLTS). Designed originally for rural areas, CLTS targets specific villages as a whole, relying on an assumption that these localities will have strong existing social bonds (Myers et al. 2016). While the ultimate goal of CLTS is for a village to become “open-defecation-free” by each household having its own latrine (Borgen Project 2018), CTLS’s main focus is “igniting a change in sanitation rather than […] constructing toilets” (Kar & Chambers 2008 in Bartram et al. 2012: 500). Fundamentally, CLTS assumes that the most crucial factor is for a community to demand better sanitation and construct imperfect toilets on their own, rather than the first step being the construction of toilets themselves. Arguably the most prominent feature of CLTS is its approach to achieving collective behavioural change: Through so-called “triggering”, community developers attempt to evoke disgust and shame at open defecation (Myers et al. 2016). Such “triggering” is usually tackled during one-day events which involve direct confrontation with the topic. The UNICEF Manual for CLTS in Sierra Leone (2010), for instance, suggests to “put feces on the floor in front of the community and discuss the way flies move between food and feces, wait for the shocked realization that the community is indirectly eating each other’s feces […].”
After this initial triggering, community developers guide the community through a conversation on how much money is wasted on treating medical conditions that stem from these unsanitary processes (Myers et al. 2016), and to therefore conduct their own analysis of just how detrimental open defecation is to the village (Musembi 2016). Often, external community developers put special focus on people from the community who are seen to be able to drive change – so-called “natural leaders” – and provide them with know-how to ignite a chain reaction in which all villagers try to improve their own sanitation.
2.1. Suitable for Motivating Collective Action
Not only is its ability to involve laymen a strength of CLTS, but it is also an approach that has understood that humans do not necessarily make rational choices; they are limited instead by their knowledge and by social ties. While major donors thus may not approve of them not being hired to provide toilets, but instead having villagers build their own toilets, donor-provided sanitation facilities are often not used because of a lack of understanding of local incentive structures (Kamal 2011). Open defecation, instead, is more suitably understood through a collective-action framework, which highlights how group action is needed to achieve the collective good of controlling diseases linked to unsanitary practices, but how individuals often freeride on the efforts of others. It has been found that effective collaboration regarding open defecation depends not only on the availability of toilets, but also on the threat of sanctions, how close-knit a community is, and the degree of commitment group members feel towards each other (Hustedde 2008).
2.2. CSLT as an Example of ABCD
Within community development literature, there seems to be a consensus that clients of development should rather be treated as actors capable of being their own change agents; this, as well, is the core premise of Asset-Based-Community Development (ABCD), which drives development by helping communities identify and mobilize existing, but often unrecognised, assets (Mathie and Cunningham 2003). Already from this brief introduction, it becomes clear that CLTS and ABCD have overlaps; this paper thus treats CLTS as a form of ABCD. For instance, both ABCD and CLTS focus on using community ties to highlight the effect individual action can have on collective improvements (Mathie and Cunningham 2003). In more detail, ABCD may be employed as an approach, a set of methods, and a strategy, but each time generally involves forming a core steering group from within the community, building relationships among local assets for problem-solving, and emphasizing successes within the community (Mathie and Cunningham 2003). While CLTS requires villagers to build latrines using their own resources, CLTS arguably does not abide fully by the ABCD model, as development practitioners from UNICEF or other NGOs generally remain present as consultants. Although they do not necessarily prescribe specific models of building latrines, they remain active figures in the process (Myers et al. 2016), potentially because of a perceived need for the process to go as quickly and smoothly as possible.
3. Case Study: Eritrea
One of the poorest countries in the world, Eritrea is also one of the youngest, having only gained independence from Ethiopia in 1993 (Borgen Project 2018). Present-day Eritreans live under highly authoritarian regime with severely restricted civil liberties, suffer from massive poverty and problems stemming from possibly preventable diseases. According to UNICEF, Eritrea has the highest prevalence of open defecation in the whole of Africa; in 2006, approximately 98% of the total population did not use latrines or even basic bucket toilets (UNICEF 2018). Until 2008, the government of Eritrea largely focussed on producing toilets by subsidizing cement; despite the subsidy, however, the costs remained far too high for most Eritreans, who thus refused to build toilets in the way publicized (CLTS 2013). Given the limited successes and the detrimental health situation, the Eritrean government adopted CLTS in 2008; attracted by the low costs promised by the approach, the Environmental Health Unit of the Ministry of Health entered into a collaboration with UNICEF (CLTS 2013). CLTS approaches typically involve an external agent such as an NGO; in the terms of this specific collaboration and given the limited financial resources of Eritrea, UNICEF may have been approached because of its commitment to be highly involved in the process. Specifically, UNICEF advertises that in any collaboration in CLTS, it will take the initiative in creating demand for toilets, strengthening supply chains and third, supporting the creation of an enabling environment through financing (UNICEF 2018).
3.1. Design and Implementation
Eritrea’s CLTS can be broadly grouped into two phases: The first involving government, UNICEF and local politicians, and the second involving individual villages as well.
In the first phase, UNICEF and the Ministry of Health drafted an Eritrea-specific CLTS proposal, which was discussed with the founder of CLTS, Dr. Kamal Kar, who provided feedback on proposed strategies (CLTS 2014). Throughout the latter half of 2008 and early 2009, UNICEF and the Ministry of Health conducted “regional advocacy workshops” with a total of four hundred participants in order to advertise its CLTS strategy and mobilize actors. The participants were largely already existing power-holders, that is: regional assembly members, local administrators, and religious leaders. As desired, a major outcome of the workshops was that forty-six regional power-holders “committed themselves to introduce CLTS in one village of each sub region” (CLTS 2014). In each of these forty-six villages, the regional power-holders together with UNICEF then established a “hygiene and sanitation committee” at village level aimed “to enable all citizens to own this initiative” (Ministry of Information 2019). At this stage, Eritrea’s CTLS slowly turns to involve the community; however, it not yet considers them as agents, but first takes stock of their current habits and the methods needed to alter the taboo of talking about defecation (Borgen Project 2018). In the very first pilot village, for instance, 172 individuals were surveyed on their defecation habits, based on which the triggering-intervention was designed (CLTS 2012). No reports are available online about the specific methods of triggering; however, it is to be expected that they were similar to those mentioned above, as UNICEF would likely follow its own handbook.
Finally, the previously prominent actors handed over the wheel to “natural leaders” in the respective village, who, after successful triggering, received a briefing on what materials UNICEF and the Ministry of Health could subsidize. The village then took control of CLTS to the extent that they designed and executed the latrine-building-process; it is known that the Tigrinyan, one ethnic group in Eritrea, successfully negotiated with UNICEF to receive different materials, as those provided would not fit the specific cultural and geographical context of Tigrinyani lifestyle (Borgen Project 2018). A study conducted in two villages, Adi Habteslus and Dongolo Tahtay, highlighted that different natural leaders introduced different sanctions for not assisting in constructing latrines or not using those constructed; ranging from social shaming over financial penalties to denying access to social services (CLTS 2012). Already in October 2008, Adi Habteslus, a village close to the capital and the first in which CLTS was piloted, was declared “open-defecation-free” (CLTS 2014). While certain barriers continue to persist, such as severe water shortages and the nomadic lifestyles of much of the Eritrean population, Eritrea departed on an eradication-spree, seriously decreasing the number of villages in which open-defecation was communally practiced (CLTS 2013).
3.2. Directed Community Development
Far from fully “community-owned”, the Eritrean example is rather a case of “directed community development” as coined by Matarrita-Cascante and Brennan (2012). Directed community development, in basic terms, refers to a project in which a community is “directed towards a program or activity that has been previously designed by a group of stakeholders […] and asked to provide feedback. The project of program is then modified based on the input of the community” (Matarrita-Cascante and Brennan 2012: 299). Correspondingly, the project’s designers generally view the community as “a place where people exchange goods and services to fulfil major functions necessary for survival” (Matarrita-Cascante and Brennan 2012: 298). Clear parallels are visible to the Eritrean example; although the pilot villages did not as such “provide feedback”, they took over the second half of the project, namely the construction of latrines, after they had been “steered” towards wanting the change in the first place. Importantly, directed community development is not “worse” or “better” than more self-help-oriented or more imposed methods. As long as it is used for projects related to “structural improvements to the community”, rather than soft issues like improving interpersonal relations or hard issues like building toilets only, directed community development can produce sustainable results (Matarrita-Cascante and Brennan 2012: 299). However, given that CLTS literally features “community-led” in its name, it is odd that the villages themselves would only be involved towards the end of the process, and even then under supervision of UNICEF.
3.3. Evaluation: Traditional Leaders and Gender Issues
A major possible criticism of Eritrea and UNICEF’s collaborative CLTS is its focus on “natural leaders” and “regional power-holders”. Admittedly, CLTS’s process of generating behavioural change is based on allowing “communities to choose and make use of an array of traditional sanctions” (Bartram 2012: 500), and that the present case would do so is thus as per plan. However, various instances have been documented worldwide in which this discretion permitted human rights violations to be carried out by natural leaders and their associates. In order to enforce the new behavioural norm of “not defecating in the open”, natural leaders have been documented to “flag piles of shit with the name of the person responsible” (Bartram 2012: 500). In other instances, “squads threw stones at people defecating” (Bartram 2012: 500), and, such as in the Eritrean case, people were withheld services if they did not construct a toilet (Bartram 2012). While CLTS per se does not lead to such human rights violations, governments as well as international actors are internationally legally obliged to protect individuals from such harm and to prevent natural leaders from employing such practices in the first place. Admittedly, the nature of open defecation, being a collective-action-dilemma, necessarily means that it requires the compromising of individual autonomy in order to secure a common good. Hence, multiple authors have noted that CLTS is necessarily accompanied by a tension between several (human) rights. On the one hand, the right to health may be the ultimate goal, but individual autonomy might have to be temporarily revoked (Musembi 2016). Similarly, upholding a community’s collective human right to decide its own development strategy may mean that individuals’ decisional autonomy will be temporarily compromised (Musembi 2016). However, the compromising of any right must be an unavoidable, legitimate and proportionate means to achieve an end; as this paper demonstrates in the following, Eritrea’s CLTS bluntly disregards SDG 5 on gender equality in the name of securing SDG 3 on health. This, given UNICEF’s pledge to gender mainstreaming, cannot be tolerated (UNICEF 2018).
Eritrea’s CLTS, as demonstrated in the timeline above, relied largely on the involvement of “regional power-holders”, a “hygiene and sanitation committee” and, as is typical for CLTS, “natural leaders”. The concept of “natural leaders” must be dissected; unquestionably, those who are considered influential in small-scale rural Eritrean villages are most likely elderly men, who, as demonstrated by the swift elimination of open defecation in the pilot villages, must have immense power to impose sanctions. In this context, it is important to revisit Eritrea’s colonial past under Italian rule; just as in any colonial system, the Italian colonial rulers required local allies in order to maintain their power. As highlighted by Chanock (1989), such allies were either artificially bestowed with immense power, or were already authoritative figures in local communities whose power was merely amplified. Put more bluntly, it is important to notice that “in a very real sense, none of the chiefs who ‘ruled’ under the French and the British were legitimate” (Crowder 1978: 213). Not only this, but colonial endeavours have been held to have worsened existing power structures and subjugated women further than before. For instance, “Christianity and Western missionaries, with their model of the nuclear family and domesticity for women, deepened women’s subordinate position” (Ubink 2018: 936). Eritrea today is largely Christian; while this faith was present prior to colonialism, Italy’s presence no doubt led to a take-over of Christianity as the dominant ideology in the country, and with it a deterioration of gender equality. When the colonial rulers left, these allies maintained their power and presented themselves as “traditional leaders”. Importantly, when governments and international donors nowadays want to involve such “traditional leaders”, what they in fact oftentimes do is only further perpetuate the colonial process (Chanock 1989).
UNICEF alleges that it embeds gender considerations as mainstream practice in any of its collaborations to end open defecation (UNICEF 2018). However, the fact that colonial systems from the Italian rule are being perpetuated in the Eritrean CLTS suggests that specifically women and youth had little involvement in the process. Not only is the process thus potentially not fully inclusive, but may also cause deteriorate conditions for women even further. In some regions worldwide, it has been found that women regarded defecating in the open as valuable social time with their friends, and having toilets in their homes meant that they no longer had an excuse to escape a male guardian’s grasp (Royte 2017). Overall, it appears that “merely subsidizing [traditional leaders] with material and technical support for [community development], providing them with a semblance of state-backed legitimacy in their administrative roles, and hoping for the best, did not provide the basis of a sustainable approach” (Ubink 2018: 945).
4. Tentative Conclusions
While cases from India, South Sudan and Ghana feature prominently in the literature about CLTS and open defecation, Eritrea’s efforts have not yet been analysed academically. This paper sought to fill a gap and highlight that Eritrea has taken important steps to eradicating open defecation by loosening its authoritarian grip and allowing outsiders such as UNICEF to effectively design a development project. This paper concludes on two major thoughts.
The first is practically oriented: Eritrea’s model of CLTS only involved established community-leaders; this departs from core requirements of ABCD, which purports that all community members provide valuable assets. Therefore, while Eritrea officially claims to have embraced CLTS, the degree to which the “community” was actually involved is debatable. While it is likely that those with toilets will continue to use the toilets, it remains to be seen whether the project may in fact have given rise to other social issues. This paper recommends that any future project should depart from merely involving those already vocal in a community, and placing more emphasis on understanding harmful power structures in target communities.
Second, it must be questioned on a much more theoretical level whether the Eritrean case was merely a flawed execution, or whether CLTS itself does not truly fall under the category of ABCD. After all, CLTS’s general emphasis on shaming and self-disgust prima facie does not seem to conform to ABCD’s emphasis on the strength of communities. While CLTS bases the improvement of health conditions of a village on that village’s own capacity to take care of itself, CLTS’s acknowledgement of self-reliance is necessarily preceded by attempts to make the community feel disgusted of itself and ashamed of its practices. This first step seems to contradict the notions of empowerment, positivity and focussing on success stories, that otherwise guide the ABCD process.
5. Bibliography
5.1. Primary Sources
Community Led Total Sanitation. 2012. “Community Led Total Sanitation and the MDG Sanitation Challenge: Case Study – Eritrea,” Report by Patrick A. Sijenyi.
Community Led Total Sanitation. Brochure, 2013. “Community Led Total Sanitation (CLTS) in Eritrea.” https://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/CLTS_Eritrea_Brochure.pdf. Accessed October 22, 2019.
Community Led Total Sanitation. July 2014. “Eritrea.” www.communityledtotalsanitation.org/print/170. Accessed October 22, 2019.
Ministry of Information of Eritrea. “Hygiene is the Mother of Health,” http://www.shabait.com/articles/nation-building/22941-hygiene-is-the-mother-of-health-?format=pdf. Accessed October 22, 2019.
Musembi, Celestine N. 2016. “CLTS and the Right to Sanitation,” Frontiers of CLTS 8, Report by Institute of Development Studies Brighton.
Myers, Jamie, Pasteur, Katherine, and Sue Cavill. August 2016. “The Addis Agreement: Using CLTS in peri-urban and urban areas,” CLTS Knowledge Hub Learning Paper.
Royte, Elizabeth. 2017. “Nearly a Billion People Still Defecate Outdoors. Here’s Why.” National Geographic, https://www.nationalgeographic.com/magazine/2017/08/toilet-defecate-outdoors-stunting-sanitation. Accessed October 22, 2019.
The Borgen Project, blog. September 27, 2018. “Sanitation in Eritrea: Efforts to end open defecation,” https://borgenproject.org/sanitation-in-eritrea-efforts-to-end-open-defecation/. Accessed October 22, 2019.
UNICEF. 2010. “CLTS Training manual for natural leaders,” UNICEF and Sierra Leone Government, Freetown, Sierra Leone. http://www.susana.org/en/resources/library/details/1446. Accessed October 22, 2019.
UNICEF. 2018. “UNICEF’s game plan to end open defecation.”
5.2. Secondary Sources
Bartram, Jamie, Charles, Katrina, Evans, Barbara, and Lucinda O’Hanlon. 2012. “Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?” Journal of Water and Health 10:4; Pp. 499-503.
Chanock, Martin. 1989. “Neither Customary nor Legal: African Customary Law in an Era of Family Law Reform,” International Journal of Law and The Family, 3; Pp. 72-88.
Crowder, Michael. 1978. “West African Chiefs,” In: Colonial West Africa. Collected Essays, Michael Crowder, London: Frank Cass; Pp. 209-230.
Hustedde, Ronald J. 2008. “Seven theories for seven community developers,” In: An Introduction to Community Development, Rhonda Phillips and Robert H. Pittman (eds.), London: Routledge; Pp. 20-37.
Kar, Kamal. 2011. “Forward,” In: Shit Matters: The potential of community-led total sanitation, Lyla Mehta and Synne Movik (eds.), Warwickshire: Practical Action Publishing; Pp. ix-xiii.
Matarrita-Cascante, David, and Mark A. Brennan. 2012. “Conceptualizing community development in the twenty-first century,” Community Development, 43:3; Pp. 293-305.
Mathie, Alison, and Gord Cunningham. 2003. “From clients to citizens: Asset-based Community Development as a strategy for community-driven development,” Development in Practice, 13:5; Pp. 474-486
Ubink, Janine. 2018. “Customary Legal Empowerment in Namibia and Ghana? Lessons about Access, Power and Participation in Non-state Justice Systems,” Development and Change 49:4; Pp. 930-950.
An (Un?)Educated Guess 