CLTS implementation in Malawi : process evaluation of a sanitation and hygiene intervention

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Panulo, Mindy and Chidziwisano, Kondwani and MacLeod, Clara and Kapazga, Timeyo and Dreibelbis, Robert and Beattie, Tara K. and Morse, Tracy (2024) CLTS implementation in Malawi : process evaluation of a sanitation and hygiene intervention. Other. Center for Open Science, Charlottesville, VA. (https://doi.org/10.31219/osf.io/9bfqd)

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Abstract

Community-Led Total Sanitation (CLTS) seeks to eliminate open defecation by empowering households to adopt improved sanitation and hygiene behaviours through latrine use. Widely integrated into national sanitation strategies in low- and middle-income countries, CLTS is implemented through pre-triggering, triggering, and post-triggering activities. However, limited evidence exists on how implementation process promotes behaviour change. This study retrospectively evaluates a community-based intervention in Chiradzulu District, Malawi, that employed CLTS alongside market-based sanitation and hygiene promotion campaigns. Using the UK Medical Research Council process evaluation framework, we analysed project documentation and collected data from household surveys (n=1,151), interviews (n=36), and focus group discussions (n=14). All planned activities were implemented, though adaptations affected fidelity and required additional household visits. Intervention reach was suboptimal: 46% of households attended triggering events, 64% received visits, 16% were exposed to market-based sanitation, and 47% received hygiene campaigns. Exposure to both triggering sessions and household visits increased the likelihood of latrine availability (OR = 1.63; CI = 1.55–1.72) and HWF presence (OR = 1.39; CI = 1.03–1.86). High costs, limited awareness of masons, and extreme weather events affected latrine adoption. Our findings emphasize the need for multi-level engagement, flexible delivery, and addressing barriers for sustainable sanitation adoption.

ORCID iDs

Panulo, Mindy ORCID logoORCID: https://orcid.org/0000-0002-0241-0180, Chidziwisano, Kondwani, MacLeod, Clara, Kapazga, Timeyo, Dreibelbis, Robert, Beattie, Tara K. ORCID logoORCID: https://orcid.org/0000-0002-5593-8368 and Morse, Tracy ORCID logoORCID: https://orcid.org/0000-0003-4185-9471;
CORE (COnnecting REpositories)