Acceptance Factors for the Social Norms Promoted by the Community-Led Total Sanitation (CLTS) Approach in the Rural Areas: Case Study of the Central-Western Region of Burkina Faso

Abstract

Although access to sanitation has been recognized as a fundamental human right, 3.6 billion people do not enjoy this right globally. In this group, the practice of unhealthy sanitation behaviors, such as open defecation (OD), is very common. To alleviate this problem, several governments in low-income countries have adopted Community-led Total Sanitation (CLTS). This is a participatory approach focused on ending OD and promoting good hygiene behaviors in target communities. This approach is centered around and highly depends upon a given community’s willingness to adopt the practices it advocates. However, the determinant factors in a community’s acceptance or refusal of these practices during and after CLTS implementation remain unclear. The aim of this paper is to highlight and categorize these factors to increase the sustainability of the approach. To achieve this, a study was conducted in the central-western region of Burkina Faso, where CLTS has successfully been deployed. We began this study by drawing a list of possible determinants through a literature review and grouping them into six categories. This enabled us to set up an evaluation matrix with scores for each factor and data collection tools. Scoring was based on the number of positive respondents for that factor. Data were then collected at the institutional, regional, local, and household levels from CLTS stakeholders to identify context-specific factors that underpinned behavior change in the surveyed villages. The literature review revealed six categories of acceptance factors. In our study, the importance of these factors according to our respondents were ranked in descending order as follows: environmental (C1 = 592), social (C2 = 390), governance (C4 = 247), territorial (C6 = 189), economic (C3 = 15), and technological (C5 = 0). The most frequently discussed factors obtained included the understanding of the health and economic consequences of OD (C1, score = 550); the popularity and reputation of Open Defecation-Free (ODF)-certified villages (C6, score = 179); men’s desire to protect their wives’ privacy (C2, score = 138); and women’s understanding of the adverse effects of OD on their children’s health (C2, score = 119). Incorporating the acceptance factors found in this study into future CLTS interventions will improve the effectiveness of the approach and increase the sustainability of ODF status in similar contexts.