This review offers a description of the CLTS intervention, tracing its evolution in theory and practice from Southeast Asia to its current place as a global phenomenon. It explores the open defecation free (ODF) concept (including varying definitions from country to country) and analyzes its strengths and weaknesses. It also highlights the disconnect between the independent monitoring and analysis of CLTS program results on the one hand and internal performance reports released by implementing organizations or their donors on the other. In compiling this information, we considered the challenges of measuring open defecation and suggest potential solutions that may lie in the more straightforward measure of private latrine ownership.
This review also seeks to assess (1) circumstances in which CLTS works best, (2) the most promising implementation modalities, and (3) instances where CLTS may not be suitable. CLTS should not be judged as a stand-alone intervention, but rather as a powerful option among an array of sanitation interventions whose limitations in selected circumstances must be recognized to best adapt it to diverse
contexts and optimize its integration with other measures.