Is community-led total sanitation programme ending open defecation? A sustainability perspective from stakeholders in Ghana

Community-led total sanitation (CLTS) is an intervention widely employed by developing countries to end open defecation (OD) in line with SDG Target 6.2. Through it, many communities have been declared open defecation-free (ODF) in Ghana, but dearth information on their sustainability. This study sought to determine the sustainability of the ODF status of certified communities across eight regions in Ghana. Qualitative data were collected using semi-structured interviews with 26 practitioners and implementers, focus group discussions and direct observations in 22 communities. The data were manually transcribed and thematically analysed. The results revealed four major sustainability factors: motivational, behavioural change, leadership and financial. While motivational factors included improved health, pride, comfort and convenience, leadership factors involved supportive traditional and active natural leaders, and behavioural change entailed understanding the consequences of OD and latrine rebuilding. Financial factors encompassed access to sanitation funds. Regional and district league tables (LT) were found to be influencing the sustainability factors of the programme. Based on the findings, policymakers and implementers of the CLTS programme should intensify persuasive education focusing on sustainable behavioural change towards OD and post-ODF follow-ups while motivating sustained ODF communities using LT and friendly loan schedule for communities willing to pay.