title: Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?
abstract: The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.
authors.affiliation: Department of Environmental Sciences and Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. jbartram@email.unc.edu
authors.forename: Jamie
authors.initials: J
authors.lastname: Bartram
authors.forename: Katrina
authors.initials: K
authors.lastname: Charles
authors.forename: Barbara
authors.initials: B
authors.lastname: Evans
authors.forename: Lucinda
authors.initials: L
authors.lastname: O'Hanlon
authors.forename: Steve
authors.initials: S
authors.lastname: Pedley
mesh_terms: D018672:Community Health Planning / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000592:standards*; D003906:Developing Countries; D040361:Healthy People Programs / Q000941:ethics / Q000592:standards; D006806:Human Rights / Q000592:standards; D006801:Humans; D006920:Hygiene / Q000191:economics / Q000592:standards; D011634:Public Health / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D012499:Sanitation / Q000941:ethics / Q000331:legislation & jurisprudence / Q000592:standards; D012935:Social Justice