title: Impact Evaluation of Training Natural Leaders during a Community-Led Total Sanitation Intervention: A Cluster-Randomized Field Trial in Ghana.
abstract: We used a cluster-randomized field trial to evaluate training natural leaders (NLs) as an addition to a community-led total sanitation (CLTS) intervention in Ghana. NLs are motivated community members who influence their peers' behaviors during CLTS. The outcomes were latrine use and quality, which were assessed from surveys and direct observation. From October 2012, Plan International Ghana (Plan) implemented CLTS in 60 villages in three regions in Ghana. After 5 months, Plan trained eight NLs from a randomly selected half of the villages, then continued implementing CLTS in all villages for 12 more months. The NL training led to increased time spent on CLTS by community members, increased latrine construction, and a 19.9 percentage point reduction in open defecation (p < 0.001). The training had the largest impact in small, remote villages with low exposure to prior water and sanitation projects, and may be most effective in socially cohesive villages. For both interventions, latrines built during CLTS were less likely to be constructed of durable materials than pre-existing latrines, but were equally clean, and more often had handwashing materials. CLTS with NL training contributes to three parts of Goal 6 of the Sustainable Development Goals: eliminating open defecation, expanding capacity-building, and strengthening community participation.
authors.affiliation: The Water Institute, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina 27599-7431, United States.
authors.forename: Jonny
authors.initials: J
authors.lastname: Crocker
authors.affiliation: Plan International Ghana, No. 10 Yiyiwa Street, Abelemkpe, Accra, Ghana.
authors.forename: Elvis
authors.initials: E
authors.lastname: Abodoo
authors.affiliation: Plan International Ghana, No. 10 Yiyiwa Street, Abelemkpe, Accra, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Asamani
authors.affiliation: Plan International Ghana, No. 10 Yiyiwa Street, Abelemkpe, Accra, Ghana.
authors.forename: William
authors.initials: W
authors.lastname: Domapielle
authors.affiliation: Plan International Ghana, No. 10 Yiyiwa Street, Abelemkpe, Accra, Ghana.
authors.forename: Benedict
authors.initials: B
authors.lastname: Gyapong
authors.affiliation: The Water Institute, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina 27599-7431, United States.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bartram
mesh_terms: D005869:Ghana; D006801:Humans; D012111:Residence Characteristics; D012424:Rural Population; D012499:Sanitation; D014038:Toilet Facilities