SHTP II Saving Lives: One Toilet at a Time

SHTP II Saving Lives: One Toilet at a Time

Latrine construction in Lologo

Walking through Lologo South, I am struck how the community here mirrors both Juba and South Sudan as a whole. Growth is explosive throughout this newly independent nation. Every day a new shop or office building breaks ground. In Lologo South, a residential community just south of Juba, thousands of new houses, fences, and animal carrels are in various states of construction. And importantly, thanks to Management Sciences for Health (MSH), there are also latrines.

In September 2010, the United States Agency for International Development (USAID)-funded, MSH-led Sudan Health Transformation Project, Phase 2 (SHTP II), in conjunction with Population Services International and the Basic Services Fund, piloted a 3-month Community Led Total Sanitation (CLTS) project to determine the most effective strategies to increase sanitary defecation methods in Southern Sudan.

CLTS motivates or “triggers” communities’ desire for change and influences them to create “open defecation-free” sites, through the construction and utilization of latrines. Community members travel together on a “walk of shame” through areas of open defecation in their community. Here CLTS leaders engage the community members using education, shame, and humor which converts embarrassment into disgust and inspires participants to take action in their own community.

SHTP II is working in communities like Lologo South to create demand to eliminate open defecation. Many illnesses in South Sudan, such as typhoid fever and cholera, are transmitted through fecal contamination. Without proper disposal and storage of feces, the transmission pathway from feces to humans is all too easy---flies and unclean hands become unwitting accomplices transmitting germs to water, food, and finally to humans.

Process of Fecal Contamination

These germs can lead to diarrhea, dehydration, serious illness, and death. Providing sanitation education and constructing areas for proper waste disposal can avert thousands of deaths a year in South Sudan.

In CLTS, once demand is created, communities are trained on proper latrine construction. People are encouraged to use locally available materials and modify designs to their needs and keep costs down in order to increase uptake of latrine construction and usage.

In Lologo, where SHTP II implemented a CLTS approach, 49 households of a targeted 60 are currently building latrines. Starting in January 2011, MSH used lessons learned from this community and began scaling up the project in several other counties in South Sudan and building on the important lessons learned from the CLTS experience in Lologo.

CLTS is usually implemented in primarily rural locations, but Lologo South is a peri-urban locale about 20 minutes drive outside Juba. Due to this, while there are many forms of latrines, most residents in peri-urban settings look to build conventional latrines, which are often more expensive and time-intensive to construct. As CLTS is scaled up across South Sudan, leaders must properly discuss with communities about the specific requirements of latrine construction in each area based on materials available, soil composition, and community motivations. Each community has its own personality and therefore the generalized approach of CLTS needs to be tailored to each area’s specific needs.

Despite some challenges, CLTS is igniting change in communities. Behavior change, especially surrounding one of the most fundamental human behaviors, is never easy---but SHTP II is beginning to have a real impact. In a country where less than 16% of the population has access to adequate waste disposal facilities, SHTP II is working with community members to transform attitudes and practices in order to improve health and well being of the population.

(A version of this post originally appeared at

Erin Polich is a communications consultant with the SHTP II project and is working in South Sudan. Erin is a graduate of Boston University’s School of Public Health.