Multi-Level Assessment of Community-Led Total Sanitation Performance across Local Government Areas in Nigeria

Open defecation (OD) remains one of the most pressing environmental sanitation and public health challenges worldwide. Although significant progress has been made in expanding access to sanitation facilities over the past two decades, an estimated 1.5 billion people still lack safely managed sanitation services, while approximately 419 million people continue to practise open defecation, particularly in rural communities of low- and middle-income countries [1]. The continued practice of open defecation contaminates soil and water sources, promotes the transmission of faecal-oral diseases such as diarrhoea, cholera, typhoid fever and intestinal helminth infections, and contributes substantially to childhood morbidity and mortality. Poor sanitation also undermines environmental sustainability, economic productivity and human dignity, making it a major barrier to achieving Sustainable Development Goal (SDG) 6 which seeks universal access to adequate and equitable sanitation and hygiene by 2030 [2].

Community-Led Total Sanitation (CLTS) has emerged as one of the most widely implemented community-based approaches for eliminating open defecation in developing countries [3]. First introduced in Bangladesh and subsequently adopted in India, Africa and several Asian countries, CLTS promotes collective behavioural change by encouraging communities to recognise the health and environmental consequences of open defecation and take collective responsibility for ending the practice without relying primarily on external subsidies [4]. Unlike conventional sanitation programmes that focus mainly on constructing toilets, CLTS emphasises community mobilisation, social accountability, local leadership and behavioural transformation as pathways towards achieving and sustaining Open Defecation-Free (ODF) status [5]. Recent studies have demonstrated that CLTS can substantially improve sanitation outcomes when effectively implemented. In Ghana, Adam and Badu in 2026 [5] reported sustained improvements in sanitation practices and increased community participation following CLTS implementation. Similarly, [6] found significant improvements in sanitation coverage associated with community-driven interventions, while [7] highlighted the contribution of behaviour-centred sanitation programmes to reducing open defecation in India. These findings suggest that while CLTS can improve sanitation outcomes, programme performance differs across locations due to variations in governance structures, community participation, resource availability and post-triggering support.

Nigeria remains among the countries with a substantial burden of open defecation despite sustained investments in sanitation programmes. Although national initiatives such as the Clean Nigeria: Use the Toilet Campaign and the implementation of CLTS have contributed to gradual improvements in sanitation coverage, progress remains uneven across states and Local Government Areas. Differences in political commitment, institutional capacity, cultural practices and socio-economic conditions continue to influence programme effectiveness, resulting in considerable disparities in sanitation outcomes between communities. Most previous studies evaluating CLTS in Nigeria have focused on single communities, individual Local Government Areas or specific states, with limited attention given to comparing programme performance across multiple administrative levels. Consequently, there is inadequate evidence on how sanitation outcomes vary simultaneously across states, Local Government Areas and wards following CLTS implementation [8]. Such information is essential for identifying geographical disparities, strengthening implementation strategies and improving resource allocation for sanitation programmes. Addressing this knowledge gap is critical for accelerating progress towards national sanitation targets and the achievement of Sustainable Development Goal 6.

This study therefore conducted a multi-level assessment of Community-Led Total Sanitation performance across selected Local Government Areas in Benue and Cross River States, Nigeria. Specifically, the study evaluated changes in improved sanitation coverage and open defecation prevalence before and after CLTS implementation at state, Local Government Area and ward levels, and compared programme performance across the different administrative units using appropriate statistical techniques.