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Evaluation database

Evaluation report

2014 Mali: Impact evaluation of community-led total sanitation (CLTS) in rural Mali

Author: Maria Laura Alzua

Executive summary

"With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is “Outstanding, Best Practice”, “Highly Satisfactory”, “Mostly Satisfactory” or “Unsatisfactory” before using it. You will find the link to the quality rating below, labelled as ‘Report’."


Globally 2.5 billion people lack access to an improved sanitation facility; in Mali, only 15% of rural households use improved sanitation (JMP 2014). Community-led total sanitation (CLTS) uses participatory approaches to facilitate sustained behavior change to eliminate open defecation by mobilizing communities in order to achieve that goal. Although CLTS has been implemented in over 50 countries, there is a lack of rigorous and objective data on its outcomes in terms of sanitation and hygiene behavior, and on health impact such as diarrhea and child growth.


The study reports a randomized controlled trial implemented by Government of Mali, UNICEF and researchers funded by the Bill & Melinda Gates Foundation to measure the causal effect of community based sanitation interventions. 


121 communities were sampled; half of the communities were randomly assigned to receive CLTS. Baseline information was collected in all the communities prior to the intervention (March to April 2011); the data collected covered household demographic characteristics, health information, anthropometrics, and sanitation and water quality samples. Follow up information was collected between April and June 2013, one year after the intervention finished.
The interventions were implemented in Koulikoro Region, by the Regional Directorate of Sanitation with the support of UNICEF. The study and sanitation programme were conducted at a time when Mali was facing an unprecedented nutrition / political humanitarian crisis.

Findings and Conclusions:

The study found a very significant increase in access to private latrines (which almost doubled among households in CLTS villages); improved quality of latrines and reduction in open defecation practices (self-reported open defecation rates fell by 70% among adults and by 50% among children under-five). CLTS households were 3 times more likely to have soap present and 5 times more likely to have water present at hand washing facility.

Other notable findings included:
Positive and significant impact on growth outcomes for children under-five years of age in CLTS villages: they were  taller (+0.16 height-for-age Z-score);
13% reduction in stunting and 26% reduction in severe stunting
15% reduction in underweight and 35% reduction in severe underweight
57% reduction in diarrhoea-related under-five mortality in CLTS villages
Significant reductions in respiratory illness, including cough, difficulty breathing, and congestion
Significant reduction in school attendance and absenteeism
Significant, positive impact on cooperation within beneficiary communities
Moreover there was no evidence that the impacts of the intervention on access to sanitation declined over time

Here is the url link to the full report: http://www.cedlas-er.org/evaluation/3/evaluating-impact-community-led-total-sanitation-programs-mali

Below are labeled as follows:

  • GEROS quality review - "Report"
  • Note de présentation - "Part 2"


Full report in PDF

PDF files require Acrobat Reader.



Report information





Universidad Nacional de La Plata, Argentina

National Directorate of Sanitation, Ministry of Environment, Government of Mali




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