change is mostly limited to those households without toilets at the start. Thus, the results support an argument put forth by the proponents of CLTS that any subsidy is going to be counterproductive in “spurring genuine household demand for private toilets” and eradicating open defecation (Kar and Chambers 2008).

The success of CLTS interventions in promoting toilet construction and use have been further documented by impact evaluations in Mali (Pickering et al. 2015) and Ghana (Crocker et al. 2016). A cluster-randomized trial of CLTS interventions in the Koulikoro region of rural Mali reported a 32 percentage point increase in latrine ownership among households in the treatment villages, and a decrease in open defecation by 24 and 23 percentage points among men and women, respectively, and by 43 percentage points among children 10 years or younger (Pickering et al. 2015). In Ghana, a study of the effectiveness of stand-alone CLTS interventions relative to those that included the training of “natural leaders” in beneficiary communities found that the training of these leaders resulted in a decline in open defecation 19.9 percentage points greater than in those villages that received only CLTS interventions (Crocker et al. 2016). The study highlights the importance of creating local champions for the success of CLTS interventions.

On the other hand, the effectiveness of subsidies is supported by a multiple-arm, cluster-randomized study in Bangladesh that compares (i) CLTS alone, (ii) CLTS plus supply-side market access, and (iii) CLTS with subsidies for poor households. The study finds that subsidies increased toilet ownership by 22 percentage points among eligible households and 8.5 percentage points among noneligible households, and reduced open defecation by 14 percentage points. The study finds no significant effects from CLTS alone or CLTS plus supply-side interventions (Guiteras, Levinsohn, and Mobarak 2015). Similar results have been reported by cluster-randomized studies of CLTS interventions with subsidies in Orissa (Pattanayak et al. 2009; Dickinson et al. 2015) and Madhya Pradesh (Patil et al. 2014) in India. Pattanayak et al. (2009) report an increase in toilet ownership of 29 percentage points in the treatment population (34 percentage points among people eligible for a subsidy and 21 percentage points among noneligible households), and Dickinson et al. (2015) report a 26 percentage point increase in toilet construction and 17 percentage point increase in toilet use. Patil et al. (2014) find that subsidies played a pivotal role in household decisions to construct toilets. Below poverty line (BPL) households that received a subsidy were much more likely to construct toilets than non-BPL households that did not receive a subsidy.

To summarize, the literature suggests that sustained follow-up and the engagement of local champions are important to the success of CLTS interventions. The CLTS approach, in principle, does not advocate any particular type of toilet technology. In fact, toilets built under such programs could be of inferior quality (Crocker et al. 2016). With the current focus on improved and safely managed toilets (as guided 9