sustainability
Article
Acceptance Factors for the Social Norms Promoted by the
Community-Led Total Sanitation (CLTS) Approach in the
Rural Areas: Case Study of the Central-Western Region of
Burkina Faso
Hemez Ange Aurélien Kouassi * , Harinaivo Anderson Andrianisa , Maïmouna Bologo Traoré,
Seyram Kossi Sossou, Rikyelle Momo Nguematio and Maeva Dominique Djambou
Citation: Kouassi, H.A.A.;
Andrianisa, H.A.; Traoré, M.B.;
Sossou, S.K.; Nguematio, R.M.;
Djambou, M.D. Acceptance Factors
for the Social Norms Promoted by the
Community-Led Total Sanitation
(CLTS) Approach in the Rural Areas:
Case Study of the Central-Western
Region of Burkina Faso. Sustainability
2023, 15, 11945. https://doi.org/
10.3390/su151511945
Academic Editor:
Helvi Heinonen-Tanski
Received: 31 May 2023
Revised: 18 July 2023
Accepted: 20 July 2023
Published: 3 August 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Sustainability 2023, 15, 11945. https://doi.org/10.3390/su151511945
Laboratoire Eaux, Hydro-Systèmes et Agriculture (LEHSA), Institut International d’Ingénierie de l’Eau et de
l’Environnement (2iE), Ouagadougou 01 BP 594, Burkina Faso; anderson.andrianisa@2ie-edu.org (H.A.A.);
maimouna.bologo@2ie-edu.org (M.B.T.); seyram.sossou@2ie-edu.org (S.K.S.);
rikyelle.momo@2ie-edu.org (R.M.N.); dominique.djambou@2ie-edu.org (M.D.D.)
* Correspondence: aurelien.kouassi@2ie-edu.org or hemezange@gmail.com
Abstract: Although access to sanitation has been recognized as a fundamental human right, 3.6 billion
people do not enjoy this right globally. In this group, the practice of unhealthy sanitation behaviors,
such as open defecation (OD), is very common. To alleviate this problem, several governments in
low-income countries have adopted Community-led Total Sanitation (CLTS). This is a participatory
approach focused on ending OD and promoting good hygiene behaviors in target communities. This
approach is centered around and highly depends upon a given community’s willingness to adopt the
practices it advocates. However, the determinant factors in a community’s acceptance or refusal of
these practices during and after CLTS implementation remain unclear. The aim of this paper is to
highlight and categorize these factors to increase the sustainability of the approach. To achieve this, a
study was conducted in the central-western region of Burkina Faso, where CLTS has successfully been
deployed. We began this study by drawing a list of possible determinants through a literature review
and grouping them into six categories. This enabled us to set up an evaluation matrix with scores
for each factor and data collection tools. Scoring was based on the number of positive respondents
for that factor. Data were then collected at the institutional, regional, local, and household levels
from CLTS stakeholders to identify context-specific factors that underpinned behavior change in the
surveyed villages. The literature review revealed six categories of acceptance factors. In our study, the
importance of these factors according to our respondents were ranked in descending order as follows:
environmental (C1 = 592), social (C2 = 390), governance (C4 = 247), territorial (C6 = 189), economic
(C3 = 15), and technological (C5 = 0). The most frequently discussed factors obtained included the
understanding of the health and economic consequences of OD (C1, score = 550); the popularity
and reputation of Open Defecation-Free (ODF)-certified villages (C6, score = 179); men’s desire to
protect their wives’ privacy (C2, score = 138); and women’s understanding of the adverse effects of
OD on their children’s health (C2, score = 119). Incorporating the acceptance factors found in this
study into future CLTS interventions will improve the effectiveness of the approach and increase the
sustainability of ODF status in similar contexts.
Keywords: acceptance factors; Burkina Faso; Community-led Total Sanitation (CLTS); open
defecation (OD); rural communities; social norms
1. Introduction
Sanitation is an essential aspect of public health and environmental sustainability.
Recognizing that poor sanitation can contribute to the spread of infectious diseases, Sustain-
able Development Goal (SDG 6.2) emphasizes the importance of ending open defecation
https://www.mdpi.com/journal/sustainability
Sustainability 2023, 15, 11945 2 of 22

(OD) and ensuring access to sanitation for all [1]. Despite progress made over the past
years on sanitation and hygiene, 3.6 billion people lack access to improved sanitation,
and 494 million people practice OD, of which 92% are living in rural areas of Central and
Southern Asia and sub-Saharan Africa [2,3]. To combat OD and help achieve SDG 6.2, sev-
eral approaches have been developed, including Community-Led Total Sanitation (CLTS).
Currently, CLTS is one of the most widely deployed behavioral hygiene and sanitation
interventions [4]. Thirty-six countries have adopted CLTS as part of their national rural
sanitation strategy and/or policy, including Burkina Faso [4,5]. CLTS is a behavioral and
participatory approach that primarily relies on feelings of shame and disgust to mobilize
rural communities to build toilets and end OD [6]. CLTS is meant to receive no funding
or provide any kind of subsidy to target communities, unlike previous approaches. CLTS
offers communities the opportunity to take their destiny into their own hands and eradicate
OD with their own resources. Nothing is imposed in the CLTS approach. The community
has the choice to continue its previous lifestyle or decide on and accept change as a result
of CLTS activities.
Although it is a participatory and community-based approach, CLTS and the values it
promotes have not always been accepted by communities. Indeed, after CLTS triggering
phase, different reactions emerged within the communities; either the whole community
accepted and recognized the harms of OD practices and decided to put an end to it by
engaging in the CLTS process; part of the community accepted and desired change while
the other part remained skeptical or refused it; or the whole community rejected change
and continued OD practices [7]. However, [8–13] have also reported that even if the CLTS
approach and its standards have been accepted, some communities revert to their old
habits of practicing OD or partially using latrines two to three years after obtaining Open
Defecation-Free (ODF) status.
Given its wide adoption, the effectiveness and sustainability of CLTS have been the
subject of numerous scientific studies [11,14–18], but its acceptance by rural communities
has not. The different experiences of several countries show, in some cases, that this new
social norm is not always accepted by the community, and for the few who accept it, the
practice of the sanitation and hygiene rules it advocates remains difficult, especially in the
long term. This is the case in Mozambique, where CLTS results have not been encouraging
so far; ref. [19] reported that 24% of communities neither accepted nor adopted latrine
construction after CLTS implementation, and ref. [20] reported that 29% of communities
lost their acquired status as open ODF communities. The results show that many people
decide to build latrines after participating in CLTS, but a large proportion still do not.
To date, it is unclear exactly how and when CLTS leads people to decide to build
latrines. The literature provides little information on the factors that explain acceptance,
refusal, and the actual motivations of rural communities with regard to CLTS.
For communities that willfully accept to abandon OD through CLTS, how do they end
up reverting back to OD? This calls into question their true acceptance of change. What
factors influence their acceptance of the behavior change advocated by CLTS? In this paper,
we examine an issue that is particularly important for all organizations that work in CLTS
and/or have strong local roots: social acceptance. To conduct this research, we focused on
the case of rural communities living in the central-western region of Burkina Faso.
The aim of this article was to identify and analyze the factors driving the acceptance
of the social norms promoted by CLTS in ODF-certified rural communities. A better
understanding of the actual factors that motivate communities to make the decision to
accept CLTS and its advocated norms will help to improve the effectiveness of the approach,
highlight the drivers that need to be played on to increase the sustainability of ODF status,
and inform future CLTS interventions in the region and similar contexts.
 located about 100 km from its capital Ouagadougou. The central-western region is one of
13 regions in Burkina Faso. This region has 289,548 households and an estimated popula-
tion of 1,660,135, of which 891,548 are women and 768,587 are men [21]. This region is
spread across four (4) provinces that make up the region. These four (4) provinces are
Sustainability 2023, 15, 11945 Boulkiemdé, with 689,709 inhabitants and 181 villages; Ziro, with 241,731 inhabitants 3 of 22 and
127 villages; Sanguié, with 391,617 inhabitants and 138 villages; and Sissili, with 337,078
inhabitants and 156 villages [21]. Most of its population lives in rural areas, and only
2. Materials
15.35% and Methods
of the population (254,831 people) lives in urban areas.
2.1. Study Area
The choice of this region in this study was motivated by several factors, the first being
that it isThis
the study was conducted
only region where CLTS in thehas
central-western
been deployed region of Burkina
in its originalFaso
form,(Figure 1),
i.e., without
located about 100 km from its capital Ouagadougou. The central-western
subsidies. Also, the largest NGOs implementing CLTS in Burkina Faso (WaterAid, region is one of Plan
13 regions in Burkina Faso. This region has 289,548 households
International, APS/UNICEF, AMUS, AEDD, IRC Wash, WeltHungerHilfe (WHH), andand an estimated population
of 1,660,135, of which 891,548 are women and 768,587 are men [21]. This region is spread
SOS Sahel) have intervened in this area, and others continue their interventions. In addi-
across four (4) provinces that make up the region. These four (4) provinces are Boulkiemdé,
tion, access to some ODF-certified villages is easy, and a large part of the region is not
with 689,709 inhabitants and 181 villages; Ziro, with 241,731 inhabitants and 127 villages;
confronted
Sanguié, with
with terrorism, unlike most
391,617 inhabitants of the
and 138 country.
villages; andMost importantly,
Sissili, with 337,078Sissili, one of its
inhabitants
fourand
provinces,
156 villages [21]. Most of its population lives in rural areas, and only 15.35% ofprovince
has had all of its 156 villages certified as ODF, making it the only the
declared ODF(254,831
population to date people)
in BurkinalivesFaso.
in urban areas.

Figure 1. Study
Figure area
1. Study with
area withthe
theposition
position of the
the households
householdssurveyed
surveyed in each
in each province.
province.

The choice of this region in this study was motivated by several factors, the first
2.2. Sampling
being that it is the only region where CLTS has been deployed in its original form, i.e.,
Twelve
without (12) villages,
subsidies. including
Also, the five implementing
largest NGOs (5) (Boutiourou,
CLTSKoalga, KayeroThio,
in Burkina Nadion,
Faso (WaterAid,
andPlan
Onliassan) in Sissili province, three (3) (Ladiga, Gallo, and Kation)
International, APS/UNICEF, AMUS, AEDD, IRC Wash, WeltHungerHilfe (WHH), in Ziro province,
andand
four (4)Sahel)
SOS (Kalwaka, Kolokom, Mongdin,
have intervened in this area,and
andPoessé) in Boulkiemdé
others continue province were
their interventions. In se-
lected for household
addition, surveys.
access to some ODF-certified villages is easy, and a large part of the region is not
confronted with terrorism, unlike most of the country. Most importantly, Sissili, one of its
four provinces, has had all of its 156 villages certified as ODF, making it the only province
declared ODF to date in Burkina Faso.
Sustainability 2023, 15, 11945 4 of 22

2.2. Sampling
Twelve (12) villages, including five (5) (Boutiourou, Koalga, KayeroThio, Nadion, and
Onliassan) in Sissili province, three (3) (Ladiga, Gallo, and Kation) in Ziro province, and
four (4) (Kalwaka, Kolokom, Mongdin, and Poessé) in Boulkiemdé province were selected
for household surveys.
No villages in Sanguié province were selected because CLTS has not yet been deployed
there. Villages in Sissili were selected on the basis of how long they had been ODF-certified
in the province (certified for at least 36 months) and their accessibility by car from the city
of Léo, the capital of Sissili province. CLTS was introduced in Ziro province in 2021; hence,
the first villages declared ODF were selected. Boulkiemdé province did not yet have any
ODF-certified villages, but the selected villages had been triggered.
The sample size of households to be surveyed “n” was calculated using the formula
of [22]:
t2p ∗ P ∗ (1 − P) ∗ (1 + tnr )
n=
y2
With:
P: The expected proportion of a population response or actual proportion. In the case
of a multi-criteria study or when no other study has been carried out, which is frequent
in the field of sanitation, it is set to 0.5 by default, which allows for the largest possible
sample (sanitation memento). In the present study, we retained an expected proportion
of response of 0.5.
y: The margin of the sampling error. The margin of error represents the range of
certainty within which the responses obtained are accurate. It is usually between 1 and
10%. In this study, we retained a margin of error of 5%.
tnr : The non-response rate. Non-response must be anticipated (refusal by the person,
lack of information by the respondent, or omission of data entry by the interviewer). The
non-response rate is considered acceptable when it is less than 10% [23]. This indicator
is commonly used to assess the quality of the data collected. In this study, we used a
non-response rate of 5%.
tp : The sampling confidence level. In this study, we chose a 95% confidence level.
tp represents the Z-score derived from the desired confidence level. For a confidence level
of 95%, the corresponding tp value is 1.96.
The calculated sample size was 404 households, but a total of 490 households were
surveyed.
Systematic random sampling was then used to select households from the villages.
Within the communities, household selection followed the random route method [24].
The number of households selected from each village was based on the total number of
households through probability proportionate to size sampling. If no one was at home or
the person present refused to participate, the next household was selected. Respondents
had to be over 18 years of age and had to have been present at CLTS triggering in the
community in order to answer questions about acceptance. Oral informed consent was
obtained from all participants. Household surveys were conducted in local languages
(Moorée, Gourounsi, and Fulfuldé) for better understanding by the respondents. A voice
recorder was used to record interviews when the interviewer allowed it. A camera was
used to capture images during data collection and during our participation in the various
CLTS events that we attended. The interviews and administration of the questionnaire
were conducted in person with strict respect for the voluntary consent of the participants.
Three (3) data collection campaigns were conducted during this study. The first was from 1
August to 31 August 2021, in the four provinces (Boulkiemdé, Sanguié, Sissili, and Ziro)
of the region; the second was from 7 November to 19 November 2021, in the province of
Boulkiemdé; and the third was from 1 July 1st to 15 July 2022, in the provinces of Sissili
and Ziro. Table 1 summarizes the sampling strategy for quantitative and qualitative data
collection and the number of people interviewed.
Sustainability 2023, 15, 11945 5 of 22

Table 1. Repartition of the respondents of the survey.

Tools for Data Number of Respondents

Stakeholders Actors Met Sampling
Collection Men Women Total
Individual
UNICEF Reasoned
Sections WASH Interview 1 0 1
Burkina choice
Guide
Association for Peace and
NGO Solidarity (APS), Plan Individual
Reasoned
implementing International, AMUS, AEDD, Interview 8 4 12
choice
partners WaterAid, WeltHungerHilfe Guide
(WHH)
At the central level (the General
Individual
Department of Sanitation (DGA) Reasoned
Interview 0 2 2
of the Ministry of Water and choice
Guide
Sanitation)
At the decentralized level (water
and sanitation department of the
Individual
central-west region, Provincial Reasoned
Interview 2 0 2
Department of Water and choice
Guide
Sanitation of Sissili of Ziro and
Boulkiemdé)
Institutional Individual
actors High commissioner of Sissili Reasoned
Interview 2 0 2
and Boulkiemdé choice
Guide
Health district of Sissili, health
district of Leo (Sissili), Sapouy Individual
Reasoned
(Ziro), Koudougou Interview 5 1 6
choice
(Boulkiemdé), and Nanoro Guide
(Boulkiemdé)
Individual
At the local level Reasoned
Interview 3 0 3
(municipalities) choice
Guide
Individual
Public Reasoned
Health facilities (health centers) Interview 3 1 4
structures choice
Guide
Individual
Reasoned
Traditional and religious leaders Interview 9 0 9
choice
Guide
Community Individual
Village sanitation committee Reasoned
stakeholders Interview 10 4 14
(VSC or CAV/Q) choice
Guide
Individual
Private operators (masons, Reasoned
Interview 5 0 5
shopkeepers) choice
Guide
Household Random
Households Men and women 292 198 490
survey selection
TOTAL 340 210 550

2.3. Ethical Considerations

In this study, it was necessary to collect information of a very personal nature. There-
fore, anonymity was of vital importance to protect the personal identity of the respondents.
Necessary precautions were taken to protect the confidentiality of respondents. Respon-
dents were told that all data would remain confidential and would be used for evaluation
purposes only. This was also made clear in the introductory text of the questionnaires,
which did not include any fields for personal data that might facilitate the identification of
respondents. Participants were duly informed of the purpose of the study. Respondents
were assured of confidentiality, although they were told, for example, in the case of per-
sonal interviews, that their voice would be recorded if they allowed it. No participant
was coerced by any means to take part in the study. They voluntarily agreed to actively
Sustainability 2023, 15, 11945 6 of 22

participate in this study. The ethical rules set forth by the Research Ethics and Deontology
Committee of the 2iE Institute (N◦ 2023/01/DG/SG/DR/HK/fg) were respected. The
committee also approved the study and its methodology.

2.4. Study Design

To determine the acceptance factors, a participatory approach with the different actors
of coordination and implementation of CLTS in Burkina Faso was adopted.
The first step (1) of this study was to conduct a literature review on the acceptance
factors of CLTS social norms, technologies, and development projects by rural communi-
ties. The goal of the literature review was to draw up a list of factors that have favored
community acceptance of development projects.
Since social acceptance it is not something tangible or palpable like a technology, the
literature has not provided answers on the factors of the acceptance of social norms, as
is the case with CLTS. However, the factors of social acceptance of development projects
found in the literature are largely based on the principles of sustainable development,
i.e., the consideration of environmental, social, and economic factors of the project [25].
Three other categories of factors have also been identified in the literature as contributors
to community acceptance: governance, territorial, and technological factors [26]. These
factors are often linked.
Table 2 presents the categories of factors contributing to social acceptance and the
factors associated with each category in the literature. The list of factors is not exhaustive
since what is “acceptable” is a subjective notion that can vary from one individual to
another, from one environment to another, and from one era to another. It is based on the
work of researchers [27–32].
The literature review also identified data collection tools that had been used in previous
similar studies. These were interviews, questionnaires/household surveys, and focus
groups. Except for the focus group, the same data collection tools were used in the present
study.
After analyzing the literature review, the second step (2) of this study was to identify
the actors involved in implementing CLTS in Burkina Faso and collect data from them.
Stakeholders were identified on the basis of the guide for implementing CLTS in
Burkina Faso [33]. The information and data sought to identify the factors behind the
acceptance of the standards advocated by CLTS were mainly qualitative. These data came
from household surveys, interviews with institutional and CLTS implementation actors,
direct observations, and participation in CLTS processes. To ensure the reliability of the
results and avoid dependence on a single data source, data were collected at different
scales: institutional, regional, and local. The methodological approach consisted of first
interviewing those involved in coordination and implementation to find out what, in their
opinion, contributed to the acceptance of the new social norms advocated by CLTS by rural
communities now certified as ODF. We then interviewed households in ODF communities
to identify the reasons that led them to accept the CLTS standards.
Sustainability 2023, 15, 11945 7 of 22

Table 2. Non-exhaustive list of factors of acceptance of development projects by communities

according to the literature.

Category Factors
Low ecological footprint
Clear regulations
Adoption of a sustainable development policy by the promoters
Adequate information to the population on the real risks of the
project
Environmental factors (C1) Knowledge of environmental risk mitigation measures by the
communities
Added value of environmental outputs (reuse, industrial
synergy, etc.)
A project will be more attractive if the outputs have local outlets
(reused waste/rejects, etc.)
Favorable historical context
Good reputation of the company involved in the project

Social factors Early consultation and transparency (access to quality

(C2) information)
Non-opposition with the cultural practices and habits of the area
Positive social spinoffs after the project
Rigorous and independent evaluation of project benefits
Favorable community purchasing power
Economic factors Positive spinoffs that go beyond economic profitability for
(C3) investors
Economic profitability
Favorable economic context
Collaborative and participatory governance model involving
the community in the different stages of decision-making and
Governance factors (C4) not the traditional governance model based on top-down
planning, in which the territories only implement government
orientations
Upstream technology information
Use of reliable and efficient technologies
Technological factors (C5) User-friendly operation, maintenance, and upkeep of reliable
and efficient technologies
Rigorous control of operations and inputs
Good knowledge of the territory in its multiple dimensions
Respect for the integrity of the territory: fauna, flora,
Territorial factors biodiversity, infrastructures, real estate heritage, etc.
(C6) Respect for local and indigenous communities and their
ancestral and treaty rights
Low impact on tourist, economic, industrial, and other
activities.
NB: These lists are not exhaustive.

2.5. Data Analysis

The last step (3) of the study was the analysis and treatment of the data collected.
The data collected were analyzed using a common method for studying qualitative
data from interviews and household surveys: Content Analysis (CA) [34–36]. This consists
of a systematic and methodical examination of textual or visual documents while minimiz-
ing possible cognitive and cultural biases in order to ensure the objectivity of the research,
according to its creator [37]. CA is a method that seeks to report what the interviewees
reported in the most objective and reliable way possible.
Having identified the various acceptance factors for CLTS using CA, a matrix based
on the six (6) categories of factors in Table 2 found in the literature was drawn up. On
Sustainability 2023, 15, 11945 8 of 22

the basis of their similarities and proximities, each acceptance factor was associated with
one of the 6 categories. Then, scores were assigned to each factor. Each factor received a
score of one (1) when a respondent identified it as a reason for accepting and committing
to CLTS social norms. The total score for an acceptance factor was thus proportional to
the number of respondents who cited it during data collection. The scores of the different
categories were calculated by adding the scores of the factors that composed them. Table 3
was subsequently filled in.

Table 3. Assessment matrix of acceptance factors for the social norms promoted by CLTS.

Category Factors Score Factor Score Category

Factor 1 n1
Factor 2 n2
Environmental factors (C1) . . Score C1 = ∑N
i=1 ni
. .
Factor N nN
Factor 1 n1
Factor 2 n2
Social factors (C2) . . Score C2 = ∑N
i=1 ni
. .
Factor N nN
Factor 1 n1
Factor 2 n2
Economic factors . . Score C3 = ∑N
i=1 ni
(C3) . .
Factor N nN
Factor 1 n1
Factor 2 n2
Governance factors
. . Score C4 = ∑N
i=1 ni
(C4)
. .
Factor N nN
Factor 1 n1
Factor 2 n2
Technological factors
. . Score C5 = ∑N
(C5) i=1 ni
. .
Factor N nN
Factor 1 n1
Factor 2 n2
Territorial factors
(C6) . . Score C6 = ∑N
i=1 ni
. .
Factor N nN

3. Results
The use of the methodology made it possible to determine the factors of acceptance
of the social norms advocated by CLTS in Burkina Faso according to the different actors
and at different levels of decision-making. Most of the actors, on the basis of their ex-
periences, indicated that they had not been confronted with a categorical refusal from
communities during CLTS triggers. However, a minority did. The results of this study
reveal that the acceptance or refusal of the CLTS approach is due to several environmental,
governance, territorial, economic, and social factors, for which each of the actors has a
share of responsibility.
Sustainability 2023, 15, 11945 9 of 22

3.1. Governance Factors

The governance factors included good coordination between CLTS implementation ac-
tors, the uniqueness of the type of approach used in a geographical area, and the monopoly
of implementation by an NGO/association.
At the institutional level, the Ministry of Water and Sanitation of Burkina Faso, through
its General Department of Sanitation (DGA), received reports from implementing structures
and NGOs of the refusal of CLTS by some communities. This challenge was related to the
acceptance of the social norms of CLTS. After analyzing some of these situations, the DGA
pointed out that the refusals or difficulties in community acceptance were associated with
CLTS implementation policies, which recommended subsidies but did not prohibit the
no-subsidy approach. As a result, two organizations could be in the same geographic area
(in the same municipality or in neighboring villages) deploying CLTS in different ways: one
with a subsidy (full or partial) and one without. The communities in which the approach
was deployed without subsidies generally refused to terminate OD by building the latrines
at their own expense after learning that their neighbors had received subsidies under CLTS,
even though they had different implementing actors. This reveals the acceptability factor of
good coordination between the institutional actors of CLTS during implementation. Good
coordination allows each of the stakeholders to be informed of the project’s progress and its
impact (economic, social, environmental, and health) and to play its role fully. In addition
to good coordination between actors, the DGA noted that the uniqueness of the type of
CLTS used in a geographical area (municipality, province, or region) and the monopoly in
an area of an implementing structure/association are also factors in the acceptance of CLTS.
Good coordination between the implementing actors (score = 2), the uniqueness of the type
of approach used in a geographic area (score = 2), and the monopoly of implementation by
an NGO/association in a geographic area (score = 2) all received a score of 2 because only
two people were interviewed from the DGA.

3.1.1. Institutional Triggering of CLTS

The water and sanitation directorate of the central-western region and the Water and
Sanitation Directorates of the provinces of Sissili, Sanguié, and Ziro stated that when an
institutional trigger is carried out successfully, communities are much more likely to accept
CLTS. According to their experiences in implementing CLTS, 80% of the communities that
have agreed to end OD and respect CLTS norms have previously undergone successful
institutional triggers. The institutional trigger is a meeting between the water and sanitation
coordinating actors of the intervention zone and the key actors (village chiefs, notables,
religious guides, etc.) of the targeted community. The purpose of this meeting held before
community triggering is to present the CLTS approach to the most influential actors to
obtain their support and commitment to the success of the triggering. The regional director
of water and sanitation of the central-western region noted that the involvement of the key
actors of the target communities in the institutional triggering contributes to the acceptance
of CLTS by the communities on the day of the triggering.
According to the provincial director of Sissili, the natural leaders of the communities
have tipped the scales in their favor on several occasions during community decisions, as
is the case in CLTS.
The institutional trigger was mentioned as a factor in the acceptance of CLTS by
the water and sanitation directorate of the west-central region (score = 2); the provincial
directorates of Sissili (score = 2) and Ziro (score = 2); the NGOs APS (score = 4) and
AEDD (score = 2); and the high commissioners of Sissili and Boulkiemdé (score = 2),
UNICEF Burkina Faso (score = 2), and six community leaders (score = 2). The “successful
institutional trigger” factor scored 18.

3.1.2. Commitment of Natural Leaders

The interviews also revealed that the commitment of natural leaders and their positions
in favor of CLTS during the triggering was one of the factors that promoted the acceptance
Sustainability 2023, 15, 11945 10 of 22

of the news advocated by CLTS. Because they have influence, their positions are generally
followed by the rest of the community. However, some actors have indicated that this
factor can be one of the factors that lead to the rejection of CLTS norms if the natural leaders
oppose the issue of OD and how to stop it. The commitment of natural leaders to the
CLTS process and the cohesion among them were identified as factors in the acceptance of
CLTS by the regional directorate of the central-western region (score = 2); the provincial
directorates of Sissili (score = 2) and Ziro (score = 1); the NGOs AMUS (score = 1), AEDD
(score = 2), WaterAid (score = 1), and APS (score = 4); the high commissioners of Sissili
(score = 1) and Boukiemdé (score = 1); UNICEF Burkina Faso (score = 2); eight community
leaders (score = 8); the municipalities of Leo (score = 1), Koudougou (score = 1), and Soaw
(score = 1); the health districts of Leo (score = 2) and Sapouy (score = 1); and 53 households
(score = 53). The factor “commitment of natural leaders” scored 88.

3.1.3. Promises during CLTS Triggering

During some CLTS triggering events that we attended, promises (such as the construc-
tion of wells, schools, and health centers, the presence of the governor or several other
regional officials, etc.) were often made to communities if they achieved ODF status. These
promises (score = 32) were elements cited by 28 households that affirmed triggers and by
four natural leaders as factors of acceptance of CLTS and the values and norms it advocates.
However, the CLTS deployment NGOs claimed that these promises were only made to
motivate communities to engage in the process.

3.1.4. Good Communication of the Message Conveyed by CLTS Approach in the Local
Language
Good communication of the CLTS message in the local language by experienced
facilitators to communities without the need for an interpreter facilitated community
acceptance of the CLTS norms, according to the NGOs APS and WHH, 31 households,
the DGA, and the municipalities of Leo and Koudougou. When their own dialects are
used, communities are much more likely to understand the message and activities of the
CLTS process. These 31 households reported that they agreed to participate because they
understood the message that was being conveyed during CLTS triggering. The factor
“Good communication of the CLTS message in the local language” scored 42.

3.1.5. Experience of CLTS Facilitators and Animators

Facilitators and animators with more experience (more than two to three years) in
implementing CLTS and communicating with communities are very often able to carry
out the process easily. This has allowed rural communities to realize the negative effects
of OD on their environments, finances, and household health. The factor “facilitators
and animators experienced in CLTS” was cited as an acceptance factor by all the NGOs
interviewed, i.e., Plan International (score = 2), APS (score = 4), AMUS (score = 1), AEDD
(score = 2), WaterAid (score = 1), WHH (score = 2), the central-western regional water and
sanitation directorate (score = 2), the Sissili provincial directorate (score = 2), and UNICEF
Burkina Faso (score = 2). Therefore, it scored 18.

3.1.6. Entering the Target Community for CLTS Triggering with a Team That Does Not
Have a History of Conflict with the Community
Carrying out the community triggering with an intermediary who has a history of
conflict or is related to someone who has a history of conflict with the community greatly
affects the community’s acceptance of CLTS. In this case, communities that already have
grievances against this person are unwilling to listen to them without considering their pro-
posal or engagement in the process. The Sissili provincial water and sanitation directorate
said that they had been confronted with such a case during a triggering process and did
not understand why the community was so hostile toward them. After investigation, it
was found that one of their team members had a history of conflict with the target village.
The community was not willing to accept anything from him or any group of which he
Sustainability 2023, 15, 11945 11 of 22

was a member. After understanding this, this person was removed from the trigger team
that would be visiting the village. When a second trigger meeting was undertaken with the
same community, the people were in favor of ending the OD and agreed to commit to the
social norms of CLTS.
Thus, entering the target community for the triggering with a team that had no
members with a history of conflict with the community was identified as one of the factors
for acceptance of CLTS. This factor was given a score of 2 because it was cited by the Sissili
provincial water and sanitation department.

3.1.7. Presence of Representatives of the Ministries and Authorities on the Day of CLTS
Triggering and Intervention of the High Commissioner and Administrative Officials for
Mediation
Some remote villages in rural areas have never had the privilege of receiving a visit
from a ministerial, regional, or even communal authority. The triggering of CLTS is often
a godsend opportunity for these villages to receive the presence of at least one of these
authorities. The communities, therefore, see the importance of the project (CLTS) and
that it will bring the authority back to their villages if they accept it. Their presence on
the day of CLTS is also an opportunity for these communities to make some demands to
the authorities for the development of their villages. The authorities generally say that
they understand and promise to make efforts to respond to the various requests of the
community and return on the day of the celebration of the ODF status. The communities
thus commit to the CLTS process by accepting it. The presence of authorities has a major
influence on the acceptance of CLTS by communities, especially those that have been
neglected, according to the NGO APS, the regional water and sanitation directorate of
the central-western region, and the provincial water and sanitation directorate of Sissili.
However, it emerged from the interviews that not all CLTS triggers were able to benefit
from the presence of an authority from the country’s public administration other than one
from the implementing NGO or association. A particular case in which this factor was
observed was that of the village of Kayero Tio in the province of Sissili. The NGO APS,
which was responsible for implementing CLTS in the province, called on the provincial
high commissioner, the first person in charge of a province according to the administrative
division of Burkina Faso, and the chair of the provincial ODF status evaluation committee.
This committee is responsible for evaluating whether a village has achieved ODF status
according to the certification criteria in Burkina Faso following CLTS implementation. His
intervention and visit to the reluctant community of Kayero-Tio led to the community’s
strong commitment to the CLTS process. This factor was cited by the NGO APS (score = 4),
the Sissili provincial water and sanitation directorate (score = 2), the high commissioner of
Sissili (score = 1), and five natural leaders (score = 5). This factor scored 12.

3.1.8. Sharing of CLTS Experiences and Success by Natural Leaders

The reputation of some communities following their achievement of ODF status and
their success in implementing CLTS in some communities led to the emergence of new
natural leaders. The sharing of CLTS experiences by these natural leaders during triggering
in other communities was found to be a factor in the acceptance of CLTS in newly triggered
communities. It helped the newly triggered communities understand that ending OD is
not impossible and that it was up to them and no one else. This also allowed the newly
triggered communities to project themselves into the future and see the potential social,
health, and economic impacts if they were to commit to ending OD through the CLTS
approach. Thus, if other communities had done it, so could they. This factor was cited by
six natural leaders (score = 6); the NGOs APS (score = 4), AMUS (score = 1), and WaterAid
(score = 2); the provincial water and sanitation directorates of Sissili (score = 2) and Ziro
(score = 2); and 12 households surveyed (score = 12). This factor scored 29.
Sustainability 2023, 15, 11945 12 of 22

3.2. Environmental Factors

Understanding the Health and Economic Consequences of OD
Understanding the origin of diarrheal diseases in the village and estimating the cost
of disease-induced expenses as a result of CLTS activities was the most cited factor in the
acceptance of CLTS. This factor was cited by both CLTS institutional actors interviewed
and the households in the villages where CLTS was implemented. It was, therefore, the
factor with the highest score since every actor cited it. This factor scored 550.

3.3. Territorial Factors

3.3.1. Popularity and Reputation of ODF-Certified Villages
The popularity enjoyed by some villages that agreed to adopt the values and standards
of CLTS and were ODF-certified was one of the factors of acceptance by surrounding
communities. Indeed, after obtaining ODF status, some villages became popular in the
region because they were cited as examples in terms of hygiene and sanitation by several
provincial, regional, and even national authorities through various communication channels
(radio, television, newspaper, etc.). This was the case for the village of Koalga, which, after
achieving ODF status in 2017, became famous in Sissili, received visits from prestigious
authorities of the country and donations, and even hosted the celebration of World Toilet
Day in Burkina Faso the same year. Thus, the villages surrounding Koalga appealed to the
NGO APS (the association that deployed CLTS in Koalga) to deploy CLTS in their area so
that they could enjoy similar fame. This was the case for the village of Nadion, a neighbor
of Koalga located in Sissili, where when CLTS triggering was conducted; the community
immediately accepted the behavior change. This then spread to all villages in Sissili
province until they were all certified as ODF, making Sissili the first and, currently, the only
province to be declared ODF in Burkina Faso. This evidence from the interview with the
Sissili provincial water and sanitation directorate (score = 2), the testimonies of 12 natural
community leaders (score = 12), and interviews with 165 households (score = 165) indicates
that the popularity of an ODF-certified village in the vicinity of a triggered village is a
factor in the acceptance of the standards advocated by CLTS. This factor scored 179.

3.3.2. Same Type of Approach Taken in Surrounding Communities

The uniformity of an approach in the same geographical area (the same province or
region) by the same implementing actor appeared during the interviews as one of the
factors of acceptance of CLTS by the communities. Indeed, target communities did not feel
disadvantaged by a neighboring village where the approach was conducted differently and
easily accepted the standards advocated by CLTS. This was a proven fact in the province
of Sissili, where the implementation of CLTS in all villages was carried out by a single
actor, namely the NGO APS, which used the same approach in all the villages in which it
intervened. This factor was cited by the NGO APS (score = 4), the provincial water and
sanitation directorate of Sissili (score = 2), the commune of Léo (score = 2), and the DGA
(score = 2). It obtained a score of 10.

3.4. Economic Factors

Projected Increase in Revenue and Demand for Skills and Materials for Latrine
Construction
The masons and shopkeepers interviewed indicated that they agreed to engage in the
CLTS process for two reasons. First, they were convinced during the institutional triggering
of the importance of stopping OD for their health, and second, they would be able to
increase their income and diversify their activities. They stated that CLTS would increase
the demand for skills (for masons) and latrine construction materials (for sanitation store
managers). The projected increase in income (score = 5) and the increased demand for skills
(score = 5) and materials for latrine construction (score = 5) were among the factors that
explained why masons and sanitation store managers agreed to engage in CLTS.
Sustainability 2023, 15, 11945 13 of 22

3.5. Social Factors

3.5.1. Natural Rivalry between Villages Located in the Same Geographical Area
Interviews with some stakeholders revealed that there was a natural rivalry between
villages located in the same geographical area (the same department or province). Each
village wants the best in terms of development and infrastructure. Villages are thus often
willing to take any action to benefit from the public authorities or the project-implementing
structures, including CLTS. Competition and rivalry between villages in the same munici-
pality, province, or region were cited as a factor facilitating the acceptance of CLTS by the
communities and local governments interviewed. Indeed, a competitive spirit was created
when several neighboring villages were triggered in the same period. Often, rewards (in
the form of visits or the presence of important personalities on the day of ODF certification;
the construction of boreholes, schools, or health centers; or being made a priority target
for future projects and investments in the province) were promised to the first village to
achieve ODF status. Competition and rivalry between villages was cited as a factor in the
acceptance of CLTS by community leaders (score = 7); the NGOs AEDD (score = 2), AMUS
(score = 1), and APS (score = 4); and 66 households (score = 66). This factor thus obtained a
score of 80.

3.5.2. Women’s Understanding of the Adverse Effects of OD on Their Children’s Health

CLTS enables communities to understand the adverse effects of their OD practices
on their own health, their children’s health, and the financial expenses incurred by cases
of illness. The management and provision of safe water, hygiene, and sanitation in a
household are usually the responsibility of women. Although they are not usually the
heads of households due to the strongly patriarchal culture of Burkina Faso, they play an
important role in the acceptance of CLTS. Women want to preserve their privacy and the
health of their children, and thus they are among the key players in the acceptance of CLTS
because they are more likely to convince their husbands to build latrines for the wellbeing
of the household. Eighty-two women with whom we spoke indicated that, initially, after
CLTS was triggered, they were in favor of building and using latrines, while their husbands
did not see the need and said they did not have the financial means to do so. However,
they said that they were finally able to convince their husbands in their own ways. Other
actors, such as the health centers (score = 4); the health districts of Leo (score = 2), Sapouy
(score = 1), Koudougou (score = 2). and Nanoro (score = 1); the provincial water and
sanitation department of Ziro (score = 2); the communes of Léo (score = 2) and Soaw
(score = 1); and 104 households (score = 104) identified this as one of the factors for the
acceptance of the norms advocated by the CLTS approach. This factor scored 119.

3.5.3. Men’s Desire to Protect Their Wives’ Privacy

Some heads of households said that they agreed to build latrines after CLTS triggering
mainly to protect their wives’ privacy. They said that their wives often had to travel long
distances to find a hiding place to defecate. This would take place either very early in
the morning or late at night to escape the gaze of other people, especially men. However,
walking away from the compound or relieving themselves early or late in the day would
not guarantee that they would not be followed by someone or be caught or seen by
someone while relieving themselves, which is considered shameful. In addition, several
trees had been cut down over time, and finding shrubs or a shelter to defecate had become
increasingly difficult. All these elements led them to agree to build latrines under CLTS.
This factor was only obtained from surveys in which the respondent was male and the
head of the household was surveyed. A total of 138 of the 292 men interviewed during the
household surveys justified their acceptance of CLTS by this factor, which thus scored 138.

3.5.4. Social Pressure from One Group on Another Group or an Individual

Achieving ODF status in Burkina Faso requires that all households in the community
have at least one latrine for their needs. Acceptance, as it is defined, does not imply
Sustainability 2023, 15, 11945 14 of 22

unanimity; in the CLTS context, it means ensuring that everyone accepts the risk of not
being able to certify the village as ODF. Achieving unanimity is not always easy, given
the religious and cultural beliefs and principles of each person in a community. It is not
surprising that after the triggering, some people do not engage in the CLTS process by not
building latrines and not ending the practice of OD. It emerged from the interviews and
surveys that pressure is placed on these people, especially when they are few (fewer than
5 households), to force them to build latrines so that the village can obtain ODF status.
This pressure often ranges from simple warnings to threats of banishment, flogging, or
payment of heavy fines from village authorities (the village chief or council of notables) or
from the rest of the community. These social pressures were thus identified as factors in the
acceptance of CLTS by the regional water and sanitation directorate of the central-western
region (score = 2), natural community leaders (score = 3), and the provincial water and
sanitation directorate of Sissili (score = 2). However, the natural leaders did not want to
show us the people who had been pressured to talk to them.

3.5.5. No or Very Few Internal Cohesion or Chieftaincy Problems

Problems of social cohesion or chieftaincy within the village were identified as obsta-
cles to the acceptance of CLTS by the actors interviewed. Villages with few or no problems
of cohesion and chieftaincy were strongholds that favored the acceptance of CLTS. This
was the case in Sissili, where the majority ethnic group is Gourounsi and there is no village
chief or king, and therefore, there are no real chieftaincy problems. The absence of social
cohesion and chieftaincy/leadership problems was identified as a factor in the acceptance
of the norms advocated by the CLTS approach by the municipalities (score = 3), the regional
water and sanitation directorate of the central-western region (score = 2), the provincial
water and sanitation directorates of Sissili (score = 2) and Ziro (score = 2), the NGOs APS
(score = 4) and Plan International (score = 2), and 31 households (score = 31). This factor
scored 46.

3.5.6. Social and Cultural Beliefs

Cultural beliefs and social norms were determining factors in the acceptance or rejec-
tion of many development projects, including the new social norms advocated by CLTS. The
interview with the General Directorate of Sanitation in Burkina Faso revealed that in some
cultures in Burkina Faso, the practice of OD is rarely perceived as socially unacceptable.
One respondent affirmed that their forefathers never had latrines, yet they were always
healthy and lived longer than many of the people who have latrines today. He thus saw
no need for them and considered latrines an unnecessary investment. A common saying
in Burkina Faso among rural communities or individuals who refused to build latrines
following CLTS triggering is that “two holes should not look at each other”. One village chief
confided that it is difficult and even taboo for men to share a toilet with women or children.
Additionally, many of these men consider women’s menstruation to be impure and dirty
and believe that it may even inhibit some of their power or abilities. Building two latrines
was not an option for them since they claimed to have no financial means. Social norms
and ingrained beliefs were among the factors that hindered the acceptance and adoption of
CLTS standards in some communities in Burkina Faso. This factor was not scored because
it often appeared to be a hindrance to CLTS or even a factor in the rejection of CLTS rather
than in its acceptance.
Table 4 summarizes the factors of acceptance of the CLTS standards obtained in this
study in descending order.
Sustainability 2023, 15, 11945 15 of 22

Table 4. Acceptance factors for the social norms promoted by the CLTS approach by descending
order in Burkina Faso.

Category Factors Score Factor Score Category

Understanding the health and economic consequences
550
of OD
Environmental factors (C1) 592
Desire for a clean living environment and the
42
reduction of nauseating odors
Men’s desire to protect their wives’ privacy 138
Women’s understanding of the adverse effects of OD
119
on their children’s health
Natural rivalry between villages located in the same 390
80
geographical area
Social factors (C2) No or very few internal cohesion or chieftaincy
46
problems
Social pressure from one group on another group or an
7
individual
Socio-cultural beliefs 0
Commitment of natural leaders 88
Good communication of the message conveyed by the
42
CLTS approach in the local language
Promises during CLTS triggers 32
Sharing of CLTS experiences and successes by natural
29
leaders
Institutional triggering of CLTS 18
Experience of CLTS facilitators and animators 18 247
Presence of representatives of the ministries and
authorities on the day of CLTS triggering and
Governance factors (C4) 12
intervention of the high commissioner or the mayor for
mediation
Uniqueness of the type of approach in a geographical
2
area
Monopoly of implementation by an NGO/association
2
in the geographical area
Good coordination between CLTS implementation
2
actors
Entering the target community for initiation with a
team that does not have a history of conflict with that 2
community
Popularity and reputation of ODF-certified villages 179
189
Territorial factors (C6) Same type of approach taken in surrounding
10
communities
Projected increase in income and diversification of
5
activities
Economic factors (C3) 15
Projected increase in demand for skills (for masons) 5
Projected increase in demand for latrine construction
5
materials
Technological factors (C5) 0

4. Discussion
Assessing the degree of acceptance of an approach, such as CLTS, can be more difficult
than assessing the degree of acceptance of a technology. The former is abstract, while the
latter is more tangible. Since the degree of acceptance of the social norms promoted by
CLTS is difficult to measure quantitatively, the determination of acceptance factors is also
difficult to measure. The evaluation of the acceptance of the values and new social norms
promoted by CLTS in Burkina Faso was conducted at two levels. One took place on the day
of the institutional triggering through the written commitment of the key actors. The other
one took place on the day of the triggering in the target village after the different activities
had taken place, when the facilitator asked the community: “Who are those who agree to
commit to the CLTS process by building a latrine and promising to use it?”. A list was then
drawn up with the names of those committed and the time frame within which they hoped
to finish building their latrine. However, these verbal and written commitments do not
Sustainability 2023, 15, 11945 16 of 22

always guarantee that actions will follow, and even if they did, they could not guarantee
that the actions would be long-lasting. Indeed, some authors [7,8,13] have reported on
communities that made a commitment by accepting the principles of CLTS and, a few
years after obtaining ODF status, slipped back to their old ways (practicing OD); other
communities were triggered without ever reaching ODF status, leading to the abandonment
of the process. Assessing the degree of acceptance of the social norms promoted by CLTS
must go beyond a simple verbal commitment, such as “yes, we will commit to building latrines,
to using them, to washing our hands with soap and water after using the latrines; we commit to stop
practicing OD”. It should go as far as being able to determine how many people are able
to meet their commitments by first building the latrines and using them. Therefore, the
true degree of acceptance can be assessed, and the acceptance factors can be determined by
questioning those who use them regularly. However, the extent to which a latrine and other
hygiene and sanitation practices (hand washing after use, food protection, etc.) promoted
by CLTS are used, which corresponds to the true level of acceptance, is much more difficult
and expensive to measure than simply counting latrines in a community. Partial use is
even more difficult to monitor and requires household surveys to learn about the sanitary
habits of all household members and allow for detailed observations. Thus, the degree
of acceptance and the factors that motivate this acceptance remain difficult to determine
and are mostly subjective. Factors for acceptance of a new social norm such as CLTS vary
among people and contexts. Thus, the acceptance factors found in this paper cannot be
generalized to all contexts (all countries) of CLTS implementation.
Some of the acceptance factors of the new social norms advocated by CLTS provided
at the end of the data collection phase leave some questions open.
Concerning the social pressure of a group on another group or a person as a factor
of acceptance, can we really speak of the acceptance of a person when he is forced or
coerced to do something against his will or under threat? Clearly, the answer is no, even
if it is for the good of all. There is no reason for such pressure. The CLTS approach
promotes social cohesion among the members of a community [6]. However, this factor,
while often leading to ODF status, could weaken the social cohesion of the community,
especially between the person or group of people being pressured and the oppressor(s).
Threats as well as the implementation of sanctions should be facilitated with great caution
because they can lead to the exclusion of the most vulnerable. According to [38], with
community-imposed sanctions, there is tension between guaranteeing the community’s
decision-making autonomy and ensuring that abuses are not carried out by the community
on behalf of CLTS. The Water and Sanitation Program (WSP) study in Bangladesh [39]
found that persuasion, social norms, public education, and community monitoring were
more effective ways to motivate communities to maintain their ODF practice than threats,
coercion, fear, or force.
Regarding women’s desire to protect their privacy and the health of their children,
taking women’s opinions and specific needs into account is necessary for the success of
water and sanitation projects. Women are the key actors in the management of the drinking
water supply, hygiene, and sanitation in households, which makes them the group most
affected by the lack of access to water and sanitation services [40]. In terms of access to
toilets, 13% of the world’s female population does not have a toilet to relieve themselves
and manage their menstruation [41]. The lack of sanitation facilities significantly increases
the risk of sexual abuse and violence against women and girls [42]. In addition to this,
diarrheal disease is the second major cause of death in children under the age of five,
causing 1.7 million morbidities and 760,000 deaths every year globally [43,44]. In Africa, it
is also one of the main causes of death in children under five [45]. These elements further
reinforce why most women readily engage in and accept the CLTS process. However, there
are communities in which women are not free to move around. They prefer to go out as
a group to defecate in the open air at certain times of the day. These moments offer an
unprecedented opportunity for them to leave the house and to meet and converse without
men present. A study in Odisha, India, by [46] found that socialization was an important
Sustainability 2023, 15, 11945 17 of 22

factor contributing to low toilet use. According to the same authors, women reported that
OD gave them a rare opportunity to leave the house and spend time away from household
chores and responsibilities. Some women also reported it as the only time when they could
vent and relieve their stress by sharing family problems. These elements would explain the
fact that in some communities, women refuse to engage in the CLTS process.
According to [47], cost appears to be one of the most important factors in a household’s
decision to accept or not construct latrines under the CLTS approach. In low-income
communities, the cost of toilet construction and maintenance influences the initial and
long-term adoption and acceptance of the CLTS approach [48]. In households in low-
income countries, a large proportion of health expenditure is due to sanitation problems.
This appears to be a real motivation for these communities to become involved in and
accept CLTS, especially as eradicating OD means fewer cases of disease, which in turn
means savings for households. Economic gains could be reinjected into other sectors.
Indeed, in low-income countries, better sanitation can have an impact on economic factors.
For example, ref. [49] noted that water bodies (ponds or lakes, rivers, seas, etc.) near
households or villages affect toilet adoption and use, as they provide convenient places
to practice OD and clean oneself simultaneously. In some cultures, water is necessary for
cleaning after defecation, so its absence near household structures encourages the practice
of OD near surface water bodies [46]. However, water scarcity in rural areas remains
an ongoing challenge, especially in the Sahelian zone. It can be said that natural factors
also negatively influence the acceptance of social norms advocated by CLTS under certain
circumstances. In rocky or lateritic soils, it is difficult to build toilets. In Kayinja, Uganda,
the proximity of the water table makes it very difficult for the community to build ordinary
latrines. This is due to the unstable nature of the soil. Therefore, the most vulnerable (the
elderly, women, etc.) cannot afford latrines [50]. These factors could explain why some
communities that have accepted CLTS standards still find themselves without a latrine and
without ODF certification long after triggering and why they may retract their commitment.
These elements confirm that acceptance is not something immutable but can change or
evolve over time due to certain constraints. The political, physical, and environmental
conditions thus appear when they are favorable to the acceptance and adoption of the
norms advocated by CLTS. Whether social trust in cooperative latrine construction is high
or low and whether individual households rate the effort required as high or low can also
influence the acceptance of latrine construction [51]. Behaviors and cultures also account
for a range of factors in the adoption and acceptance of a technology [52]. Some of the
factors found in this study show that culture and beliefs can also influence the adoption of
CLTS or the decision to accept or not accept new social norms, such as those promoted by
CLTS.
Many communities that have accepted the standards advocated by CLTS by ob-
taining ODF status reverted to their former OD practices within two to three years of
certification [7,8,11,53]. Considering these cases of slippage identified in the literature, our
study thus suggests that acceptance is not something definitive but a dynamic process.
This position is also supported by [54], who presented community–enterprise relations in
the context of development projects as a dynamic process that links the different stages of
these together. This dynamism thus assumes that the factors found in this paper are valid
only at a specific time and only in a specific context. Furthermore, while social acceptance
is often presented as an outcome, our study suggests that acceptance is neither an outcome
nor a product but rather a dynamic process that takes place over time. As socio-political
contextual factors change over time, social acceptance may also change. For this reason, we
believe that social acceptance is an iterative process that requires constant dialogue with
stakeholders, who, moreover, enrich the nature of the tensions when their number is large.
Also, unlike previous definitions of acceptance, which assume that it does not imply
unanimity, this study reveals that the notion of acceptance in the specific case of the
CLTS approach implies the unanimity of all community members willingly or by coercion.
Since ODF status is granted to the entire community and not just to the households in
Sustainability 2023, 15, 11945 18 of 22

the community that meet the ODF certification criteria, acceptance must be required and
granted by the entire community without exception or else the community may not obtain
ODF status.
Indeed, predicting an intention to use or acceptance is very close to predicting an
individual’s behavior, as social psychologists have been trying to accomplish from classical
models at least since the early 1960s (see the reviews of [55,56]). Two theories in particular
help to explain the behaviors and choices of individuals. First, the Theory of Reasoned Ac-
tion (TAR) [57,58] postulates that behavior can be predicted by the individual’s behavioral
intention, i.e., the instruction that he or she gives himself or herself to perform the behavior.
Behavioral intention, in turn, is determined by attitudes [59] and the individual’s subjective
norms (defined as the perception of social pressure from people important to the individual)
toward the behavior. The interest of this first model is to introduce the normative social
context as well as the behavioral intention. The second model, the Theory of Planned
Behavior (TPB) [60], takes the elements of the TAR and adds perceived behavioral control.
The addition of this variable makes it possible to account for the fact that not all behaviors
are under the control of the individual but may be influenced by determinants external to
the individual. The behaviors of individuals are involved in the social and organizational
functioning of the environment [61]. The social system contributes to orienting the behavior
and decisions of individuals. However, individuals are immersed in a social functioning
that imposes knowledge and actions that have value in and from the point of view of this
social functioning. According to [62], all behaviors are social because they are necessarily
influenced by the social environment in which they take place. Nevertheless, some are
probably more social than others, as the scores of the different acceptance factors of CLTS
reveal.
It must also be noted that the accumulation of tensions can constitute a relational
legacy that is sufficiently important for the future deterioration of relations between a
company and its local stakeholders. Thus, the relational legacy, which we define as the
accumulation of unresolved tensions between a CLTS deploying organization and its local
stakeholders, including primarily the community, may explain the low levels of social
acceptance or rejection in some regions. The results of our study also revealed that two
of the three pillars of sustainable development, namely the environmental and social
pillars, constitute the main categories of acceptance of CLTS social norms. These elements
predestine CLTS to be an approach producing sustainable results, even if experiences in
other countries have proven the contrary, reporting cases of unsustainable behaviors and
infrastructures built under CLTS.

5. Conclusions
The dominant perspective in the research on business–community relations to date
has been on the responsibilities that businesses have to communities. Very little work has
focused on the responsibilities that communities have to firms and other stakeholders.
In this paper, we attempted to fill this gap by providing insights into the responsibilities
and perspectives of each stakeholder (including the community) in the implementation
of the CLTS approach with respect to the factors of the acceptance of the approach in
Burkina Faso. The results of this study reveal that the acceptance of the new social norms
advocated by CLTS in rural communities in Burkina Faso is due to several organizational,
natural, socio-cultural, health, and economic factors. Each stakeholder, from the Ministry
of Water and Sanitation to the target community, plays a significant role in the acceptance
and success of CLTS. One of the factors contributing to community rejection is the CLTS
implementation policy, which recommends subsidies to associations but does not prohibit a
no-subsidy approach. This factor directly implicates the highest authorities in Burkina Faso,
namely the Ministry of Water and Sanitation and, more specifically, the DGA. This factor
calls on the DGA to standardize its policy for CLTS implementation, leaving no ambiguity
in its policies that could lead to a dual approach in the national territory. Understanding the
health and economic consequences of OD emerged as the highest-scoring acceptance factor,
Sustainability 2023, 15, 11945 19 of 22

i.e., the one that most motivated communities to engage in CLTS. The paper also draws
the attention of the scientific community to the fact that acceptance by a community in the
framework of a project is never definitive. Indeed, some communities agreed to engage
in the CLTS process but have not been able to achieve ODF status, and even among those
that have achieved ODF status, some have reverted to their former habits of OD practices.
This may be a confirmation of the maxim “a leopard cannot change its spots”. Thus, research
on the continuous maintenance of acceptance appears to be the best option to ensure the
sustainability of gains. The factors of acceptance or rejection of the norms advocated by
CLTS depend on the context and environment in which the approach is deployed. By
taking into account the factors found in this study, future CLTS interventions will improve
the effectiveness of the approach and increase the sustainability of ODF status in similar
contexts.

Supplementary Materials: The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/su151511945/s1, Definition and difference between social accep-
tance and social acceptability. References [54,63–77] are cited in the supplementary materials.
Author Contributions: Conceptualization, H.A.A.K., H.A.A. and M.B.T.; methodology, H.A.A.K.
and H.A.A.; software, H.A.A.K.; validation, H.A.A.K., H.A.A., M.B.T. and S.K.S.; formal analy-
sis, H.A.A.K. and H.A.A.; investigation, H.A.A.K., S.K.S., R.M.N. and M.D.D.; resources, H.A.A.,
M.B.T. and S.K.S.; data curation, H.A.A.K., H.A.A., M.B.T., S.K.S. and R.M.N.; writing—original
draft preparation, H.A.A.K.; writing—review and editing, H.A.A.K., H.A.A., M.B.T., S.K.S., R.M.N.
and M.D.D. visualization, H.A.A.K., R.M.N. and M.D.D.; supervision, H.A.A., M.B.T. and S.K.S.;
project administration, H.A.A.; funding acquisition, H.A.A. All authors have read and agreed to the
published version of the manuscript.
Funding: This research was supported by the World Bank through the African Center of Excellence
Impact (ACE-Impact) program (Grant Numbers: IDA 6388-BF/D443-BF).
Institutional Review Board Statement: The study was conducted in accordance with the ethi-
cal rules and approved by the Research Ethics and Deontology Committee of the 2iE Institute
(N◦ 2023/01/DG/SG/DR/HK/fg) for studies involving humans.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study.
Data Availability Statement: A file entitled “Definition and difference between social acceptance
and social acceptability” is attached as Supplementary Materials.
Acknowledgments: We are extremely grateful to Faith Muema, Djalia Umutangampundu, Succès
Kutangila, and Edmond Kohio for their help and support.
Conflicts of Interest: The authors declare no conflict of interest.

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