“What it means to the people is improved health. If your community is open defecation-free, you’re not sick, children aren’t dying, and you’re not spending all your money on medicine or trips to the clinic. Instead, you’re able to afford education and focus on improving your life and the lives of your family in other ways,” Mr. App said.

Behavior change models like CLTS are examples of promoting healthy living at a grassroots level. When these types of approaches are integrated into programs like SAREP, the potential to deliver long-lasting, sustainable impact becomes possible. Due to successes like those in Shakawe, countries are increasingly scaling-up CLTS, with at least 16 national governments having adopted it as national policy.

“As implementers, we’re beholden to indicators and deadlines, so it’s sometimes a challenge to sit back and rely on the community to change their behavior and demonstrate results. But they’re doing it of their own volition, and that’s exciting,” said Mr. App.