Approximately two billion people globally lack access to basic sanitation facilities, including a toilet or latrine. Although the number of people practicing open defecation (OD) globally has declined, Madagascar is one of only a few countries that have seen the rate increase, from 38 percent to 45 percent between 2000 and 2017. Approximately
38 percent of households in Madagascar have a basic toilet. This low level of sanitation, and especially of OD, contribute to the incidence of diarrhea, cholera, and the spread of intestinal parasites, which in turn cause malnutrition.
Madagascar’s Ministry of Water, Sanitation, and Hygiene’s (MEAH, Ministère de l’Eau, de l’Assainissement, et de l’Hygiène) Madagasikara Madio 2025 Program aims to eradicate OD and contribute to the global Sustainable Development Goals (SDGs), including goal 6.2: “to ensure access for all, under equitable conditions, to adequate sanitation and hygiene services and end OD, paying particular attention to the needs of women and girls and people in vulnerable situations; by 2030.” The Madagascar Madio 20255 Roadmap, launched in 2019, sets objectives for household latrine use and the number of people newly declared to no longer practice OD. To build community capabilities to achieve these objectives, the USAID Community Capacity for Health Program promoted and implemented the globally-proven Community Led Total Sanitation (CLTS) approach. CLTS is an integrated approach that encourages communities to analyze their sanitation practices with the aim of stimulating collective action to eliminate OD. CLTS was introduced in Madagascar in 2008 and was recommended by the MEAH to eradicate OD and improve access to sanitation in the country.