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

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.

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, Sustainable Development Goal (SDG 6.2) emphasizes the importance of ending open defecation (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, several 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, [8,9,10,11,12,13] 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 [11,14,15,16,17,18], 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.

2. Materials and Methods

2.1. Study Area

This study was conducted in the central-western region of Burkina Faso (Figure 1), 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 population 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 Boulkiemdé, with 689,709 inhabitants and 181 villages; Ziro, with 241,731 inhabitants 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 15.35% of the population (254,831 people) lives in urban areas.

The choice of this region in this study was motivated by several factors, the first being that it is the only region where CLTS has been deployed in its original form, i.e., without subsidies. Also, the largest NGOs implementing CLTS in Burkina Faso (WaterAid, Plan International, APS/UNICEF, AMUS, AEDD, IRC Wash, WeltHungerHilfe (WHH), and SOS Sahel) have intervened in this area, and others continue their interventions. In addition, 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.

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]:

$$\mathbf{n}=\frac{{\mathbf{t}}_{\mathbf{p}}^2 \ast \mathbf{P} \ast \left(\mathbf{1}-\mathbf{P}\right) \ast \left(\mathbf{1} + {\mathbf{t}}_{\mathbf{nr}}\right)}{{\mathbf{y}}^2}$$

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%.

t_nr: 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%.

t_p: The sampling confidence level. In this study, we chose a 95% confidence level. t_p represents the Z-score derived from the desired confidence level. For a confidence level of 95%, the corresponding t_p 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. Repartition of the respondents of the survey.

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

summarizes the sampling strategy for quantitative and qualitative data collection and the number of people interviewed.

2.3. Ethical Considerations

In this study, it was necessary to collect information of a very personal nature. Therefore, anonymity was of vital importance to protect the personal identity of the respondents. Necessary precautions were taken to protect the confidentiality of respondents. Respondents 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 personal 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 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 communities. 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. Non-exhaustive list of factors of acceptance of development projects by communities according to the literature.

Category	Factors
Environmental factors (C1)	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
	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.)
Social factors (C2)	Favorable historical context
	Good reputation of the company involved in the project
	Early consultation and transparency (access to quality information)
	Non-opposition with the cultural practices and habits of the area
	Positive social spinoffs after the project
Economic factors (C3)	Rigorous and independent evaluation of project benefits
	Favorable community purchasing power
	Positive spinoffs that go beyond economic profitability for investors
	Economic profitability
	Favorable economic context
Governance factors (C4)	Collaborative and participatory governance model involving the community in the different stages of decision-making and not the traditional governance model based on top-down planning, in which the territories only implement government orientations
Technological factors (C5)	Upstream technology information
	Use of reliable and efficient technologies
	User-friendly operation, maintenance, and upkeep of reliable and efficient technologies
	Rigorous control of operations and inputs
Territorial factors (C6)	Good knowledge of the territory in its multiple dimensions
	Respect for the integrity of the territory: fauna, flora, biodiversity, infrastructures, real estate heritage, etc.
	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.

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 [27,28,29,30,31,32].

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.

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) [34,35,36]. This consists of a systematic and methodical examination of textual or visual documents while minimizing 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 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. Assessment matrix of acceptance factors for the social norms promoted by CLTS.

Category	Factors	Score Factor	Score Category
Environmental factors (C1)	Factor 1	n1	Score C1 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN
Social factors (C2)	Factor 1	n1	Score C2 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN
Economic factors (C3)	Factor 1	n1	Score C3 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN
Governance factors (C4)	Factor 1	n1	Score C4 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN
Technological factors (C5)	Factor 1	n1	Score C5 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN
Territorial factors (C6)	Factor 1	n1	Score C6 = ${\sum }_{\mathit{i}=1}^{\mathit{N}}{\mathit{n}}_{\mathit{i}}$
	Factor 2	n2
	. .	. .
	Factor N	nN

was subsequently filled in.

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 experiences, 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.

3.1. Governance Factors

The governance factors included good coordination between CLTS implementation actors, 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 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 construction 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 proposal 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 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.

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.

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 municipality, 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 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 obstacles 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 rejection 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. Acceptance factors for the social norms promoted by the CLTS approach by descending order in Burkina Faso.

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

summarizes the factors of acceptance of the CLTS standards obtained in this study in descending order.

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 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 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 obtaining 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 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 Action (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, 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.