Community-Led Total Sanitation (CLTS) Interventions as a Tool to Improve Sanitation Practices in the Urban Slums of Choma District, Zambia

Improving sanitation remains a critical public-health priority, particularly in urban informal settlements where rapid population growth, inadequate infrastructure, poverty, and insecure land tenure undermine access to safe sanitation. Although Community-Led Total Sanitation (CLTS) has demonstrated considerable success in rural settings, evidence regarding its effectiveness in urban slums remains limited. This study assessed the contribution of CLTS interventions to sanitation outcomes in Zambia Compound, an urban informal settlement in Choma District, Zambia. A convergent parallel mixed-methods design was employed, combining a cross-sectional survey of 170 households with six key informant interviews and four focus group discussions involving 32 participants. Household respondents were selected through systematic random sampling, while key informants and focus group participants were purposively selected. Quantitative data were analyzed using descriptive statistics and qualitative data thematically, with the two strands integrated during interpretation. CLTS was found to have improved sanitation awareness, community participation, and household ownership of sanitation facilities. Approximately 72.2% of households owned sanitation facilities, of which 80.7% were functional, yielding an estimated functional-facility-to-household ratio of 0.58, roughly one functional facility for every 1.7 households. Open defecation was reported to have declined by 55.7%, and positive sanitation behaviours were reinforced through community sensitization, household follow-up visits, and local leadership. Persistent challenges that include overcrowding, poverty, inadequate space for latrine construction, insecure land tenure and socio-cultural norms constrained the achievement of universal coverage. The findings indicate that while CLTS remains an effective behaviour-change approach, its implementation in urban informal settlements requires adaptation to structural constraints that extend beyond individual and collective behaviour. The study contributes empirical evidence on CLTS in urban Zambia and demonstrates that sustainable sanitation improvement requires integrating behaviour-change interventions with urban infrastructure, inclusive participation, and supportive municipal policy.