still practice open defecation." more debate is still needed regarding humans rights consequences of posttriggering punitive measures. toilet standards and toilet types clts does not specify technical standards for toilets. this is a benefit in terms of keeping the costs of constructing toilets very low and allowing villagers to start building their own toilets immediately. however, it can produce two problems: first in flood plains or areas near water tables, poorly constructed latrines are likely to contaminate the water table and thus represent little improvement. second, long-term use of sanitation facilities is related to the pleasantness of the facilities, but dirty overflowing pits are unlikely to be utilised in the longer term. a related issue here is that clts does not address the issue of latrine emptying services or where they exist, how they dispose of waste. this has led some researchers to say that the success of clts is largely down to the cultural suitability of the way it is delivered and the degree to which supply-side constraints are addressed. if villagers do not know about alternative toilet options (like urine-diverting dry toilets or composting toilets), and are not told about these options by the facilitators of the clts process, they may opt for pour flush pit latrines even in situations where groundwater pollution is a significant problem. reuse of treated excreta as fertiliser feces are given a strong negative connotation in the clts approach. this can cause confusion for villagers who are already using treated human excreta as a fertiliser in agriculture and can, in fact, discourage the reuse of human excreta. long-term usage rates (sustainability) there is also concern about the number of people who go back to open-defecation some months after having been through the clts process. a plan australia study from 2013 investigated that 116 villages were considered open defecation free (odf) following clts across several countries in africa. after two years, 87% of the 4960 households had fully functioning latrines – but these were considered the most basic and none of the communities had moved up the sanitation ladder. 89% of households had no visible excreta in the vicinity, but only 37% had handwashing facilities present. when broader criteria for declaring communities odf was used, an overall "slippage rate" of 92% was found. some researchers suggest that this means support is needed to support communities to upgrade facilities in odf villages which have been triggered by clts. a study in 2018 has found little evidence for sustained sanitation behavior change as a result of clts. history kamal kar presented information about clts at a meeting of the sustainable sanitation alliance in sweden in 2010. in 1999 and 2000, kamal kar was working in a village called mosmoil in rajshahi, bangladesh, and decided that a system of attitudinal changes by villagers might have a longer-lasting effect than the existing top-down approach involving subsidies from ngos and government. the bangladeshi government began a programme of installing expensive latrines in the 1970s, but the government decided this was too costly, and many of the original latrines were abandoned. in the 1990s, a social mobilisation plan was begun to encourage people to demand and install better sanitation systems, but early success did not last, according to kar. at that point kar, a participatory development expert from india, was brought in by wateraid and he concluded that the problem with previous approaches was that local people had not "internalised" the demand for sanitation. he suggested a new approach: abandoning subsidies and appealing to the better nature of villagers and their sense of self-disgust to bring about change. the clts foundation is the organisation set up by kar to promote these ideas. kar and robert chambers stated in their 2008 clts handbook: it is fundamental that clts involves no individual house-hold hardware subsidy and does not prescribe latrine models.— kamal kar, robert chambers, clts foundation handbook, 2008 page 8 in time, ngos and governments began to see the value of the approach and ran their own schemes in various countries, some with less aversion to subsidies than kamal kar. community-led total sanitation as an idea had grown beyond its founder and is now often being run in slightly different ways, e.g. in india, pakistan, philippines, nepal, sierra leone and zambia. non-governmental organizations (ngos) were often in the lead when clts was first introduced in a country. india was an exception – here the government led the somewhat similar "total sanitation campaign" which has been turned into the "clean india mission" or swachh bharat abhiyan in 2014. it eventually became standard practice for ngos to leave the community quite soon after "triggering" activities. when communities took the lead, change in sanitation practices was more longer term and sustainable. clts as an idea now has many supporters around the world, with robert chambers, co-writer of the clts foundation handbook, describing it this way: "we have so many "revolutions" in development that only last a year or two and then fade into history. but this one is different. in all the years i have worked in development this is as thrilling and transformative as anything i have been involved in."— robert chambers from institute of development studies, the guardian, 30 may 2011 the institute of development studies (ids) coordinated research programme on clts since about 2007 and regards it as a "radically different approach to rural sanitation in developing countries which has shown promising successes where traditional rural sanitation programmes have failed". today there are many ngos and research institutes with an interest in clts, including for example the clts knowledge hub of the institute of development studies, the clts foundation led by kamal kar, the world bank, wateraid, plan usa and the water institute at unc, snv from the netherlands and unicef. clts has spread throughout bangladesh and to many other asian and african countries with financial support from the water and sanitation program of the world bank, dfid, plan international, wateraid, care, unicef and snv. large ingos and many national ngos have also been involved. many governments have in the meantime initiated clts processes or made it a matter of national policy. the concept originally focused mainly on provoking shame and disgust about open defecation. it also involved actions leading to increased self-respect and pride in one's community. with time, clts evolved away from provoking negative emotions to educating people about how open defecation increases the risk of disease. currently, clts triggering events focus more on promoting self-respect and pride.