In a large randomized-controlled trial funded by the Bill and Melinda Gates Foundation, we tested CLTS and combined it with activities based on the RANAS approach. The project was implemented in collaboration with Global Communities Ghana and local authorities. This resulted in a campaign adding action planning to construct a household latrine, a sign of commitment and accomplishment of being open defecation free and a barrier plan to the usual CLTS activities. The different campaigns were tested in 125 communities in Bole and Sawla-Tuna-Kalba districts in Northern Ghana. Although we did not find any differences between the effects on behaviour change comparing CLTS and the RANAS campaign communities, the outcomes were still impressive: the open defecation rate dropped from 97% to 46% in the participating communities. This behaviour remained stable even one year after the campaign.
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