Indonesia Water Supply and Sanitation Magazine. 'PERCIK' Vol 7 December 2004
PERCIK Special Edition 2012. Achieving Sanitation for All through STBM
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Transcript of PERCIK Special Edition 2012. Achieving Sanitation for All through STBM
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1st edition, 2012
English edition
ACHIEVING
SANITATIONFOR ALLTHROUGH STBM
Main Report Interview Lessons LearnedThe spririt of STBM inIndonesia sanitation
Interview with East JavaGovernor
Lessons from Lumajang,Probolinggo, and Soe
04 22 37
STBMspecial edition
Water and Sanitation Magazine
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Hari Cuci Tangan Pakai Sabun, 2012
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Get Our LatestPercik Yunior
Contact us :
Jl. RP Soeroso 50 Jakarta Pusat - Indonesia, Ph/Fax : +6221- 31904113
Website: http//www.ampl.or.id, Email: [email protected]
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Dear readers, once again you are holding our beloved
magazine. This issue, we are presenting a special
edition on Community-Based Total Sanitation, or in
Indonesian acronym, STBM (Sanitasi Total Berbasis
Masyarakat).
Since its launching as a national strategy through a
Decision o the Minister o Health, STBM has succeeded
as a platorm or developing community-based
sanitation to push changes in health behavior.
STBM has created unsubsidized changes. The
community becomes both teachers and subjects o
changes in health behavior. The changes in behavior
include not deecating in arbitrary places, washing
hands using soap, managing sae drinking water
and ood, managing waste properly and managinghousehold waste in a sae manner.
All these behavior give actual contribution to the
national achievement o Millenium Development Goals
(MDGs) and the water and sanitation sector o national
development targets, namely stopping the habit o
open deecation by the end o 2014.
In this STBM special edition o Percik, readers can draw
lessons and inspiration rom various gures, champions
and main actors o STBM. Each article describes STBM
rom three main elements, namely raising demand,
improving supply and enabling environment.
Interviews with the Governor o East Java and the
Regent o Bima show attempts to ormulate and
implement policies and supporting environment or
the sustainability o sanitation development.
Tales o STBM leaders rom Soe, Probolinggo, Lumajang
and the roles o partners and private sector, and
innovations in raising demand and improving supply
at the community level are also expected to inspire all
STBM actors in all levels o the society.
These tales become actual evidence that the changes
in behavior stimulated by STBM are not merely
project-based, but in act have become contagious
in disseminating the spirit to raise awareness among
society members to give more contributions to the
environment.
All roads lead to Rome, so the saying goes. There are
many roads to achieve success in the STBM program.
The key is to be alert o existing opportunities and
seizing them. Thus, it is not impossible that the targets
that are challenging the nation be achieved.
Have a good read!
Editor in chie
Maraita Listyasari
Picturing the spirit of
STBM Program
From the Editor
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Percik Magazine August 201202
Published by : Kelompok Kerja Air Minum dan Penyehatan Lingkungan (Pokja AMPL) Nasional National Water and Sanitation Working
Group Steering Committee: Director of Settlement and Housing, Ministry of National Development Planning/ National Development
Planning Agency, Director of Environmental Health, Ministry of Health, Director of Water Development, Ministry of Public Works,
Director of Natural Resources and Appropriate Technology, Ministry of Home Affairs, Director of Facilitation of Spatial Planning and theEnvironment, Ministry of Home Affairs, Director of Urban Planning, Ministry of Home Affairs Supervisor: Nugroho Tri Utomo Editor in chief:
Maraita Listyasari Managing editor: Eko Wiji Purwanto, Nur Aisyah Nasution Editor: Aldy Mardikanto Writing Team: Nissa Cita Adinia,
Lisa Imrani, Kelly Ramadhanti, Indriany, Yusmaidy, Hendra Murtidjaja, Eko Budi Harsono Translator: Indra Krishnamurti Design: Endang
Sunandar Circulation/Secretariat: Agus Syuhada, Nur Aini
Content
STBM:Achieving Sanitation
or AllSTBM brings a change in mindset in
the implementation o sanitations
programs. Besides putting community
development to the oreront, it targets
changes in the societal hygiene behavior
and cutting dependence rom subsidies.
04
28
Water and Sanitation Magazine
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Percik MagazineAugust 2012 03
Contact us : Jl. RP Soeroso 50 Jakarta Pusat- Indonesia, Ph/Fax : +6221-31904113,
Website : http//www.ampl.or.id, Email: [email protected], [email protected]
Cover : E. SunandarCover Photo : Nury Sybli
5 STBM Pillars,Applications andChallenges
Learning CLTS rom OurNeighboring Countries
Albertus Fay,FROM BONET TRADITION TOINSTRUCTION OF THE DISTRICT
HEAD
Strategic Choices inchanging community behavior
Interview with the Director General
o PP & PL Ministry o Health
STBM Milestones
What they say about STBMWith its 5 pillars, STBM has created a
signicant boost in behavior change.
As a participatory approach, CLTS has been applied in a num-
ber o our neighboring countries. Read the stories o Pakistan,
Laos and Vietnam
Albertus Fay, the champion behind the success o Polen
district in Timor Tengah Selatan Regency. He tells us his steps
in applying STBM
33
40
30
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54
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Percik Magazine August 201204
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Percik MagazineAugust 2012 05
For the sake o our descendants, and to improve the welare othe people o Maradesa Induk, with the nature as our witness, we
have to change into a healthy behavior.
Quit deecating in the open, wash hands properly, process
drinking water, manage household rubbish and waste at home...
STBM :
or All
Achieving Sanitation
Doc. Plan Indonesia
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Percik Magazine August 201206
Community active movement
The sentences above are part o the customary
oath stated by traditional leaders in the village
o Maradesa Induk, Sumba Tengah, NTB in
December 2011. In order to encourage changes in
hygiene behavior o its citizens, local traditional leaders
took the initiative to hold a customary oath witnessed
by the whole community, even the district leader.
The seriousmess o the customary oath is due to their
having been triggered.
The condition o being triggered commonly
arises when people have gone through a process
called triggering. Triggering is a method aimed tochange hygienic and sanitation behavior through
empowerment o community. A society is said to be
triggered when they become aware and committed
to change their behavior, and immediately implement
ollow-up actions.
In Indonesia, triggering has been conducted in many
locations, even in the backwater regions. Many o those
who were triggered spark are encouraged to trigger
other residents. They are known as champions. A
champion may be a citizen, a child, a local community
leader, a government ocial, etc. Champions actively
seek to change the behavior o the surrounding
community in their own ways.
One champion in Dompu, NTT, Salahuddin (13 years)
with the Tahira Children Club, created Polisi Tai Desa
Adu (Faeces Police o Adu Village). Along with village
cadres, these children actively trigger village residents
not to deecate at arbitrary locations. They perorm
routine surveillance to monitor the deecation habits o
citizens. When they nd someone doing deecation in
the open, they shouted at the oender, blow whistles
so many people know the persons behavior and
shame him.
Another champion in East Java, Hastatik, a sanitationocer in Sampang, provoke citizens using messages
that deecating in the open is immoral, as it creates
suering or others. For the Madurese, immorality
and causing others to suer is taboo and shameul.
No doubt, the people are triggered and committed
to change their behavior. The commitment is
evidenced by the amount o investment o the people
o the District o Sampang, reaching IDR 4.7 Billion
(approximately USD 520 thousand) to build latrine
acilities without subsidies rom outside sources.
All these activity are the result o a process o
community empowerment. A program is said to
Doc.STBMSec
t.
Declaration of
7 ODF villages
in Serang
Regency
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Percik MagazineAugust 2012 07
empower the community when the community acts
as active subjects as well as decision makers in all
stages o the program, said Oswar Mungkasa, ormer
Chairman o the Water and Sanitation Working Group
(AMPL).
Transorming mindset
For decades Indonesia has sanitation programs
oriented towards development o physical
inrastructure. However, during this period, the
coverage o sanitation has also shown no signicant
changes. Various programs were introduced to the
community supported by large amounts o und,
providing various types o sanitation acilities. Yet the
development o more sanitation acilities does not
increase coverage, and only result in unused acilities.
This condition shows that there is something wrong in
our thinking so ar.
In recent years, a change o mindset is starting to
appear in the current sanitation programs. People
are starting to be involved in the process, the level oinvolvement ranging rom merely participants in the
socialization, up to ull engagement.
The number o sanitation acilities built that are not
used or damaged due to the inability o the society to
maintain makes the government start thinking about
the importance o program sustainability, said Imbang
Muryanto o the Makassar Public Works Oce when
describing the Makassar sanitation program at the
National STBM Workshop on August 7-9 in Bogor, West
Java. Sanitation without the empowerment o the
people will not succeed, he added.
However, can the results o the sanitation program be
sustainable only by empowering the community?
This does not stop at empowering people, but also
changing the hygiene behavior o the society. One
o the main supporters o the sustainability o the
sanitation program is hygiene behavior change
in the society, said Zainal Nampira, Head o the
Subdirectorate o Water and Sanitation, Ministry o
Health.
The commitment o behavioral change can encourage
people to build their own sanitation acilities. Even the
poorest communities will be capable. When triggered,
Doc.IUWASH
Changes
of hygiene
mindset and
behavior ofthe targeted
community
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Percik Magazine August 201208
it turns out they were able to construct their own
sanitation acilities, said Zainal.
Zainals claim is supported by a number o indisputable
acts. Triggered communities, committed to change
behavior, will eventually be able to construct their own
sanitation acilities. Sustainable sanitation program
not only requires the empowerment o communities,
however, more important is the emergence o
behavioral changes in society. Without it, sanitation
development is less likely to be sustainable.
Developing sanitation without subsidy
The emergence o public awareness or behavioral
change resulted in many communities declaringthemselves to have quit open deecation practices,
termed Open Deecation Free (ODF) or Stop BABS in
Indonesian acronym. The ODF condition is achieved
when all inhabitants in a community have quit
practices o open deecation and become used to
deecation in healthy toilet acilities.
Triggering activities in various locations have shown
results when many villages declared themselves to
be ODF. ODF districts began to emerge across the
country, as many regencies declare to reach the status
o ODF Regency. ODF is now a prestigious status being
pursued by many local leaders.
On the other hand, many people still persist in the
old mindset that changes in the public hygiene
behavior require a lenghty, costly process and
cannot be imposed. In act, since 2005 Indonesia has
implemented a non-subsidized approach resulting in
major changes to our sanitation achievement.
What is this unsubsidized approach?
This approach is known as Community-Led Total
Sanitation (CLTS). Pioneered by Dr. Kamal Kar o
Bangladesh, CLTS has an innovative method to
mobilize community members to completely eliminate
the behavior o open deecation. The essence o CLTS
is a recognition that providing toilet acilities or the
community does not guarantee their use, nor causebehavioral changes or increase access to sanitation
hygiene. Thereore, i the targets are behavioral change
and sanitation access, the provision o latrines should
be the communitys responsibility.
It began with emulating other countries
CLTS spread quickly in Bangladesh with the
cooperation between the Bangladeshi government
and international NGOs. WSP (Water and Sanitation
Program) o the World Bank plays an important role
in the spread o this approach to India, Indonesia and
parts o Arica.
Even the poorest community will be empowered.When triggered, they turn out to be able todevelop their own sanitation facilities
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Percik MagazineAugust 2012 09
Based on the success o CLTS in Bangladesh and India,
representatives rom a number o ministries combined
in the Water and Sanitation Working Group and several
sanitation actors went to both countries to learn more
about CLTS. The visit was ollowed by inviting Dr. Kamal
Kar to Indonesia, to make an assessment on whether
the CLTS method can be applied in Indonesia.
The government ollowed up this visit with the pilot
implementation o CLTS in six regenciesin six dierent
provinces, namely: Lumajang, East Java; Sumbawa,
NTB; Sambas, West Kalimantan; Muara Enim, SouthSumatra; Muaro Jambi, Jambi, and Bogor, West Java.
Dr. Kamal Kar himselt was asked to train this method
in the national CLTS orientation in early May 2005 in
Lumajang, East Java.
Evaluation conducted approximately 6 months later
in late November 2005 showed that the result is
considered to be very good. The people o Indonesia
can trigger quickly, since 8 months ago I came to
Indonesia while no one knows about CLTS. Within 6
months, CLTS has developed well in Indonesia, said Dr.
Kamal Kar.
In-country development
Ater the trial, the CLTS method continues to be
applied in dierent regions by various sanitation actors,
both governmental and non-governmental. Starting
rom the successul trials, a national strategy to expand
the concept o improving access to rural sanitation
tailored to the mission and character o the nation o
Indonesia is also developed.
The experiments in the six regencies are able to prove
that CLTS can be applied in Indonesia. Lessons learned
rom these experiments are documented in the orm
o a video, which acts as a communication tool or
advocating various parties. Various agencies, both
government and non-government, are interested to
replicate this approach, including WSLIC2 (Water and
Sanitation or Low Income Communities), TSSM and
the program implemented by Plan Indonesia.
WSLIC2 began to aggressively implement triggering
in dierent target regions o its projects in Indonesia.
TSSM (Total Sanitation - Sanitation Marketing) in EastJava adds three components o total sanitation in
implementation, namely:
demand creation,
supply improvement, and
enabling environment.
The three components are innovations in the
replication o CLTS as CLTS ocuses solely on demand
creation. While Plan Indonesia has not yet ully
implemented CLTS, it adopted the triggering method
in 9 regencies in 2007, and by 2009 it has ully adopted
the CLTS approach.
Doc.IUWASH
The CLTS
method
continues to
be applied in
various regions
by a number
of sanitation
actors
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Percik Magazine August 201210
Replication by various parties has resulted in
remarkable changes that in 2006 as many as 160
villages have reached ODF status, and in 2007 there
were 500 ODF villages. Even the government o
Pandeglang won an Indonesian Museum o Records
award in 2007, when the NGO PCI (Project Concern
International) succeeded in its triggering and
encouraged the construction o 1,719 toilets based on
public initiative without subsidies.
Since CLTS launch, there has been an extraordinary
interest rom various programs and projects. Leverage
at the community level is also high, said Zainal.
CLTS Implementation is Not Enough
In 2007, the Indonesian sanitation world gained
valuable inormation rom WHO (World Health
Organization) and World Bank studies. The WB
study stated that the poor condition o sanitation in
Indonesia caused economic losses amounting to 2.3%
o GDP or IDR 58 trillion per year.
Poor sanitary conditions and unsae hygiene behavior
o people cause extraordinary outbreaks o diarrhea
in many provinces. Decreased incidence o diarrhea
is considered important because the disease is still
the leading cause o death o inants and toddlers in
Indonesia.
WHO states that there are three conditions that can
reduce the incidence o diarrhea, namely:
1. Increased public access to basic sanitation, reducingincidence o diarrhea by 32%;
2. Washing hands with soap, reducing by 45%; and
3. Sae drinking water in households, reducing by 39%.
Each o these conditions, on its own, does not result in
major reduction. However, i the three conditions are
integrated, the incidence o diarrhea can be reduced
by as much as 94%.
Based on these two important studies, the government
o Indonesia realizes that the implementation o CLTS
is not enough. A program large enough to integrate
the above three conditions is required i it wants to be
Doc.STBMSect.
Various
villages declare
themselves to be
open defecationfree
EnablingEnvironment
Institutionalisation
DemandCreation
SupplyImprovement
Components of Total Sanitation Diagram
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Percik MagazineAugust 2012 11
serious in improving sanitary conditions and reducing
the incidence o diarrhea.
The success o CLTS trials, replication and development
o post-trial CLTS, as well as the WHO and World Bank
studies, encourage the Government o Indonesia to
develop a program that targeted reduction in the
incidence o diarrhea by changing peoples behavior.
The result o these eorts is the Decree o the Minister
o Health No. 852/Menkes/SK/IX/2008 on the National
Strategy or Community-Based Total Sanitation.
Community-Based Total Sanitation adopted the CLTS
approach to change peoples behavior. The WHO study
results are refected here as the 5 pillars o behavior
change, now known as the ve pillars o STBM, namely:
1. Stopping the practice o open deecation
2. Washing hands with soap
3. Managing household drinking water and ood
4. Managing household waste
5. Managing household liquid sewage
Achievement o these ve conditions in a community
is called as a Total Sanitation condition.
The creation o the ministerial decision on a national
strategy o STBM, besides useul or advocacy, is also
benecial to trigger more parties to implement the
CLTS and develop into STBM. While there were initial
doubts, like when CLTS was launched, STBM slowly
but surely gained support into the largest community-
based unsubsidized sanitation program in Indonesia.
Under the coordination o the Ministry o Health
and supported by interdepartmentalinstitutions, the
National Water and Sanitation Working Group (Pokja
AMPL Nasional), STBM stakeholders rom governmentand non-government institutions initiate advocacy
eorts and implementation o STBM at various levels,
starting rom the national to the regional levels.
Successes began to appear, even in areas considered to
be very unlikely or the success o this program.
A series o changes and progresses accompany the
implementation o STBM. Many people have started to
implement triggering, not only or Stop BAB. There are
now villages achieving total sanitation in all 5 pillars o
STBM, said Zainal.
STBM, while initially designed or the rural areas, is now
Doc.PlanIndonesia
Washing
hands with
soap is proven
to reduce
incidence of
diarrhea by
45%
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Percik Magazine August 201212
beginning to be tested in urban areas. WVI (WorldVision International) and USAID (United States Agency
or International Development) are two o the donors
who initiated the pilot implementation o the STBM in
urban areas.
There is also an emergence o sanitation
businesspersons association at the community level.
All parties collaborate, again adding to the positive
leverage this program, added Zainal.
The same opinion was expressed by Nugroho Tri
Utomo, Director o Settlement and Housing o The
Ministry o National Development Planning (Bappenas).
Many people havestarted to implementtriggering, not only forStop BABS. There are
now villages achievingtotal sanitation in all 5pillars of STBM.
Doc.NWSWG
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Percik MagazineAugust 2012 13
According to Nugroho, STBM has evolved into a higher
level o complexity, STBM is the only program or
approach with a direct intervention to the household
level, which is a major determinant
o the success o sanitation
program.
As a result, Indonesia
becomes a
learning place o rural sanitation program or its
neighbors. In the Southeast Asia-Pacic CLTS Regional
Workshop in 2009, Indonesia was known as a country
experienced in a very comprehensive implementation
o CLTS, even compared to India.
It is said to be comprehensive because implementation
o CLTS in Indonesia has reached the development
o the STBM concept. In addition, not only the
implementation o the 5 pillars, sms- and web-based
monitoring o STBM has already been applied. STBM
actors also become more varied, including the regional
government, local and international NGOs, donor
institutions and the private sector through Corporate
Map o CLTS Distribution in Asian Countries 2004-2010
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Percik Magazine August 201214
Social Responsibility programs.
There are many supporting actors in Indonesia such
as existence o regulations, governments commitment
in the RPJMN, existence o AMPL/sanitation working
groups at the regency, city and province levels,
partnership with stakeholders and the presence o
champions in communities.
Serious Challenges
In all countries implementing CLTS, transition o
the approach to development o sanitation rom
subsidized to non-subsidized is perceived to be the
most ormidable challenge, or both the government
and society. Laos and Vietnam are examples o
countries that sent their teams to Indonesia to
exchange knowledge on CLTS and STBM.
In the Regional Workshop on Exchange Visits on
Scaling Up Sanitation in Solo (September 2011),
the Government o Indonesia was considered quite
successul in collaborating with donor agencies and
partners to develop rural sanitation through the
strengthening o three components o total sanitation.
This activity was attended by donors such as Water Aid,
UNICEF, Plan, ADB, World Bank and the governments o
Enthusiasm
in ODF
declaration
activities
in various
regions
Doc.PlanIndonesia
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Percik MagazineAugust 2012 15
Demand
Creation
SupplyImprovement
EnablingEnvironment
STBM triggering at the
community level
Formative research on hygiene
behavior and motivation o
community as consumers
Communications media
campaign based on ormativeresearch, using existing
motivation to change behavior
Oering options to consumers
when they are commited to
change their hygiene behavior
Evaluating sanitation markets
at provincial level to compare
existing sanitation options
and willingness and nancial
capability o consumers
Developing the range o
sanitation options demanded
and accessible to consumers
Developing a catalog o suitable
sanitation options to help
consumers select
Monitoring o local
entrepreneurs and training o
construction workers to deliver
technological choices with a
guarantee o quality
Apply a local policy to
implement STBM in the regency
through synergy o all rural
sanitation program/project
unding sources
Developing a specialised
nancial ramework in the
government budget
Providing development budget
and improving local capacity (or
demand, supply, management,
knowledge, supervision and
program results o sanitation)
Writing analysis o unding
eectiveness (input, output,
results) o sanitation programs in
the progress report o regency
programs
Formulating strategic plans or
STBM implementation in the
regency
Laos, Cambodia, Philippines, Timor Leste, Vietnam and
Papua New Guinea.
With that perormance and learning, there are still
so many challenges aced by STBM. The Indonesia
National Mid-Term Development Plan or 2010-2014
has set Indonesia Stop BABS as a goal in 2014, will it
be achieved? How to cope with the various programs/
projects in areas that are still subsidized? Achievement
o the MDGs or sanitation in Indonesia still relies on
STBM because o its eectiveness in improving access to
sanitation in rural areas. In the ace o regional autonomy,
how to make local leaders adopt this program?
As said by Nugroho Tri Utomo at the National STBM
Workshop (7/9), STBM still nding its way, still in the
pilot stage. Whereas in the eld we have known the
potential o STBM. Its success has been suciently
tested. The challenge is no longer to advocate
households but to advocate local governments
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Percik Magazine August 201216
to support these activities. The challenge is the
commitment o regional governments to allocate
unds to STBM.
Towards Achieving STBM Targets
STBM moves rom a simple learning, and increasingly
evolves, in line with increased learning. In the rst
quarter o 2012, we already have 6,457 villages
implementing STBM. Our target is 20,000 villages byat least 2014. Will we use all the learning as a oothold
into achieving targets?
With regard to creativity to reach targets, STBM
implementors have always shown a high level o
creativity. In East Java, or example, using a strategy
o one health center, one ODF village , the East Java
Provincial Health Oce targets each health center to
at least convert one village in the region each year to
ODF status. Each district usually has one health center,
some have more than one. With the strategy o one
health center, one ODF village , this is an achievable
target or the health centers, said Edy Basuki, Section
Head o Environmental Health Oce o East Java
Province.
This strategy is not impossible. I in each month a
sanitarian does a triggering event and monitoring, the
target o at least one ODF village can be accomplished
in one year. Based on the unding that is available, the
strategy o one health center, one ODF village is an
Each district usually has one community healthcentre. Thus the strategy of one communityhealth centre, one ODF has a reachable target
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Percik MagazineAugust 2012 17
excellent strategy capable to be applied in other
regions.
Wilried H. Purba, Director o Environmental Health,
Ministry o Health, added another potential. According
to Wilried, currently each health center obtains an
average o Rp. 100 million in BOK (Health Operational
Assistance). Here, the environmental health allocation
can be used or STBM. Now the question is, how we can
stimulate our colleagues to remember environmental
health through the STBM program, he said.
On the achievement o STBM targets, Nugroho added
that STBM emerges rom much learning, results o
studoes, creative work o champions and support o
many parties. STBM will also live and thrive rom such
passions. And do not orget, STBM can develop well,
when it is integrated with other programs, such as
the Acceleration Program o Sanitation Development,
Water Saety Plan or School Sanitation, said
Nugroho.
Synergy with other programs and breakthrough
in the STBM strategies o implementation. Imagine
when all districts in Indonesia, which number about 6
thousand, implement the strategy. It is not impossible
that the target o achieving 20,000 STBM villages in
2014 will be achieved, even exceeded. He invited us all
to work together in achieving the target.
Indriany, Nissa Cita
Doc.PlanIndonesia
All stakeholders
synergize in
conducting
STBM promotion
to achieve the
national target.
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Percik MagazineAugust 2012 19
Community-Based Total Sanitation
(STBM) Program has been launched
or our years. STBM is one o the
cross-sectoral national programs in
the area o sanitation. The program
was launched in August 2008 bythe Minister o Health. STBM is an
approach to changes o hygiene
and sanitation change through
community empowerment using
the triggering method.
In the 2010-2014 Strategic Plan o
the Ministry o Health, eight priority
ocus o health development are
set. One is the control o inectious
diseases, non-communicable
diseases and environmental
sanitation; with one o the main
indicators o achievement being
20,000 villages implementing
Community-Based Total Sanitation
(STBM) in 2014.
One o the attempts o handwashing with soap campaign
implemented by the Ministry o
Health. The ollowing are excerpts
o an interview by Percik magazine
journalist, Eko B Harsono with
Director General o Desease Control
and Environmental Health (PP
& PL) Ministry o Health, Pro. Dr.
Tjandra Yoga Aditama in his oce
in Jakarta, recently.
What are the undamental issues
in implementing STBM?
A number o community sanitation
programs have been implemented
or some time. The problem is
that there are a number o issues
that need to be considered: frst,
clean and healthy behavior (PHBS)has not become a necessity
or most people. The society in
general has the knowledge about
the importance o clean and
healthy behavior and infuence
o sanitary conditions to health.
However, people still have
not put priority on sanitation.
Thereore, inconsistencies in the
practice o clean living are still
ound in the community. Second,
there is a lack o commitment
rom regional governments
Pro. dr. Tjandra Yoga Aditama SpP(K)Director General of PP & PL Ministry of Health STBM
STBM, Driving ChangeWithout Subsidy
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regarding the importance o
sanitation development. Regional
development is still ocused on
inrastructure development such
as bridges or roads, while the
construction o sanitation is not
a priority. Moreover, sanitation
development has not been
integrated between relevant
sectors and a shared responsibility.
Third, there is no integrated and
synergistic approach to sanitation
development. One o the obstacles
is the absence o blueprint and
approach to manage sanitation
development. Implementation o
sanitation development was carried
out sporadically without clear
reerence rom the government.
The government has launched
STBM as a national program, and
makes it a guide or implementing
various sanitation programs/
projects. However, the program
still need to be developed to meet
the requirements o the national
program.
Why does STBM have a non-
subsidized principle?
Previously we have applied
traditional approaches to sanitation
programs, such as building latrines,
distributing amily latrines or ree
or as stimulant packages in the
orm o construction materials,
Doc.STBMSect.
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and distributing money to
the community in the orm o
revolving und.
The three activities use a physical
approach in which the ocus and
success benchmarks are always
on the physical approach. Such
a physical approach does not
provide adequate leverage to
improved sanitation because it
is not sustainable (people always
rely on subsidies).
In the absence o subsidies,what is the role o
government?
The role o government is to
acilitate in the orm o norms,
standards, guidelines, advocacy
and outreach, campaigns,
monitoring, evaluation, and
learning. Regarding the role o
the government, cross-sector
agencies and stakeholders has
developed a National Strategy
or Community-Based Total
Sanitation (STBM) and has been
designated by the Decree o
the Minister o Health No. 852/
Menkes/SK/IX/2008 dated 8
September 2008
Is STBM a success?
We have not dared to declare
it as a success but the progress
is encouraging. This approach
continues to be evaluated and
accelerated while maintaining
the quality o processes and
outcomes. We have also began
to develop other STBM pillarssuch as the Handwashing (CTPS),
Household Water Management
(PAM RT), waste and household
sewage/waste management
campaigns.
What obstacles are
encountered in the
implementation o STBM?
The main obstacle is that not all
stakeholders understand and
adopt this approach in sanitation
development and retain a
physical approach instead o
behavioral change. To counter
this, our step is to continue to
conduct roadshows or advocacy
and outreach to decision
makers and stakeholders. We
also conduct media campaigns
and learn rom lessons rom the
successul implementation STBM
in various regions.
How are non-government
actors involved in the STBM
program?
This program requires the
involvement and synergy o the
various parties (government,
private sector, NGOs, donors and
the community). The synergy is
done in the orm o partnership
and networking, such as through
Jejaring AMPL, Public-PrivatePartnerships or Handwashing
with Soap, synergies with donors
and NGOs (UNICEF, ESP, Plan) in
adopting the STBM approach or
sanitation development.
The main obstacle is that notall stakeholders understandand adopt the STBM approach.
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What was it like when STBM
program was introduced? What
was your impression when STBM
was introduced in East Java?STBM has been known since
2006, tested in Lumajang. At the
beginning the Community Led
Total Sanitation (CLTS) method
was introduced, a method o
empowering the community with
a ocus on eorts to change the
behavior o open deecation (BABS)
into using toilets. In 2007, the Total
Sanitation and Sanitation Marketing
(TSSM) approach was introduced
by WSP World Bank combining
increased demand (triggered
people) and improving supply and
business networks involving the
private sector. In 2008 there was
a budget or STBM (Community-Based Total Sanitation) activities,
and operational unding was
provided by regency government
through the regional budget.
The rst impression o STBM is
that this is a new approach to
empowerment. This approach
proved quite eective in increasing
access to toilets quickly.
What constraints have appeared
in the implementation o STBM
and what eorts have been
made to solve it?
Not all regencies/municipalities
understand this approach,sanitation is still not a priority in
development policy, and budget
allocations or sanitation is limited.
To develop the program, the
provincial government pushes or
access to resources such as CSR,
BOK unds (Fund or Operational
cost in health services), PNPM
(National Program or Community
Empowering) or other national
projects. In addition, rewards
to successul regencies could
also trigger other regencies, or
SoekarwoGovernor of East Java
Disseminating learningfrom East Java
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example, through JPIP Otonomi
Awards. Other eorts are also
shown in the orm o a national
exhibition in the ramework o
Unity Day o Village WomenOrganization and Community
Month in which STBM is able to
mobilize community participation
and mutual assistance to build
toilets in a broad scale.
What is the role o various
stakeholders (government,
private/CSR/media, public,
universities, donor/ NGOs, etc.) in
the implementation o STBM?
At the very least, regional
governments provide policy
support and cooperation with
other agencies. These include the
private sector through CSR (eg,
Bank o East Java), Media (Jawa
Post-Otonomi Award), NGOs ( WSP-World Bank, USAID), PKK (Clean and
Healthy Environment Competition),
national projects (PNPM, SANIMAS,
PAMSIMAS). Synergizing o eorts
across programs is well established
through the Healthy Cities, Alert
Village, Health Promotion, UKS and
other programs.
What counts as STBM benefts to
society?
People can enjoy cleaner and
healthier environment and
reduce the risk o disease due to
environmental conditions. People
who already have a toilet rom the
beginning will be comortable
because surrounding communitieswho previously deecate openly will
already have latrines.
What are the local conditions
beore and ater the STBM
program began to be
implemented?
The previous sanitation program
approach by providing subsidies
or latrine construction was very
limited in scope, requiring relatively
large costs because people expect
help rom the Government.
Pupils in
Tunjung Sekar
Elementary
School in Malang
enjoying hand
washing facilities
Doc.NWSWGSect.
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Additional access to latrines in
the community is very slow. With
STBM, the sanitation program
gives more attention to behavior
change through a method o
triggering and social control that
mechanisms in the community can
be sustainable, additional latrine
access grows aster and wider in
scope and evenly in all walks o
society.
In your opinion, what are the
actors that drive the success o
STBM in East Java?The support o provincial
government policy in the eld o
sanitation, creation o synergy and
conducive stakeholder cooperation
and dissemination o inormation
through the media to all parties
concerned. In terms o the
exchange o knowledge, East Java
has spread its learning to various
parties through eld trips, using
local success stories as resources, or
becoming a source person in other
regions.
What are the challenges
that must still be aced in the
implementation o STBM in East
Java?
STBM should be going at the
speed o the implementation in
Bojonegoro, Jombang, Pacitan,
Lumajang, Magetan, Ngawi,
and Nganjuk. To that end, the
provincial government will
continue to provide motivation
and advocacy to all regencies and
municipalities by maximizing three
important components o STBM:1. Continuing to create demand
with triggering; 2. Providing
solutions to the communities
that have been triggered by
speciying healthy latrines, with
easier access to sanitation markets
(closer supply); 3. The government
and its stakeholders creating a
supportive environment (enabling
environment), at least by providing
policy support.
The MDGs deadline date is
getting closer, how is the
prospect o STBM in answering
the challenges o the MDGs?
When STBM is implemented by
all parties to the maximum and o
course supported by all regents/
mayors, it is possible that MDGs
Goal 7 targets can be achieved. So
the keywords are strong support
and commitment, especially by
regents/mayors.
What are the expectations,
eedback and evaluation or the
improvement/acceleration oSTBM program at the national
level?
There should be support,
consensus and a strong
commitment by all parties, rom
the top to bottom, it is the key to
the success o STBM in the national
level.
With regard to exchanges of knowledge, EastJava has disseminated its learning to variousparties through field visits, inviting successfulregions as sources or becoming sources in otherregions
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Percik MagazineAugust 2012 25
What is the beginning o
the Community-Based Total
Sanitation program (STBM)?
What was your impression when
STBM began to be introduced in
Bima?
STBM was rst introduced in thelate stage o the Second Water
and Sanitationor Low Income
Communities (WSLIC 2) in 2005
as CLTS (Community-Led Total
Sanitation), then aggressively
adopted by other programs such as
WES Unice, Alert Village Program,
Community Month, etc.
The impression that arises when
STBM began to be introduced
in Bima is that we have
experienced since the rst Five-
Year Development Plan to build
sanitation with programs ranging
rom Presidential Instruction
Program o Water and Family Toilets
Inrastructure (Inpres Samijaga),
Unice, RWSS, Inrastructure
Development o DissadvantagesAreas Program (P3DT), the
Acceleration Development o
Dissadvantages Areas Program
(P2DT), etc. with a very large
investment. These investments
have not been able to increase the
coverage and support behavior
change on increasing the health o
society.
The presence o ve STBM pillars
has been able to provide signicant
leverage in behavior change
and improved water supply and
sanitation coverage. What is
interesting about this program is
the increased public awareness
through triggering strategy. As a
result, in early 2012 there were 25
villages and 1 district that havebeen declared as ODF (Open
Deecation Free) or ree rom
indiscriminate deecation. And in
2015, the regency o Bima plans to
achieve status as an ODF regency.
What are the obstacles that arise
in the implementation o STBM
to date, and what eorts have
been made to solve it?
Some obstacles remain, such
people still considers construction
o sanitation as the responsibility
In 2015,Bima will become an ODF regency
Ferry ZulkarnaenRegent of Bima
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o the government and is subsidy
oriented. Moreover, there remain
a number o central government
policies on sanitation development
that are not aligned with the
Decision o the Minister o Health
No.852/MENKES/SK IX/2008 on the
National Strategy or Community-
Based Total Sanitation. Another
constraint is the lack o capacity
and understanding o The Regencys
Oces in relation to STBM.
What are the eorts that have
been made such by the regional
government?
In addition to issuing several
regulations, Bima regency
gives a big role to AMPL - BM
working group to coordinate
implementation o water supply
and sanitation development. Other
steps taken include acilitation
and sustainable ostering o the
society. It also sets the WSS sector
as a development priority in the
Local Governments Medium Term
Development Plan (RPJMD).
The local government is also
seeking an increase in the
allocation o the regional budget
or STBM. Meanwhile, another eort
done is by increasing the role o
inormal leaders in the community
to work together with technical
ocers in the eld to conduct
Together
doing health
promotion
activities for
elementary
school
children.
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Percik MagazineAugust 2012 27
triggering o CLTS (Community Led
Total Sanitation).
What are the role o various
stakeholders (government,
private CSR, media,
communities, universities,
donors, INGOs, NGOs, etc.) in the
implementation o STBM?
The regional government puts
NGOs, media, universities and
others as partners in which
the government provides the
widest possible opportunity tocontribute in compliance with
existing legislation. For example,
in terms o promotion and
dissemination o STBM, the role o
the mass media (especially local
media) is optimized. Some NGOs
provide nancial support in the
planning and implementation
o government programs.
Likewise academics are active as
government partners in assessment
and advocacy programs.
What do you think are the actors
behind the success o STBM in
Bima? What have been done
to support the exchange o
knowledge with other areas who
want to learn rom Bima?
The actors behind the success in
Bima include leadership, where
there is a harmonious collaboration
and communication, especially
between the executive and the
legislature in ormulating policies
that support STBM. In addition,
the regent o Bima always heedsthe aspirations o the rural people
through activities such as BBGRM
in every village, Ramadan saari
activities, direct visits to the
community, etc., which also helped
the success o STBM.
In order to exchange knowledge
with other areas, we have acilitated
and shared our experience with
Dompu and Bima Municipality
AMPL working groups on
sustainable and community-based
management o water supply and
sanitation.
In your opinion, what are the
challenges that are still aced in
the implementation o STBM in
Bima?
Challenges still to be aced are
related to the limited ability o the
regency budget. In addition, there
needs to be improved synergy
o the role o dierent sectors/
stakeholders in the program.
Another challenge to be aced is
the topography o the regency,
which demands support acilities
and resources in acilitating the
public.
What are expectations, eedback
and evaluation or increased
acceleration o STBM program atthe national level?
National government support
needs to be increased, both
the allocation o unds and
programs within the ramework
o community-based STBM. At
the policy level, synergy o STBM
promotion policy at the national
level needs to be increased, in the
ramework o integration in the
region.
Several NGOs provide financialsupport in the planning andimplementation of governmentprograms
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Percik Magazine August 201228
Doc.PlanIndonesia
Applications and Challenges
5 Pillars of STBM,
When Indonesia started implementing a variation o
CLTS (Community Led Total Sanitation), namely STBM
(Community-Based Total Sanitation), the sanitation
situation is still weak, in which public awareness about
the importance o sanitation is lacking.
STBM itsel is a strategy having 5 pillars including
ve important aspects, namely: (1). Free rom
open deecation, (2). Washing hands with soap,
(3). Management o drinking water and household
ood, (4). Household waste management, and (5).
Management o household sewage. In particular, STBM
strategy is not made only to disseminate inormation,
but with continuous encouragement and support
creating awareness on sanitation both in attitude and
liestyle. In other words, the expected eect is a change
in liestyle, rom laissez aire(let alone) to care and
take care.
The Sanitation Hygiene and Water Program, commonly
abbreviated SHAW, is one o the consortia coordinated
by the Dutch NGO SIMAVI, in introducing the ve
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Percik MagazineAugust 2012 29
pillars o STBM. This eort is done in
collaboration with ve local NGOs
namely PLAN Indonesia (Kabupaten
TTS and TTU in NTT), Yayasan Dian
Desa (Kabupaten Sikka and Flotim
in NTT), Rumsram Foundation (Biak
Numor and Supiori in Papua), CD
Bethesda (Kab. Sumba Tengah
and SBD in NTB) and Yayasan
Masyarakat Peduli (Kab. Lombok
Timur at NTB).
The key to STBM is behaviour
change, not the number o acilities
and activities. And as experienced
in the eld, the implementation othe ve STBM pillars is divided into
our stages, namely preparation,
triggering, ollow-up support, and
monitoring and stimulation o
interest made ater the declaration.
In terms o dynamics, all partners
begin by preparing themselves
and the community so that the
triggering can be the highlight o
attention and the starting point or
change. Oten triggering cannot
be implemented at the village
level because there are too many
participants, so triggering is done
at the hamlet level, or even at a
lower level.
Since 2010, it has been considered
important to involve various
groups. Not only local government
sta, but also sanitarians,
midwives, health oce sta, task
orce members, village heads,
hamlet heads, district heads,
and community leaders. The
government as the stakeholder is
not the project manager, but acts
as a supporter o organizations and
the community, and pay respectto successul villages and their
inhabitants.
In relation to the ve pillars, a
large number o actors want to
concentrate on Pillar 1 (stopping
open deecation), because it is
easier and physically observable. In
act, during roadshows by SHAW
partners, there are districts and
villages that already understand
the importance o all ve pillars,
and that they do not want to
implement Pillar 1 only. The pride
o reaching all 5 pillars is important
to a village, because the 5 pillars are
considered as a single package that
can encourage behavioral change.
Application o 5 STBM pillars is
certainly not easy or without
challenges altogether. Always there
is a risk o returning to original
behavior. Dynamics in the village
as well as the support o all parties,
both inside and outside the village,
are instrumental. Initiatives and
joint eorts will be successul i all
people want to come and care orthe conditions experienced.
Knowledge o stages to achieve the
ve STBM pillars and alternatives to
achieve such status are important
to be encouraged. The available
choices still needs to be urther
developed by the private sector in
order to have economic value.
Pam Minnigh, Yusmaidy/ Simavi
Joint initiative and efforts will succeed wheneveryone participates and cares about thecondition being experienced
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Percik Magazine August 201230
Since 2008, STBM has become a national strategy toaccelerate the achievement o MDGs, or drinkingwater and sanitation sector. Initially, STBM was more
widely adopted in rural areas as most villagers do
not have adequate access to water and sanitation. In
act, in urban areas that are commonly understood to
have water and sanitation systems, there are still many
citizens who do not have adequate access and not
practice hygienic behaviors and sae sanitation.
Given these conditions in April 2011, USAID in
collaboration with Yayasan Cipta Cara Padu Indonesia
rolled out the High Five program to implement STBM in
urban areas as an eort to improve sanitation practices
and hygiene. In understanding that the approach
taken should be able to provide space or public
participation, as well as to accommodate the unique
characteristics o urban population with its density and
variation o livelihood, High Five develops a strategy
o holistic approach. The strategy o this approach
consists o three interrelated elements : Foster a sense
o necessity and a sense o ownership o STBM; The
mechanism o dialogue and participativeaction or
sustainability program; Partnership to increase access
and sanitation and hygiene behaviors.
Opportunities and challenges
Challenges aced in implementing STBM in urban areas
are very complex, ranging rom the regional diversity,
varied livelihoods, population density, busy society, lack
o land, up to the materialistic and ego-centric attitude
that ocuses on personal gain. On the government
side, there are still many individuals holding key
Strategic Choices inChanging Community Behavior
1. Create a sense of need and ownership of STBM
2. Dialogue mechanism and community
participatory action for the sustainability of the
program.
3. Partnership for increasing access and sanitation
and hygienic behavior
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positions who do not understand
STBM and thus not understand
the importance o STBM or their
institutions.
Instead o struggling with the
challenges that must be aced,
High Five looked at the situation
rom a dierent angle and
turned it into an opportunity
to implement the program.
The diversity o backgrounds o
the community o innovationspawned a unique approach
and a lack o understanding o
municipal government encourages
the development o methods
and collaboration o dierent
approaches.
The learning is summarized in the
ollowing several points:
First, participatory assessment
is a tool or building awareness
as well as triggering STBM. Here,
the introduction o the pillars
and triggering are done at the
same time. From High Fives
experience, people are invited to
comprehensively observe their
sanitation conditions and discuss
which STBM pillar is considered the
most crucial and will be used as
the entry point or the application
o STBM. Based on experience, in
urban areas (especially Medan,
Surabaya and Makassar), people
see waste/garbage (STBM pillar 4)as a crucial issue and provide an
entry point to carry out STBM.
Second, the approach using
a positive perspective is more
eective to trigger the action taken.
High Five uses the VIC action tool
(modied rom VIC tool developed
by JHU-CCP) to trigger people to
get moving and carrying out joint
actions.
Third, triggering people to change
their behavior to STBM must be
accompanied by triggering the
city government, particularly
the local governments oces
related to sanitation and hygiene
to implement STBM. The city
government is also encouraged
to connect the city system with
community activities. Experience
shows that the approach is
successulin creating synergy
between government programs
and community activities. Forexample, in the cities o Medan,
Surabaya and Makassar, the City
Sanitation Departments are actively
involved in activities o community
gotong royong activities by
allocating garbage trucks.
Fourth, the media is involved in
the activity, and not just as news
coverers. High Five put the media/
journalists as active participants in
discussion and implementation. It
is eective to induce curiosity and
Challenges faced in implementing STBMin urban areas are very complex
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push to urther engage in various
activities.
Given the lessons learned rom
the implementation o the High
Five program or one year, it shows
that innovation in approach and
implementation strategy or
STBM is much needed. Variations
o innovation depend on the
uniqueness o each region. This
does not only apply to the
implementation o STBM in urban
areas but also in rural areas. We
should be alert to opportunities
and development o innovation
to support the implementation o
STBM.
Ika Fransisca/ High Five
Doc.HighFive
Given the lessons learned from theimplementation of the High Five program, it showsthat innovation in approach and implementationstrategy for STBM is much needed.
Suciati Lasiman
from Petemonan
Subdistrict in
Surabaya, a
local waste
bank activist.Community
members can pay
for their loans
in the form of
waste
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Starting CLTS in Vietnam
D iseases caused by water conditions and poorsanitation is a major health problem in Vietnam.According to the MICS (Multiple Indicator ClusterSurvey) nationally conducted survey, in Vietnam
nearly 1 out o every 4 children under ve (22.7%) are
malnourished. Malnutrition is also closely related to
sanitary conditions and poor health.
On the other hand, the promotion and use o healthy
latrines has not yet achieved satisactory results when
compared with the results achieved by the water
supply sector within the 2000 to 2010 period. There is
also a large gap between the two sectors. According
to MICS 2010-2011, 73.8% o households in Vietnam
use healthy latrines, but among ethnic minorities,
only 44.2% o households have access to improved
sanitation acilities. A total o 27.7% o ethnic minorities
still deecate in the open.
Through the implementation o CLTS in WASHPLAN VN Program or 2011 - 2012, some important
actors are identied in achieving the main goal o
CLTS - ree rom open deecation, among which are:
involvement o local governments rom the beginning,
involvement o the government health authorities in
all levels, involvement o individuals and community
organizations, capacity building o local partners,
ollow-up o implementation and reporting.
Total Sanitation approach in Pakistan
Pakistans 2006 National Sanitation Policy emphasizes
social movements as a major component in to
tackle the problem o sanitation at the household
Learning CLTSfrom Our Neighboring Countries
As an unsubsidized participatory approach, Community Led TotalSanitation (CLTS) is also applied in some o our neighboring coun-
tries. Plan International is one o the supporters o the implementa-
tion o CLTS in a number o Asian countries.
Delivering the
CLTS approach to
the community in
Pakistan
Source:www.p
lan-international.org
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Percik Magazine August 201234
level, especially in rural areas.
The National Policy has a vision
to create an environment ree
rom open deecation, disposal o
wastewater and solid waste and
promotion o hygienic behavior
and health. The purpose o this
policy is to promote the CLTS
approach and ormalize the TotalSanitation Model. In March 2011
the Government o Pakistan has
approved a guidance document
entitled Pakistans Approach in
Total Sanitation (PATS).
During March 2011, the
Government o Pakistan through
the Ministry o Environment has
approved the preliminary stage o
CLTS or Pakistan. Slightly dierent
rom the CLTS approach, PATS
emphasizes the importance o
dignity, sel-esteem and pride. This
is also seen rom the intervention
rom the supply side through the
creation o sanitation marketing.
Development o rural sanitation in
food aected areas is implemented
through Community Resource
Persons (CRPs) or communityactivists. There is a total o 2,659
CRPs in 4 provinces and regions
o Pakistan. During the training
session, it is emphasized that
CRPs should know about project
activities, creation o action
plans and implementation o
the project strategy. This training
is also conducted on teachers.
10,000 school teachers attend two
days o training related to health
care. They were given exposure
on the program objectives,
methodology and the role they
play in maintaining the positive
impact o the program to embed
health promotion messages to
their students. As a result, a total o
3,279 schools have been triggered
in the target area and 6,950 health
promotion eorts have also been
made in the same schools.
A sanitation marketing strategy has
also been designed and a robust
ramework developed careully
through serious eld research. A
comprehensive guide has also
been developed to acilitate
the training o the Sanitation
Entrepreneurs in both urban and
rural areas.
Until now, 2,110 villages have been
certied ODF by the government,
Doc.PlanVietnam
CLTS triggering
activity in
Vietnam
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Percik MagazineAugust 2012 35
and more than 1,000 villages have
achieved ODF status and are in the
process o certication.
Celebrating a Healthy Liestyle
in Laos
There is a act that many people
still do open deecation in remote
villages in Laos. The condition opoor sanitation behavior causes
many occurrences o disease
and premature death. However,
this does not happen with the
children and residents in Bokeo
province, Laos. They no longer go
to the bush, chase pigs, suer rom
mosquito bites, and hopeully,
suer rom diarrhea due to poor
sanitary conditions.
In the last month, more than 2,000
ethnic Leu, Hmong, Khamu, and
Lamed in 8 villages in the districts
o Paktha, Phaoudom and Meung
celebrate their achievement o
100% toilet coverage in villages.
This means, they no longer need
to have to go to the bushes to
deecate. Eight elementary schools
and 1,400 students in the three
districts also celebrated their schoolbeing ODF. More than 20 other
villages and schools have made
signicant progress in achieving
ODF status and hope that they
celebrate the same soon.
Having toilets only since the last
year, Maisang Houay villagers still
keep the memory o losing their
children who died prematurely.
Not only causing health problems,
according to a World Bank
study, poor water and sanitation
conditions in Laos have cost 5.6%
o Gross Domestic Product (GDP) or
at 193 million USD per year.
To increase the impact o ODF,
government WASH teams also
promote hand washing with soap,
drinking boiled water and storing
in sealed containers and keeping
the village environment ree o litter
and water puddles.
At schools, where the residents
are not able to build good toilet
acilities, PLAN Laos provides
construction material or hand
washing acilities and toilet
construction. The villagers
contribute sand, wood and labor.
The joint initiative between PLAN
and the residents have created a
sense o ownership or the villagersand school children that is creating
sustainability and maintenance or
this acility.
The WASH program in Bokeo will
continue to work with the local
government, schools and villages
with support rom parties such as
the Water and Sanitation Program
(WSP) - The World Bank, SNV o
the Netherlands and various other
partners in Laos.
Rewrite by: Yusmaidy
Hand
washing with
soap, being
campaigned
in schools inVietnam
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Percik MagazineAugust 2012 37
I
n the matters o developing STBM programs,
Lumajang may be the champion. Currently almost
7 districts have reached ODF status, namely: Gucialit,
Senduro, Padang, Kedungjajang, Pasirjambe,
Pronojiwo, and Klakah is soon to ollow.
Various intensive eorts were
taken to achieve ODF and
develop STBM program,
including the ollowing:
First, empowering small-scale CSR.
The term is, small, but eective to
help accelerating the achievement o
targets. This attempt is done through the supervision
o the regency health oce, district and village heads
who intensively submit proposals or assistance to large
stores, gas stations, actories and local businesses. The
proceeds will be used to purchase materials or latrine,
communal ones in particular, while the labor needs will
be pursued through community service.
Second, the use o Operational Health Support Fund
(BOK) to uniy various existing programs in health
centers. In 2012, Gucialit health center has received
BOK unding at IDR 81 million with 70% utilization
or health promotion activities or promkes (including
STBM), 20% or Environmental Health activities and
the remainder allocated to maternal and child
health activities.
What is interesting in the utilization
o the large BOK unds, Gucialit
health center initiates promotive and
preventive programs. The programacilitates and integrates all activities
and programs under the Health Center.
Various programs were included in this program
including Maternal and Child Health, Nutrition,
Environmental Health, Family Planning and Alert
Village. All activities are also incorporated in Posyandu
Gerbang Mas (Movement to Build a Healthy Society).
One orm o the promotive, preventive and innovative
activity is the Alert Husband training. It is innovative
as the Alert Husband training was combined with a
number o CTPS (Handwashing with Soap) eatures
campaigned in STBM.
When the Washing Hands program is
combinedwith the Alert Husbands program
Learning STBM from theexperience in Lumajang
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Percik Magazine August 201238
Synergy with Alert Husband
The Alert Husband program began
in early 2012 in Lumajang. Gucialit
is one o the districts that in this
year launched an Alert Husband
training in all villages. Data showed
that there were about 500 pregnant
women in one year in Gucialit, whoneed intensive treatment during
pregnancy and labor.
The objective o the Alert Husband
training was to prepare husbands
during pregnancy, childbirth up to
the care o inants up to 2 years o
age. This includes awareness to be
responsible in assisting the wie, as
well as meeting acilities/amenities
o nutrition, sanitation and amily
hygiene in a sustainable manner.
Every three months, opportunity
is given or 10 young couples to
receive training and knowledge
about pregnancy and childbirth.
Participants exceeded the target
due to the high interest o young
couples.
The trainings used participatory
methods, the active role o both
husband and wie are expected
to bring a more comprehensive
understanding and ability to
practice in a real day-to-day
activities. Beginning with the
identication o the risks opregnancy and childbirth, and
benets o nutrition or expecting
and lactating mothers, benets
o amily planning and healthy
environment or pregnant and
lactating women, the pairs are
acilitated by cadres and midwives
One of the
teaching tools
in the Alert
Husbands
program. This
activity also
promotes STBM
efforts, such as
washing hands
using soap.
The active role of both husbands and wivesis to be developed to create comprehensiveunderstanding and ability to practice in real life
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Percik MagazineAugust 2012 39
who have prepared a check-list.
The check list becomes a tool or
monitoring the couples until ater
the birth. The understanding o the
husband beore and ater training
were also compared and measured
on a regular basis.
Importance o CTPS acilities in
the Monitoring - Post-Childbirth
Phase
Through BOK unding, each Alert
Husband training in one village
needs an average estimated cost
o IDR 750,000 used or: allowance/
transport or trainees respectively
IDR 15,000, snack and lunch as
well as post-training monitoring
activities.
In the monitoring process, it is
observed whether pit toilets have
been converted to proper toilets,
also whether CTPS acilities have
been provided either in the dining
room or near pets cages.
It is customary that a mother who
just gave birth be visited by manypeople. Beore looking at the baby,
every visitor must warm the eet
and hands over the stove, thinking
that the smoke and heat will kill
germs. This is clearly not medically
justied. This habit is changed to
washing hands beore visiting the
inant. Thus in the check-list and
campaigns, the importance o
providing CTPS means, especially
in the case o new mothers, is
stressed.
Another observed CTPS behavior
is that i not used to washing
hands, childrens ngernails will
look black. It is recognized that
CTPS activity is still hard to doeveryday, but citizens are aware
that this is the practice that should
be done. In the end, each cadre
has a role to monitor and survey
by visiting homes each month.
The monitoring tool can be
downloaded rom the internet, in
the orm o cards which is then
made in the orm o stickers and
axed in every home to be an
instrument o control.
Wendy Sarasdyani / WSP
Hariyanto,
PHBS promotor
and sanitation
entrepreneur from
Gucialit district,
Lumajang regency
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Percik Magazine August 201240
Kalu het aomin so tanaoba lais nono nim in
Lasi no nima ni, un sin ani on ni aina/Fani on ni aina, an bi monit lais aomina/
Kalu hit aomin un hit aoke namep/
Hit aoke namep, un hip mepu naomat,
un hit mepu naomat, un hit nekak an malin/
Hit neken malin, un hit pules usi neno.
I you want to live a healthy lie 5 things (STBM)
should be carried out /
The fve pillars are the center/
The center o our health /
I were healthy, the body is strong,
Productivity increased, the heart rejoice /
I the heart rejoices, we can gloriy God.
FROM BONET
TRADITIONTOINSTRUCTIONOF THEDISTRICT
HEADNotes from
the STBM Project (SHAW Program,Cooperation of Plan Indonesia -SIMAVI)
ALBERTUS FAY
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Percik MagazineAugust 2012 41
The previous ragment is a piece o Bonet poetry onSTBM, the verses containing reminder messagesto the public in order to carry out the ve pillars o
STBM in everyday lie. Bonet is a unique arts o the
community o Timor Tengah Selatan (TTS), o verses
containing advice, delivered by way o singing and
dancing in a big circle with the participants holding
hands. The art o Bonet is still preserved and highly
avored by the people at TTS, and is considered an
eective media to convey important messages to
the audience. Bonet estivals and competitions are an
annual routine agenda o the regency o TTS.
Albertus Fay is the man behind the creativity o writing
the STBM bonet. The energetic 54 years old man is
a district head in TTS, Polen. He is one o the leaders
behind the success o Polen district in implementing
the ve pillars o STBM. The regent, Paul Mella, M.Si., has
given a certicate o recognition or this success on the
declaration o STBM district on July 13, 2011.
From the beginning, when the STBM project roadshow was held in the District o Polen, February 2,
2011, Mr. Fay was determined to promote STBM to
the government and the community in 10 villages
in his region. He said that health is a basic need, We
welcome this program, its useless to talk o increased
income, higher education, i they remain sickly,
remarked the district head, who claims he is very
interested in the program o STBM, namely changes o
behavior without any subsidy.
The rst step is doing is to close ranks at the district
level, to orm a district STBM team, consisting o 16
people including himsel as the person in charge, while
as program coordinator is the head o the public health
centers. In addition, the decree also includes persons
in charge o each village called SATGAS STBM DESA
(Village Task Force or STBM), We give a special duty
to the 10 sta involved in the district to implement
triggering and monitoring the implementation o
STBM Program in 10 villages, one person in one village
explained Albert Fay, who also does direct monitoring
at several villages.
Albertus also describes various improvements in
latrine ownership that occurred in the society since the
STBM program commenced in March 2011 in Polen
district. The total number o amilies building new and
rehabilitating latrines without any subsidy is 1749. A
total o 736 units are rehabilitated, while the rest are
new. O this total, 224 are goose neck type, 893 are
plengsengan (directly channelled to water body rom
toilet), and 632 are pit type, said Albertus.
I every toilet is valued at an average o IDR 150,000,
then the community has invested IDR 262.4 milion or
better lie, he added.
We welcome thisprogram. It is uselessto talk about improving
income or higheducation when the
people are often sick.
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Percik Magazine August 201242
According to Albertus the real
challenge is the post-declaration
period. Sustaining positive
behavior change is a big challenge,
i there is no proper ormula thereis a danger o returning into old
habits. One way is to perorm
continuous monitoring, which is
the responsibility o the village
government, I instructed the village
heads to do so, he continued.
The district heads instruction was
heeded, and there are 3 villages
(Laob, Loli, and Mnesatbubuk) out
o 10 villages in the district that has
allocated ADD (Village Allocation
Funds) or routine monitoring
teams in each village, which
although not a large amount o
money, is enough or a start. Next
year, it is expected that all villages
allocate unds or perorm routinemonitoring atevery month.
Another important breakthrough
created by the district head is
instructing village heads to allocate
unds as initial or capital sanitation
marketing business groups, to the
amount o IDR 3 million per village.
Which cooperative or bank will
give capital or sanitation marketing
business groups? They do not
understand sanitation marketing,
it is still strange to them, and thus
the initial capital is provided rom
ADD. I am optimistic that these
eorts can thrive along with a good
understanding o sanitation, he
concluded.
Eorts made by Albertus Fay are
quite unusual, but had a positive
impact to the surrounding
community. Taking a phrase rom
the vernacular language, Hit neken
malin, un hit pules usi nemo, Do
things with joy at heart to gloriy
God.
Sabaruddin / Plan Indonesia
Project Manager STBM Soe Kea
Doc.PlanIndonesia
Albertus in ODF
declaration in Soe
Kefa
Sustaining positive behavior change is a bigchallenge, if there is no proper formula there is adanger of returning into old habits.
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Percik MagazineAugust 2012 43
CLTS is unique, Anton made this statement while
talking to Team IUWASH in between his busy schedule.
Why is it so? asked Team IUWASH. Indeed Despite
its playul approach, it is very striking and raising
awareness o the society to build toilet acilities. We
spoke to Anton ater our tour to 7 houses which have
latrines already built in RW 2 o Kedung Galeng village.
The conclusion o the conversation above shows that
the approach adopted is eective in changing peoples
behavior o open deecation. This was done without
realization o its dangers. However, people are still
amiliar with the counseling approach, which convey
normative doctrines that do not get internalized. The
old approach tends to make things that are presented
not attached in the minds o the people, making it
dicult to support changes in societal behavior.
Sulistyo Triantono Putro, SKM, or ondly called Pak
Anton, is one o the acilitators having considerable
potential rom Probolinggo Health Oce. Anton calls
himsel an Environmental Health Motivator.
Anton received CLTS/STBM acilitation training in
late November 2011 along with 20 other sanitarians
and health ocers. In mid-February, Anton along
with other sanitarians and community gures have
been acilitated by IUWASH East Java to perorm a
comparative study to Jombang regency, which has
implemented the STBM since 2006.
Anton has done triggering at 4 locations in the work
area, centered at Wonoasih health center. His most
impressive experience was during the triggering in
RW 2 Kedung Galeng; the people were invited to walk
up 500 meters to a river, the location o their usual
The story of Anton
the STBM Champion ofProbolinggo
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Percik Magazine August 201244
open deecation. There they were
triggered to raise a sense o disgust,
shame, and some o them were so
disgusted they threw up.
That was the time when they
were shocked and realized that
their behavior was unhealthy and
harmul to others, not to mention
how dicult it was during the rainy
season and at nights, a condition
they have experienced or all their
lives. This was utilized by Anton as
an opportunity to oer change,
though initially it was dicult to
convince people to change.
In the course o triggering, Anton
gets support rom Kyai Fauzan,
who later became the STBM
natural leader that will determine
the success o STBM program in
Probolinggo. People around him
call him, Bindereh Fauzan, a term
o respect among the Madurese.
Although Kedung Galeng was part
o the regency, the geography was
rather sparse and it looks like a
rural area. Ater the initial triggering
conducted by Anton with the help
o community leaders, Kyai Fauzan
immediately gathers mothers in
each STBM related meeting.
Following a series o meetings,
inhabitants o RW 2 agreed to hold
a credit to build latrines. The credit
system will be managed by Kyai
Fauzan. The people will pay a down
payment or the latrines betweenIDR 100,000 - IDR 200,000, and the
rest will be paid in installments o
IDR 20.000/week until the loan is
paid in ull. The total loan or the
construction o the latrine is IDR
750,000. In this program, Anton and
the technical team (carpenter) are
obliged to build latrines consisting
o toilets, septic tanks and wells.
Now there are 17 amilies
committed to participate in the
latrine credit. Seven latrines that
Doc.PlanIndonesia
Kyai Fauzan,
manager of
the toilet
credit system
in Kedung
Galeng.
Anyone can
pay the weekly
installment of
IDR 20,000.
Of course imagine sucha playful approach, butappropriate and able to createcommunity awareness toconstruct toilets
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Percik MagazineAugust 2012 45
have been built are successully
utilized by 31 people, and another
latrine is being constructed. The
community decided to build
the latrines on a credit system,