Presentation to East Asia Ministerial Conference on Sanitation and Hygiene (EASAN), December 2007
Reassessing and Triggering Rural Sanitation in Indonesia
Wan Alkadri,Director of Environmental HealthMinistry of Health, Republic of Indonesia
Presentation Outline
Sanitation Challenge in Indonesia Reassessing National Approach for Rural
Sanitation Developing a New Paradigm for Total
Sanitation Triggering Behaviour Change through CLTS -
Early Days Developing new Approach and Strategy for
Community based Total Sanitation Policy lessons through Total Sanitation and
Sanitation Marketing Program (TSSM) The Future - 2008 onwards
Republic of Indonesia
Population of 236.4m, 57% in villages (SCB, 2007)
17,500 islands over 5000kms
GDP per capita US$3,843 (UNDP, 2007/8)
45.2% (105.3m) poor and vulnerable poor (World Bank 2007)
Human Development Index ranking 107 of 177 countries (UNDP 2007/8)
Rural Sanitation Challenge in Indonesia
40% access to rural sanitation (JMP 2006) – little change in 20 years
MDG target of 69% by 2015 needs increased access for 3.7m people per year. This requires US$600m per year but current investment US$27m p.a.
In addressing poverty, GOI’s target is to halve number of those without sanitation facilities by 2015 (Medium Term Plan for Development). At current rate, needs more than 200 years
ResearchResearch Results Results in Indonesia in Indonesia
Handwashing Practices among Indonesian
12%9%
14%7% 6%
0%2%4%6%8%
10%12%14%16%
after defecation after cleaningchild bottom
before eating before feedingchild
before preparingfood
BHS, 2006
Impacts of poor sanitation in Indonesia
19% death in children under the age of 3 or around 100.000 children die annually from diarrhea – one of main causes of child mortality (others are acute respiratory infection and perinatal complications) Indonesian’s Profile,2003
Economic loss of around 2.4% of GDP or US$13 per month per household (ADB Study 1998)
Impacts of improved sanitation – global experience
Risk of diarrhea reduced by 36% with safe sanitation, by 47% through hand washing with soap (Curtis, 2004) and by 39% through h/h water treatment and safe storage (WHO, 2004 )
Investing US$5/capita/year in sanitation could increase productivity by 34-79% and reduce costs of illness by 6-19% (ISSDP,2006)
Countries with adequate sanitation get returns of US$8-12 for every US$1 invested (WHO Study, 2005)
Reassessing National Approach to Rural Sanitation
Presidential Decree on Drinking Water Supply and Household Toilets, 1973 introduced hardware subsidies: not sustainable, did not raise awareness about behaviour change and could not be scaled up
Sanitation is a low priority for Legislatures and Executives
Inadequate use of resources, knowledge and experience of people who can be part of the solution including from community and business sectors
Poor monitoring systems and inadequate sharing of learning
Few mechanisms for scaling up
CLTS introduced to Indonesia andGoI visit to India & Bangladesh
2004 CLTS pilots in 6 provinces
( 6 districts) 2005 Rapid spread of
CLTS: 72 Open defecation free
(ODF) communities and 2 ODF
sub-districts 2006
National CLTS launched by Ministry of
Health June 2006 Replication
WSLIC
NGO/PCIPro Air
CWSHP
Local Govt
University
160 communities
ODF July 2007
Draft National Strategy onCommunity Based (CB)
Total Sanitation
2007
TSSM starts in East Java
2007WES- UNICEF
PAMSIMAS
Ministerial Decree on CB Total
Sanitation 2008
CB Total Sanitation
implemented in 200
districts 2008
Triggering Behaviour Change Triggering Behaviour Change through CLTS – early days through CLTS – early days
Empowering communities to change behaviour and build and use latrines with own resources and no subsidies to achieve 100% open defecation free (ODF)
Community actively involved in self help environmental analysis. Uses disgust of open defecation and community pride as motivating factors Promotes local choice from open technology menu including simple low cost
toilets Uses champions, natural leaders and competition between neighbouring
areas to build momentum for replication Involves everyone including school children
ODF Progress May 05-Apr 07
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Date*Dus un = haml et 100- 300 hhs . Des a/ v i l l age c ompr i s es s ever al dus uns (admi ni s tr ati ve uni t)
Change to Empowerment photos
Developing the Total Sanitation Approach
Following CLTS, GoI developed a new paradigm for total sanitation which is pro-poor and supports faster scaling up
Total Sanitation means every household: Stops open defecation Uses a safe latrine for excreta disposal Washes hands with soap Manages and stores water and food in a safe way Manages domestic waste water in a safe way It targets whole communities and focuses on collective
behavior change for total sanitation rather than physical targets and subsidies
New Strategy for Community-based Total Sanitation
Increase demand for total improved sanitation and hygiene behavior and facilities, no subsidies/credit for household hardware, open technology menu (incl.low cost toilets), handwashing with soap and water treatment
Improve sanitation supply chain using market-based approaches
Improve enabling environment by building capacity of national/local govts for policy development and implementation
Increasesanitationdemand
Improveenabling
environment
Improve supply of goods & services
Total Sanitation and Sanitation Marketing Program (TSSM) 4 year program to operationalize new Community-
based Sanitation Strategy in one province with 29 local governments (funded by GATES Foundation)
Aim to scale up sustainable sanitation to achieve 100% ODF in line with district plans (1-2 years)
Reallocation of subsidy funding towards ODF certification and reward systems, improving sanitation markets, hygiene/health promotion and capacity building
Develop new knowledge on effective approaches and health and economic impacts of Total Sanitation
Policy lessons emerging from TSSM
Investing in strategic advocacy at the start helps change mind-sets and institutionalise the Total Sanitation approach
Leveraging local government funding away from past unsuccessful approaches towards implementing the new Total Sanitation strategy is possible
Local govt funding for sanitation improvement is NOT a constraint if there is political will
Scaling up needs consistent approach of incentives and rewards for collective behavior change underpinned by MONEV systems
2008 and onwards - PHOTOS - handwashing, water treatment, ODF
.
THANK YOU
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