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

0

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May-05

J un-05

J ul-05

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J an-06

Feb-06

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Apr -06

May-06

J un-06

J ul -06

Aug-06

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J an-07

Feb-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

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THANK YOU