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Indonesia National Program for Community Water Supply and Sanitation Services

3 INTERNATIONAL LESSONS LEARNED

3.1 Health improvement

Investments in sanitation and hygiene improvement can have two to three times more impact on health outcomes than investments in water supply. Recent research indicates that:
•  handwashing with soap can reduce diarrhea risk by 42-47%20
•  safe excreta disposal can reduce diarrhea risk by 30-35%
•  clean water supply can reduce diarrhea risk by 15-20%21

These findings suggest that large-scale water supply and sanitation programs should invest more heavily in sanitation and hygiene interventions to obtain more cost-effective improvements in public health and well-being. Studies into the cost-effectiveness of sanitation and hygiene interventions22 also suggest that hygiene interventions, such as handwashing campaigns, are significantly more cost-effective when water supply and sanitation facilities are present. Therefore, it is important to combine both hardware and software interventions, and to sequence these interventions for maximum benefits.
 
Another key lesson learned from past projects is that conventional hygiene promotion interventions have been too formal, too negative and too reliant on teacher-to-pupil educational approaches. There have been lots of training courses, lots of lecture-style sessions on the causes of health problems, and lots of negative messages about ‘what people do wrong’ and ‘what they must do’ to improve their health. 
 
In many cases, people are already well aware of the need for basic hygiene, such as handwashing, but lack the facilities or incentives to change their hygiene behavior. For sanitation and hygiene promotion to result in sustainable health improvements, interventions need to be more positive and more practical: promotional efforts need to focus on positive messages that suggest how families can improve their lives and their health; and on practical steps that communities and households can take to improve environmental sanitation and change hygiene behavior. 
 
In the quest for higher coverage, conventional sanitation programs tend to concentrate on those who can afford the toilets being promoted, those who have land available to build these toilets, and those who respond to promotional efforts. Providing services to the poorest can be difficult and expensive, thus programs usually focus on those they can reach through incremental improvements in sanitation coverage. Unfortunately, this approach often leaves coverage of the poorest and most marginalized, that is, those most affected by inadequate sanitation, until long after everyone else has been served. 
 
The main difference in the total sanitation approach, when compared with conventional policies, is that it targets the entire community (rather than just those households without sanitation that respond to promotional efforts): under the total sanitation approach, every household in the community must stop open defecation and use a sanitary toilet. Even the poorest and most vulnerable households in the community must be reached, which means that the local government, the community leaders, and even those households that already have toilets, must pull together to provide the poorest households with access to sanitary toilets and safe excreta disposal systems.

14 MoH (2001) Rencana Strategi Nasional
15 ADB (1998) Strengthening of urban waste management policies and strategies quoted in World Bank (2004) Indonesia: averting an infrastructure crisis – a framework for policy and action
16 Government of Indonesia partnership with the Water and Sanitation Program – East Asia and the Pacific
17 The World Bank (2005a) Indonesia: Economic and social update 
18 According to senior BAPPENAS staff (when discussing the costs of the proposed NPCWSSS).
19 The World Bank (2005a) Indonesia: Economic and social update
20 Curtis and Cairncross (2003) Effect of washing hands with soap on diarrhoea risk in the community: a systematic review London: The Lancet, Infectious Diseases Vol 3 May 2003
21 Esrey S et al (1991) Effects of improved water supply and sanitation on ascariasis, diarrhea, dracunculiasis, hookworm infection, schistosomiasis and trachoma WHO Bulletin 69(5): 690-621
22 Varley (1996) Child survival and environmental health interventions: a cost effectiveness analysis Washington DC: Environmental Health Project

3.2 Cost-effectiveness of hygiene promotion

Demand-responsive programs ask communities whether they want improved facilities or services; what level of service they want; and, most importantly, whether they are prepared to contribute towards, or pay for, the construction, operation and maintenance of facilities or services demanded. A local institution, generally a community association or an individual household, chooses from a menu of service options, with user mobilization and up-front contributions towards service costs (either in cash or in kind) signaling their commitment and involvement.
 
Hygiene promotion activities are rarely demand responsive. Some programs attempt to tailor hygiene promotion to specific community priorities and behaviors, but few programs are effective in ensuring that the community or household feel a need for the hygiene intervention, or are committed to supporting activities and promoting behavior change. Sadly, even communities that express demand for water supply and sanitation facilities, and make financial contributions towards construction, sometimes lose interest once external contributions are complete, so it should be no surprise that communities with no investment or commitment to hygiene improvement show little concern, interest or involvement when promotional efforts are ineffective and progress is poor. 
 
As a result, the cost effectiveness of conventional hygiene interventions tends to be very low. In most programs, the same lengthy schedule of promotional activities is carried out in every community regardless of their interest or involvement, and regardless of the results. This ‘universal’ approach reflects the importance and priority now given to the integration of hygiene improvement into water supply and sanitation programs. However, whilst well meaning, this universal approach can lead to ineffectual activities, demoralized project staff and wasted investments.
 
Another important factor in the cost-effectiveness of hygiene interventions is the presence (or absence) of adequate water supply and sanitation facilities. Most Indonesians use water for anal cleansing after defecation, thus distant or rationed water supply is regularly identified as a major barrier to toilet use, handwashing, and general hygiene23. Similarly, hygiene improvement is more difficult in communities with low sanitation coverage, due to the environmental pollution, fecal contamination and bad hygiene habits associated with widespread open defecation.  
 
Economic analysis of hygiene interventions24 confirms that these interventions are highly cost-effective for controlling childhood diarrhea, but the analysis also highlights the sensitivity of cost-benefit ratios to the presence or absence of adequate water supply and sanitation facilities. This research, which was based on a review of 65 studies  worldwide25, suggests that hygiene interventions are only half as cost-effective where water supply and sanitation hardware is either inadequate or unavailable26.
 
Given the importance of cost-effectiveness in large-scale sanitation and hygiene interventions, these findings question the wisdom of investing in hygiene promotion before adequate water supply and sanitation facilities are available. This should not be read as a call for less hygiene promotion, but as a powerful argument for the careful sequencing and triggering of more cost-effective interventions.
 
3.3 CLTS in South Asia

Over the last few years, non-governmental organizations (NGOs) in Bangladesh27 have been pioneering a new approach to sanitation development. It is known as Community-Led Total Sanitation28 and has several fundamental differences from conventional approaches (see Annex 4 for more detail), including:
•  Focus on stopping open defecation (rather than building toilets)
•  Need for collective action (to stop open defecation within the community)
•  No toilet subsidy (households must finance their own toilets)
•  Promotion of low-cost homemade toilets constructed using local materials (rather than standard toilet designs imposed by outsiders)
 
The primary aim of the CLTS approach is to stop open defecation within the project community29. This illustrates two major differences between CLTS and conventional approaches to sanitation development: firstly, its main aim is behavior change (stopping open defecation) rather than toilet construction; and, secondly, it requires that every member of the community has access to a sanitary toilet, as even the poorest and most vulnerable individuals must be reached in order to put a total stop to open defecation.
 
CLTS uses participatory activities to highlight sanitation problems within the community, playing on the universal feelings of shame and disgust associated with excreta to trigger the collective (and individual) action necessary to stop open defecation. One of its strengths is that those who already have toilets, often the richer, more hygiene-aware and more influential households, are motivated to try and change the behavior and habits of those without toilets, as the CLTS approach emphasizes that everyone in the community risks excreta-related disease whilst even a few people continue to defecate in the open.
 
CLTS does not involve any subsidy for toilet construction, or any imposed, external designs. Instead, people are encouraged to find low-cost sanitation solutions, and to use local materials and familiar building techniques wherever possible. Inevitably, this approach leads to the construction of some very simple and homemade toilets. However, the important issue is that households make their own decision to stop open defecation and construct a toilet, as most low-cost facilities can be easily improved and upgraded at a later date.
 
The findings from a review of seven ‘total sanitation’ programs implemented in Bangladesh and India30 confirm that the total sanitation approach is a powerful trigger for stopping open defecation; for empowering local communities; and for increasing local awareness of sanitation problems. Nevertheless, the total sanitation approach also requires effective household-level hygiene promotion, as well as sustainable institutional support mechanisms, in order to achieve sustainable behavior change and long-term health improvements. 
 
One of the more controversial aspects of community-led total sanitation (CLTS) is that, unlike conventional sanitation programs, no hardware subsidy is provided for the construction of household toilets. Inevitably, this raises the question of whether poor households can afford to construct household toilets that provide safe excreta disposal without financial assistance. The evidence from sanitation programs in Bangladesh, one of the poorest countries in the world, suggests than poor households can. In the last few years, a number of CLTS programs in Bangladesh have supported thousands of very poor households to construct very low cost toilets without any form of hardware subsidy. 
 
The ‘total sanitation approach’ was implemented slightly differently under the three successful government programs examined in India. The major difference was the use of hardware subsidies, which ranged from US$4 to US$11 per household. In one of the more successful cases, the relatively small hardware subsidy was provided in the form of post-construction incentives that were only paid to the user once every household in the community had constructed a sanitary toilet. As a result of this initiative, the Government of India has since adopted the post-construction financial incentive policy in its US$800 million Total Sanitation Campaign. 
 
Without an up-front hardware subsidy, poor households are motivated to come up with a toilet design with the lowest possible cost, often using locally available materials and their own labor. As a result, the average cost of a household toilet in three different total sanitation programs in Bangladesh31 was estimated at US$2 – US$7, all of which was paid by the users. These toilets are usually basic pit latrines, built using bamboo, mud, local matting screens, plastic toilet pans (if available) and materials left over from other house building or repair activities. 
 
Despite concerns from some sector stakeholders, the toilets constructed under CLTS qualify as ‘improved sanitation’. The WHO-UNICEF Joint Monitoring Program definition, which is also used for the MDGs, considers “simple pit latrines” as improved sanitation, providing that “they are private and … separate human excreta from human contact”. While the limited technical input and experience involved in many CLTS-inspired toilet designs raises questions about their sustainability, the vast majority of the toilets meet the basic requirement of separating human excreta from human contact. More importantly, the households have taken the important first step of deciding to stop open defecation; build themselves a toilet; and defecate in a fixed place. The simple toilet designs may not last long, but can be improved upon through the sort of regular repair and maintenance that many rural households make to their homes.
 
The CLTS process has also encouraged innovation in low-cost toilet design. VERC, one of the NGOs that started the CLTS movement (see Annex 4) has produced a catalogue detailing about forty different sanitary toilet designs produced by Bangladeshi villagers, none of which costs more than US$20 to construct. 
 
Firsthand experience of the remarkable impact of this new approach in Bangladesh has been sufficient to change the views of senior Indian politicians, many of whom were previously adamant that hardware subsidies were essential to sanitation promotion among the poor. The US$800 million Total Sanitation Campaign in India used exposure visits to Bangladeshi communities with successful ‘total sanitation’ projects to overcome strong political resistance to reducing hardware subsidies in the national rural sanitation program. The Indian politicians returned from Bangladesh convinced that they could adapt the successful approaches they’d seen to the Indian context, and have since agreed to spend the majority of the funds previously allocated to hardware subsidies on the software activities required for effective sanitation and hygiene promotion.
 
One of the key constraints identified in the review of total sanitation programs in South Asia was the lack of regular monitoring and post-construction support. Community after community noted that interest and motivation had been high while the NGO or program officers were working in the village, but that toilet usage and hygiene improvements dropped off once the sanitation sub-project was finished32. The CLTS model focuses heavily on the initial ‘ignition process’, thus must be linked to a long-term institutional support mechanism to ensure sustainable sanitation and hygiene improvements.
 
3.4 Sanitation marketing

There is increasing global interest in sanitation and hygiene marketing for large-scale and cost-effective provision of sanitation and hygiene services33. The argument is that most progress in increasing access to sanitation has been achieved by the market, i.e. private suppliers supplying individual households, and that marketing has been more successful than anything else in promoting the adoption of sanitary toilets and making sustainable changes to people’s hygiene behavior.
 
A well-designed marketing program involves a number of sequenced steps:
1.  Win consensus (on policy and approach)
2.  Learn about the market (understand both demand and supply)
3.  Overcome barriers and promote demand (advocacy, advertising, demonstrations)
4.  Develop the right products (design for specific market segments, to target prices)
5.  Develop a thriving industry (capacity building, credit, business development)
6.  Regulate waste handling and disposal (toilet pit replacement and emptying)

23 Mukherjee & Josodipoero (2000) Is it selling toilets? No, a lifestyle: Learning from communities with sanitation success stories in Indonesia
24 Varley et al (1998) A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea
25 Solari (1996) Review of studies on water availability, water quality, sanitation and domestic and personal hygiene in Varley et al (1998)
26 Cost per death averted is more than twice as high when no water supply or sanitation facilities exist
27 Notably WaterAid Bangladesh and VERC
28 Kar (2003)
29 Open defecation defined as defecation that takes place outside a sanitary toilet (note: in many parts of Indonesia, people practice open defecation into water bodies such as rivers and ponds)
30 Robinson (2005) Scaling up rural sanitation in South Asia: Lessons learned from Bangladesh, India and Pakistan
31 Ibid.
32 Robinson (2005)
33 Cairncross (2004) The case for marketing sanitation; Frias & Mukherjee (2005) Harnessing mark power for rural sanitation: Making sanitation attractive and accessible for the rural poor

 
Large-scale sanitation marketing programs are currently being developed in a number of African countries (Ethiopia, Kenya, Tanzania, Uganda), and national handwashing campaigns (based on a marketing approach) have been successfully implemented in Ghana, Senegal and Peru34. The early indicators are that the potent combination of innovative approaches to hygiene improvement and consumer-oriented marketing expertise could be the start of an exciting new field in public health.
 
One of the strengths of the marketing approach is its ability to attract private finance to sanitation and hygiene improvement initiatives. Because both the public and private sectors have an interest in promoting handwashing with soap, national handwashing programs usually take the form of public-private partnerships (PPP). While the public sector can be wary of working with private industry, and vice versa, both sectors stand to gain from cooperation. Private industry stands to gain from both market expansion and high profile contributions to national social development goals, while the public sector gains access to the unrivalled understanding of consumers, and how to reach them, held by industry. 
 
Well-designed sanitation and hygiene programs allow for market segmentation, using consumer and market research to identify the different approaches, products and services needed to improve sanitation and hygiene behavior among the diverse groups and populations targeted by the interventions. The marketing approach relies on media campaigns (radio, TV, newspapers, billboards, traditional media), local promotional efforts, and direct marketing by suppliers (masons, retailers, manufacturers) to reach consumers and persuade them to buy and use a product or service. The key principle is of voluntary exchange between a consumer and a private supplier, but public channels, such as government extension workers and community volunteers, are involved in the process, notably in local promotional activities. 
 
However, large scale sanitation and hygiene marketing is a new field, thus much remains unknown and untested. In particular, there are questions over the ability of the marketing approach to reach poor and remote rural households, or communities not well integrated into the market economy. 
 
In Indonesia, there is a clear divide between households ‘close to the market’, who tend to construct toilets using market-bought products and services, and those ‘away from the market’, who generally have no toilet or, in rare cases, build a homemade toilet using local materials. A very simplistic classification is possible in most communities, with non-poor and urbanizing households in the market segment, and poor, subsistence households in the non-market segment. In addition, the closer the community is to the nearest road and market town, the more likely it is to be market-oriented; and the more remote and inaccessible the community, the larger the non-market segment is likely to be. 
 
Private suppliers need to cover their costs and support their families, and are under no obligation to meet the needs of the poor. In general, more prosperous households demand more expensive services and offer greater returns to private suppliers, so there is a risk that private products and services are targeted largely at non-poor, market-oriented households. It is also possible that marketing messages fail to reach those with lesser access to local media or markets, e.g. poor women living in remote, rural communities.
 
Sanitation and hygiene marketing have many strengths: they ensure that people choose to receive what they want are willing to pay for; they are financially sustainable; and, they are cost-effective and can be taken to scale35. Sanitation and hygiene marketing are likely to be the most effective means of generating rapid increases in sanitation coverage, and improvements in hygiene behavior, in non-poor and peri-urban households. But marketing needs to be supplemented by more direct interventions, such as CLTS and supply chain development, to reach the poorest households in poor, rural communities.
 
3.5 Sanitation business and supply chain development in Vietnam

During 2003-04, International Development Enterprises (IDE) implemented a project for ‘small-scale private sector development and marketing for sanitation in rural areas’, which targeted 54,000 households in the central coast region of Vietnam. Unlike conventional sanitation programs, the approach developed by IDE was fully market-driven, offering customers no hardware subsidies, and instead stimulating weak rural sanitation markets and helping these markets become viable36.
 
IDE’s initial market assessment identified two major demand constraints: a lack of reliable product information, and a lack of desirable production options and suppliers. When asked whether they were willing to invest in a toilet, fully 77 percent of respondents said that they had ‘other spending priorities’ such as a television or a karaoke set. As a result, most local masons view the sanitation business as a semi-profitable seasonal business rather than a regular source of income, and few were prepared to undertake product experimentation or invest in advertising their services. 
 
IDE developed the sanitation market in the project areas through a series of activities:
•  Identifying a range of locally appropriate sanitation options (product development)
•  Increasing the availability of competent service providers (capacity building)
•  Stimulating demand for sanitation improvements (marketing campaign)
•  Mobilizing communities for behavior change (hygiene promotion, village contests)
•  Building local sanitation networks (promotional village meetings)
 
As a result of the IDE intervention, the number of toilets constructed in the project area increased from an average of about 1,500 per year to more than 6,000 toilets in 2004. Sanitation coverage doubled, going from 16% to 33% in only fourteen months. 
 
Remarkably, this large increase in sanitation coverage was achieved without any hardware subsidies. The IDE project invested US$336,00037 in market research, product development, promotion and capacity building activities to develop the local sanitation market, which represents about US$40 of software expenditure per toilet constructed. However, the approach leveraged US$66 per household in private expenditures on sanitation facilities and, now that the sanitation market and its suppliers are established, should continue to produce benefits for many years.
 
4 LESSONS LEARNED FROM INDONESIA

The World Bank supported Second Water & Sanitation for Low Income Communities Project (WSLIC-2) is recognized as one of the more successful community-driven development projects in Indonesia. Continuing on from the WSLIC-1 project (1994-99), WSLIC-2 (2003-2007) operates in seven provinces and aims to provide water supply, improved health and hygiene behavior, and community development, to about 2,500 communities. However, sanitation and hygiene development remains a weakness.
 
4.1 Targeting and equity

Targeting is an important issue. The target population for WSLIC-2 was: “households in low income rural communities. Although all households in low income rural communities could benefit from the availability of water, the immediate target population of the project are the poorest rural households and the women and children at risk of the priority diseases”. p.9 World Bank (2000) WSLIC-2 Project Appraisal Document
 
The sanitation and hygiene improvement approaches used in Indonesia appear inadequate at reaching the poorest households in the poorest communities. Households in this critical group, which suffer most from the high costs and ill effects of inadequate water supply and sanitation, rarely have toilets; rarely obtain subsidized facilities from sanitation projects; and rarely borrow from revolving sanitation funds. 
 
Results from social mappings conducted in WSLIC-2 communities in Sumatra and NTB38, during which participants use their own definitions to class each household in the community as ‘rich’, ‘middle’ or ‘poor’, reveal that access to improved sanitation is close to zero among ‘poor’ households. Poor households make up 30-70% of the population in these WSLIC-2 project communities but, in almost every case, sanitation coverage remains close to zero among the poor even after project interventions are complete.
 
The reasons for WSLIC-2’s sanitation and hygiene interventions failing to reach its ‘immediate target population’ require further research. In addition to the institutional constraints and shortcomings of the sanitation and hygiene component, two issues stand out: the lack of awareness about low cost sanitation options; and the ‘social distance’ between community leaders and poor households.
 
Despite efforts by WSLIC-2 to develop ‘sanitation ladders’ illustrating a wide range of low cost sanitation options, there remains a lack of understanding among project staff and communities about the minimum requirements of a sanitary toilet for safe excreta disposal. In most of the communities visited, project staff and beneficiary households suggested that the minimum cost of a sanitary toilet is Rp 500,000 – 1,000,000 ($50-100).  The toilet designs envisaged for this cost had solid (often brick-built) enclosures and wooden doors; pour-flush toilet pans; and some form of solid-lined tank for the safe storage and disposal of the toilet wastes. The focus on this type of toilet design has contributed to the ineffective targeting of the WSLIC-2 project, as many poor households feel that this type of toilet is unaffordable without some form of subsidy, thus rarely demand sanitation loans or build toilets. 
 
Another important factor is the control of project interventions by community institutions. Most projects aim to establish a representative community committee or association to make community decisions and allocate project benefits. Project efforts to ensure representivity in these community institutions have met with limited success, with few active women working in project institutions, and anecdotal evidence that local politics plays a strong part in the election of office holders. In addition, the community institutions formed under WSLIC-2 are more appropriate for water supply management than for the promotion of household sanitation and hygiene improvements. 
 
Hardware subsidies or loans are usually rationed because of the limited funds available, thus community institutions are asked to allocate these benefits. Anecdotal evidence from WSLIC-2 suggests that these community institutions often allocate the benefits to households that have a good relationship with the community leadership, rather than to the poorest rural households or the “women and children at risk of priority diseases”. Improving the targeting and equity of sanitation and hygiene interventions will require different institutions from those used for water supply management, specific targeting criteria, and a greatly improved awareness of appropriate and low cost sanitation options.
 
4.2 Capacity building for sanitation and hygiene improvement

The WSLIC-2 project invested heavily in training and capacity building, notably in the training of community facilitators, project consultants and local health service providers in the use of the PHAST (Participatory Hygiene and Sanitation Transformation) methodology. The PHAST methodology was to be used in both the school sanitation sub-component, to develop PHAST materials for school health teachers and students, and in the participatory identification and preparation of community-level projects for sanitation, health and hygiene improvement. 
 
Anecdotal evidence from WSLIC-2 supervision missions39 and recent rapid appraisals suggest that few of these software investments have translated into useful outputs. The PHAST methodology was supposed to enable communities to identify their sanitation and hygiene problems and devise local solutions to these problems. However, it appears that very few of the ‘immediate target population‘, i.e. the poorest rural households, have received PHAST training, or are aware of the sanitation and hygiene improvement messages and behavior changes promoted by the project.  
 
Furthermore, this process had no clear guidelines; was not monitored in any way; and the project allocated it little time or resources. The most common interventions were the construction of a limited number of household toilets (using loans from a revolving fund established by the project) and the provision of a few containers for solid waste disposal. 
 
WSLIC-2 tried to make project activities entirely participatory and community-driven, including the identification of key hygiene behavior changes and the design of hygiene improvement activities. However, the lack of a clear hygiene improvement strategy, and the limited health and hygiene experience of the community facilitators, meant that few of these participatory processes translated into concrete actions or improvements. In many cases, the community facilitators were not sure which promotional messages they were supposed to be passing on to the community, thus focused on activities with clear outputs and reporting needs (e.g. the establishment of the revolving sanitation credit). 
 
In summary, the WSLIC-2 project has built lots of PHAST capacity, which should improve local understanding and awareness of sanitation and hygiene issues, and may have long-term benefits, but there has been no coherent strategy or implementation plan for sanitation and hygiene improvement. As a result, much of the PHAST capacity remains unused. 
 
4.3 Limited knowledge about low-cost sanitation technologies

Evaluations of previous sanitation and hygiene interventions, and the rapid appraisals conducted during this technical assistance, make clear that most sector professionals in Indonesia have a limited knowledge of low-cost sanitation options, and very few are familiar with the operation and maintenance requirements of simple pit latrines. 
 
Toilets constructed under GOI sanitation programs, including the WSLIC-2 project, tend to use a common design: a solid walled and roofed toilet enclosure, a pour-flush toilet pan (ceramic, cement or plastic) and an offset, solid-lined pit with some form of vent pipe. This reflects a standard toilet design loosely based on a septic tank, which would be more appropriate in a more developed or urban setting. Moreover, unlike a septic tank, this toilet design has no effluent overflow and no base slab, thus assumes that liquid wastes are able to percolate into the soil at the base of the pit. While infiltration rates vary greatly from place to place, there is a high risk that the soil pores at the base of the pit become clogged when covered with sludge, thus preventing infiltration and allowing the liquid wastes in the pit to become stagnant and odorous. In rural Indonesia, this design is overly expensive (due to the solid enclosure and solid-lined pit), with pits that do not drain well (due to the limited sidewall porosity) and are likely to smell bad (due to the vent pipe). 
 
4.4 School sanitation and hygiene facilities

The WSLIC-2 school health and sanitation program was one of the main sub-components in the health and sanitation improvement component40, but has had a limited impact on child hygiene behavior despite significant investments in school facilities, and ongoing attempts to increase the toilet-to-student ratio and improve student hygiene behavior.  Where schoolchildren have easy access to clean toilets and places to wash their hands, and good hygiene is promoted, schools provide an excellent place for the formation and institutionalization of good hygiene habits. Schoolchildren also make excellent change agents within the community and, more importantly, within their own household. 
 
However, schools rarely utilize sanitation program funding effectively. In many communities, neither the schoolteachers nor the students make any formal commitment to use or maintain the sanitation facilities, and there is rarely any accountability for expenditures, or for the sustainability of services. Despite programs to improve school sanitation, few Indonesian schools have a reliable water supply for their pour-flush toilets, and the toilets provided are rarely sufficient for the number of boys and girls in the school. As a result, school toilets are often either dirty and abandoned, or locked to prevent them being messed up. 
 
Where school toilets are not well maintained, there is a risk that students take home the message that toilets are smelly and disgusting; and where school toilets are locked, children are unlikely to develop the good hygiene habits, or pass on the intended hygiene messages, thus the investments are wasted.
 
4.5 Sanitation development using revolving credit

In addition to its health and hygiene promotion activities, WSLIC-2 provides revolving funds to finance the development of household sanitation. Within the Rp 250 million credit (approx. US$ 25,00041) allocated in each community action plan, about 10% (US$ 2,500) is available for the household sanitation revolving fund. 
 
Typically, individual households borrow between Rp 130,000 – 900,000 (US$ 13-90) towards the cost of their toilet, and are expected to repay the loan within one or two years. The intention was that the revolving fund would continue to act as a credit facility until everyone in the community had built a household toilet, after which the fund could be invested in a facility or project chosen by the community.
 
While the WSLIC-2 project is now promoting a range of low-cost toilet designs, the majority of those already constructed adopted the relatively expensive design described above and the loan provided from the WSLIC-2 revolving credit was insufficient to cover the total cost of the toilet. The average WSLIC-2 sanitation loan is about Rp 500,000 (US$50) and the typical cost of the toilets constructed ranged from Rp 1 million to Rp 2.5 million (US$100-$250). 
 
In some areas, following problems in ensuring that the loans were used for sanitation development, the project officers and communities decided to issue sanitation materials in lieu of a cash loan, using the same repayment conditions as before. For instance, in Pandan village (Muara Enim District, South Sumatra) the village implementation committee provided the following package in lieu of a Rp 500,000 (US$50) loan: 
•  Ceramic pour-flush toilet pan (Rp 75,000)
•  3 sacks of cement (Rp 105,000) •  500 bricks (Rp 175,000)
•  Steel reinforcement (Rp 65,000)
•  1 x 4m plastic pipe (Rp 40,000)
•  1 x t-pipe for ventilation (Rp 40,000)
 
While the revolving funds have worked well in some areas and communities, their overall impact on low-income beneficiaries and sanitation coverage has been limited. According to the latest WSLIC-2 progress reports, the revolving funds have provided 23,560 household loans in about 860 communities. This represents 27 loans for household toilets in each community, which is equivalent to an 11% increase in sanitation coverage within the project communities covered to date. 
 
Unfortunately, there is little rollover of credit funds as very few of the sanitation loans are being repaid. In practice, the loans are often treated as large hardware subsidies, with little effort from community leaders to recover the loans. Anecdotal evidence from recent rapid appraisals also suggests that most of the sanitation loans are given to non-poor households, many of whom have already been assisted by previous sanitation projects. After three years of the WSLIC-2 project, 1.6 million people have access to improved water supply, but only 140,000 people have benefited from improved sanitation. 
 
In recognition of the financing and targeting issues, the WSLIC-2 project guidelines have recently been revised to increase the total funds available for household sanitation and to reduce the amount loaned to individual households. The new policy allows up to 125 households in each community to borrow Rp 200,000 (US$ 20) at the outset, thus giving 1.7 million people the means to construct sanitation facilities over the five-year life of the project42, even if none of the sanitation loans are repaid.
 
However, demand for the WSLIC-2 sanitation loans has been relatively low, even when larger amounts were offered, and many communities have been unable to utilize all of the money available for their revolving credit43. Therefore, without radical changes in approach, it seems unlikely that the project will be able to raise the number of toilets constructed in each community by 500%.
 
Assuming that WSLIC-2 reaches its target of completing sub-projects in 2,500 communities, and manages to double the number of toilets constructed in each community, the average annual increase in access to improved sanitation will be about 220,000 people. This represents only 0.2% of the rural population of Indonesia. At this rate, it will take about 170 years for Indonesia to reach the Millennium Development Goal of halving the (rural) population without access to improved sanitation. 
                                                
34 The World Bank (2005) The handwashing handbook: A guide for developing a hygiene promotion program to increase handwashing with soap
35 Cairncross (2004)
36 Frias & Mukherjee (2005) Harnessing market power for rural sanitation: Making sanitation attractive and accessible for the rural poor
37 US$142,000 for marketing and promotional activities; US$194,000 for project management and support
38 Nusa Tenggara Barat (Lombok and Sumbawa)
39 As detailed in the WSLIC-2 supervision aide-m?moires
40 The WSLIC-2 project allows Rp 15 million (US$ 1,500) per community for institutional sanitation facilities, with primary schools as a first priority.
41 Exchange rate US$1 = Indonesia Rupiahs 10,050 (October 2005)
42 Based on: (7.6 people x 125 households x 1,600 new communities) + 180,000 beneficiaries = 1.7 million 
43 Project rules dictate that the revolving credit amount is determined by the number of households without toilets that are willing to take loans at the start of sub-project implementation.

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