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Indonesia National Program for Community Water Supply and Sanitation Services

4.6 Inadequate institutional arrangements

Investments for water supply development and for sanitation and hygiene improvement are often combined into a single program, which makes it difficult to locate a suitable institutional home, or develop effective institutional arrangements. 
WSLIC-2 is recognized as one of the most effective community-driven development projects in Indonesia. However, despite a well-planned approach, the sanitation and hygiene component has been buried by the demands of the water supply development components. Many of the more innovative activities never happened, while the bulk of the sanitation and hygiene promotion expenditure went into revolving credit funds that have neither reached the target population nor been repaid. 
In WSLIC-2, several important and well-planned elements of the ‘improving health behavior and services’ component, including the mass media and social marketing campaigns, have not been implemented. The reasons for the failure of these sub-components are complex, but none of them had a direct bearing on the main program performance indicators (number of water supply facilities constructed; population benefiting from water supply facilities; number of school and household toilets constructed; number of people trained) and it proved difficult to recruit suitably qualified and motivated staff to implement these specialist activities. Inevitably, under the normal time and resource constraints, these activities received less interest and attention than the implementation of the water supply and sanitation facilities. 
Water supply development requires a high level of technical knowledge, thus must involve institutions with strong engineering skills and experience, even when implementation is participatory and community-driven. Water supply programs also need to establish relatively complex systems for the management of shared infrastructure, thus must engage with local leaders, develop community level institutions, and build financial and operational capacity.
In contrast, sanitation and hygiene interventions operate at a lower level and in a different way, working with individual mothers and children, with poor households and neighborhoods, and with local health and hygiene service providers. Inevitably, sanitation and hygiene promotion require very different skills and institutional arrangements to those needed for water supply development.
However, in most programs, there are few institutions and resources allocated exclusively to sanitation and hygiene improvement. In the WSLIC-2 project, one member of the community facilitation team is theoretically responsible for ‘health activities’, but in practice the team operates as a single unit that works together on all aspects of the project. Similarly, whilst district ‘health and community development’ consultants have broad responsibility for hygiene promotion, their duties do not extend to management of specific sanitation or hygiene activities or teams. Most project staff are responsible for activities under several different project components, including water supply development (which consumes 90% of project time and resources), thus there is little specific responsibility or accountability for sanitation and hygiene improvement. 

At present, there is no accountability for sanitation and hygiene interventions in Indonesia, at any level: there is no national level body responsible for sanitation and hygiene improvement; and no sanitation or hygiene units at either province or district level. The WSLIC-2 project recently appointed provincial ‘participatory community health development’ consultants in an attempt to improve the development and implementation of its health communication strategies and hygiene activities, but these temporary appointments have had little impact on performance to date, and will not improve long-term accountability. 
4.7 Critical constraints to sanitation behavior change

Another critical constraint to sanitation development and hygiene behavior change in Indonesia concerns the habit of defecation in water bodies:  “Almost all people wash their clothes, take a bath and defecate at the river even though they have a well. Only a few households have family toilet, because they feel that toilets are too expensive. Moreover, defecation in the river is perceived does not create a bad smell, like [defecation] in a poorly ventilated toilet. It is also interesting that the people in Muara Enim defecate in the morning as they are afraid to go to the river at night.” P.29 Baseline Impact Survey for WSLIC-2 Project (University of Indonesia, 2003) When found close to the village, rivers provide convenient and accepted places for defecation. Many Indonesian villagers have grown up with the morning ritual of walking to the river to wash and defecate, with some even reporting that they find it difficult to defecate without the feel of running water on their skin. Most users believe the river to be a clean and effective sanitation solution because, unlike open defecation on the ground (where the feces remain visible and exposed for some time), defecation into the river leaves little obvious trace or smell. The fact that people also clean their clothes, their bodies, and even their teeth, in the same river water at the same time, and that many upstream communities also defecate in the river, does not seem to worry the users. 
There are also other constraints. Some of the communities living close to large rivers face annual flooding during the rainy season, which questions the sustainability of the simple pit latrines promoted by most sanitation programs. Unsurprisingly, it is not easy to convince rural households using nearby rivers for washing and defecation that the construction of a potentially smelly and expensive toilet is going to improve their lives. Sanitation and hygiene interventions need to address this critical constraint by promoting appropriate toilets and by convincing communities (and their leaders) of the health and environmental problems caused by defecation in water bodies, and by using, or cleaning their teeth in, water that contains fecal contamination.
Given the well-documented difficulty of catalyzing change in the sanitation behavior of communities using rivers for open defecation, and the public health hazard and externalities imposed on communities downstream, this may be an issue that requires national or local legislation.

4.8 Community-Led Total Sanitation in Indonesia

Community-Led Total Sanitation (CLTS) was introduced to Indonesia in May 2005, through a series of pilot projects funded by the Water and Sanitation Policy Formulation and Action Planning (WASPOLA) project44. The WASPOLA CLTS pilot projects were implemented by the Ministry of Health (MoH) through the World Bank-supported WSLIC-2 project and the recently launched ADB-supported Community Water, Sanitation and Hygiene project. Between May and July 2005, about 200 facilitators attended CLTS training courses organized by the Water and Sanitation Program, during which the CLTS process was initiated in twenty-four rural communities. 
There has not yet been time to conduct a detailed evaluation of the CLTS pilots. However, within five months of the first pilot starting, the Ministry of Health reports very positive results, with dramatic changes in sanitation coverage and a lot of interest in the new approach from local governments and health service providers. Despite concerns that the CLTS approach would be difficult to replicate outside South Asia, rapid appraisals conducted by the author in September 2005 confirm that sanitation coverage in four of the CLTS pilot communities45 had already increased by 20-98%. 
Not all of these new toilets were yet in use, and none of the communities had managed to stop open defecation completely, but even the worst performing community had managed a 20% increase in sanitation coverage in only a few months. In one of the pilot communities (Desa Mamak, Sumbawa, NTB), every single household had built a new toilet. Unfortunately, most of these new toilets had been built in anticipation of a forthcoming WSLIC-2 water supply scheme, and less than 50% were actually in use because the scheme was not yet complete and there is no water available within the village. 
44 Government of Indonesia partnership with the Water and Sanitation Program – East Asia and the Pacific
45 Desa Babat and Ibul, Muara Enim, South Sumatra; Desa Mamak and Sebasang, Sumbawa, NTB

Examples of the range of sanitary toilets built under CLTS projects in Indonesia:
(a) Pour-flush toilet with brick enclosure (b) Simple pit latrine with bamboo vent

The toilets being built under the CLTS pilots in Indonesia are similar to those constructed under similar programs in South Asia, ranging from ceramic pour-flush toilets with brick enclosures that cost $100 - $250, down to basic or ventilated pit latrines with unroofed enclosures made from plastic sheeting, palm matting or bamboo, which cost $10 - $20. The low-cost toilets built by poorer households typically cost less than $15, which is considered affordable for 60-80% of rural households, although a few enterprising households built toilets using only local materials and labor, with no cash requirement. 
The pilot projects illustrate that CLTS is a simple concept that is easily and rapidly understood, transferred and replicated. It is also relatively low cost for a participatory approach, as no hardware subsidies are being provided. However, success is dependent on the quality of the facilitation and follow-up, which is difficult to ensure at large scale. 
The recent CLTS pilot projects in Indonesia have generated a lot of excitement and interest in this new approach. However, these pilot projects benefited from a high level of support and expertise from WSP-EAP and the MoH during their planning and implementation, with frequent follow-up and monitoring, thus the outcomes are not necessarily representative of those from a large-scale program. Nevertheless, despite the problems and weaknesses discussed above, the CLTS pilots appear to have had greater impact than any previous rural sanitation and hygiene approaches used in Indonesia.   
4.9 Sanitation development in peri-urban areas

Indonesia has one of the lowest rates of urban sewerage coverage in Asia. Less than ten cities have some form of network sewerage, and these networks are estimated to reach only 1.3% of the total population. With few other options, many urban households have provided their own sanitation facilities. At present, about 70% of urban households are thought to have some form of private on-site sanitation facility, mostly small septic tanks with inadequate effluent disposal. However, the lack of investment, oversight and regulation by local government means that few drainage or septage collection services are available in most cities and towns, and safe disposal is rare. Most sewage and effluent finds its way into open access resources such as rivers and canals, resulting in widespread contamination of surface and groundwater resources.
About 30% of the urban population does not have access to adequate sanitation services. Most of this unserved population lives in densely populated slum and squatter settlements, where land tenure problems, space constraints and poverty prevent many households from investing in on-site sanitation facilities. In a context of rapid urbanization, the number of urban poor living in these informal settlements is growing, putting further pressure on already stretched resources and creating massive public health hazards.
Sanitation development in peri-urban areas and large, informal settlements is technically complex. There are usually few networked solutions possible, and insufficient space for on-site facilities such as pit latrines. Urban inhabitants tend to demand a higher level of service than rural, and the construction of facilities is often more expensive in restricted urban environments with few viable disposal options.
The WASPOLA project recently used the Sanitation by Communities (SANIMAS) initiative to pilot community-based sanitation options in peri-urban areas in East Java and Bali. These pilot projects were implemented in partnership with BORDA46, an international NGO, and involved cooperation with urban communities and local governments to improve hygiene behavior and develop sustainable sanitation facilities that reflect the preferences of the target communities. Three types of community-based sanitation system are being implemented: communal toilet and bathing facilities (MCKs); communal septic tank systems; and small, simplified sewerage systems. 
The ISSDP project is planning to build on the WASPOLA and SANIMAS experiences, and to strengthen the capacity of local governments to plan and implement community-based sanitation systems. While clearly an area that needs a lot more work, the SANIMAS results suggest that community-based sanitation is an effective and sustainable solution in densely-populated peri-urban areas.

46 Bremen Overseas Research and Development Association

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