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Indonesia National Program for Community Water Supply and Sanitation Services

7 PROPOSED SANITATION AND HYGIENE IMPROVEMENT COMPONENT

The proposed sanitation and hygiene component contains four sub-components, which aim to:
•  trigger hygiene behavior change;
•  create ‘informed demand’ for sanitation products and services;
•  improve and increase the supply of sanitation products and services;
•  improve school hygiene and sanitation;
•  develop monitoring and evaluation systems to provide feedback and benchmarking;
•  encourage periodic revision and refinement of program approaches;
•  build sustainable support mechanisms for sanitation & hygiene services; and
•  develop responsibility and accountability for sanitation and hygiene improvement. 

At the time of writing the report, the institutional arrangements for implementation of the proposed NPCWSSS were uncertain. The WSLIC-2 project was implemented by the Ministry of Health, through its Directorate General for Communicable Disease Control, thus the Ministry of Health seems the natural home for any future program involving significant investments in sanitation and hygiene improvement. However, the Ministry of Public Works has extensive experience in the implementation of water supply projects, and it has even been suggested that the Ministry of Planning (BAPPENAS) may be best placed to manage the program using direct implementation by one or more of the line ministries. Given this uncertainty, the report does not attempt to develop detailed institutional arrangements for the proposed sanitation and hygiene improvement component. Instead, section 8.3 suggests the institutional issues that are likely require more detailed study and discussion during the program preparation stage.
 
Another major challenge has been the costing of the sanitation and hygiene improvement component. There have been no previous large-scale implementations of either ‘total sanitation’ or ‘sanitation marketing’ in Indonesia, and very little global data is available. 
 
The total component cost (US$65 million) has been estimated based on the assumption that the sanitation and hygiene improvement component will be implemented on a national scale as part of the proposed Indonesia National Program for Community Water Supply and Sanitation Services (NPCWSSS). The basis of the estimated total component cost is laid out in more detail in Section 7.5 below.
 
Given the Millennium Development Goal of halving the number of people without access to improved sanitation by 2015, the five-year investment plan for this program component has been based on increasing rural sanitation coverage by 18% (from 38% to 56%). If the program succeeds in achieving this increase over its five-year lifetime, then it seems reasonable to assume that a five-year extension to the program should allow a further 18% increase in rural sanitation coverage (assuming program refinements result in greater effectiveness and efficiency), leaving Indonesia well placed to meet its MDG target (for the rural population) of 69% access to sanitation by 201555
 
The NPCWSSS will involve only partial interventions in urban areas, and other urban programs will be responsible for the provision of institutionally-managed and networked services, thus no coverage targets have been set for urban areas. 
 
It is proposed that the component for sanitation and hygiene improvement includes the following sub-components: 
 
7.1 Total sanitation program (US$35 million)

The ‘total sanitation’ program is designed to cover 17,500 communities over five years.
This ambitious goal represents 25% of the 70,000 rural communities in Indonesia, including (on average) 58 communities in every district56. The sub-component aims to reach about 30 million poor, rural inhabitants over five years, of whom about 24 million are thought to have no access to improved sanitation. Assuming that the total sanitation program manages to provide access to ‘improved sanitation’ for only 50% of its target population, it should achieve a 10% increase in rural sanitation coverage. 
                                                
55 MDG figures used in this report are based on JMP data rather than GoI data, thus may disagree with official figures.
 
The community selection process for the total sanitation program will be different to that used in the components for water supply development, as some communities with adequate access to water supply remain without access to sanitation. Therefore, this sub-component will develop an independent set of community selection criteria based on indicators from the baseline survey, e.g. access to improved sanitation, prevalence of diarrhea, access to markets etc. 
 
As in WSLIC-2, service contracts will be used to train community facilitators; to facilitate community-level projects within the total sanitation campaign; and to monitor performance (through the ‘sanitation and hygiene unit development’ sub-component). This sub-component will improve sanitation and hygiene behavior through ‘direct consumer contact’. Sanitation and hygiene monitors will be elected in each neighborhood57
 of the community, and these sub-community institutions will be the focus for most activities within the total sanitation program.
 
The total sanitation program will use the ‘ignition process’ (see Annex 3) to trigger community initiatives to stop open defecation, improve household sanitation and safely dispose of child feces. If the community manages to stop open defecation, the program facilitators will then initiate the second stage of the community intervention, which is a handwashing campaign. 
 
The ‘second stage’ handwashing campaign will utilize the messages and materials developed by the ‘sanitation awareness and hygiene promotion campaign’ and by the proposed USAID-supported National Handwashing Campaign. If the community manages to ensure that everyone washes their hands with soap after defecation (or after cleaning feces from a child), the community facilitators will then initiate the third state of the community intervention, which is a community-driven hygiene behavior change campaign using the PHAST methodology.
 
The total sanitation approach avoids imposing external toilet designs, instead encouraging individuals and communities to develop their own sanitation solutions. This freedom often inspires innovative, low-cost designs using local materials, but does not guarantee an appropriate or sanitary toilet. Therefore, each provincial program will produce a regularly updated catalogue detailing the materials and costs of innovative, homemade designs for low-cost sanitary toilets constructed by local households58, which should then be circulated to guide or inspire other households.
                                                
56 These figures are based on the following administration data (from 2004): 32 provinces; 302 districts; 4,918 sub-districts; 70,460 villages.
57 One male and one female monitor will be elected from each neighborhood (defined as not more than 50 households), with men voting only for the male monitor and women voting only for the female monitor
58 A toilet catalogue produced by VERC (an NGO in Bangladesh) details 38 different toilet designs constructed by villagers, none of which cost more than US$20 (Rp 200,000)

 
The total sanitation program will also use institutional incentives to drive behavior change and campaign performance. Examples include ‘clean village’ competitions, citizens report cards, student health cards, community health clubs, local benchmarking (comparing community performances within each sub-district or district) and awards to local government bodies and health centers that manage to stop open defecation within their jurisdiction. 
 
7.2 Sanitation and hygiene marketing (US$19 million)

The sanitation and hygiene marketing sub-component will comprise three distinct elements, which have been linked because the findings from the initial research studies will be central to both the marketing campaigns and the business development programs. 
 
The three elements of the sanitation and hygiene marketing program are:
•  Sanitation market, consumer and supplier research studies (US$ 0.25 million)
•  Sanitation awareness and hygiene promotion campaigns (US$10 million)
•  Sanitation supply chain and business development programs (US$8.75 million)
 
The main objective of the sanitation and hygiene marketing program is to persuade more than 1.67 million unserved rural households to construct (and use) sanitary toilets and improve their hygiene behavior. The achievement of this objective will produce an 8% increase in rural sanitation coverage, at a marketing cost of about US$12 per household (US$2 per person). 
 
7.2.1  Sanitation market, consumer and supplier research studies

The diverse cultures and contexts across Indonesia result in very different attitudes, habits and behaviors, thus it is proposed to conduct the detailed sanitation research studies on a provincial basis. This approach carries the risk that there will be inadequate research expertise available at the provincial level, but this activity has the advantage that it can be linked with the national sanitation research studies currently being planned by the Indonesia Sanitation Sector Development Program (ISSDP).
 
As in ISSDP (see Annex 3 for more detail), the research studies will be done through service contracts with local firms, NGOs or academic institutions. The first provincial research study will be a full pilot carried out in advance of the others, so that the learning from this process can be used to revise and refine the design of the remaining studies. Each provincial research study will conduct detailed examinations of local hygiene behavior, sanitation supply chains, and communication channels.
 
The studies will identify key hygiene messages and behavior change ‘triggers’ for the different target groups in the study area. Whilst the studies will involve comprehensive research, reporting and analysis, the outputs should focus on the identification of a few simple messages, behavior change triggers and performance indicators for each target group, and provide convincing justification for the selection of these critical products.
 
The provincial research studies will also examine local markets, suppliers and consumers of goods and services for sanitation and hygiene improvement, and establish what people are willing to pay for these products and services. The studies will require the identification of all manufacturers, distributors, retailers, and masons involved in the supply of sanitation and hygiene goods (latrine pans, cement, pipes, potties, soap) and services to consumers in the study area, as well as any public, private, NGO or external actors involved in the sub-sector. Importantly, the studies will also examine consumer perceptions of existing goods and services, consumer preferences, barriers to adoption (why do so few poor households invest in sanitation facilities?) and alternative spending preferences. The studies will recommend practical and locally appropriate solutions to any barriers, gaps or shortcomings in the market highlighted by this research.
 
In addition, the market research studies will have to identify local communication channels and media strategies for reaching the target groups. This will involve talking to soap companies and other local firms that market products in the study area, and learning from media companies and other local outreach organizations (public, private or NGO) with experience of reaching the target groups.
 
7.2.2  Sanitation awareness and hygiene promotion campaigns

The primary aims of the provincial campaigns are to: increase demand for sanitation; increase public and political support for sanitation improvements; raise awareness of low-cost sanitation products; and promote the adoption of key hygiene behaviors to reduce disease transmission. 
 
The strategy and materials for the sanitation awareness and hygiene promotion campaigns will be designed by professional marketing and media specialists under service contracts, through a consultative process that addresses the issues, opportunities and constraints that emerge from the research studies. Using the ISSDP model (see Annex 3), the design and implementation of the provincial campaigns will be overseen by a national coordinator with extensive experience managing large-scale public health and hygiene improvement campaigns (preferably in Indonesia). Wherever appropriate, the provincial campaigns will form partnerships with other sanitation and hygiene promotion initiatives, and incorporate relevant elements of these initiatives to ensure consistent messages and approaches within the campaign area and target groups.

The campaigns should be segmented to address and influence the different priorities, attitudes and behaviors of the target groups identified by the research studies, and allow the use of several funding and implementation models. Specific efforts should be made to examine the different challenges and priorities found in peri-urban communities.
 
The campaign will also require an advocacy component calling for greater investment in sanitation and hygiene improvement, which should be targeted at national and local decision-makers, including politicians, administrators, government officials, community leaders, and health service providers; the campaign should involve local trend-setters and role models, such as entertainers, sportspeople, traditional chiefs and religious leaders. Exposure visits to communities with successful sanitation and hygiene improvement projects are powerful tools for overcoming political resistance and generating support for new ideas and approaches, thus should be incorporated in all promotional campaigns.

The segmentation of the provincial campaigns should take account of the parallel implementation of the ‘total sanitation program’ in remote, rural communities. The campaigns should ensure that specific messages and activities are developed to supplement the participatory approaches used by the total sanitation program in these communities, and to enable the campaigns to reach poor, rural households that have limited media or market access.
 
The sanitation awareness and hygiene promotion campaigns should also develop promotional materials and strategies for use in schools. The school hygiene and sanitation sub-component includes funding for district workshops, at which schoolteachers will be trained to use these campaign materials, and integrate them into school curricula and health education activities.
 
All campaign elements will require a process of pre-testing and refinement, then pilot implementation and evaluation in one district, before the final, revised provincial campaign is rolled out. Regular monitoring and evaluation of the campaign performance and impact will be carried out through the ‘sanitation and hygiene unit development’ sub-component.
 
7.2.3  Sanitation supply chain and business development programs

The main objective of the provincial sanitation supply chain and business development programs will be to improve the promotion and supply of goods and services for sanitation and hygiene improvement. The provincial programs aim to develop a range of appealing and affordable sanitation options; promote these products through direct marketing and local advertising; and create links between potential customers and competent service providers. 
 
The area covered by each provincial program will eventually match the area covered by the sanitation awareness and hygiene promotion campaign, but the programs will be developed outwards from the main market and supply hubs. Only 25% of communities will be targeted, with communities selected based on their demand for sanitation and their proximity to markets (for ease of supply). The long-term aim is that local supply chains will be able to deliver affordable sanitation goods and services to even the most remote communities, allowing those communities targeted by the ‘total sanitation program’ to upgrade and improve their sanitation facilities using market-bought goods and services. 
 
The provincial programs will use service contracts to train masons and suppliers, improve product marketing, and organize promotional events. The programs will also employ a provincial technical specialist capable of improving sanitation designs and refining manufacturing processes. 
 
Initially, the provincial programs will focus on technology transfer and capacity building.  Based on the consumer research information collected during the provincial studies, the technical specialist should work with local suppliers and communities to identify a range of sanitation options that appeal to local consumers, are affordable, and can be constructed using locally available materials and skilled labor. Where possible, the specialist should attempt to reduce the cost of these options through material substitution, simple design improvements, and the introduction of imported technologies, e.g. low cost plastic toilet pans from South Asia. 
 
The next step is to transfer these ideas to a network of suppliers. Each district will select local suppliers and masons interested in developing their construction skills and expanding their businesses. If possible, there should be two to three masons from every eligible community (to encourage competition). These private masons will be given basic construction training (when required); taught the basic principles of the design, operation and maintenance of a low-cost sanitary toilet; and instructed how to build the range of toilet designs developed from the consumer research studies. All program staff involved in the sanitation awareness and hygiene promotion campaign or the supply chain development program will also attend this technical training.
 
In addition, the suppliers and masons will be trained in basic business skills such as budgeting and marketing. Each district sub-program will assess the potential market size and advise the newly-trained service providers on the start-up, operation and expansion of their sanitation businesses. Manufacturers and retailers will be encouraged to provide credit to masons (and other frontline service providers) so that they can expand their businesses, and masons will be encouraged to allow poor households to pay by installment. Distribution costs will be reduced by encouraging retailers to create storage depots and retail outlets where demand is high, e.g. for cement, toilet pans and bricks.
 
One of the key constraints to sanitation development is a lack of reliable product information. Most poor households believe that toilets are expensive and unaffordable, thus show little interest in sanitation programs. Therefore, the provincial programs will invest in marketing and promoting a range of appealing and affordable sanitation products through local adverts, community roadshows, sanitation exhibitions (places to view products), demonstration toilets, program-financed discounts and product
catalogues. 
 
The provincial programs will also develop an accreditation system for competent service providers (masons). Trusted local institutions, e.g. health centers, will be encouraged to recognize and endorse service providers trained by the program, thus removing doubts that potential customers may have about their technical competence or experience. 

7.3 School hygiene and sanitation improvement (US$6 million)

The school hygiene and sanitation improvement sub-component includes two main activities:
•  School sanitation and hygiene facilities (US$ 4.5 million)
•  District workshops on school hygiene and sanitation (US$ 1.5 million)
 
7.3.1  School sanitation and hygiene facilities

It is proposed that a fixed sum (US$500) be provided for the construction of school sanitation and hygiene facilities in each of the 17,500 communities to be covered by the total sanitation program. However, this sum will not be made available until the community has completed the first two stages of the total sanitation program: stopping open defecation, and ensuring that everyone washes their hands with soap after contact with feces.
 
Following independent verification of these achievements, the community has the option to invest the US$500 in improving the sanitation and hygiene facilities of the school that the children in the community attend. However, any additional facility costs (above US$500) will have to be made up by the Ministry of Education, the local government, or by the community itself. In this manner, the program hopes to leverage more funds for school sanitation; increase the sense of ownership; and avoid ineffective investments in duplicate school facilities. It is also hoped that the desire for improved school facilities will provide an additional incentive for the community to meet its total sanitation targets.
 
7.3.2  Workshops on school hygiene and sanitation

District workshops on school hygiene and sanitation will take place in all program areas, regardless of community achievements in the total sanitation program.
 
The promotional materials and approaches to be used in the school hygiene and sanitation improvement sub-component will be developed under the sanitation and hygiene marketing sub-component. These materials and approaches will then be incorporated into school curricula and health education activities following a series of district workshops on school hygiene and sanitation, which will be attended by local primary school teachers and educational extension staff. 
 
Detailed information on effective promotion of hygiene and sanitation in schools, including a ‘toolkit on hygiene, sanitation and water in schools’, is now available from the World Bank website: http://www.schoolsanitation.org/.
 
7.4 Development of provincial sanitation and hygiene units (US$5 million) This sub-component aims to develop a sustainable network of ‘provincial sanitation and hygiene units’. These units will be established using program finance, but will be located within local government health structures, and all recurrent funding will be channeled through local government budgets.
 
The sanitation and hygiene units will have four main tasks:
•  Conduct baseline survey
•  Monitor and evaluate program performance
•  Monitor and evaluate program impact
•  Provide institutional support to community programs
 
7.4.1  Baseline survey

The establishment of the provincial sanitation and hygiene units will be one of the first program tasks, as these units will be responsible for developing consensus on a set of practical monitoring indicators with the Ministry of Health, and conducting a thorough baseline survey using the program performance and impact indicators discussed below.
 
The market research studies will provide much of the objective information normally provided by a baseline survey, hence it is recommended that, where possible, the baseline survey be conducted using a collaborative, multi-stakeholder approach. It is imperative that the baseline survey establishes consensus on access to improved sanitation, given the centrality of this measure to any assessment of progress towards the sanitation MDG.
 
It is proposed that the implementation of the baseline survey should follow the following approach. In the run up to the first South Asian Conference on Sanitation (SACOSAN) in 2003, the Bangladesh government realized that it needed more accurate and detailed sanitation data in order to develop a realistic strategy and implementation plan. A rapid baseline survey was commissioned, using public, NGO and donor resources to cover every community in the country in just three months at minimal cost (donors and NGOs funded their own inputs). Prior to the rapid baseline survey, 45% of the population was thought to have access to improved sanitation, but the survey results led to official sanitation coverage being revised down to 32%. The baseline survey has since been widely disseminated, and provides a common and undisputed database for all to work from.
 
In addition to the performance and impact indicators, the baseline survey will also collect information on the community selection criteria required for the sanitation and hygiene improvement component, e.g. access to markets.
 
7.4.2  Monitoring and evaluation of program performance

The monitoring and evaluation of program performance will focus on hygiene behavior change and program outcomes using easily collectable and verifiable indicators. It is important that the Ministry of Health lead the process to select and define these performance indicators, as it is hoped that they can be integrated into all future sanitation and hygiene interventions. Where appropriate, relevant indicators from the WSLIC-2 sustainability and outcome monitoring system, which is based on the MPA59, will be adopted.
 
Indicators need to be developed to monitor the performance of each of the following sub-components:
•  Total sanitation program
•  Sanitation and hygiene marketing
•  School hygiene and sanitation
 
The headline performance figures for the total sanitation program will be the number, and proportion, of communities reaching stage one (open defecation stopped) and stage two (100% handwashing after defecation or handling feces) of the process. As the program will not provide hardware subsidies, the number of ‘active’ sanitation facilities will be a reasonable proxy for the number of households that have stopped open defecation. When 100% sanitation coverage has been achieved and the community wishes to declare itself ‘open defecation free’, an independent audit will be used to confirm that open defecation (including defecation in water bodies) has stopped. 
                                                
59 Methodology for Participatory Assessments (MPA)
 
 Given the program focus on stopping open defecation and increasing handwashing after defecation, special attention should be paid to defining reliable indicators (or proxies) of the incidence of open defecation and handwashing. A recent guide to assessing hygiene improvement60 suggests the following possible indicators (and sources of data):
•  % households with access to an improved and hygienic toilet facility (observation)
•  % households that use an improved and hygienic toilet facility (observation)
•  % caretakers washing hands properly with soap and at appropriate times (direct observation or survey)
•  % households with access to a place to wash hands that has all essential supplies, e.g. water, pouring device and soap (observation)
•  % children under age five whose feces were disposed of safely (observation or
survey)
 
The sanitation and hygiene units also need to work with communication and marketing specialists to determine how best to measure the performance and reach of the marketing and promotional campaigns. Possible community-level indicators include:
•  % caretakers who have been reached through different communication channels about
water, sanitation or hygiene during past month (survey)
•  % caretakers who have heard about hygiene promotion (survey)
•  % caretakers who can recall at least one hygiene message (survey)
 
The performance indicators selected for the total sanitation campaign should be applicable in all communities, whatever the approach, to enable their use in assessing the performances of the marketing and promotional campaigns. A comparison of the varied impacts on open defecation and handwashing (and any other common performance indicators selected) will provide useful information about the relative cost-effectiveness of the different approaches.
 
The provincial sanitation and hygiene units will be responsible for regular monitoring of program performance, and for benchmarking the performance of facilitator and district teams. The units will also arrange annual community audits by independent teams, which will provide important information about the sustainability of program investments.
 
7.4.3  Monitoring and evaluation of program impact

Ideally, the monitoring and evaluation of program impact would focus on health improvements using key disease indicators from program communities but, as discussed earlier (Section 5.3), it is often difficult to obtain sufficiently reliable and relevant health data to allow accurate assessment of the impact of sanitation and hygiene interventions. 
 
Given the enormous challenge of overhauling the Ministry of Health’s community health monitoring system, it is proposed instead to supplement the performance monitoring to be carried out by local government (as described in Section 7.4.2) with specialist evaluations of hygiene behavior change in a few randomly selected (but representative) areas in each province. The specialist impact evaluations will be conducted by suitably qualified and experienced consultants before the program begins, and then at regular intervals (e.g. every two years) throughout the program life.

60 EHP (2004) Assessing hygiene improvement: Guidelines for household and community levels
 
Despite the well-recognized difficulties in making reliable assessments of the prevalence of diarrhea in a community, it is recommended that each program community undertake an annual two-week surveillance of the incidence of child diarrhea61. This annual survey should be coordinated by the health center sanitarian, with assistance from the community midwife, through the network of neighborhood sanitation and hygiene monitors established by the total sanitation program (see Section 6.2). While this annual survey is unlikely to provide an accurate assessment of community health, it should give a rough indication of relative program impact on the community over a five-year period, as well as acting as an annual reminder to both the community and the local health officials of the importance of the behavior changes promoted by the program, and the impact that these sanitation and hygiene improvements can have on family health.
 
7.4.4  Institutional support to community programs

The provincial sanitation and hygiene units will provide specialist support to district programs through involvement in capacity building initiatives; organization of knowledge sharing events; and dissemination of program innovations and improvements. The units will also be responsible for assembling independent teams for community audits, program evaluations and periodic reviews.
 
7.5 Component cost estimates

Given the roughness of the cost estimates, and the likelihood that they will have to be reworked once better data is available, no attempt has been made to break down costs into any detail, or to allow for inflation over the life of the program. 

7.5.1  Cost estimate for total sanitation program

 
(a) WSLIC-2 project  District-level costs (for 2,500 communities) =   US$ 7,300 per community 
                                                
61 Percentage of children under five with diarrhea in the two week survey period

These costs represent the total time and resources used by project staff (consultants and facilitators) in preparing and implementing community action plans, with no allowance for project management costs. During rapid appraisals in September 2005, project staff at the district level estimated that 90% of their time and resources were expended on water supply development. 
 
Assuming that 25% of the costs relate to community development, sanitation and hygiene promotion, the cost = US$ 1,825 per community.

(b) CLTS pilot projects Training workshops & community level activities =  US$ 4,000 per community
 
Despite training about 30 facilitators at each district CLTS workshop, the pilot projects covered only four communities per district (on average). As a result, the average cost per community is far higher that it would be in a larger-scale program. 
 
Assuming that five teams of two facilitators were formed following each training workshop, and that each team could complete the ‘total sanitation’ process in four villages per year, the intervention cost =    US$ 1,800 per community.  
(c) Total sanitation in South Asia

Research into total sanitation programs in South Asia62 suggests that typical program costs (including program management) range from US$10 to US$25 per household, equivalent to from US$ 2,800 to US$ 7,000 per community. These costs include many of the more general promotional activities that will be covered by the other sub-components of the NPCWSSS, thus an equivalent cost would be less than US$ 2,000 per community.
 
Based on these simplistic estimates, the cost of the total sanitation program is unlikely to exceed US$ 2,000 per community. However, more detailed information on total sanitation costs will be essential when drawing up the final plans for this sub-component.
 
7.5.2  Cost estimate for sanitation and hygiene marketing

(a) Sanitation market, consumer and supplier research studies The Handwashing Handbook (World Bank, 2005) suggests that a typical consumer research study takes two months of fieldwork with a team of eight to fourteen people, and costs US$20,000 – US$ 80,000. 
 
This research will need to examine market, consumer and supplier perspectives, and will be carried out in a series of separate provincial studies. Therefore, US$250,000 has been allowed for the studies. Before finalization, these costs should be compared against the cost of the similar research studies currently being tendered by the ISSDP project.
 
(b) Sanitation awareness and hygiene promotion campaigns There are limited data available on the costs of large-scale marketing approaches. The following data are drawn from an economic analysis of recent handwashing initiatives63:
 
Basic Support for Child Survival (BASICS) Project in Central America
Four year program, total cost   $ 1.004 million
Annual cost     $ 251,000 (at 1999 prices)
 
Peru National Handwashing Initative
Two and a half year program, total cost $ 2.567 million
Annual cost     $ 1.027 million (at 2005 prices)
 
The Secretariat for the Global Handwashing Partnership suggests64 that typical costs for national handwashing initiatives are from US$400,000 to US$500,000 per year. It should also be noted that the private sector, e.g. soap companies, media companies and service organizations, can be brought into the partnership to reduce costs through creative co-branding, donations of airtime, or provision of outreach and marketing capacity. 
 
Another important variable is the degree of fragmentation in the media. For example, if the government has one radio and one television channel that reach the poor throughout the country, the campaign cost would be lower than these average figures. However, if the media market is fragmented both geographically and linguistically, it will be more expensive for a large-scale program to reach the poor. 
 
Indonesia’s wide cultural, environmental and geographical diversity suggests that provincial campaigns are likely to be more accurately targeted than a single national campaign. Whilst there will be some knowledge sharing between these provincial campaigns, this approach is likely to increase the total campaign costs. 
 
For the purposes of this preliminary cost estimate, it has been assumed that US$2 million per year will be needed for the provincial marketing campaigns, costing a total of US$10 million over the five-year life of the program. 
                                                
63 Cercone et al (2004) Economic analysis of handwashing in Central America and Peru: Developing cost-effective approaches to improving health
64 eMail from Kate Tulenko (dated 15 November 2005)

(c) Sanitation supply chain and business development programs As the critical part of the supply chain is the interface with the community, this sub-component has been costed on a per community basis. It has been assumed that this campaign will target 25% of rural communities, although these will be different communities to those targeted under the total sanitation program.
 
The IDE Vietnam sanitation marketing program65 involved one of the few campaigns to build local supply networks and develop local sanitation businesses. It operated on a relatively small scale (covering 30 communes with a total population of 323,000) and spent about US$1 per person. The total cost of this program was equivalent to about US$1,900 per community (population 1,800). However, this amount includes program overheads, plus the development and implementation costs of the advertising and promotional campaigns.
 
Given the significantly larger scale of the proposed NPCWSSS, and the provision for promotional campaigns and community development under the other sub-components, US$500 per community has been allowed for the supply chain and business developmen campaign. 
 
7.5.3  Cost estimate for school hygiene and sanitation improvement

(a) Workshops on school hygiene and sanitation For the moment, it has been assumed that 300 district workshops will be held (enough to cover almost every district in Indonesia) and that each workshop will cost US$5,000. 
 
(b) School sanitation and hygiene facilities Only US$500 has been allocated for school sanitation and hygiene facilities in each community, in an attempt to make the school hygiene and sanitation sub-component more demand-responsive and cost-effective. The intention is that this fixed amount is available to part-fund school sanitation or hygiene facilities, with any additional costs provided either by the Ministry of Education, local government, or the community itself.

65 Frias & Mukherjee (2005) Harnessing market power for rural sanitation: Making sanitation attractive and accessible for the rural poor

In order to release the school sanitation and hygiene allocation, the community has to complete the first two stages of the total sanitation program, i.e. stop open defecation and achieve 100% handwashing. Given the likelihood that many communities will not complete these stages, the cost estimate only includes allocations for 50% of the communities to be covered by the total sanitation program.
 
7.5.4  Cost estimate for development of provincial sanitation and hygiene units

 The institutional arrangements for program implementation, and for the functioning of the provincial sanitation and hygiene units, require elaboration during the program preparation phase. For the purposes of this preliminary cost estimate, it has been assum that the cost of establishing and developing the network of provincial sanitation and hygiene units, including initial program requirements such as the baseline survey, will require US$1 million per year.

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