Presentation to East Asia Ministerial Conference on Sanitation and Hygiene (EASAN), December 2007

1. Reassessing and Triggering Rural Sanitation in Indonesia Wan Alkadri, Director of Environmental Health Ministry of Health, Republic of Indonesia Presentation to East Asia Ministerial Conference on Sanitation and Hygiene (EASAN), December 2007

2. Presentation Outline Sanitation Challenge in Indonesia Reassessing National Approach for Rural Sanitation Developing a New Paradigm for Total Sanitation Triggering Behaviour Change through CLTS - Early Days Developing new Approach and Strategy for Community based Total Sanitation Policy lessons through Total Sanitation and Sanitation Marketing Program (TSSM) The Future - 2008 onwards

3. Population of 236.4m, 57% in villages (SCB, 2007) 17,500 islands over 5000kms GDP per capita US$3,843 (UNDP, 2007/8) 45.2% (105.3m) poor and vulnerable poor (World Bank 2007) Human Development Index ranking 107 of 177 countries (UNDP 2007/8) Republic of Indonesia

4. Rural Sanitation Challenge in Indonesia • 40% access to rural sanitation (JMP 2006) – little change in 20 years • MDG target of 69% by 2015 needs increased access for 3.7m people per year. This requires US$600m per year but current investment US$27m p.a. • In addressing poverty, GOI’s target is to halve number of those without sanitation facilities by 2015 (Medium Term Plan for Development). At current rate, needs more than 200 years

5. Research Results in Indonesia BHS, 2006

6. Impacts of poor sanitation in Indonesia • 19% death in children under the age of 3 or around 100.000 children die annually from diarrhea – one of main causes of child mortality (others are acute respiratory infection and perinatal complications) Indonesian’s Profile,2003 • Economic loss of around 2.4% of GDP or US$13 per month per household (ADB Study 1998)

7. Impacts of improved sanitation – global experience • Risk of diarrhea reduced by 36% with safe sanitation, by 47% through hand washing with soap(Curtis, 2004) and by 39% through h/h water treatment and safe storage (WHO, 2004) • Investing US$5/capita/year in sanitation could increase productivity by 34-79% and reduce costs of illness by 6-19% (ISSDP,2006) • Countries with adequate sanitation get returns of US$8-12 for every US$1 invested (WHO Study, 2005)

8. Reassessing National Approach to Rural Sanitation • Presidential Decree on Drinking Water Supply and Household Toilets, 1973 introduced hardware subsidies: not sustainable, did not raise awareness about behaviour change and could not be scaled up • Sanitation is a low priority for Legislatures and Executives • Inadequate use of resources, knowledge and experience of people who can be part of the solution including from community and business sectors • Poor monitoring systems and inadequate sharing of learning • Few mechanisms for scaling up

9. CLTS introduced to Indonesia and GoI visit to India & Bangladesh 2004 DEVELOPING A NEW PARADIGM FOR TOTAL SANITATION CLTS pilots in 6 provinces ( 6 districts) 2005 Rapid spread of CLTS: 72 Open defecation free (ODF) communities and 2 ODF sub-districts 2006 National CLTS launched by Ministry of Health June 2006 Replication WSLIC Ministerial Decree on CB Total Sanitation 2008 CB Total Sanitation implemented in 200 districts 2008 TSSM starts in East Java 2007 Draft National Strategy on Community Based (CB) Total Sanitation 2007 160 communities ODF July 2007 CWSHP Pro Air NGO/PCI Local Govt University WES- UNICEF PAMSIMAS

10. Triggering Behaviour Change through CLTS – early days • Empowering communities to change behaviour and build and use latrines with own resources and no subsidies to achieve 100% open defecation free (ODF) • Community actively involved in self help environmental analysis. • Uses disgust of open defecation and community pride as motivating factors • Promotes local choice from open technology menu including simple low cost toilets • Uses champions, natural leaders and competition between neighbouring areas to build momentum for replication • Involves everyone including school children

11. ODF Progress May 05-Apr 07

12. Change to Empowerment photos

13. Developing the Total Sanitation Approach • Following CLTS, GoI developed a new paradigm for total sanitation which is pro-poor and supports faster scaling up • Total Sanitation means every household: • Stops open defecation • Uses a safe latrine for excreta disposal • Washes hands with soap • Manages and stores water and food in a safe way • Manages domestic waste water in a safe way • It targets whole communities and focuses on collective behavior change for total sanitation rather than physical targets and subsidies

14. New Strategy for Community-based Total Sanitation • Increase demand for total improved sanitation and hygiene behavior and facilities, no subsidies/credit for household hardware, open technology menu (incl.low cost toilets), handwashing with soap and water treatment • Improve sanitation supply chain using market-based approaches • Improve enabling environment by building capacity of national/local govts for policy development and implementation Increase sanitation demand Improve supply of goods & services Improve enabling environment

15. Total Sanitation and Sanitation Marketing Program (TSSM) • 4 year program tooperationalizenew Community-based Sanitation Strategy in one province with 29 local governments (funded by GATES Foundation) • Aim to scale up sustainable sanitation to achieve 100% ODF in line with district plans (1-2 years) • Reallocation of subsidy funding towards ODF certification and reward systems, improving sanitation markets, hygiene/health promotion and capacity building • Develop new knowledge on effective approaches and health and economic impacts of Total Sanitation

16. Policy lessons emerging from TSSM • Investing in strategic advocacy at the start helps change mind-sets and institutionalise the Total Sanitation approach • Leveraging local government funding away from past unsuccessful approaches towards implementing the new Total Sanitation strategy is possible • Local govt funding for sanitation improvement is NOT a constraint if there is political will • Scaling up needs consistent approach of incentives and rewards for collective behavior change underpinned by MONEV systems

17. 2008 and onwards - PHOTOS - handwashing, water treatment, ODF

18. . THANK YOU