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Information Media for Water Supply and          Environmental Sanitation              Published by:                       ...
M A I N R E P O RT NATIONAL COMMITTEE OF PAM-RT     AND LAUNCHING OF CLTS  ACTIVITY IN 10.000 VILLAGESF         or most of...
M A I N R E P O RTapproach of community based. This has           that Links with Water and Sanitation-        one of the ...
M A I N R E P O RT(KONAS PAM-RT), an exhibition was             disaster or in emergency. This year, 1 bil-        Pelita ...
M A I N R E P O RT             Community Led Total Sanitation                 (CLTS) in IndonesiaI      n point of fact, t...
M A I N R E P O RTture instead of behavior changing.    This approach was introducedthrough visit of the Government ofIndo...
M A I N R E P O RT                                                       STBM As the Approach Method to Achieve MDGs      ...
M A I N R E P O RTnew strategy and method is required to be                                                              t...
M A I N R E P O RT               Budget between government and community investment in                       building toil...
I N T E RV I E W     Director of Environmental Sanitation of the Health Department Dr. Wan Alkadri, M.Sc.              "Im...
R E G U L AT I O N                                         Health Minister Decre   No. 852/Menkes/SK/IX/2008 on National S...
INSIGHT               Institutional Dimension in CLTS                    Dispersion in IndonesiaS         ince the start o...
INSIGHTnificant.                                              The existence of instruction line (direct      sion in this ...
INSIGHTprogram ownership from NGO to local gov-         build communal toilet, every household pro-        actually not in...
INSIGHT          Community Empowerment and CLTS                 Approach/MethodI      n general, the people at the village...
INSIGHTriver will also pollute the river and disad-   the one that relates with the sanitation.         are women. The sam...
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008
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Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008

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published by Indonesia Water and Sanitation Working Group. First edition on August 2003

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Achieving MDGs Sanitation Target Through CLTS.Indonesia water and Sanitation Magazine. December 2008

  1. 1. Information Media for Water Supply and Environmental Sanitation Published by: From the Publisher 1 Water Supply and Sanitation Working Group Your Voice 2 Main Report Advisor: Director General for Human Settlement, National Committee of PAM RT and launching of CLTS Activities Department of Public Works in 10.000 Villages 3 Board of Trustee: Community Led Total Sanitation in Indonesia 6Director of Settlement and Housing, National CLTS as Approach Method to Accomplish MDGs targets on Sanitation Development Planning Agency Sector 8 Director of Water and Sanitation, Ministry of Health Interview Director of Water Supply Development, Director of Environmental Sanitation of Health Department Department of Public WorksDirector of Natural Resources and Appropriate dr. Wan Alkadri, M.Sc 11 Technology, Director General on Village and Regulation Community Empowerment, Department of Home Affairs Kepmenkes RI No. 852/Menkes/SK/IX/2008 on CLTS National Director for Facilitation of Special Planning Strategic 12 Environment Management, Insight Department of Home Affairs Institutional Dimension in CLTS Promotion in Indonesia 13 Chief Editor: Community Empowerment and CLTS Approach/Method 16 Oswar Mungkasa Ecosan Toilet; Is it possible to be applied in Indonesia? 19 Board of Editor: Maximizing the Use of Metaplan Card 20 Zaenal Nampira, Sampling Result of Ozone Disinfection 22 Indar Parawansa, Bambang Purwanto Report After CTPS Party, the Peak of Global Hand Washing Day 24 Editor: Maraita Listyasari, Rheidda Pramudhy, Our Guest Raymond Marpaung, Fany Wedahuditama Dr. Handrawan Nadesul, Initiator of Little Doctor 26 Design/Illustrator: Inspiration Rudi Kosasih Green Radio: Developing Better Environment 28 Plan Roundabout 29 Production: Machrudin ISSDP Roundabout 31 WASPOLA Roundabout 32 Distribution: Agus Syuhada Local WSES Working Group Roundabout 34 WSES Roundabout 36 Address: UNICEF Roundabout 39 Jl. Cianjur No. 4, Menteng, Jakarta Pusat Phone/Fax.: 62-21-31904113 Watsan Network Roundabout 44 http://www.ampl.or.id CLTS Roundabout 46 e-mail: redaksipercik@yahoo.com redaksi@ampl.or.id IATPI Clinic 48 oswar@bappenas.go.id CD Info 49 Unsolicited article or opinion items Book Info 50 are welcome. Please send to our address Web Info 51 or e-mail. Dont forget to be brief and WSES Literature 52 accompanied by identity. Agenda Percik magazine can be accessed through WSS website http://www.ampl.or.id
  2. 2. M A I N R E P O RT NATIONAL COMMITTEE OF PAM-RT AND LAUNCHING OF CLTS ACTIVITY IN 10.000 VILLAGESF or most of the people in UUD 45 has mandated which is Indonesia, consuming to improve better and healthy life water is still done in con- quality," she said.ventional way, such as cooking or One of the policies said theboiling the water first to ensure Health Minister is applying envi-that the water is healthy and drin- ronmental sanitation program.kable. "Some infectious disease can be Problem arises especially for pressed down by applying envi-low income community because ronmental sanitation program.boiling water requires energy; ke- Without them, the effort ofrosene, gas or fire wood. Especi- improving communitys healthally now that fuel price kept going will not run properly," she said.up. Along with the technology, Application in Other Villagesmany products have started to In providing drinking waterreplace conventional way in pro- through PAM-RT and environ-viding drinking water for house- mental sanitation through CLTS,hold. At the moment, clean and the community is encouragedsafe drinking water treatment and empowered to be the subjecteffort for households with appli- and no longer just an object.cation of treatment technology is Furthermore, the Healthcontinue to be improved. Minister hopes that the CLTS A National Conference of activity will continue to be accel-Drinking Water Treatment for erated to other villages all overHouseholds (KONAS PAM-RT) Indonesia so that along with Desaand launching of Community Led Siaga Program, as the pillar ofTotal Sanitation (CLTS) activities Healthy Indonesia Program 2010in 10.000 Villages was held on that has been established by the20-21 August 2008, at Jakarta. Health Department, the commu- The conference that was held Health Minister, Siti Fadhillah Supari, visiting the stand nity will be able to practice clean of Watsan Network. Pic: Bowo Leksonoby the Health Department of and healthy life.Republic of Indonesia in cooperation On the speech occasion, Health Equally, the Directorate General ofwith Aman Tirta, Lifestraw and National Minister Siti Fadillah Supari denied the Disease Control and EnvironmentalWSES Working Group was opened by the media reports regarding unclear direc- Sanitation (P2 and PL) of the HealthHealth Minister of Indonesia Siti Fadillah tion of the health policies. "Direction of Department I Nyoman Kandun said thatSupari. This was also marked the launch- our health policies is clear, which is both PAM-RT and CLTS Programs musting of CLTS activities in 10.000 villages encouraging community to life healthy be replicated to all villages. "The pro-all over Indonesia. independently. This is in line with what grams refer to new and strategic Percik Desember 2008 3
  3. 3. M A I N R E P O RTapproach of community based. This has that Links with Water and Sanitation- one of the programs is providing watermade Indonesia as a learning place for Related Diseases," and the second speak- supply and basic sanitation facilities.other countries, such as India, er is the Head of Litbangkes of the Health Entering the 2nd session, seminarBangladesh, Pakistan, Philippine, Lao, Department Triono Soendoro presenting presented three speakers, namely Mariaand Timor Leste," he said. his paper "Riskesdes Results Related with Elena Figueroa, Abigael W. Ati from The purpose of this conference, Drinking Water and Clean and Healthy Independent Researcher, and Bonaficioaccording to Nyoman Kandun is to Life (PHBS)". Magtibay from Switzerland WHO.improve commitment and participation Nyoman presented, some infectious Maria Elena discussed "Understan-of policy makers and related parties of diseases are caused by the poor condition ding Behavior Change on PAM RT".drinking water treatment for household of the environmental health. According to According to her, poor quality of waterand CLTS. him, infectious disease is the high cause will continue to be the main thread of The conference with the theme of death on babies and toddlers. "Some health, thus we need to care on the beha-"Healthy Water for Life" is followed by environmental-based diseases such as vior in order for the water to be safe.around 400 participants from different Pneumonia, ISPA, TBC, DBD, Malaria Unsafe water, said Maria, is contami-organizations, universities, NGOs, com- and Diarrhea are closely related to nated water due to the transportation andmunity social organizations, donor coun- improper environmental condition," he storage factors, as well as treatment fac-tries, local government, and WSES said. tor on the household level. "These factorsWorking Group. While other activities of For that reason, continue Nyoman, are behaviors in need to be changed," sheseminar, workshop, and exhibition was community has to applied clean and said.followed by 14 participants. healthy life pattern in order to get the Various simple technologies with advantage. "The advantage is decreasing regard to the water treatment such asVarious Seminars Held numbers of patient and death caused by boiling, filtering, chlorination and floccu- After the Health Minister Siti Fadillah several environmental-based diseases," lation, solar disinfection, as well as UVhas finished looking through the exhibi- he said. light were applied.tion, the 1st session of the conference One of the priorities of the Health Director of Environmental Sanitationheld seminar that presented two speak- Department on 2005-2009 is overcoming Wan Alkadri on the 3rd session said thaters, Directorate General PP and PL of the infectious diseases (including controlling half of the people in Indonesia do notHealth Department I Nyoman Kandun factor of environmental risk) by applying have access to qualified water supply.who raised the issue of "Health Aspects Healthy Environment Program, which Lack of access to safe water is caused by poverty. According to Wan Alkadri, PAM RT advantages dramatically increase quality of water bacteriology which significantly able to reduce diarrhea. Other advantage, he added, is the most effective interven- tion for water, sanitation and health that can be done quickly by high risk commu- nity. "PAM RT is not a choice but more as completion in improving water supply facilities," he said. The two days conference held six sem- inar sessions and ended by a workshop and introduction of different alternatives of drinking water treatment and imple- mentation experiences in different areas. Exhibition of Drinking Water Treatment Technology Products To support the National Conference Watsan Network Stand on Konas PAM RT event. Pic: Bowo Leksono of Household Drinking Water Treatment 4 Percik Desember 2008
  4. 4. M A I N R E P O RT(KONAS PAM-RT), an exhibition was disaster or in emergency. This year, 1 bil- Pelita Indonesia Foundation present-held, presenting 14 stands that mostly lion Aquatabs will be used all over the ed drinkable ceramic water filter that wascomes from producers of drinking water world. made from clay. The filter is made in thetreatment technology products. Dian Desa, foundation that was estab- form of simple bucket with height and They are Aman Tirta who produces lished since 1975 at Yogyakarta is also diameter of 30 cm. The process to makeAir Rahmat, Life Straw, Pelita Indonesia, participated in presenting its products the filter is by providing aluminum printDian Desa, Bali Fokus, Aquatabs, Ye and services. Dian Desa Foundation and manual hydraulic tool will then printWater Program, Directorate General PP (YDD) is one of the oldest community the filter. The next process is incinera-and PL of the Health Department, Balai independent organizations that focus on tion. After incineration, ceramic filter isBesar Teknik Kesehatan Lingkungan community development activities in coated by colloidal silver. Combination(BBTKL), MERCK, CLTS, RW 08 Petojo between pores and the nature of colloidalUtara, Unilever Peduli Foundation, and silver that function as antiseptic producesWatsan Network. highly effective drinking water filter. Velocity limit of filtering is between In providing drinkingDrinking Water Purifier Product 1,5 liter to 2,5 liter per hour is acquired water through PAM-RT Many people from different layers with proper mixture and accurate inci-already know about Air Rahmat. This and environmental sani- neration temperature. The ceramic filterdrinking water purifier product for the tation through CLTS, can be used up to 1,5 years and must behousehold level was largely promoted. Air community is encour- replaced after its usage time is over.Rahmat product is in the form of liquid aged and empowered to Replacement can happen before thethat was marketed by Aman Tirta. be the subject and no usage time is over, usually because it Aman Tirta SWS Robert Ainslie said longer be just an broke or the filter pores are pluggedthat promotion model of Air Rahmat is object. because of the water being filtered is veryPrivate Public Partnership, which is a dirty/muddy.partnership program between govern- The process is as follows; raw water isment, NGO, and private sector. "In order run through the ceramic filter. Little byto guarantee continuity of the program, little, water will be absorbed in the poresAir Rahmat is commercially produced general and accurate technology develop- of the filter side that was previously coat-and distributed," he said. ment specifically. ed with germ-killing material. Absorption Drinking water purifier product in the One of YDD programs is community- period is between 1,4 liter to 2,0 liter perform of effervescent (self-dissolve) chlo- based water supply, sanitation, and waste hour. The absorbed water will be con-rine tablets is called Aquatabs. This puri- management. Product and service which tained in a special and safe container forfier product was produced by Medentech in this occasion is presented are Sodis food and beverage materials so that thewho also supplies Aquatabs all over the and PUR. produced water will be drinkable and notworld since mid 1980s. Sodis (solar water disinfection) is contaminated by chemicals. This ceramic Michael Gately from Medentech in his drinking water that was treated by sun filter is capable of filtering 98 to 99,88paper presentation said that Aquatabs is light heat. The principle of this technolo- percent dangerous parasites and bacteriacapable of killing micro-organism in the gy is boiling water with the help of sun from the drinking water.water to prevent diarrhea diseases such light and utilizing waste packages of mi- While Bali Focus presented the prod-as cholera, typhoid, dysentery, and other neral water plastic bottle to acquire uct of BioSand Filter which latter onwater-source diseases. "This product is drinkable water. applied as water treatment tool at house-used at household level by disinfecting PUR is a mixture substance of water hold scale in urban poor settlement.the water," he said. purifier powder that can be lethal for Such as in previous exhibition, Aquatabs is used by placing it in the pathogenic bacteria and removing solid Watsan Network presented various prod-water storage, wait for 30 minutes. Prior content in the water so that contaminated ucts of information. The exhibition eventto the use, smashing, stirring or mixing of water is turned into clean, safe and is part of the effort of improving drinkingthe tablets is not required. Aquatabs will healthy water to be drink. PUR is packed water profile and environmental sanita-not cause changes on color, odor or taste, in sachet containing 4 grams of PUR pow- tion in Indonesia by providing access toor chlorine residue level after 24 hours. der. Each sachet can be used to treat 10 qualified information for all members ofThis product is normally used to handle liters of water. the network and stakeholders. BW Percik Desember 2008 5
  5. 5. M A I N R E P O RT Community Led Total Sanitation (CLTS) in IndonesiaI n point of fact, the worlds concern with regard to the sanitation issues is increasing. This is proven by somany sanitation-related conferences thatwere held at regional, national, or inter-national level. PBB has even establishedthe year 2008 as International Year ofSanitation. In Indonesia, the effort to improvequality and coverage of sanitation servi-ces has started to show some improve-ment. Various activities in order to sup-port development in the drinking watersector and environmental sanitation arecontinued to be done among othersthrough the development approach ofcommunity based sanitation. However, sanitation sector achieve-ments are still far from what is expected. Facilitators are conducting CLTS triggering to the mothers in the villages that are still practicingSanitation has not become a big issue that open defecation. Pic: Bowo Leksonois capable of influencing political issues of babys and toddlers diapers; 14 percent known as Community Led Totalthis country. This affects the budget that wash their hands before eating; 7 percent Sanitation (CLTS). Total sanitation referswas provided to develop the sector. For before feeding their babies; and 6 percent to ending the practice of open defecation,the last 30 years, the Government of before preparing food. Washing Hands With Soap (CTPS),Indonesia has only provided Rp 7,7 tril- Another result of BHS study with drinking water treatment of the house-lion, which means only Rp 200 per year regard to the drinking water treatment of hold (PAM-RT), waste water manage-for every people in Indonesia. the household (PAM-RT) is that 99,20 ment and domestic solid waste manage-Nevertheless, the need for minimal access percent boiled water for drinking, but ment. The CLTS approach that was devel-to proper sanitation facilities is approxi- 47,50 percent of the water still contain oped by Kamal Khar facilitates themately Rp 47 thousand per people per Eschericia coli (E coli) bacteria. Not to process of community empowerment toyear. mention the lack of people awareness to analyze situation and risk of environmen- Another fact is poor sanitation prac- properly manage the solid waste and safe- tal pollution that was caused by ignoringtice among the community. The result of ly manage the waste water/liquid waste. total sanitation management. Of the fivestudy that was done by Indonesia These facts contribute on the high pillars of total sanitation, CLTS prioritizeSanitation Sector Development Program numbers of diarrhea incidents in on ending open defecation as the gateway(ISSDP) in the year 2006 shows that 47 Indonesia. More often than not, Extra of introducing the concept of total sanita-percent of the people are still practicing Ordinary Event (EOE) of diarrhea strikes tion to the community. Other than that,open defecation. While based on the an area where the people take less heed building and using toilets without out-study of Basic Human Services (BHS) in on clean and healthy lifestyle. sider subsidy. The no-subsidy approachthe same year resulted in the data that was based on the past failure of tradition-only 12 percent of the people wash their CLTS Approach al approach in providing sanitation infra-hands with soap after defecation; only 9 One of the government efforts is by structure in the rural area that waspercent wash their hands after changing introducing total sanitation approach focused more on providing the infrastruc- 6 Percik Desember 2008
  6. 6. M A I N R E P O RTture instead of behavior changing. This approach was introducedthrough visit of the Government ofIndonesia to India and Bangladesh in theyear 2004. After the visit, it was agreed toconduct trials of CLTS model since May2005 in 18 communities on six kabu-patens of six provinces with differentcharacteristic. The trial results were con-sidered to be quite successful. The indica-tor was, within one implementation year,this approach has brought 159 communi-ties to be free from open defecation and An inscription regarding free of open defecation that was signed by the Bupati.changing defecation behavior in approxi- Pic: Bowo Leksonomately 28.000 households. CLTS approach is simply abstracting The Enter of CLTS Approach to Indonesia Cprinciples of relying on active participa- LTS approach was introduced by Indonesia in cooperation with thetion of the community, without outsider Kamal Khar from India on the World Bank has designed a PAMSIMASsubsidy, social solidarity, and communi- year 2004. In the same year, the project in 115 kabupatens. The pro-tys pride as the element of motivation. Government of Indonesia made a com- gram adopted CLTS approach in the In the end, it is not physical number parison study to India and Bangladesh. design. Application started in mid 2005, when July 2007 becomes the most impor-of toilets that was used as success indica- the Government launched the use of tant era for CLTS development intor, but behavior changing from open the method in 6 villages on 6 Indonesia, because the Government (indefecation to the use of familys toilet. provinces. On June 2006, the Health cooperation with the World Bank) hasThis represents major changes that were Department declared CLTS approach as started to implement a project thatnot occurred in previous projects because national strategy for sanitation pro- adopted the approach of total sanita- gram. tion under the name Total Sanitationthey were not based on empowerment On September 2006, WSLIC Program and Sanitation Marketing (TSSM) orand independent. decided to apply CLTS approach as Sanitasi Total dan Pemasaran Sanitasi replacement of rolling fund in all pro- (SToPS). Asian Development Bank (ADB)STBM as CLTS Expansion gram locations (36 kabupatens). At the also adopted CLTS approach on its san- The success of total sanitation devel- same time, several NGOs have started itation program of Clean Water,opment by applying CLTS model in dif- to adopt this approach. In January to Sanitation and Health (CWSH) on 20 May 2007, the Government of kabupatens in Indonesia. Edy/Udinferent areas in Indonesia is continued tobe developed to be latter adopted asSanitasi Total Berbasis Masyarakat the effort to apply the five STBM pillars of total sanitation in different areas.(STBM). STBM represents a movement by establishing cooperation with differenttoward clean and healthy lifestyly stakeholders so that total sanitation deve- Government Readiness in Regula-(PHBS). lopment in Indonesia is better aimed at. tion Within the STBM movement, there Other than that, strategy strengthen- Government concern in the sanitationare five pillars, namely the use of toilets, ing is also done by establishing network sector and improvement of clean andwashing hands with soap (CTPS), drink- between stakeholders. Thus the Watsan healthy lifestyle is reflected in theing water treatment on household scale, Network was born that in the future is National Medium-Term Developmentand household scale solid waste manage- expected to be able to drive sanitation Plan (RPJMN) year 2004-2009. Withment. Various parties have conducted the development in Indonesia. regard to the matter, a National Strategyfive STBM pillars but they have not well- The Government in cooperation with of STBM has been formulated throughcoordinated. NGO, donor agencies such as Unicef and Kepmenkes RI No 852/Menkes/SK- For that reason, the Government Plan International, universities, private /IX/2008. The National Strategy will bethrough the Health Department support- sectors, and other stakeholders are con- the foundation of STBM actions. Bowoed by WSES Working Group continued tinue to held trainings and developments Leksono Percik Desember 2008 7
  7. 7. M A I N R E P O RT STBM As the Approach Method to Achieve MDGs Targets on the Sanitation SectorI ndonesia is still facing big challenge in realizing access to sanitation facilities. According to the survey ofJoint Monitoring Program (JMP),Indonesias coverage is 55 percent (2004)which is below the average of sanitationregional coverage of East Asia and Pacificthat reach 67 percent. This shows that 45percent or 100 million people inIndonesia are still practicing open defeca-tion on river, field, pond, and other openspaces. Clean and healthy lifestyle is alsoproven to be very low, proven from thesurvey result that shows the people whoare practicing washing hand with soap(CTPS) on five critical time which arebefore touching food, before feeding thebaby, before eating, after changing babysdiaper, and after defecation still less than15 percent. The condition contributes to the highincidents of diarrhea in Indonesia.National diarrhea incidents in the year Local toilet producer at Bedali Village, Ngancar Kecamatan - Kediri. Pic: special2006 is 423 per one thousand people of WHO study result in the year 2007 i) have less leverage power in increasingall ages and 16 provinces experienced proven the number of diarrhea cases can demand of the people in general for sani-KLB of diarrhea with Case Fatality Rate be reduced up to 32 percent by improving tation coverage and behavior change, ii)(CFR) of 2,52. access of the community to basic sanita- less successful on involving the private The poor condition of sanitation facil- tion, 45 percent by practicing washing sector in creating market mechanism thatities has caused the economic loss of 2,4 hands with soap, 39 percent by safe provided different options widely for thepercent of Brut Domestic Product (BDP) drinking water treatment on household poor people so that the expected leverageor every household experienced econom- scale. Intervention by integrating the power on health improvement cannot beic loss of approximately Rp 120.000 per three efforts can reduce the number of seen optimally.month (ADB study 2002). On the other diarrhea accidents by 94 percent. With the limited ability of the govern-side, WHO study in the year 2005 shows A lesson from the history of sanitation ment and other development agentthat every 1 US$ investment to improve program in Indonesia shows that the (donor), in the effort of improving com-sanitation facility will generate economic approach by prioritizing physical subsidy: munitys access on sanitation facilities,return of 8-21 US$.8 Percik Desember 2008
  8. 8. M A I N R E P O RTnew strategy and method is required to be to fix sanitation facilities by differentable to drive potencies of the community options of offered facilities and funding Creatingand private sector in the effort of improv- Condusive scheme accordingly with the communi- Environmentaling access to sanitation facilities and tys need.clean and healthy lifestyle. iii) Building capacities of central and local governments in the effort of creatingThe Efforts Institutional and conducting policies that will support Sharing knowledge, skill, and expe- continuity, effectivity and efficiency ofrience in the effort of developing the sanitation programs by conducting Creating demand Improving Supplyapproach method of effective and on improved and Hygiene and advocacy on stakeholders. sanitation & improved sanita-efficient sanitation programs by Hygiene tion servicesactively involving community and uti- Approach Componentslizing the existing potencies. The mecha- ty of total sanitation and sanitation mar- To realize total sanitation community,nism is by paying visits to more experi- keting (TSSM) that includes 29 kabu- implementation is carried out phase byenced neighbor countries, excepting visits patens. The activity represents coopera- phase with the main priority of improvingfrom other countries for the learning pur- tion between Central Government and access to sanitation facilities through col-pose, and national/regional seminars. Water and Sanitation Program for East lective behavior changes by utilizing Pilot implementation that was inte- Asia and the Pacific (WSP-EAP). existing potencies in the community.grated with the existing WSES programs Gradual behavior changes using thein order to acquire learning and method STBM Approach sanitation latter that was started byperfecting that will be developed as one of Accordingly with Kepmenkes No behavior changes of community fromthe approaches on sanitation programs 852/MENKES/SK/IX/2008 on National open defecation (OD) to the phase ofespecially in the rural areas by utilizing Strategy of Community Led Total open defecation free (ODF) with the crite-collective behavior changes as the core of Sanitation, total sanitation in one com- ria of no one practicing open defecation.community motivation to perform munity is: i) Not practicing open defeca- The process used Community Led Totalchanges. tion, ii) Washing hands with soap, iii) Sanitation (CLTS) method by prioritizing Establishments, launchings, declara- Safely managing drinking water and food, collective behavior change for not practic-tions, and seminars were attended by iv) Properly managing solid waste, and v) ing OD. This was done through socialdecision makers and stakeholders at Safely managing household waste water. development process that was completednational, provincial, and local level in the Every factor in total sanitation has by facilitators inside and outside the com-effort of disseminating the approach three components that support the munity.method, so that in the future, they are approach of each factor, namely: To accomplish improved sanitationexpected to be able to making decisions to i) Improving demand is the effort of facilities, strengthened by promotionbe developed at their own regions. The improving communitys demand on sani- activity, introductory of different afford-approach method pattern has been tation for all through different advocacy able options for all people, different fund-informed to all provinces and developed and promotion activities total sanitationin kabupatens accordingly with their poli- such as improving under-cies or integrated with community standing of sanitation, all comunity use promoting hygiene, mar- toiletempowerment program in the area. Central Government through the keting product and servic-Health Department has established target es, creating incentive for open defecation free (ODF)of 10.000 villages to develop Community individual and community, Target : Building sanitation marketLed Total Sanitation (STBM) up to the and social control. open defecation Activities : Promotion (OD)year 2012 and signed National Strategy of ii) Improving supply Target : Behaviour change to environmental sanitationSTBM as foundation and guidance in and service by conducting Activities : CLTS and communicationdeveloping the program. cooperation with supplier, Target : Changing behaviour of OD Activities : CLTS and change East Java Province is one of the factories, and service pro- communicationprovinces that have been appointed to viders to learn the ex- IMPROVEMENTdevelop STBM program with main activi- pectancy of local consumer CHANGE Percik Desember 2008 9
  9. 9. M A I N R E P O RT Budget between government and community investment in building toilet - Program STOPS East Java Achievement Process of CLTS Triggering FY 2008 (1 Nov 2007 - 30 June 2008) (Nov 2007 - Sept 2008 Period) Village number In Rp Total Village Total Village on going Total Village ODFing scheme models according to commu- nities. In areas with program support sanitation is under the authority of localnity affordability with the hope of creat- from the local government, time required government, thus require a more inten-ing market mechanism between con- to achieve ODF status in shorter, such as sive dissemination effort in introducingsumers and providers. in Senduro and Gucialit Kecamatans of community led total sanitation program Lumajang Kabupaten. so that local government can make deci-Learning 4. Community with changed attitude and sion to develop the program accordingly 1. Introducing the approach of sanita- thinking pattern will be followed by fast com- with local capability.tion program with community empower- munity movement to improve access on san- 2. The strong understanding regard-ment without granting physical subsidy is itation facilities with different strategies ing improving access to sanitation facili-not always welcomed by all related par- accordingly with the condition of the area. ties by providing physical subsidy to indi-ties despite prior advocacy to decision This will usually trigger similar movement in viduals in the community, especially deci-makers, field proving that community is other sectors according to the priority and sion makers at local level.capable still required. Proving is then needs of community. 3. Limited types of sanitation materi-done through declaration of open defeca- 5. Community does not only rely on al that is available in the market limitstion free in the villages. The community individual capability in improving access community in selecting technical optionsthen proves to be able to complete toilet to sanitation facilities, but they try to dig according to their affordability. Limiteddevelopment without subsidy attended by and use existed potencies around them information regarding technical choicedecision makers. This condition will be such as cooperating with suppliers/local selection to build toilet has led communi-the foundation for decision makers to material store to provide sanitation mate- ty to consider toilets as expensive.support policies of sanitation develop- rial with layaway paying scheme. Handyman ability in providing service ofment without subsidy. 6. Using local communication media building different types of toilet is still 2. The result of cost effectiveness is highly supporting the effort of expand- very limited.analysis shows that toilet development ing coverage of triggering and sanitation 4. Attitude, behavior, thinking patterninvestment by the community is 2-12 promotion. Communication material is and culture that do not care about thetimes more than the fund provided by the adjusted accordingly with the culture and surrounding environment, thus openlocal government. communitys level of understanding so defecation is considered to be common. 3. Applying sanitasi total berbasis that the message being conveyed will be 5. Survey result shows that toiletmasyarakat (STBM) approach by the able to be understood by the target development is still a low priority incommunity led total sanitation (CLTS) groups. As an example, Lumajang household expenses. For example, themethod prove that the approach is effec- Kabupaten was using local radio as media member of the household prioritize intive. On SToPS activities within seven to trigger one community and another. buying cigarettes or other social activitiesmonths of intervention, triggering has than in saving the money to build toilet.been done in more than 300 villages and Challenges Djoko WartonoODF achievement status is 262 commu- 1. According to Law No 32 Year 2004,10 Percik Desember 2008
  10. 10. I N T E RV I E W Director of Environmental Sanitation of the Health Department Dr. Wan Alkadri, M.Sc. "Implementation of STBM Program: Progress is Quite Promising" Foto: Bowo as campaign of Washing Hands With Soap Government, in this case Directorate General of Disease Control (CTPS) and Household Drinking Water and Environmental Sanitation (P2 and PL) of the Health Department, together with other stakeholders has found supreme formula in sani- Treatment (PAM RT), management of tation sector development in Indonesia. The community based household wastewater and solid waste, are Program of Community Led Total Sanitation (STBM) is able to move continue to be developed. community independently. How is the implementation and result of applying the program? The following is summary of interview between Percik and Director of Environmental Sanitation of the Health What are the challenges and how to Department Dr. Wan Alkadri, M.Sc. overcome them? The main challenge is not all stakehold-W hat was the reason for the ers understand and adopt the STBm Government to apply the STBM What is the Government role in the approach in the sanitation development andProgram? implementation of the STBM Pro- instead, still orienting on physical approach, Previous approach was not able to create gram? not behavior change. To overcome this, ourlarge scale demand for sanitation access and Government facilitates the program in step is to continue carrying out road shows inbehavior changes. It did not support expan- the form of formulating norms, standards, the framework of advocacy and socializationsion of the private sector that can provide guidance, advocacy and socialization, cam- to the decision makers and stakeholders.wide variety of options (supply capacity) for paign, monitoring, evaluation, and learning Moreover, media campaign and successusers/poor or richer community. The process. With regard to the Government role, learning from other areas are also completedapproach we have been using was also not cross sectoral institutions and other related in STBM implementation.providing significant impact on communitys stakeholders have formulated Nationalhealth and prosperity because it was done Strategy of Community Led Total Sanitation How are other parties outside thepartially (not integrated) and based on (STBM) and it has been legalized by Government involved? And how is thehousehold/individual (not community Kepmenkes No 852/Menkes/SK/IX/2008 synergy?based). on September 8th 2008. The program requires involvedness and synergy from various parties (Government, Before STBM Program, what are How is the result of STBM Program private sector, NGO, donor and community).the ongoing Programs and how are the implementation so far? The synergy that we are conducting is in theresults? After trials of STBM implementation in form of partnership and network develop- Previously we applied traditional Indonesia for one year, on August 20th 2008, ment, such as through the Watsan Network,approach for sanitation program, such as: the Health Minister launched 10 thousand Public Private Partnership for Washing 1. Building public toilets (MCK) villages for STBM activities up to 2012. Hands With Soap, synergy with donor agen- 2. Distributing free family toilets or in the Current status is the people in 807 communi- cies and NGOs (Unicef, ESP, Plan) in adopt-form of stimulant material package for con- ties (villages/dusun) and three kecamatans ing STBM approach in sanitation develop-struction, and have stopped open defecation, an accom- ment. 3. Distributing money to the community plishment that has never been achievedin the form of rolling fund. before. What are your expectancies? The three activities are using physical For the future, we are hoping that thisapproach where focus and success indicator Can it said to be successful? Or is it Program can be included in RPJMN 2010-were always on physical approach. With the other way around? 2014 so that it will become a priority programphysical approach, there was no significant We have not yet dared to establish it as a of the Central, Province, and Localleverage power to sanitation access because it success. However, the progress is quite Governments. Moreover, in the future we arewas not sustainable (people always rely on promising. We will continue to evaluate the hoping there will be synergy with PNPMsubsidy). Moreover, previous approach did approach and accelerate it by continue to Mandiri Program because basically, STBMnot improve behavior change, and many built maintain the quality of process and result. Program is community empowerment pro-toilets were not used. Other than that, other pillars of STBM such gram to live and behave healthy. Percik Desember 2008 11
  11. 11. R E G U L AT I O N Health Minister Decre No. 852/Menkes/SK/IX/2008 on National Strategy of Community Led Total SanitationO ther than poverty and educa- activities implementation with sectoral tion, health is the sector that and subsidy approach, a hardware that continues to receive public It is written in the law that did not provide leverage power or did notattention, especially when the three sec- sanitation is under the able to change hygienic behavior andtors become problems among the com- authority of Local improving access to sanitation. STBMmunity. Nevertheless, attention/concern underlined five hygienic behaviors, Government. However, infor health sector is still translated nar- namely end the practice of open defeca- reality, not all Localrowly, just on curing diseases; in reality, tion, washing hands with soap, safelywe have to admit, preventing is far better Governments carried out managing drinking water and food, prop-than curing. the responsibility. erly managing solid waste, and safely Prevention means more than avoiding managing household wastewater.different diseases. It also means much The National Strategy that was estab-lower health cost. Therefore, it is time for implementation of PHBS. lished in Jakarta on September 9th 2008people to realize how important it is to CLTS application and other PHBS contains explanation of principles and mainapply clean and healthy lifestyle (PHBS) activities is considered to be successful activities of the strategy. There are six strate-that was based on access availability to that they later on accommodated into gies, namely creating conducive environ-Water Supply and Environmental Sanitasi Total Berbasis Masyarakat ment, improving demand, improving sup-Sanitation (WSES). (STBM). STBM is also a program that ply, knowledge management, funding, and Talking about community awareness completed the National Policy of monitoring and evaluation.is not easy, but it is not impossible either. Community Led Water Supply and On this strategy, it is also explainedIn the implementation, a joint strategy Environmental Sanitation Development the role and responsibility of stakehold-based on National Policies of WSES sec- (AMPL-BM) ers of the sanitation sector. The role andtor with the focus on sanitation sector is responsibility were formulated for insti-required. The Need of National Strategy tutions from the level of It is believed that sanitation is not household/dusun/kampong, village,Implementation of Sanitation Pro- only personal issue but also joint issue kecamatan, kabupaten/kota, province,gram and responsibility of the stakeholders. It and national. The Government has addressed the is written in the law that sanitation is Health Minister decre on Nationalconcern by establishing PHBS in the under the authority of Local Government. Strategy of STBM becomes referen-Medium-Term Development Plan However, in reality, not all Local ce/guidance for health officials and insti-(RPJMN) for the year 2004-2009. This is Governments carried out the responsibil- tutions related with formulation ofin line with target achievement of ity. They prioritize action of curing the STBM-related planning, implementation,Millennium Development Goals (MDGs) disease than providing guarantee of monitoring, and evaluation. It is expected2015 which is improving sustainable health safety. to be able to be used as material to decideaccess to water supply and basic sanita- Therefore, another regulation with a policies accordingly with local conditiontion to half of the people without access. more practical nature in the form of and to trigger creation of conducive envi- In practice, the Government together national strategy is realized in the form of ronment, improving demand, improvingwith other stakeholders have applied the Keputusan Menteri Kesehatan Republik supply, and knowledge managementactivity by implementing trials of Indonesia on National Strategy of regarding sanitation access and hygienicCommunity Led Total Sanitation (CLTS) Community Led Total Sanitation. community behavior in order to improveand other activities such as Washing The National Strategy of STBM is health degree and prosperity of commu-Hands With Soap (CTPS) in relation with started from experiences of previous nity. Bowo Leksono12 Percik 2008 Desember
  12. 12. INSIGHT Institutional Dimension in CLTS Dispersion in IndonesiaS ince the start of CLTS pilot project in train village officials, but also apply CLTS at Indonesia in the year 2005, there are By: Edy Priyono* village level. plenty of developments/progresses. Health Agencies (at Muara Enim andThis attracts several agencies to carry out Working Groups in different levels of gover- Sambas) also perform triggering activities.review on CLTS in Indonesia. Among other nance, but only coordination relation. This situation was not found at Pandeglang,is review that was done by Akademika - In general, the Health Department is the because CLTS have not been adopted as pol-Center of Public Policy Review that was key institution in the local level. The wish of icy of the local government. Nevertheless,focused on institutional dimension in CLTS kabupaten/kota to adopt the CLTS approach government of Pendeglang Kabupaten diddispersion. This review specifically wants to is not only decided by provincial policy, but not reject CLTS. For now, "not rejecting"answer the key question of impact of institu- also by capability of the Health Agencies of position is considered to be conducivetional arrangement on CLTS, both from kabupaten/kota to convince the enough.implementation speed and success, and dis- mayor/bupati; this because in the decentral- NGOs role in CLTS application can onlypersion. The study was completed at 3 kabu- ization policy, there is no commando line be seen at Pandeglang. CLTS at Pandeglangpatens of Pandeglang, Banten Province; (instruction) between province and kabu- was initiated by international NGO calledMuara Enim, Sumatera Selatan Province; paten/kota. PCI (Project Concerns International) inand Sambas, Kalimantan Barat Province. Between the three study locations, the 2006. Since 2007 until date, the implemen-The following is summary of several findings role of provincial government is only signifi- tation is continued by local NGO (Harfa).of the study. cant at Sumatera Selatan Province. The NGO is involved in every step of CLTS Governor issued a decision letter (SK) asking implementation, except in the phase of poli-Institution Involvedness local governments to apply CLTS approach cy formulation which is under the authority Implementation and dispersion of CLTS gradually. Provincial Health Department fol- of government.in Indonesia involve different institutions, lowed up by conducting CLTS trainings in all Puskesmas role is most significant atboth governmental and non-governmental, kabupaten/kota. Responding to the Muara Enim. Puskesmas is actively conduct-which is Central Government (Health Governors SK, Muara Enim Bupati issued ing promotion, training, triggering, andDepartment), especially Directorate General an SK of CLTS Technical Team establish- monitoring of CLTS. Puskesmas works veryof Disease Control and Environmental ment that was assigned to train government closely with community. At Pandeglang,Sanitation, is the key institution in the officials in kecamatans. After the training, there werent many villages that are trig-national level in CLTS implementation in interested kecamatans officials also issued gered by Puskesmas, because Puskesmas isIndonesia. an SK of technical team establishment at only at position of "supporting" NGOs work. CLTS also involves other institution than kecamatan level that not only assigned to While at Sambas, Puskesmas role is not sig-Health Department. At the moment, thereare three other institutions that are involved,namely National Development PlanningAgency (Bappenas), Domestic AffairDepartment, and Public Work Department.Moreover, there is also and ad hoc institu-tion, which is National WSES WorkingGroup. WSES Working Group is also existsin several provinces and kabupaten/kota.The provincial Working Groups are underthe governor, and kabupaten/kota WorkingGroups are under bupati/mayor. There is noboss-subordinate relation between the Officials of Lembak Puskesmas, Muara Enim Kabupaten together with midwives, is actively carrying out CLTS Program triggering. Pic: Bowo Leksono Percik Desember 2008 13
  13. 13. INSIGHTnificant. The existence of instruction line (direct sion in this area happened faster than in Active role of the midwives is only signif- relation) between local governments, health other areas.icant at Muara Enim. There are at least two agencies, puskesmas, and midwives, and Although CLTS dispersion at Muarareasons behind limited role of the midwives instruction line that connect local govern- Enim happened quickly (as the result ofat Pandeglang: (1) CLTS is still managed by ments, kecamatan and village officials, rep- institutionalization), there was "a price" toNGO who hires special facilitators and resents indication of the importance of this pay for the success. Compare to the otherplaced at every CLTS village, while midwives condition in CLTS dispersion. If these rela- two areas (Pandeglang and Sambas), moti-only helps the work of facilitators, and (2) tions are working right, with good coordina- vation in accepting CLTS as a good approachmidwives do not stay in the village thus mak- tion between the two, CLTS implementation seems to be more because of "assignmenting interaction with community less inten- and dispersion at kabupaten/kota can be from higher level of government". In thesive. expected to proceed properly. Another rela- contrary, CLTS implementation at Sambas Posyandu cadres are women who volun- tion that cannot be left behind is the relation seems to be more "natural", however, dis-tarily help village midwives to run Posyandu between legislative and executive. persion is slow. This phenomena indicates(integrated health post). In Pandeglang case, Legislative position (politically) is stronger trade-off between CLTS "quality" (as bot-the cadres help facilitators in CLTS imple- than the executives. this indicates that the tom-up approach and based on communi-mentation. effort of influencing local governments to tys needs) and speed of dispersion. In CLTS concept, the role of natural adopt CLTS does not always have to set aside The case at Tengguli Village, Sambasleader is very important, and usually is more the legislative existence. Kabupaten also shows that the learningimportant than the role of formal head of the process between villages is not somethingvillage, especially in implementation and Institutionalization Dilemma that can happen easily. The next villagemonitoring of CLTS. For facilitators, as long Basically, the purpose of institutionaliza- located just next to Tengguli Village did notas the formal leader is in the "not rejecting" tion is making CLTS as part of the official adopt CLTS. On cases like this, outsiders ini-position, it is enough for them to implement program/approach of the government. tiative is important to encourage villages thatCLTS. However, CLTS will not be able to run Institutionalization is necessary for CLTS have not implement CLTS to follow the traceproperly without real support from the natu- dispersion, because the government is the of other villages that have successfully imple-ral leaders. only institution with authority that covers all ment CLTS. Basically, donor agency provides sup- areas in the country. Without institutional- In general, the top-down approach is notport in CLTS implementation. The World ization, CLTS can only be implemented in recommended to be use in CLTS (see KarBank is involved with AusAid through limited area, or can only be implemented in and Chambers, 2008; Kar and Bongartz,WSLIC2 Project at 36 kabupatens, and short-term. However, in some cases, too fast 2005). Nevertheless, if the speed of CLTSinvolved in the TSSM Project through its of institutionalization will cause dilemma dispersion is the main purpose, there is noWSP (Water and Sanitation Program) at 29 and new challenge (Kar and Pasteur, 2005). other option than to compromise with thekabupaten/kota of East Java (working As mention before, until date, most top-down approach. This is in line with rec-together with Bill and Melinda Gates CLTS activities in Indonesia are still project- ommendation to be more flexible in imple-Foundation), also involved in the project of based, or part of NGO activities. In this situ- menting CLTS at areas where subsidy forPAMSIMAS that covers 110 kabupaten/kota ation, at least there are two institutionaliza- sanitation developments is inevitable (Karin Indonesia. While ADB supported the tion processes in CLTS dispersion in and Bongartz, 2006). The question is then,Project of CWSH that covers 20 kabupat- Indonesia, which are: (1) transfer process until what level is top-down approachen/kota in Indonesia. from project-based activities to regular pro- acceptable? Based on the observation in the gram of the government, and (2) transfer field, top down approach is still acceptableRelation between Institutions process from NGO to the government, espe- up to kecamatan level. The use of "instruc- Decentralization policy has implication cially local government. tion" to village officials or lower level of gov-on the absence of command line between CLTS at Muara Enim becomes an inter- ernment could resulted in no different out-Health Department (in the central level) and esting case to study the transfer from project puts from other sanitation approaches (thatProvincial or kabupaten/kotas Health activity to government program. As have been trying to be "corrected" by CLTSDepartment. Sectoral policy that was issued explained before, Sumatera Selatan concept) such as forging the status of ODF,by technical agency (such as the Health Province/Muara Enim Kabupaten is the temporary ODF, or even just building toiletsDepartment) does not have power to "force" only location that has official policy in CLTS without ODF.kabupaten/kota to apply the policy. implementation. No wonder CLTS disper- At Pandeglang Kabupaten, transfer of14 Percik Desember 2008
  14. 14. INSIGHTprogram ownership from NGO to local gov- build communal toilet, every household pro- actually not in accordance with the need-ernment has been slow. Until date, after two vides contribution of Rp 50,000. For those base basic principle of CLTS. If the commu-years of implantation, there is still strong who cannot afford it, no interest loan is pro- nity really need good sanitation, reward isimpression that CLTS is "NGO program that vided, with layaway method. In other word, not necessary to realize it.was supported by local government", and "pressure" for the people to implement Conducive Policynot "local government program that was CLTS (toilet development) at Sambas was One of the important factors that sup-supported by NGO". One of the key prob- done in a more "formal" way. port the success of CLTS implementation,lems is lack of political will from Bupati of Until date, government has not come up especially in the early step, is the existence ofPandeglang to adopt CLTS approach. In the with a reward system for kabupaten, village, facilitators who are capable to answer vari-long-term, CLTS at Pandeglang will only or community who successfully implement ous questions from community, encouragebecome an NGOs program. CLTS (with ODF status). At Muara Enim, the role of community, and work together local government initiated a reward system with community leaders.Incentive, Reward and Sanction with bottom-up approach. Reward system One of the interesting cases to be In some cases, CLTS implementation that was based on the need of community is observed in relation with facilitators hap-also provides incentive to local bureaucracy. also developed by PCI for villages that have pened at Pandeglang, where PCI as CLTSThis incentive does not come from "the bot- implemented CLTS, such as carried out by initiator recruited special person to be facili-tom" but from higher level of bureaucracy. CWSH project at Sambas. Villages that suc- tator who works and stay in the village.Reward from the central (Health cessfully achieved the status of ODF are When local NGO (Harfa) is appointed as theDepartment) is the main factor in the effort given reward in the form of public facilities organization that will continue the work ofof encouraging local initiative to adopt CLTS accordingly to the need, such as facilities of PCI, Harfa did not require their facilitator topractice. water supply, road, and electricity. From stay at the village. As the result, CLTS imple- The people in the villages that adopt idea point of view, this system is good (at mentation does not proceed as good as or asCLTS approach can be separated into two least compared to reward in the form of cash intensive as when the program was directlygroups, namely: "innovator" group and "fol- money) because other than it was based on managed by PCI. This shows that facilitatorslower" group. Innovator group accepts CLTS communitys need, the benefit will be felt by who work "closely" with the community areapproach that was encouraged by their need many members of community. very important.to have better sanitation condition. In the At Sambas, there is no reward for vil- With regard to the above condition, onecontrary, follower group accepts CLTS lages that implement CLTS. Nevertheless, of the key successes of CLTS dispersion atbecause they were requested to, or (at cer- local government of Sambas has tried to Muara Enim is the major role of Puskesmastain level) forced to by the innovator group. facilitate special public facility (ones outside and midwives in applying CLTS. This role At Pandeglang Kabupaten, innovator the authority of local government) for vil- came up as the result of conducive policygroup was formalized in the form of team lages that have implemented CLTS. As an (enabling environment). According to thecalled Feces Exterminator Team with 5 (five) illustration, local community at Tengguli applied regulation, midwives must stay atto 8 (eight) members. The team is trying to Village have long for telephone network, their work location to be able to work effec-persuade households in the area to build toi- thus local government encourages cellular tively. At Lembak Kecamatan (Muaralets. The approach was persuasive approach telecommunication service to build BTS Enim), all midwives obeyed the regulationthrough various ways, including offering free tower at Tengguli Village. At the moment, and stay at their assigned villages. Thus,massage service for the targeted head of community can enjoy access of cellular midwives of Lembak kecamatan are able tohousehold. For persistent households, the phone in their village. play the same function as PCI facilitators atlast step taken by the team was building toi- Other than the problem of government Pandeglang.let for them with the hope that it will embar- limitation in realizing the form of promised The authority to allocate sourcerass them. At Muara Enim, social sanction reward, there are other reasons why the (budget) is an important factor forwas applied to the persistent households by reward system must be designed wisely. Puskesmas involvedness on CLTS. Fromrougher way, such as slinging their houses. First, until date, there is no verification sys- the three study locations, only Puskesmas At Sambas, toilets were built communal- tem to evaluate the ODF status of the village. at Muara Enim that has authority toly (one toilet for 5-10 households). Toilet Through evaluation, we can see whether the arrange the allocation.developments at Sambas are coordinated by ODF status is temporarily or able to sustain *Akademika-Center of Publicformal institution of RT (neighborhood). To for long period of time. Second, reward is Policy Review, Bekasi Percik Desember 2008 15
  15. 15. INSIGHT Community Empowerment and CLTS Approach/MethodI n general, the people at the village river water has large volume and flowing. By: Owin Jamasy still perceive CLTS approach/me- This condition is the background of the thod as the process of building fam- use of river water and its kind. For villageily toilets without further understanding their times on the farm (paddy field, yard, people who really need clean water, it ison wider sanitation definition which and mountain). They usually left at 6 in possible to be use for drinking and cook-relates with clean and healthy lifestyle. the morning and back at 4 in the after- ing.This fact may be caused by two factors, noon. Some of them brought food from The people in the village with Islamnamely 1) Planning process during trig- the house and some of them dont. When religion have divided water criteria intogering is more stressed on building toilets they are in the farm, the first choice to pee three types; 1) holly water, 2) clean water(not on the form of public sanitation that or defecate is around their farms, or in the that cannot hollified, and 3) dirty wateris also the environment problems, for ditch and river around the farm. (cannot be use for wudhu). This waterexample managing wastewater, water division is certainly different from healthpuddle, cattles barns surrounding the Using the River Water in the point of view that does not recognize hollyhuman settlement, and washing hands), Perspective of Islam Religion or unholy water. From the health point ofand 2) At the moment, sanitation pro- For the village people in West Java, view, at least there are three types ofgram through CLTS approach/method is Banten, and West Sumatera, whose water; 1) physically and chemically cleannot considered to be done. majority belief is Islam; there is no specif- water; 2) sterilize water, and 3) dirty Accordingly with the basic concept, ic restriction in consuming the river water water because it contains germs.CLTS approach/method prioritize more (for wudhu, cleansing, and washingon accelerating awareness to behave clothes). Community knows and aware Open Defecation on the River andproperly and independent toilet building that water of the river, lake, and of its Etiquette Issue?(without subsidy). kind are not for drinking or cooking rice. The problem of open defecation on It is true, that river water from health the river is an etiquette problem. TheyBetween the Life of Farmers, Defe- aspect is not qualify, both physically and will only feel shame when part of theircation, and Etiquette chemically. Physically it is obvious, for private parts (around the bottom) is obvi- Farmers in the village spent most of example from turbidity and color, but ous to other people who are not family, especially the opposite sex. Among the people of Minang ethnic, it will be a great shame if children in law are caught seen by parents in law. It is not easy to make people realize/aware because they always have reasons which are right according to them. They realize that what they are doing is wrong but they like to justify themselves. Awareness process cannot be done revolutionarily, but evolutionarily. In the awareness process, community facilitators and natural leaders always raise the "mistake" topic. Community is shown to not justify wrong things such as showing private parts of their body because this is forbid- Despite of having toilets, many people are still paying less attention to the family waste. den by religion (Islam). Defecate on the Pic: Bowo Leksono16 Percik Desember 2008
  16. 16. INSIGHTriver will also pollute the river and disad- the one that relates with the sanitation. are women. The same case also found atvantage people who are living at the The reason behind success case at other villages including Sindanglayadownstream who are incidentally using Padang Doto, Sindanglaya and Margajaya Pagelaran, Banten.the river water for certain use. If this is is because natural leader worked together Natural leader with women membersthe case, then defecating on the river is with the head of the village/Kepala also has another agenda, which is to facil-considered to be wrong and sinful. Jorong and other informal leader/figures. itate influence to the women or house- At the same time they conduct CLTS wives. When natural leaders are mostlyNatural Leader, Gender and Status approach/method and triggering regular- women, it is easier for them to meet theSymbol ly as well as visit to the community. women or housewives in performing The term natural leader is not perma- CLTS approach/method.nent, because at Ciamis, West Java it is Natural Leader ad Status Symbolknown as CLTS Team, at Pandeglang Become the member of natural leader Is CLTS Approach/Method RelatesBanten, it is known as the Health Team of is a (positive) status symbol for village With the Problems of Right andthe Village, and at Sijunjung West community because they are the motiva- Justice?Sumatera, it is known as Natural Leader tor, facilitator, and chosen by the people. It is not directly related, but with fur-Team. Despite the different, they have Not all members of the community is ther observation, we will able to see it. Itsimilarity in the role and establishment willing to be natural leader because of is the right for everyone to defecate wher-process. work reason and not having enough time ever they want. However, they will have They are groups of individuals who to actively taking role as natural leader. to know their responsibility. Both regu-receive trust (choosen) by community for lated by religion or cultural law.the good nature and capacity, in knowl- Natural Leader and Genderedge, skill and attitude. They also have Right equality between women and Is CLTS Approach/Method Relatesinfluence because of their position in the men in natural leader groups is moving With the Problems of Poverty andvillage as leaders of public figure. Their toward positive development. At Empowerment?knowledge and skill are gained from Sijunjung, West Sumatera, most mem- The relation is obvious. However themeetings, trainings, or education. bers of natural leader are women. main problem needs to be understood. In a case at Sorong, Tarandam Kam- Looking at the case at Padang Doto, out of Poor people are identical with emergencypong, Sijunjung, West Sumatera, there 12 members of natural leader, 10 of them condition, less condition and uneducatedare natural leaders whose member is ateenage girl who just finished her JuniorHigh School. They are chosen because oftheir own willingness, because other Tidak perlu membangun jamban yang mahal. Cukup yang sederhana karyoung people went outside the area, also terpenting memenuhi syarat kesehatan. Foto Bowo Leksonobecause other leaders do not have plentyof time to be active in the activity. This condition is proven to be disad-vantageous. They (as natural leaders)become less active when performing con-sorting and triggering to older membersof the community, or those with higherposition in the village, they were not ableto convince the people or lost in dialogueand discussion. The existence of natural leader or itskind really supports the acceleration pro-gram of behavior change on clean andhealthy lifestyle. The more active they arethe faster the acceleration program willsucceed in changing behavior especially Community who conducts MCK activity on the river side without feeling shame. Pic: Bowo Leksono Percik Desember 2008 17

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