1) Promoting chlorine-based point-of-use water treatment in Indonesia required understanding local boiling traditions and overcoming perceptions that boiling was the only safe method. 2) Using an ecological framework, factors at multiple levels influenced adoption of the new technology, including social networks, community institutions, gender norms, and exosystem events. 3) Lessons included gaining government support, ensuring product availability, mobilizing communities, and addressing individual motivations like taste and smell through promotion and advocacy across different systems.

1. lessons learned from promoting
chlorine-based point-of-use water treatment
technology
AMAN TIRTA
2006-2010

2. INDONESIA
Binjai, Medan Makasar, Maros, Bantaeng
Serang, Tangerang, Jakarta Malang, Surabaya

3. Boiling
the main drinking water treatment method
% of households that boil their
drinking water
0
50
100
Binjai
Bantaeng
Maros
Tangerang

4. People boil…
 To make water safe to drink:
 to kill germs
 to get rid of limestone
 believed to have no side-effect
like chemical substance
 To serve better drinks:
 warm or hot drinks
 tastes better

5. boiling is believed as…
 A tradition: “our parents, our ancestors boiled their drinking
water, and so do we. It’s a tradition”
 Practical!
 For smart people: “people here are smart and
knowledgeable, they know that water needs to be boiled”

6. Percentage of households with E.coli
contaminated boiled,
ready to drink water
0
10
20
30
40
50
60
70
Household drinking water
%
Tangerang
Mauk
Binjai
Bantaeng

7. “there are ways that are as good
as boiling to make drinking water
safe”
agree
40.36%
disagree
41.73%
neutral
18%

8. 1) creating a commercial, non
subsidized sustainable product
2) creating demand for a new
technology, through community
mobilization activities, media
campaign
3) enabling environment to foster
sustainability through advocacy and
collaboration with institutions.
AMAN TIRTA

9. CREATING SUSTAINABLE PRODUCT
muRAH -- economical
Mudah -- easy to use
sehAT -- healthy
1.25% sodium hypochlorite
PT Tanshia Consumer Product
Rp. 5,000 per 100cc bottle to
treat 660 liters of water

10. DISTRIBUTION
 Traditional distribution scheme
 drugstore kiosk, traditional market
modern trade (local minimarket)
 Non-traditional distribution scheme
 Community leaders and community health kaders

11. PROMOTING Air RahMat
 Above the line: TV commercial, TV and
radio talk show
 Below the line: experiential marketing

12. Advocacy and partnership
Community mobilization
• community
• school

13. Can the new drinking water
treatment replace boiling
an existing, culturally accepted
behavior?

14. Ecological System Framework
microsystem
mesosystem
exosystem
macrosystem
MOTHER
neighborsleaders
PKK
Posyandu
Arisan
community
Quran
reading
work
market
collectivism
Gendered
norms
Hot drinks
paternalism

15. Microsystem
“… a pattern of activities, roles and interpersonal relations experienced by a
developing person in a given setting with particular physical and material
characteristics” (Bronfenbrenner, 1979 p. 22).
Bi-directional relationships with:
 Husband –AR users had positive attitudes toward AR,
had spoken to their husbands about AR, and have their
husbands’ approval.
 Children –don’t like the smell and taste of AR treated
water but aware of the benefit of using AR

16. Microsystem
Mothers’ Social Network
• Health kaders  retailers
• Community – religious leaders  retailers
• Extended family
• Neighbors
• Friends
areas with supportive health kaders and community-religious
leaders were more likely to have AR users. However, people
were suspicious that they got profit from selling AR
Example from Bojong Renged Tangerang

17. Mesosystem
is the next level that covers interrelations between two or more microsystem
settings. The number and quality of settings in the developing person’s microsystem
that connect to each other determines the quality of mesosystem.
 Community  husband-neighbors (M/F)-
community leaders-health kaders-friends
 PKK (women’s welfare movement)
 Arisan (women’s savings and loans club)
 Religious groups (Qur’an reading)
 Posyandu (integrated health service post for children
under 5 years old)
 Puskesmas
 Work place
 Market place  product outlets

18. Exosystem
Garbarino and Gilliams (1980) :
- an event in exosystem that affects people that are close to the individual,
- when decisions by local political institutions and other organizations have effects
on the individual.
 New regulation to shift fuel for household use from kerosene
into LPG  kerosene crisis - price of kerosene hiked
 Boiling is the only way to make water safe to drink – kill germs
 Safe water = no color (clear), no smell, no taste
 New water treatment method (Air RahMat) is available
 Children’s HWTS activities at school – Safe Water Day event
(students test drinking water from home)

19. Macrosystem
“consistencies, in the form and content of lower-order systems (micro-, meso-, and
exo-) that exist, or could exist, at the level of the subculture or the culture as a
whole, along with any belief systems or ideology underlying such consistencies”
(Bronfenbrenner, 1979 p. 26).
 Tradition to drink hot drinks (coffee, tea)
 good for health – no germs, no side effects,
eliminate limestone, calm bloated stomach, good
for cold
 a symbol of manner when served to guests
 Gendered role –women as the homemakers
and caregivers
 Collectivism and paternalism

20. Chronosystem
 Global HWTS issues
 “instant” lifestyle:
 Fridge
 Water dispenser
1. the patterning of environmental event and
transitions over the life course
2. sociohistorical condition

21. Behavior Change Communication
-- interlink
• Community mobilization
• microsystem and mesosystem
• Advocacy
• exosystem and chronosystem
• Media campaign
• all systems

23. Ecological System Framework
microsystem
mesosystem
exosystem
macrosystem
MOTHER
neighborsleaders
PKK
Posyandu
Arisan
community
Quran
reading
work
market
collectivism
Gendered
norms
Hot drinks
paternalism
chronosystem

24. Some insights along the way…
 Mass media creates awareness and enhance product
credibility (registered to MoH and the company is
accountable) but not enough to convince audience that the
AR is safe
 Benefits of AR motivate people to try, but not strong enough
to make them continue using
 Smell and taste make people question about safety
 Women in urban areas are more likely to try the product:
 Using the product saves time and money (had to queue to buy
expensive kerosene)
 They are more exposed to new information and trends
 They are more open to try new things
 Have electricity in their houses
 More familiar with electronic home appliance (refrigerator, water
dispenser)

25.  Perceived safety of source water
doesn’t affect the use of AR
 Convinced users help in promoting
AR
 Convincing husbands as the
secondary target is important since
they are the consumer of the wife’s
service
 According to mothers, treating water
with AR is complicated, compared to
boiling – measuring AR is difficult (so
that Tanshia produced AR in a
sachet)

26. RESULTS
 Household Water Treatment and Safe Storage
implementation strategy, policy and regulations
enacted at local and national levels – from boiling
only to chlorine-based and other options of water
treatment method (ceramic filter, biosand filter, SODIS,
floculation)
 Roll-out in 10 districts – by the Ministry of Health
 Included into STBM (Community Based Total
Sanitation) National strategy -- being promoted in
20,000 villages all over Indonesia (target in 2012)

27. Four factors to ensure
sustainability of the new behavior
 Political will and support
 Availability of product and service
 Community support and favorable norms
 Individual and household’s skill, knowledge and
motivation

28. LESSONS LEARNED
 Political will and support
 Engage Ministry of Health as a partner from the
beginning
 Engage the Ministry of Health in Global HWTS agenda
 Become a resource and a partner with Ministry of Health
and local governments in HWTS
 Produce and share data on HWTS

29. LESSONS LEARNED
 Availability of product and service
 Partner with and engage a local private sector
manufacturer that is committed to the product
 Define a strategy that ensures appropriate distribution
mix
 Conduct test markets to define optimal distribution
strategy
 Need a certain level of demand for the category/product
that is favorable, otherwise be prepared to invest time
to create demand

30. LESSONS LEARNED
 Community support/ favorable norms
 Engage opinion leaders and civil society to create
product support
 Partner and work with organizations to help them meet
their goals through water treatment
 Engage community structures and programs
 Emphasize the importance of safe water rather than
sales, to avoid misunderstandings about the program
goals

31. LESSONS LEARNED
 Individuals and households skill, attitude and
motivation
 Address taste and smell issues up front validating them
in the media
 Deal with strong norms by creating spaces (TV, radio,
others) for product advocates (real people/testimonials)
 Create more opportunities for product sampling and trial
 Invest in effective promotion – multiple channels