04 Main Report                 22 Interview                  37 Lessons Learned            1st edition, 2012   The spririt...
Hari Cuci Tangan Pakai Sabun, 2012
From the EditorPicturing the spirit ofSTBM ProgramDear readers, once again you are holding our beloved       Interviews wi...
02     Percik Magazine    August 2012    Content                                                                          ...
August 2012   Percik Magazine   03                                     33              Learning CLTS from Our             ...
04   Percik Magazine   August 2012
August 2012   Percik Magazine     05                   STBM :      Achieving Sanitation                    for All “For th...
06    Percik Magazine   August 2012                                                                                       ...
August 2012   Percik Magazine   07empower the community when the community acts               However, can the results of ...
08     Percik Magazine    August 2012it turns out they were able to construct their own         On the other hand, many pe...
August 2012   Percik Magazine   09                                                                         In-country deve...
10    Percik Magazine   August 2012                                                                                       ...
August 2012   Percik Magazine   11                                                                                        ...
12   Percik Magazine   August 2012                                                                                        ...
August 2012   Percik Magazine   13According to Nugroho, STBM has evolved into a higher   learning place of rural sanitatio...
14    Percik Magazine   August 2012Social Responsibility programs.                        most formidable challenge, for b...
August 2012   Percik Magazine      15   Demand                                     Supply                                 ...
16    Percik Magazine    August 2012to support these activities. The challenge is the           of “one health center, one...
August 2012    Percik Magazine    17                                                          On the achievement of STBM t...
August 2012    Percik Magazine     19                                             Prof. dr. Tjandra Yoga Aditama SpP(K)   ...
20    Percik Magazine   August 2012                                                                                       ...
August 2012    Percik Magazine   21and distributing money to             designated by the Decree of         physical appr...
22    Percik Magazine   August 2012                                                              Soekarwo                 ...
August 2012   Percik Magazine   23                                                                                        ...
24    Percik Magazine   August 2012Additional access to latrines in         What are the challenges               getting ...
August 2012   Percik Magazine     25                                                       Ferry Zulkarnaen               ...
26    Percik Magazine   August 2012                                                                                       ...
August 2012   Percik Magazine     27triggering of CLTS (Community Led    What do you think are the factors       managemen...
28    Percik Magazine   August 20125 Pillars of STBM,                                                                     ...
August 2012     Percik Magazine    29pillars of STBM. This effort is done in   participants, so triggering is done    impl...
30    Percik Magazine   August 2012Strategic Choices inChanging Community BehaviorS  ince 2008, STBM has become a national...
August 2012   Percik Magazine    31positions who do not understand     the introduction of the pillars          their beha...
32     Percik Magazine   August 2012                                                                                      ...
August 2012   Percik Magazine   33                                                                                        ...
34     Percik Magazine     August 2012                                                                                    ...
August 2012   Percik Magazine   35           Hand       washing with        soap, being       campaigned       in schools ...
August 2012   Percik Magazine    37           Learning STBM from the           experience in Lumajang          When the “W...
38     Percik Magazine   August 2012                                                       One of the                     ...
August 2012    Percik Magazine     39                                                                                     ...
40   Percik Magazine   August 2012                                      ALBERTUS FAY                                      ...
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
Achieving sanitation for all through stbm percik special edition indonesia 2012
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Achieving sanitation for all through stbm percik special edition indonesia 2012

  1. 1. 04 Main Report 22 Interview 37 Lessons Learned 1st edition, 2012 The spririt of STBM in Interview with East Java Lessons from Lumajang, Indonesia sanitation Governor Probolinggo, and Soe English edition Water and Sanitation Magazine STBM special edition ACHIEVING SANITATION FOR ALL THROUGH STBM
  2. 2. Hari Cuci Tangan Pakai Sabun, 2012
  3. 3. From the EditorPicturing the spirit ofSTBM ProgramDear readers, once again you are holding our beloved Interviews with the Governor of East Java and themagazine. This issue, we are presenting a special Regent of Bima show attempts to formulate andedition on Community-Based Total Sanitation, or in implement policies and supporting environment forIndonesian acronym, STBM (Sanitasi Total Berbasis the sustainability of sanitation development.Masyarakat). Tales of STBM leaders from Soe, Probolinggo, LumajangSince its launching as a national strategy through a and the roles of partners and private sector, andDecision of the Minister of Health, STBM has succeeded innovations in raising demand and improving supplyas a platform for developing community-based at the community level are also expected to inspire allsanitation to push changes in health behavior. STBM actors in all levels of the society.STBM has created unsubsidized changes. The These tales become actual evidence that the changescommunity becomes both teachers and subjects of in behavior stimulated by STBM are not merelychanges in health behavior. The changes in behavior project-based, but in fact have become contagiousinclude not defecating in arbitrary places, washing in disseminating the spirit to raise awareness amonghands using soap, managing safe drinking water society members to give more contributions to theand food, managing waste properly and managing environment.household waste in a safe manner. All roads lead to Rome, so the saying goes. There areAll these behavior give actual contribution to the many roads to achieve success in the STBM program.national achievement of Millenium Development Goals The key is to be alert of existing opportunities and(MDGs) and the water and sanitation sector of national seizing them. Thus, it is not impossible that the targetsdevelopment targets, namely stopping the habit of that are challenging the nation be achieved.open defecation by the end of 2014. Have a good read!In this STBM special edition of Percik, readers can drawlessons and inspiration from various figures, championsand main actors of STBM. Each article describes STBM Editor in chieffrom three main elements, namely raising demand,improving supply and enabling environment. Maraita Listyasari
  4. 4. 02 Percik Magazine August 2012 Content STBM: 04 Achieving Sanitation for All STBM brings a change in mindset in the implementation of sanitations programs. Besides putting community development to the forefront, it targets changes in the societal hygiene behavior and cutting dependence from subsidies. 28 Water and Sanitation MagazinePublished by : Kelompok Kerja Air Minum dan Penyehatan Lingkungan (Pokja AMPL) Nasional – National Water and Sanitation WorkingGroup Steering Committee: Director of Settlement and Housing, Ministry of National Development Planning/ National DevelopmentPlanning Agency, Director of Environmental Health, Ministry of Health, Director of Water Development, Ministry of Public Works,Director of Natural Resources and Appropriate Technology, Ministry of Home Affairs, Director of Facilitation of Spatial Planning and theEnvironment, Ministry of Home Affairs, Director of Urban Planning, Ministry of Home Affairs Supervisor: Nugroho Tri Utomo Editor in chief:Maraita Listyasari Managing editor: Eko Wiji Purwanto, Nur Aisyah Nasution Editor: Aldy Mardikanto Writing Team: Nissa Cita Adinia,Lisa Imrani, Kelly Ramadhanti, Indriany, Yusmaidy, Hendra Murtidjaja, Eko Budi Harsono Translator: Indra Krishnamurti Design: EndangSunandar Circulation/Secretariat: Agus Syuhada, Nur Aini
  5. 5. August 2012 Percik Magazine 03 33 Learning CLTS from Our Neighboring Countries As a participatory approach, CLTS has been applied in a num- ber of our neighboring countries. Read the stories of Pakistan, Laos and Vietnam 40 Albertus Fay, FROM BONET TRADITION TO INSTRUCTION OF THE DISTRICT HEAD Albertus Fay, the champion behind the success of Polen district in Timor Tengah Selatan Regency. He tells us his steps in applying STBM 19 Interview with the Director General of PP & PL Ministry of Health 30 Strategic Choices in behavior changing community5 STBM Pillars,Applications and 54 STBM MilestonesChallengesWith its 5 pillars, STBM has created asignificant boost in behavior change. 60 What they say about STBM Water and Sanitation Magazine Contact us : Jl. RP Soeroso 50 Jakarta Pusat- Indonesia, Ph/Fax : +6221-31904113, Website : http//www.ampl.or.id, Email: redaksipercik@yahoo.com, redaksi@ampl.or.id Cover : E. Sunandar Cover Photo : Nury Sybli
  6. 6. 04 Percik Magazine August 2012
  7. 7. August 2012 Percik Magazine 05 STBM : Achieving Sanitation for All “For the sake of our descendants, and to improve the welfare ofthe people of Maradesa Induk, with the nature as our witness, we have to change into a healthy behavior. Quit defecating in the open, wash hands properly, processdrinking water, manage household rubbish and waste at home...” Doc. Plan Indonesia
  8. 8. 06 Percik Magazine August 2012 Declaration of 7 ODF villages in Serang Regency Doc. STBM Sect.TCommunity active movement community in their own ways. he sentences above are part of the customary oath stated by traditional leaders in the village One champion in Dompu, NTT, Salahuddin (13 years) of Maradesa Induk, Sumba Tengah, NTB in with the Tahira Children Club, created “Polisi Tai DesaDecember 2011. In order to encourage changes in Adu (Faeces Police of Adu Village)”. Along with villagehygiene behavior of its citizens, local traditional leaders cadres, these children actively trigger village residentstook the initiative to hold a customary oath witnessed not to defecate at arbitrary locations. They performby the whole community, even the district leader. routine surveillance to monitor the defecation habits ofThe seriousmess of the customary oath is due to their citizens. When they find someone doing defecation inhaving been triggered. the open, they shouted at the offender, blow whistles so many people know the person’s behavior andThe condition of being “triggered” commonly shame him.arises when people have gone through a processcalled triggering. Triggering is a method aimed to Another champion in East Java, Hastatik, a sanitationchange hygienic and sanitation behavior through officer in Sampang, “provoke” citizens using messagesempowerment of community. A society is said to be that defecating in the open is immoral, as it creates“triggered” when they become aware and committed suffering for others. For the Madurese, immoralityto change their behavior, and immediately implement and causing others to suffer is taboo and shameful.follow-up actions. No doubt, the people are triggered and committed to change their behavior. The commitment isIn Indonesia, triggering has been conducted in many evidenced by the amount of investment of the peoplelocations, even in the backwater regions. Many of those of the District of Sampang, reaching IDR 4.7 Billionwho were triggered spark are encouraged to trigger (approximately USD 520 thousand) to build latrineother residents. They are known as “champions”. A facilities without subsidies from outside sources.champion may be a citizen, a child, a local communityleader, a government official, etc. Champions actively “All these activity are the result of a process ofseek to change the behavior of the surrounding community empowerment. A program is said to
  9. 9. August 2012 Percik Magazine 07empower the community when the community acts However, can the results of the sanitation program beas active subjects as well as decision makers in all sustainable only by empowering the community?stages of the program, “said Oswar Mungkasa, formerChairman of the Water and Sanitation Working Group This does not stop at empowering people, but also(AMPL). changing the hygiene behavior of the society. “One of the main supporters of the sustainability of theTransforming mindset sanitation program is hygiene behavior changeFor decades Indonesia has sanitation programs in the society,” said Zainal Nampira, Head of theoriented towards development of physical Subdirectorate of Water and Sanitation, Ministry ofinfrastructure. However, during this period, the Health.coverage of sanitation has also shown no significantchanges. Various programs were introduced to the “The commitment of behavioral change can encouragecommunity supported by large amounts of fund, people to build their own sanitation facilities. Even theproviding various types of sanitation facilities. Yet the poorest communities will be capable. When triggered,development of more sanitation facilities does notincrease coverage, and only result in unused facilities.This condition shows that there is something wrong inour thinking so far. ChangesIn recent years, a change of mindset is starting to of hygieneappear in the current sanitation programs. People mindset andare starting to be involved in the process, the level of behavior of the targetedinvolvement ranging from merely participants in the communitysocialization, up to full engagement.“The number of sanitation facilities built that are notused or damaged due to the inability of the society tomaintain makes the government start thinking aboutthe importance of program sustainability,” said ImbangMuryanto of the Makassar Public Works Office whendescribing the Makassar sanitation program at theNational STBM Workshop on August 7-9 in Bogor, WestJava. “Sanitation without the empowerment of the Doc. IUWASHpeople will not succeed,” he added.
  10. 10. 08 Percik Magazine August 2012it turns out they were able to construct their own On the other hand, many people still persist in thesanitation facilities, “said Zainal. old mindset that changes in the public hygiene behavior require a lenghty, costly process andZainal’s claim is supported by a number of indisputable cannot be imposed. In fact, since 2005 Indonesia hasfacts. Triggered communities, committed to change implemented a non-subsidized approach resulting inbehavior, will eventually be able to construct their own major changes to our sanitation achievement.sanitation facilities. Sustainable sanitation programnot only requires the empowerment of communities, What is this unsubsidized approach?however, more important is the emergence of This approach is known as Community-Led Totalbehavioral changes in society. Without it, sanitation Sanitation (CLTS). Pioneered by Dr. Kamal Kar ofdevelopment is less likely to be sustainable. Bangladesh, CLTS has an innovative method to mobilize community members to completely eliminateDeveloping sanitation without subsidy the behavior of open defecation. The essence of CLTSThe emergence of public awareness for behavioral is a recognition that providing toilet facilities for the“Even the poorest community will be empowered.When triggered, they turn out to be able todevelop their own sanitation facilities”change resulted in many communities declaring community does not guarantee their use, nor causethemselves to have quit open defecation practices, behavioral changes or increase access to sanitationtermed Open Defecation Free (ODF) or “Stop BABS” in hygiene. Therefore, if the targets are behavioral changeIndonesian acronym. The ODF condition is achieved and sanitation access, the provision of latrines shouldwhen all inhabitants in a community have quit be the community’s responsibility.practices of open defecation and become used todefecation in healthy toilet facilities. It began with emulating other countries CLTS spread quickly in Bangladesh with theTriggering activities in various locations have shown cooperation between the Bangladeshi governmentresults when many villages declared themselves to and international NGOs. WSP (Water and Sanitationbe ODF. ODF districts began to emerge across the Program) of the World Bank plays an important rolecountry, as many regencies declare to reach the status in the spread of this approach to India, Indonesia andof ODF Regency. ODF is now a prestigious status being parts of Africa.pursued by many local leaders.
  11. 11. August 2012 Percik Magazine 09 In-country development After the trial, the CLTS method continues to be The CLTS applied in different regions by various sanitation actors, method both governmental and non-governmental. Starting continues to be applied in from the successful trials, a national strategy to expandDoc. IUWASH various regions the concept of improving access to rural sanitation by a number of sanitation tailored to the mission and character of the nation of actors Indonesia is also developed. The experiments in the six regencies are able to prove Based on the success of CLTS in Bangladesh and India, that CLTS can be applied in Indonesia. Lessons learned representatives from a number of ministries combined from these experiments are documented in the form in the Water and Sanitation Working Group and several of a video, which acts as a communication tool for sanitation actors went to both countries to learn more advocating various parties. Various agencies, both about CLTS. The visit was followed by inviting Dr. Kamal government and non-government, are interested to Kar to Indonesia, to make an assessment on whether replicate this approach, including WSLIC2 (Water and the CLTS method can be applied in Indonesia. Sanitation for Low Income Communities), TSSM and the program implemented by Plan Indonesia. The government followed up this visit with the pilot implementation of CLTS in six regenciesin six different WSLIC2 began to aggressively implement triggering provinces, namely: Lumajang, East Java; Sumbawa, in different target regions of its projects in Indonesia. NTB; Sambas, West Kalimantan; Muara Enim, South TSSM (Total Sanitation - Sanitation Marketing) in East Sumatra; Muaro Jambi, Jambi, and Bogor, West Java. Java adds three components of total sanitation in Dr. Kamal Kar himselft was asked to train this method implementation, namely: in the national CLTS orientation in early May 2005 in Lumajang, East Java. demand creation, supply improvement, and Evaluation conducted approximately 6 months later enabling environment. in late November 2005 showed that the result is considered to be very good. “The people of Indonesia The three components are innovations in the can trigger quickly, since 8 months ago I came to replication of CLTS as CLTS focuses solely on demand Indonesia while no one knows about CLTS. Within 6 creation. While Plan Indonesia has not yet fully months, CLTS has developed well in Indonesia, “said Dr. implemented CLTS, it adopted the triggering method Kamal Kar. in 9 regencies in 2007, and by 2009 it has fully adopted the CLTS approach.
  12. 12. 10 Percik Magazine August 2012 Enabling EnvironmentReplication by various parties has resulted inremarkable changes that in 2006 as many as 160villages have reached ODF status, and in 2007 there Institutionalisationwere 500 ODF villages. Even the government ofPandeglang won an Indonesian Museum of Recordsaward in 2007, when the NGO PCI (Project ConcernInternational) succeeded in its triggering and Demand Supply Creation Improvementencouraged the construction of 1,719 toilets based onpublic initiative without subsidies. Components of Total Sanitation Diagram“Since CLTS’ launch, there has been an extraordinary Poor sanitary conditions and unsafe hygiene behavior Doc. STBM Sect. of people cause extraordinary outbreaks of diarrhea in many provinces. Decreased incidence of diarrhea is considered important because the disease is still the leading cause of death of infants and toddlers in Indonesia. WHO states that there are three conditions that can Various reduce the incidence of diarrhea, namely: villages declare themselves to be open defecation 1. Increased public access to basic sanitation, reducing free incidence of diarrhea by 32%; 2. Washing hands with soap, reducing by 45%; and 3. Safe drinking water in households, reducing by 39%.interest from various programs and projects. L d j Leverageat the community level is also high, “said Zainal. Each of these conditions, on its own, does not result in major reduction. However, if the three conditions areCLTS Implementation is Not Enough integrated, the incidence of diarrhea can be reducedIn 2007, the Indonesian sanitation world gained by as much as 94%.valuable information from WHO (World HealthOrganization) and World Bank studies. The WB Based on these two important studies, the governmentstudy stated that the poor condition of sanitation in of Indonesia realizes that the implementation of CLTSIndonesia caused economic losses amounting to 2.3% is not enough. A program large enough to integrateof GDP or IDR 58 trillion per year. the above three conditions is required if it wants to be
  13. 13. August 2012 Percik Magazine 11 Washingserious in improving sanitary conditions and reducing hands withthe incidence of diarrhea. soap is proven to reduce incidence ofThe success of CLTS trials, replication and development diarrhea byof post-trial CLTS, as well as the WHO and World Bank 45%studies, encourage the Government of Indonesia todevelop a program that targeted reduction in theincidence of diarrhea by changing people’s behavior.The result of these efforts is the Decree of the Ministerof Health No. 852/Menkes/SK/IX/2008 on the NationalStrategy for Community-Based Total Sanitation.Community-Based Total Sanitation adopted the CLTSapproach to change people’s behavior. The WHO studyresults are reflected here as the 5 pillars of behaviorchange, now known as the five pillars of STBM, namely: Doc. Plan Indonesia1. Stopping the practice of open defecation2. Washing hands with soap3. Managing household drinking water and food and supported by interdepartmentalinstitutions, the4. Managing household waste National Water and Sanitation Working Group (Pokja5. Managing household liquid sewage AMPL Nasional), STBM stakeholders from government and non-government institutions initiate advocacyAchievement of these five conditions in a community efforts and implementation of STBM at various levels,is called as a Total Sanitation condition. starting from the national to the regional levels. Successes began to appear, even in areas considered toThe creation of the ministerial decision on a national be very unlikely for the success of this program.strategy of STBM, besides useful for advocacy, is alsobeneficial to trigger more parties to implement the A series of changes and progresses accompany theCLTS and develop into STBM. While there were initial implementation of STBM. “Many people have started todoubts, like when CLTS was launched, STBM slowly implement triggering, not only for Stop BAB. There arebut surely gained support into the largest community- now villages achieving total sanitation in all 5 pillars ofbased unsubsidized sanitation program in Indonesia. STBM,” said Zainal.Under the coordination of the Ministry of Health STBM, while initially designed for the rural areas, is now
  14. 14. 12 Percik Magazine August 2012 Doc. NWSWG beginning to be tested in urban areas. WVI (World Vision International) and USAID (United States Agency”Many people have for International Development) are two of the donorsstarted to implement who initiated the pilot implementation of the STBM in urban areas.triggering, not only forStop BABS. There are “There is also an emergence of sanitation businesspersons association at the community level.now villages achieving All parties collaborate, again adding to the positive leverage this program,” added Zainal.total sanitation in all 5pillars of STBM.” The same opinion was expressed by Nugroho Tri Utomo, Director of Settlement and Housing of The Ministry of National Development Planning (Bappenas).
  15. 15. August 2012 Percik Magazine 13According to Nugroho, STBM has evolved into a higher learning place of rural sanitation program for itslevel of complexity, “STBM is the only program or neighbors. In the Southeast Asia-Pacific CLTS Regionalapproach with a direct intervention to the household Workshop in 2009, Indonesia was known as a countrylevel, which is a major determinant e experienced in a very comprehensive implementationof the success of sanitation o of CLTS, even compared to India.program.” I It is said to be comprehensive because implementationAs a result, Indonesia o of CLTS in Indonesia has reached the developmentbecomes a o of the STBM concept. In addition, not only the i implementation of the 5 pillars, sms- and web-based m monitoring of STBM has already been applied. STBM a actors also become more varied, including the regional g government, local and international NGOs, donor i institutions and the private sector through CorporateMap of CLTS Distribution in Asian Countries 2004-2010
  16. 16. 14 Percik Magazine August 2012Social Responsibility programs. most formidable challenge, for both the government and society. Laos and Vietnam are examples ofThere are many supporting factors in Indonesia such countries that sent their teams to Indonesia toas existence of regulations, government’s commitment exchange knowledge on CLTS and STBM.in the RPJMN, existence of AMPL/sanitation workinggroups at the regency, city and province levels, In the Regional Workshop on Exchange Visits onpartnership with stakeholders and the presence of Scaling Up Sanitation in Solo (September 2011),champions in communities. the Government of Indonesia was considered quite successful in collaborating with donor agencies andSerious Challenges partners to develop rural sanitation through theIn all countries implementing CLTS, transition of strengthening of three components of total sanitation.the approach to development of sanitation from This activity was attended by donors such as Water Aid,subsidized to non-subsidized is perceived to be the UNICEF, Plan, ADB, World Bank and the governments of Enthusiasm in ODF declaration activities in various regions Doc. Plan Indonesia
  17. 17. August 2012 Percik Magazine 15 Demand Supply Enabling Creation Improvement Environment STBM triggering at the Evaluating sanitation markets Apply a local policy to community level at provincial level to compare implement STBM in the regency existing sanitation options through synergy of all rural Formative research on hygiene and willingness and financial sanitation program/project behavior and motivation of capability of consumers funding sources community as consumers Developing the range of Developing a specialised Communications media sanitation options demanded financial framework in the campaign based on formative and accessible to consumers government budget research, using existing motivation to change behavior Developing a catalog of suitable Providing development budget sanitation options to help and improving local capacity (for Offering options to consumers consumers select demand, supply, management, when they are commited to knowledge, supervision and change their hygiene behavior Monitoring of local program results of sanitation) entrepreneurs and training of construction workers to deliver Writing analysis of funding technological choices with a effectiveness (input, output, guarantee of quality results) of sanitation programs in the progress report of regency programsLaos, Cambodia, Philippines, Timor Leste, Vietnam and Formulating strategic plans forPapua New Guinea. STBM implementation in the regencyWith that performance and learning, there are stillso many challenges faced by STBM. The IndonesiaNational Mid-Term Development Plan for 2010-2014has set Indonesia Stop BABS as a goal in 2014, will itbe achieved? How to cope with the various programs/ As said by Nugroho Tri Utomo at the National STBMprojects in areas that are still subsidized? Achievement Workshop (7/9), “STBM still finding its way, still in theof the MDGs for sanitation in Indonesia still relies on pilot stage. Whereas in the field we have known theSTBM because of its effectiveness in improving access to potential of STBM. Its success has been sufficientlysanitation in rural areas. In the face of regional autonomy, tested. The challenge is no longer to advocatehow to make local leaders adopt this program? households but to advocate local governments
  18. 18. 16 Percik Magazine August 2012to support these activities. The challenge is the of “one health center, one ODF village “, the East Javacommitment of regional governments to allocate Provincial Health Office targets each health center tofunds to STBM. “ at least convert one village in the region each year to ODF status. “Each district usually has one health center,Towards Achieving STBM Targets some have more than one. With the strategy of “oneSTBM moves from a simple learning, and increasingly health center, one ODF village “, this is an achievableevolves, in line with increased learning. In the first target for the health centers,” said Edy Basuki, Sectionquarter of 2012, we already have 6,457 villages Head of Environmental Health Office of East Javaimplementing STBM. Our target is 20,000 villages by Province.at least 2014. Will we use all the learning as a foothold“Each district usually has one community healthcentre. Thus the strategy of ‘one communityhealth centre, one ODF’ has a reachable target”into achieving targets? This strategy is not impossible. If in each month a sanitarian does a triggering event and monitoring, theWith regard to creativity to reach targets, STBM target of at least one ODF village can be accomplishedimplementors have always shown a high level of in one year. Based on the funding that is available, thecreativity. In East Java, for example, using a strategy strategy of “one health center, one ODF village “ is an
  19. 19. August 2012 Percik Magazine 17 On the achievement of STBM targets, Nugroho added tha that STBM emerges from much learning, results of stu studoes, creative work of champions and support of ma many parties. “STBM will also live and thrive from such pas passions. And do not forget, STBM can develop well, wh when it is integrated with other programs, such as the Acceleration Program of Sanitation Development, W Water Safety Plan or School Sanitation, “said Nugroho.excellent strategy capable to be applied in otherregions. Synergy with other programs and breakthrough in the STBM strategies of implementation. ImagineWilfried H. Purba, Director of Environmental Health, when all districts in Indonesia, which number about 6Ministry of Health, added another potential. According thousand, implement the strategy. It is not impossibleto Wilfried, currently each health center obtains an that the target of achieving 20,000 STBM villages inaverage of Rp. 100 million in BOK (Health Operational 2014 will be achieved, even exceeded. He invited us allAssistance). “Here, the environmental health allocation to work together in achieving the target.can be used for STBM. Now the question is, how we canstimulate our colleagues to remember environmental Indriany, Nissa Citahealth through the STBM program,” he said. All stakeholders Doc. Plan Indonesia synergize in conducting STBM promotion to achieve the national target.
  20. 20. August 2012 Percik Magazine 19 Prof. dr. Tjandra Yoga Aditama SpP(K) Director General of PP & PL Ministry of Health STBMSTBM, Driving ChangeWithout SubsidyCommunity-Based Total Sanitation indicators of achievement being A number of community sanitation(STBM) Program has been launched 20,000 villages implementing programs have been implementedfor four years. STBM is one of the Community-Based Total Sanitation for some time. The problem iscross-sectoral national programs in (STBM) in 2014. that there are a number of issuesthe area of sanitation. The program that need to be considered: first,was launched in August 2008 by One of the attempts of hand clean and healthy behavior (PHBS)the Minister of Health. STBM is an washing with soap campaign has not become a necessityapproach to changes of hygiene implemented by the Ministry of for most people. The society inand sanitation change through Health. The following are excerpts general has the knowledge aboutcommunity empowerment using of an interview by Percik magazine the importance of clean andthe triggering method. journalist, Eko B Harsono with healthy behavior and influence Director General of Desease Control of sanitary conditions to health.In the 2010-2014 Strategic Plan of and Environmental Health (PP However, people still havethe Ministry of Health, eight priority & PL) Ministry of Health, Prof. Dr. not put priority on sanitation.focus of health development are Tjandra Yoga Aditama in his office Therefore, inconsistencies in theset. One is the control of infectious in Jakarta, recently. practice of clean living are stilldiseases, non-communicable found in the community. Second,diseases and environmental What are the fundamental issues there is a lack of commitmentsanitation; with one of the main in implementing STBM? from regional governments
  21. 21. 20 Percik Magazine August 2012 Doc. STBM Sect.regarding the importance of development. One of the obstacles still need to be developed to meetsanitation development. Regional is the absence of blueprint and the requirements of the nationaldevelopment is still focused on approach to manage sanitation program.infrastructure development such development. Implementation ofas bridges or roads, while the sanitation development was carried Why does STBM have a non-construction of sanitation is not out sporadically without clear subsidized principle?a priority. Moreover, sanitation reference from the government. Previously we have applieddevelopment has not been The government has launched traditional approaches to sanitationintegrated between relevant STBM as a national program, and programs, such as building latrines,sectors and a shared responsibility. makes it a guide for implementing distributing family latrines for freeThird, there is no integrated and various sanitation programs/ or as stimulant packages in thesynergistic approach to sanitation projects. However, the program form of construction materials,
  22. 22. August 2012 Percik Magazine 21and distributing money to designated by the Decree of physical approach instead ofthe community in the form of the Minister of Health No. 852/ behavioral change. To counterrevolving fund. Menkes/SK/IX/2008 dated 8 this, our step is to continue to September 2008 conduct roadshows for advocacyThe three activities use a physical and outreach to decisionapproach in which the focus and Is STBM a success? makers and stakeholders. Wesuccess benchmarks are always We have not dared to declare also conduct media campaignson the physical approach. Such it as a success but the progress and learn from lessons from thea physical approach does not is encouraging. This approach successful implementation STBMprovide adequate leverage to continues to be evaluated and in various regions.improved sanitation because it accelerated while maintainingis not sustainable (people always the quality of processes and How are non-governmentrely on subsidies). outcomes. We have also began actors involved in the STBM program? This program requires theThe main obstacle is that not involvement and synergy of the various parties (government,all stakeholders understand private sector, NGOs, donors andand adopt the STBM approach. the community). The synergy is done in the form of partnership and networking, such as throughIn the absence of subsidies, to develop other STBM pillars Jejaring AMPL, Public-Privatewhat is the role of such as the Handwashing (CTPS), Partnerships for Handwashinggovernment? Household Water Management with Soap, synergies with donorsThe role of government is to (PAM RT), waste and household and NGOs (UNICEF, ESP, Plan) infacilitate in the form of norms, sewage/waste management adopting the STBM approach forstandards, guidelines, advocacy campaigns. sanitation development.and outreach, campaigns,monitoring, evaluation, and What obstacles arelearning. Regarding the role of encountered in thethe government, cross-sector implementation of STBM?agencies and stakeholders has The main obstacle is that not alldeveloped a National Strategy stakeholders understand andfor Community-Based Total adopt this approach in sanitationSanitation (STBM) and has been development and retain a
  23. 23. 22 Percik Magazine August 2012 Soekarwo Governor of East Java Disseminating learning from East JavaWhat was it like when STBM people) and improving supply and and what efforts have beenprogram was introduced? What business networks involving the made to solve it?was your impression when STBM private sector. In 2008 there was Not all regencies/municipalitieswas introduced in East Java? a budget for STBM (Community- understand this approach,STBM has been known since Based Total Sanitation) activities, sanitation is still not a priority in2006, tested in Lumajang. At the and operational funding was development policy, and budgetbeginning the Community Led provided by regency government allocations for sanitation is limited.Total Sanitation (CLTS) method through the regional budget. To develop the program, thewas introduced, a method of provincial government pushes forempowering the community with The first impression of STBM is access to resources such as CSR,a focus on efforts to change the that this is a new approach to BOK funds (Fund for Operationalbehavior of open defecation (BABS) empowerment. This approach cost in health services), PNPMinto using toilets. In 2007, the Total proved quite effective in increasing (National Program for CommunitySanitation and Sanitation Marketing access to toilets quickly. Empowering) or other national(TSSM) approach was introduced projects. In addition, rewardsby WSP World Bank combining What constraints have appeared to successful regencies couldincreased demand (triggered in the implementation of STBM also trigger other regencies, for
  24. 24. August 2012 Percik Magazine 23 Pupils in Tunjung Sekar Elementary School in Malang enjoying hand washing facilities Doc. NWSWG Sect.example, through JPIP Otonomi support and cooperation with reduce the risk of disease due toAwards. Other efforts are also other agencies. These include the environmental conditions. Peopleshown in the form of a national private sector through CSR (eg, who already have a toilet from theexhibition in the framework of Bank of East Java), Media (Jawa beginning will be comfortableUnity Day of Village Women Post-Otonomi Award), NGOs (WSP- because surrounding communitiesOrganization and Community World Bank, USAID), PKK (Clean and who previously defecate openly willMonth in which STBM is able to Healthy Environment Competition), already have latrines.mobilize community participation national projects (PNPM, SANIMAS,and mutual assistance to build PAMSIMAS). Synergizing of efforts What are the local conditionstoilets in a broad scale. across programs is well established before and after the STBM through the Healthy Cities, Alert program began to beWhat is the role of various Village, Health Promotion, UKS and implemented?stakeholders (government, other programs. The previous sanitation programprivate/CSR/media, public, approach by providing subsidiesuniversities, donor/ NGOs, etc.) in What counts as STBM benefits to for latrine construction was verythe implementation of STBM? society? limited in scope, requiring relativelyAt the very least, regional People can enjoy cleaner and large costs because people expectgovernments provide policy healthier environment and help from the Government.
  25. 25. 24 Percik Magazine August 2012Additional access to latrines in What are the challenges getting closer, how is thethe community is very slow. With that must still be faced in the prospect of STBM in answeringSTBM, the sanitation program implementation of STBM in East the challenges of the MDGs?gives more attention to behavior Java? When STBM is implemented bychange through a method of STBM should be going at the all parties to the maximum and oftriggering and social control that speed of the implementation in course supported by all regents/mechanisms in the community can Bojonegoro, Jombang, Pacitan, mayors, it is possible that MDGsbe sustainable, additional latrine Lumajang, Magetan, Ngawi, Goal 7 targets can be achieved. Soaccess grows faster and wider in and Nganjuk. To that end, the the keywords are strong supportscope and evenly in all walks of provincial government will and commitment, especially bysociety. continue to provide motivation regents/mayors.”With regard to exchanges of knowledge, EastJava has disseminated its learning to variousparties through field visits, inviting successfulregions as sources or becoming sources in otherregions”In your opinion, what are the and advocacy to all regencies and What are the expectations,factors that drive the success of municipalities by maximizing three feedback and evaluation for theSTBM in East Java? important components of STBM: improvement/acceleration ofThe support of provincial 1. Continuing to create demand STBM program at the nationalgovernment policy in the field of with triggering; 2. Providing level?sanitation, creation of synergy and solutions to the communities There should be support,conducive stakeholder cooperation that have been triggered by consensus and a strongand dissemination of information specifying healthy latrines, with commitment by all parties, fromthrough the media to all parties easier access to sanitation markets the top to bottom, it is the key toconcerned. In terms of the (closer supply); 3. The government the success of STBM in the nationalexchange of knowledge, East Java and its stakeholders creating a level.has spread its learning to various supportive environment (enablingparties through field trips, using environment), at least by providinglocal success stories as resources, or policy support.becoming a source person in otherregions. The MDGs deadline date is
  26. 26. August 2012 Percik Magazine 25 Ferry Zulkarnaen Regent of Bima“In 2015,Bima will become an ODF regency”What is the beginning of Year Development Plan to build and improved water supply andthe Community-Based Total sanitation with programs ranging sanitation coverage. What isSanitation program (STBM)? from Presidential Instruction interesting about this program isWhat was your impression when Program of Water and Family Toilets the increased public awarenessSTBM began to be introduced in Infrastructure (Inpres Samijaga), through triggering strategy. As aBima? Unicef, RWSS, Infrastructure result, in early 2012 there were 25STBM was first introduced in the Development of Dissadvantages villages and 1 district that havelate stage of the Second Water Areas Program (P3DT), the been declared as ODF (Openand Sanitation for Low Income Acceleration Development of Defecation Free) or free fromCommunities (WSLIC 2) in 2005 Dissadvantages Areas Program indiscriminate defecation. And inas CLTS (Community-Led Total (P2DT), etc. with a very large 2015, the regency of Bima plans toSanitation), then aggressively investment. These investments achieve status as an ODF regency.adopted by other programs such as have not been able to increase theWES Unicef, Alert Village Program, coverage and support behavior What are the obstacles that ariseCommunity Month, etc. change on increasing the health of in the implementation of STBM society. to date, and what efforts haveThe impression that arises when been made to solve it?STBM began to be introduced The presence of five STBM pillars Some obstacles remain, suchin Bima is that we have has been able to provide significant people still considers constructionexperienced since the first Five- leverage in behavior change of sanitation as the responsibility
  27. 27. 26 Percik Magazine August 2012 Together doing health promotion activities for elementary school children.of the government and is subsidy What are the efforts that have as a development priority in theoriented. Moreover, there remain been made such by the regional Local Government’s Medium Terma number of central government government? Development Plan (RPJMD).policies on sanitation development In addition to issuing severalthat are not aligned with the regulations, Bima regency The local government is alsoDecision of the Minister of Health gives a big role to AMPL - BM seeking an increase in theNo.852/MENKES/SK IX/2008 on the working group to coordinate allocation of the regional budgetNational Strategy for Community- implementation of water supply for STBM. Meanwhile, another effortBased Total Sanitation. Another and sanitation development. Other done is by increasing the role ofconstraint is the lack of capacity steps taken include facilitation informal leaders in the communityand understanding of The Regency’s and sustainable fostering of the to work together with technicalOffices in relation to STBM. society. It also sets the WSS sector officers in the field to conduct
  28. 28. August 2012 Percik Magazine 27triggering of CLTS (Community Led What do you think are the factors management of water supply andTotal Sanitation). behind the success of STBM in sanitation. Bima? What have been doneWhat are the role of various to support the exchange of In your opinion, what are thestakeholders (government, knowledge with other areas who challenges that are still faced inprivate CSR, media, want to learn from Bima? the implementation of STBM incommunities, universities, The factors behind the success in Bima?donors, INGOs, NGOs, etc.) in the Bima include leadership, where Challenges still to be faced areimplementation of STBM? there is a harmonious collaboration related to the limited ability of theThe regional government puts and communication, especially regency budget. In addition, thereNGOs, media, universities and between the executive and the needs to be improved synergy of the role of different sectors/ stakeholders in the program.” Several NGOs provide financial Another challenge to be faced issupport in the planning and the topography of the regency,implementation of government which demands support facilities and resources in facilitating theprograms” public.others as partners in which legislature in formulating policies What are expectations, feedbackthe government provides the that support STBM. In addition, and evaluation for increasedwidest possible opportunity to the regent of Bima always heeds acceleration of STBM program atcontribute in compliance with the aspirations of the rural people the national level?existing legislation. For example, through activities such as BBGRM National government supportin terms of promotion and in every village, Ramadan safari needs to be increased, bothdissemination of STBM, the role of activities, direct visits to the the allocation of funds andthe mass media (especially local community, etc., which also helped programs within the frameworkmedia) is optimized. Some NGOs the success of STBM. of community-based STBM. Atprovide financial support in the the policy level, synergy of STBMplanning and implementation In order to exchange knowledge promotion policy at the nationalof government programs. with other areas, we have facilitated level needs to be increased, in theLikewise academics are active as and shared our experience with framework of integration in thegovernment partners in assessment Dompu and Bima Municipality region.and advocacy programs. AMPL working groups on sustainable and community-based
  29. 29. 28 Percik Magazine August 20125 Pillars of STBM, Doc. Plan IndonesiaApplications and ChallengesWhen Indonesia started implementing a variation of Management of household sewage. In particular, STBMCLTS (Community Led Total Sanitation), namely STBM strategy is not made only to disseminate information,(Community-Based Total Sanitation), the sanitation but with continuous encouragement and supportsituation is still weak, in which public awareness about creating awareness on sanitation both in attitude andthe importance of sanitation is lacking. lifestyle. In other words, the expected effect is a change in lifestyle, from “laissez faire” (let alone) to “care andSTBM itself is a strategy having 5 pillars including take care”.five important aspects, namely: (1). Free fromopen defecation, (2). Washing hands with soap, The Sanitation Hygiene and Water Program, commonly(3). Management of drinking water and household abbreviated SHAW, is one of the consortia coordinatedfood, (4). Household waste management, and (5). by the Dutch NGO SIMAVI, in introducing the five
  30. 30. August 2012 Percik Magazine 29pillars of STBM. This effort is done in participants, so triggering is done implement Pillar 1 only. The pridecollaboration with five local NGOs at the hamlet level, or even at a of reaching all 5 pillars is importantnamely PLAN Indonesia (Kabupaten lower level. to a village, because the 5 pillars areTTS and TTU in NTT), Yayasan Dian considered as a single package thatDesa (Kabupaten Sikka and Flotim Since 2010, it has been considered can encourage behavioral change.in NTT), Rumsram Foundation (Biak important to involve variousNumfor and Supiori in Papua), CD groups. Not only local government Application of 5 STBM pillars isBethesda (Kab. Sumba Tengah staff, but also sanitarians, certainly not easy or withoutand SBD in NTB) and Yayasan midwives, health office staff, task challenges altogether. Always thereMasyarakat Peduli (Kab. Lombok force members, village heads, is a risk of returning to originalTimur at NTB). hamlet heads, district heads, behavior. Dynamics in the village and community leaders. The as well as the support of all parties,The key to STBM is behaviour government as the stakeholder is both inside and outside the village,change, not the number of facilities not the project manager, but acts are instrumental. Initiatives andand activities. And as experienced as a supporter of organizations and joint efforts will be successful if allJoint initiative and efforts will succeed wheneveryone participates and cares about thecondition being experiencedin the field, the implementation of the community, and pay respect people want to come and care forthe five STBM pillars is divided into to successful villages and their the conditions experienced.four stages, namely preparation, inhabitants.triggering, follow-up support, and Knowledge of stages to achieve themonitoring and stimulation of In relation to the five pillars, a five STBM pillars and alternatives tointerest made after the declaration. large number of actors want to achieve such status are importantIn terms of dynamics, all partners concentrate on Pillar 1 (stopping to be encouraged. The availablebegin by preparing themselves open defecation), because it is choices still needs to be furtherand the community so that the easier and physically observable. In developed by the private sector intriggering can be the highlight of fact, during roadshows by SHAW order to have economic value.attention and the starting point for partners, there are districts and Pam Minnigh, Yusmaidy/ Simavichange. Often triggering cannot villages that already understandbe implemented at the village the importance of all five pillars,level because there are too many and that they do not want to
  31. 31. 30 Percik Magazine August 2012Strategic Choices inChanging Community BehaviorS ince 2008, STBM has become a national strategy to accelerate the achievement of MDGs, for drinkingwater and sanitation sector. Initially, STBM was more characteristics of urban population with its density and variation of livelihood, High Five develops a strategy of holistic approach. The strategy of this approachwidely adopted in rural areas as most villagers do consists of three interrelated elements : Foster a sensenot have adequate access to water and sanitation. In of necessity and a sense of ownership of STBM; Thefact, in urban areas that are commonly understood to mechanism of dialogue and participative action forhave water and sanitation systems, there are still many sustainability program; Partnership to increase accesscitizens who do not have adequate access and not and sanitation and hygiene behaviors.practice hygienic behaviors and safe sanitation. Opportunities and challengesGiven these conditions in April 2011, USAID incollaboration with Yayasan Cipta Cara Padu Indonesia Challenges faced in implementing STBM in urban areasrolled out the High Five program to implement STBM in are very complex, ranging from the regional diversity,urban areas as an effort to improve sanitation practices varied livelihoods, population density, busy society, lackand hygiene. In understanding that the approach of land, up to the materialistic and ego-centric attitudetaken should be able to provide space for public that focuses on personal gain. On the governmentparticipation, as well as to accommodate the unique side, there are still many individuals holding key 1. Create a sense of need and ownership of STBM 2. Dialogue mechanism and community participatory action for the sustainability of the program. 3. Partnership for increasing access and sanitation and hygienic behavior
  32. 32. August 2012 Percik Magazine 31positions who do not understand the introduction of the pillars their behavior to STBM must beSTBM and thus not understand and triggering are done at the accompanied by triggering thethe importance of STBM for their same time. From High Five’s city government, particularlyinstitutions. experience, people are invited to the local government’s offices comprehensively observe their related to sanitation and hygieneInstead of struggling with the sanitation conditions and discuss to implement STBM. The citychallenges that must be faced, which STBM pillar is considered the government is also encouragedHigh Five looked at the situation most crucial and will be used as to connect the city system withfrom a different angle and the entry point for the application community activities. Experienceturned it into an opportunity of STBM. Based on experience, in shows that the approach isChallenges faced in implementing STBMin urban areas are very complexto implement the program. urban areas (especially Medan, successfulin creating synergyThe diversity of backgrounds of Surabaya and Makassar), people between government programsthe community of innovation see waste/garbage (STBM pillar 4) and community activities. Forspawned a unique approach as a crucial issue and provide an example, in the cities of Medan,and a lack of understanding of entry point to carry out STBM. Surabaya and Makassar, the Citymunicipal government encourages Sanitation Departments are activelythe development of methods Second, the approach using involved in activities of communityand collaboration of different a positive perspective is more gotong royong activities byapproaches. effective to trigger the action taken. allocating garbage trucks. High Five uses the VIC action toolThe learning is summarized in the (modified from VIC tool developed Fourth, the media is involved infollowing several points: by JHU-CCP) to trigger people to the activity, and not just as news get moving and carrying out joint coverers. High Five put the media/First, participatory assessment actions. journalists as active participants inis a tool for building awareness discussion and implementation. Itas well as triggering STBM. Here, Third, triggering people to change is effective to induce curiosity and
  33. 33. 32 Percik Magazine August 2012 Doc. High Five Suciati Lasiman from Petemonan Subdistrict in Surabaya, a local waste bank activist. Community members can pay for their loans in the form of wasteGiven the lessons learned from theimplementation of the High Five program, it showsthat innovation in approach and implementationstrategy for STBM is much needed.push to further engage in various implementation strategy for should be alert to opportunitiesactivities. STBM is much needed. Variations and development of innovation of innovation depend on the to support the implementation ofGiven the lessons learned from uniqueness of each region. This STBM.the implementation of the High does not only apply to the Ika Fransisca/ High FiveFive program for one year, it shows implementation of STBM in urbanthat innovation in approach and areas but also in rural areas. We
  34. 34. August 2012 Percik Magazine 33 Source: www.plan-international.org Delivering theCLTS approach tothe community in PakistanLearning CLTSfrom Our Neighboring CountriesAs an unsubsidized participatory approach, Community Led TotalSanitation (CLTS) is also applied in some of our neighboring coun-tries. Plan International is one of the supporters of the implementa-tion of CLTS in a number of Asian countries.Starting CLTS in Vietnam sanitation facilities. A total of 27.7% of ethnic minoritiesD iseases caused by water conditions and poor sanitation is a major health problem in Vietnam.According to the MICS (Multiple Indicator Cluster still defecate in the open. Through the implementation of CLTS in WASHSurvey) nationally conducted survey, in Vietnam PLAN VN Program for 2011 - 2012, some importantnearly 1 out of every 4 children under five (22.7%) are factors are identified in achieving the main goal ofmalnourished. Malnutrition is also closely related to CLTS - free from open defecation, among which are:sanitary conditions and poor health. involvement of local governments from the beginning, involvement of the government health authorities inOn the other hand, the promotion and use of healthy all levels, involvement of individuals and communitylatrines has not yet achieved satisfactory results when organizations, capacity building of local partners,compared with the results achieved by the water follow-up of implementation and reporting.supply sector within the 2000 to 2010 period. There isalso a large gap between the two sectors. According Total Sanitation approach in Pakistanto MICS 2010-2011, 73.8% of households in Vietnam Pakistan’s 2006 National Sanitation Policy emphasizesuse healthy latrines, but among ethnic minorities, social movements as a major component in toonly 44.2% of households have access to improved tackle the problem of sanitation at the household
  35. 35. 34 Percik Magazine August 2012 CLTS triggering activity in Vietnam Doc. Plan Vietnamlevel, especially in rural areas. dignity, self-esteem and pride. This methodology and the role theyThe National Policy has a vision is also seen from the intervention play in maintaining the positiveto create an environment free from the supply side through the impact of the program to embedfrom open defecation, disposal of creation of sanitation marketing. health promotion messages towastewater and solid waste and their students. As a result, a total ofpromotion of hygienic behavior Development of rural sanitation in 3,279 schools have been triggeredand health. The purpose of this flood affected areas is implemented in the target area and 6,950 healthpolicy is to promote the CLTS through Community Resource promotion efforts have also beenapproach and formalize the “Total Persons (CRPs) or community made in the same schools.Sanitation Model”. In March 2011 activists. There is a total of 2,659the Government of Pakistan has CRPs in 4 provinces and regions A sanitation marketing strategy hasapproved a guidance document of Pakistan. During the training also been designed and a robustentitled “Pakistan’s Approach in session, it is emphasized that framework developed carefullyTotal Sanitation (PATS)”. CRPs should know about project through serious field research. A activities, creation of action comprehensive guide has alsoDuring March 2011, the plans and implementation of been developed to facilitateGovernment of Pakistan through the project strategy. This training the training of the Sanitationthe Ministry of Environment has is also conducted on teachers. Entrepreneurs in both urban andapproved the preliminary stage of 10,000 school teachers attend two rural areas.CLTS for Pakistan. Slightly different days of training related to healthfrom the CLTS approach, PATS care. They were given exposure Until now, 2,110 villages have beenemphasizes the importance of on the program objectives, certified ODF by the government,
  36. 36. August 2012 Percik Magazine 35 Hand washing with soap, being campaigned in schools in Vietnam conditions in Laos have cost 5.6% of Gross Domestic Product (GDP) or at 193 million USD per year. To increase the impact of ODF, government WASH teams also promote hand washing with soap, drinking boiled water and storing in sealed containers and keeping Doc. Plan Vietnam the village environment free of litter and water puddles. At schools, where the residentsand more than 1,000 villages have Lamed in 8 villages in the districts are not able to build good toiletachieved ODF status and are in the of Paktha, Phaoudom and Meung facilities, PLAN Laos providesprocess of certification. celebrate their achievement of construction material for hand 100% toilet coverage in villages. washing facilities and toiletCelebrating a Healthy Lifestyle This means, they no longer need construction. The villagersin Laos to have to go to the bushes to contribute sand, wood and labor.There is a fact that many people defecate. Eight elementary schools The joint initiative between PLANstill do open defecation in remote and 1,400 students in the three and the residents have created avillages in Laos. The condition of districts also celebrated their school sense of ownership for the villagerspoor sanitation behavior causes being ODF. More than 20 other and school children that is creatingmany occurrences of disease villages and schools have made sustainability and maintenance forand premature death. However, significant progress in achieving this facility.this does not happen with the ODF status and hope that theychildren and residents in Bokeo celebrate the same soon. The WASH program in Bokeo willprovince, Laos. They no longer go continue to work with the localto the bush, chase pigs, suffer from Having toilets only since the last government, schools and villagesmosquito bites, and hopefully, year, Maisang Houay villagers still with support from parties such assuffer from diarrhea due to poor keep the memory of losing their the Water and Sanitation Programsanitary conditions. children who died prematurely. (WSP) - The World Bank, SNV of Not only causing health problems, the Netherlands and various otherIn the last month, more than 2,000 according to a World Bank partners in Laos.ethnic Leu, Hmong, Khamu, and study, poor water and sanitation Rewrite by: Yusmaidy
  37. 37. August 2012 Percik Magazine 37 Learning STBM from the experience in Lumajang When the “Washing Hands” program is combined with the “Alert Husbands” programI n the matters of developing STBM programs, Lumajang may be the champion. Currently almost7 districts have reached ODF status, namely: Gucialit, centers. In 2012, Gucialit health center has received BOK funding at IDR 81 million with 70% utilization for health promotion activities or promkes (includingSenduro, Padang, Kedungjajang, Pasirjambe, STBM), 20% for Environmental Health activities andPronojiwo, and Klakah is soon to follow. the remainder allocated to maternal and child health activities.Various intensive efforts weretaken to achieve ODF and What is interesting in the utilizationdevelop STBM program, of the large BOK funds, Gucialitincluding the following: health center initiates promotive and preventive programs. The programFirst, empowering small-scale CSR. facilitates and integrates all activitiesThe term is, “small, but effective to and programs under the Health Center.help accelerating the achievement of Various programs were included in this programtargets”. This attempt is done through the supervision including Maternal and Child Health, Nutrition,of the regency health office, district and village heads Environmental Health, Family Planning and Alertwho intensively submit proposals for assistance to large Village. All activities are also incorporated in Posyandustores, gas stations, factories and local businesses. The Gerbang Mas (Movement to Build a Healthy Society).proceeds will be used to purchase materials for latrine,communal ones in particular, while the labor needs will One form of the promotive, preventive and innovativebe pursued through community service. activity is the “Alert Husband” training. It is innovative as the “Alert Husband” training was combined with aSecond, the use of Operational Health Support Fund number of CTPS (Handwashing with Soap) features(BOK) to unify various existing programs in health campaigned in STBM.
  38. 38. 38 Percik Magazine August 2012 One of the teaching tools in the Alert Husbands program. This activity also promotes STBM efforts, such as washing hands using soap.Synergy with Alert Husband The trainings used participatoryThe Alert Husband program began methods, the active role of bothin early 2012 in Lumajang. Gucialit husband and wife are expectedis one of the districts that in this responsible in assisting the wife, as to bring a more comprehensiveyear launched an Alert Husband well as meeting facilities/amenities understanding and ability totraining in all villages. Data showed of nutrition, sanitation and family practice in a real day-to-daythat there were about 500 pregnant hygiene in a sustainable manner. activities. Beginning with thewomen in one year in Gucialit, who identification of the risks ofneed intensive treatment during Every three months, opportunity pregnancy and childbirth, andpregnancy and labor. is given for 10 young couples to benefits of nutrition for expectingThe active role of both husbands and wivesis to be developed to create comprehensiveunderstanding and ability to practice in real lifeThe objective of the Alert Husband receive training and knowledge and lactating mothers, benefitstraining was to prepare husbands about pregnancy and childbirth. of family planning and healthyduring pregnancy, childbirth up to Participants exceeded the target environment for pregnant andthe care of infants up to 2 years of due to the high interest of young lactating women, the pairs areage. This includes awareness to be couples. facilitated by cadres and midwives
  39. 39. August 2012 Percik Magazine 39 Hariyanto, PHBS promotor and sanitation entrepreneur from Gucialit district, Lumajang regencywho have prepared a check-list. observed whether pit toilets haveThe check list becomes a tool for been converted to proper toilets,monitoring the couples until after also whether CTPS facilities havethe birth. The understanding of the been provided either in the dining Another observed CTPS behaviorhusband before and after training room or near pets cages. is that if not used to washingwere also compared and measured hands, children’s fingernails willon a regular basis. It is customary that a mother who look black. It is recognized that just gave birth be visited by many CTPS activity is still hard to doImportance of CTPS facilities in people. Before looking at the baby, everyday, but citizens are awarethe Monitoring - Post-Childbirth every visitor must warm the feet that this is the practice that shouldPhase and hands over the stove, thinking be done. In the end, each cadreThrough BOK funding, each Alert that the smoke and heat will kill has a role to monitor and surveyHusband training in one village germs. This is clearly not medically by visiting homes each month.needs an average estimated cost justified. This habit is changed to The monitoring tool can beof IDR 750,000 used for: allowance/ washing hands before visiting the downloaded from the internet, intransport for trainees respectively infant. Thus in the check-list and the form of cards which is thenIDR 15,000, snack and lunch as campaigns, the importance of made in the form of stickers andwell as post-training monitoring providing CTPS means, especially affixed in every home to be anactivities. in the case of new mothers, is instrument of control. stressed. Wendy Sarasdyani / WSPIn the monitoring process, it is
  40. 40. 40 Percik Magazine August 2012 ALBERTUS FAY FROM BONET TRADITION TO INSTRUCTION OF THE DISTRICT HEAD Notes from the STBM Project (SHAW Program, Cooperation of Plan Indonesia - SIMAVI) Kalu het aomin so tanaoba lais nono nim in Lasi no nima ni, fun sin fani on ni ainaf/ Fani on ni ainaf, an bi monit lais aomina/ Kalu hit aomin fun hit aoke namep/ Hit aoke namep, fun hip mepu naomat, fun hit mepu naomat, fun hit nekak an malin/ Hit neken malin, fun hit pules usi neno. If you want to live a healthy life 5 things (STBM) should be carried out / The five pillars are the center/ The center of our health / If we’re healthy, the body is strong, Productivity increased, the heart rejoice / If the heart rejoices, we can glorify God.