101178 PAMSIMAS: Responding to the Water and Sanitation Challenges in Rural Indonesia A PUBLICATION BY THE WORLD BANK A PUBLICATION BY THE WORLD BANK PAMSIMAS: Responding to the Water and Sanitation Challenges in Rural Indonesia Foreword 2 When people come together around Parents cooking with dirty water. Children walking for hours, carrying pails of water. and hygiene practices. Communication and cooperation – those are the two hallmarks 3 Schools lacking running water for hand of a program that is for the community, by clean water, even though the process washing. Families using rivers and streams as open latrines. These are everyday scenes the community. takes a long time, sometimes in rural Indonesia, where access to clean water is a luxury. PAMSIMAS is also about learning by doing. When the program first debuted, many of our remarkable things happen It doesn’t have to be that way. Solutions exist. stakeholders -- the facilitators, community water boards, and so on -- did not have the For almost a decade now, the Government key skills required of the program: building of Indonesia, the World Bank, and Australian clean water infrastructure, sanitation, hygiene, Aid (now known as the Australian Department bookkeeping and financial management, and for Foreign Affairs and Trade, DFAT), have leadership skills. By learning and practicing worked together to support the Water Supply these key skills, not only have the people and Sanitation for Low Income Communities of PAMSIMAS now obtained clean water, Project – known by its acronym PAMSIMAS. sanitation and hygiene services, but their knowledge has grown as well. Striving to empower communities in managing their scarce water resources, PAMSIMAS The results of PAMSIMAS are a testament trains local governments and community in to the slow, painstaking process of building water and sanitation management techniques, community capacity to effectively manage facilitates knowledge sharing between rural water supply, improve sanitation and stakeholders, and promote better sanitation acquire hygienic behaviors. When people come Foreword 4 together around clean water, even though not only more empowered, but also healthier, 5 the process takes a long time, sometimes with sufficient access to water supply and remarkable things happen. sanitation services. Cooking with clean water would be the norm. Children spend their We trust that this book can show glimpses of afternoons studying or playing sports these communities, and the challenges they instead of fetching water. Open defecation face. We hope to share with you the humble would cease. start of PAMSIMAS, and how the faith and dedication of communities brought this This is a future that the PAMSIMAS envisions, program, slowly by surely, to its success. For and one that it is determined to bring. example, in Kedungdori Village in Central Java, villagers came together to help form the first water-board management body, or BPSPAMS, in order to share program updates and knowledge between the board members. When ideas are exchanged this ways, problems are solved – together. Nugroho Tri Utomo Director of Housings and Settlements, National Development Planning Agency (Bappenas) We hope that stories like this one and others will continue to be told, across the country and into the future, reflecting the growth and expansion of PAMSIMAS. And that future paints communities –and a country—that are 6 7 Contents 2 foreword 8 introduction 18 CHAPTER ONE PAMSIMAS 34 CHAPTER TWO EMPOWERING THE COMMUNITy 50 CHAPTER THREE Sanitation and Hygiene 66 CHAPTER FOUR PEOPLE STORIES BENEFITED 90 CHAPTER FIVE UNIVERSAL ACCESS TO SAFE 106 STAKEHOLDERS FROM PAMSIMAS WATER AND SANITATION Introduction A Community Project 8 More than 75 million Indonesians Despite continued efforts by the Government of Indonesia over two decades to provide reduce and help eliminate diseases caused by contaminated water, inadequate sanitation and 9 access to improved water and sanitation poor hygiene, it is crucial that all Indonesians lack access to safe drinking water facilities, more than 75 million Indonesians still lack access to safe drinking water and have access to quality infrastructure— unpolluted, properly functioning wells or about 100 million are still unable to access other water facilities, hand-washing and improved sanitation facilities. Shockingly, bathing facilities, and improved sanitation some 60 million Indonesians have no choice facilities that keep excreta out of human but to defecate outside, often on the ground contact. However, merely ensuring that or in rivers. The overall human and economic communities have access to toilets and other implications are devastating. More than half sanitary facilities, does not guarantee proper of the people without access to water and usage, nor does it necessarily yield improved sanitation facilities live in rural areas. sanitation and hygiene. It is also essential that communities change their hygiene behavior. In an effort to improve access to water and appropriate sanitation facilities in rural areas, Prior to the implementation of PAMSIMAS, the Government established the Water Supply many of the Government’s efforts to improve and Sanitation for Low Income Communities the country’s sanitation record failed simply Program (Program Air Minum dan Sanitasi because they ignored the complexities of Berbasis Masyarakat, PAMSIMAS) in 2006. human behavior. These programs focused almost exclusively on the supply side of PAMSIMAS does not merely see infrastructure infrastructure, without considering the construction as its end goal. Of course, to demand side. PAMSIMAS facilities are constructed for community, by community 10 To address the complicated socio- • Facilitate the promotion of good hygiene and sub-district in Indonesia. The goal should percent had adopted hand-washing with soap. 11 economic and cultural factors that underlie practices through community institutions, be to empower communities to develop In 72 percent of villages, water and sanitation open defecation and poor hand washing including schools, places of religious solutions that work best to meet their own facilities constructed under PAMSIMAS were practices, PAMSIMAS adopts an approach worship, village-level forums, and local specific needs. Indeed many studies show that found to be fully functioning, while facilities that represents a radical departure from media outlets. interventions are most effective if all members were found to be at least partially functioning earlier programs. In particular, PAMSIMAS of the community, including women and in an additional 22 percent. The study also explicitly focuses on community-level change One of the major challenges facing the marginalized groups, are involved in decision- confirmed that a large number of women, who behaviors related to the adoption of good Government in its mission to improve water making processes. In the case of PAMSIMAS, previously bore the burden of collecting water hygiene practices. This approach recognizes supplies and sanitation facilities lies in the water and sanitation facilities are constructed from distant water sources, were able to spend that the failure of even a small proportion great variation in economic, social and for communities, by communities. more of their time engaging in productive of a community to engage in good hygiene physical conditions across the archipelago. activities, such as taking care of family practices could result in the spread of While constraints exist across the country, PAMSIMAS has proven to be effective at members or working income-generating jobs. disease that affects the entire community. the nature of these vary widely, with solutions achieving its goals. An evaluation (the results PAMSIMAS is intended to: that may be effective in the context of a of which were published in August 2013) to While PAMSIMAS has provided a large •Empower communities and local-level rural rice-growing community in Java, being determine the impact of the program revealed number of communities with access to safe institutions to eliminate poor sanitation completely inapplicable in the case of remote that PAMSIMAS provided more than 5 million drinking water and improved sanitation and adopt sound hygiene practices through communities in the eastern provinces or in people in more than 7,000 villages access to facilities, many Indonesians still lack adequate measures that they themselves deem to be the mountainous regions of Sumatra. clean water and improved sanitation facilities. facilities. In terms of achieving the Millennium appropriate to their needs; Development Goals (MDGS) on providing an •Facilitate the adoption of good hygiene Given this situation, the Government cannot Of the villages where PAMSIMAS was increased number of people with improved practices at the individual, family and apply “one-size-fits-all” solutions, but instead implemented, it was found that almost 45 access to water and sanitation facilities, the community levels, with particular attention needs to tailor programs to the particular percent communities had achieved open Government is committed to ensuring that to the adoption of these practices at schools; needs of each individual province, district defecation-free status, while more than 66 no less than 67 percent of the population has 12 access to water facilities and 65 percent to also recognizes the need to provide additional involved. Furthermore, it must enable all access of improved water and sanitation 13 sanitation facilities that meet the established support to isolated communities in eastern communities and governments to continue facilities. When such institutions exist in minimum service standards by 2015. Indonesia and the isolated islands, due to the to apply new approaches long into the all rural communities and supported by limited human resources and high costs in future, beyond the point when PAMSIMAS II district governments, and are seen as a core Following the conclusion of PAMSIMAS in these areas. is completed. component of the provision of basic services, 2012 (PAMSIMAS I), the Government initiated Indonesia will be well on its way to achieving the second phase of the program, PAMSIMAS The main distinguishing characteristic of Sustainability will only be achieved through the its goal of universal access of water and II, running from 2013 to 2017. PAMSIMAS PAMSIMAS II, however, is its increased focus development of strong community institutions sanitation by 2019. II’s goal is to extend water and sanitation on ensuring the impacts of the program are with the necessary capacities to implement the interventions to an additional 5,000 villages sustainable. It is not enough for PAMSIMAS to approaches developed and socialized through in 219 target districts in order to enable achieve short-term improvements that endure PAMSIMAS. These institutions need to adopt a greater number of poor, under-served only as long as the program is in place and a participatory approach for the development communities in rural and peri-urban areas to only benefit villages directly participating in and maintenance of water and sanitation benefit from improved access to water and the program. facilities, as well as for the design and sanitation services. In addition to extending implementation of complementary policies to the coverage of the program, PAMSIMAS II If the program is to facilitate the achievement ensure proper hygiene and improved health incorporates a number of modifications to of improved hygiene and universal access for all members of the community. the initial design. Recognizing the diverse to water and sanitation across Indonesia by range of challenges faced by communities 2019 and beyond, PAMSIMAS must inspire The ultimate goal of PAMSIMAS is to facilitate across the country, PAMSIMAS II adopts a less communities and district governments not the development of these community standardized process in selecting participating directly participating in the program to adopt institutions and strengthen district villages, to avoid servicing locations where new approaches and paradigms to replicate governments to ensure communities in peri- there is insufficient demand. PAMSIMAS II the achievements in those districts directly urban and rural areas will have a sustainable PAMSIMAS I Coverage Areas 2008 - 2012 14 BPS estimated that about 15 40 percent population will live in rural areas into 2025 INDONESIA 11 2 Indonesia RURAL population BPS (2013) - 248.8 millions 14 PAMSIMAS I (2008 - 2012) 1 10 15 No participating NUMBER OF provinces VILLAGES 7 9 13 1 2 SUMATERA BARAT RIAU 897 461 3 3 SUMATERA SELATAN 524 4 BANTEN 142 5 JAWA BARAT 352 6 JAWA TENGAH 2,233 8 7 KALIMANTAN SELATAN 578 4 8 SULAWESI SELATAN 447 5 6 9 SULAWESI BARAT 180 10 SULAWESI TENGAH 466 11 12 GORONTALO NUSA TENGGARA TIMUR 198 687 12 13 MALUKU 77 14 MALUKU UTARA 97 15 PAPUA BARAT 63 PAMSIMAS Program Cycle Community Sanitation & hygiene trainings behavior change triggering using CLTS Construction of Community Disbursement of WSS facilities Participatory community block Appraisal (IMAS) grant (BLM) Formation of community-based Formation of 16 organization community water 17 (KKM, Satlak, & supply management BPSPAMS) Health and association at Hygiene district level Socialization to Implementation promotion villages and formation of proposal Planning formulation team Strengthening Sustainability Villages Selection Formulation of Improving village WSS Operation and capacity of Formulation of mid-term plan Maintenance community Formulation community actions (PJM Pro-Aksi) water supply of proposal plan (RKM) Regular management maintenance of (BPSPAMS) Appointment of WS facilities selected villages Collection of water charges 1-2 months 5-6 months 4-5 months continuous activities continuous activities 18 19 01 chapter ONE: PAMSIMAS Chapter One PAMSIMAS: Safe Water Supply and Proper Sanitation Access for Poor Communities 10 20 Over the past decades, Indonesia has made sanitation facilities. Due to a lack access to LEFT 21 Many young women across significant political, economic and social toilets, more than 60 million people have no Indonesia spend countless progress. The country has successfully choice but to defecate outdoors, often in full hours sources. This is time transitioned from an authoritarian, top-down view of other people. taken away from attending school, taking care of family political system to a thriving democracy. The members or working at number of people living below the poverty line The human and economic cost incurred income-generating jobs. (Hane Village, South Timor has declined dramatically. Almost all children from a lack of access to improved water and Tengah District of East complete at least primary-level education, and sanitation facilities is devastating. Around Nusa Tenggara Province, malnutrition, along with the child mortality the world, diarrhea continues to be one of December 2013). rate, has decreased by almost 50 percent. the leading causes of death among young A flourishing middle-income country that children, with the vast majority of cases has celebrated an average rate of economic of diarrhea caused by tainted water, poor growth of around 6 percent over recent years, sanitation and improper hygiene practices. Indonesia is poised to become a regional and The economic impact on sanitation in global powerhouse. Indonesia study in 2008 presented that some 50,000 people die prematurely as a result of However, despite significant progress and these unsafe practices. Many more fall sick, continued potential for further success, with more than 120 million cases of disease- Indonesia’s development falters in a number related illnesses occurring each year. of significant areas. More than 75 million people still lack access to safe and quality In addition to the devastating risk of drinking water, and more than 100 million contracting diarrhea and other microbial people are still unable to access adequate infections, the economic cost that comes 22 RIGHT from lack of access to clean water and poor In September 2000, the Government 23 Floating toilets on a catfish pond in a village in Central sanitation is also extremely destructive. reaffirmed its commitment to reducing Java. Discarding human Diseases caused by poor sanitation result in poverty and improving the health and welfare waste in the pond degrades increased expenditures on health care and of its population by signing the Millennium the quality of the water and creates health risks. Nobody place a serious burden on already strained Development Goals (MDGs) Declaration, in the village wants to eat health facilities. Without access to safe water, which include eradicating extreme poverty the catfish from this pond. households are forced to either purchase and hunger, achieving universal primary (Banjarnegara District of Central Java Province, bottled water or boil water themselves, education, promoting gender equality, June 2014). resulting in significant fuel expenditures. reducing child mortality, improving maternal People are forced to spend a long time health, combating HIV/AIDS, malaria and traveling great distances to access wells, other diseases, ensuring environmental resulting in a loss of income-generating sustainability, and participating in a global productivity. Meanwhile, poor sanitation is partnership for development. also a major cause of water pollution, which reduces the potential of freshwater rivers and While Indonesia has made significant progress lakes to produce fish and impacts tourism and toward achieving a number of these targets, optimum utilization of public facilities. The it is slightly behind in others. Indonesia is latest estimates indicate that Indonesia loses moving on track to achieve a specific sub- some US$6.3 billion, approximately 2.3 percent goal highlighted in the declaration, that of of the country’s annual gross domestic reducing by half the proportion of households product, as a result of poor hygiene and without ongoing, sustainable access to safe lack of basic sanitation. drinking water and basic sanitation facilities by 2015. However in rural areas, number of OTHER PAMSIMAS PROGRAMS 12.1% 7.2% 24 PAMSIMAS increased the access of communities with access of safe water and One of the leading challenges facing the Government formulated the National Policy 25 households to water supply sanitation facilities remains far behind Government and its mission to improve water for the Development of Community-Based the target. supplies and sanitation facilities is the great Water Supply and Sanitation Facilities. The variations in the geographical, economic policy seeks to improve the services and A 2013 impact study showed that In rural areas, communities often develop and social contexts across the archipelago. facilities by: PAMSIMAS increased the access of their own water supply services using natural While constraints exist across the country, •Establishing policy goals that emphasized local households to a community water springs, rainwater and groundwater sources. the nature of these constraints varies widely, sustainability and effective use of water supply by 12.1 percent, significantly higher While government agencies at different levels with solutions that may be effective in the supply and sanitation services rather than than that of other programs, which have provided community support to develop context of a rural rice growing community the achievement of coverage targets defined demonstrated an increase of 7.2 percent. both water supply services and sanitation in Java being completely inapplicable in, in terms of construction of systems facilities facilities, projects rarely invest in the creation for example, a remote communities in •Empowering communities to choose, of a comprehensive community capacity the eastern provinces or in mountainous co-finance, construct, manage and own to plan, implement, operate and maintain regions of Sumatra. In this context, it would their water systems services. Members of rural communities are be misguided for Central Government •Using gender- and poverty-sensitive also seldom involved in decisions related to agencies to apply “one-size-fits-all” solutions. approaches establishing and managing the services. This Meanwhile, it is also not feasible for the •Building stakeholders’ understanding top-down approach has led to a significant Central Government to take responsibility for with regard to service sustainability discrepancy between what users want and designing solutions that apply in individual •Measuring success in terms of sustained what they receive. The dissimilarity and districts and provinces. access to services and effective use of imbalance promotes a lack of community those services ownership and unclear responsibilities In 2003, in an effort to adopt an improved Measuring success in terms of sustained •  for maintenance of water supply and approach to addressing the poor state of water access to services and effective use of sanitation facilities. supply services and sanitation facilities, the those services PAMSIMAS measures success in terms of sustained access to services 26 Although the community-driven approach program is implemented by the Ministry records not just of how many facilities were The remaining chapters of this book 27 defined by this policy was only implemented of Public Works and Housing (MPWH), built, but if they continue to work and, more will describe the approaches adopted by in a small number of districts, it was shown Ministry of Health (MoH), and Ministry of importantly, whether they continue to be PAMSIMAS, the achievements and challenges to have a number of advantages over Home Affairs (MoHA), and supported by used and whether their use contributed to addressed, as well as personal stories of more traditional approaches to project the National Development Planning Agency improvements in the physical health and change from community members who management. Many studies revealed that a (Bappenas) and Ministry of Finance (MoF), well-being of the communities. In these terms, benefited from the program, implementers larger proportion of the facilities developed as well as their counterparts at provincial and PAMSIMAS shifts the paradigm by which the and policy makers involved in the program. through the approach worked as intended and district levels. The program receives technical Government measures the degree to which its that it fostered a higher level of participation and financial supports from the World Bank efforts are achieving their intended goals. of communities in the construction of and the Australian Department of Foreign Aid infrastructure, with communities incurring and Trade (DFAT). fees to cover the cost of maintenance. PAMSIMAS measures success not in terms Five Main Key Components of PAMSIMAS The Government is committed to ensuring of the number of facilities constructed, but a higher proportion of households are equipped with ongoing, sustainable access in terms of sustained access and the level of effective use of services. To ensure that 1 Community Empowerment and Local Institutional Development 2 Improving Hygiene and Sanitation Behavior 3 Water Supply and Public Sanitation Infrastructure 4 District and Village Incentives 5 Implementation Support and Project Management to safe drinking water and basic sanitation access is sustained, it is crucial that facilities facilities through the adoption of community- are constructed and continue to function To ensure that a greater To encourage targeted To encourage targeted To encourage local To encourage program proportion of the communities to adopt communities to manage governments to scale up management units at the driven approaches. As such, the Government effectively. For the facilities to continue Indonesian households better hygiene practices. and sustain these other water projects district and central level established the Water Supply and Sanitation to operate, they must be appropriately use and benefit from improved services. using the PAMSIMAS to successfully manage for Low Income Communities Program maintained. To determine the degree to which improved water supply methodology. and support this and (Program Air Minum dan Sanitasi Berbasis PAMSIMAS has successfully met its goals, the and sanitation services. other similar programs. Masyarakat, PAMSIMAS) in 2006. The Government must therefore maintain accurate 28 29 LEFT A woman collecting water from a lake in the woods, the main source of water in Loeram Village, North Timor Tengah District. Despite the poor quality of the water, communities in surrounding areas use the lake for bathing, drinking and washing clothes. (East Nusa Tenggara Province, December 2013). RIGHT A mother and her young child washing clothes in a spring. The poor quality of the water in this spring causes many of those who use the water to suffer from skin irritations and transmissible diseases, such as diarrhea. (Krakal Village, Kebumen District of Central Java Province). RIGHT 30 31 A mother and her teenage child using untreated water to wash vegetables for cooking. This behavior puts the family at risk of contracting water- borne diseases. Only by changing such behavior can the health of families, and the community as a whole, be safeguarded. 11 32 33 LEFT Housewives often wash their clothes in this notoriously polluted river, despite the poor quality of the water and the significant distance from their homes. RIGHT A public latrine in Kali Besar Village, Tanah Laut Districtof South Kalimantan Province. Floods, which occur regularly in the area, create serious health risks for the community. 34 35 02 chapter TWO: EMPOWERING THE COMMUNITY Chapter Two Empowering the Community to Improve the Health 10 36 The PAMSIMAS program is intended to Indonesians who need it the most, the LEFT 37 Only 56 percent of the rural ensure that a greater proportion of Indonesian program is implemented in villages with population in Indonesia households use and benefit from better a low human development index, a high has access to improved access to quality water supplies and improved level of poverty, limited current access to water and sanitation facilities. Fortunately, the sanitation services. Specifically, the goal of drinking water and sanitation facilities, and construction of a water the program is to provide access to quality a high incidence of diarrhea. While district- tower under PAMSIMAS in Manyampa Village drinking water to 11.6 million Indonesians who level governments screen villages to select provides a glimmer of hope. currently do not have access to clean water, those that meet these criteria, ultimately, the (Bulukumba District of and access to sanitation facilities for decision as to whether or not to participate in South Sulawesi Province, December 2013). 7.4 million Indonesians who currently the program must be made by the community do not have access to such facilities. itself. Therefore, an intensive socialisation process is conducted to explain the goals and To benefit from these facilities, the community methods of the program, raising awareness of must use them appropriately. Therefore, the villagers and enabling communities to make second goal of the program is to encourage a more informed decision. members of Indonesian communities to engage in better hygiene practices. Specifically, In addition, to participate in the program, the goal of the program is to ensure that at communities in the selected villages must least 50 percent of members of participating indicate they are prepared to allocate their communities refrain from open defecation own resources to cover at least 20 percent and that at least 60 percent of the community of the associated costs. This is intended to practice sound hand-washing techniques. ensure participating communities develop To ensure that PAMSIMAS benefits a strong sense of ownership and take 38 39 LEFT TO RIGHT responsibility for a program intended to approach, using two principal methodologies, A key initiative at the initial stage of these The PAMSIMAS process at village level begins with socialization and social improve the community’s infrastructure namely the Methodology for Participatory community driven approaches is rembug mapping to identify water, health and and overall public health. Assessments (MPA) and the Participatory desa, or village hall meetings, to discuss sanitation issues affecting the village. Hygiene and Sanitation Transformation the community’s needs and determine the Then facilitators provide training and assistance to villagers in preparing the One of the key features of the PAMSIMAS (PHAST). The MPA defines an approach for infrastructural demands and constraints community action plan (Rencana Kerja program is that necessary facilities are not the formulation of plans at the community required to address communal water and Masyarakat, RKM)). A RKM presents simply constructed for the community, but level, particularly in terms of identifying sanitation needs. At these meetings, a list of community ideas for health promotion activities, the technical design also by the community. Studies conclude that the community’s needs for drinking water all members of the community are encouraged of a water system, and an operation and the goals of the program are most likely to and sanitation facilities and infrastructure. to present proposals for discussion. At the maintenance plan. Subsequently, the be achieved with the active involvement of all Meanwhile, PHAST defines an approach to same meetings, members of the community community will carry out a procurement process to ensure efficient use of the community members, including women, the form plans that improve communities’ level elect representatives to a village-level resources. After this, the community gets poor, and members of marginalised groups of awareness regarding the use of these institution specifically established to plan, involved in the construction. that are not normally involved in the village- facilities to ensure better health through construct and maintain the necessary water level decision making processes. Specifically, behavioral changes of the members of and sanitation facilities. PAMSIMAS adopts a community-driven these communities. 40 While communities are best able to determine been collected, the village-level institution LEFT 41 Socialization at the village their own needs and devise customized establishes a community bank account for level aims to raise awareness solutions to meet specific needs, they may project management. among community lack the technical and institutional skills and members and village level officials. The process aims capacities necessary to implement these Once these requirements have been met, to involve all community solutions effectively. Therefore, PAMSIMAS the plans formulated by the community are stakeholders, including women, poor families as provides training for community facilitators, presented to a partnership committee at well as marginalized people. enabling them to assist in the formulation of district level for evaluation. If this committee Occasionally, district plans and the establishment of associated agrees on the feasibility of the plan and officials attend village level socialization. village level institutions. These facilitators also all other requirements have been met, the play a vitally important role in determining the district-level public works agency and the technical feasibility of the proposals presented village-level institution sign an agreement and selected by the community, and in enabling the community to receive PAMSIMAS formulating work plans for the construction or funds. Before construction of the facilities rehabilitation of the required infrastructure. begins, members of participating communities are provided with the necessary training to Following the formulation of feasible working ensure that they are able to construct and plans and the establishment of the necessary manage the facilities appropriately. Not only institutions to support their implementation, does this ensure that the facilities developed the community collects funds according to through the PAMSIMAS program meet the a formula agreed upon by the community specific needs of the communities, but it itself to meet its share of the financial cost also builds the capacity of the community to of the program. Once these funds have develop similar projects in the future. Community itself is the principal actor in PAMSIMAS 42 It must be emphasized that the primary While the community itself is the principal In particular, Bappenas, Indonesia’s central in the years following their construction, and sector officials on achieving project’s goals 43 goal of PAMSIMAS is not merely to build actor in the PAMSIMAS program, improving planning agency, serves as the overall an even higher level of effort to ensure that and the mainstreaming of its approach.In and maintain infrastructure. Rather, it is to the health of communities through national coordinator of the program, while the they are being used effectively. While the total, the program has provided training to empower communities to improve the health the provision of infrastructure and the Ministry of Public Works and Housing acts physical construction of facilities involves approximately 450,000 individuals, as follows: and well-being of the entire community. The transformation of behaviour requires as the executing agency. A number of other a relatively small number of government Community members : 439,700 infrastructure developed by the program is cooperation across agencies and organizations government departments are involved as agencies, ensuring that these facilities are PMU and SNVT staff : 5,800 merely a tool to achieve this goal. Therefore, involved in health, education, infrastructure, implementing agencies, including the Ministry maintained and used effectively to improve Community facilitators : 6,000 following the construction of the water and and community governance, to name some of of Health and the Ministry of Home Affairs. health outcomes involves a greater number Water Board Associations : 1,200 sanitation facilities under the program, the sectors involved. Therefore, the program Provincial and district governments acting as of agencies operating in a range of different (BPSPAMS) PAMSIMAS works closely with communities adopts an intersectoral approach, with the primary partners and playing a significant role sectors. Because PAMSIMAS changes the Local Government personnel : 2,900 to conduct programs that encourage the active involvement of numerous elements, in the implementation of the program at the paradigm by which the Government measures Project consultants : 850 appropriate use of sanitary facilities. including a wide variety of government community level. the degree to which its efforts are achieving agencies at all levels, as well as civil society their intended goals, it requires Government PAMSIMAS has proven to be remarkably For example, the simple act of hand- washing organizations and the private sector. As stated in the previous chapter, the agencies involved to develop new capacities effective at achieving its stated goals. A with soap and clean water is one of the most emphasis of PAMSIMAS on facilitating and new systems. study published in August 2013 to determine effective means of preventing the spread These agencies play a critical role in the the achievement of sustained access to the impact of the program in the areas in of diarrhea, skin disease and fecal-borne initial screening and selection of participating services and of the effective use of those In order to ensure these institutions which it has been implemented showed that illnesses like typhoid. The program enables villages, the training of members of the services creates a new role for these Central and agencies are able to provide the the program enabled more than 5 million communities to conduct initiatives to community and facilitators, the verification of Government agencies. It is relatively easy to necessary support, the program strives to Indonesians in more than 7,000 villages to promote hand-washing and other hygienic proposals, the administration of funding, the measure how many facilities are constructed build capacities through the provision of access clean water, with a similar number practices at schools and throughout the measurement of the program’s achievements, within any given time frame, but it requires training, workshop and hands- on learning. of individuals gaining access to improved broader community. as well as further development, replication a much higher level of effort to determine Specifically, the program provides training sanitation facilities. and expansion of the program. whether these facilities are still functioning to central, district and provincial public- LEFT PAMSIMAS monitoring is a multifaceted activity involving the use of a sophisticated information management system. Program managers and other stakeholders can monitor the performance of village water systems and community behavior changes related to sanitation through Internet- based technologies. 44 Of the villages where the program was With the high level of success of PAMSIMAS, 45 implemented, almost 45 percent had achieved the Central and Local (provincial and open defecation free status, while more district) goverments across the country have than 66 percent had adopted hand-washing expressed great interest in expanding upon programs. In 72 percent of villages where and replicating the program’s achievements to the program was implemented, water and ensure that a greater number of Indonesians sanitation facilities remain fully functioning, benefit from access to improved water supplies while facilities are at least partially functioning and sanitation facilities. Chapter 5 of this book in an additional 22 percent. As a result of these will explore in detail how governments across improved facilities, large numbers of women, Indonesia can build upon the successes of who previously bore the burden of collecting PAMSIMAS. water from often distant water sources, were able to spend increased hours engaged in productive activities. 11 46 47 LEFT TO RIGHT PAMSIMAS pushes communities to be transparent and accountable in managing block grants and activities. Relevant program information, such as financial facts and an awareness campaign, is publicly displayed. Community members are encouraged to report any suspicious activity and can also file complaints by using telephone numbers and email addresses listed on public information materials. 10 11 48 49 LEFT A PAMSIMAS facilitator provides the village implementation team (Lembaga Keswadayaan Masyarakat, LKM) staff with financial and accounting skills needed to manage the community’s block grant in a village in Bulukumba District. Often, the LKM members who have learned financial management, bookkeeping and other skills from PAMSIMAS go on to utilize these competencies in their personal life and career (Bulukumba District, South Sulawesi Province, December 2013). RIGHT A facilitator reinforces the importance of communities maintaining facilities to ensure that the benefits of the program are sustained for future generations. 50 51 03 chapter THREE: Sanitation and Hygiene Chapter Three Sanitation and Hygiene: Simple Community-Led Solutions Save Lives 10 52 In 2012 UNICEF reported that around the Human waste is teeming with pathogens LEFT 53 Proper hygiene is vital for world, diarrhea and pneumonia account and, if not properly treated and disposed of, protecting both children for 29 percent of deaths among children can lead to disease, water pollution, and air and adults against below the age of five years, with more than pollution. As presented in the CLTS Story in pathogens. 2 millions lives lost each year. Most of these Indonesia (Susenas 2004), three quarters of deaths occur among poor and disadvantaged all households in Indonesia discharge raw communities in the most impoverished sewage into rice fields, ponds, lakes, rivers or countries in the world. Almost 90 percent of the sea, while only a quarter of the population deaths caused by diarrhea and pneumonia is connected to septic tanks or improved pits. are the result of unsafe water, inadequate When it is not disposed of properly, human sanitation and poor hygiene. waste is often washed by rain directly into waterways, which serve as the main source of Indonesia can no longer be considered a poor drinking water for both humans and livestock. country, In fact, it is now one of the fastest In addition to diarrhea, these poor sanitation growing economies in the world. However, conditions could potentially result in the despite the significant advances the country outbreak of cholera, typhoid, hepatitis and has made—a high rate of economic growth, other life-threatening diseases. poverty reduction, near universal primary and junior secondary school education, increased To reduce and eliminate potential diseases provision of healthcare services—more than caused by unsafe water, inadequate 50,000 Indonesians, most of them children, sanitation and poor hygiene, it is critical continue to die of preventable diseases. that all Indonesians have access to good quality infrastructure, such as unpolluted, 54 55 LEFT TO RIGHT properly functioning wells or other water of defecating outside, on the ground preparing food and feeding children, and after The Community Led Total Sanitation (CLTS) approach supplies, hand-washing and bathing facilities, and close to water resources used by the using the toilet. The adoption of this simple promotes community efforts and improved sanitation facilities, which local community, a practice known as behavior has the potential to cut the number to identify factors that lead hygienically separate excreta from open defecation. of child diarrhea-related deaths by half and to open defecation and other poor hygiene practices as a human contact. pneumonia-related deaths by one quarter. means of triggering Additionally, it is critical that all members behavior change. Merely ensuring that communities have access of the community engage in proper hand- Prior to the implementation of PAMSIMAS, to toilets and other sanitary facilities, however, washing techniques. According to UNICEF’s many of the Government’s numerous does not guarantee they are properly used, report published in 2012, hand-washing endeavors to improve the country’s sanitation nor does it necessarily result in improved with water and soap is the single most cost- record failed to achieve their intended goals sanitation and hygiene. To improve conditions effective health intervention to reduce the simply because implementers discounted of sanitation, it is necessary for entire incidence of both pneumonia and diarrhea in the complexity of human behaviour. These communities to change their behavior. In children under the age of five. In particular, it programs focused almost exclusively on the particular, communities have to work together is vital that all members of a community wash supply of infrastructure without creating a to eliminate the extremely dangerous practice their hands properly before eating, before demand for the infrastructure by addressing Focus on behaviour change at the community level 56 RIGHT the complicated socio-economic and cultural method and practices of these earlier 57 Local women enjoy the benefits of a house water factors that underscore the practice of open programs. PAMSIMAS focuses on connection system provided defecation and poor hand-washing practices. community behavior change for clean and by PAMSIMAS. With these healthy living. This approach acknowledges the facilities, they are able to cook, wash their clothes, and Past government programs often involved fact that even the failure of a few community bathe in comfort and without delivery of construction materials for building members to commit themselves to good risking their health and the toilets to a small number of households, hygiene practices can result in the spread of health of their children. with the expectation that other households disease affecting the whole community. would be motivated to build their own toilets with their own money. Unfortunately, a large PAMSIMAS seeks to eliminate poor sanitation proportion of the beneficiaries failed to practices and adopt good hygiene behavior completely construct these facilities, and many through mobilizing communities and local even started using the granted cement and institutions including schools, places of pipes for other purposes, or building toilets worship, and village gatherings and without proper standard. Not surprisingly, local media. the demonstration effect was therefore insignificant, while the broader community The core method to achieve these goals failed to see why they should spend their is referred to as “Community-Led Total money, time and energy to build facilities for Sanitation” (CLTS). The unique features of which they felt no pressing need. CLTS include: •Eradication of open defecation through The approach adopted by PAMSIMAS preventive measures designed to encourage represents a radical departure from the the stigmatization of poor hygiene 58 59 LEFT TO RIGHT Improved sanitation involves the commitment of the It is critical that all Indonesians have practices as well as associations between good hygiene practices and self-respect, • Utilization of local institutions and mutual- help, decision-making and enforcement to generalize using a single case study. However, to show how these methodologies have been particularly by raising awareness about the promote the collective adoption of hygiene implemented at the village level the following access to adequate sanitation facilities entire community. The pictures above demonstrate negative impacts of bad practices and the practices. chapter will provide stories of a number of how changes can be made benefits of clean and healthy living. actors in Kedungori, a small village in Central and adopt proper hygienic practices gradually according to a ‘sanitation ladder’: from It is not the goal of PAMSIMAS to impose Java where most of the villagers farm rice. simple pit latrines to A focus on the transformation of behavior • standard, one-size-fits-all solutions to improve permanent facilities. at the community level rather than the hygiene behavior across the diverse societies household level. of Indonesia. Instead, the goal is to enable communities to come up with solutions that Encouragement of local innovations and • respond to their own specific needs. solutions to increase access to quality sanitary facilities, rather than relying on In many areas across Indonesia, this approach sets of instructions for implementing has been remarkably effective. The manner in standardized programs. which communities develop solutions varies widely from place to place, according to their specific circumstances, so it is difficult to 10 LEFT 60 61 A sanitarian elaborates on proper hygiene methods, reiterating the importance of appropriate hand-washing techniques as a means of preventing the spread of transmissible diseases. 11 16 62 63 LEFT TO RIGHT Hygiene and sanitation promotion in PAMSIMAS requires the active involvement of a range of stakeholders, including: teachers who play a pivotal role in promoting healthy behavior amongst children at the earliest age possible; small-scale entrepreneurs who play a significant role in enabling communities to achieve good outcomes in improved sanitation facilities; and, finally, communities which must collectively take action in changing behavior. All of the efforts resulted in a declaration of an open defecation free witnessed by district and sub-district officials. 64 65 LEFT A hygiene promotion program in a school helps introduce 10-year-old children like Eki Dwi Suryani to proper hand-washing techniques using soap and clean tap water (Sudiang Village, Makassar Municipality of South Sulawesi Province, December 2013). RIGHT Children learn how to wash their hands properly in school. Then they transfer the knowledge and practice to other family members at home. 66 67 04 chapter four: STORIES OF PEOPLE BENEFITED FROM PAMSIMAS Chapter Four Kedungori: The Implementation of Pamsimas in a Modest Village in Central Java COMMUNITY PLANNING 68 Kedungori, a modest village, where most Following an intensive socialization process, LEFT 69 Children often use water community members earn a living as either supported by the village head, the midwife, from a public tap to wash farmers or farmworkers is located in the sub- and other respected community members, their hands after school, district of Dempet, in the district of Demak, villagers agreed to participate. Through a before Friday praying or playing. Such facilities help Central Java. Prior to PAMSIMAS, fewer than series of public meetings, villagers selected to change behavior among 40 percent of village households had toilets a few representatives as volunteers to serve children and adults within community. or were connected to a water supply. For as members of the village implementation consumption and washing, most residents team (LKM) and the village water-board relied on water from the river, which became management group (Badan Pengelola extremely dirty during the rainy season. The Sarana Air Minum dan Sanitasi, BPSPAMS). river was also as a communal toilet, with residents defecating directly into the waterway. These volunteers worked relentlessly to convince community members of the value of PAMSIMAS was first introduced to Kedungori the program and supervised the construction village in 2010, when facilitators came of a simple water treatment system (Instalasi to explain the purpose of the initiative to Pengolahan Air Sederhana, IPAS) with the villagers. Initially, there was considerable capacity to produce two liters of clean water resistance to the program: villagers were per second, as well as the installation of 3,500 shocked and surprised that a government meters of pipelines, two toilets and four assistance program required them to hand-washing facilities at the local primary contribute funds and labor to the construction school. By 2011, more than 120 households of a water facility, and to pay for the had a house-connection, together with simple, construction of toilets in their own houses. functional toilets. By 2012, 350 households 70 RIGHT were connected, and by 2013, all 490 71 In Tallo Village, PAMSIMAS has become so successful that it households in the village were connected was awarded a Village Incentive to the water supply and had toilets in Grant (VIG) for its water and their houses. sanitation achievements. Following the VIG, the water system was expanded to This chapter presents the stories of the more beneficiaries and many BPSPAMS members, a school teacher, more people gained access to a water connection, such a district health official, and an initially as this housewife (Makassar reluctant member of the community. Municipality of South Sulawesi, December 2013). NGATMIN, HEAD OF BPSPAMS DESA KEDUNGORI It is a matter of pride for the village that we have built this system 72 RIGHT “In Demak, the climate is arid, but Kedungori flavor. During the rainy season, villagers are unable Government would provide the whole system The major problem was that people farther away 73 Bapak Ngatmin serves as the head of village water board is located right next to a river that never runs to clean clothes properly, and the water has a for free. Some better-off villagers wanted toilets, from the river did not believe that it would be committee (BPSPAMS) for dry. Before PAMSIMAS, almost everyone in the pungent odor and a distinct taste. Still, we were but were unable to build a system by themselves possible to pipe the water to their houses. They Kedungori Village, Demak community used the river as a public toilet, used to it. The people of Kedungori used to say unless others cooperated, so they were more were afraid that they would have to contribute District. Elected by the community, he has committed communal bath and the main source of water for you did not need to add spices or flavoring to the enthusiastic. With pressure from the village head funds and labor, but there would be no benefit for to provide a sustainable cooking and washing clothes. Less than half of food you cook, because the water from the river and health authorities, the village agreed as a them. The first year was the most difficult. When water service to the entire community. Most BPSPAMS the homes in Kedungori had toilets, and the only gave everything a strong flavor. whole to participate, but there was still the pipes were laid down and water started to members, including Bapak functioning facilities were poor quality, soak pit noticeable resistance. flow, people started to believe. Ngatmin, are agricultural laborers who, out of a sense of toilets. Some people who lived farther away from During public meetings held in 2010 to socialize pride, volunteer their time and the river used water from wells, but the water from PAMSIMAS, the village head, the village midwife, Then the villagers established a core team of In 2011, more and more people were connected to expertise to serve people. the wells is brackish, unlike freshwater from the and other village officials explained the benefits volunteers for BPSPAMS during these meetings. the system. It became a status symbol to have a river. The quality of the water in the river is good of sanitary toilets and water facilities. Officials Even though I have no technical knowledge toilet in your house. Javanese people are like that: even in the dry season, but the water gets filthy hung banners around the village to socialize of water systems, I was happy to serve as a if their neighbors have something, then they want during the rainy season, when the silt and mud the importance of good sanitation. The school volunteer. The PAMSIMAS facilitators helped me to to have it too. We never had to force people to from the rice fields floods the river. During the teachers also talked about it to the children. Even understand the technical side of it. They explained connect to the water system, we just made people rainy season, villagers are unable to clean clothes so, people could not grasp the idea of spending that there were several technical options for the feel a bit ashamed if they did not. We used social properly, and the water has a pungent odor and a their own money on toilets when they could just water system. Either we could build a system to pressure. Meanwhile, at that time, a lot of people distinct taste. Still, we were used to it. The people use the river. clean and filter water from the river, or we could were still defecating directly into the river. of Kedungori used to say you did not need to add dig wells. Nobody wanted to use the brackish spices or flavoring to the food you cook, because Some people slowly opened up to the idea. Some water from wells, so we agreed to use a simple There used to be a lot of bamboo growing along the water from the river gave everything a strong of the poorer people continued to believe the water treatment system. the riverbank, so people could defecate without 74 RIGHT being seen. So in 2012, there was another public are agricultural laborers who live nearby. They are 75 PAMSIMAS provides water facilities based on the needs meeting where it was decided to clear the bamboo. not paid; they volunteer their time and expertise of rural communities and The clearing away of the bamboo meant that if out of a sense of community. It is a matter of pride their capacity to operate and someone was defecating in the river, everyone to prevent disruptions to the water supply. Funds maintain the facilities. The program trained BPSPAMS to could see them. This put extra social pressure on for regular water system maintenance come from manage the facilities properly. the villagers. A lot of people had toilets installed monthly fees paid by the community. People do after the bamboo was removed. After we cleared not mind paying the fees because they have come the bamboo, defecating in the river became a to appreciate the service. lonely business. People say that defecating in the river used to be a social event: you went down to It is a matter of pride for the village that we have the river with your friends, you quietly went about built this system. A few months ago, the district your business, and then you hung out in a group government tried to encourage neighboring together for a while. By 2013, if you went down villages to establish a water and sanitation system to the river, you were on your own. If you did not akin to PAMSIMAS in their own village. They have a toilet in your house, you were considered brought in a group of the villagers to observe unusual. People have now adopted and embraced the Kedungori system and talk to us. It made us the idea that every house should have a clean water proud that we are being held up as an example supply and a toilet. If a problem with the filtration for others. It makes us feel like we have achieved system occurs, BPSPAMS volunteers immediately something special.” repair the issue, sometimes even in the middle of the night. Most of the core BPSPAMS volunteers KUSNANTO, FINANCIAL MANAGEMENT STAFF OF BPSPAMS DESA KEDUNGORI It was particularly difficult right at the beginning 76 “We first heard about PAMSIMAS in 2010. The and labor without any apparent benefits. Once the and maintenance costs, every household pays a use it as a threat, but we never really act on that LEFT 77 The BPSPAMS of Kedungori people from PAMSIMAS came to explain how it pipes were laid, people began to believe that the monthly fee. It took a long time to decide how to threat. We understand that some people have to Village applies a monthly tariff worked at public meetings held at each sub-village system might work. To be honest, people were not structure the fee system. We had a meeting about wait until the harvest to have cash in hand and that for water based on agreement (rukun warga, RW). At first, everyone was very so concerned about the toilets, but they were keen it that went on into the middle of the night. It was most people do want to pay when they can. with the community. As a financial manager for enthusiastic. Practically everyone in each RW came to have good quality water piped into their house exhausting, but in the end we agreed to categorize BPSPAMS, Bapak Kusnanto to the meetings, particularly more disadvantaged for cooking and washing. But we had a rule that households into three: poor, average, and well-off. Sometimes, the people who resisted most at the is responsible for collecting community contributions as people without toilets in their houses, and those you could only be connected to the water supply Each household was categorized according to the beginning are the ones who are most enthusiastic well as the water fee from living far away from the river. They thought the if you agreed to install a toilet. To build a very size of the house, the land area and the amount about the system now. It is funny, at the beginning, customers and reporting the usage to the entire community. Government was going to provide them with basic toilet and bathroom, each family had to pay of water each house uses, but we were happy to people wanted the Government to pay for At the beginning, he found it free toilets, so they wanted to be one of the first between Rp. 500,000 and Rp. 1 million. negotiate if someone felt they were being everything, but the PAMSIMAS facilitators told me difficult to convince people to families to receive one. unfairly burdened. that when the Government pays for everything, contribute, but that after the water system is functioning, Some people explained that they really could not people do not bother to keep the system working. the community is committed to When they were told that they would have to afford a toilet, so we agreed that some of the People are meant to pay on a monthly basis, With the PAMSIMAS system, it was much harder making monthly payments to keep it working. contribute their own funds, people were very money raised from village contributions could before the 10th of each month. They have been at the beginning, but now people are much more unhappy. They all complained that if PAMSIMAS be used to pay for toilets in extremely poor asked to bring the fees to my house. In practice, committed. They feel like they worked hard to build was meant to be a Government assistance households. But in fact, there were not many some people are often late, although they usually the water system and they paid for it themselves, program, they shouldn’t have to pay for their cases like that. People were embarrassed to be settle their bill when the harvest season comes. so they expect it to work and they feel they have a own toilets. Most people said that if they had considered so poor that they had to take money Sometimes, we have to go to visit people in their right to it.” to pay, they would rather just go on using the from their neighbors. They did not mind getting houses and remind them to pay up. In theory, if river the way they always did. It was very hard to something for nothing from the Government, people do not pay for three months consecutively, convince people. It was particularly difficult in the but they felt very different about taking money then we can cut off their access, but we have never beginning, when people had to contribute cash from their neighbors. To cover the operational actually done that. It is like a nuclear bomb, we just SUYATNO, SANITARIAN, DEMPET PUSKESMAS PAMSIMAS helps us to achieve our sanitation target 78 “My name is Pak Suyatno. I am employed at PAMSIMAS. But sometimes, the health personnel 79 Puskesmas Dempet which provides health in other areas are not very receptive to our services to the people of Kedungori village, messages. Maybe they have too many issues to amongst many other villages. Specifically, deal with, so they do not place a high priority on I am responsible for sanitation. sanitation. It is just one on a list of things that they have to deal with. I would like to thank the Government for introducing PAMSIMAS to our district. The What I see when I deal with the personnel from program has really helped us achieve our targets. villages where PAMSIMAS has been implemented Part of my job is collecting data related to number is that they are more interested in this issue, and of cases of infectious diseases in each village in that they ask us for more support. Instead of us the district, including cases of worm infestation, offering pamphlets and informational material diarrhea and typhoid. Before PAMSIMAS, the to them, they actually ask us for the information. Kedungori village was worse than average Perhaps, the fact that people in those villages in terms of all these issues. Since PAMSIMAS has actually have the facilities has made it possible been implemented, it has improved dramatically. for them to implement our recommendations It is now much better than average. regarding good sanitary behavior. Once people have access to clean water you can start teaching Our job is mainly to provide information and them how to wash their hands properly.” support to health personnel so that they can socialize proper sanitation practices. We do that for all villages, whether or not they participate in 11 80 81 LEFT TO RIGHT BPSPAMS technical staff inspects and records the monthly usage of their customers. In an effort to constantly improve services, BPSPAMS frequently discuss expansion and upgrading options with the community, which includes moving from a public tap to a house connection. Usually, the community will upgrade the service to house connection for an additional charge to purchase extra pipes and taps. SRI KASIHATI, BEHAVIORAL CHANGE STAFF, BPSPAMS KEDUNGORI LEFT I need to know who it is in the Ibu Sri Kasihati is a village cadre who is actively involved in PAMSIMAS. She encourages communities to adopt proper health and sanitation techniques. Ibu Sri provides examples village that people listen to of good hygiene practice to women groups. She advocates for many affluent women in the village to support the community’s behavior change program. 82 “I am nobody special, I am just an ordinary were prepared to socialize the program and make rather than going to the river. I can scare them a village that people listen to. Then I have to meet wives of Government employees, and some are 83 housewife, and my husband is just an agricultural it happen. Apart from Pak Ngatmin, who is the bit by telling them that their children’s health is at them and convince them, so they can convince based on a particular neighborhood. The arisans laborer. But about five years ago, my sister-in-law head of the BPSPAMS, we needed one person to stake. Mothers care more about their children’s other people. From the start, the village head are tight-knit groups, with strong social bonds had a difficult pregnancy, so I had to take her to be in charge of technical matters, one person to health than their own health, so that is the way supported the program. Whenever there was a between members. The women trust their money the Community Health Center (Puskesmas) for look after the community’s financial contribution, to reach them. village event, he always promoted PAMSIMAS to the leaders, so these leaders have to be held help and advice from the midwife. Because of and one person to look after behavioral change. and encouraged people to get toilets. But other in high regard and dependable. People look up to that, I became a volunteer (kader), giving advice The villagers decided that since I was so active at It is not enough just to talk, people do not get people have influence, too. For example, I meet them and they have a lot of influence. If I can get to pregnant women, helping weigh their babies the health center, I would be a good person to be the message. I use a few tricks to get my point with all the neighborhood heads (rukun tetangga, the leaders to promote PAMSIMAS, then the other and making sure they were healthy, and so on. responsible for behavioral change. across. Sometimes, before a group of people, I RT), because even if people do not attend village women will follow. And the women all compete One thing led to another, and I found myself take a glass of water and put some animal dung meetings, everyone has to deal with the RT. So, with each other. They all worry about what their volunteering for more and more activities around It is not easy to get people to change the way they in it. Then I ask who in the audience wants to if they believe in the program, then they can friends think of them. Once a few women take part, the village. I do not get paid for it! I just do it think. You cannot just tell someone something drink it. Then I tell them it is exactly the same as pressure the people in their neighborhood to all the rest follow. because I like to get out of the house, meet and expect them to change. People listen to what defecating in the river and then using the water participate. The teachers and the midwife also people and do something useful. you say and agree with you, but they still go on from the river to cook with. Everyone laughs and have a lot of influence, so I often meet with them. I have heard that in other districts, they use force behaving exactly the same way they did before. So recoils from the glass, but they get the point. Another tactic I use is through the local leaders to make people change their behavior. They have Even though I do not have any special skills or you have to keep on nagging and nagging them. One of the PAMSIMAS facilitators suggested I involved in the women’s collective fund (arisan), patrols to stop people defecating in the river, or qualifications, I have become quite well-known But there is a lot of overlap between my activities. try that, together with a few other tricks. But you where women gather together to pool their money they impose fines. That would not work here. If around the village as someone who gets involved If I am already working with a group of women to have to keep pushing. I am just one person, so I and distribute the combined sum to one of the you try to force people, then they get stubborn and in community activities. When we first had a talk about pregnancy, it is the perfect opportunity cannot talk to everyone directly. And like I said, members of the group. There are a number of resist. But Javanese are very sensitive to what other village meeting to discuss PAMSIMAS, one of the to also explain PAMSIMAS to them, to talk about I am no one special, so not everyone listens to groups like this in the village. Some are run by people think about them. The trick is used to get things we had to do was to find volunteers who washing their hands properly and using a toilet me. Therefore, I need to know who it is in the women active at the mosque, others are run by the people to change their behavior.” 11 84 85 LEFT TO RIGHT PAMSIMAS provides significant benefits to a number of communities, particularly women. Here a housewife collects water from a public hydrant near her house. The use of regularly tested and certified water for cooking and washing ensures that women have healthier families. SUDUR, AGRICULTURAL LABORER AND RESIDENT OF KEDUNGORI (RT01/RWIV) These days, I’d be embarrassed to go down to the river 86 RIGHT “My house is quite far from the river. Before used to be normal, but now people started talking village after harvest. That is when people settle 87 With a water connection exists, Bapak Sudur built a toilet at home. His family saved money PAMSIMAS, I used to go over to my parents’ about you if you did not have a toilet put in. debts and make new purchases. The PAMSIMAS for it. He then convinced her neighbors to house and use their well to fetch water for cooking facilitators know that. So just before the harvest, do the same. He is very glad that now many and bathe. The water was salty, but I did not mind, So, I had one put in. It cost a bit less than Rp. 1 they started putting on the pressure for people to houses in her village have toilets. The village has even received an award from the sub- that just meant that I saved some money because million for the basic unit, but that does not count get connected. Even beforehand, they got people district and district governments for their I did not have to buy salt for my food. If I needed the cost of putting in a proper floor with tiles. to promise they would get connected when the collective initiative to adopt this practice within community. Now nobody in her village openly to defecate, I got on my bike and went down to I spent a bit extra to make the bathroom look nicer. harvest season came. Then, when the harvest defecates anymore.” the river. I think it is probably healthier than defecating in came, they went around and reminded people of the river. I still bathe in the river after working their promise. To be honest, I was not that enthusiastic about in the fields to get the mud off, but then I come PAMSIMAS at first. There were some people who home and have another bath, with soap and clean By 2013, every house in the village had a toilet. wanted to join as soon as they heard about the water. I do not have to go to my parents’ house It makes us proud when the sub-district head program, some people came in a bit later, and for water anymore. congratulates us and tell us that our village is then some people resisted until the very end. I was so much cleaner now. These days, I would be somewhere in the middle. I did not see the point I waited until after the harvest season when I embarrassed to go down to the river. It is not in spending money on a toilet. I had a television had some spare cash, to put the toilet in. A lot of normal anymore.” in my house, but no toilet. My friends had a other people did the same thing. In this village, television, so I felt left out if I could not talk to practically everyone farms rice. Either they own them about the programs that were showing. Then their own land, or they lease land on a crop-sharing when my neighbors started getting toilets put in, I basis, or they are agricultural laborers. So, there began to feel left out because I did not have one. It is always a lot more money circulating around the SUWANTO, PHYSICAL EDUCATION TEACHER AND CO-COORDINATOR FOR SANITATION Children are naturally curious 88 “I am the teacher in charge of physical education children can wash their hands, too. Sometimes the Children are naturally curious. They like to play not have a budget for dispensers. But now that LEFT 89 As a physical education at the primary school in Kedungori village. As pressure is weak, but the water almost always runs. and see things for themselves. A few weeks ago, almost everyone has running water and a toilet at teacher in primary school, such, I am responsible for coordinating activities Puskesmas gave us some kind of brown chemical home, I am sure that at least they wash their hands Bapak Suwanto is responsible related to health and sanitation, although all As a school teacher, my fundamental philosophy dye. We got two groups of children and got them properly at home. Like I said, it is easier to change for teaching children proper hygiene, including hand teachers are expected to take part in teaching the is that if you want to change society, you have to to smear the dye over their hands. We gave one the way children behave than it is to change adults. washing with soap. He hopes children on these matters. Because of my position start with the children. There is no point trying to group plain water, and the other group water and Even though parents should teach their children that the children will practice it at home followed by other at the school, I was involved with PAMSIMAS change the way adults think, they are set in their soap. They dye was designed so that it could only how to behave properly, I think it is sometimes family members. PAMSIMAS right from the start. ways. But children are still learning and growing, come off with soap. We told them it was exactly the the other way around. I think the parents can facility and hygiene promotion program at school help him so you can guide their beliefs and change same as after they had gone to the toilet. If they did learn from their children how to wash their to make the teaching is easier One of the biggest impacts of the program was their behavior. not use soap, then the dirt and germs would not hands properly. and more fun for children. His that it improved the sanitation facilities at the come off their hands. It was like a game to them, mission is to ensure they will grow becoming a healthy adult. school itself. Before PAMSIMAS, there was no Prior to PAMSIMAS, we had already started to but they got the idea better than if we just nagged I think PAMSIMAS is an excellent start, but it running water at the school and only a single teach the children that they had to wash their them. One of the challenges is that it is difficult to would be a shame if it stops here. As I said, toilet for more than 200 students. According to hands, but it was hard for them to take it seriously provide soap at the school itself, because the kids we still do not have enough toilets at the school the school standard, there should be one toilet for without proper running water here at the school or carry it off to play with. They like to use it to make and we do not have a budget for soap. Now that every 16 to 20 students. Without any water, the at home. So, PAMSIMAS made us take the job of bubbles and such. we have come this far, we need to keep on lobbying single toilet was often in a very poor condition. teaching them more seriously, particularly because the district education agency to provide sanitation facilitators and sanitarian encouraged us to push We have tried to establish a system where different funds. We have come a long way, but to really make With PAMSIMAS, two new toilets were built. That the issue. groups of children are responsible for bringing sure that the children grow up to be healthy adults, is still not nearly enough, but at least these toilets soap to school each week, but it is not working yet. we have to take it further. PAMSIMAS was just the have water, so the students can flush properly. Maybe we could try dispensers with liquid soap, first step, now we have to build on it.” There are four or five taps around the school where if we could stop the kids getting into it, but we do 90 91 05 chapter fIVE: UNIVERSAL ACCESS TO SAVE WATER AND SANITATION Chapter Five The Ultimate Goal: Universal Access to Safe Water and Sanitation Facilities for All Indonesians 10 92 As previous chapters of this book have made access safe, high quality drinking water and LEFT 93 A mother is so happy to have clear, the community-driven approach adopted improved sanitation facilities, a significant healthier children. With the by PAMSIMAS to empower communities number of Indonesians still lack access to public tap just in front of to develop water and sanitation facilities such facilities. In 2013, BPS presented that her house she can make her children to bathe twice a according to their needs and to use these more than 75 million Indonesians lack access day–and the monthly fee for facilities appropriately, has been remarkably to safe, high quality drinking water, while more using this water is affordable. In the future, she would like effective. The program has enabled almost than 100 million Indonesians are still unable to upgrade the water service eight million people to access clean water and to access improved sanitation facilities. This is to a house connection. about 7.4 million improved sanitation facilities unacceptable. Clearly, much still remains to across 10,000 villages. In areas where the be done. program has been implemented, a significant proportion of the participating villages have The Indonesian Government has committed achieved open defecation free status and to achieving the goal of universal access to implemented community-based hand-washing safe water and sanitation facilities by 2019. programs. As a result of improved hygiene and This means providing no less than 85 percent proper sanitation in these areas, members of the country’s population access to at of rural communities enjoy improved health, least 60 liters of clean water per person per increased productivity and an overall better day, meeting minimum service standards standard of living. established by the Public Work Ministerial Regulation No. 14/2010. The remaining 15 This is an extremely impressive achievement. percent, in areas where these standards However, while PAMSIMAS has helped cannot be met, all members of the community provide a large number of communities to must have access to at least 15 liters of water 94 RIGHT per person per day, to meet the basic lifeline of PAMSIMAS I in 2012, the Indonesian 95 Members of the PAKEM (Partnership Committee) consumption standards established by the Government initiated the second phase of participate in a routine World Health Organization as the bare the program, PAMSIMAS II, which will run coordination meeting. minimum necessary for drinking and from 2013 to 2017. Under this second phase, Meetings are held to evaluate program implementation cooking purposes. the program will facilitate the provision of and determine infrastructure water facilities to an additional 5,000 villages performance and In terms of achieving universal access to and extend sanitation interventions in about functionality. Monitoring and evaluation activities are improved sanitation facilities, the Indonesian 219 districts in order to enable a greater conducted in coordination Government is committed to ensuring that number of poor, underserved communities in with district officials, district no less than 85 percent of the population rural and peri-urban areas to gain improved water-board associations and BPSPAMS members, to has access to facilities that meet the access to water and sanitation services. ensure that the community established minimum service standards. In Additionally, PAMSIMAS II incorporates a is included in the decision- making process. areas where the standards cannot be met, number of changes to the program’s initial all members of the community must at least design. Recognizing the diverse range of have access to basic improved sanitation challenges faced by communities across the facilities. Recognizing the high level of country, the second phase of the program success of PAMSIMAS, the National and adopts a less standardized selection process Local Governments, as well as provincial and for participating villages. PAMSIMAS II also district governments across the country, have recognizes the need to provide additional expressed great interest in expanding and support to isolated communities in eastern replicating its achievements to bring universal Indonesia and the outer islands, due to access to water and sanitation facilities to limited human resources and high costs all Indonesians. Following the conclusion in these areas. 96 97 LEFT TO RIGHT PAMSIMAS stakeholders oversee progress and monitor achievements through an easy-to-use website (www.pamsimas.org). The website helps ensure the program’s sustainability is continuously monitored, for example, that the tap, in the middle photo, continues to function well. The website also provides information on whether messages displayed on boards about proper hygiene and sanitation techniques, in the right photo, translate into action on the part of communities. The Indonesian government has committed itself to achieving the goal 98 The main characteristic that distinguishes implement the approaches developed and The challenge, however, is to ensure that this A national-level association of BPSPAMS 99 PAMSIMAS I and PAMSIMAS II is the socialized through the program. process of replication and expansion of the was established under PAMSIMAS I to increased focus on program sustainability in community-based approach continues beyond improve coordination and optimize knowledge the latter. This is based on the understanding In fact, since its inception, PAMSIMAS has the program period. BPSPAMS established to and information sharing in the district- that it is not enough for PAMSIMAS to achieve encouraged district government to own funded form systems to operate, maintain and expand level institutions. Meanwhile, PAMSIMAS short-term improvements that last only as long replication program to apply same principles the drinking water and sanitation facilities, II focuses on the provision of training and as the program is in place and only benefit and approaches to achieve comparable results remain instrumental to the success of the capacity-building to improve the association’s villages directly participating in the program. in terms of the development of water and replicated programs. performance by facilitating communication sanitation facilities and the adoption of good and exchanges between the district-and If the goal of the program is to bring hygiene practice. illages participating in the Despite the critical role of the BPSPAMS, village-level institutions. improved hygiene and universal access to program are expected to serve as champions a study conducted in 2013 revealed that even water and sanitation to all of Indonesia by and examples for other communities. with ongoing support provided by PAMSIMAS, The ultimate goal of the program is to facilitate 2019, PAMSIMAS must inspire communities less than 75 percent of these institutions were the development of these institutions, so that and district administrations to adopt new PAMSIMAS promotes and urges district functioning as intended. Under the first phase all rural and peri-urban communities are able approaches and paradigms to replicate the level governments to provide 25 percent of of PAMSIMAS, it was agreed that one of the to develop their self-standing institutions, achievements of those directly involved. the total program fund at the district level to best means for improving the performance of supported by district governments that are finance their own community-driven water these village-level institutions was to establish ultimately responsible for the provision of Meanwhile, PAMSIMAS should enable all and sanitation programs in other villages. For district or district-level associations to enable basic services with their own resources. communities to maintain new approaches example, in every 8 villages receiving national BPSPAMS to exchange knowledge and benefit beyond the completion of the program. This budget grants, it is expected that district level from the experiences and lessons learned from will only be achieved through the development governments providing local budget for an other, similar institutions. of sustainable, independent, community-based additional 2 other villages. institutions with the necessary capacities to 100 When such institutions – adopting LEFT 101 The proud members of a community-based approach to the BPSPAMS. They play a development, maintenance and expansion significant role in ensuring of improved water and sanitation facilities the water facilities are continuously functioning and committed to achieve good hygiene to serve communities as and improved health for all members of the intended, and whether the behavior change of good community – exist in all rural communities hygiene and sanitation and are seen as a core component of the practice within communities provision of basic services, Indonesia will can be maintained. They are members of a significant be well on its way to achieving its goal institution to whom of universal access to drinking water and PAMSIMAS relies on its sanitation. sustainability. Through PAMSIMAS Indonesia 103 will get closer to achieving the target of universal access to water and sanitation access in rural areas by 2019 PAMSIMAS II Coverages Areas 2013 - 2017 1 INDONESIA 2 104 PAMSIMAS II (2013-2017) No Participating NUMBER OF No participating number of 5 23 provinces VILLAGES provinces villages 4 28 30 1 NANGROE ACEH DARUSALLAM 42 17 NUSA TENGGARA BARAT 96 3 22 2 SUMATERA UTARA 56 18 NUSA TENGGARA TIMUR 473 3 SUMATERA BARAT 427 19 KALIMANTAN BARAT 166 19 4 RIAU 264 20 KALIMANTAN SELATAN 246 6 32 5 6 KEPULAUAN RIAU BANGKA BELITUNG 40 44 21 22 KALIMANTAN TENGAH KALIMANTAN TIMUR 56 20 8 24 21 29 7 BENGKULU 80 23 SULAWESI UTARA 36 9 20 25 8 JAMBI 68 24 SULAWESI TENGAH 287 7 9 SUMATERA SELATAN 346 25 SULAWESI BARAT 62 31 10 LAMPUNG 40 26 SULAWESI TENGGARA 72 26 11 BANTEN 95 27 SULAWESI SELATAN 329 27 12 JAWA BARAT 246 28 GORONTALO 95 10 13 JAWA TENGAH 1022 29 MALUKU 104 14 DI YOGYAKARTA 34 30 MALUKU UTARA 10 11 15 JAWA TIMUR 322 31 PAPUA BARAT 79 16 BALI 20 32 PAPUA 20 12 13 15 14 17 18 16 Stakeholders 106 The Ministry of Executing & The Australian Donor 107 Public Works Implementating Department of Foreign and Housing Agency Affairs and Trade The Ministry Implementing Agency The World Bank Donor of Health Ministry of Implementing Agency Home Affairs The National Steering committee and Planning Agency the water and sanitation working group Ministry of Steering committee Finance Colophon PAMSIMAS Responding to the Water and Sanitation Challenge in Rural Indonesia PUBLISHED BY 108 World Bank Publication 109 Indonesia Stock Exchange Building, Tower 2, 12th Floor. Jl. Jenderal Sudirman Kav 52-53, Jakarta 12190, Indonesia Tel +62 21 5299 3000 E-mail wbindonesia@worldbank.org www.worldbank.org DESIGN & PRODUCTION TEAM R&W Publishing Tel +62 21 65300085 Email info@redandwhite.co.id www.redandwhite.co.id PRINTED BY Harapan Prima Printing Jakarta - Indonesia Copyright © 2014, PAMSIMAS 110 111 PAMSIMAS: Responding to the Water and Sanitation Challenges in Rural Indonesia 112 Over the last few decades, Indonesia has enjoyed substantial achievements in poverty reduction, human development and improvements in service delivery. However, enormous challenges remain, especially in water and sanitation sectors. Severe consequences of poor sanitation infrastructure on public health, the economy, and the environment. Of the four most important causes of under-5 mortality in Indonesia, two—diarrhea and typhoid—are fecal-borne illnesses directly linked to inadequate water supply, sanitation and improper hygiene practice. Difficult access to improved water supply also means that poor households, particularly women and children, spend too much time fetching water. PAMSIMAS strives to improve existing facilities and expand sanitation access through a community-based approach.