USAID IUWASH Urban Sanitation Promotion Guide by Virgi F. Tan

IMPROVING LIFESTYLE AND HEALTH A Guide to Urban Sanitation Promotion

IMPROVING LIFESTYLE AND HEALTH A Guide to Urban Sanitation Promotion Writers: IUWASH Team Jakarta, May 2015 APPRECIATION: Input and substance: Nugroho Tri Utomo (Bappenas); Valentina Ginting (Kementerian Pemberdayaan Perempuan dan Perlindungan Anak); Kristin Darundiyah (Kementerian Kesehatan); Erly Silalahi (Kemeterian Pekerjaan Umum dan Perumahan Rakyat); Ayesha NZ, Wiwit Heris, Iin Mendah, (SPEAK Indonesia); Dormaringan HS, Huseyin Pasaribu (Win Development); Eko Setyo, Nurfadrina Mourbas (InDII); Hendra Murtidjaja (Pokja AMPL); Henning Darpito (MCA Indonesia); Kania Mayang (Bappenas); Mahda Sirait, Pedaman H. (Wahana Visi Indonesia); Mildred Pantauw, Nur Endah Shofiani, Trigeany Linggoatmodjo (USAID Indonesia); Ovik Yanuar S, Rin Mulyadi (Dit. PPLP Kemeterian Pekerjaan Umum dan Perumahan Rakyat); Sarah Adipayanti (Jejaring AMPL); Yusmaidy (SIMAVI). Photo Credit: Achmad Dardiri, Dadang Hidayat, Dwi Prihanto, Eko Purnomo, Harod Novandi, Hasan Zunaidi, Pryatin Mulyo Santoso, Ratih Astati Dewi. Cover Ilustration & Layout: Pryatin M Santoso

PREFACE

The Government of Indonesia is making huge strides in accelerating access to improved sanitation by targeting Universal Access to drinking water and sanitation by the year 2019. To achieve the universal access, contribution from everyone is necessary, including stakeholders from government, international organizations, academia, private sector, NGOs, and communities. While various guidebooks on sanitation promotion are available, focus of those guidelines are limited to rural areas. They are very useful, but often adjustments are often required for application in urban setting. This “Guide To Urban Sanitation Promotion: Improving Lifestyle and Health” is designed to serve as a reference for community leaders, health personnel, members of the Indonesian women’s association (Pembinaan Kesejahteraan Keluarga/PKK), academics and members of community to improve sanitation condition in Indonesia’s urban areas. The guide contains much information related to not only the actual promotion process, but also many other critical areas required to improve their performance in the field. Such areas include broader enabling environment for sanitation, sanitation financing, gender-related issues, technical aspects of improved sanitation facilities, etc. Most importantly, it does not provide a rigid process to follow, but rather an introduction to the field of sanitation promotion programming that can and should be adapted to each specific setting. Once again, for sanitation development to succeed, everyone’s help is needed, and your efforts and contribution are sincerely appreciated. Hopefully this Guide will be of great use in your important work.

Ir. Nugroho Tri Utomo, MRP Director of Settlements and Housing Ministry of National Development Planning/National Development Planning Agency (Bappenas)

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

TABLE OF CONTENTS

PREFACE ............................................................................................................................................................. III GLOSSARY AND ABBREVIATIONS ................................................................................................................ VI CHAPTER 1 INTRODUCTION............................................................................................................................ 1 1. STBM and the Urban Setting ....................................................................................................................................... 2 2. This Guide ................................................................................................................................................................................. 3 3. Your Job as an Urban Sanitation Promoter (USP) ......................................................................................... 4 4. What is an Urban Sanitation System? .................................................................................................................... 5 5. Gender Mainstreaming in Urban Promotion Activities ............................................................................. 8 CHAPTER 2 THE ENABLING ENVIRONMENT ............................................................................................ 10 1. Promotion Planning and Coordination ..............................................................................................................11 2. Finance ...............................................................................................................................................................................12 3. Construction..........................................................................................................................................................................13 4. Maintenance and Technical Support ..................................................................................................................15 5. Sludge Removal and Treatment..............................................................................................................................16 6. Regulations and Enforcement ..................................................................................................................................17 CHAPTER 3 WHAT MOTIVATES PEOPLE TO INVEST IN SANITATION ................................................ 19 CHAPTER 4 COMMUNITY ENTRY AND SOCIALIZATION ....................................................................... 25 1. Learning About the Community and Collecting Data ............................................................................26 2. Advocacy to Community Leaders..........................................................................................................................28 3. Program Socialization .....................................................................................................................................................29 CHAPTER 5 COMMUNITY PLANNING ........................................................................................................ 34 CHAPTER 6 COMMUNITY-LEVEL PROMOTION ....................................................................................... 38 1. The Community “Triggering” Process: ................................................................................................................38 2. A Special Note on “Triggering”: ................................................................................................................................41

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CHAPTER 7 HOUSEHOLD-LEVEL PROMOTION ....................................................................................... 43 1. Forming a household-level “Promotion Team” ............................................................................................43 2. The Household-Level Promotion Process ........................................................................................................44 3. The Household-Level Promotion Process ........................................................................................................45 4. The Construction Process and Construction Costs....................................................................................47 CHAPTER 8 SANITATION ENTREPRENEURS ............................................................................................. 50 1. Supply Chain Analysis .....................................................................................................................................................52 2. Sanitation Marketing .......................................................................................................................................................53 CHAPTER 9 SANITATION FINANCE ............................................................................................................. 56 CHAPTER 10 PROPER FACILITY USE, MAINTENANCE AND HANDWASHING WITH SOAP........... 62 1. Facility Use and Maintenance Guidelines .........................................................................................................62 2. Handwashing with Soap (HWWS) Guidelines ...............................................................................................63 CHAPTER 11 MONITORING AND EVALUATION ........................................................................... 66 ANNEXES ........................................................................................................................................... 69 ANNEX 1 Description of an On-Site or Household Wastewater Treatment System ..................69 ANNEX 2 Description of a Communal Wastewater Treatment System ..............................................72 ANNEX 3 List of Key Partners.............................................................................................................................................76 ANNEX 4 Tool for Basic Data Collection ....................................................................................................................79 ANNEX 5 Tool for Aiding in Activity Planning .......................................................................................................83 ANNEX 6 Environmentally-based Disease Transmission (mainly for diarrheal disease) ..........84 ANNEX 7 Using Communications Materials for Behavior Change .........................................................87 ANNEX 8 Gender Checklist for Urban Sanitation Promotion .....................................................................89 ANNEX 9 List of National Programs Involved in Sanitation Promotion .............................................91 ANNEX 10 Simple Tool to Support Participatory Monitoring ....................................................................94 REFERENCES ..................................................................................................................................................... 95

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

GLOSSARY AND ABBREVIATIONS

Advocacy Strategies, approaches and activities that increase the willingness of concerned parties to produce policies, mobilize resources and create an environment that supports, in the case of the Guide, increased access to safe water and improved sanitation, as well as improved hygiene-related practices. Attitude A positive or negative evaluation or feeling that an individual has towards people, objects, events, activities, and ideas. It is based on available information and experience and is subject to change. Behavior Change Communications (BCC) An interactive process with individuals or, communities based on communication strategies that promote positive behaviors that are appropriate to their settings. City Sanitation Strategy (Strategi Sanitasi Kota/Kabupaten or “SSK”) The strategic plan of a city or district as concerns sanitation sector development. Among several elements that are part of the SSK, is the mapping of sanitation-related infrastructure and conditions to better target interventions. Communal Sanitation System – Off-site system Sanitation system that channels wastewater outside of the housing plot to a common facility where such wastewater is collected and processed. Community-Based An organizational approach that confides responsibility and decision-making authority in community members with a view towards enhancing stakeholder ability to independently undertake actions that improve the quality of life and are sustainable. Community-Based Organization / CBO An organization formed, consisting of and managed by community members, that addresses general or specific purposes that meet their interests.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Enabling Environment A broad set of conditions that support the achievement of a particular goal, objective or activity, including those related to political, institutional, social, economic, environmental and other interests. Gender Everything related to the roles of and relationships between men and women, including how they work together, share tasks, make decisions, and manage activities. Healthy Latrine (Jamban Sehat) Excreta disposal facility that uses sealed septic tanks and other systems to effectively separate feces from human contact; thus breaking an important chain of disease transmission. Health Promotion Process of improving the awareness, understanding and control of individuals or groups over factors that influence their individual and collective health. Household Sanitation Systems – On-site systems Sanitation system where the means of collecting and processing wastewater is located on the plot of the house or in its immediate environment. Hygiene Practices or behaviors that support the maintenance of good health by blocking the transmission of especially water and sanitation borne disease. Investment Placement of money or other resources in the hope of obtaining additional or specific advantages. Local Government Wastewater Management Institutions Though many cities and districts do not have a separate institution responsible for wastewater management services, of those that do, the most common forms are: • UPTD-PAL: A “UPTD” is a unit within a local government department (such as Public Works) that is charged with implementing an activity that requires a longer-term and more concerted effort than other departmental services. Any revenue generated by the services it provides is managed by local government as part of the overall budgetary process. A “UPTD-PAL” is such a unit that is charged with wastewater management. • PD-PAL: This is legally recognized as a company and is owned and operated by the local government. A “PD-PAL” provides also provides wastewater management services, but it serves separately from local government departments and can manage its own revenue. • PDAM: This is a Water Utility that, in some municipalities, is also responsible for the provision of wastewater management services.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Microfinance Institution Financial institution specifically established to develop small-scale businesses and assist community members in managing savings, obtaining small loans, and/or obtaining business development services. An MFI is a legal form of cooperative or Limited Liability Company. Millennium Development Goals / MDG A set of eight (8) broad objectives formulated by member countries of the United Nations to alleviate poverty and improve the quality of life. The eight goals describe the conditions that are targeted to be met by 2015. The objective associated with improved sanitation and hygiene is to "ensure environmental sustainability" and which includes reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Natural Leader An individual who, with limited assistance or training, is especially apt at motivating others to take action towards the achievement of a targeted objective. Non-Governmental Organization / NGO Organization founded by an individual or group of individuals who voluntarily provide services to the public without the aim of making a profit from its activities. ODF An area free of the practice of open defecation Perception Interpretation of information in order to represent and understand an event, condition or circumstance. Septic Tank A key component of small-scale wastewater treatment systems that is common in areas with no centralized sewerage service. Septic tanks are fully sealed to keep fecal matter away from human contact and promote the decomposition of the wastewater so that it can be safely discharged into the environment. Socialization The process of transferring information or values to an individual or group. Stakeholders Institutions, groups or individuals that are affected by specific actions and, as such, should have a role in how such actions are designed or undertaken. Triggering Process of changing people's behavior through specific messages or activities that are designed to quickly increase awareness and move communities and individuals to a desired action. In the case of hygiene and sanitation, this is commonly set forth in the CommunityLed Total Sanitation (CLTS) approach.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Universal Access to Water and Sanitation 2019 A goal that the Government of Indonesia (GOI) is committed to pursuing following the MDGs by 2019. It is listed, among other goals, as the GOI’s sixth goal and has the purpose of: 6a. Providing universal access to safe drinking water in houses, schools, health centers and refugee camps. 6b. Eliminating open defecation, ensuring universal access to sanitation in schools and the workplace, and improving access to sanitation at homes; 6c. Properly treating and disposing of all septage and other wastewater before it is discharged into the environment. The Government of Indonesian has coined the term “100-0-100” to describe the above water and sanitation goals, meaning: 100% access to safe drinking water; 0% slums; and 100% proper treatment and disposal of wastewater. Vision Thought, the concept of what is to be achieved, how to achieve it and why is believed to be achieved within the prescribed period.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

| xi Photo: Eko Purnomo/IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 1

INTRODUCTION

INDONESIA IS SERIOUS ABOUT SANITATION. Through multiple initiatives, the Government of Indonesia is significantly expanding assistance to the development of improved sanitation 1 systems in urban areas. The commitment of Indonesia to improve sanitation has been evident throughout the duration of the Millennium Development Goal (MDG) program and continues through an initiative to ensure Universal Access to sanitation as well as water supply and other services. The focus on sanitation is important, especially in urban areas. Sanitation coverage rates in urban areas in Indonesia are low compared to neighboring countries (see Table) and the urban population of Indonesia is rapidly increasing to an estimated number of 200 million by 2035. The impact that a low rate of sanitation coverage has on Indonesian development is serious. It leads to substantially increased rates of disease, especially among children. It causes major environmental damage through degraded water resources and wildlife habitat. And it leads to lost opportunity from tourism and many other sectors that depend on a healthy workforce and healthy environment. Tabel 1: Rates of Sanitation Coverage in ASEAN

Country Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand Viet Nam Total

Urban Population x1000 % 2,995 20% 127,100 51% 2,350 35% 21,485 73% 17,532 33% 47,440 49% 5,303 100% 23,001 34% 28,756 32% 276,278

45%

Improved Sanitation 82% 71% 90% 96% 84% 79% 100% 89% 93% 80%

Open Defecation 7% 14% 4% 0% 1% 3% 0% 0% 0% 7%

1. Per official MDG/JMP data of 2012 (latest available) 2. Does not include Brunei Darussalam (total pop. of 412,000)

1 Sanitation in this document refers to the management of domestic wastewater and not solid or industrial waste nor drainage.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

While the Government is targeting many areas to improve sanitation coverage, one of the most important is promoting improved sanitation to urban households and communities. Promoting sanitation is the process by which urban communities and households are led to invest in, properly use and take care of improved sanitation systems (such as latrines, septic tanks, sewerage systems, etc.). These systems serve as barriers to the transmission of sanitation borne disease and improve the natural environment. In addition to substantially improving health conditions, such systems and the behaviors that sustain them have a very positive impact on the dignity, status and well-being of all. Promotion of improved sanitation is the responsibility of everyone, but the Ministry of Health (MOH) has a very special role to play in the development and oversight of related activities. Through the Sanitasi Total Berbasis Masyarakat (STBM) program, the Ministry of Health is committed to promoting improved sanitation nationwide. STBM addresses sanitation, health and hygiene in five programmatic “pillars”. The sanitation objective of STBM (Pillar 1) is to attain open defecation free status at the community level. This means no direct defecation or direct disposal of untreated domestic wastewater on land or into water bodies. The promotion of improved sanitation is also part of the Government’s "Universal Access Water and Sanitation 2019" initiative that seeks to expand access to clean water and sanitation to everyone by the end of 2019. This Guide is part of the above effort as well. It is written for Urban Sanitation Promoters (USPs) that are willing to take up the challenge of convincing people to invest in sanitation improvements particularly in urban areas. This is not a simple task. If you are a “USP”, be prepared for a challenging job, but one that is very necessary and one that will be highly rewarding.

1. STBM and the Urban Setting The Ministry of Health has achieved great success in implementing STBM in rural areas and more recently has embarked on an initiative to expand STBM to urban areas. Although various elements of STBM as it is implemented in rural areas can be applied in an urban setting, some things need to be adapted to the specific conditions of urban areas. The table below provides information on key differences between sanitation promotion in rural and urban areas. Additional information on the implementation of STBM in urban areas is also discussed in the Ministry of Health Regulation No. 3 of 2014.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Tabel 2: Important Differences Between Urban and Rural Areas.

Important Differences Between Urban and Rural Areas Physical Environment

Urban areas are much more densely populated than rural areas. As such, basic, nonseptic latrines (“cubluk”) are not appropriate. They will not be effective in creating a barrier to disease transmission because people live close by, and they will pollute groundwater upon which many households depend for water.

Economic Differences

Though urban incomes may be higher than rural areas, poor and low-income household often have very limited resources (such as land or basic building materials) and will find that investing in any improvement to their home or community is very hard because of other more urgent day-to-day obligations. Also, as non-septic latrines are not allowed in urban areas, the investment cost by families in appropriate sanitation systems is much higher

Land Tenure

Many urban households do not own their home. They are renters or they may be staying in their community on a temporary basis and, consequently, are reluctant to invest in improving someone else’s property.

Community Cohesion

Members of rural communities are often more willing to work together to achieve a common goal, while members of urban communities may not have the time or willingness to work together. It is also generally more difficult to enforce communitylevel rules (such as a ban against Open Defecation) in urban areas.

Environmental Regulations

Because of their complexity and the increased interaction among people, urban environments naturally require more formal regulations and more strict enforcement of those regulations. Indonesia and most other countries, for instance, require that all human waste be collected, disposed of and treated properly. Such regulations need to be respected and enforced.

2. This Guide This Guide is intended for those who have accepted the task of promoting urban sanitation in Indonesia—either those who are directly working with communities to undertake this important work or program managers who oversee these efforts on a broader scale. This includes Sanitarians and other health workers, Women’s Association members, NGO field agents, or anyone else willing to undertake this important work. This Guide addresses sanitation promotion among households that currently have no appropriate sanitation system, as well as households that already have systems but that should be upgraded through improving their septic tank, connecting to a communal wastewater management system, or connecting to a larger sewerage system. This guide is divided into the following main sections:

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

The Basics

Creating Demand

Ensuring Supply

Chapter 1. Introduction

Chapter 4. Community Entry and Data Collection

Chapter 8. Sanitation Entrepreneurs

Chapter 2. The Enabling Environment

Chapter 5. Community-Level Planning

Chapter 9. Sanitation Finance

Chapter 3. What Motivates People to Invest in Sanitation

Chapter 6. Community-Level Triggering

Chapter 10. Facility Use, Maintenance and Handwashing with

Chapter 7. Household Level Promotion

Chapter 11. Monitoring and Evaluation

IMPORTANT: Because there are very many factors that influence the sanitation sector in urban areas, this Guide is by no means an all-encompassing document that addresses every situation. Rather, it is intended to provide basic directions, guidance and advice in the urban sanitation promotion process. Many details will need to be worked out on a case-by-case basis at a local level and with others involved. As a USP, you should get used to asking many questions or many people.

3. Your Job as an Urban Sanitation Promoter (USP) While the benefits of improved sanitation may be clear, the process of convincing communities and individuals to invest in and make necessary changes is often challenging. Through years of inappropriate behavior and lack of appropriate directions, many households are reluctant to make the changes and investments required. Many urban areas also lack the support systems (the enabling environment) to make the process easier. Given this, your job as a USP is not simply to tell people that investing in sanitation and practicing improved behavior is a good idea. Your job is much broader in scope. The following are some key tasks of the USP.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Key tasks of the Urban Sanitation Promoter (USP) 1.

3. 4. 5.

7. 8.

Know the basic elements of a proper urban sanitation system. Because there are many different parts of such systems and because all of these parts are connected, be an advocate for sanitation improvement not only among households and communities, but also with local government leaders. Know the “enabling environment”. Urban sanitation is complex-- there are many individuals and institutions involved, and many variations of programs and approaches. In order to lead people to invest in and maintain improved sanitation facilities), you need to understand this environment very well. Ask many questions and learn about the condition of the sanitation sector in your area. This is important to not only be able to develop better promotional strategies and activities, but also to be able to appropriately respond to questions from target groups. Understand what motivates people to invest in sanitation and what restrains them. Only if you understand this will you be able to lead people in a structured manner to choose to invest in sanitation and improve their behaviors. Identify and work with “Sanitation Champions” who can assist in the promotion process. These include local celebrities, religious leaders, media outlets or even regular community members who are especially passionate about sanitation development and can motivate others. Sometimes even just a few words from a good “Sanitation Champion” can have a great impact. Build trust. Be aware that people at the community level are often skeptical of people coming in with new ideas and programs. You can only be effective in the promotion process if you have their trust—and you can only have their trust if you understand the issues and are willing to help them resolve problems. Be clear and consistent in your messages and make sure that others involved in the promotion process are equally clear and consistent. Don’t be discouraged and share information. Many others across Indonesia are doing exactly what you are or will be doing. Because the issues are complex, there is often not one right or wrong way. Share ideas, information and approaches.

INTERESTING FACT: In March 2014, the Aliansi Fasilitator Sanitasi Indonesia (AFSI) was established as a forum to provide information and to build capacity in sanitation programming. Its mission is to: increase awareness of the sanitation issue in Indonesia; support accelerated sanitation development; serve as a bridge between government, the private sector and communities; and improve the capacity and professionalism of those assisting in sanitation programming. Check out their website at: http://www.fasilitatorsanitasi.org/

4. What is an Urban Sanitation System? Usually, the USP is not involved in every aspect of sanitation in their City, but because people will ask them many questions, it is important that they understand the basic elements (the “building blocks”) of urban sanitation systems. These “building blocks” are presented in the graphic below which is referred to as the “Urban Wastewater Framework”. This Framework

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

provides a picture of the components of wastewater services that any municipality must develop, emphasizing the importance of both the individual “blocks” as well as interdependence of each. As shown below, the main features include:

SAN 1: Household Systems

SAN 2: Communal Systems

SAN 4: Integrated Septage Management

SAN 3: City Sewerage System

Regulation & Enforcement

Behavior Change Communications (BCC)

City Sanitation Management Unit



Technical Service Options (green boxes): At the core of a proper urban sanitation system is infrastructure. This includes: o

Household Systems (“SAN-1”): These are household latrines or toilets that are connected to a sealed septic tank located on the property of the household. They are fully maintained by the household and require periodic removal of sludge. See Annex 2 for details. IMPORTANT: Household systems that do not have sealed septic tanks but allow wastewater to seep into the ground or drain into water bodies are not allowed per government regulations and should be replaced.

Communal Systems (“SAN-2”): These include community Wastewater Treatment Plants (WWTPs) that usually 20 to 50 individual household latrines are connected to. They are usually managed by a local CBO (KSM or KPP) and require a small monthly service charge. These also include public toilets such as MCK or public toilets that also have a communal septic system (generally referred to as MCK++).

Sewerage Systems (“SAN-3”): Sewerage systems are generally much larger systems that hundreds of households connect to. In almost all cases, they are maintained by a government agency and in some cases a Water Utility (PDAM). A

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

monthly service fee is charged to each household (and sometimes integrated into the household water bill). o

Integrated Septage Management (“SAN-4”): These include sludge treatment plants (STP) located outside of the city. Sludge removal trucks collect sludge from household and communal systems and then take it to the STP for disposal and treatment. Customers (households or a CBO charged with managing communal systems) must pay a fee to have the sludge collected, transported to the STP and treated so that it is no longer dangerous.



Behavior Change (red box): Because many people in the city need to be persuaded to invest in improving their household sanitation systems or connecting to communal or sewerage systems, there is always very much triggering and promotional work to be done. The Ministry of Health and local Department of Health are charged with this area of sanitation development.



City Sanitation Management Unit (blue box): More and more cities are establishing City Sanitation Management Units that are responsible for the overall management (planning, construction operation and maintenance) of citywide wastewater management services (see green boxes San-1 to San-4). Different forms of these units exist, including UPTD, PD, etc.



Regulation and Enforcement (brown box): Accountable governance, the acceleration of financing, enabling regulations, and adequate institutional support are key drivers for the development of improved sanitation services in urban areas. Each urban area has different regulations and policies and USPs should be familiar with these. IMPORTANT: In addition to describing each individual part of a citywide sanitation system, the Framework importantly highlights that one “block” of the Framework cannot be undertaken in isolation of the others. The implications of this for the USP are critical. If you are promoting household sanitation systems (“SAN-1”), you will also need to explain to people how their septic tank can be emptied when it is full and how much it will cost to empty (See “SAN-4”). Alternatively, if you are promoting a communal system (“SAN-2”), you will need to explain to beneficiaries of that system where they can go if the system develops technical problems (see City Sanitation Management Unit).

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

5. Gender Mainstreaming in Urban Promotion Activities Addressing gender issues in the promotion process is very important. This not only means discussing about women’s issues, but about ensuring that both men and women are able to actively participate in activities, contribute to decisions over how resources are utilized, and benefit from the new facilities. Gender mainstreaming also takes into account the specific needs of all gender groups such as men, women, boys, girls, the elderly, and disabled. Taking into consideration gender issues will also help ensure the effectiveness and sustainability of improved sanitation facilities through improved use and maintenance. In this light, the USP plays a key role in promoting gender mainstreaming throughout the sanitation development process, starting from the planning stage. Additional reminders and tips on gender are included throughout this Guide, and a “Gender Checklist” is included in Annex 8 to help USPs ensure that gender is well addressed throughout the promotion process.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Photo: Pryatin M Santoso/IUWASH

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 2

THE ENABLING ENVIRONMENT

Urban sanitation systems are complex. There are many individuals and institutions involved, and there are many variations of programs and approaches to improving urban sanitation facilities for households. In order to be successful in the promotion process (and lead people to invest in and maintain improved sanitation facilities), a USP must know very much about the “enabling environment” their own program is operating in. The USP must know who to work with and, importantly, be able to answer very many questions from the communities and households they target. Below is a graphic with six boxes that summarize the main parts of the enabling environment. Following the graphic are additional descriptions of each box.

What a USP needs to know before beginning promotion 1. PROMOTION PLANNING AND COORDINATION

• Local Government • Field Agents • Community Leaders and Champions • Academic Institutions

4. MAINTENANCE/ TECHNICAL SUPPORT

• Government Agency • CBO • SME

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2. FINANCE

• Cost Sharing • Microfinance • CSR 5. SLUDGE REMOVAL

• How often to Empty • Sludge Removal Service • Wastewater Treatment Plant • Cost

3. CONSTRUCTION

• Design • Cost • Constuction Process 6. REGULATION • Health Regulations • Construction Regulations • Institutional Regulations

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

1. Promotion Planning and Coordination A. Research and Data Collection: Planning and coordination will only be effective if you know what you are doing and who you are doing it for. This Guide provides very useful forms and tools for collecting data related to: • The Enabling Environment (Annex 3) • Community-level data (Annex 4) • Monitoring (Annex 10) In addition to this Guide, you may receive additional guidance on research and data collection from specific programs (SANIMAS, USRI, etc.). There are also other good sources of information available from various Indonesian websites that support sanitation programming. A more complete listing of such websites is provided in Annex 9 and the following are some of the more useful sites: Agency: APPENDS/Pokja AMPL Ministry of Health Ministry of Public Works Ministry of Home Affairs

Website: www.nawasis.com PPPL.depkes.go.id stbm-indonesia.org www.promkes.depkes.go.id www.pu.go.id ciptakarya.pu.go.id/plp/ www.kemendagri.go.id

B. Institutional Coordination: One of the most important (and sometimes most frustrating) jobs of the USP is trying to coordinate with other agencies and personnel. Typically, those most involved in sanitation programming include the Departments of Planning, Health, Public Works, and Cleanliness; Universities; Associations (such as the Women’s Association- PKK), NGOs, Media (radio, newspaper, social media like Facebook etc.). In some urban areas, the Water Utility (PDAM) or another agency (a PD-PAL or a UPTD under another department) may also have responsibility. C. Field-Level Coordination: One of the most important tasks in the promotion process is to ensure that everyone is working according to the same plan and using consistent messages. When you involve other staff and field agents, make sure that they understand what the plan is for that community and what issues and messages are most important.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

D. Community Leaders / Champions: You do not need to be alone. You may not know it, but there are many people in your area and in the target communities you work in that want to contribute to the promotion process. These can be local community leaders (RW/RT heads), religious leaders, youth group representatives, womenâ&#x20AC;&#x2122;s association members, or community health workers. Make sure to work with both men and women community leaders and representatives from other important groups to ensure that urban promotion activities are broadly inclusive.

2. Finance One of the greatest barriers to improving sanitation in urban areas is the cost. People do not want to invest simply because they think it costs too much. If one considers the cost of not having improved sanitation (higher health care costs, missed days at school or work, decreased value of houses, etc.), this is not true. However, improved sanitation does cost money, and anything that can be done to help make it affordable (especially for low-income households) will greatly aid in the promotion process. In considering issues related to cost, the USP needs to know what assistance may be available to help households decrease the cost of their new or improved system. This can take three forms: A. Cost Sharing: Some programs at the national or local level may cover a portion of construction costs for concerned households. This is because the cost of both constructing and maintaining urban sanitation systems is usually much more expensive than rural systems. This not only helps households pay for the new system, but it can also help in the promotion process. If people know that they can benefit from such assistance (and that such assistance may not be available later), they will be encouraged to make the improvement now. The USP needs to check with the local government on the availability of such cost sharing. In terms of providing cost sharing, the USP should make sure that especially low-income women-headed households and other economically disadvantaged groups (such as the elderly) can easily access such support. B. Microfinance: Though not available everywhere, some Banks, Credit Unions and Microfinance Institutes (MFIs) are beginning to make available microfinance in support of sanitation. This allows households to make the sanitation improvement and then pay for it over a period of one or more years in easy-to-pay installments. The decision of obtaining microfinance by the household should be agreed to by wife and husband to avoid problems in household budget management. See Chapter 9 for more detail on this important topic. C. Corporate Social Responsibility: Another possibility that has proven successful in some areas is getting the support of local businesses to either provide some funding or provide some building products (such as sand, cement or pipes). It can be especially helpful for poor households that have very limited funds and may not be eligible for microfinance or other support. For the business, it can be an effective way of showing

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

their support for the community and, in the process, for promoting their products and services. THIS IS A GREAT IDEA!

3. Construction A. System Design: Much of your work in promotion will be influenced by the type of improvement that is being made. This manual deals with: • • •

Household Systems (see Annex 1) Making a Connection to a Communal System (see Annex 2) Making a Connection to a Sewerage System (See Annex 2)

General construction details and issues related to the above systems are provided in the Annexes indicated above. The design of sanitation facilities should consider the different needs of men, women, pregnant women, boys, girls, the elderly, and disabled people. This will help ensure the comfort and safety of the facility for everyone and thus increase its use and people’s interest in maintaining it. B. Cost: One of the most important factors in people’s decision to invest in sanitation improvements relates to cost. Because the above systems are all different and will be constructed in houses and communities that have different characteristics, there is not one standard answer. Though the exact cost will vary, it usually ranges from IDR 1.5 million to IDR 3 million. See the Table below for some detail on typical construction costs that one may need to pay.

For Gender Responsive Design of Sanitation Facilities, Make Sure... 1.

To have proper walls, roof and a secure door with a good latch.

There is adequate space in the facility for everyone’s needs, as well as good air ventilation.

If also used for bathing, the floor can be easily cleaned, has proper drainage, and isn’t too slippery.

The facility is easily reachable by all family members, day or night.

The position of the door provides easy access.

There is a good water container and that it is never empty.

The water container is placed on the right side of the WC and easy for users to access with a water scoop after defecation;

There is soap and clean towel available at all times.

To include additional accessories such as a mirror and waste bin for solid waste (for soap wrappings, shampoo sachets, etc.).

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Tabel 3: Typical Construction Costs .

Construction Stage Excavation Work

Household System The amount of digging depends on the type of septic system being installed. Typically, this involves one or two cylindrical septic tanks or a box made of concrete or fiberglass. These usually require digging pits that are 2 - 2,5meter wide and 1.5 to 1.8 meters deep. For portions inside the house, the floor will need to be dug-up and replaced.

Communal or Sewerage System This involves digging a small trench from the bathroom to the control box of the communal or sewerage system. There should be a downward slope of at least 2% from the bathroom to the control box. For portions inside the house, the floor will need to be dug-up and replaced

Septic Tank Installation

Septic tanks are usually made of cement rings or fiberglass. If the septic tank will be used jointly by more than one house (usually 2-3 home), the size should be enlarged to increase the volume. More detail can be found in appendix 2

Not needed.

Pipe Installation

This usually involves connecting a 4” diameter PVC pipe from the WC to the septic tank.

This usually involves connecting a 4” diameter PVC pipe from the WC to a “Control Tub”.

As a final word on Cost, USPs should make clear to people what costs they can expect to pay over the long-term. For Household Systems, this can include the cost of desludging the septic tank every two or three years (as needed) and for Communal or Sewerage Systems this usually includes a small monthly fee. Be honest about these costs. If people are not made aware of these costs, they will be less trustful of participating in sanitation programs and less willing to make the necessary investments. Also, make sure that men and women in the household agree on the cost of the sanitation investment and how it will be paid for. C. Contractors: In some cases, all construction work may be managed by the Local Government (LG) or an outside contractor hired by the LG. However, in most cases, the households themselves are responsible for finding a capable construction contractor. Before beginning the promotion process, the USP needs to identify capable contractors in the target area. The USP should assess their interest in and ability to construct improved sanitation systems and help them to: 1) learn proper construction techniques; and 2) market their services to the public. To better impact low-income households in the area, the contractors should consider involving local men and women as laborers in the construction of the sanitation facilities. The important topic of Contractors is further addressed in Chapter 8.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

4. Maintenance and Technical Support A major part of the enabling environment is about the resources that are available after construction to make sure the sanitation improvements are maintained and remain operational. As a USP, you need to be able to explain to people what these resources are and how to access them. The following are three possible sources of support for maintenance and technical issues that may arise: A. Government Agency: Check with your LG about which agency is responsible for wastewater management in your area. Hopefully, your city has a single agency responsible for this important area (such as a UPTD or the local Water Utility). However, in many cases, this responsibility may be divided over many agencies. The Departement of Cleanliness may be responsible for sludge disposal; the Departement of Health may be responsible for sanitation promotion; the Dept. of Public Works may be responsible for technical support; etc. Each LG is different, so you will probably need to do some research. Find out who in those agencies can provide assistance and get their contact information. Note: More and more LGs are developing City Wastewater Management Units (see Glossary) to help deal with wastewater management issues. These units should be able to advise on important issues related to repair and maintenance of sanitation systems. If such a Unit does not exist, encourage your LG to establish one! The job of sanitation development is huge and someone needs to be clearly responsible. B. Community-Based Organization (CBO): Especially for communal sanitation systems, many programs (such as SANIMAS, USRI, IDB, etc.) establish CBOs that are then responsible for operation and maintenance of communal sanitation systems. They usually have a Head, a Secretary and a Treasurerâ&#x20AC;&#x201D;and someone who is designated as the lead technician. C. Small / Medium Enterprises: In many cases, households or CBOs may need the help of a local SME. See Chapter 8 for more detail on this important topic!

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

5. Sludge Removal and Treatment While promoting investment in sanitation improvements at the household or community level is critical, all such systems depend on professional sludge collection, disposal and treatment services. In fact, some of the very first questions a community will ask if they are investing in a Household Sanitation System are:

How often do I need to empty the septic tank?

Who will empty it for me? How much does it cost?

Usually Household Sanitation Systems need to be emptied every two to three years. This depends on the size of the septic tanks and how many people use the toilet. For Communal Systems, this is not the concern of individual households because these are managed by a KSM or other agency. But the same factors apply: It depends on how big the septic tanks are and how many people use the system. As concerns “who will empty the septic tank” and “how much it costs”, each area is different. In most cities, a public or private service is available with special trucks that suck the sludge from the septic tank and then transport it to an IPLT for safe disposal and treatment (see below). The cost may be around IDR 200,000 to IDR 300,000. In other cities, the PDAM manages this service and charges a small “wastewater fee” as part of the monthly water bill. In this case, the customer simply calls the PDAM that then collects the sludge at no additional cost. IMPORTANT: Because each urban area is different, as a USP you need to research sludge disposal services in your area. Get their contact information and make this available to your target community.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Special Note on Disposal and Treatment: Sludge must be disposed of and treated properly! This can only happen if the sludge is safely transported and disposed of at a Sludge Treatment Plant (STP). These are managed by the LG and usually charge a fee for sludge disposal. If properly managed, STPs can treat the sludge, make it safe, and even make it into a valuable fertilizer that farmers can use on their crops. It is recommended that USPs visit the STP that serves their target area to better understand how this critical part of the sanitation system for their area works.

6. Regulations and Enforcement In all countries where sanitation rates of coverage are high, people invest in improved sanitation systems not necessarily because they want to, but because they must do so. They must do so because it is written in governmental regulations that they must, and if they do not, they risk being fined (or in extreme cases, imprisoned). This recognizes that sanitation is a common concern that goes beyond individual likes and dislikes. Indonesia also has very good regulations. At the national level in particular, there are very many regulations that govern sanitation and related areas of water resources protection, environmental protection, construction, etc. A very good listing of these regulations is available at http://www.nawasis.com/ While national regulations are important, regulations at the local level are very influential. As these vary greatly from one LG to the next, there are no standards. However, as a USP, you should inquire about those that may in place and are related to: • Health promotion; • Water quality; • Sanitation; • Construction of sanitation systems; • Water resources protection • Environmental protection. A representative from the Dinas Hukum (or others from BAPPEDA, Health, Kebersihan, PU, etc.) can assist in the above. As concerns enforcement, this is critically important. If any Government agency has regulations, but does not enforce them, the regulations have little value. Check with your LG about not only the regulations, but also their plans to enforce them and how they do or intend to do it.

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18 | Photo: Dadang Hidayat/IUWASH West Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 3

WHAT MOTIVATES PEOPLE TO INVEST IN SANITATION

Before beginning to promote investment in a new urban sanitation system (or any new “product”), it is necessary to understand what motivates people to make such investments. Very importantly, research clearly shows that people are often motivated by many different factors — with some being much more important than others. Generally, it depends very much on the individual’s level of awareness and information towards the perceived benefits of improved sanitation. In addition, the reasons that motivate people for investing in sanitation may be very different if they are investing in their first household latrine/toilet or if they are investing in a connection to a communal system or a sewerage system. Often, reasons for investing or not in sanitation will also vary greatly between men and women. While there are very good reasons for people to invest in improved sanitation, they will also have many questions about how they build or connect to these systems and issues about long-term maintenance and costs. It is very important that the USP be able to respond to these queries. As each urban situation is different, the USP will need to do some research to be able to respond appropriately. The following are the most important reasons why people want to invest in a new household sanitation system and a connection to a communal or sewerage system and likely questions they may have.

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Tabel 4: Reasons to Invest in a Household Sanitation System

Ten Great Reasons to Invest in a Household Sanitation System 1.

Improved health

Many people understand disease transmission and the role of improved sanitation in decreasing exposure to sanitation related disease.

Social status/pride

People feel proud to have a toilet/latrine. Many people talk about how a toilet makes their home seem more comfortable, proper and maybe more “modern”.

No waiting

Many like having a toilet in their home because they no longer need to wait in line at a communal bathroom or for a free space outside.

Avoid discomfort

Avoid discomfort of going to the bathroom outside in rainy weather, security (violence and harassment) or at night (people, especially children, fear ghosts at night and no need to always guide elderly and disabled people to use bathroom at night).

Accommodating Visitors

Many people want to invest in a new toilet to avoid embarrassment when they have visitors.

Improving groundwater and surface water

Ensuring the appropriate collection and disposal of wastewater means that the quality of ground water, water in rivers and lakes will improve.

Sense of control

People like the idea that they can control when and where they go to the bathroom, as well as the bathroom’s cleanliness and smell.

A better life for their children

People want a toilet so their children have a better life. They also make a connection between having a toilet, their children getting sick less often, and missing less school.

Wanting a clean neighborhood

People want a clean community, meaning seeing less trash, feces, etc.

10. Being a good neighbor

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People understand that if they do not have a safe and proper toilet, they contribute directly to pollution and many talk a lot about being good neighbors and protecting the community’s environment.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Tabel 5: Common Questions Regarding Household Systems

Common Questions Regarding Household Systems (Septic Tanks) (USPs MUST be prepared to answer these) 1.

How much will it cost?

The cost of a household system is usually 1 million to 3 million rupiah. This consists of two elements: 1) a septic tank that is typically a â&#x20AC;&#x153;fixedâ&#x20AC;? price; and 2) the cost for the connecting pipework to the latrine and the drain that varies in accordance to distances and conditions. For providing a reliable price, the supplier will first survey the premises for determining the accurate cost.

Is there a subsidy available?

Responses vary according to the program. Ask your LG representatives or program manager!

Is there a financing (microfinance) available?

Responses vary according to the program. Ask your LG representatives orprogram manager!

What is the construction process? How long will it take?

This usually involves digging two pits about 2 meters deep, installing a base, cement rings and a cover, and connecting the septic tanks to the latrine and to the receiving drain. It usually takes one week.

Who can construct this for me? Is there a SME available?

Before you start with the promotion process, you need to be aware of available suppliers. Hence, you should only commence with the promotion after you have secured the supply chain.

How long will it take the Septic Tank to fill up?

This depends very much on the volume/capacity of the septic tank and the number of users, but usually takes 2 to 3 years.

When it is full, how can I have it emptied?

The process usually involves contacting a sludge removal services that has a truck and pumping equipment.

Who can empty the septic tank?

This varies by location. Contact a representative in the LG or get the information from the program manager.

How much does it cost to empty the septic tank.

If done by a government approved service provider the cost is regulated by the local government (Perda). Private nonregistered service provides have varying cost that need to be inquired.

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Tabel 6: Ten Great Reasons to Invest in a Connection to a Communal Sanitation or Sewerage System

Ten Great Reasons to Invest in a Connection to a Communal Sanitation or Sewerage System 1.

Improved health

Many people understand the process of disease transmission and the role of wastewater management in decreasing exposure to disease. A connection to a communal or sewerage system moves wastewater (and hence, exposure to disease) further away from the house.

Social status/pride

Many people feel proud to connect to a more modern piped system for reducing maintenance issues that come with household systems. Many people talk about how it makes their community more proper and maybe more modern.

No need to empty their own septic tank

Because the wastewater is channeled off-site and maintained by a community group or the City operator, they never need to empty a septic tank.

Fewer bad smells and mosquitos

Many communities whose households have connected to communal systems report that a major benefit is fewer bad smells and mosquitos. Because all of their wastewater is going into the system, there is less polluted water in the community.

Improving groundwater and surface water

Ensuring the appropriate collection and disposal of wastewater means that the quality of water in rivers, lakes and the ground will improve.

Accommodating Visitors

Many people want to invest in a cleaner neighborhood to avoid embarrassment (mosquitos and bad smells) when they have visitors.

Sense of control

People understand that improved wastewater management is a part of an improved and better-controlled environment.

A better life for their children

People understand that improving wastewater conditions contributes to a better life for their children. They also make a connection between improved wastewater management and their children getting less sick, and missing less school.

Wanting a clean neighborhood

People want a clean community, meaning seeing less trash, feces, etc.

10. Being a good neighbor

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People understand that if they improve the way they manage their wastewater, they are contributing to a better environment for everyone. Especially in the case of sanitation, everyone needs to participate or the benefits are not as great. It will make social dynamic in the neighborhood become more stronger because people work together to do social movement for their better environment

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Tabel 7: Common Questions Regarding Connection to a Communal Sanitation or Sewerage System

Common Questions Regarding Connection to a Communal Sanitation or Sewerage System (Promoters MUST be prepared to answer these) 1.

How much will it cost?

The cost of the connecting to the communal or sewerage system depends on each program. Usually, households are responsible for all costs related to the connection and which includes digging, pipes, replacing cement or tile floors, etc.). Again, responses vary according to the program. Ask your program manager!

Is there a subsidy or microfinance available to help pay for the connection?

Again, responses vary according to the program. Ask your program manager!

What is the construction process? How long will it take?

If you already have a toilet, this usually involves digging a small trench and installing a pipe from the â&#x20AC;&#x153;control boxâ&#x20AC;? of the communal system to your toilet. It may require digging up the floor. The process usually takes about two (2) days.

Who can construct this for me? Is there a SME available?

For each communal system, a CBO (KSM) has been established to manage the system. Check with the CBO.

What can I put in the drain? Can I dispose of diapers or kitchen waste?

This system is only for wastewater. DO NOT put solid waste (diapers, kitchen waste, etc.) down the drain or it will get clogged.

If there is a problem with the system, who can I contact?

For each communal system, a CBO (KSM) has been established to manage the system. Households that are connected to the system should have contact information of the person who is in charge of system maintenance.

For sewerage systems, there is a central office (sometimes in the Water Utility) that oversees the system. Check with that office.

For sewerage systems, there is a central office that responds to problems and each household should have the number to call in case of problems. 7.

Is there a recurring cost (i.e. monthly fee)? How much and to whom do I pay?

Almost all systems charge a monthly service fee. How much and to whom you pay varies. Check with the program manager.

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24 | Photo: Harod Novandi

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 4

COMMUNITY ENTRY AND SOCIALIZATION

A major part of the strategy for creating demand among community members for improved sanitation conditions. The goal of demand creation is to build community support for investing in improved sanitation facilities and adopting improved hygiene behaviors. The MOH defines several steps to achieve this, including: • Increasing the role of all stakeholders in the planning and socialization process; • Developing public awareness of the consequences of poor sanitation habits followed by triggering changes community behavior; • Improving the ability of communities to choose sanitation technologies; • Developing leadership in the community (natural leaders) to facilitate the “triggering” of change in people's behavior. • Developing a reward system for the public to improve and sustain their sanitation conditions. This Guide breaks down the demand creation process into four parts that are described in this and the next four Chapters. These four parts include: 1) Community Entry and Socialization; 2) Community Planning; 3) Community-Level Promotion; and 4) Household-Level Promotion. This Chapter describes basic steps for the USP to undertake during Community Entry and Socialization and which include: • Learning about the Community and Collecting Data • Advocacy to Local Leaders; and • Socialization IMPORTANT: Though the overall process of demand creation is the same, you will need to make adjustments based on the type of sanitation improvement that you are promoting. For instance, if promoting household sanitation systems, it will likely be best to conduct the process for the entire community. However, if you are promoting communal sanitation systems, you may need to limit your approach to concerned neighborhoods only. You may also need to adjust the sequencing of activities to what you, as USP, believe will be most effective.

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1. Learning About the Community and Collecting Data Because each community is different, in order to initiate a successful demand creation program for sanitation, the USP should spend time learning about the community they are targeting. This includes learning about both the people in the community and what their current sanitation conditions are. The following sets forth useful tools for accomplishing both. A. Stakeholder Analysis: A Stakeholder Analysis is a simple process for identifying formal and informal community leaders and institutions that should be involved in implementing sanitation promotion within the selected community. This includes official community leadership as well as other community members that appear especially influential or active in sanitation issues and can be involved in the promotion process as sanitation “champions”. All can be involved in motivating and encouraging others to make the decision to invest in sanitation improvements. A detailed form for identifying and recording key local stakeholders is proved in Annex 3 and 4. Note that in communities, some people, local groups and organizations are better influencers than the others are. As a USP, it is important that you talk to people that know the community to identify those that can be useful in the promotion process. After knowing the community better, you might also want to add, delete or revise the list according to your experience, so keep the list (and your mind) open for making changes. B. Data Collection: At the beginning of you work in the community, it is also important to obtain basic information about the community. This includes: 1. Determining current sanitation-related conditions of the community; and 2. Identifying your direct stakeholders and analyzing their strengths and weaknesses and their suitability and readiness for supporting your activities. Mapping current sanitation-related conditions means to collect the latest data (secondary data and field observations) about hygiene and sanitation related aspects of the community, which are significant for your work in dealing with the community during demand triggering and sanitation promotion. The assessment should follow a standard procedure (see format below) and should capture both the physical conditions within and outside the households and the prevailing attitude and awareness of households on sanitation related impacts on health and the environment. Obtaining data on current sanitation-related conditions is important because: • By knowing what the real sanitation conditions in the community are, you are better placed to discuss what can and should be done with community leaders and households. • It will help you to establish priority areas and activities. The data will show what areas of promotion need more focus than others. You decide on areas and activities

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• •

that you want to prioritize based on existing conditions as well as community demands and expectations. It will serve as a baseline for your decision making process and for measuring the success of all your following activities. It will help in informing and reporting to decision makers or higher-level stakeholders about the impacts of the intervention on the target community.

Baseline data collection starts with secondary data from BPS (Badan Pusat Statistik), Kelurahan, RT, RW, Puskesmas, PKK, community kaders or Public Works office. However, to strengthen your cause, you also need to talk with some key people from the community for obtaining their views and opinions. You should also take photographs as evidence of sanitation conditions in the surrounding areas to support your arguments. Below is a list of basic data you need to build your cause. Tabel 8: Basic Data to Create Map Sanitation Conditions.

Indicators Households with basic toilet in the Kelurahan/RW/RT

Households with improved toilet in the Kelurahan/RT/RW Desludging service providers in surrounding areas Functionality of off-site systems (communal sanitation system and/or sewerage (if any) Socio-economic profile of the community (income and expenditures)

Source Secondary data –Data Potensi Desa or Profil Desa, data Rumah Sehat (Kaders, Kelurahan, Puskesmas, BPS, Bappeda) Secondary data -Data Potensi Desa or Profil Desa, data Rumah Sehat (Kaders, Kelurahan, Puskesmas, BPS, Bappeda) Interview, observation

Interview, observation, secondary data (from Kelurahan, KSM, Public Works office) Secondary data – Data Potensi Desa or Profil Desa (from Kelurahan or BPS)

Remarks • • • •

Households that practice OD Households that use shared or communal toilet Households with private toilet/latrine U-bend/syphon, connected to septic tank, communal system or sewerage system

• • • •

Manual or machine Frequency Dumping area Planned, ongoing construction, operating • number of houses connected • number of idle connections • SES A: 3.000.000 + • SES B: 2.000.000 – 3.000.000 • SES C1: 1.500.000 – 2.000.000 • SES C2: 1000.000 – 1.500.000 • SES D: 700.000 – 1000.000 • SES E : < 700.000

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Indicators Household’s occupation and source of income

House ownership

Microfinance programs and Credit Unions operating in the area Number of SMEs in the immediate or surrounding areas

Source

Remarks

Secondary data - Data Potensi Desa or Profil Desa (from Kelurahan or BPS), If available take gender based data (number of men, women, children, elderly and disabled people) Secondary data – Data Potensi Desa or Profil Desa (from Kelurahan or BPS) Interview, observation

For assessing income patterns (e.g. daily, weekly, monthly, seasonal), and activity time preferences for scheduling community meeting. In addition, to identify specific needs based on gender and other issues related to inclusiveness should be accommodated. For decision making on likeliness for investment into improved sanitation

Interview, observation

Material stores, masons, family businesses

For possible financial assistance

2. Advocacy to Community Leaders Advocacy is an effort to influence both formal and informal community leaders to support your vision and strategies accelerating community access to improved sanitation. Using the information collected during the Stakeholder Analysis, you now conduct meetings and visits with both formal and informal community leaders that you identified in the Stakeholder Analysis to discuss your vision and strategies for moving forward in the sanitation promotion process and to obtain their ideas and suggestions. A key goal during this phase is to gain trust and build a rapport with these leaders and, importantly, to gain their explicit endorsement for moving forward. This work needs to be carried out by you, the USP, but as you build trust and relations in the community, others can also help. To initiate the advocacy process, it is important to start with an initial consultation meeting with the Bapak/Ibu Lurah and other key stakeholders as possible to share your observations, vision and proposed approach. Although a key purpose of the meeting is to share your thoughts, the most important skill at this stage is to actively listen to peoples’ concerns and perceptions and ask the right questions for directing your partners’ attention towards your development objectives. Here, it is important to really understand what formal and informal leaders have to say by providing feedback that shows you have “internalized” their expressed concerns and expectations. The following should be done in the meeting:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Portray the data you have obtained about the community, and share your vision and intended approach (the use of photos and statistics will strengthen your argument).

Initiate a discussion to understand: • Their perception about sanitation conditions within and around the community • Their perception about why people don’t have improved toilets • Their thoughts about your vision and approach of providing access to improved sanitation in their community (feasibility, possible barriers, supports, etc.) • Existing social norms (including gender perspective) and economic conditions, regulations or programs that might be in support of or against your intended activities • Their perception on what works and what does not work in changing people’s behavior.

Identify specific persons that the community respects and who are willing to support your work.

Discuss and agree what further activities you will conduct with their support and how you hope to conduct them. Provide as complete of a picture as possible of what will be done and who will be involved. Make sure you spend enough time on this topic with community leaders so that they have a strong sense of ownership of subsequent activities. This part of the advocacy process is important and is especially helpful in “avoiding any surprises” that could arise later. If you discuss on who will be invited in the further activities, you need to make sure that several gender groups are invited (men, women, youth, etc.)

Summarize the results of the above consultation process and make sure that you have the consensus and support from community leaders that you need.

After the above, you should continue to meet with these and other community leaders and stakeholders to seek their endorsement and support. Please note that “Advocacy” is a continuous process. Getting full support from leaders and other community members does not happen during one meeting and, even when it does, you will need to go back often to make sure everyone remains committed.

3. Program Socialization The purpose of the socialization process is to discuss what you have learned and what you intend to do to help them improve their sanitation conditions, but also to listen to their concerns and obtain their feedback and suggestions. Community socialization is an important milestone on the road to increasing access to improved sanitation for the following reasons:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

•

It allows everyone to openly discuss, understand and appreciate sanitation-related condition, including prevailing community perceptions, hopes, expectations and frustrations; and

•

It helps you build support from the community for follow-on activities.

Socialization can be done during a large community assembly that includes targeted community members and people representing various organizations and institutions. To make sure that as many community members as possible can participate, you might need to break the socialization event down into several meetings or “piggyback” on other community meetings, such as “arisan” or other community meetings. Despite the time factor, conducting socialization in a number of smaller groups enables you to obtain more detail information and see in more depth the various pattern and perspectives of the community. The following are some tips for the socialization process: Who: This work needs to be carried out by you, the USP, but you need to do this with community leaders and others that you have identified as especially influential in the community. Remember that even though you are critical to the sanitation promotion process, you cannot do this on your own. You need to build a “network” of local champions for successfully implementing your mission. When: The socialization process begins any time after you have the understanding and endorsement of community leaders. It should follow the agreed upon planning process and at a time (or times) when community members are available especially give a convenient time for different gender groups to attend the socialization meeting. Where: Socialization activities need to be conducted within your target community. The meeting(s) can be held in the Balai Kelurahan, Kelurahan office, house of RW, RT, school, mosque, or even at the residence of a community member. How: Although the main purpose is to explain the program to other community members, remember that the role of the USP is to not only share your vision and the vision of community leaders, but also to listen carefully to the concerns and opinions of community members. A suggested agenda for socialization meetings is as follows: A. Opening speech and introduction from community leader B.

Introduction by the USP of the objective of this community meeting

C. Describe the sanitation conditions in the community (practices and facilities). D. Ask people at the meeting: i. If they agree or disagree with your description or if they have anything to add.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ii. If they have previous experience in trying to improve sanitation conditions. iii. What they think is holding them back from having access to improved sanitation? iv. If they are willing to try an improve conditions now. E.

Present basic information on your program and what you hope to accomplish.

Ask them if they are willing to participate and what obstacles or constraints they envision.

G. Wrap up with a commitment about when and where to conduct community planning exercises (see next Chapter). You have to remember that the above is not a prescription that you have to follow rigidly. You need to modify the process according to the context (which includes your own views and the community’s situation and conditions). Most important is that the community feels as though they are having a dialogue (not just listening to a speech) and that they are empowered to say “yes” or “no”. A checklist and a format for notes are attached in Annex 4. Do not forget to make notes about the information you gained from the meetings and pay attention to them because it will help in “fine-tuning” your plans for other promotion activities.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Some Tips for Facilitating the Socialization Process Helping a community decide to invest in sanitation improvements and their hygiene behaviors make changes can be a difficult process. Most important is to remember that such decisions ultimately need to be made by individual community members. As an outsider, you as the USP can only facilitate the process. Some tips for dealing with common obstacles that may arise are as follows: When you are sensing that community members do not trust you because of your status or position: • Don’t emphasize on your position and do not enforce your opinion on them, but discuss (i) the benefits the community will experience, (ii) the big picture of the community as part of a growing modern city with an improving life-style and (iii) community values and how you can help to achieve them. • Ensure that the community understands that you are not implementing a “topdown” process. Rather give the community the sense that they are “in the driver seat” and that the decisions are ultimately their own based on their own aspirations. When Community leaders or members remind you about the poor quality of past public infrastructure: • Show them real “before” and “after” illustrations/posters • Screen “testimonials” of beneficiaries from other locations • Explain the “supply and value chain” in place and how you safeguard good workmanship and functionality of the facilities When community leaders or members ask about the possibility of financial assistance: • Be clear from the very beginning about the availability of financial support, if any. See also the Chapter on Financing. When community leaders or members ask about the construction costs and process: • Explain that a household survey needs to be done first to determine the actual scope of works and the associated real cost of improvements. Any cost information prior to the survey should be handled with caution and can only be tentative; When community leaders or members reject your approach and/or development vision: • Be patient, don’t be defensive nor offensive • Identify their values and find common grounds • Listen and rephrase your vision by using their values • If there is no progress in finding common ground, leave it where it is but get back to them in a couple of weeks. As for now, strengthen your position by focusing more on working with communities that want and need your support.

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| 33 Photo: IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 5

COMMUNITY PLANNING

With the commitment and support of community leaders and community members, the USP can now engage the community in planning subsequent activities. Briefly, “planning” is the process of deciding what to do and how to do it before actually beginning. No matter what we are planning for, by thinking a project through in the beginning, we usually end up with better results. A critical feature of the planning process is the involvement of as many stakeholders as possible. When stakeholders are genuinely involved in planning, they tend to have more ownership and, as a result, greater involvement in subsequent activities. There are many forms that planning can take in the case of urban sanitation development. This will often be very much influenced by the type of sanitation intervention being discussed (household or communal systems). The basics of the planning process are, however, similar and include: Who is Involved: In all cases, the following should be involved: • The USP as a “facilitator” only. Remember that the community needs to “own” the plan, so guide the process and try not to impose • Community leaders (local authorities, religious and others leaders); • As many community members as possible. IMPORTANT: Make sure that representatives for various groups in the community participate in the planning process. This includes: men, women, youth, people of different religious or ethnic backgrounds, etc.

What is Needed: A large room, flip chart paper and markers. How to Begin: The planning process is best if opened by an influential community member (for instance the Kepala RT). After the opening, the USP should review with the group: 1) data that was collected earlier concerning current sanitation conditions; 2) what has been done and agreed to so far; and 3) the purpose of this planning exercise that is to develop a clear schedule of activities going forward. As the USP, you will know much better what needs to be planned and how those activities need to be organized, so you will need to do much of the facilitation. In general, you need to decide the Who, What, When, and Where for each of the following:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

A. Promotional Activities: What will be done during the promotion process (community meetings, transect walks, etc.) and how can community leaders make sure that as many people as possible participate. Specify specific times and places to conduct these exercises. Importantly, as not all community members will be available at the same time, some activities (such as the “Transect Walk”) may need to be done more than once. It is not necessary that everyone participate in all activities, but better if you make an effort to accommodate everyone’s schedule as best as possible. See the next Chapter for more ideas on what promotional activities to plan for. B. Construction Services: How will those involved in construction be integrated into the promotion process. This is especially important, as people will generally have very many questions about what is required and how much it will cost. While some information can be related in a large group setting, many households will have specific questions about how facilities will be constructed in their homes and what the cost will be. C. Support Services: What organization or program may be able to assist with financing. This can include Credit Unions, Micro-Finance Institutions, Government Agencies or others. Support services also include those that may assist with on-going operations and maintenance issues, such as desludging services. It is important to schedule when can they come and explain to community members the types of assistance they can provide. D. Participatory Monitoring: How will the community monitor program progress and continue to encourage people to effectively participate? E.

Celebrations, Competitions and Rewards: How will those that successfully participate in the program be recognized or rewarded. Can leaders establish a competition that will motivate others? Is it possible to organize a special celebration for the community? IMPORTANT: There is information on all of the above in other sections of this document, so make sure you have a full understanding of its contents before undertaking community planning.

TIP: Depending on how many participants you have at the Community Planning meeting, you may want to break up into small groups based on the above topics. Each small group can develop a table of planned activities for their topic. This plan can include: Sample Community-Level Activity Schedule Activity Transect Walk

Who Organizes It Kepala RT and USP

Who Participates 10-20 community members

When/Where Will It Occur April 01, 10:00-12:00

What Resources are Required Flip chart paper and markers

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After each group develops their table, they can present it to the larger group and the USP, as the facilitator can work with them to synchronize all planned activities into a final Community Plan. Once the Plan is agreed to, make sure that community leaders are ready to take on the task of monitoring implementation of the plan and resoling any problems that may arise. REALLY IMPORTANT: Other Community Planning Programs While the above describes Community Planning for a sanitation program, it is critical that USPs be knowledgeable of the main community planning processes implemented by the Government. Two of the more prominent forms of other community planning processes include:

Musrenbang: The umbrella process for participatory planning is the Musrenbang process that the Government undertakes every year. In this process, community leaders gather data on economic health and other conditions and, together with community members, decide what activities they would like to undertake with Government support. These plans are then discussed at Kelurahan level, continue at Kecamatan level, and are then submitted to the local Bappeda office and used to inform governmental departments and elected officials. By the time they are approved, these budgets may (or may not) support plans submitted by communities. However, through advocacy to decision-makers from community leaders, the USP and others, it may be possible to direct more resources to specific sectors such as sanitation. The more that decision-makers are aware that sanitation improvement is a priority for certain communities, the more they are likely to support related budget allocations. USPs should review the existing “Development Workplan” (Rencana Kerja Pembangunan or “RKP”) for the community that was developed during the Musrenbang process or try to have new sanitation activities integrated into the new RKP that will be developed. To learn more about Musrenbang check out UU No.25 Tahun 2004, PP No. 8 Tahun 2008, Permendagri no. 54 Tahun 2010. PNPM Perkotaan: The National Program for Community Empowerment in Urban Areas (PNPM-Urban) is a community driven development program that is implemented by the Ministry of Public Works. It delivers block grants to the urban poor for smallscale infrastructure projects and, to a lesser extent, small-scale social and economic development projects. It currently serves all urban areas in Indonesia with the aim of fostering community participation, improving local governance, and delivering basic needs at the community level. Some areas have been highly successful in mobilizing PNPM-Urban funding for household sanitation systems for the poorest members of targeted communities. Under these schemes, PNPM has provided material support and technical assistance, while the household themselves have been responsible for all labor requirements and the construction of the part of the facility that is above ground. If prioritized by community-level and supported by PNPM Perkotaan managers, this can be an important source of support for low-income households that may not otherwise be able to afford improved sanitation facilities.

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| 37 Photo: Ahmad Dardiri/IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 6

COMMUNITY-LEVEL PROMOTION

The community we live in has a powerful influence on what we think and do. It gives us support, ideas and motivation to do things we may not have thought of on our own. It also makes us feel more accountable for our actions. In the case of sanitation promotion, if the community makes improving sanitation conditions a priority, it is more likely that individual community members will join in the effort. Importantly, when all members of a community adopt improved sanitation, the benefits to each individual community member are also greatly enhanced. While community-level buy-in to sanitation improvements is critical, the process is not always easy. Some community members may quickly accept the idea of making investments in sanitation improvement and changes in their hygiene behaviors. Others will need much work to convince, and others may not want to participate at all. What is important to remember is that, even if only one or two begin to make sanitation improvements, others will be encouraged to do the same. People need their own reasons to make such investments, but they will also be influenced by what other community members are doing. Building on the work during Community Entry and Socialization stage, the goal of the USP during Community-Level Promotion is to build awareness among community members that will “trigger” them to take positive action to invest in sanitation improvements and adopt improved hygiene behaviors. This is perhaps the most critical element of the CLTS approach that the MOH uses in addressing Pillar 1 of STBM. This section describes the “triggering” process and related activities.

1. The Community “Triggering” Process Helping a community to decide to improve their sanitation conditions is not completed in a single event. Rather, communities are “triggered” by participating in a series of activities designed to increase their awareness of current conditions and what it will take to improve them. The following are common “tools” used by USPs in the triggering process. Additional information on these can be found in Modul Pelatihan Fasilitator Sanitasi Total Berbasis Masyarakat (STBM) di Indonesia (Kementerian Kesehatan, 2014).

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

A. Social mapping: In this exercise, you and a group of community members create a simple map of the neighborhood and identify specific groups within the community and their sanitation and hygiene practices. Use big sheets of paper or flipchart for plotting the neighborhood and for illustrating various sanitation conditions and behaviors. Lead participants in a discussion about what is good and badâ&#x20AC;&#x201D;and how conditions can be improved. The benefit of using flipchart is that you can use it for monitoring the progress and regularly sharing results with the community.

Photo: Ratih Astati Dewi/IUWASH East Java

B. Transect walk: This is simply a walk around the neighborhood with a group of community members to observe sanitary conditions and behaviors. The transect walk is the moment for you, the USP, to explore participantsâ&#x20AC;&#x2122; feelings towards current sanitation conditions and practices. Identify practices that are both good and bad and discuss how good ones can be expanded and how bad practices can be corrected. Ask the participants many questions about how they feel about current conditions and what they may be able to do to improve them. Have one of the participants take pictures. As a group, interview people along the way, especially at households with good sanitation conditions to understand the reasons and how they achieved better sanitary conditions, including gender criteria of improved sanitation facilities. As you gain more experiences in conducting transect walks, you will adjust your approach and arguments to create

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

best possible feedback from community members. Be sure to write down the results and significant observations so that you can share them with others. C. Focus Group Discussions (FGD): These are structured discussions with community groups based on a prepared list of questions. It is a very good idea to conduct a FGD after social mapping and transect walk exercises, but they can be done on other occasions as well to promote discussion among community members and lead them to become more aware of local conditions and what they can do to improve them. Visualize as your finding as much as possible with pictures taken during transect walk and bold sketches to facilitate the discussions with the community. D. Fecal-Oral Transmission or “F” Diagram: This is an exercise to show how disease is spread from human waste back to humans if such waste is exposed in the environment and not properly contained and handled. Using an F-Diagram poster, the USP shows how E.coli bacteria in the feces of humans and animals can get into the stomach through a number of ways, including through the hands (fingers), water (fluid), and flies (flies). The main message is that human waste must be contained, kept away from humans and eventually treated. If not, then E. coli can enter our food and beverages and make us sick. As a USP, you can use this to discuss what individuals and the community can do to be protected from such contamination. E.

Community Exchange Visit: As an outsider to the community, it is often very difficult to explain to people what they can do to improve their sanitation conditions. They may have limited trust in you or they may think that they do not have the resources to make the changes that are needed. One of the most effective ways to convince them is to have them visit another community that is more advanced in the sanitation improvement process. This will help to “Demystify” the process by seeing how others have made sanitation improvements. Make sure the community you want to visit is well prepared and that key leaders are available and ready. Useful things to learn during the visit include: how the community managed financing issues; successes and approaches in mobilizing the community; review of the impact of triggering events; understanding what were the most effective promotional messages; how the community plans to take care of operation and maintenance needs of the community system; what kind of celebration did they organize; and what they would do differently.

Community and Other Meetings: As you begin to become more familiar with the community and, importantly, the community becomes more familiar with you, it may be possible for you to attend other meetings and gatherings to present what you are trying to do and seek their support. This can be a meeting of local PKK members, an event at a local school, or any other forum that gives you an opportunity to talk to community members about sanitation conditions and what they think they can do to improve those conditions.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

REMEMBER: In urban areas, it can be very difficult to organize events and activities that all community members can participate in. You will need to be flexible in scheduling these activities. This will often mean that you will need to attend meetings and events at night or on the weekends. Alternatively, conduct additional meeting to accommodate specific concerns and needs of different gender groups (men, women, elderly and disabled people). Especially if you identify that there is a dominant group will play a key role to decide in supporting the development of improved sanitation facilities (husband need to make decision on development of improved sanitation facilities but most of husbands in this area are the fisherman who go to work at night. In this point, you need to add additional meeting with the group of husband in different time to get a specific support from them. Though it can be difficult, the benefits of working around everyone else’s schedule are great and the community will notice and appreciate your work even more. Also, if there are not many participants at some of your first meetings, do not be discouraged. It can sometimes take a while to get urban communities generally interested in what is happening.

2. A Special Note on “Triggering” In many other countries, traditional approaches to “triggering” improved sanitation behavior focus on making people ashamed and disgusted by their current sanitation conditions. However, because it might make people feel intimidated and unhappy with you as the facilitator, there are other approaches that can be used and that build on positive emotions. Such emotions include pride and self-esteem that people often feel when they have made important changes in their sanitation conditions. In addition, religious values can get individuals to act and engage in sanitation access improvement. Two other approaches widely used and that focus on positive aspects include: A. Positive Deviance (PD): This approach is an asset-based, problem-solving and community-driven approach that enables the community to discover successful behaviors and strategies that at least some community members are already practicing and develop a plan of action to promote their adoption by others. To apply a positive deviance approach, you can: 1. 2.

Find a typical household with a similar socio-economic status as other community members and that has already invested in sanitation improvements and is already practicing improved hygiene behaviors. This household is the “positive deviant”. While avoiding saying that this household is better, facilitate a meeting so that other community members to review what the “positive deviant” has done and is doing and to discuss how they may be able to do the same.

The above is only part of the PD approach, and much additional information is available at www.positivedeviance.org B. Appreciative Inquiry (AI): This is also an asset-based approach that can be applied in many settings (for communities, organizations, etc.). Its assumption is simple: Every

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

human system has things that work well and that can be used as references when undertaking something new. AI focuses on the positive (not the negative) and builds from there. When you the AI process in sanitation promotion, the followings are common steps: 1.

Define: This is to define what the community has already done well in terms of sanitation. A good question to define this is: “When have we been most proud with our neighborhood sanitation conditions? What can we learn and apply from those positive moments?”

Discovery: Ask participants to recall the positive moments about the neighborhood’s sanitation condition. Ask questions such as: “From the moment that you feel proud about your neighborhood or environment, what characteristics/things are present? These can be a person, an organization (like Karang Taruna, Majlis Taklim, arisan), the government (such as Peraturan Kelurahan) or feelings (like sense of community). Ask participants to tell their stories and identify positive things that are present at their proud moments.

Dream: Ask participants in small groups to create a future in which the high points identified in the previous steps are the everyday reality. Ask them to design the structure to achieve the desired future, and describe/explain it in a visual image and word image.

Design and destiny: Encourage participants to translate their visual images into an appreciative action plan. Help them in this process and in making a schedule for activities.

The above is only part of the AI approach and much additional information on AI is available at http://www.centerforappreciativeinquiry.net/

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 7

HOUSEHOLD-LEVEL PROMOTION

While a USP can register much success working at the community-level, all research and experience shows that promotion at the household-level is equally critical in motivating people to invest in sanitation and improve hygiene behaviors. This is logical. People may seem supportive during a community meeting or event, but they may still not trust what others are saying, they may still have important questions, or they may believe that they have special circumstances that make them different from other community members. Because urban residents often have busy schedules or may need to work at night, they also may not have had the opportunity to participate in important community-level meetings or activities, so may not understand the program. Very importantly, people will also want to better understand exactly how the construction will be done and how much it will cost. In brief, many households will need more information and more motivation than can be made available at the community-level. The following offers basic guidance on how to conduct promotional activities at the household level, specifically addressing: • Forming a household-level “Promotion Team” • The household-level promotion process; and • The construction process and construction costs.

1. Forming a household-level “Promotion Team” Anytime we buy something, it is based on our “Willingness” and “Ability” to buy it. Together, these make up to basis of “Demand”. Willingness and ability are different, but related to each other: • Willingness is sometimes described as how you feel after you make a decision. If you feel good about the decision, your willingness is high. If you feel uncomfortable about the decision, your willingness is low. The concept of “willingness” is a bit vague, and it is difficult to measure, but it is very real and very important. • Ability is much more simple. It is based on your budget and the cost of what you are thinking of buying.

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Both willingness and ability are essential elements in each household’s decision to invest in sanitation improvements and to improve their hygiene behaviors. First, Form a “Promotion Team”: To ensure that you are maximizing both willingness and ability, it is best to form a small “Promotion Team”. The team should include two or three community leaders and sanitation champions. It is very important that they be trusted members of the community who already have or are already willing to construct improved sanitation facilities. Depending on the conditions you have observed so far in the community, you will probably want to add: • Someone very knowledgeable of the construction process and construction costs. This can include a “Sanitation Entrepreneur” (see Chapter 8), a “Facilitator” from a program you are working with, or a construction contractor. • Someone familiar with the financing options that may be available. This can include a representative from a micro-credit agency, a government subsidy program, or a local construction contractor that is willing to accept payment in installments (see Chapter 9). With strong support of the USP, this small “Promotion Team” then conducts visits to discuss with the household leaders the community’s sanitation program in more detail.

2. The Household-Level Promotion Process Anytime we buy something, it is based on our “Willingness” and “Ability” to buy it. Together, these make up to basis of “Demand”. Willingness and ability are different, but related to each other: • Willingness is sometimes described as how you feel after you make a decision. If you feel good about the decision, your willingness is high. If you feel uncomfortable about the decision, your willingness is low. The concept of “willingness” is a bit vague, and it is difficult to measure, but it is very real and very important. • Ability is much more simple. It is based on your budget and the cost of what you are thinking of buying. Both willingness and ability are essential elements in each household’s decision to invest in sanitation improvements and to improve their hygiene behaviors. First, Form a “Promotion Team”: To ensure that you are maximizing both willingness and ability, it is best to form a small “Promotion Team”. The team should include two or three community leaders and sanitation champions. It is very important that they be trusted members of the community who already have or are already willing to construct improved sanitation facilities. Depending on the conditions you have observed so far in the community, you will probably want to add: • Someone very knowledgeable of the construction process and construction costs. This can include a “Sanitation Entrepreneur” (see Chapter 8), a “Facilitator” from a program you are working with, or a construction contractor. • Someone familiar with the financing options that may be available. This can include a representative from a micro-credit agency, a government subsidy

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program, or a local construction contractor that is willing to accept payment in installments (see Chapter 9). With strong support of the USP, this small “Promotion Team” then conducts visits to discuss with the household leaders the community’s sanitation program in more detail.

3. The Household-Level Promotion Process Using the concepts of “Willingness” and “Ability”, the following is guidance for “Promotion Teams” on household-level visits. This will need to be adapted to each situation and community, but covers the basics of what you should plan for. A. Household Willingness: •

Introducing yourselves and thank them for their time, assess the household’s willingness by asking simple questions, such as: o “Based on what you know now, do you plan to invest in an improved sanitation facility?” o “What are some of the reasons that make you want to invest or not want to invest?”

•

If the household says that they are willing to invest, congratulate them on their decision and ensure them that the community will work together to support each other.

•

If the household is still undecided or not willing to invest, try to: o Identify specific concerns they have. Aside from cost, these may relate to: changes they will need to make to their house; trust of the agencies or vendors involved in the program; future maintenance requirements; etc. o Acknowledge their concerns and try to address each one as a Team. Household leaders may be much more willing to accept explanations from community leaders and sanitation champions, so let talk the most. The first time the “Promotion Team” does this, it may be difficult, but they will get better as they visit more households. o Highlight the benefits of improved sanitation and hygiene. Some of the more common ones are listed in Chapter 3. Stress the importance of everyone in the community participating. When everyone participates, the benefits to the community’s health and the environment are much greater. If they do not participate, it also hurts everyone.

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Reassess their willingness and continue to try to convince them. However, some households may be very difficult to convince. If they are too difficult, thank them for their time and go on to the next house. You can always visit them again later.

B. Household Ability: In many cases, households will say that they are willing, but that they cannot afford the cost. •

Review with them the construction process and construction costs (see the Section below), so they understand what they will be receiving and how much they will be expected to pay.

•

Review with them the economic benefits that they will receive by having an improved sanitation facility and practicing improved hygiene behaviors. This includes: • lower health care costs; • fewer school and work days that are lost due to illness; • less time spent in going to the bathroom outside the house; etc. Weigh these economic benefits against the cost of the improved sanitation facility. FACT: In all cases, the benefits over the long-term are much greater than the costs.

•

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If they genuinely need assistance, review the “Sanitation Finance” options that may be available (see Chapter 9 for more details). Important: As a USP, you need to know these very well. Try to have detailed information available on financing options that are available for your target community. If possible, schedule a visit by the person or people responsible for that “option”, such as a representative from a micro-credit program or from a Government subsidy program.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

4. The Construction Process and Construction Costs As part of the above or during a separate visit, you also need to give households much more detailed information on the construction process, construction costs, as well as maintenance requirements and costs. To do this, you can use the same “Promotion Team”, but should add someone very knowledgeable of the construction process and construction costs. As a team, you should explain in simple language the type, function, use, maintenance requirements and the cost of the facility that will be built. Of great interest to households is also the construction process and the work that will be done on the physical structure of their home. This can include: digging up the floor for installing pipes; digging pits where the septic tanks will be installed; etc. See table 3 and the discussion below for more details. The following matrix summarizes the type of cost-related information that a household will expect to receive during the promotion process: Tabel 9: Frequently Asked Questions About Facility Construction.

No.

Household Facility

Communal Facility

What is the most suitable spot for building a new septic tank, considering: • Location of kitchen, bathroom and WC • Accessibility during construction and later for sludge emptying

How will piping from the kitchen, bathroom and WC connect to the sewer located outside? • Where is the location of the connecting pipe within the premises? • What is the size and location of the “control box”

Are there any physical modifications needed inside my house? What type of modifications?

Who will build the facility and how long it takes to be built?

What are the total costs for getting the facility ready to operate “terima bersih”?

What contributions can I make in-kind or in labor to lower the cost?

What are the payment conditions and is there any supporting financial facility for reducing the cost burden?

What are the monthly “follow-up” costs for operation and maintenance?

Whom can I contact if I have a problem with the facility that is due to poor construction?

Whom can I contact if I have another type of problem with the facility?

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VERY IMPORTANT: To give the best understanding of the actual cost for the household, the person that will be in charge of construction should: • Make a measurement within the premises of the areas that are effected by the intended sanitation improvement measure; • Make a simple sketch and identify the cost items associated with the intended improvement measure (e.g. provision of water, toilet, connecting pipes, septic tank, discharge pipe, etc. as appropriate); • Present the sketch and associated cost to the household for discussion and decisionmaking. An example of a simple sketch and price calculation sheet is included in Annex 1 and 2.

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| 49 Photo: Hasan Zunaidi/IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 8

SANITATION ENTREPRENEURS

Though some sanitation programs may use large-scale contractors for construction work and supplies, the majority of sanitation improvements depend on small-scale businesses, especially for individual household systems,. These businesses may be formally registered as Small Medium Enterprises (SMEs) or they may be part of the informal sector. They make up the “supply chain” for sanitation goods and services, and they are essential to expanding and sustaining access to improved sanitation facilities. The leaders of these businesses are referred to as “Sanitation Entrepreneurs” and they are involved in such areas as: • • • • • • • •

Sanitation promotion and marketing; Technical design of facilities; Development of cost estimates for required construction work;; Financing; Supply of construction materials and equipment; Construction work such as masonry and plumbing; Desludging service operation; and Facility maintenance and repair.

When Sanitation Entrepreneurs improve and expand their services, the entire sanitation sector benefits. Although Sanitation Entrepreneurs are absolutely critical to sanitation development, there are often not enough and more need to be encouraged to become involved in sanitation work. As important, those that do exist often need to further develop their capacity in the above listed areas, as well as in basic business management (accounting, marketing, planning, etc.). Once a community is triggered, the community will need access to improved sanitation goods and services. If these are not appropriately available (limited in supply, not technically appropriate or too expensive), the community will be frustrated and lose interest. On the other hand, if they know that Sanitation Entrepreneurs are ready to respond to their needs with reasonably priced and good quality products, they will be far more willing to invest in sanitation improvements. As USP, you need to:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

• •

•

Understand what the types of work that Sanitation Entrepreneurs can or should be involved in. This will vary according to the type of sanitation intervention that you are promoting; Know the Sanitation Entrepreneurs that already work in your target area, and know what they need to improve the quality of their services. This can include training in such areas as: marketing, construction according to SNI standards; business planning and accounting; and many other areas. Encourage others to become Sanitation Entrepreneurs. Sanitation development in Indonesia represents a rapidly growing business sector that many will find profitable.

Sanitation Business and Empowerment Association of Indonesia (APPSANI) Founded in 2012, the Asosiasi Pengusaha dan Pengelola Sanitasi Indonesia (APPSANI) is an important network of sanitation businesses and organization that seeks to support the government in promoting sanitation business development. Some of its specific areas of interest and involvement include: • developing management and technical capacity among sanitation entrepreneurs; • encouraging women’s participation in sanitation service delivery; • facilitating partnerships and cross-sector collaboration; • developing high quality and affordable technologies; • encouraging the emergence of new sanitation businesses; • anticipating subsidized interventions; and improving the skills and knowledge of human resources for sanitation. For more information, see http://www.appsani.org)

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

1. Supply Chain Analysis Sanitation Supply Chain Analysis: As defined by UNICEF, the sanitation supply chain is the network of businesses involved in the production, delivery and sale of sanitation products and services to the consumer. A supply chain has three key parts: raw materials, manufacturing and distribution. Businesses that sell sanitation products and services work with and depend on other businesses to get final products into the hands of the end consumer. Once you know the types of sanitation goods and services your target community needs, you can examine in more detail what it takes to produce and deliver those good and services. Answering the following for each good or service needed will be very helpful in accomplishing this task: •

What businesses are involved in producing this good or service?

•

For each business: o How large are they? o What is their “business model” (this includes their approach to business and financial management, human resources, cash flow, and credit)? o What is their approach to marketing, promotion and sales?

•

How do input suppliers, manufacturers, transport service providers, and others link together?

•

How do all of the above businesses compete and/or collaborate?

•

What is the current market for this good or service and what is the expected increase in this market following promotional activities?

•

Are existing businesses large enough, competent enough or sufficient in number to respond to anticipated increases in demand?

•

How can existing businesses be improved or new businesses be encouraged to become involved?

The information collected on existing sanitation businesses and available products helps us understand how to improve how the market functions and how individual business can better respond to that market. More guidance on supply chain analysis can be found in the UNICEF Sanitation Marketing Learning Series (see Guidance Note No. 3).

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

2. Sanitation Marketing One of the ways to better understand how Sanitation Entrepreneurs can respond to increased demand from communities is to analyze their sanitation business in terms of basic “marketing” elements. These are often represented as the “Four Ps” which include: Product (Produk), Price (Harga), Promotion (Promosi) and Place (Lokasi). These are further described as: •

Product: Sanitation products must comply with the needs and desires of consumers, including the special needs of women, children, the disabled and others. They must also comply with government regulations and standards.

•

Price: This is the amount of money charged for a product or service. It needs to be considered as affordable by the consumer and must also generate a reasonable profit for the sanitation business.

•

Promotion: This includes all activities undertaken to communicate and promote the businesses products in the target market. Promotion can be done through broad advertising, community-level sales promotion, or one-on-one marketing at the household level. It is often most effective if it uses all of these methods.

•

Place: This is the location of a wide range of activities undertaken by the business to make its products accessible and available to consumers.

Understanding how a Sanitation Entrepreneur is addressing the above areas is very useful for determining their strengths and weaknesses and identifying opportunities where there may be opportunities to improve their services. This can include: • •

Expanding the types of products or services they provide through technical training; Improving how they establish the price for their products to make sure they are successful in marketing them and also make a reasonable profit;

•

Helping them to develop basic marketing materials that they can use to promote their sanitation products;

•

Facilitating visits with community members to assist them in targeting their promotional activities;

•

Proving business management training to improve their capacity to expand and serve more consumers.

Very importantly, this can also include teaching them more about why improving sanitation facilities and adopting improved hygiene behaviors is so important and how to convey

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

those messages to community members. This will both assist in their marketing efforts and your own promotional messages to the community. It is important to understand that sanitation marketing activities can also be much more effective if they are supported by microfinance institutions (MFIs) that have funding available for sanitation improvements. This is because sanitation marketing supports its business. As a USP, you become familiar with MFIs that serve your target community and, if they do not support sanitation improvement now, you should encourage them to do so.

More Guidance on Sanitation Marketing One of the best resources for better understanding sanitation marketing is available in WSPâ&#x20AC;&#x2122;s Introductory Guide to Sanitation Marketing. The document and accompanying toolkit were developed by WSP to give practical guidance on the design, implementation, and monitoring of rural sanitation marketing programs (including projects in Indonesia). Though oriented towards rural sanitation programming, it is also applicable to most urban settings.

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| 55 Photo: Dwi Prihanto/IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 9

SANITATION FINANCE

In many respects, the decision-making process that someone follows for investing in an “improved sanitation facility” is the same that they follow for any other major purchase they make (for a new motorcycle, a new cell phone, a family vacation, etc.). Common questions that people will ask themselves include: 1. What type of product do I want and need? 2. What level of quality or special features do I want? 3. Whom will I buy it from? Do I trust the vendor? 4. What is a fair and reasonable price for the product? 5. When and how will it be delivered or built? 6. What am I willing to spend? How will I pay for it? Can I afford it? Very many urban sanitation programs have successfully led communities and households to want to invest in improved sanitation. They successfully answered the first five sets questions above. However, these programs ultimately did not achieve the results they wanted because they were not able to adequately help people respond to the sixth set of questions about financing. Improved sanitation facilities in urban areas cost money, and if financing issues and options are not taken into consideration, your success as a USP will likely be very limited. Although of critical importance, there is usually no standard set of financing options available to choose from. Each sanitation improvement program and each community will likely have different issues and possibilities. As USP, you need to understand what financing options can be made available to your target community. Below are descriptions of some financing options that may be available to your target community. You will need to research these further and, importantly, advocate to local government, banks, microfinance institutions, local businesses and others to improve the availability of financing for improved sanitation facilities. A. Sanitation Micro-Credit: One of the most effective ways to assist people in being able to afford to invest in improved sanitation facilities is through micro-credit. Experience in “triggering” shows that people are often willing to make the investment, but cannot do it all at once. Through micro-credit programs, they can break-up the cost into affordable payments. These payments may be made on a weekly or monthly basis, and they usually

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

extend over a one to two year period. Micro-credit loans can be made available through a number of channels, including: Banks: Very many banks in Indonesia have micro-credit programs. These include Bank Pembangunan Daerah (BPD), Bank Rakyat Indonesia (BRI), Bank Syariah Mandiri (BSM), Bank Perkreditan Rakyat (BPR), many provincial and local government banks, etc. “Non-Bank” Micro-Finance Institutes: This includes larger organizations that are specialized in micro-credit such as Credit Unions, Cooperatives and many others. Other Lenders: This can include Sanitation Entrepreneurs such small-scale construction companies that will build the facility and allow their customer to pay the amount they owe in installments. Another example is some sanitarians or community kaders who will extend personal loans for sanitation improvements to households that they know and trust. This can be a big risk for the lender, so care should be given before widely promoting this. All micro-credit providers are always worried about the rate of “Non-Performing Loans” or “NPL”. These are loans that have been provided, but for which the recipient is late in making payments or has stopped making payments entirely. This can be disastrous for a micro-credit provider because it means they will need to cover that amount from their own funds. To protect themselves against a high “NPL” rate, many micro-credit providers have specific rules and limitations. Many will provide micro-credit loans: •

Only for income generation activities and not for household improvements.

•

Only to people that have had accounts with them for a year or more and have a proven track record in saving money. Many follow the rule of “savings before credit” and will not lend to someone until they see that they have good financial management habits and are more apt to repay the loan.

•

Only to people that have acceptable collateral (such as a house with a formal title);

•

Only to people that have a steady job and can prove it.

Though many micro-credit providers have rules and limitations, many are also interested in expanding their business. They might be attracted to the sanitation sector because it is a growing market. By providing micro-credit loans for improved sanitation facilities, they can increase their overall portfolios (and profit) and expend their customer base. Many local governments are also interested in improving the availability of micro-credit for sanitation and may be interested in facilitating the process through supporting loan funds. Two great examples of this is include Kabupaten Bandung and

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Kabupaten Jombang which have each provided IDR 5 billion to a local bank, specifically to support micro-credit loans for household-level sanitation improvements. The national-level Pokja-AMPL is also very interested in increasing the availability of micro-credit for sanitation. So it will be important to monitor this sector closely for positive changes. A good resource for further understanding the important area of micro-credit is available from Water.Org and MicroSave, two organizations that jointly developed a series of toolkits to provide information and tools for financial institutions to develop microfinance products for water, sanitation and hygiene (WASH) investments. To review this Toolkit (in English) visit http://www.washmicrofinance.org. B. Corporate Social Responsibility (CSR): Many Indonesian companies and other businesses are interested in contributing to social development initiatives. Through CSR programs, they are able to help communities and demonstrate to their customers and workers that they are good members of society. This also helps them market their products and improves their operations. Because CSR can be a “Win-Win” for companies and communities, the USP should work with community members to approach local business and ask if they are interested in helping. Some tips for doing this are: • See if your local government has already established a “CSR Forum”. These Forums can be very useful for networking and trying to identify businesses that are interested in providing CSR assistance to your program. •

Prepare a short brochure and powerpoint presentation that describes the community and the type of assistance they need to improve their sanitation conditions. This can also include letters of support from local authorities. Businesses want to understand well what they will be contributing to and how others are involved.

•

With community leaders, conduct visits to business that you believe may be interested in proving CSR assistance and explain what you hope they can help with. Remember: Businesses like to have options, so do not propose just one thing. Examples of different contributions that businesses can make include in-kind contributions, cash contributions or reduced rates for: o Basic construction materials such as sand, gravel and cement; o Plumbing products; o Skilled labor; o Community events and awards; Businesses may also want to make their contributions available only to those in greatest need, such as poor or low-income households, the elderly, the disabled, etc. In all cases, be flexible in asking for CSR support.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

•

Form a small committee in the community to transparently manage any funds or materials that may be provided. Businesses will be more willing to help, if they see that there contributions are being used properly.

Subsidies: Because sanitation improvements in urban areas must comply with regulations and standards, many urban sanitation initiatives provide subsidies. These may be provided indirectly or directly to households. Examples of indirect subsidies include most all large-scale sewerage systems and many communal sanitation systems. This is because the Government usually funds construction of the main system and households only need to cover the cost of connecting it to. Examples of direct subsidies included cash or in-kind contributions directly to households. Sometimes these are available to all households in a community, and other times they are given only to those with special needs (such as poor and low-income households). Even when subsidies are available, they usually cover only part of a household’s costs. The PNPM-Perkotaan program, for instance, sometimes provides subsidies for sanitation improvements, but they only provide these in the form of materials and technical assistance for construction of the basic toilet and septic system. The poor households must themselves provide labor, all costs associated with construction of the room for the toilet, and of course, the cost they will eventually need to pay for maintenance and desludging services. The availability of subsidies varies widely among urban centers and among sanitation programs. An important job of the USP is to research what may be available to their target community. Key questions to ask are: • What subsidy programs are available? • What do they provide in terms of cash or in-kind contributions? • Whom do they provide these subsidies to? • How long will the subsidy be available? When explaining possible subsidies to the community, be very careful to be accurate in how you describe the possibility. Do not build up people’s expectations for a subsidy, if you are not 100% certain they are eligible.

D. Community Resources: In addition to resources outside the community, it may be possible to mobilize financial assistance within the community. This can take the form of: •

Community-Based Savings and Arisan Groups: These are small “revolving funds” where community or group members contribute a small amount of money each month that allows one or more participants to finance their sanitation improvement. The groups decide how funds are administered. Though it may take a while for all members to obtain their improved sanitation facility, such programs can be successful because participants will support each other. Through peer

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pressure, they will also make sure that everyone benefits and that no one does not pay back what they owe. Similar to community-based savings; the only difference is, instead of having to borrow money, the community members have to contribute a certain amount of money every certain period of time and then there will be a random drawing every certain period of time to decide which community member will get the fund on that period. â&#x20AC;˘

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Community Benefactors: Some communities may have current or former community members that have done well in business and, with their own resources, can afford helping the community in its efforts.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

| 61 Photo: IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 10

PROPER FACILITY USE, MAINTENANCE AND HANDWASHING WITH SOAP

Investing in improved sanitation is critically important to reducing water and sanitation borne disease, but sanitation facilities need to be used and maintained properly. Proper use also means handwashing with soap after use the facility. USPs should make sure that people are trained in these areas. The following are basic guidelines for both sanitation facility use and maintenance and handwashing with soap.

1. Facility Use and Maintenance Guidelines

a. b. c. d. e. f.

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Provide a water basin and small bowl with handle inside the toilet room for water storage, anal cleaning, flushing, handwashing and cleaning of the latrine.

Ensure that handwashing facilities nearby are regularly maintained with clean water and soap.

3. Teach all users of the toilet (especially children) to do the following: Before use, pour some water to wet the pan. This reduces the risk of excreta sticking onto it. Position the feet properly on the foot-rests to ensure that the excreta drops into the pan. Preferably, clean your bottom without getting in physical contact with your own excreta. Use a ladle with your right hand and wipe your bottom with your left hand. After defecation, pour water to flush the excreta. Usually, 2 liters of water are used for stools and half a liter is used for urine. ALWAYS wash your hands with soap and water after defecation. NEVER throw solid waste (diapers, kitchen waste, rocks, leaves, etc.) into the pan, as this will clog the system. 4.

The squatting pan should be cleaned daily with a soft broom or soft brush.

If any construction defect is observed during the guarantee period, report the matter to the local authority or the construction agency.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

If the trap is clogged, it may be possible to unclog it by using a wire, after removing the cover of the drain or junction chamber. Call a specialist if needed.

After a couple of years of normal use, the septic tank will become full and flushing will either become much slower or not work at all. Have the phone number of the septage removal service handy to arrange for it to be emptied and taken to a proper treatment facility. Make sure the operator knows they must dispose of it properly.

IMPORTANT NOTE: Maintenance of the sanitation facility is critically important for the sustainability of its benefits. Though many assume that this is the work of women, everyone can and should contribute to its regular cleaning and, if needed, repair. Family members need to identify what needs to be done and work together to agree on who will do what and when.

2. Handwashing with Soap (HWWS) Guidelines The World Health Organization (WHO) estimates that incidence if diarrheal disease could be reduced by 32% through improving people’s access to basic sanitation, 45% through washing hands with soap, and 39% through safely treating water in households. In addition, by integrating the three behavioral interventions, incidence if diarrheal disease can be reduced by 94%. See Ministry of Health, National STBM Strategy (852/MENKES/2008) for more information. USPs should work with community leaders and representatives from the area Health Center to hold events to promote Handwashing with Soap. Such events are especially effective when done at area schools because the children then take the messages they learned home and help to reinforce positive behavior among other family members. Good ideas and guidance for conducting Handwashing with Soap educational events are available in the “Kurikulum dan Modul Pelatihan untuk Pelatih (TOT) Fasilitator STBM, 2014” (available at http://stbmindonesia.org).

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Key Steps and Times for Handwashing with Soap A. The Correct Steps of Handwashing with Soap (HWWS): 1. Wet your hands with clean running water. 2. Rub soap on the palms of the hands until it lathers and rub the back of both hands, fingers, both thumbs, until all surfaces in contact with the foam soap. 3. Clean the fingertips and the sidelines under the nail. 4. Rinse with clean water, rubbing both hands until the soap is gone. 5. Dry your hands using a cloth, towel net, or tissue paper, or shaking them off until dry. B. Critical Times to Wash Hands, among others: 1. Before eating. 2. Before preparing and serving food. 3. Before breastfeeding. 4. Before feeding the baby or toddler. 5. After defecation. 6. After holding an animal or poultry Minister of Health Decree, Number 3, 2014

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| 65 Photo: IUWASH East Java

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Chapter 11

MONITORING AND EVALUATION

Monitoring and Evaluation (M&E) is not boring! Used properly, M&E is not only critical for measuring progress, adjusting approaches and providing reports, it can also be a powerful tool in the actual promotion process. This is especially the case when M&E is used in a participatory manner that allows for local stakeholders to be heavily involved. Monitoring is defined as a continuous process of collecting and analyzing information to determine how well an activity is being implemented compared to expected results. Monitoring aims at providing everyone involved in the implementation process with regular feedback and early indications of progress or problems, so that approaches can be adapted and corrective actions can be taken. Evaluation is similar, but it is undertaken at a specific point in time to help us determine if the activity we are implementing has achieved or is achieving its objectives. It also gives us ideas about how the approach to implementing similar activities in the future can be improved. There are different types of M&E that USPs undertake for sanitation promotion programs. The STBM program has defined a very comprehensive framework for monitoring progress in the Stop BABS campaign, including both the adoption of improved sanitation facilities, as well as handwashing with soap (HWWS). Note that very much of this information is collected for communities at the Puskesmas level, and all USPs should work closely with Puskesmas staff to make sure that they are aware of current data and that they regularly consult with and report to Puskesmas staff on progress in their own promotional efforts. The STBM program further has very many materials available to support the monitoring process. These can be found on the STBM website (at www.stbm-indonesia.org) with main resources including: • Kurikulum dan Modul Pelatihan Fasilitator STBM; • Monitoring dan Evaluasi: Verifikasi ODF di Komunitas; • Starter Kit bagi Petugas Monitoring Kabupaten/Kota; and • Starter Kit bagi Petugas Monitoring Kecamatan/Puskesmas. Some of the above includes information on the importance of participatory monitoring and how this can best be undertaken. This section only adds to that information, stressing the importance of involving local stakeholders as much as possible in the monitoring and evaluation process.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Participatory Monitoring and Evaluation (PM&E): This type of monitoring is important for several reasons: •

By involving community members in the monitoring process, their sense of ownership will increase. The program will become “their program” and not the initiative of an outsider;

•

When their sense of ownership increases, they will be more helpful in ensuring that others participate and ensuring that, if problems arise, those problems are quickly resolved;

•

They will feel more empowered and more in control, and they will develop a greater sense of responsibility and pride. All of these are essential parts of a successful sanitation promotion program;

•

The results of PM&E can be used to show the greater impact of the program activities and can be used to advocate the results in order to get more supports from local stakeholders.

Simple ways to begin PM&E: Instead of beginning with very formal monitoring process, it is sometimes best to begin by getting people involved in simple but important tasks. This can include having a community member or members: •

After each community activity, ask the participants how they felt about the activity and how, in their opinion, it could be improved. They can write this down and discuss it later as a group;

•

Prepare and use simple tools to ease the implementation of PM&E. Also, It will help to involve more community members to take part in the PM&E activities;

•

Have someone keep a record of who participates in different activities. This is not to embarrass those that do not or are not able to participate. Rather, it demonstrates that the community is serious about their work;

•

Keep a board in a public place that shows the number of households in the community and the number that have improved sanitation facilities. Every time that someone completes construction of an improved sanitation facility, add it to the total. This way the whole community will see how they are progressing.

Some of the best information and guidance on PM&E is available from WSP in their Training of Trainers’ Manual on Community-driven Total Sanitation. Participatory Monitoring and Evaluation (PM&E) by USP: USP can involve the community in conducting monitoring and evaluation by PM&E in many areas and especially the following three: • The construction of new latrines; • The prevalence of Open Defecation; and • The practice of Handwashing with Soap (HWWS)

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There are two tools that are particularly useful in monitoring the above, including a “social map” and Simple Monitoring Form. Social maps are used to plot the number of healthy latrines in areas where promotion activities are undertaken. This does not need to be a new map, but can build on the same map generated during the Social Mapping exercise described earlier (see Chapter 6 of the Promotion of Community Level). The development of new latrines can be plotted on the map by the USP together with community members, and using information from community meetings or information provided through involvement of PKK members or the local health post. The second tool that can be used is Simple Monitoring Form that serves to record information about latrine ownership, defecation behavior, and HWWS behavior (See Annex 10). Information can be recorded on a monthly basis by community members with assistance and oversight of the USP. Both of the above are not only useful for tracking progress in the sanitation promotion process, but are highly valuable in improving local ownership of the overall sanitation promotion process. House No.

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Family Name

“Healthy Latrine” Ownership Status (a)

Defecation Behavior (b)

Handwashing Behavior (c)

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEXES

ANNEX 1 Description of an On-Site or Household Wastewater Treatment System 4

Legend: 1. Control Box 2. Septic Tank 3. Sludge Removal Truck 4. Wastewater Treatment Plant Graphic: Illustration of Local Wastewater Treatment System

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Brief Description An “on-site” or household wastewater treatment system collects wastewater from the WC (called "black water") and wastewater from the kitchen and bathing/washing areas (called "gray water"). The purpose of wastewater treatment is to remove or substantially reduce harmful bacteria so that the remaining water can be disposed of safely back in the environment. The is made possible through the use of septic tanks Processing Working Principle: Many different household septic systems exist. Those most common in Indonesia have the following characteristics: • Wastewater from the house flows through a 4" pipe into the septic tank where the water “resides” for several, allowing organic material to decompose. It is aided in this process by bacteria that attaches itself to a filter media as well as use of an “upflow” filter process. • After household wastewater passes through septic system, the water can be safely discharged into a leach field or drainage channel. • The decomposed organic material is called “sludge” and, usually after two to three years, enough sludge builds up in the septic tank that it needs to be pumped out and taken to a sludge treatment facility to be further treated and disposed of properly. If done properly, the dried sludge can be used as a fertilizer. 1. Technical Overview a. Land requirement = about 2x 3.5 meters b. Construction material = Primarily concrete rings and PVC pipe.

Tuas untuk mengangkat tutup saat penyedotan

Pipa yang menyalurkan air hasil olahan tangki septik ke Up Flow Filter Tutup Up Flow Filter

Tutup Tangki Septik

Pipa Masuk ke Tangki Septik

Muka Air

Muka Air Pipa pembuangan dari Up Flow Filter ke Saluran Drainase Media Filter (Potongan Pipa PVC)

Arah Aliran Dudukan Media Filter Akumulasi lumpur dari degradasi Tinja

Arah Aliran

TANGKI SEPTIK

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UP FLOW FILTER

Saluran Drainase Umum

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

2. Photos showing the process of building an On-Site Septic System

Photo: Pryatin M Santoso/IUWASH

Left: Excavation for placement of septic tanks and upflow filter. Right: Mold used to make the septic tank wall.

Photo: Pryatin M Santoso/IUWASH

Photo: Yayan Nuryawan/IUWASH Central Java

Left: Holder for filter media, which will be incorporated into the tank upflow filter. Right: PVC pipe bundle tied together by plastic rope and which will serve as filter media. In addition to PVC pipe, filter media can also be made of bamboo, â&#x20AC;&#x153;bioballâ&#x20AC;?, old mineral water bottles, or another material that creates much surface area for bacteria to cling to.

Photo: Pryatin M Santoso/IUWASH

Left: Rebar framework for the septic tank and upflow filter covers. In this example, the cover is square, but many are circular, according to the shape of the septic tank. Right: Image after the installation is complete with an access hole in the middle for eventual desludging.

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ANNEX 2 Description of a Communal Wastewater Treatment System

2 1

Legenda: 1. Control Tubx 2. Piping system 3. Communal Wastewater Treatment Plant (WWTP) Illustration of a communal wastewater treatment system.

Brief Description A communal wastewater treatment system is a centralized system that usually serves 20 to 50 households, depending on the size of the Wastewater Treatment Plant (WWTP). Wastewater is distributed by using a piping system towards a processing building called the WWTP (Wastewater Treatment Plant). This system is often referred to as a communal system (for a limited area (20-100 houses) or centralized wastewater treatment systems scale regional / urban (sewerage system) for greater regional coverage / comprehensive. The system is usually managed by an agency or agency manager, namely the public, private and government. Ideally, a WWTP has the capacity to treat sludge, but smaller systems usually do not, and they must have accumulated sludge pumped out periodically and transported to a sludge treatment facility.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Basics of System Design • Communal WWTPs may be the best option in dense residential areas, where most homes do not have enough land available to build individual household systems and where they do not have the option of connecting to a larger sewer system. • A Communal WWTP is usually designed for a certain number of households, and if either too many or too few households are connected to the system, it may not work effectively. • The WWTP must be accessible to sludge collection services. • They also must be located "downslope" from the houses they serve so that gravity will push the wastewater through the piping network to the WWTP. A minimum slope of 2% is required; meaning that for every 10 meters of pipe length there is a decrease of at least 20 cm. • These systems should be designed so that pipes are kept straight and without any bends. • To establish a connection to a household’s wastewater drains (from toilets, showers, kitchens and washing areas, some interior construction will likely be required, including digging up the floor to install pipe. • From the household connection, wastewater flows through the pipe into a "Control Tub". • The Control Tub traps heavier waste and grease and helps keep the pipes from getting clogged. It also makes cleaning or unclogging easier. Several homes may use the same "Control Tub". • After the Control Tub, the wastewater flows through another pipe to the WWTP. In the WWTP, there is a series of chambers that collect the wastewater, allow organic matter (sludge) to settle to the bottom, and treat it through a variety of usually natural processes (depending on the specific technology used). Once wastewater has passed through the WWTP, harmful bacteria have been killed, and the water can be safely discharged back into the environment. Because of the above, surveys and careful planning are needed to determine the best location of the WWTP, the Control Tubs and house connections.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

KM+WC

DOP

1 BK

KM+WC

2 BK

JALAN / GANG UMUM

TANGKI SEPTIK EKSISTING

TROTOAR

DRAINASE UMUM

DOP

DAPUR

BoQ Alt. A: Titik 1-2 = 1,5 m Pipa 4” Titik 2-3 = 7,5 m Pipa 4” Titik 4-3 = 5,2 m Pipa 4” Titik 3-5 = 2,8 m Pipa 4” BK = 4 bh Dop 4” = 1bh Dop 2” = 1bh

ALTERNATIF A GAMBAR : INSTALASI PIPA TYPICAL DI DALAM RUMAH TANGGA LEGENDA PAGAR

BAK KONTROL

PIPA BARU

PIPA EKSISTING

BATAS RUMAH

PIPA UTAMA SISTEM TERPUSAT

TANGKI SEPTIK EKSISTING

INSPECTION CHAMBER

House Connection Plan Alternative A.

KM+WC

TANGKI SEPTIK EKSISTING

JALAN / GANG UMUM

DOP

DRAINASE UMUM

TROTOAR

DAPUR

KM+WC

ALTERNATIF B GAMBAR : INSTALASI PIPA TYPICAL DI DALAM RUMAH TANGGA LEGENDA PAGAR

BAK KONTROL

BATAS RUMAH

PIPA BARU

PIPA EKSISTING

INSPECTION CHAMBER

PIPA UTAMA SISTEM TERPUSAT

TANGKI SEPTIK EKSISTING

House Connection Plan Alternative B.

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BoQ Alt B: Titik 1-3 = 3,8 m Pipa 4” Titik 2-3 = 0,5 m Pipa 4” Titik 3-4 = 6,4 m Pipa 4” Titik 4-5 = 1,8 m Pipa 4” BK = 3 bh Dop 4” = 2bh Dop 2” = 1bh

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Some Important Benefits for the Household • There is no need to build a septic tank and, consequently, no need to use up land. The household also does not need to organize and pay for desludging of its own septic tank. • Because wastewater from toilets, showers, the kitchen and laundry is transported by pipe far from the house and treated, there are usually fewer bad odors and fewer mosquitos around the house and groundwater is also safer from contamination. Other Things Households Should Consider • Some minor construction work on the house will likely be required to make the piping connections (such as digging up and repairing the floor). Households need to be clear on the extent of work that needs to be done, who will do it, and how much it will cost. • There is usually a small monthly fee households connected to a WWTP (or sewer system) will need to pay to cover system maintenance. • All households need to make sure they do not dispose of waste that can clog the system. This includes diapers, vegetable peelings, etc.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 3 List of Key Partners The following table is a guide to record key information relating to the enabling environment for sanitation improvements at the community level. As the enabling environment in each location will vary, the table should be adjusted to local conditions.

1. Promotion Planning and Coordination Institution

Local Government Position

Name / Phone Number

WASH Working Group Department of Planning Department of Health Department of Public Works Department of Cleanliness Dept. Of Women’s Empowerment Dept. of Environmental Health Institution Urban Village Structure

Sub-Village Neighborhood Women’s Empowerment Assoc. Health Center

Health Post School CBO 1

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Community Level Position Name / Phone Number Head Secretary Infrastructure lead Health lead Head Secretary Head Secretary Head Cadre Head Sanitarian Health Promotion Head Cadre 1 Cadre 2

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

CBO 2 Religious Org. Local Champions

Media Outlet Name

Media Contact Name / Phone Number

2. Funding-Related Possible Cost Sharing Sources Institution Name

Contact Name / Phone Number

Institution Name

Microfinance Sources Contact Name / Phone Number

Company Name

Possible Sources of CSR Support Contact Name / Phone Number

3. Construction and Construction Supply Companies Company Name

Contact Name

Phone Number

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

4. Technical and Maintenance Services Company Name

Contact Name

Phone Number

5. Sludge Removal Services Company Name

Contact Name

Phone Number

Contact Name

Phone Number

6. Regulations and Laws Institution Name

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 4 Tool for Basic Data Collection 1. A list of local stakeholders Name of Institution/Org. Village

BKM RW RT PKK Posyandu

School Other CBOs:

Position

Name/Tel. No.

Level of Interest

Possible role in program

Head Secretary Infrastructure and/or health section Head Head Secretary Head Secretary Chairperson Cadre Head Midwives Cadre Head

__________ __________ __________

2. The Data community Indicator

# or%

Source

Description

Percentage of households with toilets in the village • Households practicing OD • Households using public or shared facility • Households with private toilets % of households with toilets % of households with proper septic tanks Presence of WWTP or sewer system

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Indicator

# or%

Source

Description

Income level of households (No.) • SES a: 3,000,000 + • SES B: 2,000,000 – 3,000,000 • SES C1:1,500,000 – 2,000,000 • SES C2: until RP.1.000.000 – 1,500,000 • SES d: 700,000 – until RP.1.000.000 • SES e: < 700,000 Basic Household Livelihoods Home ownership • Personal property • Rent • A family-owned The number and the name of the small and micro entrepreneurs related to sanitation

3. Information obtained from the meetings with the community Discussion topics Your Vision

Perception about the condition of poor sanitation in the community

Reasons given for not having proper latrines with septic systems Potential barriers that should be considered in the strategy of increasing the access of the community towards sanitation: • Social norms • Economic conditions

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Summary information and resources Community Leaders Members Of The Public

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Summary information and resources Community Leaders Members Of The Public

Discussion topics • •

Regulation Groups/difficult people approached

Potential factors that may support your activities • Social norms • Economic conditions • Regulation • Or donor programs • Community groups/people that support Influential community members

Activities approved by the community in public meeting

4. Example of a Neighborhood Profile Neighborhood Area

: Petemon : Sawahan

Map Total population Number of households The number of children The number of RW The number of Neighborhoods RW focus

: : : : : :

41,435 6,255 11,385 18 RWs 123RTs RW IX (12 RT) – RW XI (RT 5), RW XIII (5RT)

Socio-Economic Conditions Petemon reflect conditions across the city, with heterogeneous populations, in terms of religion, ethnicity and livelihood. Those originally from the area and newcomers generally get along well. In terms of the status of socio-economic status, the majority of households are low income. Custom CHAPS The majority of houses have private toilets, but many toilets dispose of all wastewater into local drains. A small portion uses public toilet facilities.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Water resources and use There are two main sources of water in the community: piped water from the utility and private wells. Households that use piped water typically boil it. Well water is often dirty and can only be used for bathing and washing. Wastewater Management Almost all wastewater from toilets, washing areas, kitchens, etc. is disposed of directly into drains and small channels without treatment. Parts of the village are prone to flooding in the rainy season, because the capacity of the sewer is incompatible with the discharge of water. The drain has become shallow and clogged, because of the litter and sediment and a lack of cleaning. Civic Organizations These include: the Womenâ&#x20AC;&#x2122;s Association, a Youth Group, a local Mosque, and a Church. Community Activities The Womenâ&#x20AC;&#x2122;s Association is very active. The community holds a community cleaning day twice a month. The WASH program that had worked in the neighborhood There is no active program in the area. Health centers The Health Center is interested in supporting promotion and needs to be further coordinated with the Health Center director, sanitarian and health promotion staff. Potential financial support Bank ABC has a microfinance program in the area and is interested in supporting household sanitation improvements for its long-time customers. Some possibilities exist for CSR support from local companies (especially for very poor households), but they need to be explored further.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 5 Tool for Aiding in Activity Planning Goal: Result Indicator: Activity

Timefram for Implementation

Coordinator

Key Resources Necessary Potential

1. 2. 3.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 6 Environmentally-based Disease Transmission (mainly for diarrheal disease) The transmission chain for â&#x20AC;&#x153;envionmentally-basedâ&#x20AC;? diseases is often represented by the F Diagram within which each key means of disease transmission begins with the letter "F" (in English), including Feces, Fingers, Flies (and other insects), Field (ground), Fluid (water), Food (food) and Future victims (hereinafter victim). Some detail includes: Human feces: These breed germs and bacteria that cause various diseases, especially diarrhea, typhoid and intestinal worms. Therefore, human feces must be isolated so as not to spread disease and pollute the environment.

F Diagram

The F diagram shows that germs and bacteria from feces / human waste are transferred to the human body through the five main pathways:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Fingers: Germs in feces can easily stick to fingers and can move directly into the body by touching the mouth or indirectly, by touching food and beverages. Flies: Flies perched on feces transfer germs to food, eating utensils, food preparation areas, or directly into the human mouth. Water: Bacteria that exists in feces can easily contaminate water used to wash your food, eating utensils and drinking water for brushing teeth. Soil: The bacteria that exist in feces contaminates soil if disposed of improperly (such as in fields, gardens or anywhere if not in a septic system) and can easily spread. Food: Bacteria from feces can very easily enter the body through contaminated food. Food can be contaminated with germs when touched by the fingers, flies, or by contaminated food, cooking or water.

Latrine with septic tank/communal sanitation/city sewerage system

Drinking water treatment and safe storage

Safe food handling

Household solid waste management

Handwashing with Soap (HWWS)

F Diagram and disease transmission chain breaker

The F Diagram and the transmission chain â&#x20AC;&#x153;breakersâ&#x20AC;? show how behavior can prevent bacteria from feces / human waste being transferred to the human body. Means of prevention include:

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

1. 2.

3. 4.

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Defecation in healthy latrines equipped with septic tanks in accordance with the Indonesian National Standard (SNI). Handwashing with Soap (HWWS) with clean running water at such critical times as: after defecating, before preparing food, before eating and feeding children / infants, before holding the baby, after holding the animal. Protecting food and drinking water from flies / other insects so they are not exposed to germs. Treating water and storing it in a secure storage container. Water can be treated by boiling, chlorination, filtration, or by the SODIS method.

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 7 Using Communications Materials for Behavior Change Behavior Change Communication (BCC) is an effort to influence individuals and groups to change their behavior in order to achieve a better quality of life. It used to be referred to as Information-Education-Communication (IEC), but BCC is now used to emphasize a shift from the mere production and use of IEC materials to the design of strategic programs to change behavior. BCC program benchmarks of success involve a positive change in knowledge, attitudes and practices. Typically, BCC is carried out with community mobilization and mass communication using a variety of media, from posters, brochures, videos, to community activities and interpersonal communication. Before deciding to use specific media, there are things you should consider, especially relating to the characteristics of the target audience: •

Age, Gender and Culture: BCC materials need to be adjusted for age, gender and the culture of the target population. Posters, for instance, can be used for the general public, but may be be more effective if the style of poster is designed in accordance with the age, gender and cultural target audiences. Placement of posters, for example, should also be adapted to the characteristics of the target audience. For instance, a poster targeting fathers have little impact if (in many communities) it is posted at a wet market that men do not generally frequent.

•

The Literacy Rate in the Community: Posters and brochures can be very helpful in building awareness and disseminating information, but in a society with a low literacy, language and verbal images will be more effective. Consider the use of videos or community activities in such instances.

In addition to the above general characteristics of the target populations, USPs should consider the stage of community readiness to change. This can be understood by classifying target populations (or specific segments) as follows: •

Pre-contemplation: At this stage, people are not yet aware of the problem; have no discernable willingness to change; and may even be intimidated by the suggestion that they should change. If you immediately begin to provide information on the importance of investing in “healthy latrines”, they may reject such information, especially if they believe that there will be no consequences for maintaining the status quo. In such a case, spending more time in cultivating the support of individuals first (such as local leaders, those you may have identified as possible champions, individual households, etc.)

•

Contemplation: At this stage, people are aware of the possible need to change, but still

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

hesitant and have no clear plan to do so. If asked when and how they will change (or make needed investments in improved sanitation), they may say directly or indirectly that they are still not convinced or that they are still unsure of the benefits. In sum, they require more detailed information and more encouragement. They will generally be very receptive to receiving more information (through brochures, flyers, etc.) as well as to attending community meetings where they can see how others are reacting. •

Preparation: At this stage, people are ready for change or for making an investment, but have probably not thought about everything that is required. If they are not encouraged at this stage, they may become frustrated. Encouragement and spirit are needed at this stage. Especially useful can be stories from others who have made positive changes and now see the benefits and are satisfied. Discussions with such “Positive Deviants” such as those in their own or a neighboring community that have already made a change or investment can be a powerful source of encouragement. Video testimonials from these same people can also be very effective. Flyer, brochures and other written information is helpful, but listening to real stories from others helps people to empathize and follow in the footsteps of those who made changes and investments earlier.

•

Action: It can take much time and energy for people to change, and as they take their first steps to change, there is always a risk that they will become disinterested and fall back into their old habits. Direct interaction is needed at this stage. Reinforcement in the form of small awards (which can be in the form of a sticker or even just saying “thank you”) and technical assistance (technical information specific to their situation) are important in this stage.

•

Maintenance: Until someone’s new behavior becomes an old habit, there is always a need for “maintenance” of the behavior and occasional outside support to remind them of the great achievement they have made and how bad their situation was before. Posters, brochures, and other materials about the importance of healthy latrines, about the long lines at communal latrines they had to wait in before, or about how much cleaner their environment has become are all useful. People at this stage can also help others in the process of changing (and which reinforces their own new and improved behavior as well).

A major point of the above discussion is that materials and other media are a very necessary and important part of the behavior change and sanitation promotion process. However, just handing out brochures probably will not do much good. USPs need to know and be able to adapt to the needs of their specific target populations.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 8 Gender Checklist for Urban Sanitation Promotion The Gender Checklist is a tool to ensure that gender issues are taken into account in the sanitation promotion process. The following is an example that should be adapted to each specific program. No

Question

Yes

Comment

Planning and Coordination 1 Upon beginning the program, did you discuss with women’s-related groups that exist. 2 Are there cultural barriers to involving men and women directly in the same activity (or do activities need to be conducted separately) 3 Did you try to identify problems / issues that affect men and women differently? 4 Did you discuss with community leaders how to best involve both men and women in the sanitation promotion process. 5 How many women and men participated in specific activities that you organized? 6 In group discussions, did you ensure that women and men had an equal opportunity to state their opinions and ideas? Funding 1 If additional funding is needed for sanitation improvements, does the husband decide? 2 If additional funding is needed for sanitation improvements, does the wife decide? 3 If additional funding is needed for sanitation improvements, is it a joint decision? 4 Is there a difference in the women’s and men’s access to credit or subsidies? 5 Are there differences in the terms of credit for women and men? Construction 1 Do you identify the specific needs of women or men associated with the design of sanitation facilities to be built? 2

Did both women and men participate actively in determining the design of sanitation facilities will be built?

Did you deliver and promote sanitation facilities that are gender-responsive Do you discuss with women and men about the

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Question

possibility of donating labor in the development process of sanitation facilities? 5 Do you discuss with the person in charge of construction about how women and men may be able to contribute? Care and Technical Support 1 Do you discuss with community members about the role of the equality of women and men in maintaining sanitation facilities? 2 Is there agreement on the roles of both men and women in facility maintenance? 3 Especially for communal facilities, did you ensure that there is good representation on the CBO of both women and men.

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Yes

Comment

IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 9 List of National Programs Involved in Sanitation Promotion

http://stbm-indonesia.org/

Community Based Total Sanitation (STBM) is an approach developed by the Ministry of Health to change the behavior of hygiene and sanitation through community empowerment. It is an adaptation of CLTS approaches as practiced in other countries, but in Indonesia, it has been expanded beyond focusing on improved sanitation facilities. In Indonesia, it encompasses five programmatic pillars, including: 1) access to basic sanitation; 2) drinking water and food management; 3) access to handwashing facilities; 4) household wastewater management; and 5) household solid waste management.

National Working Group on Water and Sanitation (PokjaAMPL) is an ad hoc organization formed in 1997 as a forum to improve communications and coordination among national agencies involved in the water supply and sanitation sector. A number of national programs are coordinated through the Pokjahttp://www.ampl.or.id/ AMPL, including Program for Accelerating Access to Sanitation (PPSP), Community Based Total Sanitation (STBM), Community-Based Water Supply and Sanitation (PAMSIMAS), Community Based Sanitation (SANIMAS), Drinking Water Safety Plans (RPAM), Sanitation Information System (NAWASIS), etc. A National Secretariat oversees the work of the Pokja-AMPL.

http://www.sanitasi.net/ppsp.html

Program Percepatan Pembangunan Sanitasi Permukiman (PPSP) or the Accelerated Sanitation Development Program contributes to the achievement of sanitation targets of the National Development Plan. PPSP targets: the elimination of open defecation; improved solid waste management services; and reduced flooding in urban areas.

Penyediaan Air Minum & Sanitasi Berbasis Masyarakat (Pamsimas) Program WSLIC-3/PAMSIMAS or Community-Based Water Supply & Sanitation is a program funded by the World Bank that seeks to improve water supply, sanitation and public health, especially as concerns diarrheal and other water and sanitation borne disease. http://new.pamsimas.org/

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

SANIMAS or Community-Based Sanitation is a program for the provision of wastewater infrastructure for people in densely populated urban slums. The Indonesian government has committed to increase resources in support of replication and scaling-up of decentralized sanitation facilities (decentralized wastewater treatment systems DEWATS) nationally through the SANIMAS program.

Asosiasi KSM Sanitasi Seluruh Indonesia is an association of sanitation-focused Self-Help Groups Sanitation that seeks to improve information sharing among managers of sanitation CBOs all over Indonesia, especially those related to the management of communal sanitation systems. http://aksansi.org/tentang/profil.html

Sanitation Business and Empowerment Association of Indonesia (APPSANI), is an important network of sanitation businesses and organizations that seeks to support the government in promoting sanitation business development. Some of its specific areas of interest and involvement include: developing management and technical capacity among sanitation entrepreneurs; encouraging womenâ&#x20AC;&#x2122;s participation in sanitation service delivery; facilitating partnerships and cross-sector collaboration; developing high quality and affordable technologies; encouraging the emergence of new sanitation businesses; anticipating subsidized interventions; and improving the skills and knowledge of human resources for sanitation. For more information, see http://www.appsani.org

http://nawasis.info/

NAWASIS or the National Water Supply and Sanitation Information Service is an internet-based information center for monitoring and improving the coordination of water and sanitation programs and activities. NAWASIS seeks to facilitate program evaluation, advocacy and capacity building. NAWASIS does not replace other information sources, but serve3s to complement and enhance those that already exist.

http://sanitasi-usri.org/

The Urban Sanitation and Rural Infrastructure (USRI) program aims to improve the quality of people's lives, both individually and in groups, through various infrastructure development initiatives. In urban areas, one particular focus of the program is on the development of communal sanitation facilities.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

Aliansi Fasilitator Sanitasi Indonesia (AFSI) is an alliance of those involved in facilitating the implementation of sanitation programs that serves as a forum for communication and information exchange.

http://www.fasilitatorsanitasi.org/

http://www.promkes.depkes.go.id/

Pusat Promosi Kesehatan (PromKes) is the Ministry of Healthâ&#x20AC;&#x2122;s Center for Health Promotion that supports MOH efforts in community development and health promotion. In addition to the preparation of technical policy and guidance, the Center serves as a repository for health promotion materials, including those related to water supply, sanitation and hygiene.

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IMPROVING LIFESTYLE AND HEALTH: A GUIDE TO URBAN SANITATION PROMOTION

ANNEX 10 Simple Tool to Support Participatory Monitoring Neighborhood: Village: Sub-District: Month: House No.

___________________________ ___________________________ ___________________________ ___________________________

Family Name

“Healthy Latrine” Ownership Status (a)

Defecation Behavior (b)

Handwashing Behavior (c)

a. A “Healthy Latrine”: Mark “Yes” if the household has a latrine that ensures the separation of human feces from direct/indirect human contact. b. Defecation Behavior: 1 = Latrine at home; 2 = Shared latrine; 3= Public latrine; 4 =. Other (specify) c. Handwashing Behavior: 1= After defecation; 2 = After diaper change / helping child to defecate; 3= Before eating; 4 = Before child feeding / breastfeeding; 5 = Before preparing food

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References

Devine, Jacqueline and Craig Kullmann. (September 2011). Introductory Guide to Sanitation Marketing Kurikulum dan Modul Pelatihan untuk Pelatih (TOT) Fasilitator Sanitasi Total Berbasis Masyarakat (STBM), Kementerian Kesehatan RI. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan 2014. Kurikulum dan Modul Pelatihan Untuk Pelatih (TOT) Wirausaha Sanitasi Total Berbasis Masyarakat (STBM), Kementerian Kesehatan RI. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan 2014. Kurikulum dan Modul Pelatihan Wirausaha Sanitasi Total Berbasis Masyarakat (STBM), Kementerian Kesehatan RI. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan 2014. Panduan Praktis Menjalankan Sistem Monitoring STBM; Starter Kit bagi Staf Kabupaten/Kota, Starter Kit bagi Petugas Puskesmas/Sanitarian, Kementerian Kesehatan RI. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan 2014. Pelaksanaan Sanitasi Total Berbasis Masyarakat dalam Program Pamsimas. Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2014 tentang Sanitasi Total Berbasis Masyarakat, Kementerian Kesehatan RI. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan 2014. Sudjimah, Emah. (2008). Buku Pedoman Sanimas: Sanitasi Berbasis Masyarakat. Jakarta: Direktorat Pengembangan Penyehatan Lingkungan Permukiman, Ditjen Cipta Karya, Departemen Pekerjaan Umum. UNICEF and World Health Organization. (2012). Progress on Drinking Water and Sanitation: 2012 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Community-Led Urban Environmental Sanitation, CLUES (EAWAG, WSSCC, UN HABITAT, 2011). Handbook on Community Led Total Sanitation. (Plan Int., K. Kar, R. Chambers, 2008) www.washmicrofinance.org www.stbm-indonesia.org www.positivedeviance.org www.centerforappreciativeinquiry.net

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INDONESIA URBAN WATER SANITATION AND HYGIENE Mayapada Tower 10th Fl Jl. Jend. Sudirman Kav. 28 Jakarta 12920 Indonesia Tel. +62-21 522 - 0540 Fax. +62-21 522 – 0539 www.iuwash.or.id

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