Background
The JMP estimates suggest an increase in improved sanitation coverage in rural areas from 34 per cent in 2000 to 47 per cent in 2015. A further 24 per cent of the rural population use either shared sanitation facilities or unimproved facilities. Open defecation is estimated to be 29 per cent, which suggests that more than 8 million rural households (34 million people) do not use any form of sanitation facility. However, according to JMP data, since 2012 approximately 4 million rural people have stopped open defecation, and since 1990 approximately 21 million rural people have gained access to sanitation.

CLTS status and geographic spread
Introduced by WSP in 2005, CLTS had reached 54 districts (kabupaten) by 2007 (13 per cent of the total number of Districts); by 2012 it spread to 234 out of 405 districts in Indonesia (58 per cent nationally) including 32 out of the 33 provinces (97 per cent of provinces), and as of mid 2015 it has spread to 492 out of 514 rural and urban districts across all 34 provinces.

Since 2008 CLTS has been implemented through a National Strategy for Community-Based Total Sanitation and Hygiene – Sanitasi Total Berbasis Masyarakat, STBM – which includes five pillars:

1. Open defecation free (ODF) communities;
2. Hand washing with soap at critical moments;
3. Household water treatment and safe storage of water and food;
4. Solid waste management; and
5. Liquid waste management.

The programme advocates a subsidy-free approach to sanitation and generally concentrates on achieving ODF villages with implementation at the district and village levels. Implementation is highly decentralized and dependent on district mayor support to approve funding for STBM activities, resulting in uneven implementation across the country. At central government level, a secretariat in the Ministry of Health has been set up to assist the implementation and acceleration of the STBM programme. This is key for the scale up and acceleration of STBM at the nationwide level, however the STBM secretariat requires continued assistance to build capacity and coordinate implementation. There is a need to further strengthen strategy at central levels on how to scale up nationally and how to improve consistency, quality and sustainability of sanitarian training, policy setting and monitoring with follow up. Since 2012, the private sector is a new entrant with organizations such as the mining company Adaro implementing CLTS to improve sanitation in its operational areas in South Kalimantan, done through its corporate social responsibility programme.

Major support programmes include:
World Bank PAMSIMAS Program: The Ministry of Public Works (PU) is the main implementation agency for PAMSIMAS, with the sanitation component being the responsibility of Ministry of Health. PAMSIMAS is currently in its second iteration and, since 2013/2014, implements the programme through existing government structures, such as sanitarian and health cadres to promote unsubsidized sanitation and ODF villages. According to PAMSIMAS staff, this approach has been more effective than externally employed health facilitators and builds the capacity of the health  network in the long term.19 PAMSIMAS is operating in 280 districts in the country. A third phase is being planned (2016-2019) to respond to the goal of universal access to water and sanitation. Phase 3 will increase PAMSIMAS to cover 5,000 more villages in 110 districts throughout 15 provinces.

UNICEF: Direct support to national and sub-national government on the implementation of CLTS/STBM. In partnership with the Government and civil society, learning is being derived from six districts with 12 additional indirect districts in the provinces of South Sulawesi, Nusa Tenggara Timur and Papua (including West Papua). UNICEF provides technical assistance and funding to its local planning office (Bappeda) for a full time provincial coordinator, and supports the training of sanitarians on implementation at district level. Replication and scaling up to other districts and sub-districts is achieved through advocating for the prioritization of STBM programmes and capacity building for local government staff, including planning and budgeting skills, coordination and monitoring. UNICEF is  also supporting policy development, clearer roadmap creation for planning and strategizing, capacity building, and advocacy at the national level.

World Bank Water and Sanitation Program (WSP): Support comes in the form of technical assistance to the national STBM secretariat and provincial level technical assistance for CLTS implementation in the provinces of East Java, West Java, Central Java, Nusa Tenggara Barat and Bali. This includes supporting PAMSIMAS in these provinces. At central level, support includes improving monitoring, training and capacity building of sanitarians, and advocacy.

Dutch Sanitation, Hygiene and Water Program for Eastern Indonesia (SHAW): SHAW was launched in 2010 and ended in December 2014. This programme claims to be the only civil society programme in Indonesia implementing all five STBM pillars simultaneously. The programme was implemented by a Dutch NGO, Simavi, and five Indonesian/international NGOs. At its conclusion, it reached 1,042 villages, with 489 villages being verified as achieving all 5 pillars (including ODF), and an overall access to sanitation of 88 per cent. 40 sub-districts were also declared STBM. SHAW was working in nine districts across three provinces: Nusa Tenggara Timur, Nusa Tenggara Barat and Papua, as well as the national level.

CLTS variations and practice
USAID IU-WASH programme: urban CLTS with some modifications (linking to citywide sanitation strategies and utility projects) The USAID IU-WASH programme is working with local water utilities (PDAMs), local technical waste water implementation units (UPTD PAL) and other sector stakeholders on urban CLTS. Indonesia Urban Water, Sanitation and Hygiene (IUWASH) is a five year (2011-2016) development programme funded by the US Agency for International Development (USAID). IUWASH’s sanitation component aims to create access to improved sanitation facilities and services for 250,000 people (50,000 families) in 54 cities/districts spread within the IUWASH regions of North Sumatra, West Java/Banten/DKI, Central Java, East Java and South Sulawesi/East Indonesia. CLTS-type triggering is included as part of demand creation strategies for household sanitation improvements.

Community engagement and Village empowerment, NTT: UNICEF is working with the NTT Province to integrate STBM into Desa/Kelurahan Mandiri (Empowered Village) called ANGGUR MERAH programme. The Anggur Merah is funded from province budgets, allocating IDR 300 million per villages and inclues IDR 50 million for housing direct support for poor families. Other openings in this province include stronger linkages with nutrition, especially to support both WASH infrastructure in health facilities and communities through nutritional platforms (e.g. nutrition messages with a strong handwashing component), and improving how health staff integrate these messages.

CLTS scale
As of mid 2015, the government monitoring system shows that 24,955 villages in Indonesia have been triggered (out of 80,276) with 4,419 verified as ODF and a further 1,784 villages claiming ODF. Indonesia has a moderate ODF success rate: 18 per cent of triggered villages have been verified ODF, with up to 25 per cent if claimed and verified villages are counted.

CLTS capacity
Very large numbers of CLTS facilitators have been trained in Indonesia by both development agencies and, more recently, through the Ministry of Health training course for sanitarians, with replication at provincial levels.

Most significant changes since 2012
Increased prioritization of sanitation: Sanitation is higher on the agenda. The Government has established new targets for water supply and sanitation in the National Mid Term Development Plan 2015-2019 (Rencana Pembangunan Jangka Menengah Nasional, RPJMN) which is universal accessible, though it is expected that unimproved sanitation will remain. However, the meaning of the targets are unclear despite their ambition. New targets have raised awareness on sanitation in some areas of government.

Focus on behaviour change, not subsidies, for rural sanitation: Specific partners, such as Public Works, are working to better support sanitation behaviour change through STBM and not just to allocate budgets for the construction of physical facilities (usually communal). In the past, latrines/community toilets built through subsidies and full grants were not well maintained or used in many cases.

PAMSIMAS programme change: PAMSIMAS 2 is working with sanitarians within the government system through a more programmatic approach, which is a change from PAMSIMAS 1 which used external health facilitators for implementation. Sanitarians are MoH staff that have responsibility for sanitation. This approach improves sustainability after the programme finishes and builds the capacity of government staff. PAMSIMAS 2 also has better alignment with community driven development programme PNPM – village selection is demand led and under PNPM (which subsidized sanitation), and now has to work through PAMSIMAS (unsubsidized).

Strengthening of STBM approach: Wider uptake of an STBM approach, strengthening of national monitoring systems and increased support to sanitarians (e.g. through resources and training). Sector coordination has overall become stronger.

Responsibility for urban sanitation: Urban sanitation systems are increasingly seen as a responsibility of Public Works and/or local governments, rather than being left to the community/household. This includes septage removal and treatment. Still much work remains to be done on this issue.

New Village Law 6/2014: A new village law will direct funds to villages (Unam Desa). Although in the process of being implemented, this change will mean more emphasis on strengthening STBM teams in villages and improving budgeting practices.

Lessons learned
Engaging at the provincial level takes time: Long term change is achieved by building increased ownership, accountability and associated
capacity at the provincial level in order to take responsibility for all districts within a province, but this takes more time than going directly to the district level. There is a tendency for actors to bypass provinces and go to the district level directly for implementation.

Advocacy of provincial governors can scale up: Most NGOs and development partners now have a strong focus on advocacy. Once a provincial governor and district mayor understand the benefits of sanitation and the need for prioritization, they can have a larger impact on activities in their areas. When they put into place a regulation for ODF communities and follow the STBM programme, this becomes a critical tool for communicating with local governments to improve their budgets and implement the programmes. Dissemination of the regulation to all districts and villages results in similar regulations on STBM. District government and villages then provide budgets for STBM.

District leader capacity and commitment is important but varies: There is a strong correlation between ODF districts and the strength of the Bupati (district head). Bupati issue regulations related to sanitation and hygiene practice, and provide incentives for villages or sub-districts that achieve ODF status. If the Bupati advocates for ODF and it becomes one of the programmes for the office of Bupati, budgets will be made available, regulations will be developed and it will become the priority of the sub-district and village government due to the strong push from the head of the district on the importance of becoming ODF. Replication of STBM in other villages and sub-districts can be done without external support. In several districts in NTT, for example, the average time to reach ODF from triggering was one year, but in some villages in Sumba Timur, ODF status was gained within four months due to district regulations and communication through churches.

Slippage: There is evidence of slippage in some places, but the monitoring system is not attuned to pick this up. Reasons for slippage: living near waterways which provide alternate toilets; toilet is not what the household wants and it deteriorates over time; absence of regular monitoring or
encouragement afterwards ODF; no threat of loss of ODF status for head of village.

Promoting CLTS is only one tool for influencing open defecation: Other communication involving religious leaders has increased the effectiveness of CLTS at changing open defecation practice.

CLTS weaknesses and bottlenecks
Scale of challenge: The scale of sanitation is a huge challenge because of the size of Indonesia’s population and the diversity within the country. 34 million rural people still openly defecate, with 63 million not accessing improved sanitation. Achieving universal access to sanitation for all by 2019 is a huge challenge.

National government needs to accelerate STBM: The capacity of the secretariat of the community-based Total Sanitation & Hygiene Strategy (STBM) needs to be strengthened to coordinate and assist the implementation of STBM in Indonesia at scale.

Variable quality and capacity of sanitarians: Sanitarians are government health officers with other roles and are not always available, motivated or monitored for CLTS triggering and follow up. In most areas, a sanitarian may be responsible for 20 villages. Quality and capacity of sanitarians vary across locations and within programmes. MoH, with support from partners, has developed standardized training content and modules, but more investment is needed in longer term capacity development and in the monitoring of performance, including incentives for sanitarians based on achievements. The number of skilled sanitarians graduating from training is insufficient in meeting demand for
implementation and there is an overall shortfall in numbers of sanitarians needed.

Use of subsidies/alternate funding: Where communities have received funds and projects from many development agencies for years, including from the Government, this has created a dependency (e.g. Papua and Papua Barat in 2004 after special autonomy applied). Subsidies and aid have undermined the social spirit of these communities, with working together (gotong royong) being very rare and an expectation of outside support. This is a challenge for the CLTS philosophy. After triggering, communities seek some support or expect village funds to be used to support them.

No post-ODF monitoring: There is no clear procedure for monitoring sustainability and slippage of previously verified ODF communities. Post ODF monitoring is uneven and not formalized. STBM reporting is only required annually, which is not sufficiently regular to address issues which caused the slippage. The emphasis is on reaching ODF, with follow-up being generally ignored. Also there is no natural progression to the other pillars of STBM.

Sanitation marketing: Pockets of sanitation marketing only. In Papua, and many other provinces, the focus has been more on building the capacity of sanitation entrepreneurs to produce simple and affordable latrines, with less effort on supporting the marketing of the products.

Poverty and income: Households need to bear the brunt of sanitation costs. In some parts of the country poverty is high and a major barrier for households accessing sanitation.

CLTS opportunities over the next 3-5 years
ODF in targets: ODF is already a target in RPJMN 2014-2019. This means the Government is responsible in supporting the creation of an enabling environment and is required to monitor progress and allocate sufficient funds to adequately manage and accelerate the STBM programme.
The RPJMN provides an opportunity to refocus efforts on sanitation and ODF communities.

Potential for different partnerships: There is potential for the private sector to become more involved in STBM and sanitation. For example, the Indonesian mining company Adaro carried out STBM in Tabalong regency to improve sanitation and health outcomes as part of its corporate social responsibility. There is also potential for other private companies to contribute expertise (e.g. messaging on WASH). Partnerships with religious leaders are very important. These are critical in Islamic areas where voluntary donations are made for less fortunate communities, but the community needs to be organized in spending the money effectively; work is underway on such guidance. In several areas, the police and army have also taken a keen interest in sanitation, which may be further harnessed in a positive and participatory way. Further decentralization of funding to the village level means the local village head will also be an important player within STBM partnerships in the future.

Stronger integration into health and nutrition: There are almost 9 million stunted children estimated in Indonesia. UNICEF’s statistical analysis found a 40 per cent greater chance of being stunted if a child grows up in a house without improved sanitation. UNICEF has developed an approach paper with ideas on how to better link WASH and nutrition interventions. There is strong potential to further develop the integration of CLTS and nutrition, building on the pilot work begun in NTT in 2015. More outreach on STBM via midwives – as has been the case of positive examples from Aceh – and better WASH facilities in health centres – are also critical here.

Capacity building of sanitarians: Potential for the professionalization of sanitarians through training, civil service job performance
assessments and better selection of trainee sanitarians.

(September 2016)