ende island. the first indonesian island to declare itself open defecation free

7/30/2019 Ende Island. The First Indonesian Island to Declare Itself Open Defecation Free

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Ende IslandThe First IndonesianIsland to Declare ItselOpen Deecation Free

Min ist ry o H ea lt hR epu bl ic o In don esia

POKJAAMPL


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Ende IslandA B o o k o r L e a r n i n g


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The Ministry o Health believes that hea lthy and hygienic behavior is among i mportant bu ilding blocks

in orming a productive and prosperous Indonesian society. In cooperation with provincial and district

level governments, the Ministry has introduced the Community-Led Total Sanitation (CLTS) program

to various parts o the country. The program rests on triggering communities to take initiative and

develop determination to create positive changes in regards to hygiene. It has been proven to produce

sustainable results in many communities. For example, in the past three years many communities on

Indonesias main islands have declared themselves ree rom open deecation.

However, very ew small island communities have been able to share in the same success. Small islands

ace a unique set o challenges with regard to CLTS. Among the key challenges are limited sources

o reshwater and isolation rom the circulation o inormation on hygienic behavior. These problems

aect the thousands o small islands scattered across the archipelago rom Sabang to Merauke, as

well as other small islands outside o Indonesia. This situation makes promotion o hygienic behavior

particularly diicult.

The achievements in Ende Isla nd to eradicate open deeca tion brings abou t a new sense o hope tha t

other communities living in small islands can to start living more hygienically. The islanders enthusiasm

ought to be spread to other communities; and governments at every level would do well to encourage

and support them in every way necessary.

This boo k chronicles the jou rney o the peopl e on E nde Island, and oers some tips or other regions

that wish to replicate the process. Publication o this book is expected to inspire both government

oicials and community leaders in other areas in Indonesia and beyond, particularly those working

with communities on small islands.

The Ministry o Health thanks all tho se involved in the development and execution o the CLTS program.

In particular, special recognitio n is given to the East Nusa Tenggara Province Governor and the EndeDistrict Head who had tirelessly promoted the program, especially with the launch o the 2015 Ende

District Open Deecation Free Initiative. UNICEFs collaboration with the East Nusa Tenggara Province

and especially the District o Ende and also people o Ende Island presents an exemplary mode o

cooperation; one with positive and sustainable results. We hope that this will be the irst o many

productive ventures in the uture.

Happy reading, and may this book be o great use!

Jakarta, August th 2012

Minister o Health o the Republic o Indonesia

dr. Nasiah Mboi, Sp.A, MPH

Foreword

Sources: The Ende District Commission C o the Regional Peoples RepresentativeCouncil: Heribertus Gani, SPd; Oice o Ende District Head: Martinus Ndate; Ende District

Planning and Development Agency: drg. Dominikus Minggu, M.Kes, Andreas Worho, ST, MT,

Erneseta Sri Say, ST, Yohanes Don Bosco, S.Sos, Maria Theresia Firmina Baru, S.Si, M.Sc, Patrisius

Surda, S.Si; Department o Health or the District o Ende: Anrina L.N. Mani, Ahmad Gunung;Indonesian Environmental Health Experts Association: Mukhsin Mustika; Central Ende Sub-

District Oice: Petrus H. Djata; Ende Island Sub-District Oice: Fransiskus Dadjo, AMK, Haji Ali;

Rendoraterua Village: Ahmad Yusu; Rorurangga Village: Junaidin P.S, Juleha Roja, Mashadin;

Ndoriwoy Village: Rasjid Kuri, Muchsin Bone, Boro Koa, Wahab Abdullah, Kajo Abdullah, Said

Ibrahim, Roswati, Suiah A. Ma; Redodori Village: Aliasa H.A., Hamzah Parera, Abdullah Ali

Jawa, Adulkadir Bahlil; Aejeti Village: Golkar Yusu, Suraan Muhammad, Saudin Abdullah,

Amir Jabir; Paderape Village: M. Abdullah; Puutara Village: Saleh, Pua Rasyid, Wahyah Darham,

Ismail, Dede Broto; Puutara Primary School: Musosman; Ende Island Private Nurul Ummah

Ibtidaiyah Madrasah: Maemuna Wio; Rendomaupandi Presidential Decree Primary School:

Halimah Jaenab; Ekoreko Public Primary School: Nurdin Ibrahim.

Concept and Direction: Ministry o Health o the Republic o Indonesia: WilredH. Purba, Zainal I. Nampira, Trisno Soebarkah, Kristin Darundiyah; The CLTS Secretariat; The

National Water Supply and Sanitation Working Group; UNICEF: Nadarajah Moorthy, Juliaty

Ansye Sopacua, Dormaringan Saragih; The UNICEF WES Secretariat.

Acknowledgements

Text and Design: Qipra Galang Kualita: Isna Maria, Laksmi Wardhani, Deasy Sekar T.Sari and Sylvana Corputty (text); M. Tauk S (layout and graphics). English version: Isna Maria,

Omar Soemadipradja.

July 2012


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iv 1

A JourneyShared

Foreword i

Acknowledgements ii

Table o Content iii

A Journey Shared 1Ende Island at a Glance 2

Box: The History o Ende Island 2

Why Was Change Necessary? 4

Freshwater a Rare Commodity 4

Box: Ocial Denition o Outbreak 5

Steps o The Water and Sanitation Program 6

Built By Communities, For Communities 8

Rorurangga Village 10

Aejeti Village 11

Redodori Village 12

Ndoriwoy Village 13

Rendoraterua Village 14

Paderape Village 15

Puutara Village 16

Attention rom the District 17

Astute and Dedicated Sanitarians 18

Friendly yet Determined Facilitators 19

Village Head as Movement Leaders 20

Open Deecation Patrols 21

Religious Leaders as Message Bearers 22

Women and Children Agents o Change 23

Arisan or Toilets 24

Outreach Sign-posts 25

Village Regulations 26

Supported by Data 27

Declaration on Ende Island 28Water and Sanitation Aspirations at the District Level 29

Eleven Steps to Replication 30Cultivate a Committed Leadership 32

Establish the Target Area 33

Examine Conditions o the Target Area 34

Box: Community-Led Total Sanitation 35

Plan the Program 36

Box: Funding or Water and Sanitation 37

Prepare Working Groups 38

Promote the Program 39

Plan Field Activities 40

Box: Proper Deecation 41

Prepare Village Cadres 42

Perorm Community Triggering 43

Schedule Facilitation 44

Box: The Sanitation Ladder 45

Declare Free rom Open-Deecation 46

Abbreviations 47

Bibliography 48

Table

ofContent

The success story o Ende Island is one worth retelling. The communities living on the island

have successully changed their deecation behavior, and declared Ende Island as the rst open

deecation ree island in Indonesia. This achievement has prevented recurrence o diarrhea

outbreaks, once a routine occurrence on the island. The changes permeated all levels society,

and involved cooperation between the district, the national government, and community

leaders a concerted eort that can be emulated by other regions.

This section o the book recounts the experience o the Ende Island communities, along

with other parties involved in the program. This section will also present the actors vital in

achieving the programs success. The journey o this tiny and beautiul island can be a source

o inspiration or other small-island communities in Indonesia and beyond.

Photo:Qipra/2012/TaufkS.


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Ende Island at a GlanceThe Island o Ende is one o twenty-one sub-districts that orm the District o Ende

in the Province o East Nusa Tenggara (NTT), the south-eastern stretch o islands in

the Indonesian archipelago. Located west o Ende City, Ende island has an area o 63.03

square kilometers and is only accessible via a daily motor boat service. Transport on the

island itsel is restricted to motorcycle and pedestrian trac, due to lack o inrastructure

necessary or heavier vehicles.

Currently Ende Island is inhabited by 7,786 people with a population density o 124 persons

per square kilometer. The population is spread throughout seven villages, namely the villages oRedodori, Aejeti, Rorurangga, Puutara, Paderape, Rendoraterua, and Ndoriwoy.

Ende Islanders have two unique traits that separate them rom other communities in the province, namely

their language and religion. Their everyday language, the native Bahasa Ende, is dierent to the language

used on the main island o Flores, and the entire population o the island is Moslem, whereas the province

is dominated by Catholics.

The people o Ende Island are mainly dependent on sheries or their livelihood, and their catch serves as

the main source o sh in the City o Ende and its surroundings. Furthermore, Ende Islanders are known by

other shing communities in the region or their skills in crating quality shing boats. Aside rom shing,

small-scale arming is also practiced on the island, mainly growing cassava, coconut and corn, crops that

can thrive in its poor soils.

With regards to water resources, the island relies mainly on wells that produce brackish water; as only one

village has wells with reshwater.

The History o Ende Island

Very ew records exist regarding the early history o Ende Island. The earliest might be a quote by Sir

Thomas Stamord Raes rom a manuscript by Natak oesoema (circa 1400s), who wrote in passing othe eastern territories o the Indonesian archipelago (www.portal.endekab.go.id). Several versions

appear on the topic o the introduction o Islam to the island. One source attributes it to Imam Syai,sent on mission by the Prophet Muhammad (Peace Be Upon Him) with the expressed task to introduce

Islam to Ende Island. Another source credits a Palembang (South Sumatera) trader sometime during the15th century (www.hierobokkilia.blogspot.com).

The 1600s saw Ende Island becoming a colonial administrative centre ollowing the arrival o the

Portuguese to the archipelago. The Portugese erected a ort in the Hamlet o Kemo in RendorateruaVillage; only ruins remain visible today. In more recent history, Ende Island was requented by Soekarno(who later became Indonesias rst president) between 1934 and 1938, during his exile to Ende City by

the Dutch colonial government. He allegedly wrote a play inspired by the island entitled Rendo Rate

Rua (www.sipriseko.blogspot.com).

Prole o Ende Island

Village Area (Km2) Population

Rendoraterua 6,50 996

Redodori 4,00 998

Ndoriwoy 9,53 1043

Paderape 4,69 896

Puutara 14,29 1520

Rorurangga 14,29 912

Aejeti 9,73 1421

2 3

Sawu Sea

Ndoriwoy

Redodori

Rendoraterua

Paderape

Aejeti

Puutara

Rorurangga

Sawu Sea

Sawu Sea

Sawu Sea

Ende Island

North

South

EastWest

Inographic:Qipra/2012/TaufkS.

INDONESIA

Province o EastNusa Tenggara


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Why Was Change Necessary?Prior to 2007, the District o Ende Island was known locally as Island o

Disasters or Island o Catastrophes. In consecutive years, the island was hit

by diarrhea outbreaks that aected hundreds on the island, usually at the

end o the rainy season. The outbreaks occurred once in 2004 and 2005,

and occurred twice in 2006. Children aged ve years and younger were

especially vulnerable to the disease, at worst making up 67% o the total

patient count in 2005.

Another local nickname given to Ende Island was the worlds longest

lavatory. The name aptly describes a daily scene, where locals squat along

the islands coastline to deecate in the open while socializing and gossiping

in the early hours o the morning. Such was the custom rom many

generations ago.

The District o Ende recognized that Ende Island had the highest prevalence

o diarrhea in the district. The District Government initiated many attempts

to prevent outbreaks; however, they were hindered by the limited supply o

reshwater on the island. Later on, the District realized that unless reliable

reshwater supplies were available, solutions or the outbreak would only

be temporary.

rough seas o the westerly wind season. The government also dug new wells

on the island, but was unsuccessul as much o the islands groundwater has a

high salt content. Furthermore, a Portuguese Non-Government Organization

installed a desalination unit on the island, but ound that the desalinated water

was contaminated by high levels o E.Coli originating rom human waste.

As such, the only sources or resh water on Ende Island are the wells o

Ndoriwoy village. As the men o the villages are responsible or shing and

arming, the task o carrying resh water rom Ndoriwoy to the other villages

is given to the women. Due to this limited access, most communities continue

to use brackish water or their household needs, which include

drinking water.

The District o Ende recognized that improving

community access to reshwater was a prerequisite to

solving the problems o diarrhea outbreaks and open

deecation. Thus, with support rom UNICEF, they

initiated the Water and Environmental Sanitation

Program to eectively prevent uture problems

with diarrhea.

Martinus NdateFirst Assistant to the District Head o Ende

The data showed that the Sub-District o Ende Island suered the worstwater shortages [in the District], is requently aected by outbreaks

o diarrhea, and has the lowest per capita income in the District.


5

Freshwater a Rare Commodity

Over the years, a number o approaches were made to improve the provision

o resh water to the communities o Ende Island. All attempts, however, ailed.

In 2004, the government initiated a year-long program to ship reshwater

rom the City o Ende on Flores Island. The program was a costly venture due

to prohibitive operational costs and technical diculties, especially during the

Diarrhea OutbreakData For The District

O Ende Island(2003-2011)

No Diarrhea Outbreak

Diarrhea Outbreak

2003 2007 2008 2009 2010 2011

2004 2005 2006

Ocial Denition o Outbreak

An Outbreak is dened as an event whereby the number o inections or deaths rom a disease in one area is

considered epidemiologically signicant. An Outbreak is declared when the ollowing criteria have been ullled:

The emergence o a disease that has not been previously present in the area

A continuous increase in the number o patients/deaths within 3 time periods (hours, days, weeks),

according to type o the disease

A rate o increase in inections or deaths double or higher compared to the monthly average in the

previous year.

The number o new patients in one month is two or more times higher in comparison to the monthly

average in the previous year.

Source: Decision o the Director General No.451/91 (Ministry o Health, Republic o Indonesia), on the Guidelines or Investigating

and Managing Outbreaks; quoted rom http://www.tempo.co/reead/news/2005/09/19/05566790/Kejadian-Luar-Biasa-Apa-Artinya


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STEPS OF THE WATERAND SANITATION PROGRAM

The District o Ende co-operated with UNICEF to design a multi-step program using the community-

led sanitation approach. The objective was to improve the sanitary conditions and reshwater

access on Ende Island. The diagram below displays the process undertaken in Ende Island rom its

commencement to the point o ODF (Open-Deecation-Free) declaration.

9Prepare theCommunity

The communities weregiven preparations tobuild rainwater tanksunder the guidance otrained technicians.

13Village CLTS

Training

Five individuals were selectedrom each village to undergoCLTS triggering training. Theve individuals ormed thevillage CLTS team.

Based on recommendationsgenerated rom the workshops,the University o Floresconducted research on thebehavior o Ende Islanders,identiying possible approaches

to trigger behavioral change.

5Research on

Behavior Change

10Village-Level

Program Promotion

Sta rom the HealthDepartment promoted theidea o building rainwatertanks in every village onEnde Island.

14Community

Triggering

The triggering was perormedby the village CLTS team,supported by the DistrictHealth Department.6

TeamFormation

The District sets up a programimplementation team, consisting omembers, namely the Planning andDevelopment Agency, the HealthDepartment, Village CommunityEmpowerment Board, Education andCulture Department, the Public WorksDepartment, as well as several NGOs.

Determine theTarget Area

Based on health statistics,the Districts HealthDepartment chose the targetareas or the program. TheSub-district o Ende Islandwas selected

3Prepare a Community

Work Plan

11In collaboration withlocal communities, theimplementation teamidentied problems, ormedsolutions, and designed ajoint work plan.

FacilitatedCommunity

Empowerment

15To help ease the process ochange in the community,the village CLTS team andthe acilitators conductedactivities such as competitionsand outreach sessions.

Brainstorming

The team discussed ideasto solve the issues athand. For Ende Island,the rst issue to tacklewas drinking water.

7

4Disseminate at

District Level

District-level ocials were invitedto a series o workshops aimed atinorming them o the existenceand objective o the program.The workshops generatedrecommendations or activities.

PrepareFacilitators

12The team selected andtrained acilitators, taskedwith convincing thecommunities to use onlyrainwater or drinking water.

Open DeecationFree Declaration

16Declaration o Ende Islandas an open deecation reezone was celebrated througha ceremony ociated by theMinistry o Health and attendedby representatives rom UNICEF,the District o Ende, and otherparties involved in the program.

ChooseOptions

8The team raised the issue oaccess to drinking water withthe communities o EndeIsland. Options were oeredand discussed. The communityunanimously voted on buildingrainwater tanks.

The Provincial Government o East NusaTenggara extended an oer to the Districts,and received proposals rom interestedDistricts. The Province selected thelocation or the program, using a set opredetermined criteria.

1Commitment at

the Province

2Engaging District

Level Entities

The Ende District Governmentappointed the District-Level WaterSupply and Sanitation WorkingGroups [Pokja AMPL] to spearheadthe program. Other district levelagencies were given assignments.

6 7


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8 9

Built By Communities, For CommunitiesIn 2006, the District government introduced the CLTS program to Ende Island. Through triggering,

communities began to understand that adopting proper hygiene was essential to prevent urtherspread o diseases, starting rom behavior as simple as deecating in the right place and washing hands

with soap. The lack o resh water or most communities, however, remained the primary challenge inchanging hygienic behavior.

Once the communities understood the importance o having clean drinking water, the government

and UNICEF moved to help provide additional sources o resh water on the island. UNICEF played avital role by training villagers to construct rainwater tanks and supplying tank moulds made o FRP

(Fibreglass Reinorced Plastic). The training sessions were initially held in the villages o Aejeti andPaderape, and eventually held in the other ve villages. As a result, each village gained communitymembers (technicians) who were trained to use the moulds and able to assist other amilies in building

rainwater tanks.

Villagers who wanted to build their own rainwater tanks were responsible or supplying their ownbuilding materials, namely sand, pebbles, and stones, all o which are available locally. They were also

expected to provide their own labour, with guidance rom the technicians. Facilitators observed theconstruction process and ensured that the moulds were being rotated eectively among households.

Households or household groups took turns using the tank mould, in accordance with the communitywork plan developed. Some villages decided on building rainwater tanks or each individual household,

while others built communal rainwater tanks to serve several households at once.

Once the community gained improved access to drinking water, the program ocused on triggeringor deecation behavior. The government and UNICEF held training sessions or community acilitators

and community leaders, who then relayed their new knowledge to other community members.Triggered by shame and a new understanding, the people o Ende Island aspired to have properlatrines and stop open deecation.

To ensure availability o aordable latrines, UNICEF set up a latrine production centre in Rendoraterua

Village. Several community members were trained in basic toilet manuacturing, thus providing thevillages with additional income and strengthening their sel-reliance by providing locally-made toilets.

With time, as people became more amiliar with the use and care o their new toilets, they graduallyreplaced their latrines with more sophisticated actory-made toilets, sold in the City o Ende. Now, the

majority o toilets on Ende Island are store-bought rom the City o Ende.

BBy the end o the program, the communities o Ende Island were extremely proud with theiraccomplishment. Especially since the rainwater tanks and toilets were the result o their own hard

work and material investment, rather than given by the government or other outside parties. Becausethe government and UNICEF provided only moulds, technical training, and acilitated triggeringexercises, the communities developed a strong sense o ownership over their sel-made acilities. This

is evident in the continued use and diligent care o the rainwater tanks and toilets.

8 9

Rainwater Tank Construction Process

1. Prepare the construction site and building materials

2. Prepare and assemble concrete pillars

3. Build the oundation or the rainwater tank

4. Position the FRP mould or the tank wall

5. Pour cement into the mould

6. Remove the mould

7. Position the FRP mould or the tank cover and pour

in cement

8. Remove the tank cover mould

Latrine Construction Process

1. Prepare the construction site, building materials, and tools

2. Position the latrine mould level to the surace o the foor

3. Combine cement and sand

4. Pour the mixture into the mould

5. Remove the latrine cast rom the mould


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10 11

I was struck andembarrassed by the

label worlds longestlavatory given to my

island. This motivatedme to change the

behavior o mycommunity.

Junaidin P.SVillage Head

Aejeti VillageInitial Resistance To Change

Initially, the community o Aejeti Village resisted the Water and

Sanitation Program. One o their religious leaders argued publ icly

against the District sta sent to the island. Undeterred, the District

sta led a dialog with the religious leader that approached the

subject rom a religious standpoint. By discussing in terms that

the religious leaders were amiliar with, the District sta nally

convinced them to support the program.

Furthermore, the religious leaders were shown scientic data on

the eects o open deecation. They were invited also to observe

or themselves laboratory test results that showed the water

they have been using or ablutions were contaminated by E.Coli,originating rom human eces. This convinced the religious leaders

o need or change in the communitys deecation behavior.

The religious leaders were trained or t wo days by the District

o Ende and encouraged to insert messages on hygiene in their

sermons. Ater the training, sermons held at Friday prayers

contained messages o sanitation and hygienic behavior. This

approach was maintained until the entire community changed

their deecation practices.

Changing the behavior o a community requiressacrice, patience, and wisdom. We must rstunderstand each amilys circumstances, beore we canraise the topic o toilets and deecation.

Juleha RojaVillage Civil Deence Chie

Changing age-oldbehavior is not an easy

task, but neither is itan impossible one. As

long as it is undertakenconsistently andwith patience, we will

denitely see results.

Amir JabirReligious Figure

Rorurangga VillageWater Is No Longer Far Away

Located on the northern tip o Ende Island, the village oRorurangga has always aced limited access to resh water.

Throughout history, this village has been completely dependenton water rom Aejeti Village. To reduce that dependency, an

initiative was launched in 2007 to build rainwater tanks orevery household in the village. Local builders were trained in the

construction o the tanks, and received tank moulds donated byUNICEF. Now, every house in Rorurangga has a rainwater tank, and

the villagers are now able to enjoy their own source o resh water.With the rainwater tanks, the Village Head explained, or therst time, we eel truly liberated. We no longer depend on other

villages or our resh water.

Ater solving the water problem, the program concentrated on

deecation behavior. Equipped with training rom the DistrictOce, Village Head Junaidin P.S. and Village Civil Deence ChieJuleha Roja went rom door to door and met all amilies in

Rorurangga to discuss and encourage changes in their deecationpractices. They also used existing village orum or events to discusssanitation and hygienic behavior. Despite initial resistance, the

initiative was a success and as a result every household inRorurangga Village has its own latrine.


Photo:UNICEF/2012/AnsyeSopacua

Photo:Qipra/20

12/TaufkS.

P

hoto:UNICEF/2012/AnsyeSopacua


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12 13

Rasyid Kuri

Village Head

Now every house in our village has itsown latrine.

Ndoriwoy VillageNight Patrols Prevent Open Deecation

Redodori VillageThe Turning Point

Redodori Village was ormed in 2002 as an expansion o Ndoriwoy

Village, with Aliasa H.A. Tata appointed as the rst Village Head. His

rst challenges were to prevent recurrence o diarrhea outbreaks

and ensure the communitys sel-reliance or drinking water. The

CLTS approach provided a turning point or the community, who

realized that their situation had to be changed or the better.

Facilitators tirelessly gave motivation to the adults in the

community. In turn, parents and teachers taught children about

proper hygiene. Village Regulations were drawn up, to allow the

community to police itsel against open deecation.

As a result, the beach has now become a recreation center. Free

rom the once-common eces on the sands, the beach is now used

by children and youths to play, exercise, and relax. The ocean view is

exceptionally stunning especially at sunset, and now enjoyed by all.

Aliasa H.A. Tata

Village Head

The programs triggering approach became ourturning point. Prior attempts ailed b ecause the

community was not triggered to change their

behavior. What happened beore was a lot oempty words.

Said IbrahimReligious Leader

A volunteer who keeps an eye out oropen deecators.






Ndoriwoy Village is the only village on Ende Island with its own

supply o resh water. With a total o 32 resh water wells, it

supplies resh water to the other 6 villages during the dry season.

Ndoriwoy Village also experienced outbreaks o diarrhea and

other gastrointestinal illnesses. Previous attempts by the District

to eradicate open deecation were unsuccessul, mainly due

to the communitys limited knowledge and economic means.

Behavior change only started ater triggering exercises by the

District government and UNICEF, and contribution o moulds or

latrine and rainwater tank construction.

The initiative gained momentum when village leaders

began to monitor the communitys practices. Said

Ibrahim, the imam o the Ndoriwoy mosque, would

patrol the beaches every night. Armed with his trusty

fashlight, he scoured the village coastline or people

deecating. When he does nd one, he shines his

fashlight on them, orcing most to run o hiding

their aces in shame!


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14 15

Rendoraterua VillageVillage Budget or Sanitation

Rendoraterua Village also suered repeated outbreaks o diarrhea,

with the majority o those aected being children aged ve years and

younger. In the past, the Village Head took initiative to build a public

latrine, but was not able to motivate the rest o the community to

build their own toilets. The old habit o deecating on the beach was

still more popular and convenient.

Progress was achieved ater UNICEFs support to trigger the

community. Each household was responsible or building their own

latrines. While the village contributed only three bags o cement and

one toilet bowl.

As Village Head, Ahmad Yusu allocated 45 percent o village unds

every year to support construction costs. A urther 5 percent was

allocated to improve the quality o latrines. Now, every household

has its own toilet and no new diarrhea outbreaks have occured.

As an additional measure, the village issued a village regulation

in 2009. The regulation contains sanctions agreed upon by the

community. Community members caught deecating in the open

would receive a warning and made to pick up and carry their eces to

the nearest latrine. They would also be given a ne consisting o three

sacks o cement and a latrine bowl to be used in their own house or

the house o a amily that does not yet possess a latrine.

The communal nature othe rainwater tanks made

it necessary or our villageto use a dierent tank

design comparedto that in other

villages.

M. AbdullahPaderape Village

Administation Chie

Teenage girls in PaderapeVillage actively participate in

improving community healthconditions ater joining a

training course held by thelocal integrated health

services post (Posyandu).

Integrated

Health Cadre

Paderape VillageRainwater Tanks Shared Among Families

Despite the high population density and limited land or

construction in their village, the community o Paderape were

undeterred in their eorts to build rainwater tanks. With most o

the houses in the village spaced very closely to each other, the

community had the challenge o deciding where to place the

large, space-consuming rainwater tanks.

Through several meetings and discussions, the community nally

decided on building communal rainwater tanks in between

closely-spaced house. Rainwater gutters were attached to the

roos to direct the rainwater into the communal tanks.

Sharing the tanks water supply meant that amilies had to

coordinate with each other and use their allocated water

eciently. Families agreed that reshwater rom the tank would

only be used or ood preparation and drinking.

The use o communal water tanks here has worked smoothly,

explained Paderape Village Administration Chie, M. Abdullah,

because there is a strong sense o kinship withi n our community.

Ahmad YusuVillage Head

We are proud that this village has 100 percent latrine access. Theyounger generation no longer want to deecate on the beach. On the

contrary, they now remind each other not to do it.

Photo:Qipra/2012/IsnaMaria



Photo:Qip

ra/2012/TaufkS.



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16 17

I any members o the community are caughtdeecating in the open, their punishment is to pick up

their eces and carry it to the nearest toilet.

SalehVillage Vice-Secretary

A Village Cadre who had attended the three day HygienicBehavior course at the District Ofce, Wahyah now holds

inormation sessions every Clean Friday, with such topics as thecleaning o rainwater tanks.

Wahyah Darham

Village Cadre

Puutara VillageCommunity Work Plans

One o the main reasons the Water and Sanitation Program was a success was that it

was tailored to the needs o the community. Ater receiving general description o the

program, inhabitants o Puutara Village designed their own community work plan with

guidance rom the program team. As we were designing the community work plan,

many arguments occurred among the villagers,recalls Sal eh, the Village Secretary. But

these arguments were resolved through dialog.

The community conducted their own situation analysis and identied problems

present in the village, which prompted discussions on possible solutions. Among the

villagers, several individuals were chosen as members o a committee, responsible or

coordinating program activities. In the process, the community also chose the orm o

clean water access they considered most suitable. Each household had the opportunityto voice their opinion.

The community work plan proved to be a successul approach or the program.

The community was able to plan its own activities and work schedule, as well

gain awareness o the challenges they would ace. Furthermore, involving

the entire community in the decision making process and making everyone

equally responsible helped strengthen relationships in the community.

Attention rom the DistrictThe District o Endes Health Department prepared a public health prole

or the province o East Nusa Tenggara. They ound that diarrhea outbreaks

were an annual occurrence on Ende Island. Even though medical assistance

and sta were sent by the Department to respond to each outbreak, another

outbreak would occur the ollowing year. Dominikus Minggu (M.Kes), Head

o Health Department at the time, realized that the outbreak problem could

only be permanently solved by prevention.

The rst step taken by the Head o the Health Department was to raise the

institutional status o the Environmental Health Section to a Sub-Division. The

sta was empowered, and the Sub-Divisions unding was increased to tackle

its rst challenge preventing urther diarrhea outbreaks on Ende Island.

Sta rom the Environmental Health Sub-Division was sent to visit the

island. Following the visit, the sta reported drinking water scarcity in Ende.

Thus the Department decided to improve access to drinking water beore

addressing the problem o deecation.

Furthermore, the Department also added an inpatient ward and paramedic

dwellings to Ende Islands sole clinic, the Ahmad Yani Clinic. This allowed

islanders to have easy access to better medical acilities on the island.

Ater success in Ende Island, the District was eager to replicate the program

in other districts. They were reminded, however, that strategies in Ende

Island were tailored specically to its unique traits. In the words o the

ormer Head o Health Department, Dominikus Minggu, The strength o

program is in the process. This is not solely about building rainwater tanks

or latrines; it is about building the communitys sense o ownership and

responsibility over these acilities.

drg. Dominikus Minggu, M.KesHead o the Ende District Planning and Development Agency




Photo:Qipra/2012/Ta

ufkS.

The diarrhea outbreaks were not stopped by doctors, but by the sanitarians1.The key is working at the District level. The Environmental Health unit o theDistrict Health Department must be at right place.

1 Sanitarians reer to sta o Environmental Health units, who are trained in

community outreach on environmental health issues.


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18 19

Astute and Dedicated SanitariansPetrus H. Djata, also known as Piet Djat a, was one o the rst Health Depart ment

sta members sent to Ende Island. He was well known in the Department or

his expertise in sanitation and his exceptional skills in communicating health

inormation to the community. Despite these skills, his presence in Ende

Island initially drew opposition rom several members o the seven villages,

particularly religious leaders o Aejeti Village and Paderape Village.

The rst visit taught Piet that he had to nd an eective entry-point to the Ende

communities. He embarked upon his own research o the cultural background

and attitudes o the Ende Islanders. He ound that the communities were

highly devoted to their religion o Islam and deeply revered their religious

leaders. Piet, a Catholic, created a slogan Puriy Your Land, Puriy Your

People. Equipped with quotes rom the Quran and other Islamic teachnings,

Piet began discussions with Ende Islands religious leaders. From that point

onwards, Piet Djata was accepted by the religious community, and regularly

received invitations to talk to Friday prayer congregations.

Piets experience on Ende Island shows that a highly dedicated sanitarian,

willing to delve into the local culture, is the success actor in instigating

behavioral change. Furthermore, the work o the sanitarian does not stop

at ODF declaration. To this day, sanitarians continue to inspect the state oeach households latrines and provide consultation on illnesses caused by

unsanitary behavior on the island.

Friendly yet DeterminedFacilitatorsThroughout the journey towards a hygienic liestyle, the communities and

leaders o Ende Island were able to call upon the help o acilitators at every

step. Two such acilitators were Servasius Goa and Ayub Seda Gani.

Servasius Goa, known also as Pak Servas, had been active on Ende Island

since 2004 during trials or construction o wells and household toilet. Ayub

Seda Gani, locally known as Pak Ayub, started in 2008 with rainwater tank

constructions. Their easy-going attitude and perseverance earned them trust

and riendship rom the Ende Island communities as well as Village Heads. To

this date, their presence is warmly received by everyone on the island.

The experience o Ende Island demonstrates that the most eective

acilitators are those who are highly dedicated and able to delve into

the mindset and culture o the community they work with. As collective

behavioral change is not a quick process, acilitators must be able to

persevere and maintain positive communication throughout the process.

The key to the acilitators success is building mutual trust with and strong

ties to the community.

Petrus H. DjataCentral Ende Sub-District Oce

The people o Ende Island are highly devoted to practicing their religion oIslam, so we challenged them to become Indonesias third gateway to

Mecca. To be able to achieve this, communities had to leave their oldhabits o open deecation on the beach, which is in violation o theirreligions teachings. For his services, Piet was given the honorary

title o Pua Haji Djata2 by the people o Ende Island.


Photo:Qipra/201

2/TaufkS.


The task o the acilitators duringconstruction was to monitor which

group had possession o the mould.This was done via SMS.

Ater dawn prayers, I would go to the beach. Ialways get a laugh whenever I spot someone aboutto deecate in the open, because they would scream

Its Pak Ayuuuub!, and run away.

Servasius Goa

Ayub Seda Gani

2 Hajiis an honoric given ater a Moslem

has completed pilgrimage in Mecca.


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20 21

Village Headas Movement LeadersVillage Heads played a vital role in making Ende Island an open deecation

ree area. Ater the District disseminated the objectives o the program, all

seven Village Heads became highly motivated to bring about changes to

their communities.

The Village Heads selected several community members and involved them

in the program promotion and training, with the goal o engaging them in

the triggering process. These individuals included religious leaders, Village

Community Empowerment ocials, womens rights leaders, and teachers.

Together, they approached and convinced their ellow community members o

the importance o hygienic living.

The Village Heads also served as the main counterparts or the acilitators

assigned to Ende Island. Working together they brainstormed on appropriate

activities or the communities. Good cooperation and mutual trust smoothed

the execution o each step.

Village Heads oten met initial resistance rom

individuals within their own communities. Reasons or

resisting change ranged rom monetary limitations

and deep-rooted customs, to outright reusal to

trust outsiders. Through patience and perseverance,

however, everyone in Ende Islands seven villages was

persuaded to change their deecation behavior.

The Village Heads were also responsible or initiating

preparation o village regulations. They convened

meetings and ensured consensus was reached with

community members, regarding the content o regulations. The regulations

were expected to provide a oundation to ensure that behavioral changes will

last indenitely.

In building a new culture, i.e. deecatingin proper toilets, the community policesitsel. Our dream is to create an EndeIsland pure in soil and spirit, whichmay one day became Indonesias thirdgateway to Mecca.

Open Deecation Patrols

Commitment

Open Deecation PatrolsEach village created an Open Deecation Patrol (Buru Sergap Tinja), which is a

group authorized by the Village Heads to perorm surveillance and conduct

citizens arrests on community members that continue to deecate in the

open. Coordinated directly by the Village Heads, Patrol members have to be

hard-working and well-liked by their community.

Every Patrol consisted o: 1) a General Coordinator (Sub-District Head);

2) a Technical Coordinator (Clinic and Community Facilitator); 3) Chie

Executor (Village Head); and 4) Members ( Village Council member and two

community leaders selected by the village).

The Patrols are expected to be on duty at all times, especially at dawn and

sunset, when the highest number o violations tend to occur. Any violator

caught is penalized according to the terms agreed upon in the village

regulations, which include picking up eces to be disposed o in a proper

toilet and reusal o services at the village oce (e.g. nancial aid and rice

aid). Additional Patrol duties include organising Clean Friday activities,

providing inormation on sanitary living through the mosque, supporting

the integrated health services post (Posyandu), and holding youth activities.




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22 23

Religious Leaders as MessageBearersReligion was chosen as the entry point to spread the message o behavioral

change. As such, religious leaders played an important role in conveying

inormation on hygienic behavior. To help religious leaders gain the

necessary knowledge, the District held a two day

training program entitled Hygiene Promotion

Through Moslem Teachings. According toAejeti Village religious leader Amir Jabir, each

village sent two religious leaders, where they

were trained to communicate the importance

o hygienic and healthy behavior through use o verses o the Quran and

Hadist. Thus prepared, the religious leaders understood the teachings to be

used in their respective congregations

Keep clean by any means available to you.Truly Allah built Islam on the principle ofcleanliness. And none shall enter heaven whodoes not maintain cleanliness.(The Hadist of At-Thabrani)

Photo: Qipra/2012/Isna Maria

Women and Children Agentso ChangeThe women o Ende Island have the daily task o etching and allocating

water or the household. In the past, they walked to other villages and

queued or hours to draw water rom wells, or bought more costly water

imported rom Ende City. Naturally, when rainwater tanks were constructed

in the island, the women were the immediate beneciaries, as they no

longer had to spend precious time and energy etching water.

The women also became key players in changing behavior in their respective

amilies. Everything the women learned during triggering and other sessions

were passed on to other amily members. At home, they constantly remind

their children and husbands to practice hygienic behavior. This includes

deecating in toilets, washing hands beore eating, and cooking water to

boiling point.

At school, children received more hygienic behavior. Since the

program, all schools in the Ende Island are equipped with a toilet

and a place or washing hands. Since toilets have become available

in school and home, the children have let their old deecation

practices. In act they actively remind each other. When

children see someone on the beach without a shing

rod, they would yell Someones about to return to old

habits! That would bring enough embarrassment to

the person that he/she would walk away.

Students rom the EndeIsland Nurul UmmahIbditiyah PrivateMadrassah

Each Saturday, theschool holds a personaldevelopment class. Studentsare taught how to properlybrush their teeth and washtheir hands with soap.

Photo: Qipra/2012/Tauk S.

RusminiRusmini: Housewie

Rusmini, a women rom East Java, is motherto seven children. She eels very happy withthe rainwater tanks, as she no longer needsto draw water rom the wells or buy watertransported rom Ende City.

Photo: Qipra/2012/Tauk S.

Religious leaders used Friday sermons and religious study sessions to spread the message o hygienic behavior.


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24 25

Outreach Sign-postsOne media used on Ende Island to remind communities o hygienic

behavior are outreach sign-posts, erected in strategic locations. Every village

was given opportunity to design its own sign-posts, including creating the

message and illustrations.

Throughout the island, there are 21 sign-posts, spread across seven villages.

The messages inscribed vary widely. One is inscribed in Ende language

temu tai rewo, translated in English as dont deecate in the open. Another

uses Arabic, with the message anazoatum minal iman, or cleanliness is

part o aith. The outreach sign-posts are expected to continually remind

communities o hygienic behavior and its benets.

Photo:UNICEFCollection

Rorurangga Village

Arisan or toilets applied to assist poor communities to have their own toilets


Ndoriwoy Village


Arisan or ToiletsOne o the methods used in Ende Island is arisan, a typically Indonesian

social gathering, whereby an amount o money is collected on a regular

basis, and on a certain xed interval, one member (drawn by lots) wins the

entire sum o money collected rom all members3. The routine gatherings

became a venue or communicating hygienic behavior messages. And, most

importantly, the arisan also provided a solution or amilies with nancial

limitations. When an arisan member got access to the arisan unds, they

were able to purchase materials to build a toilet.

The Sub-District Head o Ende Island, Dahlas S.Ip, introduced a large group

arisan scheme. Each village was ree to set up their own arisan rules. The

smallest group had ten members, while the largest had up to 70 members.

The amount o monthly arisan collection also varied. One arisan group agreed

to collect 5,000 Rupiah per member per month. Another village agreed to a

monthly collection o 20,000 Rupiah per member. In most villages, the unds

received by the winnerwere used to purchase materials rom outside the

island, such as tin roong, cement and iron nails. In Aejeti Village, a dierent

system was used. The arisan members who won the lucky draw received one

pipe, one latrine bowl, and three sacks o cement. Overall, the toilet-ocused

arisan signicantly increased the construction o household latrines.

3 In poorer communities, the arisan is a used as a means or members to obtain a large amount o money without going

into debt. The money is generally used to und otherwise unaordable business ventures or purchases.

Rorurangga Village


Redodori Village



17/29

26 27

Supported by DataSelecting a location or the program involved analysis o real data. In choosing

Ende Island, the Health Department o Ende District conducted analysis o

trends in disease incidence and other public health indicators. The analysis

concluded that Ende Island was severely lacking in sanitation acilities.

In addition to public health data, other data sets gave insight into the socio-

economic conditions o the Island. Data observed included demographic data

(such as population, livelihoods, education and religion) and behavior (e.g.

deecation) o the communities on the island. These actors showed direct

correlation with records o annual diarrhea outbreaks rom the islands clinic.

Field studies were perormed to support desk analysis. A eld team collected

samples o water used by the community, and samples were analyzed at the

Environmental Health Laboratory o the Districts Health Department. The

laboratory results showed that the water used by most Ende Islanders was

contaminated by the E.coli bacteria, originating rom human eces. The lab

results convinced the islanders that their water was unt or consumption

and ablutions.

Village RegulationsEach village on Ende Island developed village regulations to enorce the

new hygienic behavior adopted in the community. The content o the

regulations were discussed and agreed upon by the village administration

and community members. This meant that each individual ully understood

their responsibilities, and was aware o sanctions and penalties or violations.

The initiative to create village regulations came rom the Village Heads, the

Districts Health Department, and the Village Empowerment Agency. The

process o reaching consensus and drating the regulations were assisted

by acilitators.

The majority o village regulations on Ende Island share the ollowing rules:

Community members are obliged to 1) join the arisan or toil ets, undertake

construction work, and use their household toilet; 2) maintain their wells

through their own means; 3) protect and maintain their rainwater tanks,

and use collected rainwater only or drinking and ood preparation; 4) dig

their own reuse pit; 5) build their livestock enclosure a signicant distance

away rom their home (i they own livestock); 6) attend Clean Friday

activities; 7) build simple ltration tanks or wastewater containment or

their household latrine.

Any community members ound guilty o violating the village regulations

are penalized. For those apprehended by the Open Deecation Patrols,

penalties include: 1) verbal warnings; 2) written warning rom a village

ocial; 3) a 10,000 Rupiah ne; 4) a criminal sentence. Additionally, some

villages penalize violators by orcing them to pick up their eces by hand and

dispose o it in a toilet. Strict enorcement o the rules has proven eective in

instilling a sense o shame among villagers. As a result every community on

the island continue to lead hygienic lives.

The village regulations were designedthrough a 10 step process involving a

team o representatives rom each o theseven villages.

Photo:Qipra/2

012/Sylvana

Photo: www.wikipedia.org

Eschericia coli are bacteriathat cause gastro-intestinal

problems in humans.The ideal temperatureor bacterial growth is

between 20-40C, in which,the bacterial populationcan double within 15-20

minutes.


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28 29

Water and Sanitation Aspirationsat the District LevelThe success o eliminating open deecation in the Sub-District o Ende

Island convinced elements at the District level that behavior changes were

also possible or the entire District. To mobilize all constituents within the

District, District ocials drated the Water and Sanitation Strategic Plan. The

Strategic Plan is expected to ensure that uture activities o each technical

agency were in line with the strategic objectives o improving sanitation andaccess to drinking water.

The Commission C or the District o Endes Peoples House o Representatives

took the initiative to prepare a Drat Regulation on Water and Sanitation. The

thinking is that a regulation would: 1) provide a stronger legal basis or the Water

and Sanitation Strategic Plan; 2) outline the responsibilities o the government,

businesses, and communities, and; 3) outline the penalties or violations.

According to Heribertus Gani, SPd., the District o Endes Head o Commission

C or the Peoples House o Representatives, the spirit o the regulation is

preventive measures are ar better an investment that curative actions.

The District has invited other sub-districts to choose one o their own

villages to replicate the CLTS approach, using the Special Allocation Funds

(rom the national government budget). Triggering could be unded by theMinistry o Healths unds or clinic activities, through the Health Operations

Assistance. As explained by Head o Physical Inrastructure, Andreas Worho,

the district-government budget is oten inadequate to und water and

sanitation activities. Combining district unds with that rom the national

government is an eective approach.

Declaration on Ende IslandOn the 12th o April, 2011, the people o Ende Island declared themselves to

be ree o open deecation in a celebration that will be remembered or years

to come. Accompanied by their Village Heads, Ende District ocials, and local

leaders, hundreds o Ende Islanders focked to the serene village o Rorurangga

to attend the celebrations. Also present or the ceremony were representatives

rom the Regional Consultative Council, the District Peoples House o

Representatives, the Ende District technical agencies, the National Government,

the Netherlands Embassy in Indonesia, and, last but not least, UNICEF.

The Declaration was made by representatives o ve elements o Ende

Islands society, namely children, women, youths, local gures, and

religious leaders, with each element stating their resolve to uphold their

achievements. Following the declaration, each group perormed traditional

dances and plays, creating a estive atmosphere.

The people o Ende Island took pride in their personal involvement in the

behavior change. Although the process took some time, slowly but surely,

the entire island had nally become open deecation ree.

Through its declaration, Ende Island ocially became the rst island in

Indonesia to be completely ree o open deecation. This is no small eat or

an island once given the label o the worlds longest lavatory. Following

the declaration, Ende Island was urther recognized at the National CLTS

Conerence on 13-14 October 2011 in Bekasi, West Java, when it was awarded

Best Practice on Ende I sland in Stopping Open Deecation. The award was

evidence that the CLTS approach is suitable or small island environments.

Andreas WorhoHead o Physical Inrastructure, Planning and DevelopmentAgency or the District o Ende, and Chairman o the Water

and Sanitation Working Group.

Heribertus Gani, SPd

Head o Commission C or the Peoples House oRepresentatives or the District o Ende

Open-deecation-reedeclaration aims is toacknowledge the success o aregion, and to remind its peopleto maintain their achievementsin better hygiene.




ELEVEN STEPS TO

Th E d I l d h


19/29

30 31

ELEVEN STEPS TO

REPLICATION

Observe the wise words o the Head o the Regional Planning and Development Agency or

the District o Ende to leaders o other regions who wish to attempt replication:

1. Careully study data on environmental health, recorded occurrences and trends o

diseases in the target area.

2. Provide unding rom the regional budget. Always allocate a larger amount o unds than

the previous year.

3. Build an ecient system o coordination among technical agencies and other parties.

4. Create and announce clear political commitment. The perormance o the District Head

will be greatly enhanced by a marked decrease in disease outbreaks.

5. Do not rush! The entire process must be undertaken with patience and perseverance.

Cultivate

aCommitted

Leadership 1

Examine

Conditions

oftheTarget

Area3

Plan

theProg

ram 4 Prepare

Working

Groups 5

11

EstablishtheTargetArea 2

Promote

theProgr

am

PrepareVillageCadres

Perform

Community

TriggeringSchedu

le

Facilitation

6

8

9

10

DesignFieldActivities

7

Decla

re

TargetA

reais

Freefr

omOp

en

Defec

ation

The success on Ende Island paves the way or

other small island communities to take on the

challenge o eradicating open deecation. This

section presents steps needed to successully

replicate a Community-Led Water and Sanitation

program, and provides some tips or each step.


20/29

32 33

Tips or Success:Set GoalsSet goals at the start o the program. Goals can be selected rom a range o statements, such as

eradication o diarrhea outbreaks, increasing access to sanitation, or achieving open-deecation-ree

status. The goals and commitment o the leader must be made ocial to all parties involved.

Invite All PartiesLeaders must convince as many parties possible to be involved in the program. Each technical agency

should prepare a plan o activities and expenditure budget. Water Supply and Sanitation Working

Groups must ensure that there is clear communication between all parties involved. Private sector

and community organizations can also be invited to support the program. All levels o government

(provincial, district, sub-district and village) must be united under a common goal. Further support

can be requested rom the national government in the orm o technical assistance and training.

Appoint Unit in Charge o ProgramAppoint an institution to be responsible or the program, and provide it with a clear mandate and

adequate budget. Delegate urther planning and coordination to the unit.

1

Regional leaders must showtheir commitment to improvingdrinking water access andsanitation. Commitment canbe shown by orming and

empowering Water Supply andSanitation Working Groups,increasing unding to relevanttechnical agencies, and issuingocial decrees. The objectives orgoals must be clearly outlined.

C u l t i v a t ea CommittedLeadership

Tips or Success:Study Public Health DataData on disease incidence are very valuable, and data collected annually can help show trends or

tendencies in an area. Comparing data obtained rom dierent villages and sub-districts allows

identication o areas that require urgent attention. Also analyze supporting data, such as access to

sanitation acilities and population demographics.

KAP SurveysIn addition to studying public health data, conduct KAP (Knowledge, Attitude, Practice) surveys, to

learn more about the perceptions and practices o the community. Take note o the communitys

access to sanitation acilities, such as toilets that meet hygiene requirements. Take samples o water

used by the community and test its quality in the laboratory. Analyse survey results to corroborate

results rom analysis o public health data.

Determine the TargetOnce data has been collected, ensure that it is documented in detail. Perorm analysis, and use the

conclusions to determine the best location to implement the program. Then establish targets or the

desired level o sanitation or that area.

E s t a b l i s h

the TargetArea2

Identiy the area(s) where theprogram will be implemented. Imore than one area is selected, someprioritization is recommended.


Photo:QIPRACollection


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34 35

Tips or Success:Understand the CommunityBeore starting the process o behavior change, the most important pre-requisite is understanding the

characteristics o the target areas community. Research their culture, attitudes, and liestyles, identiy

infuential individuals, and learn which activities or media are commonly used to spread inormation

and infuence public opinion. It is also useul to observe youth groups and their activities.

Study Local Water and Sanitation ConditionsCarry out a comprehensive survey in the target area, making sure to observe the level o access to

drinking water and sanitation, as well as daily community habits regarding hygiene. Gather public health

data rom clinics and interview sanitarians or medical sta. I necessary, gather samples o the local water

supply and test its quality in the laboratory. Record all results in detail, analyse and draw conclusions.

ExamineConditions o theTarget Area3

Understand the characteristics

o the target area rom itsphysical, socio-cultural, health,and environmental aspects.Analyze and record all availableinormation to provide a basis ordecision-making.

Community-Led Total Sanitation (CLTS) is a community empowerment approach towards orming

communal hygienic and healthy behavior. The ve tenets o CLTS are:

Community-Led Total Sanitation

CLTS is a community-led program, which means that no subsidies are provided or the construction o

sanitation acilities at the household level.

CLTS was ocially adopted as a national program by the Ministry o Health or the Republic o Indonesia

in September 2008, as per Health Ministerial Decree No.852/Menkes/SK/IX/2008. This decree has

become a starting point or all involved in the planning, implementation, monitoring, and evaluation

o CLTS programs.

Each individual has access to basic

sanitation acilities to create an opendeecation ree community.

Each household and public acilityprovides a hand-washing acility thatsupplies water and soap or ash.

Each household manages its own drinkingwater and ood saety.

Each household properly manages its

solid wastes.

Each household manages its sewage properly.

Stop Open Defecation(STOP BABS)

Wash Hands with Soap(CTPS)

Manage HouseholdDrinking Water (PAM RT)

Manage Household

Waste

Manage HouseholdSewage

STOPBABS

CT

P S

PAM

RT

P SR T

S P A L

Ph

oto:QIPRACollection


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36 37

Tips or Success:The Need or FundingAll programs depend on adequate unding, and CLTS programs are no dierent. Expenses or CLTS

include the costs o outreach, training o acilitators and technicians, acilitating the community

during triggering, laboratory tests, monitoring and evaluation, transportation, and venue rental. The

main source o unding should be the regional development budget, while supplementary unds

are obtainable rom the national development budget, via the Special Allocation Funds. Triggering

activities can be considered as an activity o the local clinic, which make them eligible or unding rom

the Health Operations Assistance. Village unds, albeit small, can also be used.

Prepare Proposals and Mobilize PartnersDescribe the program plans in a proposal, which can then serve as a means o communication with

potential partners. Each level o government should develop a proposal and submit it to the higher

level o government. Cooperation with non-governmental organisations, such as donors or private

companies, is also possible. It is important to note that all cooperation begins with a proposal that

clearly outlines the programs desired objectives, activities, cost estimates, and technical requirements.

Based on the conditions andneeds o the target area,develop a site-specic program.Determine essential activities andnecessary resources, and identiypotential partners.

Planthe P rogra m4

Funding or Waterand SanitationEorts to improve access to drinking water and sanitation require adequate unding. Each village,

sub-district, district, and province must create a cost estimate or the planned activities to cover

outreach and construction in the target areas.

Budget commitments should be made or more than one year. The reason is that improving access to

drinking water and sanitation usually requires several years to show results. Thus, multi-year planning

is a necessary approach or this type o program. Furthermore, open dialog between dierent levelso government can help ensure the work plans and cost estimates are realistic.

Construction o Latrines or Drinking Water Facilities

1. Purchasing/obtaining moulds;

2. Transporting moulds to the target area;

3. Technical training or mould usage;

4. Supervision o the construction process;

5. Supervision o operation and maintenance o acilities.

Behavioral Change1. Promoting the program to institutions involved;

2. Holding training sessions or community members and

institutions involved;

3. Undertaking the acilitation process and training acilitators;

4. Transportation to and accommodations at the target area.

Research and Planning:1. Sending sta to collect inormation and carry out surveys;

2. Water sample testing at a laboratory;

3. Discussing research results and drating the work plan.

Example o activities that require unding

Ph

oto:QIPRACollection


P

hoto:UNICEFCollection



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38 39

Tips or Success:Step-wise DisseminationInormation on the program should be disseminated in a step-wise approach, rom the national

government to the targeted community, with knowledge being passed down rom one government

level to another. In other words, knowledge originating rom the national government, should be

passed down to the provincial, district, sub-district, and village governments successively, until

it is nally disseminated to the community or households. Thus, cooperation among all levels o

government is vital to the programs success.

Document Every StepEvery outreach and planning event, and implementation o the programs activities must be well-

documented, as these will provide evidence or reporting purposes. The records will also be useul as

guidelines or uture replication in other areas. Documentation may include activity l ogs, photographs

or video recordings o the activities, and a list o individuals and organizations involved.

Explain the program in detail toall levels o government to ensuremutual understanding andeective coordination.

P r o m o t e

theProgram6

Tips or Success:Appoint a Unit Responsible or the ProgramIdentiy the technical agencies responsible or the water and sanitation program, and appoint one to

be responsible or the program, with a clear written mandate. Direct the other units to work according

to their expertise and roles, while the unit responsible or the program designs a more detailed work

plan and coordinates the work o other units.

Prepare FacilitatorsFacilitators, whether individuals or non-governmental organizations, should be selected according to

their competency and passion in community empowerment, drinking water, sanitation, and/or the

environment. They can be recruited through the Districts Health Department or technical agency in

charge. It is preerable to give these acilitators training to introduce the program and its approach,

as well as provide technical inormation, the latter o which can be supplied by the Ministry o Health.

P r e p a r e

WorkingGroups

Assign individuals and institutionsto the target area, and beginprogram implementation.5

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oto:UNICEFCollection

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Proper DeecationThe rst tenet o CLTS is stopping open deecation (see box Five Pillars o CLTS, page 35). Changing

deecation behavior requires more than simply changing the location o deecation. So how does one

deecate properly, and what are the criteria or proper latrines?

Open deecation is dened as deecating in an open space viewable by other people, or in some

cases deecating in an open space alongside other people. These open spaces include paddy elds,

gardens, sewage ditch, rivers, or beaches. The eces are let on the ground, where it can be seen by

others and stepped on by both people and animals. Furthermore, the eces become pollutants and

can contaminate river, ground, and seawater.

Proper deecation must be done in a sheltered latrine that ensures the users privacy, and must

contain a sewage pit that can be covered or buried with soil to ensure others need not smell or see

the eces. A good latrine is one that ullls these requirements, and does not necessarily need to be

costly or sophisticated.

Tips or Success:Insert Outreach in Existing ActivitiesInormation on hygienic and healthy living can be delivered inormally to the community. Find the

most appropriate outreach method or each community. One approach is to insert outreach into

established local orum or routine community activities that already exist. Developing a positive

rapport with the community is vital, as is building two-way communications. Allow the community

to be involved in choosing the right orum, and give them the opportunity to give their input to any

activity they join. This will give them a sense o ownership towards the initiative.

Embrace Infuential FiguresApproach infuential community leaders, and explain the program and its goals. Convince these

leaders that the program will bring about positive change, and, in turn, they will convince other

community members. Treat infuential gures as the gatekeepers to the community.

Open dialog with the targetcommunity to determine the typeo activities that will be used andlocations suitable or those activities.Include the results rom the dialoginto the Community Activity Plan.

PlanFieldActivities7

Photo: UNICEF Collection

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Tips or Success:The Facilitators RoleFacilitators are tasked with acilitating the communitys educational process throughout the

triggering process. This task can be challenging due to the diverse personalities and attitudes o

community members. As such, creativity and strong intuition in approaching the community are

vital skills or the acilitators.

Choose a LocationChoose a location or the triggering activity. One activity commonly used as part o the triggering

process is transect walk. During the transect walk, acilitators bring the community to a location where

open deecation is practiced. Community members attending are then asked to draw a map o the

village and point out where they usually deecate openly.

Choose a TechnologyDuring the triggering, invite the community to think o technologies suitable to solve their open

deecation problem. Facilitators and experts should present viable options available. Discuss the

strengths and weaknesses o each option. At the end, it is the community who will make the nal

decision on which technology to use.

Hold activities that will help trigger

the communitys motivation tochange to hygienic behavior. Thisprocess is the most important part othe program, and it is oten dicultto predict when a community will beconvinced to change their behavior.

Perorm

CommunityTriggering9

Tips or Success:Identiy Village CadresOpen community discussions in the village and identiy volunteers, selecting a suitable number o

people or the program. They can be rom a variety o backgrounds, such as religious gures, youth

leaders, women, or even village heads. In all cases it is necessary that women should always be involved

as cadres, as they are key gures in establishing hygienic behavior in the households.

Hold TrainingsHold trainings or the selected village cadres, educating them to understand hygienic behavior and

obtain communication and monitoring skills. Furthermore, the cadres should also be prepared to start

the triggering process in their own communities.

P r e p a r e

VillageCadres

Identiy a number o communitymembers who are willing to bevoluntary cadres. Train and explainthe cadres responsibilities, as they

will manage the program oncethe acilitators leave the site. Thevillage cadres tasks are to spreadthe message o hygienic and healthybehavior, and, in the long term,monitor the communitys behavior.8

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Tips or Success:Drat Village RegulationsFacilitators can assist the Village Head and community members in discussing and drating village

regulations. The contents o the regulations must refect the agreed responsibilities and penalties

binding all members o the community. Regulations are expected to help enorce consistent

hygienic behavior.

Handing Over to the Village CadresThe role o the acilitators is considered complete once the area has declared open-deecation-ree. As

such, the responsibilities o monitoring and evaluation all to the ocials and the cadres o the village.

Thus it is mandatory or the acilitators to ocially transer all their knowledge, data, and inormation

to the village cadres beore the end o their work in the community, to ensure that achievements are

not lost.

ScheduleFacilitation

Agree upon when acilitators are

expected to be present in thetarget area. Schedule interactionswith the community, and preparea post-declaration monitoringstrategy, which does not require theacilitators presence.10

1

2

3

e Sa tat o addeTransition rom open deecation to proper deecation requires each household to choose the type

o latrine that suits their means. A amilys rst latrine is usually very simple. Once they have become

accustomed to using toilets, amilies are expected to improve the quality o their latrines. Latrine

quality improvement can be illustrated by the sanitation ladder, which shows the progression rom

the most basic latrines to latrines that meet all sanitation requirements.

Pour-ush Latrine(with U-bend pipe)This latrine requires a signicantlylarger amount o water to fush. Thewater also eliminates the smell oeces, which is a sign o cleanlinessand an indication that the latrineis unctioning properly. Pour-fushlatrines can be purchased at storesor constructed using latrine moulds.

Ofset LatrineOset latrines can be made

by home-owners, and are

angled to unnel the eces

via a latrine pan. Water isrequired or fushing. The

latrine cover should be easily

lited or removed.

Simple PitSimple pit latrines are shaped

to unnel eces into the

ground, and do not require

water to fush. Temporary

shelters can be erected

around the pit. The latrine

cover should be easily lited

or removed.


Abbreviations


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46 47

CLTS : Community-Led Total Sanitati on

FRP : Fiberglass Reinorced Plastic

KAP : Knowledge, Attitude, Practice

NGO : Non Government Organization

NTT : Nusa Tenggara Timur (East o Nusa Tenggara)

ODF : Open Deecation Free

POKJA AMPL : Kelompok Kerja Air Minum dan Penyehatan Lingkungan (Water Supply and

Sanitation Working Group)

POSYANDU : Pos Pelayanan Terpadu (integrated health service post)

SMS : Short Message Service

UNICEF : United Nations Childrens Fund

Abbreviations

Tips or Success:Monitoring and EvaluationIt is important that the behavior o the community and maintenance o acilities are constantly

monitored by the village cadres and leaders. Ocial monitoring and evaluation must also be done

by the government, in particular by the Health Department, using expertise o the sanitarians.

Furthermore, the government will also need to make periodic water quality and quantity checks to

ensure sustained conditions.

Anticipating Post-Declaration ChallengesThe governments role in CLTS does not stop once an open- deecation-ree declarati on is made.

There are several other matters that will require government attention. In the medium term, the

septic tanks attached to each household toilet will require drai ning and the sludge will require proper

disposal. For rainwater tanks, some treatment to prevent mosquito breeding is necessary. Such

interventions require services and supplies rom outside o small island communities. Thereore, the

government will need to ensure adequate unds and services. It is best that governments engage

in dialog with the community regarding necessary post-declaration actions to maintain a healthy

and hygienic behavior.

Once the target area has beenproven to be open-deecation-ree,prepare and announce an ocial

statement or decree, conrmingrecognition by the highest level ogovernment. Declaration will alsoact as a sign o appreciation or thecommunities active participation inthe process.11

Declare Free rom

OpenDeecation


Bibliography


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g p y

Central Statistics Bureau o Ende District . Pulau Ende dalam Angka 2011.

Hans. 2009. Unice sampaikan Penghargaan kepada Pemkab Ende. NTT Onlinenews.com.

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www.ampl.or.id

www.hierobokilia.blogspot.com

www.portal.endekab.go.id

www.ristek.go.id

www.sanitasi.or.id

www.sipriseko.blogspot.com

www.stbm-indonesia.org

www.watercentre.org


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For Futher Inormation Contact:

Sekretariat STBM NasionalDirektorat Penyehatan Lingkungan, Direktorat Jenderal PP dan PLGedung D Lantai 1 - Jl. Percetakan Negara No. 29,

Jakarta Pusat 10560 - PO BOX 223Telp. (021) 4209930 Ext: 182, (021) 42886822, Fax: (021) 42886822

ende island. the first indonesian island to declare itself open defecation free

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