When the Water and Sanitation Programme, a World Bank initiative, embarked on a project in 2007 to improve residents’ access to toilets in East Java, the scale of the challenge was daunting.
At the time, says Almud Weitz, the WSP’s principal regional team leader, about nine million people there did not have access to a toilet – nearly a quarter of the country’s second-most populous province.
“We didn’t just want to run our programme in one district for a year,” she says.
“We wanted to go into all 29 districts at once, and the provincial administration was committed to the plan.”
Prior to the WSP’s arrival, the administration had rolled out a smaller project to allow selected households to buy toilets at subsidised prices.
“They chose the people who would be eligible for the subsidy in the hope that it would encourage other households to get a toilet,” Weitz says. “But it didn’t work.”
The lesson here, she goes on, is that given the extent of Indonesia’s decentralisation and large population, campaigns like this must be carried out on a massive and coordinated scale, with small pilot projects no longer effective.
“Indonesia needs to campaign on a mass basis, it can no longer afford to carry out small projects or individual projects. Everything must be done at once, especially if you want to change public attitudes toward sanitation.”
Weitz says that changing attitudes is the key to improving sanitation in Indonesia, where 109 million people still lack access to sanitation and clean drinking water, according to the government.
“You don’t need much [funding] for sanitation, especially when you focus on behavioral changes,” she says.
“Indonesia has increased its budget allocation for sanitation, but it would be more cost-effective if directed toward behavioral changes because you need it for training and capacity building. It would be expensive to buy infrastructure.”
Weitz, speaking on the sidelines of the ongoing Third East Asia ministerial Conference on Sanitation and Hygiene taking place in Bali, says the government needs to focus on ending the practice of open defecation in the country by 2014 – a target that she acknowledges is “very ambitious.”
“But, if it’s not [achieved] in 2014, even if it’s [the year] two-thousand-something, it is still good to focus on open defecation.
“It doesn’t mean give up … but there should be a substantial increase because right now, 60 million people in Indonesia have no toilet whatsoever. They go out in the bush and the river. That’s a large number and a lot of them are still on Java.
“The problem in Indonesia is that this country has a lot of rivers, you can go out in the river,” Weitz adds.
“In the old days, that was fine. Everybody went to the river. It was good when Indonesia had maybe 100 million [people], not with 200 million. Now, the river is way way, way overloaded, polluted, not only household pollution but also industry. These rivers are very, very dirty.”
Cycle of poverty
The issue of open defecation has been one of the main topics at the conference, with health administrators warning that unless it is eradicated, it will continue to fuel sanitation problems that will ultimately hamper economic development.
Athula Kahandaliyanage, the director of sustainable development at the World Health Organization’s Southeast Asia office, said on Monday that countries in the region were on track to achieve their UN-mandated Millennium Development Goals on sanitation, but could be tripped up by the perennial problem of open defecation.
“According to projections of improved sanitation coverage, the MDG target of 68 percent for East Asia as a whole may be exceeded by 8 percent in 2015,” he said.
“But despite these important gains, almost 700 million people in East Asia still lack access to improved sanitation facilities and nearly 100 million of that practice open defecation.”
Kahandaliyanage also noted that diarrheal diseases, often stemming from open defecation and poor hygiene, were a major cause of death in the region.
“In East Asia, about 450 million cases of diarrhea occur each year and the number of deaths attributed to diarrhea amounts to almost 150,000 per year,” he said.
“These diseases not only threaten lives but also keep children from school and adults from work, thereby perpetuating the cycle of poverty.”
Angela Kearney, the Unicef representative to Indonesia, also called for an increased focus on tackling open defecation.
“First, we need to address the significant inequities in sanitation and water coverage,” she said on Monday.
“The poorest and the most disadvantaged among us still do not have access to water and sanitation of a standard that will help them live strong and productive lives. And second, we need to put an end, once and for all, to open defecation.”
Rp 200 per person
The government acknowledges that state spending on sanitation remains very low.
Emah Sudjimah, a Public Works Ministry official responsible for environmental health in human settlements, said prior to the start of the conference that the ideal level of investment in Indonesia’s sanitation infrastructure was Rp 54,000 ($5.64) per capita per year.
But the actual amount being put in, she said, was just Rp 200 per capita per year.
She also said regional investment in sanitation should be 4 percent to 10 percent of budgets, but most administrations across the country allocate less than 2 percent.
Emah noted that because of the low spending, Indonesia lagged its neighbours in terms of its sanitation infrastructure.
She pointed out that only 12 cities in Indonesia, out of 497 cities and districts, had a wastewater processing network, compared to 98 percent in Malaysia.
Under the MDGs, Indonesia must increase the proportion of rural households with access to proper sanitation to 55 percent by 2015. However, Emah said there was little hope of attaining the target, given that the current level was 38 percent.
“To increase the current number by another 17 percent will quite frankly be very difficult,” she said.
In her opening speech at the sanitation conference on Monday, Health minister Nafsiah Mboi said 76 percent of urban residents had access to sanitation and clean water, compared to 47 percent of rural residents, who account for the majority of the country’s population.