My River is Clean and Healthy
Health Department of Tapin District (Dinas Kesehatan Kabupaten Tapin)

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The development of sanitation in Indonesia, especially in Tapin district, which is oneof the district in South Kalimantan, has shifted from the approach of subsidized toilets to the elected households to community empowerment and behavior change for health and hygiene. This approach is well-known as the Community-Based Total Sanitation (STBM) and has been declared as a national scale by the Regulation of Indonesian Health Ministry No.03/Permenkes/2014. The problem of sanitation is an issue that remains a burden for the local government in Tapin district. There are many people in Tapin district has defecating habitsat random places. It happens for not only due to the economic problems, but also caused by some areas in the Tapin district that the geographic condition is mostly water area/river as in Hiyung village, which is a name of village in Tapin district,so that it requires greater funds and special techniques to overcome the problems of sanitation. In addition, the public has least knowledge about the importance of addressing the issue. Therefore, by implementing the Community-Based Total Sanitation approach (STBM) in Tapin district, it is expected that it can raise the achievement of access to sanitation gradually and sustainably that lead to the achievement of Indonesia at the end of 2019, which is 100% Universal Access for the society and not to mention the involvement of people with disabilities in development, as it is essential to achieve the universal access target for sanitation in Indonesia. The Open Defecation(BABS) in Hiyung village in 2014 is 87.77% high, especially for the areas along the rivers and streams in Hiyung village. There are many pit latrines owned by the community along the rivers. This habit has become a tradition of the local community. It is not only the poor who have done this habit, but the rich as well since they do not know the importance of cleanliness and healthy living. As a result, the rivers are polluted by human feces and garbage. Such behavior is clearly detrimental to public health since feces are known as a source of E.coli bacteria that could potentially cause diarrhea. The diarrhea incidence rate of Hiyung village in 2014 is 3.59%. The initiative of behavior changing and the construction of sanitation facilities in Hiyung village comes from the community itself. The government of Tapin district by the Department of Health and Regional Organization Units (SOPD) and other related sectors only act to support by determining policy, training and giving information. The Community-Based Total Sanitation (STBM) performers help to provide the input and options for solution to the communities in order to determine their own choices. All components of society are actively involved in conducting problem analysis, planning, implementing, using, and maintaining. The decision and collective implementation of society is the key to a successful Community-Based Total Sanitation (STBM) application in Hiyung village.

B. Strategic Approach

 2. What was the solution?
The improvement of sanitation needs, this component is a systematic effort to get hygiene and sanitation behavior change by triggering the behavior changes and campaign for Hiyung village. The improvement of sanitation access provision; this is specifically prioritized to improve and develop the acceleration of access provision and proper sanitation services such as entrepreneurial training sanitation as a support for communities to build healthy latrines independently, a stimulant of the district government such as the Department of Health or by village fund itself, The improvement of good environment in which this component includes the advocacy to the parties in developing a shared commitment to institutionalize the Community-Based Total Sanitation (STBM) approach in the sanitation development program. It can be seen from the commitment of Tapin district to provide the resources to implement the Community-Based Total Sanitation (STBM) program, regional policy in the form of the Tapin district Regent’s issuance of regulations regarding the implementation of its activities and in the form of mainstreaming the medium-term development plan (RPJMD).

 3. How did the initiative solve the problem and improve people’s lives?
The Health Department of Tapin district makes Hiyung village as a pilot project for other villages in 2014 by conducting environmental activities in an effort to accelerate the achievement of universal access in 2019. The officer of health care environment (Sanitarian) in Pandahan Health Center has developed an action plan to implement the approach to trigger the community by implementing Community Led Total Sanitation (CLTS) approach in Hiyung village. The strategy for successful implementation and application of these activities was started by conducting a briefing for sanitarian health center for the first step in accelerating the achievement of Open Defecation Free (SBS) and trigger changes in behavior that is done by the Health Department of Tapin district and The Agency of Planning and Research Development (Bappelitbang ). This activity aims to build a common understanding among all Community-Based Total Sanitation Program (STBM) actors in implementing the triggering behavioral changes method. Each sanitarian health center has a plan of action on health operational budget (BOK) for Community-Based Total Sanitation Program (STBM) activities, one of which is the activity of problem identification and analysis of the situation (IMAS) for triggering behavior change activity. The pioneer of this activity in Tapin district is the Sanitarian Pandahan health center. The first step to conduct is to meet the villagers to have coordination and to investigate the data access to sanitation in Hiyung village. The next activity is making the schedule of triggering behavioral changes. The method of triggering behavioral changes is implemented by an approach of making the community as a leader and stimulating them to perform a self-assessment toward the sanitary conditions in their communities. Community-Based Total Sanitation Program (STBM) is an approach of collective behavioral changes for better hygiene and sanitation in which it is conducted by implementing community empowerment method and it is based on Community Led Total Sanitation (CLTS) approach. It is an approach of changing old attitudes, which is the obligation to share the responsibility of sanitation that a clean, comfortable and healthy environment condition is the nature of human need. By conducting the approach, the awareness of the unhealthy conditions was revealed. It also raises the awareness that the habit of open defecation (BABS) is a problem that should be handled together since it affects all of the community aspects so that the solution should be taken together. The trigger is a natural activity which is expected to cause big and accumulated effects. It is classified into three (3) stages: the pre-triggering stage, the implementation stage, and post-triggering stage. Those stages have no limitation of time, yet it is a process that runs regularly and continuously as a unified and dynamic process. This activity has been carried out by the triggering team of Pandahan Health Center along with Community-Based Total Sanitation Program (STBM) facilitators and the Health Department. One of across sectors synergies for enabling good environment that has been made in Community-Based Total Sanitation Program (STBM) is the support of the regent of Tapin district by legalizing the regulation in which it is mentioned that the budget of the village fund could be used for supporting the construction of infrastructure sanitation. The role of the Health Department as a leading sector should be coordinated to the strong Community-Based Total Sanitation Program (STBM) activities. It happens to all level of community in Tapin district, such as Sanitarian health centers, community leaders, village authorities and relevant stakeholders to solicit partnerships of the Department of Community Development, Public Works and Spatial Planning, Social Services, Military District Command (Kodim) 1010 Rantau and fund allocation in the budget of the village (APBDes).

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
This initiative was conducted in line with the implementation of Community-Based Total Sanitation Program (STBM). The goal is to eliminate Open Defecation (BABS) practice and to restore the function of river as an important part of the human life cycle. The program is not only to build sanitation facilities, but also to empower people and to change their behavior. In the 2000s, the government has built sanitation facilities in the community’s place, but it was useless. It means the one that should be changed is the mindset to use the sanitation facilities. Firstly, they need torealize and be aware that sanitation is one of the aspects of development that has an important function in supporting the welfare. After people have realized the importance of good sanitation, they are asked to make a continuous plan. The active role of health centers, Department of Health and Regional Organization Units (SOPD), as well as Military District Command (Kodim) 1010 Rantau which acts as the executor of healthy toilet together with the community and by the support of community and good cross-sector synergies, these activities can run smoothly in terms of raising public awareness on the importance of having access to sanitation.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The Health Department in collaboration with The Agency of Planning and Research Development (Bappelitbang) Tapin district support the implementation of the Community-Led Total Sanitation (CLTS) approach of Community-Based Total Sanitation Program (STBM) program which is necessary to improve and streng then the capacity of the health center Sanitarian to achieve the acceleration of the Open Defecation Free (SBS). Briefing for sanitarian is intended to build a common understanding among all the people involved in implementing the triggering method of STBM program. The guide of this activity is Tapin district’s STBM facilitator, which is assigned by the Health Ministry of Indonesian Republic. The technical elements of this initiative is derived from Health Center of Pandahan as the pilot project for the village to immediately triggered Open Defecation Free (SBS) through behavioral change activities and the construction of family toilets. The Community-Led Total Sanitation (CLTS) approach and construction of sanitation facilities is derived from the budget of The Document of Budget Implementation Regional Work Units (DPASKPD) of Health Department. Other officials who participate and support this activity is the Department of Community Development, Social Services, Military District Command (Kodim) 1010 Rantau, Budget of the Village (APBDes) of Hiyung village, and the last but not least, the community of Hiyung village. The support of the Tapin Regent greatly affects the implementation of these activities. It is in the form of the publication of a letter in which it supports the Community-Based Total Sanitation Program (STBM) activities to accelerate the universal access in 2019. The detail of the Regent’s letteris thatevery village is able to budget the village sanitation in the village fund. In the MoU between the Tapin district’s Department of Health and Military District Command (Kodim) 1010 Rantau states that the implementation process of family toilets construction in Hiyung village was conducted by NGOs, the Military District Command (Kodim) 1010 Rantau in cooperation with the community and village officials. The process of monitoring and evaluation of these activities was carried out by the health care sanitarian, health department committee, and the government cadres of Community-Based Total Sanitation Program (STBM) in Hiyung village. The government of Hiyung village has rolled actively in the program. It is shown in 2015, Desa Hiyung has built 54 family toilets. It could be done by the contribution of Department of Health as a provider of material and Army Military District Command (Kodim) 1010 Rantau as the executors. In addition, the villagers of Hiyung village have also built 70 additional family toilets independently. In 2016, the Government of Hiyung village has built 43 family toilets by spending the Village Budget (APBDes) and 10 additional toilets independently. The parameter of success and monitoring impact programs lies in behavioral change of the society, not on the progress of construction. It can be seen from the usage of family toilets that each toilet is used by 2 until 4 families. These healthy toilets utilization is not only for residents who live on the riverbanks, but it is also used for the disabled community. This happens because these activities are done in a participatory manner by all of the public including women, men, rich, poor including indigenous peoples (indigenous and vulnerable people).
 6. How was the strategy implemented and what resources were mobilized?
A partnership initiative strategies of access to sanitation facilities based on community empowerment was conducted according to action plans as follows: a. Increasing the capacity of the Health Center Sanitarian Officer In order to support the implementation of Community Led Total Sanitation (STBM), it is necessary to improve the capacity of health centers for accelerating the achievement of Open Defecation Free (SBS). The briefing for health center sanitarian is intended to build common understanding among all parties in implementing Community Led Total Sanitation (STBM). b. The Problem Identification and Analysis of the Sanitation Situation The introduction of environmental conditions is very important. It is also supported by the geophysical and socio-cultural environment due to the condition will be very influential in triggering the process and its success rate. c. District Government Support In order to accelerate Open Defecation Free (SBS) in the village,the regent has published an official letter for implementing Community Led Total Sanitation (STBM). The regent’s support is very essential, in which it is mentioned that the village fund allocation could be used to support the construction of sanitation facilities. The Tapin district Government also urged Hiyung village to ban houses along the river. d. The Signing of the Memorandum of Understanding (MoU) between the Health Department and Army Military District Command (Kodim) 1010 Rantau Military District Command (Kodim) 1010 Rantau was also involved in a million toilets program. MoU between the Department of Health and Army Military District Command (Kodim) 1010 Rantau is signed and approved by the Regent of Tapin district. e. The Establishment of Environmental Health Cadre in Tapin’s Health Centers The purpose of this activity is to prepare the cadres of health centers to assist the health center Sanitarian in implementing Community Led Total Sanitation (STBM) whether it is in the data collection or in monitoring and evaluation (progress update) regarding the access to sanitation facilities. f. The Cross Sector Synergies It is necessary to continue triggering consciousness to change people's behavior. It is encouraged to integrate Community Led Total Sanitation activities (STBM) implementation agenda at the village level to be part of the village mid-term development plan (RPJMDes) and village budgets. g. Entrepreneurial Training with the Sanitary Village Officials of Hiyung village in Using Concrete Buis Mold Strengthening the supply side on the utilization of sanitation marketing methods is expected to help increasing the access speed and supply sanitation. Improving the sanitation supply capability is focused on strengthening the network of entrepreneurial sanitation market participants through rural sanitation. This activity is in line with the component of total sanitation in demand sanitation. Demand sanitation focuses on improving the quality of Community-Led Total Sanitation (CLTS implementation. The training of Hiyung village’s healthy toilets manufacture should be developed maximally to ensure understanding of the concept of knowledge and the market supply sanitation. In the implementation of innovation activities in Tapin district, various parties has provided the budget to support this initiative: a. In 2014, TheHealth Department of Tapin district has allocated Rp. 6,000,000 for capacity improvement activity and the briefing of health center Sanitarianpersonnel to accelerate the Open Defecation Free (SBS) program by conducting the approach of Community-Led Total Sanitation (CLTS). b. Pandahan’s Health Center has allocated Rp. 1,080,000 from the Health Operational Budget (BOK) for triggering the behavior changein Desa Hiyung. c. Health Department in Tapin district allocated Rp. 162.000 in 2015 for building the toilet by working alongside with Military District Command 1010 Rantau and the local society. d. Hiyung village allocated Rp. 326.086.400 on its 2016 APBDes (local government budget for village) for building the toilet.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders for this initiative program are: a. Regent of Tapin b. Bappelitbang (Regional development planning, research and development agency) Tapin district c. Health department of Tapin district d. Community and village empowerment department of Tapin district e. Social services department of Tapin district f. Military District Command 1010 Rantau g. Pandahan health centre h. Tapin Tengah subdistrict i. Apparatus of Hiyung village j. Facilitators of STBM Tapin district k. Water supply and sanitation for low income Communities program (PAMSIMAS) l. The trigger committee m. Community Based Total Sanitation people and Environmental health cadre n. Public figure o. Religion leaders p. Media q. community of Hiyung village All of the human resources mentioned are actively work hand in hand to support and run the application of the trigger program in Tapin district. The commitment is maintained and improved through specific discussion and meetings. This program is valued very important as it builds the understanding for the local people in the village. With all of the effort and support of all stakeholders, it is hoped that that program will be successful.

 8. What were the most successful outputs and why was the initiative effective?
8. The actual outputs from this initiation program are as follows: a. Circular regent of Tapin Number 441/26/Dinkes/2015 about the appeal of community based total sanitation which stated that village can estimate sanitation related program from local government budget. b. Official letter from the head of health department of Tapin district Number 443/559/P2PL/Dinkesin 2014 related to the socialization of community based total sanitation. c. Memorandum of Understanding between Health department and Military District Command 1010 Rantau. Those outputs have contributed to the following achievements: a. Houses and jamban cemplung, the local term for cubicle where the villagers defecat inside and the waste goes into the river, which were located along the riverbank are now on the land. b. Incidence rate of diarrhea number is decreasing from 3,59 % to 1,64 % c. The addition number of sanitation access every year in Hiyung villages from 143 people (2014), 388 people (2015) to 419 (2016). One toilet is provided for 2 to 4 families. d. The improvement of sanitation access in 2014 (12.23%), 2015 (48,02%), and 2016 (90,27%) e. Overall, the access to toilet for the society from 2014 to 2016 has been improved 78.04%. Indonesia has set the development priority as it was arranged on Nawacita’s program and priority and the national medium term development plan 2015–2019. The main idea of the program is the Universal Access 2019, which provide the basic sanitation service for Indonesia society. This program requires the full support of the people. Indeed, the output of the initiative program is in line with Sustainable Development Goals (SDGs) 2030 section 6b which declared the 100% availability of sanitation. Hiyung village showed its commitment to declare their villages as Open Defecation Free. The success of the initiative program is contributed by the all elements of the people, stakeholders, the apparatus and the people itself. Community based total sanitation is the implementation of government policy related to Open Defecation Free (ODF) strategic and the nations global commitment in SDGs (Sustainable development goals)

 9. What were the main obstacles encountered and how were they overcome?
9. The main constrain of this program is the cultural issues. The tradition to open defecation in the river has started from the village ancestor up until today. Most of the people in the village do not consider their action wrong nor do they think that their sanitation system is unhealthy. The condition happens in the society but they live with that as it becomes their culture. The implementation of Community Based Total Sanitation under 5 pillars especially Open Defecation Free will ease the improvement of better sanitation access as well as change and keep the sustainability of healthy and clean lifestyle. Community Based Total Sanitation is the approach under the idea of empowering the people. The goal can be achieved when the society is involved actively, especially in indentifying and solving the problem, and willing to change the healthy and clean lifestyle. In the implementation of Community Based Total Sanitation, the benchmark is not only about the information delivery and discussion, but also making decision with full control and responsibility from the local people itself. In the principle of the Community Based Total Sanitation stated that group decision and action of the society is the key. Therefore, the initiative program is considered appropriate and will be continuously applied the village. The goal to change the people from lack of awareness to the clean and healthy lifestyle will be maintained and the river will have its function back. River is the hearth beat of the village and it supposed to be clean, not filled with feces from defecate nor the defecated cubicles, for the next generation of Indonesia.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
10. Benefits of the initiative program a. Physical Aspect This program give a significant benefits for the society as it will remove the jamban cemplung (defecate cubicles located on the river and throw the waste on the river) from the river. Before the program, the society only use cubicle on the river to defecate, but now they have the toilet with pipe installed to the sanitary system. The house and jamban cemplung which were located alongside the riverbank are now relocated on the land. These significant changes are considered beneficial by the society as now they have 78.04 toilet accesses from 2014 to 2016. b. Environmental Aspect The area around Hiyung River was considered dirty before the initiative program. Human feces were easily found and contaminated or polluted the environment. The smell pollution, especially, was very disturbing the society. Through the program, the environment now is getting better as it is now clean and healthy. c. Social Aspect In the implementation of the initiative program, the society’s value on interaction has improved. The interaction in form of expressing their idea through discussion as well as working together to build the toilet, clean the environment, and keep it clean. Some people also help the program by giving material which can be used for the toilet. The power of togetherness in ideas and working on the toilet made the program run well. d. Health Aspect The improvement of health aspect in Hiyung village is proven by the decreasing number of incidence rate from the bad environment, counted from the villagers’ visit to the local health center. The incidence rate of diarrhea at Hiyung village keeps decreasing from 3.59% in 2014 to 1.64% in 2016. e. Cultural Aspect The people’s habit to defecate along Hiyung’s riverbank is caused by the culture. The people are accustomed and feel comfortable with such lifestyle. From the initiative program, the society has changed a lot and met the indicator of the expected result which is the change of the habit to defecate in the river to the toilet. This habit change happens not only to particular individual, but most of the local people collectively. f. Human Resources Aspect There is a good coordination and synchronization among the stakeholders. All of the elements in the society are actively involved in the Community Based Total Sanitation program in order to achieve Open Defecation Free. Men, women, rich, poor, indigenous and people with disability are hand in hand to run the program. g. Economic Aspect The poor people are now able to have clean sanitation. This is in line with the sustainability development target whose goal is to provide 100% sanitation availability for the society all over the world

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
11. This initiative program implements the important values and aspects which stimulates the innovation activity, valued highly and unite in the daily activity. The important values such as (a) humanity, helping each other to build the toilet, and being responsible to what they are doing, as well as being responsible and accountable to the budget of Community Based Total Sanitation program (the trigger and the development of sanitation budget from APBD (local government budget) or APBDes (local government budget for village), (b) Distance aspect, which provide accessible sanitation through the Community Based Total Sanitation program under the value of credibility and emphatic. (c) The value of transparency, through the spirit of inquisitiveness, dialogue on the planning and needs related to sanitation, (d) Enthusiastic value of the local society and the village apparatus to achieve universal access 2019 in line with sustainability development goals (SDGs). The sustainability of the program is then followed by optimizing village budget. The budget is expected to give extra energy to the village to do the development and empowering the village. The budget is considered important and very strategic so it has a big public attention for its big allocation. The local people build the toilet itself from village budget in 2016 which allocate the build of 53 toilet and 43 toilets have been finished. 10 of the total toilet is largesse from the local people. This program is indeed decrease the corruption since all people in the village control the money. The initiative program is very close to the local people as it is aimed at decreasing the poverty and imbalanced issues

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
12. The initiative program in Hiyung village is an inclusive development which involves all society aspects and group; rich-poor, men-women, vulnerable and disables people. The involvement is started from the very beginning of the Community Based total sanitation program to the sustainability of the facilities, without discriminating the people based on their genders or physical features. The stigma of disable people that they need to be pity on, cannot be involved in physical activity and cannot contribute to the society have to stop. In fact, they are very excited to be involved and work together with others. Women and children are usually the victim for losing the privacy in the case of diarrhea caused by the dirty environment, faces in this case, or other kinds of disease caused by open defecation. Open defecation has high possibility to get stung by vector mosquito and cause malaria, filariasis and dengue fever. It also has high risk of getting stung by snake, scorpion, and also possibility of being raped for woman as well as the children since they might be caught without clothes during defecating. Therefore, by implementing the program, it is hoped that such problem can be avoided and solved

Contact Information

Institution Name:   Health Department of Tapin District (Dinas Kesehatan Kabupaten Tapin)
Institution Type:   Local Government  
Contact Person:   Puji Winarta
Title:   Magister of Public Health  
Telephone/ Fax:   +6251731004, +628115195678 (Tel) +6251731004 (Fax)
Institution's / Project's Website:  
E-mail:   puji.winarta@gmail.com  
Address:   Jl. Pembangunan No.14
Postal Code:   71111
City:   Tapin Utara
State/Province:   KALIMANTAN SELATAN
Country:  

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