Ensure Availability and Sustainable Management of Sanitation Through Community Social Gathering
Health Office of Bangka Regency (Dinas Kesehatan Kabupaten Bangka)

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The Bakam district is one of the eight districts in Bangka Regency of Bangka Belitung Island. Bangka is a part of Sumatera Island which is located in the West of Indonesia. It covers the area of 48.10 KM2, with a population of 16.650 people and population density of 34 people per KM2. Kapuk Village covers the area of 27.30 KM2 with a population of 1209 people (307 head of family) in 2011. The majority of the Kapuk village community is Muslim, with the community main incomes are traditional lead mining, pepper, rubber and palm oil sectors. The majority of community educational level in Kapuk Village is below Junior High School level. Based on the Bangka Regency Health Office’s report until June 2011, Kapuk village was an endemic diarrhea and malaria. Data states that there was an outbreak of diarrhea in March. Diarrhea is closely related to the community behavior towards Improvidence defecation which reflects the low coverage of community toilet in Kapuk village of 33.02%.Kapuk village is one of the villages in Bangka Regency with the lowest coverage of toilet. Environmental sanitation is the sixth goal in Sustainable Development Goals (SDGs) that is Clean Water and Sanitation. It ensures the sustainable sanitation, obtains equal access for all people, terminates open defecation, and gives special attention to the needs of women and susceptible groups. Comparing the target and the toilet coverage in Kapuk village, the minimum toilet coverage should be increased at minimum of 33.49% to reach MDGs target of 2015 that is the minimum toilet coverage of 66.51% in Kapuk village in 2015. This condition has inspired women in Kapuk village in finding solution to this problem because women and children are the most disadvantaged groups of the open defecation free behavior which trigger threat of diseases directly sourced or transmitted by the feces such as diarrhea, dysentery, typhoid, even polio, indirect threat of diseases such as malaria, filriasis, dengue fever and many others and other threats asas scorpions, snakes, etc. Women’s and children’s privacy sector is also greatly disadvantaged from the potential threats of sexual abuses, even rapes. To solve the problem elaborated above, the Environmental Restructuring of the Health Office has set up strategies to solve the toilet problem in Kapuk village by implementing Community Lead Total Sanitations (CLTS) methods, a community empowerment strategy through comprehensive approach by facilitating the community in analyzing their sanitation condition, as well as defecation behavior and the consequences of these matters. These strategies finally lead to the achievement of ODF (Open Defecations Free) status The CLTS methods applied are the integrated CLTS methods among the Health Office, Bakam Public Health Centre, Bakam district, the Health Districts Communication Forum and Healthy Village Working group. With the expertise of the facilitator in triggering the CLTS and by attracting available resources in the community hence appears the Arisan Jamban Sederhana or “SIMPLE TOILET COMMUNITY SOCIAL GATHERING” innovation powered by the community housewives.

B. Strategic Approach

 2. What was the solution?
1. The solution the problem above is the SIMPLE TOILET COMMUNITY SOCIAL GATHERING innovation. 2. With 3 groups of housewives in every simple toilet community social gatherings program, the withdrawal shuffle of the gathering brings out 2 toilets/week/gathering which makes additional of new toilet in Kapuk village as many as 6 toilets per week. 3. Using this gathering system the problem faced in Kapuk village can be solved within 6 months.

 3. How did the initiative solve the problem and improve people’s lives?
Strategic approach begins with CLTS triggering activities in Kapuk village, due to the fact that success of the program is highly influenced by the knowledge, attitude and action to change their improvidence defecation behaviour to toilet defecation behaviour. A strong commitment of the community should be constructed so that they are encouraged to build the infrastructure supporting behaviour change. To construct the commitment these CLTS triggering steps should be applied as follows: 1. The formation of integrated team The team consists of the Health Office Environmental Restructuring, Sanitarian and Head of Bakam’s Primary Health Care, Head District of Bakam, Welfare Division Head of Bakam district, Head of Bakam district Communication Forum, Head of Kapuk Village and Head of Healthy Village Working group. 2. Problem identification and sanitation condition mapping. Problem identification starts with gathering the community who do not have a toilet and therefore have improvidence defecation behavior, as well as community representatives who have and utilize toilet at home. Afterwards, the facilitator facilitates the community to map the sanitation condition. The facilitation is done by using available resources such as branches or twigs, leaves, sago and any other things used to symbolize the toilet and improvidence or open defecation location. From the mapping result, then the community is facilitated to count the amount of feces produced each day, each week, each month and each year. This is to give the picture of how big is the level of environmental pollution as well as how big is the risks for the community to be ill/sick because of the feces. 3. Transeck Walk and Focus Group Discussion especially for women. Transeck walk is done together with the community to dig up the awareness of the ODF doers. Transeck walk has the purpose to see and find out the location frequently used for defecation. By inviting the community to the location and having an on-the-spot discussion, it is hoped that the community would feel disgusted and would feel embarrassed Next is to facilitate the community to see the process how their feces pollute their source of water, how it is infested with flies which might create disease and sickness and how itthreats the people from diseases sourced from and/or directly infected by the feces such as diarrhea, dysentery, typhoid, and even polio, or other indirect threats of open areas such as woods, river and other improper place for defecation because these places are prone tothe bite of vector mosquitos such as malaria, filariasis, dengue fever etc., animal attacks, sexual harassment and abuses. 4. Problem solving innovation. The facilitator will then introduce a Sanitation Production Center located in Puding Besar village. The location of the production center is just 15 minutes away from Kapuk village. This production center sells a cheap cement closet of US$ 3.72 and a slab of US$ 7.45 so that with US$ 11.18 the community could have a toilet. For the toilet house/shed is up to the independency of the community. For those who are economically better may build a permanent toilet house or shed, where the low economic level may temporarily utilize woods, bamboo, plastic, etc. The simple direct plunge system at least has met the SDGs terms where feces do not contaminate the water and are not disposed improvidently.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The initiative to implement toilet community social gathering in Kapuk village was an original innovation that had never been applied anywhere else in Indonesia. The initiative has given contributions of toilet coverage in Kapuk village from 33.02% to 100% in the very same year (2011). The MDGs target achievement did not have to wait until 2015 dan the SDGs target has also been fulfilled. The initiative was driven by housewives, where their contribution started from the planning up to the construction stage. This is as a form of women emancipation and participation in Kapuk village in community based health development. The Kapuk village community has declared ODF on 12 November 2011, which was on the same date as the 47th National Health Day. The uniqueness of the innovation is because it was initiated by the Bangka District Health Office by leading the community in Kapuk village, especially women through community empowerment process in solving their problem, where the toilets produced were family toilets instead of public toilets; therefore there are senses of belongings among the community. During the monitoring stage up to this moment, the community of Kapuk Village has been able to sustain the culture of toilet defecation behaviour.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The main stakeholder involved in the implementation of the innovation is the Health Office of Bangka Regency c/o.its Environmental Restructuring section, subsection of Disease Prevention and Control, with its networks, the Head of Bakam Public Health Center and the Sanitarian of Bakam Public Health Center. There are 66,51 % of the Kapuk village community who directly receive the benefit of this innovation and experience the advantages of toilet defecation. The recipient community of the indirect advantages is of 100% of the Kapuk village community in the form declining number of diarrhea and malaria.
 6. How was the strategy implemented and what resources were mobilized?
The action plan factors developed to run the strategy are as follows: 1. Empowering the coordinating team of CLTS trigger by socializing the CLTS to related inter sectoralas the member of AMPL working group of Bangka Regency such as Local Develompment Planning Agency/BAPPEDA, Village Community Empowerment Agency/BPM-Pemdes, Environmental Agency/ Badan Lingkungan Hidup and District heads in Bangka Regency 2. Since CLTS trigger, in relation to behavior change, needs time and repeat actions, Bangka Regency helped some trigger team by conducting CLTS training for the head of Public Health Centre, the sanitarian of Bangka Regency, Heads of district Communication Forum, head of healthy village working group, and integrated health service (posyandu) 3. In 2012-2016, Health Agency of Bangka Regency consistently allocated fund on CLTS Trigger in villages throughout Bangka Regency 4. Replicating simple toilet community social gathering method in targeted areas of CLTS trigger such as Sinar Baru, Air Duren, Keceper, Pemali, and Tiangtarah sub districts. 5. Up to 2016, some ODF sub districts had replicated and declared as ODF villages. They were keceper, Air duren, , and TiangTarah sub districts 6. The MOU Implementation of Bangka Regent and 0413 Military District Commander was held in September 2015. The first step of it was CSR fund raising for family toilet building for 200 families. 7. Monitoring and evaluation Monitoring and evaluation were regularly carried out in the villages that have declared themselves as ODF. The result was that this monitoring and evaluation program was a success 8. In 2015 there was an MOU between Bangka Regency and Pangkal Pinang military district commander regarding the target achievement fastening for toilet access, slum areas, and 100 percent drinkable water of 2019 as stated in President Jokowi’s program nawacita. This MOU was prioritized on Family toilet. In order to achieve the ODF regency 2019 What resources were used in this initiative how they were mobilized? Finance resource: The fund for CLTS trigger, monitoring and evaluation was purely taken annually from regional budget allocated in Health Office Environmental Restructuring Health Office Bangka Regency. The fund for trigger, supervision, and monitoring in district level, was taken from BOK Public Health Clinics Human Resource, CLTS trigger team was coordinated by Health Office Environmental Restructuring Health Office Bangka Regency together with the head and the sanitarian of Public Health Clinic. They were also supported by parties from district level. The actors of simple simple toilet community social gathering were the triggered housewives. Technical resource involved in this program was Central Production of Santitation in Puding Besar, Pemali, Gunung Muda sub districts. The central production of sanitation produced cement closet. The other resource was material shops that have provided lower price. The natural resources used were sand, bamboo, and woods which are easily accessible.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The prime idea of Arisan Jamban was originally initiated by the integrated team of CLTS trigger; nevertheless, this program was formed to inspire social empowermentgiving a notion as if the movement came to be spontaneously proposed by the locals, especially the women The main actors are the local women supported by the local government which includes village apparatus to structured levels of regencies, namely Head of Village, Head of Local Working Group, Village Health Community, Head of district, Head of Social Welfare Section, Subdistrict Communication Forum of Health, Local Development Planning Agency, Village Community Empowerment Agency and prominent natural leaders among the society. Natural leaders of Kapuk Village are those who belong to Heads of district Communication Forum of Health whose were responsible for supervising and motivating casual activities related to Simple Toilet Community Social Gathering and mutual cooperation in building sanitation. The other group involved in this breakthrough is village subfield officer of Environment Health of Centre for Sanitation Production trained in the previous years to build closets, rings of wells and slab to be further sold at reasonable prices to society.

 8. What were the most successful outputs and why was the initiative effective?
The followings are concrete outcomes of Simple Toilet Community Social Gathering‘s regular activities : 1. The Certificate of Village Declaration (ODF) at Kapuk and Air Duren village and Keceper Hamlet. 2. The Regional Regulation of Bangka Regency Numbered 5 of 2016 3.The Policy of Regent of Bangka Regency: Circular Letter of Bangka Regent Numbered: 443. 5/1290/SE/KES/2015 concerning Attainment Acceleration of Village/Urban Village ODF (OpenDefecations Free) and Proposal of Bupati Regent to boards/committee of companies in Bangka Regency numbered 500/1775/VI/2015 concerning the solicitation of CSR corporate funds to support Healthy Environmental Development activities (Building Family Sanitation) 4. The Policy of the Head of Bangka Regency Agency: Instruction of the Head of Health Agency of Bangka Regency numbered 443/5/287/Kes 2011 concerning the formulation of CLTS Pioneer Team in Bangka regency; Circular Decree of the Head of Health Agency of Bangka Regency numbered 188.41/1117/Kes/2015 concerning Structures of STBM Working Team of Health Agency of Bangka Regency numbered 443/5/3132/Kes.2015 concerning Village ODF of Bangka Regency which applied up to 2015. 5. MOU between Bangka Regency and 0413/Bangka Military District commander No: 600/879/DPUP/2015 and No: B/529/III/2015 concerning Cooperation program on supporting the environment sanitation input. The concrete outcomes of “Simple Toilet Community Social Gathering” are mostly the applications of Sustainable Development Goals (SDGs) which mainly focus on goal 6 related to Clean Water and Sanitation, comprehensively covers point 2 that is to help society achieve proper accesses to sufficient sanitation and cleanliness for everyone, as well as diminish improvident defecation, while paying special attention to female needs and fragile groups of people.

 9. What were the main obstacles encountered and how were they overcome?
The main obstacles can be categorized as follows: First, To change the people’s behaviour and to change thier mind-set from BABS to BAB in latrine main constraint is hard is revamp society behaviour, revamp mind set society to revamp their wont from open defecation goes to CHAPTER to go to toilet. If the will to change is not strong the the people do not want to perform “Simple Toilet Community Social Gathering”. The effort made was by utilizing triggering elements, such as health, religion and privacy. Second, People’s behaviour towards by subsidy and hiding behind poverty. Eventually, income of Bangka District’s people is slightly higher than other surrounding regions. In the year 2011 the people’s income from mining sector (inconventional mining) is quite high. Each Head of Family can earn US$ 3.72 up to US$ 18.63 per day, So, if people pretending that they do not have money to participate in the simple closet lottery program, this is the only way not to say that they have not change their mind yet. Effort that has been made by showing them the succsess of CLTS program in states like India and Bangladesh and by compare other regions daily income with theirs. THIRD, Part of the society has the intention to make latrine but wants to firstly gather necessary fund, because they want to have lavish latrine that cost > US$ 223.6 It gives impression that they want delay to make toilet and persist to open defecation. Efforts have been made by providing them with optional toilet and its cost so that they can build a toilet.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Several positive impacts: 1. Increasing toilet coverage in Bangka Regency 2012: 79.84%. 2013: 83.75% 2014: 85.73%, 2015: 85.83%, 2016: 86.41%. 2. Decreasing diarrhea cases number in Bangka Regency, from 3. 552 cases in 2011 to 1,373 cases in 2016 3. Decreasing malaria cases number in Bangka Regency, from 2, 253 cases in 2011 to 193 cases in 2014. Bangka Regency has attained MALARIA ERADICTION level. 4. Increasing Life Expectancy Age from 67.64 years in 2010; 67.64; in 2011: 68.08; in 2012: 70.40; in 2013: 70.45; in 2014: 70.47; and 70.51 in 2015: 5. Increasing Human Development Index/HDI from 72.50 in 2010: 72.64 in 2011: 73.35 in 2012; 73.67in 2013; 74.1 in 2014; and 74.54 6. Increasing cumulative number of Open Defecation Free (ODF) in Bangka Regency, which is in 2012: 2 villages; in 2013: 5 villages and in 2014: 10 villages, namely Pagar Alam, Air Durian, Dwi Makmur, Karya Makmur, Kace Timur, Marasenang, Bukit Betung sub-district, Srimenanti sub-district, Aik Ruai and Kapok. Convenient and healthy to toilet defecation behavior. Real example. Before has toilet, if grandma Nisa wants to defecate she has to carry one pail of water to the bush about 50 meters from the back of her house. While walking to the bush there was risk of her to fall off or bitten by animals such as scorpion etc., due to dirty pathway condition from her house to the bush. While defecating she is possible to be bitten by mosquito can be malaria vector. The excrement produces disgusting odors and in rainy days it will scatter every where and possible contaminate water source. When triggering Community Lead Full Scale Sanitations, grandma Nisa was so excited to follow Arisan jamban because she felt the diffulties to defecate in the bush, especially at night. She had to use palstic bag for keeping her excrement then discarded it the next day. (in local language it is known as helicopter toilet/Urinoir). After following Simple toiled community social gathering and a toilet was constructed by mutual aid of the neighbours not too far away from her house, grandma Nisa felt more comfortable and kept the toilet always clean.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Before Simple Toilet Community Social Gathering Innovation 1. Toilet coverage in Kapok village was 33,02% 2. Toilet coverage in Bangka Regency in year 2011 was only 76,07% 3. Total Open Defecation Free (ODF) villages of Bangka Regency was 0 (Zero) 4. Cases of Diarrhea in Bangka Regency in 2011 was 3.552 cases 5. Cases of Malaria in Bangka Regency in 2011 was 2.253 cases 6. Life Expectancy Age in 2010 was 67,64 7. Human Development Index of Bangka Regency in 2010 was 72,50 After Innovation of Simple Toilet Community Social Gathering Innovation 1. Toilet coverage in Kapok village increases to 100% 2. Toilet coverage in Bangka Regency in 2014 significantly increases to 85.73% 3. Total Open Defecation Free (ODF) villages of Bangka Regency in 2014 were significantly increased to 2 ODF sub-districts and 8 ODF villages. 4. Cases of Diarrhea in Bangka Regency in 2014 decreased significantly to was 1,373 cases. 5. Cases of Malaria in Bangka Regency in 2014 decreased significantly to 193 cases 6. In 2014 Bangka Regency attained the level of MALARIA ERADICTION 7. Life Expectancy Age in 2014 increses to 68.33. 8. Human Development Index of Bangka Regency in 2014 increses to 74,54

 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)
The group that most benefitted from this innovation was group of women, especially of the poor group. By defecating in a toilet the female group could avoid the risk of contracting diseases and also from sexual abuse and rapist. Other group that also benefitted from toilet defecation behavior was children and elderly. Children and the elderly will be avoided from the threat of diseases originated or transmitted directly from the excrements such as diarrhea, dysentery, typoid and even polio, and indirectly malaria, filariasis, dengue etc. This group will also be stayed away from other threat such as bitten by noxious animals. On indigent group, even though they are short economically, but they have the rights to access to basic health, especially to toilet and sanitation.

Contact Information

Institution Name:   Health Office of Bangka Regency (Dinas Kesehatan Kabupaten Bangka)
Institution Type:   Local Government  
Contact Person:   Nora Sukma Dewi
Title:   Sinovik's Administrator  
Telephone/ Fax:   +6271792102
Institution's / Project's Website:  
E-mail:   putrisekar32@gmail.com  
Address:   Jalan Jend. A. Yani Jalur II
Postal Code:   33215
City:   Bangka
State/Province:   Bangka Belitung Island

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