Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally

 
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Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally
WATER AND SANITATION PROGRAM: LEARNING NOTE

        Scaling Up Rural Sanitation

        Scaling Up Indonesia’s Rural Sanitation Mobile
        Monitoring System Nationally
        December 2014

                                                                                          KEY FINDINGS
        INTRODUCTION
        More than 101 million people in Indonesia—41.2 percent
                                                                                         • A structured approach, which allows for adjustments
        of the population—lack access to improved sanitation that
                                                                                           and improvements to be made, is needed in order
        hygienically separates excreta from human contact. More than                       for real-time village data mobile monitoring to scale
        half of those individuals live in rural areas. The Government                      up from 2 to 119 districts in three years and all 500
        of Indonesia has addressed this lack of access through a                           of Indonesia’s districts by 2015.
        community-based total sanitation program that includes demand                    • A national harmonized approach to rural sanitation,
        creation, supply strengthening, and enabling environment                           with sector-wide objectives and monitoring framework
        support. Called Sanitasi Total Berbasis Masyarakat (STBM), the                     is necessary for scaling up data collection.
        program started with a pilot in 2005 in six districts. Following                 • Utilizing multiple data verification systems helps
        the successful demonstration of the program’s ability to improve                   ensure data accuracy.
                                                                                         • To increase the use of the monitoring system as
        sanitation coverage, the pilot was scaled up, province-wide, to
                                                                                           a management tool for programming, feedback
        all 29 districts in the Province of East Java, home to more than                   loops, a larger set of customized data information
        38 million people. The program continued to show successful                        tools, and channels to reach specific target users
        results, so in 2008 the Ministry of Health1 issued a national                      could be explored.
        decree endorsing STBM as the national strategy with five pillars:

            1. Open defecation free (ODF) communities2
            2. Handwashing with soap                                                   sanitation targets and has plans for countrywide activities in
                                                                                       20,000 villages.
            3. Safe and sustainable household water supply for
               consumption
                                                                                       The Government of Indonesia found that having limited data
            4. Safe disposal of household solid waste                                  on rural sanitation access and hygiene behaviors created
            5. Safe treatment of household waste water.                                challenges in designing, implementing, and funding these
                                                                                       interventions. In 2009, with the support of the World Bank’s
        In 2014, the Ministry of Health issued operational guidelines3                 Water and Sanitation Program (WSP), the Ministry of Health
        further detailing how the strategy is to be implemented,                       conducted a pilot to monitor rural sanitation in two districts
        and US$9.5 million was allocated for STBM at the national                      in East Java using a mobile phone Short Message Service
        level as its operating budget. STBM has set nationwide                         (SMS) text-monitoring (mobile monitoring) system. The

        1
          Ministry of Finance, Indonesia 2008
        2
          Open defecation free (ODF) communities are those in which no one defecates
          in public and all community members have access to some form of latrine or
          toilet.
        3
          Ministry of Health, Indonesia 2014

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Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally
2    Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally                                 Scaling Up Rural Sanitation

        initiative showed that community progress toward becoming                total, team members spoke to over 170 stakeholders. This
        ODF and changes in household access to improved sanitation               research then informed the adjustments and improvements
        could be collected through SMS sent from mobile phones and               made while further scaling up the system nationally.
        stored in a district-level database (see Mukherjee 2011). After
        a stakeholder meeting at which the pilot was presented, the              FINDINGS
        Government of Indonesia requested assistance to conduct                  While improvements were made since the initial pilot in 2009,
        a phased expansion of the mobile monitoring system.                      the team found certain challenges of the system in new
        Motivation for the scale up came from the mobile monitoring              locations similar to those found in the initial pilot (Mukherjee
        pilot’s success, the scaling up of STBM nationwide, and the              2011), and some new challenges relating to the national
        desire to have data to track the Millennium Development Goal             scale up. This section discusses the system changes made
        (MDG) related to sanitation. In 2012, the mobile monitoring              in response to these challenges, such as: data collection
        system was expanded to all 119 districts and cities in five              protocol, verification of data, hardware investments, staffing
        of the country’s provinces, covering approximately 36 million            capacity, incentives dissemination, and usage.
        households and 123 million individuals. The current rollout
        plan aims to reach all 500 districts in 34 provinces in the              Data Collection Protocol: Roles and job descriptions
        country by December 2015. As of August 2014, the mobile                  are clarified and reflect the responsibilities for routine
        monitoring system is functional in 20 provinces.                         data collection
                                                                                 Similar to the pilot and other previous monitoring systems,
        PROBLEM STATEMENT                                                        the mobile monitoring system records village-level data. The
        To monitor progress toward national targets, the STBM                    number of rural households using each type of sanitation is
        program is scaling up a mobile monitoring system countrywide.            recorded based on the STBM standard definitions: improved
        This learning note documents the typical challenges faced                latrines, semi-permanent latrines, shared latrines, and open
        when scaling up a mobile monitoring system. It also documents            defecation in villages. In addition, a community’s progress
        improvements the government has made to the system and                   towards ODF status is recorded. This village-level data is
        lessons learned while embedding it in existing government                then compiled across subdistricts, districts, and provinces.
        institutions. While country and institutional contexts differ,           However, who collects the data has changed between the
        these emerging learnings aim to help other countries wishing             pilot and scale up. In the pilot, data collection started with
        to introduce or expand similar monitoring systems.                       the creation of a village-level community map during the
                                                                                 Community Led Total Sanitation (CLTS) triggering process (Kar
        ACTION                                                                   2008). A community leader was identified to assist with data
        To identify improvements since the first 2009 pilot and                  collection and reporting. The community leader would send the
        document lessons learned during the scaling up of the                    results of the community mapping process to a district gateway
        mobile monitoring system, a WSP team conducted qualitative               server via two initial text messages. The first message would
        research at the subdistrict, district, and provincial levels in          state the total number of households in the community. The
        2014 in three locations in Pemalang, Semarang, and Brebes                second message would define the baseline situation, by stating
        in Central Java. Team members interviewed individuals one                the number of households using unimproved latrines, improved
        on one, in small groups and in larger group settings, and tried          latrines, shared latrines, and open defecation. Later changes in
        to get viewpoints on the functioning of the monitoring systems           the sanitation status of households in the community were sent
        from a wide array of stakeholders, including midwives,                   through additional messages either by the sanitarian during
        community members, sanitarians,4 clinic staff, and public                regular visits to the community or directly by the community
        works, home affairs, and health department employees. In                 leader. During the scale up, the roles and official job descriptions
                                                                                 have been changed to make the data collection more routine
                                                                                 and to increase clarity on who has responsibility to collect the
        4
            Rural sanitation officers, called sanitarians are employed by the
            District Health Office at each sub-district level in Indonesia.      data. A district health officer enters all the baseline data for all

                                                                                                                                         www.wsp.org

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Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally
Scaling Up Rural Sanitation                                    Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally 3

                                                                                 Fourth, when a community reports that all households have
                                                                                 improved sanitation and the community wants to be declared
                                                                                 ODF, a verification team makes a final trip.

                                                                                 Institutional Arrangements: National government
                                                                                 takes lead role in data analysis and dissemination
                                                                                 During the pilot, most of the responsibility for the mobile
                                                                                 monitoring system rested with the district government.
                                                                                 Although the district and subdistrict still do most of the data
                                                                                 collection and verification, during the scale up, the central
           Ibu Setiowati Budi
          Utami sending data                                                     government plays a major role in coordination and leads
             in Banjarnegara,                                                    data dissemination and analysis. In addition, the central
                 Central Java                                                    government maintains the website. Figure 1 shows the roles
                                                                                 and responsibilities of the different levels of government
        villages within the district and the sanitarians send the updated        related to data collection.
        progress reports via text message. In large villages with difficult-
                                                                                 Hardware Investments: National scale up requires
        to-reach areas, the subdistrict sanitarian may still work together
                                                                                 national government to invest in hardware and software
        with a local midwife, village chief, or health cadre to collect the
                                                                                 while keeping costs low at district level
        data, but ultimate responsibility lies with the sanitarian. These
                                                                                 In order to scale up the system nationwide, the national
        updates are intended to be sent during routine village visits,
                                                                                 government had to invest substantially in appropriate
        which should occur once or twice a month to complete other
                                                                                 hardware, software, and phone credit whereas the district
        job responsibilities.
                                                                                 government only had to invest in limited hardware and
        Data Verification Process: Automated error messages,                     operating costs. In the 2009 pilot, messages sent by
        random spot-checks and ODF verification field visits are                 sanitarians or community leaders were received by a district
        used to validate data accuracy and reliability                           gateway server as well as the central server of the STBM
        Since the initial pilot, the data verification process has been          program secretariat. Currently, an upgraded central server5
        improved for better accuracy in four ways. First, the current            is used and district gateway servers are no longer needed.
        system automatically sends a response text message back                  To minimize costs, open source software programs (such
        anytime data is submitted. The response text message lets the            as PHP, MySQL, and Gammu) are used. In the scale up,
        individual who sent the data know if the information sent was            the national government has also allocated funds to pay for
        correct or had errors. If the data has errors, the response text         the telecommunication cost of the automatic responses. To
        message will indicate what was wrong. Typical errors include             scale up, districts have had little need to invest in hardware
        SMS structure is incorrect, phone number of individual sending           as the only hardware needed is a mobile phone and text
        the message is not registered, village code does not match               message credit. Most staff already have access to a mobile
        records, baseline data has not yet been entered, or data is              phone. This mobile phone can be a very simple model with
        inconsistent with previously received data. Second, the district         a number keypad; there is no need for a smartphone.
        health center and subdistrict sanitarians make verification visits       Although some districts pay for phone credit to send text
        to the communities and carry out random spot checks at the               messages, many do not as credit for messages is often given
        household level to assure validity of the community data. In             free when purchasing call time.
        some cases, this occurs multiple times a month when staff go to
        villages for other related job tasks. Third, when a village, district
        or city approaches 100 percent open defecation free status in
                                                                                 5
                                                                                     That server contains an Intel Xeon processor and a GSM multiport
                                                                                     modem. The server also includes 32 gigabytes of memory, more
        the system, local stakeholders are notified to confirm the status.           than double the memory capacity during the pilot.

        www.wsp.org

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Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally
4    Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally                                                   Scaling Up Rural Sanitation

        Figure 1: Data flow process through the different levels of government in Indonesia

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        Staffing Capacity: Structured training and back-up                                    the national level, training has been conducted to ensure
        support is provided for primary data collectors                                       the responsible team in the Ministry of Health can manage
        Hardware investments are easily addressed compared to the                             both the hardware and software. Capacity building is also
        staffing, capacity, and incentives required to actually make the                      needed for personnel directly responsible for data collection,
        system work. Initial investigations into why not all sanitarians                      maintenance, and analysis. Currently, a cascading approach
        were submitting data revealed that some sanitarians are not                           is used whereby the district environmental health officer,
        familiar with sending an SMS, ask younger family members to                           who is responsible for monitoring in the district, is trained in
        send SMS, find it hard to find time to validate the data given                        all aspects of the mobile monitoring system. These officers
        by the community, forget the village ID numbers, do not have                          then train the 20 to 40 sanitarians (and supporting data
        good phone signal, do not have a mobile phone, are “lazy,”                            collectors) in their districts and become resource persons for
        or prioritize other work.6 To address this, knowledge transfer                        the sanitarians who may have questions and need back-up
        has been required for data collection and management. At                              support to adequately use the system. Training of trainers
                                                                                              was held for 34 provinces, during two training events in South
        6
                                                                                              Sulawesi and East Kalimantan, in March and May of 2014,
            Workshop reports from Nusa Tenggara Barat (NTB) and Jawa Tengah (Central
            Java) provinces.                                                                  respectively.

                                                                                                                                                           www.wsp.org

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Scaling Up Rural Sanitation                                  Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally 5

                                                                                  As of August 2014:

                                                                                  • 3,787 of the 10,559 health center sanitarians in the
                                                                                    country have sent village sanitation data via SMS
                                                                                  • 800 to 1,000 messages have been received per
                                                                                    month by the central server
                                                                                  • 50,850 messages with data have been collected
                                                                                  • Data for 20 provinces, including 40,470 villages and
                                                                                    42.9 million households, have been uploaded into
                                                                                    the mobile monitoring system

                                                                               and evaluation system data is housed on the existing STBM
        Training of SMS-based monitoring system for data collection            website, which already attracts sanitation stakeholders by
        in Buleleng, Bali                                                      posting articles and displaying comments entered through
                                                                               social media sites such as Facebook and Twitter. District and
        Incentives: Recognition and incentives are designed                    provincial level staff can log into the monitoring website to view
        to improve data collection                                             recent SMS entries and errors or enter additional information
        To encourage staff to send data after being trained, groups            only available to those with a password, such as monitoring and
        at the national, provincial, and district levels are exploring         evaluation training participants.
        incentives to further motivate staff to submit data. At the
        national level, the task has been added to the official job            Data Usage: Data can be used as a program
        description of sanitarians and the website lists the top users         management tool to improve service delivery
        each month. In West Tenggara Barat and Central Java                    Similar to the pilot, user feedback has been generally very
        provinces, the employee “performance indicators” have been             positive at all levels. Sanitarians, district staff, and their superiors,
        adopted to include data submissions. In one district in West           are quite satisfied with the mobile monitoring system and
        Java, staff can receive a prize, such as a new mobile phone,           reported that they valued the digital form of the data, saved time
        if their name appears as top performer on the website.                 on cumbersome paper-based data collection, improved regular
                                                                               data flow, and eased data usage. During both the pilot and the
        Data Dissemination: Data is hosted on STBM national                    current scaling up of the mobile monitoring system, use of the
        website and accessible to the wider public                             data has been manifold at all levels of government to improve
        The current mobile monitoring system allows for easier                 performance. National government officers reported that the
        dissemination of data. During the pilot, the data was kept offline     mobile monitoring system is becoming more accepted as a way
        in a local computer at the district level, but now the data is         to obtain updated, more valid data on the sanitation situation in
        openly accessible to anyone. Seconds after receiving the data          rural areas to assess which areas need more assistance and
        and carrying out automatic validity checks, the STBM program           which excel at service delivery. District health officers report
        office displays the data on its website (http://stbm-indonesia         using the data to justify budget requests for rural sanitation. Two
        .org/monev/). The website has a number of graphic interfaces,          district health officers at different clinics in Pemalang, Indonesia,
        including tables, maps, and graphs, to display the regularly           even reported using the data to calculate the potential market
        updated rural sanitation data (See Figures 2–4). In the pilot,         in their respective areas to encourage entrepreneurs to get
        the data was immediately available only to some stakeholders           involved in sanitation marketing in their area. In total, during the
        with system access, but now the information is available               period July 2013 to July 2014, an average of about 4,500 users
        without restrictions to anyone with an Internet connection. The        per month and 15,131 page views were tracked; 38 percent of
        information can also be analyzed at the national, provincial,          these are returning visitors. This number is still modest, as not all
        district, or subdistrict level. To increase traffic, the monitoring    sanitarians have access to or are familiar with the Internet, but is

        www.wsp.org

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6       Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally                                                                                    Scaling Up Rural Sanitation

        Figure 2: Table of baseline and progress access to sanitation differentiate by improved sanitation, unimproved
        sanitation, Shared sanitation, and Open Defecation per province as presented on the STBM website. The far right
        column shows consistency (green bar) and completeness/progress entry of the data (blue bar).
                                                                                                           NASIONAL

                                              Identitas Data
                                                                                                                                                                 Kemajuan
                                    (Data aktual ter-entry/Data of BPS)                                  Baseline
                                                                                                                                                                 (Progress)
                                      (Data Identity (actual/census))
                     Nama
                    Provinsi   Jumiah                                            JSP         JSSP                   BABS                    JSP         JSSP                   BABS                        Status Data
          No                                Jumiah       Jumiah                                                                   %                                                          %
                               Kab/Kot                                                                Sharing                                                    Sharing
                   (Name of                   Kec       Desa/Kel    Jumiah KK (Improved) (Unimproved)               (OD)        Akses    (Improved) (Unimproved)               (OD)        Akses          (Data Status)
                   Province)    (No. of
                                            (No. of      (No. of    (No. of HH)                                                Jamban                                                     Jamban
                               districts/                                         KK          KK        KK            KK                     KK          KK        KK           KK
                                          subdistricts) villages)                                                             (% access)                                                 (% access)
                                cities)                                          (HH)        (HH)      (HH)          (HH)                   (HH)        (HH)      (HH)         (HH)

                                                                                                                                                                                                                          9
                  DI
            1                     5/5        78/78      438/438     1.073.724/   813.930     143.517      55.921    60.356      94.51     841.236      135.538       46.593   50.357       95.36                          9
                  YOGYAKARTA
                                                                    1.039.754
                                                                                                                                                                                                      0              100

                                                                                                                                                                                                                          1
            2     BALI            9/9        57/57      716/716      994.722/    765.563      34.029      84.774    110.370     88.15     769.883      34.052        85.110   105.691      88.75                          1
                                                                    1.088.136
                                                                                                                                                                                                      0              100

                                                                                                                                                                                                                          9
                  JAWA
            3     TENGAH        35/35        573/        8.577/     9.857.367/   4.652.067   1.532.796    783.199 2.889.305     69.52    5.110.840   1.541.705       896.621 2.309.547     75.63                          9
                                             573         8.577      9.670.054
                                                                                                                                                                                                      0              100

        JSSP = Jamban Sehat Semi Permanen (Semi-Permanent healthy toilet); JSP = Jamban Sehat Permanen (Permanent healthy toilet); BABS = Buang Air Besar Sembarangan (Open defecation);
        KK = HH (Household)

        expected to grow over time with increasing mobile Internet use.                                             A national harmonized approach to rural sanitation,
        Whereas 78 percent of households in Indonesia have access to                                                with sector-wide objectives and monitoring framework,
        an Internet-capable mobile phone, only 21 percent of consumers                                              is necessary for scaling up data collection. Currently,
        reported they had used the Internet in the past 12 months when                                              the Government of Indonesia has a national strategy that
        surveyed (Nielsen 2011).                                                                                    includes a national programmatic approach. Districts using
                                                                                                                    the approach share the same objective, namely to reach
        KEY LESSONS                                                                                                 100 percent ODF and are therefore interested in collecting
        Several changes, discussed above, were made during the scale                                                and monitoring similar data. A national harmonized approach
        up of the monitoring system, and there will likely be additional                                            also enables the national government to take the lead
        changes as the scale up continues nationally. The key lessons                                               in data storage, analysis and dissemination, and enable
        from the experience of going from a pilot monitoring system in                                              standardized capacity building while still allowing districts to
        five districts to a system in 20 provinces are summarized below.                                            explore different incentive options.

        A structured approach, which allows for adjustments                                                         Utilizing multiple data verification systems helps ensure
        and improvements to be made, is needed in order for                                                         data accuracy. Although technology does speed up the
        real-time village data mobile monitoring to scale up from                                                   availability of information, the quality and reliability of data
        2 to 119 districts in three years and eventually all 500 of                                                 needs to be verified. The government’s commitment to
        Indonesia’s districts by 2015. It was helpful to conduct a                                                  accurate data, by having a mix of built-in validity checks and
        pilot to ensure that the objectives were clearly defined with                                               random verification of data at the point of collection, helps
        measurable indicators that were simple enough to be coded                                                   improve the quality of the data.
        into a text message. The structured approach for scaling
        allowed for roles and responsibilities of those collecting and                                              Use of the monitoring system as a management tool for
        transmitting the data to be clearly defined.                                                                improved programming is still limited. Although the data

                                                                                                                                                                                                          www.wsp.org

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Scaling Up Rural Sanitation                                                                                                       Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally 7

        Figure 3: Snapshot of provincial data on the website.                                                                                       Figure 4: Map generated by the mobile monitoring
        The top chart shows a summary of progress for the                                                                                           system as presented on the website. This map shows
        province of Central Java, by type of access. The                                                                                            the percentage of progress toward open defecation
        bottom chart shows the percentage of individuals with                                                                                       free (ODF) status differentiated by color gradation.
        access to sanitation by district, for each district in
        Central Java.
                                                                                    Grafik Summary Kemajuan
                                                                                     PROV. JAWA TENGAH
                                         6M

                                         5M

                                         4M
           Jumlah KK

                                         3M

                                         2M

                                         1M

                                         0M
                                              Jamban Sehat Permanen          Jamban Sehat Semi                    Sharing   Open Defecation
                                              (Permanent healthy toilet)      Permanen (Semi-
                                                                           Permanent healthy toilet)

                                                                                         Baseline      Progress

                                                                              Grafik Kemajuan Berdasarkan Progres
                                                                                      PROV. JAWA TENGAH
                                100
              Persentase Akses Progres

                                         75

                                         50

                                         25

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                                                                                       % Non Akses        % Akses

        and some analysis are available for free to anyone who visits
        the STBM website, use of the online tool by key stakeholders,
        such as government, nonprofits, and the private sector, has                                                                                 Data usage in Klaten, Central Java
        been lagging. Possible reasons for the lack of data utilization
        could be a poor understanding of stakeholder data needs,                                                                                    data can be improved so that community, subdistrict, district,
        not enough customization of data for various stakeholders,                                                                                  provincial, and national government stakeholders, sanitation
        inappropriate dissemination channels, or inadequate analysis                                                                                businesses, and the general public can increase sanitation
        capacity among stakeholders.                                                                                                                coverage. Investigations could look at how other nations’
                                                                                                                                                    governments and ministries are using social media or hard-
        WHAT ELSE DO WE NEED TO KNOW                                                                                                                copy newsletters to share information.
        As the mobile monitoring system continues in national roll-
        out, there are additional learning questions that should                                                                                    Current efforts are underway to explore incentives that would
        be explored related to data use, incentives, and system                                                                                     motivate district health officers and subdistrict sanitarians to
        expansion.                                                                                                                                  understand how data collection can be more sustainable. It
                                                                                                                                                    could be worth exploring if a feedback loop can be created
        Although some stakeholders are using results of the data                                                                                    so that administrative levels not only report data but also use
        collected, ways to analyze, customize, and disseminate the                                                                                  the information to improve planning and management.

        www.wsp.org

9107-Book.pdf 7                                                                                                                                                                                                    1/9/15 3:33 PM
8   Scaling Up Indonesia’s Rural Sanitation Mobile Monitoring System Nationally                                   Scaling Up Rural Sanitation

        Lastly, currently the mobile monitoring              Sanitation in East Java. WSP Working
        system only collects data related to one             Paper. Washington, DC: World Bank.
                                                                                                                 Acknowledgements
        pillar of the STBM program. The Ministry             http://www.wsp.org /sites /wsp.org /                This Learning Note was prepared
        of Health has expressed interest in                  files /publications / WSP-Monitoring-               by Amin Robiarto, Effentrif Sofyan,
        exploring how the existing mobile                    Information-TSSM.pdf                                Deviariandy Setiawan, Alan Malina, and
        monitoring system could be expanded                                                                      Emily Rand. The authors also gratefully
                                                             Nielsen Media Research. 2011. “The                  acknowledge valuable contributions
        to collect data for some of the other                Digital Media Habits and Attitudes of               by Susanna Smets and review
        pillars of the STBM program, such as                 Southeast Asian Consumers, October                  comments provided by Jane Bevan,
        handwashing with soap.                               2011.” New York: The Nielsen Company.               Kristin Darundiyah, James Dumpert,
                                                                                                                 Jacqueline Devine, Eduardo Perez,
                                                                                                                 Upneet Singh, and Almud Weitz.
        REFERENCES                                           RELATED READING
        Kar, Kamal, and Robert Chambers. 2008.               Kumar, C. Ajith, and Upneet Singh.                  About the program
        Handbook on Community-Led Total                      2012. You Manage What You Measure:                  Today, 2.5 billion people live without
        Sanitation. London: Plan International.              Using Mobile Phones to Strengthen                   access to improved sanitation.
        http://www.communityledtotalsanitation               Outcome Monitoring in Rural Sanitation.             Of these, 71 percent live in rural
        .org/sites/communityledtotalsanitation                                                                   communities. To address this
                                                             WSP Field Note. Washington, DC:                     challenge, WSP is working with
        .org/files/media/cltshandbook.pdf                    World Bank.                                         governments and local private sectors
        Ministry of Health, Indonesia. 2008.                 Pinto, Rebekah, Deviariandy Setiawan,               to build capacity and strengthen
        Keputusan Menteri Kesehatan Health                                                                       performance monitoring, policy,
                                                             and Ari Kamasan. 2013. Results,                     financing, and other components
        Ministry Decree No. 852/2008 Strategi                Impacts, and Learning from Improving                needed to develop and institutionalize
        Nasional Sanitasi Total Berbasis                     Sanitation at Scale in East Java,                   large scale, sustainable rural
        Masyarakat/Community Based Total                     Indonesia. WSP Field Note. Washington,              sanitation programs. With a focus on
                                                                                                                 building a rigorous evidence base to
        Sanitation Program. Jakarta: MOH                     DC: World Bank.                                     support replication, WSP combines
        Indonesia.                                           Robiarto, Amin, and Effentrif Sofyan.               Community-Led Total Sanitation,
        Ministry of Health, Indonesia. 2014.                 2011. Manual for Monitoring of                      behavior change communication,
                                                                                                                 and sanitation marketing to generate
        Health Ministry Regulation No. 3/2014.               Community Based Total Sanitation.                   sanitation demand and strengthen
        Jakarta: MOH Indonesia.                              STBM Secretariat, Directorate General               the supply of sanitation products and
        Mukherjee, Nilanjana, Djoko Wartono, and             of Disease Control and Environmental                services, leading to improved health
                                                                                                                 for people in rural areas. For more
        Amin Robiarto. 2011. Managing the Flow               Health. Jakarta: Ministry of Health,
                                                                                                                 information, please visit www.wsp.org/
        of Monitoring Information to Improve Rural           Indonesia. www.depkes.go.id.                        scalingupsanitation.

                                                                                                                 Contact us
                                                                                                                 For more information please visit
                                                                                                                 www.wsp.org or email Emily Rand at
                                                                                                                 worldbankwater@worldbank.org.

        The Water and Sanitation Program is a multi-donor partnership, part of the World Bank Group’s
        Water Global Practice, supporting poor people in obtaining affordable, safe, and sustainable access
        to water and sanitation services. WSP’s donors include Australia, Austria, Denmark, Finland, France,
        the Bill & Melinda Gates Foundation, Luxembourg, Netherlands, Norway, Sweden, Switzerland,
        United Kingdom, United States, and the World Bank.
        The findings, interpretations, and conclusions expressed herein are entirely those of the author and
        should not be attributed to the World Bank or its affiliated organizations, or to members of the Board
        of Executive Directors of the World Bank or the governments they represent.
        © 2014 International Bank for Reconstruction and Development/The World Bank

9107-WSP Indonesia.pdf 8                                                                                                                       12/15/14 12:20 PM
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