Scaling Up Indonesia's Rural Sanitation Mobile Monitoring System Nationally
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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
9107-WSP Indonesia.pdf 1 12/15/14 12:20 PM
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
9107-WSP Indonesia.pdf 2 12/15/14 12:20 PM
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
9107-WSP Indonesia.pdf 3 12/15/14 12:20 PM
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
9107-WSP Indonesia.pdf 4 12/15/14 12:20 PMScaling 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
9107-WSP Indonesia.pdf 5 12/15/14 12:20 PM6 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
9107-WSP Indonesia.pdf 6 12/15/14 12:20 PMScaling 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
0
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DEM
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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 PM8 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.
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Kar, Kamal, and Robert Chambers. 2008. Kumar, C. Ajith, and Upneet Singh. About the program
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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
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Jakarta: MOH Indonesia. STBM Secretariat, Directorate General the supply of sanitation products and
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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
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