Ende Island

The First Indonesian Island to Declare Itself Open Defecation Free

POKJA
Ministry of Health Republic of Indonesia

AMPL

Ende Island
A Book for Learning

Foreword
The Ministry of Health believes that healthy and hygienic behavior is among important building blocks in forming a productive and prosperous Indonesian society. In cooperation with provincial and district level governments, the Ministry has introduced the Community-Led Total Sanitation (CLTS) program to various parts of the country. The program rests on triggering communities to take initiative and develop determination to create positive changes in regards to hygiene. It has been proven to produce sustainable results in many communities. For example, in the past three years many communities on Indonesias main islands have declared themselves free from open defecation. However, very few small island communities have been able to share in the same success. Small islands face a unique set of challenges with regard to CLTS. Among the key challenges are limited sources of freshwater and isolation from the circulation of information on hygienic behavior. These problems affect the thousands of small islands scattered across the archipelago from Sabang to Merauke, as well as other small islands outside of Indonesia. This situation makes promotion of hygienic behavior particularly difficult. The achievements in Ende Island to eradicate open defecation brings about a new sense of hope that other communities living in small islands can to start living more hygienically. The islanders enthusiasm ought to be spread to other communities; and governments at every level would do well to encourage and support them in every way necessary. This book chronicles the journey of the people on Ende Island, and offers some tips for other regions that wish to replicate the process. Publication of this book is expected to inspire both government officials and community leaders in other areas in Indonesia and beyond, particularly those working with communities on small islands. The Ministry of Health thanks all those involved in the development and execution of the CLTS program. In particular, special recognition is given to the East Nusa Tenggara Province Governor and the Ende District Head who had tirelessly promoted the program, especially with the launch of the 2015 Ende District Open Defecation Free Initiative. UNICEFs collaboration with the East Nusa Tenggara Province and especially the District of Ende and also people of Ende Island presents an exemplary mode of cooperation; one with positive and sustainable results. We hope that this will be the first of many productive ventures in the future. Happy reading, and may this book be of great use!

Acknowledgements
Sources:
The Ende District Commission C of the Regional Peoples Representative Council: Heribertus Gani, SPd; Office of Ende District Head: Martinus Ndate; Ende District Planning and Development Agency: drg. Dominikus Minggu, M.Kes, Andreas Worho, ST, MT, Erneseta Sri Say, ST, Yohanes Don Bosco, S.Sos, Maria Theresia Firmina Baru, S.Si, M.Sc, Patrisius Surda, S.Si; Department of Health for the District of Ende: Anfrina L.N. Mani, Ahmad Gunung; Indonesian Environmental Health Experts Association: Mukhsin Mustika; Central Ende SubDistrict Office: Petrus H. Djata; Ende Island Sub-District Office: Fransiskus Dadjo, AMK, Haji Ali; Rendoraterua Village: Ahmad Yusuf; Rorurangga Village: Junaidin P.S, Juleha Roja, Mashadin; Ndoriwoy Village: Rasjid Kuri, Muchsin Bone, Boro Koa, Wahab Abdullah, Kajo Abdullah, Said Ibrahim, Roswati, Sufiah A. Ma; Redodori Village: Aliasa H.A., Hamzah Parera, Abdullah Ali Jawa, Adulkadir Bahlil; Aejeti Village: Golkar Yusuf, Surafan Muhammad, Saudin Abdullah, Amir Jabir; Paderape Village: M. Abdullah; Puutara Village: Saleh, Pua Rasyid, Wahyah Darham, Ismail, Dede Broto; Puutara Primary School: Musosman; Ende Island Private Nurul Ummah Ibtidaiyah Madrasah: Maemuna Wio; Rendomaupandi Presidential Decree Primary School: Halimah Jaenab; Ekoreko Public Primary School: Nurdin Ibrahim.

Concept and Direction: Ministry of Health of the Republic of Indonesia: Wilfred

H. Purba, Zainal I. Nampira, Trisno Soebarkah, Kristin Darundiyah; The CLTS Secretariat; The National Water Supply and Sanitation Working Group; UNICEF: Nadarajah Moorthy, Juliaty Ansye Sopacua, Dormaringan Saragih; The UNICEF WES Secretariat.

Jakarta, August

th

2012

Text and Design: Qipra Galang Kualita: Isna Marifa, Laksmi Wardhani, Deasy Sekar T.
Sari and Sylvana Corputty (text); M. Taufik S (layout and graphics). English version: Isna Marifa, Omar Soemadipradja.

Minister of Health of the Republic of Indonesia

dr. Nafsiah Mboi, Sp.A, MPH

July 2012

ii

iii

Table of Content

Foreword Acknowledgements Table of Content

i ii iii 1 2 2 4 4 5 6 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

A Journey Shared
Ende Island at a Glance Box: The History of Ende Island Why Was Change Necessary? Freshwater a Rare Commodity Box: Official Definition of Outbreak Steps of The Water and Sanitation Program Built By Communities, For Communities Rorurangga Village Aejeti Village Redodori Village Ndoriwoy Village Rendoraterua Village Paderape Village Puutara Village Attention from the District Astute and Dedicated Sanitarians Friendly yet Determined Facilitators Village Head as Movement Leaders Open Defecation Patrols Religious Leaders as Message Bearers Women and Children Agents of Change Arisan for Toilets Outreach Sign-posts Village Regulations Supported by Data Declaration on Ende Island Water and Sanitation Aspirations at the District Level

A Journey
The success story of Ende Island is one worth retelling. The communities living on the island have successfully changed their defecation behavior, and declared Ende Island as the first open defecation free island in Indonesia. This achievement has prevented recurrence of diarrhea outbreaks, once a routine occurrence on the island. The changes permeated all levels society, and involved cooperation between the district, the national government, and community leaders a concerted effort that can be emulated by other regions. This section of the book recounts the experience of the Ende Island communities, along with other parties involved in the program. This section will also present the factors vital in achieving the programs success. The journey of this tiny and beautiful island can be a source of inspiration for other small-island communities in Indonesia and beyond.

Eleven Steps to Replication

Cultivate a Committed Leadership Establish the Target Area Examine Conditions of the Target Area Box: Community-Led Total Sanitation Plan the Program Box: Funding for Water and Sanitation Prepare Working Groups Promote the Program Plan Field Activities Box: Proper Defecation Prepare Village Cadres Perform Community Triggering Schedule Facilitation Box: The Sanitation Ladder Declare Free from Open-Defecation Abbreviations Bibliography

Shared

Photo: Qipra/2012/Taufik S.

iv

Ende Island at a Glance

The Island of Ende is one of twenty-one sub-districts that form the District of Ende in the Province of East Nusa Tenggara (NTT), the south-eastern stretch of islands in the Indonesian archipelago. Located west of Ende City, Ende island has an area of 63.03 square kilometers and is only accessible via a daily motor boat service. Transport on the island itself is restricted to motorcycle and pedestrian traffic, due to lack of infrastructure necessary for heavier vehicles. Currently Ende Island is inhabited by 7,786 people with a population density of 124 persons per square kilometer. The population is spread throughout seven villages, namely the villages of Redodori, Aejeti, Rorurangga, Puutara, Paderape, Rendoraterua, and Ndoriwoy. Ende Islanders have two unique traits that separate them from other communities in the province, namely their language and religion. Their everyday language, the native Bahasa Ende, is different to the language used on the main island of Flores, and the entire population of the island is Moslem, whereas the province is dominated by Catholics. The people of Ende Island are mainly dependent on fisheries for their livelihood, and their catch serves as the main source of fish in the City of Ende and its surroundings. Furthermore, Ende Islanders are known by other fishing communities in the region for their skills in crafting quality fishing boats. Aside from fishing, small-scale farming is also practiced on the island, mainly growing cassava, coconut and corn, crops that can thrive in its poor soils. With regards to water resources, the island relies mainly on wells that produce brackish water; as only one village has wells with freshwater.

INDONESIA

Province of East Nusa Tenggara

Infographic: Qipra/2012/Taufik S.

Ende Island
Sawu Sea North West South East Rorurangga

The History of Ende Island

Very few records exist regarding the early history of Ende Island. The earliest might be a quote by Sir Thomas Stamford Raffles from a manuscript by Natakoesoema (circa 1400s), who wrote in passing of the eastern territories of the Indonesian archipelago (www.portal.endekab.go.id). Several versions appear on the topic of the introduction of Islam to the island. One source attributes it to Imam Syafii, sent on mission by the Prophet Muhammad (Peace Be Upon Him) with the expressed task to introduce Islam to Ende Island. Another source credits a Palembang (South Sumatera) trader sometime during the 15th century (www.hierobokkilia.blogspot.com). The 1600s saw Ende Island becoming a colonial administrative centre following the arrival of the Portuguese to the archipelago. The Portugese erected a fort in the Hamlet of Kemo in Rendoraterua Village; only ruins remain visible today. In more recent history, Ende Island was frequented by Soekarno (who later became Indonesias first president) between 1934 and 1938, during his exile to Ende City by the Dutch colonial government. He allegedly wrote a play inspired by the island entitled Rendo Rate Rua (www.sipriseko.blogspot.com).

Profile of Ende Island

Village Rendoraterua Redodori Ndoriwoy Paderape Puutara Rorurangga Aejeti Area (Km2) 6,50 4,00 9,53 4,69 14,29 14,29 9,73 Population 996 998 1043 896 1520 912 1421
Redodori Sawu Sea

Puutara Aejeti

Sawu Sea Paderape

Rendoraterua Ndoriwoy

Sawu Sea

Why Was Change Necessary?

Prior to 2007, the District of Ende Island was known locally as Island of Disasters or Island of Catastrophes. In consecutive years, the island was hit by diarrhea outbreaks that affected hundreds on the island, usually at the end of the rainy season. The outbreaks occurred once in 2004 and 2005, and occurred twice in 2006. Children aged five years and younger were especially vulnerable to the disease, at worst making up 67% of the total patient count in 2005. Another local nickname given to Ende Island was the worlds longest lavatory. The name aptly describes a daily scene, where locals squat along the islands coastline to defecate in the open while socializing and gossiping in the early hours of the morning. Such was the custom from many generations ago. The District of Ende recognized that Ende Island had the highest prevalence of diarrhea in the district. The District Government initiated many attempts to prevent outbreaks; however, they were hindered by the limited supply of freshwater on the island. Later on, the District realized that unless reliable freshwater supplies were available, solutions for the outbreak would only be temporary.
No Diarrhea Outbreak

rough seas of the westerly wind season. The government also dug new wells on the island, but was unsuccessful as much of the islands groundwater has a high salt content. Furthermore, a Portuguese Non-Government Organization installed a desalination unit on the island, but found that the desalinated water was contaminated by high levels of E.Coli originating from human waste. As such, the only sources for fresh water on Ende Island are the wells of Ndoriwoy village. As the men of the villages are responsible for fishing and farming, the task of carrying fresh water from Ndoriwoy to the other villages is given to the women. Due to this limited access, most communities continue to use brackish water for their household needs, which include drinking water. The District of Ende recognized that improving community access to freshwater was a prerequisite to
Photo: Qipra/2012/Taufik S.

solving the problems of diarrhea outbreaks and open defecation. Thus, with support from UNICEF, they initiated the Water and Environmental Sanitation Program to effectively prevent future problems with diarrhea. Martinus Ndate

First Assistant to the District Head of Ende The data showed that the Sub-District of Ende Island suffered the worst water shortages [in the District], is frequently affected by outbreaks of diarrhea, and has the lowest per capita income in the District.

Diarrhea Outbreak Data For The District Of Ende Island (2003-2011)

2003 2004 2005 2006

2007

2008

2009

2010

2011

Diarrhea Outbreak

Official Definition of Outbreak

An Outbreak is defined as an event whereby the number of infections or deaths from a disease in one area is considered epidemiologically significant. An Outbreak is declared when the following criteria have been fulfilled: The emergence of a disease that has not been previously present in the area A continuous increase in the number of patients/deaths within 3 time periods (hours, days, weeks), according to type of the disease A rate of increase in infections or deaths double or higher compared to the monthly average in the previous year. The number of new patients in one month is two or more times higher in comparison to the monthly average in the previous year.
Source: Decision of the Director General No.451/91 (Ministry of Health, Republic of Indonesia), on the Guidelines for Investigating and Managing Outbreaks; quoted from http://www.tempo.co/reead/news/2005/09/19/05566790/Kejadian-Luar-Biasa-Apa-Artinya

Freshwater a Rare Commodity

Over the years, a number of approaches were made to improve the provision of fresh water to the communities of Ende Island. All attempts, however, failed. In 2004, the government initiated a year-long program to ship freshwater from the City of Ende on Flores Island. The program was a costly venture due to prohibitive operational costs and technical difficulties, especially during the

STEPS OF THE WATER AND SANITATION PROGRAM

The District of Ende co-operated with UNICEF to design a multi-step program using the communityled sanitation approach. The objective was to improve the sanitary conditions and freshwater access on Ende Island. The diagram below displays the process undertaken in Ende Island from its commencement to the point of ODF (Open-Defecation-Free) declaration.

Commitment at the Province

The Provincial Government of East Nusa Tenggara extended an offer to the Districts, and received proposals from interested Districts. The Province selected the location for the program, using a set of predetermined criteria.

Choose Options

8 7

The team raised the issue of access to drinking water with the communities of Ende Island. Options were offered and discussed. The community unanimously voted on building rainwater tanks. The team discussed ideas to solve the issues at hand. For Ende Island, the first issue to tackle was drinking water.

Prepare the Community

The communities were given preparations to build rainwater tanks under the guidance of trained technicians.

Open Defecation Free Declaration

16 1 5

Engaging District Level Entities

2 3 4

The Ende District Government appointed the District-Level Water Supply and Sanitation Working Groups [Pokja AMPL] to spearhead the program. Other district level agencies were given assignments.

Brainstorming

Village-Level Program Promotion

10 1 1

Declaration of Ende Island as an open defecation free zone was celebrated through a ceremony officiated by the Ministry of Health and attended by representatives from UNICEF, the District of Ende, and other parties involved in the program. To help ease the process of change in the community, the village CLTS team and the facilitators conducted activities such as competitions and outreach sessions.

Staff from the Health Department promoted the idea of building rainwater tanks in every village on Ende Island.

Facilitated Community Empowerment

Determine the Target Area

Based on health statistics, the Districts Health Department chose the target areas for the program. The Sub-district of Ende Island was selected

Team Formation

The District sets up a program implementation team, consisting of members, namely the Planning and Development Agency, the Health Department, Village Community Empowerment Board, Education and Culture Department, the Public Works Department, as well as several NGOs. Based on recommendations generated from the workshops, the University of Flores conducted research on the behavior of Ende Islanders, identifying possible approaches to trigger behavioral change.

Prepare a Community Work Plan

In collaboration with local communities, the implementation team identified problems, formed solutions, and designed a joint work plan.

Community Triggering

14 1 3

The triggering was performed by the village CLTS team, supported by the District Health Department.

Disseminate at District Level

District-level officials were invited to a series of workshops aimed at informing them of the existence and objective of the program. The workshops generated recommendations for activities.

Research on Behavior Change

Prepare Facilitators

12

The team selected and trained facilitators, tasked with convincing the communities to use only rainwater for drinking water.

Village CLTS Training

Five individuals were selected from each village to undergo CLTS triggering training. The five individuals formed the village CLTS team.

Built By Communities, For Communities

In 2006, the District government introduced the CLTS program to Ende Island. Through triggering, communities began to understand that adopting proper hygiene was essential to prevent further spread of diseases, starting from behavior as simple as defecating in the right place and washing hands with soap. The lack of fresh water for most communities, however, remained the primary challenge in changing hygienic behavior. Once the communities understood the importance of having clean drinking water, the government and UNICEF moved to help provide additional sources of fresh water on the island. UNICEF played a vital role by training villagers to construct rainwater tanks and supplying tank moulds made of FRP (Fibreglass Reinforced Plastic). The training sessions were initially held in the villages of Aejeti and Paderape, and eventually held in the other five villages. As a result, each village gained community members (technicians) who were trained to use the moulds and able to assist other families in building rainwater tanks. Villagers who wanted to build their own rainwater tanks were responsible for supplying their own building materials, namely sand, pebbles, and stones, all of which are available locally. They were also expected to provide their own labour, with guidance from the technicians. Facilitators observed the construction process and ensured that the moulds were being rotated effectively among households. Households or household groups took turns using the tank mould, in accordance with the community work plan developed. Some villages decided on building rainwater tanks for each individual household, while others built communal rainwater tanks to serve several households at once.

Latrine Construction Process

1. 2. 3. 4. 5. Prepare the construction site, building materials, and tools Position the latrine mould level to the surface of the floor Combine cement and sand Pour the mixture into the mould Remove the latrine cast from the mould

Rainwater Tank Construction Process

1. 2. 3. 4. 5. 6. 7. 8. Prepare the construction site and building materials Prepare and assemble concrete pillars Build the foundation for the rainwater tank Position the FRP mould for the tank wall Pour cement into the mould Remove the mould Position the FRP mould for the tank cover and pour in cement Remove the tank cover mould

Once the community gained improved access to drinking water, the program focused on triggering for defecation behavior. The government and UNICEF held training sessions for community facilitators and community leaders, who then relayed their new knowledge to other community members. Triggered by shame and a new understanding, the people of Ende Island aspired to have proper latrines and stop open defecation. To ensure availability of affordable latrines, UNICEF set up a latrine production centre in Rendoraterua Village. Several community members were trained in basic toilet manufacturing, thus providing the villages with additional income and strengthening their self-reliance by providing locally-made toilets. With time, as people became more familiar with the use and care of their new toilets, they gradually replaced their latrines with more sophisticated factory-made toilets, sold in the City of Ende. Now, the majority of toilets on Ende Island are store-bought from the City of Ende. BBy the end of the program, the communities of Ende Island were extremely proud with their accomplishment. Especially since the rainwater tanks and toilets were the result of their own hard work and material investment, rather than given by the government or other outside parties. Because the government and UNICEF provided only moulds, technical training, and facilitated triggering exercises, the communities developed a strong sense of ownership over their self-made facilities. This is evident in the continued use and diligent care of the rainwater tanks and toilets.

Photo: UNICEF/2012/Ansye Sopacua

Photo: Qipra/2012/Taufik S.

Rorurangga Village
Water Is No Longer Far Away
Located on the northern tip of Ende Island, the village of Rorurangga has always faced limited access to fresh water. Throughout history, this village has been completely dependent on water from Aejeti Village. To reduce that dependency, an initiative was launched in 2007 to build rainwater tanks for every household in the village. Local builders were trained in the construction of the tanks, and received tank moulds donated by UNICEF. Now, every house in Rorurangga has a rainwater tank, and the villagers are now able to enjoy their own source of fresh water. With the rainwater tanks, the Village Head explained, for the first time, we feel truly liberated. We no longer depend on other villages for our fresh water. After solving the water problem, the program concentrated on defecation behavior. Equipped with training from the District Office, Village Head Junaidin P.S. and Village Civil Defence Chief Juleha Roja went from door to door and met all families in Rorurangga to discuss and encourage changes in their defecation practices. They also used existing village forum or events to discuss sanitation and hygienic behavior. Despite initial resistance, the initiative was a success and as a result every household in Rorurangga Village has its own latrine.
Photo: UNICEF/2012/Ansye Sopacua

Aejeti Village
Initial Resistance To Change
Initially, the community of Aejeti Village resisted the Water and Sanitation Program. One of their religious leaders argued publicly against the District staff sent to the island. Undeterred, the District staff led a dialog with the religious leader that approached the subject from a religious standpoint. By discussing in terms that the religious leaders were familiar with, the District staff finally convinced them to support the program. Furthermore, the religious leaders were shown scientific data on the effects of open defecation. They were invited also to observe for themselves laboratory test results that showed the water they have been using for ablutions were contaminated by E.Coli, originating from human feces. This convinced the religious leaders of need for change in the communitys defecation behavior. The religious leaders were trained for two days by the District of Ende and encouraged to insert messages on hygiene in their sermons. After the training, sermons held at Friday prayers contained messages of sanitation and hygienic behavior. This approach was maintained until the entire community changed their defecation practices.
Photo: Qipra/2012/Taufik S.

Amir Jabir

Religious Figure
Changing age-old behavior is not an easy task, but neither is it an impossible one. As long as it is undertaken consistently and with patience, we will definitely see results.

Junaidin P.S
Village Head
I was struck and embarrassed by the label worlds longest lavatory given to my island. This motivated me to change the behavior of my community.

Juleha Roja

Village Civil Defence Chief

Changing the behavior of a community requires sacrifice, patience, and wisdom. We must first understand each familys circumstances, before we can raise the topic of toilets and defecation.

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11

Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Taufik S.

Redodori Village
The Turning Point
Redodori Village was formed in 2002 as an expansion of Ndoriwoy Village, with Aliasa H.A. Tata appointed as the first Village Head. His first challenges were to prevent recurrence of diarrhea outbreaks and ensure the communitys self-reliance for drinking water. The CLTS approach provided a turning point for the community, who realized that their situation had to be changed for the better. Facilitators tirelessly gave motivation to the adults in the community. In turn, parents and teachers taught children about proper hygiene. Village Regulations were drawn up, to allow the community to police itself against open defecation. As a result, the beach has now become a recreation center. Free from the once-common feces on the sands, the beach is now used by children and youths to play, exercise, and relax. The ocean view is exceptionally stunning especially at sunset, and now enjoyed by all.
Photo: UNICEF/2012/Ansye Sopacua Photo: UNICEF/2012/Ansye Sopacua

Ndoriwoy Village
Night Patrols Prevent Open Defecation
Ndoriwoy Village is the only village on Ende Island with its own supply of fresh water. With a total of 32 fresh water wells, it supplies fresh water to the other 6 villages during the dry season. Ndoriwoy Village also experienced outbreaks of diarrhea and other gastrointestinal illnesses. Previous attempts by the District to eradicate open defecation were unsuccessful, mainly due to the communitys limited knowledge and economic means. Behavior change only started after triggering exercises by the District government and UNICEF, and contribution of moulds for latrine and rainwater tank construction.
Photo: UNICEF/2012/Ansye Sopacua

The initiative gained momentum when village leaders began to monitor the communitys practices. Said Ibrahim, the imam of the Ndoriwoy mosque, would patrol the beaches every night. Armed with his trusty flashlight, he scoured the village coastline for people defecating. When he does find one, he shines his flashlight on them, forcing most to run off hiding their faces in shame! Rasyid Kuri Village Head
Now every house in our village has its own latrine.

Aliasa H.A. Tata Village Head

The programs triggering approach became our turning point. Prior attempts failed because the community was not triggered to change their behavior. What happened before was a lot of empty words.

Said Ibrahim Religious Leader

A volunteer who keeps an eye out for open defecators.

12

13

Photo: Qipra/2012/Isna Marifa

Photo: Qipra/2012/Taufik S.

Rendoraterua Village
Village Budget for Sanitation
Rendoraterua Village also suffered repeated outbreaks of diarrhea, with the majority of those affected being children aged five years and younger. In the past, the Village Head took initiative to build a public latrine, but was not able to motivate the rest of the community to build their own toilets. The old habit of defecating on the beach was still more popular and convenient. Progress was achieved after UNICEFs support to trigger the community. Each household was responsible for building their own latrines. While the village contributed only three bags of cement and one toilet bowl. As Village Head, Ahmad Yusuf allocated 45 percent of village funds every year to support construction costs. A further 5 percent was allocated to improve the quality of latrines. Now, every household has its own toilet and no new diarrhea outbreaks have occured. As an additional measure, the village issued a village regulation in 2009. The regulation contains sanctions agreed upon by the community. Community members caught defecating in the open would receive a warning and made to pick up and carry their feces to the nearest latrine. They would also be given a fine consisting of three sacks of cement and a latrine bowl to be used in their own house or the house of a family that does not yet possess a latrine.
Photo: Qipra/2012/Taufik S.

Paderape Village
Rainwater Tanks Shared Among Families
Despite the high population density and limited land for construction in their village, the community of Paderape were undeterred in their efforts to build rainwater tanks. With most of the houses in the village spaced very closely to each other, the community had the challenge of deciding where to place the large, space-consuming rainwater tanks. Through several meetings and discussions, the community finally decided on building communal rainwater tanks in between closely-spaced house. Rainwater gutters were attached to the roofs to direct the rainwater into the communal tanks. Sharing the tanks water supply meant that families had to

Paderape Village Administation Chief

M. Abdullah

coordinate with each other and use their allocated water efficiently. Families agreed that freshwater from the tank would only be used for food preparation and drinking. The use of communal water tanks here has worked smoothly, explained Paderape Village Administration Chief, M. Abdullah, because there is a strong sense of kinship within our community.

The communal nature of the rainwater tanks made it necessary for our village to use a different tank design compared to that in other villages.

Integrated Health Cadre

Teenage girls in Paderape Village actively participate in improving community health conditions after joining a training course held by the local integrated health services post (Posyandu).

Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Taufik S.

Ahmad Yusuf

14

We are proud that this village has 100 percent latrine access. The younger generation no longer want to defecate on the beach. On the contrary, they now remind each other not to do it.

Village Head

15

Attention from the District

The District of Endes Health Department prepared a public health profile for the province of East Nusa Tenggara. They found that diarrhea outbreaks were an annual occurrence on Ende Island. Even though medical assistance and staff were sent by the Department to respond to each outbreak, another outbreak would occur the following year. Dominikus Minggu (M.Kes), Head of Health Department at the time, realized that the outbreak problem could only be permanently solved by prevention. The first step taken by the Head of the Health Department was to raise the institutional status of the Environmental Health Section to a Sub-Division. The staff was empowered, and the Sub-Divisions funding was increased to tackle its first challenge preventing further diarrhea outbreaks on Ende Island. Staff from the Environmental Health Sub-Division was sent to visit the island. Following the visit, the staff reported drinking water scarcity in Ende. Thus the Department decided to improve access to drinking water before addressing the problem of defecation. Furthermore, the Department also added an inpatient ward and paramedic dwellings to Ende Islands sole clinic, the Ahmad Yani Clinic. This allowed islanders to have easy access to better medical facilities on the island. After success in Ende Island, the District was eager to replicate the program in other districts. They were reminded, however, that strategies in Ende Island were tailored specifically to its unique traits. In the words of the former Head of Health Department, Dominikus Minggu, The strength of program is in the process. This is not solely about building rainwater tanks or latrines; it is about building the communitys sense of ownership and responsibility over these facilities.
Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Taufik S.

Puutara Village
Community Work Plans
One of the main reasons the Water and Sanitation Program was a success was that it was tailored to the needs of the community. After receiving general description of the program, inhabitants of Puutara Village designed their own community work plan with guidance from the program team. As we were designing the community work plan, many arguments occurred among the villagers, recalls Saleh, the Village Secretary. But these arguments were resolved through dialog. The community conducted their own situation analysis and identified problems present in the village, which prompted discussions on possible solutions. Among the villagers, several individuals were chosen as members of a committee, responsible for coordinating program activities. In the process, the community also chose the form of clean water access they considered most suitable. Each household had the opportunity to voice their opinion. The community work plan proved to be a successful approach for the program. The community was able to plan its own activities and work schedule, as well gain awareness of the challenges they would face. Furthermore, involving the entire community in the decision making process and making everyone equally responsible helped strengthen relationships in the community.
Photo: Qipra/2012/Taufik S.

Saleh

drg. Dominikus Minggu, M.Kes

Photo: Qipra/2012/Taufik S.

Village Vice-Secretary
If any members of the community are caught defecating in the open, their punishment is to pick up their feces and carry it to the nearest toilet.

Head of the Ende District Planning and Development Agency

The diarrhea outbreaks were not stopped by doctors, but by the sanitarians1. The key is working at the District level. The Environmental Health unit of the District Health Department must be at right place.
1 Sanitarians refer to staff of Environmental Health units, who are trained in community outreach on environmental health issues.

Wahyah Darham

Village Cadre

16

A Village Cadre who had attended the three day Hygienic Behavior course at the District Office, Wahyah now holds information sessions every Clean Friday, with such topics as the cleaning of rainwater tanks.

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Astute and Dedicated Sanitarians

Petrus H. Djata, also known as Piet Djata, was one of the first Health Department staff members sent to Ende Island. He was well known in the Department for his expertise in sanitation and his exceptional skills in communicating health information to the community. Despite these skills, his presence in Ende Island initially drew opposition from several members of the seven villages, particularly religious leaders of Aejeti Village and Paderape Village. The first visit taught Piet that he had to find an effective entry-point to the Ende communities. He embarked upon his own research of the cultural background and attitudes of the Ende Islanders. He found that the communities were highly devoted to their religion of Islam and deeply revered their religious leaders. Piet, a Catholic, created a slogan Purify Your Land, Purify Your People. Equipped with quotes from the Quran and other Islamic teachnings, Piet began discussions with Ende Islands religious leaders. From that point onwards, Piet Djata was accepted by the religious community, and regularly received invitations to talk to Friday prayer congregations. Piets experience on Ende Island shows that a highly dedicated sanitarian, willing to delve into the local culture, is the success factor in instigating behavioral change. Furthermore, the work of the sanitarian does not stop at ODF declaration. To this day, sanitarians continue to inspect the state of each households latrines and provide consultation on illnesses caused by unsanitary behavior on the island.
Photo: Qipra/2012/Taufik S.

Friendly yet Determined Facilitators

Throughout the journey towards a hygienic lifestyle, the communities and leaders of Ende Island were able to call upon the help of facilitators at every step. Two such facilitators were Servasius Goa and Ayub Seda Gani. Servasius Goa, known also as Pak Servas, had been active on Ende Island since 2004 during trials for construction of wells and household toilet. Ayub Seda Gani, locally known as Pak Ayub, started in 2008 with rainwater tank constructions. Their easy-going attitude and perseverance earned them trust and friendship from the Ende Island communities as well as Village Heads. To this date, their presence is warmly received by everyone on the island. The experience of Ende Island demonstrates that the most effective facilitators are those who are highly dedicated and able to delve into the mindset and culture of the community they work with. As collective behavioral change is not a quick process, facilitators must be able to persevere and maintain positive communication throughout the process. The key to the facilitators success is building mutual trust with and strong ties to the community.

Photo: Qipra/2012/Taufik S.

Central Ende Sub-District Office The people of Ende Island are highly devoted to practicing their religion of Islam, so we challenged them to become Indonesias third gateway to Mecca. To be able to achieve this, communities had to leave their old habits of open defecation on the beach, which is in violation of their religions teachings. For his services, Piet was given the honorary title of Pua Haji Djata2 by the people of Ende Island.

Petrus H. Djata

Servasius Goa
The task of the facilitators during construction was to monitor which group had possession of the mould. This was done via SMS.
Photo: Qipra/2012/Taufik S.

Ayub Seda Gani

After dawn prayers, I would go to the beach. I always get a laugh whenever I spot someone about to defecate in the open, because they would scream Its Pak Ayuuuub!, and run away.

Haji is an honorific given after a Moslem has completed pilgrimage in Mecca.

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Village Head as Movement Leaders

Village Heads played a vital role in making Ende Island an open defecation free area. After the District disseminated the objectives of the program, all seven Village Heads became highly motivated to bring about changes to their communities. The Village Heads selected several community members and involved them in the program promotion and training, with the goal of engaging them in the triggering process. These individuals included religious leaders, Village Community Empowerment officials, womens rights leaders, and teachers. Together, they approached and convinced their fellow community members of the importance of hygienic living. The Village Heads also served as the main counterparts for the facilitators assigned to Ende Island. Working together they brainstormed on appropriate activities for the communities. Good cooperation and mutual trust smoothed the execution of each step. Village Heads often met initial resistance from individuals within their own communities. Reasons for resisting change ranged from monetary limitations and deep-rooted customs, to outright refusal to trust outsiders. Through patience and perseverance, however, everyone in Ende Islands seven villages was persuaded to change their defecation behavior. The Village Heads were also responsible for initiating preparation of village regulations. They convened meetings and ensured consensus was reached with community members, regarding the content of regulations. The regulations were expected to provide a foundation to ensure that behavioral changes will last indefinitely.
Photo: UNICEF/2012/Ansye Sopacua

Open Defecation Patrols

Each village created an Open Defecation Patrol (Buru Sergap Tinja), which is a group authorized by the Village Heads to perform surveillance and conduct citizens arrests on community members that continue to defecate in the open. Coordinated directly by the Village Heads, Patrol members have to be hard-working and well-liked by their community. Every Patrol consisted of: 1) a General Coordinator (Sub-District Head); 2) a Technical Coordinator (Clinic and Community Facilitator); 3) Chief Executor (Village Head); and 4) Members (Village Council member and two community leaders selected by the village). The Patrols are expected to be on duty at all times, especially at dawn and sunset, when the highest number of violations tend to occur. Any violator caught is penalized according to the terms agreed upon in the village regulations, which include picking up feces to be disposed of in a proper toilet and refusal of services at the village office (e.g. financial aid and rice aid). Additional Patrol duties include organising Clean Friday activities, providing information on sanitary living through the mosque, supporting the integrated health services post (Posyandu), and holding youth activities.

Photo: UNICEF/2012/Ansye Sopacua

Open Defecation Patrols Commitment

In building a new culture, i.e. defecating in proper toilets, the community polices itself. Our dream is to create an Ende Island pure in soil and spirit, which may one day became Indonesias third gateway to Mecca.

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Religious Leaders as Message Bearers

Religion was chosen as the entry point to spread the message of behavioral change. As such, religious leaders played an important role in conveying information on hygienic behavior. To help religious leaders gain the necessary knowledge, the District held a two day training program entitled Hygiene Promotion Through Moslem Teachings. According to Aejeti Village religious leader Amir Jabir, each village sent two religious leaders, where they were trained to communicate the importance of hygienic and healthy behavior through use of verses of the Quran and Hadist. Thus prepared, the religious leaders understood the teachings to be used in their respective congregations

Women and Children Agents of Change

The women of Ende Island have the daily task of fetching and allocating water for the household. In the past, they walked to other villages and queued for hours to draw water from wells, or bought more costly water
Photo: Qipra/2012/Taufik S.

Keep clean by any means available to you. Truly Allah built Islam on the principle of cleanliness. And none shall enter heaven who does not maintain cleanliness. (The Hadist of At-Thabrani)

Students from the Ende Island Nurul Ummah Ibditiyah Private Madrassah
Each Saturday, the school holds a personal development class. Students are taught how to properly brush their teeth and wash their hands with soap.

imported from Ende City. Naturally, when rainwater tanks were constructed
Religious leaders used Friday sermons and religious study sessions to spread the message of hygienic behavior.
Photo: Qipra/2012/Isna Marifa

in the island, the women were the immediate beneficiaries, as they no longer had to spend precious time and energy fetching water. The women also became key players in changing behavior in their respective families. Everything the women learned during triggering and other sessions Rusmini were passed on to other family members. At home, they constantly remind Rusmini: Housewife their children and husbands to practice hygienic behavior. This includes Rusmini, a women from East Java, is mother defecating in toilets, washing hands before eating, and cooking water to the rainwater tanks, as she no longer needs to draw water from the wells or buy water boiling point.
transported from Ende City. to seven children. She feels very happy with

At school, children received more hygienic behavior. Since the program, all schools in the Ende Island are equipped with a toilet and a place for washing hands. Since toilets have become available in school and home, the children have left their old defecation practices. In fact they actively remind each other. When children see someone on the beach without a fishing rod, they would yell Someones about to return to old habits! That would bring enough embarrassment to the person that he/she would walk away.
Photo: Qipra/2012/Taufik S.

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Arisan for Toilets

One of the methods used in Ende Island is arisan, a typically Indonesian social gathering, whereby an amount of money is collected on a regular basis, and on a certain fixed interval, one member (drawn by lots) wins the entire sum of money collected from all members . The routine gatherings
3

Outreach Sign-posts
One media used on Ende Island to remind communities of hygienic behavior are outreach sign-posts, erected in strategic locations. Every village was given opportunity to design its own sign-posts, including creating the message and illustrations.
Rorurangga Village
Photo: UNICEF/2012/Ansye Sopacua

became a venue for communicating hygienic behavior messages. And, most importantly, the arisan also provided a solution for families with financial limitations. When an arisan member got access to the arisan funds, they were able to purchase materials to build a toilet. The Sub-District Head of Ende Island, Dahlas S.Ip, introduced a large group arisan scheme. Each village was free to set up their own arisan rules. The smallest group had ten members, while the largest had up to 70 members. The amount of monthly arisan collection also varied. One arisan group agreed to collect 5,000 Rupiah per member per month. Another village agreed to a monthly collection of 20,000 Rupiah per member. In most villages, the funds received by the winner were used to purchase materials from outside the island, such as tin roofing, cement and iron nails. In Aejeti Village, a different system was used. The arisan members who won the lucky draw received one pipe, one latrine bowl, and three sacks of cement. Overall, the toilet-focused arisan significantly increased the construction of household latrines.
Photo: UNICEF/2012/Ansye Sopacua

Ndoriwoy Village

Photo: Qipra/2012/Taufik S.

Throughout the island, there are 21 sign-posts, spread across seven villages. The messages inscribed vary widely. One is inscribed in Ende language temu tai rewo, translated in English as dont defecate in the open. Another uses Arabic, with the message anazofatum minal iman, or cleanliness is part of faith. The outreach sign-posts are expected to continually remind communities of hygienic behavior and its benefits.
Photo: UNICEF/2012/Ansye Sopacua

Photo: UNICEF Collection

Redodori Village

Rorurangga Village

Arisan for toilets applied to assist poor communities to have their own toilets

In poorer communities, the arisan is a used as a means for members to obtain a large amount of money without going into debt. The money is generally used to fund otherwise unaffordable business ventures or purchases.

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Village Regulations
Each village on Ende Island developed village regulations to enforce the new hygienic behavior adopted in the community. The content of the regulations were discussed and agreed upon by the village administration and community members. This meant that each individual fully understood their responsibilities, and was aware of sanctions and penalties for violations. The initiative to create village regulations came from the Village Heads, the Districts Health Department, and the Village Empowerment Agency. The process of reaching consensus and drafting the regulations were assisted by facilitators. The majority of village regulations on Ende Island share the following rules: Community members are obliged to 1) join the arisan for toilets, undertake construction work, and use their household toilet; 2) maintain their wells through their own means; 3) protect and maintain their rainwater tanks, and use collected rainwater only for drinking and food preparation; 4) dig their own refuse pit; 5) build their livestock enclosure a significant distance away from their home (if they own livestock); 6) attend Clean Friday activities; 7) build simple filtration tanks or wastewater containment for their household latrine. Any community members found guilty of violating the village regulations are penalized. For those apprehended by the Open Defecation Patrols, penalties include: 1) verbal warnings; 2) written warning from a village official; 3) a 10,000 Rupiah fine; 4) a criminal sentence. Additionally, some villages penalize violators by forcing them to pick up their feces by hand and dispose of it in a toilet. Strict enforcement of the rules has proven effective in instilling a sense of shame among villagers. As a result every community on the island continue to lead hygienic lives.
Q Photo: ipra ylvana /2012/S

Supported by Data
Selecting a location for the program involved analysis of real data. In choosing Ende Island, the Health Department of Ende District conducted analysis of trends in disease incidence and other public health indicators. The analysis concluded that Ende Island was severely lacking in sanitation facilities. In addition to public health data, other data sets gave insight into the socioeconomic conditions of the Island. Data observed included demographic data (such as population, livelihoods, education and religion) and behavior (e.g. defecation) of the communities on the island. These factors showed direct correlation with records of annual diarrhea outbreaks from the islands clinic. Field studies were performed to support desk analysis. A field team collected samples of water used by the community, and samples were analyzed at the Environmental Health Laboratory of the Districts Health Department. The laboratory results showed that the water used by most Ende Islanders was contaminated by the E.coli bacteria, originating from human feces. The lab results convinced the islanders that their water was unfit for consumption and ablutions.

Eschericia coli are bacteria that cause gastro-intestinal problems in humans. The ideal temperature for bacterial growth is between 20-40C, in which, the bacterial population can double within 15-20 minutes.

The village regulations were designed through a 10 step process involving a team of representatives from each of the seven villages.

Photo: www.wikipedia.org

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Declaration on Ende Island

On the 12th of April, 2011, the people of Ende Island declared themselves to be free of open defecation in a celebration that will be remembered for years to come. Accompanied by their Village Heads, Ende District officials, and local leaders, hundreds of Ende Islanders flocked to the serene village of Rorurangga to attend the celebrations. Also present for the ceremony were representatives from the Regional Consultative Council, the District Peoples House of Representatives, the Ende District technical agencies, the National Government, the Netherlands Embassy in Indonesia, and, last but not least, UNICEF. The Declaration was made by representatives of five elements of Ende Islands society, namely children, women, youths, local figures, and religious leaders, with each element stating their resolve to uphold their achievements. Following the declaration, each group performed traditional dances and plays, creating a festive atmosphere. The people of Ende Island took pride in their personal involvement in the behavior change. Although the process took some time, slowly but surely, the entire island had finally become open defecation free. Through its declaration, Ende Island officially became the first island in Indonesia to be completely free of open defecation. This is no small feat for an island once given the label of the worlds longest lavatory. Following the declaration, Ende Island was further recognized at the National CLTS Open-defecation-free Conference on 13-14 October 2011 in Bekasi, West Java, when it was awarded declaration aims is to

Water and Sanitation Aspirations at the District Level

The success of eliminating open defecation in the Sub-District of Ende Island convinced elements at the District level that behavior changes were also possible for the entire District. To mobilize all constituents within the District, District officials drafted the Water and Sanitation Strategic Plan. The Strategic Plan is expected to ensure that future activities of each technical agency were in line with the strategic objectives of improving sanitation and access to drinking water. The Commission C for the District of Endes Peoples House of Representatives took the initiative to prepare a Draft Regulation on Water and Sanitation. The thinking is that a regulation would: 1) provide a stronger legal basis for the Water and Sanitation Strategic Plan; 2) outline the responsibilities of the government, businesses, and communities, and; 3) outline the penalties for violations. According to Heribertus Gani, SPd., the District of Endes Head of Commission C for the Peoples House of Representatives, the spirit of the regulation is preventive measures are far better an investment that curative actions. The District has invited other sub-districts to choose one of their own villages to replicate the CLTS approach, using the Special Allocation Funds (from the national government budget). Triggering could be funded by the Ministry of Healths funds for clinic activities, through the Health Operations Assistance. As explained by Head of Physical Infrastructure, Andreas Worho, the district-government budget is often inadequate to fund water and sanitation activities. Combining district funds with that from the national government is an effective approach.
Photo: Qipra/2012/Taufik S.

acknowledge the success of a Best Practice on Ende Island in Stopping Open Defecation. The award was region, and to remind its people to maintain their achievements evidence that the CLTS approach is suitable for small island environments. in better hygiene.

Photo: UNICEF Collection Photo: Qipra/2012/Taufik S.

Heribertus Gani, SPd

Head of Commission C for the Peoples House of Representatives for the District of Ende

Andreas Worho
Head of Physical Infrastructure, Planning and Development Agency for the District of Ende, and Chairman of the Water and Sanitation Working Group.

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Cultivate ted a Commitip Leadersh

Establis the Targh et Area

ne Examit ions Condi T get of the ar Area

REPLICATION
3
ram n g a l o P e Pr th

ELEVEN STEPS TO
4

The success on Ende Island paves the way for other small island communities to take on the challenge of eradicating open defecation. This section presents steps needed to successfully replicate a Community-Led Water and Sanitation program, and provides some tips for each step.

Prepare Working Groups

5
ote am m o r P Progr the

Prepare Village Cadres

rm Perfomunity Comgering Trig

Design Field Activities

is n a e e r pe1 1 O claet Ar e D arg fromon T ree cati F efe D

le Schedution Facilita

10

Observe the wise words of the Head of the Regional Planning and Development Agency for the District of Ende to leaders of other regions who wish to attempt replication: 1. 2. 3. 4. Carefully study data on environmental health, recorded occurrences and trends of diseases in the target area. Provide funding from the regional budget. Always allocate a larger amount of funds than the previous year. Build an efficient system of coordination among technical agencies and other parties. Create and announce clear political commitment. The performance of the District Head will be greatly enhanced by a marked decrease in disease outbreaks. Do not rush! The entire process must be undertaken with patience and perseverance.

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5.

31

Cultivate

a Committed

Leadership

Regional leaders must show their commitment to improving drinking water access and sanitation. Commitment can be shown by forming and empowering Water Supply and Sanitation Working Groups, increasing funding to relevant technical agencies, and issuing official decrees. The objectives or goals must be clearly outlined.

Photo: Qipra/2012/Taufik S.

Photo: QIPRA Collection

Establish

the Target Are a

Identify the area(s) where the program will be implemented. If more than one area is selected, some prioritization is recommended.

Tips for Success:

Set Goals
Set goals at the start of the program. Goals can be selected from a range of statements, such as eradication of diarrhea outbreaks, increasing access to sanitation, or achieving open-defecation-free status. The goals and commitment of the leader must be made official to all parties involved.

Tips for Success:

Study Public Health Data
Data on disease incidence are very valuable, and data collected annually can help show trends or tendencies in an area. Comparing data obtained from different villages and sub-districts allows identification of areas that require urgent attention. Also analyze supporting data, such as access to sanitation facilities and population demographics.

Invite All Parties

Leaders must convince as many parties possible to be involved in the program. Each technical agency should prepare a plan of activities and expenditure budget. Water Supply and Sanitation Working Groups must ensure that there is clear communication between all parties involved. Private sector and community organizations can also be invited to support the program. All levels of government (provincial, district, sub-district and village) must be united under a common goal. Further support can be requested from the national government in the form of technical assistance and training.

KAP Surveys
In addition to studying public health data, conduct KAP (Knowledge, Attitude, Practice) surveys, to learn more about the perceptions and practices of the community. Take note of the communitys access to sanitation facilities, such as toilets that meet hygiene requirements. Take samples of water used by the community and test its quality in the laboratory. Analyse survey results to corroborate results from analysis of public health data.

Appoint Unit in Charge of Program

Appoint an institution to be responsible for the program, and provide it with a clear mandate and adequate budget. Delegate further planning and coordination to the unit.

Determine the Target

Once data has been collected, ensure that it is documented in detail. Perform analysis, and use the conclusions to determine the best location to implement the program. Then establish targets for the desired level of sanitation for that area.

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Community-Led Total Sanitation

Photo: QIPRA Collection

Community-Led Total Sanitation (CLTS) is a community empowerment approach towards forming communal hygienic and healthy behavior. The five tenets of CLTS are:

C T

Examine

Conditions of the Target Area

Understand the characteristics of the target area from its physical, socio-cultural, health, and environmental aspects. Analyze and record all available information to provide a basis for decision-making.

ST
O

Stop Open Defecation (STOP BABS) Wash Hands with Soap (CTPS) Manage Household Drinking Water (PAM RT) Manage Household Waste Manage Household Sewage
S

Each individual has access to basic sanitation facilities to create an open defecation free community.

PB
ABS

Each household and public facility provides a hand-washing facility that supplies water and soap or ash.
RT

Tips for Success:

Understand the Community
Before starting the process of behavior change, the most important pre-requisite is understanding the characteristics of the target areas community. Research their culture, attitudes, and lifestyles, identify influential individuals, and learn which activities or media are commonly used to spread information and influence public opinion. It is also useful to observe youth groups and their activities.

PA

Each household manages its own drinking water and food safety.

P S R

Each household properly manages its solid wastes.

Study Local Water and Sanitation Conditions

Carry out a comprehensive survey in the target area, making sure to observe the level of access to drinking water and sanitation, as well as daily community habits regarding hygiene. Gather public health data from clinics and interview sanitarians or medical staff. If necessary, gather samples of the local water supply and test its quality in the laboratory. Record all results in detail, analyse and draw conclusions.

P A L

Each household manages its sewage properly.

CLTS is a community-led program, which means that no subsidies are provided for the construction of sanitation facilities at the household level. CLTS was officially adopted as a national program by the Ministry of Health for the Republic of Indonesia in September 2008, as per Health Ministerial Decree No.852/Menkes/SK/IX/2008. This decree has become a starting point for all involved in the planning, implementation, monitoring, and evaluation of CLTS programs.

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Funding for Water and Sanitation

Photo: QIPRA Collection

Efforts to improve access to drinking water and sanitation require adequate funding. Each village, sub-district, district, and province must create a cost estimate for the planned activities to cover outreach and construction in the target areas. Budget commitments should be made for more than one year. The reason is that improving access to drinking water and sanitation usually requires several years to show results. Thus, multi-year planning is a necessary approach for this type of program. Furthermore, open dialog between different levels of government can help ensure the work plans and cost estimates are realistic.

Plan

t he Pro gram

Based on the conditions and needs of the target area, develop a site-specific program. Determine essential activities and necessary resources, and identify potential partners.

Example of activities that require funding Research and Planning:

1. Sending staff to collect information and carry out surveys; 2. Water sample testing at a laboratory; 3. Discussing research results and drafting the work plan.

The Need for Funding

All programs depend on adequate funding, and CLTS programs are no different. Expenses for CLTS include the costs of outreach, training of facilitators and technicians, facilitating the community during triggering, laboratory tests, monitoring and evaluation, transportation, and venue rental. The main source of funding should be the regional development budget, while supplementary funds are obtainable from the national development budget, via the Special Allocation Funds. Triggering activities can be considered as an activity of the local clinic, which make them eligible for funding from the Health Operations Assistance. Village funds, albeit small, can also be used.

1. Promoting the program to institutions involved; 2. Holding training sessions for community members and institutions involved; 3. Undertaking the facilitation process and training facilitators; 4. Transportation to and accommodations at the target area.

Prepare Proposals and Mobilize Partners

Describe the program plans in a proposal, which can then serve as a means of communication with potential partners. Each level of government should develop a proposal and submit it to the higher level of government. Cooperation with non-governmental organisations, such as donors or private companies, is also possible. It is important to note that all cooperation begins with a proposal that clearly outlines the programs desired objectives, activities, cost estimates, and technical requirements.

Construction of Latrines or Drinking Water Facilities

1. Purchasing/obtaining moulds; 2. Transporting moulds to the target area; 3. Technical training for mould usage; 4. Supervision of the construction process; 5. Supervision of operation and maintenance of facilities.
Photo: UNICEF Collection

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Photo: Qipra/2012/Taufik S.

Behavioral Change

Photo: UNICEF Collection

Tips for Success:

37

Photo: UNICEF Collection

Photo: UNICEF Collection

Prepare

Work ing G roups

Assign individuals and institutions to the target area, and begin program implementation.

Promote

the Pro g ra m

Explain the program in detail to all levels of government to ensure mutual understanding and effective coordination.

Tips for Success:

Appoint a Unit Responsible for the Program
Identify the technical agencies responsible for the water and sanitation program, and appoint one to be responsible for the program, with a clear written mandate. Direct the other units to work according to their expertise and roles, while the unit responsible for the program designs a more detailed work plan and coordinates the work of other units.

Tips for Success:

Step-wise Dissemination
Information on the program should be disseminated in a step-wise approach, from the national government to the targeted community, with knowledge being passed down from one government level to another. In other words, knowledge originating from the national government, should be passed down to the provincial, district, sub-district, and village governments successively, until it is finally disseminated to the community or households. Thus, cooperation among all levels of government is vital to the programs success.

Prepare Facilitators
Facilitators, whether individuals or non-governmental organizations, should be selected according to their competency and passion in community empowerment, drinking water, sanitation, and/or the environment. They can be recruited through the Districts Health Department or technical agency in charge. It is preferable to give these facilitators training to introduce the program and its approach, as well as provide technical information, the latter of which can be supplied by the Ministry of Health.

Document Every Step

Every outreach and planning event, and implementation of the programs activities must be welldocumented, as these will provide evidence for reporting purposes. The records will also be useful as guidelines for future replication in other areas. Documentation may include activity logs, photographs or video recordings of the activities, and a list of individuals and organizations involved.

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Proper Defecation
The first tenet of CLTS is stopping open defecation (see box Five Pillars of CLTS, page 35). Changing defecation behavior requires more than simply changing the location of defecation. So how does one
Photo: UNICEF Collection

defecate properly, and what are the criteria for proper latrines? Open defecation is defined as defecating in an open space viewable by other people, or in some cases defecating in an open space alongside other people. These open spaces include paddy fields, gardens, sewage ditch, rivers, or beaches. The feces are left on the ground, where it can be seen by others and stepped on by both people and animals. Furthermore, the feces become pollutants and can contaminate river, ground, and seawater. Proper defecation must be done in a sheltered latrine that ensures the users privacy, and must contain a sewage pit that can be covered or buried with soil to ensure others need not smell or see the feces. A good latrine is one that fulfills these requirements, and does not necessarily need to be costly or sophisticated.

Plan

Field Activities

Open dialog with the target community to determine the type of activities that will be used and locations suitable for those activities. Include the results from the dialog into the Community Activity Plan.

Tips for Success:

Insert Outreach in Existing Activities
Information on hygienic and healthy living can be delivered informally to the community. Find the most appropriate outreach method for each community. One approach is to insert outreach into established local forum or routine community activities that already exist. Developing a positive rapport with the community is vital, as is building two-way communications. Allow the community to be involved in choosing the right forum, and give them the opportunity to give their input to any activity they join. This will give them a sense of ownership towards the initiative.

Embrace Influential Figures

Approach influential community leaders, and explain the program and its goals. Convince these leaders that the program will bring about positive change, and, in turn, they will convince other community members. Treat influential figures as the gatekeepers to the community.

Photo: UNICEF Collection

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Photo: UNICEF Collection

Prepare

Village Cadres

Identify a number of community members who are willing to be voluntary cadres. Train and explain the cadres responsibilities, as they will manage the program once the facilitators leave the site. The village cadres tasks are to spread the message of hygienic and healthy behavior, and, in the long term, monitor the communitys behavior.

Photo: UNICEF Collection

Perform

Community Triggering

Hold activities that will help trigger the communitys motivation to change to hygienic behavior. This process is the most important part of the program, and it is often difficult to predict when a community will be convinced to change their behavior.

Tips for Success:

Identify Village Cadres
Open community discussions in the village and identify volunteers, selecting a suitable number of people for the program. They can be from a variety of backgrounds, such as religious figures, youth leaders, women, or even village heads. In all cases it is necessary that women should always be involved as cadres, as they are key figures in establishing hygienic behavior in the households.

Tips for Success:

The Facilitators Role
Facilitators are tasked with facilitating the communitys educational process throughout the triggering process. This task can be challenging due to the diverse personalities and attitudes of community members. As such, creativity and strong intuition in approaching the community are vital skills for the facilitators.

Hold Trainings
Hold trainings for the selected village cadres, educating them to understand hygienic behavior and obtain communication and monitoring skills. Furthermore, the cadres should also be prepared to start the triggering process in their own communities.

Choose a Location
Choose a location for the triggering activity. One activity commonly used as part of the triggering process is transect walk. During the transect walk, facilitators bring the community to a location where open defecation is practiced. Community members attending are then asked to draw a map of the village and point out where they usually defecate openly.

Choose a Technology
During the triggering, invite the community to think of technologies suitable to solve their open defecation problem. Facilitators and experts should present viable options available. Discuss the strengths and weaknesses of each option. At the end, it is the community who will make the final decision on which technology to use.

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The Sanitation Ladder

Transition from open defecation to proper defecation requires each household to choose the type of latrine that suits their means. A familys first latrine is usually very simple. Once they have become accustomed to using toilets, families are expected to improve the quality of their latrines. Latrine
Photo: QIPRA Collection

quality improvement can be illustrated by the sanitation ladder, which shows the progression from the most basic latrines to latrines that meet all sanitation requirements.

10
not lost.

Schedule
Facilitation

Agree upon when facilitators are expected to be present in the target area. Schedule interactions with the community, and prepare a post-declaration monitoring strategy, which does not require the facilitators presence.

Pour-flush Latrine (with U-bend pipe)

This latrine requires a significantly larger amount of water to flush. The water also eliminates the smell of feces, which is a sign of cleanliness and an indication that the latrine is functioning properly. Pour-flush latrines can be purchased at stores or constructed using latrine moulds.

Tips for Success:

Draft Village Regulations
Facilitators can assist the Village Head and community members in discussing and drafting village regulations. The contents of the regulations must reflect the agreed responsibilities and penalties binding all members of the community. Regulations are expected to help enforce consistent hygienic behavior.

Offset Latrine
Offset latrines can be made by home-owners, and are angled to funnel the feces via a latrine pan. Water is required for flushing. The latrine cover should be easily lifted or removed.

Handing Over to the Village Cadres

The role of the facilitators is considered complete once the area has declared open-defecation-free. As such, the responsibilities of monitoring and evaluation fall to the officials and the cadres of the village. Thus it is mandatory for the facilitators to officially transfer all their knowledge, data, and information to the village cadres before the end of their work in the community, to ensure that achievements are

Simple Pit
Simple pit latrines are shaped to funnel feces into the ground, and do not require water to flush. Temporary shelters can be erected around the pit. The latrine cover should be easily lifted or removed.

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Abbreviations
CLTS FRP
Photo: QIPRA Collection

: Community-Led Total Sanitation : Fiberglass Reinforced Plastic : Knowledge, Attitude, Practice : Non Government Organization : Nusa Tenggara Timur (East of Nusa Tenggara) : Open Defecation Free : Kelompok Kerja Air Minum dan Penyehatan Lingkungan (Water Supply and Sanitation Working Group) : Pos Pelayanan Terpadu (integrated health service post) : Short Message Service : United Nations Childrens Fund

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Declare Free from

Open Defecation

Once the target area has been proven to be open-defecation-free, prepare and announce an official statement or decree, confirming recognition by the highest level of government. Declaration will also act as a sign of appreciation for the communities active participation in the process.

KAP NGO NTT ODF POKJA AMPL POSYANDU SMS UNICEF

Tips for Success:

Monitoring and Evaluation
It is important that the behavior of the community and maintenance of facilities are constantly monitored by the village cadres and leaders. Official monitoring and evaluation must also be done by the government, in particular by the Health Department, using expertise of the sanitarians. Furthermore, the government will also need to make periodic water quality and quantity checks to ensure sustained conditions.

Anticipating Post-Declaration Challenges

The governments role in CLTS does not stop once an open-defecation-free declaration is made. There are several other matters that will require government attention. In the medium term, the septic tanks attached to each household toilet will require draining and the sludge will require proper disposal. For rainwater tanks, some treatment to prevent mosquito breeding is necessary. Such interventions require services and supplies from outside of small island communities. Therefore, the government will need to ensure adequate funds and services. It is best that governments engage in dialog with the community regarding necessary post-declaration actions to maintain a healthy and hygienic behavior.

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Bibliography
Central Statistics Bureau of Ende District . Pulau Ende dalam Angka 2011. Hans. 2009. Unicef sampaikan Penghargaan kepada Pemkab Ende. NTT Onlinenews.com. Kabupaten Ende. Laporan Kegiatan Air Minum dan Penyehatan Lingkungan Kabupaten Ende Tahun 2006 2011. Mukherjee, Nilanjana & Shatifan Nina .2008. The CLTS Story in Indonesia: Empowering communities, transforming institutions, furthering decentralization. AMPL Obor, Hans. 2011. UNICEF Deklarasi Stop BABS di Pulau Ende. NTT Onlinenews.com. Pamsimas. Field Book: Sanitation Ladder (Tangga Sanitasi). Pius, Romualdus. 2011. Pulau Ende Bebas BABS. Tribunnews.com UNICEF . 2008. WES-NTT News. Edisi 1, tahun 2008. Kupang. UNICEF. 2009. Modul Pelatihan: Promosi Hygiene Melalui Mimbar Agama Islam. Kerjasama UNICEF dengan Dinas Kesehatan dan Pemerintah Kabupaten Ende Tahun 2009. UNICEF. 2009. Status and Trends Drinking Water and Sanitation in East Asia and the Pacific. Bangkok. UNICEF. 2010. Annual Report 2010. UNICEF Indonesia Country Office. Willetts J, Wicken J, Robinson A. 2008. Meeting the Sanitation and Water Challenge in South-East Asia and the Pacific : Synthesis Report on The Sanitation and Water Conference. International Water Centre . www.ampl.or.id www.hierobokilia.blogspot.com www.portal.endekab.go.id www.ristek.go.id www.sanitasi.or.id www.sipriseko.blogspot.com www.stbm-indonesia.org www.watercentre.org

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For Futher Information Contact:

Sekretariat STBM Nasional

Direktorat Penyehatan Lingkungan, Direktorat Jenderal PP dan PL Gedung D Lantai 1 - Jl. Percetakan Negara No. 29, Jakarta Pusat 10560 - PO BOX 223 Telp. (021) 4209930 Ext: 182, (021) 42886822, Fax: (021) 42886822