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Ende Island

The First Indonesian Island to Declare Itself Open Defecation Free


AMPL Ministry of Health Republic of Indonesia


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 society.

Sources: The Ende District Commission C of the Regional People’s Representative Council: Heribertus Gani, SPd; Office of Ende District Head: Martinus Ndate; Ende District Planning and Development

In cooperation with provincial and district governments, the Ministry of Health 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 with regards to hygiene. It has been proven to produce sustainable results in many communities. During the past three years many communities on Indonesia’s Island have declare themselves free from open defection. However, very few small island communities who have been able to share the same success.

Agency: drg. Dominikus Minggu, M.Kes, Andreas Worho, ST, MT, Erneseta Sri Say, ST, Yohanes

Small island face a set of challenges with regards to CLTS. Among the key challenges are limited sources of freshwater and isolation from circulation of information on hygienic behavior. These problems affect the thousands of small island scattered across the archipelago from Sabang to Merauke.

Yusuf; Rorurangga Village: Junaidin P.S, Juleha Roja, Mashadin; Ndoriwoy Village: Rasjid Kuri,

The achievements in Ende Island to eradicate open defecation bring about a new sense of hope – that the communities living in small islands can start living more hygienically. The islanders’ enthusiasm ought to be spread to other communities.

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 Sub-District Office: Petrus H. Djata; Ende Island Sub-District Office: Fransiskus Dadjo, AMK, Haji Ali; Rendoraterua Village: Ahmad 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

This book depicts 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.

School: Musosman; Ende Island Private Nurul Ummah Ibtidaiyah Madrasah: Maemuna Wio;

My gratitude goes to all those involved in the development and execution of the CLTS program. Special recognition is given to 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. The East Nusa Tenggara Province and especially the District of Ende and also the people of Ende Island – working together with UNICEF – present an exemplary mode of cooperation; one with positive and sustainable results.

Concept and Direction:

I wish this book to be great use in materializing the highest health status of Indonesian people.

Rendomaupandi Presidential Decree Primary School: Halimah Jaenab; Ekoreko Public Primary School: Nurdin Ibrahim.

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.

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. September 2012



Table of Content





Daftar Isi


A Journey Shared

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

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 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

Eleven Steps to Replication

Photo: Qipra/2012/Taufik S.


Cultivate a Committed Leadership Establish the Target Area Examine Conditions of the Target Area Box: Indonesia’s Community-Led Total Sanitation (STBM) Develop Work Plan Box: Funding for Water and Sanitation Establish Working Groups Promote the Program Plan Field Activities Box: Proper Defecation Prepare Village Cadres Conduct Community Triggering Schedule Facilitation Box: The Sanitation Ladder Declare Free from Open-Defecation

30 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46





A Journey Shared

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 of 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 program’s success. The journey of this tiny and beautiful island can be a source of inspiration for other small-island communities in Indonesia and beyond.


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 daily motor boat services. 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.

Province of East Nusa Tenggara Infographic: Qipra/2012/Taufik S.

Ende Island Sawu Sea

With regards to water resources, the island relies mainly on wells that produce brackish water; as only one village has wells with freshwater.

North West

Rorurangga East


The History of Ende Island Very few records exist regarding the 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 ( Several versions appear on the topic of the introduction of Islam to the island. One source attributes it to Imam Syafi’i, 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 ( 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 Indonesia’s 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 (


Profile of Ende Island Village Rendoraterua

Puutara Aejeti

Area (Km2)




Sawu Sea

Sawu Sea Paderape



















Rendoraterua Ndoriwoy


Sawu Sea


Why Was Change Necessary?

rough seas of the westerly wind season. The government also dug new wells

Prior to 2007, the District of Ende Island was known locally as ‘Island of

high salt content. Furthermore, a Portuguese Non-Government Organization

Disasters ‘or ‘Island of Catastrophes’. In consecutive years, the island was hit

installed a desalination unit on the island, but found that the desalinated water

by diarrhea outbreaks that affected hundreds on the island, usually at the

was contaminated by high levels of E.Coli originating from human excreta.

on the island, but was unsuccessful as much of the island’s groundwater has a

end of the rainy season. The outbreaks occurred once in 2004 and 2005,

As such, the only sources for fresh water on Ende Island are the wells of

and occurred twice in 2006. Children aged five years and younger were

Ndoriwoy village. As the men of the villages are responsible for fishing and

especially vulnerable to the disease, at worst making up 67% of the total

farming, the task of carrying fresh water from Ndoriwoy to the other villages

patients count in 2005.

is given to the women. Due to this limited access, most households continued

Another local nickname given to Ende Island was “the world’s longest

to use brackish water for their household needs, which include

lavatory”. The name aptly describes a daily scene, where locals squat along

drinking water.

the island’s coastline to defecate in the open while socializing and gossiping

The District of Ende recognized that improving

in the early hours of the morning. Such was the custom from many

community access to freshwater was a prerequisite to solving the problems of diarrhea outbreaks and open

The District of Ende recognized that Ende Island had the highest prevalence

defecation. Thus, with support from UNICEF, they

of diarrhea in the district. The District Government initiated many attempts

initiated the Water and Environmental Sanitation

to prevent outbreaks; however, they were hindered by the limited supply of

Program to effectively prevent future problems

freshwater on the island. Later on, the District realized that unless reliable

with diarrhea.

freshwater supplies were available, solutions for the outbreak would only

Martinus Ndate

be temporary.

First Assistant to the District Head of Ende No Diarrhea Outbreak

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

Photo: Qipra/2012/Taufik S.

generations ago.


2007 2004







“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”.

Official Definition of Outbreak Diarrhea Outbreak

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, have 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

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





Commitment at the Province


Engaging District Level Entities

3 4

Determine the Target Area

Disseminate at District Level


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

The Ende District government appointed the District-Level Water Supply and Sanitation Working Groups [Pokja AMPL] to spearhead the program District technical agencies were assigned with tasks according to their specialties, for example; district Health Office was task with ‘behavior change’ aspect of the program, while District Public Works office was tasked with technical civil works and training. Based on health statistics, the District’s Health Department chose the target areas for the program. The Sub-district of Ende Island was selected as one of the project sites 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.


Choosing Technology Options




Team Formation


Research on Behavior Change

The team raised the issue of access to drinking water with the communities of Ende Island. Various technological 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 access to drinking water.

The district government 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.

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.


Prepare the Community


Village-Level Program Promotion


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

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

Prepare a Community Work Plan

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


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

Prepare Facilitators


Open Defecation Free Declaration


Facilitated Community Empowerment


Community Triggering


Village CLTS Training

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 the NTT Provincial official, District of Ende, Nederland Embassy, UNICEF, 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. The triggering was conducted by the village CLTS team, supported by the District Health Department.

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, 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 molds made of FRP (Fiberglass 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 molds 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 construction 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 molds were being rotated effectively among households. Households or household groups took turns using the tank mold, 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.

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 mold for the tank wall Pour cement into the mold Remove the mold Position the FRP mold for the tank cover and pour in cement Remove the tank cover mold

Latrine Construction Process 1. 2. 3. 4. 5.

Prepare the construction site, building materials, and tools Position the latrine mold level to the surface of the floor Combine cement and sand Pour the mixture into the mold Remove the latrine cast from the mold

Once the community gained improved access to drinking water, the program focused on triggering for defecation behavior. District 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 new understanding about links between hygiene behavior and diarrheal disease, 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 center 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. By 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 molds, 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: Qipra/2012/Taufik S.

Photo: UNICEF/2012/Ansye Sopacua

Aejeti Village

Rorurangga Village

Initial Resistance to Change

Water Is No Longer Far Away

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.

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

Amir Jabir

Religious Figure

Junaidin P.S Village Head

“I was struck and embarrassed by the label “world’s longest lavatory” given to my island. This motivated me to change the behavior of my community.”

“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”.

Photo: UNICEF/2012/Ansye Sopacua

Photo: UNICEF/2012/Ansye Sopacua

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 molds 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”.

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 community’s 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.v

Village Civil Defence Chief “Changing the behavior of a community requires sacrifice, patience, and wisdom. We must first understand each family’s circumstances, before we can raise the topic of toilets and defecation”.


Photo: Qipra/2012/Taufik S.

Juleha Roja


Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Taufik S.

Redodori Village

Ndoriwoy Village

The Turning Point

Night Patrols Prevent Open Defecation

Redodori Village was formed in 2002 as an expansion of Ndoriwoy

Ndoriwoy Village is the only village on Ende Island with its own

Village, with Aliasa H.A. Tata appointed as the first Village Head. His

supply of fresh water. With a total of 32 fresh water wells, it

first challenges were to prevent recurrence of diarrhea outbreaks

supplies fresh water to the other 6 villages during the dry season.

and ensure the community’s self-reliance for drinking water. The

As with every other village on the island, Ndoriwoy Village also

CLTS approach provided a turning point for the community, who

experienced outbreaks of diarrhea and other gastrointestinal

realized that their situation had to be changed for the better.

illnesses. Previous attempts by the District to eradicate open

Facilitators tirelessly gave motivation to the adults in the

defecation were unsuccessful, mainly due to the community’s

community. In turn, parents and teachers taught children about

limited knowledge and economic means. Behavior change only

proper hygiene. Village Regulations were drawn up, to allow the

started after triggering exercises by the district government

community to police itself against open defecation.

and UNICEF, and contribution of molds for latrine and rainwater

exceptionally stunning especially at sunset, and now enjoyed by all.

Photo: UNICEF/2012/Ansye Sopacua

by children and youths to play, exercise, and relax. The ocean view is

Photo: UNICEF/2012/Ansye Sopacua

from the once-common feces on the sands, the beach is now used

The initiative gained momentum when village leaders began to monitor the community’s 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!

Aliasa H.A. Tata Village Head “The program’s 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”.

Photo: UNICEF/2012/Ansye Sopacua

tank construction.

As a result, the beach has now become a recreation center. Free

Rasyid Kuri Village Head “Now every house in our village has its own latrine.”

Said Ibrahim Religious Leader A volunteer who keeps an eye out for open defecators.



Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Isna Marifa

Rendoraterua Village

Paderape Village

Village Budget for Sanitation

Rainwater Tanks Shared Among Families

Rendoraterua Village also suffered repeated outbreaks of diarrhea,

Despite the high population density and limited land for

with the majority of those affected being children aged five years and

construction in their village, the community of Paderape was

younger. In the past, the Village Head took initiative to build a public

undeterred in their efforts to build rainwater tanks. With most of

latrine, but was not able to motivate the rest of the community to

the houses in the village spaced very closely to each other, the

build their own toilets. The old habit of defecating on the beach was

community had the challenge of deciding where to place the

still more popular and convenient.

large, space-consuming rainwater tanks.

Progress was achieved after UNICEF’s support to trigger the

Through several meetings and discussions, the community finally

community into building their own latrines. Each household

decided on building communal rainwater tanks in between

was responsible for building their own latrines. While the village

closely-spaced house. Rainwater gutters were attached to the

contributed only three sacks of cement and one toilet bowl.

roofs to direct the rainwater into the communal tanks.

As Village Head, Ahmad Yusuf allocated 45 percent of the Village

Sharing the tanks water supply meant that families had to

Fund every year to support construction costs. A further 5 percent

M. Abdullah

of the Fund was allocated to improve the sanitary quality of the

Paderape Village Administation Chief

latrines. Now, every household has its own toilet and no new diarrhea outbreaks have occurred.

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

Ahmad Yusuf

Village Head


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

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”.

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.

the house of a family that does not yet possess a latrine.

Photo: Qipra/2012/Taufik S.

sacks of cement and a latrine bowl to be used in their own house or

Photo: Qipra/2012/Taufik S.

As an additional measure, the village issued a village regulation

“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”.

coordinate with each other and use their allocated water

Photo: Qipra/2012/Taufik S.

Attention from the District Ende’s District Health Office 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

Puutara Village

the time, realized that the outbreak problem could only be permanently solved by prevention.

Community Work Plans

The first step taken by the Head of the District Health Office was to raise the

One of the main reasons the Water and Sanitation Program was a success was that it

institutional status of the Environmental Health Section to a Sub-Division. The

was tailored to the needs of the community. After receiving general description of the

environmental health personnel were empowered, and the sub-division’s

program, inhabitants of Puutara Village designed their own community work plan with

funding was increased to prevent further diarrhea outbreaks on Ende Island.

guidance from the program team. “As we were designing the community work plan,

Staff from the Environmental Health Sub-Division was sent to visit the island. Following

many arguments occurred among the villagers,” recalls Saleh, the Village Secretary. “But

the visit, the staff reported that the majority of complaints from the islanders were to do

these arguments were resolved through dialog”.

with lack of clean drinking water. Thus the Department decided to improve access to drinking water before addressing the problem of defecation.

The community conducted their own situation analysis and identified problems present in the village, which prompted discussions on possible solutions. Among the

Furthermore, the Department also decided to add new facilities to Ende

villagers, several individuals were chosen as members of a committee, responsible for

Island’s sole clinic. As islanders had difficulty accessing medical facilities outside

coordinating program activities. In the process, the community also chose the form of

the island, the health office saw it necessary to add an inpatient ward and

clean water access they considered most suitable. Each household had the opportunity

paramedic dwellings.

to voice their opinion.

that worked on Ende Island were tailored specifically to its unique communities

gain awareness of the challenges they would face. Furthermore, involving

and geographical traits. In the words of the former Head of Health Department

the entire community in the decision making process and making everyone equally responsible helped strengthen relationships in the community.

“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”.

Wahyah Darham

Village Cadre

A Village cadre who had attended the three day hygiene behavior course at the district health office, Wahyah now holds information sessions every ‘clean Friday’, with such topics as the cleaning of rainwater tanks.

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 community’s sense of ownership and responsibility over these facilities”. Photo: Qipra/2012/Taufik S.


Photo: Qipra/2012/Taufik S.

Photo: Qipra/2012/Taufik S.

the program in other districts. They were reminded, however, that the strategies

The community was able to plan its own activities and work schedule, as well

Village Vice-Secretary


After Ende Island showed outstanding results, the district was eager to replicate

The community work plan proved to be a successful approach for the program.

drg. Dominikus Minggu, M.Kes

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 Office must be at right place.” 1

“Sanitarians” refer to staff of Environmental Health units, who are trained in community outreach on environmental health issues.


Astute and Dedicated Sanitarians

Friendly yet Determined Facilitators

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

Throughout the journey towards a hygienic lifestyle, the communities and

his expertise in sanitation and his exceptional skills in communicating health

leaders of Ende Island were able to call upon the help of facilitators at every

information to the community. Despite these skills, his presence in Ende

step. Two such facilitators were Servasius Goa and Ayub Seda Gani.

Island initially drew opposition from several members of the seven villages,

Servasius Goa, known also as Pak Servas, had been active on Ende Island

particularly religious leaders of Aejeti Village and Paderape Village.

since 2004 during trials for construction of wells and household toilet. Ayub

The first visit taught Piet that he had to find an effective entry-point to the Ende

Seda Gani, locally known as Pak Ayub, started in 2008 with rainwater tank

communities. He embarked upon his own research of the cultural background

constructions. Their easy-going attitude and perseverance earned them trust

and attitudes of the Ende Islanders. He found that the communities were

and friendship from the Ende Island communities as well as Village Heads. To

highly devoted to their religion of Islam and deeply revered their religious

this date, their presence is warmly received by everyone on the island.

leaders. Piet, a Catholic, created a slogan “Purify Your Land, Purify Your People”. Equipped with quotes from the Quran and other Islamic teachings, Piet began

The experience of Ende Island demonstrates that the most effective

discussions with Ende Island’s religious leaders. From that point onwards,

facilitators are those who are highly dedicated and able to delve into

Piet Djata was accepted by the religious community, and regularly received

the mindset and culture of the community they work with. As collective

invitations to talk to Friday prayer congregations.

behavioral change is not a quick process, facilitators must be able to persevere and maintain positive communication throughout the process.

Piet’s experience on Ende Island shows that a highly dedicated sanitarian,

The key to the facilitator’s success is building mutual trust with and strong

willing to delve into the local culture, is the success factor in instigating

ties to the community.

behavioral change. Furthermore, the work of the sanitarian does not stop at ODF declaration. To this day, sanitarians continue to inspect the state of

Petrus H. Djata



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

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 Indonesia’s “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 religion’s teachings.” For his services, Piet was given the honorary title of Pua ‘Haji’ Djata2 by the people of Ende Island.

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 ‘It’s Pak Ayuuuub!’, and run away.”

Photo: Qipra/2012/Taufik S.

unsanitary behavior on the island.

Photo: Qipra/2012/Taufik S.

each household’s latrines and provide consultation on illnesses caused by

Servasius Goa “The task of the facilitators during construction was to monitor which group had possession of the mold. This was done via SMS.”


Village Head as Movement Leaders

‘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

Village Heads played a vital role in making Ende Island an open defecation

citizens arrests on community members that continue to defecate in the

free area. After the District disseminated the objectives of the program, all

open. Coordinated directly by the Village Heads, Patrol members have to be

seven Village Heads became highly motivated to bring about changes to

hard-working and well-liked by their community.

their communities.

Every Patrol consisted of: 1) a General Coordinator (Sub-District Head);

The Village Heads selected several community members and involved them

2) a Technical Coordinator (Clinic and Community Facilitator); 3) Chief

in the program promotion and training, with the goal of engaging them in

Executor (Village Head); and 4) Members (Village Council member and two

the triggering process. These individuals included religious leaders, Village

community leaders selected by the village).

Community Empowerment officials, women’s rights leaders, and teachers. Together, they approached and convinced their fellow community members of

The Patrols are expected to be on duty at all times, especially at dawn and

the importance of hygienic living.

sunset, when the highest number of violations tend to occur. Any violator caught is penalized according to the terms agreed upon in the village

The Village Heads also served as the main counterparts for the facilitators

regulations, which include picking up feces to be disposed of in a proper

assigned to Ende Island. Working together they brainstormed on appropriate

toilet and refusal of services at the village office (e.g. financial aid and rice

activities for the communities. Good cooperation and mutual trust smoothed

aid). Additional Patrol duties include organizing ‘Clean Friday’ activities,

the execution of each step.

providing information on sanitary living through the mosque, supporting

Village Heads often met initial resistance from

the integrated health services post (Posyandu), and holding youth activities.

individuals within their own communities. Reasons for and deep-rooted customs, to outright refusal to trust outsiders. Through patience and perseverance, however, everyone in Ende Island’s seven villages was persuaded to change their defecation behavior.

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

The Village Heads were also responsible for initiating

Photo: UNICEF/2012/Ansye Sopacua

resisting change ranged from monetary limitations

‘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 Indonesia’s gateway to Mecca.”


Religious Leaders as Message Bearers

Women and Children – Agents of Change

Religion was chosen as the entry point to spread the message of behavioral

The women of Ende Island have the daily task of fetching and allocating

change. As such, religious leaders played an important role in conveying

water for the household. In the past, they walked to other villages and

information on hygienic behavior. To help religious leaders gain the

queued for hours to draw water from wells, or bought more costly water

necessary knowledge, the District held a two day training program entitled ‘Hygiene Promotion through

Moslem Teachings’.



Aejeti Village religious leader Amir Jabir, each village sent two religious leaders, where they

“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)

Photo: Qipra/2012/Taufik S.

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.

were trained to communicate the importance of hygienic and healthy behavior through use of verses of the Qur’an and Hadist. Thus prepared, the religious leaders understood the teachings to be used in their respective congregations. 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.

in the island, the women were the immediate beneficiaries, as they no longer had to spend precious time and energy fetching water.

Photo: Qipra/2012/Isna Marifa

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 to seven children. She feels very happy with

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.

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 “Someone’s 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.


Arisan for Toilets

Outreach Sign-posts

One of the methods used in Ende Island is arisan, a typical Indonesian social

One media used on Ende Island to remind communities of hygienic

gathering, whereby an amount of money is collected on a regular basis, and

behavior are outreach sign-posts, erected in strategic locations. Every village

on a certain fixed interval, one member (drawn by lots) wins the entire sum of

was given opportunity to design its own sign-posts, including creating the

money collected from all members . The routine gatherings became a venue

message and illustrations.

for communicating hygienic behavior messages. And, most importantly, the

Rorurangga Village


an arisan member got access to the arisan funds, they were able to purchase

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

Throughout the island, there are 21 sign-posts, spread across seven villages.

monthly collection of 20,000 Rupiah per member. In most villages, the funds

The messages inscribed vary widely. One is inscribed in Ende language

received by the ‘winner’ were used to purchase materials from outside the

“temu tai rewo”, translated in English as “don’t defecate in the open”. Another

island, such as tin roofing, cement and iron nails. In Aejeti Village, a different

uses Arabic, with the message “anazofatum minal iman”, or “cleanliness is

system was used. The arisan members who won the lucky draw received one

part of faith”. The outreach sign-posts are expected to continually remind

pipe, one latrine bowl, and three sacks of cement. Overall, the toilet-focused

communities of hygienic behavior and its benefits.

arisan significantly increased the construction of household latrines.

Photo: UNICEF/2012/Ansye Sopacua

Photo: UNICEF/2012/Ansye Sopacua

Photo: UNICEF Collection

Photo: Qipra/2012/Taufik S.

materials to build a toilet.

Ndoriwoy Village

Photo: UNICEF/2012/Ansye Sopacua

arisan also provided a solution for families with financial limitations. When

Redodori Village

Rorurangga Village

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



In poorer communities, the ‘arisan’ is 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. In the case of Ende Island, it was used to purchase a toilet for the home.


Village Regulations

Supported by Data

Each village on Ende Island developed village regulations to enforce the

Selecting a location for the program involved analysis of real data. In choosing

new hygienic behavior adopted in the community. The content of the

Ende Island, the Health Department of Ende District conducted analysis of

regulations were discussed and agreed upon by the village administration

trends in disease incidence and other public health indicators. The analysis

and community members. This meant that each individual fully understood

concluded that Ende Island was severely lacking in sanitation facilities.

their responsibilities, and was aware of sanctions and penalties for violations.

In addition to public health data, other data sets gave insight into the socio-

The initiative to create village regulations came from the Village Heads, the

economic conditions of the Island. Data observed included demographic data

District’s Health Department, and the Village Empowerment Agency. The

(such as population, livelihoods, education and religion) and behavior (e.g.

process of reaching consensus and drafting the regulations were assisted

defecation) of the communities on the island. These factors showed direct

by facilitators.

correlation with records of annual diarrhea outbreaks from the island’s clinic.

The majority of village regulations on Ende Island share the following rules:

Field studies were performed to support desk analysis. A field team collected

Community members are obliged to 1) join the arisan for toilets, undertake

samples of water used by the community, and samples were analyzed at the

construction work, and use their household toilet; 2) maintain their wells

Environmental Health Laboratory of the District’s Health Department. The

through their own means; 3) protect and maintain their rainwater tanks,

laboratory results showed that the water used by most Ende Islanders was

and use collected rainwater only for drinking and food preparation; 4) dig

contaminated by the E.coli bacteria, originating from human feces. The lab

their own refuse pit; 5) build their livestock enclosure a significant distance

results convinced the islanders that their water was unfit for consumption

away from their home (if they own livestock); 6) attend ‘Clean Friday’

and ablutions.

activities; 7) build simple filtration tanks or wastewater containment for their household latrine. Community members found guilty of violating the village regulations are penalize. 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 continues to lead hygienic lives.

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


Q Photo:


.C ylvana /2012/S

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



Declaration on Ende Island

Water and Sanitation Aspirations at the District Level

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

The success of eliminating open defecation in the Sub-District of Ende

years to come. Accompanied by their Village Heads, Ende District officials,

Island convinced elements at the District level that behavior changes were

and local leaders, hundreds of Ende Islanders flocked to the serene village of

also possible for the entire District. To mobilize all constituents within the

Rorurangga to attend the celebrations. Also present for the ceremony were

District, District officials drafted the Water and Sanitation Strategic Plan. The

representatives from the Regional Consultative Council, the District Peoples’

Strategic Plan is expected to ensure that future activities of each technical

House of Representatives, the Ende District technical agencies, NTT provincial

agency were in line with the strategic objectives of improving sanitation and

government, the National Government, the Netherlands Embassy in Indonesia,

access to drinking water.


The Commission C for the District of Ende’s People’s House of Representatives

The Declaration was made by representatives of five elements of Ende

took the initiative to prepare a Draft Regulation on Water and Sanitation. The

Island’s society, namely children, women, youths, local figures, and

thinking is that a regulation would: 1) provide a stronger legal basis for the Water

religious leaders, with each element stating their resolution to uphold their

and Sanitation Strategic Plan; 2) outline the responsibilities of the government,

achievements. Following the declaration, each group performed traditional

businesses, and communities, and; 3) outline the penalties for violations.

dances and plays, creating a festive atmosphere.

According to Heribertus Gani, SPd., the District of Ende’s Head of Commission C for the People’s House of Representatives, the spirit of the regulation is

The people of Ende Island took pride in their personal involvement in the

preventive measures are far better an investment that curative actions.

behavior change. Although the process took some time, slowly but surely, the entire island had finally become open defecation free.

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

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

national government budget). Triggering could be funded by the Ministry

an island once given the label of ‘the world’s longest lavatory’. Following Open-defecation-free the declaration, Ende Island was further recognized at the National CLTS declaration aims at

Assistance. As explained by Head of Physical Infrastructure, Andreas Worho,

of Health’s funds for health center activities, through the Health Operations

acknowledging the success of a Conference on 13-14 October 2011 in Bekasi, West Java, when it was awarded region, and to remind its people “Best Practice on Ende Island in Stopping Open Defecation”. The award was to maintain their achievements in better hygiene.

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: UNICEF Collection

Heribertus Gani, SPd Head of Commission C for the People’s House of Representatives for the District of Ende

Photo: Qipra/2012/Taufik S.


Photo: Qipra/2012/Taufik S.

evidence that the CLTS approach is suitable for small island environments.

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


Cultivateitted a Comm ip Leadersh



Establis the Targh et Area

Examitnieons Condi Target of the Area



ork w op

el Devn pla


Prepare Village Cadres

is n a e e e r claet Arm Op 11 e D arg fro on T ree cati F efe D

le Schedution Facilita


rm Perfomunity Comgering Trig

Establish Working Groups

Design Field Activities


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.

5 ote am m o r P Progr the




Below are 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.

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 stakeholders.


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.


a Committed




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:

Tips for Success:

Set Goals

Study Public Health Data

Set goals at the start of the program. Goals can be selected from a range of criteria, such as eradication

Data on disease incidence are very valuable, and data collected annually can help show trends or

of diarrhea outbreaks, increasing access to sanitation, or achieving open-defecation-free status. The

tendencies in an area. Comparing data obtained from different villages and sub-districts allows

goals and commitment of the leader must be made official to all stakeholders involved

identification of areas that require urgent attention. Also analyze supporting data, such as access to

Invite All Parties

sanitation facilities and population demographics.

Leaders must convince as many stakeholders possible to be involved in the program. Each technical

KAP Surveys

agency should prepare a plan of activities and expenditure budget. Water Supply and Sanitation

In addition to studying public health data, conduct KAP (Knowledge, Attitude, Practice) surveys, to

Working Groups must ensure that there is clear communication between all parties involved.

learn more about the perceptions and practices of the community. Take note of the community’s

Private sector and community organizations can also be invited to support the program. All levels

access to sanitation facilities, such as toilets that meet hygiene requirements. Take samples of water

of government (provincial, district, sub-district and village) must be united under a common goal.

used by the community and test its quality in the laboratory. Analyze survey results to corroborate

Further support can be requested from the national government in the form of technical assistance

results from analysis of public health data.

and training.

Determine the Target

Appoint Unit in Charge of Program


Photo: QIPRA Collection

Photo: Qipra/2012/Taufik S.



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.

Once data has been collected, ensure that it is documented in detail. Perform analysis, and use the

Appoint an institution to be responsible for the program, and provide it with a clear mandate and

conclusions to determine the best location to implement the program. Then establish targets for the

adequate budget. Delegate further planning and coordination to the specific technical units.

desired level of sanitation for that area.


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

Understand the Community Before starting the process of behavior change, the most important pre-requisite is understanding the

Manage Household Drinking Water (PAM RT)


Study Local Water and Sanitation Conditions water and sanitation, as well as daily community habits regarding hygiene. Gather public health data from health centers 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, analyze and draw conclusions.


Manage Household Waste

Carry out a comprehensive survey in the target area, making sure to observe the level of access to drinking

Manage Household Sewage



and influence public opinion. It is also useful to observe youth groups and their activities.

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

Each household manages its own drinking water and food safety.

characteristics of the target area’s community. Research their culture, attitudes, and lifestyles, identify influential individuals, and learn which activities or media are commonly used to spread information

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



Wash Hands with Soap (CTPS)



Tips for Success:

Stop Open Defecation (STOP BABS)


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.


Photo: QIPRA Collection

Indonesia’s Community-Led Total Sanitation (STBM)


Each household properly manages its solid wastes.


Each household manages its sewage properly.

STBM is a community-led program, which means that no subsidies are provided for the construction of sanitation facilities at the household level. STBM 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 STBM programs.



work plan

Tips for Success: The Need for Funding All programs depend on adequate funding, and STBM programs are no different. Expenses for STBM

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.

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.

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

Behavioral Change

are obtainable from the national development budget, via the Special Allocation Funds. Triggering

1. Promoting the program to all stakeholders;

activities can be considered as an activity of the local health center, which make them eligible for

2. Holding training sessions for community members and stakeholders;

funding from the Health Operations Assistance. Village funds, albeit small, can also be used.

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

3. Undertaking the facilitation process and training facilitators; 4. Transportation to and accommodations at the target area.

level of government. Cooperation with non-governmental organizations, such as donors or private

Construction of Latrines or Drinking Water Facilities

companies, is also possible. It is important to note that all cooperation begins with a proposal that

1. Purchasing/obtaining molds;

clearly outlines the program’s desired objectives, activities, cost estimates, and technical requirements.

2. Transporting molds to the target area; 3. Technical training for mold usage; 4. Supervision of the construction process; 5. Supervision of operation and maintenance of facilities.


Photo: UNICEF Collection



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.

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.

Photo: Qipra/2012/Taufik S.

Conditions of the Target Area

Photo: UNICEF Collection

Photo: QIPRA Collection


Funding for Water and Sanitation


Photo: UNICEF Collection

Photo: UNICEF Collection


Establish Work ing Groups

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



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:

Tips for Success:

Appoint a Unit Responsible for the Program

Step-wise Dissemination

Identify the technical agencies responsible for the water and sanitation program, and appoint one to

Information on the program should be disseminated in a step-wise approach, from the national

be responsible for the program, with a clear written mandate. Direct the other units to work according

government to the targeted community, with knowledge being passed down from one government

to their expertise and roles, while the unit responsible for the program designs a more detailed work

level to another. In other words, knowledge originating from the national government, should be

plan and coordinates the work of other units.

passed down to the provincial, district, sub-district, and village governments successively, until

Prepare Facilitators

it is finally disseminated to the community or households. Thus, cooperation among all levels of

Facilitators, whether individuals or non-governmental organizations, should be selected according to

government is vital to the program’s success.

their competency and passion in community empowerment, drinking water, sanitation, and/or the

Document Every Step

environment. They can be recruited through the District’s Health Office or technical agency in charge.

Every outreach and planning event, and implementation of the program’s activities must be well-

It is preferable to give these facilitators training to introduce the program and its approach, as well as

documented, as these will provide evidence for reporting purposes. The records will also be useful as

provide technical information, the latter of which can be supplied by the Ministry of Health.

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.



Proper Defecation The first tenet of STBM is stopping open defecation (see box ‘Five tenets of CLTS, page 35). Changing Photo: UNICEF Collection

defecation behavior requires more than simply changing the location of defecation. So how does one 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,



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.

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 properly-covered latrine that ensures the user’s privacy, must contain a sewage pit that can be covered or buried with soil to ensure others need not smell or see the feces and can stop contact between flies and feces. A good latrine is one that fulfills these requirements, and does not necessarily need to be costly or sophisticated.

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: Qipra/2012/Taufik S.



Village Cadres

Photo: UNICEF Collection

Photo: UNICEF Collection



Identify a number of community members who are willing to be voluntary cadres. Train and explain the cadre’s 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 community’s behavior.



Community Triggering

Hold activities that will help trigger the community’s 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:

Tips for Success:

Identify Village Cadres

The Facilitators’ Role

Open community discussions in the village and identify volunteers, selecting a suitable number of

Facilitators are tasked with facilitating the community’s educational process throughout the

people for the program. They can be from a variety of backgrounds, such as religious figures, youth

triggering process. This task can be challenging due to the diverse personalities and attitudes of

leaders, women, or even village heads. In all cases it is necessary that women should always be involved

community members. As such, creativity and strong intuition in approaching the community are

as cadres, as they are key figures in establishing hygienic behavior in the households.

vital skills for the facilitators.

Hold Trainings

Choose a Location

Hold trainings for the selected village cadres, educating them to understand hygienic behavior and

Choose a location for the triggering activity. One method commonly used as part of the triggering

obtain communication and monitoring skills. Furthermore, the cadres should also be prepared to start

process is transect walk. During the transect walk, facilitators bring the community to a location where

the triggering process in their own communities.

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.



The Sanitation Ladder Transition from open defecation to proper defecation requires each household to choose the type of latrine that suits their means. A family’s first latrine is usually very simple. Once they have become Photo: QIPRA Collection

accustomed to using toilets, families are expected to improve the quality of their latrines. Latrine 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.


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 molds.

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

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.

binding all members of the community. Regulations are expected to help enforce consistent hygienic behavior.

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 not lost.



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.


Photo: QIPRA Collection



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.


: 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 Children’s Fund

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 Office, 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 government’s role in STBM 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 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.



Bibliography Central Statistics Bureau of Ende District . Pulau Ende dalam Angka 2011. Hans. 2009. Unicef sampaikan Penghargaan kepada Pemkab Ende. NTT 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 Pamsimas. Field Book: Sanitation Ladder (Tangga Sanitasi). Pius, Romualdus. 2011. Pulau Ende Bebas BABS. 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 .


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

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