identifying safely managed sanitation options in two

SEHATI | Sustainable Sanitation and Hygiene for Eastern Indonesia

Identifying Safely Managed Sanitation options in two districts in Eastern Indonesia

Study Report

Final

26 August 2020

Identifying Safely Managed Sanitation options in two districts in Eastern Indonesia | Study Report

© SEHATI SDG 6.2 Study report_Final 1

© 2020

This report presents the findings from the study “Identifying Safely Managed Sanitation options in two districts in Eastern Indonesia”

Author: Erick Baetings, IRC Consult

Editor:

Design and layout: Erick Baetings, IRC Consult

Photos: Erick Baetings

With thanks to Paul van Essen, SEHATI Programme Manager, and Angelina Yusridar, SEHATI Monitoring, Evaluation, Learning and Documentation Officer DISCLAIMER The findings, interpretations and conclusions contained in this report are those of the author and may not

necessarily reflect the views of Simavi.

.



Contents

_Toc49097219 Glossary and acronyms .............................................................................................3

1. Introduction to the Study .................................................................................. 6

1.1 Background ......................................................................................................... 6

1.2 Purpose and Objectives of the Study ..................................................................... 8

1.3 Methodology ....................................................................................................... 9

2. Sustainable Development Goal Target 6.2 ........................................................ 12

2.1 The Sustainable Development Goals ................................................................... 12

2.2 SDG 6 and Target 6.2 ......................................................................................... 12

2.3 Safely managed sanitation .................................................................................. 13

2.4 Safe management of excreta along the sanitation service chain ........................... 16

3. Findings of the study ....................................................................................... 20

3.1 Manggarai Barat district | An introduction ........................................................... 20

3.2 Manggarai Barat district | Key study findings ....................................................... 24

3.2.1 Field work ................................................................................................. 24

3.2.2 Meeting with district authorities ................................................................ 32

3.3 Lombok Utara | An introduction .......................................................................... 34

3.4 Lombok Utara | Key study findings ...................................................................... 38

3.4.1 Field work ................................................................................................. 38

3.4.2 Meeting with district authorities ................................................................ 44

4. Conclusions and recommendations ................................................................. 46

4.1 Conclusions ........................................................................................................ 46

4.2 Recommendations ............................................................................................. 52

References ..............................................................................................................56

Annex A: Study programme and travel details.......................................................... 57

Annex B: Government of Indonesia definitions for SDG target 6.2 ............................58

Annex C: Information on villages visited in Manggarai Barat .................................... 60



Glossary and acronyms

BABS Buang Air Besar Sembarangan (Open Defecation)

EKN Embassy of the Kingdom of the Netherlands

Faecal sludge Faecal sludge is a mixture of human excreta, water and solid wastes (e.g. toilet paper or other anal cleansing materials, menstrual hygiene materials) that are disposed of in pits, tanks or vaults of onsite sanitation systems. Faecal sludge that is removed from septic tanks is called septage.

Faecal sludge management

Faecal sludge management is the collection, transport, and treatment of faecal sludge from pit latrines, septic tanks or other onsite sanitation systems.

FGD Focus Group Discussion

FSM Faecal Sludge Management

GoI Government of Indonesia

IDR Indonesian Rupiah

IPAL Instalasi Pembuangan Air Limbah (Wastewater Treatment Plant)

IPLT Instalasi Pengolahan Lumpur Tinja (Faecal Sludge Treatment Plant)

JMP Joint Monitoring Programme. The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) by WHO and UNICEF is the official United Nations mechanism tasked with monitoring progress towards the Sustainable Development Goal Number 6 (SDG6) since 2016. It reports country, regional and global estimates of progress on drinking water, sanitation and hygiene (WASH).

MCK An MCK is a public facility where people can have a bath (= Mandi), wash (= Cuci) and use the toilet (= Kakus). MCK = Mandi, Cuci, Kakus.

MDGs The Millennium Development Goals were eight international development goals for the year 2015 that had been established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. The Sustainable Development Goals (SDGs) succeeded the MDGs in 2016.

NGO Non-Governmental Organisation

NTB Nusa Tenggara Barat (West Nusa Tenggara) is a province of Indonesia. It comprises the western portion of the Lesser Sunda Islands, with the exception of Bali which is its own province.

NTT Nusa Tenggara Timur (East Nusa Tenggara) is the southernmost province of Indonesia. It comprises the eastern portion of the Lesser Sunda Islands, facing the Indian Ocean in the South and the Flores Sea in the North. It consists of more than 500 islands, with the largest ones being Sumba, Flores, and the western part of Timor.

ODF Open Defecation Free

Onsite sanitation A sanitation system in which excreta and wastewater are collected, stored and/or treated on the plot where they are generated. There are two main categories of on-site sanitation technologies: ‘wet’ which require water for flushing; and ‘dry’ which do not require any water for flushing.

Offsite sanitation A sanitation system in which excreta and wastewater are collected and conveyed away from the plot where they are generated. An off-site sanitation system relies on a sewer technology (e.g. simplified sewer, solids free sewer or conventional sewer) for conveyance.



SDGs The Sustainable Development Goals are a collection of 17 global goals set by the United Nations General Assembly in 2015 for the year 2030. The SDGs are part of Resolution 70/1 of the United Nations General Assembly, the 2030 Agenda.

SEHATI Sustainable Sanitation and Hygiene for Eastern Indonesia programme (2016-2020)

Septage The combination of scum, sludge, and liquid that accumulates in septic tanks.

Sewer A pipe or conduit for carrying sewage and wastewater

Sewerage Sewerage is the infrastructure that conveys wastewater (sewage) and or surface runoff to a treatment plant or disposal point. It includes all infrastructure for collecting, transporting, and pumping sewage. Sewerage ends at the entry to a sewage treatment plant or at the point of discharge into the environment.

SHAW Sanitation, Hygiene and Water programme (2010-2015)

SPAL Sarana Pembuangan Air Limbah (communal wastewater disposal system), sometimes also called komunal septik tank (communal septic tank)

SPALD Sistem Pengelolaan Air Limbah Domestik (domestic wastewater treatment system) these systems only treat septage or blackwater

STBM Sanitasi Total Berbasis Masyarakat. Indonesia’s National Strategy for Community-Based Total Sanitation and Hygiene includes the following five pillars:

1) Open defecation free (ODF) communities; 2) Hand washing with soap at critical moments; 3) Household water treatment and safe storage of water and food; 4) Solid waste management; and 5) Liquid waste management

SUSENAS Survei Sosial Ekonomi Nasional (National Socio-economic Survey)

UNICEF United Nations Children’s Fund

WASH Water, Sanitation and Hygiene

WHO World Health Organisation

YDD Yayasan Dian Desa is one of the five SEHATI implementing partners working in the district of Manggarai Barat on the island of Flores in the province of Nusa Tenggara Timur



Sanitation products and sanitation entrepreneurs in Lombok Utara



1. Introduction to the Study

1.1 Background

The Sustainable Sanitation and Hygiene for Eastern Indonesia Programme

The Sustainable Sanitation and Hygiene for Eastern Indonesia programme (SEHATI) aims to create the conditions for local government actors to achieve district-wide access to and utilisation of sustainable and improved sanitation and hygiene facilities. The programme is expected to contribute towards the Indonesian Government's target of providing universal access to water and sanitation for the entire population by 2019. The impact of this programme will be that under the leadership of the district authorities all communities within the selected seven intervention districts will have sustainable access to and utilise improved sanitation and hygiene facilities within the foreseeable future.

SEHATI is the successor to the Sanitation, Hygiene and Water (SHAW) programme which was successfully implemented in nine districts in Eastern Indonesia from May 2010 till June 2015. During the implementation period a total of 802 villages were declared 100% STBM1 benefiting some 1.45 million people. Similar to the SHAW programme, SEHATI is implemented in partnership with local district administrations, five Indonesian NGOs (Rumsram in Biak Numfor, Yayasan Dian Desa in Manggarai Barat, Yayasan Masyarakat Peduli in Lombok Timur, CD-Bethesda in Sumba Tengah and Sumba Barat Daya, and Plan Indonesia in Lombok Utara and Dompu), two Dutch NGOs (Simavi and IRC) and other relevant stakeholders in seven districts in East Indonesia. In 2020, Kopernik was added as a new implementing partner. Simavi is responsible for overall programme coordination; IRC provides expert advice and support to Simavi and the five implementing partners.

The programme was expected to run from February 2016 till August 2019. In June 2019 the Embassy of the Kingdom of the Netherlands (EKN) agreed to extend the programme in two of the seven districts (Lombok Utara and Manggarai Barat) till August 2020. Implementation will be concluded by June 2020. July and August 2020 will be used for final reporting to EKN. As can be seen in the timeline presented in figure 1-1, there are different timeframes for the different districts with work in the four old districts continuing for only two and a half years. The locations of the seven districts is shown in figure 1-2.

Figure 1-1: SEHATI timeline

1 STBM (Sanitasi Total Berbasis Masyarakat) is the community-based total sanitation approach adopted by the Ministry

of Health as the national sanitation strategy in 2008. For further details check the Glossary and acronyms section in this report.



Five years of previous SHAW implementation have taught Simavi and the local partners what the key determinants are for successful implementation of STBM. The SEHATI programme is testing and refining a new model to accelerate progress in sanitation and hygiene by strengthening the capacity of local government actors (at district, sub-district and community level), private sector sanitation entrepreneurs and other local stakeholders for more efficient and effective service delivery. This is done by equipping the different stakeholders with the right models, approaches, tactics, tools and skills to enable them to achieve full coverage in their districts over time including paying specific attention to gender and pro-poor issues.

The SEHATI model consists of several integrated elements in order to develop and roll out a sustainable service delivery approach that has the potential for implementation at scale by local stakeholders. The two main components of the model are:

1) Improving WASH governance: leadership and commitment, strategy, planning, monitoring, financing, and supportive legislation and enforcement.

2) Strengthening local capacity for sustainable service delivery: demand creation, sanitation marketing, pro-poor (financial) support, hygiene promotion and monitoring and follow up.

The programme is designed on the conviction that when capacities of local governments are enhanced and key elements are embedded in regular government systems and processes, local actors will be able to replicate and scale up STBM throughout Indonesia. At the end of the programme, it is expected that the local government authorities of the seven districts will be able to independently implement, replicate, scale up where necessary, and sustain STBM 5-pillars in all the villages under their jurisdiction. It is also expected that by further refining the implementation model of the programme it will be suitable for replication in other districts. The ultimate aim is to develop an effective model that can be applied anywhere in Indonesia with the potential to accelerate progress towards achieving universal access to improved sanitation and hygiene.

Figure 1-2: SEHATI intervention districts

During the early stages of the SHAW programme the main goal was to create Open Defecation Free communities, partly as a consequence of the fact that the community-led total sanitation approach was adopted by most of the implementing partners. The simple mantra was: “any toilet is better than no toilet”. This often resulted in the constructing of simple latrines that were neither user friendly nor durable. Somewhere mid-way the programme the MDG inspired sanitation ladder was embraced and efforts were made to encourage and support individual households to install improved type of toilets. In the SEHATI programme only improved toilets have been promoted. The challenge is now to encourage and support people to continue to move up the sanitation ladder towards safely managed sanitation to improve the quality of the sanitation facilities and practices and thus the overall quality of life.



1.2 Purpose and Objectives of the Study

This study was commissioned in January 2020 as a final piece of research focusing on safely managed sanitation in two districts where the SEHATI programme is being implemented. The study is expected to inform local authorities responsible for WASH service delivery what action is necessary to ensure that everybody has access to safely managed sanitation within the foreseeable future.

One issue that may not have received adequate consideration during the more than 4 years of SEHATI programme implementation is the new SDG 6.2 inspired JMP sanitation ladder. The programme has been actively promoting the uptake of ‘improved’ sanitation facilities through the demand creation and sanitation marketing interventions. Figure 1-3 illustrates the differences between the MDG and SDG sanitation ladders. The most prominent change is the fact that a ‘safely managed’ service level category has been added to the ladder. To ensure public health beyond the household level, this service level incorporates the safe management of faecal waste along the entire sanitation service chain.

Figure 1-3: Transitioning from MDG to SDG sanitation ladders

The central question that needs answering by the study is:

How do we transition from ‘improved’ sanitation to ‘safely managed’ sanitation?

Or in other words: what does it take – for all relevant sanitation actors such as individual households, sanitation entrepreneurs, local government authorities, and possibly others – to make it possible to move up the sanitation ladder towards safely managed sanitation?

Study objectives

The specific objectives of the study (as outlined in the ToR) are:

1. To provide qualitative and quantitative data on the sanitation situation in Lombok Utara and Manggarai Barat from a socio-economic and technical perspective, specifically as it relates to safely managed sanitation;

2. To identify appropriate (and affordable) sanitation technologies and appropriate (and affordable) faecal sludge management practices and services (for example semi-mechanised emptying and transportation solutions that can be easily operated by small-scale district-based entrepreneurs;

3. To provide recommendations and initial inputs for appropriate faecal sludge management guidelines and models to ensure safe practices by households and service providers.



This document “Identifying Safely Managed Sanitation options in two districts in East Indonesia” is the sole deliverable for the study.

1.3 Methodology

The study consisted of two separate but interlinked phases:

1) A desk study to get an understanding of how safely managed sanitation is defined and a better idea of potential safely managed sanitation options both within and outside Indonesia; and

2) A field study to the two districts of Manggarai Barat and Lombok Utara to assess the situation on the ground to get a better understanding of local needs and aspirations as well as a chance to assess and weigh potential solutions.

Re 1) Desk study

The desk study was carried out to provide insight in two aspects relevant for the study: 1) an idea of the socioeconomic situation of households in the two rural districts of Manggarai Barat and Lombok Utara so as to determine their ability to pay for safely managed sanitation; and 2) an overview or an inventory of onsite sanitation technologies that could be labelled as safely managed sanitation.

It was hoped that recent socioeconomic data would be available for the two districts similar to what is captured in the National Socio-Economic Survey (SUSENAS) 20102. The two researchers were not able to find any relevant and up to date information online about the socioeconomic situation of the two districts. However, as will be explained in the main part of this report, some limited information was collected during the field visits.

The overview or inventory of onsite sanitation technologies focused on safe capture and containment options that meet improved sanitation criteria, now better known as basic services. To qualify as safely managed sanitation options the selected improved sanitation technologies will need to be constructed such that human waste can either be contained (stored) safely onsite indefinitely or emptied safely and easily – either manually (by the household or by a professional pit emptier) or mechanically (by a public or private service provider) – and transported offsite.

Re 2) Field study

Field studies were carried out in the two remaining SEHATI districts of Manggarai Barat on the island of Flores (NTT) and Lombok Utara on the island of Lombok (NTB). Manggarai Barat was visited from the 23rd to the 29th of February 2020 and Lombok Utara was visited from the 1st to the 7th of March 2020.

The visits to the two districts were more or less identical. The following activities were carried out during the one-week visits:

Team meeting with SEHATI partner. A kick-off meeting was conducted with the SEHATI implementation partner (Yayasan Plan International Indonesia in Lombok Utara and Yayasan Dian Desa in Manggarai Barat) on the first day of the visit. These meetings were conducted to obtain a good impression of the situation on the ground with regards to

Types of improved sanitation and safely managed sanitation options available in the district;

Faecal sludge management (FSM) practices and services available in the district;

Selected list of villages to be visited for the study;

Selected key informants that should be interviewed particularly at district level; and 5)

Any other information that might be relevant for the study.

Visits to selected villages to conduct village transect walks, focus group discussions and household interviews. A total of six villages were visited in the two districts (three villages per district).

2 STATISTIK KESEJAHTERAAN RAKYAT 2010 (Welfare Statistics 2010 report)



The following activities were carried out in these six villages:

Courtesy call with the village leaders to introduce the team and to explain the purpose of the visit.

Village transect walk to obtain an idea of the types of sanitation facilities in place but also to invite villagers to participate in neighbourhood focus group discussions.

Focus Group Discussions (FGD) with a group of villagers to discuss the topic of safely managed sanitation. The FGDs were used to obtain an impression on the villagers’ interest, perceptions, attitudes, beliefs, opinions and or ideas on sanitation in general and safely managed sanitation in particular. The FGDs were also used to zoom into specific topics, for example issues related to costs of sanitation facilities and pit emptying services. A Microsoft Excel-based questionnaire was developed for the FGDs to ensure systematic and consistent data collection of data but also to ease data analysis and data comparison across the six villages.

Interviews with sanitation entrepreneurs and FSM service providers. Interviews were conducted with a number of sanitation entrepreneurs to obtain information on the demand and supply of sanitation related products and services and to what extent these products and services are relevant to work towards safely managed sanitation facilities and services.

Interviews with district authorities. Interviews were conducted with a number of district departments to be able to obtain an idea of district level initiatives, policies and or legal frameworks. It proved to be impossible to meet with the district level Pokja AMPL3 in Manggarai Barat and instead we met with the Head of the Sanitation Division of the Department of Housing and the Section Head of the Environmental Health and Safety Section of the Department of Health separately. In Lombok Utara we were able to participate in a Pokja AMPL meeting which was solely used to discuss the study.

Wrap up meeting with SEHATI partner. At the end of each district a meeting was organised with staff of the SEHATI partner to brief them on the main findings of the fieldwork and to validate and further discuss these findings.

More details on places visits and key informants met will be provided in the following chapter. The overall study programme and travel details are provided in Annex 1.

3 Pokja AMPL is the district level water supply and sanitation working group responsible for coordinating policies, plans,

budgets and programmes related to water supply and sanitation.



Toilets damaged due to the mid-2018 earthquakes in Lombok Utara



2. Sustainable Development Goal Target 6.2

This section provides insight in Sustainable Development Goal (SDG) target 6.2 which is part of the 2030 sustainable development agenda. It is important to understand SDG 6.2 and what definitions and targets have been set with regards to sanitation and hygiene. The SDG inspired sanitation ladder will be discussed and in particular the newly defined safely managed sanitation service level.

2.1 The Sustainable Development Goals

SDG 6.2 is one of the 17 SDGs included in the 2030 Agenda for Sustainable Development adopted on 25 September 2015 by Heads of State and Government at a special UN summit4. The Agenda is a commitment to eradicate poverty and achieve sustainable development by 2030 world-wide, ensuring that “No One is Left Behind”. The adoption of the 2030 Agenda was a landmark achievement, providing for a shared global vision towards sustainable development for all.

The 2030 Agenda and the SDGs seek to build on the Millennium Development Goals and complete what these did not achieve. The 17 SDGs with 169 targets are broader in scope and go further than the MDGs by addressing the root causes of poverty and the universal need for development that works for all people. The goals cover the three dimensions of sustainable development: economic growth, social inclusion and environmental protection. Building on the success and momentum of the MDGs, the new goals cover more ground, with ambitions to address inequalities, economic growth, decent jobs, cities and human settlements, industrialisation, oceans, ecosystems, energy, climate change, sustainable consumption and production, peace and justice. The new Goals are universal and apply to all countries, whereas the MDGs were intended for action in developing countries only.

The 2030 Agenda explicitly includes all aspects of water resources, water supply, and sanitation.

2.2 SDG 6 and Target 6.2

Sustainable Development Goal 6 is to “ensure availability and sustainable management of water and sanitation for all”. Sustainable management of water resources and access to safe water and sanitation are essential for unlocking economic growth and productivity and provide significant leverage for existing investments in health and education.5

SDG 6 goes much further than water supply, sanitation, and hygiene (WASH) and includes all aspects of the water cycle and explicitly recognises that water has impact across the entire development agenda. It targets water quantity (scarcity) and quality, water-use efficiency, and water-related ecosystems. It promotes a basin approach to water management and the need for Integrated Water Resources Management (IWRM), which goes beyond national administrative boundaries and embraces transboundary water management that affects almost half the Earth’s land surface (Cordeira Ortigara et al. 2018). SDG 6 comprises of eight targets that address the entire water cycle. For this paper target 6.2 is of particular interest.

Target 6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.

4 Transforming our world: the 2030 Agenda for Sustainable Development. Resolution adopted by the United Nations

General Assembly on 25 September 2015. Available on: https://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

5 https://www.unenvironment.org/explore-topics/sustainable-development-goals/why-do-sustainable-development-

goals-matter/goal-6

https://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

https://www.unenvironment.org/explore-topics/sustainable-development-goals/why-do-sustainable-development-goals-matter/goal-6

https://www.unenvironment.org/explore-topics/sustainable-development-goals/why-do-sustainable-development-goals-matter/goal-6



SDG target 6.2 tracks the proportion of the population using an improved sanitation facility at the household level that is not shared with other households, and where excreta are treated and disposed of in situ or transported and treated off-site. It also tracks the proportion of the population with basic handwashing facilities in the home, where the presence of a handwashing facility is used as a proxy for handwashing behaviour. Target 6.2 is measured with the use of indicator 6.2.1 which reads as follows:

Proportion of population using safely managed sanitation services, including a hand-washing facility with soap and water.

Indicator 6.2.1 in fact consists of two sub-indicators, the first monitoring access to sanitation (6.2.1a), the second to handwashing facilities (6.2.1b). The WHO and UNICEF Joint Monitoring Program (JMP)6 is the data custodian for SDG 6.2.1. Baseline estimates for the new SDG sanitation indicators were published by the JMP in July 2017 (WHO and UNICEF, 2017). Data are reported biennially, with a one-year lag between collection and publication.

In the case of Indonesia, it relates to the following two STBM pillars7: pillar 1 – Open Defecation Free communities; and pillar 2 – Handwashing with soap at critical moments. Ideally, changes and improvements in those two pillars should therefore be guided by indicator 6.2.1 and the specific definitions and ladders developed by the JMP.

2.3 Safely managed sanitation

Poor management of excreta is linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio, and also contributes to malnutrition. Inadequate sanitation is estimated to cause 280,000 diarrhoeal deaths annually and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma (WHO website). Using basic8 and safely managed sanitation facilities is an important way to stop this transmission by removing faecal matter from the environment. While various types of facilities fall into this category, the main focus is to ensure that the way human excreta are collected and stored does not allow pathogens to easily contaminate the surrounding environment. (Spring-nutrition website)

Globally, only four out of ten people (45%, equal to some 3.4 billion people) used safely managed sanitation services in 2017. In many countries, including Indonesia, there was insufficient data to estimate the proportion of safely managed sanitation. (JMP 2019)

Safely managed sanitation is defined as the use of an improved sanitation facility9 which is not shared with other households, where human excreta are safely disposed of in situ or transported and treated offsite, and where handwashing facilities with soap and water are available. There are three main ways to meet the criteria for having a safely managed sanitation service:

1) Human excreta are treated and disposed in situ (safely disposed in situ)10,

2) Human excreta are stored temporarily and then emptied and transported to treatment off-site, or

3) Human excreta are transported through a sewer with wastewater and then treated off-site.

6 The Joint Monitoring Programme (JMP) for Water Supply and Sanitation by WHO and UNICEF is the official United

Nations mechanism tasked with monitoring progress towards SDG6 since 2016. 7 Indonesia’s National Strategy for Community-Based Total Sanitation and Hygiene (Sanitasi Total Berbasis Masyarakat

or STBM).

8 Note that these “basic” sanitation services used to be known as “improved” sanitation. 9 Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and include

flush/pour flush to piped sewer, septic tank or pit latrine; composing toilet or pit latrine with slab. 10 Safely disposed in situ; refers to cases in which the contents of pit latrines or septic tanks are not emptied, and the

faecal wastes remain in the ground, with pathogens dying off over time.



Moving beyond the eradication of open defecation towards safely managed sanitation has been conceptualised as a ladder progressing from lower-cost sanitation options of lower health benefits to higher-cost options with higher health benefits. The SDG sanitation ladder is shown in figure 2-1.

Figure 2-1: SDG sanitation ladder

If the excreta from improved sanitation facilities are not safely managed, then people using those facilities will be classed as having a basic sanitation service. People using improved facilities which are shared with other households will be classified as having a limited sanitation service. People practising open defecation will be classified as having no service.

Improved sanitation facilities are those designed to hygienically separate excreta from human contact. These include wet sanitation technologies (flush and pour flush toilets connecting to sewers, septic tanks or pit latrines) and dry sanitation technologies (ventilated improved pit latrines; pit latrines with slabs; or composting toilets). Improved facilities shared with other households have previously been reported separately and did not count towards the MDG target. The JMP now divides improved sanitation facilities into three categories: limited, basic and safely managed services. The population using improved facilities that are shared with other households will now be called limited rather than shared. Improved facilities that are not shared count as either basic or safely managed services, depending on how excreta are managed. (WHO and UNICEF, 2017; page 16) The JMP definitions are provided in figure 2-2 below.

Figure 2-2: SDG sanitation ladder definitions



Improved sanitation facilities can be connected to either sewer networks or to onsite storage and treatment facilities such as septic tanks or latrine pits. With the SDG focus on safe management of excreta, it is useful to distinguish between sewered and non-sewered sanitation facilities depicted in figure 2-3, as they require different forms of excreta management.

Figure 2-3: Different types of sanitation technologies

While septic tanks have certain defining design features (including watertight walls and floor, multiple chambers separated by baffles, and an outlet pipe leading to a soak pit or leach field), many onsite systems lack these features, and should actually be classified as simple vaults or cesspools. The JMP recognises that the term “septic tanks” covers many kinds of on-site storage systems. For the purposes of calculating safely managed sanitation services, the JMP treats all improved onsite sanitation systems equally.

Where data on excreta management are available, some of the basic services can meet the criteria for safely managed sanitation services. Toilets connected through sewers to a facility which provided wastewater treatment, can be classified as safely managed sanitation services. Improved onsite facilities where wastes are disposed of in situ counts as a form of treatment and is also classified as safely managed. However, where data on excreta management are not available, the entire population using improved facilities that are not shared is classified as having at least basic services.

If data on wastewater treatment are available, and sewer connections are more prevalent than onsite sanitation systems, the JMP can make an estimate of safely managed sanitation services. If onsite sanitation is more prevalent, however, data on wastewater treatment are not sufficient to produce an estimate of safely managed sanitation and some information on treatment of excreta from onsite systems is required. The collection of reliable statistics on treatment and disposal of excreta is a prerequisite for safe management, so if countries do not have any data it is not possible to estimate the proportion of onsite facilities which are safely managed. (WHO and UNICEF, 2017; page 29)

As the following chapter will highlight, there are a number of challenges when monitoring indicator 6.2.1. Data on safe disposal and treatment of human waste and handwashing facilities are often not readily available, which makes monitoring indicators 6.2.1a and 6.2.1b a challenge.

The Government of Indonesia (GoI) is applying the same JMP sanitation ladder but made some noticeable changes to the JMP definitions. By doing so willingly or unwillingly it will be more difficult for especially rural households to attain safely managed sanitation services. The main differences are 1) toilets with a direct pit are not recognised as improved sanitation; and 2) toilets where human excreta are safely stored (and treated and disposed) in situ are not recognised as safely managed sanitation. This issue will be revisited in the following chapter.



2.4 Safe management of excreta along the sanitation service chain

Safely managed sanitation goes beyond the use of a hygienic toilet and implies safe management of human excreta at each step of the sanitation service chain, including containment, emptying, transport or conveyance, treatment, and eventual disposal and or reuse.

This study and its outcomes will focus on the entire sanitation service chain illustrated in figure 2-4. A distinction is made between the capture and containment elements at the start of the chain – which is primarily the domain and responsibilities of individual households – and the other four elements (emptying, transport, treatment, and safe reuse of disposal) of the chain which are often the responsibility of a wide range of actors including individual households, (professional) service providers, village and or district authorities and possibly even others.

Figure 2-4: Non-sewered sanitation service chain

Safely and unsafely managed sanitation can be recapitulated as follows:

If safely managed, faecal waste is properly contained, emptied, transported, treated, and safely disposed and or reused.

If unsafely managed, faecal waste is lost somewhere along the sanitation service chain, and contamination occurs through water sources, drains, and open spaces before spreading by contact with food, water, flies and direct exposure. This results in increased disease risk and environmental damage for the entire population.

To meet the new SDG criteria for safely managed sanitation services, households must use an improved type of sanitation facility that is not shared with other households and the excreta produced must either be safely treated in situ or transported and treated offsite. In practice, there are three possible pathways to safely managed services (figure 2-5):

Wastewater treated offsite: excreta are conveyed with wastewater through sewer lines and treated off-site at wastewater treatment plants

Excreta emptied and treated off-site: excreta are emptied from septic tanks and latrine pits, removed and treated offsite at facilities designed for faecal sludge

Excreta treated and disposed of in situ: excreta are treated and disposed of in situ in septic tanks with appropriate leach fields, or in latrine pits that are covered and left undisturbed when full.



Figure 2-5: Pathways to safely managed services (Source: JMP)

As will be explained in the following chapter, there are no conventional centralised sewerage systems in the two districts of Manggarai Barat and Lombok Utara. Except for a few decentralised communal wastewater treatment systems11 in Lombok Utara, the vast majority of the households in the two districts make use of onsite sanitation facilities. These onsite facilities can be divided in two types: 1) facilities where faecal waste is stored or contained on site indefinitely; and 2) facilities where faecal waste is temporarily stored or contained onsite, but which require emptying when these facilities fill up. Figure 2-6 shows simplified versions of the three most distinct sanitation service chains, both offsite (sewerage) and onsite (permanent onsite containment and temporary onsite containment with offsite faecal sludge management arrangements).

Figure 2-6: Simplified sewered and non-sewered sanitation service chains

The sanitation service chain for the decentralised communal wastewater treatment systems looks identical to the sewerage service chain.

If safely managed, faecal waste is properly contained, emptied, transported, treated, and safely disposed and or reused. If unsafely managed, faecal waste is lost somewhere along the sanitation service chain, and contamination occurs through water sources, drains, and open spaces before spreading by contact with food, water, flies and direct exposure. This results in increased disease risk and environmental damage for the entire population. (Du, J. et al, December 2019)

11 Called SPALD (Sistem Pengelolaan Air Limbah Domestik) in Bahasa Indonesia.



Most people living in rural villages rely on pit latrines for their sanitation needs. But even though these latrines are shared between smaller, specific groups users, and might be counted as "improved sanitation", they still need to be properly emptied every so often – a service either not available or where available not affordable to low-income households. As figure 2-7 shows, anything can go wrong and as a result faecal waste can be lost anywhere along the sanitation service chain. `

Figure 2-7: Sanitation service chain for onsite (non-sewered) sanitation facilities

For the sake of clarity, faecal sludge related activities carried out independently by households will be termed faecal sludge management practices, whereas the faecal sludge related activities carried out by (professional) service providers will be termed faecal sludge management services in this report. Faecal sludge management related service providers could be both public and privately owned enterprises. In those cases where (professional) faecal sludge management services are absent, the study puts more emphasis on the role and responsibilities of the individual households to safely contain and dispose of the human waste. Figure 2-8 illustrates the most likely faecal sludge management options – both individual household practices and professional services – available for onsite sanitation facilities.

Figure 2-8: Emptying and desludging options for onsite sanitation facilities



Examples of the main types of onsite sanitation facilities found in Manggarai Barat



3. Findings of the study

This section provides an overview of the main findings of the study carried out in the two districts of Manggarai Barat and Lombok Utara in Eastern Indonesia and a discussion there of. The findings are presented separately for the two districts.

3.1 Manggarai Barat district | An introduction

Kabupaten Manggarai Barat (West Manggarai Regency) is one of the eight Kabupatens which divide the island of Flores, located in the province of Nusa Tenggara Timur (East Nusa Tenggara) in Indonesia. It covers a land area of 2,947.46 square kilometres and had a population of 221,703 at the 2010 Census, rising to 251,689 at the 2015 Intermediate Census. The latest official estimate12 (as at end 2018) is 269,029. The regency's capital is the town of Labuan Bajo. The Kabupaten includes the western portion of Flores island (Pulau Flores) and several small islands mainly lying to the west of it, including the two largest islands, Komodo (Pulau Komodo) and Rinca (Pulau Rinca). In 2018, Manggarai Barat Regency consisted of 12 sub-districts, 164 villages and 5 urban villages.

Figure 3-1: Map of Manggarai Barat

Access to sanitation

To assess whether sanitation services are safely managed, it is first necessary to understand the main types of sanitation facilities people use and in particular the proportion of improved sanitation.

Figure 3-2 shows that the proportion of the population using improved sanitation facilities varies widely depending on the used data sources. Between mid-2016 and end 2019, there have been significant changes in the 45 SEHATI villages in Manggarai Barat. For example, improved sanitation recorded a 42-percentage point increase and houses with no sanitation facility (practising open defecation) recorded a 23-percentage point decrease. Over the same period, improved sanitation facilities recorded a mere 22 percentage point increase across all 215 intervention villages in the seven SEHATI districts. Open defecation practices decreased with only 12 percentage points.

12 Bureau of Statistics of Manggarai Barat (2019). Manggarai Barat in figures 2019. Male: 133,003; female: 136,026 [page

44]. Annual growth rate 2017-2018 was 2.21% [page 43]. Data relates to 2018!



Figure 3-2: Manggarai Barat JMP sanitation ladder

As can be seen in the above figure, the 45 SEHATI villages compare favourably with other data sources such as Manggarai Barat in figures data for Manggarai Barat district (44% improved sanitation) and Nusa Tenggara Timur province (57% improved sanitation), and JMP data for the entire country (65%).

It must be noted that the proportion of safely managed sanitation facilities is not known as the SEHATI monitoring tools were developed on the basis of the earlier MDG inspired JMP sanitation ladder. However, in the next section an attempt will be made to estimate the proportion of safely managed sanitation facilities in Manggarai Barat district.

Access to hygiene

As explained in Section 2.2, indicator 6.2.1 used to measure SDG Target 6.2 consists of two sub-indicators, the first monitoring access to sanitation (6.2.1a), the second monitoring access to handwashing facilities (6.2.1b). Safely managed sanitation requires the existence of handwashing facilities with soap and water13.

The current corona pandemic has illustrated the urgent need for personal hygiene. Viruses such as the coronavirus14 can be spread by hand contact. Many people often touch their nose or mouth with their hands, without even noticing. Hand hygiene – frequently and thoroughly washing of hands - is one of the most important measures to prevent the spread of diseases. With the coronavirus gaining traction, it’s has become all the more critical.

Frequent handwashing with soap is one of the most effective ways to stop the spread of coronavirus (COVID-19).15

13 UNICEF recommends the use of soap explaining that different kinds of soap and alcohol-based hand rubs are available

as hand-cleaning agents. Chlorine-based solutions, ash and handwashing with water only are not recommended, but can be considered as last resort. Source: https://www.unicef.org/media/68896/file/Handwashing-Facility-Factsheet.pdf

14 The name of the corona virus is SARS-CoV-2.

15 https://washmatters.wateraid.org/water-and-hygiene-against-coronavirus

https://www.unicef.org/media/68896/file/Handwashing-Facility-Factsheet.pdf

https://www.unicef.org/media/68896/file/Handwashing-Facility-Factsheet.pdf

https://washmatters.wateraid.org/water-and-hygiene-against-coronavirus



Coronaviruses are a group of contagious, flu-like viruses. They cause symptoms that can be as mild as a common cold but in some cases can be fatal. COVID-19 is the decease caused by a new type of coronavirus that is spreading quickly around the world. Early symptoms include fever, cough and difficulty in breathing – similar to other flu-like illnesses. With specific treatments or a vaccine not yet available, preventing its spread from person to person is vital to reduce the outbreak’s impact on people’s lives, health, livelihoods and the healthcare systems we rely on. Along with other important behaviours, thoroughly washing hands often and at key moments is essential to controlling the pandemic. (WaterAid global website)

Additional information on COVID-19 and the impact of COVID-19 on Simavi’s work can be obtained from their website: https://simavi.org/long-read/COVID-19/

Promoting frequent handwashing with soap at critical times is an integral part of the SEHATI programme as it constitutes the second of the five STBM pillars. For that reason, the presence of handwashing facilities, as a proxy indicator16 for actual handwashing behaviour, is monitored by the programme. Figure 3-3 shows the proportion of the population having access to handwashing facilities with soap and water.

Figure 3-3: Manggarai Barat JMP hygiene ladder

In the period mid 2016 till end 2019 the availability of handwashing facilities with soap and water increased with an astonishing 70 percentage points from 6 to 76 percent. The actual availability is expected to be higher as the programme only monitors the existence of handwashing facilities in or near a toilet17. Therefore, the presence of handwashing facilities in other locations (e.g. kitchen, bathroom) are not included in the above figures.

Data on handwashing behaviour is scant and the only comparative figures found were those reported by JMP (WHO and UNICEF, 2019). Figure 12 includes the JMP figures for rural Indonesia for the year 2017. JMP reports that in 2017, 55 percent of the rural population in Indonesia had access to a handwashing facility with soap and water.

16 Proxy indicators are indirect measures or signs that approximates or represents a phenomenon or behaviour in the

absence of a direct measure or sign.

17 This is based on the concept that if handwashing facilities/stations are located where it is hard to avoid, very visible

and it takes no additional time to get to the handwashing facility, they are more likely to be used.

https://simavi.org/long-read/covid-19/



Socioeconomic situation

A good insight in the socioeconomic situation of the district is critically important to judge whether individual households have the ability to pay18 for higher level of services. Moving from improved sanitation to safely managed sanitation costs money, either to construct or install better facilities such as safe containment options or to ensure that faecal waste is safely removed and transported to a safe disposal site such as a faecal sludge treatment plant. The biggest concerns are with the lower-income groups. Even now they already must deal with lower service levels and often do not have access to their own improved sanitation facilities.

At the time of developing the proposal for this study it was assumed that the SUSENAS (National Socio-economic Survey) would be able to provide relevant information. SUSENAS was designed to look at three different aspects, namely 1) household consumption/expenditure, education and socio-culture, and 3) health and housing. Each aspect was to be conducted every three years. Information on the GoI website19 indicates that the last household consumption and expenditure survey was conducted in 2011. Unfortunately, more up to date surveys were not found which means that recent data on annual household level disposable incomes20 are not available.

Some limited information was obtained from the Manggarai Barat in figures 2019 booklet21. Page 131 of the booklet states that in 2018 18.14 percent of the population in the district (equal to some 48,800 people) had incomes below the poverty line22 of 313,380 Rupiah per month (US$ 22). This is almost twice as much as the national poverty rate of 9.66 percent estimated by the National Statistical Office (Bapan Pusat Statistik) in September 2018 (OECD, 2019). The World Bank’s International poverty line of USD 1.90 per day is some two and a half times more than the poverty line of 313,380 Rupiah per month (US$ 0.72 per day).

On page 130 of the Manggarai Barat in figures 2019 booklet information is provided on the number of people targeted by a range of different social protection programmes. In 2018 a total of 34,146 people received support from these social protection programmes. These people included 5,704 extreme poor23, 8,409 poor, and 20,033 near-poor24. It is not clear why there is such a remarkable gap between the total number of people living below the poverty line and the number of people benefiting from some form of social protection. OECD (2019) states on page 150 that only a minority of the poor population is accessing all the interventions to which they are entitled, and which they need to exit poverty on a permanent basis.

18 Ability to pay is a principle of taxation. Individuals who earn more income pay more tax, not because they use more

government goods and services, but because taxpayers who earn more have the ability to pay more. In the WASH

context it is used to express whether households have the ability to pay for WASH services.

19 https://mikrodata.bps.go.id/mikrodata/index.php/catalog/411

20 Disposable income is the amount of money you have left over from your total annual income after paying national and

local taxes. Just because you have disposable income does not mean you can go on a spending spree. Most of the

disposable income will be spent on paying for all necessities of life like housing, food, transportation, education,

healthcare and clothing. This is called discretionary income: disposable income minus the unavoidable costs of living.

21 Manggarai Barat in figures 2019 published by the Bureau of Statistics of Manggarai Barat.

22 National (monetary) poverty line: the minimum amount needed to afford a specific basket of food and non-food basic

needs, defined by the food poverty line and the non-food poverty line, respectively.

23 Extreme poor are people that live below the food poverty line.

24 Near-poor are people with an income between the poverty line and 1.2 times the poverty line.

https://mikrodata.bps.go.id/mikrodata/index.php/catalog/411



3.2 Manggarai Barat district | Key study findings

Manggarai Barat district was visited from Sunday 23rd February up to and including Saturday 29th February 2020. The findings presented in this section are based on the activities carried out during the visit:

Monday 24 February: Intake meeting with YDD staff and a meeting with Hari Yanto, Section Head Environmental Health and Safety, District Health Office

Tuesday 25 February: Visit to Golo Damu village in Mbeliling sub-district

Wednesday 26 February: Visit to Watu Nggelek village in Komodo sub-district

Thursday 27 February: Visit to Tiwu Nampur village in Komodo sub-district

Friday 28 February: Meeting with John Stat, Head of Sanitation Division, Department of Housing, and a wrap up meeting with YDD staff

Saturday 29 February: Drawing up of preliminary conclusions

3.2.1 Field work

Most of the information was collected during the visits to the three villages. In each village two clusters of houses (sub-villages) were visited and within these clusters a range of toilets were inspected to obtain a good impression of the different types of toilets in use in the village. After a range of toilets were inspected within one sub-village, the toilet owners present during the inspections, were invited to participate in a structured focus group discussion (FGD). Table 3-1 provides an overview of the villages visited and the number of villagers participating in the FGDs.

Table 3-1: Villages visited in Manggarai Barat and number of FGD participants

Name of village Golo Damu Watu Nggelek Tiwu Nampur

Name of sub-village Wae Masa Ndole Bontang Dalong Mbuhung 2 Mbuhung 1 Totals In %

# of FGD participants 6 5 5 6 5 4 31 100%

# of male participants 3 4 2 2 2 3 16 52%

# of female participants 3 1 3 4 3 1 15 48%

More information on the three villages is provided in Annex C.

Type of sanitation facilities

All the toilets in Manggarai Barat can be classified as onsite sanitation25 as offsite sanitation26 is not possible due to the absence of sewerage27. As shown in Table 3-2, the three out of every four families in Manggarai Barat who own a toilet have a leher angsa type of toilet (pour-flush toilet): 76% according to the Manggarai Barat Regency in figures 2019 and the SEHATI monitoring data collected at the end of 2019. One out of four toilets (24%) is either a cemplung (simple direct pit latrine) or a plengsengan (back-shute toilet) type of toilet.

As already explained in Section 3.1, a relatively small proportion of families use a ‘shared’ toilet (5% in the 45 SEHATI villages). These can either be toilets owned by relatives or neighbours, or public toilets better known as MCKs28.

25 Onsite sanitation is a sanitation system in which excreta and wastewater are collected, stored and/or treated on the

plot where they are generated. There are two main categories of onsite sanitation technologies: ‘wet’ which require water for flushing; and ‘dry’ which do not require any water for flushing.

26 Offsite sanitation is a sanitation system in which excreta and wastewater are collected and conveyed away from the

plot where they are generated. An off-site sanitation system relies on a sewer technology (e.g. simplified sewer, solids free sewer or conventional sewer) for conveyance.

27 Sewerage is the infrastructure that conveys wastewater (sewage) and or surface runoff to a treatment plant or

disposal point. It includes all infrastructure for collecting, transporting, and pumping sewage. Sewerage ends at the entry to a sewage treatment plant or at the point of discharge into the environment.

28 An MCK is a public facility where people can have a bath (= Mandi), wash (= Cuci) and use the toilet (= Kakus). MCK =

Mandi, Cuci, Kakus.



Table 3-2: Types of toilets in Manggarai Barat

SEHATI data | End 2019 MB in figures | 2018

Type of toilet In % In % of toilets In % In % of toilets

Cemplung (pit latrine) 3.2% 3.4% 9.7% 11.0%

Plengsengan (back-shute latrine) 18.9% 20.2% 11.4% 13.0%

Leher angsa (pour- flush latrine) 71.6% 76.4% 66.9% 76.0%

No toilet 6.3% 12.0%

Totals 100.0% 100.0% 100.0% 100.0%

The three main types of onsite toilets seen in Indonesia are shown in Figure 3-4. The jamban cemplung (pit latrine) is the most basic of the three. It is a dry toilet which does not require water for flushing and in which the excreta (both urine and faeces) falls through a drop hole in a pit directly situated below the toilet. The jamban plengsengan (back-shute latrine) is an ‘unique’ Indonesian invention where the pit is positioned behind the toilet instead of directly underneath and where one defecates in an open channel (or chute) which is connected to an offset pit. The jamban leher angsa (pour-flush toilet) is a simple flush toilet where the water is poured directly by the user. The toilet has a U-shaped pipe underneath the squatting pan (like a swan's neck) which stores enough water to keep odour from coming out.

Figure 3-4: Different types of toilets found in Indonesia

The proportion of the different types of toilets in place in the 45 SEHATI villages is visualised in Figure 3-5. Overall access to a toilet has increased with 24 percentage points from 70 percent in mid-2016 to 94 percent by the end of 2019. The proportion of pour-flush toilets has seen an even higher increase with 36 percentage points from 36 percent in mid-2016 to 72 percent by the end of 2019.

It is expected that most of the simpler type of toilets (cemplung and plengsengan) are constructed and used by poor families. As reported in the previous section, in 2018 some 18% of the population of Manggarai Barat were considered to be living below the poverty line29. As in the 45 SEHATI villages more than 28% of the houses either had a simple toilet (cemplung and plengsengan) or no toilet at all, it is expected that those without access to an improved toilet include a large portion of the near-poor in addition to the poor and extreme poor. Reasons why near-poor, and possibly also non-poor families, are likely to use these types of toilets are:

As long as these toilets can be actually used, they will be used.

Families have other priorities that come before constructing a new toilet (for example education, cultural or religious events, constructing a new house or buying a motorbike, etc.).

29 Manggarai Barat Regency in figures 2019 [page 131]. The figure of 18% consists of the poor and extreme poor but it

does not include the near-poor (people with an income between the poverty line and 1.2 times the poverty line).

https://en.wikipedia.org/wiki/Urine

https://en.wikipedia.org/wiki/Feces



Figure 3-5: Different types of toilets in Manggarai Barat

Although reducing with 10 percentage points since the start of the SEHATI programme, the relative high proportion of plengsengan type of toilets (19% of all houses) requires attention going forward as these types of toilets are considered unimproved toilets.

Number of sanitation facilities

Seventeen (55%) out of the 31 individuals who participated in the Focus Group Discussions had had a toilet prior to the current one. The main reasons for constructing a new toilet were:

1) Previous toilet had filled up and could not be used anymore; and

2) Previous toilet was either not convenient, not comfortable or did not provide sufficient privacy to the users.

Table 3-3: FGD participants that owned a toilet prior to the current toilet




# of previous toilets - 3 2 5 4 3 17 55%

In % 0% 60% 40% 83% 80% 75% 55%

The cemplung and plengsengan toilets (simple pit latrines) are usually constructed with a relatively small pit to contain the human waste onsite. Due to their small size, pits tend to fill up relatively fast which leaves the families with two options: 1) empty the pit and continue using the same toilet; or 2) abandon the toilet due to the lack of safe and affordable pit emptying options and construct a new toilet.

Type of subsurface system

Table 3-4 shows that three out of four FGD participants (#23) had a toilet connected to some kind of underground tank30. The remaining eight toilets were connected to some kind of simple pit.

The 74% ‘septic tanks’ corresponds neatly to the same proportion of pour-flush toilets owned by the people participating in the FGDs. It also corresponds more or less to a similar proportion of pour-flush toilets found in the 45 SEHATI intervention villages (72%). Unfortunately, the interchangeable use of the terms “tangki septik” and “cubluk” (Bahasa Indonesian for leach pit) does not accurately reflect the type of onsite sanitation systems found in Indonesia.

30 Underground tanks are often called ‘septic tank’ by the villagers we interviewed even though they are usually just

simple rectangular storage or containment tanks often with an open bottom.



Table 3-4: FGD participants and types of faecal waste containment options




# of single direct pits - - 2 - - - 2 6%

# of single offset pits - 2 - 2 2 - 6 19%

# of double offset pits - - - - - - 0 0%

# of ‘septic tanks’ 6 3 3 4 3 4 23 74%

% of ‘septic tanks’ 100% 60% 60% 67% 60% 100% 74%

Simple single pits – either direct pits or single offset pits – are found where families have either a cemplung or plengsengan type of toilet. Double offset pits – a common feature in countries such as Bangladesh and Cambodia – were not found in any of the villages.

Figure 3-6 shows four alternative ‘septic tank’ configurations found in Manggarai Barat. Three out of the four options consist of two separate chambers and in essence mimic a simple septic tank design. The functioning of a properly designed septic tank is provided in Box 3-1 below.

Figure 3-6: Different ‘septic tank’ configurations found in Manggarai Barat

In most cases the toilet drains initially into a small chamber in which the solids are expected to settle and accumulate over time. When this first chamber is not emptied in a timely manner it will fill up and eventually faecal waste (sludge, scum and effluent) will overflow in the larger second chamber. When that happens, it is unlikely that some form of primary treatment through anaerobic digestion will take place. It is also possible that the accumulated faecal waste (in particular the solids) clock up the overflow pipe which connects the smaller first chamber with the larger second chamber. In this case the first chamber will fill up and eventually block the pipe coming from the toilet.

The second chamber basically functions as a leach pit or soakaway where the septage slowly seeps into the subsoil. Manggarai Barat is a predominantly hilly (mountainous) district where protected springs are used for domestic purposes such as drinking and cooking. Due to the prominence of safe springs and the relatively great depth at which ground water is found, the latter is not used. Therefore, the leaching of semi-treated or untreated septage in the subsoil does not appear to create any significant health risks at present.

In general, there appears to be a poor understanding of what an adequate and appropriate onsite sanitation system entails. From what was observed during the field visits, the capacity of the two chambers was in most cases somewhat odd. Whereas the capacity of the first chamber was often not much bigger than 0.5 cubic metres, the capacity of the larger second chamber often exceeded 5 to 6 cubic metres. The second chamber is constructed as large as household finances allow, as a large (and preferably leaking) tank is unlikely to fill up and thus will never require emptying. Consider here that there are no pit emptying services available in the district and that in general people are not inclined to empty



their own toilets. What is unfortunate though is that the first smaller chamber will fill up with faecal sludge – requiring regular emptying – and that the second chamber in most cases only contains effluent which will soak away through the porous bottom.

Box 3-1: Functioning of a well-designed septic tank

1. All faecal waste flows to the septic tank.

2. The septic tank is a water-tight container usually made of bricks or concrete. The septic tank acts like a settling pond. Greases and oils float to the top. Heavier solids sink to the bottom. A T-shaped outlet should be fitted to prevent the sludge and scum from leaving the tank.

3. Wastewater, called “effluent,” fills most of the tank. Anaerobic bacteria begin breaking down the organic material in the effluent.

4. A layer of sludge settles down at the bottom. Sludge is composed of inorganic solids and the by-products of bacterial digestion.

5. A layer of scum floats to the top. Scum is primarily composed of fats, greases and oils.

6. A filter could be fitted to the outlet pipe to prevent most solids from entering the outlet pipe.

7. Finally, the effluent percolates or disperses directly into the subsurface soil or alternatively indirectly via a drain field, naturally removing harmful coliform bacteria, viruses and nutrients.

The SEHATI programme introduced the “SEHATI septic tank”. It is a much smaller and, therefore, much cheaper version of a regular septic tank31. It is made of three precast concrete rings and two concrete covers that can be easily installed by a village mason. Figure 3-7 provides a simple sketch of the SEHATI septic tank. The first ‘tank’ functions as the faecal waste settling chamber. The second pit is basically a soakaway or leach pit that allows the septage to seep into the subsurface.

Figure 3-7: SEHATI septic tank

The potential problem with the SEHATI septic tank is that it has been ‘undersized’. The first chamber is rather small and depending on the size of the prefabricated concrete rings, it may contain only as much as 500 litres (0.5 cubic metres). This has the potential of creating new challenges particularly in the absence of pit emptying options.

31 YDD staff working in Manggarai Barat mentioned the costs of installing the SEHATI septic tank to be around 1 to 2

million Rupiah (US$ 70 to 140). Noticeably cheaper than the 5 to 8 million Rupiah spent on the local ‘oversized’ septic tanks.



Filling up of toilets

Demand for pit emptying appears to be extremely low. Table 3-5 shows that till date only five out of the 31 toilets (16%) owned and used by the FGD participants have filled up so far. Two of these toilets were simple pit latrines and three of them had some sort of a ‘septic tank’. On average the pits/tanks had filled up after some 11.5 to 12 years of continued use.

Table 3-5: FGD participants and number of toilets that have filled up




Total # of toilets that filled up 3 2 - - - - 5 16%

# of filled pits 0 2 - - - - 2 6%

# of filled septic tanks 3 - - - - - 3 10%

After how many years 12 11.5 - - - - -

The information obtained during the FGDs furthermore revealed that the average age of the 31 toilets was 7.6 years, that the average number of families using one toilet was 1.4 families, and that the average number of users per toilet was 6.2 users. None of the toilets was used by more than two families and if the one MCK (public or shared community toilet) is ignored the maximum number of users was 10 persons.

Sludge accumulation rates are low32 and these as well as pit filling rates are influenced by a range of variables which depend on local conditions. Mills et al (2014) provides the following variables:

1) Temperatures: higher temperatures are expected to increase the metabolic rate of digestion resulting in less faecal sludge. (Franceys et al, 1992)

2) Addition of solid material: the use of water for anal cleansing reduces the amount of solids (e.g. paper other materials used for wiping) added to the pit or tank. Furthermore, less rubbish is thrown in toilets fitted with a water seal such as the common pour-flush toilet.

3) Wet content: toilets with a high degree of wet content – because of high water tables and or the use of water for anal cleansing and flushing – create ideal anaerobic conditions which is expected to reduce sludge volumes.

4) Single pit versus standard septic tank configurations: the settling and digestion of sludge in a single pit is different to that in a standard septic tank due to surface area, volume and no use of T-shaped outlets and baffles33 which could cause different flow paths reducing contact with biomass in settled sludge and short circuit of flows direct to the overflow is possible in systems with overflow pipes.

Mills et al (2014) recommends using an average sludge accumulation rate of 25 litres per person per year. Assuming that the first chamber, with a capacity of 0.5 cubic metres, requires emptying when it is half full, it would take a family consisting of five members just two years to fill it up.

32 Sludge accumulation rates in Indonesia: Mills et al (2014) provides two rates: 1) a mean (average) rate of 25 litres per

person per year, and a median (the middle value in a list of numbers) rate of 13 litres per person per year. The paper

states that the mean is influenced by the very high rates in some regularly emptied systems. Sludge accumulation rates

significantly reduce over time and this is likely caused by a delayed digestion start-up. Mills et al also explains that

never emptied sanitation systems had a noticeable lower sludge accumulation rate of 14 litres per person per year

compared to regularly emptied systems at 41 litres per person per year.

33 A properly constructed septic tank should have baffles. The purpose of the inlet baffle is twofold: to direct flow coming

from the toilet downward into the tank to create a longer detention time for the waste to allow settling of solids, and to keep the floating scum layer from plugging the inlet pipe. The outlet baffle also has two functions: to ensure the effluent moving to the next part of the system is from the clear effluent zone, and to prevent floating scum or debris from leaving the septic tank. The septic tank design shown in Box 3-1 makes use of T-shaped outlets instead of physical baffles.



Pit emptying options and practices

Table 3-6 shows that only one of the five pits/tanks that has filled up to date was emptied. The septic tank was emptied manually by the owner in the absence of (professional) pit emptying service providers. The other pits were either abandoned or blockages removed.

Table 3-6: Pit emptying practices




# of toilets that have filled up 3 2 - - - - 5 16%

# of toilets that were emptied 1 - - - - - 1 3%

# of toilets emptied by owner 1 - - - - - 1 3%

Except for the one household that had emptied their toilet, none of the other participants in the FGDs were seriously considering emptying their own toilet if it would fill up.

Of the 31 FGD participants, 26 participants (84%) were worried that their toilet would fill up in future. When asked what they would do if the toilet fills up, 10 participants (32%), although not all of them fully convinced that professional pit emptying services would be available when required, said that they would try to get their pit emptied. Fifteen participants (48%) said that in the absence of pit emptying service providers they would have to abandon their current toilet and construct a new one. Four participants (13%) said that they would either construct a new septic tank or enlarge the existing septic tank. Two participants (6%) did not know what they would do.

Toilet satisfaction and dreaming about future toilets

Table 3-7 shows that 21 FGD participants (68%) were satisfied with their current toilet. Nine participants (29%) were not satisfied and the main reason (78%) they gave was that their toilet did not have a permanent structure. Out of a total of 23 pour-flush toilets owners, 19 (83%) were satisfied, whereas among the participants that owned a simpler toilet – either cemplung or plengsengan – only 25% were satisfied.

Table 3-7: Toilet satisfaction and dreams




How many are satisfied with

current toilet 4 3 2 5 3 4 21 68%

How many with a pour-flush

toilet are satisfied 4 2 2 4 3 4 19 61%

In % 67% 100% 67% 80% 100% 100% 83%

How many consider building

a new toilet in future 4 3 2 2 2 3 16 52%

In % 67% 60% 40% 33% 40% 75% 52%

A total of 16 participants (52%) indicated that they would consider building a new toilet in future. Eight of them (50%) are considering constructing a new toilet as their current toilet is not durable. Two participants mentioned that they would have to consider constructing a new toilet when the current one fills up. Two participants mentioned that they would like to construct their own toilet as they are



currently sharing a toilet with relatives. One participant wanted to construct a fancier toilet (with tiles and so on) and three participants did not provide a clear reason. Four participants, although indicating that they would like to construct a permanent toilet in future, mentioned that it is unlikely to happen any time soon as they do not have the money to do so.

Towards the end of the FGDs the likely cost of the preferred future toilets was discussed. The average costs of a toilet were guestimated at IDR 9.5 million (US$670), with the cheapest toilet coming at IDR 5 million (US$ 350) and the most expensive toilet at IDR 20 million (US$ 1,400). It is projected that the large ‘septic tanks’ cost somewhere between IDR 5 and 8 million (US$ 350 to 560). A permanent superstructure was predicted to cost somewhere between IDR 2 and IDR 3 million (US$ 140 to 210).

Interestingly when asked whether they would be willing to invest in a future toilet, eleven out of the 16 participants (69%) that had indicated interest in constructing a new toilet were willing to invest an average amount of some IDR 3.5 million (US$ 250), equal to just 37% of the average estimated cost of IDR 9.5 million. Five out of the 16 participants (31%) mentioned that they would not be able to afford a pour-flush toilet with ‘septic tank’ and permanent superstructure.

When asked how much they would pay to get their pit or tank emptied in future, ten out of the 31 participants (32%) taking part in the FGDs were willing to pay an average amount of IDR 1 million (US$ 70). Expected costs varied from IDR 200,000 (US$14) to a staggering IDR 5 million (US$ 350). It must be mentioned that there is no way they can possibly know as there are no professional pit emptying services available in the district at present.

Summary of predominant types of toilets

Table 3-8 gives an overview of the three predominant types of toilets found in Manggarai Barat. The cemplung and plengsengan toilets are the cheapest types of toilets but they also provide the lowest level of service: JMP’s unimproved sanitation service level. It is unlikely that these types of toilets can be improved or upgraded to meet the basic sanitation service level criteria let alone the safely managed sanitation service level criteria. A majority of the pour-flush toilets are now classified as basic sanitation service level. However, a proportion of them will be shared with other families and therefore only classifies as limited sanitation service. Depending on the data source this could be as ‘few’ as 7% in the SEHATI intervention villages to as much as 22% in the remaining villages of Manggarai Barat.

Table 3-8: Summary of types of toilets found in Manggarai Barat

Type of toilet Tentative size and

volume of pit/tank Construction costs

How long does it take for

pit/tank to fill up

What to do when pit/tank is

full

Cemplung

(pit latrine)

Round pit with a

diameter of 1 metre

and 2 metres deep

(~1.5 cubic metres)

Local materials

only

2 to 5 years depending on pit

size, number of users, and

local conditions34

Abandon and construct new

toilet

Plengsengan

(back-shute)

Round pit with a

diameter of 1 metre

and 2 metres deep

(~1.5 cubic metres)

Very little; mainly

local materials

2 to 5 years depending on pit

size, number of users and local

conditions

Abandon and construct new

toilet

Leher Angsa

(pour-flush)

Rectangular tank of

2 x 2 x 2 metres

(5-6 cubic metres)

IDR 7 to 10 million

(US$ 490 to 710)

Large chamber does not fill up

quickly but small first chamber

possible does

Requires emptying but pit

emptying services are not

available

34 Local conditions such as climate, type of soil, groundwater table, type of cleansing materials.



3.2.2 Meeting with district authorities

Unfortunately, it was not possible to meet with the Pokja AMPL of Manggarai Barat district. Instead we were able to interview Mr. Hari Yanto, Head of the Environmental Health and Safety Section of the District Health Department, and Mr. John Stat, Head of Sanitation Division of the District Department of Housing.

Central funds are used to construct improved toilets in the district. During 2019 a total of IDR 8,037 million (~US$ 570,000) was spent on a total of 973 families in 10 villages to construct family toilets at an average cost of IDR 8.3 million, equal to some US$ 580. The plans for 2020 reveal that a minimum of 50 families in 22 villages will be supported to construct their own family toilet. The average budget allocated for one toilet comes at IDR 8.8. million (US$ 624).35 The total budget allocation for 2020 exceeds IDR 10 billion (more than US$ 700,000). However, following the visit to Manggarai Barat we were informed that this plan is now being postponed due to the COVID-19 pandemic with the budget being reallocated to immediate emergency responses such as providing direct cash assistance for poor households.

Box 3-2: Village level smart subsidies

Some villages provide material or financial support to families to construct their own family toilet. This is what is practised in the three visited villages.

Golo Damu village: a maximum of IDR 3 million (US$ 210) worth of materials is provided to needy families.

Watu Nggelek village: locally produced toilet pans have been provided to some 40 families at a unit cost of IDR 100,000 (US$ 7) only.

Tiwu Nampar village: no support provided so far as the Head of Village does not want community to become dependent.

With support from the Central Government, the district authorities have plans to construct a faecal sludge treatment plant (IPLT) at a cost of IDR 8 billion (~US$ 560,000) and purchase a vacuum truck for emptying and transporting faecal sludge septage and urine at a cost of IDR 450 million (~US$ 31,000). The IPLT is designed to serve two urban villages and six rural villages all in the vicinity of Labuan Bajo.

Figure 3-8: Location and service area of proposed IPLT (Source: Dept. of Housing)

35 During our discussions with John Stat on 28 February 2020, he explained that they were planning to construct a total

of 2,224 toilets during 2020. This would come to some IDR 4.4 million per toilet (~US$ 310).



Initially during the first years up to 2024 the IPLT will have a capacity of 12 cubic metres per hour to service some 5,000 families with septic tanks. Thereafter the capacity of the IPLT will be increased to 24 cubic metres per hour to service some 10,600 families with septic tanks in 2 urban villages and 12 rural villages.

Figure 3-9: Hydraulic profile of proposed IPLT (Source: Dept. of Housing)

Figure 3-10: 3D image of proposed IPLT (Source: Dept. of Housing)

The District Department of Housing will be responsible for constructing and operating the plant. To overcome the current low demand for pit emptying services, the District Authorities are considering issuing a regulation (Perda) that will provide guidance related to faecal sludge management in the district. The regulation is expected to include standards for improved septic tank construction to ensure that they are safe and do not pollute the environment. As a consequence of improved septic tank designs, demand for pit emptying is expected to increase. John Stat also explained that there are ideas to introduce a sanitation tax of IDR 200,000 per year per family (US$ 14) for which a family would receive a new septic tank and free emptying services. He explained further that it is foreseen that during the first years the district will have to allocate APBD funds to subsidise the running of the pit emptying services and the IPLT. According to the proposal it will costs close to IDR 360 million in the first year36 (some US$ 25,000) to run the vacuum truck and operate the IPLT.

36 The costs per targeted family is estimated at some IDR 100,000 per year (US$ 7).



3.3 Lombok Utara | An introduction

Kabupaten Lombok Utara (North Lombok Regency) is one of four Kabupatens which divide the island of Lombok, located in the province of Nusa Tenggara Barat (West Nusa Tenggara) in Indonesia. North Lombok Regency is bounded by the Java Sea to the north, Central Lombok Regency and West Lombok to the south, East Lombok Regency to the east and the Lombok Strait to the west. Central to the region is Mount Rinjani which at 3,726 metres (12,224 ft) is the third highest mountain and the second largest volcano in the country. It covers a land area of 776.25 square kilometres and had a population of 200,740 at the 2010 Census rising to 212,265 at the 2015 Intermediate Census. The latest official estimate37 (as at end 2018) is 218.533. The regency's capital is the town of Tanjung situated on the north coast. In 2018, Lombok Utara consisted of 5 sub-districts, 33 villages and 442 sub-villages. Lombok Utara is one but the smallest district in Nusa Tenggara Barat after Sumbawa Barat.

Figure 3-7: Map of Lombok Utara


Figure 3-8 shows that the proportion of the population using improved sanitation facilities varies widely depending on the used data sources. Between mid-2016 and end 2019, there have been some changes in the 15 SEHATI villages in Lombok Utara albeit not as impressive as the changes in Manggarai Barat as highlighted in Section 3.1. Improved sanitation recorded a 14-percentage point increase and houses with no sanitation facility (practising open defecation) recorded a 10-percentage point decrease. Over the same period, improved sanitation facilities recorded a mere 22 percentage point increase across all 215 intervention villages in the seven SEHATI districts. Open defecation practices decreased with 12 percentage points.

As can be seen in figure 3-8, the 15 SEHATI villages compare favourably with most other data sources such as the Sanitation Strategy38 developed for Lombok Utara district (49% improved sanitation) and JMP data for the entire country (65%). However, in 2020 Nusa Tenggara Barat province reported39 a slightly higher figure of 76% improved sanitation for the entire province.

37 Bureau of Statistics of Lombok Utara (2019). Lombok Utara in figures 2019. Male: 107.729; female: 110.804 [page 49].

These figures relate to 2018.

38 Pokja Sanitasi Kabupaten Lombok Utara (2016). Dokumen Pemutakhiran Strategi Sanitasi Kabupaten (SSK) Kabupaten

Lombok Utara 2017-2021 (Sanitation Strategy Update Document). 39 BPS-Statistics of Nusa Tenggara Barat province (2020). Nusa Tenggara Barat in figures 2020. Access to improved

sanitation is reported on page 152.

https://en.wikipedia.org/wiki/Java_Sea

https://en.wikipedia.org/wiki/Central_Lombok_Regency

https://en.wikipedia.org/wiki/East_Lombok_Regency

https://en.wikipedia.org/wiki/Lombok_Strait

https://en.wikipedia.org/wiki/Mount_Rinjani



Figure 3-8: Lombok Utara JMP sanitation ladder

It must be noted that the proportion of safely managed sanitation facilities is not known as the SEHATI monitoring tools were developed on the basis of the earlier MDG inspired JMP sanitation ladder. However, in the next section an attempt will be made to estimate the proportion of safely managed sanitation facilities in Lombok Utara district.

Lombok Utara experienced destructive earthquakes in July and August 201840. Widespread damage was reported in Lombok and Bali and officials stated that at least 80% of structures in North Lombok were damaged or destroyed. As one can imagine this had an enormous negative impact on the overall sanitation progress that was being made up to then in the district.

The figure to the right shows the consequences of the 2018 earthquake on the progress made in the 15 SEHATI villages. Whereas 75% of the families in the 15 SEHATI villages had access to an improved toilet in June 2018, this had gone down to just 46% at the end of the same year. Families with no toilets – most likely referring back to open defecation practices – had almost doubled from 13% in June 2018 to 24% at the end of the year. However, by the end of 2019 sanitation progress was almost back to where it was in June 2018.

40 On 5 August 2018, at 6.46 pm local time a 7.0-magnitude earthquake rocked the island of Lombok and parts of nearby

Bali causing particularly severe damage in North Lombok, A total of 105 people were reported to have been killed, over 70 of whom died in North Lombok. A foreshock occurred on July 29, 2018 with a magnitude of 6.4 which also caused significant damage and claimed the lives of 20 people and injured hundreds more. In the aftermath of the sequence of earthquakes in August, a total of 563 people were confirmed killed while more than 1,000 were confirmed injured. The BNPB estimated that 198,846 people were displaced by the earthquake - over 90% of Lombok Utara’s population.



Access to hygiene

As explained in Section 2.2, indicator 6.2.141 used to measure SDG Target 6.2 consists of two sub-indicators, the first monitoring access to sanitation (6.2.1a), the second monitoring access to handwashing facilities (6.2.1b). Safely managed sanitation requires the existence of handwashing facilities with soap and water.

The current corona pandemic (COVID-19) has illustrated the urgent need for personal hygiene. Hand hygiene – frequently and thoroughly washing of hands – is one of the most important measures to prevent the spread of diseases. With the coronavirus gaining traction, it’s has become all the more critical.

Promoting frequent handwashing with soap at critical times has been an integral part of the SEHATI programme since the start of the programme in 2016 as it constitutes the second of the five STBM pillars. For that reason, the presence of handwashing facilities, as a proxy indicator42 for actual handwashing behaviour, is monitored by the SEHATI programme. Figure 3-9 shows the proportion of the population having access to handwashing facilities with soap and water.

Figure 3-9: Lombok Utara JMP hygiene ladder

In the period mid 2016 till end 2019 the availability of handwashing facilities with soap and water increased with 43 percentage points from 30 to 73 percent. The actual availability of handwashing facilities is expected to be higher as the programme only monitors the existence of handwashing facilities in or near a toilet43. Therefore, the presence of handwashing facilities in other locations (e.g. kitchen, bathroom) are not included in the above figures.

Data on handwashing behaviour is scant and the only comparative figures found were those reported by JMP (WHO and UNICEF, 2019). Figure 3-9 includes the JMP figures for rural Indonesia for the year 2017.

41 SDG indicator 6.2.1: Proportion of population using safely managed sanitation services, including a hand-washing

facility with soap and water.

42 Proxy indicators are indirect measures or signs that approximates or represents a phenomenon or behaviour in the

absence of a direct measure or sign. The following proxies for hand washing behaviour is used by the SEHZATI

programme: 1) Existence of a hand washing facility in or near the toilet, 2) availability of sufficient clean water, 3)

Availability of soap, and 4) Existence of knowledge on when and how to wash hands.

43 This is based on the concept that if handwashing facilities/stations are located where it is hard to avoid, very visible

and it takes no additional time to get to the handwashing facility, they are more likely to be used.



JMP reports that in 2017 55 percent of the rural population in Indonesia had access to a handwashing facility with soap and water.

Socioeconomic situation

An introduction to this section is given in Section 3.1. A good insight in the socio-economic situation of the district is important to be able to assess whether households are able to pay for higher level of services. Moving from improved sanitation to safely managed sanitation costs money, either to construct or install better facilities such as safe containment options or to ensure that faecal waste is safely removed and transported to a safe disposal site such as a faecal sludge treatment plant. Similarly, to what was concluded for Manggarai Barat, recent data on annual household level disposable incomes44 are not available for Lombok Utara.

Some limited information was obtained from the Lombok Utara in figures 2019 booklet45. Page 119 of the booklet states that in 2018 28.83 percent of the population in the district (equal to 62,860 people) had incomes below the poverty line46 of 416,705 Rupiah per month (US$ 29). The 28.83 percent is almost twice as much as the average of 14.75 percent for the province, and almost three times as much as the national poverty rate of 9.66 percent estimated by the National Statistical Office (Bapan Pusat Statistik) in September 2018 (OECD, 2019). According to the Nusa Tenggara Barat in figures booklet47, the number of people with incomes below the poverty line had increased with 1,000 in 2019 [page 187]. However, the proportion of poor people had not really increased (29.03%) even though the July and August 2018 earthquakes must have caused a lot of distress to many families/people.

The above poverty line of 416,705 Rupiah per month (equal to roughly USD 1 per day) is almost half of the poverty rate of the World Bank’s International USD 1.90/day.

Lombok Utara is the poorest district out of eight districts and two municipalities in Nusa Tenggara Barat. The poverty gap index48 is at 6.98 the highest in the province and two and a half times higher than the average of 2.82 for the province. The poverty severity index49 is at 2.56 the highest in the province, and three and a half times higher than the average of 0.74 for the province.

Page 244 of the Lombok Utara in figures booklet provides insight in average expenditure per capita per month. The lowest expenditure class (the poorest segment) spent some 174,000 Rupiah per person per month on food and non-food commodities50. That is one fifth of the average monthly expenditure of 866,000 Rupiah for all expenditure classes (wealth segments). The highest expenditure class spent some 2.1 million Rupiah per person per month or twelve times more than the lowest expenditure class.

44 Disposable income is the amount of money you have left over from your total annual income after paying national and

local taxes. Just because you have disposable income does not mean you can go on a spending spree. Most of the

disposable income will be spent on paying for all necessities of life like housing, food, transportation, education,

healthcare and clothing. This is called discretionary income: disposable income minus the unavoidable costs of living.

45 Lombok Utara in figures 2019 published by the Bureau of Statistics of Lombok Utara.

46 National (monetary) poverty line: the minimum amount needed to afford a specific basket of food and non-food basic

needs, defined by the food poverty line and the non-food poverty line, respectively.

47 Nusa Tenggara Barat in figures 2020 published by BPS-Statistics of Nusa Tenggara Barat province. 48 The poverty gap index is a measure of the intensity of poverty. It is defined as the average poverty gap in the

population as a proportion of the poverty line and it is used to construct a measure of poverty that takes into account

inequality among the poor. The poverty gap index is an improvement over the poverty measure headcount ratio which

simply counts all the people below a poverty line, in a given population, and considers them equally poor. Poverty gap

index estimates the depth of poverty by considering how far, on the average, the poor are from that poverty line. 49 The poverty severity index, also known as squared poverty gap index, is related to the poverty gap index. It is

calculated by averaging the square of the poverty gap ratio. By squaring each poverty gap data, the measure puts

more weight the further a poor person's observed income falls below the poverty line. The squared poverty gap index

is one form of a weighted sum of poverty gaps, with the weight proportionate to the poverty gap.

50 IDR 147,000 (or 84%) on food items and IDR 27,000 (or 16%) on non-food items.



3.4 Lombok Utara | Key study findings

Lombok Utara district was visited from Sunday 1st up to and including Saturday 7th March 2020. The findings presented in this section are based on the activities carried out during the visit:

Monday 2 March: Intake meeting with Plan Indonesia staff, and separate meeting with pit emptying entrepreneurs from Mataram

Tuesday 3 March: Visit to Teniga village in Tanjung sub-district

Wednesday 4 March: Visit to Jenggala village in Tanjung sub-district, and separate meeting with sanitation producers/entrepreneurs

Thursday 5 March: Visit to Pendua village in Kayangan sub-district

Friday 6 March: Meeting with Pokja AMPL of Lombok Utara district, followed by a wrap up meeting with Plan Indonesia staff

3.4.1 Field work

Most of the information was collected during the visits to the three villages. In each village two clusters of houses (sub-villages) were visited and within these clusters a range of toilets were inspected to obtain a good impression of the different types of toilets in use in the village. After a range of toilets were inspected within one sub-village, the toilet owners present during the inspections, were invited to participate in a structured focus group discussion (FGD). Table 3-9 provides an overview of the villages visited and the number of villagers participating in the FGDs.

Table 3-9: Villages visited in Lombok Utara and number of FGD participants

Name of village Teniga Jenggala Pendua

Name of sub-village Dasan Anyar Batu Lilir Muhajirin +

Langgar Sair

Sentual +

Sentul Asri Totals In %

# of FGD participants 5 4 5 4 18 100%

# of male participants 3 1 3 2 10 56%

# of female participants 2 3 2 1 8 44%

Type of sanitation facilities

The vast majority of toilets in Lombok Utara can be classified as onsite sanitation51. According to the District Sanitation Strategy52, among the people in the district that have access to a toilet, almost 97% use an onsite sanitation facility. The remaining 3% use a toilet connected to a communal septic tank. Centralised sewerage is nowhere to be seen in the district.

As shown in Table 3-10, available data provides a mixed picture of what types of toilets are in use in Lombok Utara. According to the SEHATI monitoring data collected in the 15 intervention villages at the end of 2019, almost all families in Lombok Utara who owned a toilet at that time had a leher angsa type of toilet (99.6% is pour-flush toilet). According to District Sanitation Strategy which presents data analysed by the Pokja AMPL in 2016, at that time two out of every three families who owned a toilet had a leher angsa type of toilet (66.9%). The information provided in the District Sanitation Strategy is incomplete and therefore somewhat difficult to analyse and compare with the SEHATI monitoring data. The remaining one third consists of a mix of families who owned an unimproved toilet (either a cemplung or a plengsengan type of toilet) and families that used a ‘shared’ toilet. Shared toilets can either be toilets owned by relatives or neighbours, or public toilets better known as MCKs53.

51 Onsite sanitation is a sanitation system in which excreta and wastewater are collected, stored and/or treated on the

plot where they are generated. There are two main categories of onsite sanitation technologies: ‘wet’ which require water for flushing; and ‘dry’ which do not require any water for flushing.

52 Pokja Sanitasi Kabupaten Lombok Utara (2016). Dokumen Pemutakhiran Strategi Sanitasi Kabupaten (SSK) Kabupaten

Lombok Utara 2017-2021 (Sanitation Strategy Update Document). 53 An MCK is a public facility where people can have a bath (= Mandi), wash (= Cuci) and use the toilet (= Kakus). MCK =

Mandi, Cuci, Kakus.



Table 3-10: Types of toilets in Lombok Utara

SEHATI data | End 2019 SSK LU | 2016

Type of toilet In % In % of toilets In % In % of toilets

Cemplung (pit latrine) 0.0% 0.0% 24.1% 33.1%

Plengsengan (back-shute latrine) 0.4% 0.4%

Leher angsa (pour- flush latrine) 86.8% 99.6% 48.6% 66.9%

No toilet 12.8% 27.3%

Totals 100.0% 100.0% 100.0% 100.0%

The three main types of onsite toilets seen in Indonesia are the jamban cemplung (pit latrine), jamban plengsengan (back-shute latrine) and the jamban leher angsa (pour-flush toilet). They are explained in Section 3.1 and shown in figure 3-4.

The proportion of these types of toilets in place in the 15 SEHATI villages is visualised in Figure 3-10. Overall access to a toilet has increased with 10 percentage points from 77 percent in mid-2016 to 87 percent by the end of 2019. The proportion of pour-flush toilets has seen an increase of 15 percentage points from 72 percent in mid-2016 to 87 percent by the end of 2019.

Figure 3-10: Different types of toilets in Manggarai Barat

As reported in the previous section, in 2018 some 29% of the population of Lombok Utara were considered to be living below the poverty line54. As at the end of 2019 some 13% of the families still did not have a toilet, it is expected that these families consisted mainly of the extreme poor and possibly poor.

Number of sanitation facilities

Table 3.11 shows the number of FGD participants that had owned a toilet previous to the current one. Eight (44%) out of the 18 individuals who participated in the FGDs had had a toilet prior to the current one. The main reasons for constructing a new toilet were:

1) Three toilets had collapsed during the August 2018 earthquake.

2) Three toilets had filled up and could not be used anymore;

3) Two families had constructed an additional toilet; and

4) One toilet had been replaced by a more permanent toilet.

54 Lombok Utara Regency in figures 2019 [page 119]. The figure of almost 29% consists of the poor and extreme poor but

does not include the near-poor (people with an income between the poverty line and 1.2 times the poverty line).



Table 3-11: FGD participants that owned a toilet prior to the current toilet



Langgar Sair

Sentual +



# of previous toilets 2 3 2 1 8 44%

In % 40% 75% 40% 25% 44%

Although not recorded as such, it is assumed that the toilets that had filled up were of the cemplung and plengsengan type of toilets (simple pit latrines). These type of toilets are usually constructed with a relatively small pit to contain the human waste onsite. Due to their small size, pits tend to fill up relatively fast which leaves the families with two options: 1) empty the pit and continue using the same toilet; or 2) abandon the toilet due to the lack of safe and affordable pit emptying options and construct a new toilet.

Type of subsurface system

Table 3-12 shows that only one of the 18 FGD participants had a toilet connected to some kind of septic tank55. All the other 17 toilets were connected to some kind of offset pit: 14 single offset pits and 3 double offset pits. Whereas in Manggarai Barat a large majority of the toilets had a septic tank type of underground tank (74%), in Lombok Utara the majority of the toilets are connected to a single offset pit.

Table 3-12: FGD participants and types of faecal waste containment options



Langgar Sair

Sentual +



# of single direct pits - - - - 0 0%

# of single offset pits 4 4 3 3 14 78%

# of double offset pits - - 2 1 3 17%

# of ‘septic tanks’ 1 - - - 1 6%

% of ‘septic tanks’ 20% 0% 0% 0% 6%

Figure 3-11 shows the two main offset pit configurations found in Lombok Utara: the single offset pit and the double offset pit.

Figure 3-11: Most prominent pit configurations in Lombok Utara

Two additional types of subsurface tanks were found in the study villages, namely the SEHATI simple septic tank and the Bionet septic tank.

55 Underground or subsurface tanks are often called ‘septic tank’ by the villagers we interviewed even though they are

usually just simple rectangular storage or containment tanks.



The SEHATI septic tank was developed and promoted by the SEHATI programme. It is a much smaller and, therefore, much cheaper version of a regular septic tank. It is made of three precast concrete rings and can be easily installed by a village mason. Figure 3-12 provides a simple sketch of the SEHATI septic tank.

The first ‘tank’ functions as the faecal waste settling chambers. The second pit is basically a soakaway or leach pit that allows the septage to seep into the subsurface.

Figure 3-12: SEHATI simple septic tank

The fibreglass reinforced plastic Bionet septic tanks are produced by PT Cahaya Mss Cemerlang in Jakarta and aggressively promoted across the nation. These prefabricated septic tanks are distributed by the district but funded with central funds allocated by the Ministry of Public Works. Bionet septic tanks are made of some kind of plastic and are available in different sizes. The ones observed in one of the study villages (Teniga village in Tanjung sub-district) had a size of 800 litres.

Disadvantage of this solution is the relatively high costs56 associated with the procurement, transportation and installation of these septic tanks.

Figure 3-13: Bionet septic tank in situ

Both the SEHATI septic tank and the Bionet septic tank require regular emptying as the first faecal waste settling chamber is rather small and thus cannot store a huge amount of faecal waste. This is likely to lead to rapid filling up of the septic tank. Not ideal in the absence of (affordable) pit emptying services. This shows that, similar to what was learnt in Manggarai Barat, there appears to be a poor understanding of what an adequate and appropriate onsite sanitation system entails and especially understanding on the proper design and operation of a septic tank. Section 3.1, and in particular Box 3-1, provide additional information on the functioning of septic tanks.

Filling up of toilets

Demand for pit emptying appears to be extremely low. Table 3-13 shows that till date only three out of the 18 toilets (17%) owned and used by the FGD participants have filled up so far. All three toilets had simple offset pits. On average the pits had filled up after almost eight years of use.

The information obtained during the FGDs furthermore revealed that the average age of the 18 toilets was 12 years, that the average number of families using one toilet was 1.3 families, and that the average number of users per toilet was 4.3 users. One toilet was used by three families and three toilets were used by two families. The maximum number of users per toilet was 8 persons.

56 According to Teniga village, the total costs of installing one Bionet septic tank comes at IDR 5 million (~US$ 350): IDR

3.5 million for the Bionet septic tank and IDR 1.5 million to purchase cement and bricks to encase the entire septic tank as shown in figure 3-13.



Table 3-13: FGD participants and number of toilets that have filled up



Langgar Sair

Sentual +



Total # of toilets that filled up - 1 1 1 3 17%

# of filled pits - 1 1 1 3 17%

# of filled septic tanks - - - - 0 0%

After how many years - 8 5 10 -

Similar to Manggarai Barat, and probably many other rural districts in Indonesia, sludge accumulation rates are low. Section 3.1 provides further details on sludge accumulation rates and the variables that influence pit filling rates. Mills et al (2014) recommend using an average sludge accumulation rate of 25 litres per person per year.

In preparation of this study the Plan Indonesia team in Lombok Utara conducted a series of spot checks in the three study villages. The spot checks were meant to get some insight in how long it takes for pits to fill up. As can be seen in table 3-14, a total of 50 toilets were visited by the team. The average number of families and people using one toilet is almost identical to what was recorded during the FGDs. A total of six pits (12%) filled up. Only one pit was emptied and for the other five toilets new pits or tanks were constructed.

Table 3-14: Information on pits and tanks (Source: Plan Indonesia Lombok Utara team)

Desa Teniga Jenggala Pendua Sum /

Averages

As % of

sample size

Sample size 12 13 25 50

Average # of families per toilet 1.5 1.1 1.3 1.3

Average # of people using toilet 4.6 3.6 4.4 4.2

Average age of toilet 9.0 8.5 5.9 7.8

# of pits or tanks that have been emptied 0 0 1 1 2%

# of new pits or tanks built 1 2 2 5 10%

Average depth of pit or tank 2.0 1.1 1.6 1.6

Average depth of sludge 0.5 0.2 0.2 0.3

The depth of the pits/tanks and the depth of the accumulated faecal sludge were measured by the team. This revealed that the average depth of the pits/tanks was 1.6 metres and the average depth of the sludge a mere 30 centimetres, equal to about one fifth of the average depth of the fifty pits/tanks. This means that it took on average almost eight years to accumulate 30 centimetres of sludge at the bottom of the pits/tanks.

Pit emptying options and practices

Table 3-15 shows that only one of the three pits/tanks that had filled up was emptied. The pit was emptied by a “professional” pit emptying service provider based in Mataram town. It is not known what was done to the other two pits but it is expected that they were abandoned and replaced by new pits.

Table 3-15: Pit emptying practices



Langgar Sair

Sentual +



# of toilets that have filled up - 1 1 1 3 17%

# of toilets that were emptied - - 1 - 1 6%

# of toilets emptied by owner - - - - 0 0%



Of the 18 FGD participants, 16 participants (89%) were worried that their toilet would fill up in future. When asked what they would do if the toilet fills up, 11 participants (61%), although not fully convinced or aware that professional pit emptying services would be available when required, said that they would try to get their pit emptied. Six participants (33%) said that in the absence of pit emptying service providers they would have to abandon their current toilet and construct a new one. One participant (6%) did not know what they would do.

Toilet satisfaction and dreaming about future toilets

Table 3-16 shows that 11 FGD participants (61%) were satisfied with their current toilet. Five participants (28%) were not satisfied and two participants (11%) were somewhat satisfied with their toilet. Six participants (86%) gave as the reason for not being (fully) satisfied was that their toilet did not have a permanent structure. One participant mentioned that he wanted to construct his own family toilet so that he did not have to use his brother’s toilet.

Table 3-16: Toilet satisfaction and dreams



Langgar Sair

Sentual +



How many are satisfied with

current toilet 2 2 5 2 11 61%

How many with a pour-flush

toilet are satisfied 2 2 5 2 11 61%

In % 40% 50% 100% 50% 61%

How many consider building a

new toilet in future 1 2 0 1 4 22%

In % 20% 50% 0% 25% 28%

Seven participants had expressed that they were not (fully) satisfied with their toilet but only four participants (22%) indicated that they would consider building a new toilet in future. Three of them (75%) are considering constructing a new toilet as their desire a more permanent toilet. One participant mentioned that he would like to construct his own toilet as his family is currently sharing a toilet with relatives.

Towards the end of the FGDs the likely cost of the preferred future toilets was discussed. The average cost of a toilet was guestimated at IDR 6 million (US$430), with the cheapest toilet coming at IDR 2 million (US$ 140) and the most expensive toilet at IDR 20 million (US$ 1,400).

All four participants that had indicated interest in constructing a new toilet were willing to invest an average amount of some IDR 1.6 million (US$ 110), equal to just 26% of the average estimated cost of IDR 6 million.

When asked how much they would pay for getting their pit or tank emptied in future, 13 out of the 18 participants (72%) taking part in the FGDs were willing to pay an average amount of IDR 300,000 (US$ 22). Expected costs varied from IDR 50,000 (US$14) to IDR 750,000 (US$ 53). The IDR 750,000 comes close to what is currently being charged by the pit emptying services providers based in Mataram.



3.4.2 Meeting with district authorities

On Friday the 6th of March 2020 the study team, accompanied by the Plan Indonesia team, was able to meet with the Pokja AMPL of Lombok Utara district. The meeting was chaired by the Secretary of Bappeda (Ibu Yuni Kurniati). Representatives of Bappeda, Department of Health, Department of Public Works and the Environmental Department participated in the meeting.

Some of the issues discussed during the meeting are summarised below:

1) The goal for 2020 is to declare the entire district Open Defecation Free (ODF) by the end of the year. Sanitation is therefore the priority for the district. Creating an ODF district it is not about the provision of facilities but about changing mindsets and behaviour.

2) The district has allocated some 3.5 billion from APBD and 8.5 billion from APBDes for 2020. Additionally, central funds will be available to invest in sanitation facilities. Examples are the construction of toilets financed by the Ministry of Health’s stunting programme; the Bionet septic tanks financed by the Ministry of Public Works and Housing; and communal septic tanks also financed by the Ministry of Public Works and Housing.

3) The district will also get support from the Central Government to construct an IPLT. 2020 will be used to finalise all the preparations such as detailed design, site selection and land acquisition. The IPLT is planned to be constructed in 2021.

4) The designs for onsite sanitation facilities are guided by the standards set by the Central Government and the district is obliged to follow those standards. The appropriateness of constructing septic tanks or installing Bionet septic tanks in the absence of professional pit emptying services was questioned. The immediate goal for 2020 is to create an ODF district, and therefore central standards (septic tanks) will only be met in future.

5) Poverty levels have gone up in the district as a consequence of the mid 2018 earthquakes. As far as possible regular programmes are used to provide specific and targeted support to poor families.

6) During 2020 there will be an election for a new Bupati. This means that a new multi-annual development plan (RPJMD) will be developed during 2021 with a new vision and possibly new priorities for the district.



Examples of pour-flush toilets found in Lombok Utara



4. Conclusions and recommendations

This section provides a summary of the key findings followed by a set of recommendations for the District Authorities. Where necessary the conclusions and recommendations focus on the unique situations found in the two districts.

4.1 Conclusions

The following general conclusions have been drawn on the basis of the detailed findings presented in Chapter 3.

1. SEHATI intervention villages appear to be doing better than other villages

Overall progress in SEHATI intervention villages has been noticeably better than other villages in the two districts. This can be said for the original SEHATI villages as well as for the SEHATI replication villages57. The combination of a tried and tested approach, dedicated and capacitated STBM teams at district, sub-district and village levels, adequate resources, and a commitment to support village authorities as long as it takes appears to have been successful.

In Manggarai Barat, three out of four families (76%) in SEHATI villages had access to a toilet that meets basic sanitation service levels (better known as an improved toilet) at the end of 2019. In other villages this was lower than two out of four families (45%). In SEHATI villages one out of sixteen families (6%) did not use a toilet; in other villages this could have been twice as much (15%). Whereas in SEHATI villages one out of twenty families (5%) had to share a toilet with other families (most likely relatives or neighbours), this could have been as high as one out of every five families (22%) in the other villages.

As shown in table 4-1, the local authorities in Manggarai Barat have been successfully replicating the approach in other villages across the district. The SEHATI approach is now being implemented in a total of 135 villages out of a total of 169 villages58 in the district, equal to 80 percent. By the end of the SEHATI programme towards the end of June 2020, a combined total of 50 SEHATI and replication villages had been declared 100% STBM.

Table 4-1: SEHATI programme targets and actual results in Manggarai Barat

Initial intervention villages with EKN funding Replication by local authorities

# of sub-

districts # of villages

# of STBM

declared

villages

# of sub-


# of STBM

declared

villages

Original programme targets 9 45 9 10 30 6

Actual interventions 11 45 23 12 90 27

In % 100% 256% 300% 450%

In Lombok Utara, the situation with regards to access to improved sanitation facilities is very similar. At the end of 2019, three out of four families (74%) in the 15 SEHATI villages had access to an “improved” toilet that meets basic sanitation service levels. In other villages this could have been as low as two out of four families (49%). In SEHATI villages one out of eight families (13%) did not use a toilet; in other villages this could have been twice as much (27%).

57 Intervention villages are the initial villages where the SEHATI approach was tested by the SEHATI implementation

partner together with the local authorities. This work was financed by a grant from the Embassy of the Kingdom of the Netherlands. The approach was thereafter replicated by the district and sub-district authorities in other villages, the “replication villages”. Work in the replication villages was financed by the district authorities.

58 Manggarai Barat district is divided into 12 sub-districts, 164 (rural) villages and 5 urban villages.



As shown in table 4-2, the local authorities in Lombok Utara have made a push to implement the SEHATI approach across all 33 villages in the district59. By the end of the SEHATI programme towards the end of June 2020, a combined total of 7 SEHATI and replication villages had been declared 100% STBM.

Table 4-2: SEHATI programme targets and actual results in Lombok Utara

Initial intervention villages with EKN funding Replication by local authorities

# of sub-


# of STBM

declared

villages

# of sub-


# of STBM

declared

villages

Original programme targets 5 15 4 5 15 0

Actual interventions 5 15 6 5 18 1

In % 100% 150% 120% -

2. A majority of families use a pour-flush toilet

Most of the pour-flush toilets found in the two district can be classified as “improved toilets” and meet the JMP standards for basic sanitation services. This service level for onsite sanitation facilities is relatively close to the ultimate safely managed sanitation service level. The global challenge is increasingly one of moving up the sanitation ladder to improve the quality of sanitation facilities and practices and to work towards safely managed sanitation. The assumption made here is that the higher the proportion of pour-flush toilets the easier it is to realise safely managed sanitation.

Actual ownership of different types of toilets in Manggarai Barat is shown in figure 4-1. At end of 2019, ownership of pour-flush toilets was as high as 72% in SEHATI villages (66% in non-SEHATI villages). The proportion of families with either no toilet or an unimproved toilet was at 28% in SEHATI villages (34% in non-SEHATI villages) still relatively high but much lower than the 64% at the start of the SEHATI programme. One would assume that these are all poor families – and thus lacking the funds to construct a pour-flush toilet – but that may not be the case as in 2018 ‘only’ 18% of the population in the district had an income below the poverty line.

Figure 4-1: Types of toilets in Manggarai Barat

It is obvious that this requires the utmost attention of the authorities at village, sub-district and district level. Somewhere between 25,000 and 30,000 families might require a new toilet (or their first toilet) that meets at a minimum basic sanitation service level criteria (“improved” toilet). With the district investing in a maximum of 2,200 toilets this year, it will take some 11 to 14 years at this scale to reach out to all the families that do not have an “improved” toilet.

59 Lombok Utara district is divided into 5 sub-districts, 33 villages and 442 sub-villages.



Actual ownership of different types of toilets in Lombok Utara is shown in figure 4-2. At end of 2019, ownership of pour-flush toilets was as high as 87% in SEHATI villages (64% in non-SEHATI villages60). The proportion of families with either no toilet or an unimproved toilet was 13% in SEHATI villages (36% in non-SEHATI villages). This is half of what was found at the start of the SEHATI programme.

Compared to Manggarai Barat the proportion of unimproved sanitation facilities is extremely low (1% versus 13%). However, the proportion of shared toilets is higher (12% versus 5%).

Figure 4-2: Types of toilets in Lombok Utara

3. A lot of money is put under the ground

In general, there appears to be a poor understanding of what an adequate and appropriate onsite sanitation system entails. The confusion is primarily with the design and functioning of the sub-structure. The interchangeable use of the terms “tangki septik” and “cubluk” (Bahasa Indonesian for leach pit) does not accurately reflect the type of onsite sanitation systems found in Indonesia. The so-called septic tanks found in rural villages are usually simple tanks or pits with lined or unlined walls and in most cases an open bottom.

Figure 4-3: Main toilet components

There are noticeable differences in the two districts. In Manggarai Barat, those families that can afford it construct relatively large substructures in the form of underground faecal waste containment tanks. Due to the absence of professional pit emptying service providers, people prefer to construct a large (and preferably leaking) tank that will never require emptying. These local “septic tanks” are often oversized (as large as 6 cubic metres) and may cost as much as IDR 8 million (US$ 560) to construct. It looks like too

60 Data for non-SEHATI villages is somewhat outdated as it comes from the 2016 SSK. Source: Pokja Sanitasi Kabupaten

Lombok Utara (2016). Dokumen Pemutakhiran Strategi Sanitasi Kabupaten (SSK) Kabupaten Lombok Utara 2017-2021 (Sanitation Strategy Update Document).



much money is put under the ground and that smaller, read cheaper, sub-structures could do the job, particularly considering that faecal sludge accumulation rates appear to be very low.

Most of the “tangki septic” inspected in the three study villages did not have a manhole or any other opening to inspect and ultimately empty the content of the tank. In particular the first of the two chambers need to be accessed from time to time for inspection and emptying purposes.

There does not appear to be an affordable, but still acceptable, alternative for those families that cannot afford the large sub-structure. Consequently, they construct simple unlined shallow pits that either collapse or that fill up (relatively) fast.

In Lombok Utara, the majority of toilets are connected to a single off-set pit with an open bottom. This is usually a much cheaper option than the larger “tangka septic” in Manggarai Barat. Simple pits with open bottoms should pose no problems if constructed in sparsely populated rural villages with piped water supply, however, this option is questionable in urban villages with open shallow wells used for drinking and other domestic purposes. An example of such a toilet observed in one of the study villages is shown in figure 4-4.

Figure 4-4: Toilet in Langgar Sari sub-village of Jenggala village in Lombok Utara

In both districts, village as well as district authorities do provide some sort of support (either in kind or in cash) to “needy” families to construct a toilet. Most of the district support is financed by funds coming from the Central Government (e.g. Ministry of Public Works and Housing, Ministry of Health’s stunting programme). Central funds usually come together with technical guidance that are likely to be based on the Indonesian SDG 6.2 standards61. These “one-size-fits-all” designs may or may not be appropriate for the specific conditions found in the district.

Due to the absence of professional faecal sludge management service providers, the installation or construction of sub-structures that require frequent emptying is currently not really appropriate for the majority of villages in Manggarai Barat and Lombok Utara. In general, “expensive” septic tanks should only be constructed in the following locations: 1) densely populated villages or localities; 2) where groundwater sources are used for drinking and other domestic purposes; and 3) where professional pit emptying services are available and affordable. Until that time that pit emptying services will be available throughout the two districts, alternative designs may have to be considered. Alternative substructures will be discussed in the next section.

61 BAPPENAS, POKJA for Housing, Settlement, National Water and Sanitation Development (PPAS) and USAID IUWASH

PLUS (Undated). META DATA TARGET INDIKATOR SANITASI, Kupas Tuntas SDG 6.2 dan 6.3 Sanitasi.



4. Toilets appear to fill up very slowly

Although not fully understood, faecal sludge accumulation rates appear to be very low in Indonesia. Mills et al (2014) recommends using an average sludge accumulation rate of 25 litres per person per year. This would mean that a simple round pit with a diameter of 1 metres and a depth of 2 metres (volume of 1.5 cubic metres) would take more than ten years to fill up if used by a family of five. This of course will differ from village to village and even from family to family as sludge accumulation rates depend on a lot of factors, such as ambient temperature, overall retention time and anal-cleansing material used, etc.

In Manggarai Barat, only one out of the 31 toilets visited in the three villages had filled up and required emptying. Twenty toilets (65%) were older than 5 years, of which seven toilets (23%) were even older than 10 years. Simple unlined pits dug for cemplung of plengsengan type of toilets are told to fill up though.

In Lombok Utara, only three out of the 18 toilets visited in the three villages had filled up. Only one of them had been emptied. Fifteen toilets (83%) were older than 5 years, of which five toilets (28%) were older than 10 years. Out of the 50 toilets inspected by the Plan Indonesia team, as preparation to this study, six (12%) had filled up of which only one (2%) had been emptied.

5. Currently there is nobody to empty toilets that have filled up

During the village visits and in particularly the Focus Group Discussions it became clear that the villagers are not motivated to empty their own toilets. It is perceived to be disgusting to handle (fresh) human waste by hand.

In Manggarai Barat, the absence of mechanised pit emptying services has created huge challenges, and this is the main reason why villagers aspire to construct the large “tangki septic” seen everywhere in the district. The plans to construct a faecal sludge treatment plant (IPLT) at a cost of IDR 8 billion (~US$ 560,000) and purchase a vacuum truck62 at a cost of IDR 450 million (~US$ 31,000) will alleviate some of these challenges, at least for the two urban villages and six rural villages, all in the vicinity of Labuan Bajo, that will be served by the services.

In Lombok Utara, there are basically two options to consider when a pit fills up: 1) families either abandon their toilet and construct a new one; or 2) they hire a “professional” pit emptying entrepreneur from outside the district. Mataram based entrepreneurs offer their services in and around Tanjung at a cost of IDR 750,000 (US$ 55). Although the entrepreneurs claim to take the faecal sludge back to Mataram for safe disposal, it is very unlikely that this will actually happen. This for the simple reason that there is no faecal waste disposal site in Mataram.

The district authorities are in the process of making plans to construct a faecal sludge treatment plant that is to serve 5,000 families. Preparations are to be completed in 2020 so that actual construction of the IPLT can commence in 2021.

Considering the costs involved to construct and operate an IPLT, it is likely that this level of service can be replicated at scale and brought to benefit the entire population of the two districts in the coming ten years. Thus, alternative onsite safe disposal (and possibly faecal waste treatment) options will need to be considered in the coming years.

6. Indonesia’s safely managed sanitation criteria are too demanding

The proportion of toilets in the two district that can be classified as safely managed sanitation service is currently not known. This for the simple reason that the safely managed sanitation service levels are not used to monitor access. One needs to be careful when trying to estimate the proportion of safely managed sanitation services. However, if the Indonesian SDG 6.2 standards are applied, then only a very small proportion of existing toilets would meet the requirements.

62 A vehicle equipped with a motorised pump and a storage tank for emptying and transporting faecal sludge septage

and urine.



The differences between the Joint Monitoring Program (JMP) and Government of Indonesia (GoI) definitions for safely managed sanitation are shown in figure 4-5. Whereas the JMP considers three different pathways to safely managed sanitation, the GoI guidance considers only two pathways to safely managed sanitation. The biggest difference is the fact that the GoI does not recognise toilets where human excreta are safely stored (and treated and disposed) in situ as safely managed sanitation.

Figure 4-5: Definitions for safely managed sanitation services

Furthermore, the criteria for onsite sanitation facilities that require emptying are also stricter. The criteria stipulate that the substructure needs to be a septic tank, and the septic tank requires to be emptied at least once every five years. One could get the impression that the GoI definitions are meant to be applied in urban areas only. Not a crazy idea considering that the GoI guidance document was developed with the support from the USAID funded IUWASH PLUS project63 which is designed to assist the Government of Indonesia in increasing access to water supply and sanitation services as well as improving key hygiene behaviours among urban poor and vulnerable populations.

The contrasting definitions make a huge difference when trying to estimate the proportion of toilets that can be classified as safely managed sanitation services in the two districts. Due to the lack of properly designed, constructed and operated septic tanks, and the lack of professional emptying services, it is unlikely that any of the existing toilets would meet the GoI definitions/criteria at present. If the JMP definitions are used than the overall picture would become a lot more encouraging.

In Manggarai Barat, as much as 50% of the existing toilets could be classified as safely managed sanitation. This crude estimation is based on underlying data obtained from Manggarai Barat in figures 2019 document64 which states that in 2018 80% of the population had access to an improved drinking water sources, and 63% of the population had access to a pour-flush toilet. The figure of 50% safely managed sanitation is thus based on the assumption that 80% of the 63% of the population with a pour-flush toilet live in villages where it is safe to store the faecal waste in onsite tanks or pits and leave it there undisturbed forever. This is solely based on the principle that no groundwater is used for drinking water and other domestic purposes such as cooking.

A similar crude estimation of safely managed sanitation could not be made for Lombok Utara due to the lack of reliable information on improved drinking water sources. However, considering the geography of the district with more than 50% of the villages located on flat areas near the coast, it is expected that a larger proportion of the population rely on (shallow) ground water aquifers. As already illustrated in the third conclusion above, these villages may not provide the ideal situation for onsite containment of faecal waste in tanks and pits as there is a real danger that faecal matter seeps into the ground.

63 IUWASH PLUS or USAID Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua

project. For further info: https://www.iuwashplus.or.id/?lang=en 64 Bureau of Statistics of Manggarai Barat (2019). Manggarai Barat in figures 2019. Percentage of HH by drinking water

sources in 2018 [page 150] and percentage of HH by kind of toilet in 2018 [page 153].

https://www.iuwashplus.or.id/?lang=en



4.2 Recommendations

The following general recommendations have been drawn on the basis of the above conclusions. As the SEHATI programme has come to an end it will be up to the district authorities to address the challenges illustrated in this report.

1. Replicate the SEHATI approach across the two district

When comparing the latest SEHATI programme data with access to sanitation figures obtained from the districts, it is obvious that the SEHATI programme has been successful in increasing access to sanitation facilities in the SEHATI intervention villages and by doing so noticeably increasing the proportion of families that now own and use an “improved” toilet.

The fact that the SEHATI approach has been successfully replicated by the district and sub-district authorities in the two districts demonstrates that there is genuine interest and commitment at the highest levels in both districts. It should therefore be doable to replicate and scale up the STBM approach across the two districts. Even more so because adequate resources, capacities, supportive mechanisms and systems are now in place.

2. Develop a plan to realise the SDG Goal 6.2 by 2030

It is essential that a sanitation and hygiene vision “Destination 2030” or “Tujuan 2030” is developed in the two districts. The vision then needs to be translated in a concrete multi-annual strategy or roadmap to ensure that the SDG Goal 6.2 is reached by 2030. The plan or roadmap should provide answers to the following questions: What is the current situation? Where do we want to be by 2030? What does it take and how are we going to realise the vision in time and within budget?

The previously developed District Sanitation Strategy (SSK) could be used as a starting point. However, to make them relevant they need to be updated and aligned with SDG Goal 6.2. Note that at the time of concluding the SSKs the new SDG sanitation and hygiene ladders had not been developed and safely managed sanitation services had not yet entered our vocabulary let alone that they had been defined.

It will be quite a challenge to realise universal access to safely managed sanitation services in the two districts given the rigorous criteria set by the Government of Indonesia. If all onsite sanitation facilities need to be connected to a septic tank that is emptied at least once every five years, then a lot of resources will be required to work towards the goal of safely managed sanitation. The districts will therefore need to set realistic targets for what they want to achieve by 2030. Creating Open Defecation Free districts, where the entire population has access to a toilet, would be a first major milestone. Ensuring that by 2030 the entire population has access to an “improved” toilet (JMP: basic sanitation service level) would be a remarkable achievement.

The vision for 2030 and its corresponding strategy or roadmap should not only focus on sanitation. The current COVID-19 pandemic has taught us that personal hygiene, and in particular frequent hand washing with soap, is critically important to stay healthy. Handwashing is one of the most effective ways to prevent transmission of disease—not just the coronavirus but also diarrhoea, cholera, and typhoid. Village and district authorities should do their utmost to ensure villagers have access to handwashing facilities, soap, and reliable water supplies. Investments in toilets should go hand in hand with investments in handwashing facilities.

3. Encourage and stimulate incremental improvements towards safely managed sanitation

As explained above the roadmap should indicate a clear direction based on a broad vision. The roadmap should also include a couple of major milestones to mark specific achievements along the road towards universal access to basic sanitation service levels and ultimately on towards safely managed sanitation. The following milestones should be considered:

First milestone (as soon as possible): eradicate open defecation practices in the districts.

Second milestone (by 2025): ensure that every family has its own toilet (no more shared facilities).



Third milestone (by 2030): replace or upgrade all unimproved toilets (cemplung and plengsengan) and by doing so ensure that the entire population has access to “improved” toilets.

From now onwards, investments – either by individual families or local government authorities – should be geared towards reaching the third milestone. In other words, families without a toilet should be encouraged and or supported to construct an “improved” toilet. Cemplung and plengsengan types of toilets that cannot be upgraded over time to an “improved” toilet should be prevented by all means as this would be a poor investment decision.

The process to move towards “improved” sanitation (basic sanitation service level), including the three milestones, is illustrated in figure 4-6. To be able to achieve universal access to basic sanitation service levels by 2030, it is advisable to jump a couple of steps on the ladder (for example a huge jump from no service (open defecation) all the way up to basic service).

Figure 4-6: Moving up the sanitation ladder

4. Support the economically marginalised families to construct an “improved” toilet and promote appropriate toilet designs

In line with what is explained above, district and village resources should be pooled to support poor or less well-off families to construct a toilet that meets the basic sanitation service level criteria. The type of toilets that will be promoted by the district should reflect local conditions. Ideally over time it should be possible to upgrade these “basic” toilets to meet the criteria for safely managed sanitation.

One uniform design will not provide the required service levels throughout the district. For example, for the time being (Bionet) septic tanks should only be constructed in densely populated areas and in the vicinity of an IPLT. Installing these rather expensive solutions in remote and mountainous villages may be a bad investment decision. Septic tanks require regular emptying and who is going to do that in difficult to reach areas.

Some relevant considerations:

1) Encourage and support the construction of toilets that are appropriate considering the conditions found in the villages, particularly where it relates to use of groundwater sources for drinking water and other domestic purposes.

2) Be careful not to invest in toilet substructures that require frequent emptying in villages where professional pit emptying services will not become available in the coming five years.

3) Promote toilet designs that meet “basic” sanitation criteria but that over time can be relatively easy upgraded to meet safely managed sanitation criteria.

4) Consider alternative toilet designs such as the alternating twin pit substructure.



Some examples of appropriate toilet designs are provided below. Figure 4.7 shows a relatively simple toilet that is initially constructed to meet “basic” sanitation service level standards. It is a pour-flush toilet connected to a simple lined tank or pit but with an open bottom to avoid that it fills up too fast. These type of toilets are appropriate in areas where there is no danger of faecal waste polluting groundwater aquifers or where there are alternative sources for drinking water. The content of these tanks will leak into the subsoil without causing any harm to the environment.

Figure 4-7: Upgradeable toilet from “basic” to “safely managed”

Overtime this “basic” toilet can be upgraded to meet safely managed sanitation standards or criteria by constructing an additional water-tight pit or tank (with lined walls and a closed bottom). This pit or tank can then serve as the first chamber of a septic tank where anaerobic digestion will break down the organic material in the effluent.

Both Manggarai Barat and Lombok Utara are in the process of constructing their first IPLT (faecal sludge treatment plant). These are expected to serve some six to eight villages from 2021 onwards. In those villages, substructures could look rather simply. Figure 4-8 shows a possible option for substructures to be constructed in villages where professional pit emptying services will become available within the next couple of years. The only thing that is required is a simple holding tank that can store faecal waste safely until it needs to be emptied and taken to a treatment facility. The tank needs to be large enough to cope with an emptying services interval of a maximum of two years.

Figure 4-8: Toilet with a holding tank that requires emptying



Consider promoting alternating twin pits for families that would like to use the dried (safely composted) human waste for gardening purposes. As can be seen in figure 4-9, this technology consists of a pour-flush toilet connected to two offset pits. The blackwater (faeces, urine and water used for flushing) is collected in one pit and allowed to slowly infiltrate into the surrounding soil. Over time, the solids are sufficiently dewatered and can be manually removed with a shovel and reused on-site, much like compost, to improve soil fertility and fertilise crops. When the first pit is full, it will be left alone, and the second pit is used. By the time the second pit is full the content of the first pit should be safe enough to empty manually and used as soil conditioner.

Figure 4-9: Toilet with alternating twin pits

Similarly, to what was said above for the “basic” toilet with a single pit or tank and open bottom, these alternating pits should only be used in villages that do not use groundwater for drinking water and other domestic purposes. This because although most pathogens are filtered during soil infiltration or die-off with time and distance, there remains a risk of groundwater pollution, particularly in densely populated areas or in areas with a high groundwater table.



References

BAPPENAS, POKJA for Housing, Settlement, National Water and Sanitation Development (PPAS) and USAID IUWASH PLUS (Undated). META DATA TARGET INDIKATOR SANITASI, Kupas Tuntas SDG 6.2 dan 6.3 Sanitasi.

Mills, F., Blackett, I. and Tailer, K. (2014) Assessing on-site systems and sludge accumulation rates to understand pit emptying in Indonesia. Paper presented during the 37th WEDC International Conference in Hanoi, Vietnam in 2014. Available on https://wedc-knowledge.lboro.ac.uk/resources/conference/37/Mills-1904.pdf

WHO and UNICEF (2017), Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), 2017. Available on https://www.unicef.org/publications/index_96611.html

WHO and UNICEF (2019), Progress on household drinking water, sanitation and hygiene 2000-2017. Special focus on inequalities. New York: United Nations Children’s Fund (UNICEF) and World Health Organization, 2019. Available on https://www.unicef.org/reports/progress-on-drinking-water-sanitation-and-hygiene-2019

WHO website: Global Health Observatory (GHO) data webpage. Accessed on https://www.who.int/gho/mdg/environmental_sustainability/sanitation_text/en/

https://wedc-knowledge.lboro.ac.uk/resources/conference/37/Mills-1904.pdf

https://wedc-knowledge.lboro.ac.uk/resources/conference/37/Mills-1904.pdf

https://www.unicef.org/publications/index_96611.html

https://www.unicef.org/reports/progress-on-drinking-water-sanitation-and-hygiene-2019

https://www.who.int/gho/mdg/environmental_sustainability/sanitation_text/en/



Annex A: Study programme and travel details

Day Date Where

What Who From To

Wednesday 19/02/2020 Amsterdam Erick Baetings (EB) depart for Indonesia EB

Thursday 20/02/2020 Jakarta Arrive in Jakarta EB

Friday 21/02/2020 Jakarta Meeting at Simavi office with Angelina Yusridar

(AY) and Catur Nugroho (Acting Director) AY + EB

Saturday 22/02/2020 Jakarta

23/02/2020 Jakarta Labuan Bajo Travel to Labuan Bajo in Manggarai Barat AY + EB

Monday 24/02/2020 Labuan Bajo Kick-off meeting with YDD staff AY + EB

Tuesday 25/02/2020 Field visit to Golo Damu village AY + EB

Wednesday 26/02/2020 Field visit to Watu Nggelek village AY + EB

Thursday 27/02/2020 Field visit to Tiwu Nampar village AY + EB

Friday 28/02/2020 Labuan Bajo Meeting at Department of Housing and wrap up

meeting with YDD staff AY + EB

Saturday 29/02/2020 Labuan Bajo Drawing up preliminary conclusions AY + EB

Sunday 01/03/2020 Labuan Bajo Tanjung Travel to Tanjung in Lombok Utara AY + EB

Monday 02/03/2020 Tanjung Kick-off meeting with Plan Indonesia staff and

meeting with pit emptying service providers AY + EB

Tuesday 03/03/2020 Field visit to Teniga village AY + EB

Wednesday 04/03/2020 Field visit to Jenggala village AY + EB

Thursday 05/03/2020 Field visit to Pendua village AY + EB

Friday 06/03/2020 Tanjung Meeting with Pokja AMPL and wrap up meeting

with Plan Indonesia staff AY + EB

Saturday 07/03/2020 Tanjung

Sunday 08/03/2020 Lombok Bali Travel to Bali (Erick) and Jakarta (Ange) AY + EB

Monday 09/03/2020

Tuesday 10/03/2020 Bali EB return to the Netherlands EB

Wednesday 11/03/2020 Amsterdam EB arrives back home EB

.



Annex B: Government of Indonesia definitions for SDG target 6.2

Sustainable Development Goal 6, Target 6.265

Nr Description Remarks

Target 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

Indicators 6.2.1 Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water

6.2.1 (a) Proportion of population using a hand washing facility with soap and water

It compares the proportion of households that have a hand washing facility with soap with the entire households.

6.2.1 (b) Proportion of population have access to improved sanitation services

Improved sanitation facility is facility that meets the health standard e.g.: pour-flush toilet, using septic tank or SPAL (waste management system) and used by one household or shared with other households.

6.2.1 (c) Number of villages / urban villages which have implemented STBM

6.2.1 (d) Number of villages / urban villages which have achieved ODF status

6.2.1 (e) Number of districts / municipalities which have built communal centralized sewage system

6.2.1 (f) Proportion of households have received the centralized sewage system

Sanitation ladder developed by BAPPENAS, POKJA for Housing Development, Settlements, Drinking Water and National Sanitation (PPAS), and USAID IUWASH PLUS

Service levels in brackets are the corresponding JMP service levels

1. Open Defecation (no service): no sanitation facility and people defecate in the open, or there is a facility but people do not use it.

2. Unimproved sanitation (unimproved service):

a. Sanitation facility constructed with unlined pits in urban areas: - Used by single family or shared with other families - Superstructure is pour-flush toilet (leher angsa) - Substructure is unlined pit (with open bottom) (direct or offset pit)

b. Basic (non pour-flush toilet) - Used by single family or sharing - Superstructure is plengsengan (back-shute latrine) or cemplung (simple direct pit latrine)

without lid or cover

65 Translated from Bahasa Indonesia by Angelina Yusridar, Simavi Indonesia Monitoring, Evaluation, Learning and

Documentation Officer



- Substructure is unlined pit (direct or offset), septic tank or connected to IPAL

c. Public facility (MCK)

d. Closed open defecation (BABS): users use a sanitation facility but the facility is not connected to a treatment facility (IPAL or septic tank); final disposal of faeces in ponds, rice fields, rivers, lakes, sea and or beaches, fields, gardens and other.

3. Improved - Shared sanitation:

a. Urban: - Shared with one or more families - Superstructure is pour-flush toilet - Substructure is septic tank

b. Rural: - Shared with one or more families - Superstructure is pour-flush toilet - Substructure is unlined pit (with open bottom) (direct or offset)

4. Non-shared sanitation:

a. Urban: - Used by one family - Superstructure is pour-flush toilet - Substructure is septic tank that has never been emptied

b. Rural: - Used by one family - Superstructure is pour-flush toilet - Substructure is unlined pit (with open bottom) (direct or offset)

5. Safely managed sanitation:

a. Used by one family

b. Superstructure is pour-flush toilet

c. Substructure is septic tank, excreta is emptied at least once every 5 years and transported to an IPLT (faecal sludge treatment plant) or connected to SPAL (wastewater disposal system)

Source: BAPPENAS, POKJA for Housing, Settlement, National Water and Sanitation Development (PPAS) and

USAID IUWASH PLUS (Undated). META DATA TARGET INDIKATOR SANITASI, Kupas Tuntas SDG 6.2 dan 6.3 Sanitasi.



Annex C: Information on villages visited in Manggarai Barat

1. Golo Damu

The village lies in Mbeliling sub-district some 60 to 70 minutes east of Labuan Bajo just of the trans Flores highway. The village has four dusun (sub-villages): Ndole, Wae Masa, Ranong and Mejer. STBM related activities started with a training for the village STBM team in May 2018. A triggering (demand creation) event was held on 23 May 2018, and the villages was declared 100% STBM on 12 November 2019.

Baseline 2016 End 2019 Change

Number of people 833 1,046 213

Number of families 175 175 -

Number of houses 143 143 -


• Open defecation 1% 0% -1%

• Sharing 21% 0% -21%

• Cemplung 1% 0% -1%

• Plengsengan 56% 6% -50%

• Leher angsa 1% 94% +93%

2. Watu Nggelek

The village lies in Komodo sub-district some 20 to 30 minutes to the east of Labuan Bajo along the Trans Flores highway. The village has four dusun: Dalong, Bontang and Cuka. The first two dusun were visited during the field study. Watu Nggelek is a “replication village” in which STBM was implemented independently by the district and sub-district authorities. The village was triggered in December 2017. STBM verification took place one year later in December 2018, and the village was declared 100% STBM in September 2019.


Number of people 783 982 +199

Number of families 207 201 -6

Number of houses 166 172 +6


• Open defecation 4% 0% =4%

• Sharing 16% 0% -16%

• Cemplung 1% 0% -1%

• Plengsengan 25% 40% +15%

• Leher angsa 54% 60% +6%

3. Tiwu Nampar

The village lies in Komodo sub-district some 30 minutes to the south-west of Labuan Bajo. The village has four dusun: Mbuhung 1, Mbuhung 2, Mejer and Lambur. The first two dusun were visited during the field study. The triggering event took place on 8 September 2016. The village was declared 100% ODF on 12 November 2017, and the village was declared 100% STBM on 1 June 2019.


Number of people 935 1,110 +175

Number of families 254 254 -

Number of houses 203 203 -


• Open defecation 58% 0% -58%

• Sharing 1% 0% -1%

• Cemplung 1% 2% +1%

• Plengsengan 13% 34% +21%

• Leher angsa 27% 64% +37%

identifying safely managed sanitation options in two

Documents