sanitation and health: out what works€¦ · sanitation and health: the past, the future and...
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![Page 1: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/1.jpg)
Sanitation and Health:The Past, the Future and Working Out What Works
Lisa Cameron and
Susan Olivia
Monash University
![Page 2: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/2.jpg)
Sanitation and Health:The Past, the Future and Working Out What Works
Lisa Cameron and
Susan Olivia
Monash University
![Page 3: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/3.jpg)
The Past, the Future and Working out What Works
1. The state of sanitation in Indonesia today and recent gains.
2. What we know about the relationship between sanitation and health.
3. Policy: What has and is currently being tried.
4. How we can learn more about what works.
![Page 4: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/4.jpg)
Consequences of Poor Sanitation
• Of the four most common causes of under‐5 mortality in Indonesia, two are faecal borne illnesses (diarrhoea and typhoid).
• About 11% of Indonesian children have diarrhoea in any two week period.
• 33,000 children die each year in Indonesia from diarrhoea; 11,000 from typhoid.
• Losses also accrue from time spent collecting safe drinking water and/or money spent purchasing it.
![Page 5: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/5.jpg)
Sanitation in Indonesia Today
• 23% of households do not have a toilet.• 7% in urban areas; 32% in rural areas.
Large Variations Across Provinces• Worst SanitationMaluku & Papua: 41%; NTB: 39%.
• Best SanitationJakarta 2.5%; Yogya 5%; Kalimantan Timur 9.2%.
![Page 6: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/6.jpg)
Large improvements in last 15 years
• Overall: 49% with no access in 1993 → 23% in 2009
• Rural : 61% → 32%
• Urban: 21% → 7%.
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![Page 8: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/8.jpg)
![Page 9: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/9.jpg)
What do we know?• Having a toilet decreases the probability of having diarrhoea by
14%;
• Having a flush toilet decreases it by a further 11%;
• Using a shared or public toilet increases the probability by 11% (c.f. no toilet).
• Having the water source within 10m of where people defecate increases the probability of having diarrhoea by 12%.
• If 32% of your community defecate in the open, you are 5.3% more likely to have diarrhoea.
![Page 10: Sanitation and Health: Out What Works€¦ · Sanitation and Health: The Past, the Future and Working Out What Works Lisa Cameron and Susan Olivia Monash University](https://reader034.vdocuments.site/reader034/viewer/2022042217/5ec1f803003cea443b38d30f/html5/thumbnails/10.jpg)
Change in No Toilet (By Province)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1 2
Sumatra Utara
DKI Jakarta
Jawa Barat
DI Yogyakarta
Nusa TenggaraBaratMaluku
Papua
1993 2009
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Previous Policy1. Inpres Sarana Air Minum dan Jamban Keluarga (1974‐1990)• Government supplied toilets to communities and households.• Top down approach. Unsuccessful.
2. Water Supply and Sanitation for Low Income Communities (WSLIC)• Block grant to villages (approx Rp 200 million, A$25,000). • Community‐driven development.• Some co‐funding from village and district government.
3. Total Sanitation and Sanitation Marketing (TSSM)• Community‐led• Aims to generate demand for sanitation by facilitating frank
discussions of defecation practices in the community and their negative health consequences.
• Offers little financial assistance.
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TSSM Video
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What do we know about what works?
• Not all that much. • Governments locate sanitation programs in particular areas (e.g.
WSLIC ‐ where sanitation is poor; high diarrhoea prevalence;)• Hence comparing health in villages that got the program with those
that didn’t can be misleading.• Also changes over time are not necessarily associated with the
program.• Randomised evaluations can overcome these difficulties.• Communities are randomly chosen to be in or out of the program.• A comparison of health in randomly chosen “treatment” villages
with randomly chosen “control” villages provides an estimate of the impact of the program on health.
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In Summary
• Poor sanitation leads to poor health.
• Top down approaches to providing sanitation have failed.
• Community‐driven demand side programs seem to be having some success.
• Randomised evaluations are a tool that allow an unbiased assessment of the impact of these programs.
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The End
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Sanitation facilities by household per capita expenditure quintile
0.000.100.200.300.400.500.600.700.800.901.00
1 (poorest) 2 3 4 5 (richest)
Share of hou
seho
lds w
ith ...
Quintile
Private ToiletShared ToiletPublic ToiletNo Toilet
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Sanitation Type by household per capita expenditure quintile
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1 (poorest) 2 3 4 5 (richest)
% of H
Hs with
...
Quintile
Water seal flush toilet
Pit latrine with slab
Pit latrine without slab