Problem: What problem is this project trying to address?
From a population of 250 million, 70 million Indonesians still live without access to basic sanitation facilities. Open defecation or direct river defecation is still common practice among 19% of the urban population and 40% of the rural population. National data claims that around three quarters of households are discharging raw sewage into paddy fields, ponds, lakes, rivers, and the sea; only one quarter are connected to septic tanks or improved pits. In addition to the environmental damages, which include water pollution and a reduction in the productivity of the land, the problem has caused serious outbreaks of preventable diseases such as diarrhea and cholera, resulting in major losses to the country.
District governments fund sanitarians, a functional position at Community Health Centers (Puskesmas). Their main responsibility is illness prevention through environmental health and hygiene initiatives in the dedicated villages within sub-district areas. One sanitarian is usually responsible for covering eleven villages or serving a population of 10,000-20,000. Not only is this number below the number of people and communities that need to be served,, but sanitarians are also not keeping pace with changes in health conditions in Indonesia and fail to make the appropriate adjustments. With a supply provision mindset, sanitarians are not able to see local potential, mobilize communities and other professionals to collaborate in order to address the problem. New Health School graduates wish to become civil servants and public service providers, which is what the school prepares the students to become, rather than skilled workers ready to tackle their communities’ problems with innovative solutions.
In addition to the human resource challenges, the government has not put sanitation as a high priority on their agenda. Although aiming for communities to be 100 percent open defecation-free has already been set as one of the government’s five-year goals, the government’s limited support on provisions for sanitation construction has failed to stimulate the community to voluntarily build their own facilities. Even those receiving the stimulant packages have often failed to build the toilets by themselves due to lack of information and skills and the government’s lack of investment in supporting healthy behaviors. Worse, by and large, international and local NGOs and donors have followed suit with these supply driven models, which undermine people’s willingness to pay for the facilities. To a large extent, sanitation programs are still driven and financed as a part of donor-funded water and sanitation loan programs and national level budgets in Indonesia. Not only has the approach created dependency on the government’s subsidies, it leaves the facilities unmaintained and therefore unsustainable due to a poor sense of ownership. Not surprisingly, even when these public toilets are available, many still continue to practice unhealthy behaviors.
Solution: What is the proposed solution? Please be specific!
By redefining the role of sanitarians, Sumadi has shifted the attitude and behavior of sanitarians from a passive employee mindset to one of a community entrepreneur. Together with his 38 sanitarian community entrepreneurs, who also play the role of marketers, Sumadi has been able to engage village midwives, construction workers, building material suppliers, and community members to bring about 5,000 units of household toilets serving over 25,000 poor people in the Nganjuk District, East Java, among other cities in Indonesia.
Sumadi envisions each sanitarian as a community entrepreneur, a professional who can perform above their duties and act beyond only implementing a sanitation campaign. By using a market-based approach, Sumadi’s sanitarians have reduced inefficiencies in the supply chain. Like doctor-pharmacist-drugstore partnerships, Sumadi helps sanitarians build relationships with construction workers and building material suppliers. Through the Indonesia Association of Sanitation Management and Empowerment (APPSANI), he connects the Sanitation Works Association (Asosiasi Karya Sanitasi) with construction workers, material suppliers, and the Association of Sanitation Entrepreneurs (Asosiasi Pengusaha Sanitasi) to join efforts in facilitating the emergence of sanitation demands across different villages in Indonesia.
His model has been replicated across at least 38 districts and associations have been set up in nine cities in Java, Lombok, Sulawesi and Papua islands. His model has also inspired the village youth in South Kalimantan to become community sanitation entrepreneurs. Now Sumadi is approaching Schools of Health Polytechnic in Aceh and Surabaya to include entrepreneurship curriculum in order to build a community of future sanitarians.