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Published on: 26/11/2015

As current sanitation conditions threaten the world we live in, delivering change at scale is becoming increasingly urgent. However, for too long, improving sanitation and hygiene conditions have been characterised by individual efforts and by small, time-bound projects. Although these projects often have a strong grassroots and pro-poor focus, their capacity to benefit larger populations and to contribute to lasting change is limited.

Funding agencies, policy makers, practitioners, and the public are seeking large-scale, transformational solutions to adapt improved sanitation and hygiene behaviours and practices. At the same time, initiatives that provide change at scale are becoming viable because of the emergence of national and local leadership coupled with an increase in public sector funding. It is expected that the new global goals for sustainable development will be helpful in accelerating this process.

A successful programme in East Indonesia

The Sanitation, Hygiene and Water (SHAW) programme implemented across nine districts in East Indonesia by Simavi and five Indonesian organisations with support from IRC ran from mid-2010 to mid-2015. The programme, building on Indonesia’s Ministry of Health’s National Sanitation Strategy (STBM), applied a community-based approach for delivering change and was the first-ever attempt to implement STBM in its entirety and at scale in Indonesia. The STBM policy focuses on the following five practices: 1) ending the practice of open defecation; 2) hand washing with soap; 3) household water treatment and safe storage; 4) household solid waste management; and 5) household liquid waste management. 

During the past five years almost 1.5 million people across five islands in East Indonesia benefited from the programme. At the end of the programme in June 2015, almost 85% of the families had their own toilet and many more families were using these toilets. 802 villages (76% of the total intervention villages) and 445 schools (75% of the total intervention schools) were declared 100% STBM. And that was achieved at an average cost per person reached of €6 to €7.

… provided us with the following lessons

The programme has been extremely successful in achieving its targets. Particularly considering that four out of five Indonesian implementing partners had no prior experience in implementing sanitation and hygiene programmes and that STBM implementation guidelines did not exist at the start of the programme in 2010. However, towards the end of the programme, while developing ideas for a possible follow-up phase, it was realised that the programme was not scalable in its present form. The programme took too much time and was too expensive when it is placed in the context of Indonesia where only one out of two rural persons has access to an improved sanitation facility and where some 34 million people still resort to defecating in fields, beaches and water bodies. [1]  With over 60,000 rural villages it would require the equivalent of 75 SHAW programmes to cover all these villages in the country.

What are the challenges…  

The Indonesian decentralisation process which started in 2001 has created a number of challenges. Although it is perceived as a positive change, district governments lack the capacity to take up their responsibilities in providing basic services, including water supply and sanitation, to communities in their jurisdiction. Most current programmes do not do enough to develop the organisational and institutional capacities at the decentralised levels. Despite decentralisation, most policies and strategies for the sector are still being developed at the national level for implementation at the sub-national level. Translating national strategies to the sub-national level remains a big challenge and because of capacity problems at the sub-national level national strategies are often not well implemented.

The impact and sustainability of most programmes is questionable. Most programmes try to achieve short-term goals and focus on capital investments without embracing sustainable service delivery approaches that consider full life-cycle elements along the sanitation service chain and full life-cycle costs. Large scale programmes with relatively low per capita investments and a focus on hardware are often not sustainable and, small programmes with relatively high per capita investments may result in small islands of success but are often not scalable.

… and how to move forward?

To address these challenges, Simavi supported by IRC developed a completely new theory of change which formed the basis for a new programme as successor to the SHAW programme called SEHATI. The new programme has been designed on the following principles: 1) sanitation (and hygiene) service delivery models must result in sustained change and must be scalable to support and contribute to the Government of Indonesia’s goal of ensuring universal and sustainable access to sanitation and hygiene by 2019; 2) local government authorities with strong and committed leaders must be in the lead as they are the duty bearers and thus responsible for WASH service delivery within their jurisdiction; and 3) non-governmental organisations should stay away from direct implementation and instead facilitate, innovate and in particular strengthen the organisational and institutional capacities at the district and lower levels. Organisational and institutional capacity building should include interventions that will help to embed the key STBM elements in local government planning, budgeting and service delivery systems and processes. This will then enable local authorities to replicate and scale up the STBM model throughout their district.

The main actors and the capacity strengthening process are shown in the following simplified illustration.


The new programme SEHATI which is expected to start in early 2016 will put the district authorities in the driving seat right from the start. This is done to encourage local leadership and local ownership of the development process. Successful replication and scaling up of the rural service delivery model will require strong leadership and commitment, the right attitude, a deep understanding, and the skills and competences to be able to initiate, implement, and sustain sanitation and hygiene programmes. The programme will strengthen the capacity of local government actors (at district, sub-district and community level), private sector sanitation entrepreneurs and other local stakeholders by equipping them with the right models, approaches, tactics, tools and skills to enable them to achieve full coverage in their districts.

The programme aims to build capacity for future scaling of sanitation and hygiene initiatives and thereby supporting the Government of Indonesia’s vision of achieving universal access to sanitation by 2019. The ultimate success will depend, to a large extent, on how STBM is embedded in existing local government structures, systems and processes. The main capacity strengthening activities are summarised in the following table.



Capacity to



Lead and steer

Incorporate STBM in plans and budgets

Develop supportive legislation

Implement and sustain STBM

Monitor STBM achievements


District level







Sub-district level







Village level






To avoid similar problems with phasing out and handing over responsibilities to the local authorities as experienced in the first phase, the programme partners will not be directly responsible for the implementation. Furthermore, the intensity of the partners’ involvement will gradually change and diminish over the course of the programme with the local authorities taking up increased roles and responsibilities for leading, steering, implementing and sustaining the programme activities. This is depicted in the following picture.

The diminishing role of the partners and the increasing role for the local authorities are also reflected in the programme budget. Local authorities will be expected to contribute an increasing share of the required funds necessary to implement and replicate the STBM programme in their districts.

The programme hopes to contribute to the Indonesian Government’s goal of achieving universal access to improved sanitation and hygiene in Indonesia by 2019 as follows:

  1. It’s time to think big(ger): the programme embraces the idea to shift from one-off, small scale activities to one that in potency benefits more people and informs policy and practices.
  2. Scaling starts at the project design phase and requires dedicated resources: the programme is designed by considering key scaling elements and to safeguard successful future scaling (and replication) a lot of emphasis will be put on ensuring that financial and human resources will be in place towards the end of the programme.
  3. Adaptation of the new service delivery model can be done in a variety of ways: developing a scalable model is not an easy thing and successful scaling will depend upon local factors such as resources, local context, partnerships and networks. When implementing the programme various routes, actors and conditions need to be identified and addressed to maximise its success and minimise future challenges.
  4. Do not change a winning team: as scaling brings its own challenges it is crucial that the programme continues with the same partners. Likewise the partners should engage the same teams that successfully implemented the SHAW programme and also stick as much as possible to the STBM implementation approaches developed and tested during that programme.

[1]       World Health Organization and UNICEF (2015) Progress on sanitation and drinking-water - 2015 Update and MDG Assessment. 


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