Wednesday, 13 August 2014

Sanitation in Alor – spreading the message, tracking its progress

By Sarah Grainger

7-year-old Novianti with her mother Amelia above the beach near their house
© UNICEF Indonesia/2014/Sarah Grainger

FUNGAFENG, NTT province, Indonesia, April 2014 - Novianti Atafan, 7, was one of the last children in her village to get a latrine at home. She lives in the seaside village of Fungafeng on Alor island in Nusa Tenggara Timur province (NTT). The family has a traditional lopo house made of bamboo and wood with a steep, thatched roof where the family sleeps.

Novianti and her mother, father, grandfather and 5 older siblings used to get up each morning and scramble down the slope behind the wooden structure to the beach below to defecate.

All that changed when a sanitarian – a local health worker who specialises in sanitation and hygiene – visited the village.

“I felt ashamed about what we were doing,” says Novianti’s mother Amelia. “And I could see that when we went to the toilet on the beach, the flies were contaminating our food and water.”

The family built its own latrine a few metres from their house and all the family members now use it.

“Now we don’t have to waste time running down to the beach every morning,” says Amelia.


Agnes Gale, a sanitarian from the local Puskesmas (health centre) is responsible for spurring the Atafan family into action. She visited Fungafeng and three other villages to try to trigger residents into building and using latrines instead of defecating in the open.

She demonstrated how faeces could contaminate water and food. She also showed people how their neighbours can see them defecating in the open.

Local sanitarian Agnes Gale visits Novianti and Amelia at their lopo house
© UNICEF Indonesia/2014/Sarah Grainger

“The two elements that are most effective in getting people to change their behaviour are shame and disgust,” she says.

Before the triggering session, 90 of the 129 households in Fungafeng had a latrine and some people were practicing open defecation. Now the villagers claim they are “open-defecation free”. But some people are still sharing latrines with neighbours and others have basic pit latrines, but no septic tank.

“We want to promote improvements in the kinds of latrines people have,” Agnes says. “Eventually we want everyone to have a permanent, healthy latrine. Even if just one person returns to defecating in the open, all the community is at risk from contamination.”

Monitoring Progress

Indonesia has the second highest number of people, after India, practising open defecation and the problem is most acute in NTT province.

Poor sanitation leads to an increase in diarrhoeal diseases with diarrhoea rates being 66 % higher among young children from families practising open defecation in rivers or streams than among those in households with a private toilet facility and septic tank. Diarrhoea is also still a major killer of children in Indonesia: Around 31% of infant deaths and 25% of deaths among children between one and five years of age are caused by diarrhoea.

Working with the district health office, UNICEF trained Agnes and 9 other sanitarians in Alor in how to use SMS text messages to monitor the villages they are responsible for.

Agnes Gale sends her SMS reports from the local health centre
© UNICEF Indonesia/2014/Sarah Grainger

Every time Agnes makes a visit to Fungafeng, she notes what kind of sanitation each household is using. There are four categories – open defecation, a shared latrine, a semi-permanent latrine and a permanent latrine.

She sends the information via SMS text message to a central database where it’s picked up by district health staff. This system is much quicker than the previous method where sanitarians would send in a quarterly report on progress in their villages.

“Now we get the data on time and we can see how effective our sanitarians are,” says Dominggus Prakameng, Head of Environmental Health for Alor district. “It helps us plan ahead to allocate resources to places where sanitation is still a problem.”

The sanitarians prefer the new SMS reporting system too. “It’s quicker and easier. We don’t have to fill out forms we just collect the information and send it,” says Agnes.

The triggering sessions and the follow up monitoring seem to be having an effect on health in Fungafeng. There used to be an outbreak of diahorrea in the village every year, but Agnes says that’s not happening anymore.

Thanks to support from the Bill and Melinda Gates Foundation and Unilever, UNICEF is rolling out the SMS monitoring system in South Sulawesi, NTT and Papua provinces.