By Sarah Grainger
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7-year-old
Novianti with her mother Amelia above the beach near their house
© UNICEF Indonesia/2014/Sarah Grainger
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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.
Triggering
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.
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Local sanitarian
Agnes Gale visits Novianti and Amelia at their lopo house
© UNICEF Indonesia/2014/Sarah Grainger
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“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.
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Agnes Gale sends
her SMS reports from the local health centre
© UNICEF Indonesia/2014/Sarah Grainger
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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.
