WATER AND SANITATION PROGRAM: TECHNICAL PAPER Global Scaling Up Rural Sanitation Project Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia Lisa Cameron and Manisha Shah November 2010 The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. 7554-Book.pdf i 11/12/10 10:41 AM Lisa Cameron Monash University Manisha Shah University of California, Irvine Global Scaling Up Rural Sanitation is a WSP project focused on learning how to combine the approaches of CLTS, behavior change communications, and social marketing of sanitation to generate sanitation demand and strengthen the supply of sanitation products and services at scale, leading to improved health for people in rural areas. It is a large-scale effort to meet the basic sanitation needs of the rural poor who do not currently have access to safe and hygienic sanitation. Local and national governments are implementing the project with technical support from WSP. For more information, please visit www.wsp.org/scalingupsanitation. This Technical Paper is one in a series of knowledge products designed to showcase project fi ndings, assessments, and lessons learned in the Global Scaling Up Rural Sanitation Project. This paper is conceived as a work in progress to encourage the exchange of ideas about development issues. For more information, please email Lisa Cameron and Manisha Shah at [email protected] or visit our website at www.wsp.org. WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank. WSP reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available. The fi ndings, interpretations, and conclusions expressed herein are entirely those of the author and should not be attributed to the World Bank or its affi liated organizations, or to members of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank Group concerning the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to [email protected]. WSP encourages the dissemination of its work and will normally grant permission promptly. For more information, please visit www.wsp.org. © 2011 Water and Sanitation Program 7554-Book.pdf ii 11/12/10 10:41 AM Global Scaling Up Rural Sanitation Project Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia Lisa Cameron and Manisha Shah November 2010 7554-Book.pdf iii 11/12/10 10:41 AM Acknowledgements An integral component of the Water and Sanitation Pro- impact evaluation investigators Lisa Cameron and Manisha gram’s Global Scaling Up Rural Sanitation Project, a cross- Shah with research support from Ari Perdana and Ririn country impact evaluation (IE) study is being conducted in Purnamasari. Photographs courtesy of Lisa Cameron. India, Indonesia, and Tanzania. Th e task team leader for the project in Indonesia is Almud Th e World Bank’s Water and Sanitation Program (WSP) Weitz and Eduardo Perez is the global task team leader of Global Impact Evaluation Team in Washington, DC, leads the project. Th e country implementation team was led by the study, with the contribution of WSP teams and consul- Nilanjana Mukherjee, followed by the late Ratna Indrawati tants in each of the participating countries. Th e baseline Josodipoero, and is now headed by Djoko Wartono. Nilan- data collection for all countries was conducted during 2008 jana Mukherjee continues as an advisor. Th e country imple- and 2009, and the reports have undergone several peer re- mentation team has benefi ted from the continuous support view processes. of WSP staff . Th e project’s Global IE Team oversees the IE design, method- Peer review support was received from regional and global ology and instruments, and manages the country teams. It is resource staff . Th e initial impact evaluation design was pre- led by Bertha Briceno (in its early stages the Global IE was sented to the Ministry of Health and the Ministry of Edu- led by Jack Molyneaux), together with Alexandra cation by the Impact Evaluation team in Jakarta, Indonesia Orsola-Vidal and Claire Chase. Professor Paul Gertler has in September 2007. Contributions to the initial impact provided guidance and advice throughout the project. Global evaluation concept design were received from the technical IE experts also include Sebastian Galiani, Jack Colford, Ben body of the National Department for Health Promotion Arnold, Pavani Ram, Lia Fernald, Patricia Kariger, Mark (Ministry of Health) and the Environmental Education Sobsey, and Christine Stauber. In Indonesia, in-country IE Department (Ministry of Education). design, fi eld activities, and data analysis is led by principal iv Global Scaling Up Rural Sanitation 7554-Book.pdf iv 11/12/10 10:41 AM Executive Summary Background fi ndings of the baseline survey conducted in Indonesia In response to the preventable threats posed by poor and is part of a series of papers analyzing the baseline sanitation and hygiene, in December 2006 the Water and data from all countries where the project has been Sanitation Program (WSP) launched two related large-scale implemented. projects, Global Scaling Up Handwashing1 and Global Scaling Up Rural Sanitation. Th ese hygiene and sanitation Indonesia Intervention interventions are designed to improve the health and welfare WSP’s Global Scaling Up Rural Sanitation Project, known outcomes for millions of poor people. Local and national as Sanitasi Total dan Pemasaran Sanitasi (SToPs) in governments are implementing these projects with technical Indonesia, aims to improve the sanitation practices in support from WSP. Indonesian rural communities, reaching a total of 1.4 million people in 29 rural districts in East Java by project Th e goal of Global Scaling Up Rural Sanitation is to reduce end. Th e main components of the intervention include: the risk of diarrhea and therefore increase household pro- • Community-Led Total Sanitation (CLTS), which ductivity by stimulating demand for sanitation in the lives aims to trigger the desire for an open defecation free of people in India, Indonesia, and Tanzania. community by raising collective awareness of the open defecation problem. Th e project approach demands involvement from commu- • Social Marketing of Sanitation, which aims to nities, local government, and the private sector. It aims to popularize improved sanitation via extensive con- trigger the desire for an open-defecation free community by sumer and market research that inquires into the raising collective awareness of the open defecation problem. sanitation solutions that people desire, the options Facilitators are sent to communities to initiate participatory available to them in the market, and their attitudes analysis of the communities’ existing sanitation practices, and knowledge of sanitation issues. and the consequences and implications of such practices for • Strengthening the Enabling Environment, which themselves. Th is process is designed to catalyze collective aims to support the development of policies and community desire and action to become open defecation institutional practices that facilitate scaling up, pro- free (ODF). Th e community must forge their own plan for gram eff ectiveness, and sustainability on national, making this happen with only limited follow-up support state, and local levels. and monitoring from the program. Communities claiming to have become ODF are verifi ed by local government Methodology and Design agencies. ODF achievement by a community brings recog- To accurately measure the long-term health and welfare im- nition and commendation from local and provincial gov- pacts of these sanitation interventions, a proper impact ernments. Th e project also seeks to stimulate the supply of evaluation (IE) methodology that establishes the causal appropriate sanitation products and services by conducting linkages between the intervention and the outcomes of in- market research and training local artisans to build the rel- terest is needed. In order to estimate the causal relationship evant facilities. between the project (treatment) and the outcomes of inter- est, the construction of an accurate counterfactual is To measure the magnitudes of the impacts, the project is required—that is, a comparison group that shows what implementing randomized-controlled trial impact evalu- would have happened to the target group in the absence of ations (IE) study in order to establish causal linkages be- the intervention. Th e IE methodology uses randomization tween the intervention (treatment) and the outcomes of to construct the comparison group. Communities are ran- interest.