Component C1 of ISSDP concerns raising the awareness of government institutions and the public on the importance and values of good urban sanitation and getting their support for city-level work. National campaigns are an important part of the work. The Joint Review report of ISSDP calls for attention to gender in the sanitation awareness campaign.
National Communication Strategy
A national Advocacy/Communication Strategy has been developed (ISSDP Working paper 4). It stresses that opinion leaders, policy makers, managers and the public do not see the links between sanitation, public health and economics. Women do, but as individuals at home. Sanitation is their 2nd priority, but only the 8th for men. This can be changed through good communication and advocacy.
The strategy also stresses that addressing both women and men is important from a point of view of passing on information: women share information in their families and with fellow-women. Men share information through their formal networks which are mainly male. Functionaries at national and city level also rely on different media for their information (here no distinction was made between males and females). Effective promotion and advocacy of sanitation and hygiene must thus raise use different channels to reach all.
The Plan of Action is not gender-specific and the national message to be spread by (only) the Minister of Women Affairs is “without toilets women suffer more”.
Not included in this message is that women are also actors who (when given the chance) will put toilets and hygiene on the community and city agendas and as women should participate in public decision-making and management, given that sanitation and hygiene are areas for which they have special responsibilities, commitments and hands-on knowledge.
The campaign draws on formative research on health and hygiene by ESP-USAID. Focus Group Discussions (FGDs) took place with women and men, but the findings do not report separately on their practices, perceptions and responsibilities.
Separate findings have been reported on poorer people (but again not sex-disaggregated) and children, but not on adolescent girls and boys. From elsewhere it is known that puberty affects e.g. the demand for and use of toilets and the influence of mothers/parents which are all lower for teenage boys than for girls. Findings on gender are as follows (Table 1).
There is no norm making that everyone participates equitably. However, in some areas it is now expected that people who have no time or desire to give labour (e.g. the better-off) should pay or contribute food instead.
For the national hand washing campaign, it has been decided that the target group will predominantly be female caretakers (mothers, grandmothers, sisters and nannies) of children under five, because they suffer and die most from diarrhoeas. Other target groups for safe hand washing (schoolchildren, teenage boys and girls, fathers) may be addressed in later campaigns.
The campaign will consist of mass activities (mainly TV and radio) supported by personal communication in small groups. The central message will be “washing hands with soap at critical times”. The key media for awareness building and message spreading are TV, radio and women’s journals for higher class women and tabloids for lower class women. Supportive material: tip cards packed with commercially sold soap.
Person-to-person communication will am at behaviour change. Trained female cadres at RT (community) level, such as Puskesmas (Public Health Centre) and PKK (women’s program) workers will lead women’s group sessions. Flyers and stickers will be spread through the groups (and in general?). All caretakers will get a Child Monitoring Card to monitor diarrhoeas. Piloting will be in the six cities (not rural). The pilot will include a comparative study on effectiveness of mass media vs. mass media plus person-to-person media to measure impacts.
Table 1. Findings on gender from formative research on hand washing
Hand washing is seen as a female and not a male responsibility. Yet especially men use stagnant water for hand washing;
Only some women wash hands with soap after defecation & cleaning kid’s bottom;
Most people (men, women, children, youths?) wash hands only with water;
Food is not washed with poured/running water, but in basins (risk of dirty hands);
Risky hygiene practices of brushing teeth with raw water and cleaning children’s feeding bottles and comforters have not been investigated;
Men are responsible for earning money. However, their roles in financing hygiene, sanitation and water connections were not investigated;
Women cannot go alone to MCKs in dark and quiet locations, e.g. at night;
Some women feel using water after urinating/defecating is unsafe ( polluted by chemicals);
Mothers, wives and daughters clean toilets, but if there are more women in the house, daughters or sisters do it and men do it when their wife is away or sick;
Gender differences in reasons for and use of toilets were not investigated;
Parents (mothers and fathers) stimulate children to defecate in the open area and Parents (but in reality mothers, sisters?) cover, but also often throw away children’s stools in streams, ditches. Parents do not see children’s faeces as risky except when they have diarrhoea, because the excreta smell less bad than adult’s faeces;
Depending upon region, managing garbage is a female or a joint responsibility, besides Men process (e.g. burn) garbage. Community clean-ups are by men or done jointly with women cleaning around individual houses or doing the catering;
TV and person-to-person contacts and discussions are the most important information channels for women and men. Posters and pamphlets reach, but contents are easily forgotten. Few people, none of them poor, read newspapers. Women and men watch at different times and watch different programs; evenings are also family watching times;
Local health cadres are trusted sources of information and people (men and women?) would like to get more hygiene and health information, which they now seldom give;
Communities wait for the initiatives of local leaders, which are mostly men, to undertake community hygiene activities. Health activities are the domain of women, but their initiation in the community is hampered by the fact that local leaders are mostly men. Men go for different big issues such as roads development and repairs and security, not health/hygiene.
National Sanitation Awareness Campaign
In this campaign urban men (aged 15-65) from lower and middle class levels are the primary targets, because they are the household heads, decide on household investments and have a lower appreciation of good sanitation than women. Women are seen as intermediaries who can encourage the men to lead.
The key message is ‘a clean and healthy living environment’ which men are responsible for, to protect the women and children against disease and nuisance and create dignity for women and the whole family. “Are you responsible enough to create a clean and healthy environment for your loved ones?”
The key media chosen is TV, supported by radio, local newspapers and printed materials (posters, flyers, sanitation options catalogue for men’s community meetings (Musrenbang). Women will be reached through their own meetings and clubs.
From FGDs with women and men on sanitation and personal hygiene in Banjarmasin we learned that bad environmental conditions are seen as an important area for community action. The use of helicopter latrines was seen as a ‘bad practise’ which everyone still continues, however, as alternatives are seen as less easy. In personal hygiene, washing hands without soap and brushing teeth and washing kitchen utensils and food washing with raw (river) water are especially common among poorer women and men without a PDAM connection. They buy only water for drinking and cooking from PDAM reservoirs or from neighbours with a tap. They thought that only drinking and cooking with river water was risky and feared that using tap water also for other purposes would use a lot more water for such uses which would make it expensive for them.
The FGDs in Banjarmasin also taught that:
Women want to participate more in community meetings and local leadership to get sanitation and hygiene on the community agenda;
They can encourage their husbands and older sons to practice hygiene, but find it hard to convince them to practice. This may need more/other forms of hygiene promotion e.g. male meetings/discussions on their own hygiene practices;
Men have no problem with a greater participation of women in community decision-making meetings and local leadership to represent their domains;
They feel that financially they can contribute more to sanitation and hygiene;
They welcome a greater role in educating their children on sanitation and hygiene.
Both sexes like the use of participatory methods/tools in hygiene promotion sessions.
Both are concerned with the economic side of sanitation, in terms of cost-benefits for households and opportunities to generate resources/income
Poor-inclusive Sanitation Campaign
A strategy for poor-inclusive sanitation has been drafted. It has four key recommendations:
All improvements should be labour-intensive and labour based
The reasons are that (1) present services already represent important sources of work and income, including for many poor men, women and children and (2) more work contribute to Indonesia’s poverty reduction targets (as do other benefits from sanitation).
In Solo alone, 179 daily labourers work in SWM for the municipality and an estimated equal number or more in informal waste collection and recycling. Recycling of plastics, paper and metal has an estimate value of US $ 5.8 million per year. This does not include organic waste, which constitutes 70% of all solid waste (Salter, 2007). Not given is how SWM work is divided between poor men, women and children.
They should follow the example set by earlier community-driven programs such as KDP (Kecamatan Development Program). Not mentioned is that the KDP strategy has been mostly male driven. Local decision-making bodies have few women members and no direct link with women constituencies, as Musrenbangs (community assemblies) are typically male meetings which made that KDP focused on male rather than female development priorities.
Data should be poverty-specific.
The draft strategy mentions two sources of secondary data (BSP and DHI). Both are national classifications, however, with disadvantages for poverty definition at Kelurahan level or below. ESP as well as ISSDP combine secondary data on subsidy (not clear which of the two) with primary data on water supply, waste disposal and sanitation conditions and practices to identify high risk parts of the city. The Health Agency in Payakumbuh used primary data for poverty (housing criteria) and conditions to make its own classification.
While combination of poverty and environmental data will facilitate targeting sanitation programs to the highest areas at risk (i.e. those that combine poor sanitation with a high incidence of poverty) there are disadvantages in not using local poverty indicators as is done in Payakumbuh. Under BSP, already one out of 9 indicators such as illness in the last three months classifies a household as poor. The DHI classification is based on the available income and expenditure for basic needs. The amounts are the same for the whole nation, while costs and expenditures for basic needs are likely to vary by region. E.g. what is available and spent in Flores is likely to be less than in Java.
Campaigns to include hygiene promotion through Community Health Clubs
The poor-inclusive strategy emphasizes that behaviour change is needed to improve environmental health and reduce high incidences of water and sanitation related disease among the poor. The recommended strategy, community health clubs, have been proven to have a high cost-effectiveness (Waterkeyn, 2006). Session subjects stem however from Zimbabwe and will need adjustments to include e.g. technology options with financial, managerial and O&M implications and community planning, monitoring and accountability.