The proposed strategy for hygiene promotion is that the Posyandu (Health Posts) volunteers will be trained to organise and run Community Health Clubs. The CHCs will have 20 sessions of two hours to enhance health and hygiene knowledge and practices.
This strategy, which was proven to be cost- effective in Zimbabwe, would be valuable to test in the urban sanitation program with the following proposed modifications:
Making it possible for existing groups, such as religious and PKK groups, to take up the community health programme, unless this means that interested persons will be excluded (The existing clubs may for example involve only the locally better-off);
Include gender and poverty equity subjects in the curriculum e.g. representation of women and the poor in local decision making meetings and bodies, accountability to users for local management and financing, and roles and responsibilities of women and men in domestic and community environment, hygiene and health;
Make hygiene promotion sessions accessible to men and promote their participation through male communication channels. Accessibility may involve opening the possibility of a second series of evening sessions, as men and women tend to meet at different times;
Include demonstration visits from groups to individual households with interesting solutions to sanitation and hygiene to strengthen horizontal learning;
Matching incentives and compensation for health volunteers (proposed is free health insurance) to the amount of time spending. It should be avoided that as women, the health workers are expected to work for (almost) free while the same work when done by men would be compensated according to government scales;
Train Posyandu workers hands-on, using the same participatory methods that they will use with the groups;
Develop a set of no/low-cost participatory learning activities, involving such interesting group activities as drawing, sorting, ranking, mapping and matrix making. Communal learning materials, such as pictures of technology options and designs and pictures for sorting and ranking of sanitation and hygiene priorities, should preferably low-cost so that local groups can have their own sets. Encouraging members to replicate sessions at home with relatives and neighbours can be a good way to spread learning and skills and involve men.
School Water Supply, Sanitation & Hygiene
The ToR of ISSDP only stipulate including schools in the sanitation campaign. They are not included in the development of the city sanitation strategy. Although there is a national program for healthy schools2, it would make sense when the cities assess the situation locally, especially the O&M and use and hygiene of the facilities (which are now not known) and develop a strategy for preserving hygiene in schools. Schools are places where many children meet. Sanitation related diseases are easily transmitted when toilets are locked or dirty and/or no hand washing with water and soap is possible. Moreover, separate toilets for girls in schools help their attendance and completion, especially at the age of (pre) puberty. A simple format for assessing is included in Annex 3.
In the FGDs in poor communities, financial and economic concerns were very prominent. It emerged that in community information and mobilisation it is very important that facilitators can help people actually calculate what their net costs in water and waste disposal will be when they improve their hygiene and sanitation provisions and habits. This went for poor women as well as men.
It will be helpful for facilitators of FGD to have not only drawings or pictures of the different models and materials, but also an example of the annual cost of a typical middle, low and lowest class family in terms of loss of work days, costs of medicines, transport and medical help (where Puskesmas are not free) and in the worst case in case of the death of a child, mother or father due to hygiene and sanitation-related diseases. This can probably be based on the work for ISSDP by Juli Sumirat.
More paid work and income
Besides the net reduction in health-related costs, there are also many opportunities for more paid work and income for especially poor city people, if the city administration adopts labour intensive sanitation solutions and implementation methods.
Open unemployment is increasing in Indonesia. It doubled from 3.0% of the EAP in 1990 to 6% in 1999, with a higher rate for women of 6.9%. Although women slightly outnumber men in the population, women’s participation in the formal work force is much lower (45%) than that of men (73.5%). Among women, unpaid work is common: 34.9% of women worked with no wages in 1999, compared with 9.4% of men. Women also tend to work in the informal more than in the formal sector, because this kind of work allows them to also perform their roles in the household. Women earned 70.3% of what men received for the same or comparable work (Zulminarni, 2005).
There has been an increase in the number of women headed households Over 13% of households with women between 45 and 60 were headed by a divorced, widowed or single woman. PEKKA is a special program helping single women to work, but it is only for widows in selected rural areas.
The following are types of work which allow especially poor women to get paid work and income as part as a city strategy for improved sanitation and hygiene:
PDAM water tank operators are preferably women who besides free water for themselves get either a fixed or variable compensation from water sold with a small surcharge of say Rp. 20 per Jernigan;
Collection, cleaning and recycling of plastic water bottles and cups;
Collection and recycling of various types of plastic into mats, curtains and bags;
(Vermi) composting of kitchen and market organic waste with sale of solid and liquid compost and worms, or productive use of compost for urban horticulture (e.g. ornamental plants and trees nursery, box and garden cultivation of small fruits and vegetables;
Productive use and/or sales of compost from eco-latrines (especially suitable in high water table areas with some solid land and space for urban horticulture);
Meter readers and tariff collectors in their neighbourhoods, enabling poor families to pay locally other than monthly (e.g. per week) and following up non-payment;
Promoting and selling toilet parts, especially through contacts with other women;
Toilet masons, promoting, building and repairing on-site toilets;
Managers of a recycling business;
Managers and operators of MCKs;
Home and Group Industry for snack production (22 in Banjarmasin, inventory City Facilitator)
Hygiene promoters trained in participatory promotion and monitoring.
The city strategies include a policy to enhance such employment starting with an inventory of male and female workers in municipal solid waste management and women, men and children in solid waste collection, segregation and recycling in the informal and formal private sector (Annex 18).