Behavior Change Strategy - pdf.usaid.gov

a

USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE

PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)

Behavior Change Strategy CONTRACT NO. AID-497-TO-16-00003

APRIL 2018

This report is made possible by the support of the American People through the United States Agency

for International Development (USAID). The contents of this report are the sole responsibility of DAI Global,

LLC and do not necessarily reflect the views of USAID or the United States Government.

Cover Page Photo: Image visualization of priority behaviors discussed during the BC strategy workshop in January 2018.

Photo by Febryant Abby/USAID IUWASH PLUS



Behavior Change Strategy April 2018

Project Title: USAID IUWASH PLUS: Indonesia Urban Water,

Sanitation and Hygiene Penyehatan Lingkungan untuk Semua

Sponsoring USAID Office: USAID/Indonesia Office of Environment

Contract Number: AID-497-TO-16-00003

Contractor: DAI Global, LLC

Date of Publication: April 2018

Author: DAI Global, LLC

ii

iii

ACKNOWLEDGEMENTS It is envisioned that this Behavior Change (BC) Strategy will play an important role in guiding project

implementation to change people’s behavior and increase access to WASH for the poorest

households in the target urban communities. The formulation of this strategy is the result of the

combined efforts of many people and organizations. It is made possible by the openness of the

people and research team involved in the formative research that underpins it and who shared their

time to discuss the sanitation, hygiene and water related challenges faced by the urban poor across

Indonesia. The team responsible for this strategy comprised of members of USAID IUWASH PLUS

Behavior Change/Marketing (BC/M) team in Jakarta and BC/M team in regions with support from the

SNV team. The strategy process was strengthened by the active engagement of a wide number of

participants and organizations as part of the national workshop in Jakarta and a preliminary team

workshop in Makassar in January 2018.

USAID IUWASH PLUS acknowledges the important contributions of Government of Indonesia

(GOI) and other partners in providing invaluable input throughout the overall strategy development,

from workshop, analysis and consultation process. Such partners include: Bappenas and the

Ministries of Health (MoH), UNICEF, WHO, and organizations active throughout the WASH

community in Indonesia.

USAID IUWASH PLUS hopes the strategy and process contributes to the improved delivery of

water, sanitation and hygiene services across Indonesia that benefit the urban poor.

iv

ABBREVIATIONS B40 Poorest 40% of the population

Bappenas Badan Perencanaan Pembangunan Nasional/National Development Planning Agency

BCD Behavior Centered Design

BC Behavior Change Communication

CSS City Sanitation Strategy

FSM Fecal Sludge Management

GOI Government of Indonesia

HH Household

HWWS Handwashing with soap

HWTS Household Water Treatment and Storage

USAID IUWASH PLUS Indonesia Urban Water, Sanitation and Hygiene PLUS Programme

IBM-WASH Integrated Behavioral Model for Water, Sanitation, and Hygiene

IPC Inter-personal communications

IPLT Instalasi Pengolahan Lumpur Tinja (Septage Treatment Plant)

JMP Joint Monitoring Program

LSHTM London School of Hygiene and Tropical Medicine

LSIC Local Sustainability and Innovation Component

MoH Ministry of Health

NGOs Non-Government Organizations

OD Open Defecation

PDAM Perusahaan Daerah Air Minum (Municipal Drinking Water Company)

Posyandu Pos Pelayanan Terpadu (Integrated Healthcare Service)

PPSP Program Pembangunan Sanitasi Permukiman (Accelerated Sanitation Development

for Human Settlements Program)

Puskesmas Pusat Kesehatan Masyarakat (Community Health Center)

SME Small and medium sized enterprise

STBM Sanitasi Total Berbasis Masyarakat (Community-Based Total Sanitation)

TNP2K Tim Nasional Percepatan Penanggulangan Kemiskinan (National Team for the

Acceleration of Poverty Reduction)

UPTD PAL Unit Pelaksana Teknis Daerah Pengelolaan Air Limbah (Regional Technical

Implementing Unit of Wastewater Management)

USAID United States Agency for International Development

WASH Water, sanitation and hygiene

WSP Water and Sanitation Programme of the World Bank Group

v

TABLE OF CONTENTS ACKNOWLEDGEMENTS ...............................................................................................iii

ABBREVIATIONS ............................................................................................................. iv

TABLE OF CONTENTS ................................................................................................... v

LIST OF FIGURES ............................................................................................................ vi

SECTION 1. INTRODUCTION ................................................................................. 1

SECTION 2. OVERVIEW ........................................................................................... 4

SECTION 3. BEHAVIOR CHANGE STRATEGY .................................................. 10

SECTION 4. CREATE AND DELIVER .................................................................... 38

SECTION 5. MONITOR AND EVALUATE ............................................................ 41

SECTION 6. RECOMMENDATIONS ...................................................................... 43

REFERENCES .................................................................................................................. 45

ANNEXES ....................................................................................................................... 47

vi

LIST OF FIGURES EXHIBIT 1: USAID IUWASH PLUS PROGRAM COMPONENTS AS PART OF THE URBAN

WASH ECOSYSTEM ......................................................................................................................... 2

EXHIBIT 2: MAP OF USAID IUWASH PLUS.................................................................................................... 3

EXHIBIT 3: IBM FRAMEWORK ........................................................................................................................... 5

EXHIBIT 4: BEHAVIOR CENTERED DESIGN (BCD). ................................................................................... 6

EXHIBIT 5: STAKEHOLDER WORKSHOP AS PART OF THE PROCESS TO DEVELOP BC

STRATEGY. ......................................................................................................................................... 7

EXHIBIT 6: CONSULTATION WITH BAPPENAS REPRESENTATIVE. ................................................... 7

EXHIBIT 7: BEHAVIOR, OUTREACH AND COMMUNICATION OBJECTIVES ................................ 11

EXHIBIT 8: BCD THEORY OF CHANGE CONCEPT ................................................................................ 12

EXHIBIT 9: THEORY OF CHANGE FOR ENDING OPEN DEFECATION .......................................... 15

EXHIBIT 10: THEORY OF CHANGE FOR UPGRADING SANITATION FACILITIES ........................ 18

EXHIBIT 11: THEORY OF CHANGE FOR TIMELY SAFE DESLUDGING .............................................. 23

EXHIBIT 12: THEORY OF CHANGE PROCESS FOR HANDWASHING WITH SOAP ..................... 26

EXHIBIT 13: THEORY OF CHANGE PROCESS FOR SAFE DISPOSAL OF CHILD FECES ............... 30

EXHIBIT 14: THEORY OF CHANGE PROCESS FOR HOUSEHOLD STORAGE AND

TREATMENT OF DRINKING WATER ..................................................................................... 32

EXHIBIT 15: THEORY OF CHANGE PROCESS FOR HOUSEHOLD CONNECTIONS TO PIPED

WATER .............................................................................................................................................. 36

EXHIBIT 16: FLOW IMPLEMENTATION OF PARTICIPATORY MONITORING AND

EVALUATION .................................................................................................................................. 42

USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)

BEHAVIOR CHANGE STRATEGY

1

SECTION 1. INTRODUCTION The Government of Indonesia through its Universal Access Target 100-0-100 seeks to provide100%

access to water, 0 slum area and 100% access to sanitation in 2019. Initiatives to achieve the target

are reflected in national programs and approaches such as the STBM (Sanitasi Total berbasis

Masyarakat/Community-Based Total Sanitation) and the PPSP (Program Percepatan Pembangunan

Sanitasi Permukiman/Accelerated Sanitation Development for Human Settlement Program). STBM is

the Ministry of Health (MOH)’s approach to improve hygiene behavior through community

empowerment, including through triggering (pemicuan) in both urban and rural communities. STBM

consists of five pillars being i) stopping open defecation; ii) practicing hand washing with soap; iii)

household drinking water treatment & safe storage and food handling; iv) solid waste management

(household); and v) drainage. PPSP is national government program to improve sanitation condition

through the development of city sanitation strategy’s (CSS). The CSS are important tools are used as

guideline to improve city condition, including to end open defecation.

Despite such strong commitments and notable progress in access to water and sanitation services,

the related outcomes have not been realized for a large portion of the country’s population. This is

especially the case for the poorest 40 percent of the urban population. This population is referred to

as the “B40” as determined by the National Team for the Acceleration of Poverty Reduction (Tim

Nasional Percepatan Penanggulangan Kemiskinan or “TNP2K”), and which, per all reliable data sources,

have the lowest rates of coverage in urban areas in terms of access to piped water, improved

sanitation or appropriate handwashing facilities and hygiene behaviors.

USAID Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua (USAID

IUWASH PLUS) project seeks to address this gap. As a five-year initiative (2016-2020), it assists the

Government of Indonesia (GOI) to expand access to water supply and sanitation services as well as

to improve key hygiene behaviors among urban poor and vulnerable populations. The high-level

outcomes of USAID IUWASH PLUS are: (1) an increase of one million people in urban areas with

access to improved water supply service quality, of which at least 500,000 are from the poorest 40

percent of the population; and (2) an increase of 500,000 people in urban areas with access to safely

managed sanitation systems.

USAID IUWASH PLUS focuses on strengthening the overall urban WASH Ecosystem. The concept

of a WASH Ecosystem recognizes that all sector actors have an important role to play and that the

linkages between them must be supported and reinforced. This concept stands in contrast to most

traditional approaches to sector development that prioritize the construction of new facilities while

ignoring the systemic weaknesses that undermine sustainability.

To ensure that improvements in access to WASH services are sustained, USAID IUWASH PLUS

focuses on strengthening service delivery systems so they can more effectively reach the poorest

and most vulnerable segments of the population. In order to achieve this at scale, USAID IUWASH

PLUS undertakes activities through four interrelated components, including:

1. Improving household WASH services;

2. Strengthening city WASH institutional performance;

3. Strengthening the WASH financing environment; and

4. Advancing national WASH advocacy, coordination and communication.


BEHAVIOR CHANGE COMMUNICATION STRATEGY

2

In support of these components, USAID IUWASH PLUS also implements a Local Sustainability and

Innovation Component (LSIC) that is designed to stimulate WASH innovations that strengthen

community, private sector and government WASH service provision.

More specifically, key stakeholders and linkages include the following:

At the center of the WASH ecosystem, poor households must be empowered to advocate for and

finance improved WASH services as well as reaping the benefits of those services through better

health and hygiene practices (Component 1).

Households connect directly to city/district WASH institutions, which are responsible for delivering

services that safeguard public health and protect the environment. USAID IUWASH PLUS

strengthens the capacity of these institutions through engagement of local government leaders,

operator reform, and PDAM (municipal drinking water company) (Component 2).

Local government WASH services are then be enabled by the national regulatory environment

through policies, guidelines, and frameworks. USAID IUWASH PLUS capitalizes on local level

experience to share inclusive, city-wide best practices with national decision makers, influencing

government policy and funding decisions (Component 4).

Finally, there is the critical flow of financing for WASH infrastructure, products, and technical

assistance which enables and drives each element of the urban WASH ecosystem. Toward this end,

USAID IUWASH PLUS expands financing opportunities at all levels, from the channeling of the

capital finance to the development of financial products for households and small and medium-sized

enterprises (SMEs) (Component 3).

Exhibit 1: USAID IUWASH PLUS Program Components as part of the urban WASH ecosystem

The development of this Behavior Change (BC) Strategy is to support initiatives to increase WASH

access to services and products through WASH product marketing and hygiene promotion. The

promotion and marketing will be complimented by financial support from microfinance as part of



3

component 3 works. As highlighted in the strategy, the timing of behavior change communications is

also considered in alignment with the provision of services as they become available, notably for

desludging and connection to piped water supply which is linked to the broader components. This

BC Strategy will be compliment for the development of Marketing Strategy that will focus more to

product marketing.

USAID IUWASH PLUS works in eight (9) high priority provinces, which are North Sumatra, West

Java, Central Java, East Java, South Sulawesi, Maluku, North Maluku, and Papua, as well as DKI Jakarta

and Tangerang district.

Exhibit 2: Map of USAID IUWASH PLUS.



4

SECTION 2. OVERVIEW

2.1. THE STRATEGY

The purpose of this BC strategy is to provide USAID IUWASH PLUS guidance to promote WASH,

especially to change behavior and to increase access to water and sanitation facilities. Moreover,

partners who are intended to contribute in increasing access to WASH and improving hygiene

behavior will also use this document as their guidance. Specifically, the USAID IUWASH PLUS

Behavior Change Strategy is designed to:

• Be specifically targeted to urban poor and vulnerable populations;

• Be based upon both stakeholder consultation and evidence derived from a significant

formative research study conducted by the project in 2017, environmental health risks and

supporting literature.

• Be guided by the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-

WASH), as a conceptual framework and informed by Behavior Centered Design theory and

processes.

• Address seven key behaviors targeted by USAID IUWASH PLUS BC programming related

to household investment in WASH products and services; handwashing with Soap (HWWS);

and household Water Treatment and Storage (HWTS).

• Articulate the target audiences for each of the identified behaviors;

• Respond to the sector’s broader need to improve market-based approaches in WASH

product and service provision whilst balancing the support needs of the poorest 40% of the

population

• Closely align with Government of Indonesia (GOI) programs and initiatives (specifically

STBM and PPSP.

• Support and integrate with the broader programs of components to 2) Strengthen city

WASH institutional performance; 3) Strengthen the WASH financing environment; and 4)

Advance national WASH advocacy, coordination and communication.

• Reflect the findings and recommendations of the USAID IUWASH PLUS gender analysis and

assessment (Annex A)

• Provide further focus to the existing community mobilization and advocacy initiatives

underway and where possible integrate messaging and interventions.

2.2. USAID IUWASH PLUS FORMATIVE RESEARCH

In order to develop an evidence based behavior change and marketing (BCM) program, USAID

IUWASH PLUS conducted formative research to improve understanding of WASH conditions for

urban B40 households, explore barriers and motivations to key WASH behaviors, and mapped key

communication channels among adults in B40 households. As a cross-sectional study, it was carried

out using a mixed-methods approach to assess WASH practices and associated factors in 15 urban

locations throughout Indonesia. Data collected from 3,458 households using pretested

questionnaires triangulated with qualitative information obtained from 60 structured observations,

60 focus-group discussions and 60 in-depth interviews from March to May 2017. Research was

conducted in urban areas in ten provinces in five region: North Sumatra (North Sumatera Region);



5

DKI Jakarta, Bekasi, Tangerang (WJDT Region); Central Java (Central Java Region); East Java (East

Java Region); South Sulawesi, Maluku, North Maluku, and Papua (SSEI Region). The areas selected

from cities and districts that are formal partners of USAID IUWASH PLUS.

As such, the formative research sort to address knowledge gap within the USAID IUWASH PLUS

project areas, and, more broadly, by the Government of Indonesia for other urban WASH

promotion programs. Its findings underpin the development of this strategy and have been widely

shared, including through the stakeholder workshops facilitated to develop this strategy.

2.3. CONCEPTUAL FRAMEWORKS AND THEORY

The analysis of the extensive findings of the formative research was undertaken using the Integrated

Behavioral Model for Water, Sanitation and Hygiene (IBM-WASH) (Dreibelbis et al, 2013). Several

frameworks for behavior change interventions were reviewed and each presented strengths

(Coomes & Devine, 2010; Aunger & Curtis, 2015; Devine, 2009; Michie et al, 2011; Mosler, 2012).

The IBM-WASH frameworks’ integration of the role of technology, the ability to consider multiple

behaviors and multiple dimensions of influence were seen to be of specific value to the team given

the complex urban WASH environments targeted by USAID IUWASH PLUS. As a framework, its

development was informed by a systematic review of existing BC models used in WASH, including

for example FOAM/SANIFOAM and RANAS as referenced above, which have sort to organize the

factors (known as behavioral determinants) that influence the adoption of WASH technologies and

the continuation of improved practices underpinned by behavior change theory (Dreibelbis et al.

(2013). As such, it represents a synthesis of these models. Applying the framework, whilst complex

for teams, facilitated analysis across three dimensions (Contextual Factors, Psychosocial Factors, and

Technology Factors) that operate on five-levels (structural, community, household, individual, and

habitual) as represented in Diagram 3 below. The analysis against key findings for each behavior and

target group are provided in Annex B

Exhibit 3: IBM Framework1

Levels Contextual factors Psychosocial factors Technology factors

Societal/

Structural

Policy and regulations,

climate and geography

Leadership/advocacy,

cultural identity

Manufacturing, financing, and

distribution of the product; current

and past national policies and

promotion of products

Community

Access to markets, access

to resources, built and

physical environment

Shared values, collective

efficacy, social integration,

stigma

Location, access, availability,

individual vs. collective

ownership/access, and maintenance

of the product

Interpersonal/

Household

Roles and responsibilities,

household structure,

division of labor, available

space

Injunctive norms, descriptive

norms, aspirations, shame,

nurture

Sharing of access to product,

modelling/demonstration of use

of product

1 Adapted from (Dreibelbis et al, 2013, p6), refer for additional definitions of terms and levels.



6

Levels Contextual factors Psychosocial factors Technology factors

Individual

Wealth, age, education,

gender, Livelihoods,

employment

Self-efficacy, knowledge,

disgust, perceived threat

Perceived cost, value, convenience,

and other strengths and weaknesses

of the product

Habitual

Favorable environment for

habit formation, opportunity

for and barriers to

repetition of behavior

Existing water and sanitation

habits, outcome

expectations

Ease/Effectiveness of routine use

of product

In developing the strategy, following the analysis of the formative research findings using the IBM

Model, the theory and process of Behavior Centered Design (BCD) was used. As a relatively new

approach developed at the London School of Hygiene and Tropical Medicine (LSHTM) it draws on

evolutionary psychology, the latest techniques in marketing and existing behavior change approaches

(Aunger et al, 2017, p11). BCD encompasses both a theory of behavior change and a process model

for designing behavior change interventions. Within this strategy, the process was used to map the

factors that are currently driving behavior identified through the formative research and analysis

using the IBM Framework, to inform the development of a proposed theory of change and to make

recommendations to guide subsequent behavior change interventions through USAID IUWASH

PLUS. Represented visually below, the ASSESS stage commenced with the USAID IUWASH PLUS

participatory baseline process, formative research and initial analysis undertaken in 2016/17, the

BUILD stage is then reflected by the further analysis and strategy formulation with stakeholders in

2017, this in turn will guide the subsequent CREATE, DELIVER and EVALUATE phases in 2018-2021.

Exhibit 4: Behavior Centered Design (BCD).

2.4. PROCESS OF DEVELOPING THIS STRATEGY

As noted, the strategy was developed in broad alignment with the first two steps of a behavior

centered design process (Exhibit 4 above). These being to first “Assess” what is known about the

target behaviors, the target audience, the context and the parameters of the intervention primarily

through formative research of the focus WASH-related behaviors of the poorest 40% of the

population across six study sites and regions of Indonesia (North Sumatra, West Java/DKI

Jakarta/Tangerang, Central Java, East Java, South Sulawesi and East Indonesia).



7

The “Build” step involved further key activities including analysis of the behavioral determinants using

the IBM-WASH framework per behavior and consultations with project staff, partners and other

stakeholders to reach consensus on the key behaviors, priority determinants to address through

communication objectives and potential interventions.

These processes were then validated and further tested through a one day workshop with the team

in Makassar on the 11th January 2018 and a two-day national workshop in Jakarta on the 18-19th

January. The national workshop was attended by more than 90 stakeholders, including

representatives of the project, Bappenas, MoH, UPTD PAL (Unit Pelaksana Teknis Daerah Pengelolaan

Air Limbah/Regional Technical Implementing Unit of Wastewater Management), provincial and local

government, donor, local and international NGOs, private companies, service operators, partners

who engaged in the strategy development, reviewed, prioritized and analyzed the findings of the

Formative Research, generated initial “insights”,

formulated communication objectives responding to

the prioritized determinants and shared experiences

and approaches to strengthen behavior change

interventions in the various contexts (Annex C

Participant List).

The outcomes of this were then further refined

along with the generation of further insights from

the findings in a series of discussions with the

USAID IUWASH PLUS team for Component 1 and

in consultation with partners from the MoH and

Bappenas in Jakarta. The draft strategy was then

reviewed in consultation with the Ministry of Health and other Government of Indonesia (GOI)

programs and initiatives to ensure it complements and/or aligns with these as best as possible. These

first two steps are intended to then inform subsequent steps to Create, Deliver and Evaluate the

intended evidence based behavior change interventions.

Exhibit 5: Stakeholder Workshop as part of the process to develop BC Strategy.

Agustinus Tuauni/USAID IUWASH PLUS

Exhibit 6: Consultation with Bappenas

representative.

USAID IUWASH PLUS



8

2.5. KEY GUIDING PRINCIPLES AND RECOMMENDATIONS2

• Habit formation: Most of our decisions about behavior happen at a sub-conscious level and

increasing evidence support the importance of focusing on habit formation.

• Avoid educating people about the ‘right’ behavior, particularly when knowledge is already

shown to be high as this will likely be an ineffective approach.

• Make it easy: People often don’t do the ‘right’ behaviors because the ‘right’ behaviors are

more time consuming, costlier, more difficult or more inconvenient and are therefore less

rewarding than the ‘wrong’ behaviors. There is a need to understand what would make the

priority behavior easier–involving less hassle, time or money. If the goal is complex, break it

down into smaller actions.

• Make it attractive: There are core human drivers that can be used to form the basis of

effective behavior change campaigns and add “value” to behaviors, these include drivers such

as fear, disgust and comforts but also emotions such as affiliation, status and nurture.

Activities should facilitate people experience the benefits of practicing the behavior by, for

example, letting them test it (e.g. experience using a hand wash device); sharing successful

examples (e.g. of someone who has used a desludging service); and using appealing messages

that engage people’s emotions.

• Make it social: People are heavily influenced by what people around them do. Showing that

some people already practice the promoted behavior, using the power of social networks

(e.g. peer-to-peer), or encouraging people to commit to someone to practice a behavior can

work well.

• Think about settings: Much of our behavior is influenced by the setting in which it takes place.

To change behavior, we should consider how to also change the physical and/or social

environment, the objects within in it and the rules or norms that are associated with the

setting, as these things all predict how people will behave.

• Make it timely: The same campaign conducted at different times can have drastically different

levels of success. Schedule campaigns for when people are most receptive (e.g. promoting

the purchase of latrine when people have money or services are launched; or posting hand

washing messages in kitchens), when services are available and include a cue to action. Keep

in mind the need to focus on one behavior at a time, so that target groups are not receiving

multiple messages/materials or feel overwhelmed by the number of tasks needed to adopt

the focus behaviors.

During the workshop, stakeholders also shared the following insights about successful behavior

change interventions in urban Indonesia

• Regulation and enforcement have a role to play particularly in urban settings, not only

socialization and participation efforts

• Alignment with efforts to improve access to services, affordable technology and be

appropriate to local context at the community level

• Need to adjust triggering and approaches to urban contexts, not just replicate rural

approaches

2 These principles have been adapted with acknowledgement and reference to the Behaviour Centred Guide (Aunger, et al,

2017) and the Behavioral Insights team as referenced in Schmied, 2017, p12.



9

• Communication channels should reach the household level and can include working through

natural leaders and cadre, through religious leaders (and values), through Posyandu

(Integrated Healthcare Service), role models and potentially children as ambassadors.

• Consensus building, coordination and collaboration among stakeholders including District

Health Office, UPTD PAL and District Environmental Health Office is important and creates

a movement.

• Prioritize regular follow-up and monitoring.



10

SECTION 3. BEHAVIOR CHANGE STRATEGY

3.1. OVERVIEW

USAID IUWASH PLUS Project Objective: Assist the Government of Indonesia to increase

access to improved water and sanitation services and improve key hygiene behaviors, especially

among the poorest and most vulnerable.

Priority Behaviors and Target Groups

Priority Behavior Target Groups

1 Adoption of at least a basic sanitation

facility when at home by all households

currently without a sanitation facility or

using shared services.

Primary: Male and female household decision makers and

landlords of urban B40 households without a basic sanitation

facility or using shared facilities

Secondary (Influencers): Male and female family members of

urban B40 households without a basic sanitation facility.

2 Upgrading to a safely managed sanitation

facility by households who currently use

an unimproved or shared sanitation

facility.


landlords of urban B40 households currently using

unimproved or shared sanitation facility

Secondary (Influencers): Male and female family members

and neighbors of urban B40 households with limited

sanitation facilities.

3 Timely use by households of safely

managed desludging services


landlords of urban B40 households currently using basic

sanitation facilities from which excreta is not safely managed3

Secondary (Influencers): Male and female family members

and neighbors of urban B40 households currently using basic

sanitation services from which excreta is not safely managed.

4 Handwashing with soap at the critical

junctures4 by women, men, boys and girls.

Male and female caretakers of children under five years of

age living in B40 households; and

Women, men, girls and boys living in urban households in

USAID IUWASH PLUS target areas.

5 Safe disposal of feces of children under 3

into an improved sanitation facility.

Male and female caretakers of children under three years of

age living in B40 households;

6 Safe treatment and storage of all

household drinking water.

Male and female adults within urban B40 households

currently without access to safely managed drinking water

services from improved sources

7 Household connections to piped water

services

Male and female decision makers within urban B40

households currently without household connections to

basic drinking water services

3 In alignment with the JMP definitions, to meet the criteria for safely managed sanitation services, people should use

improved sanitation facilities which are not shared with other households, and the excreta produced should either be:

• treated and disposed in situ,

• stored temporarily and then emptied and transported to treatment off-site, or

• transported through a sewer with wastewater and then treated off-site. 4 Critical junctures of before eating or feeding a child, before handling food, after going to the toilet or cleaning a child and

after touching animals (poultry).



11

As the central part of the strategy, the following section is organized by priority behaviors and

reflects the outcomes of the workshops and further discussion with the team and government

partners. For each behavior, it establishes the behavior objective, presents the top line formative

research findings, communication objectives and target audiences for future campaigns and outlines

an initial theory of change to guide subsequent activities, messaging and creative work and alignment

with USAID IUWASH PLUS and wider programs. Where appropriate it integrates findings and

recommendations from the USAID IUWASH PLUS Gender Assessment and Analysis (Refer to

ANNEX A).

When developing the strategy, distinctions have been made between the desired change in behavior

itself (the behavioral objective), the communication objective and any outreach objective for target

groups (SNV, 2016). Formulating communication objectives that respond to key determinants, can

both focus interventions but also help to cross-check assumptions, and to further understand if they

are then effective and relevant in the different contexts targeted through USAID IUWASH PLUS.

The following exhibit reflects the relationship between the three levels objectives.

Exhibit 7: Behavior, outreach and communication objectives

This section also seeks to apply the recommendations and guiding principles presented in the

preceding section. The theory of change illustrated in Exhibit 8 below seeks to present conceptually

the intended connections (and assumptions) between the inputs, outputs and intended outcomes

and to guide actions. It has been informed by the initial insights5 from the findings generated through

the workshop and with the team and is intended to be tested and refined further in the creative

phase and adjusted to the different regions. The challenge is to i) create surprise – getting exposure

and ensuring it grabs the target audiences’ attention; ii) cause revaluation – re-thinking the value

placed on the current behavior e.g. making it more/less rewarding; and iii) Performance – modifying

the setting/environment, opportunity is created to practice the behavior.

5 Insights is a term used in BCD process, in this it reflects the initial creative process of collective

brainstorming to move from findings to initial insights



12

Exhibit 8: BCD Theory of Change Concept

3.2. COMMUNICATION CHANNELS

The main source of information cited by survey respondents during the formative research was the

television (63%) which is consistent with the observation study where almost all case study

households own a television. The second most popular source of information is neighbors (36%).

Again, this fits with information from the case study households that people in some locations gather

together with neighbors on a regular daily basis to share news. Sometimes these gatherings are for

arisan/community savings and loan schemes or religious meetings.

The third source is the government official (18%). Local government administration in Indonesia

extends to the neighborhood level of 40-100 households known as the rukun tetangga or RT

(literally harmonious neighbors) and is highly structured with regular meetings held at every level

from the RT to the city or district. Of interest, newspapers, internet or health workers as a source

of information were ranked the lowest.

Social media and communication apps are of increasing importance as a means of obtaining news

from neighbors and family. About 60% of survey households have at least one member using social

media and Facebook is by far the most common (42%). Turning to communication application,

Blackberry messenger (BBM) is the most popular communication app used by 30% of survey

respondents, and WhatsApp (WA) used by 25%.



13

Priority Behavior 1: Adoption of at least a basic sanitation facility when at home

by households without a sanitation facility or using shared services (ending open

defecation)

Behavioral Objective: Additional 250,000 (50,000 HHs) men, women, boys and girls gaining

access to a shared or basic sanitation facility as a result of US Government assistance.

Target group: Primary: Male and female household decision makers and landlords of urban B40

households without a without a sanitation facility or using shared services.

Secondary (Influencers): Male and female family members of urban B40 households without a

sanitation facility or using shared services, landlords, community leaders, religious leader.

Topline findings from Formative Research as per the IBM-WASH framework and

Gender Analysis

Context:

Community level: Access/availability: B40 households without access (or sharing) are facing

complex access issues and are can be living in challenging environments (e.g. over water).

Barriers to toilet ownership included insufficient space (17%) or are renting houses without

facilities (11%). The majority also own the house they are living in and have lived there for

substantial periods of time. Only 9% were renting their home and a further 8% were

borrowing a house without paying.

Interpersonal/household: Women have limited control on important decision making related to

WASH, for example the construction of toilet, etc. The decisions made by women tend to

be limited to regular household activities. The majority of households do not have bank

accounts, even if they have, usually are registered under the adult males (husbands). The

presumption of women as household “treasurer”, it is often that after the husband handed

over his income there is a tendency that he does not care with the difficulties faced by the

wife in managing family expenditure (Ref Annex A).

Psychosocial “Software”

Community level: Shared values and collective efficacy relating to being a “good neighbor” are

positive drivers. Conversely, using a neighbor’s toilet makes you feel ‘malu’ (embarrassed or

ashamed), creates a feeling of dependence, a social/symbolic debt and a sense of inferiority.

Interpersonal and household levels: Using a toilet is predominantly the social norm and is

valued as reflected in the expressed expectations that ‘everyone should have a toilet’,

‘everyone has one’, ‘it’s a basic need’. Whilst 23% have no access at the HH level, 80% of

non-owners expressed having a strong preference to have a toilet.

Individual/habitual level: Convenience and comfort (59%) is most commonly cited in survey

responses as positive attributes, followed by cleanliness, and expectations of health and

safety of family. Practicing open defecation is seen as unsafe and environmentally risky.



14

Product/Technology “Hardware”

Community level: Communal facilities have limited acceptance - inconvenience, delays of

queue, embarrassment, poor toilet quality, and cost. 6% of all survey respondents and 19%

of those with no toilet in their home use shared toilets which is typically informal

arrangements.

Individual: 61% identified affordability as a barrier to owning a toilet. Different family members

use different toilet options at different times of the day and this is influenced by social and

physical aspects. WASH facilities are often accessed by women and children altogether,

especially for mother with children under five due to working and caring for children at the

same time. Men are more likely to use public toilets then women, but at night may also

return to open defecation practices.

Communication Objectives

After the campaign,

• Male and female household decision makers (and landlords) will believe that investing in a

latrine is a way to show that they are good neighbors’ (affiliation, social integration)

• Male and female household members will feel that installing and using a sanitary latrine will

provide comfort, convenience and pride (physical, emotional drivers)

• Male and female household decision makers, landlords and household members will know

the affordable sanitation technology options, services and costs available to meet their

household access needs (perceived cost).

Theory of Change Concept

Expressions of embarrassment at practicing open defecation, using a neighbor’s toilet or using a

public toilet indicate that people are concerned about maintaining a good reputation and good

relations with their neighbors and family. Developing a creative campaign at the community level that

emphasises the positive drivers of comfort and convenience - linked to marketing activities could be

combined with interventions that highlight the perceived rewards of affiliation and pride that comes

from being a “good neighbor” by using your own household latrine and avoiding the negative

aspects of shame and embarrassment in the process. Combined these may be a powerful tool to

trigger the remaining households (and landlords) to invest in household level latrines, supported by

marketing activities and messaging. Reflecting the gendered dimension of household decision making,

it will be important to avoid reinforcing norms and seek to reinforce the importance of involvement

of both men and women in the selection of WASH technology options and the decision making and

ensure communications appeal to potentially different motivators.



15

Exhibit 9: Theory of Change for ending open defecation

Potential Inputs of an

Intervention

Implementation

Surprise

(links to outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to behavior

objective)

Impact

(links to Project

Objective)

• Emotional

narrative

/promotional

materials “being a

good neighbor” –

interpersonal

communications,

social media

• Role modelling –

respected leaders

within community

• Marketing

materials and

design innovations

to address

“affordability” and

perceived costs

and add value by

promoting

comfort,

convenience and

pride.

• Technology

options

“challenging

environments” –

supply chain

options.

Community level -

Integration within

routine meetings,

community and

religious events

and group

mobilising

Supported by

targeted HH visits

reaching women

and men-

counselling,

marketing with

SMEs, utilising

social media.

• Sanitation

facilities are

affordable,

convenient and

comfortable

• Reinforce social

affiliation,

positive drivers

and the values

of being a

“good

neighbor”

Increased adoption

and use of

sanitation facilities

by all household

members at all

time.

Ending open

defecation.

Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs

and priorities.

Analysis against the IBM-Framework indicate that there are specific access, technology and

marketing challenges that are presenting barriers for a percentage of the B40 households that are

beyond the influence of behavior change interventions, (reflected in the Psychosocial levels). Within

the remaining 23% without household access there is a strong preference to have a toilet reflecting

IPC on "good

neighbors", role

modelling, SME

marketing

materials and

design innovations

Community

events, marketing

activities, HH

visits, social media

Sanitation facilities

are affordable,

convenient and

comfortable

Being a "good"

neighbor, pride and

social affiliation

Increased adoption

and use of sanitation

facilities by all

household members

at all time

Ending open

defecation

Intervention Implementation Outputs Outcome Impact



16

the existing demand for sanitation services and also the low satisfaction with communal options.

Efforts to address the need for solutions for challenging environments, improve technology design

options to meet the needs of all within the household and unpacking potentially complex issues of

affordability, linked to financing options are needed.

USAID IUWASH PLUS

• Component 2 Alignment: Marketing materials, activities with SMEs and design innovations to

address “affordability”, perceived costs and use by all could also add value by promoting

messages of comfort, convenience and pride along with the value of being a “good

neighbor”. It is noted that affordability may need further analysis to guide responses as it is

important to understand if it is related to perceived costs, for example a lack of accurate

information about the actual costs and services, or linked to a lower priority or willingness to

pay or an expectation of financing options. Potential for design innovations with SMES to reduce

the costs should also be explored.

• Component 3: People who currently do not have toilets are among the poorest of the B40 and

for whom actual affordability presents a major constraint. Experience in the earlier IUWASH

showed that a micro-credit program could in practice exclude those most in need of toilets.

Micro-credit may be more successful for existing toilet owners to upgrade as it includes less

poor households that have some credit experience. If developed, the Gender Assessment

recommended a tailored product for poor women that can support increased access to

improved WASH facilities and too bring the microfinance facility and services closer to them in

the process.

Priority areas for this behavior: In developing regional action plans for this strategy, the teams

should prioritise areas where there are high rates of OD (open defecation) and where options

are most viable. Reflecting the need for behavior change to be “timely”, alignment of component

2 and 3 activities with behavior change activities is especially important to ensure that additional

social pressure to B40 is not generated, unless alternatives are viable and available. In addition,

activities should ensure alignment with the planned USAID IUWASH PLUS Gender Strategy.

Priority Behavior 2: Upgrading to improved sanitation facilities

Behavioral objective: Additional 500,000 men, women, boys and girls within B40

households have access to a safely managed sanitation facilities.

Target group: Primary: Household male and female decision makers and landlords of urban B40

households currently using unimproved or shared sanitation facility

Secondary (Influencers): Male and female family members and neighbors of urban B40 households

currently using unimproved or shared sanitation facilities, landlords, community leaders, religious

leaders.

Topline findings from Formative Research

Context

Community: Barriers to upgrading also include insufficient space, rental properties, and the

need for technology options in challenging environments. In addition, the lack of access to



17

credit is a major impediment to B40 access to WASH improvements and upgrades, lending

is dominated by private lenders and there is wide regional variation in access to Bank/MFI

services.

Interpersonal/household: Women have limited control on important decision making related to

WASH, for example the construction or upgrading of a toilet, etc. The decisions made by

women tend to be limited to regular household activities and there are gendered dimensions

to control of HH financing as noted above (Ref Annex A). Strong stereotype that WASH

technical role (and decisions) is more for men rather than for women.


Interpersonal/household: Descriptive norms - “Families here are willing to have a proper toilet

and septic tank. However, they are still waiting for the government to give them materials.

They can do the work, but they cannot buy the materials”. In addition, costs to build toilets

with a proper septic tank are in examples seen as too high and not a priority now.

Individual: Technical knowledge of how to build a sealed septic tank is limited, suggesting a

lack of access to standardized advice (Observations). Awareness of the function and benefits

of a septic tank is mixed among the urban B40 and between men and women. 94%

mentioned that it contained feces, 20% said it protected the environment, 11% said it

protected humans from dirt and 10% said it protected water sources. Low perceived threat

“I don’t want to upgrade my cubluk (unsealed septic tank) since it doesn’t affect my health

and water quality.”


Community level: Construction of sanitation facilities was observed to be in an ad hoc

manner, there are multiple designs in use and wide regional variations. Of the 2,652 survey

households with toilets, 402 (12%) have no tank attached so that effluent is discharged

directly into a drain or body of water (river, sea, lake). Of the 65% who have a tank, only

13% remembered emptying their tank, while only 1.5 % reported emptied their septic tank

with government facility/truck. Many of these same households consume ground water via

household wells located less than ten meters from their leaky tanks. Four different systems

observed being i) a toilet bowl connected to a pipe leading to septic tank; (ii) a toilet bowl

connected to a pipe leading to a cubluk; (iii) a toilet bowl connected to a pipe leading directly

to a drain or a body of water such as a canal, river, lake or sea (plengsengan); and (iv) a hole

in the ground leading to a drain or to a body of water such as a canal, river, lake or sea

(helikopter). Systems (iii) plengseng and (iv) helikopter are essentially open defecation practiced

in the home and described by stakeholders as “elite OD”. Smell is seen as an issue for toilets

without a septic tank.


After the campaign, male and female household decision makers (and landlords)

• will know the improved sanitation technology options, services and costs available to meet

their household access need

• will believe that upgrading to an improved latrine is affordable and doable



18

• will believe that upgrading to an improved latrine is a way to show that they are good

neighbors (values).


In most instances, “septic tanks” do not provide containment and are not in reality safely managed

facilities. At worst they are closer to fixed point defecation, or what is termed “elite OD”.

Communication and marketing activities that assist in demystifying this through “visualizing” the

functions, process and broader links to the immediate environment for both males and females

could address this. Examples to explore could include demonstration models, the current adaption

of the F-Diagram, or short clips. Whilst the messaging of being a “good neighbor” has potential

overlap and there are physical drivers (visual, smell), those relating to comfort and convenience may

not have the same resonance without these additional efforts to address knowledge gaps. These

should relate not only to what a tank is, how it works and its immediate benefits to neighborhoods.

Exhibit 10: Theory of Change for upgrading sanitation facilities

Potential Inputs of

an Intervention

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to Project

Objective)

• Demonstration

models and visual

aids of septic tanks.

• Emotional narrative

/promotional

materials “being a


interpersonal

communications,

social media

• Role modelling and

testimonies –

respected leaders

within community

and people who

have upgraded

• Targeted

household visits

and counselling

reaching

women and

men,

• Promotion

through

neighborhood

community and

religious events

and within

routine

meetings.

• Marketing and

SME activities

Improved

sanitation facilities

are affordable,

convenient, safe

and comfortable

Reinforce social

affiliation, and

values - being a

“good neighbor”.

Improving and/or

upgrading of

unimproved or

shared sanitation

facility

Additional access

to basic sanitation

services.

IPC on "good

neighbors", role

modelling, SME

marketing

materials and

design innovations

Community

events, marketing

activities, HH



are affordable,

convenient and

comfortable Being a "good"

neighbor, pride and social affiliation

Increased

adoption and use

of sanitation

facilities by all

household

members at all

time

Increased access to

basic sanitation

services




19

Potential Inputs of

an Intervention

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to Project

Objective)

• Marketing materials

and design

innovations to

address

“affordability” and

demystify septic

tanks.

• Technology options

for upgrading and

addressing

“challenging

environments” –

supply chain

options.

linked to social

media.


and priorities.

Analysis against the IBM-Framework indicate that there are specific access, technology and context

challenges operating at the household and broader community level that are presenting barriers for

B40 households, in addition to knowledge related barriers and gendered differences between men

and women (access to knowledge, decisions, finance). Similarly, to efforts to end open defecation,

behavior change communications to promote upgrading will need to be closely timed with wider

USAID IUWASH PLUS activities and programs, including the Gender Strategy. Within STBM in

urban areas, the GOI promotes the use of septic tanks followed by the promotion of desludging

services. Additional efforts may be needed to communicate existing regulations (toilet standards)

and the need for compliance by the landlords while reducing financial pressure on poor tenants.

USAID IUWASH PLUS

Timing and alignment of component 2 (strengthening city WASH institutional performance) and

component 3 (strengthening the WASH financing environment) activities with behavior change

activities to promote upgrading should take into consideration:

i) the need for technical or communal solutions for challenging environments to be available,

ii) the need to improve the quality of design and construction of sanitation facilities through

further training and support to small enterprises that offer toilet and septic tank construction

(sanitation entrepreneurs), and

iii) improved access to financing options, noting the gendered differences in women’s and men’s

access to and knowledge of.

Priority areas for this behavior: There would be value in targeting areas where the absence of tanks

is reported to be highest: Surakarta, Medan, Tangerang, Maluku Tengah and Jayapura.



20

Component 2 Alignment: Marketing materials, activities with SMEs and design innovations to address

“affordability” could also add value by promoting messages of comfort, convenience and pride along

with values of being a “good neighbor”. Local sanitation entrepreneurs who can offer toilet and

septic tank upgrading services could also be involved in promotional activities that reach both men

and women. As noted previously, affordability may need further analysis to guide responses, as it is

important to understand if it is for example a lack of information about the actual costs and services,

linked to a lower priority or willingness to pay or an expectation of subsidy or external financing

options.

Component 3: Formative research findings indicated that micro-credit may be more successful for

existing toilet owners to upgrade as it includes less poor households that have some credit

experience. However, the lack of access to credit is a major impediment to B40 access to WASH

improvements and in particular for poor female householders. B40 lending is dominated by private

lenders and companies whilst MFIs/Banks cover only about 4% (a tenth of coverage by private

lenders) and there is wide regional variation e.g. from 0.54% in NS to 7.25% in Central Java. There is

currently further USAID IUWASH PLUS research into MFI coverage of the B40.



21

Priority Behavior 3: Timely Safe Desludging (or Operation and Maintenance)

Behavioral objective: Additional 500,000 men, women, boys and girls within B40 households have

access to a safely managed sanitation services (HR-2).

Target group: Primary: Male and female household decision makers and landlords of urban B40

households currently using basic sanitation facilities from which excreta is not safely managed6.

Secondary (Influencers): Male and female family members and neighbors of urban B40 households

currently using basic sanitation facilities from which excreta is not safely managed.


Contextual

Society/structural: Currently there is either no regulation or clear incentive for compliance by

householders or operators to safely manage septage. Sludge is meant to be disposed of in a

dedicated government septage treatment plant (IPLT) however without regulation if sludge

is removed at all, it is reportedly often deposited in a river, pit or open space.

Household: Strong stereotype that WASH technical role is more for men rather than for

women.


Individual: Failure to empty a tank regularly poses environmental health risks which are

under-valued. They hold a low perceived threat as many people do not regard it as an

immediate problem or feel they experience any disadvantage from having a leaky tank in

their daily lives. It may perversely be seen as an advantage if it saves the family the cost of

desludging.

Knowledge: Technical knowledge of how to build a sealed septic tank is limited. Mixed

awareness of the function, benefits or risks of a septic tank amongst users and between men

and women. Women are less involved in the role of troubleshooting so tend to be

dependent on men for this knowledge.


Community/Household: There are multiple tank designs of varying quality in use of which the

majority at the household level are not likely to be sealed (septic), only two households

were connected to communal tanks. There is only limited practice or experience in

maintaining septic tanks safely. “I made my septic tank large so that I don’t have to empty it for a

long period.”

6 In alignment with the JMP definitions, to meet the criteria for safely managed sanitation services, people should use

improved sanitation facilities which are not shared with other households, and the excreta produced should either be:

treated and disposed in situ,

stored temporarily and then emptied and transported to treatment off-site, or

transported through a sewer with wastewater and then treated off-site.



22

Of the 85% who have a tank, only 20% had experienced a full tank, 80% of tanks are

between 6-15 years old, 57% of tanks older than 15 years have not been full. Only 14% have

ever been emptied. High likelihood of leakages, improperly constructed and poorly

functioning tanks. Households with tanks are not accessing scheduled desludging services but

rather using them only in emergency situations and the majority are using private services

(57%), a further 12% used a government operated service, 10% used an individual and 8%

self-emptied. Wide regional variation in frequency of emptying tanks (e.g. ½ of tank owners

in Surabaya had, compared to none in Maluku Tengah) and in the prices with a median of

IDR 200-400,000 ($0.15-$30) paid by 36% of respondents reporting tank emptying. Almost

two-fifths (38%) in Surabaya and Jayapura paid over IDR 400,000 whilst 1/3 in Jayapura

received a free service. Currently no data on user satisfaction of desludging services but

concerns over timeliness and costs.


After the campaign, male and female household decision makers (and landlords),

• will know the safely managed sanitation technology options, services and costs available to meet

their household access needs

• will believe that only a properly operated and maintained sanitation facility will provide comfort,

safety and convenience to their families.

• will want to pay for timely desludging to avoid fines/punishments (sanctions)

After the campaign, male and female household decision makers (and landlords) and male and female

influencers,

• will believe that only a properly operated and maintained sanitation facility will provide comfort,

safety and convenience to their families.

• will believe that good neighbors, properly operate and maintained their sanitation facility (values).

Theory of Change Concept for Timely Safe Desludging

Whilst behavior change communication can support, experience in the urban sector increasingly

acknowledges the limits of appealing to the collective sense of “public good”, and to people’s

willingness to prevent harm to the environment and/or the health of the wider community alone

(Chong et al, 2017) in the absence of incentives, regulation or services. The concept should not

stand alone, but should be aligned with the provision and marketing of the regular desludging

services, regulation (including potentially community level) and governance activities as they are

established and to improve their uptake. Seen in parallel, using communication activities that trigger

change based on the similar motivators of affiliation, values of being a good neighbor and emphasizing

the drivers of comfort and convenience for one’s family could strengthen the service outcomes.

There should though also be clear messaging on the introduction of sanctions should they occur and

the responsibilities of landlords.

Knowledge gaps exist for men and women that could be addressed with linkage to the other

sanitation behavior change activities to demystify septic tanks using visual aids/images and F-diagrams

and demonstration models which the team are currently exploring. By including messages within

marketing activities that acknowledge both the maintenance requirements and life-cycle costs,

informed choice would also be supported for men and for women.



23

Exhibit 11: Theory of Change for timely safe desludging


Intervention –

linked to Behavior 2

Implementation

(links to outreach

objective)

Outputs

(links to

communication

objective)

Outcomes

Performance

(links to behavior

objective)

Impact

(links to Project

Objective)

• Demonstration

models and visual

aids of septic

tanks.

• Emotional

narrative

/promotional

materials -“being a


interpersonal

communications,

social media,

marketing events.

• Role modelling

and testimonies –

respected leaders

within community

and people who

regularly empty

• Marketing of

desludging

services including

life cycle costs and

benefits

• Community level

regulation and

monitoring

• Targeted

household visits

and counselling

that reach both

men and

women.

• Promotion

through

neighborhood,

community and

religious events,

• Within routine

meetings and

existing public

health channels

including

Posyandu,

puskesmas

(community

health center),

sanitarians

• Marketing and

SME activities

linked to social

media.

Safely managed

sanitation services

are affordable,

convenient, safe

and comfortable.

Reinforce social

affiliation, and

values - being a

“good neighbor”.

Timely use of safe

desludging services

by households.

Additional access

to safely managed

sanitation services.


and priorities.

Analysis against the IBM-Framework indicates constraints within the technology and context,

particularly the absence of incentives, regulation and enforcement. Alignment with the provision and

marketing of the regular desludging services, introduction of related regulation (including potentially

community level) by the GOI and related governance activities is key.

IPC on "good

neighbors", role

modelling, SME

marketing

materials and

monitoring

activities

Community

events, marketing

activities, HH



are affordable,

convenient and

comfortable Being a "good"

neighbor, pride and social affiliation

Increased and

timely use of safe

desludging

services by

households

Increased

access and use

of safely

managed

sanitation

services




24

USAID IUWASH PLUS

Timing and alignment of component 2 and 3 activities with behavior change activities should be

timed with the development and marketing of regular desludging services, financing mechanisms,

marketing activities and potentially regulations and related governance activities. Additional data will

be available through the marketing research on customer satisfaction with the desludging services

which can support tailoring of messages. Depending on activities, support to the expansion of either

local government desludging services or private sector services will increase competition and

potentially put downward pressure on the price.

Priority areas for this behavior: Consideration could be made to target areas where failure to empty

tanks is most common: Maluku Tengah, Bulukumba, Probolinggo and Jayapura. There is the potential

to explore payment options which learn from current successes and take into account the

recommendations for poor female households (Annex A). In Jakarta there is a scheme whereby

residents can pay for desludging through collecting trash for recycling and delivering it to the local

government office which provides a possible example.

GOI programs and priorities

Government of Indonesia through its Universal Access (100-0-100) Target 2019 has been promoting

access to sanitation facilities. Since 2014 GOI has started to promote more comprehensive fecal

sludge management (FSM) system, that is consists of fecal containment, desludging, transporting and

fecal sludge treatment in waste water treatment plant. Bappenas and Ministry of Public Works, with

support from MOH has been promoting FSM. Several workshops were conducted with support

from USAID IUWASH PLUS to discuss the FSM framework and advocacy events are continuing to

be conducted to encourage local government investment to support FSM.

3.3. HYGIENE BEHAVIORS

Priority Behavior 4: Handwashing with soap at the critical junctures

Behavioral objective: 20% increase in safe handwashing with soap by B40 male and female

household members at the critical junctures of before eating or feeding a child, before handling food,

after going to the toilet or cleaning a child.

Target Group:

1. Male and female caretakers of children under five years of age living in B40 households; and

2. Women, men, girls and boys living in urban households in USAID IUWASH PLUS target areas.


Contextual

Interpersonal/household: Expected role of the mother in the family as teacher in matters

of health and hygiene. Low participation of men in WASH related activities at the household

level. Traditional gender roles are socialized to boys and girls. Low participation of men in



25

social activities at the community level, especially those related to health promotion (Annex

A).


• Interpersonal/Household: Hand washing with soap is not yet normative practice for all

members of B40 households, handwashing with water only (no soap) is observed to be

common.

• Individual: Limited association with the critical junctures, diarrhea and associated poor health

outcomes.

• Habitual: Mothers are the most likely to practice and encourage others to wash hands with

soap, either alone or together with others but this is not considered important. Also, they

are not necessarily practicing as much as they encourage. Children, then fathers are the least

likely to use soap, but grandparents also.

• 80% disagreed that soap was unnecessary when washing hands after defecation, yet only 18%

reported they do it. Washing hands with soap is more common after eating than before

eating, whereas washing HWWS and HW observed most frequently after an activity, such as

eating or returning from work. Washing hands with water only is more common before

eating.

• Hand washing perceptions are influenced by the senses of sight, feeling and smell–some only

if “visibly dirty”, or if “feel dirty or greasy”, or if they smell (e.g. after handling fish). Soap is

reportedly perceived as time consuming/waste of time if you need to go and fetch it. There

is a “hassle factor”.

Product/Technology “Hardware

• Habitual: Ease of access, availability of running water, soap and presence of facility in

proximity to critical junctures are important facilitating factors. 50% have a permanent hand

washing place observed inside the house, 20% outside the house and 30% of households had

no hand washing station observed. ¾ of surveyed households had soap observed to be

available at the place where respondents said they usually washed hands. All households use

soap for bathing, meaning that soap is available somewhere in the house.

Findings on Communication channels related to handwashing with soap

• 55% received information on handwashing from their family

• 38% mentioned television or mass media,

• 23% mentioned branded soap advertisements,

• 15% mentioned the Posyandu (of which 40% of mothers attend) and

• 10% mentioned a health professional such as a doctor or nurse.

5% mentioned schools as a source of information on hand washing with soap.

Communication objectives

After the campaign, male and female caretakers of children under 5,

• will believe HWWS at the critical times is important for their families and easy to do.

• will believe that washing their hands with soap is an activity that most B40 households do

(social norms).



26

• will make a plan to ensure that soap and a device are near the toilet and food preparation

area to make handwashing easier (intention and access);

After the campaign, all household members

• will be reminded to wash their hands before critical times (cues) and have the opportunity to

do so (access).

Theory of Change Concept for handwashing with soap

Whilst analysis against the IBM Framework (Annex B) highlights multiple barriers at the Habit,

Individual and Household levels in the software and hardware dimensions, the balance of findings for

the habitual level highlights the complexity in practicing the behavior. Efforts to facilitate habit

formation should seek to address the “hassle factor” presented by the access barriers and increase

opportunities (stations + soap) close to the critical junctions. Small scale trials of improved practices

to select type of station, soap options and locations may support these facilitators and could be

developed at regional/city level. In turn, the use of creative visual cues and nudges would reinforce

habit formation.

Caretakers, predominantly mothers - are using their role and influence to provide social support in

the households. This is both enabling and a potential communication channel and builds on

marketing experience in the region which seek to add value to caretakers as “WASH experts”

(Bartell and Chhin, 2018). The example of the LSHTM’s “Super Amma” campaign provides further

examples and evidence of working with and through mothers and using nurture to add value to the

behavior7. Communication activities that seek to change the social norms to reinforce use of soap at

critical times could work with and through caretakers and use the narrative of nurture to add value

to the behavior. Shifting from “do as I say not as I do” in the process. Care should be taken not to

reinforce gender stereotypes and roles, but rather shown in a positive role and test with both

images of males with females and with male and female grandparents.

Exhibit 12: Theory of Change process for handwashing with soap

7 http://www.superamma.org/

Trials of improved

practices for HWWS

stations,

demonstrations, visual

cues, emotional

narrative/IPC materials

Campaign, HH

visits,

environmental

cues, Posyandu

and meetings

HWWS critical times is easy to do,

Social norm to hand wash with soap, reinforce

values of nurturing

Habit formation and

increased access/use

HW facilities with

soap at critical

junctures by all

household members

Increased

handwashing with

soap at critical

junctures by

households

members




27

Potential Inputs of

an Intervention

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to

Project

Objective)

• Trials of improved

practices for

HWWS stations –

opportunities,

setting changes,

potential regional

innovations.

• Demonstrations, use

of visual nudges/cues

e.g. stickers, soap

pumps, facilities -

reminders

• Emotional narrative

/promotional

materials for

interpersonal

communications

with care-takers

(soap + critical

junctures)- motives

Intensive time-

bound campaign at

HH level at key

times of year

Environmental

cues

Posyandu, Arisan

Pengajian/Ibadah

Mingguan (regular

religious meeting)

Believe HWWS at

critical times is easy to

do.

Believe that by washing

their hands with soap

at critical junctures and

encouraging family

members to do so,

they are taking care of

their family (Nurture)

Believe that the

majority of B40

households always

HWWS (social norms).

Reminded to wash

their hands before

critical times (cues) and

have the opportunity

to do so (access)

Have a plan to ensure

that soap and a device

are near the toilet and

food preparation area

to make handwashing

easier (intention and

access);

Habit formation +

20% increase in

access to

handwashing

facilities with soap

commonly used

by family

members

Increased

handwashing

with soap at

critical times by

B40 household

members


and priorities.

• Linked to USAID IUWASH PLUS Component 3, marketing activities with SMES could

explore opportunities for promoting low cost attractive handwashing facilities to overcome

the limitations of tippy tap style solutions linked to the nurture narrative.

• The 5 key times for handwashing with soap endorsed by MoH as used by the Public Private

Partnership in Indonesia are before eating, before preparing and serving food, before feeding

a child and after going to the toilet and after touching animals (Dutton, P, 2011). Based on

the evidence of existing practices and environmental health risk, the strategy has included

after cleaning a child’s bottom as a critical juncture.

As the second pillar of STBM, handwashing with soap (HWWS) is one of key hygiene

behaviors that the strategy closely aligns with and can contribute tested approaches suitable

to the urban contexts.

Priority Behavior 5: Safe disposal of child feces

Behavioral objective: Safe disposal of feces of children under 3 into an improved sanitation facility

in urban B40 households.

Target group: Male and female carers of children under three within urban B40 households.



28


Context

Solid waste management means waste disposed in trash cans may still end up in a drain,

river, garden or other communal location, issue of plastics disposal.

Mothers as the primary carers are busy and frequently interrupted from other tasks, such as

cooking, to clean up the feces and the child before resuming her task. Low participation of

men in WASH related activities at the household level. Traditional gender roles are

socialized to boys and girls. Low participation of men in social activities at the community

level, especially those related to health promotion (Annex A).

Psychosocial “software”

Interpersonal/household: Descriptive social norm is unsafe disposal of nappies with the

majority of carers reporting they do not clean diapers before disposal (64%). There are

some positive deviations with 22% reporting cleaning nappies before disposal.

Individual: High knowledge (72% think equally dangerous as adult feces, 21% more) yet

reported practices and diapers observed in surrounds highlight the gap between perceptions

of risk of unsafe disposal vs actual practices.

Habitual: Survey data: 53% of cases reported the feces were disposed in a toilet, 44% HHs

children’s feces were reported disposed of directly into the environment (regional variation

up to 85%).

Product/technology “hardware”

Household/individual: 35% of HHs have at least one child U5, 23% of households don’t have

access to sanitation facility although even when access is available it does not ensure safe

practices, and facilities are not always “child friendly”, no data on potty use or availability.

Disposables are "easy" and convenient even if expensive, they save times for busy mothers.

They are also easier to dispose of unsafely or without rinsing. Even more so for households

living close to or over water.

Small children will often defecate in a different place from adults in the same households and

this changes with age as they progress through toilet training. They go through several stages

before they use a toilet. Typically, children under one year of age use a disposable diaper,

then there is usually a gap of several months or even years between the removal of the

diaper and the use of a toilet typically at 2-3 years of age. During this period toddlers

defecate in their trousers, or on the ground in the house or in drain outside the house.


After the campaign, male and female carers of children under three within urban B40 households will

have



29

• increased self-efficacy in their ability to carry out small do-able actions that improve the safe

dispose of their child’s feces at all times

• will have demonstrated intentions to apply these safe disposal methods for their child feces

• will believe that safe disposal of child feces is valued in their communities.


The research documented the changing behaviors associated with the different stages of toilet

training. This introduces different levels of risk and diarrheal transmission pathways and added

complexity and challenges in targeting behavior change interventions. Essentially, whilst the carer

remains constant there are multiple behaviors which change with the age and development of the

child, including

• Cleaning diapers (and baby bottoms)

• Assisting child to use potty

• Safe disposal of used diapers.

• Safe disposal of feces (cleaning up)

• Upgrading to “child friendly” facilities (eg more easily accessible).

Against the IBM Framework, the analysis highlights that whilst most factors can be influenced

through behavior change (software) at the individual, household or habitual level or are related to

the disposable nappies/sanitation facilities (“products”) the context also presents a limiting factor in

relation to solid waste management. As highlighted in recent research “the usage of all types of

diapers (washable or disposable) is regarded as unsafe given that the current solid waste disposal

practices in Indonesia cannot systematically ensure the safe containment of excreta” (Cronin, 2017).

Currently the “wrong” risky behavior is significantly easier than the “right” behavior which is

complex to address. There is no social pressure or urgency to change this. Following the definitions

used in Indonesia for example by WSP and UNICEF, the right behavior of safe disposal of child’s

feces “implies there is minimal risk of the excreta entering fecal-oral pathogen transmission

pathways and is only possible where there is access to an improved latrine and is defined when a

child’s feces is discarded or rinsed into an “improved” toilet. Methods of disposal of child feces that

are termed unsafe in this analysis include feces being thrown outside the dwelling, left in the open,

buried in the yard, and rinsed away into anything but an improved toilet or latrine” (Cronin et al,

2016, p 2-3). There is potential to use disgust as a driver but this would need to be tested as it was

not explored in depth in the formative research.

Communications need to find a “unifying theme” that reinforces safe practices whilst working with

caretakers to identify and take feasible actions and acceptable safe practices for safe disposal of child

feces responding to the change needs/life-cycle. There are positive deviations that if better

understood, could be recognized and rewarded. There are regional examples documented by

WASH Plus which focus on “small doable actions” which could be targeted to “hot spot” areas then

promoted within communities more broadly which may prove a feasible way to break down the

complexity of the behavior for carers although may present challenges of scalability.



30

Exhibit 13: Theory of Change process for safe disposal of child feces


Intervention – linked

to Behavior 2

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to

Project

Objective)

• Trials of small do-able

actions in hot-spot

areas with carers.

• Role modelling and

testimonies of positive

deviation within

communities.

• Use of visual

nudges/cues/

reminders.

• Technology options

and demonstrations to

make sanitation

facilities more “child-

friendly”.

• Reinforce the related

critical juncture to

HWWS activities and

narrative.

• Targeted

household visits

and counselling.

• Promotion

through

community and

religious events

and within

routine meetings.

• Marketing and

SME activities

linked to social

media.

Self-efficacy in ability

to carry out small

do-able actions that

improve the safe

dispose of their

child’s feces always

Form Intentions to

apply these safe

disposal methods

for their child feces

Believe that safe

disposal of child

feces is valued in

their communities

(linked to social

affiliation).

Improved safe

disposal of child

feces at all times

within

households

Additional access

to safely managed

sanitation

services.


and priorities.

It is important that USAID IUWASH PLUS arrives at shared understanding of what is “safe disposal”

of a child’s feces for the purpose of this strategy within the context, in alignment with MoH but also

with JMP (Joint Monitoring Program) definitions and sector practice8. The safest way to dispose of a

child’s feces is to help the child use a toilet or latrine or, for very young children, to put or rinse

their feces into a toilet or latrine. Within this strategy, these disposal methods are referred to as

“safe,” whereas other methods are considered “unsafe”, including for example burying. Following

sector definitions, “safe disposal” is only possible where there is access to an improved latrine.

8 Further examples are provided in WSP Sanitation Marketing Toolkit “Management of Child Feces: Study Design and

Measurement Tips, July 2015 available online http://www.wsp.org/sites/wsp.org/files/publications/Child-Feces-Formative-

Research-Study-Design.pdf

Small do-able

actions, role

modelling,

marketing

materials, visual

cues

Community

events, HH visits,

social media

Increased self-efficacy and

intentions, social afflation, beliefs and

value

Improved safe

disposal of child

faeces

Increased access

and use of safely

managed sanitation

services




31

When a child’s feces is put or rinsed into an “improved” toilet or latrine, this is termed “improved

child feces disposal.” (WSP and UNICEF, 2014).

It is noted that the Ministry of Health includes a criteria for a community to be certified as open

defecation free (ODF) is that the feces from babies are disposed of into a toilet in 100 percent of

households which this aligns with.

USAID IUWASH PLUS Component 1 Alignment: Marketing materials, activities with SMEs and

design innovations to address “child-friendly” latrines could also be tested and promoted as part of

promotional activities.

Priority Behavior 6: Consistent treatment and hygienic storage of household

drinking water at all times.

Behavioral objective: 1 million people have gained access to improved water services quality from

an existing basic or safely managed drinking water service9, including 500,000 from the bottom 40%

by wealth.

Target group: Male and female adults within urban B40 households currently without access to

safely managed drinking water services from improved sources.

Topline findings from the formative research

Psychosocial “software”

Individual: Many people believe that they are treating and storing water correctly and may

not see water treatment as a problem. They also believe that refill bottled water is safe to

drink without boiling, despite MoH warnings and increasing evidence of the risk of

contamination. There are high levels of awareness of the importance of boiling, but specific

knowledge about how to do so safely (and store safely) and the options beyond boiling may

be lower. The decision made by women tends to be limited to regular household activities,

such as this.

Habitual: Treatment of water before drinking is common in the target areas and wider

Indonesia. Boiling is reported by 84% of survey respondents, 38% of observation case study

respondents. Practice for boiling water is to turn off the heat as soon as the water comes to

the boil (57%) in comparison to 21% who report that they keep the water boiling for 3

minutes or more as per the MoH recommendation. It is rare for people (less than 2%) to

drink water from sources other than bottled water without treatment.

9 To meet the criteria for a safely managed drinking water service (SDG 6.1) defined by JMP, people must use an improved

source meeting three criteria: it should be accessible on premises, water should be available when needed, and the water

supplied should be free from contamination. If the improved source does not meet any one of these criteria, but a round

trip to collect water takes 30 minutes or less, it is classified as a basic drinking water service (SDG 1.4). Improved sources

include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered

water.



32

Product/technology “hardware”

Individual: Whilst boiling is costly, labour intensive and may create other hazards (smoke,

burns, etc.) it has higher uptake then other non-boiling methods despite programme

investments, especially regarding chlorine which has residual effects that decrease

acceptability. No survey respondents reported using chlorine or solar disinfection, 2

reported use of ceramic filter and 6 used bio-sand. In general, locations with lower incidence

of boiling have higher usage of refill bottle water suggesting most people either boil or use

bottled water. Observation households -5 households drink untreated water that is not

bottled water, of which 3 is from piped water and 2 from well water without boiling and are

amongst the poorest households of which 4 are dependent on neighbors for their source of

drinking water.


After the campaign, male and female adults will

• Believe that only adequately boiled and safely stored water is safe drinking water

• Know that refill bottled water also needs to be boiled when at home

• Know at least two different methods for safely treating drinking water suitable for their

household needs.


Analysis against the IBM Framework shows barriers within the individual dimensions for both the

software and hardware components. There is existing normative practice to boil drinking water and

a high level of the awareness of the importance which provides a strong foundation. There is though

low recognition of the potential increasing risk associated with not boiling refill bottled water, with

not adequately boiling and with poor storage practices (e.g. uncovered, potential contamination from

ladles/cups). It would be important to link safe treatment and storage messaging to activities that

promote household connections to piped water and also to increase awareness on the need to boil

all drinking water, including refill when at home. The formative research did not explore outcome

expectations or perceptions of threats which would support developing more targeted

communication objectives.

Exhibit 14: Theory of Change process for household storage and treatment of drinking water

IPC materials,

marketing

materials, visual

aids

Community events,

HH visits, social

media

Increased knowledge and beliefs, affordability,

convenient and easy to do

Increased in safe

treatment and

storage of

household

drinking water

Increased access

to safe drinking

water and storage




33


and priorities.

Within Indonesia, there has been mixed uptake of non-boiling methods despite programme

investments, especially regarding chlorine for which further research into chlorine marketing and

messaging is needed. There may be opportunities to explore and market products with further

research such as ceramic filters.

Clarification on the current MoH messaging on the length of time required to boil water is needed

and potentially materials could be adjusted. The MoH advice is that water is to be brought to the

boil for at least 3 minutes to be considered safe for drinking which has implications for ease of

practicing by B40 households and in costs. In comparison, WHO recommendation as per its drinking

water guidelines is for water to be brought to a “rolling boil10 before being removed from the heat

and does not provide a time indication. This may be more feasible given the current practices and in

reality may mean that additional messaging is not essential.

Component 1 Alignment: Social marketing of ceramic filters and other affordable technologies could

be conducted following further formative research and market analysis or efforts to align with other

organisations active in this area explored.

10 http://www.who.int/water_sanitation_health/dwq/Boiling_water_01_15.pdf

Potential Inputs

of an

Intervention

Implementation

Surprise

(links to

outreach

activities for

behavior 6

Outputs

Revaluation

(links to

communication

objectives)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to Project

Objective)

IPC materials and

visual aids

Social marketing of

treatment

products.

Integrated into

targeted household

visits and

counselling.

Integrated within

promotion through

community and

religious events

and within routine

meetings.

Marketing activities

linked to social

media.

Believe that only

adequately boiled

and safely stored

water is safe

drinking water

Know that refill

bottled water

also needs to be

boiled when at

home

Know at least two

different

methods for

safely treating

drinking water

suitable for their

household needs.

Increase in safe

treatment and

storage of

household drinking

water.

Additional access

to improved water

services quality for

drinking water

from an existing

basic or safely

managed drinking

water service.



34

3.4. WATER BEHAVIORS

Priority Behavior 7: Household connections to basic water services by B40

households.

Behavioral objective: 1 million people have gained access to improved water services quality from

an existing basic or safely managed drinking water service11, including 500,000 from the bottom 40%

by wealth.

Target group: Male and female decision makers within urban B40 households currently without

access to basic drinking water services from improved sources.


Context

Roles and Responsibilities: Women (senior females) are more used to collect water than men,

regardless of the source. Females in case study households collect water in 54% of

households, males in 25% of households and both females and males in 21%. Women have

limited control on important decision making related to WASH, for example having new

connection to PDAM and the finances related to this.


Community: Not owning your own source was inconvenient and caused embarrassment if

you were depending on a neighbor.

Most households use multiple water sources, with different sources used for different

purposes determined by factors of quality, convenience and cost saving

considerations. Motivations to connect are convenience (33%) as it was available, higher than

being cheaper (23%) or related to water quality (29%).

Product / Technology “Hardware”

Community: Getting a piped water connection is complex, it involves making an application,

fulfilling the requirements of the local municipal water utility, purchasing piped extensions to

the home and paying for the connection-“many conditions needed”.

Access/availability: Coverage is not available in all areas and wide geographical variation in

water usage patterns. 62% of households use well water (mainly bore wells, but also dug

wells and unprotected dug wells), 42% use pipe water (majority of connections to the HH,

wide ranging from 3 to 77%, of which 72% are metered), 39% use refill bottle, 6% use other

11 To meet the criteria for a safely managed drinking water service (SDG 6.1) defined by JMP, people must use an improved

source meeting three criteria: it should be accessible on premises, water should be available when needed, and the water

supplied should be free from contamination. If the improved source does not meet any one of these criteria, but a round

trip to collect water takes 30 minutes or less, it is classified as a basic drinking water service (SDG 1.4). Improved sources

include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered

water.



35

sources (e.g. rainwater, water carts/trucks). Majority of piped water users access their water

from a municipal water utility (PDAM), 13% participate in a communal system, managed by

the community via a committee and around 1% use private companies.

In some neighborhoods where many households do not have independent access to water, a

network of exchanges develops between buyers and sellers-a moral economy of water

exchanges. Rates are determined partly by the social relationships–1/5 of those using piped

water (6% of all surveyed HHs) access their piped water from a neighbor, it also cheaper for

the poorest households.

Households/Individual: Generally, refill bottle water is the most common source for drinking

as its considered the highest quality, piped water is the most common source for

cooking, well water is the most common source for washing, bathing and cleaning but the

degree of well water used is influenced by the availability of piped water. 88% of those

purchasing refill bottled water use it as their main source of water for drinking as they find it

“cheap, convenient and good quality” compared to 61% of those with a pipe connected in their

home use this piped water as their main drinking source. Piped water source users are

overall quite satisfied with the service and 89% rate the quality as fine or very good, but it

still requires boiling. May also be reluctant to complain as there are service issues raised

(limited flow, only available at night, poor quality/taste).

Affordability/costs: Monthly costs for water vary widely, the mean amount paid for all sources

of water combined is IDR 42,650 (US$3.16) including those that pay none. Monthly

payments for piped water varies greatly depending on location, median payment is IDR

57,300 (US$4.25) per month. Initial cost of connecting to piped water ranges from IDR 1 –

2.5 million but does not include the cost of materials for piped extensions. Life cycle costs

incurred for piped water to well and refill water are more or less comparable.

Costs of refill water is in generally more expensive that piped water, yet 70% households

surveyed said that they thought the price of refill water was less expensive. Of the 23% who

gave the reason to connect as it is cheaper than other sources, of these 42% thought the

price was “cheap enough” for a connection and only 9% said it was “very expensive”. Savings

are made by using poor quality water (river water or open dug well water) for washing and

bathing; and relying on family members or neighbors. Buying refill-bottled water is a cost

saving option as it saves on fuel needed for boiling water. Primary reasons for not

connecting to piped water was affordability (mainly the connection costs, but also monthly

costs).

Individual: Dissatisfaction with services may demotivate non-owners in investing in piped

water services. Families continue to use well water for bathing and washing because it is so

much easier to access, always available and free of charge.


After the campaign, male and female decision makers within urban B40 households will

• Know the actual costs of basic drinking water services available in their area

• Know the steps to connect piped water services



36

• Believe that connecting to piped water services (when available) is convenient, affordable and

easy to do.


Analysis against the IBM-Framework indicate that whilst there are examples of specific access and

availability challenges (e.g., no services available) beyond the influence of behavior change

interventions, the barriers to connecting to piped water services predominantly relate to the

services (affordability, reliability, availability, quality) and what are interconnected practices of using

multiple household level sources for different uses and to meet different consumer preferences,

along with cost saving measures.

There is potential to use communications in ways that present the “economic argument” that

illustrates the full life cycle costs of different options – including of boiling. This would also support

informed choice and address potential knowledge gaps but will need to respond to the gendered

dimensions of household financing and decision making.

Communications could also be used to support efforts by service providers to address the “hassle

factor” of connecting and meeting PDAM requirements and also in marketing of any improvements

in services (e.g. in reliability, quality) as they eventuate. This would involve clearly communicating the

steps in the process i.e. what they need to connect, and how to connect if they wanted to.

Marketing messaging should focus on the positive physical driver of “convenience” of independent

access. Potential to also link to the broader campaigns perceived rewards of affiliation and pride that

comes from being a “good neighbor”.

Exhibit 15: Theory of Change process for household connections to piped water

Potential Inputs

of an

Intervention –

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to Project

Objective)

• Infographics /

visual aids of life

cycle costs of

different types of

basic drinking

water services.

• Targeted

household visits

and counselling.

• Promotion

through

community and

Believe that

connecting to

piped water

services is

convenient,

Increase in B40

household

connections to

piped water

services that

Additional access

to improved water

services quality

drinking water

services from an

existing basic or

safely managed

Info-graphics,

marketing

materials, visual

aids

Community

events, HH

visits, social

media

Increased

knowledge and

beliefs,

affordability,

convenient and

easy to do

Increased in

household

connection to

piped water

supplies

Increased access

and use of basic

drinking water

services




37

Potential Inputs

of an

Intervention –

Implementation

Surprise

(links to

outreach

objective)

Outputs

Revaluation

(links to

communication

objective)

Outcomes

Performance

(links to

behavior

objective)

Impact

(links to Project

Objective)

• Marketing of

piped water

services.

religious events

and within

routine

meetings.

• Marketing

activities linked

to social media.

affordable and easy

to do.

Know the

“economics” of

basic drinking

water services.

provide basic

service levels.

drinking water

service.


and priorities.

Considerations of costs and affordability are barriers for B40 households who are least able to

adsorb financial risks. As per previous activities, the recommendations of the Gender Analysis and

Assessment and subsequent Gender Strategy needs to be considered.

Timing and alignment of USAID IUWASH PLUS Component 1, 2 and 3 activities would include the

following,

• Investigate options for making piped water connections more affordable, for example

improve availability of connection payment options rather than large upfront fees, a using

multi-meters and tailoring options to poor female households

• Work with PDAM to facilitate connections for the poorest households including addressing

issues of land tenure.

• Provide technical support to PDAM and private providers of piped water to improve the

quality of the service, especially with respect to water flow, water pressure and water

quality and improve customer satisfaction in the process.

• Link marketing activities and messages to improvements in services.



38

SECTION 4. CREATE AND DELIVER This section outlines the key steps to operationalize the strategy, aligned with behavior centered

design processes (refer to Figure 3) with a focus on the immediate steps to Create and Deliver.

Create

Strategic investment in a unifying communication campaign concept or narrative focused on “good

neighbors” would bring together the different creative components and their specific motivational

drivers) for the sanitation (“affiliation”), hygiene (“nurture”) and potentially water related behaviors.

This would support the delivery of the strategy as a package (e.g. through branding, training) and also

support the target audience in identifying the campaign and recalling its messages. Ideally at least 2-3

concepts would be pre-tested.

Communication briefs should be developed to guide the creative development and testing of the

campaign components (i.e. activities, events, channels and materials) as parts of the overarching

umbrella campaign to achieve the desired behavior change outcomes.

The creative process involves moving from 1) describing the idea; to 2) developing a mock-up of the

idea; to 3) pre-testing the mock-up of the idea; to 4) generating feedback about the idea; to 5) using

the feedback to redesign the idea; before 6) re-testing the idea again (Aunger, 2017).

The process should include simplified version of touchpoint mapping to identify the specific contexts

or behavior settings within which the target populations can be exposed to the activities.

Considerations of the need for regional flexibility and adaption could also be reflected in design

principles.

Keeping in mind the theory of changes, each of the campaign components need to clearly play

specific roles. For example, as explained by Aunger in 2017, some are designed to get the attention

of the target population, others to make the intervention memorable. Some components will

cause people to add value to the target behavior (e.g. by getting influential community members to

role model the target behavior), while others may increase opportunities for performance of the

target behavior (e.g. adjusting infrastructure so that the behavior is easier to perform) or for the

target behavior to actually be selected when those opportunities arise (e.g. through sanitation

marketing). Some components may be able to do more than one of these things (Aunger et al, 2017,

p41.)

The final tested communication products would then be developed as communication toolkit or

“Package” that will ensure consistency in approach, provide guidance on adaptations, support the

uptake and training and ideally be made available externally.

Key steps:

• Develop campaign brief – umbrella brand.

• Develop 2-3 concepts, messages and pretest in different contexts

• Develop IPC process, events and tools

• Develop create brief

• Finalize campaign materials and “package”



39

Deliver

Further consultations are needed to develop a supporting implementation plan at the regional and

city level that aligns with broader USAID IUWASH PLUS activities. The teams are currently using a

series of participatory activities summarized below which present opportunities for communication

messages to be integrated within. These are in addition to ongoing routine meetings, household

visits (presenting opportunities for counselling and targeting), neighborhood events and marketing

activities with SMEs. Exhibit 16 below presents illustrates how these are implemented in practice.

USAID IUWASH PLUS Participatory Community Level Activities

Stakeholder analysis: To understand/mapping potential partners, existing programs/projects, and

other actors

Program Socialization: To explain USAID IUWASH PLUS program, general information of the

project

Advocacy and preparation of Participatory Assessment and Triggering: To get support from local

leader and develop planning/timeline to conduct participatory assessment and triggering

Participatory Assessment and Triggering: Together with community assessing WASH condition in

respective area/neighborhood to raise awareness, change behavior and encourage people to invest

on WASH facilities. Tools to conduct assessment are social mapping, transect walk and group

discussion. The map will be used as tool for participatory monitoring evaluation

Community meeting to develop action plans: To raise awareness, endorsement and consensus

building on activities that is necessary to improve WASH condition (increasing access to facilities and

improving hygiene behavior). The action plan include promotion and campaign, and capacity building

Implementation of action plan: Community activities and capacity building to support implementation

of community activities to promote positive behavior and increase access to WASH

Participatory Monitoring and Evaluation: Community conducting household monitoring and

evaluating their action plan to

Community meeting to discuss action plan (revisit and adjustment): To get support from community

leader and all community member on the implementation of community action plan (revised action

plan)

In line with the recommendations and principles in section 2, this strategy should be reflected in

regional level action plans to provide critical focus and alignment, to phase “timely” behavior change

activities and to target hot spot areas based on the available evidence, resources and needs. It is not

the intention that all behaviors be addressed in all communities at once but rather they are

strategically planned and delivered to add value to the community mobilization and advocacy

activities already underway. For example, it is proposed that handwashing with soap interventions be

boosted by time-bound and targeted campaigns reaching the households to improve their

effectiveness rather than integrated only as single messages in ongoing community activities. At the

same time, targeting activities for desludging could be focused to areas identified as hot spots or

aligned with areas where services are being introduced.



40

Regional level action plans should also include opportunities for adapting and tailoring the

communication products and undertaking trials of i) improved practices for HWWS stations –

opportunities, setting changes, and ii) trials of small do-able actions for safe child feces disposal in

hot-spot areas with carers.

As noted in Section 3, alignment with broader USAID IUWASH PLUS activities and components is

fundamental to ensuring activities are “timely”, that communications are integrated into financing,

private sector and marketing activities. They would also both benefit from the outcomes of parallel

studies and guide the formulation of potential future studies. In planning for delivery, it would be

advisable to regularly review this strategy and reflect in subsequent annual planning in close

consultation with the wider teams.

Capacity building of the delivery teams and partners should focus not only on the use of the final

communication products but also their underlying behavior change theories. This would support

consistency in messaging, quality, effectiveness, build further behavior change skills and improve

regional adaptions.

Key steps

• Develop regional level implementation plans, including timing of activities and alignment with

broader components, gender strategy and service delivery improvements

• Training and capacity building

• Implement plans

• Monitor and adjust (refer to next section) and evaluate.



41

SECTION 5. MONITOR AND EVALUATE

USAID IUWASH PLUS Activity Monitoring and Evaluation Plan (AMEP) Indicators and Targets

Result No. Target Indicator

Higher level result

HR-1 1 million people have gained access to

improved water services quality,

including 500,000 from the bottom 40%

by wealth

Number of people receiving improved service

quality from an existing basic or safely managed

drinking water service

HR-2 At least 500,000 people have gained

access to safely managed sanitation

services.

Number of people gaining access to safely

managed services

Component 1: Improving household

water services

C1-a 250,000 people gain access to shared

or basic sanitation services

Number of people gaining access to shared or

basic sanitation services

C1-b 20% more households in targeted areas

practicing key hand washing with soap.

% of households with soap and water at a

handwashing station commonly used by family

members.

Currently the AMEP measures impact level changes for the behavioral change objective level for the

priority behaviors of sanitation, hygiene and connection to piped water services. An additional

indicator is recommended for safe disposal of child feces.

It will also be important to monitor communication objectives as they respond to key determinants,

to cross-check assumptions and to further understand if they are then effective and relevant in the

different contexts targeted through USAID IUWASH PLUS. It can be done simply as steps in the

different stages, for example as part of the creative process, through the current participatory

monitoring approaches and monitoring form or through conducting further FGDs after the campaign

in response to the stated objectives summarized in Annex C . For example, after the campaign, do

more or less people ‘believe’ that handwashing with soap at the critical junctures is now easy to do?

In this way, in addition to looking at the change in behavior, there is also value in measuring whether

the targeted behavioral determinants changed as a result of the campaign or if adjustments are

needed to the communication objectives, in order to ultimately influence the behavior itself.

Without outreach, the strategy campaigns will have no impact. While measuring outreach will not

tell us if behaviors have changed, it is a means of monitoring the number of people reached and

exposed to the messages through the different mediums. This will also identify any logistical issues

in, for example, the distribution of materials. The monitoring form used by the program presents a

means to capture the number of the target groups reached through the various communication

activities and mediums used.

Community engagement to self-evaluate and monitor the changes provide additional benefits to

better understand and ensure the sustainability of outreach activity. Engaging community as actors to

conduct the HH behavior monitoring and supporting community to evaluate the effectiveness of



42

outreach program will encourage community to continue promoting positive behavior. Household

monitoring will be combining with promotion to encourage HH to change behavior and improved

their access to water and sanitation facilities and improve hygiene behavior. Below are the steps of

participatory monitoring and evaluation used:

• Data gathered from the participatory assessment and triggering (open defecation practices,

toilet ownership, HWWS) as the baseline data of WASH condition in the respected

community

• After the development of community action plan and its implementation, the community

committee conducting monitoring and evaluation to monitor the changes/update and to

evaluate the action plan and its implementation. During the household monitoring/home

visit, the committee provides household member with related information/promotion, such

as:

If the HH still practicing OD: provide information why they should change their

behavior, what is the benefit etc.

If the HH has not practicing HWWS: provide information why should practice

HWWS, how to do it, the critical junctures (see the matrix I sent earlier)

• The committee evaluate the implementation of action plan and analyze it along with the HH

monitoring result

• The committee organize community meeting to presents the monitoring and evaluation

result and discuss with community member what need to be done to improve the condition;

this will include revisiting community action plan and revise it

Exhibit 16: Flow implementation of Participatory Monitoring and Evaluation

Participatory Assessment

and Triggering

Community Action Plan &

Implementation (Community Activities)

Participatory Monitoring and

Evaluation

Community Committee

conducting HH visit to monitor

the changes

Community meeting to share the findings and discussion to

revise community action plan

Implementation

of revised

community

action plan

(community

activities



43

SECTION 6. RECOMMENDATIONS The USAID IUWASH PLUS Formative Research has provided a wealth of information to guide the

subsequent development and targeting of behavior change interventions to support the achievement

of the high level goals of increased access to improved water services and safely managed sanitation

services with a focus on the poorest 40%. Undoubtedly the reach of the project across 32 cities and

8 provinces in Indonesia and the diversity in settings presents inevitable limitations as to the depth of

analysis of the behavior determinants that is possible and the effectiveness of communication

channels. The Strategy has sort to manage the tension of providing both enough guidance to ensure

ongoing activities have the necessary focus to achieve targeted behavioral outcomes with the need

for further tailoring, testing and adapting in response to project needs, regional and localised

realities. Supporting a more iterative creative process that includes touchpoint mapping and testing

and re-testing of the concepts and messages will go some way to further “grounding” the proposed

campaign and approaches and further refining the theory of changes.

From an effectiveness perspective, the Strategy has also sort to place emphasis on a limited set of

priority behaviors rather than respond to all of the researched behaviors. This has involved taking

into account the environmental health risk, available resources, capacity, potential to align with other

USAID IUWASH PLUS components and the potential contributions to the broader sector. Including

the focus on the unsafe practices prevalent relating to child feces was intentionally included as

important emerging priority for the sector, and one in which the inherent risks and local diarrhea

transmission pathways were evident. Addressing the issue is complex and an area for further

learning.

In turn, there is value and learning from measuring the effectiveness of the behavior change strategy

itself. There is a distinction that should be made between measuring the change in behavior itself

through the AMEP indicators, the communication objectives and the outreach objective (SNV,

2016). Therefore, in addition to looking at the behavior, there is also value in measuring whether the

targeted behavioral determinants changed as a result of the campaign or if adjustments are needed

to the communication objectives, in order to ultimately influence the behavior itself. Measuring

communication objectives can thus help us to understand if they were effective. For example, after

the campaign, do more or less people ‘believe’ that handwashing with soap at the critical junctures is

now easy to do? This can be done through quantitative or qualitative measures (depending on the

determinant in question), but can be as simple as conducting some further FGDs after the initial

interventions. It is also useful as a means for cross-checking if the determinants are relevant in the

different contexts and are still effective. The results of the monitoring at these three different levels

is ideally shared in a discussion with the key stakeholders/partners in a process of sense making.

From this there will be a clearer understanding any necessary adjustments to be made in the

approaches.

As noted in Section 3, alignment with broader USAID IUWASH PLUS activities, strategies and

components is fundamental to ensuring the proposed activities are “timely”, are integrated into

financing, private sector and marketing activities and can benefit from the outcomes of current

parallel studies and guide the formulation of potential future studies. In seeking alignment it would be

advisable to review this strategy and subsequent annual planning in close consultation with these

wider teams. Specific points of attention include the sanitation marketing (and messaging), design

innovations to address upgrading, child friendly latrines and challenging environments, tailoring



44

financing mechanisms and phasing with the introduction or expansion of regular desludging services

or regulations. Further research could support deepening current understandings of affordability and

its links to willingness to pay.



45

REFERENCES Aunger, R, White, S, Greenland, K, Curtis, V (2017). Behavior Centred Design A Practitioners

Manual,

London School of Hygiene and Tropical Medicine, Version 1 February 2017, accessed online at

https://www.lshtm.ac.uk/bcd

Aunger, R and Curtis, C (2015). A Guide to Behavior Centred Design (Draft), Robert Aunger and

Valerie Curtis, Hygiene Centre, London School of Hygiene and Tropical Medicine, accessed

online at https://www.lshtm.ac.uk/bcd

Bartell, J and Chhin, S (2018). “Empowering women as participants in the rural WASH market”,

Watershed, presentation made as part of the Brisbane WASH Futures Conference, March

5-8th 2018, available online at http://washfutures.com/

Coomes Y and Devine J (2010), Introducing FOAM: A Framework to Analyze Handwashing

Behaviors to Design Effective Handwashing Programs, World Bank Water and Sanitation

Programme,

http://www.wsp.org/sites/wsp.org/files/publications/WSP_IntroducingFOAM_HWWS.pdf

Cronin, A, Sebayang, SK, Torlesse, H and Nandy R (2016). Association of Safe Disposal of Child

Feces and

Reported Diarrhea in Indonesia: Need for Stronger Focus on a Neglected Risk, International Journal of

Environmental Research and Public Health, 13, 310; doi:10.3390/ijerph13030310.

Curtis, Valerie, C, Danquah, L and Aunger, R (2009) ‘Planned, motivated and habitual hygiene

behavior: an eleven country review.’ Health Education Research 24(4): 655-673. accessed

online at http://her.oxfordjournals.org/content/24/4/655.long

Chong, J, Murta, J, Kome, A, Grant, M., and Willetts, J (2017). Exploring smart enforcement within

urban sanitation, Prepared by Institute for Sustainable Futures, University of Technology

Sydney for SNV Netherlands Development Organisation, accessed online at

http://www.snv.org/public/cms/sites/default/files/explore/download/snv_isf_-

_exploring_smart_enforcement_within_urban_sanitation_-_final_web.pdf

Devine J (2009), Introducing SaniFOAM: A Framework to Analyze Sanitation Behaviors to Design

Effective Sanitation Programs, World Bank Water and Sanitation Programme,

http://www.wsp.org/wsp/sites/wsp.org/files/publications/GSP_sanifoam.pdf.

DAI Global (2017). Final Report: Behavior Change Formative Research, USAID Indonesia Water,

Sanitation and Hygiene Programme, Jakarta.

Dreibelbis et al. (2013). The Integrated Behavioral Model for Water, Sanitation, and Hygiene: a

systematic review of behavioral models and a framework for designing and evaluating

behavior change interventions in infrastructure-restricted settings, BMC Public Health 2013,

accessed online at http://www.biomedcentral.com/1471-2458/13/1015



46

Dutton, P (2011). Field Note: Handwashing with Soap — Two Paths to National-Scale Programs

Lessons from the Field: Vietnam and Indonesia, prepared for the Water and Sanitation

Programme of the World Bank, accessed online at

https://www.wsp.org/sites/wsp.org/files/publications/WSP-HWWS-National-Scale-

Programs.pdf

Kusmiati, Y & Wibowo, J (2014). Review of Policy: Domestic wastewater management in Indonesia

WASH, Royal Haskoning DHV and SNV Netherlands Development Organisation, accessed online at

www.snv.org

Ministry of Rural Development (2015). National Guidelines for Behavior Change Communication for

Rural Sanitation and Hygiene in Cambodia, Phnomm Penh.

Michie, S, van Stralen, M and West, R (2011). The behavior change wheel: A new method for

characterising and designing behavior change interventions, Journal of Implementation Science, 6:42,

accessed online at http://www.implementationscience.com/content/6/1/42

Mosler, H.J. (2012) A systematic approach to behavior change interventions for the water and

sanitation sector in developing countries: a conceptual model, a review, and a guideline,

International Journal of Environmental Health Research, 22 (5), 431-449.

O’Connell, K (2015). Management of Child Feces: Study Design and Measurement Tips, WSP

Sanitation Marketing Toolkit, available online

http://www.wsp.org/sites/wsp.org/files/publications/Child-Feces-Formative-Research-Study-

Design.pdf

Schmied, P (2017). Behavior Change Toolkit for International Development, developed for People in

Need, accessed online at https://www.fsnnetwork.org/behavior-change-toolkit-international-

development-practitioners-enabling-people-practice-positive

Service, O et al (2014). EAST: Four Simple Ways to Apply Behavioral Insights, Behavioral Insights

Team, accessed online at www.behavioralinsights.co.uk/wp-content/uploads/2015/07/BIT-

Publication-EAST_FA_WEB.pdf

SNV (2016). Behavior Change Communication Guidelines, Sustainable Sanitation & Hygiene for All

Programme (SSH4A), Netherlands, accessed online at

http://www.snv.org/public/cms/sites/default/files/explore/download/snv_behavior_change_co

mmunication_guidelines_-_april_2016.pdf

WSP and UNICEF (2014). Research Brief: Child Feces Disposal in Indonesia, jointly prepared by the

Water and Sanitation Programme of the World Bank and the United Nations Childrens

Fund, accessed online at http://www.wsp.org/content/ensuring-safe-sanitation-children-0



47

ANNEXES

A. KEY POINTS FROM USAID IUWASH PLUS GENDER ANALYSIS

SUMMARY OF DETAILED GENDER ANALYSIS/ GENDER ASSESSMENT

USAID IUWASH PLUS Annual Progress Report 1 Annex 14, Oct 2017

Key findings

External Gender

Assessment at

Household Level

Access Gender Gap at Household Level:

Access to Resources/WASH facilities:

• WASH facilities in households are more accessible to adult women but

the condition is still poor to the safety, comfort and privacy of women

(both adults and children).

• In the case of households without proper toilet, the majority of adult

women and girls practice open defecation, defecate in public toilets or a

neighbor’s toilet while most men (adults and boys) prefer to practice open

defecation only.

• WASH facilities are often accessed by women and children altogether,

especially for mother with children under five due to working and caring

for children at the same time.

• The handwashing with soap facility is mostly accessed by adult women and

children, especially those who are under five years old, but this practice is

not widely practiced and considered unimportant.

Access to WASH Financial Resources:

• The majority of households do not have bank accounts, even if they have,

usually are registered under the adult males (husbands).

• The presumption of women as household “treasurer”, it is often that after

the husband handed over his income there is a tendency that he does not

care with the difficulties faced by the wife in managing family expenditure.

External Gender

Assessment at

Household Level –

cont’

Participation Gender Gap:

Participation at Household Level:

• Low participation of men in WASH related activities at the household

level

• Women are less involved in the role of troubleshooting so tend to be

dependent on men

• Strong stereotype that WASH technical role is more for men rather than

for women

• Traditional gender roles are socialized to boys and girls

Participation at Community Level:

• Low participation of men in social activities at the community level,

especially those related to health promotion



48

Key findings

• There are still few women who occupy positions as decision makers in

WASH CBO (Community-based Organization)

Control over resources at household level:

• Women have limited control on important decision making related to

WASH, for example having new connection to PDAM, construction of

toilet, etc. The decision made by women tends to be limited to regular

household activities.

• Women have control over household assets with low value (kitchen

utensil) while men usually have control over household assets that have

high value such as motorbike, TV, etc.

Benefit: Increased access to WASH facilities at household level does not

necessarily bring benefits, especially for children and women because of

strong perception that the domestic role is women’s responsibility, for

example assuring clean water availability at the household is usually the

responsibility of women.

Recommendations for Program Integration:

• Development of gender friendly design of WASH facilities

• Increase involvement of men and women in the selection of WASH technology options

• Handwashing with soap promotion targeted more to men. However, it will be good if

promotional activities included men and women to assure their commitment to practice

handwashing with soap at household level

• Increase involvement of men and women in making decisions on obtaining alternative financing

to improve WASH facilities and services at household level

• Develop a microfinance product for poor women that can support increased access to improved

WASH facilities

• Closer bring the microfinance facility and services to the poor women (for livelihood and

improving WASH access)

• Conduct gender awareness capacity building to emphasize the importance of gender equality of

roles and participation of men and women in WASH activities at household and community

levels

• Conduct Operation and Maintenance training of WASH facilities for women

• Implementation of project activities should be considered as part of the daily schedule of men

and women

• Encourage men's participation in social activities, especially related to the promotional activities

on environmental health

• Encourage greater role of women to be involved in the decision-making positions at WASH

CBO

• Improve understanding of the importance of male and female equality regarding the aspects of

control in decision making in the household

• • Ensuring the equal access, participation and control between men and women in the WASH

sector so that benefits can be shared by all parties



49

B. KEY FINDINGS FROM FORMATIVE RESEARCH BY BEHAVIOR (IBM FRAMEWORK)

Priority Behavior 1 Ending Open Defecation (OD).

Context Psychosocial “Software” Product / Technology “Hardware”

Society Regional variation due to site-specific factors

such as sanitation and housing infrastructures,

not just cultural factors

Community OD occurs more frequently in district

locations than in cities. Public toilets are used

more in the cities (mostly), but also in some

districts;

B40 more likely to live in challenging

environments (eg above water)

Everyone should have a toilet’ and ‘everyone

has one’; wanting to be a "good neighbor"

(Expressions of embarrassment at practicing

OD, using a neighbor’s toilet or using a public

toilet reflect people are concerned about

maintaining a good reputation, good relations

with their neighbors and family); “We can

encourage households here to work together

to build a communal system.”, social support

through sharing arrangements

23% of HHs have no access to toilet in house,

communal facilities have limited acceptance -

inconvenience, delays of queue,

embarrassment, poor toilet quality, cost

Interpersonal/

Household

Difference in gender perceptions/needs;

Physical barriers to access /insufficient space

(17%)

- house didn’t come with one,/renting

Using a toilet is predominantly the social norm

and this is a social driver, 80% non-owners

have strong preference to have a toilet; using

a neighbor’s toilet makes you feel ‘malu’

(embarrassed or ashamed), creates a

dependence, a social/symbolic debt, sense of

inferiority; having a toilet “is a basic need. A

house is not complete without a toilet.”,

perception of affordability.

Affordability barrier (61%);

Individual

Feeling "embarrassed", "afraid", Open

defecation is unsafe and environmentally risky;

comfort and convenience 59%; health and

People go where they feel most nyaman

(comfortable) but many factors can contribute



50


cleanliness (31%), safety of family members

(19%); self-efficacy "I’m renting so not my

decision (11%)";

to comfort including social and physical

aspects;

“we live above the lake and hard to build a

proper toilet and septic tank.” Using a toilet is

betah (convenient) or nyaman (comfortable)

Habit Communal facilities, night time, outside HH

provides less supportive environments for

habit formation

With no HH access, open defecation is most

common option, then communal or informal

sharing of toilets is common, often a

neighbors and then a family.

Different family members use different toilet

options at different times of the day;

influenced by social AND physical aspects;

some are able to access a river, a public toilet

or sharing already.



51

Priority Behavior 2 Upgrading


Society

No/limited regulation of designs, construction

or for unsafe/leaking tanks.

Multiple designs/types, not standardized, some

are directly discharging-Likely > 95% does not

meet "Safely Managed"

Community

Leaking tanks posed risk to close by wells, risk

to environment and water sources

“Families here are willing to have a proper

toilet and septic tank. However, they are still

waiting for the government to give them

materials. They can do the work, but they

cannot buy the materials.”

(65%) have household tanks attached

(1.5%) properly disposed of septage

Interpersonal/

Household

Lack of HH level resources such as cash to

construct a toilet and space to build and

maintain a septic tank; renting.

Knowledge: Technical knowledge of how septic

tanks function, their benefits and how to build

a sealed septic tank.

Affordability perceptions.

Individual

Lack of access to credit is a major impediment

to B40 access to WASH improvements.

B40 lending is dominated by private lenders

and companies. MFIs/Banks cover only about

4% (a tenth of coverage by private lenders/

comp.) Wide regional variation in Bank/MFI

coverage (from 0.54% in NS to 7.25% in

Central Java.

Perception that they are unaffordable/price to

high. Smell is an issue if you don’t have the

tank. Low priority to upgrade - “I don’t want

to upgrade my cubluk since it doesn’t affect my

health and water quality.”

Habit It’s harder to empty more often



52

Priority Behavior 3 Desludging

Contextual Psychosocial “Software” Product / Technology “Hardware”

Society Low clarify on rules and regulations at HH

level, no enforcement or compliance impetus

for existing facilities.

Sludge is meant to be disposed of in a

dedicated government treatment facilities

(IPLT) however without regulation it is often

deposited in a river, pit or open space.

Multiple designs/types, not standardized

advice or construction. Not all septic tanks

are tanks. Wide regional variation in

frequency of emptying tanks (eg ½ of tank

owners in Surabaya had, compared to none in

Maluku Tengah) and wide range in the prices

(including free). Likely > 95% does not meet

"Safely Managed" definitions. Increasing

promotion of regular desludging.

Community Leaking tanks pose risk to close by wells, risk

to environment and water sources.

Environmental health risks underestimated. 65% have household tanks attached, of the

13% who have emptied – 59% used a private

service, 17% used a government service

(mainly in Medan, Pematang Siantar, Ternate

and Bekasi). 10% tukang (handymen) mainly in

Surabaya City), and 8% emptied the tank

themselves. Communal system data? Regular

desludging services are marketing and using

service reminder stickers.

Interpersonal/

Household

Gender bias in perceptions of division of

labor around toilet cleaning – both over

report their own gender roles and

responsibilities. Lack of HH level resources

such as cash and availability to properly

maintain household latrines; renting.

Norms - "I made my septic tank large so that I

don’t have to empty it for a long period.” "It’s

never been full". Awareness of the function and

benefits of a septic tank is low. Lack of

knowledge, low motivation, limited practice or

experience in maintaining septic tanks.

Not accessing regular desludging services,.

Likely only in emergency - 80% of those with

tanks are between 6 - 15 years old, 57% of

tanks older than 15 years have not been full.

Only 13% have ever been emptied. High

likelihood they are leaky. Some mason

training underway on upgrading.



53


Individual Low/no perceived threat. 94% mentioned that

it contained feces, 20% said it protected the

environment, 11% said it protected humans

from dirt and 10% said it protected water

sources (Survey).

Affordability issues; “Technical knowledge of

how to build a sealed septic tank is limited,

can be ad hoc, different designs.

Currently no data on user satisfaction of

desludging services but concerns over

timeliness and costs

Habit No outcome expectations, no incentive to

comply regulation. Emptying and maintaining

are not habits.

If tanks are emptied, majority are using

services rather than self-emptying – likely that

it’s not easy to do.



54

Priority Behavior 4 Handwashing with soap at the critical junctures


Society

Community Access to piped water supplies

barriers/facilitators;

Schools are limited info sources

Mothers’ exposure to health promotion at the

Posyandu (40% attend).

Environmental health risks in general appear

to be underestimated

Less likely in a public toilet facility, often not in

factories

Interpersonal/

Household

Expected role of the mother in the family as

teacher in matters of health and hygiene;

Mothers are the most significant

source/encouragement on HWS in HH;

Gender and age dimension of practice and

roles

HWWS is not normative practice for B40.

HW with water only (no soap) is common.

30% of households had no hand washing

station observed; all HH use soap for bathing/

soap is available somewhere in the house;

Various HW facility designs and locations,

Influenced by time of day

Individual

Limited association with critical junctures and

diarrhea; gap between knowledge and

practices

Potential perception that soap is expensive or

unavailable;

May require multiple stations linked to critical

junctures

Habit Not always supportive environment (eg in

factories, when no piped water); alternatively

positive examples also

Only if “visibly dirty”, or “feel dirty or greasy”,

or smell;

HWWS and HW observed most frequently

after an activity, before eating/feeding a child

was usually water only;

Wash hands with water before eating so that

the rice doesn’t stick to their hands.

Limited expectation of health outcomes

Soap is time consuming /waste of time – if you

need to go and fetch

“Hassle factor”;

Ease of access/convenience is important

Location of HW facility,

Availability of running water and soap are

facilitating factors,

Facility as a visual cue.



55

Priority Behavior 5 Safe disposal of feces of children under 3


Society

Community

Solid waste management means waste

disposed in trash cans may still end up in a

drain, river, garden or other communal

location; issue of plastics disposal

Interpersonal/

Household

35% of HHs have at least one child under five,

Responsibility of the parents or older siblings

to clean up the mess, usually the mother

Descriptive social norm is unsafe disposal of

nappies somewhat more than feces; majority

do not clean diapers before disposal (64%),

some positive deviations (cleaning nappies

before disposal; disposing of feces in toilets)

23% of HHs don’t have toilet access in house;

facilities are not always “child friendly”. No

data on potty use or availability.

Individual

Disposables are "easy" and convenient even if

expensive, save times for busy mothers; gap

between perceptions of risk of unsafe disposal

vs practices; high knowledge (72% think

equally dangerous as adult feces, 21% more)

yet diapers observed in surrounds.

Diarrhea is regarded as a sign that a child is

teething, about to start walking or about to

have a growth spurt.

Changing routines - U5s from urban B40 HH

go through several stages before they use a

toilet with different challenges. Typically,

children under one year of age use a

disposable diaper; there is usually a gap of

several months or even years between the

removal of the diaper and the use of a toilet.

During this period toddlers defecate in their

trousers, or on the ground in the house or in

drain outside the house. Training happens

from 2-3.

Habit

HHs living by water, may fling the diaper

straight into the river, canal or sea, usually

without removing feces.

53% of cases the feces disposed in a toilet,

44% HHs children’s feces disposed of directly

into the environment (regional variation up to

85%), Small children will often defecate in a

different place from adults in the same

households

Easier to dispose unsafely or without rinsing,

mothers are busy and frequently interrupted

from other tasks, such as cooking, to clean up

the feces and the child before resuming her

task, frequently without washing her hands

(Observations)



56

Priority Behavior 6 Household connections to piped water services


Society Wide geographical variation in water usage

patterns

Poorest households use water of the lowest

quality.

Community

Coverage was not available in all areas e.g.

piped water providers are unable to extend

coverage to HHs over bodies of water or

where there are land tenure issues.

Some B40 HHs depend on neighbors and

public sources. Network of exchanges

determined partly by the social relationships.

1/5 one of those using piped water, accesses

their piped water from a neighbor. Three

percent of survey households and 7% of those

accessing piped water (99 households) access

a public tap.

Interpersonal/

Household

Women (senior females) are more likely to

collect water than men, regardless of the

source

61% of those with a pipe connected in their

home use this piped water as their main

drinking source. Inconvenience of not owning

your own source. Embarrassment of

depending on a neighbor. Motivated by

convenience (it was available) in the area,

then as it was cheaper or better water

quality.

Affordability (mainly the connection costs, but

also monthly costs) is primary barrier but

many also felt it was reasonable. Most HH use

more than one source of water, for different

purposes. Usage is based on quality and cost

considerations. 62% use well water, 42% of

households use pipe water (wide ranging

from 3 to 77%) and 39% use refill bottle.

Meters are use in 72% of households

accessing piped water. Monthly costs for

piped water vary widely between HHs.

Individual

Lower preference for piped water for

drinking purposes over refill as they boil it –

refill is “cheap and convenient”. Knowledge

gap with regards to the actual cost of piped

water compared to alternative sources.

Knowledge gap of the actual quality of refill.

Don’t expect it to be safe to drink.

Getting a piped water connection is

administratively complex. There are examples

of instalment payments. Piped water source

users are overall quite satisfied with the

service but may also be reluctant to complain

as there are service issues raised - flow was

limited and there were frequent stoppages,

water was only available at night (Makassar)

or the quality was bad (e.g. salty).

Habit Perceived hassle to connect and to boil it.



57

Priority Behavior 7 Safe treatment and storage of household drinking water.


Society

Wide geographical variation in water usage

patterns.

MOH is responsible for monitoring “refill”

water quality (Permenkes 736 of 2010) but

monitoring is limited in practice. Association

of Water Distributors indicates that, of 3,500

refill water depots in the Jakarta area, only

about 600 are registered members.

Community

Interpersonal/

Household

Normative practice for boiling water is to turn

off the heat as soon as the water comes to the

boil (56%) compared to 21% who keep the

water boiling for 3 minutes or more.

Boiling is very effective, but susceptible to

recontamination. Chlorine provides a

“residual” effect. No uptake of non-boiling

methods (despite program investments, esp.

re: chlorine). Reasons to not boil: Water

already clean, boiling is impractical, don’t want

to wait. Believe boiling is costly, labor

intensive and may create other hazards

(smoke, burns, etc.).

Individual

Belief that that refill is safe despite MoH

warnings. Over reporting of boiling practice.

High level of awareness about the importance

of treating water before drinking, specific

knowledge about how to do so may be lacking

Low compliance vis-à-vis MOH

recommendations for length of time to boil (3

minutes)

Boiling reported by 84% of survey

respondents, 38% of observation case study

respondents, 2 reported use of ceramic filter

and 6 used bio-sand. In general, locations with

lower incidence of boiling have higher usage

of refill bottle water suggesting most people

either boil or use bottled water.

No survey respondents reported using

chlorine or solar disinfection.

Habit Boiling may be perceived as a hassle. Refill

bottles are easier.



58

C. GUIDANCE ON MEASURING THE EFFECTIVENESS OF THE

BCC STRATEGY

The following table presents a summary of the overall behavioral, communication and outreach

outcomes and indicators to support project level monitoring systems in alignment with existing

systems and data currently collected through participatory monitoring approaches.

Behavioral level

outcome indicators

Communication objective

outcomes Outreach objectives

Mean of

verifications

Behavior 1 Ceasing open defecation and adopting a household latrine

Number of people

gaining access to

shared or basic

sanitation services

(Ref USAID

Indicators)

• # of households/landlords that

have built a latrine

• # of households that know the

accurate cost of a latrine

• # of households that believe

that a sanitary latrine is

affordable

• # of households that report

building a latrine because of

pride, convenience or comfort.

• # of households that cite peer

pressure as a reason for

building their latrine (with

containment)

# B40 HHs visits and

targeted counselling

sessions

# Promotional activities

(et community,

religious, routine

meetings) that have

included messaging or

demonstrations.

# Household decision

makers # landlords, #

adults (M/F) reached

through community

level promotional

activities

# adults (M/F) reached

through social media

activities

# SMEs marketing

services that include

aligned messaging and

pricing details.

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Attendance

records of

meetings and

activities

Records of private

sector service

providers

Behavior 2 Upgrading to safely managed sanitation services

Number of people

gaining access to

safely managed

services (Ref USAID

Indicators)

# household decision makers (and

landlords) that

• have upgraded their latrine to

provide containment

• report upgrading a latrine

because of pride, convenience

or comfort.

• cite peer pressure as a reason

for upgrading their latrine

(with containment)

• know the safely managed

sanitation technology options,

services and costs available to

meet their household access

needs

• believe that upgrading to a

improved latrine is affordable

and doable



sessions


(et community,

religious, routine

meetings) that have


demonstrations.




through community

level promotional

activities



activities

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Attendance

records of

meetings and

activities

Records of private

sector service

providers



59

Behavioral level

outcome indicators



Mean of

verifications

• that believe that upgrading to

an improved latrine is a way

to show that they are good

neighbors (values).

# SMEs marketing


aligned messaging and

upgrading options

Priority Behavior 3 Timely safe -desludging (or Operation and Maintenance)

Number of people

gaining access to

safely managed

services (Ref to

USAID Indicators)

• # B40 HHs using regular safe

desludging services

• # household decision makers

(and landlords) that know the

safely managed sanitation

technology options, services

and costs available to meet

their household access needs

• # of households/landlords

that cite sanctions as a reason

for timely safe desludging

services

• # of households/landlords

that cite peer pressure as a

reason for timely safe

desludging services

• # of household decision

makers that cite comfort,

safety or convenience for

their families as reasons for

using regular safe desludging

services.



sessions


(et community,

religious, routine

meetings) that have


demonstrations.




through community

level promotional

activities



activities

# desludging services

that include aligned

messaging

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Attendance

records of

meetings and

activities

Records of

desludging service

providers

Priority Behavior 4 Handwashing with soap at critical junctures

% of households with

soap and water at a

handwashing station

commonly used by

family members

(Referent to USAID

Indicator)

# adults who know the

critical times for HWWS

# households that have HW

devices or soap in accessible

distance to latrine, and to

food preparation area.

# caretakers of children

under 5 who believe that by

washing their hands with soap

at critical junctures and

encouraging family members

to do so, they are taking care

of their family

# of adults who believe

HWWS at critical times is

easy to do in their HHs

# adults who feel that

washing hands with soap is

common practice in their

community.

# of HHs with visual

cues near HW facilities

# HHs visits and


sessions

# HH/carers

participating in Trials of

improved practices for

HWWS per region.


(et community,

religious, routine

meetings) that have

included messaging

and/or demonstrations.

# Carers, # adults

(M/F) reached through

promotional activities

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Attendance

records of

meetings and

activities

Priority Behavior 5 Safe disposal of child feces

# households with

children under 3

whose last stools

# Carers of children under 3 in

B40 HHs who

# HH/carers

participating in small –

doable action trials

Project level

participatory



60

Behavioral level

outcome indicators



Mean of

verifications

were disposed of

safely (defined as per

JMP definitions or

context eg child used

sanitary latrine, feces

disposed of in sanitary

latrine)

Self report safe disposal

practices of feces of children

under 3

Can recall and/or

demonstrate actions that

improve safe disposal of child

feces in their HHs

Who believe that safe child

feces disposal is valued in

their communities.

# HHs visits and


sessions


(et community,

religious, routine

meetings) that have

included messaging.

# Carers, # adults

(M/F) reached through

promotional activities

# SMEs providing


child-friendly design

options/adaptions.

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Records of private

sector small scale

service providers.

Priority Behavior 6 Safe treatment and storage of all household drinking water

# household receiving

improved service

quality from an

existing basic or safely

managed drinking

water service

• # adults who report knowing

that refill water also needs to

be treated

• # of adults who know water

is safe for drinking once it

reaches a rolling boil/3

minute boil

• # adults who report safe

storage practices

• increase in # of products to

safely treat drinking water

available in local markets.

# HHs visits and


sessions to HHs

without connections to

piped water services


(et community,

religious, routine

meetings) that have

integrated messaging.


through promotional

activities.

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms Records

of small scale water

treatment product

providers.

Priority Behavior 7 Household connections to basic drinking water services

# household receiving

improved service

quality from an

existing basic or safely

managed drinking

water service

# additional B40 households who

have connected to piped water

services.

Decision makers within urban B40

households with new connections

# who can recall the steps to

connect to piped water services in

their area

# who know the actual costs of

basic drinking water services

available in their area

# who cite convenience,

affordability and easy to do as

reasons for new connections.

# HHs visits and


sessions to HHs

without connections to

piped water services


(et community,

religious, routine

meetings) that have

included messaging.


through promotional

activities.

Project level

participatory

baseline and end-

line

Project-level

monitoring systems

– HH forms,

community action

plan forms

Records of service

providers.



61

D. PARTICIPANT LIST OF THE NATIONAL WORKSHOP

18-19 January 2018, Le Meridien Hotel – Jakarta

External Participants

Total : 82 Person (45 Female, 37 Male)

USAID IUWASH PLUS:

Total : 30 People (15 Female, 15 Male)

NO. Name M/F Organisation

1 Rusdin Pinem, SKM, M,Si M Kabid Kesling Prov. Sumatera Utara

2 Ani Widiani F Bappeda Jawa Barat

3 Eduar Fredrik Tefa M Bappeda Jawa Barat

4 Nathan S M Bappeda Jawa Tengah

5 Gies Saimima, S.Sos F Bappeda Maluku

6 Tri Dewi Virgiyanti F BAPPENAS

7 Aldy Mardikanto M BAPPENAS

8 Wahanudin M BAPPENAS

9 Nurul F BAPPENAS/PMU PPP

10 Nanda L.E Siratit M DA PPLP -PUPR

11 Puti Yasmira F Danamon Peduli

12 Leonardus Vicho M Danamon Peduli

13 Sessario Bayu M M Danamon Pedulu

14 May Haryanti F Dinas Kesehatan Kota Depok

15 Erdi K M Dinkes DKI Jakarta

16 Sri Indriastuti F Dinkes Kab Tangerang

17 Euis Purwanisari F Dinkes Kota Bogor

18 Kristin D F Dit Kesling

19 Andi Sari Bunga F Dit Promosi Kes.

20 Yulita Suprihatin F Dit. Kesling Kemenkes

21 Diah Suryaningtyas F Ditjen Cipta Karya Kemen. PUPR

22 Elesvera Destry F Ditjen Cipta Karya PPLP

23 Riha Hanum F DPPLP DSAK

24 Henricus M. W. P M Gugah Nurani Indonesia

25 Dias Yunita N F Jejaring AMPL

26 Dr. Rosdiana Perau, Mkes F Kabid Kesmas Prov Maluku

27 Ambo Masse, SKM, MPH M Kasi Kesling & Kesjaor Prov Maluku

28 Pujiati, SKM F Kasie Kesling, Kesja dan Kes.OR

Magelang 29 Ir. Zuhdi, MM M Kasubdit Perumahan Pemukiman

30 M. Naufan D M Kemen PUPR

31 Imran Agus Nurali M Kemenkes

32 Shodiq TJahjono M Kepala Dinas Kesehatan Kab Probolinggo

33 Usma Polita Nasution F kepala dinas kesehatan Pov. Sumut

34 Edy Basuki, SKM, M.Si M Kepala Seksi Kesling Kesjaor prov Jatim

35 Ronald Luntungan, SKM M Kepala Seksi Kesling Kesjaor Prov Papua

36 Antonius Eddy Sutedja M Kompas

37 Mifta Huda M LPLN & SDA

38 Mifta Hendra M MUI

39 Alwi M M PALD Bekasi



62


40 Andrea Sucipto M PALD Bekasi

41 Narda S M PALD Bekasi

42 Nay Lenur F PKPU

43 Vina Anggraeni F PKPU

44 Nadia I. S F PMU PPSP

45 Achmad Rizki Azhari M PMU PPSP

46 Haryanto M Pundi Amal

47 Zikra M PUPR Dit.PSPAM

48 Miko Rahayu W F SAIIG-KIAT

49 Arti Indallah F SNV

50 Athina Triyananda F SNV

51 Elzafira Felaza F SNV

52 Gabrielle Halcrow F SNV

53 Iffah F SNV

54 Retno Ika Praesty F SNV

55 Saniya Niska F SNV

56 I Nyoman Suartana M SNV

57 Kamelia Jedo F SPEAK

58 Wiwit Heris F SPEAK

59 Filla Sofia F SPEAK Indonesia

60 Haryanty Swasni Salamba F Staf seksi Kesling & Kesjoar

61 Aida Fitria F Staf Seksi Kesling Kota Ternate

62 Risang Rimbawan M STTA

63 Aiden M UNICEF

64 Mitsunori Odagiri M UNICEF

65 Alive Ardhiani F UNICEF

66 Helena Siagian F Unilever

67 Ratu Mirah A F Unilever

68 Rossa F UPTD PALD

69 Ade Andriansyah M UPTD PALD

70 Samin Baharudin M UPTD PALD

71 Satam S M UPTD PALD

72 Suhandi M UPTD PALD

73 Endah Shofiani F USAID

74 Arina Priyanka F USDP

75 Hony Irawan M USDP

76 Musfarayani F Water.org

77 Reny Yuniawati F Water.org

78 Itsnaeni Abbas F WHO

79 Agustin F YPCII

80 Lydia Francisca F YPCII

81 Danny Setiawan, SKM., M. Kes M

82 Dwi Angkasa Wasis M



63

USAID IUWASH PLUS Participants


1 Mohamad Yagi M Regional Manager NSRO

2 Ricky Pasha Barus M BC/M Specialist NSRO

3 Elia Wati F BC/M Associate NSRO

4 Dwi Anggraheni Hermawati ,

SE.

F BC/M Specialist CJRO

5 Edy Triyanto, Drs. M BC/M Associate CJRO

6 Laksmi Cahyaniwati, Ir. F Regional Manager EJRO

7 Ratih Astati Dewi F BC/M Specialist EJRO

8 Manoak Rejauw M BC/M Associate SSEI

9 Shofyan Ardiansyah M BC/M Associate SSEI

10 Johanis Valentino Fofied M BC/M Specialist SSEI

11 Lidiastuty Anwar F BC/M Associate SSEI

12 Achmad Dardiri M BC/M Associate EJRO

13 Mashuri Mashar M BC/M Associate SSEI

14 Ika Francisca F Behavior Change and Marketing Advisor

15 Agustinus Tuauni M BC/Marketing Associate -WJDT

16 Usniati Umaya F BC/Marketing Specialist-WJDT

17 Louis O'Brien M Chief of Party

18 Alifah Lestari F Deputy Chief of Party for Programs

19 Lina Damayanti F Advocacy and Communication Advisor

20 Menuk Primawati F Adminisrative Associate

21 Meitiawati F Adminisrative Associate

22 Noviana Eva F Product Marketing Specialist

23 Pryatin Santoso M IEC/Communication Specialist

24 Deasy Sekar Tanjung F Citizen Engagement Mechanism (CEM)

Specialist 25 Febriant Abby Marcel M BC/Social Mobilization Specialist

26 Santi DS F Adminisrative Associate

27 Dwi Angkasa Wasir M WASH Finance Specialist -EJRO

28 Pritta Basuki F National Coordinator Micro Finance

29 Asep Maman M Senior Raw Water Specialist

30 Garry Adam M Jr Environment Staff for National Pokja

AMPL Secretariat



Mayapada Tower I, 10th Fl

Jl. Jend. Sudirman Kav. 28

Jakarta 12920

Indonesia

Tel. +62-21 522 - 0540

Fax. +62-21 522 – 0539

@airsanitasi

facebook.com/iuwashplus

www.iuwashplus.or.id

Documents

Behavior Change Strategy - pdf.usaid.gov