IssueBriefs

UNICEF INDONESIA

OCTOBER 2012

Water, sanitation & hygiene

Critical issues

oor sanitation and hygiene practices and

unsafe water contribute to 88 per cent of
deaths from diarrhoea amongst young
children worldwide. In those who survive, frequent
diarrhoea episodes contribute to malnutrition, which
prevents the child from reaching his or her full
potential. This, in turn, has serious implications for
the quality of human capital and the future earning
capability of a nation.
In Indonesia, diarrhoea is still a major cause of
death amongst children under the age of five.
Riskesdas 2007 reports diarrhoea as the cause of 31
per cent of deaths between the ages of 1 month to
a year, and 25 per cent of deaths between the ages
of one to four years old. Compared to children from
households using piped water, diarrhoea rates are
higher by 34 per cent amongst young children from
households using an open well for drinking water.
Moreover, diarrhoea rates are higher by 66 per cent
in young children from families practising open
defecation in rivers or streams than those in
households with a private toilet facility and
septic tank.
The important role of hygiene is often neglected.
Diarrhoea-related deaths and illnesses are largely
preventable. Even without improvements in water and
sanitation systems, proper hand washing with soap
can reduce the risk of diarrhoeal diseases by 42 to
47 per cent.
The situation of the urban poor requires urgent
attention. In urban slum areas, inadequate sanitation,
poor hygiene practices, overcrowding and
contaminated water converge to create unhealthy

unite for children

conditions. The associated diseases include

dysentery, cholera and other diarrheal diseases,
typhoid, hepatitis, typhus, leptospirosis, malaria,
dengue, scabies, chronic respiratory diseases and
intestinal parasitic infections. Moreover, poorer
families who are less educated tend to have poor
hygiene practices, which contribute to spreading disease and increasing the child mortality risk.
A study of mega-urban Jakarta (called Jabotabek1),
Bandung and Surabaya in 2000 showed that the poor
living in Jakartas peri-urban areas are less educated
than other Jakartans, having high school completion
rates that are only one-fourth of those in the city
centre. The same study calculated child mortality
rates up to five times higher in Jabotabeks poor
peri-urban subdistricts than in Jakarta city centre.

Patterns and trends

n earlier decades, Indonesia made significant

progress in increasing access to safe water
supply and sanitation services. The water and
sanitation targets of the seventh Millennium
Development Goal (MDG) are to halve by 2015 the
proportion of households without sustainable
access to safe drinking water and basic sanitation.
For Indonesia, this means achieving access rates of
68.9 and 62.4 per cent, respectively, for safe water
and sanitation.
Indonesia is currently not on track to achieve the
2015 MDG target in safe water. Calculations using
1

The urban area surrounding Jakarta; includes Bekasi; and

Bogor and Depok in West Java Province; Tangerang and South
Tangerang in Banten Province.

ISSUE BRIEFS

OCTOBER 2012

rief: Water, sanitation & hygiene

d unsafe
from
wide. In
des
e child
n turn,
man
nation.

use of
five.
use of 31
nth to a
ages of
rom
es are
n from
water.
per cent
en

Indonesias national MDG criteria for safe water and

data
from the 2010
census
show that Indonesia needs
Patterns
and
trends
to reach an additional 56.8 million people with safe
In earlier
decades,
madeifsignificant
water
supply
by 2015.Indonesia
Alternatively,
the criteria
progress
in
increasing
access
to
safe
water
of the WHO-UNICEF Joint Monitoring Programme
supply and sanitation
services.
The
water
and
2 were to be used, Indonesia
(JMP)
for safe
water
sanitation
targets
of the
seventh Millennium
would
need to Goal
reach(MDG)
an additional
36.3by
million
people
Development
are to halve
2015 the
of households
without
sustainable access
byproportion
2015. Currently,
even in
the better-performing
to safe drinking
water
basic
sanitation. Foraround
provinces
(Central
Javaand
and
DI Yogyakarta),
Indonesia, this means achieving access rates of 68.9
one
in three households lacks access to safe water
and 62.4 per cent, respectively, for safe water and
supply
(Figure 1).
sanitation.

glected.
argely
water and
h soap
y 42 to 47

urgent

ding and
althy

ses,
aria,
s and
er
poor
ding
k. A
abek 1),
the poor
educated
mpletion
city
tality
oor peri-

and Bogor
and South

Quintile 4

Quintile 3

2010
Quintile 2

2007

Urban

Figure 2. Percentage of
households with
access to safe water,
by rural/urban and
wealth quintile, 2007 &
2010. Source: Riskesdas

Rural

2007 and 2010

Indonesia
0%

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Comparison with 2007 shows safe water access

Figure 1.
Percentage of
households with
access to
improved water
sources, by
province. Source:
Riskesdas 2010.
JMP criteria,
bottled water not
included.

0%

20%

40%

60%

80%

100%

Indonesia iswith
currently
on track
to achieve
thein
Comparison
2007 not
shows
safe water
access
2015
MDG
target
in
safe
water.
Calculations
using
2010 has declined by about seven per cent. This
Indonesias national MDG criteria for safe water and
reversal
is largely
to a decline
inIndonesia
urban areas (by
data from
the 2010due
census
show that
23
per cent
of 2007
levels, Figure
2). Access
towith
safe
needs
to reach
an additional
56.8 million
people
safe water
supply
bydecreased
2015. Alternatively,
thecent
criteria
water
in Jakarta
has
from 63 ifper
in
of
the
WHO-UNICEF
Joint
Monitoring
Programme
2010 to 28 per cent in 2007, according to Riskesdas.
2 were to be used, Indonesia
(JMP) for safe
water
Surprisingly,
the
two highest
wealth quintiles have
would need to reach an additional 36.3 million people
also
seen Currently,
a decline even
in safe
access by 8 and 32
by 2015.
in water
the better-performing
per
cent
respectively
compared
to
2007. Those
who
provinces (Central Java and DI Yogyakarta),
around
oneafford
in three
households
lacks
safe water
can
it buy
packaged
or access
bottledtodrinking
water:
supply (Figure
1). households in Indonesia did so
one-third
the urban
in 2010.

Since 1993, Indonesia has doubled the percentage

of households having access to improved sanitation
facilities, but it is still not on track to achieve the
2 JMP criteria do not specify the distance between the water
2015
MDG sanitation target. To achieve the national
supply and excreta disposal site and are therefore less rigorous.
MDG target in sanitation will require reaching an 1
additional 26 million people with improved sanitation
2

Quintile 5
(highest wealth)

Quintile 1
(lowest wealth)

DKI Jakarta
Bangka Belitung
Papua
Central Kalimantan
Riau Islands
West Kalimantan
Banten
South Sumatra
East Nusa Tenggara
Aceh
Jambi
East Kalimantan
North Sulawesi
West Papua
Riau
South Kalimantan
Maluku
South Sulawesi
West Sumatra
Bali
West Sulawesi
North Sumatra
West Java
Central Sulawesi
Bengkulu
Lampung
Southeast Sulawesi
East Java
West Nusa Tenggara
North Maluku
Gorontalo
DI Yogyakarta
Central Java

eptic

by 2015. Planning for the longer term requires

dealing with even larger numbers: Riskesdas 2010
data show that overall, some 116 million people still
lack adequate sanitation.

in 2010
has declined
by about
cent.
Open
defecation
is a health
andseven
socialper
issue
that
This
reversal
is
largely
due
to
a
decline
in
urban
needs urgent attention. Some 17 per cent of
areas (by 23 per cent of 2007 levels, Figure 2).
households in 2010 or about 41 million people still
Access to safe water in Jakarta has decreased from
defecate
in the
open.toThis
includes
one63 per cent
in 2010
28 per
cent in more
2007, than
according
third
of the population
in Gorontalo,
Westwealth
Sulawesi,
to Riskesdas.
Surprisingly,
the two highest
quintiles
have also
seenNusa
a decline
in safe
water
Central
Sulawesi,
West
Tenggara
and
West
access
by
8
and
32
per
cent
respectively
compared
Kalimantan. The practice is even found in provinces
to 2007. Those who can afford it buy packaged or
with
relatively
sanitation
bottled
drinkinghigh
water:
one-thirdcoverage,
the urbanand amongst
the
urban
population
and
across
wealth quintiles
households in Indonesia did so in all
2010.
(Figures 3 and 4).

East Nusa Teng

Goron
Central Kalima
West Sula
Pa
West Nusa Teng
West Pa
West Sum
Southeast Sula
Central Sula
West Kalima
Lamp
North Ma
South Sum
Ma
South Kalima
Ja
A
East
INDONE
West

Bangka Beli
Beng
South Sula
Central
North Sum
Ba
North Sula
East Kalima

DI Yogyak
Riau Isla
DKI Jak

Since 1993, Indonesia has doubled the

percentage of households having access to
Sanitation
coverage amongst different groups
improved sanitation facilities, but it is still not on
shows
much
stronger
disparities
than thattarget.
for water
track to achieve
the 2015
MDG sanitation
(Figure
4). The
of target
urbaninhouseholds
To achieve
the proportion
national MDG
sanitation will
requireaccess
reaching
an additional
26 million
people with
having
to improved
sanitation
facilities
is
improved
sanitation
by
2015.
Planning
for
the
longer
nearly twice that of rural households. The proportion
term requires dealing with even larger numbers:
ofRiskesdas
households
served
improved
sanitation
2010
databy
show
that overall,
some facilities
116
inmillion
the highest
is sanitation.
2.6 times that in the
peoplewealth
still lackquintile
adequate

lowest wealth quintile. Geographic disparities are

Open
defecation
is aof
health
social issue
that
also
marked.
The rate
accessand
to improved
sanitation
needs urgent attention. Some 17 per cent of
in the best performing province (69.8 per cent,
households in 2010 or about 41 million people still
DKI
Jakarta)
is three
higher than
the
defecate
in the
open. times
This includes
more that
thanin
oneworst
performing
province
(22.
4
per
cent,
East
Nusa
third of the population in Gorontalo, West Sulawesi,
Central Sulawesi, West Nusa Tenggara and West
Tenggara).
Kalimantan. The practice is even found in provinces
with relatively high sanitation coverage, and amongst
Faecal
contamination of soil and water is common
the urban population and across all wealth quintiles
in(Figures
urban areas,
due to overcrowding, insanitary
3 and 4).

toilets and the release of raw sewage into the open

Sanitation coverage amongst different groups

shows much stronger disparities than that for
2 JMP criteria do not specify the distance between the water
water (Figure 4). The proportion of urban households
supply
and
excretatodisposal
sitesanitation
and are therefore
less
having
access
improved
facilities
is rigorous
nearly twice that of rural households. The proportion
of households served by improved sanitation facilities
in the highest wealth quintile is 2.6 times that in the
lowest wealth quintile. Geographic disparities are also
marked. The rate of access to improved sanitation in

Jakarta) is
performing
Tenggara)

Faecal co
common
insanitary
into the o
proportion
or spring f
within 10 m
In Jakarta,
(BPLHD) r
by househ
septic tank
leak sewa

OCTOBER 2012

D
2010
2007

. Percentage of
olds with
to safe water,
/urban and
quintile, 2007 &

urce: Riskesdas
2010

% 100%

r access
r cent.
urban
e 2).
ased from
according
wealth
water
ompared
aged or

ISSUE BRIEFS

East Nusa Tenggara

Gorontalo
Central Kalimantan
West Sulawesi
Papua
West Nusa Tenggara
West Papua
West Sumatra
Southeast Sulawesi
Central Sulawesi
West Kalimantan
Lampung
North Maluku
South Sumatra
Maluku
South Kalimantan
Jambi
Aceh
East Java
INDONESIA
West Java
Riau
Bangka Belitung
Bengkulu
South Sulawesi
Central Java
North Sumatra
Banten
North Sulawesi
East Kalimantan
Bali
DI Yogyakarta
Riau Islands
DKI Jakarta

Improved
sanitation facilities

Shared/
unimproved
sanitation facilities

Open defecation

Figure 3.
Percentage of
households
using different
means of excreta
disposal, by
province. Source:
Riskesdas 2010,
using JMP
criteria for
improved
sanitation.

0%

20%

40%

60%

80%

groups
hat for
households
ies is
proportion
on facilities
at in the
es are also
nitation in
t, DKI

Compared to the rich, the urban poor pay a larger

proportion of their income for water that is of
poorer quality. For example, Jakartas municipal
piped system covers only a small proportion of its
population, as service expansion cannot keep pace
with the burgeoning population in urban areas. The
rest of the population rely on a variety of sources,
including shallow wells, water vendors and private
networks connected to deep wells. Many of these
alternative sources cost more per unit volume than
piped water supply and are often used by the poor.

Barriers

ore investment is needed in the water

and sanitation sector. The government
investment in the sector is less than one per
cent of GDP. The government is making efforts to
address the issue. Following the initiation of PPSP (the
National Sanitation Acceleration Programme) in 2010,
the sanitation budget allocation by local governments
increased in 2011 by 4 to 7 per cent.

100%

Different ministries and agencies involved in the

water and sanitation sectors need stronger
coordination. For example, contractors who build
rural water systems are answerable to government
agencies, rather than to the users of services.
Responsibilities for maintenance are unclear and
community management structures are weak. In
recent years, the coordination has improved with the
establishment of working groups called Pokja AMPL
at national, provincial and district levels on drinking
water and environmental sanitation.

s to
ill not on
n target.
tation will
eople with
he longer
bers:
me 116
.

ssue that
t of
ople still
han oneSulawesi,
d West
provinces
d amongst
quintiles

is a particular problem where consumers use suction

pumps to obtain water from the city system.

Jakarta)
is three times
higher thanproportion
that in the worst
without
treatment.
A significant
of all
performing province (22.4 per cent, East Nusa
urban
households
using
a
pump,
well
or
spring
for
Tenggara).

their water supply have these sources within 10

Faecal
soil and
water is
metres
of contamination
a septic tank oroftoilet
discharge.
In Jakarta,
common
in
urban
areas,
due
to
overcrowding,
the Jakarta Environmental Agency (BPLHD) reports
insanitary toilets and the release of raw sewage
that 41 per cent of dug wells used by households
into the open without treatment. A significant
areproportion
less than of
10allmetres
the septic
Septic
urban from
households
usingtank.
a pump,
well
tanks
are seldom
out and
leak
sewage
into
or spring
for theirpumped
water supply
have
these
sources
10 metres
of and
a septic
tank or toilet
thewithin
surrounding
soil
groundwater.
A discharge.
2007 World
In
Jakarta,
the
Jakarta
Environmental
Agency
Bank report mentions that only 1.3 per cent of the
(BPLHD) reports that 41 per cent of dug wells used
population
is connected
a sewerage
by households
are less to
than
10 metres system.
from thePiped
systems
are
prone
to
contamination
due
to leaks
and
septic tank. Septic tanks are seldom pumped
out and
leak sewage
intocreated
the surrounding
soil andsupply. This
negative
pressure
by intermittent
groundwater. A 2007 World Bank report mentions

Following decentralization, many district governments

are constrained by a lack of sector expertise and
institutional capacity. Remote districts find it difficult
to recruit skilled personnel, who generally prefer to live
and work in urban areas.
Communities need to improve their hygiene
awareness and practices. The hygiene situation is
often poor in health centres and other public places,
such as local markets and among street food vendors.
A survey of six provinces, conducted by the
University of Indonesia in 2005 for USAID, found
that less than 15 per cent of mothers reported
washing their hands with soap after defecation,
3

ISSUE BRIEFS

OCTOBER 2012

before preparing food, before feeding their

child, before eating, or before cleaning the
childs bottom.

are being developed but progress is slow. Facilities,

equipment and transport for solid waste management
remain limited.

Field visits indicate the need to improve school

hygiene, water and sanitation, but robust data are
lacking in this respect. Data from the Ministry of
Education and Culture indicate that 77 per cent of
junior secondary schools are equipped with safe
water supply from pipes or tube wells, meaning
that over 10,000 junior secondary schools are
without such facilities. Extrapolating the proportion
to all of Indonesias 234,711 primary and secondary
schools (2009) indicates the scale of action required.
More than 50,000 schools are likely to need safe
water supply.

Opportunities for action

Urban water utilities are poorly governed and

generally small in coverage. Of the 402 local
government-owned water utilities (PDAM), which
serve mostly urban areas, only 31 had more than
50,000 connections in 2009. The smaller than
optimal size leads to high operating costs. In 2010,
the levels of unaccounted-for-water were between
38-40 per cent and only 30 PDAMs were able to recover full operating and maintenance costs.
PDAMs divert a significant proportion of revenue
as much as an estimated 40 per cent to the district
government with little accountability, and have little
or no funds left for operations and maintenance.
Not surprisingly, urban water supply systems are
generally in a state of neglect and deterioration.
Some PDAMs have entered into Public-Public Partnerships, but the complexities of negotiations
between the central, provincial and district
governments have caused cancellations and delays.
Urban sewerage and wastewater systems are
generally under-developed and poorly managed.
A World Bank study estimates that each year,
households without proper sanitation facilities in
Jakarta and across Indonesia release respectively
260,731 tons and 6.4 million tons of human faeces
into water bodies without treatment.
Arrangements for urban solid waste management
are piecemeal and unregulated. The agency officially
in charge of the sector contracts with small private
entrepreneurs who collect and bring the waste from
households to temporary storage facilities for onward
transport by the agency. Neighbourhoods pay for
these services through the local collectors. Landfills
4

he National Policy for Community-Based

Water Supply and Environmental Sanitation
provides an enabling framework. The policy
makes good use of lessons learned in the water and
sanitation sector in Indonesia and other countries.
It follows sound principles of demand-responsive,
community-based approaches, emphasizing the
need for womens involvement, and it focuses on the
principles of sustainable operation, maintenance and
cost-recovery.
The National Programme of Community-Based
Total Sanitation (STBM) and its five pillars form
a useful framework. The five pillars are the
elimination of open defecation, hand washing with
soap, household water treatment, solid waste
management and liquid waste management. The
leadership of the Ministry of Health is crucial in
scaling up STBM. Districts and provinces will
need to accelerate efforts, keeping to national
standards and guidelines. The poorest groups
will need to have access to financing in order to
initiate STBM.
STBM needs social marketing approaches that
mobilize large numbers of people and scale up the
supply of and demand for improved sanitation
facilities. Revitalizing school water and sanitation
around health and social themes offers several
opportunities. Students could become change
agents in their communities for STBM and good
health and hygiene practices, which should include
point-of-use water treatment, appropriate water
storage, diarrhoea reduction, and the prevention of
dengue and malaria. Advocacy that makes the links
with nutrition, early childhood development and
education performance would be more powerful
than messages on preventive health alone. Studies
elsewhere suggest the persuasiveness of social
reasons, such as the desire to feel and smell clean
and follow social norms, and the use of soap as
a desirable consumer product.
Data systems need to be strengthened.
The Government has expressed an interest in
developing a National Schools STBM programme.

OCTOBER 2012
This will require better data collection and
monitoring systems than currently exist for school
water and sanitation. In addition, systems for water
quality testing and reporting need to be strengthened
and the data made public.

The involvement of both local government and

private sector is essential for improving urban and
peri-urban systems.
For urban areas, innovative technologies in
sanitation and water provision need to be explored.
Urban sanitation and sewerage systems present the
greater challenge, since standard sanitation
technologies may not work due to overcrowding,
lack of space, and the proximity of water sources.
In water supply, decentralized technologies and
approaches, such as point-of-use water treatment,
would be much more effective than centralized
systems, due to the range of disparate sources and
multiple providers.
Strengthening PDAMs governance and capacity
will require the review of various roles, institutional
processes and accountabilities, especially of
PDAM heads. The central level should establish
minimum standards of performance for PDAMs,
with monitoring, enforcement and incentive
mechanisms.
District agencies need convergent planning and
targeting to make rural systems more sustainable.
In their planning processes, the different district level
agencies (public works, rural empowerment, district
health office and the district planning office) should
target the same communities, so that community
mobilization and training takes place in the same
communities where the infrastructure is built. This
would optimize community participation in planning,
construction and management of water supply and
sanitation services.
Increasingly, the sustainability and continuity of
water supply demand attention. One in ten
households already suffers from irregular water
supply, especially in the dry season. Optimizing
water quality, quantity and sustainability will require
water resource management involving a broad array
of stakeholders. The government has initiated policy
discussions on Water Safety Plans, which are aimed
at ensuring the quality, quantity, continuity and
affordability of water services.

ISSUE BRIEFS

Resources
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Conference of the Australian Population Association,
15-17 September 2004, Canberra.
Bakker, K. and Kooy, M. (2010): Citizens without
a City: The Techno-Politics of Urban Water Governance,
Chapter 5 in Beyond Privatization: Governance failure
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Cornell University Press.
Bappenas (2010): Peta Jalan Percepatan Pencapaian
Tujuan Pembangunan Milenium di Indonesia
(Roadmap for Acceleration of MDG Achievement in
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BPPSPAM (2010): Performance Evaluation of PDAMs
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BPS-Statistics Indonesia and Macro International
(2008): Indonesia Demographic and Health Survey
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Crompton, D.W.T. and Savioli, L. (1993). Intestinal
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Haller, L. and Colford Jr, J.M. (2005): Water, sanitation, and hygiene interventions to reduce diarrhoea
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meta-analysis Lancet Infect Dis 2005; 5: 4252
5

ISSUE BRIEFS

Jakarta Environmental Agency (BPLHD) (2012):

Neraca Lingkungan Hidup Provinsi DKI Jakarta 2011.
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Daerah (BPLHD)
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Indonesia (Indonesian Water Supply Association)

OCTOBER 2012

University of Indonesia Center for Health Research

(2006): Survei rumah tangga pelayanan kesehatan
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Victora, C.G., Adair, L., Fall, C., Hallal, P.C.,
Martorell, R., Richter, L. and Sachdev, H.S. (2008):
Maternal and child undernutrition: consequences
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Child Undernutrition 2, Lancet 371: 340-357
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Cambodia, Indonesia, Lao PDR, the Philippines, and
Vietnam under the Economics of Sanitation Initiative
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Unger, A. and Riley, L.W. (2007) Slum health: From

understanding to action. PLoS Med 4(10): e295.
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This is one of a series of Issue Briefs developed by UNICEF Indonesia. For more information, contact jakarta@unicef.org or go to www.unicef.or.id