“I HAVEN’T tried it yet because we only finished installing it yesterday and (the cement) is still wet,” 65-year-old Jumali told the Jakarta Globe earlier this year. Mr Jumali, a farmer who lives in the village of Jombe in South Sulawesi, was talking about the latest addition to his home – a toilet.

Sanitation is a major problem in Indonesia. A study carried out last year by Unicef suggested that 26 per cent of Indonesians still urinate and defecate openly in fields, gardens, rivers and even on the roadside. Mr Jumali was one of many villagers to install toilets in their homes in June after the government responded to public apathy by stepping up public awareness programmes.

But many Indonesians living in rural areas prefer to install satellite dishes rather than toilets.

Together with the lack of access to safe drinking water, this results in the deaths of almost 151,000 children under the age of five every year from diarrhoeal disease, according to a 2010 World Bank report. The bank put the economic loss at US$5.6 billion (S$6.9 billion).

The problem is not confined to the generally poorer and less developed outer islands. According to Public Works Minister Djoko Kirmanto, 76 per cent of the rivers in Indonesia’s most populated islands of Java, Sumatra and Bali are contaminated with ammonium, a substance originating from urine and excrement.

The Banyumas regency in Central Java, in particular, is known for its poor sanitation facilities. Local health agency data shows that in 2010 alone, there were more than 33,000 known diarrhoea cases, 651 dengue fever cases and 42 malaria cases in a population of around 1.8 million people.

Beginning in 1970, the Indonesian authorities attempted to address this problem by building communal toilets. But as Mr Eka Setiawan of Plan Indonesia explained when I met him in Jakarta last month, the impact was limited. “Many villagers continued to use local rivers and fields because they felt more comfortable there,” he said. As a result, mortality rates remained high. Plan Indonesia is part of Plan International, a British-based international development organisation.

Since 2008, both government and non-government agencies have changed their approach. The focus is no longer on building toilets but rather on changing community attitudes.

Community-based Total Sanitation (CBTS) programmes now involve the use of volunteers trained by the Ministry of Health. These facilitators attempt to convince villagers of the need for toilets by placing emphasis on the unpleasant odour and appealing to their sense of personal dignity.

According to Mr Setiawan, a CBTS facilitator typically begins by calling the villagers to a meeting. During the discussion, he holds up a glass of water, inserts a small amount of human excrement and calls for a volunteer to drink the mixture. “Their reluctance to drink provides the opportunity for the facilitator to explain the health risks involved,” said Mr Setiawan.

The aim of the meeting, of course, is to get the villagers themselves to not only appreciate the importance of proper sanitation but also to become involved in the construction of their own sanitation facilities.

Much remains to be done in other areas of hygiene management as well. Public sanitation facilities at bus stations and entertainment spots across the nation, for example, are not always well maintained.

Other research has revealed that only 33 per cent of Indonesians wash their hands before a meal and only 50 per cent do so after defecating. Mr Setiawan also pointed out that while nearly all Indonesians boil their water before drinking it, traces of E. coli bacteria can still be found in about half of all drinking water containers as a result of other unhygienic practices.

E. coli, a bacterium in human intestines that helps the body break down and digest food, can be very dangerous if ingested directly. The germ is often present on fresh vegetables and fruit, sometimes as a result of being washed with contaminated water. Meat sold at traditional markets has also been found to contain the bacteria.

Cultural myths need to be tackled too. CBTS field observations show that in some areas, mothers believe that diarrhoea is caused by changing weather patterns rather than germs on their hands. Some apparently even believe that a child with diarrhoea will be smarter and that the faeces of babies are not dangerous.

The government hopes to declare the archipelago free of open defecation by 2015. With health ministry data showing that 42 million people in the country still defecated in the open in 2010, this may seem like a difficult target to achieve. But it is a marked improvement from 2007, when 71 million people did so.
Mr Jumali has taken a step in the right direction. Hopefully, many others will soon follow.

(C) Singapore Press Holdings Limited