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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE
PENYEHATAN LINGKUNGAN UNTUK SEMUA (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
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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.
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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
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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
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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
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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.
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE COMMUNICATION STRATEGY
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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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE STRATEGY
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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.
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE COMMUNICATION STRATEGY
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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);
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE STRATEGY
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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.
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
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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).
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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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
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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.
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• 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.
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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.
Primary: Male and female household 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 with limited
sanitation facilities.
3 Timely use by households of safely
managed desludging services
Primary: Male and female household decision makers and
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).
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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
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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%.
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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.
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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.
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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
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BEHAVIOR CHANGE COMMUNICATION STRATEGY
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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
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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.
Psychosocial “Software”
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.”
Product/Technology “Hardware”
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.
Communication Objectives
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
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• will believe that upgrading to an improved latrine is a way to show that they are good
neighbors (values).
Theory of Change Concept
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
good neighbor” –
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
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
Increased access to
basic sanitation
services
Intervention Implementation Outputs Outcome Impact
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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.
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 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.
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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.
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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.
Topline findings from Formative Research
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.
Psychosocial “Software”
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.
Product/Technology “Hardware”
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.
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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.
Communication Objectives
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.
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BEHAVIOR CHANGE STRATEGY
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Exhibit 11: Theory of Change for timely safe desludging
Potential Inputs of an
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
good neighbor” –
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.
Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs
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
visits, social media
Sanitation facilities
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
Intervention Implementation Outputs Outcome Impact
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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.
Topline findings from Formative Research
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
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social activities at the community level, especially those related to health promotion (Annex
A).
Psychosocial “Software”
• 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).
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• 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
Intervention Implementation Outputs Outcome Impact
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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
Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs
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.
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Topline findings from Formative Research
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.
Communication Objectives
After the campaign, male and female carers of children under three within urban B40 households will
have
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• 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.
Theory of Change Concept
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.
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Exhibit 13: Theory of Change process for safe disposal of child feces
Potential Inputs of an
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.
Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs
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
Intervention Implementation Outputs Outcome Impact
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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.
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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.
Communication Objectives
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.
Theory of Change Concept
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
Intervention Implementation Outputs Outcome Impact
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Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs
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.
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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.
Topline findings from Formative Research
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.
Psychosocial “Software”
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.
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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.
Communication Objectives
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
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• Believe that connecting to piped water services (when available) is convenient, affordable and
easy to do.
Theory of Change Concept
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
Intervention Implementation Outputs Outcome Impact
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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.
Key points for alignment with wider USAID IUWASH PLUS activities, GOI programs
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.
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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”
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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.
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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.
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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
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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
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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
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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.
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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/
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Behaviors to Design Effective Handwashing Programs, World Bank Water and Sanitation
Programme,
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Cronin, A, Sebayang, SK, Torlesse, H and Nandy R (2016). Association of Safe Disposal of Child
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USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
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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
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Programs.pdf
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Schmied, P (2017). Behavior Change Toolkit for International Development, developed for People in
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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
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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
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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
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Context Psychosocial “Software” Product / Technology “Hardware”
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.
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Priority Behavior 2 Upgrading
Context Psychosocial “Software” Product / Technology “Hardware”
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
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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.
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Contextual Psychosocial “Software” Product / Technology “Hardware”
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.
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Priority Behavior 4 Handwashing with soap at the critical junctures
Contextual Psychosocial “Software” Product / Technology “Hardware”
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.
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Priority Behavior 5 Safe disposal of feces of children under 3
Context Psychosocial “Software” Product / Technology “Hardware”
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)
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Priority Behavior 6 Household connections to piped water services
Context Psychosocial “Software” Product / Technology “Hardware”
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.
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Priority Behavior 7 Safe treatment and storage of household drinking water.
Context Psychosocial “Software” Product / Technology “Hardware”
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.
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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
# 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
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
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Behavioral level
outcome indicators
Communication objective
outcomes Outreach objectives
Mean of
verifications
• that believe that upgrading to
an improved latrine is a way
to show that they are good
neighbors (values).
# SMEs marketing
services that include
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.
# 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
# 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
targeted counselling
sessions
# HH/carers
participating in Trials of
improved practices for
HWWS per region.
# Promotional activities
(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
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Behavioral level
outcome indicators
Communication objective
outcomes Outreach objectives
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
targeted counselling
sessions
# Promotional activities
(et community,
religious, routine
meetings) that have
included messaging.
# Carers, # adults
(M/F) reached through
promotional activities
# SMEs providing
services that include
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
targeted counselling
sessions to HHs
without connections to
piped water services
# Promotional activities
(et community,
religious, routine
meetings) that have
integrated messaging.
# adults (M/F) reached
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
targeted counselling
sessions to HHs
without connections to
piped water services
# Promotional activities
(et community,
religious, routine
meetings) that have
included messaging.
# adults (M/F) reached
through promotional
activities.
Project level
participatory
baseline and end-
line
Project-level
monitoring systems
– HH forms,
community action
plan forms
Records of service
providers.
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BEHAVIOR CHANGE STRATEGY
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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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE COMMUNICATION STRATEGY
62
NO. Name M/F Organisation
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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
BEHAVIOR CHANGE STRATEGY
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USAID IUWASH PLUS Participants
NO. Name M/F Organisation
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
USAID INDONESIA URBAN WATER, SANITATION AND HYGIENE
PENYEHATAN LINGKUNGAN UNTUK SEMUA (USAID IUWASH PLUS)
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