12 - Sanitation and Health: The Past, the Future and Working Out What Works

Summary

Of the four most important causes of mortality among children under five years old in Indonesia, two (diarrhoea and typhoid) are faecal-borne illnesses directly linked to inadequate water supply, sanitation and hygiene (Ministry of Health 2002). It has been estimated that about 11 per cent of Indonesian children have diarrhoea in any two-week period, and that in excess of 33,000 children die each year from diarrhoea, and 11,000 from typhoid (Curtis 2004). Apart from the effect on health, inadequate sanitation is associated with significant economic losses. These losses accrue from households having to purchase expensive drinking water and from the time spent collecting safe water (often by women and children). Napitupulu and Hutton (2008) estimated the economic losses from inadequate sanitation, poor hygiene practices and lack of access to safe water at over 2.4 per cent of GDP, amounting to approximately $6.3 billion. Women also often do not feel safe defecating in the open.

This chapter seeks to document the current sanitation situation in Indonesia and the extent to which it has improved over the last 16 years. Much remains to be done. On current estimates, Indonesia is unlikely to reach its Millennium Development Goal of halving the number of people without access to sanitation by 2015 (Napitupulu and Hutton 2008). Below, we provide a potted history of past and current policy attempts to improve sanitation in Indonesia. We discuss the state of knowledge with regard to the relationship between health and sanitation, while noting that empirical evidence on the health impacts of sanitation infrastructure in developing countries – including Indonesia – is scarce.2 Based on the data that are available, and our own work in East Java, we provide naive estimates of the relationship for Indonesia today. We then go on to discuss how understanding of the relationship between sanitation and health could be improved further, in particular through randomised program evaluations.

SANITATION IN INDONESIA

Table 12.1 presents information on the sanitation situation in Indonesia by province. The data are drawn from the 1993 and 2009 National Socio- Economic Surveys (Survei Sosio-Ekonomi Nasional, or Susenas). They show that approximately 23 per cent of households did not have access to a toilet in 2009.