Results, impacts, and learning from improving sanitation at scale in East Java, Indonesia

Inadequate access to sanitation remains a persistent issue, affecting the lives of millions of children and families especially in poor and rural communities throughout the world. In Indonesia, efforts to expand coverage have barely affected the lives of poorest populations where rampant diarrheal disease continues to affect the health and well-being of the next generation of children. These efforts were further complicated by policies that provided sanitation hardware subsidies limited to populations identified under specific programs, rather than strategies aimed at promoting large-scale sustained behavior change such as awareness building and hygiene education. As a result, Indonesia has the second highest number of open defecators worldwide at 59 million, according to the 2013 update published by the WHO/UNICEF Joint Monitoring Program (JMP), and lags substantially behind its peers in the region in terms of access to sanitation. This field note presents the achievements, learning and reflections that resulted from implementing a large-scale sanitation program in East Java, Indonesia and provides recommendations for future initiatives aimed at increasing access to improved sanitation globally.