The effects of the Total Sanitation and Sanitation Marketing programme on gender and ethnic groups in Indonesia
The Total Sanitation and Sanitation Marketing (TSSM) programme launched in the province of East Java, Indonesia in 2007. The TSSM promoted collective behaviour change moving from open defecation to more hygienic practices. This paper expands the analysis of a previous rigorous impact evaluation based on a cluster randomized controlled trial by studying programme differential impacts by female-headed households and three main ethnic groups. Because previous TSSM impacts found were relatively small, this led to small improvement in morbidity and child growth effects among poor households. This study examines two subgroups within the sample, female-headed households and ethnic populations (GEG), to explore whether the effects can be identified for both of these subgroups. The paper shows that female-headed TSSM households experienced a reduction of 5.8 per cent in diarrhoea prevalence of children under 5 years old. Ethnicities benefited differently from the programme: the Javanese ethnicity experienced no improvements in outcomes while the Madurese ethnic group showed significant improvements of one-sixth of one standard deviation (8.6 cm) of height-for-age in children (1.43 cm average) and one-fifth of a standard deviation (3.7 cm) increase in head circumference. Other ethnic groups showed a 20.6 per cent reduction in open defecation compared to non-exposed households. Because sanitation campaigns reach households and the intra-household responsibilities for sanitation practices depend partly on culture and social norms, certain components of TSSM can be mainstreamed to achieve behaviour change effectively towards gender and ethnic groups.Amin, S., Rangarajan, A. and Borkum, E. (2011) Improving Sanitation at Scale: Lessons from TSSM Implementation in East Java, Indonesia, Reference Number 06781.500, Princeton, NJ: Mathematica Policy Research.
Bevan, J. and Thomas, A. (2009) ‘Community approaches to total sanitation : triggering and sustaining sanitation behaviour change in West Africa’, paper presented at West Africa Regional Sanitation and Hygiene Symposium, Accra, Ghana.
Bongartz, P. (2008) ‘Community-led total sanitation’, Global Future 1: 19 <www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf≯ [accessed 20 December 2013]. www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf
Buvinic, M. and Gupta, G.R. (1997) ‘Female-headed households and female-maintained families: are they worth targeting to reduce poverty in developing countries?’ Economic Development and Cultural Change 45(2): 259–80 <www.jstor.org/stable/1154535≯. www.jstor.org/stable/1154535
Cameron, L. and Shah, M. (2010) Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia, Technical Paper, Water and Sanitation Program (WSP), Washington, DC: World Bank.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia, Policy Research Working Paper 6360 [online], Washington, DC: World Bank <http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360≯ [accessed 20 December 2013]. http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360
Eldridge, S.M., Okoumunne, O. and Carlin, J.B. (2009) ‘The intra-cluster correlation coefficient in cluster randomized trials: a review of definitions’, International Statistical Review 77(3): 378–94 <http://dx.doi.org/10.1111/j.1751-5823.2009.00092.x≯.
Frias, J. (2008) Opportunities to Improve Sanitation: Situation Assessment of Sanitation in Rural East Java, Indonesia, New York: Water and Sanitation Program, World Bank.
Luby, S., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W., Keswick, B. and Hoekstra, R. (2006) ‘Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial’, Tropical Medicine and International Health II(4) <http://dx.doi.org/10.1111/j.1365-3156.2006.01592.x≯.
Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Psacharopoulos, G. and Patrinos, H.A. (2004) ‘Returns to investment in education: a further update’, Education Economics 12(2): 111–13 <http://dx.doi.org/10.1080/0964529042000239140≯.
Rajaram, R. (2009) Female-Headed Households and Poverty: Evidence from the National Family Health Survey [pdf] Georgia Tech Economics Papers <www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf≯ [accessed 20 December 2013]. www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf
United Nations Children's Fund (UNICEF) (2010) Child Poverty and Disparities in Indonesia: Challenges for Inclusive Growth [pdf] SMERU Research Institute and UNICEF <www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf≯ [accessed 20 December 2013]. www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf
Water and Sanitation Program (WSP) (2009) Total Sanitation and Sanitation Market Program in Indonesia: Learning at Scale, WSP-Field Note, Washington, DC: World Bank.
WSP (2010a) TSSM Implementation Manual, Jakarta, Indonesia: Government of Indonesia, and Water and Sanitation Program, World Bank.
WSP (2010b) Gender in Water and Sanitation: Mainstreaming Gender in Water and Sanitation, Sector Brief WSP, Washington, DC: World Bank.
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (2010) Progress on Sanitation and Drinking Water: 2010 Update, New York: World Health Organization and UNICEF.
Amin, S., Rangarajan, A. and Borkum, E. (2011) Improving Sanitation at Scale: Lessons from TSSM Implementation in East Java, Indonesia, Reference Number 06781.500, Princeton, NJ: Mathematica Policy Research.
Bevan, J. and Thomas, A. (2009) ‘Community approaches to total sanitation : triggering and sustaining sanitation behaviour change in West Africa’, paper presented at West Africa Regional Sanitation and Hygiene Symposium, Accra, Ghana.
Bongartz, P. (2008) ‘Community-led total sanitation’, Global Future 1: 19 <www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf≯ [accessed 20 December 2013]. www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf
Buvinic, M. and Gupta, G.R. (1997) ‘Female-headed households and female-maintained families: are they worth targeting to reduce poverty in developing countries?’ Economic Development and Cultural Change 45(2): 259–80 <www.jstor.org/stable/1154535≯. www.jstor.org/stable/1154535
Cameron, L. and Shah, M. (2010) Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia, Technical Paper, Water and Sanitation Program (WSP), Washington, DC: World Bank.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia, Policy Research Working Paper 6360 [online], Washington, DC: World Bank <http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360≯ [accessed 20 December 2013]. http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360
Eldridge, S.M., Okoumunne, O. and Carlin, J.B. (2009) ‘The intra-cluster correlation coefficient in cluster randomized trials: a review of definitions’, International Statistical Review 77(3): 378–94 <http://dx.doi.org/10.1111/j.1751-5823.2009.00092.x≯.
Frias, J. (2008) Opportunities to Improve Sanitation: Situation Assessment of Sanitation in Rural East Java, Indonesia, New York: Water and Sanitation Program, World Bank.
Luby, S., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W., Keswick, B. and Hoekstra, R. (2006) ‘Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial’, Tropical Medicine and International Health II(4) <http://dx.doi.org/10.1111/j.1365-3156.2006.01592.x≯.
Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Psacharopoulos, G. and Patrinos, H.A. (2004) ‘Returns to investment in education: a further update’, Education Economics 12(2): 111–13 <http://dx.doi.org/10.1080/0964529042000239140≯.
Rajaram, R. (2009) Female-Headed Households and Poverty: Evidence from the National Family Health Survey [pdf] Georgia Tech Economics Papers <www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf≯ [accessed 20 December 2013]. www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf
United Nations Children's Fund (UNICEF) (2010) Child Poverty and Disparities in Indonesia: Challenges for Inclusive Growth [pdf] SMERU Research Institute and UNICEF <www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf≯ [accessed 20 December 2013]. www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf
Water and Sanitation Program (WSP) (2009) Total Sanitation and Sanitation Market Program in Indonesia: Learning at Scale, WSP-Field Note, Washington, DC: World Bank.
WSP (2010a) TSSM Implementation Manual, Jakarta, Indonesia: Government of Indonesia, and Water and Sanitation Program, World Bank.
WSP (2010b) Gender in Water and Sanitation: Mainstreaming Gender in Water and Sanitation, Sector Brief WSP, Washington, DC: World Bank.
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (2010) Progress on Sanitation and Drinking Water: 2010 Update, New York: World Health Organization and UNICEF.
Amin, S., Rangarajan, A. and Borkum, E. (2011) Improving Sanitation at Scale: Lessons from TSSM Implementation in East Java, Indonesia, Reference Number 06781.500, Princeton, NJ: Mathematica Policy Research.
Bevan, J. and Thomas, A. (2009) ‘Community approaches to total sanitation : triggering and sustaining sanitation behaviour change in West Africa’, paper presented at West Africa Regional Sanitation and Hygiene Symposium, Accra, Ghana.
Bongartz, P. (2008) ‘Community-led total sanitation’, Global Future 1: 19 <www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf≯ [accessed 20 December 2013]. www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf
Buvinic, M. and Gupta, G.R. (1997) ‘Female-headed households and female-maintained families: are they worth targeting to reduce poverty in developing countries?’ Economic Development and Cultural Change 45(2): 259–80 <www.jstor.org/stable/1154535≯. www.jstor.org/stable/1154535
Cameron, L. and Shah, M. (2010) Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia, Technical Paper, Water and Sanitation Program (WSP), Washington, DC: World Bank.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia, Policy Research Working Paper 6360 [online], Washington, DC: World Bank <http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360≯ [accessed 20 December 2013]. http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360
Eldridge, S.M., Okoumunne, O. and Carlin, J.B. (2009) ‘The intra-cluster correlation coefficient in cluster randomized trials: a review of definitions’, International Statistical Review 77(3): 378–94 <http://dx.doi.org/10.1111/j.1751-5823.2009.00092.x≯.
Frias, J. (2008) Opportunities to Improve Sanitation: Situation Assessment of Sanitation in Rural East Java, Indonesia, New York: Water and Sanitation Program, World Bank.
Luby, S., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W., Keswick, B. and Hoekstra, R. (2006) ‘Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial’, Tropical Medicine and International Health II(4) <http://dx.doi.org/10.1111/j.1365-3156.2006.01592.x≯.
Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Psacharopoulos, G. and Patrinos, H.A. (2004) ‘Returns to investment in education: a further update’, Education Economics 12(2): 111–13 <http://dx.doi.org/10.1080/0964529042000239140≯.
Rajaram, R. (2009) Female-Headed Households and Poverty: Evidence from the National Family Health Survey [pdf] Georgia Tech Economics Papers <www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf≯ [accessed 20 December 2013]. www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf
United Nations Children's Fund (UNICEF) (2010) Child Poverty and Disparities in Indonesia: Challenges for Inclusive Growth [pdf] SMERU Research Institute and UNICEF <www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf≯ [accessed 20 December 2013]. www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf
Water and Sanitation Program (WSP) (2009) Total Sanitation and Sanitation Market Program in Indonesia: Learning at Scale, WSP-Field Note, Washington, DC: World Bank.
WSP (2010a) TSSM Implementation Manual, Jakarta, Indonesia: Government of Indonesia, and Water and Sanitation Program, World Bank.
WSP (2010b) Gender in Water and Sanitation: Mainstreaming Gender in Water and Sanitation, Sector Brief WSP, Washington, DC: World Bank.
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (2010) Progress on Sanitation and Drinking Water: 2010 Update, New York: World Health Organization and UNICEF.
Amin, S., Rangarajan, A. and Borkum, E. (2011) Improving Sanitation at Scale: Lessons from TSSM Implementation in East Java, Indonesia, Reference Number 06781.500, Princeton, NJ: Mathematica Policy Research.
Bevan, J. and Thomas, A. (2009) ‘Community approaches to total sanitation : triggering and sustaining sanitation behaviour change in West Africa’, paper presented at West Africa Regional Sanitation and Hygiene Symposium, Accra, Ghana.
Bongartz, P. (2008) ‘Community-led total sanitation’, Global Future 1: 19 <www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf≯ [accessed 20 December 2013]. www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/Global%20Futures_Sanitation.pdf
Buvinic, M. and Gupta, G.R. (1997) ‘Female-headed households and female-maintained families: are they worth targeting to reduce poverty in developing countries?’ Economic Development and Cultural Change 45(2): 259–80 <www.jstor.org/stable/1154535≯. www.jstor.org/stable/1154535
Cameron, L. and Shah, M. (2010) Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Indonesia, Technical Paper, Water and Sanitation Program (WSP), Washington, DC: World Bank.
Cameron, L., Shah, M. and Olivia, S. (2013) Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia, Policy Research Working Paper 6360 [online], Washington, DC: World Bank <http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360≯ [accessed 20 December 2013]. http://elibrary.worldbank.org/content/workingpaper/10.1596/1813-9450-6360
Eldridge, S.M., Okoumunne, O. and Carlin, J.B. (2009) ‘The intra-cluster correlation coefficient in cluster randomized trials: a review of definitions’, International Statistical Review 77(3): 378–94 <http://dx.doi.org/10.1111/j.1751-5823.2009.00092.x≯.
Frias, J. (2008) Opportunities to Improve Sanitation: Situation Assessment of Sanitation in Rural East Java, Indonesia, New York: Water and Sanitation Program, World Bank.
Luby, S., Agboatwalla, M., Painter, J., Altaf, A., Billhimer, W., Keswick, B. and Hoekstra, R. (2006) ‘Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial’, Tropical Medicine and International Health II(4) <http://dx.doi.org/10.1111/j.1365-3156.2006.01592.x≯.
Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: World Health Organization.
Psacharopoulos, G. and Patrinos, H.A. (2004) ‘Returns to investment in education: a further update’, Education Economics 12(2): 111–13 <http://dx.doi.org/10.1080/0964529042000239140≯.
Rajaram, R. (2009) Female-Headed Households and Poverty: Evidence from the National Family Health Survey [pdf] Georgia Tech Economics Papers <www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf≯ [accessed 20 December 2013]. www.frbatlanta.org/documents/news/conferences/09-3rd_se_international_economics_paper_rajaram.pdf
United Nations Children's Fund (UNICEF) (2010) Child Poverty and Disparities in Indonesia: Challenges for Inclusive Growth [pdf] SMERU Research Institute and UNICEF <www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf≯ [accessed 20 December 2013]. www.unicef.org/indonesia/Child_Poverty_Indonesia.pdf
Water and Sanitation Program (WSP) (2009) Total Sanitation and Sanitation Market Program in Indonesia: Learning at Scale, WSP-Field Note, Washington, DC: World Bank.
WSP (2010a) TSSM Implementation Manual, Jakarta, Indonesia: Government of Indonesia, and Water and Sanitation Program, World Bank.
WSP (2010b) Gender in Water and Sanitation: Mainstreaming Gender in Water and Sanitation, Sector Brief WSP, Washington, DC: World Bank.
WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (2010) Progress on Sanitation and Drinking Water: 2010 Update, New York: World Health Organization and UNICEF.
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