Communities are not always aware of the importance of good hygiene, hygiene practices are often not conducive to good health, and latrines are not maintained or used appropriately. High occurrences of diarrhea, skin disease, intestinal and other waterborne disease in low-income communities therefore remain a frequent obstacle to improving child health more generally. Besides poor access to safe water, a failure to aggressively promote behavioral change—particularly among low-income families and slum dwellers—has further worsened Indonesia’s water and sanitation situation.

A World Bank study released in August 2008 found that the lack of access to sanitation poses heavy financial and economic costs to the Indonesian economy, not only to individuals but also to the public and commercial sectors. Poor sanitation, including poor hygiene, causes at least 120 million disease episodes and 50,000 premature deaths annually with a resulting economic impact of more than US$3.3 billion per year. Poor sanitation also contributes significantly to water pollution—adding to the cost of safe water for households, and reducing the production of fish in rivers and lakes. The associated economic costs of polluted water attributed to poor sanitation alone exceed US$1.5 billion per year. In 2006, Indonesia lost 2.3 percent of gross domestic product due to poor sanitation and hygiene.

Throughout its 10 year history in Indonesia, IRD has been at the forefront of working with local communities to build and repair water and sanitation infrastructure, educating the population about better hygiene, contributing to environmental protection, and helping communities capture revenue from provision of basic services.

Most recently, the Small Town and Rural Communities Restoration Program improved the long-term health status of tsunami-affected communities, particularly women and children, in Aceh province through the combination of improved access to water and sanitation services and education on good health and hygiene practices. Collaborating with UNICEF, local authorities, and the public utility company, IRD has worked to provide clean water to more than 300,000 citizens.

Every IRD intervention begins with engaging local government authorities and community leaders to create buy-in for programs and to generate a mind-set of sustainability. Beneficiaries of IRD’s work are actively engaged throughout the process from planning and building to education on operation and maintenance of the systems. This is achieved through the creation of village water committees, with citizens deciding how to raise the village contribution to the project. This is usually done by a monthly levy whereby each household contributes a small amount of money over the course of four to six months. IRD works with the committee to employ and organize local contractors and laborers and provides necessary training to workers to build or restore small water supply systems, household connections, sanitation and sewage systems, and proper septic tanks. Much of the labor is done manually, reducing both costs and environmental impact.

Water treatment plants and water distribution networks have connected schools and households to sustainable water supplies where previously none existed. In Aceh, IRD restored and improved four major water supply systems for 197,000 residents. The local water authority, PDAM, was trained to properly operate and maintain these facilities. IRD also worked with 20 rural communities to construct village-appropriate water supply and sanitation facilities that will be operated and maintained by the community. In addition, the water sanitation facilities of 20 schools in these communities were rehabilitated. IRD engages students and community leaders in promoting proper hygiene whenever new infrastructure comes on-line.

Without understanding and awareness of proper hygiene practices, infrastructure improvements alone would be insufficient for maintaining good health in the long-term. IRD trains midwives, both at community health clinics and at the village level, as well as women’s groups and the village water sanitation committees in hygiene promotion methodologies. IRD implemented the WASH program in local schools, training teachers and student peer educators on good hygiene practices with active learning methodologies.