REPORT
HIGH FIVE PROGRAMS
MIDLINE HOUSEHOLD SURVEY 
COVERAGE AREA: MAKASSAR
Prepared for
September, 2013
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
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TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................... i
LIST OF FIGURES .......................................................................................................iii
LIST OF TABLES .........................................................................................................iv
PART I Background and Research Objectives ...................................................... 1
A. Background.............................................................................................. 1
B. Objectives................................................................................................ 1
PART II Research Methodology ............................................................................. 3
A. Survey Method ......................................................................................... 3
B. Number of respondents............................................................................. 3
C. Sample Selection Technique ...................................................................... 5
Part III Findings .................................................................................................... 6
A. Respondent Profile – Age .......................................................................... 6
B. Respondent Profile – Relationship between Respondent and Household 
Head ....................................................................................................... 6
C. Respondent Profile – Number of Under-5s per Household ............................ 6
D. Respondent Profile – Education.................................................................. 7
E. Respondent Profile – Socioeconomic Class .................................................. 8
F. Respondent Profile Summary ....................................................................11
Part IV Program Implementation .......................................................................13
A. Effectiveness ...........................................................................................13
B. Efficiency ................................................................................................27
C. Sustainability...........................................................................................29
D. Relevance and Appropriateness ................................................................33
Part V Evaluation of Program Outcomes ...........................................................36
Hygiene and Sanitation Practices in Five CBTS Pillars............................36
A. Open Defecation Free ..............................................................................36
Condition of Toilets in General ..................................................................37
Summary of First Pillar Findings: Open defecation free................................44
B. Hand-Washing with Soap .........................................................................45
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Summary of Second Pillar: Practices of washing hands with soap.................48
C. Safe Drinking Water Treatment and Storage ..............................................50
Summary of the Third Pillar: Household Safe Water Treatment and 
Storage Practices.................................................................................56
D. Percentage of households that practice solid waste management.................57
Summary of Fourth Pillar: Solid Waste Management Practices .....................61
E. Proper Wastewater Management ..............................................................63
Summary of Fifth CBTS Pillar: Wastewater management practices ...............68
F. Role of Community Members as Informants ...............................................74
G. Healthy Life Practices...............................................................................77
Attitude ..................................................................................................78
Practices .................................................................................................82
Part VI ..........................................................................................................86
Children Baseline – Elementary School.........................................................86
A. Perceptions of children regarding conditions that impact on healthy and 
clean life practices ...................................................................................86
B. Children’s Understanding of CBTS .............................................................87
C. Perceptions of Children of Environmental Cleanliness at School and at 
Home .....................................................................................................98
Attachment ................................................................................................. 101
Observations on Schools.............................................................................101
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LIST OF FIGURES
Figure 3.1. Respondent Age Groups............................................................................ 7
Figure 3.2 Number of Under-5s per Household ........................................................... 7
Figure 3.3 Highest Educational Attainment ................................................................. 8
Figure 3.4 Average Household Expenditure Per Month................................................. 9
Figure 3.5 Home Ownership Status...........................................................................10
Figure 3.6 Number of Persons Over Age of 5 Living in Home.......................................11
Figure 5.1. Last Place of Defecation ...........................................................................36
Figure 5.2. Types of Toilets Used, Based on Observations............................................38
Figure 5.3. Toilet Condition – based on Observations ..................................................39
Figure 5.4 If you have a child aged under 3, is he/she toilet trained?...........................41
Figure 5.5 Location of Last Defecation among Under-3s .............................................42
Figure 5.6 Disposal of Infant Feces ........................................................................... 42
Figure 5.7 What Respondents Do after Children Defecate ...........................................43
Figure 5.8 Use of Soap in Last Two Days in Tallo Sub-district – Multiple Answer ...........45
Figure 5.9 Use of Soap over Last Two Days in Lembo Sub-district – Multiple Answer.....46
Figure 5.10 Scores for Use of Soap at 5 Critical Times in Last 2 Days ............................46
Figure 5.11 Availability of Running Water....................................................................47
Figure 5.12 Availability of Soap ..................................................................................48
Figure 5.13 Sources of Drinking Water........................................................................50
Figure 5.14 Sources of Drinking Water for Under-5s in the Home ..................................51
Figure 5.15 What is done (to improve quality) before consumption ...............................51
(Excludes branded packaged water and water refills)..................................51
Figure 5.16 Drinking Water Storage Places ..................................................................52
Figure 5.17 Places Used to Store Drinking Water – Observations...................................52
Figure 5.18 Places used to store water for cooking in Tallo - Observations – Multiple 
Answer ...................................................................................................53
Figure 5.19 Places used to store water for cooking in Lembo - Observations – Multiple 
Answer ...................................................................................................54
Figure 5.20 Places where food is stored – Observations................................................55
Figure 5.21 Receptacles or Places Used for Collecting Garbage .....................................57
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Figure 5.22 Disposal of Solid Waste / Garbage.............................................................58
Figure 5.23 Frequency of Garbage Collection By Official Garbage Collectors ...................58
Figure 5.24 Do You Pay for Garbage Collection? ..........................................................59
Figure 5.25 Expenditure on Garbage Collection............................................................59
Figure 5.26 Is Organic and Inorganic Garbage Separated? – Respondent Claims ............60
Figure 5.27 Is Garbage (Organic and Inorganic) Separated? – Observations ..................60
Figure 5.28 Means Used for Collecting Garbage – Observations.....................................61
Figure 5.29 Disposal of kitchen wastewater – Observations ..........................................63
Figure 5.30 Discharge of Wastewater from Bathroom/Toilet – Observations...................64
Figure 5.31 Discharge of Wastewater from Washing Clothes – Observations ..................64
Figure 5.32 Location of Septic tank – confined to those that have septic tank.................65
Figure 5.33 Final place of disposal of feces (by those that lack septic tanks) – 
Observations ...........................................................................................66
Figure 5.34 Has your septic tank ever been emptied?...................................................66
Figure 5.35 When was the last time your septic tank was emptied?...............................67
Figure 5.36 Who emptied your septic tank the last time?..............................................67
Figure 5.37 Distance from Home to Public Toilet..........................................................68
Figure 5.38 Have you Heard of CBTS?.........................................................................77
Figure 5.39 Have you ever heard of PHBS ...................................................................78
Figure 5.40 Has Your Under-5 Ever Suffered from Diarrhea?.........................................83
Figure 5.41 Last Time your Under-5 Suffered from Diarrhea .........................................84
Figure 5.42 Treatment of Diarrhea..............................................................................85
Figure 5.43 Overall Cost of Treatment (transportation, consultation, medicine) ..............85
Figure 6.1 Children’s Understanding of CBTS .............................................................87
Figure 6.2 Behavior Before Eating (Snacks and Meals)................................................93
Figure 6.3 Reasons for Washing Hands Prior to Eating – Multiple Answer.....................94
LIST OF TABLES
Table 2.1 Number of Respondent by Respondent Category in Each Area...................... 4
Tabel 3.1 Respondent Profile Summary ....................................................................11
Table 5.1. Findings of Observations on Destination of Toilet Waste .............................37
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Table 5.2 Toilet Conditions, Based on Observations...................................................40
Table 5.3 First Pillar Indicator: Open defecation free .................................................44
Table 5.4 Indicators Showing Practice of Washing Hands with Soap ...........................48
Table 5.5 Observations on Drinking Water Storage Receptacles, Processing and 
Presentation............................................................................................54
Table 5.6 Indicators for Third Pillar: Safe Water Treatment........................................56
Table 5.7 Fourth Pillar Indicators: Solid Waste Management Practices ........................61
Table 5.8 Indicators for Fifth Pillar: Wastewater Management Practices ......................68
Table 5.9 Summary of Indicators for all Five CBTS pillar ............................................70
Table 5.10a Sources of information on the 5 CBTS Pillars in Tallo – Makassar – 
Multiple Answer - Spontaneous ................................................................. 74
Table 5.10b Sources of Information on 5 CBTS Pillars in in Lembo – Makassar – 
Makassar – Multiple Answer - Spontaneous................................................75
Table 5.11 Perceptions of Residents about Health.......................................................78
Table 5.12 Residents Perception of Community ..........................................................81
Table 5.13 Behaviors that can cause health and hygiene problems...............................82
Table 6.1 Understanding of CBTS by Grade ..............................................................87
Table 6.2 What More Do You Know About CBTS?......................................................88
Table 6.3 Information on CBTS Obtained From:........................................................89
Table 6.4 Perceptions of Children Related to Defecation ............................................90
Table 6.5 Children’s Explanations on Inappropriate Defecation Behavior in their 
Home and School Environments................................................................90
Table 6.6 Thing that make urinating/defecating at school different from at home ........91
Table 6.7 Perceptions of Children Regarding CTPS-related Activities ...........................92
Table 6.8 Children’s Description on Water Availability At Home and At School..............92
Table 6.9 Hand Washing Practices Before Eating (Main Meals and Snacks)..................94
Table 6.10 Perceptions of Children About Activities Related to Defecation .....................96
Table 6.11 Children’s Descriptions of Drinking Water Treatment At Home and At 
School ....................................................................................................96
Table 6.12 Condition of Wastewater Disposal Channels in Place Where You Live ...........97
Table 6.13 Perceptions about Environmental Cleanliness .............................................98
Table 6.14 Children’s Descriptions of Inappropriate Actions Related to Cleanliness in 
the Home and School Environments ..........................................................99
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Table 6.15 Illnesses Experienced in Last 12 Months – Multiple Answer..........................99
Table 6.16 Causes of Diarrhea in Last 2 Weeks – Multiple Answer..............................100
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
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PART I
Background and Research Objectives
A. Background 
The Indonesian government launched the Community-Based Total Sanitation (CBTS) 
Program in 2007 to improve hygiene and sanitation practices in households, thereby 
reducing the incidence of diarrhea, the second leading cause of infant mortality. The 
program consists of five hygiene and sanitation pillars, namely:
1. Stopping open defecation 
2. Washing hands with soap
3. Household safe water treatment and storage
4. Solid waste management
5. Waste water management
The program was focused primarily on rural areas, where the emphasis was on Pillar 1 
(stopping open defecation). Through the High Five Program, the Cipta Cara Padu (CCP)
Foundation proposed that the program be extended to urban areas, thus contributing to the 
efforts to improve compliance with the five CBTS pillars in households and communities.
The High Five Program has now been running for 1.5 years in 3 cities, namely, Surabaya, 
Medan and Makassar. The program is conducted at the city level and the sub-district level. 
At the city level, The High Five Program advocates the incorporation of CBTS into current 
policies and AMPL/Sanitation Working Group activities, as well as the integration of CBTS 
strategies into municipal government development plans. At the sub-district level, The High 
Five Program operates in three RW (neighborhoods) at a high level of intensity, and in other 
neighborhoods at a low level of intensity.
It is very important to ensure that the program at every level is on track to achieve the key 
indicators in respect of intermediate results, particularly those resulting from interventions 
during the operative period, and that the implementation process is in accordance with 
participatory principles, and reflects gender equity and environmental considerations. 
Accordingly, an independent evaluator is required to review the performance of the program 
and provide recommendations for improving program implementation during its remaining 
lifetime. 
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B. Objectives
The High Five Program focuses on improving hygiene practices at the household and 
community levels, identifying how many households are aware of children's health, 
sanitation and hygiene issues, whether that number has increased or decreased when 
compared with the 2012 baseline survey having regard to The High Five Program objective 
indicators. Accordingly, this midline survey evaluates:
a. Program outcomes by comparing the midline survey’s findings with those of the 
baseline survey so as to identify changes as regards:
- Understanding of the CBTS pillars
- Perceptions of the CBTS pillars
- Habits/ behaviors associated with the CBTS pillars
b. Program implementation so as to identify program effectiveness, efficiency, 
relevance, and sustainability.
c. Providing recommendations for better program implementation. 
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PART II
Research Methodology
In general, both primary and secondary data were required for the purposes of this study. 
However, Polling Center (in accordance with its agreement with High Five Program) 
collected primary data using the quantitative and qualitative methods. 
In the implementation of this study, the collection of primary data in the field was carried 
out using the quantitative method aimed at respondents from households with children, 
while the qualitative data was collected using in-depth interviews with stakeholders of the 
CBTS program being implemented by CCP. 
A. Survey Method 
In order to obtain the data required for this research (as set out in the study objectives), 
both the quantitative and qualitative methods employed questionnaires. 
Data collection in the field in the Makassar area was conducted as follows:
Quantitative Data
- Households : 9 to 14 March 2013
- Children : 6 to 10 March 2013
Qualitative Data 
- Focus Group Discussion (FGD) : 5 March 2013
- In-depth Interviews (IDI) : 8 to 22 March 2013
B. Number of respondents
The number of respondents in each category in the Makassar survey area is shown in 
the following table:
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Bringing You The Real Portrait of Indonesia
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Table 2.1
Number of Respondent by Respondent Category in Each Area
Category Area/Sub-district Sample Size
Household Tallo 30 respondents
Lembo 30 respondents
Elementary 
School (Sekolah 
Dasar/SD)
Children
SD Tallo Tua 1 6 respondents
SD Tallo Tua 2 6 respondents
SD KIP Baraya 6 respondents
SD Malimongan Baru 6 respondents
SD Inpres Baraya 2 6 respondents
Total Respondents in Quantitative Study 90 respondents
Focus Group Discussion
1 group from Pokja Kota 
(Kelompok Kerja Kota – 
City Working Group)
1 group from Pokja 
Kelurahan (Kelompok 
Kerja Kelurahan – 
Administrative Village 
Working Group)
IDI – per respondent category
High Five Program District Leaders 1 respondent
High Five Program Facilitators 1 respondent
Community Leaders (Sub-district Heads) 2 respondents
Teachers with High Five Program training 2 respondents
Bappeda (Badan Perencanaan Daerah – Local Development 
Planning Board)
1 respondent
Journalists 1 respondent
Sanitarians 1 respondent
Other Partners: BTKL (Balai Teknik Kesehatan Lingkungan – 
Technical Unit Environmental Health) 
1 respondent
Total Respondents in Qualitative Survey 11 respondents
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C. Sample Selection Technique
1. Respondent Households 
Respondent households were selected using the simple random sampling method. The 
objective was to obtain findings that are representative of the population.
In the selected sub-districts in each city, a mapping process was first carried out in 
respect of households with under-5s, with the approval of local leaders (heads of RT/RW 
or sub-district heads).
After the population had been mapped, the selection of households was preceded by 
determining the household interval, that is, by dividing the total number (population) of 
households with children under 5 with the total respondent target (30 respondents) for 
each sub-district. 
In this way, the caregiver respondents for under-5s to be interviewed were selected.
2. Elementary school children in grades 4, 5 and 6
The selected elementary schools were all located in sub-districts where interventions had 
been effected. Respondents in the child category were selected randomly using the 
sampling interval technique. A total of 10 children from each school were interviewed, all 
of whom were from grades 4, 5, and 6. Consequently, the average sample size for each 
class was 3 children.
To select the children to be interviewed from each class, the interval random sampling 
method was used based on desk or attendance role sequences. 
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Bringing You The Real Portrait of Indonesia
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Part III
Findings
A. Respondent Profile – Age 
The criteria for the selection of respondents for interview during the midline survey were 
the same as in the case of the previous baseline survey, namely, caregivers of under-5s. 
During the midline surveys in both Tallo and Lembo, the percentage of female 
respondents was the same – 100% of the total number of 30 respondents per sub￾district. This meant that all of the respondents in Makassar were women, unlike at the 
time of the baseline survey when there were also male respondents, albeit a small 
percentage.
As a whole in the city of Makassar, the biggest proportion (43.3%) of respondents 
interviewed were between 25 and 35, while the second largest age group was 35-45 
(23.3%). The percentage in Tallo was almost the same as for Makassar as a whole, 
However, there were some differences, with the biggest proportion of the respondents 
interviewed were under 25 (36.7%) – slightly different from the 25-35 age group, which 
was in second place on 33.3%.
In Lembo sub-district, the results were the same for Makassar as a whole, that is, the 
biggest proportion of respondents were aged 25-35, while in second place was the 35-45 
age group (53.3% and 20%, respectively).
B. Respondent Profile – Relationship between Respondent and Household 
Head
A total of 66.7% of the respondents were the wives of household heads, while 21.7% 
were the children of household heads. In more detail, in Tallo sub-district 66.7% of 
respondents said that they were the wife of the household head, while 23.3% were the 
children of the household head. The remaining 10% were made up of the parents of the 
household head.
In Lembo sub-district, the responses on respondent status were more varied. As in Tallo, 
the majority of respondents were the wives of households heads (66.7%), while in 
second place were the children of household heads (20%). Meanwhile, 6.7% were the 
parents of household heads and 3.3% were households and 3.3% caregivers.
C. Respondent Profile – Number of Under-5s per Household
Overall, in the two sub-districts in which interviews held, the majority of respondents 
lived with 1 under-5 at home (71.7%), while 26.7% of respondents had 2 under-5s in 
the house. The results were similar for both Tallo and Lembo, with the majority of 
respondents living with one under-5 (73.3% and 70% respectively). The remaining 
Midline Household Survey - Makassar 
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22.3% of respondents in Tallo living with 2 under-5s, while 3.3% living with 3 under-5s. 
In Lembo, 30% lived with 2 under-5s in the home.
Figure 3.1.
Respondent Age Groups 
Figure 3.2
Number of Under-5s per Household
D. Respondent Profile – Education 
As regards the educational background of the respondents in Makassar, an overall 
majority (58.3%) had graduated from elementary school (or equivalent), while only 
23.3% had graduated from high school (or equivalent). The remainder (16.7%) had 
graduated from junior high school (or equivalent).
Baseline 
(n=60)
Midline (n=30) Baseline 
(n=60)
Midline (n=30)
18,30%
36,70% 33,30%
10,00%
55,0%
33,3% 51,7%
53,3%
16,7% 23,3% 11,7%
20,0%
8,30%
50-55 years old
45-50 years old
35-45 years old
25-35 years old
<25 years old
Tallo Lembo
Baseline 
(n=60)
Midline (n=30) Baseline 
(n=60)
Midline (n=30)
28,3% 23,3% 33,3% 30%
65% 73,3% 63,3% 70%
1 child
2 children
3 children
4 children
Tallo Lembo
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Bringing You The Real Portrait of Indonesia
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The results for Tallo were similar to the results for Makassar overall, with 60% of 
respondents having graduated from elementary school (or equivalent), and 23.3% 
having done so from high school (or equivalent). 
Figure 3.3 below shows the education attainments of the interviewed respondents in 
percentage terms and compares these with the findings of the baseline survey.
Figure 3.3
Highest Educational Attainment
E. Respondent Profile – Socioeconomic Class
Overall, the midline survey in Makassar found that socioeconomic status was more 
balanced, with socioeconomic classes B (average monthly expenditure of Rp 1,750,001 – 
Rp 2,500,000) and D (average monthly expenditure of Rp 600,001 – Rp 900,000) 
accounting for the same percentages – 23.3%. Next came socioeconomic class C1 
(average monthly expenditure of Rp 1,250,001 – Rp 1,750,000) and C2 (average 
monthly expenditure of Rp 900,001 – Rp 1,250,000), each of which also had the same 
percentages – 20%. By sub-district, in Tallo the biggest proportion of respondents 
(36.7%) were in socioeconomic class D (average monthly expenditure of Rp 600,001 – 
Rp 900,000), while in second place on 30% was socioeconomic class C2 (average 
monthly expenditure of Rp 900,001 – Rp 1,250,000).
Things were rather different in Lembo, where the distribution of percentages were 
almost the same. The largest socioeconomic classes were B and C1, both on 33.3%, 
while in second place on 13.3% was socioeconomic class A2 (average monthly 
expenditure of Rp 2,500,001 – Rp 3,500,000).
The socioeconomic classes of the respondents in each sub-district are as shown below: 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
20,0% 23,3% 20,0% 23,3%
20,0% 16,7% 31,7% 16,7%
53,30% 60,00% 45,00% 56,70%
Elementary School / equal
Middle School / equivalent
High School / equivalent
Undergraduate Diploma / equivalent
Graduate Degree
Tallo Lembo
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Bringing You The Real Portrait of Indonesia
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Figure 3.4 
Average Household Expenditure Per Month
Staying on the issue of socioeconomic class, the following is a description of the home 
ownership situation, and observations concerning the homes occupied by respondents.
The majority of the 60 respondents in Makassar (68.3%) said that they owned the homes 
they currently occupy, while 18.3% said that they were renting. The remaining respondents 
were living in homes owned by family members (11.7%) and official residences (1.7%). By 
sub-district, in Tallo the majority (63.3%) owned their own homes, while in second place on 
16.7% each were rented homes and homes owned by family members. In Lembo, the 
figures were almost the same with 73.3% of respondents occupying their own homes, and 
20% occupying rented homes.
As regards the condition of the respondents’ houses, the biggest proportion of homes in 
Makassar as a whole (40%) used timber for flooring, while in second place was ceramic tiles 
(33.3%). In Lembo, the most common type of flooring was ceramic tiles (50%), while in 
second place was cement (33.3%).
As regards the roofs of the respondents’ homes, all of the respondents, both in Tallo and 
Lembo, had galvanized iron roofs (100%). 
As regards walls, the biggest proportion of respondents in Makassar (41.7%) used 
galvanized iron sheets (41.7%), while in second place was cement walls (35%). By sub￾district, in Tallo the majority of respondents had galvanized iron walls (60%), while next 
came cement and brick walls (both on 16.7%). By contrast in Lembo, the biggest 
proportion of respondents had cement walls (23.3%).
The following chart shows the situation as regards home ownership status in the survey 
areas in Makassar:
Baseline Midline Baseline Midline
5,0% 3,3% 1,7% 5,0% 8,3% 13,3% 13,3% 6,7%
31,7% 33,3% 6,7%
35,0%
33,3%
16,7%
30,0%
18,3%
10,0% 36,7% 36,7% 28,3%
1,7% 6,7% 5,0% 10,0% < Rp. 600.000 [E]
Rp. 600.001 s\d Rp. 900.000 [D]
Rp. 900.001 s\d Rp. 1.250.000 [C2]
Rp. 1.250.001 s\d Rp. 1.750.000 [C1]
Rp. 1.750.001 s\d Rp. 2.500.000 [B]
Rp. 2.500.001 s\d Rp. 3.500.000 [A2]
> Rp. 3.500.000 [A1] Tallo Lembo
Respondent base : 60
Midline Household Survey - Makassar 
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Figure 3.5 
Home Ownership Status
In general, the respondents at the time of the midline survey did not only live in nuclear 
family units (husband-wife-child). However, the responses were quite evenly spread so that 
no response was dominant. The biggest proportion was respondents who lived with 4-5 
other people besides under-5s (33.4%), followed by those who lived with 2-3 other people 
(31.6%). By sub-district, there is also no dominant response group. In Tallo, the two
response groups with the biggest percentages are respondents who live with 2-3 people 
other than under-5s, and those who live with 4-5 people other than under-5s (36.6% in 
each case). Meanwhile in Lembo, a total of 30% of total respondents live with 4-5 other 
people in the home, while 26.6% live with 6-7 other people besides under-5s in the home.
The following graph shows the number of people living with respondents (other than under￾5s) in the two sub-districts of Makassar, and presents a comparison with the findings of the 
baseline survey.
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
45,0%
63,30%
46,7%
73,3%
20,0%
16,7%
21,7%
30,0% 20,0%
16,7% 30,0%
6,7% 1,7% 3,3% 1,7%
Company house
House owned by the family
Rent
Self owned
Tallo Lembo
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Figure 3.6 
Number of Persons Over Age of 5 Living in Home
F. Respondent Profile Summary
A summary of the characteristics of the respondents in each of the sub-districts surveyed 
in Makassar (Tallo and Lembo) is shown in the following table:
Tabel 3.1 
Respondent Profile Summary
Characteristic Tallo Lembo
Age (Majority) 36.7% >25 years old 53.3% 25 – 35 years old
Education (Majority) 60% elementary school 
graduates
56.7% elementary school 
graduates
Number of under-5s (Majority)
73.3% 1 under-5 
23.3% 2 under-5 
90% 1 under-5 
10% 2 under-5 
SES (Majority) 
53.3% B
33.3% C1
53.3% B
16.7% A2
Home Ownership (Majority) 56.7% owner occupied 43.3% renting
Baseline Midline Baseline Midline
33,4% 36,60% 36,7%
16,6%
45,0% 36,6% 18,3%
30,0%
10,0%
20,0%
11,7%
26,6%
13,3%
6,6%
6,7% 3,3%
8,40% 6,7% 13,4% > 10 persons
8 - 9 persons
6 - 7 persons
4 - 5 persons
2 - 3 persons
Tallo Lembo
Respondent Base: 60
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Tallo 
The respondents in Tallo were generally (36.7%) homemakers (caregivers to under-5s) 
of between the ages of 25 and 35 who had graduated from junior high school or 
equivalent (60% of total respondents). They occupied their own homes (56.7%) and 
53.3% had an average monthly expenditure of between Rp 1,750,001 and Rp 
2,500,000, while 33.3% had an average monthly expenditure of between Rp 1,250,001 
and Rp 1,750,000. The majority of respondents in Tallo lived with one under-5.
The respondents in Tallo did not only live in nuclear families, but rather 36.6% of them 
lived with 2-3 other people besides under-5s, while 36.6% lived with 4-5 other people 
besides under-5s.
Lembo
The majority of respondents in Lembo (53.3%) were homemakers (caregivers to under￾5s) of between the ages of 25 and 35 who had graduated from elementary school or 
equivalent (56.7% of total respondents). The majority of respondents (90%) lived with 1 
under-5s in the home, while only 10% lived with 2 under-5s. The majority of the 
respondents (53.3%) belonged to socioeconomic class B (average expenditure of Rp 
1,750,001 – Rp 2,500,000), while 16.7% were in socioeconomic class A2, with an 
average monthly expenditure of Rp 2,500,001 to Rp 3,500,000).
Unlike Tallo, where the majority of respondents said they owned their own houses, in 
Lembo the biggest proportion of respondents (43.3%) said that they occupied rented 
homes. They did not live just in nuclear families, but also lived with other people over 
the age of 5. The biggest proportion, 30%, lived with 4-5 people over the age of 5 in 
their home.
The following discussion of the findings is based on the strategic objectives of High Five 
Program (as explained in Part I of this survey).
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Part IV
Program Implementation
A. Effectiveness
a. Outcome Comparison
On the level of involvement of the public, private sector and community in developing 
and implementing plans to improve water availability, and sanitation and hygiene 
practices (coded as IR1 – program’s success indicator).
1. Role of High Five Program in developing partnership strategies as part of the SSK
(Strategi Sanitasi Kota - Makasar City Sanitation Strategy) 
High Five Program is not considered to have played a meaningful role in the 
development of partnership strategies between the Makassar Municipal AMPL 
Working Group in the implementation of the SSK. While there were changes in 
personnel in the SKPD (Satuan Kerja Perangkat Daerah - Regional Working Units) in 
the relevant local government agencies, structurally their work processes and 
activities remained the same. It was acknowledged by the City Working Group 
(during the group discussion) that activities had to be somewhat delayed as people 
were busy with other things. High Five Program coordinated with the relevant 
agencies to inform them of what had been done in the High Five Program sub￾districts. However, this did not always extend to the forging of partnerships with the 
SKPDs.
“… In the Education Agency it wasn’t clear … however, there appeared to be with the Health 
Agency and Bappeda …” (City Working Group – Education Agency)
Bappeda, as the institution responsible for serving as coordinator, regularly did so with 
High Five Program. 
“… We called all of the relevant agencies, like the Health Agency, Sanitation Agency, Community 
Empowerment Board, Environment Agency, Municipal Water Company, Building Agency, 
academia, NGOs, and members of the House of Representatives. Bappeda frequently acted as 
the coordinator of these bodies …” (Bappeda)
“… there was an SSK familiarization event, we went through it chapter by chapter – health, clean 
water …” (Bappeda)
1. Replication of High Five Program Sub-district by local governments and/or 
Nongovernmental Organizations (NGOs) 
During the focus group discussion, the Makassar Municipal AMPL Working Group said 
that it was very much in favor of program replication so that more than 2 sub-districts 
would be reached. However, no official meeting was held or proposals submitted.
“… Every time there’s a meeting, this proposal emerges. There have also recently been 
proposals for workshops …” (City Working Group)
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“… 50% of the total number of sub-districts in Makassar or be prioritized for those areas 
with poor sanitation …” (City Working Group)
The Sub-district CBTS Working Groups said that people in neighboring sub-districts had 
asked to be taught about what High Five Program was doing in the High Five Program
sub-districts. Further, it was stated that there would be good chances for the replication 
of the program. The reason this had not been done to date was that it was felt that the 
High Five Program needs to be fine-tuned in their own sub-districts first so that it would 
be better able to help other sub-districts.
“… We had considered how we could provide examples to other sub-districts, but this is 
still at the preparation stage …” (Sub-District Working Group)
“… What we mean is that we should fix up our own areas first so that we can then 
bring it to other areas …” (Sub-District Working Group)
The community leaders who were interviewed (the heads of Lembo and Tallo sub￾districts) also said that there were plans to replicate High Five Program. 
“… To the best of my knowledge, sub-districts Rappokalling and Wala Walayap lan to 
do so …” (Head of Lembo Sub-district) 
“… not yet, it’s still at the planning stage. So far, it only Lembo and Tallo that are 
involved in Makassar …” (Head of Lembo sub-district)
“… Lots, in Tallo district we have Rappokalling and Buloa, Kaluku and Bodoa, they also 
have sanitation plans as many of the residents there are not locals but rather 
newcomers who have built their houses along the coast …” (Head of Tallo Sub-district)
The things that it was believed would encourage others to replicate the High Five 
Program sub-districts were: (i) the activities could be directly put into practice by the 
residents; and (ii) the program help improve environment health, as evidenced by a 
decline in the incidence of diarrhea and Dengue fever.
The sub-district heads were also very pleased with the changes that had taken place in 
people’s behavior, not only adults but also children. As a result, High Five Program was 
considered to be effective in changing mindsets and behavior through intensive 
socialization efforts.
“… I’ve seen elementary school kids washing their hands before eating and doing other 
things. There mindsets have been changed by their parents and teachers so that they’re 
now a bit cleaner …”
“… in addition, defecation must be in the right place, not in the open. Usually during 
voluntary cleanup drives we used to find feces in the drains …” (Head of Tallo Sub￾district) 
“… Because people weren’t embarrassed about open defecation. kids would do it in the 
drains and adults would cover themselves up with a sarong, although only at night. So, 
this socialization process has, in essence, made people embarrassed to practice open 
defecation …” (Head of Lembo Sub-district)
Nevertheless, the Sub-district CBTS Working Groups also said there were constraints 
that could hamper the replication of High Five Program, including:
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 The sanitation and hygiene problems in other sub-districts were possibly different 
from in the High Five Program sub-districts. Consequently, the High Five Program 
would need to be adjusted if it were to be successfully replicated.
 The members of the Sub-district Working Groups were willing to help, but said they 
lack confidence to teach people about the program in other sub-districts as residents 
of these other sub-districts might doubt their capacity and credibility. Accordingly, 
they said the people from “outside the sub-district” would still need to be involved 
(i.e., the Makassar High Five Program team).
“… Given social conditions (in the target sub-districts) … for example, we could 
approach people here as they already know us. But in other sub-districts we would 
have to approach them first, get to know the area so that we would be accepted …” 
(Sub-District Working Group)
2. Level of financial support from private sector and community partners
The fact that the residents of the High Five Program sub-districts underwent changes in 
mindset and behavior in the end encouraged them to be work hard to fund the 
construction of their sanitation and hygiene facilities.
“… My experience was … he said I’m embarrassed, I have a drop toilet, it leaks, 
people can see my behind, he said ‘I’m embarrassed. In the end I got some money, 
so I’ll build it myself …’, so in the end 18 households built their own toilets …” (Sub￾District Working Group)
As regards the construction of even large infrastructure, such as communal septic tanks, 
synergies developed between High Five Program (for the development of facilities) and 
the communities in the High Five Program sub-districts.
“… the communal IPAL (Instalasi Pengolahan Air Limbah – Wastewater Treatment 
Installation) could not be built as it was the wet season. Thank heavens, after the 
end of the third month the building of the septic tank was facilitated by High Five. 
The people only had to buy pipes and the toilets …” (Sub-District Working Group)
The community leader respondents also were thankful that residents were willing to pay 
for the resolution of sanitation and hygiene problems after receiving information and 
explanations from High Five Program and the members of the Sub-District Working 
Groups.
“… In reality, the residents of RW 5 were very eager to work together. I didn’t have 
any authority to intervene. They managed the fees themselves. Thank heavens, 
everything is still going well …” (Head of Tallo Sub-district)
Nevertheless, it was revealed by the members of the Sub-District Working Groups 
(during the group discussions) that for residents who were very poor, help was needed 
to finance the construction of facilities, in the same was that help had been provided by 
other programs. Nevertheless, it was also acknowledged that such programs made 
people “spoiled” and did not help change their mindsets.
On the duplication of hygienic behavior and improving sanitation through participatory 
programs at the community level involving stakeholders, social networks and community 
members (coded as IR2 – program’s success indicator).
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1. Promoting hygiene and sanitation in the schools
According to the Heads of the 2 High Five Program Sub-districts, every state school in 
the sub-districts had been visited by High Five Program CBTS workers. It was stated that 
this had benefited both the schools and their students. Consequently, the schools 
welcomed the program to change the mindsets of the children and to develop physical 
facilities in the schools.
“… they held a joint hand washing event. They also helped change the mindsets of the 
children, washing hands before eating, stopping open defecation… (Head of Tallo Sub￾district)
“… For the time being, 3 elementary schools provided access for hand washing in the 
hope that the children would wash their hands after snacking or playing. This was 
because observations revealed that conditions in the 2 schools were worrying … “ (Head 
of Lembo Sub-district)
“What High Five has done is to encourage/motivate clean and healthy practices, the 
consumption of clean and healthy food, how to deal with garbage problems in the 
schools, how to properly wash hands. But it hasn’t done much about physical 
development. So, a physical development program is needed as this is greatly needed by 
both students and residents …” (Elementary school teacher)
2. Media Support for Hygiene and Sanitation 
The members of the City Working Group who were present at the group discussion said 
that the issues of sanitation and hygiene were still not sufficiently communicated to the 
public at large by the media.
“… Ok, the media has its own limitations and can’t concentrate solely on sanitation …” 
(Makassar FJS)
However, a number of activities related to tree planting and improving the environment 
along canal banks were undertaken by both government and residents. The same 
applied to the Green & Clean and the High Five Program. There was a perception among 
members of the Makassar Municipal AMPL Working Group that in order to increase media 
attention, it would be necessary to give “tips” or pay “transportation” money to the 
journalists.
“… To get it covered, what’s important is money …” (City Working Group)
“… When it’s news about the lower classes, particularly news about sanitation, which 
isn’t very interesting …” (Makassar FJS (Forum Jurnalis Sanitasi – Forum of Journalists
for the Sanitation) 
In order to secure more media attention, High Five Program was advised to:
 Continue its activities on an ongoing basis. The program should be extended. This 
would encourage the media to cover it as they would be impressed with the 
program’s consistency in promoting sanitation and hygiene.
 Help enhance the capacity of journalists, particularly free-lance journalists.
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Other sources who were interviewed separately said that a number of media outlets had 
environmental columns, which sometimes also covered sanitation and hygiene issues. 
These sources also wanted to see more media involvement in highlighting sanitation and 
hygiene issues.
“…. In reality, there are print media outlets that give attention to this issue, like Fajar 
Harian Pagi Makassar (local newspaper), Unilever (multinational company), they 
focused on Green & Clean (program). I think it would be good if they highlighted 
environmental issues so that they become popular and in future have dedicated columns 
dealing with environmental issues …” (Head of Lembo Sub-district) 
“… the media could report that the people of Tallo Sub-district have to live like this 
because of inadequate sanitation or because the water supply from the Municipal Water 
Company is a mess, isn’t that right? …” (Head of Tallo Sub-district)
“… In order to influence government policy, High Five needs to forge good relations with 
the media by providing imagination, providing input, providing information. However, 
High Five doesn’t have the right to influence what we write. That’s our job. So it would 
be good if they forge close relations with various media outlets, particularly those that 
have an interest in environment hygiene and sanitation issues. But they must avoid 
trying to influence what we write, whether it’s good or bad …” (FJS Makassar) 
Also as regards journalistic support for the CBTS program, members of the public were 
also empowered to provide reports on sanitation and hygiene in their areas, as well as 
the behavior of people in these areas.
“… I feel the role of the media is good. People in this area have also been involved by 
portraying particular activities so that other people may be made aware, not just people 
from this sub-district …” (Makassar BTKLPP - Balai Teknik Kesehatan Lingkungan￾Pengendalian Penyakit – Technical Unit Environmental Health-Diseases Control)
For the journalists in the KJPS, they were aware that the media could play a major role 
in conveying information to stakeholders and in focusing on hygiene and sanitation 
programs.
“… For sure, the media can be very influential as it can provide the government with 
information that it has a sanitation, health problem in the area …” (Makassar FJS) 
The next goal for the journalists is the establishment of columns devoted to sanitation 
and hygiene so as to support these two issues by encouraging both government and 
residents to participate in resolved related problems.
“… I myself am obsessed with the idea of setting up a tabloid or other print media outlet 
that will focus on environmental sanitation and hygiene. If the truth were to be 
highlighted in a newspaper, the government would have to act. About diarrhea, for 
example, it would have to act …” (Makassar FJS) 
Another component of IR2 – the extent to which households understanding the 
importance of the CBTS pillars – will be discussed in the quantitative report, while the 
number of households that have adopted positive behaviors and improved their hygiene 
and sanitation practices will be dealt with in the section on effectiveness.
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On the empowerment of communities to ensure sustainable demand and access to safe 
water, hygiene and sanitation facilities at the household and community levels (coded as 
IR3 – program’s success indicator).
1. Preparation and collection of proposals by communities/groups/schools 
The concept of eliciting proposals from the public was inadequately socialized to the 
Makassar Municipal AMPL Working Group, and almost all of the members of the Sub￾District Working Groups who were present at the group discussions said that they had 
not been provided with information on the opportunities to be afforded to members of 
the public to prepare and submit proposals to High Five Program so that they could be 
forwarded to third parties, such as the local government, private sector organizations, 
and so forth.
The community leader respondents also felt that they had not been provided with 
enough information on the submission of proposals. This was because there was ‘clog in 
communication and coordination’ with High Five Program. 
“… I didn’t know that proposals had been prepared by the deputy chair of the LPM 
(Lembaga Pemberdayaan Masyarakat – Institute for Community Empowerrment) and his 
volunteers. This was because the lines of communication with High Five were broken …” 
(Head of Tallo Sub-district)
As regards the preparation and collecting of proposals, the principal constraints, 
according to the Sub-District Working Groups, were as follows:
 Residents (including members of the Sub-District Working Groups) did not have the 
capacity to make proposals in the absence of prior training.
 Volunteers were worried that people would assume that the making of a proposal 
was the same as the proposal being accepted and put into effect. Thus, people 
needed to be informed that proposals might end up being adjusted or even 
rejected.
“… as we weren’t able to prepare proposals, there was no demand to do so …” (Sub￾District Working Group)
“… If they were to submit a proposal, there would have to be funds. So the Working 
Group would then become the target …” (Sub-District Working Group)
Information was not provided to the community leaders on the efforts made by the 
members of the High Five Program Sub-District Working Groups in relation to the 
preparation of proposals and their distribution to the private sector or other relevant 
parties. The relevant sub-district heads and district heads had not been provided with 
information on this issue.
“… In reality, we at the sub-district level continued to coordinate with High Five. As 
regards proposals, we continued to operate through the Musrenbang (Musyawarah 
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Perencanaan Pembangunan – Community Discussion on Development Planning) process 
…” (Head of Lembo Sub-district).
2. Use of BCC (Behavioral Change Communication) Materials in Socialization Process
Almost all members of the Sub-District Working Groups who were in attendance at the 
FGD were familiar with and able to identify the BCC materials that were shown. The BCC 
materials that were used were as follows:
 Flipcharts 
 Brochures (various types)
 Media cycle showing how diseases spread
 High Five Program calendars 
Nevertheless, the members of the Sub-District Working Groups said that the BCC 
materials needed to be smaller so as to be able to carry around (by the volunteers and 
members of the Working Groups) when conducting socialization/outreach work, while at 
the same time continuing to comprehensively cover the 5 CBTS pillars.
“… they would be easier to bring around if they were smaller …” (Sub-District Working 
Group)
“… it’s important that they cover the 5 pillars comprehensively … (Sub-District Working 
Group)
b. Views of stakeholders (community leaders, facilitators, Sub-District Working 
Groups, High Five Program team, sanitation workers, and teachers) 
In Makassar, the 1.5-year CBTS was assessed by stakeholders as being capable of 
achieving the set goals. Much had already been achieved, as could be seen by 
comparing the findings of the baseline survey in 2012 and those of the midline survey in 
2013. Among the achievements identified were the following:
1. Volunteers had been taught how to effectively approach the public, namely, by 
providing examples so as to avoid the impression of “lecturing” and to get all 
components of society on board.
“… We practice what we preach so that women know … how to wash their hands 
properly. If they do something wrong, then we tell them that what they are doing is 
good but not yet sufficient. We talk to them like this to avoid giving offense. To make 
sure they don’t get upset …” (Sub-District Working Group)
“… After I perform a demonstration, I set up a garbage disposal site in front of the 
house, organic and inorganic garbage, I show the women. Some of them understand 
that if we do it like that then it will be very unsightly, also a lot of flies spreading 
germs around …” (Sub-District Working Group)
“… High Five didn’t deal directly with the local government water company (PDAM). 
While the program had a clean water component, this was simultaneous, what they 
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were doing was encouraging the people to be self-reliant …” (City Working Group – 
PDAM)
2. People were taught gradually on an ongoing basis so as to ensure that the High Five 
Program messages were taken on board by the public socialization and monitoring 
were conducted routinely, and community activities (prayer meetings, youth groups) 
were availed of for socialization purposes.
“… There was always socialization work underway in RW 4. We always conducted 
monitoring and provided outreach when we were engaged in socialization. We 
continually provide the people with information on garbage and open defecation 
when we conduct our socialization meetings … at the Posyandu (Pos Pelayan 
Terpadu – Integrated Services Center) at prayer meetings, at ‘arisan’ (social 
gathering often involving informal savings and credit schemes) get together…” (Sub￾District Working Group)
3. Improving the knowledge of Working Group members (through training, provision 
of visual aids and training on how to use them, such as the disease-spread cycle).
“… We were taught by High Five about how diseases spread from one person to 
another, which we then taught to the people. Before this I didn’t know anything 
about the spread of disease, but I’ve been aware since I joined the CBTS program
…” (Sub-District Working Group)
4. Empowering women so as to enable them to speak in public so as to influence 
those around them in Lembo and Tallo sub-districts.
“… With the presence of High Five , the women were helped to speak in public … 
those who lacked the courage originally were, in the end, able to influence people, 
to become triggers. As they had proved their worth, they became involved in data 
collection …” (City Working Group)
5. Cleaning up garbage that had been piled up in Lembo Sub-district 
“… I saw that in Lembo there was garbage piled up from the outset, in front, in the 
street. Now all that has changed, the garbage is gone. Before, people used to 
dump it in the river. Now they put in garbage bags …” (City Working Group – LPM)
6. Women have been taught how to purify water, which can then be sold (it is 
believed that this is one of the reasons that people were willing to participate in the 
High Five Program).
“… Some time ago, the High Five showed us how to purify drinking water, like 
that, the women can sell it as agents. Maybe that’s one of the reasons they were
interested (in participating in the High Five) …” (City Working Group)
7. High Five Program has contributed to enhancing the role of the AMPL Working 
Group 
“… In my opinion they played quite a major role as they always coordinated with the 
Working Group members. The essence is how to change behavior. They got 
involved in drinking water and environmental health so that their role was … “ (City 
Working Group)
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c. Challenges and Their Potential to Result in Non-Achievement of Program 
Objectives 
One of the principal challenges faced by High Five Program, according to those members 
of the City Working Group who were present during the group discussion) was the limited 
scope of the program (only 2 sub-districts). The Makassar City Working Group also was of 
the opinion that High Five Program had failed to significantly affect the implementation of 
the CBTS program in Makassar as its duration was only 1.5 years compared to the dozens 
of years that the government had been working in the same field. Other points raised by 
the City Working Group were as follows:
 High Five Program did not reach the local government water company (PDAM) at all. 
Collaboration is needed with PDAM so as to expand its distribution area, enhance its 
capacity.
 The Health Agency felt that it played a significant role in CBTS.
“…After the Health Agency conducted socialization in the school. It was only then 
that we saw the change, for example, the children became aware of CTPS…” (City 
Working Group)
 Other NGO programs were also mentioned by the City AMPL (Air Minum dan 
Penyehatan Lingkungan – Working Group on Water and Sanitation), which stated 
that these also played a role in the development of sanitation and hygiene programs 
in Makassar. So, this role was not confined to the High Five CBTS program. The 
same applied to PKK (Pembinaan Kesejahteraan Keluarga - Empowerment Family 
Welfare) programs (which taught that hands had to be washed under running 
water).
“…We have what they call the IHPP (Integrated Health Promotion Program) program 
in Makassar…” (City Working Group)
As regards the replication of High Five Program, a problem was the lack of human 
resources (including sanitarians) assigned to 4 sub-districts. Consequently, they had 
difficulties in carrying out all of their duties.
“… There is only one sanitarian assigned to 4 sub-districts, while at the same time there 
are all kinds of programs underway. Not just the CBTS program, but also water 
supervision, food supervision. So we have to find time for 4 sub-districts (Sanitarian at 
the Rappokalling Puskesmas - Pusat Kesehatan Masyarakat - Community Health Clinic)) 
“… The first thing is human resources who understand the importance of CBTS, while the 
second thing is lack of land for building CBTS infrastructure …” (Lembo Sub-district Head)
The community leaders who were interviewed for the midline survey also were of the 
opinion that support for the development of infrastructure would help change mindsets 
and behavior (in line with the High Five Program’s objectives) much more effectively in 
the High Five Program sub-districts.
“… The High Five program only changes mindsets and is not accompanied by good 
channels for the residents …” (Tallo Sub-district Head)
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One Sub-district Head explained that another challenge faced by the CBTS program in his 
area was resistance by people who did not like the changes brought about by the 
program.
“…Sometimes there are these people who see programs like this as being unnecessary – 
they were quite happy with life the way it was …” (Lembo Sub-district Head)
The partners who worked with High Five Program also felt that a challenge faced when 
the work partners went into the field to work with residents of the High Five Program 
sub-districts was breaks in communication between High Five Program, the residents and 
work partners. 
“… perhaps there were approaches, but these approaches were between individuals 
alone. Maybe there was socialization, but it wasn’t too effective as the High Five people 
don’t come from around here. So, it is difficult for us to help the residents as they don’t 
know us …” (Other Partner, BTKL-PP)
d. Steps that Can Be Taken to Prevent the Challenges Resulting in Non￾Achievement of Program Objectives
In order to respond to the challenges (from the perspectives of the stakeholders) 
described above, there are a number of things that should be done by High Five 
Program to make sure that the program achieves its objectives:
 According to the Makassar City AMPL Working Group, High Five Program needs to 
interact and work together more with other relevant institutions, such as the local 
government water company (PDAM), the Sanitation Agency, and the sub-districts. 
More information from High Five Program would help the relevant partiers 
understand what High Five Program is doing and this in the end would influence how 
they perceive High Five Program’s work.
“… what I mean is that we have been doing this for dozens of years (in the High Five 
sub-districts), the health agency and others, Ibu (Ms) Nilma of the BPM doesn’t 
appreciate their roles, just High Five, … no one else …” (PDAM)
 Both the City Working Group and the Sub-District Working Groups were of the 
opinion that High Five Program allocation of 20% for physical assistance was 
inadequate (particularly in the case of people with financial difficulties). It was 
important to bear in mind that the development of infrastructure was also important 
if people’s mindsets and behavior were changed.
“…The fact that it’s only 20% won’t be a problem for those who understand. But 
what Bapak (Mr) Samsudin said earlier, the fact that people have financial problems 
means that they can’t do anything. So we can’t force them to do it …” (Sub-District 
Working Group)
“…While bringing about changes in mindset from not wanting to wanting to do it, we 
should at the same time improve the facilities, programs should get involved. The 
facilities aren’t there. Now is the time to do it …” (Sub-District Working Group)
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 The target areas should be expanded and the existing successful program replicated 
using innovative ideas and a pattern that will benefit the public financially. By 
innovative and benefitting the public financially is meant something along the lines of 
the water purification project, which has increased the income of the sellers, who are 
also Sub-District Working Group volunteers. The water purification products, which 
are brought in from outside South Sulawesi Province, could be produced within the 
province so as to be able to resolve the potable water problem and provide 
additional income not only for the province, but also its residents.
“…High Five needs to be able to replicate this successful project in other places 
(other sub-districts) and achieve the same results. Innovation can increase people’s 
incomes…” (City Working Group)
“… we are dependent (the people of Makassar). If we try it and like it, then we’ll buy 
it. If it isn’t produced here, then we’ll import it from Java or Banda Aceh. That’s our 
problem. Why don’t we produce it ourselves so that we can then sell it …” (City 
Working Group)
 High Five Program should work with other problems and local government agencies 
so as to accelerate High Five Program activities and also the programs of the local 
government agencies.
“…Like I said, we didn’t know if High Five could be accessed by all of the local 
government agencies … better coordination would be really good as it would help 
motivate the local government agencies. We already have an AMPL Working Group, 
it’s been set up, there no one else to motivate them except the AMPL Working Group
…” (City Working Group)
 High Five Program should ensure that there is no overlapping with other 
organizations in its target areas.
“… We need to think about this as sometime a Pamsimas (Penyediaan Air Minum dan 
Sanitasi Berbasis Masyarakat - Water Supply and Sanitation Program) program 
arrives in sub-district A but we are building it in RW A, while there are still many 
residents of RW B who don’t have any sanitation facilities. So if High Five wants to 
go into the same sub-district, where they already have facilities, then of course they 
should develop it in another area so that there is no overlapping …” (City Working 
Group)
 Improving coordination with related parties
“…We in the PDAM haven’t been involved in coordination … maybe as I wasn’t there 
I didn’t hear about it, maybe my colleagues heard about it …” (City Working Group)
 The CBTS program should be supported by equipment/requisites sourced from 
Makassar so as to make use of available resources and reduce dependence on those 
outside Makassar.
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“… we are dependent (the people of Makassar). If we try it and like it, then we’ll buy 
it. If it isn’t produced here, then we’ll import it from Java or Banda Aceh. That’s our 
problem. Why don’t we produce it ourselves so that we can then sell it …” (City 
Working Group)
 Bearing in mind that the objectives of High Five Program are to change behavior, 
which is something that is abstract in nature, the program needs to be supported by 
performance assessments conducted by third parties (through surveys/evaluations) 
so as to ensure neutrality.
 Resident involved (invited) in program implementation should be expanded and 
widened (although a number of respondents said that this had already been done in 
their areas).
“… Before there were only a few people who really understood High Five … so what 
is needed is that it should not just be confined to the Working Group, but also the 
public …” (Sub-District Working Group)
 High Five Program needs to map out its successes in Tallo and Lembo sub-districts 
so that the program can be replicated more quickly in other sub-districts. 
 An opportunity needs to be given to highlight the successes of both the Sub-District 
Working Groups and residents so as to encourage pride and recognition of the 
changes that have taken place.
Both the City Working Group and Sub-District Working Groups hoped that High Five 
Program in the future would:
 Increase assistance for infrastructure development, particularly for people who were 
truly impoverished.
“…The amount allocated to physical infrastructure is inadequate, it should be 
increased above 20% as most of the people here are in the middle to lower income 
brackets. That’s the most important thing as there are money problems everywhere. 
I think the physical aspect needs to be enhanced as much as possible …” (Sub￾District Working Group)
 Follow-up programs should be instituted in other areas so that a higher percentage 
of residents can be reached by the program.
“…For me, I want to see it in 50% of our sub-districts (in Makassar) …” (City 
Working Group)
e. Role of High Five Program in Integrating CBTS into the SSK Program 
It was stated by those members of the Makassar City Working Group who attended the 
group discussion that the SSK had been prepared in 2012 by Working Groups in the 
relevant local government agencies based on their respective areas of authority. The 
process was coordinated by Bappeda.
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It was also stated that prior to the socialization and publication of the SSK, input had 
been received from academia.
“… We ran it past the academics …” (City Working Group)
I-WASH was considered to have greatly assisted the preparation of the SSK (through 
collaboration and mentoring), while High Five Program had not played a significant role.
As regards the contents of the SSK, it was more influenced by PHBS (Perilaku Hidup 
Bersih Sehat – Healthy and Clean Living Behavior) than CBTS as PHBS was better known, 
while CBTS had only been introduced around 1 year earlier.
“… Previously, there was much more about PHBS than CBTS … that’s because CBTS 
hadn’t yet been started. So, there was a lot more talk about PHBS than CBTS …” (City 
Working Group)
 Hygiene and sanitation programs that had been operated in the High Five Program 
sub-districts and in Makassar Municipality in general include:
 Wash (construction of public latrines and hydrants)
 I-Care (construction of public latrines)
 Pamsimas (focused on clean water)
 USRI (sewerage system/treatment plant in Lembo)
 Nice (nutrition for under-5s)
 Green & Clean (mentoring, assistance with provision of garbage bins along 
canals -> only mentioned by City Working Group)
 IDB (Islamic Development Bank) -> new program focused on PHBS.
All of the programs referred to above were deemed to focus more on physical sanitation 
and hygiene infrastructure and facilities, while High Five Program was primarily focused 
on changing people’s attitudes.
Only the members of the City Working Group were familiar with Community Led Total 
Sanitation (CLTS), which they considered to be similar to CBTS.
“… The essence is the same … in our view there is no difference between the programs. 
We talk to them about CLTS, how they want to behave, trying to get them to voluntarily 
change their behavior. In other words, we also act as a catalyst, we talk to them so as to 
get them to want to change … CBTS is in essence the same, except that it’s called 
community led total sanitation …” (City Working Group – Health Agency)
“… CLTS covers one pillar, I think it was adopted from India. It focuses on how to trigger 
people to adopt clean and healthy practices, particularly in connection with the first pillar. 
So, for example, they become willing to change their practices as regards open 
defecation. They become embarrassed and in the end they become willing to build their 
own infrastructure – (Question from moderator – For CBTS, what’s the trigger?) – a 
feeling of disgust, embarrassment … the same …” (City Working Group)
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 Identified Improvements 
In the implementation of the CBTS program by High Five Program in Makassar, a 
number of positive changes had been brought about, according to a number of resource 
persons: 
 People’s behavior and mindsets had been changed as regards open defecation, 
CTPS, treatment of water prior to consumption, and the proper disposal of 
garbage. Respondent also applied peer pressure on each other to maintain 
environmental hygiene and sanitation.
(Reprimanding a child) “… when you finish your snack, throw the garbage in the 
garbage bin …” (Sub-District Working Group)
“ … in the home previously, we had a tradition of all of us washing our hands in 
the same finger bowl before eating. But after we received information from the 
CBTS volunteers, we changed our ways and started washing our hands with soap 
under running water. That was the biggest change …” (Sub-District Working 
Group)
“… As regards changes, people are now embarrassed to practice open defecation, 
including children. Adults also understand the importance of hand washing. 
(Lembo Sub-district Head)
“There were people who originally didn’t agree with the building of a communal 
septic tank. But, thank heavens, after being enlightened by USRI and High Five 
Program , they came to support the program …” (Lembo Sub-district Head)
“… the problem of open defecation … previously there was a lot of open defecation, 
behind the houses, in the drains. Now the kids defecate in the toilet. So, we can conclude 
that the mindsets of the children have moved in the direction of clean and healthy 
practices …” (Teacher in Penjaskes [Pendidikan Jasmani dan Kesehatan – Health and 
Physical Education) Malimongan Baru)
 The City Working Group felt that they had been assisted by the High Five Program 
in increasing the number and membership of the Sub-District Working Groups in 
Makassar Municipality.
“… For example, 10 members in a Working Group, suppose 10 members, these 10 
members have to train a number of volunteers. So High Five was able to help us 
with this. If we didn’t have enough volunteers for a sanitation and hygiene 
program, High Five was of assistance to us as we didn’t need to go into the High 
Five areas, meaning that we could focus our efforts on the other areas …” (City 
Working Group)
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B. Efficiency
As regards efficiency, the most appropriate sources are those from within High Five 
Program itself, namely, those responsible for implementing the CBTS Program in their 
respective areas. The following are the results of an interview with the High Five 
Program District Leader in Makassar.
a. Use and Allocation of Resources for Program Implementation 
As with the allocation of resources, like funding and equipment, in other High Five 
Program cities, this was also done in Makassar based on the priority objectives to be 
achieved. These were then submitted to High Five Program head office in Jakarta for 
approval for the following year. Budget preparation was based on the outcome of 
discussions between the facilitator team in the High Five Program Makassar District.
High Five Program Jakarta then evaluated the proposed budget, and the objectives that 
had been prioritized so as to ensure that they were capable of achieving the 
performance targets that had been agreed.
“… So the reality is like this, every year we prepare what we call our AWP, our Annual 
Work Plan, which runs from January to December. Then, after we have prepared it on a 
district by district basis, we have a national meeting. Everyone attends, and they all 
make their presentations, including operational strategy definitions and so forth. We 
then discuss it after returning home from there. Jakarta knows what we have, so we 
break it down further into more simple activities. Every area can modify its plan. For 
example, our goals are the same. We want to engage in partnerships with those who 
can contribute to the High Five. There are those who get involved at the local 
government agency level, as needed …” (District Leader)
With the process being that the allocations for each area are based on proposals from 
the areas themselves, the resources used will obviously have been identified in 
accordance with the area’s needs. As the High Five Program Makassar District makes 
plans for one year ahead and submits to the High Five Program head office in Jakarta, 
the resources provided by High Five Program’s head office should be in line with the 
Makassar District’s needs. High Five Program’s head office almost never changes the 
AWPs submitted by the districts provided that these have been prepared in line with the 
rules and are approved by High Five Program Jakarta office. 
“… Normally the budget proposal is 100% prepared by us, and it is rarely changed by 
High Five Jakarta, unless the finance rules have been broken in connection with venues, 
accommodation, for example, for any expenditure over Rp 3 million, there must be 3 
offers from hotels. If this rule isn’t complied with, we can’t go ahead. The High Five 
people in Jakarta help us choose. But they don’t interfere with other things …” (District 
Leader)
As regards the allocation of financial resources, the Makassar District feels that its needs 
have been fully supported by High Five Program Jakarta office. Consequently, it has 
experienced no financial difficulties in program implementation. However, as regards 
human resources, the Makassar District considers this to be a challenge given how few 
people are currently on the team. As a consequence, some activities have had to been 
postponed.
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“… Yes, perhaps some of our friends are too creative so that we sometimes forget the 
limited human resources that we have available. So, we often have to carry over 
programs to the subsequent month as we don’t have enough time (due to lack of 
personnel) to do them …” (High Five Program District Leader)
“… there needs to be real support (what do you mean by support? – interviewer) … 
yeah, finance administration support, part of supporting, and monitoring and evaluation 
is also part of support. There are other things that are needed, for example, as regards 
procurement, particularly as regards equipment ….” (High Five Program District Leader)
b. Program Adaption and Implementation 
There were a number of activities that in essence were outside the principal activities 
that were agreed on and identified by High Five Program (for implementation in High 
Five Program Districts). However, during the course of the High Five program’s 1.5 
years in Makassar, not only were program adjustments made, but also program 
enhancements instituted:
 Appreciation for High Five Program work partners (the Sub-District Working 
Groups) in the form of capacity-building training. This was packaged as 
attractively as possible while at the same time incorporating education and games 
that were capable of bringing the team members closer together, enriching their 
capacities, and providing appreciation for what had been done by the Working 
Groups. 
“…We (High Five Makassar) once did something that was a bit beyond the scope 
of the High Five program, namely, upgrading training. This was provided at 
Galeso beach. In reality, my objective was to provide an enjoyable break for the 
members of the Sub-District Working Groups. We have “refreshing training.” But 
we later received input from Jakarta, not to make it look to enjoyable. In the end, 
we also incorporated training on facilitation and on CBTS triggering, even though 
in reality what we had was an outbound program, lots of role play, lots of games. 
We did it at a comfortable picnic spot. In reality, the purpose was solely to provide 
appreciation for our friends in the Sub-District Working Groups. What we do 
normally only has to be sorted out with the High Five people in Jakarta …” (High 
Five Program District Leader)
Changes in the form of adjustments to take account of developments in the field 
generally did not result in significant changes to the overall budget plan. Such 
adjustments took place due to:
 Adjusting program timeframes to take account of programs run by relevant 
agencies in the Makassar government
“… As of March, according to my calculations we had only spent 68% out of 
100%. So we still had around 32% that had not been spent. The bulk of that 
32%, 22% consisted of community events. We had a budget of around Rp 120 
million for this and it consisted of a competition at the community level. We have 
2 sub-districts, so we adopted the slogan “CBTS Sub-district” … we planned to 
have the competition in April, while we had to do the calculations in March. So it 
was quite difficult because the series of events were already underway. So, out of 
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the budget of Rp 120 million we arranged meetings in July, a number of briefings, 
socialization with the sub-district authorities. We gave the sub-districts the 
opportunity to select the RWs and to nominate 3 RTs for assessment. They were 
give a month, from March to April, to make the preparations …” (High Five 
Program District Leader) 
 External factors, for example, the holding of local government elections
“… A lot of community activities had to be postponed because of the local 
elections. They (Sub-District Working Group), the PPK, the PPS also. All of the 
volunteers were taken. So, whether we liked it or not, we had to change the 
timing. This also had an impact on our spending. So the 32% I referred to was 
primarily due to this …” (High Five Program District Leader)
 Another constraint was changes on the part of work partners which had different 
goals from High Five Program. As a result, changes in plans occurred and these 
resulted in changes in implementation costs.
“… At the start, to promote CTPS we joined up with the AMPL Working Group, 
that was back in October last year. So, the leading sector was the Health Agency 
on behalf of the Municipal Government and the AMPL Working Group, then there 
was CARE (an NGO). As regards contributions, PDAM provided clean water. That 
was it. Then High Five normally supplied consumables in the form of snacks. In 
October, Unilever wanted to force its concept on the local government. But we 
didn’t agree as the branding was too prominent. As a result, we would not have 
been able to take part. The CARE people also agreed that we would each do our 
own thing in our respective locations. Now, the budget that I allocated was 
originally Rp 12 million for consumables. But this mushroomed to Rp 60 million as 
I had to organize special events in Makassar at the community level. So we 
promoted CTPS in the schools through various competitions, and at the 
community level through neighborhood campaigns. We had door prizes, went 
around the neighborhood, campaigning, door prizes again, like that …” (High Five 
Program District Leader)
C. Sustainability 
a. How do the stakeholders perceive the High Five Program methodology 
compared with CLTS?
At the Sub-District Working Group level, people were not familiar with CLTS, although 
the Makassar City Working Group (Health Agency) was familiar with the concept, 
which it considered to be more or less the same as CBTS, that is, it focused on 
arousing disgust and embarrassment in people.
“… it was adopted from India. It focuses on how to trigger people to adopt clean and 
healthy practices, particularly in connection with the first pillar. So, for example, they 
become willing to change their practices as regards open defecation. They become 
embarrassed and in the end they become willing to build their own infrastructure – 
(Question from moderator – For CBTS, what’s the trigger?) – a feeling of disgust, 
embarrassment … the same …” (City Working Group)
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b. Level of Acceptance by Stakeholders of High Five Program Approach 
There was quite a variety of information and experiences obtained from the relevant 
stakeholders in connection with the methods applied by High Five Program in the 
selected sub-districts. In the in-depth interviews, some of the stakeholders expressed 
positive views and understood that the focus of High Five Program was on non￾physical development, namely, changes people’s behavior as regards sanitation and 
hygiene.
“… As far as I know there was once a comparative study. I don’t know who was on it, 
maybe they picked the wrong people at the sub-district level. I don’t know where the 
comparative study was because on people from BPN and Public Works Agency were 
picked. No one from Bappeda was involved. So I don’t really know what is going on at 
the sub-district level (Is there any difference with other programs? – Interviewer). 
Sure there are differences. High Five is only about capacity-building, while the other 
programs are more about building and physical development. High Five doesn’t involve 
physical development. “The other programs aren’t focused on triggering, not 100% 
triggering, while High Five is about consent, 100% triggering.” It’s good because its 
specifically about changing people’s behavior, and it’s focused on two sub-districts …” 
(Bappeda)
The Environmental Concern Journalists Forum, which has relatively close relations with 
High Five Program also had a positive view of how High Five Program was 
implementing the CBTS program in Makassar.
“… I’ve been familiar with High Five since 2012. The program is concentrated on two sub￾districts in Makassar and its activities include providing mentoring to local communities about 
the 5 CBTS pillars. First, how they encourage them not to practice open defecation. How to 
encourage people to wash their hands before eating, particularly children. Proper garbage 
management, managing waste in the RT. As regards garbage, a number of garbage banks 
have been set up in connection with the volunteers …” (PWI)
During the in-depth interviews, a number of teachers who had received training 
offered a positive view of the methods applied by High Five Program, although there 
were a number of less positive comments:
High Five Program was asked by the teachers who received training to always needed 
to preserve its neutrality.
“… the people from Rahmat water company. They showed people how to purify water so as to 
make it drinkable. I had to ask myself, is this part of the program or not …” (teacher who had 
received training)
The teachers with training also said that assistance was needed for physical 
development on the part of residents and their students as this could not be separated 
from the effort to change mindsets.
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“… What has been done by High Five has involved mobilizing and motivating people. 
But they haven’t done anything about physical development. It is this physical 
development that they need to incorporate in their program so that it can be seen by 
students and residents, so that they know that the program is really beneficial …” 
(teacher with training)
c. Contribution of High Five Program to Development of AMPL Working 
Group’s Functions 
High Five Program ’s role in developing the functions of the Makassar Municipal AMPL 
Working Group was viewed positively as High Five Program’s presence meant that:
 The meetings held by High Five Program helped bring together each line units 
from the relevant local government agencies, and served as media for 
coordination and communication with the line units.
“… So one of High Five Program ’s roles was to improve coordination among us
…” (City Working Group)
“… With the programs coming in, sometimes we met again here (meetings 
between local government line units), with CARE. The point was programs were 
coming in … sometimes we would have meetings 3 or 4 times a month …” (City 
Working Group)
 With the presence of High Five Program , it meant that the Makassar City Working 
Group had 2 sub-districts less to worry about.
“… For sure there was an impact as the presence of High Five meant that 
automatically the workload of the AMPL Working Group was lessened as the 
people of these 2 sub-districts had already changed …” (City Working Group)
“… Because whatever way you looked at it, the High Five activities were the same 
as our activities or duties as members of the AMPL Working Group …” (City 
Working Group)
However, the role played by High Five Program did not mean that the City 
Working Group and the local government line units were dependent on High Five 
Program in Makassar as the local government line units already had a system of 
coordination in place, with routine meetings held every 3 months between the line 
units.
“… One of the functions of the line units in the relevant local government agencies 
is to coordinate with the AMPL Working Groups. Normally we meet the members 
of the AMPL Working Groups every three months to discuss sanitation issues. The 
AMPL Working Groups are able to work on their own and have a lot of sanitation 
programs. Sure there was an influence, but it wasn’t overriding …” (City Working 
Group)
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d. Possibility of Program Replication
This aspect was dealt with in IR1 on “Replication of High Five Program Sub-district 
Program by local governments and/or NGOs.”
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D. Relevance and Appropriateness
Our information on relevance and appropriateness was obtained from a number of 
different sources: the High Five Program team, community leaders (sub-district heads), 
Working Groups (City and Sub-district), teachers and households. The following are the 
results of the interviews with the sources.
a. How is the Participatory Approach Carried Out?
The participatory approach applied by the High Five Program team in Makassar at the 
outset of program execution was more or less the same as that applied by the High 
Five Program teams in Medan and Surabaya. The triggering process involved 3 stages 
– mapping, demarcating the area and finally discussions. The triggering process 
involved all components of society in the selected sub-districts. 
“… So, from the outset we commenced what we call CBTS triggering. This consisted of 
3 components -- mapping, demarcating the area and finally focus group discussions. 
We then focused on 4 groups in the community. Fathers with under-5s, mothers with 
under-5s, teenagers, and children aged 10-16. We gathered them all together in the 
same place, we joined up pieces of card together then we started with the place most 
familiar to local people, for example, the canal. We started by drawing the canal and 
then every house in the area, recorded. That was all part of the mapping process. So, 
they drew the houses that had under-5s, then the public facilities in the area, for 
example, Poskamling, Posyandu, the RT’s house, the mosque, etc. We did that with 
each group. After they had drawn everything, we affixed flags for our 5 components, 
for example, places where people practiced open defecation, in pillar 1, for example. 
They would mark these places in red. So, the houses along the canal were marked in 
red. Homes that didn’t have toilets were also marked …” (High Five Program District 
Leader)
During the focus group discussions between members of the Sub-District Working 
Groups, it was also recalled how High Five Program had first commenced the 
triggering process. The meeting was not only attended by representatives of the 
relevant municipal agencies, but also children, teenagers, and religious and community 
leaders from the selected sub-districts.
“… The first time High Five Program , or the CBTS Sub-District Working Group came to 
our sub-district, the first thing that was done was mapping, mapping out the area, so 
that we would be aware of those places that were susceptible to, for example, open 
defecation, undisciplined garbage disposal, blocked drains. Then, we gather again with 
the residents and the sub-district authorities, the sub-district head himself, as well as 
children, teenagers and religious and community figures …” (Sub-District Working 
Group)
b. Determining Hygiene and Sanitation Priorities
The placing decisions in the hands of the public (in line with CBTS), High Five 
Program’s triggering efforts in Makassar involved all components of society, including 
various age groups and genders. The responsibility for determining priorities was 
assigned to the community based on the results of mapping and demarcation. These 
priorities were then set out in the RKM, and a Sub-District Working Group established.
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“… So after the RKM had been drawn up, it only remained for us in High Five to see 
what areas the residents needed help with. Now, when the community started 
implementing the RKM, whose responsibility were the various activities it envisaged, 
from land procurement to construction of public latrines. Then we had to reduce the 
piles of garbage in particular locations. Some of the volunteers cleaned up the place 
where garbage was dumped and turned it into a mini garden ….” (High Five Program 
District Leader)
The way in which sanitation and hygiene priorities were determined through the 
involvement of the community was also highlighted by community leaders during the 
in-depth interviews. They also compared this with other programs, which programs 
they considered to be better as they were not only orientated towards changing 
mindsets, but also the development of financial infrastructure (in Tallo Sub-district).
“… Before making any decisions about activities, High Five Program would always 
invite community leaders and those of us from the government to discuss what was 
needed by the people of Lembo sub-district. They would ask for input from community 
leaders at the RT and RW levels, also from religious leaders. Thankfully, everything 
has worked well, with no problems …” (Lembo Sub-district Head)
Stakeholders continue to be very influenced by paradigm of physical development of 
infrastructure and facilities. Thus, the stakeholders viewed the High Five Program 
approach, which is orientated towards changing behavior, as being “different” from 
the normal community assistance programs.
“… Oh clearly High Five was not the best. The best was Pamsimas (Pamsimas, is that 
right? So, High Five did not involve the community? – interviewer). Sure it involved the 
community, but Pamsimas was better as it not only changes mindsets but also 
involves the building of infrastructure and facilities. What is clear is that the one 
community figure who is really listened to by the residents in the LPM chairman. If 
he’s on your side, then that will very good. They people really listen to him …” (Tallo 
Sub-district Head).
c. Inclusion of Gender and Environmental Issues in Program Implementation 
In line with the participatory approach, men and women were involved equally. In 
fact, thanks to the involvement of women, the activities involving the men and 
teenagers proved to be more successful.
“…We (High Five) involved the children, teenagers and women, and in the end the 
men saw that everything went better when the women were in charge …” (High Five 
Program District Leader)
Environmental factors were also given close attention when it came to such things as 
selecting the locations for communal septic tanks.
“… For example, the land was available and we (High Five) were ready to start 
building, it was difficult to construct the connections to the toilets as we had to dig 
through the houses. For example, there would be one house here, then the house 
behind it would also want a connection. The distance involved was no problem as it 
was only a matter of adding additional lengths of piping. But the problem was the 
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physical digging. We had to dig through houses and they didn’t want it. So, people at 
the back would not get access even though they wanted it. As a result, we had to 
reduce the scale, we had to see how many could be linked up to each communal 
septic tank. We tried an average of between 5 and 10 households. Not more than 
that. Then we make the necessary adjustments in size having regard to the number of 
connections. But if a building went up along the line of the pipe, we could still connect 
as we made provision for between 5 and 10 households. That was the problem. The 
land was available but because of the overcrowded conditions in the area there was 
no room for the pipes. So we had to didg up a number of roads. It was difficult to 
make the connections to their toilets …” (High Five Program District Leader)
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Part V 
Evaluation of Program Outcomes
Hygiene and Sanitation Practices in Five CBTS Pillars
A. Open Defecation Free 
The majority (more than 50%) of respondents in Makassar (both in Tallo and Lembo) 
during the midline survey said that the last time they defecated was in a flush/U-bend 
toilet connected to a septic tank. This proportion was very different from at the time of 
the baseline survey in 2012, when the equivalent percentage was only 4.2%. In 
addition, the midline survey found that the proportion of respondents who defecated in 
the sea (13.3%) was the same as at the time of the baseline survey.
In Tallo, 50% of the respondents at the time of the midline survey used a flush U-bend 
toilet connected to a septic tank. This was a massive increase from the time of the 
baseline survey, when only 1.7% of respondents did so. However, 26.7% of 
respondents continued to defecate in the sea. The situation in Lembo was similar, with 
66.7% of respondents saying that they last defecated using a flush U-bend toilet 
connected to a septic tank, compared with only 5.8% at the time of the baseline survey. 
Unlike Tallo, 13.3% of respondents defecated in a flush U-bend toilet that was not 
connected to a septic tank, while 10% defecated in communal toilets.
Having regard to the above data, we may conclude that overall the use of flush U-bend 
toilets connected to a septic tank in Makassar (both Tallo and Lembo) has massively 
increased since the time of the baseline survey.
The locations where the respondents habitually defecate are as shown below:
Figure 5.1.
Last Place of Defecation
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
22% 23% 22% 30%
45,0%
76,7%
3,3%
26,7%
26,70%
6,7%
50%
1,7%
66,7%
Flush toilet connected to 
septic tank
Directly into sea
In private toilet
15 other responses
Tallo Lembo
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The following table sets out the survey’s observation findings:
Table 5.1.
Findings of Observations on Destination of Toilet Waste
Description Tallo Lembo
Respondent Base 30 30
Location of Last Defecation– by claim
Flush toilet with septic tank 50% 66.7%
Non private toilet 13.3% - 
Toilet cubicle (communal and sea) 10% 13.3%
Disposed of in sea 26.7% - 
Flush and non-flush toilets without septic tanks - 16.6%
Private toilet - 3.3%
Place where human waste is channeled – based on observations
Septic tank 60% 80%
River/Lake/Sea 40% 10%
Drainage system and drop toilet/hole in the ground - 10%
Based on the above table, we can see that the majority of residents in both Tallo and 
Lembo have started to use flush toilets draining into septic tanks. However, based on 
respondent claims (16.6%), there continue to be both flush toilets and non-flush toilets 
that are not connected to septic tanks.
Meanwhile, table 5.1 above shows that the situation regarding final disposal of human 
waste in both sub-districts is similar. In Tallo, residents said that 60% of respondents’ 
toilets are connected to septic tanks, while 40% are not connected to septic tanks. 
Meanwhile while in Lembo, the equivalent figures are 80% and 20%, respectively. This 
shows that there has been a reduction in open defecation in both sub-districts, although 
they are still not free of open defecation.
Condition of Toilets in General
Based on the observations conducted on the types of toilets used by the respondents 
during the midline survey, the majority (between 53.3% and 86.7%) in the two sub￾districts used U-bend squat toilets. In Tallo, the houses that at the time of the baseline 
survey used drop/pit toilets (36.7%) no longer did so at the time of the midline survey. 
However, the midline survey found that there were still respondents who did not have 
private toilets (20%). Meanwhile in Lembo, there had been a significant increase in the 
use of squat toilets by the time of the midline survey (increase of 35%)
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Figure 5.2.
Types of Toilets Used, Based on Observations 
Still based on observations, in both sub-districts the majority of respondents said that 
they had private toilets in their homes (73.3% in Tallo and 83.3% in Lembo). In Tallo, 
26.6% of respondents still needed quite a lot of time to reach the toilet (between 5 and 
15 minutes). Similarly in Lembo, 13.3% needed between 2 and 15 minutes.
Based on the observations of toilet conditions in Tallo and Lembo, toilets were found to 
be quite clean (66.7% in Tallo and 56.7% in Lembo). However, there was a decline in 
the proportion of quite clean toilets from 71.7% at the time of the baseline survey. 
Conversely, there were quite significant increases in the percentages of toilets that were 
dirty (increase of 3.4%) and very dirty (increase of 1.7%). In Lembo, there was an 
increase in the proportion of toilets that were quite clean (up 13.4%). However, this 
increase was accompanied by an increase in the proportion of very dirty toilets and a 
decline in the proportion that were very clean.
The following graph presents a comparison between the condition of respondents’ 
toilets at the time of the baseline survey and the midline survey.
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
26,70%
5,00%
20%
21,70%
36,7%
46,7% 53,3%
51,7%
86,7%
10,0% 21,7% 6,7%
Flush/U-bend sit-down toilet
Flush/U-bend squat toilet
Drop/pit toilet
Non U-bend toilet
No toilet in house
3 other responses
 Tallo Lembo
 
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
39
Figure 5.3.
Toilet Condition – based on Observations
Table 5.2 below provides a more detailed picture of toilet conditions in homes with 
under-5s in Makassar.
Overall, the condition of the toilets in target households in the two High Five Program 
Sub-districts was better than it was at the time of the baseline survey in 2012. The 
following improvements were noted:
- In Tallo, hygiene in toilets had improved (no longer traces of feces or sanitary 
napkins) compared with at the time of the baseline survey. In Lembo, the level of 
toilet hygiene had also improved, although traces of feces and sanitary napkins 
continued to be found in toilets (36.7% of respondents had feces on the wall/in the 
toilet bowl, while 3.3% of respondent toilets were found to have discarded sanitary 
napkins).
- In Tallo, 40% of respondents had taps with running water. Although not significant, 
this figure was 1.7% higher than at the time of the baseline survey. In Lembo, 
50% of the taps had running water, 3.3% higher than at the time of the baseline 
survey.
The following table sets out a comparison of toilet conditions as observed during the 
baseline and midline surveys.
Baseline Midline Baseline Midline
5,0% 6,7% 18,3%
3,3%
23,3% 26,7%
33,3%
36,7%
71,7% 66,7%
43,3% 56,7%
5,5% 3,3% Very clean
Quite clean
Dirty
Very dirty
 Tallo Lembo 
Respondent base: 60
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Bringing You The Real Portrait of Indonesia
40
Table 5.2
Toilet Conditions, Based on Observations 
Toilet Conditions 
Tallo Lembo
Baseline 
(n=60)
Midline 
(n=30)
Baseline
(n=60)
Midline
(n=30)
Feces in toilet or on toilet walls Yes 10% - 31.7% 36.7%
No 90% 100% 88.3% 63.3%
Sanitary napkin in toilet Yes 3.3% - - 3.3%
No 96.7% 100% 100% 96.7%
Flies in toilet Yes 33.3% 6.7% 23.3% 33.3%
No 66.7% 93.3% 76.7% 66.7%
Water available (if there is a tap, it 
is working)
Yes 38.3% 40% 46.7% 50%
No 61.7% 60% 53.3% 50%
Water scoop present Yes 60% 70% 78% 86.7%
No 40% 30% 21.7% 13.3%
Water bucket/receptacle present Yes 63.3% 76.7% 73.3% 83.3%
No 36.7% 23.3% 26.7% 16.7%
Towel/cloth for drying available Yes 1.7% - 5% 23.3%
No 98.3% 100% 95% 76.7%
A further criterion for assessing achievements made under the first CBTS pillar concerns 
the number of under-3s who are toilet trained. The 2012 baseline survey found that 
there was a higher percentage of under-3s in both Tallo and Lembo who were not toilet 
trained (79%-89%).
At the time of the midline survey in 2013, there had been an increase in the percentage 
of under-3s who were toilet trained in both Tallo and Lembo, with the increase in Tallo 
(38.6%) being relatively higher compared with Lembo (16.6%). The figures in figure 
5.4 below are absolute figures based on the consideration that the respondent base at 
the time of the midline survey was less than the minimum sample size, namely, 30 
individuals. During the midline survey in Tallo, 6 respondents said that their under-3s 
were toilet trained, a smaller figure than the number of under-3s who were toilet 
trained (9 individuals). However, the percentage was bigger as the respondent base in 
the baseline survey consisted of 43 individuals, while the figure for the midline survey 
was only 16. In Lembo, the number of respondents who said that their under-3s were 
toilet trained amounted to 7 (respondent base: 14 individuals), while during the 
baseline survey in 2012 only 5 respondents said that their under-3s were toilet trained 
(respondent base: 44 individuals). 
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
41
Figure 5.4. below shows in absolute terms as the base number of respondents was less than 
30, the number of under-3s who are and who are not toilet trained.
Figure 5.4
If you have a child aged under 3, is he/she toilet trained?
Also with regard to defecation practices among infants and the last place where under￾3s defecated, at the time of the midline survey in both sub-districts in Makassar, there 
was found to be an increase in the percentage of under-3s who defecated in the 
household toilet (up by 18%-39%), and a significant decline (24.7%) in the percentage 
that last defecated in their pants.
If we look at the matter in more detail using absolute figures, at the time of the midline 
survey in Tallo, 6 respondents said that the last time their under-3s defecated was in 
the household toilet (with respondent base 16). This number was smaller than at the 
time of the baseline survey, when the equivalent figure was 8 (with respondent base 4). 
However, the percentage at the time of the midline survey was higher as there was a 
significant difference in the respondent base. Meanwhile in Lembo, 8 respondents at the 
time of both the baseline survey and the midline survey said that their under-3s last 
defecated in the household toilets (bigger percentage at the time of the midline survey 
than the baseline survey due to a quite significant difference in the respondent base).
The following graph shows in absolute terms as the base number of respondents was 
less than 30, the places where under-3s in Makassar last defecated:
Baseline (n=43) Midline (n=16) Baseline (n=44) Midline (n=14)
2 1
34 8
39
6
9
6
5
7
Yes
No
No toilet in house
Tallo Lembo
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Bringing You The Real Portrait of Indonesia
42
Figure 5.5
Location of Last Defecation among Under-3s
As regards where caregivers last disposed of infant feces (see Figure 5.6), in Tallo 
almost one half of respondents with under-3s said that they directly disposed of it in the 
trash can without first cleaning. Meanwhile in Lembo, the biggest proportion of 
respondents said that they directly disposed of the feces in the household toilet.
Figure 5.6 shows in absolute terms as the base number of respondents was less than 
30, how caregivers dispose of infant feces in the target areas:
Figure 5.6
Disposal of Infant Feces
Baseline 
(n=43)
Midline 
(n=16)
Baseline 
(n=44)
Midline 
(n=14)
3
7
6 1
8
6
8
8
16
1
16
4 16
2
14
1
In pants
In diapers
In household toilet
10 other responses
Tallo Lembo
Baseline 
(n=43)
Midline 
(n=17)
Baseline 
(n=44)
Midline 
(n=22)
18
4 7
6
5
5
7
7
13
5
4
9
2
5
4
7
1
10
7 Directly disposed of in household 
toilet
Cleaned first, then disposed of in 
household toilet
Cleaned first, then disposed of in 
river/ditch/drain
Not cleaned, disposed of in 
trashcan
Thrown into the sea
9 other responses
Tallo Lembo
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Bringing You The Real Portrait of Indonesia
43
The defecation practices of children between 3 and 5 (under-5s) were also relatively 
heterogeneous, with the most common places for defecation being shown in Figure 5.7.
At the time of the baseline survey in 2012, under-5s in Makassar were already 
accustomed to defecating in private toilets, although the types of toilets were not 
identified (23.3% for Tallo and 29% for Lembo). At the time of the midline survey, the 
majority of under-5s in Makassar were accustomed to defecating in a flush/U-bend toilet 
connected to a septic tank. However, under-5s were found in both Tallo and Lembo 
who practiced open defecation, with the percentages varying between 49% and 56% 
(these percentages are accumulated from a variety of responses, such as defecation in 
the sea, flush toilet/non flush toilet without septic tank, etc).
The majority of respondent caregivers of under-5s in Makassar were accustomed to 
wiping baby’s bottom with soap after the child defecated (83.3% in Tallo and 93.3% in 
Lembo). These percentages had increased compared with at the time of the baseline 
survey, as shown in Figure 5.7. However, there continued to be caregivers who did not 
clean baby’s bottom after defecation, although the percentage was down compared 
with at the time of the baseline survey in 2012 (down by 3% in Tallo and 16.6% in 
Lembo).
Figure 5.7
What Respondents Do after Children Defecate
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
5% 8,30%
16,70%
13,30%
23,30%
6,70%
78,30% 83,30%
68,30%
93,30%
Wash child's bottom with 
soap
Wash child's bottom without 
soap
3 other responses
 Tallo Lembo 
Respondent base: 60
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Bringing You The Real Portrait of Indonesia
44
Summary of First Pillar Findings: Open defecation free 
Table 5.3
First Pillar Indicator: Open defecation free 
Indicator
Tallo Lembo
Baseline Midline Baseline Midline
Caregiver’s Last Place of Defecation (n=60) (n=30) (n=60) (n=30)
Flush toilet draining into septic tank 6.7% 50% 1.7% 66.7%
Defecation Locations of Under-3s (n=43) (n=16) (n=44) (n=14)
Household toilet 8 6 8 8 
Place of disposal of under-3s’ feces (n=43) (n=17) (n=44) (n=22)
Directly disposed of in toilet 7 1 10 7 
Not cleaned, thrown into trash can 7 7 13 5 
Defecation Locations of Under-5s 
 
(n=60) (n=30) (n=60) (n=30)
Flush toilet draining into septic tank 5% 30% 3.3% 26.7%
Post-infant defecation practices (n=60) (n=30) (n=60) (n=30)
Wash child’s bottom with soap 78.3% 83.3% 68.3% 93.3%
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
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B. Hand-Washing with Soap
In order to ascertain the extent to which respondents practiced hand washing with soap 
over the last 2 days, they were given multi answer questions and responses related to 
bathing and clothes washing were ignored (as the most common responses, up to 
100%). This resulted in a finding that there was still 1 person in Tallo who bathed 
without using soap (percentage: 96.7%). The second most common response in Tallo 
was that respondents used soap to wipe baby’s bottom after defecation (73.3%). This 
figure marked a significant compared with at the time of the baseline survey, when it 
was 18.3%. Overall, there had been many improvements in the use of soap at the time 
of the midline survey in Tallo, as shown in Figure 5.8 below.
The situation as regards washing hands with soap in Tallo Sub-district is as shown in 
the following chart:
Figure 5.8
Use of Soap in Last Two Days in Tallo Sub-district – Multiple Answer
Meanwhile in Lembo Sub-district, it will be seen from Figure 5.9 that the percentage of 
respondents using soap at the time of the midline survey had increased significantly 
compared with at the time of the baseline survey. The most significant increase was in 
the washing of baby’s bottom with soap by caregivers after defecation, which increased 
by more than 50% to 66.67% from 15% previously. Similarly in Lembo, there was still 1 
respondent at the time of the midline survey who did not use soap when bathing. If we 
compare Lembo and Tallo, it would seem that Tallo has better use of soap practices 
than Lembo.
Baseline (n=60) Midline (n=30)
98,3% 96,7%
18,3%
73,3%
21,7%
46,7%
11,7%
53,3%
3,3%
43,3%
8,3%
36,7%
11,8%
50,0%
Washing infant's bottom
Washing infant's hands
Washing hands after defecation 
Washing hands after cleaning 
infant's bottom
Washing hands before feeding 
infant
Washing hands before eating
5 other responses 
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
46
The following chart shows the use of soap over the last 2 days in Lembo:
Figure 5.9
Use of Soap over Last Two Days in Lembo Sub-district – Multiple Answer
Each interviewed caregiver to an under-5 was assessed on washing hands with soap at 
five critical times, namely: (i) before eating; (ii) after feeding child, (iii) after defecation, 
(iv) after cleaning child’s bottom, and (v) before preparing food. Based on a score of 1 
for each of the above behaviors, the maximum score receivable was 5.10 The following 
graph shows the overall scores: 
Figure 5.10
Scores for Use of Soap at 5 Critical Times in Last 2 Days
As will be seen from Figure 5.10 above (in absolute terms as the base number of 
respondents was less than 30), respondents in neither sub-districts washed their hands 
with soap at all critical times, either at the time of the baseline survey or the midline 
survey. Those who washed hands with soap at 1-2 critical times formed the majority in 
Tallo, while Lembo was almost the same, with 1 critical time being the most common 
Baseline (n=60) Midline (n=30)
95,0% 96,7%
15,0%
66,7%
18,3%
30,0%
8,3%
23,3%
6,7%
20,0%
10,0%
41,7% 43,3%
63,3%
Bathing
Cleaning child's bottom
Washing hands after eating
Washing hands after defecation 
Washing hands after cleaning 
child's bottom
Washing hands before eating
12 Other responses
Baseline 
(n=22)
Midline 
(n=22)
Baseline 
(n=23)
Midline 
(n=16)
12
8
13 7
8
8
10
5
2
5 3
1 1
Score of 5
Score of 4
Score of 3
Score of 2
Score of 1
 Tallo Lembo 
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response, followed by 2 critical times. Only 1 individual in each sub-district did so at all 
5 critical times (no respondents did so at the time of the baseline survey). 
Another indicator for evaluating the second pillar of CBTS in connection with the 
practice of washing hands with soap is the availability of running water and soap. This is 
assessed based upon observations in the bathroom or when respondents wash their 
hands. 
At the time of the midline survey in Makassar, less than half of total respondents (45%) 
had running water in their toilets. In Tallo, the percent was only 40%. This marked an 
increase of only 1.7% compared with the baseline survey. In Lembo, half (50%) of 
toilets that were observed had a tap with running water (an increase of 3.3% from the 
time of the baseline survey).
Figure 5.11 shows the availability of running water in toilets in the surveyed sub￾districts: 
Figure 5.11
Availability of Running Water
The situation as regards the availability of soap (for washing hands) in the toilet or the 
place where the dishes are washed is as shown in Figure 5.12 below:
Baseline (n=60) Midline (n=30) Baseline (n=60) Midline (n=30)
61,7% 60% 53,3% 50%
38,3% 40% 46,7% 50%
Yes
No
Tallo Lembo
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Figure 5.12
Availability of Soap
By comparing the observation findings from the 2 sub-districts, it will be seen that the 
availability of soap (both for washing hands and utensils) is more common in Lembo 
(86.7%), while in Tallo only 70% of households have soap available (both for washing 
hands and utensils). In fact, the percentage availability of soap at the time of the 
midline survey was smaller compared with the baseline survey (13.3% lower).
Summary of Second Pillar: Practices of washing hands with soap 
Table 5.4
Indicators Showing Practice of Washing Hands with Soap 
Indicator
Tallo Lembo
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
Use of soap in last 48 hours – Multiple Answer 
Washing clothes/dishes 98.3% 96.7% 95% 96.7%
Bathing 18.3% 73.3% 15% 66.7%
Washing child’s bottom 21.7% 46.7% 18.3% 30%
Washing child’s hands 11.7% 53.3% 8.3% 23.3%
Washing hands after eating 3.3% 43.5% 6.7% 20%
Washing hands after defecation 8.3% 36.7% 10% 43.3%
Washing hands after cleaning child’s bottom 11.8% 50% 41.7% 63.3%
Washing hands before feeding child 98.3% 96.7% 95% 96.7%
Baseline 
(n=60)
Midline (n=30) Baseline 
(n=60)
Midline (n=30)
16,7% 30% 31,7% 13,3%
83,3% 70% 68,3% 86,7%
Yes
No
 Tallo Lembo
Respondent base: 60
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49
Indicator
Tallo Lembo
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
Washing hands before dining 18.3% 73.3% 15% 66.7%
Other responses 21.7% 46.7% 18.3% 30%
Observations
Availability of water (if tap, running 
water from tap)
Yes 38.3% 40% 46.7% 50%
No 61.7% 60% 53.3% 50%
Availability of soap
Yes 83.3% 70% 68.3% 86.7%
No 16.7% 30% 31.7% 13.3%
Midline Household Survey - Makassar 
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50
C. Safe Drinking Water Treatment and Storage
The next CBTS pillar is safe and healthy drinking water treatment. By the water source 
most commonly used in the households (with under-5s) in the two sub-districts, mains 
water from a neighbor was the most common source in Tallo (56.7%), with water refills 
coming second (30%). In Lembo, 46.7% of respondents used water refills as their 
principal source of drinking water, followed by mains water from a neighbor and mains 
water in the house (both on 26.7%).
However, the findings for under-5s were different, with there being a decline in the use 
of mains water from a neighbor and an increase in the use of water refills. At the same 
time, the use of branded packaged water had emerged in both sub-districts, only the 
percentage was only 10% in each case.
The principal sources of drinking water used in households (with under-5s) are as 
shown in the following graphs:
Figure 5.13
Sources of Drinking Water
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
11,70% 6,70% 11,70%
16,7%
6,7%
25,0% 46,7%
38,3%
30,0%
31,7%
26,7%
33,3%
56,7%
31,7% 26,7%
Mains water at neighbor's
Water Refills
Mains water in the home
5 other responses 
 Tallo Lembo
Respondent base: 60
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Figure 5.14
Sources of Drinking Water for Under-5s in the Home
Do caregivers in the surveyed sub-districts do anything (or not do anything) so as to 
improve the quality of drinking water before consumption? Water refills and branded 
packaged water were excluded from data processing, and only data on mains water 
(whether in the house or from a neighbor) has been used in the data processing so as to 
produce the following graph (in absolute terms as the base number of respondents was less 
than 30): 
Figure 5.15
What is done (to improve quality) before consumption
(Excludes branded packaged water and water refills)
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
8,30% 10% 10% 3,30%
16,67% 3,33%
21,67%
20%
5%
10%
11,67%
10%
31,67% 36,67%
28,33%
23,33%
38,33% 40% 28,33%
43,33%
Water Refills
Mains water at neighbor's
Branded packaged water
Mains water in the home
3 other responses
Baseline 
(n=28)
Midline 
(n=20)
Baseline 
(n=36)
Midline 
(n=25)
3
5
2
13
26
15
33
12
Water is boiled
Directly consumed
 Tallo Lembo
Respondent base: 60
 Tallo Lembo
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Almost half of total respondents in Lembo said that they first boiled water before 
drinking it, while the remainder said that they drank it directly without doing anything. 
In Tallo, the findings were slightly different with more than half of respondents saying 
that they boiled the water, and only 5 saying that they consumed it directly.
The following graph shows where drinking water is stored in households (with under￾5s) in the surveyed sub-districts.
Figure 5.16
Drinking Water Storage Places 
A covered pot or bucket was the most common place for storing water in Tallo (40%), 
while in second place was a one- gallon water bottle. In Lembo, covered pots/buckets 
and one-gallon water bottles were the preferred choices on 40% each.
Figure 5.17
Places Used to Store Drinking Water – Observations 
Baseline 
(n=60)
Midline (n=30) Baseline 
(n=60)
Midline (n=30)
15,0% 13,3% 11,7% 16,7%
18,3% 16,7% 8,3% 3,3%
41,7%
26,7%
33,3% 40,0%
25,0%
40,0% 46,7% 40,0% Covered pot or bucket
One-Gallon Water Bottle
Covered earthenware 
storage jar
Baseline 
(n=60)
Midline (n=30) Baseline 
(n=60)
Midline (n=30)
18,3% 23,3% 20,0% 16,7%
8,3%
21,7%
26,7% 23,3%
20,0%
50,0%
13,3% 30,0% 13,3%
23,3% 33,3% 23,3% 25,0%
10,0%
One-gallon refill 
bottles
Kettle
Dispenser
Open bucket
5 other 
responses
 Tallo Lembo
Respondent base: 60
 Tallo Lembo 
Respondent base: 60
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Based on observations, the most common places for storing water in Makassar were 
water dispensers, although the percentage was less than half of total respondents 
(36.7%). In Lembo, dispensers were the favorite choice of half of the total respondents 
(50%), while kettles were employed by 23.3%. Meanwhile in Tallo, responses were 
more evenly distributed, with 30% of respondents storing their water in kettles and 
46.6% doing so in one-gallon water refills and dispensers.
Besides observations on the places used for storing drinking water, observations were 
conducted on how respondents store water used for cooking. The following graphs 
shows the places used for such purposes in Tallo and Lembo:
Figure 5.18
Places used to store water for cooking in Tallo - Observations – Multiple Answer
Based on the results of the observations conducted during the midline survey in Tallo 
Sub-district, it was found that there had been regression in respondents’ behavior as 
regards the storage of water to be used for cooking, which appeared to be better at the 
time of the baseline survey, when more than half (55%) of respondents used covered 
pots/buckets and only 6.7% used uncovered earthenware storage jars. By contrast, at 
the time of the midline survey, the percentage of respondents who stored water for 
cooking in uncovered earthenware jars had risen significantly to 44.4%, which was 
accompanied by a decline in the percentage of respondents using covered pots/buckets 
(down to 14.8%).
Baseline (n=60) Midline (n=30)
55%
14,8%
6,67%
44,4%
10%
33,3%
18,3%
35,0%
Covered pot or bucket
Uncovered earthenware jars 
Uncovered pot or bucket
Covered earthenware jars
8 other responses
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54
Figure 5.19
Places used to store water for cooking in Lembo - Observations – Multiple 
Answer
Figure 5.19 above shows the places used to store water for cooking by respondents in 
Lembo at the time of the midline survey. The findings for Tallo were almost the same, 
with a regression in the storage of water for cooking being apparent. At the time of the 
baseline survey, 76.3% of respondents said that they stored water for cooking in 
covered pots/buckets. However, this figure had declined to 10% at the time of the 
midline survey, while the percentage of respondents who used uncovered pots/buckets 
had increased.
Table 5.5
Observations on Drinking Water Storage Receptacles, Processing and 
Presentation 
Indicator Tallo Lembo
Baseline Midline Baseline Midline
Receptacle with Narrow aperture 88.3% 83.3% 75% 100%
Wide aperture 11.7% 16.7% 25% - 
Hard/non-cloth material 
Yes 88.3% 93.3% 81.7% 100%
No 11.7% 6.7% 18.3% - 
How about hands when 
taking water
Touch - 3.3% 3.3% - 
Do no touch 100% 96.7% 96.7% 100%
Baseline (n=60) Midline (n=30)
76,3%
10,0%
1,69%
16,7%
5,1%
80,0%
13,6%
3,30%
20,3%
Covered pot or bucket
Uncovered earthenware jar
Uncovered pot or bucket
Covered earthenware jar
Taken directly from water 
source
One-gallon refill jar
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As regards the observation findings on the places used for storing drinking water 
(presented for day-to-day consumption in the home), there was a tendency for 
percentages to decline between the baseline survey and midline survey in Tallo. In the 
case of the presentation of drinking water indicator, at the time of the baseline survey 
88.3% used receptacles with small apertures. However, by the time of the midline 
survey this figure had dropped to 83.3%. In addition, there was also a decline in the 
hands coming into contact with drinking water indicator. At the time of the baseline 
survey, all of the respondents (100%) were able to present water without touching it. 
However, at the time of the midline survey the hands of 3.3% of respondents came into 
contact with drinking water. However, in Tallo there was an increase in the percentage 
of covers made from hard material rather than cloth (up from 88.3% to 93.3%).
Unlike Tallo, in Lembo all of the respondents at the time of the midline survey used 
drinking water receptacles with small apertures, hard rather than cloth covers, and did 
not touch the water when presenting it (at the time of the baseline survey, none of 
these indicators registered 100%).
Also based on field observations, practices as regards the storage of food in households 
with under-5s are as shown in Figure 5.20 below:
Figure 5.20
Places where food is stored – Observations
The bulk of ready-to-consumed food was stored in closed cabinets (80% in Tallo and 
90% in Lembo). These figures were considerably up compared with the baseline survey.
Baseline 
(n=60)
Midline(n=30) Baseline 
(n=60)
Midline(n=30)
35%
20%
36,7%
10%
65%
80%
63,3%
90% In a closed cabinet
9 other responses
 Tallo Lembo 
Respondent base: 60
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Summary of the Third Pillar: Household Safe Water Treatment and Storage 
Practices
The indicators for the third pillar of CBTS are summarized in the following table:
Table 5.6
Indicators for Third Pillar: Safe Water Treatment 
Indicator
Tallo Lembo
Baseline Midline Baseline Midline
Treatment of water prior to 
consumption (from mains, well) (n=28) (n=20) (n=36) (n=25)
Boil water 
(in absolute terms as the base number of 
respondents was less than 30)
26 15 33 12
Consume directly 
(in absolute terms as the base number of 
respondents was less than 30)
3 5 2 3 
Observations
Respondent base (individuals) (n=60) (n=30) (n=60) (n=30)
Receptacle with
Narrow aperture 88.3% 83.3% 75% 100%
Wide aperture 11.7% 16.7% 25% - 
Hard/non-cloth 
material
Yes 88.3% 93.3% 81.7% 100%
No 11.7% 6.7% 18.3% - 
How about hands 
when taking water
Touch - 3.3% 3.3% - 
Do not touch 100% 96.7% 96.7% 100%
Places where prepared food is kept 
In closed cabinet 65% 80% 63.3% 90%
3-7 Other Responses 35% 20% 36.7% 10%
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D. Percentage of households that practice solid waste management
Not all households in Makassar had a trash can in the house – 9 household were 
recorded as not having trash cans. Meanwhile in Lembo, all of the households had a 
trash can. Lembo appeared to have a garbage disposal pattern that was more orderly 
than Tallo, with more than 50% of respondents disposing of garbage in an official 
disposal point outside the home. In Lembo by contrast, almost half of respondents 
(43%) disposed of their garbage directly into the sea, while only 33% disposed of it at 
an official garbage disposal point outside the home.
When compared with the baseline survey, the findings of the midline survey showed 
that the pattern of garbage disposal in Tallo was more disciplined as the number of 
respondents who dumped garbage outside the house yard in public places declined from 
38.3% to 16.7%. In addition, there was an increase in the percentage of respondents 
who dumped their garbage at official garbage disposal points outside their homes. By 
contrast, in Tallo there was a regressive trend, with an increase in the number of 
respondents who dumped garbage in the sea (up from 35% to 43.3%).
Figure 5.21 shows the various responses elicited on household garbage disposal:
Figure 5.21 
Receptacles or Places Used for Collecting Garbage 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
28,3% 40,0% 30% 30,0%
6,7%
20%
6,7%
23,3% 40%
10%
36,67%
30%
21,7%
20% 30% 26,67%
Directly dumped into sea
Closed plastic sacks
Open plastic sacks
Sack
6 other responses
 Tallo Lembo
Respondent base: 60
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Figure 5.22
Disposal of Solid Waste / Garbage
At the time of the midline survey, only 2 respondents from Tallo collected their garbage 
in the home or at a joint collection point for removal by official garbage disposal 
workers, while in Lembo none of the respondents had their garbage collected by official 
garbage disposal workers. By contrast, at the time of the baseline survey 9 respondents 
in Tallo and 6 in Lembo used official garbage collection services.
In the case of the 2 respondents in Tallo who used official garbage collection services, 
they said that the garbage was collected every day.
The frequency of garbage collection is as shown in Figure 5.23 below (in absolute terms 
as the base number of respondents was less than 30): 
Figure 5.23
Frequency of Garbage Collection By Official Garbage Collectors
Baseline(n=60) Midline (n=30) Baseline(n=60) Midline (n=30)
30%
10%
28% 20,0%
15%
38,3%
16,7%
16,7%
6,7%
18,3%
10%
35%
43,3%
33,3%
15%
50%
Dumped outside of home in 
official garbage disposal 
point
Dumped into sea
Dumped in yard, in garbage 
pit
Dumped outside of home, in 
river/stream
Dumped outside of home, in 
open space
Other response
Baseline 
(n=9)
Midline (n=2) Baseline 
(n=6)
Midline (n=0)
1 1
3 1
4 4
1
2
Every day
A couple of times every 
couple of weeks
Couple of times a week
Once a week
Every month
Don't know
 Tallo Lembo
Respondent base: 60
 Tallo Lembo 
 Respondent base: 60
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None of the respondents in Lembo paid to have their garbage removed, while in Tallo, 
of the 2 respondents who said they used official garbage collection services, only 2 said 
he paid for them, while the other did not pay. As regards the amount of money paid, 
the 2 respondents said that they paid Rp 3,000. This differed from the baseline survey 
when payments ranged between Rp 1,000 and Rp 2,000.
The following graph shows in absolute terms as the base number of respondents was 
less than 30, whether respondents pay to have garbage removed:
Figure 5.24
Do You Pay for Garbage Collection? 
The amounts paid by respondents for garbage collection services are as shown in the 
following chart (in absolute terms as the base number of respondents was less than 30): 
Figure 5.25
Expenditure on Garbage Collection
Baseline (n=9) Midline (n=2) Baseline (n=6) Midline (n=0)
5 2
5
4 2
1
No
Yes
Baseline 
(n=5)
Midline (n=2) Baseline 
(n=5)
Midlline (n=0)
5 2
3
2
> Rp. 15.000
Rp.10.001 - 15.000
Rp. 7.501 - 10.000
Rp. 5.001 - 7.500
Rp. 2.501 - 5.000
<= Rp. 2.500
 Tallo Lembo 
 Tallo Lembo
 
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More than half of the households (that have under-5s) did not practice garbage 
separation (organic and inorganic). In Tallo at the time of the midline survey, only 
13.3% of respondents practiced garbage separation, while only 20% did so in Lembo. 
The percentage that practiced garbage separation in Tallo was down 3.4% compared 
with at the time of the baseline survey.
Figure 5.26
Is Organic and Inorganic Garbage Separated? – Respondent Claims
The observation findings differed somewhat from the respondent claims, and revealed that 
smaller percentages actually separated garbage – 10% in Tallo and 16.7% in Lembo.
The following graph shows the findings of observations on whether or not respondents 
actually practice garbage separation:
Figure 5.27
Is Garbage (Organic and Inorganic) Separated? – Observations 
Baseline (n=60) Midline (n=30) Baseline (n=60) Midline (n=30)
83,33% 86,67% 81,67% 80%
16,67% 13,33% 18,33% 20%
Yes
No
Baseline (n=60) Midline (n=30) Baseline (n=60) Midline (n=30)
86,7% 90% 86,7% 83,3%
13,3% 10% 13,3% 16,7%
Yes
No
 Tallo Lembo 
Respondent base: 60
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Based on the results of the field observations on the receptacles used to collect garbage, it 
was found that 30% of residents of Tallo continued to practice undisciplined garbage 
disposal by primarily dumping it into the sea. Meanwhile, only 16.7% collected garbage in 
the home in plastic sacks, while another 16.7% did so in baskets. In Lembo, people were 
more disciplined in disposing of garbage than in Tallo, with a total of 33.3% of respondents 
using baskets located in their yards and 30% using garbage baskets located inside the home 
in which to collect garbage.
Figure 5.28
Means Used for Collecting Garbage – Observations
Summary of Fourth Pillar: Solid Waste Management Practices
The following table summarizes the findings in respect of the fourth CBTS pillar indicators:
Table 5.7
Fourth Pillar Indicators: Solid Waste Management Practices 
Indicator
Tallo Lembo
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
Garbage Disposal Places
Dumped outside the home at an official garbage 
disposal point 3.3% 33.3% 15% 50%
Dumped in sea 35% 43% - - 
Dumped in garbage pit in yard - 6.7% 18.3% 10%
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
10%
23%
40%
3,30%
30%
16,7%
28,3%
23%
20%
8,3%
10%
16,7% 30,0%
16,7% 13,3%
33,3% 23% 30% 23,3%
Dumped directly into sea
Basket - in the yard
Basket - inside the home
Plastic sacks - stacked inside 
the home
Plastic sacks - stacked in the 
yard
4 other responses
 Tallo Lembo
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Indicator
Tallo Lembo
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
Dumped outside the home, in river/stream 16.7% 3.3% - 3.3%
Dumped outside the home in public place 15% 3.3% 38.3% 16.7%
Other responses 30% 10% 28% 20%
Garbage 
Separation
No 83.3% 86.7% 81.7% 80%
Yes 16.7% 13.3% 18.3% 20%
Receptacles used for collecting garbage – observations – 3 top answers
Directly dumped in sea 23% 30% 23.3% - 
Basket in yard 16.7% 13.3% - 33.3%
Plastic sack in yard 30% 16.7% 28.3 23%
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E. Proper Wastewater Management 
The final CBTS pillar is proper household wastewater management. A number of 
indicators were used to evaluate people’s behaviors in this respect in Makassar. The 
findings of our observations on wastewater disposal are shown in the following graphs:
Figure 5.29 
Disposal of kitchen wastewater – Observations 
In Lembo, the findings of the midline survey observations revealed that wastewater 
disposal (kitchen, bathroom and laundry wastewater) methods were evenly distributed, 
with no response accounting for more than 50%. The wastewater produced by a total of 
30% of respondents was recorded as flowing into covered channels and the sea, while 
in the case of 16.7%, the wastewater flowed into open channels. In Tallo, the 
wastewater produced by the majority of respondents flowed into covered channels, 
while in the case of 30% of respondents it flowed into rivers/ponds/drains/canals and 
open channels.
At the time of the midline survey, none of the respondents in the two sub-districts were 
connected to piped sewerage systems. By contrast, at the time of the baseline survey, a 
number of residents (13.3% in Tallo and 26.7% in Lembo) availed of piped sewerage 
systems to dispose of wastewater.
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
40,0%
16,7%
40,0%
13,3%
26,7%
70,0%
36,7% 30,0%
28,3%
16,7%
3,3%
6,7%
26,7%
13,3%
26,7%
IPAL (Waste Water Processing Instalation) 
Pipe
Sewerage pipe
Into the sea
Drain under house
Pit
Into street, yard, garden
River, pond, drain, canal
Covered channel
Uncovered channel
 Tallo Lembo
 
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Figure 5.30
Discharge of Wastewater from Bathroom/Toilet – Observations 
Figure 5.31 
Discharge of Wastewater from Washing Clothes – Observations 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
40,0%
16,7%
38,3%
13,3%
26,7%
70,0%
30,0%
28,3%
16,7%
3,3% 6,7%
13,3% 26,7% 25,0%
IPAL (Waste Water Processing Instalation) 
Pipe
Sewerage pipe 
Into sea 
Channel under house 
Pit 
Into the street, yard, garden 
River, pond, drain, canal 
Covered channel 
Open channel
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
40,0%
16,7%
40,0%
10,0%
26,7%
66,7%
36,7% 30,0%
28,3%
16,7%
3,3%
5,0%
6,7%
26,7%
13,3%
25,0%
IPAL (Waste Water Processing Instalation) 
Pipe
Sewerage pipe 
Into sea 
Channel under house 
Pit 
Into the street, yard, garden 
River, pond, drain, canal 
Covered channel 
Open channel
 Tallo Lembo 
Respondent base: 60 
 Tallo Lembo 
Respondent base: 60 
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There were differences in the locations of septic tanks in Tallo and Lembo. In Tallo, the 
septic tanks of more than half of respondents were not under the house, but were 
rather in the yard. A total of 11 houses in Tallo had their septic tanks in the front or side 
yards, while 1 had it in the back yard. Only 4 households had their septic tanks under 
the floor, while 2 did not know where their septic tanks were located.
In Tallo, lack of land meant that half of total respondents had their septic tanks under 
the floors of their houses, while the septic tanks of 11 houses were located outside the 
house, with 6 being in the back yard and 5 being in the front/side yard. In addition, 
there were households using rented septic tanks.
Figure 5.32 
Location of Septic tank – confined to those that have septic tank 
In the case of respondents that did not have septic tanks, field observations, the results 
of which are shown in Figure 5.32(in absolute terms as the base number of respondents 
was less than 30) revealed that the toilet waste produced by 12 of these was discharged 
into a river/lake. This was similar to the findings of the baseline survey in Tallo, where it 
was found that more than half of respondents whose toilets were not connected to 
septic tanks discharged their toilet waste into a river/lake.
Of the 6 residents in Lembo who did not have a septic tank, toilet waste in the case of 3 
discharged into a river/lake, into drainage channels in the case of 2, and into a toilet pit 
in the case of 1. In Lembo, the distribution of responses to the midline survey were 
rather different from at the time of the baseline survey, when the distribution of 
responses was more even and discharge into drain was the most common response 
(almost half of total respondents who did not have septic tanks). The figure below is in 
absolute terms as the base number of respondents was less than 30.
Baseline 
(n=35)
Midline 
(n=18)
Baseline 
(n=50)
Midline 
(n=24)
4 2 2 1
1
7 4
26 12
10
1
7 6
13
11
15 5
In the frontyard, at the side of 
the yard
In the backyard
Under floor within in home
Beside Toilet
Rented Septic tank
Don’t know where
 Tallo Lembo 
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Figure 5.33 
Final place of disposal of feces (by those that lack septic tanks) – Observations 
Of the homes in Makassar that were the targets of the survey, the majority (70%-75%) 
said that they had never emptied their septic tanks. For more details on this, see Figure 
5.34 (in absolute terms as the base number of respondents was less than 30). 
Of the 16 residents of Tallo who had septic tanks, the majority (12 respondents) had 
never emptied their septic tanks, 3 had emptied their septic tanks, and 1 did not know. 
Meanwhile in Lembo, of the 24 respondents with septic tanks, the majority (17) said 
they had never emptied them, 6 said they had emptied them, while 1 respondent did 
not know.
Figure 5.34 
Has your septic tank ever been emptied?
For those who said that their septic tanks had been emptied at one time or another, 
Figure 5.35 below shows the last time their septic tanks were emptied. In Tallo, for the 
3 respondents who said that their septic tanks had been emptied, there was an even 
Baseline 
(n=25)
Midline 
(n=12)
Baseline 
(n=10)
Midline 
(n=6)
2
2
1 22
12
1
3
1
1
1
1
4
1 1
Not visible
Ditch
Garden-open ground 
Pond/Rice field 
River/Lake/Sea
Drop Toilet / Pit 
Directly into drainage channels
Baseline (n=31) Midline (n=16) Baseline (n=48) Midline (n=24)
1 2 1
23
12
27
17
8 3
19
6
Yes
Never
Don't know
 Tallo Lembo
 Tallo Lembo 
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distribution of responses, with 1 respondent saying it had been emptied less than 2 
years ago, 1 respondent saying it had been emptied between 2 and 5 years ago, and 1 
saying it had been emptied more than 5 years ago.
In Lembo, the majority (4 respondents) said it had been more than five years ago, while 
1 said it had been emptied less than 2 years ago, and 1 saying it had been emptied 
between two and five years ago. The figure below is in absolute terms as the base 
number of respondents was less than 30.
Figure 5.35 
When was the last time your septic tank was emptied?
Figure 5.36 below shows that all of the respondents in Tallo opted to use suction truck 
services to empty their septic tanks, while in Lembo (of 6 respondents) not all used such 
services, with 1 respondents opting to empty his septic tank himself without using a 
suction truck. The figure below is in absolute terms as the base number of respondents 
was less than 30.
Figure 5.36 
Who emptied your septic tank the last time?
Baseline 
(n=3)
Midline (n=0) Baseline 
(n=6)
Midline (n=3)
3 1 8
1
2 1
8
1
2
1
1
4
1
Don't know
> 5 years ago
2 - 5 years ago
< 2 years ago
baseline (n=8) midline (n=3) baseline (n=19) midline (n=6)
8 3
16 5
1
2 1
Emptied it ourselves
Hired help
Suction truck
 Tallo Lembo
 Tallo Lembo
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The graph below shows the distance, based on observations, from a respondent’s home to 
the toilet that the respondent normally uses.
Figure 5.37 
Distance from Home to Public Toilet
As shown in the above graph, the majority of respondents in both Tallo (73.3%) and Lembo
(83.3%) used a toilet in their own homes so that they did not need any time to reach the 
toilet. These percentages were significantly up from the time of the baseline survey in 2012, 
when the corresponding figures were 43.3% in Tallo and 40% in Lembo.
Summary of Fifth CBTS Pillar: Wastewater management practices
The following table sets out a summary of household wastewater management practices:
Table 5.8
Indicators for Fifth Pillar: Wastewater Management Practices 
Indicator Tallo Lembo
Baseline Midline Baseline Midline
Place where kitchen wastewater is disposed of– 3 top answers
Respondent base 60 30 60 30
Open channel 40% 16.7% 40% 13.3%
River, pond, drain, canal 36.7% 30% 28.3% 16.7%
Sewerage pipe 13.3% - 26.7% - 
Covered channel - 26.7% - 70%
Baseline (n=60) Midline (n=30) Baseline 
(n=60)
Midline(n=30)
16,7%
43,3%
6,7%
10,0%
3,3%
11,7%
6,7%
6,7%
23,4%
5,00% 3,3%
6 - 12 minutes
3 - 5 minutes
<=2 minutes
 
 Tallo Lembo 
Respondent base: 60 
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Indicator Tallo Lembo
Baseline Midline Baseline Midline
Into Sea - 26.7% - - 
Place where bathroom wastewater is disposed of – 3 top answers
Respondent base 60 30 60 30
Open channel 40% 16.7% 38.3% 13.3%
River, pond, drain, canal - 30% 28.3% 16.7%
Sewerage pipe 13.3% - 25% - 
Covered channel - 26.7% - 70%
Into Sea - 26.7% - - 
Place where wastewater from clothes-washing is disposed of – 3 top answers
Respondent base 60 30 60 30
Open channel 40% 16.7% 40% - 
River, pond, drain, canal 36.7% 30% 28.3% 16.7%
Sewerage pipe 13.3% - 25% - 
Covered channel - 26.7% - 66.7%
Into Sea - 26.7% - - 
Has septic tank 
No 25 12 10 6 
Yes 35 18 50 24
Final Place of Disposal of Feces – Majority
Respondent base (the lack of septic tank) 25 12 10 6 
River/lake/sea 22 12 - 3 
Ditch - - 4 - 
Directly into drainage channel - - 2 2 
1 to 4 other responses 3 - 4 1 
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The following table sets out a summary of the indicators for all five CBTS pillars in the sub￾districts that were surveyed.
Table 5.9
Summary of Indicators for all Five CBTS pillar
Indicator
Tallo Lembo
Baseline Midline Baseline Midline
First Pillar: open defecation free
Last place where caregiver defecated (n=60) (n=30) (n=60) (n=30)
Flush toilet draining into septic tank 6.7% 50% 1.7% 66.7%
Place of defecation for children aged 0 – 3 (n=43) (n=16) (n=44) (n=14)
Household toilet 8 6 8 8 
Place of disposal of under-3s’ feces (n=43) (n=17) (n=44) (n=22)
Directly disposed of in toilet 7 1 10 7 
Not cleaned, thrown into trash can 7 7 13 5 
Place of disposal of feces of children aged 3 – 5 (n=60) (n=30) (n=60) (n=30)
Flush toilet draining into septic tank 5% 30% 3.3% 26.7%
What was done after child defecated (n=60) (n=30) (n=60) (n=30)
Washed child’s bottom with soap 78.3% 83.3% 68.3% 93.3%
Second Pillar: Hand washing with soap at least 2 out of 5 critical times
Use of soap in last 48 hours – Multiple Anser
Bathing 98.3% 96.7% 95% 96.7%
Washing child’s bottom 18.3% 73.3% 15% 66.7%
Washing hands after eating 21.7% 46.7% 18.3% 30%
Washing hands after defecating 11.7% 53.3% 8.3% 23.3%
Washing hands after washing child’s bottom 3.3% 43.5% 6.7% 20%
Washing hands before eating 8.3% 36.7% 10% 43.3%
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Indicator
Tallo Lembo
Baseline Midline Baseline Midline
Other responses 11.8% 50% 41.7% 63.3%
With scoring n= 22 n= 22 n= 23 n=16
score 1 12 8 13 7 
score 2 8 8 10 5 
score 3 2 5 0 3 
score 4 0 1 0 1 
Observations
Is water available 
(if there is tap, is 
it running?)
Yes 38.3% 40% 46.7% 50%
No 61.7% 60% 53.3% 50%
Is soap available?
Yes 83.3% 70% 68.3% 86.7%
No 16.7% 30% 31.7% 13.3%
Third Pillar: Household safe water treatment and storage
Treatment of water before consumption (water 
from mains/well) (n=28) (n=20) (n=36) (n=25)
Boil water 26 15 33 12
Directly drink 3 5 2 3 
Observations (n=60) (n=30) (n=60) (n=30)
Receptacle with Small aperture 88.3% 83.3% 75% 100%
Wide aperture 11.7% 16.7% 25% - 
Hard material/not cloth
Yes 88.3% 93.3% 81.7% 100%
No 11.7% 6.7% 18.3% - 
What about hands when 
taking water
Touches - 3.3% 3.3% - 
Doesn’t touch 100% 96.7% 96.7% 100%
Place where ready-to-consume food is kept
In closed cabinet 65% 80% 63.3% 90%
3- 7 Other Responses 35% 20% 36.7% 10%
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Indicator
Tallo Lembo
Baseline Midline Baseline Midline
Fourth Pillar: Practice solid waste management
Place of disposal of garbage
Dumped outside the home at an official garbage 
disposal point 3.3% 33.3% 15% 50%
Dumped in sea 35% 43% - - 
Dumped in garbage pit in yard - 6.7% 18.3% 10%
Dumped outside the home, in river/stream 16.7% 3.3% - 3.3%
Dumped outside the home in public place 15% 3.3% 38.3% 16.7%
Other responses 30% 10% 28% 20%
Garbage Separation
No 83.3% 86.7% 81.7% 80%
Yes 16.7% 13.3% 18.3% 20%
Receptacles used for collecting garbage – Observations – 3 top answers
Directly dumped in sea 23% 30% 23.3% - 
Basket in yard 16.7% 13.3% - 33.3%
Plastic sack in yard 30% 16.7% 28.3 23%
Fifth Pillar: Wastewater Management Practices
Place where kitchen wastewater is disposed of– 3 top answers
Open channel 40% 16.7% 40% 13.3%
River, pond, drain, canal 36.7% 30% 28.3% 16.7%
Sewerage pipe 13.3% - 26.7%
Covered channel - 26.7% - 70%
Into Sea - 26.7% - 
Place where bathroom wastewater is disposed of – 3 top answers
Open channel 40% 16.7% 38.3% 13.3%
River, pond, drain, canal - 30% 28.3% 16.7%
Sewerage pipe 13.3% - 25%
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Indicator
Tallo Lembo
Baseline Midline Baseline Midline
Covered channel - 26.7% 70%
Into Sea - 26.7%
Place where wastewater from clothes-washing is disposed of – 3 top answers
Open channel 40% 16.7% 40% - 
River, pond, drain, canal 36.7% 30% 28.3% 16.7%
Sewerage pipe 13.3% - 25% - 
Covered channel - 26.7% - 66.7%
Into Sea - 26.7% - - 
Has septic tank 
No 25 12 10 6 
Yes 35 18 50 24
Final Place of Disposal of Feces – Majority
River/lake/sea 22 12 - 3 
Ditch - - 4 - 
Directly into drainage channel - - 2 2 
1 to 4 other responses 3 - 4 1 
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F. Role of Community Members as Informants
Table 5.10a below shows the sources that provided information to the public on CBTS.
Both in Tallo and Lembo, quite a lot of people played a role as sources of information, 
including RT heads and administrators, and Posyandu/sub-district and PKK workers (a 
number also mentioned TV as a source of information on the CBTS pillars). These were 
the figures that were deemed to play the most important role in providing information of 
CBTS to the public.
A CCP Facilitator (Asrul) also played a role in disseminating information on the 5 CBTS 
pillars since December 2012 (in Tallo). 
As regards dissemination, socialization and outreach (including providing examples) 
were the most common methods mentioned by Respondents in Tallo. For parents 
(mothers), the providing of examples by women was the most common method used in 
connection with hygienic defecation practices. The first time the women provided 
examples of hygienic defecation practices was when the respondents were still children 
(around 20-24 years ago).
TV was also mentioned as a medium for the dissemination of information by a small 
group of respondents in connection with the first CBTS pillar. However, the respondents 
had forgotten when they had received such information from TV.
Table 5.10a
Sources of information on the 5 CBTS Pillars in Tallo – Makassar - Multiple 
Answer - Spontaneous
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent
First time when 
provided with 
Name information Resp. 
Base Relationship
Method of 
information 
provision
Defecation in 
proper place
Asrul 3 Facilitator Socialization outreach January 2013
21 other names
(including TV) 
23 Varied (Parents/Mothers, 
RT, Teachers, etc) 
Advice, 
Socialization/Outreach, 
Varied, from 23 
answers
Washing hands 
with soap
Asrul 4 Facilitator Socialization outreach January 2013
20 other names
(including TV) 
23 Varied (Parents, RT, 
Teachers, etc) 
Advice, recounted, 
practised/examples, 
socialization
Varied, from 23 
answers 
Treatment of 
household 
drinking water
Asrul 4 Facilitator Socialization outreach February 2013
24 other names 24 Varied (Parents, RT, 
Teachers, etc) 
Advice, recounted, 
practised/examples, 
socialization
Varied, from 24
answers
Garbage Asrul 3 Facilitator Socialization/outreach January 2013
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Environmental 
Health Topic
Give name of person and that person’s relationship with respondent
First time when 
provided with 
Name information Resp. 
Base Relationship
Method of 
information 
provision
Management 19 other names
(including TV) 
24 Varied (Parents, RT, 
Teachers, etc) 
Advice, recounted, 
practised/examples, 
socialization
Varied, from 24
answers
Treatment of 
household 
wastewater
Asrul 4 Facilitator Socialization/outreach December 2012
20 other names
(including TV) 
20 Varied (Parents, RT, 
Teachers, etc) 
Advice, recounted, 
practised/examples, 
socialization
Varied, from 20
answers
Table 5.10b
Sources of Information on 5 CBTS Pillars in in Lembo – Makassar – Multiple 
Answer - Spontaneous
Environmen
tal Health 
Topic
Give name of person and that person’s relationship with respondent First time when 
provided with 
Name information Resp. 
Base Relationship Method of information 
provision
Defecation 
in proper 
place
Medical students, Akper, Hj. Hasna, 
Diana, Dg. Mansur, Hj. Nani 14 Volunteers, 
Facilitators, RT
Practiced, Socialization/Outreach, 
Monitoring 
February – March
2013
(students: 2010)
11 other names (including TV) 12 Parents 
Advice, Recounted, 
Practiced/Examples, Socialization, 
AdvertiCementts
When respondents 
were young
Washing 
hands with 
soap
Serniwati 4 Volunteer Socialization/outreach, monitoring, 
lectures in school 
Varied from 4 
respondents 
Students (Medical, Unhas, Akper) 
Diana, Dg Nginga, Hj Hasna, Farida 
Hana, Hj Nani, Dg Mansyur 
16 
Facilitator, 
Posyandu, 
Volunteers, RT
Socialization outreach, residents’ 
meetings, practice 
March 2012 - March
2013
10 other names (including TV) 11 
Volunteers, 
Parents/mothers
Socialization outreach, practice, 
advertiCementts 
When respondents 
were young – 
March 1013
Treatment 
of 
household 
drinking 
Serniwati 3 Volunteer Socialization/outreach, lectures in 
school March 2013
15 other names
(including TV) 
15 Volunteers, 
parents/mothers Practice/examples
Varied, since 
respondents were 
young
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Environmen
tal Health 
Topic
Give name of person and that person’s relationship with respondent First time when 
provided with 
Name information Resp. 
Base Relationship Method of information 
provision
water Medical students, Unhas. Diana / 
Dg Nginga 
Hana, Hj Nani, Hj Hasna 
12 
Facilitator , 
students, 
RT/RW, TV
Socialization/outreach March 2012
Garbage 
Managemen
t 
Medical students, Unhas, Diana/Dg 
Nginga, Hasnah 6 
Facilitator, 
Volunteers, 
Parents/mothers
Socialization/outreach, examples March 2012 – 
January 2013
11 other names
(including TV) 
11 Volunteers, 
Parents/mothers
Socialization/outreach, monitoring, 
lectures in school 
Varied, since 
respondents were 
young – March 
2013
Treatment 
of 
household 
wastewater
Diana/Dg Nginga, Dg Mansyur, Hj. 
Nani, Mhs Kedokteran 9 
Facilitator, 
Volunteers, 
RT/RW, 
Parents/Mothers
Socialization/outreach, monitoring, 
lectures in school, examples, 
residents’ meetings, Posyandu 
January 2013 - 
since respondents 
were young
12 other names 12 Volunteers, 
Parents/mothers
Socialization/outreach, monitoring, 
lectures in school, examples
since respondents 
were young – 
March 2013.
It was found that there were more sources of initial information on each of the CBTS 
pillars in Lembo. Parents (mothers) were one source of initial information since the 
respondents had been young. Other names frequently mentioned were those of 
volunteers like Serniwati, Hj. Hasna, Dg Nginga/Diana, Hj. Nani dan Kasmawati. Dg 
Mansur (RT/RW) was also mentioned as a source of information. In addition, 
information was provided by medical students from Hasanuddin University and Akademi 
Keperawatan (Nursing Academy) in the 2 years prior to the midline survey (around 
2012).
The information provided by parents (mothers) on sanitation and hygiene was 
remembered by the respondents many years later, which clearly shows that parents 
(mothers) have a strategic and significant influence on their children. The other 
information that was received, such as from volunteers, facilitators and sub-district 
officials, served as a reminder of what had already been taught and shown by parents 
(mothers) to their children, who were now adults and the main caregivers to their own 
under-5s.
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G. Healthy Life Practices
Knowledge
Figure 5.38 below shows an increase in awareness on the part of residents in both Tallo 
and Lembo between the baseline survey (in 2012) and the midline survey (in March 
2013). In Tallo, 23.3% of caregivers to under-5s said they were aware of CBTS, while 
not one respondent had ever heard of CBTS at the time of the baseline survey. In 
Lembo, the percentage of those who said they had heard of CBTS increased by 13.4% 
to 16.7% at the time of the midline survey, compared with only 3.3% at the time of the 
baseline survey. Having regard to the relevancy of the High Five Program in the 2 
students, this shows that the hard work of the High Five Program team and the Sub￾District Working Groups has borne fruit as the people are now much more aware of 
CBTS and its related activities.
Figure 5.38 
Have you Heard of CBTS?
Also in connection with awareness, Figure 5.39 below shows that the level of awareness 
of PHBS is relatively low (although 16.7% of respondents in Lembo said that they had 
heard of it). However, no respondent had heard of it in Tallo.
Baseline Midline Baseline Midline
23,3%
3,3% 16,7%
91,7% 33,3% 86,7% 73,3%
8,3%
43,3%
10,0% 10,0%
Don’t know/Forget
No
Yes
 
 Tallo Lembo 
Respondent base: 60 
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Figure 5.39 
Have you ever heard of PHBS (Perilkau Hidup Bersih Sehat – Clean and Healthy 
Living Behavior)
People’s knowledge of sanitation can be specifically evaluated by assessing the level of 
agreement with a number of prepared questions, as discussed further below.
Attitude
The data set out in Table 5.11 below is based on closed-ended responses on a scale of 
four, where 1 expresses strong disagreement and 4 strong agreement with the following 
10 health related statements that were presented to respondents:
Table 5.11
Perceptions of Residents about Health
Statement
Tallo Lembo 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
Every family should have its own toilet 3.2 3.1 3.2 3.1
Open defecation is not a problem for me 2.1 2.2 2.1 2.2
Hand washing with soap before eating is 
bothersome
2.1 2.2 2.1 2.2
Baseline Midline Baseline Midline 
16,7%
95,0%
40,0%
93,3% 70,0%
5,0%
60,0%
13,3%
Don’t know/Forget
No
Yes
 Tallo Lembo 
Respondent base: 60 
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Statement
Tallo Lembo 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
We don’t need a septic tank if we can 
dump feces directly into the river/drain 2.1 2.1 2.1 2.1
Wastewater from clothes washing can be 
discharged/dumped anywhere as it is 
quickly absorbed 
2.3 2.4 2.3 2.4
Separating garbage is only a waste of 
time and does no good 2.2 2.5 2.2 2.5
My neighbors garbage is no concern of 
mine even though it goes everywhere 2.2 2.3 2.2 2.3
Preventing blockages in the drains is also 
my concern as a resident of this sub￾district 
3.0 2.9 3.0 2.9
As long as there are not too many, flies
do no harm if they land on food 2.1 2.2 2.1 2.2
There no need to worry about cleaning 
drinking water receptacle as they are 
always full of water anyway
2.1 2.3 2.1 2.3
Scale of 1 to 4, where 1 = strongly disagree, and 4 = strongly agree
The findings in Tallo may be further explained as follows:
 The baseline survey in each sub-district in Makassar involved 60 respondents (as 
this district was not divided into intervention and non intervention areas, all of 
areas in each sub-district were designated as intervention areas) consisting of 
caregivers to under-5s. However, the midline survey covered 30 respondents in 
the same category, i.e., caregivers to under-5s.
 In Tallo, the responses to almost all of the prepared statements designed to 
assess the perceptions of caregivers to under-5s in connection with sanitation and 
hygiene issues revealed no significant differences (p > 0.05) between their 
perceptions prior to the High Five Program (baseline survey, 2012) and current 
conditions, after the program had been underway for 1.5 years (midline survey, 
2013). This means that there has been no improvement in perceptions of 
sanitation and hygiene issues among caregivers to under-5s in Tallo.
 Also in Tallo, there has been a regression in respondent perceptions in respect of 
two statements (No. 6 and No. 10) related to separating garbage being a waste of 
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time, and that a water drinking water receptacle does not need to be cleaned. 
This regression is statistically significant at p < 0.05.
 In Lembo, no significant difference (p >0.05) was found in respect of any of the 
statements. This shows that the perceptions of caregivers of under-5s are the 
same now as they were prior to the launching of the High Five Program (as 
assessed by the baseline survey in 2012). The difference in average values shown 
in Table 5.11 above is not significant statistically.
Residents, Community and Sanitation 
The table below shows residents’ responses (closed responses) to a series of 10 
statements designed to gauge whether there is a sense of community among residents 
and administrators in their neighborhoods. The responses are ranked on a scale of 1 to 
4, where 1 = fully sure, and 4 = not at all sure.
The general picture painted by the responses to the questions in the 2 sub-districts in 
Makassar is as follows:
 As regards the perceptions of residents as to whether there is a sense of 
community and collaboration between residents themselves and between 
residents and the sub-district authorities in Tallo and Lembo, Table 5.12 below 
shows that the perceptions of caregivers of under-5s in this regard are the same 
now (as assessed by the midline survey in 2013, 1.5 years after the launch of the 
High Five Program) as they were before the implementation of the High Five 
Program (as assessed by the baseline survey in 2012). This is best on statistical 
test outcome of p > 0.05.
 In Tallo, the question on the willingness of respondents to follow the advice of 
sub-district officials showed a significant increase (p < 0.05) from 2.9 at the time 
of the baseline survey to 3.1 at the time of the midline survey. This indicates that 
the residents of Tallo are now more willing to heed the advice of sub-district 
officials (compared to at the time of the baseline survey in 2012).
 Also in Tallo, willingness to follow the advice of religious leaders on sanitation 
issues decreased significantly (p < 0.05), from 2.9 at the time of the baseline 
survey in 2012 to 2.6 at the time of the midline survey in 2013.
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Table 5.12
Residents Perception of Community 
Statement
Tallo Lembo 
Baseline 
(n=60)
Midline 
(n=30)
Baseline 
(n=60)
Midline 
(n=30)
The people here are aware of the 
importance of environmental hygiene and 
health
2.9 2.7 2.9 2.7
The people here have a strong sense of 
community, particularly as regards 
maintaining environmental hygiene and 
health
2.8 2.8 2.8 2.7
The people here are willing to work together 
to improve health conditions 2.9 2.9 2.9 2.9
The people here are willing to voluntarily pay 
contributions/charges to improve
environmental hygiene and health
2.5 2.7 2.6 2.6
The people here are willing in all cases to 
follow the advice of sub-district officials 2.9 3.1 3.0 3.0
The people here are highly motivated in 
participating in environmental hygiene 
activities 
2.9 2.9 3.0 3.1
The sub-district authorities are highly 
motivated in organizing environmental 
hygiene activities
3.0 2.9 3.0 3.1
The people here consider environmental 
hygiene and health to be the responsibility of 
the sub-district authorities
2.7 2.7 2.8 2.8
Community leaders support environmental 
hygiene and health activities 2.9 2.8 3.0 3.0
If religious leaders recommended 
environmental hygiene and health activities, 
residents would comply
2.9 2.6 2.9 3.0
Scale of 1 to 4, where 1 = fully sure, and 4 = not at all sure.
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Practices
In the practices section, residents were asked about 7 things related to health. In 
general, their responses revealed that:
 Tallo and Lembo has the same trouble (more than 50%) of environment that still 
finds the citizen defecate in places other than toilet, channel the sludge to the 
sewer lines, scattered garbage and clogged gutter.
 There is 43.3% of the people in Tallo and 46.7% in Lembo admitted also having 
problems with the availability of fresh water in the region. 
Table 5.13
Behaviors that can cause health and hygiene problems
Prevalency 
Tallo Lembo
Baseline Midline Baseline Midline
Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know 
Defecation 
in place 
other than 
toilet
86.7% 11.7% 1.7% 66.7% 30.0% 3.3% 55.0% 40.0% 5.0% 73.3% 26.7% - 
Feces 
discharge
into drains/
water 
channels
55.0% 40.0% 5.0% 63.3% 33.3% 3.3% 48.3% 45.0% 6.7% 56.7% 43.3% - 
Unsanitary 
environmen
t due to 
undiscipline
d garbage 
disposal
33.3% 66.7% - 100.0% - 76.7% 23.3% 86.7% 13.3.% - 
Blocked 
drains or 
water 
channels
58.3% 40.0% 1.7% 76.7% 23.3.% - 58.3% 40.0% 1.7% 70.0% 30.0% - 
Well water 
not fit for 
drinking 
even after 
treatment 
28.3% 71.7% - 56.7% 43.3% - 16.7% 75.0% 8.3% 53.3% 46.7% - 
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Prevalency 
Tallo Lembo
Baseline Midline Baseline Midline
Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know 
Dengue 
fever 28.3% 66.7% 5.0% 13.3% 86.7% - 26.7% 70.0% 3.3% 36.7% 63.3% - 
Difficulties 
with clean 
water 43.3% 56.7% - 66.7% 33.3% - 38.3 61.7% 70.0% 23.3% 6.7%
Diarrhea
More than 50% (51.7%) of the caregivers to under-5s who were the respondents in the 
baseline survey in Tallo (2012) said that their children had suffered from diarrhea at 
one time or another. At the time of the midline survey in March 2013, the percentage 
had declined to 40%.
In Lembo, 43.3% of caregivers to under-5s at the time of the baseline survey in 2012 
said that their children had suffered diarrhea at one time or another. By the time of the 
midline survey in 2013, this figure had increased to 56.7%.
Figure 5.40
Has Your Under-5 Ever Suffered from Diarrhea?
The last time the under-5s were reported as suffering from diarrhea is as shown in 
the following graph. The figure below is in absolute terms as the base number of 
respondents was less than 30.
Baseline Midline Baseline Midline
51,7% 40,0% 43,3% 56,7%
48,3% 60,0% 56,7% 43,3% Yes
No
 Tallo Lembo 
Respondent base: 60 
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Figure 5.41 
Last Time your Under-5 Suffered from Diarrhea
 In Tallo, at the time of the baseline survey in 2012, most of the under-5s had 
suffered diarrhea within the last 3 months, whereas at the time of the midline 
survey in March 2013, most of the children had suffered diarrhea within the last 3 
months and more than 3 months ago, i.e., at the end of 2012 and start of 2013.
 In Lembo, at the time of the baseline survey most of the diarrhea cases had 
occurred 3 months ago, i.e., at the end of 2012. At the time of the midline survey, 
most of the cases of diarrhea had occurred within the last 3 months, i.e., at the 
start of 2013.
As regards what caregivers did when their under-5s suffered from diarrhea:
 The first choice for caregivers in Tallo and Lembo was to bring the under-5s to the 
nearest Puskesmas. The situation in this respect was the same both at the time of 
the baseline survey and the midline survey. 
 Besides bringing the children to the nearest Puskesmas, caregivers also brought 
their children to the nearest medical professional (midwife/doctor/medical 
technician) or purchased over the counter medicine at the nearest warung.
The situation as regards the treatment of diarrhea in under-5s is as shown in the
following chart (in absolute terms as the base number of respondents was less than 
30): 
Baseline 
(n=31)
Midline 
(n=12)
Baseline 
(n=26)
Midline 
(n=17)
1
5 2 2
5
4
16 5
7
7
12 5 9 6
More than 3 months ago
Within last 3 months
1 week ago
24 hours ago
Tallo Lembo
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Figure 5.42 
Treatment of Diarrhea
As regards the total cost (transportation, medical care and medicines) of treating under￾5s suffering from diarrhea:
 In Tallo, to bulk of the caregivers said that they expended between Rp 10,000 and 
Rp 150,000 (at the time of the baseline survey, 2012). At the time of the midline 
survey in 2013, the cost of treatment had fallen to less than Rp 10,000.
The caregivers in Lembo said that they spent between Rp 150,000 and Rp 400,000 on 
treating their children for diarrhea, while another group said that they expended less 
than Rp 10,000 (at the time of the baseline survey, 2012). At the time of the midline 
survey in 2013, the bulk of the caregivers expended between Rp 10,000 and Rp 
150,000.
Figure 5.43 
Overall Cost of Treatment (transportation, consultation, medicine)
The figure above is in absolute terms as the base number of respondents was less than 30.
Baseline 
(n=31)
Midline 
(n=12)
Baseline 
(n=26)
Midline 
(n=17)
13
8
9
9
8
1
2
4
3
1
6
2
7 2
9
2 5 Other responses
Treated with over the counter 
medicines
Treated by nearest medical 
professional (midwife/doctor/medical 
technician)
Treated at nearest Puskesmas
Tallo Lembo
Baseline (n=21) Midline (n=9) Baseline (n=11) Midline (n=13)
5
6
4 4
7
2
3
8 4
4
1 1
5
Free
Don't know
Rp 150.000-Rp 400.000
Rp 10.000 - Rp 150.000
< Rp 10.000
Tallo Lembo
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Part V
Children Baseline – Elementary School
A. Perceptions of children regarding conditions that impact on healthy and clean 
life practices
During this process, the respondents were provided with stimuli in the form of pictures, 
where each CBTS pillar and non-CBTS pillar aspect was represented by two pictures. The 
stimuli also included pictures showing ‘healthy children laughing’, ‘children bathing 
together in a well’, and so forth. Each of these was represented by 2 pictures. A number 
of pictures showing the opposite were also presented (dirty/contrary to the CBTS 
pillars). Once again, each situation was represented by 2 pictures.
Of the pictures that were shown, two pictures showing ‘washing hands with running 
water (tap)’ and ‘soap’ were the 2 top choices, with 73% and 63% of the children 
selecting these as showing examples of clean and healthy lifestyles. The children at all 
age levels and genders chose these activities. The following choices were selected by at 
least 20% of respondents:
Figure 6.1
8 top responses for conditions that are deemed clean and healthy – Multiple 
Answer 
As in Surabaya and Medan, in Makasar the ‘washing hands’ picture also was more often 
selected by respondents between 10 and 12 years of age, compared with the other 
pictures. This may be influenced by a number of factors, such as: (1) recent campaign 
for washing hands with soap in the targeted schools so that the awareness of children 
about the importance of washing hands with soap was high. It was found that 90% of 
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the children (out of 26.7% of the children) who said they had heard of the term CBTS 
associated it with washing hands with soap; (2) washing hands was a practice that was 
taught as standard by the adults around them (parents and teachers) so as to maintain 
healthy and hygiene.
As with the 2 pictures showing ‘washing hands with soap’ that were most frequently 
selected as the two top answers, the next choices were pictures showing ‘covering food’ 
and ‘a dispenser against a background of a clean kitchen’. These were selected by 50% 
and 46.7% of the children, respectively.
After the two top choices (‘washing hands’ and ‘covering food’), the picture of ‘a sit￾down toilet’ was the next choice (40%), followed by ‘food protected with a red cover’ 
(30%). The next choice was ‘a clean squat toilet’ (20%).
All of the choices of the children tended to correlate with the five CBTS pillars. 
Nevertheless, when the children were questioned about their awareness of CBTS, more 
than half of the respondents (80%) said that they had never heard of the term.
B. Children’s Understanding of CBTS
When the elementary school respondents were asked, 80% said they had never heard 
of CBTS, while only 20% said they had heard of the term.
Figure 6.1 Table 6.1 
Children’s Understanding of CBTS Understanding of CBTS by 
Grade 
Comparing the information on respondent grades and their knowledge of the term 
CBTS, 3 children each from grades 5 and 6 said they were familiar with the term, but 
not one respondent from grade 4 was familiar with it.
Further, when the respondents who said they were familiar with CBTS were asked what 
they know about the concept, of the 6 who were familiar with it only 2 were able to 
state that the abbreviation stood for “Community Based Total Sanitation,” while 4 others 
responded by naming CBTS pillars, namely, proper disposal of garbage, washing hands 
with soap. One respondent also misunderstood what CBTS stood for (“Community Based 
Evident Sanitation”). When probed further about their knowledge of CBTS, the following 
information was obtained:
Do You Know 
About CBTS
Grade 
4 
Grade 
5 
Grade 
6 
Total
Yes 0 3 3 6 
No 10 7 7 24
Total 10 10 10 30
Yes, 
30%
No; 
80%
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Table 6.2
What More Do You Know About CBTS?
Knowledge of CBTS – Multiple Answer Number of Respondents * 
Washing hands with soap 6 
Safe Treatment and Storage of Drinking Water 1 
Respondent Base: 6
Note: * Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
Washing hands with soap was the practice most frequently identified with CBTS (other than 
the term CBTS itself). There were also those who could state 2 CBTS pillars (like CTPS itself 
and safe treatment and storage of water).
A number of pictures were shown to the respondents and they were asked to select those 
that reflected CBTS. The following are their choices:
Figure 6.2
Pictures Showing CBTS – Multiple Answer
Choice 1:6 respondents Choice 2: 1 respondent
Respondent Base: 6 
The only CBTS pillar that was popular/remembered by respondents who were aware was 
CTPS, while one respondent selected another pillar – safe treatment and storage of drinking 
water. The two pictures selected to represent these were (1) washing hands with soap 
(selected by 6 respondents); (2) picture of dispenser against background of clean kitchen 
(selected by 1 respondent).
As regards where the 9 children who knew about CBTS had received their information, the 
following responses were obtained:
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Table 6.3
Information on CBTS Obtained From:
Person Providing Information on 
CBTS – Single Answer
Person’s name
Number of 
Respondents * 
Health outreach from High Five Program Don't know/forget 3 
Older brother Chairil Anwar 1 
Students Don't know/forget 1 
Outreach from Puskesmas Don't know/forget 1 
Respondent Base : 6
Note: * Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
One respondent said that he had been provided with information on CBTS by his elder 
brother Chairil Anwar around 1 month ago (February 2013). Similarly 1 respondent had 
received information in the form of outreach from the Puskesmas, while 3 respondents had 
received information in the form of outreach from High Five Program (in each case about 1 
month ago – February 2013). However, those who had received information in the form of 
outreach from the Puskesmas and High Five Program could not remember the names of the 
people who had conveyed the information. The same applied in the case of one respondent 
who had been provided with information on CBTS directly by a student – the child could not 
remember the name of the person conveying the information or the time when it had been 
conveyed. 
The following are the responses of the elementary school respondents related to their 
perceptions of the various practices involved in the CBTS pillars.
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Pillar 1: Open Defecation 
While in general the child respondents in Makassar were familiar with various practices 
related to defecation, such as the importance of defecation in the right place, the causes of 
diarrhea and the dangers of diarrhea to children, it should also be noted that only 23.3% – 
40% of the children were aware of the dangers that arise from infectious diseases 
transmitted through feces (including infant feces), such as diarrhea. The responses of the 
children on their perceptions related to human feces/excrement are as shown below:
Table 6.4
Perceptions of Children Related to Defecation 
Description Correct Incorrect
Defecation in a toilet that has a proper waste disposal system 
 
73,3% 26,7%
Infant feces can be injurious to health 76.7% 23.3%
No need to wash hands with soap after defecation 10,0% 90,0% 
Human feces contain germs that can cause diarrhea 60,0% 40,0% 
Respondent Base: 30 
As regards various activities that are not appropriate in connection with defecation in the 
home or school environment, their responses are presented in the table below.
The responses of the elementary school children show that many unhealthy and unhygienic 
practices continue to be prevalent in their school and home environments. A total of 66.7%
said that open defecation continues to occur around their homes, while 23.3% said it was 
still prevalent in the school environment. Similarly, 86.7% said that feces continued to be 
disposed of in water channels/drains around their homes, while 6.7% said the same applied 
in the school environment.
Table 6.5
Children’s Explanations on Inappropriate Defecation Behavior in their Home and 
School Environments 
Do any of the following things happen: At Home %) At School (%)
Yes No Yes No Don't know 
Defecation outside of toilet. 66,7 30,0 23,3 76,7 66,7 
Disposal of feces into drain/water channel 86,7 13,3 6,7 93,3 86,7
Respondent base: 30
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The quite significant differences in people’s sanitation behavior in the school and home 
environments may be due to: (a) the time spent by respondents in the school environment 
is much less than in the home environment – thus, the description of behaviors around the 
home is more accurate than in the school environment; or (b) residents’ behavior is much 
more hygienic around the schools.
Last place of defecation 
A total of 86.75% of respondents said that their last place of defecation was in the toilet at 
home or at school. However, 13.3% said that it was a pond near their home/school, in an 
open space or in the sea. After defecation, 53.3% said that they directly washed themselves 
(without mentioning soap and water), 13.3% said they did so with soap and water, 23.3% 
said they did so with just water, while another 3.3% said they did nothing.
Defecation in school 
A total of 90% of the students had urinated at one time or another in school (all in the 
toilet), but only 50% said they had defecated at one time or another at school, and all did 
so in the student’s toilet. 
A total of 33.3% of students said that urinating/defecating at school was different from at 
home for the following reasons:
Table 6.6
Thing that make urinating/defecating at school different from at home
No. Difference Number of 
Respondents 
1. No Soap 4 
2. Not enough water 4 
3. If I’m at home, I defecate in the sea 3 
4. Dirty/smelly 2 
5. Afraid because toilet is dark 1 
Respondent Base: 10 
Note: * Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
From the statements made by the respondents in connection with the differences in 
defecation at home and defecation at school, besides a lack of convenience at school (no 
soap, not enough water, dirty/smell, dark), another factor was the practice of defecating in 
the sea on the part of a number of respondents. 
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Bringing You The Real Portrait of Indonesia
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Pillar 2: Washing hands with soap 
The knowledge of the children regarding the benefits of washing hands with soap was 
better than their knowledge of the first CBTS pillar. However, 33.3% of the respondents still 
needed to be informed that washing hands without soap was not enough to kill dangerous 
germs. In addition, 10% thought that there was no need to wash hands with soap after 
defecating, unless the hands were sticky.
Table 6.7
Perceptions of Children Regarding CTPS-related Activities 
Description Right Wrong
Washing hands with water alone is enough to clean off disease￾spreading germs 33,3% 66,7% 
We don’t need to washing hands with soap after defecation unless 
our hands are sticky 10,0% 90,0% 
Respondent base: 30 
As regards availability of water, 83.3% said that they had experienced difficulties with water 
for bathing and washing in their home environments. However, only 10.0% said that this 
was the case in their school environments.
Table 6.8
Children’s Description on Water Availability At Home and At School 
Have you ever experienced any of the 
following?
At home (%) At school (%)
Yes No Yes No
Foul smelling or tasting drinking water 53.3 40 6,7 83,3
Difficulties with availability of water for bathing 
or washing
83,3 13,3 10,0 83,3
Respondent Base: 30
Also as regards the availability of clean water, 53% of the respondents said that they had 
had experience of foul smelling or tasting drinking water in their home environment, while 
only 6.7% had experience of this at school.
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Washing Hands in the Home
A total of 83.3% of respondents ate lunch at home, while only 16.7% did so at school. All of 
the respondents ate dinner at home. The following are their responses on their behavior 
before eating (both snacks and meals):
Figure 6.2
Behavior Before Eating (Snacks and Meals)
Respondent base: 30
There was a greater tendency among respondents to wash hands with soap before a main 
meal compared to when they would eat snacks. The biggest proportion of respondents 
(40%) just said that they washed their hands (without mentioning water/soap) before a 
main meal, while 36.7% washed their hands with soap before eating a snack. The above 
table shows differences in hand washing practices before eating. When the respondents eat 
a main meal, they make sure to wash their hands with soap (26.7%), compared to only 
20% before eating a snack. Meanwhile, 26.7% of respondents said that they wash their 
hands with water before eating a main meal, while 20% did so before consuming a snack. 
The following table sets out an overview of hand washing practices before consuming main 
meals and before consuming snacks.
Wash hands (without 
mentioning water/soap)
Wash hands with soap Wash hands with water
36,7%
20,0%
26,7%
40,0%
26,7%
20,0%
Snacks
Meals
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Table 6.9 
Hand Washing Practices Before Eating (Main Meals and Snacks)
Group MAKASSAR
Children who always wash their hands with water but without soap (before 
eating snack or main meal) 53.3% 
Children who always wash their hands with soap (before eating snack or main 
meal) 26.7% 
Children who have better hand-washing practices before eating main meals 
compared with snacks 6.7% 
Children who never wash their hands before eating 13.3% 
Respondent Base: 30
The reasons given by respondents for washing their hands before eating were as follows:
Figure 6.3
Reasons for Washing Hands Prior to Eating – Multiple Answer
Respondent base: 26
So that hands are 
free of germs 
Because there are 
a lot of germs on 
the hands 
Because hands are 
dirty 
So as not to get a 
sore stomach
5 other responses
15 
6 
1 
2 
4 
Midline Household Survey - Makassar 
Bringing You The Real Portrait of Indonesia
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Using open-ended questions, it was found that the main reason for washing hands before 
eating was to rid the hands of germs (15 respondents). The remaining responses varied, but 
were also concerned with germs, while there were also 5 other responses: so as not to get a 
stomach ache, not to get diarrhea, not to get sick and not to have sticky hands.
The primary source of information on the importance of washing hands before eating so as 
to avoid germs was teachers in school (50%), parents (34.4%), health outreach campaigns 
in school (11.5%) and doctors (3.8%).
The other situations when they practiced hand-washing with soap were (1) after defecating 
(25%), (2) after playing (62.5%) and (3) after eating (25%)
Hand-washing practices at school 
All of the respondents (100%) said that they had facilities at school for washing hands, 
while 50% said that they always washed their hands before eating, and 23.3% said that 
they sometimes did so. Meanwhile, 26.7% said that they never washed their hands before 
eating.
As regards the practice of hand washing with soap, only 16.7% of respondents did it 
correctly (rubbing the palm and between the fingers with water and soap), while 3.3% 
rubbed between the fingers (without rubbing the palm) with water and soap, 53.3% rubbed 
the palm and between the fingers with water alone, while 20% just wet their hands with 
water alone.
Pillar 3: Clean and healthy treatment of drinking water 
A total of 60% of the elementary school respondents were aware of the importance of 
treating water before consumption, as well as treating food before consumption. 
Nevertheless, they still need more information on the risk of diarrhea from untreated water, 
and the dangers of consuming untreated vegetables (40% of the children thought that 
consuming raw vegetables was healthy and that there was no need to worry about 
contracting germs from the such raw vegetables). The responses as regards their knowledge 
of diarrhea and bacteria from untreated vegetables, and the spread of germs by flies, are as 
shown in the following table:
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Table 6.10
Perceptions of Children About Activities Related to Defecation 
Description Right Wrong
Eating untreated vegetables is healthy, and you don’t need to worry 
about germs 60,0% 40,0% 
Drinking untreated water can cause diarrhea 73,3% 26,7% 
The legs of flies carry thousands of germs that can be spread from 
place to place 66,7% 33,3%
Respondent Base: 30 
Although the elementary school respondents had quite good knowledge about the need to 
treat water before consumption (73.3%), 27.7% did not understand why this was 
important. In addition, 70.0% referred to the drinking of untreated water at home. 
However, none of them referred to the drinking of untreated water at school. This could be 
because the respondents spend much more time at home, or because those in the school 
environment are aware of the health risks of consuming untreated water, such a diarrhea.
Table 6.11
Children’s Descriptions of Drinking Water Treatment At Home and At School 
Have any of the following 
things happened?
At Home (%) At School (%)
Yes No Don't know Yes No Don't know 
People drank untreated water 70,0 23,3 6,7 - 83,3 16,7
Respondent Base: 30
As regards sources of water at school, 96.7% of respondents said that they purchased it at 
school, while only 3.3% brought it from home. Of the 96.7% who purchased it at school (29 
students), 22 purchased branded packaged water (both in cup and bottle form), while 
others purchased ices (branded, such as Marimas and Pop Ice, as well as unbranded). 
Thirteen respondents purchased drinks in the school canteen, while 16 did so in stalls 
outside the school.
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Pillar 4: Garbage Management 
Based on observations conducted in the schools, uncovered garbage bins were the most 
common places (66.7%) where students disposed of the packaging from their snacks 
(whether consumed during playtime or in the classroom). The remaining approximately 
3.3% disposed of the garbage in the drain/ditch/stream/river.
Pillar 5: Solid and Liquid Waste Treatment
As regards the wastewater disposal channels in the places where the respondents lived, 4 
pictures were used, consisting of 2 pictures showing clean drains and 2 pictures showing
dirty drains. These elicited the following responses from the elementary school children:
Table 6.12
Condition of Wastewater Disposal Channels in Place Where You Live
Picture Number Picture Water Channel 
Category 
Percentage
11 Clean 20%
12 Clean 30%
13 Dirty 50%
14 Dirty - 
Respondent base: 30 
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C. Perceptions of Children of Environmental Cleanliness at School and at Home
The elementary school respondents in Makassar were made made up equally of children 
whose schools were located in Tallo and those whose schools were located in Lembo. Of 
these, 59% said that their school environment was quite clean, 36.7% said that their 
school environment was very clean. Out of 15 respondents from SDN (Sekolah Dasar 
Negeri – State Elementary School) Tallo, only 1 said that the school environment was 
not clean/dirty. Similarly, out of 15 respondents from SDN Lembo, only 1 said that the 
school environment was very dirty 
The following table shows the children’s responses:
Table 6.13
Perceptions about Environmental Cleanliness
Perceptions of Environment School Home
Quite Clean 50.0% 56.7%
Very Clean 36.7% 16.7%
Not clean (dirty) 10.0% 16.7%
Very dirty 3.3% 10.0%
Respondent base 30 
Although 96.7% of respondents perceived their school environment to be clean (quite 
clean and very clean), and only 26.7% felt their home environments to be dirty, 
nevertheless all (100%) said that environmental cleanliness at school and at home 
needed to be improved (70% and 30% said, respectively, that it needed to be greatly 
improved).
A number of behaviors found in the children’s environment (school and home) were 
acknowledged by almost all respondents (more than 96.7%) as being inappropriate, 
such as adults discarding garbage in the open, which could lead to blocked drains (90% 
in the home environment, and much cleaner in the school environment – only 30% had 
seen blocked drains around their schools), and the continued occurrence of floods 
during the wet season – 83.3% said that there were floods every wet season in their 
home environment, while 40% said that this was the case in their school environment. A 
total of 80% of respondents said that diarrhea was still found in their home 
environments, while only 23.3% said that this was the case in their school 
environments.
As regards Dengue fever, 70% of respondents said that this was prevalent in their home 
environments, while only 10% said that this was the case in their school environments.
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Table 6.14
Children’s Descriptions of Inappropriate Actions Related to Cleanliness in the 
Home and School Environments 
Have any of the following things happened:
At home (%) At School (%)
Yes No Yes No
Adults incorrectly disposing of garbage 96.7 3.3 40 60
Blocked water channels or drains 90 10 30 66.7
Dengue Fever 70 30 10 76.7
Flooding every wet season 83.3 13.3 76.7 23.3
Frequent outbreaks of diarrhea 80.0 13.3 23.3 70
Respondent Base: 30
Sickness Episodes in the Last Month
A total of 60.0% of children had been absent from school on account of sickness in the last 
month (February 2013). The illnesses experienced were as follows:
Table 6.15
Illnesses Experienced in Last 12 Months – Multiple Answer 
No. Illness Experienced Number 
1 Fever 14 persons
2 Headache 7 persons
3 Diarrhea 2 persons
4 Cough 1 person
5 Cut on leg 1 person
6 Toothache 1 person 
7 Sprain 1 person
Respondent base: 20 
Note: Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
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As regards diarrhea in the last 2 weeks (end February 2013), 26.7% of children had 
experienced it, while 73.3% had not experienced diarrhea in the last 2 weeks. According to 
the children, the causes of diarrhea were as follows:
Table 6.16
Causes of Diarrhea in Last 2 Weeks – Multiple Answer
No. Cause Number
1 Because of not being careful where I eat/snack 3 persons
2 Because of not washing hands before eating/because of germs on hands 2 persons
3 3 other reasons
(eating spicy food, consuming ice, because of being rained on)
7 persons
Responden Base: 11 
Note: * Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
The causes of the diarrhea episodes experienced over the last two weeks, according to the 
responses of the respondents, were quite varied and revealed that many of the respondents 
were unaware of what the true causes of diarrhea are (responses: eating spicy food, 
consuming ice, being rained upon – these responses were given by 7 respondents). Other 
causes that are closer to the causes of diarrhea were (1) Because of not being careful where 
I eat/snack – cited by 3 respondents; and (2) Because of not washing hands before 
eating/because of germs on hands – cited by 2 respondents.
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Attachment
Observations on Schools 
Target Schools and General Conditions 
TARGET SCHOOL NUMBER OF 
STUDENTS 
NUMBER OF 
TEACHERS 
NUMBER 
OF 
TOILETS
SCHOOL 
FLOOR
SCHOOL 
ROOF
SCHOOL 
WALLS
SDN 69 TALLO 542 15 3 Ceramic Tiles Corrugated 
iron Ceramic Tiles
SD TALLO TUA 2 301 10 2 Terrazzo Tiles Corrugated 
i on
Tiles
SD TALLO TUA 1 566 19 3 Ceramic Tiles Corrugated 
i on
Cement
SD KIP BARAYA 239 10 2 Ceramic Tiles Corrugated 
i on
Ceramic tiles
SD MALIMONGAN BARU 183 9 2 Ceramic Tiles Corrugated 
i on
Cement
SD INPRES BARAYA 2 220 14 3 Terrazzo Tiles Corrugated 
i on
Cement
SDN: Sekolah Dasar Negeri - state elementary school
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Target Schools and CBTS Pillar 1 – 1
TARGET SCHOOL TYPE OF 
TOILET
PLACE OF 
FECES 
DISPOSAL
CONDITION OF 
SCHOOL 
BATHROOMS
DISTANCE FROM 
WELL TO SEPTIC 
TANK/DROP TOILET
DISTANCE FROM WELL 
TO NEIGHBORING 
SEPTIC TANKS
SDN 69 TALLO U-bend Septic Tank Quite clean No well Not measurable
SD TALLO TUA 2 U-bend Septic Tank Very dirty 10 steps Not measurable
SD TALLO TUA 1 U-bend Septic Tank Very dirty No well Not measurable
SD KIP BARAYA U-bend Septic Tank Dirty 5 steps Not measurable
SD MALIMONGAN BARU U-bend Septic Tank Dirty 12 steps 10 steps
SD INPRES BARAYA 2 U-bend Septic Tank Quite clean No well Not measurable
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and CBTS Pillar 1 – 2
TARGET SEKOLAH 
GENERAL CONDITION OF TOILET
FECES 
PRESENT
GARBAGE 
PRESENT
FLIES 
PRESENT
WATER 
AVAILABLE 
SCOOP 
PRESENT
WATER 
RECEPTACLE 
TOWEL 
PRESENT
YES NO YES NO YES NO YES NO YES NO YES NO YES NO
SDN 69 TALLO x   x x   x  x  x X 
SD TALLO TUA 2   x x  x   x x  X 
SD TALLO TUA 1 x   x x   x  x  x X 
SD KIP BARAYA x   x x  x   x x  X 
SD MALIMONGAN BARU x   x x   x  x  x X 
SD INPRES BARAYA 2 x  x   x  x  x  x X 
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and CBTS Pillar 2
TARGET SCHOOL RUNNING WATER CLEAR WATER SOAP AVAILABLE DRY TOWEL AVAILABLE 
YES NO YES NO YES NO YES NO
SDN 69 TALLO x   x x   x
SD TALLO TUA 2   x x  x 
SD TALLO TUA 1 x   x x   x
SD KIP BARAYA x   x x  x 
SD MALIMONGAN BARU x   x x   x
SD INPRES BARAYA 2 x  x   x  x
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and Pillar 3
TARGET SCHOOL FOOD CONTAINER IN 
CANTEEN
HOW IS FOOD PRESENTED 
IN CANTEEN
TYPE OF SCHOOL 
CANTEEN
HAND WASHING 
FACILITY IN CANTEEN
YES NO
SDN 69 TALLO Covered Covered “Wet foods” on sale  x
SD TALLO TUA 2 Covered Some covered, some uncovered “Wet foods” on sale x 
SD TALLO TUA 1 NA Only packaged foods and drinks “Dry foods” on sale x x
SD KIP BARAYA Covered Uncovered “Dry foods” on sale x 
SD MALIMONGAN BARU x x x x x
SD INPRES BARAYA 2 Covered Covered “Wet foods” on sale x 
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and Pillar 4 – 1 
TARGET SCHOOL NUMBER OF 
GARBAGE BINS
TYPE OF 
GARBAGE BIN
CLEANLINESS 
OF SCHOOL
FINAL DISPOSAL OF 
GARBAGE 
GARBAGE SEPARATION
YES NO
SDN 69 TALLO 10 Uncovered basket Quite clean Basket – in the yard X 
SD TALLO TUA 2 2 Uncovered basket Very dirty In the grounds  X 
SD TALLO TUA 1 10 Uncovered basket Very dirty In the grounds  X 
SD KIP BARAYA 3 Covered basket Quite clean Public garbage disposal 
point
 X 
SD MALIMONGAN BARU 8 Uncovered basket Very dirty In the grounds  X 
SD INPRES BARAYA 2 14 Covered basket Quite clean Basket – in the yard X 
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and Pillar 4 – 2 
TARGET SCHOOL CLEANLINESS OF 
CANTEEN
TYPE OF GARBAGE 
RECEPTACLE IN 
CANTEEN
REGULARITY OF 
GARBAGE 
COLLECTION 
ARE FOOD LEFTOVERS 
SEPARATED
YES NO
SDN 69 TALLO Very clean Uncovered basket Every day x 
SD TALLO TUA 2 Quite clean Uncovered basket Every day  x
SD TALLO TUA 1 Quite clean Uncovered basket Every day NA NA 
SD KIP BARAYA Quite clean Uncovered basket Every day  x 
SD MALIMONGAN BARU x x X x x 
SD INPRES BARAYA 2 Quite clean Uncovered basket A couple of times a day  x
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and Pillar 5
TARGET SCHOOL METHOD OF WASHING 
IN CANTEEN
WHERE DOES 
WASTEWATER 
FROM CANTEEN 
GO
FILTER ON 
WASHING IN 
CANTEEN
FINAL DISPOSAL OF WASTEWATER
YES NO BATHROOM WASH HAND BASIN (IF 
AVAILABLE)
SDN 69 TALLO Washed with soap, rinsed in 
clean water Uncovered channel X  Covered channel Not available 
SD TALLO TUA 2 Washed with soap, rinsed in 
clean water IPAL pipe X  Wastewater 
discharge pipe Not available 
SD TALLO TUA 1 NA NA NA NA Uncovered channel Covered channel 
SD KIP BARAYA 
Washed with soap, rinsed in 
dirty water before being 
rinsed in clean water
Uncovered channel X  Street, yard, 
garden Not available 
SD MALIMONGAN BARU X X X X Uncovered channel Not available 
SD INPRES BARAYA 2 Washed with soap, rinsed in 
clean water Uncovered channel X  Uncovered channel Not available 
SDN: Sekolah Dasar Negeri - state elementary school
REPORT
HIGH FIVE PROGRAMS
MIDLINE HOUSEHOLD SURVEY 
COVERAGE AREA: MEDAN
Prepared for
May, 2013
 
Bringing You The Real Portrait of Indonesia
i
TABLE OF CONTENTS
TABLE OF CONTENTS ................................................................................................... i
LIST OF FIGURES .......................................................................................................iii
LIST OF TABLES .......................................................................................................... v
PART I Background and Research Objectives .................................................... 1
A. Background............................................................................................................. 1
B. Objectives............................................................................................................... 1
PART II Research Methodology ........................................................................... 3
A. Survey Method........................................................................................................ 3
B. Number of respondents............................................................................................ 3
C. Sample Selection Technique ..................................................................................... 5
Part III Findings .................................................................................................. 6
A. Respondent Profile – Age ......................................................................................... 6
B. Respondent Profile – Relationship between Respondent and Household Head............... 6
C. Respondent Profile – Number of Under-5s per Household ........................................... 6
D. Respondent Profile – Education ................................................................................ 7
E. Respondent Profile – Socioeconomic Class ................................................................. 8
Average Household Expenditure Per Month ................................................................ 9
F. Respondent Profile Summary...................................................................................11
Part IV Program Implementation .....................................................................13
A. Effectiveness..........................................................................................................13
B. Efficiency ...............................................................................................................27
C. Sustainability..........................................................................................................29
D. Relevance and Appropriateness ...............................................................................31
Part V Evaluation of Program Outcomes
Hygiene and Sanitation Practices in Five CBTS Pillars..........................34
A. Open Defecation Free .............................................................................................34
Condition of Toilets in General .......................................................................................36
Summary of First Pillar Findings: Open defecation free.....................................................42
B. Hand-Washing with Soap ........................................................................................44
Summary of Second Pillar: Practices of washing hands with soap......................................48
 
Bringing You The Real Portrait of Indonesia
ii
C. Safe Drinking Water Treatment and Storage.............................................................49
D. Percentage of households that practice solid waste management ...............................56
Summary of Fourth Pillar: Solid Waste Management Practices ..........................................61
E. Proper Wastewater Management .............................................................................62
Summary of Fifth CBTS Pillar: Wastewater management practices ....................................68
F. Role of Community Members as Informants..............................................................73
G. Healthy Life Practices..............................................................................................78
Knowledge ..........................................................................................................78
Attitude ..........................................................................................................80
Practices ..........................................................................................................86
Part V Children Baseline – Elementary School ................................................91
A. Perceptions of children regarding conditions that impact on healthy and clean life 
practices................................................................................................................91
B. Perceptions of Children of Environmental Cleanliness at School and at Home.............103
Attachment Observations on Schools....................................................................106
 
Bringing You The Real Portrait of Indonesia
iii
LIST OF FIGURES
Figure 3.1 Respondent Age Groups........................................................................ 7
Figure 3.2 Number of Under-5s per Household ....................................................... 7
Figure 3.3 Highest Educational Attainment ............................................................. 8
Figure 3.4 Average Household Expenditure Per Month............................................. 9
Figure 3.5 Home Ownership Status.......................................................................10
Figure 3.6 Number of Persons Over Age of 5 Living in Home ..................................11
Figure 5.1. Last Place of Defecation.......................................................................34
Figure 5.2. Types of Toilets Used, Based on Observations .......................................36
Figure 5.3. Toilet Condition – based on Observations ..............................................37
Figure 5.4 If you have a child aged under 3, is he/she toilet trained? ......................39
Figure 5.5 Location of Last Defecation among Under-3s .........................................40
Figure 5.6 Disposal of Infant Feces.......................................................................41
Figure 5.7 What Respondents Do after Children Defecate .......................................42
Figure 5.8 Use of Soap in Last Two Days in Kota Bangun Sub-district – Multiple 
Answer...............................................................................................44
Figure 5.9 Use of Soap over Last Two Days in Tegal Sari Mandala 3 Sub-district - 
Multiple Answer...................................................................................45
Figure 5.10 Scores for Use of Soap at 5 Critical Times in Last 2 Days ........................46
Figure 5.11 Availability of Running Water................................................................47
Figure 5.12 Availability of Soap ..............................................................................47
Figure 5.13 Sources of Drinking Water....................................................................49
Figure 5.14 Sources of Drinking Water for Under-5s in the Home..............................50
Figure 5.15 What is done (to improve quality) before consumption ...........................50
(Excludes branded packaged water and water refills) .............................50
Figure 5.16 Drinking Water Storage Places..............................................................51
Figure 5.17 Places Used to Store Drinking Water – Observations...............................52
Figure 5.18 Places used to store water for cooking in Kota Bangun (Observations) – 
Multiple Answer...................................................................................52
 
Bringing You The Real Portrait of Indonesia
iv
Figure 5.19 Places used to store water for cooking in Tegal Sari Mandala 3 -
Observations – Multiple Answer ............................................................53
Figure 5.20 Places where food is stored – Observations ...........................................55
Figure 5.21 Receptacles or Places Used for Collecting Garbage .................................57
Figure 5.22 Disposal of Household Garbage ............................................................58
Figure 5.23 Frequency of Garbage Collection...........................................................59
Figure 5.24 Do You Pay for Garbage Collection? ......................................................59
Figure 5.25 Expenditure on Garbage Collection........................................................60
Figure 5.26 Is Organic and Inorganic Garbage Separated? .......................................60
Figure 5.27 Means Used for Collecting Garbage – Observations ................................61
Figure 5.28 Disposal of kitchen wastewater – Observations ......................................63
Figure 5.29 Discharge of Wastewater from Bathroom/Toilet – Observations...............64
Figure 5.30 Discharge of Wastewater from Clothes Washing – Observations ..............64
Figure 5.31 Location of Septic tank – confined to those that have septic tank ............65
Figure 5.32 Final place of disposal of feces (by those that lack septic tanks) – 
observations .......................................................................................66
Figure 5.33 Has your septic tank ever been emptied? ..............................................66
Figure 5.34 When was the last time your septic tank was emptied?...........................67
Figure 5.35 Who emptied your septic tank the last time?..........................................67
Figure 5.36 Distance from Home to Public Toilet......................................................68
Figure 5.37 Have you Heard of CBTS? ....................................................................78
Figure 5.38 Have you ever heard of PHBS...............................................................79
Figure 5.39 Has Your Under-5 Ever Suffered from Diarrhea?.....................................88
Figure 5.40 Last Time your Under-5 Suffered from Diarrhea .....................................88
Figure 5.41 Treatment of Diarrhea .........................................................................89
Figure 5.42 Overall Cost of Treatment (transportation, consultation, medicine) ..........90
Figure 6.1 8 top responses for conditions that are deemed clean and healthy...........91
Figure 6.1 Children’s Understanding of CBTS .........................................................92
Figure 6.2 Behavior Before Eating (Snacks and Meals)............................................99
Figure 6.3 Reasons for Washing Hands Prior to Eating – Multiple Answer...............100
 
Bringing You The Real Portrait of Indonesia
v
LIST OF TABLES
Table 2.1 Number of Respondent by Respondent Category in Each Area.................. 4
Table 3.1 Respondent Profile Summary................................................................11
Table 5.1. Findings of Observations on Destination of Toilet Waste .........................35
Table 5.2 Toilet Conditions, Based on Observations ..............................................38
Table 5.3 First Pillar Indicator: Open defecation free.............................................42
Table 5.4 Indicators Showing Practice of Washing Hands with Soap .......................48
Table 5.5 Observations on Drinking Water Storage Receptacles, Processing and 
Presentation........................................................................................54
Table 5.6 Indicators for Third Pillar: Safe Water Treatment ...................................56
Table 5.7 Fourth Pillar Indicators: Solid Waste Management Practices ....................61
Table 5.8 Indicators for Fifth Pillar: Wastewater Management Practices ..................68
Table 5.9 Summary of Indicators for all Five CBTS pillar........................................69
Table 5.10a Sources of information on the 5 CBTS Pillars in Kota Bangun, Medan – 
Multiple Answer -Spontaneous..............................................................73
Table 5.10b Sources of Information on 5 CBTS Pillars in Tegal Sari Mandala 3, Medan
– Multiple Answer - Spontaneous ..........................................................75
Table 5.11 Perceptions of Residents about Health...................................................80
Table 5.12 Residents Perception of Community ......................................................85
Table 5.13 Behaviors that can cause health and hygiene problems...........................86
Table 6.1 Children’s Understanding of CBTS by Grade...........................................92
Table 6.2 What More Do You Know About CBTS?..................................................93
Table 6.3 Information on CBTS Obtained From:....................................................95
Table 6.4 Perceptions of Children Related to Defecation ........................................96
Table 6.5 Children’s Explanations on Inappropriate Defecation Behavior in their 
Home and School Environments............................................................96
Table 6.6 Thing that make urinating/defecating at school different from at home....97
Table 6.7 Perceptions of Children Regarding CTPS-related Activities .......................98
 
Bringing You The Real Portrait of Indonesia
vi
Table 6.8 Children’s Description on Water Availability At Home and At School .........98
Table 6.9 Below sets out a compilation of the responses on hand washing before 
eating main meals and snacks:.............................................................99
Table 6.10 Perceptions of Children About Activities Related to Defecation...............101
Table 6.11 Children’s Descriptions of Drinking Water Treatment At Home and At 
School ..............................................................................................101
Table 6.12 Condition of Wastewater Disposal Channels in Place Where You Live .....102
Table 6.13 Perceptions about Environmental Cleanliness .......................................103
Table 6.14 Children’s Descriptions of Inappropriate Actions Related to Cleanliness in 
the Home and School Environments....................................................104
Table 6.15 Illnesses Experienced in Last 12 Months – Multiple Answer ...................104
Table 6.16 Causes of Diarrhea in Last 2 Weeks – Multiple Answer..........................105
 
Bringing You The Real Portrait of Indonesia
1
PART I
Background and Research Objectives
A. Background
The Indonesian government launched the Community-Based Total Sanitation (CBTS) Program 
in 2007 to improve hygiene and sanitation practices in households, thereby reducing the 
incidence of diarrhea, the second leading cause of infant mortality. The program consists of five 
hygiene and sanitation pillars, namely:
1. Stopping open defecation 
2. Washing hands with soap
3. Household safe water treatment and storage
4. Solid waste management
5. Waste water management
The program was focused primarily on rural areas, where the emphasis was on Pillar 1 
(stopping open defecation). Through the High Five Program, the Cipta Cara Padu (CCP)
Foundation proposed that the program be extended to urban areas, thus contributing to the 
efforts to improve compliance with the five CBTS pillars in households and communities.
The High Five Program has now been running for 1.5 years in 3 cities, namely, Surabaya, 
Medan and Makassar. The program is conducted at the city level and the sub-district level. At 
the city level, The High Five Program advocates the incorporation of CBTS into current policies 
and AMPL/Sanitation Working Group activities, as well as the integration of CBTS strategies into 
municipal government development plans. At the sub-district level, The High Five Program
operates in three RW (neighborhoods) at a high level of intensity, and in other neighborhoods 
at a low level of intensity.
It is very important to ensure that the program at every level is on track to achieve the key 
indicators in respect of intermediate results, particularly those resulting from interventions 
during the operative period, and that the implementation process is in accordance with 
participatory principles, and reflects gender equity and environmental considerations. 
Accordingly, an independent evaluator is required to review the performance of the program 
and provide recommendations for improving program implementation during its remaining 
lifetime.
 
Bringing You The Real Portrait of Indonesia
2
B. Objectives
The High Five Program focuses on improving hygiene practices at the household and 
community levels, identifying how many households are aware of children's health, sanitation 
and hygiene issues, whether that number has increased or decreased when compared with the 
2012 baseline survey having regard to The High Five Program objective indicators. Accordingly, 
this midline survey evaluates:
a. Program outcomes by comparing the midline survey’s findings with those of the baseline 
survey so as to identify changes as regards:
- Understanding of the CBTS pillars
- Perceptions of the CBTS pillars
- Habits/ behaviors associated with the CBTS pillars
b. Program implementation so as to identify program effectiveness, efficiency, relevance, 
and sustainability.
c. Providing recommendations for better program implementation. 
 
Bringing You The Real Portrait of Indonesia
3
PART II
Research Methodology
In general, both primary and secondary data were required for the purposes of this survey. 
However, Polling Center (in accordance with its agreement with High Five Program) collected 
primary data using the quantitative and qualitative methods.
In the implementation of this survey, the collection of primary data in the field was carried out 
using the quantitative method aimed at respondents from households with children, while the 
qualitative data was collected using in-depth interviews with stakeholders of the CBTS program 
being implemented by Cipta Cara Padu Foundation. 
A. Survey Method 
In order to obtain the data required for this research (as set out in the survey objectives), both 
the quantitative and qualitative methods employed questionnaires. 
Data collection in the field in the Medan area was conducted as follows:
Quantitative Data
- Households : 9 to 14 March 2013
- Children : 6 to 10 March 2013
Qualitative Data 
- Focus Group Discussion(FGD) : 5 March 2013
- In-depth Interviews (IDI) : 8 to 22 March 2013
B. Number of respondents
The number of respondents in each category in the Medan survey area is shown in the 
following table:
 
Bringing You The Real Portrait of Indonesia
4
Table 2.1
Number of Respondent by Respondent Category in Each Area
Category Area / Sub-district Total Sample
Household
Kota Bangun 30 respondents
Tegal Sari Mandala 3 (TSM 3) 30 respondents
Children
Surya Bakti Elementary School, Kota Baru 10 respondents
Mis Al Wasliyah 10 respondents
Baraya II Elementary School 10 respondents
Total Respondents in Quantitative Survey 90 respondents
FGD
1 group from Pokja Kota
(Kelompok Kerja Kota – 
City Working Group)
1 group from Pokja 
Kelurahan (Kelompok 
Kerja Kelurahan – 
Administrative Village 
Working Group)
IDI – per respondent category 
High Five Program District Leaders 1 respondent
High Five Program Facilitators 1 respondent
Community Leaders (Sub-district Heads) 2 respondents
Teachers with High Five Program training 2 respondents
Journalists 1 respondent
Medan Municipal Health Agency 1 respondent
BTKL (Balai Teknik Kesehatan Lingkungan – Technical Unit 
Environmental Health (replacing other Partners)
1 respondent
Local Government Water Company 1 respondent
 
Bringing You The Real Portrait of Indonesia
5
Category Area / Sub-district Total Sample
Community Leaders (District Heads) 1 respondent
Total Respondents in Qualitative Survey 11 respondent
C. Sample Selection Technique
1. Respondent Households 
Respondent households were selected using the simple random sampling method. The 
objective was to obtain findings that are representative of the population.
In the selected sub-districts in each city, a mapping process was first carried out in respect 
of households with under-5s, with the approval of local leaders (heads of RT/RW or sub￾district heads).
After the population had been mapped, the selection of households was preceded by 
determining the household interval, that is, by dividing the total number (population) of 
households with children under 5 with the total respondent target (30 respondents) for each 
sub-district. 
In this way, the caregiver respondents for under-5s to be interviewed were selected.
2. Elementary school children in grades 4, 5 and 6
The selected elementary schools were all located in sub-districts where interventions had 
been effected. Respondents in the child category were selected randomly using the 
sampling interval technique. A total of 10 children from each school were interviewed, all of 
whom were from grades 4, 5, and 6. Consequently, the average sample size for each class 
was 3 children.
To select the children to be interviewed from each class, the interval random sampling 
method was used based on desk or attendance role sequences.
 
Bringing You The Real Portrait of Indonesia
6
Part III
Findings
A. Respondent Profile – Age 
The criteria for the selection of respondents for interview during the midline survey were the 
same as in the case of the previous baseline survey, namely, caregivers of under-5s. Both in 
Kota Bangun and Tegal Sari Mandala 3, 100% of respondents were women, the same as in 
the Medan baseline survey. This means that all of the respondents to the midline survey in 
Medan were female.
As a whole in the city of Medan, the majority (58.3%) of respondents interviewed were 
women aged 25-35. The second largest age group was those aged 35-45 (23.3%).
In more detail, the proportions of young women respondents (25-35 years of age) in Kota 
Bangun and Tegal Sari Mandala 3 were respectively 53.3% and 63.3%. In second place in 
Kota Bangun were women of under 25 years of age (26.7%). By contrast, Tegal Sari 
Mandala 3, women respondents of between the ages of 35 and 45 were the second biggest 
group on 26.7%.
B. Respondent Profile – Relationship between Respondent and Household Head
The respondents were the wives of household heads in the majority of cases in both sub￾districts of Medan where interviews were held, with the proportion being 91.7% (93.3% in 
Kota Bangun and 90% in Tegal Sari Mandala 3). In the case of Kota Bangun, the remaining 
respondents were children or parents-in-law of household heads (3.3% for each category), 
while in Tegal Sari Mandala 3, they were children of household heads (6.7%) or parents of 
household heads (3.3%).
C. Respondent Profile – Number of Under-5s per Household
Overall, in the two sub-districts in which interviews held, the majority of respondents lived 
with 1 toddler at home (83.3%), while only 16.7% of respondents had 2 toddlers in the 
house. Similarly, when the findings are studied in more detail, in Kota Bangun the greatest 
percentage of interviewed respondents lived with 1 toddler at home (76.7%) while the 
remaining 23.3% of respondents had 2 toddlers in the home.
 
Bringing You The Real Portrait of Indonesia
7
Figure 3.1.
Respondent Age Groups 
Figure 3.2
Number of Under-5s per Household
D. Respondent Profile – Education 
As regards the educational background of the respondents selected in Medan, an overall 
majority (43.3%) of them had completed high school (or equivalent), while the second 
largest group (36.7% of respondents) had graduated from junior high school (or 
equivalent).
Baseline Midline Baseline Midline
26,70% 26,70%
10% 7%
60,0% 53,3%
66,7% 63,3%
13,3% 20,0% 23,3% 26,7%
10,00% 3,30% >50-55 
>45-50 
>35-45 
25-35 
<25 
Kota Bangun TSM 3
Respondent base : 60 
Baseline Midline Baseline Midline
23,3% 23,3% 23,3%
10%
70% 76,7% 73,3%
90% 1 child 
2 children 
3 children 
Kota Bangun TSM 3
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
8
The percentages were exactly the same at the sub-district level, where 43.3% of 
respondents in both Kota Bangun and Tegal Sari Mandala 3 having graduated from high 
school (or equivalent) and 36.7% having graduated from junior high school (or equivalent). 
Figure 3.3 below shows the education attainments of the interviewed respondents in 
percentage terms and compares these with the findings of the baseline survey.
Figure 3.3
Highest Educational Attainment
E. Respondent Profile – Socioeconomic Class
The midline survey in the Medan area found that overall 53.3% of respondents were 
categorized as being in socioeconomic class B, meaning that they had an average 
expenditure of Rp 1,750,001 to Rp 2,500,000, while the second biggest group was made 
up of those in socio-economic class C1 (indicating an average expenditure of Rp 1,250,001 
to Rp 1,750,000 per month). By sub-district, both Kota Bangun and Tegal Sari Mandala 3, 
the majority of interviewees (53.3%) were found to be in socioeconomic class B (average 
expenditure of Rp 1,750,001 to Rp 2,500,000). In Kota Bangun, the next biggest group 
(33.3%) was made up of respondents in socioeconomic class C1 (average expenditure - Rp 
1,250,001 to Rp 1,750,000). By contrast, in Tegal Sari Mandala 3 the second biggest group 
(16.7%) was made up of respondents in socioeconomic class second A2 (average 
expenditure Rp 2,500,001 to Rp 3,500,000). 
The socioeconomic classes of the respondents in each sub-district are as shown below:
Baseline Midline Baseline Midline
40,0% 43,3% 43,3% 43,3%
43,3% 36,7% 43,3% 36,70%
13,30% 16,70% 13,30% 13,30%
Elementary 
school/Equivalent
Junior High/Equivalent
High school/Vocational 
School/Equivalent
Diploma/Academy
Kota Bangun TSM 3
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
9
Figure 3.4
Average Household Expenditure Per Month
Staying on the issue of socioeconomic class, the following is a description of the home 
ownership situation, and observations concerning the homes occupied by respondents.
The majority of respondents in Medan (40%) said that they owned the homes they currently 
occupy, while 35% said that they were renting. In Kota Bangun sub-district, the figures 
were similar to the overall figures, with 56.7% owning their own homes and 26.7% renting. 
By contrast, in Tegal Sari Mandala 3 the majority of respondents (43.3%) said they were 
living in rented accommodation, while 33.3% were living in their extended family home and 
only 23.3% saying they owned their own homes. 
As regards the condition of the respondents’ houses, the majority of homes (70%) had 
cement floors, while 26.7% had ceramic tile floors. Precisely the same proportions were 
prevalent in both Kota Bangun and Tegal Sari Mandala 3.
As regards the roofs of the respondents’ homes, overall the majority (95%) had galvanized 
iron roofs. In both Kota Bangun and Tegal Sari Mandala 3, the majority of respondent 
homes had such roofs, although the proportions were different, with the percentage in Kota 
Bangun being 93.3%, and in 96.7% in Tegal Sari Mandala 3.
Overall, the biggest proportion of homes had cement walls (43.3%), while the second 
biggest category was brick walls (23.3%). However, at the sub-district level there were 
some differences, with 33.3% of respondent homes (the biggest proportion) having plywood 
walls, and 30% having brick walls. In Tegal Sari Mandala 3, the proportions were similar to 
the overall situation in Medan, with a majority of houses (66.7%) having cement walls, and 
16.7% having brick walls.
Baseline Midline Baseline Midline
23,3% 26,7% 16,7%
53,3%
53,3% 53,3%
33,3%
43,3%
20,0% 13,3%
3,3%
16,7% < Rp. 600.000 [E]
Rp. 600.001 s\d Rp. 900.000 [D]
Rp. 900.001 s\d Rp. 1.250.000 [C2]
Rp. 1.250.001 s\d Rp. 1.750.000 [C1]
Rp. 1.750.001 s\d Rp. 2.500.000 [B]
Rp. 2.500.001 s\d Rp. 3.500.000 [A2]
Kota Bangun TSM 3 > Rp. 3.500.000 [A1]
Respondent base : 60
 
Bringing You The Real Portrait of Indonesia
10
The following chart shows the situation as regards home ownership status in the survey 
areas in Medan:
Figure 3.5
Home Ownership Status
Overall, respondents in Medan do not only live with their main family (spouse and children), 
other than toddlers, we found that about 2 – 3 people live in the same house with 37 – 47% of 
the respondent. If we look closer in the village scale, about 43% respondents live with another 
4 – 5 people in Kota Bangun. Whereas in Tegal Sari Mandala 3 about 30% of the respondent 
live with 4 – 5 other people over the age of 5.
The graph that shows the number of people who lives with the respondent (other than toddler) 
in both villages in Medan can be seen in the following chart (Figure 3.6)
Baseline Midline Baseline Midline
56,7% 56,70% 70,0%
23,3%
20,0% 26,7%
30,0%
43,3%
23,3% 16,7%
33,3% Parents' home
family home
Rented
Owner occupied 
Kota Bangun TSM 3
Respondent Base: 60
 
Bringing You The Real Portrait of Indonesia
11
Figure 3.6 
Number of Persons Over Age of 5 Living in Home
F. Respondent Profile Summary
A summary of the characteristics of the respondents in each of the sub-districts surveyed in 
Medan is shown in the following table:
Table 3.1 
Respondent Profile Summary
Characteristic Kota Bangun Tegal Sari Mandala 3
Age 53.3% 25 – 35 years of age 63.3% 25 – 35 years of age
Education 43.3% graduated from high 
school 
43.3% graduated from 
junior high school 
Number of under-5s 76.7% 1 under-5 
23.3% 2 under-5s 
90% 1 under-5 
10% 2 under-5s 
SES 53.3% B 53.3% B
Home Ownership 56.7% owner occupied 43.3% rented
Baseline Midline Baseline Midline
36,6% 46,70% 46,7% 36,6%
36,7%
43,3% 33,3%
30,0%
20,0%
10,0%
13,3%
20,0%
6,7% 3,3% 10,0% > 10 persons
8 - 9 persons
6 - 7 persons
4 - 5 persons
2 - 3 persons
Kota Bangun TSM 3
Respondent Base: 60
 
Bringing You The Real Portrait of Indonesia
12
Kota Bangun 
The majority of respondents in Kota Bangun (53.3%) were homemakers (caregivers to 
under-5s) of between the ages of 25 and 35 who had been educated up to high school level 
or equivalent (43.3% of total respondents). They occupied their own homes (56.7%) and 
had an average monthly expenditure of between Rp 1,750,001 and Rp 2,500,000 (53.3%), 
while 33.3% had an average monthly expenditure of between Rp 1,250,001 and Rp 
1,750,000.
A total of 76.7% of the respondents cared for one under-5, while 46.7% shared their homes 
not just with immediate family members (wife-husband-child), but with between 2-3 other 
family members (besides the under-5s).
Tegal Sari Mandala 3 
The majority of respondents in Tegal Sari Mandala 3 (63.3%) were homemakers (caregivers 
to under-5s) of between the ages of 25 and 35 who had been educated up to high school 
level or equivalent (43.3% of total respondents). The majority also occupied their own 
homes (43.3%) and had an average monthly expenditure of between Rp 1,750,001 and Rp 
2,500,000 (53.3%), while 16.7% had a higher average monthly expenditure of between Rp 
2,500,001 and Rp 3,500,000, meaning that they are categorized as being in the A2 
socioeconomic group. A total of 36.6% shared their homes not just with immediate family 
members, but with between 2-3 other adults.
The following discussion of the findings is based on the strategic objectives of High Five 
Program (as explained in Part I of this survey).
 
Bringing You The Real Portrait of Indonesia
13
Part IV
Program Implementation
A. Effectiveness
On the level of involvement of the public, private sector and community in developing and 
implementing plans to improve water availability, and sanitation and hygiene practices (coded 
as IR1 – program’s success indicator).
1. Role of the High Five Program in developing partnership strategies as part of the SSK
(Strategi Sanitasi Kota - Medan City Sanitation Strategy) 
The High Five Program is considered to have played a very significant role in helping 
coordinate (and make routine) meetings of the Medan City AMPL Working Group. When 
High Five Program routinely coordinated with the related local government agencies to 
provide updates on what the program was doing, the meetings arranged by High Five 
Program for such purposes helped encourage the agencies to harmonize the programs of 
each line unit.
“… There was a role played by High Five in respect of the local government agencies). It 
helped unify the programs of the different line units …” (City Working Group)
As regards the perspectives of other sources who participated in the in-depth interviews, the 
community leaders (sub-district and district heads) viewed High Five Program as playing a 
quite significant role in developing partnership strategies as part of the SSK. This was 
because coordination and participation in the AMPL/Sanitation Working Groups was 
considered to be optimal (even without High Five Program).
“… It’s optimal. We are working together well. They (the City Working Group) always 
coordinate with the sub-district heads…” (Head of Medan Denai District)
“… It’s not as good as it could be as we’re still waiting for the programs to be followed 
up on … The main thing is that they (High Five) optimize the 5 pillars so that they can 
be properly applied. That’s the key...” (Head of TSM 3 Sub-district) 
As regards the possibility of further developing the partnership strategy under the Medan 
SSK, this was essentially viewed as feasible as the program was considered to be good and 
worthy of expansion. Nevertheless, the community leaders felt that it was outside their 
authority to expand the partnerships.
 
Bringing You The Real Portrait of Indonesia
14
“… I don’t know as this is the responsibility of the municipality, while I’m just a sub-district 
head. However, in my view the program should be included in the SSK as it is good. It could 
be expanded to all of the sub-districts in Medan City …” (Head of Kota Bangun Sub-district).
The community leaders also said that it would not be easy to integrate High Five Program
(in this case, the partnership model developed by High Five Program) into the SSK. This was 
because the SSK was the responsibility of the municipality government. Any process of 
integration would not be easy and tend to be complicated.
“… As I said, this is the responsibility of the municipal government, while High Five is 
a private operation. So the procedures would probably be difficult due to the 
convoluted bureaucracy…” (Head of Kota Bangun District)
2. Replication of High Five Program Sub-district Program by local governments and/or 
nongovernmental organizations (NGOs)
During the focus group discussion, the Medan City Working Group (which did not include 
representatives of Bappeda - Badan Perencanaan Daerah – Local Development Planning 
Board) said that the possible replication of the program was the responsibility of 
Bappeda. Thus, they felt they lacked the capacity to respond to the question as to 
whether or not there were any plans to replicate the “High Five Program Sub-district 
Program.” 
Further, the City Working Group said that Bappeda had never raised the issue during 
their meetings, something that was probably due to Bappeda being busy with other 
matters.
The sub-district group has been prepared (mentally) by High Five Program to be left to 
work on its own and to spread the CBTS Program to other sub-districts. 
“… We are optimistic. From the outset, High Five told us that they would only be 
here on a temporary basis, for only 3 years, and helped prepare us to disseminate 
what we had learned after High Five had left …” (Sub-district Group).
Two of the community leaders who were interviewed (the Head of TSM 3 Sub-district 
and the Head of Medan Denai District, also said that they were not aware of any plans 
to replicate the High Five Program Sub-district Program. Meanwhile, the Head of Kota 
Bangun Sub-district said that the neighboring sub-district (Mabar) planned to replicate 
the High Five Program Sub-district Program. However, the Mabar sub-district head’s 
concept of replication did not mean that the CBTS Program would be implemented in the 
same way as in the selected sub-districts, but rather would be expanded to include 
social activities and healthy lifestyles in general.
“… There doesn’t appear to be a plan yet. But if there was a plan, the program could 
be applied in Tegal Sari Mandala 2 Sub-district …” (Head of TSM 3 Sub-district).
“… There’s a plan to replicate it to in Mabar (sub-district). The idea is that the clinic 
in Mabar will focus on social assistance through free medical care, as well as things 
that are related to healthy lifestyles …” (Head of Kota Bangun Sub-district).
 
Bringing You The Real Portrait of Indonesia
15
The things that it was believed would encourage others to replicate the High Five 
Program Sub-district Program were (i) the nature of the activities, which could be 
directly applied by the public, and (ii) the benefits of the program in the form of better 
health in the surrounding community, as evidenced by decreases in the incidences of 
diarrhea and Dengue fever due to more hygienic practices.
"... Activities on the ground with the people, such as waste management, and how it 
can be converted into useful things ..." (Head Medan Denai District)
"... Because the program is good for improving the public health. For example, the 
people in other sub-districts might be interested because the incidences of diarrhea 
and dengue fever here have been reduced due to better hygiene, because we 
stopped open defecation and harmful garbage disposal practices. We have also 
instituted regular community work … " (Head of Kota Bangun Sub-district) 
As regards the lack of public exposure about the activities of High Five Program, as well 
as the difficulty in determining the right sub-districts for application of the program in 
Medan given the large number of sub-districts that suffer from poor sanitation, these 
factors were considered to be the reasons why neither local governments nor NGOs 
were willing to officially replicate the High Five Program Sub-district Program.
"... Probably due to lack of publicity, many people do not know about the High Five
and what they do .." (Head of TSM 3 Sub-district) 
"... In Medan, many sub-districts still suffer from poor sanitation. So determining the 
appropriate sub-districts for selection could be difficult ..." (Head of TSM 3 Sub￾district) 
Funding constraints also posed a challenge for the related local government department 
(Health Agency) in replicating the High Five Program Sub-district Program in the city of 
Medan.
"... On the Health Agency side, not yet. Because it’s like this. Of the 2012 the plans 
that we prepared, a lot of the work was not carried out. This was because the 
budget was not sufficient. As regards the 2013 budget, it has not yet been 
disbursed. Not one cent has been disbursed. In fact, part of the 2012 budget has still 
to be paid out. That’s the way it is. So what is the point of us making so many plans 
when we know that we won’t have enough money to implement them ..." (Medan 
Municipal Health Agency)
The representatives of the agencies that were present during the group discussion were 
of the view that the implementation of the CBTS program by High Five Program had 
been effective in reaching the community and that it would be beneficial to expand the 
program to other sub-districts.: 
 The people-to-people approach will be more effective than city government officials 
making the approaches (about sanitation) to the public.
"... In my view, the people all have the same character. They (the High Five
volunteers) are hard workers. The local government officials feel they are smarter 
 
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16
and speak down to the ordinary people. The ordinary people don’t like this. But 
these ladies (the High Five volunteers) never give up, they keep plugging away 
about littering and septic tank ...... they know how to talk to the ordinary people. 
When we (government officials) get involved, it’s like a battle ..." (City Working 
Group)
 High Five Program has disseminated the necessary knowledge to allow communities 
to continue the program in other sub-districts after High Five Program leaves.
"... In terms of sustainability, what they have disseminated to the community groups 
that have been set up, this is what will allow the program to be completed, the 
availability of volunteers ..." (City Working Group)
3. Level of financial support from private sector and community partners
Residents of the selected sub-districts worked hand in hand and donated materials for 
the building of composting facilities.
As regards the facilities / infrastructure that has been developed, residents collectively 
raise money for their management based on agreements among those who benefit from 
the facilities. Such facilities include:
 communal septic tank in Tegal Sari Mandala 3
 communal toilets, washing facilities, and composting facility in Kota Bangun 
Collective responsibility processes had been agreed on since the beginning. In addition, 
special actions were taken (it is believed) based on particular events/occurrences, 
including regular fund-raising.
"... raw materials have been supplied by the community, there were those who 
donated bricks, sand ..."
“…it has been agreed upon that the 13 households will collectively pay for the 
suctions …” (Sub-district Working Group)
"... Normally when it happens (the septic tank is full), that’s when we do fund￾raising. We can’t be doing it all the time. But as long as there is proof (for what is 
needed), we’ll set to work. The people now think that it’s fine as long as there is 
proof... "(Sub-district Head)
The community involvement process, the fact that people are informed about the 
importance of health, and the approaches employed mean that local residents are willing 
to pay for what they receive, rather than just waiting for assistance.
"... In reality, it’s not all of them (High Five), all of the public, that work together ... 
they (the people living along the railway tracks) want to because they feel it is good 
for their health ..." (City Working Group)
"… The approach (carried out by respondents so that residents would be willing to 
help themselves) ... We conducted socialization so as to make them aware of the 
importance of healthy living. Open defecation gives rise to a lot of diseases. So we 
 
Bringing You The Real Portrait of Indonesia
17
first gave them examples, if open defecation was prevalent, this would cause 
diarrhea and TB. We sometimes gathered people together in groups, sometimes we 
went house to house. But we focused more on talking the residents’ groups --
residents consultation, we called it ..." (City Working Group)
"... On the one hand there are people who are willing to spend money on hygiene 
issues as they are aware of the importance of hygiene ..." (City Working Group).
On the duplication of hygienic behavior and improving sanitation through participatory 
programs at the community level involving stakeholders, social networks and community 
members (coded as IR2 – program’s success indicator).
1. Promoting hygiene and sanitation in the schools
According to the Head of Tegal Sari Mandala 3 Sub-district, every state school in the 
sub-district had been visited by CBTS workers. However, in the case of High Five 
Program, the schools to be visited were selected based on their condition (i.e., those 
that needed better health and hygiene facilities) and locations (located within Tegal Sari 
Mandala 3). It was also stated that the activities undertaken were beneficial (both for 
the schools and their students). As a consequence, the schools were in favor of the 
program. In addition, the program was in line with the programs being run by the 
Medan Municipal Government.
“… High Five visited those schools to conduct socialization and provide advice. In 
addition, they held a joint hand-washing event to mark World Hand-Washing Day …” 
(Head of TSM 3 Sub-district) 
“… A state elementary school on Jalan (street) Poksit and a private elementary 
school in Neighborhood 5 have installed sinks for washing hands with soap and 
provided trash cans so as to encourage students not to throw litter on the ground. 
They have also organized the students to work together to keep the school 
bathrooms clean …” (Head of Kota Bangun Sub-district).
“… They (High Five) selected 30 children for training on the importance of hygiene. 
At the start they selected the children from grades 3, 4 and 5, but by the end they 
had more than 30 children. The children were asked to write essays on hygiene and 
the need to dispose of litter in its proper place. The essays were then read by the 
groups. There was also a joint hand-washing event …” (elementary school teacher).
2. Media Support for Hygiene and Sanitation 
The members of the Medan City Working Group who were present at the group 
discussion said that the issues of sanitation and hygiene were still not sufficiently 
communicated to the public at large as they were considered not “sexy” enough by the 
media. However, there were a number of journalists and media outlets that were 
concerned about such issues.
The establishment by High Five Program of KJPS (Komunitas Jurnalis Peduli Sanitasi - 
Community of Concerned Journalists for the Sanitation) was considered to be a major 
 
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18
step forward, and it was hoped that the group could help improve public awareness 
about the importance of hygiene and sanitation.
“… High Five has established a community of journalists, who will promote such 
issues and also recruit new volunteers …” (City Working Group).
The training provided to members of the public on how to write about hygiene and 
sanitation (community environmental journalists) was considered to be a good way of 
exposing the hygiene and sanitation problems facing the community, and sharing 
experiences with other sub-districts.
“So, they know how to get selected. Their volunteers are now even able to write 
about CBTS in the newspapers … (City Working Group)
In addition to spreading information on hygiene and sanitation, journalists could also 
help accelerate the resolution of problems by highlighting them in the media.
“… The involvement of journalists is absolutely essential so that other people can be 
made aware of this program and be motivated to adopt healthy practices …” (Head 
of TSM 3 Sub-district). 
“… What the journalists can do to support the CBTS Program is to go out into the 
community and find out about the real problems being faced by the people, and 
then to share their views on these problems with the public at large …” (Medan 
BTKL)
“… The media is a provider of essential information to the public. So, it’s really good 
that High Five has partnered with the media and journalists. In this way, what the 
program is doing can be read by all member of the public. All of the High Five
programs and activities will be reported in the newspapers, for example. This 
informs the public about CBTS, and they can learn how to practice it in their own 
neighborhoods …” (Head of Medan Denai District).
“… High Five held a meeting with journalists to provide them with information on the 
program. According to High Five, for the program to achieve maximum success, 
journalists would have to be involved. After that, High Five facilitated the 
establishment of a community of concerned journalists …”( KJPS). 
In addition to being neutral parties when entering communities, journalists also will 
provide investigative reports on the hygiene and sanitation situations in particular areas, 
as well as the behaviors practiced by the people in those areas.
“… I think that journalists will find it the easiest to be accepted in communities. They 
will find out what the people really want. Why are they unwilling to change? That’s 
the most important thing. Finding the roots of the problems …” (BTKL).
Nevertheless, there was also a perception that such issues were not of much interest to 
readers.
“… The problem is that there is no guarantee people will want to read about this as 
they are not interested in in-depth reports …” (PDAM Tirtanadi Medan Denai)
 
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For the journalists grouped in the KJPL, their motivation in joining the community and 
focusing on issues that are not normally considered “sexy” was because not only 
because they felt that hygiene and sanitation issues needed to be highlighted (after 
receiving training from High Five Program), but also because they felt that these issues 
were of major importance to the public.
“… In reality, we often wrote about these issues but only haphazardly. We didn’t 
realize how important proper garbage disposal is. After High Five Program brought 
us together and told us about this program based on the five CBTS pillars, we felt it 
was newsworthy, especially given the severity of the problems on the ground. While 
there is no special columns we can use to publicize hygiene and sanitation issues, 
such information is nevertheless important and needed by the public … “ (KJPS) 
The journalists now plan to write articles on hygiene and sanitation so as to encourage 
greater participation on the part of both government and the public in resolving the 
problems facing communities.
“… In line with the functions of the media, the press will print news and opinion 
pieces, both critical and supportive, which we hope will boost government and 
community participation … “ (KJPS) 
Another component of IR2 – the extent to which households understanding the 
importance of the CBTS pillars – will be discussed in the quantitative report, while the 
number of households that have adopted positive behaviors and improved their hygiene 
and sanitation practices will be dealt with in the section on effectiveness.
On the empowerment of communities to ensure sustainable demand and access to safe 
water, hygiene and sanitation facilities at the household and community levels (coded as 
IR3 – program’s success indicator).
1. Preparation and collection of proposals by communities/groups/schools 
The Sub-district Working Groups said that they had received 25 proposals (for the same 
thing, namely, the development of a composting facility), which were prepared by Sub￾district Working Group members, assisted by the High Five Program facilitators as 
editors. These proposals were subsequently sent to private businesses in the sub￾districts, and relevant local government agencies. 
The preparation of proposals by the Sub-district Working Groups (in this case their LPM - 
Lembaga Pemberdayaan Masyarakat - Community Empowerment Council sections) was 
dependent on “instructions” from the High Five Program team, which generally laid the 
groundwork by seeking information, making contacts and conducting exploratory 
meetings with businesses and local government units.
“... The shredding machine was provided by the local government. But it was High 
Five which served as the go-between. After High Five got involved, it became easier
…” (Sub-District Working Group).
 
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20
“… We haven’t made any proposal as the green light (for operating a garbage bank) 
is still a long way off. The facilitators (High Five) haven’t told us to make a proposal. 
Maybe they will in 2013. If they tell us to make a proposal, then we’ll draw one up
…” (Sub-District Working Group)
The motivation for members of the Sub-District Working Groups in making proposals 
was primarily to support to CBTS Program, and an awareness that this would require 
assistance in the form of money and facilities from external parties (both private sector 
and government). Thus, the objective of preparing proposals was to elicit support from 
third parties so that the CBTS Program could be successfully implemented in their areas.
The members of the Sub-District Working Groups were also aware of the possibility of 
failure in their attempts to elicit support from third parties. Nevertheless, they continued 
to make proposals and never gave up hope of success.
“… So, we were asked to make a proposal. According to High Five, if the people 
were willing to prepare proposals, there was always a possibility that they would be 
successful …” (Sub-District Working Group)
“… We prepared 25 proposals for the same thing, a composting facility, as there was 
no guarantee that the companies would give us anything. Some of the proposals for 
funding came from the LPM” (Sub-District Working Group)
In many cases, the efforts of the High Five Program Sub-District Working Groups in 
preparing fund-raising proposals and their forwarding to private sector businesses and 
other relevant parties were not informed to the community leaders, the sub-district and 
district heads.
“… I’ve heard nothing to date. I don’t know why I’ve not been informed. The people 
around here never think about putting in proposals to the sub-district. That’s 
because they’ve always been content with what they have. If we were to receive a 
proposal, especially if it benefitted all of the community, we would of course give it 
our full support …” (Head of Kota Bangun Sub-district).
“… To the best of my knowledge we haven’t received any. I don’t think there’s 
anything stopping people submitting proposals. Perhaps they don’t feel it necessary 
to submit proposals to the district. Perhaps they submit their proposals to the sub￾district. I don’t really know …” (Head of Medan Denai District).
2. Use of BCC (Behavioral Change Communication) Materials in Socialization Process 
High Five Program’s BCC materials, which were shown during the FGD, were familiar to 
all of the Sub-District Working Group members, who said they were effective in helping 
the members of the Working Groups in conducting socialization on the CBTS Program.
Each Working Group member said that they employed different methods when using the 
BCC materials, depending on how comfortable they were in using the materials. 
 
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21
However, the objective in all cases was the same – to familiarize people with the CBTS 
Program. 
“… effective, gets the message across, easy to understand, especially with diagram V
…” (Sub-District Working Group)
“… banners were set up in one neighborhood so that everyone could read about the 
5 CBTS pillars …” (Sub-District Working Group)
“… everyone employed different ways of using them. In my case, I wrote them down 
on a sheet of paper, then I posted it up, and then I explained what it was all about 
using a flipchart. Everyone has their own way of doing it …” (Sub-District Working 
Group)
It was stated that it would be better for the BCC materials to be printed more clearly, 
using bigger letters.
“… for me, the writing on the CBTS stickers is too small, the format is also too small
…” (Sub-District Working Group)
 
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A. Views of stakeholders (community leaders, facilitators, Sub-District Working 
Groups, High Five Program team, sanitation workers, and teachers) 
According to the stakeholders, the CBTS Program, which has now been underway for 1.5 
years in Medan, should achieve its objectives. Besides considering what has already been 
achieved (by comparing the findings of this survey and those of the 2012 baseline survey), 
this survey also assessed the extent to which:
1. Communities in the High Five Program sub-districts prioritize public so that prior 
assistance and programs provide an opportunity for the community to complete them in 
line with the community’s capacity. It is only then that High Five Program steps in as a 
facilitator. This gives rise to a spirit of self-help in the community as a concrete 
manifestation of the community’s participation.
“… so, High Five involves the people, increases the role of the people in CBTS …” (Sub￾District Working Group)
2. High Five Program has proved itself through concrete action on the part of communities 
in carrying out the CBTS Program in the selected sub-districts so that the communities in 
question respect, trust and voluntarily participate in the implementation of the things 
that have been socialized by High Five Program (assisted by the Sub-District Working 
Group).
“… I feel that what has been done by High Five is very good … High Five has involved all 
sections of the community. Not just the district head, sub-district head or other local 
officials, but the entire community. As a result, everyone feels responsible for keeping 
the neighborhood clean …” (Head of Medan Denai District)
3. High Five Program has played a role as a mediator by involving other parties (such as 
the private sector, journalists, the relevant local government agencies, and so forth). In 
Kota Bangun sub-district, for example, the community is currently in the process of 
submitting fund-raising proposals for the development of a composting facility and a 
communal septic tank to a number of local companies.
“… When I told the facilitators that the next-door neighbors’ children had come down 
with diarrhea, they immediately paid a visit. They did something concrete. This was the 
first time something like this had happened. Before this, all we got were campaigns …” 
(Sub-District Working Group)
“… There’s a lot of companies here, so we submitted our proposals to them. There’s a 
lot of big factories in Belawan (port city). They shouldn’t just leave us to suffer from the 
pollution …” (Sub-District Working Group)
 
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a. Challenges and Their Potential to Result in Non-Achievement of Program 
Objectives 
According to the City Working Group (the members of which were present during the group 
discussion), the number of High Five Program personnel (only 3) posed a constraint on the 
geographical reach of the program, with the areas benefitting being small compared to the 
overall size of Medan.
“… They have only 3 officers and the distance between Kota Bangun Deli and Tegal Sari 
Mandala 3 is very far. When we meet them, they sometimes appear exhausted …” (Medan City 
Working Group)
The members of the Sub-District Working Groups said that the principal challenges they faced 
when carrying out the CBTS Program were as follows:
 Low level of awareness on the part of the public so that sometimes when people were 
invited to take part in the program, they would seek some sort of enticements or 
inducements.
“… If we have a meeting, they won’t come unless we feed them. We have to give them 
food at every meeting …” (Sub-District Working Group)
 The Sub-District Working Groups found that there were small numbers of people who 
attempted to dissuade others from participating in the CBTS Program.
“… There is a group of people who have no interest in hygiene. They sometimes try to 
provoke those who are participating. They say all sorts of things, try to dissuade people. 
People who are participating sometimes change their minds because of this. They are 
always complaining, trying to poison the minds of others. In my area there are 15 
alleyways, and there’s up to 10 of them in each alleyway …” (Sub-District Working 
Group)
 As regards media support, the principal challenges are: (i) the level of understanding on the 
part of journalists about the issues, and who to keep them interested in the issues; and (ii) 
the impossibility of having special columns dedicated to hygiene and sanitation as these 
issues have never been considered as priorities. In fact, they are regarded as being low 
down on the list compared to other issues. Thus, articles on hygiene and sanitation will only 
be printed when space is available.
“… It’s probably mostly about how to increase the level of awareness of the journalists. 
Then, how to keep the journalists interested so that they don’t become preoccupied with 
other issues to the detriment of sanitation …” (KJPS) 
“… There are no specific columns devoted to sanitation in the media. So, it’s impossible 
for us to keep publishing regular articles on sanitation as there are many other more 
pressing and fresher issues. Sanitation is not regarded as being particularly pressing so 
that articles are only published when there is space …” (KJPS).
 
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b. Steps that Can Be Taken to Prevent the Challenges Resulting in Non￾Achievement of Program Objectives
In order to achieve The High Five Program objectives and overcome the challenges the 
program faces (from the perspectives of the stakeholders), the Medan City Working Group and 
the CBTS Working Group made the following suggestions:
 High Five Program should take steps to ensure the sustainability of the program so that 
when High Five Program leaves, what has been done to date by High Five Program will be 
continued by the community. This is despite the steps that have already been taken by High 
Five Program in this respect, such as:
• Transferring knowledge to the local community 
“… From the perspective of sustainability, it is the transfer of knowledge that has taken 
place and the setting up of community groups that will ensure the completion of the 
program. We have volunteers …” (City Working Group)
• Each volunteer should have another team of volunteers so as to make the the team 
stronger, particularly when High Five Program is due to terminate the program.
“… So as to ensure that the volunteers we have trained are strong enough and will 
continue the struggle, they will recruit other volunteers, like MLM (multi level 
marketing). It will trickle down from the top … so they’ll develop solid networks …” (City 
Working Group)
• Physical infrastructure that benefits the entire community and which can be used in the 
long term needs to be developed. The members of the Sub-District Working Groups said 
that such facilities would serve as monuments so as to keep the spirit of High Five
Program alive.
“… They would be like monuments, such as the communal septic tank. That’s one of 
High Five’s monuments, something that is really useful. We were asking for it for 1.5 
years. We’ll really make maximum use of it and it will keep the memory of High Five
alive after the program is over …” (Sub-District Working Group)
 Regarding community elements that were attempting to undermine the program, the Sub￾District Working Groups said that a number of things could be done:
• Neutralize the damage done by “provocateurs” by providing accurate information.
“… so how do we neutralize it … by keeping going …” (Sub-District Working Group)
• Making approaches to the “provocateurs” so as to identify why they are trying to 
undermine the program and to persuade them to join with the rest of the community 
and the members of the Sub-District Working Group in implementing the CBTS Program.
“… We will continue to inform them, rather than letting enmity get out of control …” 
(Sub-District Working Group)
 
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The members of the Medan City Working Group who were in attendance at the group 
discussion also suggested that High Five Program: 
 Fully involve the public. In this respect, the respondents said that the reach of the program 
should be expanded.
“… Perhaps the High Five approach is like planting a seed that grows into a large tree. I 
mean, because of their limited number of personnel, they have to keep recruiting new 
volunteers. Once a new volunteer is recruited, he goes to another area to help the local 
people and recruit more volunteers. So, while they go everywhere, they continue to 
maintain their noble values …” (City Working Group)
 Work together with various organizations and institutions so as to make sanitation and 
healthy practices major issues that are continually in the public eye.
“… In my opinion, not enough information is being disseminated on the program’s 
successes. We need to involve more journalists, we need to unite to manage everything 
well – members of the public, journalists, local government agencies, we need to form a 
media network, prepare programs, print leaflets, set up a Facebook page …” (City 
Working Group)
 Regarding journalists and the media, High Five Program needs to always make effective 
approaches by providing journalistic training so as to improve the awareness of journalists 
in writing articles and in news reporting, as well as to keep them updated on the latest 
news on hygiene and sanitation.
c. Role of High Five Program in Integrating CBTS into the SSK Program 
According to the Medan City Working Group, the Medan SSK had been designed following the 
holding of consultative planning meetings at the district level. Then, five local government 
agencies discussed the recommendations produced by the consultative planning meetings, 
under the coordination of Bappeda.
“… In the municipal government we have a system (for preparing the SSK), that is to say, 
through consultative planning meetings in each of Medan’s districts. This also covers sanitation. 
So, there is a system, which also includes coordinating meetings at the provincial right up to the 
national level …” (City Working Group).
Based on this system for preparing the SSK, and also based on the views of the members of the 
City Working Group who were present during the group discussion, High Five Program did not 
play a role in the formulation of the SSK. The role played by High Five Program was more 
focused on mentoring the public on who to apply CBTS. 
“… it played a role in providing mentoring, it played a role in promotion …” (City Working 
Group).
As the City Working Group was not very active in the performance of its duties due to the fact 
that its members were busy with their work in the relevant local government agencies, the 
 
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presence of a High Five Program representative on the Working Group had been beneficial by 
leading to an increase in the number of meetings held.
“… So, because the members drawn from the local government agencies were too busy with 
their own work, managing their own agencies, the Working Group was not as active as it could 
be… We used to hold a meeting only once a year. There was no such thing as regular meetings 
to discuss sanitation or anything else …” (High Five Program District Leader)
 The presence of the High Five Program representatives served as a reminder that they had 
a CBTS program that contained various activities that had yet to be implemented due to 
the busy schedules of the respondents.
 High Five Program played a role as a partner of the Working Group in implementing the 
CBTS Program (even though it was only applied in two sub-districts).
“… We who are from the local government agencies have our own busy schedules. High Five 
acts as a mentor to communities, develops a willingness on the part of communities … we 
do what we can to help, for example, when they needed a composting shredder, we were 
there to help. We gave it to them. But if we were to give it to just anyone, then it would be 
disappear just like that …” (City Working Group)
 The activities / programs related to hygiene and sanitation that have been undertaken in 
the High Five Program sub-districts or in Medan City as a whole are as follows:
Both the City Working Group and the Sub-District Working Groups felt that they did not have 
enough information on similar programs to High Five Program. Among the other programs they 
were aware of:
- Yespi 
- Nice
- NBR
- IUWASH
- ADB (Asian Development Bank)
- IDB (Islamic Development Bank) > Clean and Healthy Behaviors, a new program that is due 
to start.
All of the programs listed above were considered to be more focused on the financial 
development of sanitation and health facilities, while High Five Program was primarily aimed at 
changing people’s behavior.
Not all of the members of either the City Working Group or Sub-District Working Groups fully 
understood the concept of CLTS (Community Led Total Sanitation).
 
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 Improvements Brought About by High Five Program 
Regarding hygiene and clean and healthy lifestyles in Medan City, the implementation of the 
CBTS Program by High Five Program has resulted in a variety of positive changes, according to 
a number of the respondents. These changes may be listed as follows:
 The High Five Programhas helped improve hygiene and clean and healthy practices in the 
selected sub-districts.
“… The High Five would be capable of overcoming the problems related to hygiene and 
cleanliness in the community here if it was continued on a sustainable basis. Significant 
inroads have been made to date into the garbage and open defecation problems …” (Head 
of TSM 3 Sub-district) 
 The High Five Programhas helped induce changes in people’s behavior so that they no 
longer dispose of garbage in the river or practice open defecation. Such changes in 
behavior happened because they were made aware of the dangers these practices posed.
“… In Kota Bangun, very little attention was paid in the past to hygiene and sanitation. 
People used to defecate in the river, throw their trash in the river. Now the people are 
aware of the dangers of disposing of garbage in the river, of open defecation. In my 
opinion, The High Five has been just what the people here needed. I can see that they 
have started to pay attention to environmental hygiene, and the place is no longer awash 
with garbage. The children are also being taught to wash their hands with soap. So, 
everything has changed as regards hygiene practices. But not everyone has changed. 
There are still some who don’t understand. But hopefully they will come to understand if 
we keep explaining things to them …” (Head of Kota Bangun Sub-district).
Another related party, UPT BTKL (Unit Pelaksana Teknis BTKL – BTKL Techical Implementer 
Unit), acknowledged that they did not know a lot about High Five Program and had not 
been following the program’s progress. They said that people’s behavior was not easy to 
change and there was no guarantee that the problems related to hygiene and sanitation 
would be overcome permanently.
“… High Five Program, eh? I don’t really know much about it, just a little. But we need to 
focus more on finding the real roots of the problem. We have to deal with the roots first. 
So, it hasn’t been going very well? The problem is that the roots of the problem are to be 
found in the culture. People’s awareness? Increasing their awareness won’t solve the 
problem …” (BTKL)
B. Efficiency
As regards efficiency, the most appropriate sources are those from within High Five Program
itself, namely, those responsible for implementing the CBTS Program in their respective areas. 
The following are the results of an interview with the High Five Program District Leader in 
Medan.
 
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a. Use and Allocation of Resources for Program Implementation 
The use and allocation of resources, such as funds and equipment, by High Five Program
Medan is based on the priority of the objectives that it is desired to achieve. The allocation 
proposals are forwarded to High Five Program head office in Jakarta one year in advance. The 
formulation of the program’s budget is based on discussions between the members of the High 
Five Program team of facilitators in Medan.
High Five Program head office evaluates the budget proposals that are submitted, and the 
objectives that are to be focused on, assessing whether these are likely to help achieve the 
High Five Program key performance indicators before giving approval.
“… (High Five Medan) submit our proposals. The key consideration is what we have achieved. 
The main thing for us (High Five Medan) is to achieve our targets. So, we (High Five Medan) 
design the programs. We also discuss everything with the facilitators so as to seek their 
agreement. The question is whether the proposed program will help us achieve our indicators
…” (District Leader)
Given that the resource allocations for CBTS Program implementation in each area is based on 
proposals from the areas in question, resources are applied in accordance with local needs. As 
High Five Program Medan prepares a resource allocation plan for one year ahead and submits it 
for approval to High Five Program Central, the allocation of resources by High Five Program
Central should be in accordance with real needs in the Medan district.
b. Program Adaption and Implementation 
As regards the programs that had been envisaged, a number have not proceeded as planned 
over the last 1.5 years of The High Five Program in Medan. These are as follows:
 CBTS training for members of the City Working Group. This has not been implemented due 
to the busy schedules of the City Working Group’s members. The purpose of the proposed 
training was primarily to provide them with information and a better understanding of the 
CBTS Program so as to encourage them to integrate the CBTS Program into the SSK or 
other sanitation-related programs.
“…The Working Group have not fully understood about CBTS, maybe their thoughts are 
similar with PHBS (Perilaku Hidup Bersih Sehat – Healthy and Clean Living Behavior)
and therefore The working Group central have decided to create awareness to those 
who have yet to have a mindset about CBTS and its aim to totally achieve their purpose 
by inviting members of the working group and AMPL (Air Minum dan Penyehatan 
Lingkungan – (Working Group on Water and Sanitation) from different areas. So, when 
we talk to them, they don’t know what CBTS is all about. They just do this as they are 
told to by their superiors. Every regency and municipality must do this … But they 
themselves don’t really understand CBTS. So that’s why we planned to provide them 
with training. But it turned out that they were all too busy. So we couldn’t proceed with 
the plan. So while we wanted to provide training, it couldn’t go ahead as they were busy 
with other things …” (High Five Program District Leader)
 
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29
Program changes and adaptations in response to conditions on the ground did not have 
a significant effect on the program budget.
“… There were changes to the original plans. We (High Five Medan) have contingency 
funds that we can use to fund such changes. So we have the authority to make 
changes, while at the same time remaining within budget. But we have to justify any 
changes, which we do by preparing justification memos. The funds will then be 
disbursed later. As long as there is a justification, then it’s not a big program. An 
example of a change at the community level is where they suddenly say to us, “Miss, we 
want a socialization meeting.” In such circumstances, we may hold the meeting even 
though it wasn’t included in our plan. It will all depend on our financial situation …” 
(High Five Program District Leader).
C. Sustainability 
a. How do the stakeholders perceive the High Five Program methodology compared 
with CLTS?
Nobody from either the Medan City Working Group or the Sub-District Working Groups had ever 
heard of the CLTS methodology. Thus, the approach applied by High Five Program in the 
selected sub-districts in Medan cannot be compared with the CLTS approach.
b. Level of Acceptance by Stakeholders of High Five Program Approach 
High Five Program was viewed positively by the members of the Medan City AMPL Working 
Group, who said that the High Five Program approach differed from those of other similar 
programs. The differences included the following:
 High Five Program involved a community of journalists to support program socialization 
in the selected sub-districts
“… High Five set up a community of journalists, which helps promote High Five’s CBTS 
Program, in addition to the volunteers recruited by High Five …” (City Working Group)
 High Five Program involves community leaders from a variety of backgrounds when 
making approaches in the selected sub-districts so that the program is able to reflect the 
real needs of the community and encourage people to solve their own problems.
“… They (High Five) regularly visit us (chairman of Environmentally Concerned Youth 
Community), all three of them frequently visit us. They ask us about what is going on … 
whom should they invite to participate in particular activities, community leaders, youth 
leaders, religious leaders. That’s the way they do it. So we can see that they are willing 
to come down here to the people, not just go directly to the district head. They first 
map out the problems, who should be invited. So they are very diligent when they come 
into an area …” (Other Partner – NGO).
According to the members of the Sub-district CBTS Working Group, High Five Program employ 
the right approach as they:
 Come directly into the community, contacting people who have influence in the community.
 
Bringing You The Real Portrait of Indonesia
30
 Directly address the needs of the community as they visit people and seek input from 
them. For example, they go door-to-door to meet the people and find out what they can do 
to help.
 The CBTS Program is focused on the real needs of the people. In other words, its activities 
are formulated based on the outcomes of repeated discussions with local people.
 High Five Program receives unstinting assistance from the members of the Sub-District 
Working Groups when making approaches to the community, and employs a gradual 
strategy so as to impart an understanding of the program to local people.
“… The construction of the septic tank involved three phases. During the first phase, we 
(members of the Sub-District Working Group) were roundly attacked by a really 
emotional guy who was shooting off his mouth. He accused us of owning the land. He 
said it was the government which should be building it, but the people were being asked 
to pay. What he meant was that it should have been free. So I said that it wasn’t a 
question of money. All that was needed was for people to work together. If you have no 
money, then you can contribute your labor. But he wouldn’t change his stance. During 
the second phase, he came around a little, but not fully. Finally, during the third phase 
he apologized to us for being so angry. After we explained things to him, he finally 
signed up and is now involved in negotiations with the landowner. So, there has been 
progress …” (Sub-district Group)
c. Contribution of High Five Program to Development of AMPL Working Group’s 
Functions 
The Medan AMPL Working Group has experienced difficulties in organizing regular coordination 
meetings (particularly if under Bappeda coordination). So, the approach to coordination adopted 
by the Medan High Five Program team is to contact each of the line units in the relevant local 
government agencies.
High Five Program believes that each of the members of the Medan AMPL Working Group has a 
contribution to make in improving interaction with the other members. Among the coordinative 
functions performed by High Five Program, as revealed during the group discussion, are the 
following:
 Thanks to the regular meetings held by High Five Program, communication and interaction 
between the members of the AMPL Working Group have strengthened.
“Good (referring to the role played by High Five in ensuring coordination between the 
members of the AMPL Working Group and line unit heads) … although they (High Five) 
used the wrong procedure the first time they came to us, but they’re good …” (City 
Working Group).
“… But nowadays, if there is an event or a meeting, there’s no need for a letter. All they 
have to do is call us. Same thing for both High Five Program and Bappeda, all they have to 
do is call and we’ll come. That’s the way it is, no need for formalities. We often have 
meetings …”
 
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31
 Every meeting between High Five Program and line units from the relevant local 
government agencies is considered to have resulted in practical outcomes capable of 
implementation.
“… The fact is that it’s much too easy to talk about coordination. It’s a cliché. Coordination 
is easy, but implementation is the hard part. We in this line unit have our own programs. 
All of these programs may be said to be related to CBTS, but the problem is coordination. 
So, whenever there is an activity, they always invite us, we work together. That’s the type 
of role that High Five Program plays …” (City Working Group)
“… The Working Group is not good at implementation as our members are too busy with 
other things. But our meetings with High Five Program remind us about realization, about 
implementation …” (City Working Group)
 High Five Program has greatly assisted the Working Group (Municipal Health Agency) in 
implementing its programs as High Five Program uses a bottom up approach. As a result, it 
is responsive to community needs.
“… Schoolchildren are encouraged to adopt clean and healthy practices by washing their 
hands with soap. This is really important for us. High Five is assisting us as our programs 
also involve the socialization of CBTS in the community…” (City Working Group)
“… It’s very different in the case of the government’s approaches, when everything is very 
formal. But when High Five goes into the community, it’s all very different. The people are 
kind of reticent with us as we employ a top-down approach, while High Five uses a bottom￾up approach. They’re great. They really know what they’re doing. If we were trained like 
High Five, then we would be able to change …” (City Working Group)
d. Possibility of Program Replication
This aspect was dealt with in IR1 on “Replication of High Five Program Sub-district Program by 
local governments and/or NGOs.”
D. Relevance and Appropriateness
Our information on relevance and appropriateness was obtained from a number of different 
sources: the High Five Program team, community leaders (sub-district heads), Working Groups 
(City and Sub-district), teachers and households. The following are the results of the interviews 
with the sources.
a. How is the Participatory Approach Carried Out?
High Five Program was considered by the city group to have had a significant impact, as shown 
by the following statements:
 
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32
“… I was not involved directly, it was Pak (Mr) Oden who attended. But Pak Oden reported to 
me. They (High Five) organized a meeting to encourage public involvement in seeking solutions 
to the various problems. I thought to myself, that’s the way it should be. The people should be 
involved in identifying and solving their own problems. Everyone should help and support each 
other in overcoming the problems. I thought that this was a good model to be developed …” 
(Municipal Health Agency).
The Sub-District Working Groups also appreciated the way in which High Five Program involved 
all elements of society in the socialization of The High Five Program as part of the application of 
CBTS in the selected sub-districts.
“… At least 40 people attended the discussion. Those in attendance included community 
leaders, Muslim and Christian religious leaders, influential figures, Muslim clerics, clan chiefs. 
Many of us were members of associations, like STM (Mutual Assistance Society). Six groups and 
their chairpersons were invited to attend … “ (Sub-District Working Group)
It was also stated that the volunteers who were selected were properly trained and provided 
the support the needed for the successful operation of the program.
“… when those of us from the Working Group joined the High Five Program CBTS Program, we 
were provided with the knowledge we needed by High Five Program. For example, if garbage 
kept being thrown into the Deli River, it would eventually burst its banks. That’s how our 
meetings went …” (Sub-District Working Group)
b. Determining Hygiene and Sanitation Priorities
The prioritization of hygiene and sanitation issues in the High Five Program sub-districts in 
Medan is based on input from the local communities conveyed through the Sub-district CBTS 
Working Groups. As the nature of The High Five Programis facilitation, the choice of priorities is 
left up to the members of the Working Group. The same applies when various options are 
available for resolving a problem, as well as which matters will be followed up on and which will 
not. In all these cases, High Five Program endeavors to listen closely to the views of Working 
Group members, and to carry out what they have planned. Whenever assistance is needed from 
High Five Program to make approaches to particular third parties, then High Five Program will 
always be forthcoming with such assistance.
“… We work in partnership with the National Community Empowerment Program (PNPM), the 
Community Empowerment Council (LPM) and the Environmental Health Technology Center 
(BTKL). The LPM was selected as a partner as they are one of the few bodies operating in the 
sub-district. So we teamed up with them for various programs. As regards the BTKL, we used 
their services to survey drinking water depots so as to check the quality of the water …” (High 
Five Program Facilitator).
 
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c. How are Gender and Environmental Issues Included in Program Implementation 
The environment is one of the most important issues to be taken into consideration when 
making decisions on the ground. In attempting to resolve hygiene and sanitation problems, it is 
impossible to ignore the environment. During the process of resolving the problems covered by 
Pillar 1 (toilets without septic tanks), land has emerged as an important issue as the area is 
densely populated and there is not much vacant land available. So, the local residents will be 
invited to discuss possible solutions, and their decisions will be communicated to and discussed 
by the High Five Program team. In this way, High Five Program can consider the choice of 
location based on land availability and environmental issues.
As regards gender, although this has not received specific attention in the implementation of 
the CBTS Program in Medan, the role of women in implementing the program on the ground 
has been very pronounced. The majority of volunteers are women, and most of those 
approached by the team are also women. The reason why the majority of volunteers are 
women is because it is easier for them to make approaches to and conduct socialization among 
residents (particularly mothers) as they themselves play a strategic role in the home. The 
socialization media that are employed are very much dominated by women, such as Koranic 
survey sessions and other types of meeting. 
 
Bringing You The Real Portrait of Indonesia
34
Part V 
Evaluation of Program Outcomes
Hygiene and Sanitation Practices in Five CBTS Pillars
A. Open Defecation Free 
The majority of respondents in both Kota Bangun and Tegal Sari Mandala 3 during the midline 
survey used flush or U-Bend toilets connected to a septic tank. In Kota Bangun, by the time of 
the midline survey in 2013 there had been an increase of 100% in the use of flush/U-bend 
toilets connected to septic tanks. Previously at the time of the midline survey, not a single 
respondent said they used a flush/U-bend toilets connected to a septic tank. A similar situation 
was apparent in Tegal Sari Mandala 3, where there was also an increase in the use of flush/U￾bend toilets connected with septic tanks, although the increase was not as significant (16.7%).
The data obtained reveals that the number of residents with their own toilets connected to 
septic tanks has increased over the course of approximately the last two years (the interval 
between the baseline and midline surveys).
The locations where the respondents habitually defecate are as shown below:
Figure 5.1.
Last Place of Defecation
Baseline Midline Baseline Midline
20,0% 10,0% 20,0%
76,7%
30,0%
46,7% 90,0%
60,0%
33,3%
4 other responses
Private toilet
Flush toilet with septic tank
Toilet flushed into 
rive/stream/ditch/drain Kota Bangun TSM3
Respondent base: 60
 
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35
The following table sets out the survey’s observation findings:
Table 5.1.
Findings of Observations on Destination of Toilet Waste
Description Kota Bangun TSM 3
Respondent Base 30 30
Location of Last Defecation– by claim 
Flush toilet with septic tank 76.7% 46.7%
Flush toilet draining into river/stream/ditch/drain 20.0% 20.0%
Non-flush toilet draining into river/stream/ditch/drain 3.3% - 
Flush toilet connected to sewage system - 23.3%
Shared toilet - 3.3%
No facilities, into river/drain/ditch/stream - 6.7%
Place where human waste is channeled – based on observations 
Septic tank 73.3% 63.3%
Directly into drainage system 26.7% 10%
River/Lake/Sea - 23.3%
Drop toilet/hole in the ground - 3.3%
The above table presents a comparison between the place of last defecation based on the 
claims of respondents, and the findings of the observations conducted in the field. In Tegal Sari 
Mandala 3, only 46.7% of respondents said that their toilets drained into a septic tank. By 
contrast, the observations in the field found that 63.3% of respondents’ toilets drained into a 
septic tank.
The above table shows that the majority of respondents in both Kota Bangun (73.3%) and 
Tegal Sari Mandala 3 (63.3%) have toilets that are connected to septic tanks. However, there 
were also respondents in both sub-districts whose toilets were not connected to septic tanks. 
Thus, open defecation free status has not yet been achieved in these two sub-districts. 
 
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36
Condition of Toilets in General
 
Based on the observations conducted on the types of toilets used by the respondents, the 
majority (more than 95%) in both Kota Bangun and Tegal Sari Mandala 3 used flush/U-bend 
squat toilets. Only a small proportion (3.3%) used flush/U-bend sit-down toilets. The 
proportions of the different types of toilets were found to be almost the same during the 
midline survey as at the 2012 baseline survey, with flush/U-bend squat toilets predominating at
both times.
Figure 5.2.
Types of Toilets Used, Based on Observations 
The observations revealed that there had been a regression as regards respondent behavior in 
maintaining toilet cleanliness. This was apparent from a decline in the proportion of toilets 
categorized as being “quite clean” in both sub-districts. In Kota Bangun, the proportion declined 
from 76.7% to 56.7%, and was accompanied by an increase in the proportion of toilets 
classified as “dirty” (from 3.3% to 40%). The midline survey found that some toilets were “very 
dirty”, while this was not the case at the time of the baseline survey.
Baseline Midline Baseline Midline
93,30% 96,67% 96,67% 96,67% No response
Flush/U-bend sit-down toilet
Flush/U-bend squat toilet
 Kota Bangun TSM3
Respondent base: 60
 
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The following graph presents a comparison between the condition of respondents’ toilets at the 
time of the baseline survey and the midline survey.
Figure 5.3.
Toilet Condition – based on Observations
Table 5.2. below sets out in more detail the findings of the observations on toilet cleanliness in 
target households with under-5s.
Overall, the condition of the toilets in target households in the two High Five Program Sub￾districts was no better than it was at the time of the 2012 baseline survey. Table 5.2 shows that 
the condition of the toilets in Kota Bangun, is getting better than in Tegal Sari Mandala 3. 
Regressions are apparent in a number of areas in both sub-districts. 
- Two respondent households were found to have feces in the toilet. At the time of the 
baseline survey, no such incidences were found.
- A used sanitary napkin was observed in one toilet in Tegal Sari Mandala 3. No such 
incidence was found during the baseline survey.
- 1 toilet in Kota Bangun lacked a water scoop, while during the baseline survey all 
households were found to have a water scoop in their toilets. In addition, 3 households 
in Tegal Sari Mandala 3 were found not to have water buckets in their bathrooms, while 
15 did not have a towel or cloth for drying hands in their toilets.
The following table sets out a comparison of toilet conditions as observed during the baseline 
and midline surveys.
Baseline Midline Baseline Midline
76,67%
56,67%
70,00% 63,33%
40,00% 13,33%
13,33%
20,00%
20,00% 10,00%
Very clean
Very dirty
Dirty
Quite clean
 Kota Bangun TSM3 
Responden base: 60
 
Bringing You The Real Portrait of Indonesia
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Table 5.2
Toilet Conditions, Based on Observations 
Toilet Conditions 
Kota Bangun TSM3
Baseline 
(n=30)
Midline 
(n=30)
Baseline
(n=30)
Midline 
(n=30)
Feces in toilet or on toilet walls
Yes - - 6.7%
No 100.0% 100.0% 100.0% 93.3%
Sanitary napkin in toilet
Yes - - 3.3%
No 100.0% 100.0% 100.0% 96.7%
Flies in toilet
Yes - 10.0% 3.3% 3.3%
No 100.0% 90.0% 96.7% 96.7%
Water available (if there is a tap, it 
is working)
Yes 43.3% 40.0% 83.3% 90.0%
No 56.7% 60.0% 16.7% 10.0%
Water scoop present
Yes 100.0% 96.7% 93.3% 96.7%
No - 3.3% 6.7% 3.3%
Water bucket/receptacle present
Yes 100.0% 100.0% 100.0% 90.0%
No - - - 10.0%
Towel/cloth for drying available 
Yes 50.0% - 56.7% 50.0%
No 50.0% 100.0% 43.3% 50.0%
A further criterion for assessing achievements made under the first CBTS pillar concerns the 
number of under-3s who are toilet trained. The 2013 midline survey found that a greater 
proportion of under-3s in Kota Bangun than in Tegal Sari Mandala 3 are toilet trained.
 
Bringing You The Real Portrait of Indonesia
39
During the midline survey in Kota Bangun, more than half of the total number of respondents 
(who had under-3s) said that their under-3s were toilet trained, while in Tegal Sari Mandala 3 
more than half of the respondents said that their under-3s were not toilet trained.
Figure 5.4. below (in absolute terms as the base number of respondents was less than 30)
shows the proportions of under-3s who are and who are not toilet trained.
Figure 5.4
If you have a child aged under 3, is he/she toilet trained?
Also with regard to defecation practices among infants, the last place where the majority of 
under-3s defecated was their pants, while only a small proportion of respondents said that the 
last place where their under-3s defecated was their private toilet (as the respondent base in 
each sub-district was 8, the figures shown are absolute given that the respondent base is below 
the minimum sample size, i.e., 30 respondents).
Baseline (n=27) Midline (n=8) Baseline (n=22) Midline (n=8)
23
3
16 6
4
5
6 2
Yes
No
Kota Bangun TSM 3
 
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The following graph shows the places where under-3s in Medan last defecated (the figure 
below is in absolute terms as the base number of respondents was less than 30):
Figure 5.5
Location of Last Defecation among Under-3s
As regards where caregivers last disposed of infant feces (see Figure 5.6), the majority of 
respondents in Kota Bangun (51.9%) said that they first cleaned the infant and then disposed 
of the foul water down the toilet drain/outlet, while 18.5% said they flushed it down the toilet. 
In Tegal Sari Mandala 3, almost half of respondents said that they first cleaned the infant and 
then flushed the foul water down the toilet, while 24% said they first washed the infant and 
then poured the foul water out on the toilet floor or down the toilet drain/outlet.
Baseline (n=27) Midline (n=8) Baseline (n=22) Midline (n=8)
4 2
3 4 3
7
2
19 5 13
3
In pants
In household toilet
2 other responses
Kota Bangun TSM 3
 
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Figure 5.6 shows how caregivers dispose of infant feces in the target areas (in absolute terms 
as the base number of respondents was less than 30): 
Figure 5.6
Disposal of Infant Feces
The next question concerns the defecation practices of children aged 3 to 5. In Kota Bangun, at 
the time of the baseline survey the majority of respondents said that their 3-5 year olds were 
used to defecating in the private household toilet (the types of toilets used were not identified). 
Meanwhile, during the midline survey more than half of respondents said that the last time their 
3-5 year olds defecated they had used a flush/U-bend toilet connected to a septic tank, while 
25% were considered to practice open defecation as their toilets drained directly into a 
river/stream/ditch/drain.
In Tegal Sari Mandala 3, the last places where 3-5 year olds defecated were more diverse, with 
37.5% of respondents stated that the last place was a flush/U-bend toilet draining into a 
sewerage system. However, another 37.5% said that the last place their 3-5 year olds had 
defecated was in their pants. In addition, 12.5% said that the last place their 3-5 year olds had 
defecated was in a shared bathroom, while another 12.5% were categorized as practicing open 
defecation as their flush toilets drained directly into a river/stream/ditch/drain, rather than into 
a septic tank.
Baseline 
(n=27)
Midline 
(n=27)
Baseline 
(n=22)
Midline 
(n=25)
3 3 2 4
5
1
7
12
2
3
8
6
5
5
5
3
14
12
Infant cleaned first, then foul water 
poured into ditch
Infant cleaned first, then foul water 
poured down toilet drain
Flushed down toilet
Infant cleaned first, then foul water 
disposed of on toilet floor/flushed 
down drain
Infant cleaned first, then foul water 
disposed of in household toilet
6 other responses
Kota Bangun TSM 3
 
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As regards what caregivers did after their 3-5 year olds defecated, the majority of respondents 
in both sub-districts said that they washed their children’s bottoms using soap. However, the 
midline survey also found that there were respondents who did not do this (13.3% in Kota 
Bangun and 6.7% in Tegal Sari Mandala 3), while only 3.3% of respondents in Tegal Sari 
Mandala 3 said that they immediately washed their hands after cleaning their children’s 
bottoms.
Figure 5.7
What Respondents Do after Children Defecate
Summary of First Pillar Findings: Open defecation free 
Table 5.3
First Pillar Indicator: Open defecation free 
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Caregiver’s Last Place of Defecation 
Respondent Base 30 30 30 30
In private toilet 90.0% - 60.0% - 
Toilet draining into septic tank - 76.7% 30.0% 46.7%
Baseline Midline Baseline Midline
70,0% 80,0%
66,7%
80,0%
13,3%
16,7%
20,0% 6,7%
13,3% 3,3%
3,3% 6,7% 3,3% 10,0%
Clean with wet wipes
Wash Hands
Wash child's bottom without 
soap
Wash child's bottom with soap
 Kota Bangun TSM3 
Responden base: 60
 
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43
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Toilet draining into sewerage system 6.7% - - 23.3%
Toilet draining into river/stream/ditch/drain 3.3% 20.0% 10.0% 20.0%
Non-flush toilet draining into river/stream/ditch/drain - 3.3% - - 
In shared toilet - - - 3.3%
No facilities, into river/drain/ditch/irrigation channel - - - 6.7%
Defecation Locations of Under-3s
Respondent Base 27 8 22 8 
In pants 70.4% 62.5% 59.1% 37.5%
In household toilet 14.8% 37.5% 31.8% 25.0%
In disposable diapers 14.8% - - 37.5%
Place of disposal of under-3s’ feces 
Respondent Base 11 8 16 8 
Flushed down toilet into sewerage system 1 - - 3 
Flushed down toilet into septic tank - 6 3 
Flushed down toilet into river/stream/ditch/drain - 2 1 1 
In private toilet 10 - 11 - 
In bathroom - - 1 - 
In shared toilet - - - 1 
In pants - - - 3 
Post-infant defecation practices
Wash child’s bottom with soap 70.0% 80.0% 66.7% 80.0%
Wash child’s bottom without soap 13.3% 16.7% 6.7%
Wash hands 20.0% 13.3% 3.3%
Clean with wet wipes 6.7%
 
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B. Hand-Washing with Soap
In order to ascertain the extent to which respondents practiced hand washing with soap over 
the last 2 days, they were given multi response questions and responses related to bathing and 
clothes washing were ignored (as the most common responses, up to 100%). Besides bathing 
and washing clothes, all of the respondents in Kota Bangun said that they had used soap in the 
last two years to wash baby’s bottom, and more than half of respondents (76.7%) used soap 
when washing their hands after defecating. Overall in Kota Bangun, the level of respondent 
awareness of the importance of washing hands with soap was found to be higher than at the 
time of the 2012 baseline survey. 
The situation as regards washing hands with soap in Kota Bangun Sub-district is as shown in 
the following chart:
Figure 5.8
Use of Soap in Last Two Days in Kota Bangun Sub-district – Multiple Answer
In Tegal Sari Mandala 3, it was found that not all of the respondents used soap when washing 
clothes (86.7% used soap for washing clothes, while 96.7% did so when bathing). Besides 
bathing and washing clothes, the majority of respondents also used soap when washing their 
hands before eating (83.3%) and after washing their children’s bottoms (80%). When 
compared with the Baseline Survey, the Midline Survey does not reveal any improvement in 
Baseline Midline
60,0%
100,0%
50,0%
53,3%
63,3% 63,3%
40,0%
76,7%
43,3%
66,7%
30,0%
13,3%
43,3%
63,3%
13,3%
26,7%
Washing infant's bottom
washing infant's hands
Washing hands after eating
washing hands after defecation 
Washing hands after cleaning infant's 
bottom
Washing hands before feeding infant
Washing hands before eating
3 other responses
Respondent base: 60 
 
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45
people’s awareness of the importance of using soap. In fact, quite a few incidences of 
regression were revealed by the Midline Survey. Overall, the respondents from Kota Bangun 
demonstrated better practices and behavior in the use of soap than was the case with those 
from Tegal Sari Mandala 3.
The following chart shows the use of soap over the last to days in Tegal Sari Mandala 3:
Figure 5.9
Use of Soap over Last Two Days in Tegal Sari Mandala 3 Sub-district – Multiple Answer
Each interviewed caregiver to an under-5 was assessed on washing hands with soap at five 
critical times, namely: (i) before eating; (ii) after feeding child, (iii) after defecation, (iv) after 
cleaning child’s bottom, and (v) before preparing food. Based on a score of 1 for each of the 
above behaviors, the maximum score received was 5. 
Baseline Midline
86,7% 86,7%
96,7%
96,7%
53,3%
33,3% 40,0%
6,7%
83,3%
80,0%
60,0%
26,7%
63,3%
36,7%
46,7%
13,3% 33,3%
83,3%
33,3%
50%
20%
Washing clothes/utensils
Bathing
Cleaning child's bottom
Washing child's hands
Washing hands after eating
Washing hands after defecation 
Washing hands after cleaning child's 
bottom
Washing hands before feeding child 
Washing hands before eating
Washing hands after working outside
7 other responses
 
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The following graph shows the overall scores (in absolute terms as the base number of 
respondents was less than 30): 
Figure 5.10
Scores for Use of Soap at 5 Critical Times in Last 2 Days
As will be seen from Figure 5.10 above, the midline survey in Kota Bangun found that the 
majority of the respondents (14) only washed their hands with soap at 2 out of the 5 critical 
times, and not one respondent did so at all 5 critical times. This demonstrates a marked 
regression from the findings of the baseline survey in 2012, where 8 respondents stated that 
they washed their hands with soap at all 5 critical times. The same applied in Tegal Sari 
Mandala 3, where the midline survey found that not one respondent washed their hands with 
soap at all critical times. In fact, the majority (12 respondents) said that the only washed their 
hands with soap at 2 out of the 5 critical times. By contrast, the baseline survey found that 6 
respondents washed their hands with soap at all critical times.
Another indicator for evaluating the second pillar of CBTS in connection with the practice of 
washing hands with soap is the availability of running water and soap. This is assessed based 
upon observations in the bathroom or when respondents wash their hands. 
In Kota Bangun, less than half of the toilets that were observed (40%) had running water when 
the tap was opened, while 60% did not have running water. The situation was different in 
Tegal Sari Mandala 3, where almost all the toilets had running water.
Figure 5.11 shows the availability of running water in toilets in the surveyed sub-districts:
Baseline 
(n=22)
Midline 
(n=29)
Baseline 
(n=28)
Midline 
(n=27)
8
4 3
10
1 14
6
12
1
7
7
4
4
4
6
1
8
6
Score of 5
Score of 4
Score of 3
Score of 2
Score of 1
 Kota Bangun TSM3 
 
Bringing You The Real Portrait of Indonesia
47
Figure 5.11
Availability of Running Water
Besides the availability of running water, the availability of soap in the toilet (for washing 
hands) is another indicator of the practice of washing hands with soap. The situation as regards 
the availability of soap (for washing hands) in the toilet or the place where the dishes are 
washed is as shown in Figure 5.12 below:
Figure 5.12
Availability of Soap
As will be seen from Figure 5.12 above, not all houses in the two sub-districts had soap 
available (for washing hands or dishes). In Kota Bangun, 13.3% of respondents did not have 
soap available in the toilet or place where dishes are washed, while the baseline survey found 
that all respondents in Kota Bangun had soap available in these places. Meanwhile in Tegal Sari 
Mandala 3, only 3.3% of respondents did not have soap available, which marked an 
Baseline Midline Baseline Midline
43,3% 40,0%
83,3% 90,0%
56,7% 60,0%
16,7% 10,0%
No
Yes
Baseline Midline Baseline Midline
100,0%
86,7%
93,3% 96,7%
13,3%
6,7% 3,3%
No
Yes
 Kota Bangun TSM3
Respondent base: 60
 Kota Bangun TSM3
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
48
improvement over the situation at the time of the baseline survey in 2012, when 6.3% of 
respondents did not have soap available in the bathroom (for washing hands or dishes).
Summary of Second Pillar: Practices of washing hands with soap 
Table 5.4
Indicators Showing Practice of Washing Hands with Soap 
Indicator
Kota Bangun TSM3
Baseline
n=30
Midline
n=30
Baseline
n=30
Midline
n=30
Use of soap in last 48 hours – Multiple Answer 
Washing clothes/dishes 100.0% 90.0% 86.7% 86.7%
Bathing 100.0% 100.0% 96.7% 96.7%
Washing child’s bottom 60.0% 100.0% 53.3% 40.0%
Washing child’s hands 50.0% 53.3% 33.3% 6.7%
Washing hands after eating 63.3% 63.3% 83.3% 80.0%
Washing hands after defecation 40.0% 76.7% 60.0% 26.7%
Washing hands after cleaning child’s bottom 43.3% 66.7% 63.3% 36.7%
Washing hands before feeding child 30.0% 13.3% 46.7% 13.3%
Washing hands before dining 43.3% 63.3% 33.3% 83.3%
Other responses 13.3% 26.7% 83.3% 20%
Observations
Availability of water (if tap, running 
water from tap)
Yes 43.3% 40.0% 83.3% 90.0%
No 56.7% 60.0% 16.7% 10.0%
Availability of soap
Yes 100% 96.7% 93.3% 96.7%
No 3.3% 6.7% 3.3%
 
Bringing You The Real Portrait of Indonesia
49
C. Safe Drinking Water Treatment and Storage
The next CBTS pillar is safe and healthy drinking water treatment. By the water source most 
commonly used in the households (with under-5s) in the two sub-districts, water refills were the 
main choice of the majority of respondents (both in Kota Bangun and Tegal Sari Mandala 3).
More specifically, in Kota Bangun, as in the case of the baseline survey, water refills continued 
to be the principal source of water for the respondents (70% according to the midline survey), 
followed by mains water in the home (16.7%). Almost the same situation prevailed in Tegal Sari 
Mandala 3. Both at the time of the baseline and midline surveys, water refills were the main 
source of water for more than half of respondents (53.3%), followed by mains water in the 
home (33.3%).
As regards water for children in the home, the majority of caregivers in Kota Bangun said that 
they also used water refills as the main source of water for under-5s. By contrast, the majority 
of respondents in Tegal Sari Mandala 3 felt more confident using water from covered wells 
(53.3%) and mains water (33.3%) for the under-5s.
The principal sources of drinking water used in households (with under-5s) are as shown in the 
following graphs:
Figure 5.13
Sources of Drinking Water
Baseline Midline Baseline Midline
73,3% 70,0% 76,7%
53,3%
13,3% 16,7%
33,3%
6,7% 10,0% 10,0% 6,7% 6 other responses 
Mains water at neighbor's
Branded packaged water
Mains water in the home
Water Refills
 Kota Bangun TSM3 
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
50
Figure 5.14
Sources of Drinking Water for Under-5s in the Home
Figure 5.14 above shows what caregivers in the surveyed sub-districts do (or do not do) so as 
to improve the quality of drinking water before consumption. Water refills and branded 
packaged water were excluded from data processing, and only mains water, water from bore 
wells, water purchased from itinerant water vendors and water from covered wells were 
included in the data processing so as to produce the following graph:
Figure 5.15
What is done (to improve quality) before consumption
(Excludes branded packaged water and water refills)
Baseline Midline Baseline Midline
73,3% 66,7% 70,0%
3,3%
53,3%
13,3% 16,7% 13,3% 33,3%
3,3% 3,3% 6,7%
6,7% 10,0% 13,3% 10,0%
6 other responses
Branded packaged water
Mains water in the home
Covered Well
Water Refills
Baseline Midline Baseline Midline
43,3%
66,7%
43,3% 50,0%
53,3%
33,3%
36,7%
40,0%
3,3%
20,0% 10,0%
2 other responses 
Directly consumed
Water is boiled
 Kota Bangun TSM3
Respondent base: 60
 Kota Bangun TSM3
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
51
The biggest proportion of respondents in Kota Bangun and Tegal Sari Mandala 3 said that they 
boiled water prior to drinking it, while a small proportion said that the consumed it directly 
without first treating it in some way.
All of the caregivers to under-5s in Kota Bangun and Tegal Sari Mandala 3 said that they 
obtained their water from the water refill, excavated wells or bore wells, and that they treated 
the water before consuming it.
The following graph shows where drinking water is stored in households (with under-5s) in the 
surveyed sub-districts. 
Figure 5.16
Drinking Water Storage Places 
Based on what the respondents said, one-gallon water bottles are the most common drinking 
water storage places in Medan. In more detail, 66.7% of respondents from Kota Bangun used 
one-gallon water bottles to store their drinking water. In second place were kettles (20%).
However, some inconsistencies were noted during the observations to verify what the 
respondents had to say, with 50% being found to use water dispensers and 40% kettles as 
their preferred places for storing drinking water. Meanwhile in Tegal Sari Mandala 3, where the 
majority of respondents said that they used one-gallon water bottles to stores their drinking 
water, the observations found that 50% of all respondents took their drinking water from open 
buckets. The types of receptacle used to store drinking water by the respondents is shown in 
greater detail in Figure 5.17 below.
Baseline Midline Baseline Midline
80,0%
66,7% 66,7%
50,0%
20,0%
6,7%
26,7%
10,0%
23,3%
20,0%
16,7%
3 other responses 
Kettle
Covered pot or bucket
One-Gallon Water Bottle
 Kota Bangun TSM3
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
52
Figure 5.17
Places Used to Store Drinking Water – Observations 
Besides observations on the places used to store drinking water, observations were also 
conducted so as to ascertain what receptacles respondents used to store water for cooking.
The following graphs shows the places used for such purposes in Kota Bangun and Tegal Sari 
Mandala 3:
Figure 5.18
Places used to store water for cooking in Kota Bangun - Observations – Multiple Answer
Respondent base: 60
Baseline Midline Baseline Midline
56,7% 50,0% 46,7%
30,0%
3,3%
40,0%
13,3%
16,7%
20,0%
10,0%
20,0%
6,7% 16,7%
50,0%
13,3%
4 other responses
Open bucket
One-Gallon refill bottles
Kettle
Dispenser
Baseline Midline
46,7%
88,9%
33,3%
63,0%
77,8%
44,4%
10,0%
40,7%
33,3%
3,3%
Uncovered pot or bucket
Covered pot or bucket
Uncovered earthenware jar
Covered earthenware jar
One-Gallon refill jar
Taken directly from water 
source
Bucket
 Kota Bangun TSM3 
Responden base: 60
 
Bringing You The Real Portrait of Indonesia
53
Based on Figure 5.18, the incidence of use of an uncovered pot or bucket has increased from 
46.7% at the time of the baseline survey to 88.9% during the midline survey. This increase 
corresponds with the emergence of uncovered earthenware jars for storing water for cooking. 
However, while this increase has been significant, it has been accompanied by an increase in 
the use of covered pots or buckets to 29.7%.
As regards the receptacles used by the residents of Tegal Sari Mandala 3 to store water for 
cooking, these are as shown in Figure 5.19 below:
Figure 5.19
Places used to store water for cooking in Tegal Sari Mandala 3 - Observations – Multiple Answer
Respondent base: 60
From the above table, it will be seen that the receptacles used to store water for cooking were 
more homogenous at the time of the midline survey. The favorite choice was uncovered pots 
and buckets (79.2%), compared with 42.9% of respondents at the time of the baseline survey 
though it was safer to store their cooking water in covered pots/buckets. Thus, the usage of 
covered pots/buckets had declined by the time of the midline survey.
Baseline Midline
17,9%
79,2%
42,9%
16,7%
28,6%
14%
4,2%
Uncovered pots or buckets
Covered pots or buckets
One gallon refill bottles
4 other responses 
Jerrycan 
 
Bringing You The Real Portrait of Indonesia
54
Table 5.5
Observations on Drinking Water Storage Receptacles, Processing and Presentation 
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline 
Respondent base 30 30 30 30
Receptacle with
Narrow aperture 80% 100.0% 80% 50.0%
Wide aperture 20% - 20% 50.0%
Hard/non-cloth material 
Yes 50% 56.7% 90% 40%
No 50% 43.3% 10% 60%
How about hands when 
taking water
Touch 3.3% 13.3% 13.3% - 
Do no touch 96.7% 86.7% 86.7% 100.0%
As regards the observation findings on the places used for storing drinking water (presented for 
day-to-day consumption in the home), in Kota Bangun the use of receptacles with narrow 
apertures increased to 100% (compared with 80% previously). However, a different story was 
apparent in Tegal Sari Mandala 3, with the use of such receptacles declining from 80% to 50%.
In addition, Tegal Sari Mandala 3 also witnessed a quite drastic decline in the use of a hard 
cover for water receptacles, down from 90% to 40%. Nevertheless, there was an improvement 
as regards whether the respondents’ hands touched the water when taking it from the 
receptacle. All of the respondents in Tegal Sari Mandala 3 said that they could take water 
without touching it with their hands.
In Kota Bangun, more than 50% of respondents said that they covered their water receptacles 
with a hard cover (rather than a cloth cover). However, there was a decline as regards whether 
the respondents’ hands touched the water when taking it from the receptacle, with 13.3% of 
respondents saying that their hands now came in contact with the water, compared with just 
3.3% at the time of the baseline survey.
 
Bringing You The Real Portrait of Indonesia
55
Figure 5.20
Places where food is stored – Observations
More than half of the respondents in Kota Bangun (53.3%) put prepared food in a closed 
cabinet, similar to the situation at the time of the baseline survey (66.7%). Meanwhile, in Tegal 
Sari Mandala 3 almost half of respondents (46.7%) left prepared food on the table, protected 
by a cover. However, one respondent in Tegal Sari Mandala 3 left prepared food uncovered on 
the table, while 20% of respondents kept prepared food in an open cabinet.
No respondents in Kota Bangun said that they left prepared food uncovered on the table, 
although there were respondents who kept prepared food in an open cabinet.
Baseline Midline Baseline Midline
66,7%
53,3%
73,3%
30,0%
3,3%
16,7%
3,3%
20,0%
30,0% 30,0%
16,7%
46,7%
3,3%
Left uncovered on the 
table
Protected by a cover
In an open cabinet
 Kota Bangun TSM3 
Respondent base: 60
 
Bringing You The Real Portrait of Indonesia
56
Summary of the Third Pillar: Household Safe Water Treatment and Storage Practices
The indicators for the third pillar of CBTS are summarized in the following table:
Table 5.6
Indicators for Third Pillar: Safe Water Treatment 
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline 
Treatment of water prior to consumption (from mains, well)
Respondent base 14 30 13 27
Boil water 92.9% 66.7% 100.0% 55.6%
Consume directly 100% 33.3% 64.7% 44.4%
Observations
Respondent base 30 30 30 30
Receptacle with
Narrow aperture 80% 100.0% 80% 50.0%
Wide aperture 20% 0.0% 20% 50.0%
Hard/non-cloth 
material
Yes 50% 56.7% 90% 40%
No 50% 43.3% 10% 60%
How about hands 
when taking water
Touch 3.3% 13.3% 13.3 0.0%
Do not touch 96.7% 86.7% 86.7% 100.0%
Places where prepared food is kept – top 3 answers
In closed cabinet 66.7% 53.3% 73.3% 30.0%
Protected by cover 3.3% 16.7% 3.3% 20.0%
Left uncovered on table 30.0% 30.0% 16.7% 46.7%
D. Percentage of households that practice solid waste management
The next CBTS pillar is household waste management. All of the surveyed households (with 
under-5s) in Kota Bangun and Tegal Sari Mandala 3 said that they had a place for disposing of 
garbage in their homes. In Kota Bangun, 50% of the respondents collected their garbage in 
 
Bringing You The Real Portrait of Indonesia
57
uncovered garbage baskets, while in Tegal Sari Mandala 3 40% of respondents used covered 
plastic sacks in which to collect their garbage. Uncovered plastic sacks were used by 36.7% of 
respondents in both Kota Bangun and Tegal Sari Mandala 3.
In disposing of their garbage, the residents of Tegal Sari Mandala 3 tended to be more orderly 
than those of Kota Bangun. A total of 70% of the respondents in Tegal Sari Mandala 3 said that 
they used the services of garbage collectors (house-to-house collection or shared collection 
point). By contrast, only 16.7% of respondents in Kota Bangun used the services of garbage 
collectors, while the biggest proportion (36.7%) burned their garbage. In addition, 20% of 
respondents in Tegal Sari Mandala 3 disposed of their garbage at an official garbage collection 
point, while only 10% gave other responses, including burying garbage in a pit in their yard. 
Two responses fell within the category of littering (directly dumped into the river/ditch/drain 
and in open places).
A total of 40% of the respondents in Kota Bangun practiced a variety of different methods of 
garbage disposal (these were treated cumulatively), ranging from dumping in a pit in the yard 
and then burning, dumping in a pit in the yard and then leaving it, collecting in the yard and 
then burning, dumping in an official garbage disposal point, directly burying, and directly 
dumping into the river/ditch/drain and in open places outside the home.
Figure 5.21 shows the various responses elicited on household garbage disposal:
Figure 5.21 
Receptacles or Places Used for Collecting Garbage 
Baseline Midline Baseline Midline
16,7%
36,7% 40,0% 36,7%
33,3%
6,7%
30,0% 40,0% 20,0%
50,0%
13,3% 13,3% 10,0%
20,0% 10,0% 3,3%
6,7% 6,7% 10,0%
5 other responses
Sack
Open garbage basket
Closed plastic sacks
Open plastic sacks
 Kota Bangun TSM 3
Respondent Base: 60
 
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58
Figure 5.22
Disposal of Household Garbage
For the respondents who used an official garbage collection service (home-to-home or at joint 
collection point), the frequency of collection varied quite a lot. In Kota Bangun, of the 5 
respondents who used an official collection service, 3 said that the garbage was collected every 
day, while the remaining 2 said that garbage was collected once a week.
In Tegal Sari Mandala 3, of 21 respondents who used a garbage collection service, the biggest 
proportion (9 respondents) said that the garbage was collected only a few times a month. Six 
said that the garbage was collected only a couple of times a month, while 4 other respondents 
said that the garbage was collected once a week. Only one respondent said that the garbage 
was collected every day, while 1 other respondent said that the garbage was collected once a 
month.
The frequency of garbage collection is as shown in Figure 5.23 below (in absolute terms as the 
base number of respondents was less than 30):
Baseline Midline Baseline Midline
3,3% 6,7%
63,3%
26,7% 40,0%
10,0%
23,3%
30,0%
3,3% 36,7%
3,3%
43,3% 6,7%
23,3%
40,0%
13,3%
26,7%
8 other responses
Dumped in the yard, not in 
pit/collected, then burned
Directly burned
Dumped at joint collection 
point, then collected by 
official 
Stored in the home, then 
collected by official 
 Kota Bangun TSM 3 garbage collector
Respondent base: 60
 
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59
Figure 5.23
Frequency of Garbage Collection
Of all of the households in Tegal Sari Mandala 3 that used an official garbage collection service, 
only 15 said that they paid for this, while the other 6 households said that never paid for 
garbage collection. By contrast, of the 5 households in Kota Bangun that used an official 
garbage collection service, all of them said that they paid for it.
Figure 5.24
Do You Pay for Garbage Collection? 
The figure above is in absolute terms as the base number of respondents was less than 30.
In Kota Bangun, of the household that said they paid for garbage collection, 2 paid less than Rp 
2,500, 2 paid between Rp 7,501 and Rp 10,000, while 1 household paid between Rp 10,001 
and Rp 15,000.
Baseline (n=9) Midline (n= 5) Baseline (n=26) Midline (n= 21)
9
3
2 1
12 9
2 12
4
6
1 Once a month
A couple of times a month
Once a week
Couple of times a week
Every day
Baseline (n=9) Midline (n=5) Baseline (n=26) Midline (n=21)
4
5 24
15
5
2
6
No
Yes
 Kota Bangun TSM 3 
 Kota Bangun TSM 3 
 
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60
The biggest proportion of households in Tegal Sari Mandala 3 paid between Rp 7,501 and Rp 
10,000. This was followed between Rp 5,001 and Rp 7,500.
The amounts paid by respondents for garbage collection services are as shown in the following 
chart (The figure below is in absolute terms as the base number of respondents was less than 
30): 
Figure 5.25
Expenditure on Garbage Collection
Separation between organic and inorganic was increasingly practiced by households with under￾5s in the selected sub-districts in Medan, with the figures being 36.7% in Kota Bangun (while 
only 6.7% in 2012) and 26.7% in TSM3 (only 16.7% on baseline survey). Figure 5.26 below 
shows garbage separation behaviors based on respondents claims and observations verifying 
such claims.
Figure 5.26
Is Organic and Inorganic Garbage Separated?
Baseline (n=4) Midline (n=5) Baseline (n=24) Midline (n=15)
2 2
1 2
1
10
5
4
2
7
6
1
1
1 2
1 > Rp. 15.000
Rp.10.001 - 15.000
Rp. 7.501 - 10.000
Rp. 5.001 - 7.500
Rp. 2.501 - 5.000
<= Rp. 2.500
Baseline Midline Baseline Midline
6,7%
36,7%
16,7% 26,7%
93,3%
63,3%
83,3% 73,3% No
Yes
 Kota Bangun TSM 3 
Respondent base: 60
 Kota Bangun TSM 3
 
 
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61
Besides the claims of respondents, observations were also conducted to ascertain the means 
used to collect garbage in both Kota Bangun and Tegal Sari Mandala 3. Based on the 
observations, it was found that the situation in Kota Bangun had changed since the time of the 
baseline survey, when the biggest proportion of respondents used plastic sacks, which they 
stacked outside their homes. Rather, 46.7% of respondents were using garbage baskets placed 
inside the home. However, plastic sacks stacked outside the home were still used by 23.3% of 
respondent households.
In Tegal Sari Mandala 3, the situation was similar to that prevailing at the time of the baseline 
survey, with 33.3% of respondents using plastic sacks which they stacked inside the home, 
while another 33.3% of respondents used plastic sacks which they stacked outside the home.
Figure 5.27
Means Used for Collecting Garbage – Observations 
Summary of Fourth Pillar: Solid Waste Management Practices
The following table summarizes the findings in respect of the fourth CBTS pillar indicators:
Table 5.7
Fourth Pillar Indicators: Solid Waste Management Practices
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Garbage Disposal Places – 3 top answers
Baseline Midline Baseline Midline
36,7%
23,3% 20,0%
33,3%
16,7%
10,0%
30,0%
33,3%
46,7%
16,7%
16,7%
13,3%
36,7% 26,7% 20,0%
7 other responses
Basket - outside the home
Basket - in the yard
Basket - inside the home
Plastic sacks - stacked in the 
yard
Plastic sacks - stacked 
outside the home
 Kota Bangun TSM 3 
Respondent base: 60
 
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62
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Stored in home, then collected by 
garbage collection official 3.3% 6.7% 63.3% 40.0%
Stored at joint collection point, then 
collected by garbage collection official 26.7% 10.0% 23.3% 30.0%
Dumped in yard, without pit/collected, 
then burned 43.3% 6.7%
Garbage separation?
No 93.3% 63.3% 83.3% 73.3%
Yes 6.7% 36.7% 16.7% 26.7%
Receptacles used for collecting garbage – observations – 3 top answers
Uncovered garbage basket 36.7% 23.3% 20.0% 33.3%
Closed plastic sack 16.7% 10.0% 30.0% 33.3%
Open plastic sack 3.3% 46.7% 3.3% - 
E. Proper Wastewater Management 
The final CBTS pillar is proper household wastewater management. A number of indicators were 
used to evaluate people’s behaviors in this respect in Medan. The findings of our observations 
on wastewater disposal are shown in the following graphs:
 
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Figure 5.28
Disposal of kitchen wastewater – Observations 
As shown in Figure 5.28, the majority of respondent households in Tegal Sari Mandala 3 
discharged wastewater (from kitchen, toilet/bathroom and from washing clothes) into the river, 
pond, drain or canal, while only 6.7% of them discharged wastewater into a covered channel. 
By contrast, at the time of the baseline survey, the majority of respondent households 
discharged wastewater into a wastewater discharge pipe, while 16.7% did so into a covered 
channel.
In Kota Bangun, there was a more even distribution of responses. Figure 29.a below shows that 
the situation was still the same as at the time of the baseline survey, with 30% of respondents 
discharging wastewater into an open channel. There were no respondents in Medan who 
discharged wastewater into a closed channel.
Baseline Midline Baseline Midline
30,0%
20,0%
3,3%
10,0% 76,7%
23,3% 73,3%
13,3%
36,7%
30,0%
23,3%
10,0% 16,7% 3,3%
3,3% 6,7%
26,7%
3 oiher responses
Covered channel
Open channel
Wastewater disposal pipe
Into 
river, pond, drain, canal 
 Kota Bangun TSM 3 
Respondent base: 60
 
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64
Figure 5.29
Discharge of Wastewater from Bathroom/Toilet – Observations 
Figure 5.30
Discharge of Wastewater from Clothes Washing – Observations 
baseline midline baseline midline
30,0% 20,0%
3,3%
16,7% 76,7%
23,3% 73,3%
13,3%
36,7% 30,0%
23,3%
20,0% 3,3%
26,7%
13,3% 6,7% 5 other responses
Into open channel
Into wastewater 
discharge pipe
Into 
river, pond, drain, ca
nal
Baseline Midline Baseline Midline
30,0%
20,0%
3,3%
13,3% 76,7%
23,3% 73,3%
13,3%
36,7%
30,0%
23,3%
13,3% 3,3% 26,7%
13,3% 6,7%
4 other responses
Into open channel
Into wastewater discharge pipe
Into the river, pond, drain, canal
 Kota Bangun TSM3 
Respondent base: 60 
 
 Kota Bangun TSM 3 
Respondent base: 60 
 
Bringing You The Real Portrait of Indonesia
65
We now look at the location of septic tanks. From figure 5.31 below, it will be seen that at the 
time of the midline survey, the most common location for septic tanks in Kota Bangun was in 
the yard of the house (18 out of 15 respondents), and also in Tegal Sari Mandala 3 (11 out of 
22 respondents). This was because sufficient land was available so that it was necessary to 
have the septic tank within the house. This was different from at the time of the baseline 
survey, when many households in both Kota Bangun and Tegal Sari Mandala 3 had septic tanks 
within the home (under the floor) due to a lack of land.
Only 2 households at the time of the midline survey in Tegal Sari Mandala 3 had septic tanks 
within the home, while none did so in Kota Bangun, although there was one household which 
did not know where its septic tank was located.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.31
Location of Septic tank – confined to those that have septic tank 
As regards households that did not have septic tanks based on observations in the field, Figure 
5.32 shows that the drain was the main choice for all households (4 respondents) in disposing 
of waste from the toilet. The midline survey found that 5 households that did not have septic 
tanks directly disposed of toilet wastewater into drainage channels.
In Tegal Sari Mandala 3, 5 (out of 8) respondent households that did not have septic tanks 
disposed of toilet waste into the river/lake/sea, while the remaining 3 respondents disposed of 
such waste into drainage channels or used a drop toilet/cesspool/pit. Those who did not have 
septic tanks may be categorized as engaging in open defecation as although they have toilets, 
the toilet waste is disposed of in the open.
Baseline 
(n=26)
Midline 
(n=25)
Baseline 
(n=24)
Midline 
(n=22)
1
13
9
2
13
6
15
9
18
11 In the backyard
In the frontyard, at the side of 
the yard
Under floor within in home
Don’t know where
 Kota Bangun TSM 3 
 
Bringing You The Real Portrait of Indonesia
66
The following graph shows how feces are disposed of by those who lack septic tanks, based on 
field observations:
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.32
Final place of disposal of feces (by those that lack septic tanks) – Observations 
Among the households that did have septic tanks, the majority said that they were never 
emptied. In Kota Bangun, of 24 households that had septic tanks, not one had ever emptied the 
tank, while in Tegal Sari Mandala 3 only 3 (out of 22 respondent households) said that they had 
ever emptied their tank. Five also said that they did not know if their tank had ever been 
emptied.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.33 below shows the situation as regards the emptying of septic tanks:
Figure 5.33
Has your septic tank ever been emptied?
Baseline 
(n=4)
Midline (n=5) Baseline 
(n=6)
Midline (n=8)
1
5
3 2
1
5
1
4
1
Ditch
Pond/paddyfield
River/lake/sea
Directly into disease channel
Drop toilet/pit
Baseline (n=26) Midline (n=24) Baseline (n=24) Midline (n=22)
3 6 3
22 24 13 14
1 5 5
Don't know
Never
Yes
 Kota Bangun TSM 3
 Kota Bangun TSM3 
 
Bringing You The Real Portrait of Indonesia
67
Of those who said that their septic tank had ever been emptied, Figure 5.34 shows the last time 
this happened. It will be seen that in Tegal Sari Mandala 3 3 respondents said that their septic 
tank had at one time or another been emptied, while 2 said that it had been emptied less than 
5 years ago. The remaining respondent said that their septic tank had been emptied less than 2 
years ago.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.34
When was the last time your septic tank was emptied?
It will be seen from Figure 5.35 below that households in Tegal Sari Mandala 3 did not use 
suction trucks to empty their septic tanks but rather preferred to do it themselves.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.35
Who emptied your septic tank the last time?
Baseline 
(n=3)
Midline (n=0) Baseline 
(n=6)
Midline (n=3)
1
1
1
1
3
2
2
1
Don't know
> 5 years ago
2 - 5 years ago
< 2 years ago
Baseline 
(n=3)
Midline (n=0) Baseline 
(n=6)
Midline (n=3)
1
1
1
5
3
1
Don't know
Emptied it ourselves
Hired help
Suction truck
 Kota Bangun TSM 3
 Kota Bangun TSM 3
 
Bringing You The Real Portrait of Indonesia
68
Figure 5.36
Distance from Home to Public Toilet
Figure 5.36 above shows the distance from the home to the toilet normally used by 
respondents. The majority of respondents in both Kota Bangun (93.3%) and Tegal Sari Mandala 
3 (70%) said that there was no distance to the toilet as the toilet was in the home. In Kota 
Bangun, 3.3% of respondents needed less than 2 minutes to reach the toilet, while in Tegal 
Sari Mandala 3, 20% of respondents needed between 3 and 5 minutes, 6.7% up to 12 minutes, 
and only 3.3% less than two minutes.
Summary of Fifth CBTS Pillar: Wastewater management practices
The following table sets out a summary of household wastewater management practices:
Table 5.8
Indicators for Fifth Pillar: Wastewater Management Practices
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Place where kitchen wastewater is disposed of– 3 top answers
River, pond, drain, canal 30.0% 20.0% 3.3% 76.7%
Wastewater disposal pipe 10.0% 23.3% 73.3% 13.3%
Covered channel 36.7% 30.0% 23.3% 3.3%
Place where bathroom wastewater is disposed of – 3 top answers
Baseline Midline Baseline Midline
3,3% 3,3% 3,3%
20,0%
6,7%
96,7% 93,3% 93,3%
70,0% Don't know
No distance
6 - 12 minutes
3 - 5 minutes
<=2 minutes
 
 Kota Bangun TSM3 
Respondent base: 60 
 
Bringing You The Real Portrait of Indonesia
69
Indicator
Kota Bangun TSM3
Baseline Midline Baseline Midline
Wastewater disposal pipe 16.7% 23.3% 73.3% 13.3%
River, pond, drain, canal 30.0% 20.0% 3.3% 76.7%
Open channel 36.7% 30.0% 23.3% 3.3%
Place where wastewater from clothes-washing is disposed of – 3 top answers
Wastewater disposal pipe 13.3% 23.3% 73.3% 13.3%
River, pond, drain, canal 30.0% 20.0% 3.3% 76.7%
Open channel 36.7% 30.0% 23.3% 3.3%
Covered channel
Has septic tank 
No 13.3% 26.7% 20.0% 36.7%
Yes 86.7% 73.3% 80.0% 63.3%
Place where septic tank is disposed of – observations – 3 top answers
Septic tank 86.7% 73.3% 80.0% 63.3%
River/lake/sea - 26.7% 3.3% 23.3%
Ditch 13.3% - 3.3% - 
Directly into drainage channel - - 10.0% 10.0%
The following table sets out a summary of the indicators for all five CBTS pillars in the sub￾districts that were surveyed.
Table 5.9
Summary of Indicators for all Five CBTS pillar
Indicator Kota Bangun TSM3
Baseline Midline Baseline Midline
First Pillar: open defecation free
Last place where caregiver defecated– 3 top answers
Respondent Base 30 30 30 30
Private toilet 90.0% 60.0% -
Flush toilet draining into septic tank - 76.7% 30.0% 46.7%
Flush toilet draining into river/stream/ditch/drain 3.3% 20.0% 10.0% 20.0%
 
Bringing You The Real Portrait of Indonesia
70
Indicator Kota Bangun TSM3
Baseline Midline Baseline Midline
Flush toilet draining into wastewater disposal - 20.0% - 20.0%
Place of defecation for children aged 0 – 3 
Respondent Base 27 8 22 8
In pants 70.4% 62.5% 59.1% 37.5%
Household toilet 14.8% 37.5% 31.8% 25.0%
Disposable diapers 14.8% - - 37.5%
Place of disposal of feces of children aged 3 – 5 
Respondent Base 11 8 16 8
Flush toilet, into pipe/sewerage system 1 - - 3
Flush toilet draining into septic tank - 6 3
Flush toilet draining into river/stream/ditch/drain - 2 1 1
Private toilet 10 - 11 -
Bathroom - - 1 -
Shared toilet - - - 1
In pants - - - 3
Place of defecation of children aged 3 – 5 
Private toilet 10 - 11 -
What was done after child defecated
Respondent Base 27 8 22 8
Washed child’s bottom with soap 70.0% 80.0% 66.7% 80.0%
Washed child’s bottom without soap - 13.3% 16.7% 6.7%
Washed hands 20.0% - 13.3% 3.3%
Wiped with wet wipes - 6.7% - -
Second Pillar: Hand washing with soap at at least 2 out of 5 critical times
Use of soap in last 48 hours – Multiple Answer
Respondent Base 30 30 30 30
Washing clothes/utensils 100.0% 90.0% 86.7% 86.7%
Bathing 100.0% 100.0% 96.7% 96.7%
Washing child’s bottom 60.0% 100.0% 53.3% 40.0%
Washing child’s hands 50.0% 53.3% 33.3% 6.7%
Washing hands after eating 63.3% 63.3% 83.3% 80.0%
Washing hands after defecating 40.0% 76.7% 60.0% 26.7%
Washing hands after washing child’s bottom 43.3% 66.7% 63.3% 36.7%
Washing hands before feeding child 30.0% 13.3% 46.7% 13.3%
Washing hands before eating 43.3% 63.3% 33.3% 83.3%
 
Bringing You The Real Portrait of Indonesia
71
Indicator Kota Bangun TSM3
Baseline Midline Baseline Midline
Other responses 13.3% 26.7% 83.3% 20%
With scoring
Respondent Base 22 29 28 27
score 1 36.4% 13.8% 10.7% 37.0%
score 2 4.5% 48.3% 21.4% 44.4%
score 3 4.5% 24.1% 25.0% 14.8%
score 4 18.2% 13.8% 21.4% 3.7%
Score 5 36.4% - 21.4% -
Observations
Is water available (if there is tap, is it 
running?)
Yes 43.3% 40.0% 83.3% 90.0%
No 56.7% 60.0% 16.7% 10.0%
Is soap available? Yes 100% 96.7% 93.3% 96.7%
No 3.3% 6.7% 3.3%
Third Pillar: Household safe water treatment and storage
Treatment of water before consumption (water from mains/well)
Respondent Base 14 30 13 27
Boil water 92.9% 66.7% 100.0% 55.6%
Directly drink 100% 33.3% 64.7% 44.4%
Observations
Receptacle with Small aperture 80% 100.0% 80% 50.0%
Wide aperture 20% - 20% 50.0%
Hard material/not cloth Yes 50% 56.7% 90% 40%
No 50% 43.3% 10% 60%
What about hands when 
taking water
Touches 3.3% 13.3% 13.3 0.0%
Doesn’t touch 96.7% 86.7% 86.7% 100.0%
Place where ready-to-consume food is kept– 3 top answers
Respondent Base 30 30 30 30
In closed cabinet 66.7% 53.3% 73.3% 30.0%
Protected by cover 3.3% 16.7% 3.3% 20.0%
Left uncovered on table 30.0% 30.0% 16.7% 46.7%
Fourth Pillar: Solid waste management
Place of disposal of garbage – 3 top answers
Respondent Base 30 30 30 30
Gathered in home, then collected by official 3.3% 6.7% 63.3% 40.0%
Gathered at shared collection point, then 
 
26.7% 10.0% 23.3% 30.0%
 
Bringing You The Real Portrait of Indonesia
72
Indicator Kota Bangun TSM3
Baseline Midline Baseline Midline
Dumped on surface of yard, then burned 43.3% 6.7%
Dumped outside of yard into sea 3.3% 6.7% 63.3% 40.0%
Dumped on surface of yard, then burned 26.7% 10.0% 23.3% 30.0%
Dumped in pit, then burned 43.3% 6.7%
Separation of garbage?
No 93.3% 63.3% 83.3% 73.3%
Yes 6.7% 36.7% 16.7% 26.7%
Means of collecting garbage – observations – 3 top answers
Open basket 36.7% 23.3% 20.0% 33.3%
Closed plastic sack 16.7% 10.0% 30.0% 33.3%
Open plastic sack 3.3% 46.7% 3.3% -
Fifth Pillar: Wastewater management
Place where kitchen wastewater is disposed of– 3 top answers
Respondent Base 30 30 30 30
River, Pond, Drain, Canal 30.0% 20.0% 3.3% 76.7%
Wastewater disposal pipe 10.0% 23.3% 73.3% 13.3%
Covered channel 36.7% 30.0% 23.3% 3.3%
Place where bathroom wastewater is disposed of – 3 top answers
Wastewater disposal pipe 16.7% 23.3% 73.3% 13.3%
River, Pond, Drain, Canal 30.0% 20.0% 3.3% 76.7%
Uncovered channel 36.7% 30.0% 23.3% 3.3%
Place where wastewater from clothes-washing is disposed of – 3 top answers
Wastewater disposal pipe 13.3% 23.3% 73.3% 13.3%
River, Pond, Drain, Canal 30.0% 20.0% 3.3% 76.7%
Uncovered channel 36.7% 30.0% 23.3% 3.3%
Covered channel
Have septic tank?
No 13.3% 26.7% 20.0% 36.7%
Yes 86.7% 73.3% 80.0% 63.3%
Place where septic tank is disposed of – observations – 3 top answers
Septic tank 86.7% 73.3% 80.0% 63.3%
River/Lake/Sea - 26.7% 3.3% 23.3%
Ditch 13.3% - 3.3% -
 
Bringing You The Real Portrait of Indonesia
73
F. Role of Community Members as Informants
The CBTS managers and Posyandu (Pos Pelayan Terpadu – Integrated Services Center) workers 
are those who were considered to play the dominant role in providing information on the CBTS 
pillars in Kota Bangun.
- CBTS managers (not explained from where they came or their positions) were deemed to 
play a vital role in Kota Bangun disseminating information on all of the CBTS pillars, 
namely: Open Defecation (11 respondent), washing hands with soap (12 respondents), 
treatment of drinking water (5 respondents), household solid waste management (9 
respondents) and household wastewater management (2 respondents).
- Posyandu workers were also deemed to play a very important role on the five CBTS pillars, 
namely: Open Defecation (15 respondents), washing hands with soap (10 respondents), 
treatment of drinking water (1 respondent), household solid waste management (3 
respondents) and household wastewater management (2 respondents).
Table 5.10a
Sources of information on the 5 CBTS Pillars in Kota Bangun, Medan – Multiple Answer -
Spontaneous
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent
First time when 
provided with 
information
Name Number of 
Respondents Relationship
Method of 
information 
provision
Defecation in proper 
place
Melly
5
CBTS
Posyandu meeting January 2013
3 Outreach February 2013
2 House-to-House 
visit
January & 
February 2013
1 PKK December 2012
Pipi
2
Posyandu Posyandu meeting December 2013
5 Outreach January 2013
Latifah
5
Posyandu 
worker
Outreach January 2013
1 Outreach December 2013
1 House visit December 2012
Ida 1 Worker House visit January 2013
Vivi 2 NGO Posyandu meeting December 2012
Washing hands with Melly 4 CBTS Posyandu meeting January 2013
 
Bringing You The Real Portrait of Indonesia
74
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent
First time when 
provided with 
information
Name Number of 
Respondents Relationship
Method of 
information 
provision
soap 6 Outreach January 2013
1 House visit December 2012
1 PKK December 2012
Ida
2
Posyandu
Posyandu meeting December 2012
1 Outreach December 2012
2 House visit February 2013
Pipi 4 Posyandu Outreach January 2013
Vivi 1 NGO Posyandu meeting January 2013
Vivi 1 Posyandu Posyandu meeting December 2012
Treatment of 
household drinking 
water
Melly
2
CBTS
Posyandu meeting January 2013
2 Outreach January 2013
1
House visit February 2013
PKK December 2012
Ita 1 Cadre House visit January 2013
Pipi 1 Posyandu Outreach January 2013
Garbage disposal Melly
2
CBTS
Posyandu meeting January 2013
5 Outreach January 2013
1 House visit December 2012
1 PKK December 2012
Pipi 3 Posyandu Outreach January 2013
Treatment of 
household 
wastewater
Melly 2 CBTS
Outreach February 2013 Pipi 2 Posyandu
A total of 11 respondent said that they had heard information about open defecation from Melly 
during home visits, Posyandu or PKK meetings, or through outreach work between December 
2012 and February 2013. In addition to Melly, 7 respondents said that they had received such 
information from Pipi and Latifah, Posyandu workers, between December 2012 and February 
 
Bringing You The Real Portrait of Indonesia
75
2013. The information was provided through meetings and outreach work in the Posyandu, as 
well as visits to residents’ homes.
As regards washing hands with soap, 11 residents said that they had received information from 
Melly (they did not identify her position or role), with such information being provided through 
Posyandu/PKK meetings, home visits, and outreach work, while 5 residents said they had 
received such information from Ida (who was stated to be a Posyandu worker) during Posyandu 
meetings and outreach work. There were also some who said that the information had been 
provided through home visits.
As regards treatment of household drinking water, 9 respondents said they received information 
on this from Melly between December 2012 and February 2013, with the information being 
provided through Posyandu/PKK meetings, and also direct home visits.
As regards garbage disposal, the biggest proportion of respondents (11) said that they had 
received information from Melly at the same times and using the same methods as described 
above. The same applied in the case of household wastewater management, where Melly’s 
name was once again mentioned (by 2 respondents) as a source of information.
Meanwhile in Tegal Sari Mandala 3, Table 5.10b shows that RT/RW officials, Posyandu workers 
and Sub-district officials were the parties who played dominated roles in providing information 
on CBTS. Overall, information on each pillar was not only provided by one of these categories, 
but by a number working together, as will be seen from Table 5.10b.
Table 5.10b
Sources of Information on 5 CBTS Pillars in Tegal Sari Mandala 3, Medan – Multiple Answer - 
Spontaneous
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent First time when 
provided with 
Name information Number of 
Respondents Relationship
Method of 
information 
provision 
Defecation in 
proper place
Don’t know 1 Posyandu Home visit December 2012 
Don’t know 1 Sub-district 
official During community 
work activities
A few months ago
Don’t know 1 Sub-district 
official March 2012 
Mira 1
Neighborhood 
Block 
Assistant/RT 
Home visit October 2012
Syafrizal 2 RT/RW Home visit December 2012 
Bapak 
Dudung 2 RT/RW Home visit March 2012 
Ibu Butet 2 Posyandu Home visit February 2013 
 
Bringing You The Real Portrait of Indonesia
76
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent First time when 
provided with 
Name information Number of 
Respondents Relationship
Method of 
information 
provision 
1 During community 
work activities January 2013
Washing hands 
with soap 
Ibu butet 
2
Posyandu 
Home visit February 2013 
1 During community 
self-help activities January 2013
Don’t know 
1 Posyandu Home visit October 2012
1 During community 
work activities January 2013 
Bapak 
Dudung 
1 RT/TW Residents meeting March 2012 
1 Puskesmas 
brochure March 2012 
Mira 1
Neighborhood 
Block 
Assistant/RT
Home visit October 2012
Don’t know 1 Celebrity Advertisement March 2012
Don’t know 1 Sub-district 
official 
During community 
work activities A few months ago 
Don’t know 1 Television Advertisement October 2012
Treatment of 
household 
drinking water
Ibu butet 
1
Posyandu 
Home visit February 2013
2 During community 
self-help activities January 2013
Don’t know 1 Sub-district 
official
During community 
self-help activities A few months ago
Don’t know 1 Posyandu During community 
self-help activities January 2013
Garbage disposal
Don’t know 
2
RT/RW
Residents meeting May 2012 
1 Outreach 6 years ago
1 Home visit March 2012
1 During community 
self-help activities October 2012
1 Never happened
Mira 
1 Neighborhood 
Block 
Assistant/RT
Residents meeting October 2012
3 Home visit October 2012
Ibu Butet 
2
Posyandu 
Home visit February 2013 
1 During community 
self-help activities January 2013
Pak Dudung 
2
RT/RW
Residents meeting March 2012 
1 During community 
work activities March 2012
Syafrizal 3 RT/RW Home visit October 2012
Don’t know 1 Sub-district 
official
During community 
self-help activities A few months ago
 
Bringing You The Real Portrait of Indonesia
77
Environmental 
Health Topic
Give name of person and that person’s relationship with respondent First time when 
provided with 
Name information Number of 
Respondents Relationship
Method of 
information 
provision 
Bakar Koto 1 RT/RW Outreach October 2012
Don’t know 1 Posyandu During community 
self-help activities January 2013
Treatment of 
household 
wastewater 
Ibu Butet 
2
Posyandu 
Home visit February 2013
1 During community 
self-help activities January 2012
Pak Dudung 1 RT/RW Residents meeting March 2012
Don’t know 1 Subdistrict 
official 
During community 
self-help activities A few months ago
According to the respondents, the advice to avoid open defecation was conveyed not only by 1 
person, but rather simultaneously by a number of people during the period from March 2012 to 
the end of February 2013. Such advice was delivered using various methods, namely, 
Posyandu/PKK meetings, outreach, and direct socialization through home visits. Information on 
washing hands with soap was also stated by the respondents to have come from a number of 
people during the period from March 2012 to the end of February 2013. One of the sources of 
information named by 2 respondents was Ibu Butet (from the Posyandu). The methods of 
conveying information varied, ranging from meetings and outreach work to community self-help 
activities and even brochures. Besides information being directly provided by the persons 
concerned, two respondents said that they had received information on washing hands with 
soap from television advertisements.
As regards the third CBTS pillar, treatment of drinking water, 3 respondents said that they had 
heard of it from Ibu Butet (from the Posyandu) between January and February 2013, with the 
information being provided on a house-to-house basis and during community self-help 
activities. 
For the fourth CBTS pillar 5 respondents said that they had heard about it for the first time as 
part of admonitions for proper waste management from the RT/RW (couldn’t remember name 
of person or his position) at different times. The information had been provided during 
meetings, outreach drives, community self-help efforts, and on a house-to-house basis. Four 
other respondents said that they had heard of it from Mira (Neighborhood Block Assistant/RT) 
in October 2012 during house-to-house visits and meetings with residents.
Ibu Butet was also stated to have provided information by 3 residents on the fifth pillar, 
namely, domestic waste management. Such information had been provided on a house-to￾house basis or during community self-help efforts.
 
Bringing You The Real Portrait of Indonesia
78
G. Healthy Life Practices
Knowledge
Figure 5.37 below shows an increase in awareness on the part of residents in both Kota Bangun 
and Tegal Sari Mandala 3. This is shown by the fact that at the time of the baseline survey, only 
16.7% of respondents had heard of the term CBTS, while at the time of the midline survey in 
2013, all of the respondents in Kota Bangun said they had heard of it. There was also an 
increase in Tegal Sari Mandala 3, with 60% of respondents saying that they had heard of it at 
the time of the midline survey, compared with none at the time of the 2012 baseline survey. 
Figure 5.37
Have you Heard of CBTS?
Of 30 respondents who said they had heard of CBTS in Kota Bangun, 28 said that they had 
heard of it during activities undertaken by an NGO some time ago in the area where they lived, 
while 2 read about it in a newspaper/magazine. Meanwhile in Tegal Sari Mandala 3, the biggest 
proportion of respondents said that they had heard of CBTS during activities undertaken by an 
NGO some time ago, while 4 said they had heard about it at the Posyandu. Five others gave a 
variety of responses (during training from the local health agency, from a newspaper/magazine, 
from a brochure or heard about it from the Block Head).
As regards the understanding of CBTS among those who had heard about it (multiple 
responses), the biggest proportion of residents in Kota Bangun said that it referred to washing 
hands with soap (26 respondents), stopping open defecation (21 respondent), garbage 
management (18 respondents) and bathing two times a day with soap (11 respondent). In 
Baseline Midline Baseline Midline
16,7%
100,0%
60,0%
60,0% 90,0%
26,7%
23,3% 10,0% 13,3%
Don’t know/Forget
No
Yes
 
 Kota Bangun TSM3 
Respondent base: 60 
 
Bringing You The Real Portrait of Indonesia
79
Tegal Sari Mandala 3 (respondent base 18, multiple responses), 16 respondents said it referred 
to garbage management, 14 to washing hands with soap, and 10 to stopping open defecation.
As regards people’s level of concern for the program, Figure 5.38 below shows people’s level of 
concern for PHBS. Unlike CBTS, the biggest proportion of respondents in Medan (both at the 
time of the baseline survey and midline survey) did not know what PHBS was. At the time of 
the baseline survey in Kota Bangun, 3.3% of respondents knew what PHBS was, while at the 
time of the midline survey, not one knew what it was. In Tegal Sari Mandala 3, at the time of 
the baseline survey, not a single respondent knew what PHBS was, while only 3.3% knew what 
it was at the time of the midline survey.
Figure 5.38
Have you ever heard of PHBS
People’s knowledge of sanitation can be specifically evaluated by assessing the level of 
agreement with a number of prepared questions, as discussed further below.
Baseline Midline Baseline Midline
3,3% 3,3%
66,7%
100% 100%
56,7%
30,0% 40,0%
Don’t know/Forget
No
Yes
 
 Kota Bangun TSM3 
Respondent base: 60 
 
Bringing You The Real Portrait of Indonesia
80
Attitude
The data set out in Table 5.11 below is based on closed-ended responses on a scale of four, 
where 1 expresses strong disagreement and 4 strong agreement with the following 10 health 
related statements that were presented to respondents:
Table 5.11
Perceptions of Residents about Health
Statement
Kota Bangun TSM 3
Baseline Midline Baseline Midline
Every family should have its own toilet 3.3 3.3 3.4 3.2
Open defecation is not a problem for me 1.8 1.8 1.6 1.9
Hand washing with soap before eating is 
bothersome 1.9 1.9 2.0 2.3
We don’t need a septic tank if we can dump 
feces directly into the river/drain 1.8 2.0 2.0 2.4
Wastewater from clothes washing can be 
discharged/dumped anywhere as it is 
quickly absorbed 
1.8 2.5 1.9 2.1
Separating garbage is only a waste of time 
and does no good 2.0 2.1 2.2 2.5
My neighbors garbage is no concern of mine 
even though it goes everywhere
2.0 2.4 2.2 2.3
Preventing blockages in the drains is also 
my concern as a resident of this sub-district 3.0 2.7 3.2 2.7
As long as there are not too many, flies do 
no harm if they land on food. 1.9 1.9 1.6 1.9
 
Bringing You The Real Portrait of Indonesia
81
Statement
Kota Bangun TSM 3
Baseline Midline Baseline Midline
There no need to worry about cleaning 
drinking water receptacle as they are always 
full of water anyway.
1.8 2.0 1.7 1.9
Scale of 1 to 4, where 1 = strongly disagree, and 4 = strongly agree
The findings in Kota Bangun may be further explained as follows:
1. At the time of both the baseline survey and midline survey, the residents of Kota Bangun 
tended to feel that every family should have its own toilet (average score of 3.3) 
2. Open defecation was described on average in Kota Bangun as being a problem during both 
the baseline survey and midline survey (average score of 1.8)
3. Both at the time of the baseline survey and midline survey, the residents of Kota Bangun 
did not see washing hands with soap before eating as troublesome.
4. At the time of the evaluation of the baseline survey, residents did not agree with the 
statement, “We don’t need a septic tank if we can dump feces directly into the river/drain”
(average score of 1.8). However, at the time of the midline survey, the average had 
increased significantly (p < 0.05 to 2.0, although residents continued to disagree with the 
statement.
5. The baseline survey found that the residents of Kota Bangun at that time did not agree 
with the statement that “Wastewater from clothes washing can be discharged/dumped 
anywhere as it is quickly absorbed” (1.8). However, at the time of the midline survey, the 
average had increased significantly (p < 0.05) to 2.5. Thus, it may be concluded that at the 
time of the midline survey residents tended to agree that “Wastewater from clothes 
washing can be discharged/dumped anywhere.”
6. Both at the time of the baseline survey and midline survey, residents tended not to agree 
that garbage separation was a waste of time.
7. It may also be said that residents disagreed with the statement that “My neighbors’ 
garbage is no concern of mine even though it goes everywhere.” The midline survey 
showed that there had been an increase in the awareness of residents about their joint 
responsibility for environmental hygiene (significant average difference at p < 0.05).
8. At the time of the baseline survey, the residents of Kota Bangun expressed agreement with 
the statement “Preventing blockages in the drains is also my concern as a resident of this 
sub-district,” with an average score of 3.0. At the time of the midline survey, this figure had 
dropped significantly (p < 0.05) to 2.7.
 
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9. The residents of Kota Bangun at the time of both the baseline survey and midline survey 
did not agree with the statement that “As long as there are not too many, flies do no harm 
if they land on food.”
10. According to the residents of Kota Bangun at the time of the baseline survey, water 
containers must be kept clean even though they are always in contact with water (1.8). A 
significant increase in awareness (at p < 0.05) was noted at the time of the midline survey 
(2.0).
The findings in Tegal Sari Mandala 3 may be further explained as follows:
1. The level of awareness of respondents was the same at the time of the baseline survey and 
the midline survey as regards the need to have one’s own septic tank, and that open 
defecation was a problem.
2. Respondents also did not see washing hands with soap before eating as bothersome. There 
was an increase in awareness in this regard at the time of the midline survey (significant 
difference at p < 0.05).
3. Although feces could be thrown directly into the river/drain, respondents at the time of 
both the baseline survey and the midline survey took the view that a septic tank was 
obligatory – no differences were recorded in this respect during the time between the 
baseline survey and midline survey.
4. The evaluations of the baseline survey and midline survey revealed that residents did not 
agree that “Wastewater from clothes washing can be discharged/dumped anywhere as it 
was easily absorbed.”
5. As in the case of Kota Bangun, the residents of Tegal Sari Mandala 3 at the time of both 
the baseline survey and the midline survey did not believe that garbage separation was a 
waste of time.
6. At the time of both the baseline survey and midline survey, residents felt jointly responsible 
for garbage.
7. At the time of the baseline survey, the residents of Tegal Sari Mandala 3 felt that drain 
blockages were their joint responsibility as residents (average of 3.2). However, this had 
declined significantly at the time of the midline survey (p < 0.05) to 2.7.
8. Flies around food, even in small numbers, were considered dangerous by residents at the 
time of both the baseline survey and midline survey.
9. Even though water receptacles are continuously in contact with water, residents felt that 
they still needed to be cleaned (at the time both of the baseline survey and midline 
survey).
 
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Residents, Community and Sanitation 
The table below shows residents’ responses (closed-ended responses) to a series of 10 
statements designed to gauge whether there is a sense of community among residents and 
administrators in their neighborhoods. The responses are ranked on a scale of 1 to 4, where 1 
= fully sure, and 4 = not at all sure.
The general picture painted by the responses to the questions in Kota Bangun is as follows:
1. While residents were aware of the importance of environmental hygiene and health (2.6) at 
the time of the baseline survey, this awareness was found to have increase at the time of 
the midline survey (3.0).
2. The baseline survey found that the residents of Kota Bangun lacked a sense of community 
as regards the need to maintain environmental hygiene and health. However, the findings 
of the midline survey were different – residents by that stage did have a sense of 
community as regards the need to maintain environmental hygiene and health. 
3. During the baseline survey, it was found that residents were willing to work together so as 
to improve environmental health and hygiene. This willingness had increased by the time of 
the midline survey with the average response being 3.1.
4. At the time of the baseline survey, the residents of Kota Bangun had a relatively low 
willingness to voluntarily contribute/pay dues so as to improve the quality of environmental 
health and hygiene. However, the level of willingness had increase by the time of the 
midline survey (significantly at p < 0.05).
5. At the time of the baseline survey, the respondents in Kota Bangun said that there was no 
guarantee that advice from the village authorities would be heeded. However, this had 
changed at the time of the midline survey, when it was stated that such advice would be 
heeded.
6. The residents of Kota Bangun at the time of both the baseline survey and the midline 
survey were willing to participate it neighborhood hygiene activities.
7. As regards the statement that “village authorities are interested in conducting village 
hygiene activities”, the level of agreement stood at 2.8 at the time of the baseline survey. 
This had increased by the time of the midline survey.
8. At the time of the baseline survey, the residents of Kota Bangun said that thery were not 
sure that hygiene in Kota Bangun was the responsibility of the village authorities. However, 
at the time of the midline survey, the respondents agreed on average with this statement.
9. Both at the time of the baseline survey and the midline survey, it was found that there was 
a relatively similar level of confidence that community leaders would support environmental 
health and hygiene activities.
 
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10. At the time of the midline survey, it was found that there was a higher level of willingness 
to comply with advice from religious leaders regarding environmental health and hygiene 
than at the time of the baseline survey (2.7).
As regards Tegal Sari Mandala 3, the general picture painted by the responses to the questions 
was as follows:
1. The findings of the baseline survey showed that there was a low level of awareness of the 
importance of health and hygiene, However, people were quite sure that health and 
hygiene were important.
2. The findings of the baseline survey showed that the residents of Tegal Sari Mandala 3 did 
not have a very strong sense of community as regards maintaining environmental health 
and hygiene. However, this had increased by the time of the midline survey.
3. At the time of the baseline survey, residents were quite willing to work together so as to 
improve environmental health and hygiene. The level of willingness had increased at the 
time of the midline survey.
4. The resident of Tegal Sari Mandala 3 were not very willing to voluntarily make 
contributions/pay fees for health and hygiene, and were not very willing to follow the 
advice of village officials on anything.
5. At the time of both the baseline survey and the midline survey, residents may be said to be 
willing to participate in efforts to clean up their areas.
6. At the time of the baseline survey, the residents were not quite sure that cleanliness was 
the responsibility of village officials. However, by the time of the midline survey, the 
average belief that this was the responsibility of village officials had increased significantly 
at p < 0.05.
7. Residents believed that village officials were quite interested in conducting hygiene 
activities. 
8. The residents of Tegal Sari Mandala 3 (both at the time of the baseline survey and midline 
survey) took the view that community leaders were supportive of environmental health and 
hygiene.
9. At the time of both the baseline survey and the midline survey, the residents of Tegal Sari 
Mandala 3 said that advice on environmental health and hygiene from religious leaders 
would be followed.
 
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Table 5.12
Residents Perception of Community 
Statement
Kota Bangun TSM 3
Baseline Midline Baseline Midline
The people here are aware of the 
importance of environmental hygiene and 
health
2.6 3.0 2.6 2.9
The people here have a strong sense of 
community, particularly as regards 
maintaining environmental hygiene and 
health
2.6 3.0 2.6 2.8
The people here are willing to work 
together to improve health conditions 2.8 3.1 2.7 3.1
The people here are willing to voluntarily 
pay contributions/charges to improve 
environmental hygiene and health
2.5 3.1 2.5 2.5
The people here are willing in all cases to 
follow the advice of sub-district officials
2.6 3.2 2.8 2.7
The people here are highly motivated in 
participating in environmental hygiene 
activities
2.9 3.3 2.7 2.8
The sub-district authorities are highly 
motivated in organizing environmental 
hygiene activities
2.8 3.1 2.8 3.0
The people here consider environmental 
hygiene and health to be the responsibility 
of the sub-district authorities
2.3 2.7 2.8 2.7
Community leaders support environmental 
hygiene and health activities. 2.8 3.0 2.9 3.0
 
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Statement Kota Bangun TSM 3
If religious leaders recommended 
environmental hygiene and health activities, 
residents would comply
2.7 3.0 2.8 2.7
Scale of 1 to 4, where 1 = fully sure, and 4 = not at all sure.
Practices
In the practices section, residents were asked about 7 things related to health (Tabel 5.13 
below). In general, their responses revealed that:
 There are still many residents in Kota Bangun (60%) who dispose of feces in drains/water 
channels (although the figure is lower than at the time of the baseline survey).
 In Kota Bangun, the proportion of respondents who dispose of feces in drains/water 
channels has increased quite significantly (30%) compared to at the time of the 2012
baseline survey in. 
 The midline survey found that garbage was more widespread in Kota Bangun than at the 
time of the baseline survey. In Tegal Sari Mandala 3, however, the percentage of garbage 
had declined, although the sub-district was not yet garbage-free. In fact, >80% of 
respondents said the area was dirty due to garbage.
 In general, it may be concluded that both Kota Bangun and Tegal Sari Mandala 3 remain 
dirty and that people lack discipline in matters related to cleanliness.
 As regards environmental hygiene, it may be said that Tegal Sari Mandala 3 was somewhat 
ahead of Kota Bangun. However, Kota Bangun was slightly ahead of Tegal Sari Mandala 3 
in terms of clean water and the incidence of Dengue fever.
Table 5.13
Behaviors that can cause health and hygiene problems
Prevalent
Kota Bangun TSM 3
Baseline Midline Baseline Midline
Yes No Don’t 
know Yes No Don’t 
know Yes No Don’t 
know Yes No Don’t 
know
Defecation in 
place other 
than toilet
30.0% 66.7% 3.3% 20.0% 80.0% - 13.3% 86.7% - 53.3% 46.7% - 
 
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Prevalent
Kota Bangun TSM 3
Baseline Midline Baseline Midline
Yes No Don’t 
know Yes No Don’t 
know Yes No Don’t 
know Yes No Don’t 
know
Feces dumped 
in drains/water 
channels
63.3% 36.7% - 60.0% 40.0% - 16.7% 83.3% - 46.7% 53.3% - 
Dirty 
environment 
due to 
widespread 
garbage 
73.3% 26.7% - 100% - 90.0% 10.0% - 83.3% 16.7% - 
Blocked drains 
or water 
channels
86.7% 13.3% - 50.0% 50.0% - 50.0% 50.0% - 73.3% 26.7% - 
Well water not 
fit for drinking 
even after 
treatment 
10.0% 90.0% - 10.0% 90.0% - 26.7% 73.3% - 36.7% 63.3% - 
Dengue fever - 100.0% - 3.3% 96.7% - 46.7% 53.3% - 23.3% 73.3% 3.3%
Difficulties with 
clean water 3.3% 96.7% - - 100.0% - 60.0% 40.0% - 26.7% 66.7% 6.7%
 
Diarrhea
In Medan, as shown in Figure 5.39, the incidence of under-5s suffering from diarrhea is 
relatively low. This can be seen from the low percentage of respondents in Kota Bangun saying 
that their under-5s had ever suffered from diarrhea (only 20% at the time both of the baseline 
survey and midline survey). Meanwhile in Tegal Sari Mandala 3, while 30% of respondents said 
that their under-5s had ever suffered from diarrhea during the baseline survey, this had fallen 
to 13.3% by the time of the midline survey.
 
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Figure 5.39
Has Your Under-5 Ever Suffered from Diarrhea?
Of the 6 respondents in Kota Bangun who said that their under-5s had ever suffered from 
diarrhea, 3 said that the last time had been within the last 3 months, while the other 3 said that 
it had been more than 3 months ago.
In Tegal Sari Mandala 3, of 4 respondents who said that their under-5s had ever suffered from 
diarrhea, 2 said that it had been within the last 3 months, while 2 said it had been more than 3 
months ago.
Figure 5.40 below shows the last time the respondents’ under-5s suffered from diarrhea (in 
absolute terms as the base number of respondents was less than 30). 
Figure 5.40
Last Time your Under-5 Suffered from Diarrhea
Baseline Midline Baseline Midline
20,0% 20,0% 30,0%
1,3%
80,0% 80,0% 70,0%
86,7%
Yes
No
Baseline (n=6) Midline (n=6) Baseline (n=9) Midline (n=4)
1
3
7
2
3
1
2
4
1 1
24 hours ago
1 week ago
Within last 3 months
More than 3 months ago
Kota Bangun TSM 3
 
 Kota Bangun TSM3 
Respondent base: 60 
 
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Of the respondents whose under-5s had suffered diarrhea at one time or another, in Kota 
Bangun 3 of the 6 respondents said they had brought their children to be treated by the nearest 
medical professional (midwife/doctor/medical technician). The remaining respondents did not 
seek treatment as she believed the child would get better by himself.
Meanwhile in Tegal Sari Mandala 3, 2 respondents brought their children to the nearest medical 
professional, while the other 2 self-treated the diarrhea with over-the-counter drugs purchased 
at a nearby side street stall. 
The situation as regards the treatment of diarrhea in under-5s is as shown in the following 
chart (in absolute terms as the base number of respondents was less than 30): 
Figure 5.41
Treatment of Diarrhea
The following chart shows the costs incurred in the treatment of diarrhea among under-5s (in 
absolute terms as the base number of respondents was less than 30): 
Baseline 
(n=6)
Midline 
(n=6)
Baseline 
(n=9)
Midline 
(n=4)
1
2
1
1 3
5
3 2
1
3
3
Treated at nearest Puskesmas 
(Community Health Center)
Treated using medicinal plants from 
garden
Did not do anything, child would get 
better by himself
Treated by nearest medical 
professional (midwife/doctor/medical 
technician)
Purchased medicine in pharmacy
 Kota Bangun TSM3 
 
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Figure 5.42
Overall Cost of Treatment (transportation, consultation, medicine)
Four respondents from Kota Bangun spent between Rp 10,000 and Rp 50,000 on the treatment 
of diarrhea among their under-5s, while 1 respondent had spent Rp 100,000. In Tegal Sari 
Mandala 3, 1 respondent spent between Rp 10,000 and Rp 50,000, while 1 other spent Rp 
175,000. At the time of the midline survey, none of the respondents received treatment, while 
at the time of the baseline survey in Kota Bangun, 2 respondents said that they had received 
free treatment for diarrhea for their under-5s.
Baseline 
(n=4)
Midline 
(n=5)
Baseline 
(n=8)
Midline 
(n=2)
2
1
4
5
1
1
1
1 2
1 <=100.001
Rp 50.001-Rp 100.000
Rp 10.000 - Rp 50.000
> Rp 10.000
Free
 Kota Bangun TSM3 
 
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Part VI 
Children Baseline – Elementary School
A. Perceptions of children regarding conditions that impact on healthy and clean 
life practices
During this process, the respondents were provided with stimuli in the form of pictures, where 
each CBTS pillar and non-CBTS pillar aspect was represented by two pictures. The stimuli also 
included pictures showing ‘healthy children laughing’, ‘children bathing together in a well’, and 
so forth. Each of these was represented by 2 pictures. A number of pictures showing the 
opposite were also presented (dirty/contrary to the CBTS pillars). Once again, each situation 
was represented by 2 pictures.
Of the pictures that were shown, two pictures showing ‘washing hands with running water and 
soap’ were the 2 top choices, with 86% and 80% of the children selecting these as showing 
examples of clean and healthy lifestyles. The children at all age levels and genders chose these 
activities. The following choices were selected by at least 20% of respondents:
Figure 6.1
8 top responses for conditions that are deemed clean and healthy 
As in Medan, the ‘washing hands’ picture was more often selected by respondents between 10 
and 12 years of age, compared with the other pictures. This may be influenced by a number of 
factors, such as: (1) recent campaign for washing hands with soap in the targeted schools so 
that the awareness of children about the importance of washing hands with soap was high – 
only 91.7% of the children (out of 26.7% of the children) who said they had heard of the term 
 
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CBTS associated it with washing hands with soap; (2) washing hands was a practice that was 
taught as standard by the adults around them (parents and teachers) so as to maintain healthy 
and hygiene.
As with the 2 pictures showing ‘washing hands with soap’ that were most frequently selected as 
the two top answers, the next choices were pictures showing ‘covering food’, which were 
selected by 63.3% and 60.0%.
After the two top choices (‘washing hands’ and ‘covering food’), the picture of ‘a dispenser 
against a background of a clean kitchen’ was the next choice (56.7%), followed by the picture 
of ‘a house with a clean yard’ (50%). The next choices were the picture showing ‘a child 
defecating in a sit-down toilet’ (43.3%), and ‘a clean squat toilet’ (also 43.3%).
All of the choices of the children tended to correlate with the five CBTS pillars. Nevertheless, 
when the children were questioned about their awareness of CBTS, more than half of the 
respondents (70%) said that they had never heard of the term.
1. Children’s Understanding of CBTS
When the elementary school respondents were asked, 70% said they had never heard of CBTS, 
while around 30% had heard of the term.
Figure 6.1 Table 6.1 
Children’s Understanding of CBTS Understanding of CBTS by Grade
 
Comparing the information on respondent grades and their knowledge of the term CBTS, there 
appears to be no correlation between grade and awareness -- the fact that a child is in a higher 
grade does not mean that he or she will be more aware than a child in a lower grade.
Further, when the 9 respondents who said they were aware of CBTS were asked what they 
know about the concept, only 6 were able to state that the abbreviation stood for “Community 
Based Total Sanitation,” while the 2 others said “Community Based Sanitation.” The remaining 
Do You Know 
About CBTS
Grade 
4 
Grade 
5 
Grade 
6 Total
Yes 4 2 3 9 
No 6 8 7 21
Total 10 10 10 30
Yes, 
30%
No; 
70%
Respondent Base: 30
 
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respondent could only say “Community Based Total.” When probed further about their 
knowledge of CBTS, the following information was obtained:
Table 6.2
What More Do You Know About CBTS?
Knowledge of CBTS – Multiple Answer Number of 
Respondents *
Washing hands with soap 9 
Stopping open defecation 3 
Consists of 5 pillars 3 
Garbage Management 2 
Treating and Storing Drinking Water Safely 1 
Treatment of household wastewater 1 
Respondent base : 9 
* Number of respondents is stated in absolute terms/frequency as number was below minimum 
of 30
Washing hands with soap was the practice most frequently identified with CBTS (other than the 
term CBTS itself). There were also those who stated the number of CBTS pillars and a number 
of different pillars (like CTPS, stopping open defecation, safe treatment and storage of drinking 
water and household waste management).
A number of pictures were shown to the respondents and they were asked to selected those 
that reflected CBTS. The following are their choices:
 
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Figure 6.2
Pictures Showing CBTS – Multiple Answer
Choice 1:7 resp Choice 2: 7 resp Choice 3: 5 resp Choice 4: 4 resp
 
Choice 5: 2 resp Choice 6: 2 resp Choice 7: 2 resp 6 Other choices: 6 resp
 
Respondent Base: 9
The most popular CBTS pillars (the ones most frequently remembered, and therefore the 
relevant pictures most frequently selected) were as follows: ‘Washing hands with soap’ – the 
pictures representing this pillar were selected by 7 respondents; ‘Covering food’ and ‘treating 
drinking water’ were selected by 5 respondents who picked the same picture, while 2 other 
respondents picked another picture to represent this pillar. Meanwhile, the ‘squat toilet’ 
(representing stopping open defecation) was selected by 4 respondents, while the ‘sit-down 
toilet’ was selected by 2 respondents. ‘Protecting prepared food with a cover’ was chosen by 2 
respondents.
However, 2 of the children selected the picture showing ‘defecation in a drain’ as representative 
of CBTS (outside of CBTS activities). In addition, the following three pictures were chosen by 1 
respondent each: ‘bathing’, ‘dirty hands’, ‘playing with friends’. 
As regards where the 9 children who knew about CBTS had received their information, the 
following responses were obtained:
 
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Table 6.3
Information on CBTS Obtained From:
Person Providing Information on CBTS – 
Single Answer Person’s name
Number of 
Respondents 
* 
From school (health outreach from High Five 
Program) 
Ibu Mely 4 
Women who visited school Don’t know/Forget 4 
From friends Don’t know/Forget 1 
Respondent base : 9
* Number of respondents is stated in absolute terms/frequency as number was below minimum 
of 30
As will be seen from the above table, information on CBTS was obtained from a variety of 
sources, namely: (1) from health outreach work in school provided by Ibu Mely on behalf of 
High Five Program Medan (2 visits in 1 month) – 4 respondents gave this response, also stating 
that the first time they received information on CBTS was around February 2013; (2) 
information from women who visited school – this response was given by 4 respondents, 
however none of them knew or could remember the name of the person who provided the 
information. They said that they had first received information on CBTS around January 2013; 
(3) information from friends – this was stated by 1 respondent, however he did not know or 
could not remember the name of the friend and he also forgot when he had received the 
information. 
The following are the responses of the elementary school respondents related to their 
perceptions of the various practices involved in CBTS.
Pillar 1: Open Defecation 
While in general the child respondents in Medan were familiar with various practices related to 
defecation, such as the importance of defecation in the right place, the causes of diarrhea and 
the dangers of diarrhea to children, it should also be noted that there were also children who 
were not aware (10 – 16.7%) of the dangers that arise from infectious diseases transmitted 
through feces. The responses of the children on their perceptions related to human 
feces/excrement are as shown below:
 
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Table 6.4
Perceptions of Children Related to Defecation 
Description Correct Incorrect
Defecation in a toilet that has a proper waste disposal system 
 
90% 10% 
Human feces contain germs that can cause diarrhea 90% 10% 
No need to wash hands with soap after defecation 6.7% 93.3%
Infant feces can be injurious to health 83.3% 16.7%
Respondent base: 30 
As regards various activities that are not appropriate in connection with defecation in the home 
or school environment, their responses are presented in the table below.
The responses of the elementary school children show that many unhealthy and unhygienic 
practices continue to be prevalent in their school and home environments. A total of 63.3% said 
that open defecation continues to occur around their homes, while 10% said it was still 
prevalent in the school environment. Similarly, 40% said that feces continued to be disposed of 
in water channels/drains around their homes.
Table 6.5
Children’s Explanations on Inappropriate Defecation Behavior in their Home and School 
Environments 
Do any of the following things happen: 
At Home (%) At School (%)
Yes No Yes No Don't know 
Defecation outside of toilet 63,3 36,7 10 83,3 6,7
Disposal of feces into drain/water channel 40 60 0 93,3 6,7
Respondent base: 30
The quite significant differences in people’s sanitation behavior in the school and home 
environments may be due to: (a) the time spent by respondents in the school environment is 
much less than in the home environment – thus, the description of behaviors around the home 
is more accurate than in the school environment; or (b) residents’ behavior is much more 
hygienic around the schools.
 
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Last place of defecation 
A total of 96.7% of respondents said that their last place of defecation was in the toilet at home 
or at school. However, 3.3% said that it was a pond near their home/school. After defecation, 
70% said that they directly cleaned themselves with soap and water, while 23.3% said they did 
so with water only, 3.3% said they just washed their hands, and another 3.3% said they did 
nothing.
Defecation after school 
All of the students had urinated at one time or another in school (36.7% in the bathroom and 
63.3% in the WC), but only 40% said they had defecated at one time or another at school, and 
all did so in the student’s WC.
A total of 76.7% of students said that urinating/defecating at school was different than at home 
for the following reasons:
Table 6.6
Thing that make urinating/defecating at school different from at home
No. Difference Percentage
1. No soap 43.5%
2. Dirty/smelly 30.4%
3. No enough water 30.4%
4. Have to queue, take turns with other students 30.4%
5. 2 other responses 8.6%
Respondent base: 23 
The biggest difference between going to the toilet in school and at home was lack of soap 
(43.5%), dirty and smelly, and lack of water. In addition, queuing was another problem bearing 
in mind that the ratio between toilet facilities and number of students was quite high (30.4%). 
The two other responses referred to the comfort of going to the toilet at home (more relaxed, 
not need to queue/shove).
Pillar 2: Washing hands with soap 
The knowledge of the children regarding the benefits of washing hands with soap after 
defecation was better than their knowledge of the first CBTS pillar (spread of disease through 
human feces). However, the respondents still needed to be informed that washing hands 
without soap was not enough to kill dangerous germs.
 
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Table 6.7
Perceptions of Children Regarding CTPS-related Activities 
Description Right Wrong
Washing hands with water alone is enough to clean off 
disease-spreading germs 20% 80% 
We don’t need to wash hands with soap after defecation 
unless our hands are sticky 6,7% 93,3%
Respondent base: 30 
As regards availability of water, 43.3% said that they had experienced difficulties with water for 
bathing and washing in their home environments, and also in their school environments.
Table 6.8
Children’s Description on Water Availability At Home and At School 
Have you ever experienced any of the 
following?
At home (%) At school (%)
Yes No Yes No Don't 
know 
Foul smelling or tasting drinking water 40 60 20 80 - 
Difficulties with availability of water for 
bathing or washing
43,3 56,7 43,3 50 6,7
Respondent base: 30
Also as regards the availability of clean water, 40% of the respondents said that they had had 
experience of foul smelling or tasting drinking water in their home environment, while only 20% 
had experience of this at school.
Washing Hands in the Home
A total of 96.7% of respondents ate lunch at home, while only 3.3% did so at school. All of the
respondents ate dinner at home. The following are their responses on their behavior before 
eating (both snacks and meals):
 
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Figure 6.2
Behavior Before Eating (Snacks and Meals)
Respondent base: 30
There was a greater tendency among respondents to wash hands with soap before a main meal 
compared to when they would eat snacks. The majority of respondents (66.7%) said that they 
washed their hands with soap before a main meal, while only 16.7% washed their hands with 
soap before eating a snack. A total of 56.7% said they did not do anything before eating a 
snack, while 3.3% said they did not do anything before eating a main meal. In addition, 16.7% 
said that they washed their hands with water prior to eating a main meal, while another 16.7% 
did so before eating a snack. The remaining respondents (13.3%) said that they washed their 
hands, without mentioning soap or water, prior to eating a main meal, while 10.0% did the 
same before eating a snack.
Table 6.9 
Below sets out a compilation of the responses on hand washing before eating main meals and 
snacks:
Group MEDAN
Children who always wash their hands with water but without soap (before 
eating snack or main meal) 63,3%
Children who always wash their hands with soap (before eating snack or main 
meal) 13,3%
Children who have better hand-washing practices before eating main meals 
compared with snacks 16,7%
Children who never wash their hands before eating 3,3%
Respondent base: 30
Wash hands 
(without mentioning 
water/soap)
Wash hands with 
soap 
Wash hands with 
water
Doesn’t do 
anything, directly 
eats
10,0%
16,7% 16,7%
56,7%
13,3%
66,7%
16,7%
3,3%
Snacks Meals
 
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100
The reasons given by respondents for washing their hands before eating were as follows:
Figure 6.3
Reasons for Washing Hands Prior to Eating – Multiple Answer
Respondent base: 30
Using open-ended questions, it was found that the main reason for washing hands before 
eating was to rid the hands of germs (82% of respondents). The remaining responses varied, 
but were also concerned with germs, while there were also 4 other responses: so as not to get 
a stomach ache, not to get diarrhea, not to get sick and not to have sticky hands.
The primary source of information on the importance of washing hands before eating so as to 
avoid germs was parents (69.0%) and teachers in school (20.7%). The remaining respondents 
said they had received the information during outreach campaigns in school (6.7%) or from 
elder siblings (3.4%).
The other situations when they practices hand-washing with soap were (1) after defecating 
(47.6%), (2) after playing (38.1%); (3) after eating (28.6%) and after disposing of garbage 
(23.8%). The remainder consisted of 7 other responses, namely: after cleaning the house 
(13.3%), after urinating (9.5%), before sleeping (9.5%), after holding animals (9.5%), and 
after bathing and after eating snacks , each on 4.8%.
Hand-washing practices at school 
A total of 96.7% of respondents said that they had facilities at school for washing hands, while 
30% said that they always washed their hands before eating, and 26.7% said that they 
sometimes did so. Meanwhile, 43.3% said that they never washed their hands before eating.
As regards the practice of hand washing with soap, only 6.7% of respondents did it correctly 
(rubbing the palm and between the fingers with water and soap), while 36.7% rubbed between 
the fingers (without rubbing the palm) with water and soap, 40% rubbed the palm and 
To rid their hands 
of germs
Because there are 
many germs on 
the hands
4 other responses
82,8%
10,3% 13,6%
 
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between the fingers with water alone, and 16.7% rubbed between the fingers with water alone. 
The remainder did not use water and soap.
Pillar 3: Clean and healthy treatment of drinking water 
A total of 73.3% of the elementary school respondents were aware of the importance of 
treating water before consumption, as well as treating food before consumption. Nevertheless, 
they still need more information on the risk of diarrhea from untreated water, and the dangers 
of consuming untreated vegetables. The responses were quite encouraging as regards their 
knowledge of diarrhea and bacteria from untreated vegetables, and the spread of germs by 
flies, as shown in the following table:
Table 6.10
Perceptions of Children About Activities Related to Defecation 
Description Right Wrong
Eating untreated vegetables is healthy, and you don’t need to worry 
about germs 26,7% 73,3%
Drinking untreated water can cause diarrhea 96,7% 3,3%
The legs of flies carry thousands of germs that can be spread from 
place to place 96,7% 3,3%
Respondent base: 30 
Although the elementary school respondents had quite good knowledge about the need to treat 
water before consumption, 60% of respondents referred to the drinking of untreated water at 
home.
Table 6.11
Children’s Descriptions of Drinking Water Treatment At Home and At School 
Have any of the following 
things happened?
At Home (%) At School (%)
Yes No Yes No Don't 
know 
People drank untreated water 60 40 10 73,3 16,7
Respondent Base: 30
 
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As regards sources of water at school, 66.7% of respondents said that they purchased it at 
school, while only 33.3% brought it from home. Of the 66.7% who purchased it at school (20 
students), 5 purchased branded packaged water in tea form (X Teh), while others purchased 
ices (branded such as Pop Ice, Seger Sari, and unbranded, such as cucumber ice, chocolate ice, 
melon ice, and ‘es cendol’ – a traditional dessert). Thirteen respondents purchased drinks in the 
school canteen, while 7 did so in stalls outside the school.
Pillar 4: Garbage Management 
Based on observations conducted in the schools, uncovered garbage bins were the most 
common places (96.7%) where students disposed of the packaging from their snacks (whether 
consumed during playtime or in the classroom).
Pillar 5: Solid and Liquid Waste Treatment
As regards the wastewater disposal channels in the places where the respondents lived, 4 
pictures were used, consisting of 2 pictures showing clean drains and 2 pictures showing dirty 
drains. These elicited the following responses from the elementary school children:
Table 6.12
Condition of Wastewater Disposal Channels in Place Where You Live
Picture Number Picture Water Channel Category Percentage
11 Clean 50%
12 Clean 25,6%
13 Dirty 23,3%
 
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Picture Number Picture Water Channel Category Percentage
14 Dirty 1,1%
Respondent base: 30 
B. Perceptions of Children of Environmental Cleanliness at School and at Home
The elementary school respondents in Medan were dominated by children whose schools were 
within Tegal Sari Mandala 3 (20 respondents out of a total of 30 in Medan). Of these, 33.3% 
said that their school environment (TSM-3 Elementary School) was quite clean, while 36.7% 
said that their school environment was very clean. Of the 20 respondents, 3 said that the school 
environment was not clean/dirty. The following table shows the children’s responses:
Table 6.13
Perceptions about Environmental Cleanliness
Perceptions of Environment School Home
Quite Clean 33,3% 63,3%
Very Clean 36,7% 13,3%
Dirty 30% 23,3%
Respondent base: 30 
Although 70% of respondents perceived their school environment to be clean (quite clean and 
very clean), and only 23.3% felt their home environments to be dirty, nevertheless all (100%) 
said that environmental cleanliness at school and at home needed to be improved (53.3% and 
40% said, respectively, that it needed to be greatly improved).
A number of behaviors found in the children’s environment (school and home) were 
acknowledged by almost all respondents (more than 60%) as being inappropriate, such as 
adults discarding garbage in the open, which could lead to blocked drains (70% in the home 
environment, and much cleaner in the school environment – only 43.3% had seen blocked 
drains around their schools), and the continued occurrence of floods during the wet season. A 
total of 83% of respondents said that diarrhea was still found in their home environments, while 
53.3% said that this was the case in their school environments.
 
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Table 6.14
Children’s Descriptions of Inappropriate Actions Related to Cleanliness in the Home and School 
Environments 
Have any of the following things 
happened:
At home (%) At School (%)
Yes No Yes No Don't 
know 
Adults incorrectly disposing of garbage 93,3 6,7 60 40 - 
Blocked water channels or drains 70 30 43,3 53,3 3,3
Dengue Fever 73,3 26,7 43,3 53,3 3,3
Flooding every wet season 60 40 23,3 76,7 - 
Frequent outbreaks of diarrhea 83,3 16,7 53,3 40 6,7
Respondent base: 30
Sickness Episodes in the Last Month
A total of 60.0% of children had been absent from school on account of sickness in the last 
month (February 2013). The illnesses experienced were as follows:
Table 6.15
Illnesses Experienced in Last 12 Months – Multiple Answer
No. Illness Experienced Number * 
1 Fever 15 persons
2 Headache 3 persons
3 Stomach ache 3 Persons
Respondent Base: 18 
* In absolute terms as the base number of respondents was less than 30
As regards diarrhea in the last 2 weeks (end February 2013), 20% of children had experienced 
it, while 80% had not experienced diarrhea in the last 2 weeks. According to the children, the 
causes of diarrhea were as follows:
 
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Table 6.16
Causes of Diarrhea in Last 2 Weeks – Multiple Answer
No. Cause Number * 
1 Eating spicy food 3 Persons
2 Because of fever 2 Persons
3 Consuming ice drinks 1 Person
Respondent base: 6 
*In absolute terms as the base number of respondents was less than 30
According to the children, the bouts of diarrhea they had experienced in the last 2 weeks were 
not due to their food being contaminated by bacteria or germs, but were rather due to eating 
spicy food (3 respondents), fever (2 respondents) and consuming ice drinks (1 respondent).
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Attachment
Observations on Schools 
Target Schools and General Conditions 
TARGET SCHOOL NUMBER OF 
STUDENTS 
NUMBER OF 
TEACHERS 
NUMBER 
OF 
TOILETSs 
SCHOOL 
FLOOR
SCHOOL 
ROOF
SCHOOL 
WALLS
SDN SURYA BAKTI KOTA BARU 308 14 3 Cement Corrugated 
Iron Cement
MIS AL WASLIYAH 248 10 3 Ceramic Tiles Corrugated 
Iron 
Cement
SDN 06 497 356 22 4 Ceramic Tiles Corrugated 
I on 
Cement
Target Schools and CBTS Pillar 1 – 1 
TARGET SCHOOL TYPE OF 
TOILET
PLACE OF 
FECES 
DISPOSAL
CONDITION OF 
SCHOOL 
BATHROOMS
DISTANCE FROM 
WELL TO SEPTIC 
TANK/DROP TOILET
DISTANCE FROM WELL 
TO NEIGHBORING 
SEPTIC TANKS
SDN SURYA BAKTI KOTA BARU U-Bend Septic Tank Quite clean 20 steps 34 steps
MIS AL WASLIYAH U-Bend Septic Tank Dirty No well No well
SDN 06 497 U-Bend Septic Tank Quite clean 12 steps 20 steps
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and CBTS Pillar 1 – 2 
TARGET SEKOLAH 
GENERAL CONDITION OF TOILET
FECES 
PRESENT
GARBAGE 
PRESENT
FLIES 
PRESENT
WATER 
AVAILABLE 
SCOOP 
PRESENT
WATER 
RECEPTACL
TOWEL 
PRESENT
YES NO YES NO YES NO YES NO YES NO YES NO YES NO
SDN SURYA BAKTI KOTA X  X  X   X  X  X X 
MIS AL WASLIYAH  X X  X   X  X X  X 
SDN 06 497 X  X  X   X  X  X  X
Target School and CBTS Pillar 2
TARGET SCHOOL RUNNING WATER CLEAR WATER SOAP AVAILABLE DRY TOWEL AVAILABLE 
YES NO YES NO YES NO YES NO
SDN SURYA BAKTI KOTA BARU  X  X  X  X 
MIS AL WASLIYAH  X  X X  X 
SDN 06 497 X   X  X  X 
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Target School and Pillar 3
TARGET SCHOOL FOOD CONTAINER IN 
CANTEEN
HOW IS FOOD PRESENTED 
IN CANTEEN
TYPE OF SCHOOL 
CANTEEN
HAND WASHING 
FACILITY IN CANTEEN
YES NO
SDN SURYA BAKTI KOTA BARU Covered Uncovered Dry foods on sale x  
MIS AL WASLIYAH X X X X X
SDN 06 497 X X X X X
Target School and Pillar 4 – 1 
TARGET SCHOOL NUMBER OF 
GARBAGE BINS
TYPE OF 
GARBAGE BIN
CLEANLINESS 
OF SCHOOL
FINAL DISPOSAL 
OF GARBAGE 
GARBAGE SEPARATION
YES NO
SDN SURYA BAKTI KOTA 8 Uncovered basket Quite clean Basket – in yard  X
MIS AL WASLIYAH 8 Uncovered basket Quite clean In sack  X
SDN 06 497 10 Uncovered basket Very clean Basket – in yard  X 
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Target School and Pillar 4 – 2 
TARGET SCHOOL CLEANLINESS OF 
CANTEEN
TYPE OF GARBAGE 
RECEPTACLE IN 
CANTEEN
REGULARITY OF 
GARBAGE 
COLLECTION 
ARE FOOD LEFTOVERS 
SEPARATED
YES NO
SDN SURYA BAKTI KOTA BARU Quite clean Covered basket Everyday NA NA
MIS AL WASLIYAH X X X X X 
SDN 06 497 X X X X X
SDN: Sekolah Dasar Negeri - state elementary school
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Target School and Pillar 5
TARGET SCHOOL
METHOD OF 
WASHING IN 
CANTEEN
WHERE DOES 
WASTEWATER 
FROM CANTEEN 
GO
FILTER ON 
WASHING IN 
CANTEEN
FINAL DISPOSAL OF WASTEWATER
YES NO BATHROOM WASH HAND BASIN (IF 
AVAILABLE)
SDN SURYA BAKTI KOTA BARU
Washed with soap, 
rinsed in dirty water, 
then clean water
Collected in 
bucket, then 
thrown in ditch
X  River, pond, 
drain, canal River, pond, drain, canal
MIS AL WASLIYAH X X X X River, pond, 
drain, canal River, pond, drain, canal
SDN 06 497 X X X X River, pond, 
drain, canal River, pond, drain, canal
SDN: Sekolah Dasar Negeri - state elementary school
REPORT
HIGH FIVE PROGRAMS
MIDLINE HOUSEHOLD SURVEY 
COVERAGE AREA: SURABAYA
Prepared for
September, 2013
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TABLE OF CONTENTS
Table Of Contents ............................................................................................................... I
List Of Figures ..................................................................................................................III
List Of Tables .................................................................................................................... V
Part I Background And Research Objectives ......................................................................... 1
A. BACKGROUND.................................................................................................. 1
B. OBJECTIVES ........................................................................................................... 1
Part II Research Methodology ............................................................................................. 3
A. SURVEY METHOD..................................................................................................... 3
B. NUMBER OF RESPONDENTS ........................................................................................ 3
C. SAMPLE SELECTION TECHNIQUE .................................................................................. 5
Part III Findings ................................................................................................................. 6
A. RESPONDENT PROFILE – AGE ..................................................................................... 6
B. RESPONDENT PROFILE – RELATIONSHIP BETWEEN RESPONDENT AND HOUSEHOLD HEAD .......... 6
C. RESPONDENT PROFILE – NUMBER OF UNDER-5S PER HOUSEHOLD....................................... 6
D. RESPONDENT PROFILE – EDUCATION............................................................................ 8
E. RESPONDENT PROFILE – SOCIOECONOMIC CLASS ............................................................ 8
F. RESPONDENT PROFILE SUMMARY................................................................................. 11
Part IV Program Implementation ........................................................................................13
A. EFFECTIVENESS....................................................................................................... 13
B. EFFECTIVENESS....................................................................................................... 20
C. EFFICIENCY............................................................................................................ 28
D. SUSTAINABILITY...................................................................................................... 30
E. RELEVANCE AND APPROPRIATENESS ............................................................................. 33
Part V Evaluation Of Program Outcomes Hygiene And Sanitation Practices Under The Five CBTS
Pillars ...............................................................................................................38
A. OPEN DEFECATION FREE ........................................................................................... 38
Toilet Conditions In General...................................................................................... 39
Summary Of First Pillar Findings: Open Defecation Free .............................................. 45
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B. HAND-WASHING WITH SOAP...................................................................................... 46
Summary Of Second Pillar: Practices Of Washing Hands With Soap.............................. 50
C. SAFE DRINKING WATER TREATMENT AND STORAGE ......................................................... 51
Summary Of The Third Pillar: Household Safe Water Treatment And Storage Practices .. 56
D. PERCENTAGE OF HOUSEHOLDS THAT PRACTICE SOLID WASTE MANAGEMENT ......................... 58
Summary Of Fourth Pillar: Solid Waste Management Practices ..................................... 62
Proper Wastewater Management............................................................................... 63
Summary Of Fifth CBTS Pillar: Wastewater Management Practices ............................... 69
E. ROLE OF COMMUNITY MEMBERS AS INFORMANTS............................................................ 75
F. HEALTHY LIFE PRACTICES.......................................................................................... 79
Knowledge .............................................................................................................. 79
Attitude................................................................................................................... 82
Practices ................................................................................................................. 88
Part VI Children Baseline – Elementary School................................................................92
A. PERCEPTIONS OF CHILDREN REGARDING CONDITIONS THAT IMPACT ON HEALTHY AND CLEAN 
LIFE PRACTICES ...................................................................................................... 92
B. PERCEPTIONS OF CHILDREN OF ENVIRONMENTAL CLEANLINESS AT SCHOOL AND AT HOME .......103
Attachment Observations On Schools................................................................................106
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LIST OF FIGURES
Figure 3.1 Respondent Age Groups..................................................................................... 7
Figure 3.2 Number Of Under-5s Per Household.................................................................... 7
Figure 3.3 Final Education Completed ................................................................................. 8
Figure 3.4 Average Household Expenditure Per Month.......................................................... 9
Figure 3.5 House Ownership ............................................................................................ 10
Figure 3.6 Number Of Persons Over Age Of 5 Living In Home............................................. 11
Figure 5.1 Type Of Toilet - Observation ............................................................................ 39
Figure 5.2 Toilet Condition - Observation .......................................................................... 40
Figure 5.3 If You Have Children From The Age Of 0 – 3, Can They Defecate On Their Own On 
The Toilet? ..................................................................................................... 42
Figure 5.4 Last Location Of Defecate................................................................................ 42
Figure 5.5 Place Of Disposal Of Infant Feces..................................................................... 43
Figure 5.6 What Respondents Do After Children Defecate .................................................. 44
Figure 5.7 Use Of Soap In Last Two Days In Wonorejo Sub-District – Multiple Answer.......... 46
Figure 5.8 Use Of Soap Over Last Two Days In Petemon Sub-District – Multiple Answer....... 47
Figure 5.9 Scores For Use Of Soap At 5 Critical Times In Last 2 Days.................................. 48
Figure 5.10 Availability Of Running Water ......................................................................... 49
Figure 5.11 Availability Of Soap........................................................................................ 49
Figure 5.12 Sources Of Drinking Water ............................................................................. 51
Figure 5.13 Sources Of Drinking Water For Under-5s In The Home ..................................... 52
Figure 5.14 What Is Done (To Improve Quality) Before Consumption (Excludes Branded 
Packaged Water And Water Refills) .................................................................. 53
Figure 5.15 Drinking Water Storage Places........................................................................ 53
Figure 5.16 Places Used To Store Drinking Water – Observations ........................................ 54
Figure 5.17 ..Places Used To Store Water For Cooking - Observations Observations On Drinking 
Water Storage Receptacles, Processing And Presentation ................................... 55
Figure 5.18 Places Where Food Is Stored – Observations ................................................... 56
Figure 5.19 Receptacles Or Places Used For Collecting Garbage .......................................... 58
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Figure 5.20 Disposal Of Waste / Garbage.......................................................................... 59
Figure 5.21 Frequency Of Garbage Collection .................................................................... 59
Figure 5.22 Do You Pay For Garbage Collection?................................................................ 60
Figure 5.23 Expenditure On Garbage Collection ................................................................. 61
Figure 5.24 Is Organic And Inorganic Garbage Separated? ................................................. 61
Figure 5.25 Receptacles Used For Collecting Garbage – Observations .................................. 62
Figure 5.26 Disposal Of Kitchen Wastewater – Observations ............................................... 64
Figure 5.27 Discharge Of Wastewater From Bathroom – Observations................................. 64
Figure 5.28 Discharge Of Wastewater From Clothes Washing – Observations ....................... 65
Figure 5.29 Location Of Septic Tank – Confined To Those That Have Septic Tank................. 66
Figure 5.30 ..Final Place Of Disposal Of Toilet Wastewater (By Those That Lack Septic Tanks) – 
Observations .................................................................................................. 66
Figure 5.31 Has Your Septic Tank Ever Been Emptied?....................................................... 67
Figure 5.32 When Was The Last Time Your Septic Tank Was Emptied?................................ 68
Figure 5.33 Who Emptied Your Septic Tank The Last Time?................................................ 68
Figure 5.34 Distance From Home To Public Toilet .............................................................. 69
Figure 5.35 Have You Heard Of Cbts? ............................................................................... 79
Figure 5.36 Have You Ever Heard Of Phbs......................................................................... 80
Figure 5.37 Has Your Under-5 Ever Suffered From Diarrhea? .............................................. 90
Figure 5.38 Last Time Your Under-5 Suffered From Diarrhea .............................................. 90
Figure 5.39 Treatment Of Diarrhea ................................................................................... 91
Figure 5.40 Overall Cost Of Treatment (Transportation, Consultation, Medicine)................... 91
Figure 6.1 8 Top Responses For Conditions That Are Deemed Clean And Healthy................. 92
Figure 6.1 Children’s Understanding Of Cbts ..................................................................... 93
Figure 6.2 Pictures Showing Cbts – Multiple Answer .......................................................... 95
Figure 6.2 Behavior Before Eating (Snacks And Meals)....................................................... 99
Figure 6.3 Reasons For Washing Hands Prior To Eating ....................................................100
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LIST OF TABLES
Table 2.1 Number of Respondentst by Respondentst Category In Each Area.......................... 4
Table 3.1 Respondent Profile Summary............................................................................. 11
Table 5.1 Observations On Discharge Of Toilet Wastewater................................................ 38
Table 5.2 Toilet Conditions – Observations ........................................................................ 41
Table 5.3 First Pillar Indicator: Open Defecation Free......................................................... 45
Table 5.4 Indicators Showing Practice Of Washing Hands With Soap ................................... 50
Table 5.5 Observations onDrinking Water Storage Receptacles, Processing & Presentation.... 55
Table 5.6 Indicators For Third Pillar: Safe Water Treatment................................................ 56
Table 5.7 Fourth Pillar Indicators: Solid Waste Management Practices ................................. 62
Table 5.8 Fifth Cbts Pillar: Wastewater Management Practices ............................................ 69
Table 5.9 Summary Of Indicators For All Five Cbts Pillar..................................................... 71
Table 5.10a Sources Of Information On The 5 Cbts Pillars In Surabaya – Multiple Answer - 
Spontaneous .................................................................................................. 76
Table 5.10b Sources Of Information On 5 Cbts Pillars In Wonorejo – Surabaya Multiple Answer - 
Spontaneous .................................................................................................. 77
Table 5.11 Perceptions Of Residents About Health............................................................. 82
Table 5.12 Residents Perception Of Community................................................................. 87
Table 5.13 Behaviors That Can Cause Health And Hygiene Problems ................................... 88
Table 6.1 Understanding Of Cbts By Grade........................................................................ 93
Table 6.2 What More Do You Know About Cbts?................................................................ 94
Table 6.3 Information On Cbts Obtained From: ................................................................. 95
Table 6.4 Perceptions Of Children Related To Defecation.................................................... 97
Table 6.5 Children’s Explanations On Inappropriate Defecation Behavior In Their Home And 
School Environments....................................................................................... 97
Table 6.6 Thing That Make Urinating/Defecating At School Different From At Home ............. 98
Table 6.7 Perceptions Of Children Regarding Ctps-Related Activities.................................... 98
Table 6.8 Children’s Description Of Water Availability At Home And At School ...................... 99
Table 6.9 Hand Washing Practices Before Eating (Meals And Snacks)................................. 100
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Table 6.10 Perceptions Of Children About Activities Related To Defecation..........................101
Table 6.11 Children’s Descriptions Of Drinking Water Treatment At Home And At School .....102
Table 6.12 Condition Of Wastewater Disposal Channels In Place Where You Live ................102
Table 6.13 Children’s Perceptions Of Environmental Cleanliness .........................................103
Table 6.14 Children’s Descriptions Of Inappropriate Actions Related To Cleanliness In The 
Home And School Environments.................................................................... 104
Table 6.15 Illnesses Experienced In Last 2 Months – Multiple Answer................................. 104
Table 6.16 Causes Of Diarrhea In Last 2 Weeks – Multiple Answer.....................................105
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Part I 
Background and Research Objectives
A. Background
The Indonesian government launched the Community-Based Total Sanitation (CBTS) Program 
in 2007 to improve hygiene and sanitation practices in households, thereby reducing the 
incidence of diarrhea, the second leading cause of infant mortality. The program consists of five 
hygiene and sanitation pillars, namely:
1. Stopping open defecation 
2. Washing hands with soap
3. Household safe water treatment and storage
4. Solid waste management
5. Waste water management
The program was focused primarily on rural areas, where the emphasis was on Pillar 1 
(stopping open defecation). Through the High Five Program, the Cipta Cara Padu (CCP)
Foundation proposed that the program be extended to urban areas, thus contributing to the 
efforts to improve compliance with the five CBTS pillars in households and communities.
The High Five Program has now been running for 1.5 years in 3 cities, namely, Surabaya, 
Surabaya and Makassar. The program is conducted at the city level and the sub-district level. At 
the city level, the High Five Program advocates the incorporation of CBTS into current policies 
and AMPL/Sanitation Working Group activities, as well as the integration of CBTS strategies into 
municipal government development plans. At the sub-district level, the High Five Program
operates in three RW (neighborhoods) at a high level of intensity, and in other neighborhoods 
at a low level of intensity.
It is very important to ensure that the program at every level is on track to achieve the key 
indicators in respect of intermediate results, particularly those resulting from interventions 
during the operative period, and that the implementation process is in accordance with 
participatory principles, and reflects gender equity and environmental considerations. 
Accordingly, an independent evaluator is required to review the performance of the program 
and provide recommendations for improving program implementation during its remaining 
lifetime. 
B. Objectives
The High Five Program focuses on improving hygiene practices at the household and 
community levels, identifying how many households are aware of children's health, sanitation 
and hygiene issues, whether that number has increased or decreased when compared with the 
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2012 baseline survey having regard to the High Five Program objective indicators. Accordingly, 
this midline survey evaluates:
a. Program outcomes by comparing the midline survey’s findings with those of the baseline 
survey so as to identify changes as regards:
- Understanding of the CBTS pillars
- Perceptions of the CBTS pillars
- Habits/ behaviors associated with the CBTS pillars
b. Program implementation so as to identify program effectiveness, efficiency, relevance, 
and sustainability.
c. Providing recommendations for better program implementation.
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Part II
Research Methodology
In general, both primary and secondary data were required for the purposes of this study. 
However, Polling Center (in accordance with its agreement with High Five Program) collected 
primary data using the quantitative and qualitative methods.
In the implementation of this survey, the collection of primary data in the field was carried out 
using the quantitative method aimed at respondents from households with children, while the 
qualitative data was collected using in-depth interviews with stakeholders of the CBTS program 
being implemented by Cipta Cara Padu Foundation. 
A. Survey Method
In order to obtain the data required for this research (as set out in the study objectives), both 
the quantitative and qualitative methods employed questionnaires. 
Data collection in the field in the Surabaya area was conducted as follows:
Quantitative Data
- Households : 9 to 13 March 2013
- Children : 6 to 12 March 2013
Qualitative Data 
- Focus Group Discussion (FGD) : 5 March 2013
- In-depth Interviews (IDI) : 7 to 22 March 2013
B. Number of respondents
The number of respondents in each category in the Surabaya survey area is shown in the 
following table:
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Table 2.1
Number of Respondents by Respondents Category in Each Area
Category Area / Sub-district Total Sample
Households
Wonorejo 30 respondents
Petemon 30 respondents
Elementary 
School (Sekolah 
Dasar/SD) 
Children 
SD Petemon 5 children
SD Wonorejo 7 5 children
SD Wonorejo 5 5 children
SD Wonorejo 4 5 children
SD Wonorejo 2 5 children
SD Wonorejo 1 5 children
Total Respondents in Quantitative Survey 90 respondents
FGD
1 group from Pokja Kota
(Kelompok Kerja Kota – City 
Working Group)
1 group from Pokja Kelurahan
(Kelompok Kerja Kelurahan – 
Administrative Village Working 
Group)
IDI – per respondent category 
High Five Program District Leaders 1 respondent
High Five Program Facilitators 1 respondent
Community Leaders (Sub-district Heads) 2 respondents
Sanitarians 1 respondent
Teachers with High Five Program training 1 respondent
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Category Area / Sub-district Total Sample
Other Relevant Parties: Private Sector – PundiAmal SCTV (tv 
station)
1 respondent
Other Relevant Parties: Academia 1 respondent
Other Relevant Parties: nongovernmental organization (NGO) 1 respondent
Provincial Health Agency 1 respondent
Media/Journalists 1 respondent
Total Respondents in Qualitative Survey 11 respondents
C. Sample Selection Technique
1. Respondent Households 
Respondent households were selected using the simple random sampling method. The 
objective was to obtain findings that are representative of the population.
In the selected sub-districts in each city, a mapping process was first carried out in respect 
of households with under-5s, with the approval of local leaders (heads of RT/RW or sub￾district heads).
After the population had been mapped, the selection of households was preceded by 
determining the household interval, that is, by dividing the total number (population) of 
households with children under 5 with the total respondent target (30 respondents) for each 
sub-district. 
In this way, the caregiver respondents for under-5s to be interviewed were selected.
2. Elementary school children in grades 4, 5 and 6
The selected elementary schools were all located in sub-districts where interventions had 
been effected. Respondents in the child category were selected randomly using the 
sampling interval technique. A total of 10 children from each school were interviewed, all of 
whom were from grades 4, 5, and 6. Consequently, the average sample size for each class 
was 3 children.
To select the children to be interviewed from each class, the interval random sampling method 
was used based on desk or attendance role sequences.
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Part III
Findings
A. Respondent Profile – Age 
The criteria for the selection of respondents for interview during the midline survey were the 
same as in the case of the previous baseline survey, namely, caregivers of under-5s. Both in 
Wonorejo and Petemon, 100% of respondents were women. While in the case of Wonorejo, 
this was the same as during the baseline survey, the percentage of female respondents during 
the baseline survey in Petemon was 96.7%, while the remaining respondents were male.
As a whole in the city of Surabaya, the majority (56.7%) of respondents interviewed were 
women aged 25-35, with the proportions in Wonorejo and Petemon being respectively 46.7% 
and 66.7%.
B. Respondent Profile – Relationship between Respondent and Household Head
A total of 86% of the respondents were the wives of household heads (with the percentages for 
Wonorejo and Petemon being respectively 83.3% and 90%). Meanwhile, those who were the 
children or parents of households in Indonesia amounted to only 3.3% and 5% respectively.
These figures show that the majority (45%-67%) of caregivers in both sub-districts are young 
women of between 25 and 35.
C. Respondent Profile – Number of Under-5s per Household
Overall, in the two sub-districts in which interviews held, the majority of respondents lived with 
1 toddler at home (81.7%), while only 16.7% of respondents had 2 toddlers in the house.
More specifically, the number of households with one under-5 in the respondents’ homes in
Wonorejo was 86.7%, while 13.3% of households had 2 under-5s.
The following graphs show the respondent age-group distribution and the number of under-5s 
in respondent households by sub-district in Surabaya at the time of the midline and baseline 
surveys.
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Figure 3.1.
Respondent Age Groups 
Figure 3.2
Number of Under-5s per Household
Baseline Midline Baseline Midline
10,0% 3,3% 3,3% 6,7%
6,7%
3,3% 10,0%
23,3%
30,0%
26,7%
16,7%
50,0%
46,7%
56,7%
66,7%
10,0% 16,7%
3,3% 10,0% <25 years old
25-35 years old
>35-45 years old
>45-50 years old
>55 years old
>50-55 years old
Wonorejo Petemon
Respondent base : 60
Baseline Midline Baseline Midline
3,3%
13,3% 16,7%
20,0%
100,0%
86,7% 83,3% 76,7%
1 child
2 children
3 children
Wonorejo Petemon
Respondent base : 60
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D. Respondent Profile – Education
As regards the educational background of the respondents selected in Surabaya, an overall 
majority (40.6%) of them had completed high school (or equivalent), while the second largest 
group (29.4% of respondents) had graduated from elementary school (or equivalent).
In Wonorejo, 56.7% of respondents had graduated from high school (or equivalent), while 
26.7% had graduated from elementary school. 
The percentages in Petemon were almost the same, with 53.3% graduating from junior high 
school (or equivalent). However, in second place was junior high school (or equivalent), from 
which 23.3% of respondents had graduated.
The following graph shows the educational attainments of respondents in Wonorejo and 
Petemon sub-districts. 
Figure 3.3 
Final education completed
E. Respondent Profile – Socioeconomic Class
Based on average monthly expenditure at the time of the midline survey in Surabaya, the socio￾economic stratification of both sub-districts was found to be the same. A total of 36.7% of 
respondents belonged to socioeconomic class C1 (average expenditure of Rp 1,250,001 and Rp 
1,750,000), while in second place 23.3% were respondents belonging to socioeconomic class B 
(average expenditure of Rp 1,750,001 – Rp 2,500,000). More specifically, both in Wonorejo and 
Petemon, the majority of respondents belonged to socioeconomic class C1 (33-40%). In 
Wonorejo, 33.3% of respondents were in socioeconomic class C1, while in second place on 
Baseline Midline Baseline Midline
6,7%
16,7%
3,3% 3,3%
3,3%
60,0% 56,7%
40,0%
53,3%
29,0%
13,3% 36,7%
23,3%
13,3%
26,7% 20,0%
3,3%
Elementary School / equal
Middle School /equivalent
High School / equivalent
Undergraduate Diploma / 
equivalent
Bachelor Degree
Wonorejo Petemon
Respondent base : 60
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26.7% was class C2 (average expenditure of Rp 900,001 to Rp 1,750,000). Similarly in Petemon 
sub-district, the majority of respondents belonged to socioeconomic C1 (40%), while, in second 
place, 26.7% belonged to class B (average expenditure of Rp 1,750,001 to Rp 2,500,000).
The socioeconomic classes of the respondents in each sub-district are as shown below:
Figure 3.4
Average Household Expenditure Per Month
Staying on the issue of socioeconomic class, the following is a description of the home 
ownership situation, and observations concerning the homes occupied by respondents.
Overall, 66.7% of respondents said that they owned their own homes. By sub-district, in 
Wonorejo the percentage of home ownership was 73.3%, while 26.7% of homes were rented. 
Meanwhile in Petemon, 60% of respondents owned their own homes, while 23.3% of homes 
were rented, 13.3% of respondents lived in houses owned by family members, and the 
remaining 3.3% lived in their parents’ homes.
As regards observations on the condition of the houses lived in by the respondents, overall in 
Surabaya the most common form of flooring was ceramic tiles (76.7% - the percentage was the 
same in both sub-districts). 
As regards roofing material, 80% of homes used tiles in Surabaya, with the figures being 70% 
for Wonorejo and 90% for Petemon.
Cement was the most common material used for walling in Surabaya (45.6%). By sub-district, 
in Wonorejo 96.7% used cement for walls, while the remainder used plywood. By contrast, in 
Baseline Midline Baseline Midline
3,3%
10,0%
6,7% 3,3%
30,0%
20,0% 26,7% 26,7%
50,0%
33,3% 33,3% 40,0%
26,7% 20,0% 16,7%
6,7%
10,0% 16,7%
6,7%
3,3% 10,0% < Rp. 600.000 [E]
Rp. 600.001 s\d Rp. 900.000 [D]
Rp. 900.001 s\d Rp. 1.250.000 [C2]
Rp. 1.250.001 s\d Rp. 1.750.000 [C1]
Rp. 1.750.001 s\d Rp. 2.500.000 [B]
Rp. 2.500.001 s\d Rp. 3.500.000 [A2]
> Rp. 3.500.000 [A1]
Wonorejo Petemon
Respondent base : 60
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Petemon, the majority of respondents (76.7%) used bricks for their walls, while cement was in 
second place (20%).
The following chart shows the situation as regards home ownership status in the survey areas 
in Surabaya: 
Figure 3.5
House Ownership
In general, the respondents in Surabaya at the time of the midline survey did not only live in 
nuclear families (husband-wife-children). Besides under-5s, there were also 2-3 people who 
lived in the respondents’ homes (20%-23%). By sub-district, in Wonorejo a total of 20% 
respondents lived with 2-3 people, while in Petemon 20% of respondents lived with 2 people 
over the age of 5, while 26.7% lived with 3 people over the age of 5.
The following graph shows the number of people who lived with respondents (besides under￾5s) in the two sub-districts of Surabaya:
Baseline Midline Baseline Midline
56,7%
73,30% 70%
60%
20%
26,7% 30%
23,3%
23,3% 13,3%
3,3%
House owned by Parents
House owned by the family
Rent
Self owned
Wonorejo Petemon
Respondent base : 60
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Figure 3.6
Number of Persons Over Age of 5 Living in Home
F. Respondent Profile Summary
A summary of the characteristics of the respondents in each of the sub-districts surveyed in 
Surabaya is shown in the following table:
Table 3.1
Respondent Profile Summary
Characteristic Wonorejo Petemon
Age (majority) 46.7% 25 – 35 years of age 66.7% 25 – 35 years of 
age 
Education (majority) 56.7% graduated from high 
school 
53.3% graduated from 
high school 
Number of under-5s (majority) 86.7% 1 under-5 
13.3% 2 under-5 
76.7% 1 under-5 
20% 2 under-5 
SES (majority) 33.3% C1
26.7% C2
40% C1
26.7% B
Home Ownership (majority) 73.3% owner occupied 60% owner occupied
Baseline Midline Baseline Midline
40,0% 40,00% 50% 46,6%
36,7% 16,6%
23,3% 20,0%
13,3% 26,7%
23,3% 23,4% 6,7% 3,4% 3,30% 3,3% 3,4%
> 10 people
8 - 9 people
6 - 7 people
4 - 5 people
2 - 3 people
Wonorejo Petemon
Respondent base : 60
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Wonorejo
The respondents were generally young homemakers (25-35 years of age) who had been 
educated up to high school level or equivalent (56.7% of total respondents). They occupied 
their own homes (73.3%) and had an average monthly expenditure of between Rp 1,250,001 
and Rp 1,750,001 (33.3%), while 26.7% had an average monthly expenditure of between Rp 
900,001 and Rp 1,250,000.
A total of 86.7% of the respondents cared for one under-5, while 40% shared their homes not 
just with immediate family members (wife-husband-child), but with between 2-3 other family 
members (besides the under-5s).
Petemon
The majority of respondents in Petemon (66.7%) were homemakers (caregivers to under-5s) of 
between the ages of 25 and 35 who had been educated up to high school level or equivalent 
(53.3% of total respondents). The majority also occupied their own homes (60%) and had an 
average monthly expenditure of between Rp 1,250,001 and Rp 1,750,000 (40%), while 26.7% 
had a higher average monthly expenditure of between Rp 1,750,000 and Rp 2,500,000.
A total of 76.7% of respondents cared for 1 under-5, while 746.6% shared their homes only 
with members of their immediate family (husband-wife-child), and without other 2-4 other 
family members (besides under-5s).
The following discussion of the findings is based on the strategic objectives of High Five 
Program (as explained in Part I of this survey).
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Part IV
Program Implementation 
A. Effectiveness
On the level of involvement of the public, private sector and community in developing and 
implementing plans to improve water availability, and sanitation and hygiene practices (coded 
as IR1 – program’s success indicator).
1. Role of High Five Program in coordinating partnership strategies as part of SSK (Strategi 
Sanitasi Kota - Surabaya City Sanitation Strategy) 
The role of High Five Program in integrating CBTS into the SSK was not very pronounced as the 
Surabaya SSK had already been established before High Five Program commenced its work. 
However, as the partner of the City Working Group in implementing the SSK, High Five Program
provided assistance by:
 Helping the City Working Group’s CBTS program by focusing on changing behavior, 
intensive community empowerment work and monitoring the implementation of CBTS 
activities. 
“The Health Agency itself was happy that High Five was present as it was able 
to help us. We were also confused at the beginning as to what CBTS was all 
about. So, the presence of High Five was a great help … they provided us with 
training on garbage management using composters and to establish garbage 
banks … waste from the drains could also be reused to feed catfish” (Municipal 
Health Agency)
“… we wouldn’t have been able to monitor (the implementation of CBTS 
activities) directly on a sustained basis – whether it was still functioning properly 
or whether its functions had changed. That is perhaps one of our weaknesses. 
But High Five was able to do it continuously …” (Revenue Agency)
 Collaborating with related agencies on:
- Synhcronizing data (with the local government water utility) on mains water 
customers in the High Five Program areas and households that were not linked to 
the mains water supply, coordinating operations with the City Working Group so as 
to produce synergies and avoid overlapping. 
“ … They synchronized data with PDAM (Perusahaan Daerah Air Minum - 
Regional Water Utility Company) (on water sources used by the residents of the 
selected sub-districts) as they were present on the ground there. All we knew 
was who the PDAM customers were …” (PDAM)
“High Five was one of the programs operating in the municipality, and so it 
accelerated sanitation development. They worked closely with the municipal 
government … so High Five was a coordinated program, that was the concept 
from the outset …” (City Working Group)
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- Provided training to sanitarians
“They also provided frequent training to sanitarians from Puskesmas (Pusat 
Kesehatan Masyarakat - Community Health Clinic) all around Surabaya …” 
(Municipal Health Agency)
There was a strong possibility of incorporating the type of partnership model that had been 
developed by High Five Program into the SSK given that High Five Program had been 
successfully applied both in the community and with its work partners.
“… There is a strong possibility because their strategy was very good, their 
approach to the people was also successful based on the kind of partnerships 
that are underway at the present time. They made the people aware … also the 
evaluations in the hotels served as a reward for the Working Groups for their 
hard work, it can be compared with the experience of Working Groups in other 
areas … “ (Wonorejo sub-district head).
2. Replication of High Five Program Sub-district Program by local governments and/or NGOs 
While the Surabaya Municipal Health Agency has conducted socialization and outreach work on 
CBTS (including readying a team of CBTS workers), there appears to be quite a lot of 
enthusiasm for the replication of the CBTS program based on the High Five Program model 
(particularly in RWs in the vicinity of the RWs where High Five Program conducted its CBTS 
program). This was due to the obvious improvements that took place in the selected RWs in the 
High Five Program sub-districts, the successful approach adopted by High Five Program towards 
the public and other stakeholders.
“… the health agency had already done things … like, if we were invited to sub￾district A to provide information on sanitation, we would also talk about CBTS, 
and this was implemented by the Puskesmas sanitarians. We also provided 
training to facilitators to promote CBTS. So 1 team of facilitators would consist of 
5 people, composed of sanitarians, sub-district officials, PKK (Pembinaan 
Kesejahteraan Keluarga - Empowerment Family Welfare), sanitation volunteers, 
and community leaders in the area. Meetings of the sanitation volunteers took 
place once a year …” (City Working Group)
“… the other RWs in Wonorejo wanted it (replication of the High Five CBTS 
program), but the focus is still on the 3 RWs (RW 4, 6, and 7). But for our 
activities, we involved 6 RWs. All of the RWs that weren’t touched by High Five 
Program, they all wanted it. Our workers weren’t convincing when talking to the 
people, but the workers from High Five were really zealous …” (Wonorejo Sub￾district Head).
“ … in reality, our problem is how to convince people to accept it (changing their 
behavior/practices, like convincing people who leave near a river to build septic 
tanks). So, this program was really good. If it could be expanded, it would 
benefit even more people. That would be better than just benefitting 2 sub￾districts (City Working Group).
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However, as High Five Program was focused on changing behavior, there was no doubt that it 
would face difficulties if replicated. These difficulties included:
 Need for sustained efforts
“… You can’t do it overnight, it has to be done gradually, it has to become 
routine. That’s how success will come about. As proof, there are those who 
became willing to build toilets after being provided with information on CBTS …” 
(Sub-district Working Group)
 Working Group members who lacked the self-belief to “progress”
“… if the cadres provided information, the people wouldn’t be convinced, but if 
they were provided by information by High Five (people in replication areas), 
then the people would be all for it …” (Wonorejo Sub-district Head)
3. Level of financial support from private sector and community partners
As the focus of High Five Program is on behavioral change, rather than physical construction, 
there was a lack of funds available when they were needed by the CBTS program to finance the 
construction of infrastructure and facilities. This was however properly explained and 
communicated to Sub-district Working Group members. Nevertheless, as funds were needed 
during implementation for the construction of infrastructure and facilities, there was a need for 
the public to raise funds themselves. As a result of the changes in thinking and behavior that 
were brought about in connection with sanitation and hygiene, the public turned out to be 
willing to do so.
“… After the final round of socialization, they (the residents of the selected RWs) 
voluntarily built their own latrine and bathing facilities with assistance from High 
Five. They were mobilized and motivated by the presence of the CBTS program 
…” (Petemon Sub-district Head).
While High Five Program did not provide funding, it provided help by putting people in touch 
with private sector firms that operated Corporate Social Responsiblity (CSR) programs related to 
environmental and hygiene issues.
“… High Five really helped us a lot. For example, the building where I live was 
also facilitated by High Five so that third parties provided funding for the physical 
construction work. That septic tank was built at a cost of more than 25 million
rupiah. The local people could only provide 700,000 rupiah. So High Five helped 
us even though they didn’t provide us with funding. But what they did do was 
put us in touch with third parties … (Sub-district Working Group)
“… High Five Program worked to make people aware, while others like SCTV 
helped with the physical construction of the toilets through their PundiAmal 
program. Thus, the two worked together, one made people aware while the 
other helped with the physical work. So, this made people willing to help. This 
area is not only densely populated, but people’s incomes are below average. So, 
the construction work kept on being delayed. But then someone came along who 
was willing to build, with the payment to be made by installment. As a result, 
people were interested and it went ahead …” (Wonorejo Sub-district Head).
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On the duplication of hygienic behavior and improving sanitation through participatory 
programs at the community level involving stakeholders, social networks and community 
members (coded as IR2 – program’s success indicator).
1. Promoting hygiene and sanitation in the schools
As one of the High Five Program focuses for involving the schools in the High Five Program sub￾districts, an intensive training program was provided to teachers and 5 students. After the 
children had been trained, they were encouraged to survey their areas and see for themselves 
the consequences of a dirty environment. In addition, from their perspective of student 
awareness of CBTS, the student partners were the most frequently recalled source of 
information by the elementary school respondents, besides the members of the High Five 
Program team.
The teachers who received training saw that, besides direct approaches to the public, it was 
also appropriate to use approaches through the schools, bearing in mind that the schools had a 
role to play in influencing the surrounding community. Through the schoolchildren, it was to be 
hoped that they would bring the knowledge they had gained into the community and thereby 
help effect change in their families (sourced from the children) and in this way create a ripple 
effect in the community at large.
“…. In my view, it’s better to undertake such activities in the schools as the 
schools are a reflection of the community, the behavior of the public is reflected 
when the children are at school. The children bring the practices of their families 
into the schools, so that when they are at school we can inform them. We should 
be able to change them in a coordinated way (through socialization and training) 
so that it is easier to effect change in society (the behavior of the children 
reflects the behavior of their families) …” (teacher who received training).
One of the considerations involved in the selection of the elementary schools was the number 
of children attending the school. The more children, the greater the potential for disseminating 
information in the community. In addition, the impact on the school itself was also taken into 
consideration. If at the outset the school lacked hand washing facilities, it was hoped that after 
the activity hand washing facilities would be provided.
“ … Because it had a lot of students, who could then influence their 
environments. Hand washing with soap, describing healthy environments, 
voluntary work in the school, trash separation (reasons for selecting activities). 
There were a lot of activities aimed at the children … they used to eat directly 
without washing their hands, leaving them vulnerable to germs. Making them 
aware of the importance of hand washing with soap can have a major beneficial 
impact on health …” (Wonorejo Sub-district Head)
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When High Five Program targeted elementary school children as one means of disseminating 
information on the CBTS pillars, early childhood education centers also became the target of 
school activities (by the Surabaya City Working Group).
“… We encouraged all components of the community, we trained teachers right 
down to the kindergarten level. We conducted socialization on a number of 
occasions to kindergartens, for example, by providing examples of hand washing 
with soap in still water, like in a bucket. Thank goodness, although we didn’t 
reach all, we did manage to reach about 90% …” (Petemon Sub-district Head).
2. Media Support for Hygiene and Sanitation 
The role of the media is important in communicating messages about sanitation and hygiene, 
although not many media outlets make such issues a priority or even report on them regularly.
“… In reality, the influence of the media is very strong – at the decision-making 
level it is very strong. That’s what happened. High Five wasn’t just talking to 
sub-district heads so as to make them more aware of sanitation. We were also 
working with the media. If the media was covering an event, then the district 
head would have to attend. That’s the role of the media, very strong. Our friends 
in the media were very, very helpful …”
(District Leader).
Another function of the media in communicating hygiene and sanitation issues was to help 
motivate other sub-districts (outside of the High Five Program sub-districts) to take the initiative 
in doing the same so as to resolve hygiene and sanitation problems.
“… so that the public knew about the programs that were being carried out – the 
media can focus on the hygiene and sanitation programs being undertaken in the 
sub-districts. In this way, the public become more familiar with these programs. 
It also helps provide an example to other sub-districts so that they will replicate 
the programs… “ (Petemon Sub-district Head).
“… It was essential. CBTS was covered by SCTV, SBO (Suroboyo tv station), 
SSFM (local radio station), they also covered voluntary community work and so 
forth. If we were too dependent on the government, we would have achieved 
nothing, it would have taken ages. With the presence of NGOs, supported by the 
media, things got done quickly. The help of the media is essential for 
socialization. We could have moved ahead without the media, but the progress 
would have been slow …” (Wonorejo Sub-district Head)
According to the Communications and Information Agency, government program were normally 
communicated through various media, but the High Five Program activities were not sufficiently 
covered by the media. The agency said that this was because the interaction with High Five 
Program was “light” and was confined to coordination, rather than official collaboration.
“… High Five could have moved beyond coordination if things had been put on a 
more systematic level (formal collaboration, whereby the agency acted as its 
partner, for example) so as to be able to participate in city government 
programs. Systematic in the sense of what could later be developed in this 
regard …” (Communications and Information Agency)
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As one yardstick of the success of High Five Program in applying a participatory approach to 
stakeholders, social networks and community members, High Five Program Surabaya 
established good relations with the media through the forming of a community of journalists 
concerned with environmental and sanitation issues. As an manifestation of High Five Program’s 
concern for the media, journalistic training was also provided so as to improve the 
professionalism of journalists in their respective fields.
“… There were never any obstacles faced regarding the media because in 
Surabaya we had a community of journalists … before the establishment of the 
community, there had never been much interest in sanitation. But we (High Five) 
introduced sanitation to the community and they took things from there. I was 
recently invited by our friends to appear on an RRI (Radio Republik Indonesia – 
public radio station) talk show on sanitation. So they have become actively 
involved in sanitation issues, without having to be coaxed any longer by us …” 
(District Leader)
In promoting hygiene and sanitation issues, the media are also able to encourage the Municipal 
Government to be more responsive in acting on behalf of city residents, particularly as regards 
hygiene and sanitation issues.
“… A significant change took place (after the media became involved in 
sanitation issues). Previously, the government didn’t care about the conditions in 
which people were living. The arrival of donor agencies, let’s put it like that, to 
help bring about change on the ground eventually led to the government getting 
involved. Before they didn’t care. If a foreign aid agency wanted to help back 
then, the government would let them, but had no interest in getting involved. 
But now they want to be involved. That’s a significant change since the 
establishment of the government of Bambang DH (Mayor of Surabaya) …” (Other 
Partner – Journalist).
Other planned support from the media for hygiene and sanitation issues in collaboration 
between High Five Program and the KJPL (Komunitas Jurnalis Peduli Lingkungan - Community 
of Concerned Journalists for the Environment) includes training for members of the public so as 
to improve writing skills so that they can serve as citizen journalists. Such training is needed so
as to educate the public about hygiene and sanitation issues.
“… We will train people to publish a regular news bulletin as part of the CBTS 
campaign. This will be going ahead soon. The focus of the KJPL is on education. 
We educate the public at environmental, hygiene and sanitation issues. We don’t 
provide much direct mentoring on the ground. But if needed, we will do so. We 
will provide training to members of the public on how to become citizen 
journalists …” (Other Partner – Journalist)
Another component of IR2 – the extent to which households understanding the importance of 
the CBTS pillars – will be discussed in the quantitative report, while the number of households 
that have adopted positive behaviors and improved their hygiene and sanitation practices will 
be dealt with in the section on effectiveness.
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On the empowerment of communities to ensure sustainable demand and access to safe water, 
hygiene and sanitation facilities at the household and community levels (coded as IR3 – 
program’s success indicator).
1. Preparation and collection of proposals by communities/groups/schools 
One of the indicators of the success of High Five Program in Surabaya is the preparation and 
collection of proposals to help with the implementation of the CBTS program. Not all of the Sub￾district Working Group members who attended the focus groups were aware of this aspect, 
although they were aware that High Five Program acted as a mediator between the community 
and other relevant parties (both private sector and municipal government). Nevertheless, the 
LKMK (Lembaga Ketahanan Masyarakat Kota – ICity Community Resilience Institution) had 
intended to make proposals, although they were never collected.
“… There was a plan, but the proposals were never put in … the LKMK …” 
(Petemon Sub-district Head)
The principal constraint faced by the LKMK in making proposals was technical in nature. To 
date, they are still at the discussion stage.
Both the City Working Group and the Sub-District Working Groups appreciated the role of High 
Five Program in mediating between the community and private sector organizations with CSR 
programs for fund-raising purposes. However, at the advocacy level, their efforts were confined 
to putting the Sub-District Working Groups in contact with the municipal government or private 
sector organizations. However, the Sub-District Working Groups were not trained on how to 
comply with the existing procedures when seeking assistance, such as how to submit their 
proposals, seek meetings, and to negotiate with the responsible parties.
2. Use of Behavioral Change Communication (BCC) Materials in Socialization Process 
High Five Program’s BCC materials, which were shown during the FGD, were familiar to all of 
the Sub-District Working Group members, who were able to identify their functions and uses. 
All of the materials were deemed effective in helping the members of the Working Groups in 
conducting socialization and in monitoring the Sub-District Working Groups.
“… They were really helpful, like in Petemon sub-districts, where only 3 RWs 
were focused on, we had a Healthy Walk (event) for the entire sub-districts. The 
stickers were also very helpful as they showed people what CBTS was all about, 
about the 5 pillars. So, they were very helpful…” (Sub-District Working Group)
“… The (CBTS pillars) … were affixed to the houses …” (Sub-District Working 
Group)
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B. Effectiveness
According to the stakeholders, the CBTS Program, which has now been underway for 1.5 years 
in Surabaya, should achieve its objectives. Besides considering what has already been achieved 
(by comparing the findings of this survey and those of the 2012 baseline survey), this survey 
also assessed the extent to which:
1. People’s awareness and knowledge of clean and healthy behaviors as part of the 5 CBTS 
pillars, and how to make effective approaches, have increased.
High Five Program conducted intensive and continuous socialization of clean and healthy 
practices using various means, both involving training and direct example (practice). It was 
acknowledged not only by the Sub-District Working Groups, but also the City Working Group 
(during the FGD), that what had been done by High Five Program had been far from easy. The 
results, both qualitative and quantitative, showed that there had been an improvement in the 
knowledge and information of people (and also Sub-District Working Group members) related to 
clean and healthy lifestyles.
Among the factors operating against the adoption of clean and healthy practices was the fact 
that they had been doing things the wrong way since time immemorial. Thus, the information 
and knowledge that High Five Program disseminated was something new, and sometimes was 
at odds with what people thought was “right”. Example of things that people thought were right 
but which were in fact incorrect are:
 Channeling waste from a private toilet into a nearby river
“It’s easy and cheap just to flush it into the river. They have a toilet, but the 
problem is it discharges into the river …” (Working Group)
 Dumping garbage directly into the river
2. Changing behaviors in connection with clean and healthy practices as part of the 5 CBTS 
pillars 
The High Five Program, if compared with other sanitation programs, stresses the style of 
approach to the public, emphasizing outreach and encouragement, so as to make people more 
receptive to change. While fully aware that changing behaviors is never easy, the High Five 
Program approach not only provides training but also concrete examples, thus making people 
more willing to change their mindsets and behavior.
“… The High Five Program is focused on its approach to the community. It isn’t 
like other sanitation programs, which are more focused on outreach. By contrast, 
the High Five approach to the community is based on encouragement, by making 
people aware so that they will change their behavior … “ (Other Partner – 
Academia)
“… One example – whereas previously people dumped trash everywhere, in the 
end they realized that the trash had serious consequences, like floods, 
contaminating the environment. So they started separating garbage, collecting it. 
The area is now quite clean …” (Sub-District Working Group)
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3. For the volunteers, the CBTS program undertaken by High Five Program provided 
information and knowledge on:
 Basic sanitation 
The training and support materials provided by High Five Program to the volunteers 
made it easier for them to disseminate information to people in the High Five Program
sub-districts. It also provided the volunteers with a lot of knowledge on basic sanitation.
“… Essentially, whatever was available (like outreach materials, encouragement 
materials, information on disease transmission cycles, flipcharts, stickers), we 
were always given it … “ (Sub-District Working Group)
 How to make effective approaches to people
The volunteers were aware that they were not only receiving support in the form of 
increased knowledge about sanitation, but also about how to approach people more 
effectively. As regards their “mental quality,” the volunteers felt that this also increased.
“… We often received training, attended discussions, advocacy sessions, 
advocacy training, socialization. To be honest, being part of High Five meant that 
we mixed a lot with well-educated people. We saw how they approached people, 
communicated with people, and we learned from this …” (Sub-District Working 
Group)
“Since I joined High Five, I’ve become more patient …” (Sub-District Working 
Group).
a. Challenges and Their Potential to Result in Non-Achievement of Program 
Objectives 
As the nature of the High Five CBTS program is closely related to behavior, meaning that it is 
orientated towards changing people’s mindsets and actions, the principal challenge faced was 
the reaction elicited from the people themselves. The following are some aspects related to 
people’s reactions to the Sub-District Working Group in the High Five Program sub-districts.
1. The response of people when invited to take part in High Five Program was constrained by 
(i) lack of time to attend meetings; (ii) a small number of residents were apathetic, or even 
tried to turn other residents against High Five Program. 
“… We got together at 7 pm, but we were often late…” (Sub-District Working 
Group)
“… it was not possible to involve the people of the housing complex as they were 
busy so it was difficult for them to attend meetings …” (Sub-district Head)
“… We provided encouragement, but there was one provocateur who got all 
heated, he even affected us …” (Sub-District Working Group)
“… There was one guy who was really egoistic, he claimed I was paid, got 
facilities. He was a provocateur …” (Sub-District Working Group)
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Among the arguments used by a small group of people to discourage others from participating 
in the CBTS program were the following:
 The volunteers are paid, and this is a waste of government money, which should be 
used for public purposes in the hygiene and sanitation fields. In reality, the volunteers 
were not paid and did what they did out of a sense of vocation and commitment to the 
ideals of High Five Program. 
 The rumormongers were only prepared to become involved if they were paid as they 
were convinced that the program had a lot of money to spend.
2. The funding available under the High Five Program for the construction of facilities is 
inadequate.
According to both the Sub-District Working Groups and the municipal government, the funding 
provided by High Five Program for the development of sanitation facilities is too small, and that 
it is difficult for the community self-funded model to work giving that most of the people in the 
relevant sub-districts are living close to the poverty line. People who are genuinely poor are not 
capable of funding the development of infrastructure, including the development of sanitation 
infrastructure.
“… building such an installation is expensive, they would need help … it would be 
great if High Five were able to help …” (Sub-District Working Group)
There were a number of constraints that arose in Surabaya that were primarily internal to the 
Sub-District Working Groups and their relations with local people. Such constraints had the 
potential to disrupt the High Five Program. Examples are as follows:
3. It was not easy to find residents to act as unpaid volunteers. Even though a person had 
been active in the area in a particular program, this was no guarantee that he or she would 
be willing to work as a volunteer for the High Five Program. Constraints included lack of 
time (busy with work or in the home), or the person concerned wanted to spend more time 
with his or her family and so was unwilling to devote any more time to volunteerism.
“… I knew that Ibu (Ms) Ninik could disseminate information in the community 
because she was involved in all sorts of activities, like senior citizens, PKK, youth 
organizations, but she didn’t want to …”
4. Even after the volunteer/Working Group teams had been established, this was no guarantee 
that everything would run smoothly. There was still the possibility of team members 
“dropping out” over the course of the program due to time constraints. 
“… At the relevant times he had to work as a teacher, so he had to drop out. The 
problem was, it was not easy finding a replacement for him… “ (Sub-District 
Working Group)
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5. The Sub-District Working Groups lack self-confidence in providing encouragement in their 
areas. As a result, they were often dependent on the High Five Program team.
“… They were really dependent on High Five. What I mean is, when they were 
encouraging people, they often lacked self-confidence to do it themselves. So we 
had to help them…” (District Leader)
6. In the particular case of program implementation in the schools, the communication 
appeared to lack intensity. This had an impact on the project’s success in changing the 
mindsets of the schoolchildren.
“… there was a lack of intensity. High Five should have had meetings every two 
months. God willing, this would have changed mindsets more quickly. Because 
what we need is to work harder to change people’s mindsets (in the vicinity of 
the schools, including the students), we need more students to be involved. To 
date, there has only been 5 in each school. It should be increased to 10, then 
things would move more quickly …” (teacher who received training)
As regards the City Working Group, the constraints on achieving the High Five program 
objectives were as follows:
7. Lack of collaboration between the High Five Program Surabaya and the relevant local 
government agencies, like the Communications and Information Agency. The collaboration 
was deemed to be inadequate as it was still on an unofficial basis and lacked intensity. 
Thus, the Communication and Information Agency did not fully understand what High Five 
Program was doing, and as a result did not know what it could do to help.
“… High Five could not rise above the coordination level (with the 
Communication and Information Agency) …” (Communication and Information 
Agency)
“… I would have liked to see our partners regularly coming here so that that we 
could share information. As it was, there was a lack of information .sometimes 
when we called, there was no one to talk to us. We were invited to coordinate at 
the SKPD (Satuan Kerja Perangkat Daerah - Regional Working Units) meetings… 
so before taking action, what we need is a report on the desk …” (Provincial 
Health Agency).
8. The High Five Program work area was considered relatively restricted when compared with 
the overall work area of the Surabaya Government.
“… it should have been rolled out on a bigger stage by High Five. While this 
might have implications for quality, at least the majority of people in Surabaya 
would know about the 5-pillars program. So in future, the pilots should not be 
confined to two areas, but should be expanded to 4 or even 10 areas, given that 
there are a large number of sub-districts in Surabaya …” (City Working Group)
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b. Steps that Can Be Taken to Prevent the Challenges Resulting in Non￾Achievement of Program Objectives
The constraints described above need to be responded to quickly by High Five Program so that 
it can achieve its objectives. Among the responses that are urgently needed are the following:
• High Five Program should intensify its relations with the relevant municipal agencies, like 
the Communication and Information Agency. Such collaboration should stress the respective 
roles of each side, and what is agreed upon between the parties should be set down in 
black and white. This is necessary if the role played by the Communication and Information 
Agency is to be expanded in voluntarily and sincerely supporting the High Five Program
CBTS program in Surabaya by more intensively and effectively disseminating information to 
the public.
“… High Five should not just be about coordination, but should be more 
systematic so that it can participate in municipal government programs … 
systematic in the sense of identifying what can be developed in the future in this 
respect … “ (Communication and Information Agency)
• As regards matters related to the work patterns and activities of the Sub-District Working 
Groups, general speaking the volunteers have taken action to overcome the challenges 
faced, including by:
- Making approaches to those in the community who spread false and destructive 
information, and explaining that the volunteers work free of charge, rather than being 
paid out of public funds that should be used for other purposes.
“… We made the approaches … Since High Five started, we’ve learned to be 
patient. At the outset however, we used to get angry…” (Sub-District Working 
Group)
- Coordinating with the field team if a volunteer planned to leave the program for the 
purpose of finding a replacement, or a new Sub-District Working Group member who 
would be willing to voluntarily commit his or her time to the High Five Program. 
“… It wasn’t easy to find replacements, I was difficult for me. So I always 
coordinated with Ibu Ratih, the coordinator in Surabaya, if we needed to find 
someone new …” (Sub-District Working Group)
“… What we wanted for the Working Group were people with a social 
conscience, people who were really willing to volunteer their time …” (Sub￾District Working Group)
- When High Five Program is about to end its program in the selected sub-districts, the 
volunteers in the Working Group need to be prepared so that the program can continue 
after High Five Program leaves. In this respect, High Five Program needs the support 
both of government and NGOs.
“… I think it can continue and support for the sanitation program, even beyond 
sanitation, can be increased, we’re ready to help …” (Municipal Revenue Agency)
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“High Five can continue on a sustainable basis, helping people, even after the 
system they have been operating to date changes…” (Municipal Revenue 
Agency)
As regards the efforts to prepare the volunteers on the Sub-District Working Groups so 
that the program can be sustained, the following issues need to be considered:
 An extension of the High Five Program’s duration
“… It needs to be extended (the program’s duration) so as to make people better 
aware…” (Wonorejo Sub-district Head)
 The provision of training to the volunteers on both soft skills (how to approach, 
interact with and influence people) and hard skills (knowledge of sanitation and 
hygiene) so that the program can be sustained by the community.
“Training, what’s important is that we can help the people understand …” (Sub￾District Working Group)
The provision of training on soft skills and hard skills will have both a direct and indirect 
on the self-confidence of the Sub-District Working Group volunteers and better equip 
them to speak when providing encouragement, socialization and so forth.
After they have been trained, they will also need additional formal training on public 
speaking, similar to what has already been provided by the High Five Program team.
“… we also encourage them, we encourage them on the ground. They lack self￾confidence, so we say, ‘go on, you can do it, just think of High Five …’, we 
always encourage them. We push them a little bit, we encourage them to speak 
first, but maybe we take over later. But we always continue to encourage them 
…” (District Leader)
 Teaching the community how to raise funds for facilities, for example, approaching 
the government so as to obtain funds or take over some program that has already 
been underway.
“… So , like the PNPM (Program Nasional Pemberdayaan Masyarakat Mandiri – 
National Program for Community Empowerment) in the DKN (Dewan Kehutanan 
Nasional-The National Forest Countil) is already involved in sanitation, it can 
provide part of the paving, this could be in the sanitation sector, although it’s 
difficult to get funds … “ (Sub-District Working Group)
 Teaching the community how to connect with other relevant parties who are willing 
to collaborate by providing funding for the development of public facilities (such as 
universities, etc)
“ .. it would be great if High Five could help, perhaps they could help by getting 
assistance from the government (for the development of public facilities) …” 
(Sub-District Working Group)
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“… we need third parties to help, like Pundi Amal SCTV, to help with the physical 
work, so as to heighten the awareness of the public …” (Wonorejo Sub-district 
Head)
c. Role of High Five Program in Integrating CBTS into the SSK Program 
SSK was prepared in 2010 as one of the outputs of the urban sanitation acceleration program. 
It was designed jointly by the Working Groups in the relevant municipal agencies based on the 
SKPD of each agency. The process was coordinated by Bappeda (Badan Perencanaan Daerah – 
Local Development Planning Board) (now known as Bappeko – Badan Perencanaan 
Pembangungan Kota Surabaya – Surabaya City Development Planning Board).
“… back then at the start, we mediated with the City Sanitation Working Group 
to obtain information in the form of the sanitation white book. So there is already 
a SSK for Surabaya. So Surabaya already has a Sanitation Working Group, which 
involves a large number of SKPD agencies related to sanitation. This was 
required by the central government … “ (District Leader)
As the SSK was prepared prior to High Five Program’s arrival in Surabaya, High Five Program
has no official role to play in integrating CBTS into the Surabaya SSK. In addition, the SSK is 
more closely related to PHBS (Perilaku Hidup Bersih Sehat – Healthy and Clean Living Behavior)
because at that time CBTS was not a familiar concept. PHBS was better known and more 
popular as the program was designed by the Ministry of Health. CBTS only became a familiar 
concept at the end of 2010.
“… the Health Agency’s STBM program started in 2012 and was based on 
Minister of Health Decree No. 5 of 2008. This was primarily aimed at rural areas, 
and was only expanded into urban areas in 2012. So it was something new in 
the cities, although it had long been underway in the villages…” (City Working 
Group)
 Hygiene and sanitation programs that had been operated in the High Five Program sub￾districts and in Surabaya Municipality in general include:
- USRI (Urban Sanitation and Rural Infrastructure in collaboration with Public Works, this 
program was focused on the supply of drinking water).
“… While High Five Program collaborated with the Ministry of Health, USRI was 
one sanitation program, but operated by Public Works. STBM was promoted 
through USRI, development through USRI, and was funded by the World Bank 
…” (City Working Group)
- APPSANI (Asosiasi Pengelola dan Pemberdayaan Sanitasi Indonesia - Indonesian 
Association for Sanitation Management and Empowerment), which carried out a 
program to promote the construction of compatible concrete septic tanks (not requiring 
a lot of land), which could be paid for by installment.
- INDI, which carried out work in connection with the sanitation master plan. 
- Green & Clean (promotion, competitions based on liquid and solid waste 
management). 
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- Collaboration between Sub-District Working Groups (excluding the City Working 
Group), World Vision and Wahana Visi on hygiene and sanitation at the sub-district 
level. World Vision focused on environmental cleanliness efforts (such as mutual self￾help and voluntary work to keep residential areas clean), while Wahana Visi focused 
on developing educational facilities.
“… World Vision Surabaya provided rice, tissue, nuts … was involved in 
organizing voluntary work …” (Sub-District Working Group)
“… the people of Wonorejo really need the help of High Five, because it is a 
densely populated area – if I compare High Five with Wahana Visi, which was 
also from America, their programs are very different. They provided milk, rice 
and so forth, the people were encouraged to keep the streets clean, but it wasn’t 
educative. But High Five Program is educative and provides solutions …” 
(Wonorejo Subdistrict Head)
- CLTS (Community Led Total Sanitation) was mentioned by the City Working Group 
(but was not familiar to the Sub-District Working Groups). This was stated as being 
similar to what High Five Program was doing in connection with CBTS.
“… the CLTS program was not the same in each area. They tried to encourage 
people by providing examples, such as, what would happen if we continued to 
practice open defecation, if feces entered the water, who would want to drink it. 
Things like that. Its implementation was more gradual in nature … (City Working 
Group)
- IUWASH (mentioned only by the Provincial Health Agency) was operated in close 
coordination with the Provincial Health Agency. They provided training on 
entrepreneurial sanitation, facilitator training, also facilitate partnerships.
“… compared with other partners, IWASH focused on community sanitation 
through the provision of entrepreneurial training in the sanitation sector, 
providing training to facilitators, providing training on facilitating with 
partnership, things like that. Maybe High Five is doing similar things, we don’t 
really know as we rarely meet. However, IWASH came here regularly, we were in 
close touch …” (Provincial Health Agency)
 Improvements Brought About by High Five Program 
The High Five Program was considered to have played an important role in changing the 
mindsets and behavior of people in the selected sub-districts. After having been 
provided with socialization and training, people were now more hygienic and aware of 
the need to maintain environmental hygiene.
- Assisting the City Working Group’s CBTS program in changing behavior 
“… The Health Agency is very happy that High Five has been able to assist us. 
We were at first confused by what was meant by CBTS. So the High Five 
Program was a major help to us …” (Municipal Health Agency)
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“… There has been a change in people’s behavior since High Five arrived on the 
scene. There were similar programs before but they never worked well. So, High 
Five’s arrival resurrected the effort. The change in behavior has occurred 
because High Five made people aware and provided outreach, and also the 
Working Groups regularly remind people to always adhere to clean and healthy 
practices. Sometimes people forget and have to be reminded. The change in 
behavior is not due solely to High Five, however, but also to other parties, such 
as Green & Clean (an NGO), which originally introduced the program, Pundi Amal 
SCTV, and the municipal government itself. However, High Five has played the 
dominant role … “ (Wonorejo Sub-district Head)
- People now willing to voluntarily separate garbage 
“… yes, there’ve been changes. For example, toilet waste is no longer 
contaminating the drains and river as people now have their own toilets and 
septic tanks, constructed with the people’s own money. They also now regularly 
collect and separate garbage as they know it has economic value as it can be 
turned into compost …” (Wonorejo Sub-district Head)
- Empowering the community by enhancing people’s incomes
“… the volume of garbage has fallen, people now know not to dump it willy-nilly. 
All garbage can be used to generate income …” (Sub-District Working Group)
- Controls exercised by community groups 
“one of the reason is self awareness, now we are discussing about involving the 
community, automatically we don’t have to remind them anymore, from their 
own community they should now know not to do this and not to do that. So they 
are reminded by their community hence we don’t have to remind them anymore”
(Pokja Kelurahan)
C. Efficiency
As regards efficiency, the most appropriate sources are those from within High Five Program
itself, namely, those responsible for implementing the CBTS Program in their respective areas. 
The following are the results of an interview with the High Five Program District Leader in 
Surabaya. 
a. Use and Allocation of Resources for Program Implementation 
In the implementation of the CBTS program by High Five Program in the selected sub-districts, 
funds were allocated based on the annual plan (and the monthly breakdowns). The proposed 
program activities for the following year were submitted by each district/city to High Five 
Program head office in Jakarta. Obviously, the proposed programs were discussed with other 
districts before being submitted to Jakarta. The program plan and the required resources were 
also based on the objectives that it was wished to achieve.
“… Each year we produced a work plan. In Surabaya, for example, we planned 
what we were going to do in the following year, with details of proposed 
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activities and the required budget for each month. We would set out how much 
we needed for activity A, for activity B, this was done for each month over the 
course of one year …” (District Leader) 
Although detailed budget plans for each month had been prepared, this did not result in 
inflexibility during implementation. It was possible to accelerate or decelerate activities in line 
with developments in the field, or in connection with the programs being carried out by other 
parties.
“… we submitted proposals for a full year to High Five Jakarta. But this did not 
mean that things were set in stone. Activities could be accelerated or postponed, 
and the budget could be adjusted accordingly …” (District Leader) 
With regard to program funding, High Five Program, which was funded by USAID, was 
regarded by the people affected by the program as having access to very large funds. However, 
people were informed that the program was aimed at changing behavior rather than funding 
infrastructure development and that it was not a very heavily funded program. As a result, 
people began to understand the real situation.
“… At the start when we launched our program, the impression among the 
people was that High Five, as an outside body associated with USAID of America, 
had a lot of money and would have a lot of programs in the sub-districts. But 
from the outset we told them that we had no money, we had only so much
resources, that we were focused on changing behavior. In this way the people 
eventually came to realize that our program did not involve a lot of expenditure 
…” (District Leader) 
While there was enough money to provide things like equipment so as to be able to pursue 
normal operations, there were funding limitations as regards personnel. As a result, it was not 
possible to undertake a number of activities (such as monitoring and evaluation) due to a lack 
of personnel. There were also problems with a lack of administrative personnel.
b. Comparison Between Use of Resources and Achievement of Program Objectives 
If we compare the use of resources and achievement of program objectives, the ratio in 
Surabaya stood at between 70% and 80%. This means that some resources went unused as a 
result of changes in plan on the ground. These changes in plan resulted from some activities 
not being capable of being undertaken until such time as approaches, both formal and informal, 
had been made to the relevant municipal agencies.
“… Like I said, we had an achievement rate of 70-80% in Surabaya. The hope is 
that we will be able to strengthen people’s resolve so that they will be able to 
carry out these activities at their own behest, without having to rely on High Five 
Program. The second thing that is still a challenge for me at the municipal level 
is how to make them see sanitation as an integrated issue so that CBTS is not 
just the responsibility of the Health Agency but rather of everyone. We are still in 
the process of making formal and informal approaches to the City Working Group 
so as to bring this about…” (District Leader) 
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c. Program Adaptation and Implementation 
Adaptations in the program occurred due to external factors, including other relevant 
stakeholders (particularly the City Working Group). This had consequences for the allocation of 
available resources. While expenditure exceeded the budget, the overrun was not significant.
“… spending, there wasn’t a big difference. The difference overall was 
reasonable and quite small. It wasn’t like an overrun from 10 million (rupiah) to 
100 million (rupiah). If it goes from 10 to 9 million (rupiah), or from 10 million to 
12 million (rupiah), that’s acceptable.” (District Leader) 
“… for example, when we invited the mayor, the plan was for just a small event. 
But in the end thousands of people turned up. This wasn’t in line with the plan. 
Originally we had expected 1,000 (people), but 2,000 (people) turned up. While 
this was unexpected, it was nevertheless positive. It was because our work with 
the people was dynamic so that we couldn’t always predict outcomes …” (District 
Leader) 
Taking into consideration all aspects related to the allocation of resources vis-à-vis the 
achievement of program targets, the High Five CBTS program in Surabaya may be said to have 
been efficiently implemented from the qualitative perspective as it optimized the use of 
available resources and achieved up to 80% of the program targets. As regards the increase in 
the number of personnel in the High Five Program Surabaya team, it is to be hoped that the 
level of program achievement will increase significantly during the remainder of its duration.
D. Sustainability
a. How do the stakeholders perceive the High Five Program methodology compared 
with CLTS?
At the Sub-District Working Group level, people were not familiar with CLTS, even though they 
had experience of a variety of sanitation programs in their areas. By contrast, the members of 
the City Working Group (particularly the Health Agency) were familiar with CLTS. High Five 
Program was considered to be identical to CLTS, although it was stated to be more 
responsive/sensitive in its approach to the community. The differences in the High Five Program
approach to the community that were considered favorably were as follows: (i) it did not lecture 
the people; and (ii) it did not provide assistance, but encouraged people to fund their own 
needs in the hygiene and sanitation fields.
“… High Five was similar to CLTS, but probably more advanced. CLTS was not 
applied in the same way in each area. They tried to encourage people by 
providing examples, such as, what would happen if we continued to practice 
open defecation, if feces entered the water, who would want to drink it. Things 
like that. Its implementation was more gradual in nature. We had to explain 
things, check out locations. So, High Five was more advanced, better suited to 
encouraging people, more responsive to the people…” (City Working Group)
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b. Feedback from stakeholders on the Method Applied by High Five Program 
Both the City Working Group and the Sub-District Working Groups were aware of how the High 
Five Program commenced, that is, by inviting the participation all components of society in the 
High Five Program areas (youth, religious leaders, local administrators, residents, and even 
children). This was followed by encouragement: mapping, surveying the area, FGDs and the 
establishment of the Working Groups. The Working Groups (both at the city and sub-district 
levels) were aware of the activities on which High Five Program was focused, namely, changing 
people’s mindsets and behavior in connection with the CBTS program.
The City Working Group and Sub-District Working Groups were of the view that High Five 
Program was very helpful and that it had played a major role in changing behavior, which they 
acknowledged was not easy (in fact, some said it was impossible) through training, continuous 
mentoring, the furnishing of practical examples, and monitoring.
For the private sector organizations involved in providing financial assistance to High Five 
Program, they had selected High Five Program as they had a positive view of what High Five 
Program was doing in Surabaya.
“… It was focused. It was carried out by real experts, and we were also involved. 
I was involved in everything, from the training material up to the outcome of 
training in the field. In my view, other private sector organizations could do like 
this. We were invited to see how High Five provides training to candidate 
motivators in the community, and to see their practices in the field. This 
encouraged the private sector to participate as it was not just about theory and 
money. They are kept abreast of everything from the very outset … “ (Private 
sector partner)
The fact that the High Five Program approach was participatory also encouraged other partners 
(NGOs) to get involved.
“… in my view, High Five has a different type of network. For example, if they 
have a meeting, they invite people from the municipal government, academics, 
NGOs, and the public at large. That’s good. When other programs hold meetings, 
the only invite working group and no one else. The working group then go back 
into their own sub-districts. But High Five invites academics, and people from the 
relevant municipal agencies – health, sanitation and environment, and also 
representatives of the public …” (Other Partner – NGO)
“… I felt it was very good (the way in which High Five forges partnerships with 
other stakeholders). I read about it in the media, on the Internet, I heard from 
my colleagues about High Five. When I crosschecked by email, the Web, 
especially Google, the news was good. High Five Program’s networking is very 
good. I saw Ibu Risma arrive, I also felt welcome. Not just because there were a 
number of ITS (Institut Teknologi Subaya – Surabaya Technology Institute)
alumni working with High Five, but also because of the environmental work 
being done by High Five. It wasn’t just because of the alumni. What was being 
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done by High Five, what we were doing, there was no miscommunication as far 
as I could see …” (Other Partner – Academia)
How High Five Program trained its trainers (during the seminars organized by High Five 
Program) was also viewed positively by the Other Partners (in this case, NGOs), and this had an 
impact in the forging of close and solid partnerships.
“… What I saw when I attended a training seminar, I myself was trained as a facilitator 
by High Five, the seminar was better and more interesting, interactive, so that the 
members of the audience didn’t become bored. None of the others do it like that. 
Normally people are treated as objects, but High Five Program treated them as subjects, 
training subjects …” (Other Partner – NGO)
Appreciation of High Five Program on the part of the stakeholders was also evident from the 
willingness of people to attend the events organized by High Five Program. 
“… I really appreciate High Five’s activities. On the official side, their events were 
well attended by government people, particularly by those from agencies related 
to hygiene and sanitation – people from the Health Agency, Education Agency, 
Public Works. They were also good at networking, they really understand how to 
work together with others. And High Five also took concrete action. When the 
invited the public, they also invited youth. They involved a number of schools to 
promote simple things like washing hands with soap. So, that was on the 
official/formal side, when they themselves acted in a semi-formal manner. But 
they were also able to give serious education on washing hands with soap. This 
could reduce deaths from diarrhea by 30-40%. So, I thought it was great …” 
(Other Partner – Academia)
However, the implementation of CBTS by High Five Program in Surabaya in the eyes of other 
partners (in this case journalists) did not sufficiently involve young people.
“ while their programs were good, they need to intensify their campaigning and 
socialization work on a sustainable basis. This is not being done optimally right 
now, especially among the youth. It’s still not enough. This would touch the 
people directly …” (Other Partner – Journalist)
c. Contribution of High Five Program to Development of AMPL (Air Minum dan 
Penyehatan Lingkungan – (Working Group on Water and Sanitation) Working 
Group’s Functions 
High Five Program’s work (although confined to only 2 sub-districts in Surabaya) was deemed 
to have helped enhance the development of the Working Groups. Synchronization in the 
performance of various duties (the City Working Group verified that High Five Program had 
provided mentoring in connection with with the implementation of the CBTS program) was one 
of the contributions of High Five Program, according to the Surabaya City Working Group. The 
success of High Five Program in providing mentoring for the implementation of the CBTS 
program was verified by the Health Agency.
“… for example, whether or not a sub-district is open defecation free needs to be 
verified. So, we conducted surveys to see if this was the case. For instance, not 
one person should be defecting in the river. So this year, the Health Agency, 
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using its existing budget, plans to verify whether sub-districts that are stated to 
be open defecation free are in fact open defecation free …” (Health Agency)
d. Possibility of Program Replication
This aspect is dealt with in IR1 on “Replication of High Five Program Sub-district Program by 
local governments and/or NGOs.”
E. Relevance and Appropriateness
Our information on relevance and appropriateness was obtained from a number of different 
sources: the High Five Program team, community leaders (sub-district heads), Working Groups 
(City and Sub-district), teachers and households. The following are the results of the interviews 
with the sources.
a. How is the Participatory Approach Carried Out?
People were familiarized with the participatory approach in the selected sub-districts from the 
very outset of the program. Invitations were sent out to attend social mapping events, and 
these received a warm response from the public. The invitations were addressed not just to 
adults, but also to youth and even children.
“… There was no criteria. After socialization at the district level, the sub-districts, 
together with the sub-districts heads, gave lists of RWs that suffered from 
sanitation problems. This was followed by social mapping in each of these RWs, 
involving men, women, teenagers, children. Whoever was interested and 
whoever was concerned with these issues then worked closely with us. We had 
no criteria. What was important was that they had to be willing to work for the 
community …” (District Leader)
“… Everyone in the RT was invited, it was also attended by the mayor, by 
representatives of the Municipal Health Agency, local residents, everyone 
attended …” (Sub-District Working Group)
“… I was invited by High Five to the first event in the sub-district, I was also 
there for 2 days at the restaurant on Jl. Kedungsari …” (teacher who received 
training)
After groups had been formed during the meetings, they jointly conducted a mapping process 
to describe their areas and the conditions in those areas.
This participatory approach was of great benefit in supporting the successful implementation of 
the CBTS program, bearing in mind that all components of society were involved. As a result, 
they were prepared to work hard so as to ensure the success of the CBTS program and the 
resolution of hygiene and sanitation problems in their areas.
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“… Like I said earlier, High Five had a wide perspective on how to motivate 
people, how to mobilize people, how to empower people. They provided physical 
help to the people so as to help change people’s mindsets about hygiene …” 
(Petemon Sub-district Head)
“… Other similar programs in the past suffered from differences in opinion 
among community leaders so that the programs were constrained. However, 
High Five’s approach to the people from the outset was more effective…” 
(Wonorejo Sub-district Head)
As regards the making of decisions when problems arose, High Five Program was also deemed 
to have involved the stakeholders.
“… Yes, for example, the Sub-district Head, the RW heads and so forth, were all 
informed by letter. The LKMK was also involved in decision-making. They also 
provided training in Bogor. Also for program evaluation, we were invited to a 
hotel in Surabaya. This shows that High Five involved local community leaders 
…” (Wonorejo Sub-district Head)
“ … Yes, there was no way High Five could have taken decisions directly without 
involving the Sub-district Head. So the Sub-district Head, after being informed by 
High Five, would coordinate with our partners, LKMK, RWs, RTs. Without their 
assistance, the program could not have operated. So High Five needed them 
(RTs, RWs) to help. It would have been impossible for them to work on their 
own …” (Petemon Sub-district Head)
The participatory approach was successfully implemented by High Five Program in Surabaya, 
and this resulted in many benefits. As stated by volunteers in the Sub-District Working Groups, 
people came to feel responsible for sanitation problems in their own areas (and the decisions 
taken in respect thereof) as a result of High Five Program’s participatory approach.
“… they highlighted problems in their own areas …” (Sub-District Working Group)
“…So, they started to focus on their own problems …” (Sub-District Working 
Group)
“… they became motivated and they began to know what they needed. We (the 
Sub-District Working Group) only accommodated what they said. We identified 
solutions together with the volunteers. That’s how it worked. So, it was the 
people themselves. By contrast, we used to tell them that they needed a toilet, 
needed this, needed that. It’s not like that anymore. It’s the people themselves 
who say it now (that they need a toilet) …” (Sub-District Working Group)
b. Determining Hygiene and Sanitation Priorities
In Surabaya, where the level of awareness of hygiene and sanitation issues was already high, 
and where people were familiar with garbage management so that garbage banks had already 
been set up and communal garbage processing facilities established, the arrival of High Five 
Program helped to focus people’s minds on the 4 pillars.
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However, it was only after a number of High Five Program socialization events on CBTS that 
people became aware that there were still problems related to the other pillar in Wonorejo and 
Petemon, such as the fact that there continued to be households that lacked private toilets and 
that toilet waste was still being discharged into the river. Nevertheless, at the outset High Five 
Program focused on the four pillars as an entry point.
“… in Surabaya, when we talk about CBTS, people also referred to the four 
pillars related to garbage. It was like that at the beginning, but that was OK. We 
also focused on the 4 pillars related to garbage – there were a lot of garbage 
banks already in Petemon and Wonorejo sub-districts, as the government had 
been focusing heavily on this issue. But as time went on, we informed people 
that CBTS consists of 5 pillars. So in the end they came to realize that there were 
still a lot of households without private toilets, still a lot of communal toilets, still 
a lot of toilets discharging into the drain. This was also a priority. So, we started 
with the 4 pillars. We continued to socialize pillars 2 and 3, but in the end they 
realized that pillar 1 was a problem. Meanwhile, pillars 2 and 3 also continued to 
receive attention …” (District Leader).
If each of the individual programs implemented under the different CBTS pillars are evaluated, 
then it may be said that High Five Program worked on all of the CBTS pillars. However, 
implementation was still small in scope and so what High Five Program has done to date cannot 
be considered capable of resolving all sanitation and behavioral problems in the selected sub￾districts.
“… Because not all community leaders were involved, besides the original 
sampling (RWs 4, 6, and 7) community leaders still need to be made aware. This 
will take time. If it is successful, then they will come on board. But it will take 
time to make them aware. Overall it hasn’t solved all of our hygiene and 
sanitation problems, but it is still running. It has produced results, people have 
started to be able to do things for themselves. They have started to order toilets 
from High Five, which they can pay for by installment …” (Wonorejo Sub-district 
Head)
In addition, sanitation issues also concern support infrastructure and facilities, something that 
was not a focus of High Five Program, which was primarily orientated towards changing 
mindsets and behavior. That fact that High Five Program was not involved with the 
development of infrastructure and facilities led to a perception that High Five Program could not 
fully resolve sanitation problems in the selected sub-districts in particular, and in Surabaya city 
in general.
“… when we talk about sanitation, we should not just be focused on toilets, but 
rather on a program run by the municipal government, that is undertaken by all 
of the related local government agencies – the Sanitation and Parks Agency, 
Highways Agency, which is responsible for drainage, waste and garbage 
management. So, when we talk about sanitation, it’s not just enough to focus on 
the residents …” (City Working Group)
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“… High Five provided a great deal of assistance with the 5-pillars program. But 
if we look at the bigger picture, Surabaya consists of more than just Petemon …” 
(Petemon Sub-district Head)
c. Inclusion of Gender and Environmental Issues in Program Implementation
Environmental and gender issues have been a continual focus of attention in the 
implementation of the CBTS program in Surabaya, where, automatically, the role of women on 
the ground was predominant, as evidenced by the fact that the majority of volunteers were 
women, as well as the fact that the majority of people approached by High Five Program were 
also women. This was because women were better suited to making approaches and to 
conducting socialization work in the community (particularly among mothers) as they played a 
strategic role in household management. The media that was employed was also very much 
women focused, such as the use of ‘arisan’ (social gathering often involving informal savings 
and credit schemes) get-togethers for socialization purposes.
It was also natural that the environment should be an important consideration in decision￾making on the ground in connection with the resolution of hygiene and sanitation problems. 
When resolving the problems under pillar 1 (on toilets and septic tanks), land was an important 
issue due to the densely populated character of the High Five Program sub-districts. People 
were encouraged to come up with solutions, and these were then communicated for discussion 
with the High Five Program team. In this way, High Five Program was able to consider the 
choice of locations based on the availability of land and environmental issues.
d. Most strategic approach in identifying needs of stakeholders 
High Five Program Surabaya made maximum efforts to get all stakeholders involved in the 
implementation of the CBTS program. However, the desired outcomes were not always 
achieved, particularly as regards communication and cooperation with the City Working Group. 
This was due to the fact that the related local government agencies (except for the Health 
Agency) were under the impression that the implementation of the CBTS was not relevant to 
their respective areas of responsibility (for example, the Public Works Agency, PDAM, etc) so 
that High Five Program was always told to coordinate solely with the Health Agency.
“… Coordination with the Health Agency was easy, they were also open and 
ready to help facilitate High Five. However, the fact that CBTS was always put at 
the door of the Health Agency was a problem for us as regards its integration 
into the ‘home work’ process and in connection with time considerations …” 
(District Leader)
As regards other stakeholders, such as work partners (private sector, universities, NGOs), the 
choice of who to consult and who to collaborate with on particular issues was made after a 
particular sanitation issue had been identified, having regard to the relevance of the partners 
particular area of expertise. 
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“… Why choose them? Why? Because, for example, CIBI (Cita Bina Insani 
Foundation), which had the Bina Mandiri Waste Bank, they were the only ones, 
they were the ones who could most help the public to get to the waste bank, 
and were able to provide comprehensive mentoring…” (District Leader)
“… Pusdakota Ubaya (Pusat Pemberdayaan Komunitas Perkotaan - Center for 
Urban Community Empowerment) because they have long been known as an 
NGO that is aware of environmental issues …”(District Leader)
“… We are working more with ITS because they are also involved in the CBTS 
process. So it’s only fitting that previously when we were running the hand 
washing with soap campaign that we sent them the installations. We paid for the 
design, but not for the workmen. We just provided the materials and they did 
the rest …”(District Leader)
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Part V 
Evaluation of Program Outcomes
Hygiene and Sanitation Practices under the Five CBTS Pillars
A. Open Defecation Free 
The majority (more than 80%) of respondents (both in Wonorejo and Petemon) said that the 
last time they defecated was in their own private toilet. The situation in Wonorejo was the same 
as it was at the time of the 2012 baseline survey, while in Petemon at the time of the baseline 
survey, 10% of respondents (including other adults in the household) used a shared toilet or 
communal toilet the last time they defecated.
In Petemon, 100% of respondents said they used flush toilets discharging into a septic tank, 
although observations revealed that only 93.3% of toilets discharged into a septic tank (with 
the remainder discharging directly into the river or not known where they discharged).
A total of 83.3% of respondents in Wonorejo last defecated in their own private toilets 
connected to a septic tank, while the remainder used a shared toilet. Based on observations, a 
total of 86.7% of toilets in Wonorejo discharged into septic tanks, while the remainder (13.3%) 
discharged into the river.
The above data reveal that there has been an increase in the proportion of residents with their 
own toilets discharging into a septic tank (during the two years since the time of the baseline 
survey and midline survey). However, Wonorejo and Petemon were still not free of open 
defecation.
The following presents data on last place of defecation based on respondent claims and 
observations:
Table 5.1
Observations on Discharge of Toilet Wastewater 
Description Wonorejo Petemon
Respondent Base 30 30
Location of last defecation – by claim 
Flush toilet discharging into septic tank 83.3% 100%
Last defecation in communal toilet, toilet without septic tank 16.7% -
Place of final discharge of toilet wastewater – observations
Septic tank 86.7% 93.3%
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Description Wonorejo Petemon
River/lake/sea 13.3% 3.3%
Not visible - 3.3%
Toilet Conditions in General 
Based on observations in the field, it was found that almost all households that had under-5s 
(81.7%-93.3%) used U-bend toilets (both squat and sit-down). In Wonorejo, the households 
that originally used drop toilets (6.6% at time of the baseline survey) all used u-bend toilets at 
the time of the midline survey (in 2013). The use of u-bend sit-down toilets declined by 10% 
from 16.7% in 2012 to only 6.7% in 2013.
In Petemon, the types of toilets used were the same at the time of the baseline survey in 2012
and the midline survey in 2013, namely, 93.3% squat toilets and the remainder sit-down.
Figure 5.1
Type of toilet - Observation
 
Still based on observations, overall the majority (90%) of toilets were in the home in both 
Petemon and Wonorejo. In Petemon, the remaining 10% were between 2 and 5 minutes away, 
while in Wonorejo the remaining 10% were between 2 minutes and 7 minutes away. 
As regards the condition of the toilets, they were found to be quite clean (66.7% in Wonorejo 
and 76.7% in Petemon), while 30% were categorized as dirty in Wonorejo and 20% in 
Petemon. A comparison of toilet conditions in between the baseline survey and midline survey 
reveals that there was an improvement of 11.7% in Wonorejo and 8.4% in Petemon. While the 
Baseline Midline Baseline Midline
6,7%
76,7% 93,3% 93,3% 93,3%
16,7% 6,7% 6,7% 6,7%
Flush/U-bend sit-down toilet
Flush/U-bend squat toilet
Non-flush toilet draining into 
Wonorejo Petemon
Respondent base : 60
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size of the improvement was greater in Wonorejo based on observations, overall toilets were 
found to be cleaner in Petemon.
Figure 5.2
Toilet Condition - Observation
Table 5.2 below presents a more detailed description of toilets in households (with under-5s) in 
Surabaya.
Overall the condition of toilets in the two High Five Program sub-districts in Surabaya (at the 
time of the 2013 midline survey) was better than at the time observations were conducted 
during the 2012 baseline survey. Among the improvements are the following:
- Cleanliness (free of feces and sanitary napkins). Only one respondent in Petemon was found 
to have feces in the toilet. Similar, there was also a reduction in the number of toilets with 
flies (only found in Wonorejo, but decreased from 6.7% in 2012 to 3.3% in 2013).
- In both of the High Five Program sub-districts, only 6.7% of respondents lack running water 
in the tap. In Wonorejo, this marked an improvement of 20% compared to the baseline 
survey. In Petemon, 93.3% of respondents had running water in their taps at the time of 
both the baseline survey and midline survey.
- A water scoop was present in all of the toilets. By contrast, 13.3% of the respondents in 
Wonorejo and 3.3% in Petemon did not have a scoop in the toilet at the time of the 2012
baseline survey. 
The following table describes toilet conditions based on observations (at the time of the 
baseline survey and midline survey)
Baseline Midline Baseline Midline
50,0%
66,7% 70,0% 76,7%
3,3%
23,3% 23,3% 16,7%
16,7%
3,3%
30,0%
3,3% 6,7%
Quite dirty
Very Clean
Very Dirty
Dirty
Quite Clean
Wonorejo Petemon
Respondent base: 60
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Table 5.2
Toilet Conditions – Observations 
Condition of Toilet
Wonorejo Petemon
Baseline 
(n= 30)
Midline 
(n=30)
Baseline 
(n= 30)
Midline 
(n=30)
Feces in or on wall of toilet
Yes 10% - 16.7% 3.3%
No 90% 100% 83.3% 96.7%
Sanitary napkin in vicinity of 
toilet
Yes - - - -
No 100% 100% 100% 100%
Flies in vicinity of toilet
Yes 6.7% 3.3% 13.3% -
No 93.3% 96.7% 86.7% 100%
Water available (if tap, running 
water in tap)
Yes 73.3% 93.3% 93.3% 93.3%
No 26.7% 6.7% 6.7% 6.7%
Water scoop available 
Yes 86.7% 100% 96.7% 100%
No 13.3% - 3.3% -
Bucket/water container available 
Yes 86.7% 100% 96.7% 83.3%
No 13.3% - 3.3% 16.7%
Dry cloth/towel available 
Yes 43.3% 50% 40% 80%
No 56.7% 50% 60% 20%
As an additional criteria for assessing the first CBTS pillar in households with children under 3, 
at the time of the baseline survey in both Wonorejo and Petemon, less than half of respondents 
with under-3s said that their infants were toilet trained.
By the time of the midline survey in 2013, there had been an increase in the number of under￾3s who were toilet trained, with more than half of respondents with under-3s saying that their 
infants were toilet trained.
Figure 5.3 below shows the number (in absolute terms as the base number of respondents with 
under-3s was less than 30) of under-3s who are toilet trained.
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Figure 5.3
If you have children from the age of 0 – 3, can they defecate on their own on the toilet?
With regard to the last place of defecation of under-3s, disposable diapers were the last place 
where the under-3s who were not toilet trained defecated, while those who were toilet trained 
last defecated in to toilet (with the respondent for each sub-district being below the minimum 
sample size of 30 individuals).
Figure 5.4
Last location of defecate
Baseline (n=19) Midline (n=15) Baseline (n=21) Midline (n=15)
13
2
12
4
6
13
9
11
Yes, they can
Not yet
Wonorejo Petemon
Baseline (n=19) Midline (n=15) Baseline(n=21) Midline (n=15)
3 2 1 -
7
12
11
11
9
1
9
4 Diaper
Toilet at home
3 other responses
Wonorejo Petemon
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As regards where the feces of under-3s who last defecated in a place other than the household 
toilet were disposed of by caregivers, as will be seen from Figure 5.5 (in absolute terms as the 
base number of respondents was less than 30), in Wonorejo more than half of the caregivers 
(14 individuals) directly disposed of the feces into the toilet, while the remaining 6 directly 
disposed of the diapers, without first cleaning, in the trash can. Similarly in Petemon, almost all 
the caregivers (18 out of 20 individuals) disposed of the feces directly in the toilet, while the 
remainder disposed of the diapers, without first cleaning them, in the trash can.
Figure 5.5 shows where infant waste was disposed of by caregivers:
Figure 5.5 
Place of disposal of Infant Feces
The 2013 midline survey in Surabaya found that infants aged 3-5 were toilet trained, with the 
types of toilet being used being flush toilets discharging into septic tanks, flush toilets 
discharging into the river, and communal toilets (in Wonorejo). In Petemon, all children aged 3-
5 defecated in flush toilets leading to septic tanks.
In the 2013 midline survey in connection with children aged 3-5, the situation was almost 
totally open defecation free (save for 1 caregivers who said that her flush toilet was not 
connected to a septic tank).
How caregivers treated children after defecation is as shown in the following chart : 
Baseline (n=19) Midline (n=17) Baseline (n=21) Midline (n=20)
13 
14 
11 
18 
6 
3 
10 
2 
3 other responses
Directly disposed of in 
toilet
Wonorejo Petemon
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Figure 5.6
What Respondents Do after Children Defecate
Petemon showed a relatively significant change when compared to Wonorejo in connection with 
cleaning baby’s bottom with soap after defecation. In Wonorejo, there were still caregivers who 
cleaned baby’s bottom without soap after defecation, while one caregiver said that she washed 
her hands.
The table below sets out a summary of the data on the first CBTS pillar. It shows that while 
neither Wonorejo nor Petemon can be said to be open defecation free, there has been a 
significant improvement in pillar 1 as regards knowledge and behavior about defecation in 
appropriate places (including as regards the use of private toilets with septic tanks).
In a number of respects, Petemon demonstrated relatively greater progress when compared 
with Wonorejo, such as: number of homes whose toilets discharge into septic tanks, number of 
children with toilet training, and how caregivers clean their infants after defecation.
Baseline Midline Baseline Midline
93,3% 90,0%
70,0%
100,0%
6,7% 6,7%
23,3%
3,3% 6,7%
3 other answers
Wash child's bottom without 
soap
Wash child's bottom with soap
Wonorejo Petemon
Respondent base: 60
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Summary of First Pillar Findings: Open defecation free 
Table 5.3
First Pillar Indicator: Open defecation free 
Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Location where caregiver last defecated
Respondent base 30 30 30 30
Private toilet 83.3% - 90.0% -
Flush toilet with septic tank - 83.30% - 100%
Place where children aged 0-3 last defecated
Respondent base 19 15 21 15
Diapers 9 persons 1 person 9 persons 4 persons
Household toilet 7 persons 12 persons 11 persons 11 persons
3 other responses 3 persons 2 persons 1 person -
Place where feces of children aged 0-3 are disposed of – MA 
Respondent base 19 15 21 15
Directly into toilet 13 persons 14 persons 11 persons 18 persons
Cleaned first, dirty water disposed of in 
household toilet 2 persons 1persons 5 persons -
5 other responses 4 Persons 2 persons 5 persons 2 persons
Location where children aged 3-5 defecate
Respondent base 13 13 17 15
Private toilet 13 persons - 17 persons -
Flush/U-bend toilet connected to septic tank - 13 Persons - 15 persons
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
What is done after children defecate
Respondent base 30 30 30 30
Baby’s bottom cleaned with soap 93.3% 90.0% 70.0% 100.0%
Baby’s bottom cleaned without soap 6.7% 6.7% 23.3% -
B. Hand-Washing with Soap
In order to ascertain the extent to which respondents practiced hand washing with soap over 
the last 2 days, they were given multi response questions and responses related to bathing and 
clothes washing were ignored. The situation as regards washing hands with soap in Wonorejo
sub-district is as shown in the following chart:
Figure 5.7
Use of Soap in Last Two Days in Wonorejo Sub-district – Multiple Answer
Baseline Midline
100,0%
100,0% 90,0%
93,3% 100,0%
33,3%
63,3%
20,0%
80,0%
63,3%
33,3%
53,3%
16,7%
60,0%
30,0%
46,7%
10,0%
40,0%
60,0%
43,3%
Washing clothes / utensil
Bathing
Washing baby's bottom
Washing children's hand
Washing hands after eating
Washing hands after working outside
Washing hands after cleaning home
Washing hand after defecate
Washing hands after wiping baby's 
bottom
Wasing hands before feeding child
Washing hands before preparing a meal
Washing hands before eating Respondent base : 30
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The above chart shows the practices of caregivers in Wonorejo at the time of the 2012 baseline 
survey and 2013 midline survey. Overall, it will be seen that there has been a decline in the 
prevalence of washing hands with soap. This has occurred not just at critical times, but also 
outside of such times. For example, hand washing with soap before eating was practiced by 
60% of respondents in 2012, but by only 43.3% in 2013. Similarly, in 2012 a total of 93.3% of 
caregivers used soap to clean baby’s bottom, but only 33.3% said they did so in 2013.
Hand washing with soap practices in Petemon are as shown in the following chart:
Figure 5.8
Use of Soap over Last Two Days in Petemon Sub-district – Multiple Answer
Unlike in Wonorejo, in Petemon the prevalence of hand washing with soap showed a relatively 
big increase. For example, in 2012 only 13.3% of respondents washed their hands with soap 
after cleaning baby’s bottom, but this proportion had increased to 66.7% in 2013. Further, only 
3.3% of respondents washed hands with soap after defecation in 2012, but this had increased 
to 70% by 2013.
Each interviewed caregiver to an under-5 was assessed on washing hands with soap at five 
critical times, namely: (i) before eating; (ii) after feeding child, (iii) after defecation, (iv) after 
cleaning child’s bottom, and (v) before preparing food. Based on a score of 1 for each of the 
above behaviors, the maximum score receivable was 5. The following graph shows the overall 
scores (in absolute terms as the base number of respondents was less than 30): 
baseline midline
86,7%
93,3% 93,3%
100,0%
43,3% 43,3%
16,7%
50,0%
23,3%
73,3%
3,3%
70,0%
13,3%
66,7%
13,3%
73,3%
33,3%
26,7%
50,0%
Wash clothes/utensils
Bathing
Washing baby's bottom
Washing baby
Washing hands after eating
Washing hands after defecate
Washing hands after washing 
baby's bottom
Washing hands before meal
Washing dishes
5 other responses
Respondent base: 30
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48
Figure 5.9
Scores for Use of Soap at 5 Critical Times in Last 2 Days
As will be seen from Figure 5.9 above, the 2013 midline survey in Wonorejo found that the of 
respondents who washed hands with soap at the 5 critical times had fallen since the time of the 
baseline survey, when 12 respondents did so. However, by the time of the midline survey, no 
did so. This was accompanied by an increase in the number of respondents who only did so at 
1 of the critical times (up from 8 to 15). Meanwhile, only 1 respondent did so at 4 out of the 5 
critical times. Similarly in Petemon, 9 respondents only did so as 4 out of the 5 critical times. 
Overall in both Wonorejo and Petemon, none of the respondents washed hands with soap at all 
5 critical times.
Another indicator for evaluating the second pillar of CBTS in connection with the practice of 
washing hands with soap is the availability of running water and soap. This is assessed based 
upon observations in the bathroom or when respondents wash their hands. 
As regards availability of running water in Wonorejo, there was an increase of 20% (73.3% in 
2012 compared with 93.3% in 2013), while in Petemon the percentage was the same as in 
2012 (93.3%).
Figure 5.10 shows the availability of running water in toilets in the surveyed sub-districts:
Baseline (n=29) Midline (n=21) Baseline (n=20) Midline (n=27)
8
15
18
5
3
4
5
1
1 1
8 5
1 1
9 12
None
Score 5
Score 4
Score 3
Score 2
Score 1
Wonorejo Petemon
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Figure 5.10
Availability of Running Water
Besides the availability of running water, the availability of soap in the toilet (for washing 
hands) is another indicator of the practice of washing hands with soap. The situation as regards 
the availability of soap (for washing hands) in the toilet or the place where the dishes are 
washed is as shown in Figure 5.11 below:
Figure 5.11
Availability of Soap
A comparison of the findings at the time of the baseline and midline observations reveals that 
Wonorejo once again experienced a regression (6%) as regards the availability of soap (for 
washing hands and for washing dishes in the kitchen), while Petemon experienced a regression 
of 3.3%.
Baseline Midline Baseline Midline
73,3%
93,3% 93,3% 93,3%
26,7%
6,7% 6,7% 6,7%
No
Yes
Wonorejo Petemon
Respondent base: 60
Baseline Midline Baseline Midline
86,7% 93,3% 100,0% 96,7%
13,3% 6,7% 3,3%
No
Yes
Wonorejo Petemon
Respondent base: 60
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An overall summary of the data for the second CBTS pillar in Wonorejo and Petemon at the 
time of the baseline survey and midline survey reveals that there has been a decline in the 
proportion of caregivers who wash their hands with soap at the 5 critical points. Meanwhile as 
regards toilet conditions, observations revealed that there has been a relative increase in the 
availability of running water and soap for hand washing. 
Summary of Second Pillar: Practices of washing hands with soap 
Table 5.4
Indicators Showing Practice of Washing Hands with Soap
Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
Use of soap in last 48 hours– Multiple Answer
Washing hands before eating 80.0% 63.3% 23.3% 73.3%
Washing baby’s bottom 93.3% 33.3% 43.3% 43.3%
Washing hands before washing baby’s bottom 60.0% 30.0% 13.3% 66.7%
Washing hands before eating 60.0% 43.3% 13.3% 73.3%
Washing hands after defecation 53.3% 16.7% 3.3% 70.0%
Washing child’s hands 63.3% 20.0% 16.7% 50.0%
Washing hands before cleaning home 53.3% - 3.3% -
Washing hands before feeding child 46.7% 10.0% 3.3% 20.0%
Other responses - 26.7% - 50.0%
Washing clothes or utensils 100.0% 90.0% 86.7% 93.3%
Bathing 100.0% 100.0% 93.3% 100.0%
Observations
Availability of water (if tap, running water from tap) Yes 73.3% 93.3% 93.3% 93.3%
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
No 26.7% 6.7% 6.7% 6.7%
Availability of soap
Yes 86.7% 93.3% 100.0% 96.7%
No 13.3% 6.7% - 3.3%
C. Safe Drinking Water Treatment and Storage
The next CBTS pillar is safe and healthy drinking water treatment. The following is a description 
of the water sources most commonly used in the households (with under-5s) in the two sub￾districts of Wonorejo and Petemon. At the time of the baseline survey in 2012, the biggest 
proportion of households used branded packaged water for drinking purposes. This situation 
persisted at the time of the midline survey in 2013.
Branded packaged water was the first choice of 36.7% of households in Wonorejo and 33.3% 
in Petemon. Besides branded packaged water. 33.3% of households in Petemon used mains 
water, while 33.3% of respondents in Wonorejo preferred to use water refill jars.
The principal sources of drinking water used in households (with under-5s) are as shown in the 
following graphs:
Figure 5.12 
Sources of Drinking Water
Baseline Midline Baseline Midline
40,0% 36,7% 36,7% 33,3%
20,0% 33,3% 40,0%
23,3%
26,7% 16,7% 16,7%
33,3%
3 other responses
Mains water
Water refills
Branded packaged water
Wonorejo Petemon
Respondent base : 60
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Also with regard to the sources of drinking water used by households, there now follows a 
description on the sources of drinking water used by households with under-5s. The principal 
choice was branded packaged water both at the time of the baseline survey and at the time of 
the midline survey. In Wonorejo, 50% of respondents said that they used branded packaged 
water as a source of water for their under-5s, while in second place, 33.3% of respondents said 
they used water refills. Similarly in Petemon, 50% of respondents used branded packaged 
water as the principal source of water for their under-5s, while in second place were water 
refills and mains water – both on 23.3%.
The following chart shows the principal sources of water used by under-5s:
Figure 5.13
Sources of Drinking Water for Under-5s in the Home
Based on the sources of water used, Figure 5.13 shows what caregivers in the surveyed sub￾districts do (or do not do) so as to improve the quality of drinking water before consumption. 
Water refills and branded packaged water were excluded from data processing, and only mains 
water, water from bore wells, water purchased from itinerant water vendors and water from 
covered wells were included in the data processing so as to produce the following graph:
Baseline Midline Baseline Midline
50,0% 50,0% 46,7% 50,0%
20,0%
33,3% 33,3% 23,3%
20,0%
6,7% 13,3% 23,3%
10,00% 10,00% 6,7% 3,3%
3 other responses
Mains water
Water refills
Branded packaged water
Wonorejo Petemon
Respondent base: 60
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Figure 5.14 
What is done (to improve quality) before Consumption
(Excludes branded packaged water and water refills)
All of the caregivers in Wonorejo and Petemon said that boiled water from the mains, wells and 
excavated wells (as well as from itinerant water vendors) before consuming it.
The following graph shows where drinking water is stored in households (with under-5s) in the 
surveyed sub-districts. 
Figure 5.15
Drinking Water Storage Places 
Based on Figure 5.15, it may be concluded that one-gallon water bottles were the most 
common drinking water storage places in Surabaya both at the time of the baseline survey and 
Baseline Midline Baseline Midline 
50,0% 43,3% 40,0% 40,0%
43,3% 56,7%
43,3% 53,3%
6,7% 16,7% 6,6%
2 other responses
Drink directly
Boil water
Wonorejo Petemon
Respondent base : 60
Baseline Midline Baseline Midline
13,3% 30,0%
13,3%
60,0%
70,0%
63,3%
56,7%
0,0%
13,30% 6,7%
30,0%
2 other responses
One-gallon water bottle
Pot/Bucket with a lid
Wonorejo Petemon
Respondent base : 60
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the midline survey. In more detail, 70% of respondents in Wonorejo used one-gallon water 
bottles to store their drinking water, while the equivalent figure in Petemon was 56.7%.
Figure 5.16
Places Used to Store Drinking Water – Observations 
Besides the claims of respondents, observations were also conducted to ascertain where 
respondents really stored their water. Based on these observations, the findings of which are 
shown in Figure 5.16, it was found the one-gallon water bottles were the most common choice 
for storing water in both Wonorejo (70%) and Petemon (53.3%). A small proportion used 
kettles in which to store water (Wonorejo 6.7% and Petemon 30%).
Figure 5.17
Places used to store water for cooking - Observations
The place where respondents store water for cooking is also one of the appraisal indicators. 
Figure 5.17 (in absolute terms as the base number of respondents was less than 30), which is 
based on observations, shows that more than half of respondents in Wonorejo use covered 
pots/buckets to store water, while some households store their water for cooking in a covered 
earthenware jar.
Baseline Midline Baseline Midline
40,0%
73,3%
53,3% 53,3%
20,0%
6,7%
13,3%
30,0%
40,0%
19,9% 33,3%
16,6%
6 other responses
Kettles
One-gallon water bottle
Respondent base : 60
Wonorejo Petemon
Baseline 
(n=30)
Midline 
(n=29)
Baseline 
(n=30)
Midline 
(n=29)
17 17
10 10
12 12
12 12
2 2
7 7 2 other responses
Earthenware jar
Pots/buckets
Wonorejo Petemon
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Covered earthenware jars are the favorite choice of almost half the respondents in Petemon, 
while a number of other respondents prefer a covered pot/bucket.
The following table presents the findings of observations on the receptacles used by 
respondents, the process of treating water and how they take drinking water. 
Table 5.5
Observations on Drinking Water Storage Receptacles, Processing and Presentation 
Indicator
Wonorejo Petemon
Baseline
(n=30)
Midline
(n=30)
Baseline
(n=30)
Midline
(n=30)
Receptacle with 
Narrow aperture 76.7% 96.7%% 73.3% 93.3%
Wide aperture 23.3% 3.3% 26.7% 3.3%
Hard/non-cloth material 
Yes 100% 53.3% 96.7% 66.7%
No - 46.7% 3.3% 33.3%
How about hands when 
taking water
Touch - 1.7% 3.3% 13.3%
Don’t touch 100% 98.3% 96.7% 86.7%
From Table 5.5 above, it will be seen that the use of receptacles with narrow apertures has 
increased to 90% of respondents, compared with the baseline survey.
Nevertheless, this increase was accompanied by a declined in the proportion of respondents 
who use covers made from hard material. During the baseline survey 100% of respondents 
from Wonorejo used hard covers, but this percentage had fallen to 46.7% at the time of the 
midline survey. A similar finding was made in Petemon, where the figure fell from 96.7% to 
66.7%.
As well as a decline in the use of hard materials to cover receptacles, there was also a decline 
in the proportion of respondents who did not touch water when taking it. At the time of the 
baseline survey in Wonorejo, not one respondent said that his or her hands touched the water 
when taken it. However, at the time of the midline survey, 1.7% of respondents said that their 
hands came into contact with the water when taking it. Meanwhile, the figures for Petemon 
were only 3.3% at the time of the baseline survey, but 13.3% at the time of the midline survey.
We will now discuss the places where prepared food is stored until being served, as shown in 
Figure 5.18 below:
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Figure 5.18
Places where food is stored – Observations
As at the time of the baseline survey, the majority of Wonorejo respondents (56.7%) stored 
prepared/ready to consume food in a closed cabinet, while 30% left it on the table, protected 
with a cover.
In Petemon, 73.3% left it on the table, protected with a cover (same as at the time of the 
baseline survey), while only 16.7% kept it in a closed cabinet.
Summary of the Third Pillar: Household Safe Water Treatment and Storage Practices
The indicators for the third pillar of CBTS are summarized in the following table:
Table 5.6
Indicators for Third Pillar: Safe Water Treatment 
Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
Treatment of water prior to consumption (from mains, well)
Baseline Midline Baseline Midline
56,7% 56,7%
26,7% 16,7%
33,3% 30,0%
60,0% 73,3%
10,0% 13,3% 13,3% 10,0%
3 other responses
Protected with a cover
In a closed cabinet
Wonorejo Petemon
Respondent base : 60
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
Boil Water 50.0% 43.3% 40.0% 40.0%
Consume Directly 43.3% 56.7% 43.3% 53.3%
3 Other Responses 6.7% - 16.7% 6.6%
Observations
Receptacle with
Narrow aperture 76.7% 96.7% 73.3% 93.3%
Wide aperture 23.3% 3.3% 26.7% 6.7%
Hard/non-cloth 
material
Yes 100% 96.7% 96.7% 93.3%
No - 3.3% 3.3% 6.7%
How about hands 
when taking water
Touch - 96.7% - 3.3%
Do not touch 100% 3.3% 100% 96.7%
Places where prepared food is kept – top 3 answers
In closed cabinet 56.7% 56.7% 26.7% 16.7%
Protected by cover 33.3% 30.0% 60.0% 73.3%
Left uncovered on table 10.0% 13.3% 13.3% 10.0%
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D. Percentage of households that practice solid waste management
The next CBTS pillar is household waste management. All of the surveyed households (with 
under-5s) in Surabaya said that they had a place for disposing of garbage in their homes. In 
more detail, in Wonorejo the garbage receptacle most frequently used was an open plastic sack 
(46.7%), while in Petemon 50% of respondents used closed plastic sacks.
Figure 5.19 shows the various responses elicited on household garbage disposal:
Figure 5.19
Receptacles or Places Used for Collecting Garbage 
The practices of the respondents in Surabaya at the time of the midline survey as regards 
garbage disposal tended to be quite orderly, with all of the respondents in both Wonorejo and 
Petemon using official garbage disposal services (whether the garbage was first collected in the 
home or at a collection point to be taken away by garbage men. More specifically, 70% of the 
respondents in Wonorejo disposed of their garbage at a collection point, while 30% collected 
their garbage in the home before it was taken away by garbage men.
In Petemon, 73.3% of respondents first collected their garbage in the home before it was 
collected by garbage men, while the remainder dumped it at an official collection point.
Baseline Midline Baseline Midline
16,7%
46,7%
26,7%
3,3%
26,7%
30,0%
10,0% 50,0%
30,0%
23,3%
43,3%
20,0%
23,3% 20,0% 26,7%
Closed garbage basket
Open garbage basket
Closed plastic sacks
Open plastic sack
Wonorejo Petemon
Respondent base: 60
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The following graph shows how the respondents dispose of their garbage:
Figure 5.20
Disposal of waste / garbage
In the particular case of those who used the services of official garbage collectors (whether 
going house to house or collecting garbage at an official collection point), the frequency of 
collection was quite varied. In Wonorejo, 73.3% said that the garbage was collected routinely 
every day, while the remaining 26.7% said it was collected a couple of times a week. 
Meanwhile in Petemon, 56.7% said that the garbage was collected a number of times a week, 
while 40% said it was collected routinely each day.
The frequency of garbage collection by official garbage collectors is as shown in Figure 5.21 
below:
Figure 5.21
Frequency of Garbage Collection
Baseline Midline Baseline Midline
66,7%
30,0% 43,3%
73,3%
33,3%
70,0% 56,7%
26,7%
Collected at an official 
collecting point, picked up by 
official garbage collector
Collected at home, picked up 
by official garbage collector
Wonorejo Petemon
Respondent base: 60
Baseline Midline Baseline Midline
76,7% 73,3% 80,0%
40,0%
23,3% 26,7% 20,0%
56,7%
3,3%
2 other responses
A few times a week
Everyday
Wonorejo Petemon
Respondent base: 60
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Almost all of the households in Wonorejo and Petemon paid for garbage collection, with only 
3.3% of respondents in Wonorejo saying that they did not pay garbage collection fees. 
Meanwhile in Petemon, 100% of respondents said that they paid for garbage collection.
Figure 5.22 
Do You Pay for Garbage Collection? 
As regards how much respondents had to pay, in Wonorejo it ranged between Rp 2,501 and Rp 
5,000 for more than half of the respondents, while the second highest range was between Rp 
5,001 and Rp 7,500. The highest range (paid by one respondent) was between Rp 10,001 and 
Rp 15,000. However, there were also 2 respondents who paid less than Rp 2,500.
In Petemon, more than half of respondents paid between Rp 5,001 and Rp 7,500, while the 
next biggest number of respondents (11 in total) paid between Rp2,501 and Rp 5,000. Only 1 
respondent paid less than Rp 2,500 while there were 5 respondents who paid more, of which 4 
paying between Rp 7,501 and Rp 10,000 and 1 paying between Rp 10,001 and Rp 15,000.
Baseline Midline Baseline Midline
100,0%
96,7%
100,0% 100,0%
3,3%
No
Yes
Wonorejo Petemon
Respondent base: 60
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The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.23
Expenditure on Garbage Collection 
The majority of households in Surabaya (both at the time of the baseline survey and at the time 
of the midline survey) did not practice separating garbage into biodegradable and non￾biodegradable, which was only done by a small number of households. In Wonorejo, of 30 
respondents, only 13.3% normally practiced garbage separation, while in Petemon the figure 
was only 6.7%.
Figure 5.24
Is Organic and Inorganic Garbage Separated?
Baseline 
(n = 30) 
Midline 
(n=29)
Baseline (n = 
30)
Midline 
(n=30)
2 2 1 1
20 18
17
11
3
6
12
13
4 4
1 1 1
Don't Know
Rp. 10.001 - 15.000
Rp. 7501- 10.000
Rp. 5001 - 7.500
Rp. 2.501 -5.000
< Rp. 2500
Wonorejo Petemon
Baseline Midline Baseline Midline
10,0% 13,3% 3,3% 6,7%
90,0% 86,7% 96,7% 93,3%
No
Yes
Wonorejo Petemon
Respondent base : 60
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Based on the observations as to the receptacles used to collect garbage in the home, the 
biggest proportion of respondents in both Wonorejo and Petemon used closed plastic sacks 
(with the percentages being 46.7% and 50% respectively). The second most popular choice 
were closed garbage baskets in both Wonorejo and Petemon, with the respective figures being 
30% and 26.7%.
Figure 5.25
Receptacles Used for Collecting Garbage – Observations 
Summary of Fourth Pillar: Solid Waste Management Practices
The following table summarizes the findings in respect of the fourth CBTS pillar indicators:
Table 5.7
Fourth Pillar Indicators: Solid Waste Management Practices
Indicator
Wonorejo Petemon
Baseline
(n=30)
Midline
(n=30)
Baseline
(n=30)
Midline
(n=30)
Garbage Disposal Places – 3 top answers
Stored in home, then collected by garbage collection 
official 66.7% 70.0% 43.3% 73.3%
Baseline Midline Baseline Midline
30,0% 23,3%
43,3%
20,0%
23,3% 30,0%
20,0%
26,7%
26,7%
46,7%
10,0% 50,0%
16,7% 26,7%
3,3% 3,3%
Directly to landfills
Open garbage sack
Closed garbage sack
Closed garbage basket
Opened garbage basket
Wonorejo Petemon
Respondent base : 60
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Indicator
Wonorejo Petemon
Baseline
(n=30)
Midline
(n=30)
Baseline
(n=30)
Midline
(n=30)
Stored at joint collection point, then collected by 
garbage collection official 33.3% 30.0% 56.7% 26.7%
Garbage Separation?
Yes 90.0% 86.7% 3.3% 6.7%
No 10.0% 13.3% 96.7% 93.3%
Receptacles used for collecting garbage – observations – 3 top answers
Uncovered garbage basket 30.0% 23.3% 43.3% 20.0%
Covered garbage basket 23.3% 30.0% 20.0% 26.7%
Closed plastic sack 26.7% 46.7% 10.0% 50.0%
Open plastic sack 16.7% - 26.7% 3.3%
Brought directly to garbage disposal point 3.3% - - -
Proper Wastewater Management 
The final CBTS pillar is proper household wastewater management. A number of indicators were 
used to evaluate people’s behaviors in this respect in Surabaya. The findings of our 
observations on wastewater disposal are shown in the following graphs:
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Figure 5.26
Disposal of kitchen wastewater – Observations
In Wonorejo, as shown in Figure 5.26, the biggest proportion of households at 36% disposed of 
their wastewater (from kitchen, bathroom and washing clothes) in the river, pond, drain or 
canal, while 33.3% did so through wastewater disposal pipes.
Meanwhile in Petemon, more than half of respondents (60%) disposed of wastewater using 
covered channels, while 20% did so using the sewerage system. Only 6.7% of respondents in 
Petemon discharged their wastewater in the river, pond, drain or canal.
Figure 5.27
Discharge of Wastewater from Bathroom – Observations 
Baseline Midline Baseline Midline
63,3% 33,3% 76,7%
20,0%
70,0%
36,7%
70,0%
6,7%
23,3%
26,7%
20,0%
60,0%
3,3% 3,3% 13,3%
4 other responses
Covered channels
River, pond, drain or canal
Wastewater disposal pipes
Wonorejo Petemon
Respondent base: 60
Baseline Midline Baseline Midline
63,3% 33,3%
76,7%
20,0%
70,0%
36,7%
6,7%
23,3% 26,7% 20,0%
60,0%
3,3% 13,3%
3 other responses
Covered chanels
River, Pond, drain or canal
Wastewater disposal pipes
Wonorejo Petemon
Respondent base: 60
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Figure 5.28
Discharge of Wastewater from Clothes Washing – Observations 
We will now discuss the location of septic tanks in the survey areas in Surabaya. The most 
common location in both Wonorejo and Petemon was underneath the floor of the house (same 
as at the time of the baseline survey). The principal reason for this was a lack of space in the 
two sub-districts. More specifically, in Wonorejo more than half (15 out of 26) households had 
their septic tanks underneath the floor. Besides the backyard, there was also one household 
that had its septic tank in the front yard/to the side. Three other respondents in Wonorejo did 
not know where their septic tank was located.
In Petemon, the situation was almost the same as in Wonorejo. The majority of households 
(both at the time of the baseline survey and the midline survey) had their septic tanks 
underneath the floor due to lack of space. Only 4 households had their septic tanks located in 
the back yard. In addition, 1 house each was found to have its septic tank underneath the 
bathroom floor and in the front yard/at the side of the house, while 1 household had a shared 
septic tank, and another household did not know where its septic tank was located.
The figure below is in absolute terms as the base number of respondents was less than 30.
Baseline Midline Baseline Midline
63,3% 33,3%
76,7%
20,0%
70,0%
36,7%
6,7%
23,3%
26,7% 20,0%
60,0%
3,3% 13,3%
3 other responses
Coverd Channels
River, Pond, drain or canal
Wastewater disposal pipes
Wonorejo Petemon
Respondent base : 60
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Figure 5.29
Location of Septic tank – confined to those that have septic tank 
As regards those who did not have septic tanks, observations on the ground, as shown in 
Figure 5.30 (in absolute terms as the base number of respondents was less than 30), revealed 
that the wastewater was discharged into the river/lake.
The following figure shows where toilet waste is discharged in the case of those who do not 
have septic tanks:
Figure 5.30
Final place of disposal of Toilet Wastewater (by those that lack septic tanks) – Observations 
Baseline 
(n=26)
Midline 
(n=26)
Baseline 
(n=29)
Midline 
(n=30)
13 15 18
20
5
7 7 4 4
1
4
1
4 3 1
1
1 Shared septic tank
Underneath the bathroom floor
Don't know
Front yard / at the side of the 
house
Underneath the flooe
Underneath room floor inside 
house 
Wonorejo Petemon
Baseline (n=4) Midline (n=4) Baseline (n=1) Midline (n=0)
4 4 1
River/ Lake/ Sea
Wonorejo Petemon
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Among the households that have septic tanks, only in Petemon did the biggest proportion of 
residents have them regularly cleaned. In Wonorejo, unlike at the time of the baseline survey 
(when the biggest proportion of households said that they had cleaned their septic tank on one 
occasion or another), at the time of the midline survey more than half said that they never 
cleaned their septic tanks. Only 7 respondents said that they had ever cleaned their septic tank, 
while 3 said that they did not know whether their septic tank had ever been cleaned or not.
Meanwhile in Petemon, only 6 respondents said that they had never emptied their septic tanks, 
while 7 others said that they did not know if it had ever been emptied. Meanwhile, the majority 
of respondents in Petemon (14) said that their septic tank had been emptied at one time or 
another.
Figure 5.31 (in absolute terms as the base number of respondents was less than 30) below 
shows the situation as regards the emptying of septic tanks in the 2 sub-districts:
Figure 5.31
Has your septic tank ever been emptied?
For those who said that their septic tanks had been emptied at one time or another, Figure 5.32 
(in absolute terms as the base number of respondents was less than 30) shows that last time 
that it was emptied. In Wonorejo, 3 respondents said that their septic tanks had been emptied 
less than 2 years ago, while 2 others said that the last time their septic tank had been emptied 
was between 2 and 5 years ago. Two others said that their tanks had been emptied less than 5 
years ago.
In Petemon, the last time the septic tanks of the biggest proportion of respondents had been 
emptied was longer ago than in Wonorejo. At the time of the midline survey, 5 respondents 
said that it was less than 5 years ago, while 4 said that it was less than 2 years ago. Two others 
said that it was between 2 and 5 years ago, while 1 did not know if his septic tank had ever 
been emptied or not.
Baseline (n=22) Midline (n=23) Baseline (n=29) Midline (n=27)
15
7
18 14
7
13
9
6
3 2
7
Don't know
Never
Yes
Wonorejo Petemon
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Figure 5.32
When was the last time your septic tank was emptied?
Of the households in Wonorejo and Petemon who said that their septic tanks had been emptied 
at one time or another, almost all of them said that they used the services of professional septic 
tank cleaners. The situation at the time of the midline survey in Wonorejo was the same as at 
that of the baseline survey, namely, all of the households who septic tanks had been cleaned in 
Wonorejo used the services of professionals using a suction truck to clean their tanks.
In Petemon, only one household did not use a suction truck, with this respondent said that he 
used the services of hired workmen.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.33
Who emptied your septic tank the last time?
Baseline 
(n= 15)
Midline (n=7) Baseline 
(n= 18)
Midline (n=14)
8 3 6 4
5
2
11
3
2
2
1
5
1
Don't know
> 5 years ago
2 - 5 years ago
< 2 years ago
Wonorejo Petemon
Baseline 
(n=15)
Midline (n=7) Baseline 
(n=18)
Midline 
(n=14)
15 7
10
13
8
1
Hired a workmen
Professional septic tank cleaners
Wonorejo Petemon
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Figure 5.34 
Distance from Home to Public Toilet
Respondent base: 60 
Figure 5.34 above shows the distance from the home to the toilet normally used by 
respondents. In the midline survey, the majority of respondents (90%) did not need any time to 
get to the toilet as the toilet was located in their own homes. This percentage marked an 
increase compared with the baseline survey, when more than 70% of respondents had toilets 
located in their own homes.
In Wonorejo, 10% said that they needed between 3 and 15 minutes to reach the toilet, while in 
Petemon, 10% said that they needed between 2 and 5 minutes.
Summary of Fifth CBTS Pillar: Wastewater management practices
The following table sets out a summary of household wastewater management practices:
Table 5.8
Fifth CBTS Pillar: Wastewater management practices
Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
Place where kitchen wastewater is disposed of– 3 top answers
Wastewater disposal pipe 63.3% 33.3% 76.7% 20.0%
Baseline Midline Baseline Midline
73,3%
90,0% 76,7% 90,0%
26,7%
10,0% 23,3% 10,0%
5 other responses
No distance as toilet is in home
Wonorejo Petemon
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Respondent base 30 30 30 30
River, pond, drain, canal 70.0% 36.7% 70.0% 6.7%
Covered channel 23.3% 26.7% 20.0% 60.0%
4 other responses 20.0% 3.3% 60.0% 13.3.%
Place where bathroom wastewater is disposed of – 3 top answers
Wastewater disposal pipe 63.3% 33.3% 76.7% 20.0%
River, pond, drain, canal 70.0% 36.7% - 6.7%
Covered channel 23.3% 26.7% 20.0% 60.0%
3 other responses - - 3.3% 13.3%
Place where wastewater from clothes-washing is disposed of – 3 top answers
Wastewater disposal pipe 63.3% 26.7% 76.7% 6.7%
River, pond, drain, canal 70.0% 36.7% 70.0% 6.7%
Covered channel 20.0% 30.0% 20.0% 83.3%
4 other responses - 6.6% 3.3% 3.3%
Has septic tank?
Yes 4 3 2 -
No 26 25 28 30
Place where feces is disposed of – observations – 3 top answers
Septic tank 86.7% 86.7% 93.3% 93.3%
4 other responses 13.3% 13.3% 6.6% 6.6%
The following table sets out a summary of the indicators for all five CBTS pillars in the sub￾districts that were surveyed.
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Table 5.9
Summary of Indicators for all Five CBTS pillar
Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
First Pillar: open defecation free
Last place where caregiver defecated– 3 top answers
Respondent base 30 30 30 30
Private toilet 83.3% - 90.0% -
Flush toilet draining into septic tank - 83.3% - 100.0%
2 other responses 16.7% 16.7% 10.0% -
Place of defecation for children aged 0 – 3
Respondent base 19 15 21 15
Disposable diapers 9 1 9 4
Household toilet 7 12 11 11
3 other responses 3 2 1 -
Place of disposal of feces of children aged 0 – 3 – MA 
Respondent base 19 15 21 15
Directly into the toilet 13 14 11 18 
First cleaned, then dirty water disposed of in 
private toilet 2 1 5 -
5 other responses 4 2 5 2 
Place of defecation of children aged 3 – 5
Respondent base 13 13 17 15
Private toilet 13 - 17 -
Flush/u-bend toilet draining into septic tank - 13 - 15 
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
No children aged 3-5 16 2 12 -
2 other responses 1 - 1 -
What was done after child defecated
Washed child’s bottom with soap 93.3% 90.0% 70.0% 100.0%
Washed child’s bottom with soap 6.7% 6.7% 23.3% -
3 other responses - 3.3% 6.6% -
Second Pillar: Hand washing with soap at at least 2 out of 5 critical times
Use of soap in last 48 hours – MA
Washing hands after eating 80.0% 63.3% 23.3% 73.3%
Washing clothes/utensils 100.0% 90.0% 86.7% 93.3%
Cleaning baby’s bottom 93.3% 33.3% 43.3% 43.3%
Bathing 100.0% 100.0% 93.3% 100.0%
Washing hands after washing baby’s 
bottom 60.0% 30.0% 13.3% 66.7%
Washing hands before eating 60.0% 43.3% 13.3% 73.3%
Washing hands after defecating 53.3% 16.7% 3.3% 70.0%
Washing child’s hands 63.3% 20.0% 16.7% 50.0%
Washing hands after cleaning house 53.3% - 3.3% -
Washing hands before feeding child 46.7% 10.0% 3.3% 20.0%
Other Responses - 26.7% - 50.0%
With scoring
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Score 0 - - - -
Score 1 8 15 18 5
Score 2 3 4 5
Score 3 1 1 1 8
Score 4 5 1 1 9
Score 5 12 - - -
Observations
Is water available 
(if there is tap, is 
it running?)
Yes 73.3% 93.3% 93.3% 93.3%
No 26.7% 6.7% 6.7% 6.7%
Is soap available?
Yes 86.7% 93.3% 100.0% 96.7%
No 13.3% 6.7% - 3.3%
Third Pillar: Household safe water treatment and storage
Treatment of water before consumption (water from mains/well)
Boil water 50.0% 43.3% 40.0% 40.0%
Directly drink 43.3% 56.7% 43.3% 53.3%
3 other responses 6.7% - 16.7% 6.6%
Observations
Receptacle with
Small aperture 76.7% 96.7% 73.3% 93.3%
Wide aperture 23.3% 3.3% 26.7% 6.7%
Hard material/not cloth
Yes 100% 96.7% 96.7% 93.3%
No - 3.3% 3.3% 6.7%
What about hands when Touch - 96.7% - 3.3%
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
taking water? Do not touch 100% 3.3% 100% 96.7%
Place where ready-to-consume food is kept– 3 top answers
In closed cabinet 56.7% 56.7% 26.7% 16.7%
Protected by cover 33.3% 30.0% 60.0% 73.3%
3 other responses 10.0% 13.3% 13.3% 10.0%
Fourth Pillar: Solid waste management
Place of disposal of garbage – 3 top answers
Gathered in home, then collected by 
official garbage collector 66.7% 70.0% 43.3% 73.3%
Gathered at shared collection point, then 
collected by official garbage collector 33.3% 30.0% 56.7% 26.7%
Separation of 
Garbage 
No 90.0% 86.7% 3.3% 6.7%
Yes 10.0% 13.3% 96.7% 93.3%
Means of collecting garbage – observations – 3 top answers
Open garbage basket 30.0% 23.3% 43.3% 20.0%
Closed garbage basket 23.3% 30.0% 20.0% 26.7%
Closed plastic sack 26.7% 46.7% 10.0% 50.0%
Open plastic sack 16.7% - 26.7% 3.3%
Directly at garbage disposal point 3.3% - - -
Fifth Pillar: Wastewater management
Place where kitchen wastewater is discharged – 3 top answers
Wastewater disposal pipe 63.3% 33.3% 76.7% 20.0%
River, Pond, Drain, Canal 70.0% 36.7% 70.0% 6.7%
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Indicator
Wonorejo Petemon
Baseline Midline Baseline Midline
Covered channel 23.3% 26.7% 20.0% 60.0%
4 other responses 20.0% 3.3% 60.0% 13.3.%
Place where bathroom wastewater is disposed of – 3 top answers
Wastewater disposal pipe 63.3% 33.3% 76.7% 20.0%
River, Pond, Drain, Canal 70.0% 36.7% - 6.7%
Covered channel 23.3% 26.7% 20.0% 60.0%
3 other responses - - 3.3% 13.3%
Place where wastewater from clothes-washing is disposed of – 3 top answers
Wastewater disposal pipe 63.3% 26.7% 76.7% 6.7%
River, Pond, Drain, Canal 70.0% 36.7% 70.0% 6.7%
Covered channel 20.0% 30.0% 20.0% 83.3%
4 other responses 6.6% 3.3% 3.3%
Have septic tank?
No 4 3 2 -
Yes 26 25 28 30
Place where feces is disposed of – observations – 3 top answers
Septic tank 86.7% 86.7% 93.3% 93.3%
4 other responses 13.3% 13.3% 6.6% 6.6%
E. Role of Community Members as Informants
Table 5.10a below shows the sources of information on CBTS in the community.
Both in Wonorejo and Petemon, RT heads/administrators and Posyandu/Sub-district and PKK 
workers were the parties who were considered to play the greatest role in disseminating 
information on CBTS to the public.
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- RT heads/administrators were considered to play a role in disseminating information on 
proper defecation and garbage management practices. 
- Teachers played a role in disseminating information on the importance of washing hands 
with soap to the community.
Table 5.10a
Sources of information on the 5 CBTS Pillars in Surabaya – Multiple Answer - Spontaneous
Environmental 
Health Topic
Petemon (respondent base: 30) First time 
when 
provided 
with 
information
Give name of person and that person’s relationship with 
respondent
Name Number of 
Respondents Relationship
Method of 
information 
provision
Defecation in 
proper place
Bidan 
(Midwife) 
Suri
4 Volunteer Arisan meeting January 2013
Don’t know 4 Ibu RT House-to-House 
visit 
February 
2013
Bidan 
(Midwife) 
Santi
4 Ibu RT Arisan meeting March 2012
Bapak (Mr)
Teguh 4 RT/RW Meeting with 
residents January 2013
Bapk (Mr) 
Kasiyoto 4 RT/RW House-to-House 
visit October 2012
Washing hands 
with soap Don’t know 4 Teacher Practice/examples When 
younger
Treatment of 
household 
drinking water
Ibu (Ms) 
Puput 4 Don’t know Practice/examples March 2012
Garbage 
disposal - - - 
Household 
wastewater 
management 
- - - 
Four respondents said that they had received information from Bidan Suri and Bidan Santi on 
proper defecation practices in January 2013. The information was conveyed during arisan 
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meetings. Bapak Teguh also provided information to residents of the neighborhood in January 
2013 by going door to door. Meanwhile, Bapak Kasyito provided information to residents during 
meeting in October 2012. In addition, 4 respondents said that the “Lady RT” (whose name she 
did not know) also visited residents homes in February 2013 to provide then with information 
on proper defecation practices. 
As regards outreach on hand washing with soap, 4 respondents said that they had received 
messages on this from their teachers when they were young (there was no indication as to the 
names of the teachers involved or precisely when they were taught). Meanwhile in March 2012, 
4 respondents said that they had received outreach on the treatment of drinking water from Ibu 
Puput (they were unaware of her position or role). The information had been presented through 
teaching.
Based on Table 5.10b below, it was be seen that in Wonorejo, the role played by community 
members in providing information on the CBTS pillars was as follows:
• RT administrators played a role in conveying messages on proper defecation and 
garbage management practices 
• Midwives from the Health Agency also played a role in providing information on proper 
defecation practices.
• Posyandu representatives were stated by respondents to have provided information on 
washing hands with soap
• The PKK chairman, in addition to providing outreach on washing hands with soap, was 
also stated to have provided information on household solid waste management.
• Sub-district representatives were also stated to have played a role in conveying 
messages on household solid waste management.
Table 5.10b
Sources of Information on 5 CBTS Pillars in Wonorejo – Surabaya Multiple Answer - 
Spontaneous
Environmental 
Health Topic Name
Wonorejo (respondent base: 30)
First time 
when provided 
with 
information
Give name of person and that person’s relationship 
with respondent
Number of 
Respondents Relationship
Method of 
information 
provision
Defecation in 
proper place
Don’t know 4 Ibu RT Arisan January 2013 
Ibu Mesni 4 Ibu RT Posyandu meeting December 2012
Midwife 
Nuraini
4 Midwife Posyandu meeting September 2012
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Environmental 
Health Topic Name
Wonorejo (respondent base: 30)
First time 
when provided 
with 
information
Give name of person and that person’s relationship 
with respondent
Number of 
Respondents Relationship
Method of 
information 
provision
Don’t know 4 Health Agency Residents’ meeting September 2012
Washing hands 
with soap
Ibu Santo 4 Posyandu Practiced during baby 
weighing February 2013
Don't know 4 PKK Chair Arisan PKK March 2012
Don't know 4 Don't know Outreach at 
elementary school December 2012
Treatment of 
household 
drinking water
Bapak 
Ahmed 4 Husband Outreach at 
elementary school December 2012
Garbage 
Management 
Don't know 4 Sub-district 
authorities
Socialization in sub￾district February 2013
Ibu 
Makmur 4 PKK Chair Arisan meeting March 2012
Ibu Tri 4 Volunteer PKK December 2012
Ibu Jodi 4 Ibu RT PKK Arisan Meeting Don't know 
Treatment of 
household 
wastewater
Don't know 4 Don't know Arisan meeting December 2012
Four respondents said that they had received information on proper defecation practices 
through the Lady RT during an arisan meeting in January 2013. Ms. Mesni said was referred to 
by the 4 respondents as have provided such information during a Posyandu meeting in 
December 2012. Midwife Nurani also provided outreach on proper defecation practices at the 
Posyandu during a meeting held in September 2012. Meanwhile, a meeting of residents in 
September 2012 was availed of by a representative from the local government health agency 
(no name recalled) to convey messages in proper defecation practices.
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According to 4 respondents, they received information on hand washing with soap from Ibu 
Santo from the Posyandu when practicing baby weighing in February 2013. In addition to Ibu 
Santo, the 4 respondents also said that the PKK Chair (whose name they did not know) had 
provided outreach on hand washing with soap during an arisan meeting at the PKK in March 
2012. Furthermore, they said that they had received information in December 2012 at an 
elementary school via a person whose name and position they were unaware of.
Four respondents said that they had been taught about how to treat drinking water by their 
husbands during an outreach event at the elementary school in December 2012. Meanwhile,
respondents said that they had received outreach on the management of solid household waste 
from the sub-district representative during a socialization event on garbage management in 
February 2013. Four respondents said that they had been provided with information on 
household solid waste management during a PKK arisan meeting in February. The messages 
had been conveyed by the PKK Chair and Ibu Jodi.
An ‘arisan’ meeting in December 2012 was also stated by 4 respondents as providing a venue 
for the socialization of household solid waste management.
F. Healthy Life Practices
Knowledge
As will be seen from Figure 5.35 below, the level of awareness among the residents of 
Wonorejo and Petemon was very low, relatively speaking. This is shown by the fact that only 
20% of residents (both at the time of the baseline survey and midline survey) had ever heard 
of the CBTS. In Wonorejo, out of 30 respondents, only 3 had heard of CBTS, while at the time 
of the midline survey 40% of residents of Wonorejo said they had never heard of CBTS, while 
50% said that they didn’t know/forgot. A similar situation was found in Petemon, where only 
20% of the total respondents said that they had heard of CBTS. The majority (66.7%) said that 
they didn’t know/forgot whether they had heard of CBTS or not, while 13.3% said that they had 
never heard of it.
Thus, it is only to be expected that people are unable to carry out what is being promoted by 
the CBTS program given the high proportions that have not received information on the 
program.
Figure 5.35 
Have you Heard of CBTS?
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Also with regard to awareness, Figure 5.36 below provides a picture of the level of people’s 
concern for PHBS. At the time of the baseline survey, it was found that 16.7% of the residents 
of Petemon and 3.3% of the residents of Wonorejo had heard of PHBS. Nevertheless, at the 
time of the midline survey, not one resident was found who said he or she had heard of PHBS 
(both in Wonorejo and Petemon).
Of the 3 residents in Wonorejo who said that they had heard of CBTS, 2 of them said that they 
had obtained information on CBTS through training provided by the local government’s Health 
Agency, while the other respondent said that they had obtained the information through 
activities carried out an NGO. 
In Petemon, of the 6 people who had heard of CBTS, 2 of them said that they had done so 
through outreach at school, while 4 others had done so through activities carried out by an 
NGO, from brochures, during activities at school and at PKK arisan meetings.
With a respondent base of 9 from Wonorejo and Petemon (and multiple response questions), 
those who acknowledged they had heard of CBTS said that it referred to stopping open 
defecation (8 persons), bathing twice a day with soap (3 persons), garbage management (3 
persons), cooking food properly (2 persons), and treating drinking water and water for 
household use. The remaining respondents (3 persons) said that CBTS was concerned with 
resolving sanitation problems.
Figure 5.36
Have you ever heard of PHBS
Baseline Midline Baseline Midline
16,7% 10,0% 3,3%
20,0%
46,7%
40,0% 66,7%
13,3%
36,7% 50,0%
30,0%
66,7%
Don't know
Have not heard
Have heard
Wonorejo Petemon
Respondent base : 60
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Baseline Midline Baseline Midline
3,3%
16,7%
60,0% 60,0%
53,3%
16,7%
36,7% 40,0% 30,0%
83,3%
Don't know/Forget
No
Yes
Wonorejo Petemon
Respondent base : 60
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People’s knowledge of sanitation can be specifically evaluated by assessing the level of 
agreement with a number of prepared questions, as discussed further below.
Attitude
The data set out in Table 5.11 below is based on closed-ended responses on a scale of 1 to 4, 
where 1 expresses strong disagreement and 4 strong agreement with the following 10 health 
related statements that were presented to respondents. 
Table 5.11
Perceptions of Residents about Health
Statement
Wonorejo Petemon
Baseline Midline Baseline Midline
Every family should have its own toilet 3.5 3.4 3.6 3.7
Open defecation is not a problem for me 1.6 2.1 1.5 1.5
Hand washing with soap before eating is 
bothersome 1.8 2.0 1.9 1.7
We don’t need a septic tank if we can dump feces 
directly into the river/drain 1.8 1.8 1.7 1.3
Wastewater from clothes washing can be 
discharged/dumped anywhere as it is quickly 
absorbed 
2.0 2.0 1.7 1.6
Separating garbage is only a waste of time and 
does no good 2.2 2.0 2.4 3.0
My neighbors garbage is no concern of mine even 
though it goes everywhere 2.0 2.0 2.1 1.8
Preventing blockages in the drains is also my 
concern as a resident of this sub-district 3.3 2.1 3.2 2.1
As long as there are not too many, flies do no 
harm if they land on food 1.8 3.0 1.6 1.3
There no need to worry about cleaning drinking 
water receptacle as they are always full of water 
anyway
1.9 1.8 1.8 1.5
Scale of 1 to 4, where 1 = strongly disagree, and 4 = strongly agree
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We will now discuss the issues identified as regards the health behaviors of residents of 
Wonorejo:
1. At the time of both the baseline survey and midline survey, the residents of Wonorejo had a 
high level of awareness, as evidenced by the fact that a high proportion of them agreed that 
every family must have its own toilet.
2. The residents of Wonorejo at the time of the baseline survey saw open defecation as a 
problem in their area (1.6). However, there had been a quite significant increase by the 
time of the midline survey (p <0.05), showing that an increasing number of people did not 
agree with open defecation (average increase to 2.1).
3. Both at the time of the baseline survey and the midline survey, the residents of Wonorejo 
regarded washing hands with soap before eating as not being burdensome. There was an 
average quite significant increase (p < 0.05) between the time of the baseline survey and 
that of the midline survey (1.8 to 2.0).
4. The residents of Wonorejo (both at the time of the baseline survey and the midline survey) 
did not agree with the statement that a septic tank is not necessary if toilet wastewater can 
be discharged into a river/drain.
5. The resident of Wonorejo, both at the time of the baseline survey and the midline survey, 
did not agree that water from clothes washing should be allowed to be discharged 
haphazardly. 
6. The statement that separating garbage is just a waste of time was not approved on average 
by the people of Wonorejo, both at the time of the baseline survey (2.2) and the midline 
survey (2.0) – no significant difference was detected.
7. On average the residents of Wonorejo at both the time of the baseline survey and the 
midline survey took the view that improperly disposed of garbage from a neighbor’s was 
also their concern.
8. Based on the baseline survey, the residents of Wonorejo agreed that the maintenance of 
drains is their joint responsibility as residents. However, at the time of the midline survey 
there had been a significant decline (p < 0.05) in those agreeing with this statement.
9. At the time of the baseline survey, the resident of Wonorejo did not agree with the 
statement, As long as there are not too many, flies do no harm if they land on food. 
However, at the time of the midline survey, the perceptions of the residents had changed 
significantly towards agreement.
10. The residents of Wonorejo did not agree that water receptacles need not be cleaned. This 
was true at the time both of the baseline survey and midline survey, and no significant 
difference was detected.
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We will now discuss the issues identified as regards the health behaviors of residents of 
Petemon:
1. At the time of both the baseline survey and midline survey, the residents of Petemon had a 
high level of awareness, as evidenced by the fact that a high proportion of them agreed that 
every family must have its own toilet (there was an average difference but not significant).
2. The residents of Petemon at the time of both the baseline survey and midline survey saw 
open defecation as a problem in their area.
3. Both at the time of the baseline survey and the midline survey, the residents of Petemon did 
not regard washing hands with soap before eating as being burdensome. While there was 
an average decline, it was not significant increase. 
4. The residents of Petemon at the time of the baseline survey said they did not agree with the 
statement that a septic tank is not necessary if toilet wastewater can be discharged into a 
river/drain. By the time of the midline survey, they tended to strongly disagree (1.3).
5. The resident of Petemon, both at the time of the baseline survey and the midline survey, 
did not agree that water from clothes washing should be allowed to be discharged 
haphazardly (no significant difference).
6. At the time of the baseline survey, residents tended to almost not agree with the statement 
that separating garbage is just a waste of time. By the time of the midline survey, there had 
been a significant change (p < 0.05) with people now tending to see garbage separation as 
a waste of time. 
7. Both the time of the baseline survey and the midline survey, the residents of Petemon did 
not agree with the statement that improperly disposed of garbage from a neighbor’s was 
not their concern.
8. Based on the baseline survey, the residents of Petemon agreed that the maintenance of 
drains is their joint responsibility as residents (3.2). However, at the time of the midline 
survey there had been a significant decline in those agreeing with this statement.
9. At the time of both the baseline survey and the midline survey, the residents of Petemon did 
not agree with the statement, As long as there are not too many, flies do no harm if they 
land on food. However, there was quite a significant difference on average (p < 0.05) 
between the findings at the time of the baseline survey and at the time of the midline 
survey.
10. At the time of the baseline survey the residents of Petemon did not agree that water 
receptacles need not be cleaned. At the time of the midline survey, there had been a 
significant change (p < 0.05), with residents coming to increasingly disagree with the 
statement.
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Residents, Community and Sanitation 
The table below shows residents’ responses (closed-ended responses) to a series of 10 
statements designed to gauge whether there is a sense of community among residents and 
administrators in their neighborhoods. The responses are ranked on a scale of 1 to 4, where 1 
= fully sure, and 4 = not at all sure.
The general picture painted by the responses to the 10 questions in Wonorejo is as follows:
1. At the time the baseline survey was conducted, it was found that the respondents of 
Wonorejo were almost certain (2.7) that people in their neighborhood were aware of the 
importance of environmental health and hygiene. By the time of the midline survey, there 
had been quite a significant increase (p < 0.05) to 3.1, meaning that people increasingly 
believed in the accuracy of the statement.
2. Based on the findings of the baseline survey and midline survey, respondents in Wonorejo 
felt quite confident that residents of the sub-district felt a strong sense of community in 
maintaining environmental health and hygiene (no significant difference).
3. The evaluation of the baseline survey showed that they were confident (3.1) that people in 
their neighborhood wanted to work so as to improve the quality of the environment. By the 
time of the midline survey, the residents remained confident in the accuracy of the 
statement (3.0), although a statistical count showed a significant difference (p < 0.05).
4. The respondents in Wonorejo felt confident (3.0) that residents would expend money 
voluntarily to pay for the cost of improve environmental health and hygiene. When the 
findings of the midline survey are evaluated, it will be seen that the level of confidence in 
this statement increased to 3.1 (although the increase was not significant statistically).
5. If advice is given by the sub-district authorities for whatever reason, both the baseline 
survey and midline survey findings in Wonorejo show that residents are almost confident 
that such advice will be followed (no significant difference).
6. The respondents in Wonorejo, both at the time of the baseline survey and midline survey, 
felt confident (2.9) that residents living in their neighborhood would be glad to participate in 
neighborhood cleanup drives.
7. The evaluation of the baseline survey data shows that the respondents feel confident (3.0) 
that the sub-district authorities will be zealous about organizing neighborhood cleanup 
drives. However, the midline survey data reveals a decline of 2.8 in this regard (although 
the difference is not significant), so that overall respondents are almost confident about the 
accuracy of the statement.
8. It may be concluded that both at the time of the baseline survey and the midline survey, 
the residents of Wonorejo do not overly regard environmental hygiene and sanitation as the 
responsibility of the sub-district authorities.
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9. Both at the time of the baseline survey and the midline survey, the residents of Wonorejo 
believed (3.0) that community leaders would support environmental hygiene and sanitation 
activities. 
10. The residents of Wonorejo at the time of the baseline survey were not overly convinced 
(2.8) that if religious leaders were to disseminate messages on environmental hygiene and 
sanitation that the public would comply with such messages. However, by the time of the 
midline survey, there had been a significant change (p < 0.05) and the public now felt 
confident (3.0) that such messages would be complied with.
As regards Petemon, the average responses of the respondents may be described as follows:
1. At the time the baseline survey was conducted, it was found that the respondents of 
Petemon were certain (3.0) that people in their neighborhood were aware of the importance 
of environmental health and hygiene. By the time of the midline survey, this figure had 
increased to 3.2 (although the increase was not significant statistically).
2. Both at the time of the baseline survey and midline survey, respondents in Petemon felt 
confident that residents of the sub-district felt a strong sense of community in maintaining 
environmental health and hygiene. 
3. In addition, the respondents in Petemon, both at the time of the baseline survey and the 
midline survey, said that people in their neighborhood wanted to work together so as to 
improve the quality of the environment. 
4. The baseline survey data showed that respondents in Petemon felt confident that residents 
would expend money voluntarily to pay for the cost of improving environmental health and 
hygiene. Meanwhile, the midline survey found that the level of confidence in this statement 
had increased to 3.3 (although the increase was not significant statistically).
5. If advice is given by the sub-district authorities for whatever reason, the baseline survey 
found that residents were confident (3.0) that such advice would be followed. However, 
analysis of the midline survey data showed that this level of confidence had declined to 2.8. 
As this decline was not significant, it may be concluded that people continued to believe 
that such advice would be followed.
6. The respondents in Petemon at the time of the baseline survey said they felt confident (3.3) 
that residents living in their neighborhood would be glad to participate in neighborhood 
cleanup drives. By the time of the midline survey, they were still confident, although the 
average level had declined (not significantly) to 3.1. 
7. Both the baseline survey and midline survey data shows that the respondents feel confident 
that the sub-district authorities will be zealous about organizing neighborhood cleanup 
drives (no significant difference between the two surveys). 
8. At the time of the baseline survey, the respondents said that they were not overly convinced 
that the sub-district authorities were responsible for environmental hygiene and sanitation. 
However, at the time of the midline survey there had been quite a significant increase (p < 
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0.05) in the level of confidence of respondents that the sub-district authorities are also 
responsible for environmental hygiene and sanitation. 
9. Both at the time of the baseline survey and the midline survey, the residents of Petemon 
believed that community leaders would support environmental hygiene and sanitation 
activities. 
10. The residents of Petemon at the time of the baseline survey were not overly convinced (2.8) 
that if religious leaders were to disseminate messages on environmental hygiene and 
sanitation that the public would comply with such messages. However, by the time of the 
midline survey the public felt confident that such messages would be complied with.
Table 5.12
Residents Perception of Community 
Statement
Wonorejo Petemon
Baseline Midline Baseline Midline
The people here are aware of the importance 
of environmental hygiene and health 2.7 3.1 3.0 3.2
The people here have a strong sense of 
community, particularly as regards 
maintaining environmental hygiene and health
2.8 2.9 3.1 3.1
The people here are willing to work together 
to improve health conditions 3.1 3.0 3.1 3.1
The people here are willing to voluntarily pay 
contributions/charges to improve 
environmental hygiene and health
3.0 3.1 3.1 3.3
The people here are willing in all cases to 
follow the advice of sub-district officials 2.9 2.8 3.0 2.8
The people here are highly motivated in 
participating in environmental hygiene 
activities
2.9 2.9 3.3 3.1
The sub-district authorities are highly 
motivated in organizing environmental 
hygiene activities
3.0 2.8 3.1 3.3
The people here consider environmental 
hygiene and health to be the responsibility of 
the sub-district authorities
2.5 2.3 2.3 2.9
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Statement Wonorejo Petemon
Community leaders support environmental 
hygiene and health activities 3.0 3.0 3.0 3.1.
If religious leaders recommended 
environmental hygiene and health activities, 
residents would comply
2.8 3.0 2.7 2.9
Scale of 1 to 4, where 1 = fully sure, and 4 = not at all sure
Practices
In the practices section, residents were asked about 7 things related to health. In general, their 
responses revealed that:
 In Wonorejo, there has been an overall improvement in people’s behaviors and awareness 
in connection with hygiene, as reflected in the decline in open defecation, discharge of toilet 
wastewater into the drains/water channels, undisciplined garbage disposal, and the 
incidence of blocked drains.
 The midline survey found that the proportion of respondents with water problems had 
increased (although the increase was not significant). However, the majority of respondents 
(more than 60%) said they had no problems with water sources.
 Overall, the types of behavior that give rise to health and hygiene at the time of the midline 
survey were more frequently found in Petemon. However, at the least the incidences of 
undisciplined garbage disposal, blocked drains and undrinkable well water (despite being 
treated) had declined.
 Overall, the most pressing problem in Petemon was Dengue fever, with 73.3% of 
respondents saying that cases of Dengue had occurred in their neighborhood. This marked 
an increase over 50% at the time of the baseline survey.
Table 5.13
Behaviors that can cause health and hygiene problems
Prevalent*
Wonorejo Petemon
Baseline (n = 30) Midline (n = 30) Baseline (n = 30) Midline (n = 30)
Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know 
Defecation in 
place other 
than toilet 
26.7% 60.0% 13.3% 13.3% 86.7% - 13.3% 86.7% - 13.3% 86.7% - 
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Prevalent*
Wonorejo Petemon
Baseline (n = 30) Midline (n = 30) Baseline (n = 30) Midline (n = 30)
Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know Yes No Don't 
know 
Feces 
discharged 
into 
drains/water 
channels
43.3% 56.7% - 20.0% 80.0% 3.3% 20.0% 76.7% - 30.0% 66.7% 3.3%
Unsanitary 
environment 
due to 
undisciplined 
garbage 
disposal 
63.3% 36.7% - 56.7% 43.3% - 73.3% 26.7% - 53.3% 46.7% - 
Blocked drains 
or water 
channels
53.3% 43.3% 3.3% 30.0% 63.3% 6.7% 76.7% 23.3% - 20.0% 80.0% - 
Well water 
not fit for 
drinking even 
after 
treatment 
16.7% 80.0% 3.3% 30.0% 63.3% 6.7% 26.7% 66.7% 6.7% 20.0% 80.0% - 
Dengue fever 13.3% 80.0% - 20.0% 76.7% 3.3% 50.0% 50.0% - 73.3% 26.7% - 
Difficulties 
with clean 
water
3.3% 96.7% - 20.0% 80.0% - 13.3% 86.7% - 13.3% 86.7% - 
Diarrhea
The percentage of under-5s who suffered from diarrhea in Surabaya is quite high. In Wonorejo, 
43.3% of respondents said that their under-5 had suffered from diarrhea at some time. At the 
time of the 2013 midline survey in, this figure had increased slightly to 46.7%.
In Petemon, the proportion of under-5s who had suffered from diarrhea at the time of the 
midline survey had declined, with 36.7% of respondents saying that their under-5s had suffered 
from diarrhea at one time or another (previously 63.3%).
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Figure 5.37
Has Your Under-5 Ever Suffered from Diarrhea?
Based on the last time when under-5s had suffered diarrhea, in both Wonorejo and Petemon, 
both at the time of the baseline survey and midline survey, the majority of respondents said 
within the last three months. A small proportion said that their under-5s had suffered diarrhea 
between 1 week and 3 months ago.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.38
Last Time your Under-5 Suffered from Diarrhea
When their under-5s suffered diarrhea, more than half of respondents in Wonorejo and 
Petemon opted to bring the child to a medical professional (midwife/doctor/medical technician). 
Out of a total of 14 respondents in Wonorejo, 6 brought their sick children to the nearest 
medical professional, while 4 others brought their children to the Puskesmas. Meanwhile in 
Baseline Midline Baseline Midline
43,3% 46,7%
63,3%
36,7%
56,7% 53,3%
36,7%
63,3%
No
Yes
Wonorejo Petemon
Respondent base : 60
Baseline 
(n=13)
Midline 
(n=14)
Baseline 
(n=19)
Midline 
(n=11)
2 2 2 2
3 3 5 2
8 9 11 7
1 within the past 24 
hours
> 3 months ago
within the last 3 
months
Wonorejo Petemon
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Petemon, out of a total of 11 respondents, 6 brought their under-5s to the nearest medical 
professional when they suffered diarrhea. Only 3 brought them to the Puskesmas for treatment.
The figure below is in absolute terms as the base number of respondents was less than 30.
Figure 5.39
Treatment of Diarrhea
As regards the total cost of treatment (including transportation, care and medication):
• In Wonorejo, 4 respondents said that they spent quite a lot of money (Rp 150,000 – Rp 
400,000) when their children were sick with diarrhea, while 4 others expended between Rp 
10,000 and Rp 150,000. There were also 2 respondents who said they spent less than Rp 
10,000.
• In Petemon, the most common range was Rp 10,000 – Rp 150,000, although three people 
said they spend more than that.
The following chart shows the costs incurred in the treatment of diarrhea among under-5s (in 
absolute terms as the base number of respondents was less than 30): 
Figure 5.40
Overall Cost of Treatment (transportation, consultation, medicine)
Baseline 
(n=13)
Midline 
(n=14)
Baseline 
(n=19)
Midline 
(n=11)
3 4
11
3
9
6
5
6
2
1 2 4 2
Two other responses
Hospitalization
Treated by nearest medical 
professional 
(midwife/doctor/medical technician)
Treated at nearest Puskesmas
Wonorejo Petemon
Baseline (n=13) Midline (n=14) Baseline (n=19) Midline (n=11)
6
2
10
4
4
3
6
2
4
2
3
> Rp 150.000 - Rp 400.000
> Rp 10.000 - Rp 150.000
< Rp 10.000
Wonorejo Petemon
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Part VI
Children Baseline – Elementary School 
A. Perceptions of children regarding conditions that impact on healthy and clean 
life practices
During this process, the respondents were provided with stimuli in the form of pictures, where 
each CBTS pillar and non-CBTS pillar aspect was represented by two pictures. The stimuli also 
included pictures showing ‘healthy children laughing’, ‘children bathing together in a well’, and 
so forth. Each of these was represented by 2 pictures. A number of pictures showing the 
opposite were also presented (dirty/contrary to the CBTS pillars). Once again, each situation 
was represented by 2 pictures.
Of the pictures that were shown, two pictures showing ‘washing hands with running water and 
soap’ were the 2 top choices, with 90% and 80% of the children selecting these as showing 
examples of clean and healthy lifestyles. The children at all age levels and all sexes chose these 
activities. The following choices were selected by at least 20% of respondents:
Figure 6.1
8 top responses for conditions that are deemed clean and healthy
 ‘The washing hands’ picture was more often selected by respondents between 10 and 12 years 
of age, compared with the other pictures. This may be influenced by a number of factors, such 
as: (1) recent campaign for washing hands with soap in the targeted schools so that the 
awareness of children about the importance of washing hands with soap was high – only 91.7% 
of the children (out of 26.7% of the children) who said they had heard of the term CBTS 
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associated it with washing hands with soap; (2) washing hands was a practice that was taught 
as standard by the adults around them (parents and teachers) so as to maintain healthy and 
hygiene.
As with the 2 pictures showing ‘washing hands with soap’ that were most frequently selected as 
the two top answers, the next choices were pictures showing ‘covering food’, which were 
selected by 66.7% and 63.3%.
After the two top choices (‘washing hands’ and ‘covering food’), the picture of a ‘dispenser 
against a background of a clean kitchen’ was the next choice (33.3%). The next choices were 
the picture showing ‘a child defecating in a sit-down toilet’ (30%) and ‘a squat toilet’ (also 
26.7%). In addition, ‘a clean squat toilet’ was selected by 20% of respondents as representing 
a clean and healthy life.
All of the choices of the children tended to correlate with the five CBTS pillars. Nevertheless, 
when the children were questioned about their awareness of CBTS, more than half of the 
respondents (70%) said that they had never heard of the term.
1. Children’s Understanding of CBTS
When the elementary school respondents were asked, 70% said they had never heard of CBTS, 
while around 30% had heard of the term.
Table 6.1
Understanding of CBTS by Grade
Figure 6.1
Children’s Understanding of CBTS
Comparing the information on respondent grades and their knowledge of the term CBTS, there 
appears to be a correlation between grade and awareness -- the fact that a child is in a higher 
grade means that he or she will be more likely to be aware than a child in a lower grade.
Further, when the 9 respondents who said they were aware of CBTS were asked what they 
know about the concept, only 6 were able to state that the abbreviation stood for “Community 
Yes; 
30%
No;
70%
CBTS Grade 4 Grade 5 Grade 6 Total
Yes 2 3 4 9 
No 8 7 6 21
Total 10 10 10 30
Respondent base: 30
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Based Total Sanitation,” while the 3 others did not know or had forgotten. When probed further 
about their knowledge of CBTS, the following information was obtained:
Table 6.2
What More Do You Know About CBTS?
Knowledge of CBTS – Multiple Answer Number of 
Respondents *
Washing hands with soap 7 
Stopping open defecation 4 
Consists of 5 pillars 2 
Garbage Management 2 
Treating and Storing Drinking Water Safely 1 
Treatment of household wastewater 1 
Clipping nails 1 
Washing Hands 1 
Maintaining cleanliness 1 
Manage meals and drinks at home 1 
Respondent Base: 9
∗ Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
Washing hands with soap was the practice most frequently identified with CBTS (other than the 
term CBTS itself). There were also those who stated the number of CBTS pillars and a number 
of different pillars (like CTPS, stopping open defecation, safe treatment and storage of drinking 
water and household waste management).
A number of pictures were shown to the respondents and they were asked to select those that 
reflected CBTS. The following are their choices:
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Figure 6.2
Pictures Showing CBTS – Multiple Answer
Choice 1: 8 resp Choice 2: 7 resp Choice 3: 6 resp Choice 4: 6 resp
 
Choice 5: 3 resp Choice 6: 3 resp 6 Other Responses: 6 resp.
 
Respondent Base: 9
Resp: respondent
The most popular CBTS pillars (the ones most frequently remembered, and therefore the 
relevant pictures most frequently selected) were as follows: (1) ‘Washing hands with soap’; (2) 
‘covering food and safe treatment of drinking water’. Another pillar, ‘managing household 
wastewater’, was selected by 3 respondents, while others, mentioned by 1 respondent each, 
were ‘defecating in a toilet’ and ‘a closed earthenware water jar’. Other pictures (outside of 
CBTS) that were selected by one respondent each were ‘bathing’, ‘dirty hands’ and ‘playing with 
friends’. 
As regards where the 9 children who knew about CBTS had received their information, the 
following responses were obtained:
Table 6.3
Information on CBTS Obtained From:
Person Providing Information 
on CBTS – Single Answer Person’s Name 
Number of 
Respondents 
* 
From school principal Ibu Sri Lestari 1 
From older classmate Nurul Aziza 2 
From friend Nurul Aziza 1 
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Person Providing Information 
on CBTS – Single Answer Person’s Name 
Number of 
Respondents 
* 
From younger classmate Nurul Aziza 1 
From High Five Program Promoter Mamik, Citra, Raihis, Nujrum 1 
From teacher Ibu Ika 1 
From sticker posted up at school - 1 
School outreach School outreach 1 
Respondent Base: 9
∗ Number of respondents is stated in absolute terms/frequency as number was below 
minimum of 30
As regards how information was presented to the respondents, the respondents said that 
informant Ibu Nurul Aziza had provided information directly to them less than a month ago 
(around February 2013). Ibu Ika (a teacher) had informed the respondents about CBTS around 
3 months ago (around December 2013), while the school principal had told the respondents 
about CBTS while urging them to maintain cleanliness (the respondents could not remember 
precisely when this had taken place).
The High Five Program Promoters (Kakak Pembina High Five Program) had explained High Five 
Program to the respondents in their class less than one month ago (around February 2013). 
One respondent had found out about High Five Program from stickers put up in the school, 
which he had seen for the first time about 2 months ago (January 2013).
The following are the responses of the elementary schoolchildren in connection with their 
perceptions of various activities related to CBTS activities.
While in general the child respondents in Surabaya were familiar with various practices related 
to defecation, such as the importance of defecation in the right place, the causes of diarrhea 
and the dangers of diarrhea to children, it should also be noted that there were a relatively 
large number of children who were not aware (33-40%) of the dangers that arise from 
infectious diseases transmitted through feces. The responses of the children on their 
perceptions related to human feces/excrement are as shown below:
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Table 6.4
Perceptions of Children Related to Defecation 
Description Correct Incorrect
Defecation in a toilet that has a proper waste disposal system 
will reduce the incidence of diarrhea 83.3% 16.7% 
Human feces contain germs that can cause diarrhea 60% 40% 
No need to wash hands with soap after defecation 6.7% 93.3%
Infant feces can be injurious to health 66.7% 33.3%
Respondent Base: 30 
As regards various activities that are not appropriate in connection with defecation in the home 
or school environment, their responses are presented in the table below.
The responses of the elementary school children show that many unhealthy and unhygienic 
practices continue to be prevalent in their school and home environments. A total of 43.3% said 
that open defecation continues to occur around their homes, although it was almost non￾existent in the school environment. Similarly, 40% said that feces continued to be disposed of 
in water channels/drains around their homes.
Table 6.5
Children’s Explanations on Inappropriate Defecation Behavior in their Home and School 
Environments 
Do any of the following things happen: 
At Home (%) At School (%)
Yes No Yes No
Defecation outside of toilet. 43,3 56,7 3.3 96.7
Disposal of feces into drain/water channel 40 60 0 90 
Respondent Base: 30
The quite significant differences in respondents’ sanitation behavior in the school and home 
environments may be due to: (a) the time spent by respondents in the school environment is 
much less than in the home environment – thus, the description of behaviors around the home 
is more accurate than in the school environment; or (b) residents’ behavior is much more 
hygienic around the schools.
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Last place of defecation 
A total of 93.3% of respondents said that their last place of defecation was in the toilet at home 
or at school. However, 6.7% said that it was a pond near their home/school. After defecation, 
50% said that they directly cleaned themselves with soap and water, 26.7% said they directly 
washed their hands, and the remaining 23.4% had four other responses: “cleaning themselves 
with water”, “washing hands with soap”, and “did nothing”.
Defecation in school 
All of the students (100%) had urinated at one time or another in school (36.7% in the student 
bathroom and 63.3% in the student toilet), but only 50% said they had defecated at one time 
or another at school, and all did so in the student toilet. 
A total of 50% of students said that urinating/defecating at school was different than at home 
for the following reasons:
Table 6.6
Thing that make urinating/defecating at school different from at home
No. Difference Number of Students* 
1. No soap 4 
2. Dirty/smelly 5 
3. No enough water 3 
4. Have to queue, take turns with other students 2 
5. 4 other responses 4 
Respondent Base: 15 students 
Pillar 2: Washing hands with soap 
*The table above is in absolute terms as the base number of respondents was less than 30.
The knowledge of the children regarding the benefits of washing hands with soap after 
defecation was better than their knowledge of the first CBTS pillar (‘spread of disease through 
human feces’).
Table 6.7
Perceptions of Children Regarding CTPS-related Activities 
Description Right Wrong
Washing hands with water alone is enough to clean off disease-spreading germs 16.7% 83.3% 
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Description Right Wrong
We don’t need to washing hands with soap after defecation unless our hands are 
sticky 6.7% 93.3%
Respondent Base: 30 
As regards availability of water, 40% said that they had experienced difficulties with water for 
bathing and washing in their home environments, but only 26.7% said they had done so in 
their school environments.
Table 6.8
Children’s Description of Water Availability At Home and At School
Have you ever experienced any of the following?
At Home (%) At School (%)
Yes No Yes No
Foul smelling or tasting drinking water 26,7 73,3 16,7 83,3
Difficulties with availability of water for bathing or 
washing
40 60 26,7 73,3
Respondent Base: 30
Washing Hands in the Home
A total of 96.7% of respondents ate lunch at home, while only 3.3% did so at school. All of the 
respondents ate dinner at home. The following are their responses on their behavior before 
eating (both snacks and meals):
Figure 6.2
Behavior Before Eating (Snacks and Meals)
Washing hands (without 
mentioning water/ soap)
Washing hands with soap Washing hands with water
56,7%
23% 20%
46,7%
40%
13,30%
Snacks
Meal
Respondent base: 30
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The majority of respondents (56.7%) said they just washed their hands (without mentioning 
water/soap) before eating snacks. The above table also shows differences in behavior prior to 
eating, with 40% of respondents saying that the washed their hands with soap before eating a 
meal, while only 23% did so before eating a snack. The table below summarizes the situation 
as regards washing hands before eating a meal and a snack:
Table 6.9
Hand Washing Practices Before Eating (Meals and Snacks)
Group SURABAYA
Children who always wash their hands with water but without soap (before 
eating snack or main meal) 63,3%
Children who always wash their hands with soap (before eating snack or main 
meal) 13,3%
Children who have better hand-washing practices before eating main meals 
compared with snacks 16,7%
Children who never wash their hands before eating 3,3%
Respondent base: 30
The reasons given by respondents for washing their hands before eating were as follows:
Figure 6.3
Reasons for Washing Hands Prior to Eating 
To rid their 
hands of germs
So that germs 
on the hands 
don't enter the 
stomach
Because the 
hands are dirty
Because there 
are many germs 
on the hands
5 other 
responses
50,0%
16,7% 13,3% 10,0%
20,0%
Respondent base : 30
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Using open-ended questions, it was found that the main reason for washing hands before 
eating was to rid the hands of germs (50% of respondents). The remaining responses varied, 
but were also concerned with germs, while there were also 4 other responses: so as not to get 
a stomach ache, not to get diarrhea, not to get sick and not to have sticky hands.
The primary source of information on the importance of washing hands before eating so as to 
avoid germs was teachers in school (46.7%) and parents (43.3%).
The other situations when they practiced hand-washing with soap were (1) after defecating 
(50%), (2) after playing (33.3%); (3) after urinating (33.3%) and before sleeping (25%). The 
remainder consisted of 8 other responses, namely: after eating, after handling animals, after 
handling dirty things, after holding baby, etc.
A total of 100% of respondents said that they had facilities at school for washing hands, while 
63.3% said that they always washed their hands before eating at school, and 36.7% said that 
they sometimes did so.
As regards the practice of hand washing with soap, 33,3% of respondents did it correctly 
(rubbing the palm and between the fingers with water and soap), while 23.3% rubbed between 
the fingers (without rubbing the palm) with water and soap, and 20% rubbed between the 
fingers with water alone. The remainder did not use water and soap.
Pillar 3: Clean and healthy treatment of drinking water 
A total of at least 60% of the elementary school respondents were aware of the importance of 
treating water before consumption, as well as treating food before consumption. Nevertheless, 
they still need more information on the risk of diarrhea from untreated water, and the dangers 
of consuming untreated vegetables. Their responses as regards their knowledge of the risks of 
diarrhea and bacteria from untreated vegetables, and the spread of germs by flies, are as 
shown in the following table:
Table 6.10
Perceptions of Children About Activities Related to Defecation 
Description Right Wrong
Eating untreated vegetables is healthy, and you don’t need to worry 
about germs 36,7% 63,3%
Drinking untreated water can cause diarrhea 70% 30% 
The legs of flies carry thousands of germs that can be spread from 
place to place 80% 20% 
Respondent base: 30 
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
102
Although the elementary school respondents had quite good knowledge about the need to treat 
water before consumption, 36.7% of respondents referred to the drinking of untreated water at 
home.
Table 6.11
Children’s Descriptions of Drinking Water Treatment At Home and At School
Have any of the following things happened?* 
At home (%) At School (%)
Yes No Yes No
People drank untreated water 36,7 63,3 16,7 83,3
Respondent base: 30
*There were ’don’t know’ responses
As regards sources of water at school, 86.7% of respondents said that they purchased it at 
school, while only 6.7% brought it from home. Of the 86.7% who purchased it at school (20 
students), 16 purchased branded packaged water (in both plastic cups and bottles), while 
others purchased ices (both branded such as Marimas, Sisri and Pop Ice, and unbranded). 
Seventeen respondents purchased drinks in the school canteen, while the remainder did so in 
stalls outside the school.
Pillar 4: Garbage Management 
Based on observations conducted in the schools, uncovered garbage bins were the most 
common places (90%) where students disposed of the packaging from their snacks (whether 
consumed during playtime or in the classroom).
Pillar 5: Solid and Liquid Waste Treatment 
As regards the wastewater disposal channels in the places where the respondents lived, 4 
pictures were used, consisting of 2 pictures showing clean drains and 2 pictures showing dirty 
drains. These elicited the following responses from the elementary school children:
Table 6.12
Condition of Wastewater Disposal Channels in Place Where You Live
Picture Number Picture Water Channel Category Percentage
11 Clean 40%
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
103
Picture Number Picture Water Channel Category Percentage
12 Clean 20%
13 Dirty 40%
14 Dirty - 
Respondent Base: 30 
B. Perceptions of Children of Environmental Cleanliness at School and at Home
The elementary school respondents in Surabaya were dominated by children whose schools 
were within Wonorejo (25 respondents out of a total of 30 in Surabaya). Of these, more than 
half (66.7%) said that their school environment was quite clean, while 30% said that their 
school environment was very clean. Of 5 respondents from Wonorejo Elementary School No. 2, 
one said that his school environment was not clean/dirty. The following table shows the
children’s responses:
Table 6.13
Children’s Perceptions of Environmental Cleanliness
Perceptions of Environment School Home
Quite Clean 66.7% 83,3%
Very Clean 30% 10%
Dirty 3.3% 6.7%
Respondent base: 30 
Although 96.7% of respondents perceived their school environment to be clean (quite clean and 
very clean), and only 6.7% felt their home environments to be dirty, nevertheless all (100%) 
said that environmental cleanliness at school and at home needed to be improved (53.3% and 
40% said, respectively, that it needed to be greatly improved).
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
104
A number of behaviors found in the children’s environment (school and home) were 
acknowledged by almost all respondents (more than 60%) as being inappropriate, such as 
adults discarding garbage in the open, which could lead to blocked drains (60% in the home 
environment, and much cleaner in the school environment – only 26.7% had seen blocked 
drains around their schools), and the continued occurrence of floods during the wet season. A 
total of 70% of respondents said that diarrhea was still found in both their home and school 
environments.
Table 6.14
Children’s Descriptions of Inappropriate Actions Related to Cleanliness in the Home and School 
Environments 
Have any of the following things happened: 
At home (%) At school (%)
Yes No Yes No
Adults incorrectly disposing of garbage 80 20 40 60
Blocked water channels or drains 60 40 26,7 70
Dengue Fever 60 40 26,7 73,3
Flooding every wet season 80 20 80 20
Frequent outbreaks of diarrhea 70 30 73,3 26,7
Respondent base: 30
Sickness Episodes in the Last Month
A total of 46.7% of children had been absent from school on account of sickness in the last 
month (February 2013). The illnesses experienced were as follows:
Table 6.15
Illnesses Experienced in Last 2 Months – Multiple Answer
No. Illness Experienced Number of respondents* 
1 Fever 2 persons
2 Temperature 8 persons
3 Stomach ache 2 persons
4 Headache 3 persons
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
105
No. Illness Experienced Number of respondents* 
6 Cough 2 persons 
7 Typhus 2 persons
8 6 other illnesses 6 persons 
Respondent base: 14 persons
*The table above is in absolute terms as the base number of respondents was less than 30.
As regards diarrhea in the last 2 weeks (end February 2013), 36.7% of children had 
experienced it, while 63.3% had not experienced diarrhea in the last 2 weeks. According to the 
children, the causes of diarrhea were as follows:
Table 6.16
Causes of Diarrhea in Last 2 Weeks – Multiple Answer
No. Cause Number of 
respondents*
1 Eating spicy food 8 persons
2 Eating too many snacks 2 persons
3 2 other causes 2 persons
Respondent base: 11 persons
*The table above is in absolute terms as the base number of respondents was less than 30.
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Attachment
Observations on Schools 
Target Schools and General Conditions
TARGET SCHOOL
Number 
of 
Students 
Number 
of 
Teachers 
Number 
of 
toilets
School Floor School 
Roof 
School 
Walls
SDN PETEMON 600 25 5 Ceramic floor 
tiles Roof tiles Cement 
SDN WONOREJO 7 405 15 2 Tiles Roof tiles Cement 
SDN WONOREJO 5 271 26 3 Tiles Asbestos Cement
SDN WONOREJO 4 189 10 4 Ceramic floor 
tiles Asbestos Cement
SDN WONOREJO 2 245 15 3 Ceramic floor 
tiles Roof tiles Cement 
SDN WONOREJO 1 373 18 4 Ceramic floor 
tiles Roof tiles Cement 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target Schools and CBTS Pillar 1 – 1 
TARGET SCHOOL TYPE OF 
TOILET
PLACE OF 
FECES 
DISPOSAL
CONDITION OF 
SCHOOL 
BATHROOMS
DISTANCE FROM 
WELL TO SEPTIC 
TANK/DROP 
TOILET
DISTANCE FROM 
WELL TO 
NEIGHBORING 
SEPTIC TANKS
SDN PETEMON U-bend Septic tank Quite clean No well No well 
SDN WONOREJO 7 U-bend Septic tank Quite clean No well No well 
SDN WONOREJO 5 U-bend Septic tank Quite clean No well No well 
SDN WONOREJO 4 U-bend Septic tank Quite clean 25 steps 12 steps
SDN WONOREJO 2 U-bend Septic tank Quite clean 20 steps 60 steps
SDN WONOREJO 1 U-bend Septic tank Quite clean No well No well 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and CBTS Pillar 1 – 2 
TARGET SCHOOL
GENERAL CONDITION OF TOILET
FECES 
PRESENT
GARBAGE 
PRESENT
FLIES 
PRESENT
WATER 
AVAILABLE 
SCOOP 
PRESENT
WATER 
RECEPTACLE 
PRESENT
TOWEL 
PRESENT
YES NO YES NO YES NO YES NO YES NO YES NO YES NO
SDN 06 497 x  x  x   x  x  x  x
SDN PETEMON x  x  x   x  x  x x 
SDN WONOREJO 7 x  x  x   x  x  x x 
SDN WONOREJO 5 x  x  x   x  x  x  x
SDN WONOREJO 4 x  x  x   x  x  x x 
SDN WONOREJO 2 x  x  x   x  x x   x
SDN WONOREJO 1 x   x x   x  x  x x 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and CBTS Pillar 2
TARGET SCHOOL
PLACE WHERE STUDENTS WASH HANDS
RUNNING WATER CLEAR WATER DRY TOWEL 
AVAILABLE 
DRY TOWEL 
AVAILABLE 
YES NO YES NO YES NO YES NO
SDN PETEMON  x  x  x x 
SDN WONOREJO 7  x  x x  x 
SDN WONOREJO 5  x  x  x  x 
SDN WONOREJO 4  x  x x  x 
SDN WONOREJO 2  x  x  x x 
SDN WONOREJO 1  x  x  x x 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and Pillar 3
TARGET SCHOOL
FOOD 
CONTAINER IN 
CANTEEN
HOW IS FOOD 
PRESENTED IN CANTEEN
TYPE OF SCHOOL 
CANTEEN
HAND WASHING 
FACILITY IN 
CANTEEN
YES NO
SDN PETEMON Covered Some covered, some 
uncovered “Wet foods” on sale  x 
SDN WONOREJO 7 Covered Covered “Wet foods” on sale  x 
SDN WONOREJO 5 Covered Covered “Dry foods” on sale  x
SDN WONOREJO 4 Covered Some covered, some 
uncovered “Wet foods” on sale x 
SDN WONOREJO 2 Covered Covered “Wet foods” on sale  x 
SDN WONOREJO 1 Covered Covered “Wet foods” on sale  x 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and Pillar 4 – 1 
TARGET SCHOOL
NUMBER 
OF 
GARBAGE 
BINS
TYPE OF 
GARBAGE BIN
CLEANLINESS 
OF SCHOOL
FINAL DISPOSAL OF 
GARBAGE 
GARBAGE 
SEPARATED? 
YES NO
SDN PETEMON 4 Uncovered basket Very clean Permanent covered 
container
 X 
SDN WONOREJO 7 10 Uncovered basket Quite clean Permanent covered 
container
 X 
SDN WONOREJO 5 9 Covered basket Quite clean Basket - outside  X 
SDN WONOREJO 4 12 Covered basket Quite clean Basket – in yard  X 
SDN WONOREJO 2 13 Covered basket Quite clean Basket - outside  X 
SDN WONOREJO 1 9 Covered basket Quite clean Basket - outside  X 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and Pillar 4 – 2 
TARGET SCHOOL CLEANLINESS OF 
CANTEEN
TYPE OF GARBAGE 
RECEPTACLE IN 
CANTEEN
REGULARITY OF 
GARBAGE 
COLLECTION 
ARE FOOD LEFTOVERS 
SEPARATED
YES NO
SDN PETEMON Very clean Uncovered basket Everyday  x 
SDN WONOREJO 7 Quite clean Uncovered basket Everyday  x
SDN WONOREJO 5 Quite clean Uncovered basket Everyday x 
SDN WONOREJO 4 Quite clean Uncovered basket Everyday  x
SDN WONOREJO 2 Very dirty Uncovered basket Everyday x 
SDN WONOREJO 1 Quite clean Uncovered basket Everyday x 
SDN: Sekolah Dasar Negeri - state elementary school
Midline Household Survey - Surabaya
Bringing You The Real Portrait of Indonesia
Target School and Pillar 5
TARGET SCHOOL
METHOD OF 
WASHING DISHES 
IN CANTEEN
WHERE DOES 
WASTEWATER FROM 
CANTEEN GO
IS THERE A 
FILTER 
WHERE 
DISHWASHI
NG TAKES 
PLACE?
WHERE DOES WASTEWATER GO
YES NO BATHROOM WASH-HAND 
BASIN (if any)
SDN PETEMON Washed with soap, 
rinsed in clean water Covered channel

x Covered channel Covered channel
SDN WONOREJO 7 Washed with soap, 
rinsed in clean water Covered channel

x Covered channel Covered channel
SDN WONOREJO 5 Washed with soap, 
rinsed in clean water No wastewater discharge X
 River, pond, drain, canal & 
covered channel 
Wastewater 
discharge pipe
SDN WONOREJO 4 Not available River, pond, drain, canal & 
covered channel x

River, pond, drain, canal Not available 
SDN WONOREJO 2 Washed with soap, 
rinsed in clean water Covered channel X 

Discharge pipe Covered channel
SDN WONOREJO 1 Washed with soap, 
rinsed in clean water Covered channel X 

Covered channel Covered channel
SDN: Sekolah Dasar Negeri - state elementary school