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DOI: 10.14738/aivp.92.10009

Publication Date: 25th April, 2021

URL: http://dx.doi.org/10.14738/aivp.92.10009

Policy Implementation of Community-Led Total

Sanitation

Saepul Harom, Ria Arifianti, Mohammad Benny Alexandri

Faculty of Social and Political Sciences, Universitas Padjadjaran, Indonesia

ABSTRACT

The purpose of this study was to analyze the implementation of the Community-Led

Total Sanitation (CLTS) Program in Bandung Regency which has been implemented.

This research uses qualitative research methods by analyzing documents, according

to the specified research topic, including examining journal article sources, book

sources, program policy sources from documents, and conducting interviews with

informants focused on finding information guided by relevant documents for

research. Findings from the Community-Led Total Sanitation (CLTS) program

research show that this Open Defecation Stop begins with facilitator training to

community health center sanitarians by the Health Office. The follow-up after the

training is carrying out triggering activities, namely stopping open defecation.

Implemented with a focus on changing the behavior of each individual in the

community not to defecate in the open, followed by utilizing sanitary facilities,

namely healthy latrines. Triggering is carried out so that people change attitudes

and behavior, from defecating in the open to stop open defecation. The results of the

triggering must be monitored to ensure that the community starts taking follow-up

actions after the triggering.

Keywords: Sanitation; Community-Led Total Sanitation; Stop Open Defecation;

Policy Implementation; Bandung District

1. INTRODUCTION

The behavior of open defecation is one of the causes of poor sanitation. This can

cause various types of diseases so that this is an example of unhealthy living

behavior [1]. Health quality is influenced by factors that exist in the environment,

community behavior, health services, and genetic [2]. In an environment whose

condition is not by health requirements, then unhygienic and sanitary community

behavior that is found both in urban and rural areas is the strongest and most

influential factor on the quality of public health [3].

Based on data from the World Health Organization (WHO) and the United Nations

Children's Emergency Fund (UNICEF) in the Progress on Sanitation and Drinking

Water in 2010, it is estimated that 17% of the world's population still defecates in

open areas [4]. From the data above, 81% of the population defecates in open

defecation, there are 10 countries, and Indonesia is the second country with the

largest number of people who defecate in open areas [5]. As much as 5% and 42.24%

of the total population of Indonesia do not have access to feces disposal and 24% of

the population still defecate openly. Globally, governments in several regions

allocate funds for public services in the form of sanitation which are still very

limited, more than 2.5 billion people lack hygienic sanitation facilities [6].

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On the goal of sustainable development, one of the agendas is the problem of

sanitation [7]. Of the 17 SDGs goals, sanitation is included in the 6th SDGs goal, which

is to ensure the availability and management of sustainable clean water and

sanitation for all [8]. One of the targets of the SDGs' 6th goal is to achieve access to

adequate and equitable sanitation and hygiene for all and end open defecation, by

paying special attention to the needs of women and girls and those in vulnerable

situations (Ministry Health of the Republic of Indonesia, 2019).

Many bad impacts can arise as a result of poor sanitation, one of which is diarrhea

and many other environmental-based diseases. Sources of disease related to water

quality, sanitation, and poor hygiene account for more than 4% of the total sources

of disease and death that occur [9] [10]. Because sanitation is a basic need, the

government must be able to encourage the fulfillment of proper sanitation needs.

Until now, access to sanitation in Indonesia is still inadequate, many of the

infrastructure and facilities that have been built are no longer functioning or do not

meet the requirements.

Environment-based diseases are still one of the biggest health problems in the

people of Bandung Regency, this can be seen from the high incidence and visits of

patients with environmental-based diseases to the community health center. The

causes of the high incidence of environmental-based diseases include poor

sanitation conditions such as clean water and family latrines, increasing water and

soil pollution due to waste disposal, unhygienic food management methods, and low

hygiene and healthy behavior in the community [11] [12] [13]. Inadequate

knowledge, financially disadvantaged people, and technology are the most basic

things that can affect the success of development programs in the Indonesian health

sector [14].

Efforts to prevent the spread of environmentally-based diseases, increase

community capacity, and implement the government's commitment to increasing

access to sustainable drinking water and basic sanitation, it is necessary to cultivate

a clean and healthy life [15]. One of the efforts is environmental health efforts, which

are aimed at creating a healthy environmental quality, both from the physical,

chemical, biological, and social aspects that enable everyone to achieve the highest

degree of health (Government Regulation Number 66 of 2014).

This program emphasizes the aspect of changing the behavior of individuals or the

community not to defecate openly such as in rivers, rice fields, and others, and does

not emphasize the construction of facilities in the form of latrines [16]. In this

program, the provision of sanitation facilities in the form of latrines or materials can

be done only as a leverage/trigger only for people who are willing and able to

independently build healthy latrines to achieve the program objectives, namely

people with 100% free from open defecation or Open Defecation Free (ODF).

As happened in several regions in Indonesia, the problem of Community-Led Total

Sanitation is mostly found in the poor household segment, so it is a very important

concern [17]. Indonesia still faces enormous challenges related to health

development, particularly hygiene and sanitation. 2015 data from UNICEF and WHO

states that around 51 million Indonesians still defecate in the open. Around the

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Harom, S., Arifianti, R., & Alexandri, M. B. (2021). Policy Implementation of Community-Led Total Sanitation. European

Journal of Applied Sciences, 9(2). 252-264.

URL: http://dx.doi.org/10.14738/aivp.92.10009

world, every year 300 thousand children under five die from diarrhea, or a day that

dies from diarrhea that arises from a bad environment as many as 800 children

under five. Research from [18] shows that the incidence of diarrhea in children from

households using open wells for drinking water is 34% more at risk compared to

children from households using tap water [19].

Community-Led Total Sanitation (CLTS) is a policy of the Indonesian government in

the context of realizing hygienic and sanitary community behavior independently to

improve the highest public health status. The Ministry of Health of the Republic of

Indonesia launched a national program in 2008 through the Minister of Health

Regulation Number 3 of 2014, which was followed up with a circular to all

Governors in Indonesia to implement the program. In 2009 the West Java Provincial

Health Office instructed all District/City Health Offices in West Java to implement

the Community-Led Total Sanitation (CLTS) program. In Bandung Regency, this

program has been implemented since 2009, with the issuance of Regent Regulation

Number 53 of 2014 concerning the implementation of Community-Led Total

Sanitation (CLTS).

The purpose of this study was to describe the implementation process of the

Community-Led Total Sanitation (CLTS) Program in Pasirjambu District, Bandung

Regency. Given the enormous benefits of the program to create hygienic and

sanitary community behavior independently to improve the highest public health

status.

2. LITERATURE REVIEW

Research on the implementation of Community-Led Total Sanitation (CLTS) Stop

Open Defecation using a public policy implementation model [20], which looks at

factors that might influence the implementation of a policy with 6 (six) dimensions,

namely: Standards and Objectives, Resources, Executive Characteristics,

Communication, Attitude of Implementers, Social, economic and political

conditions, and trends of the implementers. This focuses on triggers for changes in

sanitation use behavior [21], which are achieved through appeals from facilitators,

both from within and outside the community [22]. Communities jointly decide how

to create a clean and hygienic environment and benefit everyone [23][24]. [25], [26]

argue that institutional arrangements through the development of technical

supervision procedures, mechanisms for sanctions for non-conformist behavior,

and conflict resolution are very important.

However, [27] stated an aspect of caution, stating that in many cases, sanctions will

usually increase the severity of the offense. Institutions are not organizations,

because organizations operationalize institutional arrangements [28]. Organization

according to [29] is an endogenous factor run through various capital, namely

human capital (skills, knowledge, health), social capital (trust, network, and

reciprocity), resource capital (stocks in nature and environmental services), and

capital physical (infrastructure and goods).

According to [30], public policies are formed when in people's lives there are

complex problems that require action as something that can solve the problem at

hand. Public policy is a decision made by the government which is always related to

a specific goal to be able to solve a particular problem and affect the majority of

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society [31]. Implementation is a process that involves several sources including

human, financial, and organizational capabilities carried out by the government and

the private sector (individuals or groups). This process is carried out to achieve the

goals previously set by policymakers [32]. Meanwhile, policy implementation is an

effort process to bring abstract policy into reality. Policy implementation is an effort

to generate outputs, outcomes, and benefits as well as impacts that can be enjoyed

by target groups.

The developing definition of this liaison organization is a forum or institution that

uses a specific mechanism such as a working group that connects and facilitates

interaction and translates knowledge between individual actors in management

[33] [34] [35] [36]. Through this organization, transaction costs in the context of

cooperation and collaboration will be reduced through task coordination, trust- building, and social learning.

The implementer's understanding of the objectives of the policy is an important

thing. Successful policy implementation must be accompanied by an awareness of

the policy as a whole. This means that the failure of policy implementation is often

the result of non-compliance of the implementers with the policy. In these

conditions, individual perceptions play a role. There are several reasons why these

policies are not accepted by the implementers, including policy objectives conflict

with the executive's values, extra loyalty to the organization, feelings of self-interest,

or because of existing and preferred relationships [37].

3. METHOD

This study uses a qualitative research method by analyzing documents, according to

the specified research topic, using a deductive and inductive approach [38] [39]. So

that the scope of research mostly includes an examination of policy sources, both

primary and secondary from written legal documents, journal article sources, book

sources, as well as reference materials and reports from respective institutions

related to the implementation of Community-Led Total Sanitation (CLTS) policies in

Pasirjambu District, Bandung Regency.

The assumption is that the truth is currently happening, so qualitative data is needed

to provide the best understanding of the research problem. Thus, the application of

various approaches in collecting and analyzing data was carried out rather than

choosing only one approach. This study uses two approaches, namely post-positivist

and constructivist [40]. It can be understood that this research will also seek an

understanding of policy implementation. This study will develop a subjective

understanding based on the informants' experience directly from the relationship

between institutional factors [41].

4. RESULTS AND DISCUSSION

Analysis related to Community-Led Total Sanitation (CLTS) Stops Open Defecation

using a public policy implementation model [20]. Policy implementation is a process

that involves many parties, government officials as the implementing party of

policies supported by sources including funds, facilities, and infrastructure,

operational and organizational capabilities, regulations, procedures, and networks

of political, social, and economic forces that can directly influence various parties

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Harom, S., Arifianti, R., & Alexandri, M. B. (2021). Policy Implementation of Community-Led Total Sanitation. European

Journal of Applied Sciences, 9(2). 252-264.

URL: http://dx.doi.org/10.14738/aivp.92.10009

involved and at the same time produce a positive impact on the target group by the

objectives that have been previously set.

4.1 Policy Standards and Objectives

Policy standards and objectives relate to how the level of success of a program can

be achieved because the success of a program is one of the indicators that can be

used as guidelines for the policy to be continued or requires further evaluation to be

improved. With the Community-Led Total Sanitation (CLTS) program to Stop Open

Defecation, many people are increasingly aware of and aware of the impact of open

defecation. Community access to healthy latrines is also increasing. However,

obstacles in the field remain, not a few people feel comfortable with the current

conditions.

Based on the research results obtained in the field, it shows that the measure of the

stop open defecation program is a change in people's behavior not to defecate

openly and access to healthy in the latrine and 5% for the people who ride.

Therefore it can be concluded that the implementers of the defecation stop program

in Pasirjambu District already understand the purpose and size of the program but

there are still people who do not know the size and purpose of the defecation stop

program implemented in Pasirjambu District. The goal of the stop open defecation

program, namely that 100% of the people of the village already have access to

healthy latrines, cannot be achieved in implementing the stop open defecation

program in Pasirjambu District because the number of access to toilet ownership

owned by the people of Pasirjambu District is still 55%.

In implementing the stopping defecation program in Pasirjambu District, the

District government has only just carried out the triggering or socialization process

in achieving the program objectives. So far, the implementing actors in Pasirjambu

District have only done the triggering, so they are considered ineffective in

triggering the community to build healthy latrines. Meanwhile, other processes such

as mentoring, monitoring, and evaluation have never been implemented so that the

implementation of the stop open defecation program in Pasirjambu District has not

had a maximum impact on the target groups in Pasirjambu District. With the 2021

target for Bandung Regency to stop open defecation, it means that all areas must

have reached 100% access to sanitation or healthy latrines. Of course, this is not an

easy job, it needs commitment from all sectors to make this happen, including

budget support and public participation.

4.2 Resource

Resources that support the implementation of Community-Led Total Sanitation

(CLTS) in the Pasirjambu District, be it humans, funds, time and other supporting

facilities are quite well available. At the Pasirjambu Community Health Center, some

sanitarians have been trained as Community-Led Total Sanitation (CLTS)

facilitators, and in the village, there are environmental health cadres who have been

trained as Community-Led Total Sanitation (CLTS) facilitators. Even in terms of

costs, at the community health center, there is a budget for the implementation of

Community-Led Total Sanitation (CLTS) which comes from the State Revenue and

Expenditure Budget (Special Operational Assistance).

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However, in 2020 the implementation of Community-Led Total Sanitation (CLTS)

did not run optimally because it was affected by the Covid-19 pandemic that hit most

countries in the world including Indonesia, which prompted both central and

regional governments to refocus their budgets. , whether it comes from the State

Revenue and Expenditure Budget as well as the Regional Revenue and Expenditure

Budget. Some several programs and activities have been diverted to deal with the

Covid-19 pandemic and its impact on society, such as providing means of washing

hands with soap, providing cash and food assistance to poor people.

Although the number of supporting programs for improving and improving

sanitation is still limited, these programs have helped and contributed to improving

access and achievement of sanitation or healthy latrines in the area of the

Pasirjambu Community Health Center. Meanwhile, other support resources, such as

the private sector in the Pasirjambu area, have not been exploited and utilized. Of

course, this requires support from policymakers at the sub-district and district

levels so that the private sector can be optimized for community social

responsibility (CSR) activities in the community.

4.3 Communication Between Organizations and Implementing Activities

Communication between organizations is one of the keys to the successful

implementation of a policy. Related to the implementation of the policy to stop open

defecation. The Pasirjambu community health center maintains communication and

coordination with all parties involved in implementing the stop open defecation

program in the working area of the Pasirjambu community health center. The

Pasirjambu community health center maintains communication and coordination

with the head of the sub-district as the authority holder at the sub-district level and

especially maintains communication and coordination with the Village Head who

holds authority at the village government level and is the direct implementer of the

stop open defecation program at the village level. Coordination and communication

between the community health center and the village government are usually

carried out in terms of the development of latrine ownership by reporting data on

latrine ownership every month from representatives of the integrated village

service post and Village Midwives to the Sanitarian to the Pasirjambu community

health center. Although coordination and communication have been carried out well

by program implementing actors, there are still many target communities who do

not understand the purpose of this open defecation program.

Communication across various sectors in the implementation of the Community-Led

Total Sanitation (CLTS) program in the area of the Pasirjambu community health

center has been quite well established. The communication intensity is also

increasing along with the nutrition and toddler stunting program. The existence of

a village midwife in every village in the Pasirjambu District area takes part in

maintaining cross-sectoral communication. Besides, the Community Health Center

routinely conducts quarterly mini-workshops attended by all relevant sectors at the

sub-district level. This activity is an opportunity to exchange ideas and coordinate

between implementing organizations. Social media such as WhatsApp, Instagram,

and Facebook can be a medium of communication between Community-Led Total

Sanitation (CLTS) implementers and the community.

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Harom, S., Arifianti, R., & Alexandri, M. B. (2021). Policy Implementation of Community-Led Total Sanitation. European

Journal of Applied Sciences, 9(2). 252-264.

URL: http://dx.doi.org/10.14738/aivp.92.10009

defecation to defecating in healthy latrines [42]. The results of the triggering must

be monitored to ensure that the community starts taking follow-up actions after the

triggering [43]. Community-Led Total Sanitation (CLTS) is one of the most tested

sanitation interventions [44] [45]. It aims to take advantage of social pressure by

creating embarrassment to improve sanitation. With evidence that Community-Led

Total Sanitation (CLTS) can effectively reduce open defecation in rural areas, but

less effective in urban environments [46] [47].

With current conditions in the area of the Pasirjambu community health center (7

villages), the budget available to support program implementation is deemed

insufficient. From interviews with 7 village heads and those representing (the

Village Secretary), it was found that the budget in the village was still very minimal

allocated for sanitation or healthy latrines [48]. Most villages have a budget for

sanitation below 10% and even zero (zero) in 2020. Because one of the main

principles of Community-Led Total Sanitation (CLTS) is the emergence of an active

role from all levels of society, starting from planning, planning, implementation, use,

and use so that people feel they belong [49].

Research on Community-Led Total Sanitation (CLTS) programs from a financial

perspective in Ghana and Ethiopia shows the cost per household in program

activities, the highest cost allocation refers to training activities [50] [51]. These

findings are useful in considering a policy [52]. Thus, both cost-effectiveness and

efficiency are needed to support the sustainability of the sanitation program. An

expensive budget causes unhealthy community behavior for sanitation seen from

the lower middle segment of society and low economic status, so this is a problem

of Community-Led Total Sanitation (CLTS) [53].

In terms of organizational and management theory, [54] defines an; organization as

a goal-oriented social entity, designed based on structured and coordinated systems

of activity and related to the external environment. In terms of sociology, [55]

suggests that the concept of institutions is increasingly focused on aspects of values,

norms, and behavior; whereas organizations focus on structure. [56], [57] includes

aspects of structure in the sense of an institution, whereas [58] uses the term social

institution.

Public Policy Studies has a relevant approach to analyzing the relationship between

stakeholders in a government. Process activities of mutually beneficial interactions

or cooperation between actors, both government and non-government, which aim

to solve a public problem, which together is due to a common vision, and if done

individually it will be difficult. According to [59] that in general the collaboration

process can be divided into two definitions, namely collaboration in the meaning of

process and collaboration in the normative sense.

Seeing these conditions the sustainability of this program is one of the main

challenges of Community-Led Total Sanitation (CLTS) [60] [61] [62]. Research

results from [63] show that the supporting factors for the Community-Led Total

Sanitation (CLTS) program are the support and commitment of the government and

community bureaucracy. The inhibiting factors for the program are access to public

information on the program of monitoring mechanisms, and the economic

limitations of the community [64]. In implementing programs related to sanitation