1. Sustaining Behaviour Change Results with Participatory Monitoring Tools Our experience in Eastern Indonesia

2. About Simavi Established in 1925 9 countries: Bangladesh, Ghana, India, Indonesia, Kenya, Malawi, Nepal, Uganda, Tanzania Offices in Indonesia, Bangladesh and Tanzania 50 employees in Haarlem, the Netherlands Vision : Simavi strives for a world in which basic health is accessible to all, since basic health is the first step towards building a better existence and getting out of poverty. Therefore we invest in WASH and SRHR.

3. BACKGROUND Simavi’s rural sanitation project in Indonesia (2010 – 2015) improved the behaviour of over 1.4 million people in 9 districts across 5 islands in Eastern Indonesia, covering five key sanitation and hygiene behaviour and practices. =

4. Post-project challenge: 1.How do you ensure that communities will sustain their newly adopted healthy behaviour? 2.How do you keep track of toilets and hand washing facilities used by 1.4 million people living in over 1,000 villages in five remote islands? 3.How do you ensure that all those facilities are used and continue to function forever?

5. METHODS: Output & Outcome Monitoring Two types of indicators were used to monitor performance: Output indicators to check the presence and type of sanitation facilities, individual or communal. Outcome indicators to assess the conditions of the facilities (e.g. quality 0f construction, hygienic state, maintenance) and the effective use of the facilities by the people. The condition and effective usage gives a comprehensive indication of adoption and behaviour change.

6. Output indicators were used to measure increased access to physical assets or facilities for all five STBM pillars. This was done by recording the presence of and types of the sanitation and hygiene facilities, for example: Pillar 1: Access to improved toilets: existence (numbers) and type of toilet facilities Pillar 2: Access to hand washing facilities: existence (numbers) and type of hand washing facilities Pillar 3: Household water treatment and safe storage: existence and type of water treatment facilities The tools - 1

7. Outcome indicators were used to measure increased quality of the facilities and changes in behaviour and practices or all five STBM pillars. This was done with the use of QIS indicators which quantify quantitative information, for example: Pillar 2: Access to hand washing with soap facilities Changes in hand washing behaviour were measured with the use of this proxi-indicator Proxy indicators are indirect measures or signs that approximates or represents a phenomenon or behaviour in the absence of a direct measure or sign The tools - 2

8. The set-up Regular house-to-house visits by trained village volunteers, using forms with pictograms:  Monthly, immediately following demand creation (output monitoring only)  Quarterly, 3 months after demand creation triggering (output & outcome monitoring)  Half-yearly, after a village is declared “100% STBM” which means all villagers practice all 5 STBM pillars (outcome monitoring only) Aggregation and analysis at every level, from hamlet to village to sub-district to district.

9. RESULTS The participatory monitoring tools provide detailed insight in the actual situation in a village on whether it is progressing or slipping backward. The information can be used by the community to determine follow up activities. Because of its participatory and transparent nature, villagers are regularly reminded what is expected from them to improve or maintain their healthy behaviour. Strong linkage between communities and local government, especially with the sanitarian at the health centres. The monitoring results facilitate and stimulate follow-up activities by all the concerned levels: community, sanitarian, head of sub-district and district.

10. WHY IT WORKS It is managed by the community and data collection and follow up is done by trained volunteers selected from the same communities. It is carried out regularly and continuously and therefore becomes a ritual for the communities. It follows the principle of KISS (Keep It Short and Simple). It makes use of pictograms so that villagers know what is expected from them.

11. MOVING FORWARD To be able to monitor sustained use of the improved facilities: The outcome indicators were simplified and incorporated in the existing Ministry of Health’s WASH monitoring system (Inspeksi Sanitasi / Sanitation Inspection) Inspeksi Sanitasi is done by sanitarians based in the community health centres The sanitarians collect the data from the community volunteers

13. For more information the following is available from IRC:  Training modules on performance monitoring which provide detailed explanations on all the different indicators: http://www.ircwash.org/resources/training-modules-performance- monitoring http://www.ircwash.org/resources/training-modules-performance- monitoring  A blog “How are you and how is your loo” describing how the system is applied: http://www.ircwash.org/blog/how-are-you-and- how-your-loohttp://www.ircwash.org/blog/how-are-you-and- how-your-loo