Assessing Market Interventions to Strengthen the Hand Hygiene Roadmap in Indonesia

Clients

UNICEF

Geography of work

Indonesia

Sector

Water, Sanitation and Hygiene (WASH)

Situation/Challenge

In Indonesia, one of the leading causes of mortality amongst children under five years of age is diarrhoea (UNICEF, n.d.). The five key critical moments of handwashing as recommended by health experts including UNICEF and the WHO include before, during, and after preparing food, before and after eating food, and before and after caring for someone at home who is sick with vomiting or diarrhoea, and after using the toilet. Although the importance of handwashing is well known for reducing deaths amongst children, data suggests, that very few children in Indonesia practice handwashing with soap after defecating and before and after eating food. While the government of Indonesia (GoI) along with development partners have implemented several interventions and programs that focus on improving water, sanitation, and hygiene (WASH) services, multiple demand and supply-side challenges still hamper access to hand hygiene practices. One of the major reasons for the lack of regular handwashing is the lack of access to soap and water in schools and households. A study conducted across Indonesia highlights that around 22% of the schools under the Ministry of Education, Culture, Research, and Technology (MoECRT) lack access to soap and running water, a threat which poses a serious challenge to the health of children (UNICEF, 2020a; Wray, 2019).

While the government of Indonesia (GoI) along with development partners have implemented several interventions and programs that focus on improving water, sanitation, and hygiene (WASH) services, multiple demand and supply-side challenges still hamper access to hand hygiene practices. A few demand-side challenges including a) lack of funds for buying and maintaining handwashing facilities by communities and institutions, b) unavailability of basic supplies like water and soap, and c) lack of space to practice handwashing at critical moments affect handwashing practice. On the supply side, challenges are present across all levels including a) limited distribution in rural areas, b) pricing challenges, and c) unavailability of locally applicable and affordable handwashing infrastructure solutions. Though the COVID-19 pandemic led to enhanced awareness and efforts at promoting hand washing facilities and wider awareness about hand hygiene, some systemic challenges still need to be addressed to ensure accessibility and availability of high-quality, affordable hand hygiene products and services across Indonesia.

In this context, UNICEF Indonesia sought to conduct a comprehensive market assessment to assess the ground realities and develop market-based solutions to strengthen the hand hygiene ecosystem in Indonesia. The market assessment study aimed at providing a detailed assessment of the existing value chain, market gaps, customer preferences, and behaviour related to hand hygiene. The outcomes and solutions of this study will help UNICEF and the Government of Indonesia (GoI) to design and launch interventions to make the essential resources available through innovative means and create a robust supply chain of essential hand hygiene products. The study included an extensive field-based survey of around 600 respondents including adolescent children, household heads, teachers, healthcare workers, school teachers, facility managers at transport hubs, markets and religious places, and sanitation workers.

Outcome and Impact

The assessment found that across most rural and semi-urban areas, water access through groundwater sources was not a challenge. Most households reported having sufficient water supplies to fulfill daily needs.
However, nearly 60% of households did not have water connections inside homes, that would enable installation of handwashing stations at necessary locations such as kitchens and near toilets. Locally suitable handwashing stations are
Many public places such as schools, markets and workplaces have water supplies, but do not have financial and operational mechanisms to ensure maintenance of handwashing infrastructure.
The situation is particularly poor in transport hubs, where the lack of separate washrooms for women is a major challenge for women to practice handwashing.
While sanitizers are used in public places, household or personal use is growing, but limited.
Another major challenge was the patchy or inconsistent access to key handwashing products like soaps in rural areas. While products are available, the unavailability of suitable, affordable SKUs/package sizes often discourages people from buying soaps.
Most multinational companies did not have a detailed map of areas where supply chains were weak or inaccessible. This is likely to affect access to affordable products in rural and remote areas.
Indonesia faces significant challenges in enhancing access to piped water in households, mainly because its vulnerability to climate change limits its ability to extract groundwater, while household connections in urban slums etc. are not feasible options.
Indonesia’s entrepreneurial ecosystem needs to be shaped through technical and financial support
Indonesia has experimented with some interesting solutions like sanitation entrepreneur collectives and deploying microfinance for sanitation infrastructure, such initiatives need to be explored further.

Key Recommendations:

Strengthen the current PPP-HWWS platform for more active engagement of private companies with the government agencies
Develop and implement a Water, Sanitation and Hygiene Monitoring Index (WASH MI) that can support the authorities at various levels to take informed decisions and develop appropriate interventions
Create an enabling environment to build the capacity of the Innovators and Start-ups to scale indigenous technologies/ products in the local market
WASH facilities (including HH infrastructure) can be developed and managed in PPP mode using various revenue models to ensure regular maintenance of the facility.
Existing social structures, grass-root organizations, and other collectives (SHGs) can be leveraged for market activation and delivery of products. The MNC/distributors can adopt an incentivizing model to have product penetration through these ‘Service Providers’.
Design a loan product that addresses the missing middle for enterprises to grow and scale with the help of financial institutions (FIs) at different stages of their growth

Behind the Scenes:

The project needed a lot of in-depth research, scouting and hunting for suitable entrepreneurs, partners and organizations whom we could interview. The India-based team managed to coordinate with local field team members and complete data collection across nearly 10 cities in 3 provinces, some of which were very remote, accessible only by boat and planes. The team completed the data collection within the stipulated time. Another major hurdle to overcome was the language barrier, but with the help of our local experts and partners, we managed to reach nearly 750 people through interviews and surveys. The UNICEF Indonesia team will now use our report to advocate for change with the Ministry of Health in Indonesia.

Testimonials:

Sanitation entrepreneur in Jakarta, Indonesia, added that “We need much more ecosystem-based support to develop a pool of entrepreneurs who can develop sanitation-related infrastructure for Indonesian people at a reasonable cost”

USAID added that “Indonesia has made great strides in enhancing access to water and sanitation in most settings. The next phase is instilling awareness among people for using these resources wisely for appropriate sanitation and hygiene.”