Sustaining Behaviour
Change Results with
Participatory
Monitoring Tools
Our experience in Eastern Indonesia
About Simavi
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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.
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.
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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?
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.
The tools - 1
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 - 2
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 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.
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.
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.
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
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-performancemonitoring
 A blog “How are you and how is your loo” describing how the
system is applied: http://www.ircwash.org/blog/how-are-you-andhow-your-loo