Country and region: Indonesia
Point person and Role: Ann Thomas, Chief of WASH
Population served by the programme: 268 million
Unique characteristics of the setting: 268 million persons live in Indonesia. They are spread across more than 16,000 islands which are incredibly diverse in terms of socio-economic factors, culture and access to services.
Number of cases and deaths due to COVID-19 at time of publishing: 336,716 cases and 11,935 deaths
Briefly describe the key components of your COVID-19 response programme.
Indonesia currently has the second highest number of COVID-19 cases in Southeast Asia and cases continue to rise in line with increased testing capacity. The Government of Indonesia has adopted a strategy for mitigating COVID-19 transmission based on three key hygiene behaviours: handwashing with soap (HWWS), proper use of facemasks and physical distancing.
Our support to the COVID-19 response was structured in terms of immediate and transitional support.
During the ‘immediate response’ phase, we supported the Government of Indonesia on three main activities:
Distribution of hygiene materials: We supported the provision of handwashing stations, soaps, disinfectants and COVID hygiene kits in partnership with the Ministry of Health. To date, we have reached nearly 2 million people in over 11 provinces.
Provision of technical support: We provided technical support to develop and roll-out protocols on HWWS in schools and in public places. We also supported the implementation of Intervention, Prevention and Control (IPC) measures in healthcare facilities and measures regarding the management of medical waste at the household level.
Revision of the National Sanitation Program: We revised the protocols for Community Engagement in the National Sanitation Program in light of COVID-19 situation.
Worker moving medical aid items at the warehouse of the Indonesian Ministry of Health in Central Jakarta, Indonesia on 7 September, 2020. UNICEF is working with the ADB (Asian Development Bank) to assist the Indonesian government by providing medical aid kits to fight Covid-19. UNICEF/Arimacs Wilande
In the current ‘transitional phase’ of the response, we have been focusing on two main activities:
Support the school reopening process: We are supporting enhanced assessments and data collection exercises to prioritize WASH in schools.
Development of a national monitoring system for key target behaviours: We have been asked to support the Government in developing and implementing a national real-time monitoring system for three COVID-19 prevention behaviours - handwashing with soap, mask usage and physical distancing. The idea is that this monitoring system will allow the government to visualise and understand the effectiveness of their campaigns over time. This monitoring initiative, called 3M, is based on structured observations which are undertaken by a network of over 30,000 volunteers. Structured observations are conducted at the entrance of public places or institutions, such as markets, mosques or schools. Volunteer observers are asked to complete a short survey about the behaviours of the first ten people entering the place and not whether there is anyone at the location responsible for encouraging COVID-19 prevention behaviours. Specifically, volunteers document whether there is a handwashing facility with water and soap available and what proportion of the people they observe wash their hands with water and soap on entry to the location. The observers also note down whether people are correctly wearing a face mask, whether there are measures in place to enable physical distancing or whether people adhere to these. Volunteers report their data via smartphones and then data is collated at the national level by our 3M platform to further inform decision-making around COVID-19 preventive measures.
A young boy wearing a facemask in a public place in Indonesia on August 16, 2020. UNICEF/Arimacs Wilander
What process did you use when designing your COVID-19 response programme?
In this section we focus specifically on the 3M monitoring system. When we designed this we had three main considerations in mind:
The system provides a credible system for learning about behaviour: In setting up the system our primary goal was to understand actual behaviour. Several methods for measuring behaviours are currently used by the Government of Indonesia, mostly based on either self-reporting or structured observations. While real-time monitoring of self-reported behaviours is known to overestimate actual practice, observation-based approaches suffer from a lack of scalability and consistency in reporting. To ensure our system is able to gather credible and consistent data while being nationally scalable, we decided to adapt, simplify and shorten the structured observation methodology, relying on a network of more than 30,000 volunteer observers. In addition to observing actual behavioural compliance, this approach allows us to understand whether handwashing facilities are functional and have water and soap available to enable practice. It also allows us to see whether there are ‘attendants’ in these public settings whose role it is to remind people to wash their hands, wear a mask and key at a distance.
Data collection can feasibly be done across the country by volunteers: Considering the size of Indonesia and its socio-economic and cultural diversity, our monitoring system had to be designed to work everywhere and to be implemented by a network of 30,000 volunteers with little or no training. The data collection process only requires the volunteer to have a smartphone or data collection device. We also designed a simplified orientation training for volunteers which explained to them how to conduct observations.
The monitoring system is socially supported: It was important to us that Indonesians accepted and saw value in the monitoring process. To address this our volunteers were recruited via an existing Civil Society Organisation (CSO). Volunteer recruitment was boosted by the fact that we engaged our national UNICEF ambassador to promote the process and encourage volunteers. As such we positioned this monitoring as part of a social movement which is about adopting healthy behaviours to protect each other. We are also rewarding volunteers with mobile phone credit, instead of in-cash payment, aiming to leverage their sense of civic duty.
What is one thing that has been working really well so far and is there something other programmes could learn from this?
As behaviour change is the Government of Indonesia’s primary strategy for mitigating COVID-19 transmission, our system for monitoring behaviours has been positively received by the Government staff. Our programme has benefited from having full support from the Office of the President. This has allowed us to work effectively with multiple ministries and to gain the active support of national volunteers across the entire country.
Using mobile phones as data collection devices was particularly suited for scale-up across Indonesia. The initial training we developed seemed to have enabled volunteers to do the date collection with quality. Since then we have launched WhatsApp groups to promote communication between volunteers and peer-led learnings.
What is one challenge that you have encountered and how are you trying to overcome this?
One of our main challenges lies in the scalability and sustainability of our monitoring system based on data reported by volunteers. Although we were able to initially engage with an existing network of more than 30,000 volunteers, more volunteers are needed to collect data across the entire country, especially rural areas.
We have decided to open up data collection more broadly by involving existing groups of volunteers as well as the general population. For instance, we would like to engage with the National COVID-19 Task Force which is active at village level and is part of the Government’s Village Resilience Programme. Volunteers from the general population will be recruited as ‘public volunteers’, leveraging their sense of civic duty, with the aim of increasing behavioural compliance in the population.
How have you been engaging communities throughout your programme and what feedback have you received?
We initially pilot-tested our monitoring tool in Jakarta province, revealing that handwashing with soap was the least practiced behaviour of the three target behaviours. In transport hubs, markets and religious places, less than 50% of people washed their hands with soap before entering the area. Volunteers reported no issue using their mobile phone as a data collection device or entering data using our surveys.
Concerns were raised by some people around the presence of the volunteers next to handwashing facilities in public locations. We issued letters of authority to the volunteers to explain their presence to the general population. We also provided volunteers with further training on how to answer questions and issues raised by people about their work.
Lia, 23, is helping her daughter, Nur Halizha, 6, wash her hands at her home in East Jakarta, Indonesia on 4 September, 2020. During the COVID-19 pandemic, Lia and Nur Halizha wash their hands more frequently in their daily lives. According to Lia, washing hands is one way to fight COVID-19. UNICEF/Arimacs Wilander