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Achieving the Sustainable Development Goals for water and sanitation in Indonesia - Results from a five-year (2013-2017) large-scale effectiveness evaluation.

ABSTRACT: BACKGROUND:Access to safe sanitation and the elimination of open defecation are pre-conditions for improved child health and nutrition and wider achievement of the Sustainable Development Goals (SDGs). While Indonesia has a solid policy framework, the country ranks third globally in terms of numbers of people practicing open defecation. OBJECTIVES:Our aim was to assess the effectiveness of a five-year strategy to reduce open defecation through accelerating implementation of the national sanitation program across districts receiving variable levels of external support. METHODS:Among three provinces with poor sanitation program performance, districts were selected to receive one of three levels of external support. High intensity districts (n = 6) benefitted from enabling environment strengthening support including political and social mobilization, direct capacity development, and efforts to strengthen planning, budgeting, monitoring and supervision; learning districts (n = 16) benefitted from cross-district learning opportunities and political mobilization through provincial government advocacy efforts; and comparison districts (n = 58) were monitored under routine program conditions. Outcomes included open defecation free (ODF) status and new toilet facility construction and were assessed through village level monitoring systems across all districts. Negative binomial regression and multivariate analysis were used to assess associations between levels of intervention intensity and outcomes. FINDINGS:Among districts receiving high-intensity external support improvements in political commitment, planning, coordination, financing, monitoring and supervision were observed. Relative to comparison districts, high intensity districts were more likely to be ODF (aRR 4.65, CI 2.12-10.20) with greater increase in household toilet coverage (aRR 11.15 CI 1.04-119.82). Weaker non-significant associations with ODF were observed among learning districts relative to comparison districts. INTERPRETATION:Efforts to strengthen provincial and district government capacity to implement sanitation programming in Indonesia can yield substantial improvements in outcomes in a relatively short period of time.

SUBMITTER: Odagiri M

PROVIDER: S-EPMC7607394 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Achieving the Sustainable Development Goals for water and sanitation in Indonesia - Results from a five-year (2013-2017) large-scale effectiveness evaluation.

Odagiri Mitsunori M Cronin Aidan A AA Thomas Ann A Kurniawan Muhammad Afrianto MA Zainal Muhammad M Setiabudi Wildan W Gnilo Michael Emerson ME Badloe Chander C Virgiyanti Tri Dewi TD Nurali Imran Agus IA Wahanudin Laisa L Mardikanto Aldy A Pronyk Paul P

International journal of hygiene and environmental health 20200821

<h4>Background</h4>Access to safe sanitation and the elimination of open defecation are pre-conditions for improved child health and nutrition and wider achievement of the Sustainable Development Goals (SDGs). While Indonesia has a solid policy framework, the country ranks third globally in terms of numbers of people practicing open defecation.<h4>Objectives</h4>Our aim was to assess the effectiveness of a five-year strategy to reduce open defecation through accelerating implementation of the na ...[more]

PMID: 32829164

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Project description:ObjectivesAchieving the Sustainable Development Goals will require data-driven public health action. There are limited publications on national health information systems that continuously generate health data. Given the need to develop these systems, we summarised their current status in low-income and middle-income countries.SettingThe survey team jointly developed a questionnaire covering policy, planning, legislation and organisation of case reporting, patient monitoring and civil registration and vital statistics (CRVS) systems. From January until May 2017, we administered the questionnaire to key informants in 51 Centers for Disease Control country offices. Countries were aggregated for descriptive analyses in Microsoft Excel.ResultsKey informants in 15 countries responded to the questionnaire. Several key informants did not answer all questions, leading to different denominators across questions. The Ministry of Health coordinated case reporting, patient monitoring and CRVS systems in 93% (14/15), 93% (13/14) and 53% (8/15) of responding countries, respectively. Domestic financing supported case reporting, patient monitoring and CRVS systems in 86% (12/14), 75% (9/12) and 92% (11/12) of responding countries, respectively. The most common uses for system-generated data were to guide programme response in 100% (15/15) of countries for case reporting, to calculate service coverage in 92% (12/13) of countries for patient monitoring and to estimate the national burden of disease in 83% (10/12) of countries for CRVS. Systems with an electronic component were being used for case reporting, patient monitoring, birth registration and death registration in 87% (13/15), 92% (11/12), 77% (10/13) and 64% (7/11) of responding countries, respectively.ConclusionsMost responding countries have a solid foundation for policy, planning, legislation and organisation of health information systems. Further evaluation is needed to assess the quality of data generated from systems. Periodic evaluations may be useful in monitoring progress in strengthening and harmonising these systems over time.

Project description:The COVID-19 pandemic continues to pose substantial challenges to achieving the Sustainable Development Goals (SDGs). Exploring systematic SDG strategies is urgently needed to aid recovery from the pandemic and reinvigorate global SDG actions. Based on available data and comprehensive analysis of the literature, this paper highlights ongoing challenges facing the SDGs, identifies the effects of COVID-19 on SDG progress, and proposes a systematic framework for promoting the achievement of SDGs in the post-pandemic era. Progress towards attaining the SDGs was already lagging behind even before the onset of the COVID-19 pandemic. Inequitable distribution of food-energy-water resources and environmental crises clearly threaten SDG implementation. Evidently, there are gaps between the vision for SDG realization and actual capacity that constrain national efforts. The turbulent geopolitical environment, spatial inequities, and trade-offs limit the effectiveness of SDG implementation. The global public health crisis and socio-economic downturn under COVID-19 have further impeded progress toward attaining the SDGs. Not only has the pandemic delayed SDG advancement in general, but it has also amplified spatial imbalances in achieving progress, undermined connectivity, and accentuated anti-globalization sentiment under lockdowns and geopolitical conflicts. Nevertheless, positive developments in technology and improvement in environmental conditions have also occurred. In reflecting on the overall situation globally, it is recommended that post-pandemic SDG actions adopt a "Classification-Coordination-Collaboration" framework. Classification facilitates both identification of the current development status and the urgency of SDG achievement aligned with national conditions. Coordination promotes domestic/international and inter-departmental synergy for short-term recovery as well as long-term development. Cooperation is key to strengthening economic exchanges, promoting technological innovation, and building a global culture of sustainable development that is essential if the endeavor of achieving the SDGs is to be successful. Systematic actions are urgently needed to get the SDG process back on track.

Project description:Globally, ~1 billion people, mostly residing in Africa and South Asia (e.g. India), still lack access to clean drinking water and sanitation. Resulting, unsafe disposal of fecal waste from open-defecation to nearby drinking water sources severely endanger public health. Until recently, India had a huge open-defecating population, leading declining public health from water-borne diseases like diarrhoea by ingesting polluted water, mostly sourced to groundwater. However, in recent past, sanitation development to achieve Sustainable Development Goals (SDGs) has been encouraged throughout India, but their effect to groundwater quality and human health conditions are yet-unquantified. Here, for the first time, using long term, high-spatial resolution measurements (>1.7 million) across India and analyses, we quantified that over the years, groundwater fecal coliform concentration (2002-2017, -2.56?±?0.06%/year) and acute diarrheal cases (1990-2016, -3.05?±?0.01%/year) have significantly reduced, potentially influenced by sanitation development (1990-2017, 2.63?±?0.01%/year). Enhanced alleviation of groundwater quality and human health have been observed since 2014, with initiation of acceletated constructions of sanitation infrastructures through Clean India (Swachh Bharat) Mission. However, the goal of completely faecal-pollution free, clean drinking water is yet to be achieved. We also evaluated the suitability of using satellite-derived night-time light (NLan, 1992-2013, 4.26?±?0.05%/year) as potential predictor for such economic development. We observed that in more than 80% of the study region, night-time light demonstrated to be a strong predictor for observed changes in groundwater quality, sanitation development and water-borne disease cases. While sanitation and economic development can improve public health, poor education level and improper human practices can strongly influence on water-borne diseases loads and thus health in parts of India.

Project description:BackgroundCOVID-19 has reinforced the importance of having a sufficient, well-distributed and competent health workforce. In addition to improving health outcomes, increased investment in health has the potential to generate employment, increase labour productivity and foster economic growth. We estimate the required investment for increasing the production of the health workforce in India for achieving the UHC/SDGs.MethodsWe used data from National Health Workforce Account 2018, Periodic Labour Force Survey 2018-19, population projection of Census of India, and government documents and reports. We distinguish between total stock of health professionals and active health workforce. We estimated current shortages in the health workforce using WHO and ILO recommended health worker:population ratio thresholds and extrapolated the supply of health workforce till 2030, using a range of scenarios of production of doctors and nurses/midwives. Using unit costs of opening a new medical college/nursing institute, we estimated the required levels of investment to bridge the potential gap in the health workforce.ResultsTo meet the threshold of 34.5 skilled health workers per 10 000 population, there will be a shortfall of 0.16 million doctors and 0.65 million nurses/midwives in the total stock and 0.57 million doctors and 1.98 million nurses/midwives in active health workforce by the year 2030. The shortages are higher when compared with a higher threshold of 44.5 health workers per 10 000 population. The estimated investment for the required increase in the production of health workforce ranges from INR 523 billion to 2 580 billion for doctors and INR 1 096 billion for nurses/midwives. Such investment during 2021-2025 has the potential of an additional employment generation within the health sector to the tune of 5.4 million and to contribute to national income to the extent of INR 3 429 billion annually.ConclusionIndia needs to significantly increase the production of doctors and nurses/midwives through investing in opening up new medical colleges. Nursing sector should be prioritized to encourage talents to join nursing profession and provide quality education. India needs to set up a benchmark for skill-mix ratio and provide attractive employment opportunities in the health sector to increase the demand and absorb the new graduates.

Dataset Information

Achieving the Sustainable Development Goals for water and sanitation in Indonesia - Results from a five-year (2013-2017) large-scale effectiveness evaluation.

Publications

Achieving the Sustainable Development Goals for water and sanitation in Indonesia - Results from a five-year (2013-2017) large-scale effectiveness evaluation.

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