Safely Managed On-Site Sanitation: A National Assessment of Sanitation Services and Potential Fecal Exposure in Indonesia

Abstract

Sustainable Development Goal target 6.2 calls for universal access to adequate and equitable sanitation, setting a more ambitious standard for ‘safely managed sanitation services’. On-site sanitation systems (e.g., septic tanks) are widely used in low- and middle-income countries (LMICs). However, the lack of indicators for assessing fecal exposure risks presents a barrier to monitoring safely managed services. Furthermore, geographic diversity and frequency of disasters require a more nuanced approach to risk-informed decision-making. Taking Indonesia as an example, the purpose of this paper is to provide insights into current status and practices for on-site sanitation services in the contexts of LMICs. Using a dataset from a national socio-economic survey (n = 295,155) coupled with village census (n = 83,931), we assessed (1) household sanitation practices across Indonesia stratified by city-level population density and meteorological factors, (2) factors associated with septic tank emptying practice, and (3) inequalities in potential fecal exposure as measured by population density and WASH access by wealth quintile. We found a high reliance on on-site sanitation facilities (80.0%), almost half of which are assumed to be ‘uncontained’ septic tanks and one in ten facilities discharging untreated waste directly into the environment. The most densely populated areas had the highest rates of septic tank emptying, though emptying rates were just 17.0%, while in the lowest population density group, emptying was rarely reported. Multivariate regression analysis demonstrated an association between flooding and drought occurrence and septic tank emptying practice. Higher groundwater usage for drinking among poorer households suggests unsafe sanitation may disproportionally affect the poor. Our study underscores the urgent need to strengthen the monitoring of on-site sanitation in LMICs by developing contextualized standards. Furthermore, the inequalities in potential fecal exposure require greater attention and tailored support mechanisms to ensure the poorest gain access to safely managed sanitation services.

Public health performance of sanitation technologies in Tamil Nadu, India: Initial perspectives based on E. coli release

“…Previous studies have reported discharge of containment effluent to the environment as a common practice in India, with about 72% of containment systems discharging effluent to open drains, especially in the urban environment ( Dasgupta et al, 2019 ). This study and other studies in Dhaka, Bangladesh ( Amin et al, 2019 ) and Indonesia ( Odagiri et al, 2021 ) have found this practice to contribute to the release of faecal pathogens to the environment, constituting a clear public and environmental health hazard. However, our findings suggest that, where feasible, changing from the household fully-lined tanks with effluent pipes to the environment to effectively the same system discharging to soakaways would yield a 1.8 Log 10 reduction in the average combined daily per capita E. coli release.…”

“…This is in alignment with the well-established fact that some partial treatment of excreta and inactivation or removal of E. coli occurs during safe containment of excreta ( Feachem et al, 1981 ; Franceys et al, 1992 ; Mara, 1996 ). Other studies ( Odagiri et al, 2021 ; Maxcy-Brown et al, 2021 ) have also found that the direct discharge of black-water to the environment is a common practice in India and elsewhere, which we believe results in the substantial release of faecal pathogens to the environment, and a substantive public health hazard. We observe from our data in Fig.…”

Access to inclusive sanitation and participation in sanitation programs for people with disabilities in Indonesia

“…That could be because the respondents are over-claimed that their septic tank is regularly emptied which could not be confirmed at that moment. In the Indonesian context, a household septic tank that is regularly emptied, e.g., every three to five years, indicates a safely managed sanitation facility 49 . A closer inspection should be conducted to confirm this finding.…”

Quantities and qualities of fecal sludge: Experiences from field implementation with a Volaser in 7 countries during a pandemic

“…Unfortunately, sustainable implementations are still grossly lacking worldwide, and exposure risks to public health due to non-functional service chains remain high. For example, "uncontained" septic tanks and containment outflows that discharge directly to the urban environment (Odagiri et al, 2021), illegal dumping, and inadequate treatment (Okaali et al, 2022). However, the importance of a FSM service chain to protect public health is gaining recognition, and as a result the demand for infrastructure and services to manage fecal sludge is increasing (Vijayan et al, 2020).…”