Assignment on Anthropology and Public Health

The national government’s role in public health is of utmost importance. It must be committed in
its programs and advocacies such that it will legislate policies and invest on infrastructure and
education of its constituents towards prevention of diseases. It has been documented many times
that prevention is less expensive rather than the cost of treatment.

The author of the article “Sanitary Makeshifts” made mention that there was reluctance on the
national government of Indonesia (Central Java) to invest in sanitary infrastructure. Sanitation is
one of the pillars of public health and local or national governments must come up with policies
to support the program and give appropriate financial support for its implementation. The article
we read gave us a glimpse of how sanitation programs especially on access to toilets and clean
water evolved in Central Java, Indonesia. These programs were mostly initiated by international
organization and funding agencies since Indonesia, like many other Asian countries, is a colony
of European nations. The primary objective then was to protect the lives and economic welfare
of the colonists. This must be one of the reasons why even now colonized countries tend to be
dependent on international funds even on the most basic public health matter such as sanitation.

The Rockefeller Foundation initiated the hookworm prevention sanitary campaigns in 1924.
They came in at a time where the nationalist movement is starting to become popular as the
nation is gearing towards independence. The “hygiene mantri” which was considered as the
centerpiece of the Intensive Rural Hygiene project seemed to be very helpful and wise especially
in the effort of reaching out to local populations. Many of the hygiene mantri came from the elite
or influential people of the villages and they came or put in place at a time when the nationalist
movement of Indonesia was also growing. The goal was actually sanitation but it was infused
with the power dynamics at that time. This must be one of the reasons why this program was
unsuccessful in some areas given the time it was running or implemented (about 70 years). Also,
during this time many of the villagers were really very poor, even if they wanted to build latrines
they could not afford it. The national government then was also not giving support in this regard
by providing all the other materials or resources necessary for the completion of the latrines such
as construction materials, labor and even maintenance of such. There was no access to clean
water. There was no service to pump and discard latrine contents when it becomes full. There
were many challenges and gaps in its implementation. That is why it was just supposedly
“makeshift” which became permanent.

By the late 1960s, the Indonesian government has become independent and still its public health
policies and programs was largely dependent on international initiatives. There was
deprioritization of sanitation and hygiene in the global arena and family planning became the
focus. So that even if the rural hygiene program has not yet been fully accomplished it is put in
the background since the funds and priority was now on family planning. In 2002, the author
mentioned that only about 50% of families in the Banyumas region have access to basic private
toilet facilities in their homes.

In my related readings, the website of Center for Global Development reported that in 2006 the
Indonesian government adopted the Community-Led Total Sanitation (CLTS) as a pillar of the
country’s sanitation policy. This is a new approach on self-motivated, community-level behavior
change which was derived from the model used in Bangladeshi villages by the World Bank’s
Water and Sanitation Program. This sanitation initiative is still funded internationally but it is
now accompanied by government commitment. And in 2011 there were 2,200 communities
declared open-defecation free in Java. The results were very impressive. The same report stated
that there was behavioral changes in the target communities which translated to a 30% drop in
the prevalence of diarrhea among people in these communities.

To date, the Indonesian government continues to be challenged in its sanitation-related health

concerns. It continues to be part of the national health agenda and we can only hope for the best.