Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools June 2021: Rythia Afkar, Citra Kumala, Shinsaku Nomura This report was prepared by: Rythia Afkar, Citra Kumala, Shinsaku Nomura This work is a product of the staff of The World Bank, supported by funding from the Australian Government. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions © 2021 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for non-commercial purposes as long as full attribution to this work is given. All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Attribution Please cite the work as follows: Afkar, R; Kumala, C; Nomura, S. 2021. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools, World Bank. Jakarta. © World Bank. Contact Information The authors can be contacted at rafkar@worldbank.org, snomura@worldbank.org Photo Credits Cover Photo: October 2019, Akhmad Dody/World Bank Photo Page 3: Husniati Salma/Unsplash Photo Page 7: March 2019, Akhmad Dody/World Bank Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools Table of Contents Abbreviations and acronyms 2 1. Introduction 5 2. Key findings: 8 2.1 Key findings from Dapodik - a focus on MoECRT schools 8 2.2 Key findings from SDI data - a focus on MoRA schools 12 2.3 Key findings from school interviews 13 2.4 Key findings from district interviews 16 3. Conclusions and policy recommendations 17 4. References 24 Annex 1: Government Regulations setting standards for WASH facilities in Indonesia 25 2 Abbreviations and acronyms APBD Local Government Budgets (Anggaran Pendapatan dan Belanja Daerah) BOS School Operational Assistance (Bantuan Operasional Sekolah) DAK Special Allocation Fund (Dana Alokasi Khusus) Dapodik Basic Education Data (Data Pokok Pendidikan) DAU General Allocation Grant (Dana Alokasi Umum) GoI Government of Indonesia HE His Excellency IDR Indonesian Rupiah KemenPUPR Ministry of Public Works and Housing Regulation (Kementerian Pekerjaan Umum dan Perumahan Rakyat) KRISNA Collaborative Planning and Budget Information (Kolaborasi Perencanaan dan Informasi Anggaran) M&E Monitoring and Evaluation MI Islamic Primary School (Madrasah Ibtidaiyah) MoECRT Ministry of Education, Culture, Research, and Technology Ministry of Education Culture (MoEC) was merged with Ministry of Research and Technology (MoRT) to form the Ministry of Education, Culture, Research, and Technology (MoECRT) as approved by the Parliament on 9 April 2021. MoF Ministry of Finance MoH Ministry of Health MoRA Ministry of Religious Affairs PAD Own-Source Revenue (Pendapatan Asli Daerah) Permendikbud MoECRT Ministerial Regulation (Peraturan Menteri Pendidikan dan Kebudayaan) Permendiknas MoECRT Ministerial Regulation (Peraturan Menteri Pendidikan Nasional) PP Government Regulation (Peraturan Pemerintah) SD Elementary School (Sekolah Dasar) SDI Service Delivery Indicator SMA Senior Secondary School (Sekolah Menengah Atas) SMP Junior Secondary School (Sekolah Menengah Pertama) UKS School Health Unit (Unit Kesehatan Sekolah) UNESCO United Nations Educational, Scientific, and Cultural Organization UNHCR United Nations High Commissioner for Refugees UNICEF United Nations International Children's Emergency Fund USA United States of America USD United States Dollar WASH Water, Sanitation, and Hygiene WB World Bank WFP World Food Programme WHO World Health Organization 3 Acknowledgements T his report was written by Rythia Afkar (Education Economist), Citra Kumala (Consultant), and Shinsaku Nomura (Senior Economist) from the Education Practice, East Asia and Pacific Region (HEAED). The authors are grateful for overall guidance provided by Tobias Linden (Practice Manager, HEAED), and the report also benefited from inputs, contributions, and comments from the wider Indonesia team, including Achim Daniel Schmillen, Noah Yarrow, Ratna Kesuma, Ruwiyati Purwana, Noviandri Nurlaili Khairina, Ning Fu, Petra Wiyakti Bodrogini. The team appreciates Sylvia Njotomihardjo for the operational support to the team and Sheila Town for editorial support. The study benefited immensely from discussions and consultations with the government officials and development partners. Consultations on preliminary findings were organized with the Ministry of Education and Culture, the Ministry of Religious Affairs, the Basic Education Working Group of Indonesia Education Development Partners, and the Department of Foreign Affairs and Trade of the Government of Australia. The authors gratefully acknowledge that part of the funding for this study provided by the Australia World Bank Indonesia Partnership (ABIP) through the Government of Australia’s Department of Foreign Affairs and Trade. The findings and recommendations are those of the authors and do not necessarily represent the views of the Executive Directors of the World Bank or of the countries they represent. 4 Overview M any countries around the world closed schools along with other widespread restrictions as an immediate response to the spread of COVID-19. Affairs (MoRA) but focuses on the basic education sub-sector only (primary to senior secondary schools). Nationally, eight percent of MoECRT However, disruptions to instructional time in the schools and 20 percent of MoRA primary schools classroom can have a severe impact on a child’s have no functional toilets for students. Even if toilets ability to learn. In Indonesia, the COVID-19 pandemic are available in schools, more than 25 percent of has led to school closures, similar to other countries, MoECRT schools do not have gender-segregated forcing more than 68 million young Indonesians out toilets, and the average number of toilets, 58 of their classrooms, but the new school reopening students to one toilet in primary schools, is not up to plan is expected to come into effect from the new the international standards of 25:1 ratio. Twenty-two academic year starting July 2021. Consistent with the percent of MoECRT schools have no access to water global framework of school reopening, the school and 47 percent reported no soap nor running water. reopening guidelines emphasize that school re- opening must be safe and aligned with the country’s This Policy Note identifies four areas of policy gaps: overall COVID-19 response, including an emphasis (1) current national regulations and requirements on water, sanitation and hygiene (WASH) facilities. under COVID, (2) written regulations and This Policy Note aims to summarize an assessment implementation of them, (3) stipulated standards of the current situation of WASH facilities, norms, and school practices, and (4) national regulations standards and practices in schools and to discuss and international standards. The key corresponding policy implications related to the response to the recommendations for these four gaps are: (1) COVID-19 pandemic and implications for achieving ensure the availability of handwashing facilities universal access to basic WASH in schools by 2030 for teachers and students to practice regular under the Sustainable Development Goals. handwashing for disease prevention at school; (2) ensure planning and budget allocation to comply This study included a rapid situation analysis with the regulations and standards of WASH of WASH facilities in Indonesian schools using facilities (at national and subnational levels); (3) quantitative and qualitative data, including a review ensure all stakeholders are aware of the standards of relevant regulations. It covers schools under both and follow appropriate practices at school level; and the Ministry of Education, Culture, Research, and (4) update the national standards to international Technology (MoECRT) and the Ministry of Religious standards. Improving toilet hygiene and 5 handwashing practices during and post-COVID-19 pandemic in Indonesian schools Introduction 1. M any countries around the world closed schools along with other widespread restrictions as an immediate response to the spread of COVID-19. However, disruptions to instructional time in the classroom can have a severe impact on a child’s ability to learn, and countries continue to grapple with the complex decisions of when and how to reopen schools for in-person learning following widespread closures due to the pandemic.1 In Indonesia, the COVID-19 pandemic has led to school closures, similar to other countries, forcing more than 68 million young Indonesians out of their classrooms.2 The Government of Indonesia (GoI)’s plan to re-open schools has prescribed a district-by-district approach based on infection rates and appropriate facilities for social distancing, with higher levels of education (secondary) opening before lower levels (primary).3 1 UNESCO, UNICEF, World Bank, WFP, UNHCR 2020. Supplement to Framework for reopening schools: Emerging lessons from country experiences in managing the process of reopening schools. https:// unesdoc.unesco.org/ark:/48223/pf0000374312 2 MoECRT Circular Letter No. 4/2020 on Implementation of Education activities in the COVID-19 Emergency Period which closed all schools and suspended exams on March 24, 2020. 3 https://www.kemdikbud.go.id/main/blog/2020/06/buku-saku- panduan-pembelajaran-di-masa-pandemi-covid19 6 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools The new school reopening plan is expected to come water, sanitation and hygiene ‘for all’, while ‘paying into effect from July 2021, allowing face-to-face special attention to the needs of women and girls learning after teacher vaccination is completed in and those in vulnerable situations’. June 2021. Indonesia’s face-to-face learning policy is based on a system of permits granted by the local The objective of this note is to summarize a quick government / regional education offices / Ministry assessment of the current situation of WASH of Religious Affairs (MoRA) offices and includes a facilities, norms, standards and practices in schools tiered system of consent from education units and and to discuss policy implications related to the parents. The previously applied risk zoning map will response to the COVID-19 pandemic and more no longer determine the granting of face-to-face generally. learning permits.4 Existing literature on school hygiene and WASH Consistent with the global framework of school facilities shows that even before the pandemic, reopening , the guidelines emphasize that school 5 WASH was seen as important for student re-opening must be safe and aligned with the enrollment, retention, school attendance, and country’s overall COVID-19 health response, with academic performance. Developing country cases all reasonable measures taken to protect students, such as Zambia7 and Ethiopia8 demonstrate this, staff, teachers and their families. In line with the as does a review of twelve low-income country development of school reopening protocols and studies9. Developed country cases such as New procedures, there has been increased attention to York state in the USA also indicate the importance the status of water, sanitation and hygiene (WASH) of WASH in schools. Functional and hygienic WASH facilities in Indonesian schools, including toilets and facilities are particularly important for adolescent hand washing facilities6. This is not only to address girls.11 The need for WASH facilities is even more the urgent conditions due to the pandemic, but acute when it comes to disease prevention during also to accelerate the achievement of universal and after pandemics – as reported by emerging access to basic WASH in schools by 2030 under literature from China12,13, and a recent comparative the Sustainable Development Goals that aim for review of policy and practices from Norway, ‘universal’ and ‘equitable’ access to safe drinking Denmark, Singapore, and China14. 4 9 12 Based on MoECRT Minister, HE. McMichael, C., 2019. Water, sanitation Chen, X., Ran, L., Liu, Q., Hu, Q., Du, X. and Tan, X., Nadiem Makarim’s presentation and hygiene (WASH) in schools in 2020. Hand Hygiene, Mask-Wearing Behaviors and Its on November 20, 2020. low-income countries: A review of Associated Factors during the COVID-19 Epidemic: evidence of impact. International A Cross-Sectional Study among Primary School 5 journal of environmental research and Students in Wuhan, China. International journal of UNESCO, UNICEF, World Bank, public health, 16(3), p.359. environmental research and public health, 17(8), WFP, UNHCR. 2020. p.2893. https://www.mdpi.com/1660-4601/17/8/2893 10 6 13 In this note, we define WASH facilities Durán-Narucki, V., 2008. School as toilets and handwashing facilities building condition, school attendance, Cheng, S.Y., Wang, C.J., Shen, A.C.T. and Chang, S.C., (faucets/running water). and academic achievement in New 2020. How to safely reopen colleges and universities York City public schools: A mediation during COVID-19: experiences from Taiwan. Annals 7 model. Journal of environmental of Internal Medicine, 173(8), pp.638-641. Citation: Agol, D. and Harvey, P., 2018. psychology, 28(3), pp.278-286. https://www.acpjournals.org/doi/full/10.7326/ Gender differences related to WASH M20-2927 11 in schools and educational efficiency. 14 Water Alternatives, 11(2), p.284. Van Eijk, A., M. Sivakami, M. Thakkar, A. Bauman, K. Laserson, S. Coates, and Melnick, H. and Darling-Hammond, L., 2020. 8 P. Phillips-Howard. 2016. “Menstrual Reopening Schools in the Context of COVID-19: https://www.unicef.org/wash/schools/ Hygiene Management among Adolescent Health and Safety Guidelines from Other files/WinS_ESAR_-_Nairobi_Workshop_ Girls in India: A Systematic Review and Countries. Policy Brief. Learning Policy Institute. Final_Report__August_2012.pdf Meta-Analysis.” BMJ Open 6 (3). https://files.eric.ed.gov/fulltext/ED606555.pdf Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 7 This study included a rapid situation analysis Survey conducted during 2018 of a sample of 350 of WASH facilities in Indonesian schools using primary schools (of which 87 are from MoECRT quantitative and qualitative data, including a review and 263 from MoRA); and (b) Dapodik data 2019 of relevant regulations. It covers schools under for MoECRT, which contains information on both the Ministry of Education, Culture, Research, 219,950 schools (including all levels of schools from and Technology (MoECRT) and the Ministry of primary to upper secondary). The study also took a Religious Affairs (MoRA) but focuses on the basic qualitative approach: (c) conducting a desk review education sub-sector only (primary to senior of government policies, regulations and norms for secondary schools). This study adopts quantitative service provision, and (d) conducting interviews in and qualitative approaches to assess the current a selected number of SDI sampled schools using provision of WASH facilities in Indonesian schools. semi-structured questionnaires with some open- Two quantitative data sets are used, including ended answers. the following: (a) Service Delivery Indicator (SDI) Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools Key Findings 2.1 Key findings from Dapodik - a focus on MoECRT schools 2. Toilet availability in schools N ationally, 8.2 percent of schools in Indonesia did not have a functional toilet in 2019. According to Dapodik 2019 data,18,019 out of 219,084 schools in the country do not have a functional (usable) toilet. This proportion is similar for public and for private schools – 8.3 percent (13,845) and 7.9 percent (4,174) of public and private schools do not have toilets. The statistics can be further broken down to schools without any toilets and schools with toilets that are not functional. In fact, 3.6 percent (7,816) of schools reported there are no toilets in the school and 4.7 percent (10,233) reported they have toilets but that they are not functional. Schools without functional toilets, whether because they do not exist or do not function, are commonly found in West Java, North Sumatera, East Java and Papua, all of which have more than a thousand schools each without functional toilets. 15 Definition of usable toilets in Dapodik: Toilets function properly for students, and there is clean water available for the needs of the toilet and wiping (anal washing). Water can be sourced from a faucet that flows clean water or there is a tub/water reservoir in the latrine which holds enough clean water. Toilet must be walled, roofed, lockable and easy cleaned. The minimum standard by the government regulations is three toilets (for boys, girls and teachers) as discussed in the following paragraphs. However, the statistics here show that 8.2 percent of schools do not have even one functional toilet. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 9 ''Nationally, 8.2 percent of schools in Indonesia did not have a functional toilet in 2019. '' In schools where toilets are available, 92 percent by gender. Dapodik data show that the national of MoECRT schools have gooseneck toilets while average number of toilets available are one toilet the remaining eight percent of schools have per 58 students in elementary schools (SDs), one per septic tank toilets or toilets above the river, 47 in junior secondary schools (SMPs), and one per raising a question concerning the standards 51 in senior secondary schools (SMAs). The available for functional toilets. In 201,095 schools where data does not allow the calculation of toilet ratio toilets are available, gooseneck toilets are the most and students by gender as required in the MoECRT common type (Panel 1) in public and private schools. Regulation No. 24/2007 and MoECRT Regulation No. However, some provinces still have hundreds of 40/2008 (Table 1). At the aggregate level, nationally, schools using septic tanks without lids (Panel 2), the ratios for elementary schools are close to such as East Java, Central Java, West Java, and North the standard norms, but the ratios for secondary Sumatera. Toilets directly over a river (Panel 3) also schools are not. There is also regional variation in exist in 0.5 percent of schools (1,066 schools) even these ratios. The worst cases can be found in Papua, though they are considered functional. Banten, and West Java, especially in elementary public schools where more than 80 students may Even if toilets are available in schools, they have to share a single toilet. Nationally, 41.1 percent may not be available to students if there are of schools in Indonesia fail to meet the criteria of the insufficient facilities and they are not separated minimum three functional toilets. Figure 1. Types of toilets Panel 1: Gooseneck toilets Panel 2: Septic toilets Panel 3: Toilets directly with or without lid above the river Sources: MoECRT’s Guidelines for School Sanitation Data in DAPODIK version 2017 16 MoECRT’s regulations cover all types of schools, including schools administered or registered with MoRA. 10 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools The standards for toilets can be reviewed in for girls or female staff (i.e. one toilet to 25 staff and comparison with international standards. student) and one toilet plus one urinal per 50 boys Although the student to toilet ratio seems overall or male staff (i.e. the ratio of 1:25 of toilet/urinal to consistent with the standard norms, this may not be boys or male staff).17 By this definition, 75.9 percent in line with international standards as stipulated by (152,580) of schools with at least one toilet do not WHO and UNICEF, which determine a ratio of 1:25 meet the standard of 1:25. Table 1. Comparison of student-to-toilet ratio by standards against the national average and WHO guidelines Standards National average WHO guidelines Elementary Schools - 1:58 1:25 Boys 1:60 - 1:25 Girls 1:50 - 1:25 Secondary Schools - 1:49 1:25 Boys 1:40 - 1:25 Girls 1:30 - 1:25 Sources: Regulation No. 24/2007 and MoECRT Regulation No. 40/2008; Dapodik 2019; Adams, John, et al., 2009. Note: More detailed descriptions of WHO guidelines are found in Box 1. Figure 2: Distribution of schools with student-to-toilet ratios 35,000 30,604 30,604 30,000 25,085 24,456 25,000 Total schools 22,494 20,000 19,562 15,000 14,724 11,035 10,000 8,375 8,011 6,345 5,000 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 100+ Student-to-toilet ratio Source: Dapodik 2019 17 Adams, John, et al., 2009. Water, Sanitation and Hygiene Standards for Schools in Low-cost Settings. World Health Organization. Geneva. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 11 Box 1. Excerpts from the WHO guidelines for school WASH facilities For toilets: Water: Sufficient, accessible, private, secure, Quality: Water for drinking, cooking, personal hygiene, cleaning and clean and culturally-appropriate toilets laundry is safe for the purpose intended. are provided for school children and staff. Quantity: Sufficient water is available at all times for drinking and personal hygiene, and for food preparation, cleaning and laundry when There are sufficient toilets available applicable. – 1 per 25 girls or female staff, and 1 Day schools 5 liters per person per day for all school children and staff toilet plus 1 urinal (or 50 centimeters of Flushing toilets 10–20 liters per person per day for conventional urinal wall) per 50 boys or male staff. flushing toilets/1.5–3 liters per person per day for pour-flush toilets Source: Adams, John, et al., 2009. Water availability is more of a challenge than public schools and 39.8 percent of private schools the availability of toilets – 22 percent of MoECRT reported no soap nor flowing water available. While schools have no access to water. Among 219,084 soap is commonly available in local markets, this MoECRT schools with available data, 47,393 schools may be partly because the government regulations reported no access to water. By definition, this do not require soap for school toilets. According means schools do not have water sources for to the statistics, schools without soap and flowing sanitation available around the school environment water are largely located in West Java, East Java, and or collected and stored around the school for student North Sumatera – where more than 10,000 schools needs. Private schools are marginally better – 19.1 reported that they had no soap or flowing water. By percent of private schools reported no water access proportion, many provinces, namely Aceh, Bengkulu, whereas 22.4 percent of public schools reported no East Java, North Maluku, Papua, West Papua, East water access. Schools without water availability are Nusa Tenggara, West Sumatera, Central Sulawesi, concentrated in West Java and East Java, where more Southeast Sulawesi, and North Sumatera report that than 5,000 schools have no water. East Nusa Tenggara more than 60 percent of schools have no soap nor also faces the same problem, with more than 4,000 flowing water. schools with no water availability. In terms of the proportion of schools, North Kalimantan, East Nusa Regulations related to waste management Tenggara, and Papua face the worst situation since are not clear. While waste management such as more than 50 percent of their schools have no water. drainage and availability of emptying services are important elements in WASH facilities, the regulatory Almost half of schools in Indonesia reported that framework is not explicit about requirements for they had no soap and flowing water (47%), and them. Standard information on waste management this poses a serious public health concern as focusing on sewage and drainage has now been regular handwashing with hand soap is critical for incorporated to the Dapodik questionnaire for disease prevention. By school type, 48.9 percent of 2021.19 18 Either from bottled water, piped water, river water, rainwater, protected/unprotected well, protected/unprotected water springs, or other sources. 19 The new Dapodik questionnaire covers basic questions: whether school has trash bins, a sewage system, and if schools routinely clean the septic tank (every 3-5 years). unprotected water springs, or other sources. 12 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 2.2 Key findings from SDI data - a focus on MoRA schools T he team then reviewed the Survey Delivery Indicator (SDI) survey 2019 dataset which was collected in a sample of 350 primary schools The WASH indicators for MoRA madrasahs are overall lower than MoECRT schools, largely because private madrasahs, consisting the in February–March 2019. This dataset contains majority of MoRA madrasahs, perform lower on information on both MoECRT and MoRA schools these indicators. Table 2 presents a comparison of but is more focused on MoRA schools.20 The sample some key WASH indicators. Although the total number includes 253 madrasahs that were randomly chosen of public madrasahs is much smaller than private from across the country, although the sample is not madrasahs, the condition of WASH facilities is generally large enough to make comparisons across provinces. better among public madrasahs. Public madrasahs The SDI collected information about toilets and alone show better statistics than MoECRT schools handwashing facilities assessed by an independent (except relating to toilets for staff), however the less survey firm, instead of relying on school principals’ developed WASH facilities in private madrasahs seem a self-reported information. A World Bank study critical issue when compared to other types of schools on education data reliability found that data in the country. It should be also noted that both MoRA discrepancies between the real conditions in schools madrasah and MoECRT schools perform some way and information recorded in education datasets below international standards. Generally, the ratio of appear in 28 percent of sampled schools (World students per toilet is 1:86 in public madrasahs and Bank, forthcoming-b). Although the reason for the 1:75 in private madrasahs, which is about three times discrepancy is not assessed, this dataset allows more higher than the international standard. In comparison objective insights relating to the conditions of the with government regulations, out of all madrasahs that WASH facilities and information from MoRA schools have separate toilets for boys and girls, 47.5% fulfill the (as enumerators apply the same criteria across minimum ratio for girls (the ratio of 1:50), and 50.3% sampled schools). fulfill the minimum ratio for boys (1:60). Table 2. Percentage of schools with WASH facilities by school type, 2019 SDI MoRA Madrasah Ibtidaiyah MoECRT Indicator All Public Private SDI Dapodik Dapodik (Primary (Primary (all schools) schools only) schools only) Toilets for staff 77.2 89.4 76.3 92.3 N/A N/A Toilets for students 80.4 86.2 80.0 85.7 91.5 91.8 Hand-washing facilities 49.7 64.3 48.6 56.0 54.0 53.3 (with soap) Number of toilets per school 3.4 6.4 3.2 5.2 3.5 4.6 Source: Sawamoto & Marshall, 2020.21 20 A small number of non-madrasah religious schools were also included, but their results are not represented due to the very small sample size. There may also be some limits to the generalizability of the madrasah sub-sample results (public and private), especially since there are only 54 public madrasahs. A convenience sampling was employed for the selection of MoECRT schools (i.e., the selection was made based on their proximity to madrasah schools). The sample size of MoECRT schools is small relative to the population, so it is provided simply as a reference point. 21 World Bank. Forthcoming-a. Infrastructure, Learning Complements, and Student Learning: Working Together for a Brighter Future. Washington, D.C. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 13 2.3 Key findings from school interviews T he third source of data was qualitative interviews of a selected number of school principals and local government officials. Interviews were conducted 22 and accessible.23 On the other hand, definitions of functionality commonly used by principals are: availability of gooseneck toilet, running water, good with a sub-sample of 15 school principals from SDI- air circulation, lighting, privacy and cleanliness. The surveyed schools and three local government officials negative list for declaring dysfunctionality of toilets based in the locations of SDI school samples. The are: heavily damaged or can no longer be used by the interviews were qualitative in nature with the main students. Consequently, except for one school without objective of assessing the WASH related knowledge of a toilet, principals’ assessments are generally more school principals and norms in schools. positive than the SDI surveyor’s assessments. While it is not clear if the gap comes from the difference Assessment of WASH facility of the definition or objectivity of assessment by the standards assessors, it is likely that a much larger proportion of schools actually have issues with the functionality of School principals are typically unaware of the toilets if we apply the SDI standards. standards for WASH facilities and do not know how to assess them against standards. Based on the There is scope to refine MoECRT’s regulations limited sample of the interviews, there seems to be on school WASH facilities and to strengthen a gap in principals’ familiarity with the standards for enforcement, especially during the pandemic. The school WASH facilities – as stipulated by the MoECRT COVID-19 pandemic has led schools across the world Regulation No. 24/2007 and MoECRT Regulation No. to follow new hygiene practices and guidelines to 40/2008. Principals tended to say that the conditions prevent the spread of disease in school premises. of WASH facilities are compliant with the standards A review of MoECRT Regulation No. 24/2007 and as long as they do not have any broken or unusable MoECRT Regulation No. 40/2008 indicates that there toilets. is an opportunity to refine Indonesia’s school WASH standards as at present, soap is not a requirement in There is a lack of objective and pragmatic criteria school toilets, only one toilet is required for teachers, for assessing WASH functionality. The interviews without gender separation. There are no specific with the principals of the SDI-sampled schools requirements for handwashing facilities. In addition, identified gaps between principals’ assessments and enforcement of these laws seems to be weak – as SDI enumerators’ assessments of the conditions of evidence from the ground has demonstrated. Many toilets/WASH facilities, and it was clear that these gaps schools have not fulfilled the stipulated minimum originated from knowledge gaps and the definition of requirements, and with a lack of adequate funding for functionality. In SDI, toilets are marked as functional if WASH facilities, there is no strong pressure at present they fulfill three requirements namely clean, private, to enforce these policies in schools. 22 The interview questionnaires and more detailed information about the interviews are available upon request. Please contact Rythia Afkar for more information. 23 This indicator is composed by using three questions: 1. Are the toilets clean? (1= Extremely clean, 2= Reasonably clean, 3= Not clean); 2. Are the toilets private (have doors or separating entry way wall)?; and 3. Are the toilets accessible (unlocked, not overflowing, etc.) 14 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools Gender dimensions of WASH BOS (Bantuan Operational Sekolah). According to the facilities regulations (Presidential Regulation No. 141/2018 and MoECRT Regulation No. 11/2020), schools are More than twenty-five percent of schools reported expected to use BOS funds for minor repairs or that there were no gender-segregated toilets for maintenance of toilets if the observed damage is less students or teachers. According to Dapodik data, than 30 percent of the physical damage. However, more than 25 percent of MoECRT schools nationally many schools do not commonly allocate BOS to the do not have gender-segregated and decent toilets. expenses related to toilet repair and maintenance. Forty five percent of special schools do not have The primary reason is that schools prioritize honorary separate and decent toilets24. Based on the interviews, teacher salaries within the limited amount of BOS out of 15 schools, one does not have a toilet at all and funds, followed by purchase of teaching and learning three have only one toilet for all, including teachers. materials or consumables. Consequently, repair and A lack of gender-segregated toilets is also an issue maintenance of WASH facilities usually comes lower for teachers. According to MoECRT Regulation No. on the priority list. Moreover, if the damage of the 24/2007 and MoECRT Regulation No. 40/2008, at a WASH facilities is assessed at 30 percent or more26, minimum there should be one toilet for teachers, then the responsibility for repair is shifted to the so gender-segregated toilets are not a standard subnational governments (provinces, districts, cities). requirement and thus less likely to be provided. The issues associated with this current policy lie in From our interview samples, in addition to three the ambiguity in the definition and criteria of the schools which only have one toilet for all (students 30 percent damage and also the perverse incentive and teachers), four schools only have one toilet for related to repair and maintenance of WASH facilities teachers. – as repairing more damaged toilets falls under the remit of subnational governments, thus freeing schools of the responsibility. Maintenance practices and responsibilities Schools are entitled to funds from the government for major repairs or new construction, but WASH Schools are responsible for maintaining school facilities are not usually prioritized. According to WASH facilities, but they may not be adequately Presidential Regulation No 88/2019 on the Physical incentivized to do so. Schools are responsible for Special Allocation Fund (DAK-Fisik), funds for the maintaining their WASH facilities according to MoECRT rehabilitation of toilets will be provided to schools if Regulation No. 8/2020 and are provided with an 25 their damage is assessed as medium (30-45 percent) annual per capita-based School Operational Grant – or major (45-65 percent)27. Under this scenario, 24 Based on MoECRT's presentation titled "Penyediaan WASH (water, sanitation, hygiene) di Satuan Pendidikan" on 8 September 2020 25 The use of BOS funding includes maintenance of school facilities and infrastructure with minor damage including repair of school toilets, hand washing stations, drainage of dirty water and other sanitation. 26 According to Minister of Public Works and Housing Regulation, Permen PUPR 22/2018 on Construction of State Buildings, slight damage (0-30 percent) is defined as damage to non-structural components, such as roof covers, ceilings, floor covers and infill walls, medium damage (30-45 percent) includes damage to some non-structural components, and / or structural components such as roof and floors structures, heavy damage (> 45 percent) is damage to most building components, both structural and non-structural, which after repair can still function effectively. 27 The Circular letter from the Minister of Finance (MoF) to Governors/Mayors (S-30/MK.7/2020) on the guideline for proposal submission of DAK-Fisik funds states that the subnational governments submit their proposals based on function/sub-function/activity through the KRISNA portal. In the case of education, MoECRT and subnational governments usually gather to discuss the plan to address school infrastructure gaps. MoECRT then validates the gaps with Dapodik data to ensure that the proposals are aligned with infrastructure needs. MoF then allocates DAK-Fisik funds for education based on final verification from MoECRT. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 15 the responsibility to fix WASH facilities shifts from Needs for repair and maintenance of WASH schools to local governments. However, subnational facilities, as perceived by policy makers, may be governments typically do not prioritize the use of underestimated. The number of schools in need DAK-Fisik for repair of toilets as the priorities are of new construction of toilets is huge. Based on usually related to facilities that are seen as directly Dapodik data in December 201928, there are 28,725 supporting learning such as classrooms or libraries. schools without WASH facilities and 91,868 with Apart from DAK-Fisik, subnational governments can limited facilities,29 with an estimated IDR 14.8 trillion also use their own source revenue (PAD/Pendapatan (US$ 3.5 billion) needed for repair, maintenance, and Asli Daerah) as part of their APBD (local government construction of WASH facilities. Accurate assessments budgets) to fund the rehabilitation of school toilets by civil engineers may be required for all schools and other WASH facilities. However, limited data and because schools may not have reported accurate information is available to estimate how much of conditions of the toilets according to the government subnational government budgets are allocated for the guidelines. There could be other potential hidden rehabilitation of school WASH facilities. infrastructure costs as well. MoECRT Regulation No. 11/2020 requires elementary schools to provide a Subnational government decision making relies minimum 28 square-meter area for one toilet, but heavily on the Dapodik data on school facilities, there are cases where this criterion may not be met but schools may report inaccurately as they lack due to lack of space.30 civil engineering expertise. According to interviews '' with principals and districts, there are variations in the practices of identifying the needs for repair and maintenance. Out of three districts interviewed, two reported that schools should submit requests for 75.9 percent of maintenance while the other said they would rely on MoECRT to decide based on Dapodik. In districts schools with at least one toilet where only Dapodik is used, there is a caveat. MoECRT guidelines for Dapodik are comprehensive, containing do not meet the detailed information on how to determine the level of damage to facilities. However, without civil engineer international inputs, calculations of damage to infrastructure is not an easy task for most school staff. Interviews with standard of toilet schools and districts indicate that some inspection visits by districts local offices discover a much higher '' degree of damage than was reported by schools in Dapodik, which would cause the schools to be left out of opportunities to receive funding for necessary ratio 1:25. repairs and maintenance. 28 MoECRT PowerPoint received during a meeting on 8 September 2020. 29 Schools with limited drinking water facilities are defined as schools with insufficient water resources (not available at all times). Limited toilet facilities mean toilets are not separated (for boys and girls) and/or damaged. Limited handwashing facilities are those without running water and hand soap. 30 There is a requirement for an area of field for ceremonies and sports (15x20 m). Toilets cannot be constructed if there is not sufficient land in school campuses. The land on which the school is built must be owned either by the school itself or by the local government. Thus, availability of land is important for building new WASH facilities (either on a new land or in an extension to an upper floor), and this could be a constraint for schools with limited space. 16 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 2.4 Key findings from district interviews O ''Almost verall, interviews with district officers validate half of the findings identified from interviews with school principals. Local education offices (Dinas schools in Indonesia Pendidikan) only support schools in terms of funding for the repair of toilets with medium to heavy damage reported that they (i.e. above 30 percent damage, which is not clearly defined) while schools are responsible for regular had no soap and maintenance using BOS funds. Determining the schools with medium to heavily damaged WASH facilities is based on Dapodik data. This confirms the importance of accurate Dapodik information to properly identify the needs for WASH facility repairs flowing water, and this poses and to allocate necessary resources from education budgets. Procedures for repair and maintenance of WASH a serious public health concern as facilities vary across education local offices. There are different systems in each district for schools to regular handwashing follow in order to obtain funding for toilet repairs and construction. Among the interviewed districts, with hand soap is two require proposals from schools to proceed while one reported that Dapodik data is sufficient for such decisions. The first two districts select which schools get the funding while one does not have the authority critical for disease '' to do it as MoECRT selects directly based on Dapodik prevention. data. Local education offices tend not to prioritize WASH facility repairs. The small sample of interviews gave the impression that the repair and maintenance of WASH facilities is overall low on their priority list because there are many other competing demands for civil works, such as improvement of classroom and facilities that are seen as more directly linked to learning. When resources are allocated to the repair of WASH facilities, higher priority is given to more damaged WASH facilities which meet the minimum land ownership and physical space requirements. Improving toilet hygiene and 17 handwashing practices during and post-COVID-19 pandemic in Indonesian schools Conclusions and policy recommendations 3. 18 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools T o recap, functional WASH facilities consist of: (a) sanitation infrastructure – toilets, (b) hygiene infrastructure – for handwashing and bathing, (c) non-polluted adequate quality water, and (d) effective waste management – drainage and waste emptying. In addition, particularly for adolescent girls, gender segregated facilities are a necessity. In conclusion, this study highlights four gaps to be addressed by future policy discussions and presents a number of policy recommendations. It also suggests concrete immediate next steps for policy maker consideration. GAP 1: Between the required and current availability of handwashing facilities at schools during and after the COVID-19 pandemic. The most urgent gap relates to the availability of can be further elaborated by the ratio of students handwashing facilities for teachers and students so to the facilities and protocols for maintenance and they can practice regular handwashing for disease ‘sanitization’ practices of handwashing facilities. To this prevention at school. Refining MoECRT Regulation end, the immediate recommended actions are to (i) No. 24/2007 and MoECRT Regulation No. 40/2008 on supply necessary hand soap; (ii) install handwashing school WASH facility standards to require every school facilities with running water if currently unavailable to have functional handwashing facilities with running as well as maintain the soap supply and handwashing water and hand soap will help limit transmission of facilities; and (iii) maintain consistent messaging on COVID-19 and other common diseases. This regulation handwashing as key strategy for COVID-19 prevention. GAP 2: Between national regulations and resource availability for local implementation of the regulations Planning and budgetary allocations are required to WASH facilities.31,32 For MoRA schools, the number enable all Indonesian schools to comply with the is unknown, however by extrapolating SDI findings, regulations and standards of WASH facilities. To around 3,514 public schools and 40,262 private schools implement the regulations of WASH facilities, especially need the repair and renovation of toilet facilities.33 during this pandemic, public financing for the capital The total investment to achieve the national target for cost of toilets in 28,725 public/private schools and toilet facilities in all schools in Indonesia is estimated at repair/maintenance costs in 91,868 public/private around IDR 18.5 trillion (USD 1.3 billion).34 Meanwhile schools will be required and should particularly focus in public financing for the capital cost of handwashing regions and districts where there is a lack of functional and water facilities in 91,627 public/private schools and 31 MoECRT Presentation on 8 September 2020. 32 Private schools can also obtain funding from the government through DAK-Fisik, but public schools are usually prioritized. 33 SDI data shows: (i) percentage of schools without toilets are 14 percent and 20 percent for public and private MoRA primary schools respectively, (ii) schools with limited toilet facilities are 74 percent and 63 percent for public and private MoRA primary schools respectively. 34 Estimated with the assumptions on the unit cost to support schools with no and limited facilities as much as 200 and 100 million rupiah per school respectively (MoECRT Presentation on September 8, 2020). The total number of schools in need of funding are for all school levels under both MoECRT and MoRA combined. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 19 '' The most urgent gap to address relates to the availability of handwashing facilities for teachers and students so they can practice regular handwashing for disease prevention at school. repair/maintenance costs of 48,410 public/private local education offices and schools respectively. '' schools is estimated to be around IDR 1.77 trillion However, systemic incentives of different stakeholders (USD 125.5 million)35. This means not only providing may not be aligned as schools perceive that financial one functional toilet/handwashing facility for each responsibilities are passed on to the education school (which currently 8.2 percent of schools lack) but local offices once toilets become dysfunctional and also to comply with student-toilet ratios and gender- they therefore neglect the importance of minor segregated toilets (which currently 41.1 percent of maintenance. A sustainable maintenance scheme schools lack). Proper installment of these WASH is built on a culture of preventive maintenance at facilities will require investment (capital) budgets. schools, where schools maintain WASH facilities (and This is critical during the pandemic and an additional buildings as well) before the damage becomes large. budget allocation is required if schools are to open This will have financial implications as the average life safely. However, if this capital spending should be of facilities and buildings will be prolonged. As schools allocated over time, all subnational governments need receive BOS funding every year, it is imperative to develop WASH facility improvement plans for the to understand how schools use BOS – especially next three years, estimating the needs for capital and related to salary and non-salary expenditures. repair/maintenance budgets. Regular maintenance of WASH facilities will prevent escalation of minor damages to moderate and major Recommendations: Ensure availability of gender- damage. Immediate action would be to develop a separated toilets and nurture a preventive training program to improve assessment, planning and maintenance culture rather than fix and repair in budgeting for better WASH facility management, and schools for sustainable maintenance of functional deliver training to all relevant subnational government WASH facilities, clarifying the BOS guidelines for that officers to adequately assess WASH needs and purpose. As per current standards, it is important to reflect these in the planning and budget preparation ensure that gender-separated toilets are available process, providing targeted support to specific for all schools to manage menstrual hygiene-related geographical areas and private madrasahs that show needs. While the current standards require gender- low performance on key WASH indicators. In addition, separated toilets for students only, gender-separated collaboration and coordination across relevant toilets for teachers and staff are also necessary; thus ministries (such as MoECRT and Ministry of Public the recommendation for four toilets (male and female Works) as well as coordination with subnational and for students and teachers). In terms of maintenance village governments (through Village Funds) could also practices, the current system divides responsibilities be strengthened to ensure all schools have proper of minor maintenance and major repairs between and functional WASH facilities. 35 Estimated by MoECRT and UNICEF for MoECRT schools with the assumption of the unit costs of IDR 25 million and IDR 20 million to build water and handwashing facilities respectively. Data limitations prevent similar estimations for MoRA schools. 20 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools GAP 3: Between the standards, implementation, and monitoring at school level All stakeholders including central and subnational maintenance, and accurate assessments of the governments, school principals and communities conditions and planning to mobilize necessary need correct information about standards and resources to maintain WASH functions. As an follow appropriate practices at school level. The immediate action, develop an assessment tool for study has discovered that most of the interviewed regular use by principals to assess the condition principals are not aware of the standards for WASH of drinking water, sanitation, hygiene, and waste facilities. While many deviations might be minor, it is management facilities/infrastructure and usage. important for principals to know the correct standards Then produce (online-based) awareness raising for good hygiene practices at schools, including programs for principals and teachers to update knowledge of the importance of gender-separated their knowledge. Good hygiene practices are key to toilets and nurture a preventive maintenance culture. prevent spread of diseases and to maintain health. It Schools need to be able to assess the conditions is recommended that principals are held accountable of their WASH facilities and take adequate action. for ensuring good hygiene practice within their Parents and communities can help to promote local schools through annual reviews. The tool should be oversight on the adequacy of the WASH facilities at used by school supervisors in their regular school school. Both subnational and central government visits. The tool should also produce reliable and should use this information as a benchmark to timely data which can support both subnational and develop short- and long-term investment and central governments to identify and plan immediate improvement plans to accelerate progress in and long-term actions to improve WASH facilities achieving the Sustainable Development Goal targets at school. To support long-term behavioral change, to provide universal access to basic WASH in schools. integrating hygiene education and practices in the curriculum (for example through Science and Recommendations: Develop an assessment and Physical and Health Education) as well as in the school monitoring tool36 for regular use by principals, regulations (requirement to wash hands before governments, and communities and raise entering school premises, after outdoor activities, awareness of school hygiene practices and before and after lunch break, etc.) could support maintenance of WASH facilities among principals, hygiene behavior change and improve the health teachers, students, and communities. School status in school environment. Another immediate hygiene practices can only improve through action could be to develop a hotline for students and behavioral changes of all stakeholders. Awareness communities to directly raise WASH related issues in raising of all school level stakeholders is necessary the schools. Posters and brochures accessible to girls to establish good school hygiene – including proper and boys, including those with disabilities, those from use of WASH facilities and regular handwashing minority language groups, and those in remote areas, for disease prevention, regular cleaning and will be useful to inform them about the hotline. 36 Currently Dapodik is used as monitoring data for school conditions and infrastructure. However, validation of Dapodik data, including monitoring and evaluation of school infrastructure is conducted by local education offices. Data validation and M&E mechanisms vary depending on subnational government technical and financial capacities. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 21 GAP 4: Between international and Indonesian standards of WASH facilities '' All stakeholders The currently implemented standards for school hygiene in Indonesia may not be sufficient for the including central current pandemic and are not up to international standards. WHO guidelines recommend 1:25 ratio for toilets to children (for both boys and girls) at elementary and secondary school. On the other hand, the standards in Indonesia are 1:60 (boys) or 1:50 (girls) and subnational governments, school for elementary schools and 1:40 (boys) and 1:30 (girls) for secondary schools. There is scope for improving the principals and standards of WASH facilities for schools in Indonesia and reviewing the specifications of facilities – such as communities need locations, ventilation, lighting, space, size of the facilities, and waste management – for various types of schools correct information (including pre-schools, primary, and secondary schools), and for male and female students and teachers. Recommendations: Review and ensure that the policies and regulations governing school hygiene about standards and are sufficient to prevent COVID-19 transmission and are aligned with international standards. Several to follow appropriate practices at school immediate and medium-term policy measures can '' be considered to fill the gaps between international level. and national norms and standards for WASH facilities. The policy would also need to ensure all types of schools, including both public and private schools under MoECRT and MoRA, adhere to the standards. In the medium term, it is important to re-evaluate and update the current regulations, including updating the regulations to ensure all WASH facilities are accessible to all children, including children with special needs in inclusive schools.37 Immediate action would be to conduct a review of the current policy framework against international standards in all aspects of WASH facilities in the context of COVID-19 and update them if necessary. 37 The regulations for special education (MoECRT Ministerial Regulation No 33/2008) refers to some requirements on toilets, but regulations for inclusive education (MoECRT Ministerial Regulation No 70/2009, Government Regulation No. 13/2020) do not mention requirements of WASH facilities for children with special needs. 22 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools Table 3. Summary of gap areas and policy recommendations Suggested measures Gaps During COVID-19 Post-COVID-19 (immediate) (medium- to long-term) Required versus Availability of handwashing Continue promoting good currently available facilities is a critical aspect of for handwashing practice in schools handwashing schools to reopen safely during for disease prevention and daily facilities and post-pandemic. If current hygiene. standards do not prescribe this, they should be updated. Consider additional budgets and immediate repair or installation of functional WASH facilities in schools where WASH facilities are not functional. This should be a minimum requirement for school reopening during the COVID-19 pandemic. Immediate action: (i) supply necessary hand soap; (ii) install handwashing facilities with running water if currently unavailable as well as maintaining soap supply and handwashing facilities; and (iii) maintain consistent messaging on handwashing as key strategy for COVID-19 prevention. National regulations Consider additional budgets for Develop subnational government- versus funding against constructing gender-separated wide yearly plans for upgrading all implementation of toilets for both students and toilets to functional status, instead of the regulations for teachers. The standard of relying on ad hoc budget allocations. gender-separated toilets for teachers is necessary though Gradually shift the funding mechanism not explicit in the current to incentivize preventive maintenance regulations. over waiting for major repairs. Immediate action: Develop Conduct a stock-take of the use of awareness and training materials BOS and identify how much flexibility to improve diagnosis, planning, schools have to spend on non-salary and budgeting process for WASH expenses from BOS. at subnational government level. Clarify the guidelines for using BOS for Immediate action: Provide salary and non-salary expenses. targeted support to specific geographical areas and private Update data collection and reporting madrasahs that show low protocols for more consistent and performance on key WASH standardized information about WASH indicators. facilities across districts. Strengthen necessary coordination between central, subnational, and village governments on the funding for WASH facilities at school. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 23 Standards versus Provide information training for Develop a regular online training practices in schools all school principals about the program for school headmasters standards for WASH facilities and and staff (including teachers) for expected hygiene practices and school maintenance, including ensure they are well informed maintenance of WASH facilities. about them (notification of regulations; information packages, Promote a culture of preventive with confirmation of their maintenance in schools. understanding of the regulations). Integrating hygiene education and Immediate action: Develop an practices in the curriculum as well assessment tool for WASH facilities as in the school regulations. for regular use by principals and provide training in its use. Providing relevant information on hygiene education and its Immediate action: Introduce practices in school for parents and a community monitoring and communities. reporting hotline. Brochures and posters for awareness raising will be useful. International versus Immediate action: Review the Re-evaluate, revise and update the national standards current policy framework against regulations to align standards for international standards and WASH facilities to international update as needed. standards, including accessibility for children with special needs. Ensure the updated standards apply to all types of schools – MoECRT, MoRA, public, and private schools. 24 Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools References Adams, John, et al., 2009. Water, Sanitation and Hygiene Standards for Schools in Low-cost Settings. World Health Organization. Geneva. Agol, D. and Harvey, P., 2018. Gender differences related to WASH in schools and educational efficiency. Water Alternatives, 11(2), p.284. Chen, X., Ran, L., Liu, Q., Hu, Q., Du, X. and Tan, X., 2020. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. International journal of environmental research and public health, 17(8), p.2893. https://www.mdpi.com/1660-4601/17/8/2893 Cheng, S.Y., Wang, C.J., Shen, A.C.T. and Chang, S.C., 2020. How to safely reopen colleges and universities during COVID-19: experiences from Taiwan. Annals of Internal Medicine, 173(8), pp.638-641. https://www.acpjournals.org/doi/full/10.7326/M20-2927 Durán-Narucki, V., 2008. School building condition, school attendance, and academic achievement in New York City public schools: A mediation model. Journal of environmental psychology, 28(3), pp.278-286. McMichael, C., 2019. Water, sanitation and hygiene (WASH) in schools in low-income countries: A review of evidence of impact. International journal of environmental research and public health, 16(3), p.359. Melnick, H. and Darling-Hammond, L., 2020. Reopening Schools in the Context of COVID-19: Health and Safety Guidelines from Other Countries. Policy Brief. Learning Policy Institute. https://files.eric.ed.gov/fulltext/ED606555.pdf MoECRT guidance for organizing learning for the 2020/2021 school year and the 2020/2021 academic year during the Covid-19 pandemic. https://www.kemdikbud.go.id/main/blog/2020/06/buku-saku-panduan-pembelajaran-di-masa-pandemi-covid19 MoECRT Minister, HE. Nadiem Makarim’s presentation titled “Panduan Penyelenggaraan Pembelajaran pada Semester Genap Tahun Ajaran dan Tahun Akademik 2020/2021 di Masa Pandemi COVID-19” on November 20, 2020. MoECRT. 2020. Profil Sanitasi Sekolah Tahun 2020. UNESCO, UNICEF, World Bank, WFP, UNHCR. 2020. Supplement to Framework for reopening schools: Emerging lessons from country experiences in managing the process of reopening schools. https://unesdoc.unesco.org/ark:/48223/pf0000374312 UNICEF. 2012. WASH in Schools – Improving the Learning Environment. https://www.unicef.org/wash/schools/files/WinS_ESAR__Nairobi_ Workshop_Final_Report__August_2012.pdf Van Eijk, A., M. Sivakami, M. Thakkar, A. Bauman, K. Laserson, S. Coates, and P. Phillips-Howard. 2016. “Menstrual Hygiene Management among Adolescent Girls in India: A Systematic Review and Meta-Analysis.” BMJ Open 6 (3). World Bank. Forthcoming-a. Infrastructure, Learning Complements, and Student Learning: Working Together for a Brighter Future. Washington, D.C. World Bank. Forthcoming-b. An Independent Verification of Education Sector Data in Indonesia. World Bank. Washington, D.C. Improving toilet hygiene and handwashing practices during and post-COVID-19 pandemic in Indonesian schools 25 Annex 1 Government Regulations setting standards for WASH facilities in Indonesia 1 Government Regulation In the description on school facility standards, toilets are not mentioned (PP) No. 19 Year 2005 (PP as facilities that should exist in schools. No.19/2005) 2 Ministry of Health (MoH) Ratio: 1:40 for boys, 1:25 for girls Regulation No. 1429/2006 Location: Separated from classrooms, the health emergency room (UKS – Guidelines on School room), and the library Environmental Health Condition: Clean, no standing water Air circulation: Ventilation hole area to floor area 30% Lighting: Light intensity 100 LUX, no glare 3 MoECRT Ministerial Toilet Regulation (Permendiknas) Ratio of toilets to students No. 24 Year 2007 Primary (SD): 1: 60 for boys; 1:50 for girls (Permendiknas No.24/2007) Secondary (SMP and SMA): 1:40 for boys, 1:30 for girls Building requirement: Toilet has roof, wall, can be locked, has clean water, and is easy to clean. Size: Minimum 2 m2. Sink (for washing hands) Ratio: 1 per classroom, 1 per UKS room, 1 per teacher room. No explanation about the size or other requirement. Building age (for schools): Built to last at least 20 years (no specific instruction about the age of toilets) 4 Permendikbud No.8/2018 on Toilet blocks in schools Operational Guidelines for 2 toilets for boys, 2 toilets for girls the Special Allocation Fund 2 urinals for boys (DAK) for Education Physical Sinks: 2 for boys, 4 for girls (Construction) No per classroom requirement for sinks. Water: Clean water from a water tower, if there is no public water supply Air circulation: Available as per building standards Lighting: Available as per building standards Location: Easy to access Size: Minimum 1.5 m x 1.75 m = 2.55 m2