WATER KNOWLEDGE NOTE Scaling Up Disability Inclusion in Water Projects Case Study of PAMSIMAS Background More than 1 billion people worldwide, or 15 percent of the global population, have some form of disability (World Bank 2011) with higher rates in low-income countries. This number is expected to rise significantly due to factors such as aging populations, conflict, and the impacts of climate change (World Bank 2019a). For these reasons, disability-inclusive development is of interest to the Water Global Practice of the World Bank, to the World Bank’s twin goals of reducing extreme poverty and promoting shared prosperity, and to Sustainable Development Goal (SDG) 6 (to ensure the availability and sustainable management of water and sanitation for all). SDG 6 relates not only to water and sanitation access by persons with disabilities, but also to their engagement in the management of water and sanitation.1 The new Environmental and Social Framework requires borrowers to look specifically at persons with disabilities as part of any social assessments, and the proposed International Development Association (IDA) 19 policy ensures disability inclusion in projects.2 Disability-inclusive development in the water sector is an emerging issue, particularly in water supply, sanitation, and hygiene (WASH). There is growing recognition that WASH facilities must be designed in a safe, accessible, and usable way, that benefits all members of a community, including people with disabilities. Although limited, some studies suggest that inclusive school latrines can be constructed © SNP_SS/Shutterstock. at less than 3 percent of the total cost of a regular latrine Overview of PAMSIMAS (Jones 2011). Such examples may encourage decision makers to incorporate disability-inclusive interventions. PAMSIMAS is a rural WSS development platform that The guidance note for water sector operations (World Bank contributes to Indonesia’s national agenda of achieving 100 2017) promotes various disability-inclusive interventions, percent universal access to water. PAMSIMAS has helped emphasizing both hard (e.g., infrastructure) and soft (e.g., Indonesia’s low-income rural and peri-urban population— training, guidelines) components. However, cost data on spread across 28,529 villages—by providing improved water this more holistic disability-inclusive approach has been supply to 19.3 million people and access to better sanitation sparse to date. Establishing precise examples of the cost facilities to 15.46 million people (MIS data, June 2020). of both hard and soft components will help task teams to The third phase of the project (PAMSIMAS III, 2016–21), incorporate disability-inclusive designs into their projects. targets 15,000 new villages and provides technical assistance and follow-up support to almost 27,000 participating villages. Indonesia’s Community-Based Drinking Water and The PAMSIMAS III project development objective and the Sanitation Program (PAMSIMAS) includes comprehensive components are summarized in figure 1. disability-inclusive approaches in its components. The project focuses on improving participation and access to Since the start of the project in 2011, PAMSIMAS has used disability-inclusive water supply and sanitation (WSS) a community-driven development approach for planning, facilities, and has managed to do so at scale. The first section constructing, and monitoring WSS services. To achieve of this case study summarizes the project and discusses why universal access, village implementation teams (VITs) are and how, with the Assistance of the Government of Australia formed to formulate community action plans (CAPs). (GoA), this project has been able to involve persons with Once a CAP is approved, block grants finance construction disabilities through all stages of the process. The second and rehabilitation of WSS infrastructure. These grants are section delves into the cost of disability-inclusive activities. shared among central (60 percent) and district (10 percent) FIGURE 1. Summary of PAMSIMAS Project development objective To increase the number of underserved rural and peri-urban populations accesssing sustainable WSS services. Component 1 Community empowerment and local institutional development • Support facilitators and train local community, district and provincial levels for planning and management of WSS facilities and hygiene improvement programs. It uses a community-driven development approach, builds stakeholder commitment, and expands the capacity of central, provincial and district government agencies. Component 2 Improving hygiene and sanitation behavior and services • Support households to access improved sanitation facilities of their choice, use improved WSS infrastructure effectively and progressively adopt key hygiene practices. It applies a phased program of community-led total sanitation, including school sanitation and hygiene improvement grants and training for provincial and district government units responsible for envionmental health and hygiene. Component 3 Water supply and public sanitation infrastructure • Finances block grants based on CAPs developed using a community-driven developement approach in component 1. Block grants are provided under the following windows: (i) water supply system for new villages; (ii) scaling up and expansion of existing village water supply systems (iii) optimization of existing underperforming village water systems. Component 4 District and village grants • Provides incentive grants to participating districts and villages that have met or exceeded predetermined project preformance criteria to support expansion and optimization of existing community water supply systems. Component 5 Implementation support and project management • Provides technical implementation support for the project, including project management services to the implementing agencies. Source: World Bank 2015. Note: CAP = community action plan; WSS = water supply and sanitation. WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 2 governments; village funds (10 percent), and communities Although participation in community meetings by persons (20 percent). Communities contribute 4 percent in cash and with disabilities increased, the evaluation of pilot villages 16 percent in kind, which results in villagers undertaking showed a need to improve participation. Specifically noted most of the nonskilled construction work. were low facilitation skills of community facilitators, the absence of a common understanding of disability inclusion Disability Inclusion in PAMSIMAS at a Glance among community members, a lack of confidence among persons with disabilities, and insufficient development of Legal Basis for Disability Inclusion accessible facilities. In light of these findings, the project developed standard operating procedures (SOPs) for The Government of Indonesia (GoI) has a legal framework to disability-inclusive development,3 and refresher training ensure equal rights and inclusion of persons with disabilities. was held for facilitators and central and local government The government first formulated the law on persons officers. Subsequently, the disability-inclusive approach was with disabilities in 1997 (Law 4), and ratified the United introduced in all new villages supported by PAMSIMAS, Nations  (UN) Convention on the Rights of Persons with with the goal of applying it in 10,000 villages by 2021. Disabilities (CRPD) in 2011. Law 8/2016 on persons with disabilities adopts provisions stipulated in the CRPD. Under Disability Inclusion in Project Activities this law, central and local governments must ensure access to clean WSS for persons with disabilities. In 2017, the Ministry Community Planning, Implementation, of Public Works formulated Regulation 14/PRT/M/2017, and O&M which introduces accessibility requirements. In addition, the National Medium Term Development Plan, 2015–19, sets The first step in the process of implementing projects in targets of achieving universal access to WSS, which encourages specific communities is community mobilization, in which localities to provide water access to persons with disabilities. government facilitators visit villages to organize community Disability inclusion was introduced into PAMSIMAS at the meetings to explain the project process. The facilitators identify end of 2016 by DFAT (Department of Foreign Affairs and disabled people’s organizations and reach out to persons with Trade) of the Government of Australia (GoA). disabilities so they can participate at the beginning of the project. Villagers review the current status of WSS services and The GoA has a long history of supporting the WSS sector in identify the location and type of WASH facilities on a map. Indonesia, including by providing grants to PAMSIMAS. The facilitators encourage persons with disabilities to attend the Disability inclusion is a focus area for the GoA (GoA, meetings (which of course should be held at accessible venues), DFAT 2016), and it supported the introduction of disability share their ideas, and ensure accessible WASH facilities are inclusion into the project. included in community action plans (CAPs). The continuous participation of persons with disabilities in implementation Introduction of Disability-Inclusive and O&M is also encouraged. Through this process, data on Development in PAMSIMAS persons with disabilities in the village is collected.4 In November 2016, PAMSIMAS invited the Christian At the implementation phase, villagers receive training Blind Mission (CBM), an international nongovernmental in aspects such as construction engineering and financial organization (NGO), to conduct a disability-inclusive management to assure smooth implementation of the CAPs. WASH training workshop for national level government In addition, persons with disabilities continue to be encouraged officers and provincial WASH facilitators (CBM 2016). to participate in all aspects of implementation. For example, It was the first step for PAMSIMAS to introduce some provide in kind contributions of labor for construction. disability-inclusive WASH. In 2017, the project applied They can also check the facilities to assure accessibility. a comprehensive disability-inclusive approach in 59 pilot villages in 26 districts. This meant not only developing The project includes an option to subsidize water tariffs for the technical designs and constructing accessible WASH persons with disabilities and the elderly because they tend facilities but also involving persons with disabilities from to pay more for health services and transportation, and planning to implementation. Community facilitators face barriers to education and employment opportunities. assisted in community-based planning, implementation, Further, including persons with disabilities in O&M work and operation and maintenance (O&M), and were trained creates opportunities for them to take up leadership roles to involve persons with disabilities in the planning process. and build self-esteem. WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 3 Capacity Development for National, District, number of persons with disabilities in a village and the and Village Levels number of participants with disabilities of each community meeting and training.6 Community facilitators collect a wide PAMSIMAS has conducted continuous capacity development range of village-level data and send it to district coordinators. training, including trainings focused on disability-inclusive Provincial and regional level operators monitor the data and development held in 2017 and 2018. Online training for provide support to the district coordinators, if necessary. facilitators includes a module on inclusion of persons with disabilities (World Bank 2019b). The refresher training held Cost of Disability-Inclusive in 2018 provided an opportunity for 61 staff to share the Development for WASH challenges they faced in the pilot villages, and to discuss possible actions for further improvements (CBM 2018). The first day Using the cost data from the MIS as of May 2019, this of the training focused on refreshing the understanding of case study details the costs of disability inclusion in the importance of disability inclusion, sharing success and each activity.7 Data are available on the soft component challenges from experiences of the pilot villages, and learning (training, meetings, technical assistance, the technical from disabled people’s organizations to deepen knowledge. specifications of inclusive water facilities, and data On the second day, the participants met in small groups to collection) and the hard component (water sanitation discuss different topics related to strengthening disability- infrastructure and facilities). inclusive development at the community level. Finally, each participant created an individual work plan for the next Cost of the Soft Component phase using what they had learned in the training. As noted, adequately involving persons with disabilities in the planning The overall costs of each activity and the share of disability- process was identified as a common challenge. One of the inclusive portions are shown in table 1. PAMSIMAS lessons gleaned was that accommodating the specific needs reached out to 6,000 new villages in 2018, including 1,154 of persons with disabilities to participate in community villages that have applied disability inclusion. Since the meetings5 required a proper understanding of disability disability-inclusive work is embedded in each activity, the inclusion among other village members, or it tended to be cost of disability inclusion in each activity is estimated by unintentionally neglected. the task team and the project management unit. The soft component includes the following: Management Information System Monitoring Mechanism • Training for community facilitators. In total, 84 trainings for community facilitators were held Data on persons with disabilities is systematically collected (World Bank 2019b), and the two-day training as part of the web based management information system specifically on disability inclusion was held in (MIS), and available in the project website, such as the October 2018. The disability-inclusive portion covers TABLE 1. Cost of Disability Inclusive Activities in 2018 Costs (US$) Disability- Disability-inclusive activities Overall Disability-inclusive portion inclusive cost (%) Training for community facilitators 2,040,816 127,551 6.2 Community training 4,897,959 228,571 4.7 Technical assistance 25,984,234 312,580 1.2 Accessible technical design in the SOPs for disability-inclusive development 455,000 70,000 15.4 Data collection 2,666,675 266,668 10.0 Total 36,044,684 a 1,005,370 a 2.8 Source: Data from MIS as of May 2019. Note: SOP = standard operating procedures. a. Theoretically, the total soft component costs about US$6,000 per village (US$36,044,684 per 6,000 villages), while the total disability-inclusive portion costs about US$870 per village (US$1,005,370 per 1,154 villages). However, some activities, such as the accessible technical design, could be used in other villages without a cost. Thus, the costs of the overall soft component and disability- inclusive portions would be lower when new villages introduce disability inclusion WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 4 the preparation of training materials and delivery of TABLE 2. Sample Villages with and without the training. Disability Inclusion • Training for the communities. This refers to the dedicated disability-inclusive development training Number of villages for community members. The cost covers preparation Without of training materials and delivery of the training. With disability disability Province inclusion inclusion • Technical assistance. This includes overall Jawa Barat 23 53 technical assistance for community-based planning, implementation, and O&M. It covers staff time of Jawa Tengah 55 No data the national management consultant, provincial and Jawa Timur 35 66 district management consultants, and facilitators. Banten No data 16 • Inclusive water facility specifications in the SOP Total 113 a 135 for disability-inclusive development. The technical Source: PAMSIMAS task team. designs for inclusive water facilities were developed Note: a. Approximately 10 percent of the villages introduced and included in the SOP for disability-inclusive disability-inclusive water facilities throughout Indonesia in 2018. development. The figure of disability-inclusive portion is the cost of developing technical designs, and the total is the overall cost of producing the SOP. TABLE 3. Profile of Sample Villages with Disability Inclusion • Data collection. This covers the annual monitoring and supervision costs of the MIS. Number of villages Cost of the Hard Component Only inclusive latrine(s) 4 Inclusive latrine(s) but The cost of the hard component is analyzed through the non-inclusive handwashing facility(s) 72 sample villages that constructed water and sanitation Only inclusive handwashing facilities with and without disability inclusion. Details are facility(s) 26 shown in table 2. Inclusive handwashing facility(s) but non-inclusive Types of Due to the limitation of the sample data, there are neither latrine(s) 10 school villages with disability inclusion in Banten province nor WASH Both an inclusive latrine villages without disability inclusion in Jawa Tengah province. facilities and inclusive handwashing This case study looks at only school WASH facilities such as constructed facilities 1 school latrines and school handwashing facilities.8 Number 0 39 of persons 1–100 58 with Table 3 shows the detailed profile of the sample villages 101–300 11 disabilities with disability inclusion by types of school WASH facilities in village Above 300 4 constructed and by the number of persons with disabilities. Source: Data from MIS as of May 2019. A majority of villages (72) constructed inclusive latrines, but not hand-washing facilities while 26 villages constructed facilities are available at a village level. Cost analysis does only inclusive hand-washing facilities. The remarkable point not differentiate incremental costs for accessible features is that 39 villages introduced disability-inclusive school (i.e., ramps or rails) versus non-accessible features. latrine(s) or handwashing facility(s), even though there were Table 4 shows the costs of total WSS system and facilities, no persons with disabilities in these villages. In Indonesia, and the cost of school latrine  or  handwashing with and schools are usually open for the public, and villagers not without disability inclusion. attending the school can use the disability-inclusive wash facilities in schools. (See photographs 1 and 2.) According to the sample data in Table 4, the unit costs of an inclusive school latrine and handwashing facility Because PAMSIMAS introduces the WSS system at a village appear to be lower than those of a non-inclusive school level, data of the total WSS system and facilities costs9 latrine and handwashing facility. Part of this may be driven and data of the inclusive school latrines and handwashing by differences in the facilities’ locations as the province WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 5 PHOTOGRAPH 1. Accessible School Latrine that reported a larger number of disability inclusive WSS infrastructure (Jawa Tengah Province) had a lower cost of living/cost of materials than the province reporting no data on numbers of disability inclusive WSS (Banten Province). When comparing cost of accessible and non- accessible handwashing facilities in the same region (Jawa Timur Province), inclusive facilities cost 1 percent more than non-inclusive facilities (figure 2). However, most likely a larger driving factor is simply that the incremental cost of the handwashing infrastructure and latrines compared to the total cost of the WSS system is so small, that disability inclusive approaches and adaptations do not add in any significant way to infrastructure costs, and Source: World Bank project team. in this case actually cost less. For example, the proportion of total WSS costs attributed to the construction of a PHOTOGRAPH 2. Accessible Handwashing non-inclusive school latrine is only 5.4 percent of the Facility total system cost, and for a non-inclusive hand-washing station, this is only 0.5 percent of total costs; moving towards inclusive latrines only represented 5.2 percent of total cost and the same cost (0.5 percent) for inclusive hand-washing stations. Even when “soft” components  – many of which diminish on the margins (for example inclusive designs) – are spread over many villages, they also do not add significantly to overall costs (in this case 2.8 % of soft costs). Conclusion and Way Forward PAMSIMAS is highly driven by community engagement. Mainstreaming disability-inclusive development contributes to ensuring access to WSS services for persons with disabilities and to breaking social and attitudinal barriers for persons with disabilities and other members of the community. The analysis reveals that the soft component, such as capacity building, required higher costs than the hard component. Because disability-inclusive development is embedded in Source: World Bank project team. each component, the proportion of disability inclusion is TABLE 4. Costs of Total WSS System and Facilities and Cost of School WASH Facilities with and without Disability Inclusion Average cost with disability inclusion Average cost without disability inclusion Total WSS Inclusive Number Total WSS Non-inclusive system and school wash of system and school wash Types of school Number of facilities per facility per unit villages facilities per facility per unit wash facilities villages village (US$) (US$) (US$) village (US$) (US$) Latrine 77 21,259 1,107 42 22,060 1,199 Handwashing facility 37 21,906 102 131 21,607 113 Source: Data from MIS as of May 2019. Note: Village data from sample villages in Java, as mentioned in table 3. The number of villages is the cumulative number. WSS = water supply and sanitation. WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 6 FIGURE 2. Average per Unit Cost of Notes Handwashing Facilities in Jawa Timur Province 1. There are four specific areas to embed disability inclusion as a cross-cutting theme. See details on the World 108.2 108.0 108.0 Bank website “Disability Inclusion” at https://www​ 107.8 .worldbank.org/en/topic/disability#2. 107.6 2. Particularly, SDG 6.1, 6.2, and 6.B. See the UN website 107.4 1% on SDG 6 at https://sustainabledevelopment.un.org/sdg6. 107.2 107.0 106.9 3. The SOP is available only in Bahasa, Indonesia. See 106.8 the PAMSIMAS website at http://pamsimas.org/pob​ 106.6 -pengadaan-fasilitator-pamsimas-iii-2018-2/. 106.4 4. The project employs the Washington Group’s Short 106.2 Accessible Non-accessible Set of Disability Questions to identify the number of Source: Data from MIS as of May 2019, based on average cost persons with disabilities; see the website “Short Set of of 34 accessible and 64 non-accessible handwashing facilities in Disability Questions” at http://www.washingtongroup​ Jawa Timur Province (in USD). -disability.com/washington-group-question-sets/short​ -set-of-disability-questions/. 5. For example, meeting venues should be accessible for a modest amount if the disability-inclusive development is all and information should be delivered in appropriate incorporated at the beginning of the activities. Retrofitting, formats, encouraging persons with disabilities in however, would be substantially more expensive. respectful manners. 6. See the PAMSIMAS website at http://pamsimas.org​ Since PAMSIMAS has introduced the community- /­data-aplikasi/pelaporan-sim/#pembrdyn-msyrkt. driven development (CDD) approach, the monetary 7. Cost data used in this analysis are originally in costs of embedding disability inclusion in the soft Indonesian rupiah. The average currency rate of 2018 component are modest (2.8% of total soft costs). is applied to show the U.S. dollar equivalent figures However, improving the quality of disability inclusion in (US$1 = Rp 147,000). each activity requires more time and innovative approaches 8. The PAMSIMAS also works for household connections to promote persons with disabilities’ participation in all and public taps and hydrants, but they are not included stages of the project. in this study. 9. It shows the overall cost of the WSS system and facilities, In constructing disability-inclusive school WASH facilities, including pipes, water intake facilities, water treatment the incremental costs for items such as ramps and rails are facilities, public WSS facilities, consultant fees, and labor marginal or non-existent relative to the much larger costs of (except for community contribution). pipes and pumps of the WSS system. The average proportion of the inclusive latrine and handwashing facility in the total WSS system and facilities is equivalent to non-inclusive References latrine and handwashing facilities. Therefore, when implemented at scale, the cost of the hard component CBM (Christian Blind Mission). 2016. Handbook on should not affect the decisions made by governments Inclusive WASH in Indonesia for PAMSIMAS WASH Program. or communities on whether disability-inclusive WASH Box Hill, Australia. facilities are constructed. ———. October 2018. PAMSIMAS Refresher Training: A challenge is creating an enabling environment for Disability Inclusive Development for PAMSIMAS III. Report persons with disabilities to participate in society. Evidence on workshop held in Jakarta, Indonesia. collected by the project task team through the supervision works reveals that strengthening facilitators’ capacity and GoA (Government of Australia), DFAT (Department of promoting a shared understanding among government Foreign Affairs and Trade). 2016. Disability Action Strategy officials and other community members on disability- 2017–20. Canberra, Australia: Department of Foreign inclusive development are important to success, and Affairs and Trade. https://dfat.gov.au/about-us/publications​ represent areas to improve further. /Documents/disability-action-strategy-2017-2020.pdf. WATER GLOBAL PRACTICE | SCALING UP DISABILITY INCLUSION IN WATER PROJECTS 7 GoI (Government of Indonesia), PAMSIMAS (Community- ———. 2019a. “Disability in Water: Brief for Task Based Drinking Water and Sanitation Program). 2018. Teams.” World Bank, Washington, DC. http://documents​ “Standard Operating Procedure for the Disability-Inclusive .worldbank.org/curated/en/314281548315217194/Disability​ Development (in Bahasa).” Jakarta, Indonesia. http://pamsimas​ -in-Water-Brief-for-Task-Teams. .org/pob-pengadaan-fasilitator-pamsimas-iii​-2018-2/. ———. 2019b. “Indonesia - Third Water Supply and Jones, H. 2011. “Inclusive Design of School Latrines: Sanitation for Low Income Communities Project: Mid- How Much Does It Cost and Who Benefits?” Briefing Term Review Mission - February 1 to March 4, 2019.” Note 1, Water, Engineering and Development Centre, Internal document, World Bank, Washington, DC. Loughborough, U.K. http://wedc.lboro.ac.uk/resources​ Wray, Ed. 2019. “Indonesia: Expanding Access to Clean /­briefnotes/BN001_School_Latrines.pdf. Water for the Rural Poor.” Results Briefs (blog), July 29. https:// www.worldbank.org/en/results/2019/07/29/indonesia​ Tanozisochi, Lase. August 2018. “Disability Inclusion at Scale: -expanding-access-to-clean-water-for-the-rural-poor. Sharing Experiences from Indonesia’s PAMSIMAS Project.” Presentation at World Water Week, Stockholm, Sweden. Acknowledgments World Bank. 2011. “Report on Disability: Main Report.” This case study was prepared by Ayumi Koyama (Junior World Bank, Washington, DC. http://documents.worldbank​ Professional Officer) under the guidance from Soma .org/curated/en/665131468331271288/Main-report. Ghosh Moulik (Practice Manager) and Sarah Keener (Senior Social Development Specialist). The team ———. 2015. “Indonesia - Second Additional Financing for the appreciates valuable support and comments received from Third Water Supply and Sanitation for Low Income Communities the PAMSIMAS task team: Dea Widyastuty (Operations and Community Based Water Supply Project: Restructuring.” Officer), George Soraya (Lead Municipal Engineer), and World Bank, Washington, DC. http://documents.worldbank​ Onny Trijunianto (Consultant). The study benefitted from .org/curated/en/356861468184755063/Indonesia-Second​ a series of discussions and inputs from Charlotte McClain- -Additional-Financing-for-the-Third-Water-Supply-and​ Nhlapo (Global Disability Advisor), Deepti Samant -Sanitation-for-Low-Income-Communities-and-Community​ Raja (Disability and Development Consultant), Mari -Based-Water-Supply-Project-restructuring. Koistinen (Senior Social Development Specialist), Toyoko Kodama (Water Supply and Sanitation Specialist), Kamila ———. 2017. “Including Persons with Disabilities Galeza  (Social  Development Specialist), and Amjad in Water Sector Operations: A Guidance Note.” World Muhammad Khan (Young Professional). Special thanks are Bank, Washington, DC. http://documents.worldbank.org​ due to Marie-Adele Tchakounte Sitchet (Program Assistant) /­curated/en/834711499660401130/Including-persons​-with​ for administrative assistance and Erin Barrett (Publishing -disabilities-in-water-sector-operations-a-guidance​-note. Associate) for publication support. Connect with the Water Global Practice www.worldbank.org/water worldbankwater@worldbank.org    @worldbankwater  blogs.worldbank.org/water © 2020 International Bank for Reconstruction and Development / The World Bank. Some rights reserved. 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