• Diseases caused by dirty drinking water.
• The poor suffer more. Drinking water is more expensive for the poor.
• Women disproportionally carry the burden of collecting and treating water
• Treating water by boiling on fuel wood causes global warming
• Plastic that is used to package causes an environmental disaster.

Access to drinking water

Globally, 4.4. billion people do not have access to treated water in their home [Dalberg, 2017] . This lack of access leads to the following problems.

70% of the Indonesian population has a self-provided source of primary water; this means that there is no quality control of the water that people use for their daily needs[1]. People get their water through a private well, community well or from a water truck. Mostly this water is contaminated with bacteria that can cause diseases like diarrhea. The 30% that has access to the water provided by the national water supply (PAM) also has water below drinking standards due to maintenance problems and contamination with ground water². Therefore, nobody in Indonesia can drink their water from the tap and chances are very high that the primary source of water is not clear but contaminated. Although the GDP of Indonesia is growing, Indonesia has trouble in reaching its targets for the MDGs. 63 million people (1/4 of the total population) still practice open defecation[2]. Just 12% of people wash their hands after defecating, which means that there are harmful bacteria everywhere³.

Diseases caused by dirty drinking water

Although most Indonesians boil their water, studies found that 47.5% of the boiled drinking water still contained e-coli bacteria[3]. As a result, each year 27,000 children die due to diarrhea[4]. As a result 8 million Indonesian children (40%) are stunted. The WHO estimates that diarrhea can be reduced by 39% through household water treatment and safe storage[5]. Worldwide, as a result of constant exposure to contaminated water around 525 000 children die every year of diarrhoea [2].

Water is expensive and the poor pay more

In order to get safe drinking water, Indonesians, in general, are used to boil their water using wood or gas or buy bottled water at refill stations. Bottled water is called Isi ulang and is provided in big 19L bottles called gallons. Few data is available on the methods that people use to purify their water. Many households use multiple disinfection methods; combining boiling and buying of water.[6].

Nazava observed that ways to acquire drinking water are related to income as well as local practices. Based on our observations and the patchy information from reports, we constructed the following division of ways people get their drinking water in Indonesia:

Table 1 Estimated distributions of methods in which the Indonesian population acquire drinking water

Practice	Daily income	% of population	Location
Boiling using wood	< 2 USD	50 %*	Rural
Boiling using gas	>2 USD		Rural and Urban
Buying refill water	< 10 USD	50%	Rural and Urban
Buying branded water	> 10 USD		Urban
Using a whole house RO machine	>20 USD		Urban
* no information available on % of population that uses wood or gas as primary source for drinking water

n general, we estimate that 50% of the Indonesians buy water, 25% use gas to boil their water and 25% use wood. Boiling water is more common in rural areas and buying water is more common in urban areas. Although bottled water is more expensive, it is becoming more popular than boiling, because of the convenience of being able to drink it directly from the container².

On an annual basis, Indonesian households spent between 51 to 132 USD to get safe drinking water (see Figure 2). This means that many households spend up to one monthly wage on drinking water[7].

People living in the slums of Jakarta pay 5 to 10 times more for water than those living in high-income areas in those same cities and more than consumers in London or New York [3].

Women waste their time collecting and treating water.

According to a study done by Santa clara university women spend 125 hours pear year boiling water. This is 3 workings weeks. This does not even count for collecting the water itselves.

and there’s a disproportionate burden for women to provide safe drinking water to their families. Poor people pay a lot of money for bad quality of water.

Environmental disaster – plastic soup

The lack of accessible safe drinking water has made the majority of the country dependent on single-use plastic water bottles resulting in the consumption of 29 billion liters packaged drinking water in 2018 (= 0.3 liter/person/day). As a result, Indonesia is the world’s second-largest contributor of plastic pollutants in the oceans, emitting around 200,000 tonnes/year of plastic from rivers and streams. (https://go.nature.com/2r6QY64 ). PET bottles are the fifth most common item found in ocean debris, compromising around 15% of marine waste, and it takes between 500-1000 years to degrade. http://citi.us/2MWgABu.

Environmental disaster of lack of drinking water- global warming

For consumption at home, well-off households buy expensive bottled water, but most households prefer boiling on either wood or LPG, causing deforestation and Co2 emissions. The 60m Indonesians that boil on wood and the 60m boiling on LPG emit an estimated 63 million tCO₂e/year. This equals the total emissions of four 500 Megawatt coal fired power plants.

Political and economic context

Within the Indonesian government, the responsibility for safe drinking water is divided among three institutes: The Ministry of Health, Public Works and the National Planning Agency. Coordination among these three institutes is insufficient. Officially, the water provided by the municipal water system (PDAM) could be drinkable, but nobody drinks the tap water without treatment. Local governments rarely make funds available to address water and sanitation issues[9].

Indonesia works hard to implement the UN Millennium Development Goals. MDG 7c states: “Reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation”. However, the accomplishment of this MDG is measured in the number of people that have access to an improved source of drinking water. Having access to an improved source does not imply that people have access to water that is safe to drink. The formulation of this MDG tends to focus more attention towards access to water, as a result the quality and costs obtaining drinking water is often overlooked.

The Ministry of Health has adopted the STBM (Sanitasi Total Berbasis Masyarakat – Community Led Total Sanitation – CLTS) strategy since 2008. The third pillar of the strategy is related to safe water treatment and storage at the household level. So far, most local governments and NGOs that adopted the STBM strategy focused on sanitation issues. Some NGOs such as Plan and Mercy Corps are starting programs to promote treatment and safe storage of drinking water.

Indon

[1] http://water.worldbank.org/sites/water.worldbank.org/files/publication/WATER-Indonesia-Water-Investment-Roadmap-2011-2014.pdf

[2] http://www.who.int/water_sanitation_health/monitoring/jmp2012/fast_facts/en/index.html

[3] http://www.slideshare.net/espslide/strategi-implementasi-p-a-m-r-t

[4] Unicef Indonesia (http://www.unicef.org/indonesia/children.html) and US government Global Health initiative (http://www.ghi.gov/documents/organization/175131.pdf)

[5] Combating waterborne disease at the household level, WHO 2007. Ref ISBN 978 4 15922 3

[6] Most water related studies focus on the source of the water (MDGs) and not on the type of drinking water and how it is purified. Besides, the studies are based on samples, taken either in Jakarta or on Java, which is not representative for the whole country. Practices between rural and urban areas also vary Example of a report: Worldbank (2012): http://water.worldbank.org/sites/water.worldbank.org/files/publication/WATER-Indonesia-Water-Investment-Roadmap-2011-2014.pdf

Statistics Indonesia (BPS) Indonesia Demographic and Health survey 2007: Boiling 91.4%, Bleach/Chlorine 1,2%, Ceramic sand or other 4,3%, Solar Disinfection 0.1%, Other 25.5%, No treatment 6.3% http://www.motorcycleoutreach.org/FR218_April_09_2009.pdf

[7] Minimal wages differ per district but are around 120 USD (http://www.wageindicator.org/main/minimum-wages/indonesia)

[8]Sodah et al, 2011, http://www.ncbi.nlm.nih.gov/pubmed/21976204 And: http://www.scribd.com/doc/98488936/STRATEGI-NASIONAL-SANITASI-TOTAL-BERBASIS-MASYARAKAT-STBM

[9] http://www.ode.ausaid.gov.au/publications/documents/aus-water-supply-and-sanitation-easttimor-indonesia.pdf visited on 16 October