Clean water, improved and healthy sanitation, and then accompanied by hygienist behaviour is an absolute requirement for a healthy and dignified human being. Infectious diseases such as tuberculosis, malaria, diarrhoea, dysentery, dengue fever and COVID 19, which have recently become pandemics around the world, can be prevented if humans have healthy habits, wash their hands with running water and soap, and maintain a clean environment. Death rates from infectious diseases also can be prevented.

Therefore, CD Bethesda is well aware of the importance of environmental health and sanitation as part of primary health care. Environmental health cannot be abandoned. Proven, for example, when dealing with malaria and TB endemic areas, it turns out that one of the contributing factors is a humid, unclean environment, both in rural and residential areas. The high number of cases of diarrhea, not only because there is not enough clean water available in the household, but a way of life that is less clean, that is not washing your hands at important moments, and there is still a habit of drinking raw water without being treated.

At the beginning of running an environmental health and sanitation program, as like other institutions in general, CD Bethesda provided public facilities for clean water and public toilets, with support from partners. The form of clean water facilities built on a community-based basis is quite diverse, from the treatment of springs, piping installations complete with reservoirs, rainwater reservoirs in barren areas, wells, and others. The clean water installation is then accompanied by public toilet buildings which are built at certain points that can be accessed by rural residents.

At that time, as like government agencies and other non-government organizations, CD Bethesda believed that through the construction of clean water facilities, the community would automatically change their sanitation habits and hygiene into healthier. In fact, no. The high rate of diarrhea and other infectious diseases (even several times indeed outbreaks occured) in rural communities that have been intervened by the water program and sanitation facilities, shows there are things that have not been completed. It turns out, the construction of clean water facilities and public toilets without being accompanied by an empowerment process raises awareness of health behavior will be in vain.

Having this background of experience, CD Bethesda supports and actively be involved in a national strategy called Community Lead Total Sanitation (or STBM as familiar calling) from 2010 to the present. The focus is on changing sanitation and hygiene behavior at the family or household level, so that they are aware and willing to access sanitation facilities created by the household itself. The empowerment approach with triggering method turned out to be able to boost access to sanitation (toilets, washing hands, drinking water, garbage, and liquid waste facilities) at the household level to exceed 70% in the past 10 years or so. The goal is to meet the SDGs target of 2030 by almost 90%, even if it can be 100%, because we believe that being healthy and accessing sanitation is part of human rights. From the process of awareness in the community, creating their own latrines in households, now local initiatives have emerged from the toilet and natural soap entrepreneurs created by the community themselves in form of the sanitation entrepreneur or business.