MULTIPLE STRATEGIES FOR REDUCING OPEN DEFECATION IN PASURUAN REGENCY, EAST JAVA, INDONESIA

1. Postgraduate student of environmental science, brawijaya university. 2. Postgraduate lecturer of brawijaya university. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 17 May 2019 Final Accepted: 19 June 2019 Published: July 2019

One of the city in Indonesia with a high level of Open defecation is Pasuruan Regency, East Java (Ministry of health, 2007;Ministry of health, 2010). The sanitation and access to clean water and drinking water conditions in Pasuruan Regency were still relatively poor and far from the SDGs target. The Pasuruan regency government has implemented a sanitation program (Community Based Total Sanitation, Kemkes, 2009)  Da'i is an Islamic religious leader who is close to the community. Da"i educates people about Islam and invites people to do good deed based on Islamic rules (Mubasyaroh, 2016). The people in Pasuruan has a robust Islamic boarding school background, so Da"i might have a big role in their way of living (Mukhlis, 2009). Da"i has the potential to help to decrease open defecation by inviting people to have a healthy living behavior (Risdiana, 2014). The potential is supported by the concept of Islamic teaching. Islam is a religion that emphasizes cleanliness and environmental health (Yusuf, 2015). Guidances about health is clearly written in the Qur'an and the Hadith of the Prophet. In this study, we evaluate the factors that can reduce open defecation practice in Pasuruan, such as water quality, the availability of sanitation facility, and the effectiveness of Da'i sanitation's role in increasing public awareness to not defecate in open areas.
Research Purpose:-Based on the formulation of the problem above, the objectives of this study are as follows: Analyze multiple strategies for reducing open defecation in Pasuruan Regency, East Java, Indonesia.

Study sites and Data sampling:-
The study was conducted in 24 districts inside Pasuruan regency ( Figure 1) from 2016 to 2018. We used the survey method to take samples from a population using questionnaires as a tool. We used Stratified Random Sampling that allows us to select the sample/respondent to get the information that we want. The respondents were families that are still practicing open defecation. There were 1200 respondents in total, 50 respondents in each district. We interviewed the respondent with questionnaires. We also documented the facility related to sanitation in each area to get information on the number of available public toilets. We refer to Winarningsih (2019) for water quality data on each district.
There are two types of data that were collected in this study, primary and secondary data. Primary data is needed for testing predetermined hypotheses, while secondary data is needed to provide a description (description) of the object of research. Primary data includes the respondent"s individual information, their reason to still defecate in the open area, their ability to access public toilets or other facility related to sanitation, and their perception of Da"i. The secondary data are taken from agencies associated with this research, such as health agencies and the district government.  Da'i plays a great role in solving problems that exist in Islamic society (Vyas and Spears, 2018), especially in Java, Indonesia (Lukens-bull, 2000). In our study, Da"i can have a great influence on the people in Pasuruan regency maybe because of two correlated factors. The first factor is the Pasuruan community culture that is dominated by Islamic cultures and values. In Islamic culture, Da"i has a fundamental role. Da"i is the leader, influencer, teacher, and also the doctor in the Islamic community (Ratoni, 2015). Therefore, Pasuruan residence will have great trust in Da"i.

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The second reason is the low level of education. Duverger (2010) states that a person's education level determines their perspective on health aspects. The Pasuruan district residences that still defecate in open area mostly had a low education level. Therefore, it is hard for this community to understand the risk of open defecation even though health workers already informed them. Notoadmojo (2007) states that a low level of education will cause the information conveyed by the speaker to be very difficult to digest and understood. Meanwhile, Da"i has a robust place in this kind of community. Even though the uneducated community could not understand the information to stop open defecation, if the provision of information is conveyed by people who they obey, then the information from Da'i will be accepted by the community (Darmawan et al., 2013).
In Islamic countries, especially in southeast Asia where the people are not evenly educated and poor, religion is the primary tool that could shape the community health condition (Levin, 1996;Vyas and Spears, 2018). A health study in the Middle East and North Africa (MENA) countries by Goldstein, 2016 found that by utilizing Islamic texts such as the Quran and Sunnah, and also by employing religious leaders as spokespersons, the communities in MENA countries respond positively to the health promotion, and many health programs result in positive outcomes. Generally, religious practices and beliefs must be taken into account to develop a health system in religiousdeveloping countries, for example, the MENA countries, and probably also Indonesia. The decrease in the number of permanent healthy toilet was due to the abandonment of those toilets. In some districts, the healthy toilets were too far, so not many people come to those toilets, and eventually, those toilets were abandoned and damaged. Or in another case, the toilets were damaged naturally but the residence of that particular area unable to repair it due to several reasons such as finance and time, so they abandoned those damaged toilets. In this kind of cases, the health workers and government workers need to support financially and educate the residents on how to manage the permanent healthy toilets. Besides the existence of permanent healthy toilets and the role of health workers or Da"i, several other factors can influence the success of stopping open defecation behavior. These factors include community characteristics, economic level, education, and regional topography (Widayanti, 2012). After spending time for further study, we found out that this district has limited access to clean water. Water quality study by Winarningsih (2019) showed that there are only three water stations available in Rembang district, and the water does not pass the drinking water standard according to the biological parameters. Therefore, this district needs special care to provide clean water, and management strategies to prioritize the available clean water for drinking and health care in this region The water quality in all water station in this district was way above the drinking water 645 standard according to the biological parameters. The people of this district were aware of healthy living behavior, so their behavior connected and adapted to shape their healthy environment (Antonovsky, 1979). Pasuruan Regency should monitor the health program in this district closely, and implement the positive things to the programs in other districts.

Cnclu
The main factor that is influencing people behavior to stop defecating carelessly in Pasuruan Regency is the availability of permanent healthy toilets and the role of Da'i.

Conclusion:-
Drinking water stations in districts of Pasuruan are still remain in poor quality. The coliformic bacteria contamination especially E. coli in drinking water stations is the main problem that cause the quality becomes poor and can not fulfil the drinking water standard according to the biological parameters. Therefore, strategy to reduce the coliformic bacteria including E. coli contamination on drinking water stations is needed to develop for further increase the drinking water quality in Pasuruan Regency of East Java, Indonesia.