Permasalahan
Ada beberapa jenis permasalahan dasar yang terkait dengan sistem pengelolaan sanitasi, yaitu: akses dan kualitas pengelolaan yang rendah, kelembagaan yang belum efektif dan efisien termasuk belum lengkapnya peraturan perundang-undangan yang terkait, terbatasnya alternatif pendanaan pembangunan, dan rendahnya peran masyarakat dan swasta.
Persoalan Akses dan Kualitas
Berdasarkan data Susenas, untuk fasilitas sanitasi, pencapaian Indonesia sempat meningkat tinggi dari tahun 1992 (30,9%) sampai dengan tahun 1998 (64,9%), dimana dalam enam tahun terjadi peningkatan sebanyak tiga kali lipat. Walaupun demikian, sejak tahun 1998 pertumbuhan akses ini melambat, bahkan sempat menurun di tahun 2000 (62,7%) dan 2002 (63,5%) karena tingkat pertumbuhannya tidak sebanding dengan tingkat pertumbuhan penduduk. Data terakhir untuk tahun 2004, proporsi rumah tangga yang memiliki akses pada fasilitas sanitasi yang layak, artinya menggunakan tangki septic atau lubang sebagai tempat pembuangan akhir mencapai dua pertiga dari seluruh rumah tangga di Indonesia (67,1%).
Dari data di atas, tampaknya akses masyarakat pada fasilitas sanitasi yang layak cukup tinggi, sayangnya tingkat aksesibilitas ini tidak memperhitungkan kepemilikian atau tingkat penggunaan jamban itu sendiri. Padahal, menurut definisi dari UN-HABITAT, jamban yang layak sebaiknya digunakan oleh jumlah orang yang terbatas. Data tersebut juga belum menjelaskan kualitas jamban, apakah berfungsi dengan baik, apakah sesuai dengan peruntukannya, dan apakah sesuai dengan standar kesehatan maupun teknis yang telah ditetapkan.
Persoalan Kelembagaan
Pemerintah Daerah yang menjadi garda terdepan pengelolaan air limbah (sanitasi) masih belum dilengkapi dengan kebijakan dan pengaturan soal organisasi dan tata kerja institusi atau lembaga yang bertugas mengelola prasarana dan sarana yang ada. Perangkat pengaturan masih jauh dari operasional sehingga pengelolaan, terutama pemeliharaan, prasarana dan sarana menjadi terbatas. Lebih jauh lagi, data-data yang reliable dan valid atas prasarana dan sarana air limbah sangat terbatas sehingga sulit untuk melakukan identifikasi kebutuhan peningkatan pelayanan.
Persoalan Perhatian, Pendanaan, dan Dampak Lingkungan
Minimnya kepedulian pemerintah dan wakil rakyat akan persoalan sanitasi tercermin dari alokasi anggaran yang sangat sedikit untuk pembangunan fasilitas sanitasi dasar. Padahal, bahaya kerusakan lingkungan dan menurunnya kualitas air baku karena kurangnya perhatian pada masalah sanitasi dapat menyebabkan upaya perbaikan yang 10 kali lebih mahal daripada biaya pencegahannya. Perhatian yang terbatas kepada air limbah juga ditandai dengan keterbatasan pilihan teknologi alternatif sehingga aplikasinya pada masalah dan lingkungan yang beragam, misalnya untuk jenis buangan padat dan cair, dari kawasan industri maupun rumah tangga, menjadi jauh dari optimal. Penyakit seperti diare dan malariapun biasa muncul pada daerah dengan sanitasi buruk. Data dari survey sumur dangkal di Jakarta menyatakan bahwa 84% dari sample menunjukkan adanya pencemaran terhadap air tanah (Laporan Pencapaian MDG Indonesia 2004).
Persoalan Kesadaran Masyarakat
Sanitasi juga masih menjadi masalah pelik, terutama di daerah perdesaan, karena rendahnya tingkat pendidikan dan pengetahuan masyarakat. Hal ini menyebabkan banyaknya jamban yang tidak digunakan sebagaimana mestinya karena ketidakmengertian masyarakat. Sayangnya LSM yang bergerak di bidang sanitasi masih sangat sedikit. Keterlibatan dan komitmen pemangku-kepentingan (stakeholder) termasuk pemerintah, para wakil rakyat, dunia usaha, dan warga masih jauh dari kemampuan untuk bersama-sama berembug dan bertindak sesuai kesepakatan peran dan kewajiban untuk mengelola air limbah.
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