The challengeLike other countries throughout the world, Indonesia is steadily urbanising and it is estimated that 60.7% of Indonesians will be living in urban areas by 2025. Often the new arrivals to cities live in the poorest communities, with inadequate and unsanitary living conditions and poor health status. Currently it is estimated that up to 25% of Jakarta residents reside in poor urban neighbourhoods (kampungs ), with an additional 4-5% squatting illegally on riverbanks, empty lots and flood plains.
The conditions of mothers and children living in these areas are poor. The baseline survey conducted by CARE International Indonesia in the project area found that 31% of the children over 6 months and under 5 years of age were either moderately or severely underweight and 20% of children in this age group were stunted. Sixteen percent of the children under five suffered from diarrhoea in the past two weeks; a rate that is higher than the national average. Children between 6 and 18 months appear to be the most vulnerable. Mothers’ health was also not good as 46% of the pregnant mothers suffer from anaemia. The health services available to these mothers and children have also deteriorated. In the 1980s and ‘90s, the government established a health system of village health posts and community health centres that had a positive impact on child nutrition and mother health. However, in the past eight years the number of village health posts manned by volunteers (who provide baby weighing and arrange for village level immunization) has declined, as have the outreach and services of Community Health Centres which provide doctor care to these communities.
CARE’s response
CII’s response is to work in up to forty urban villages in Tangerang City and Tangerang District to:
- Improve the nutritional status of children under five years of age and pregnant and lactating women; and
- Reduce the incidence of diarrheal disease among children under five years of age.
To achieve these goals, the BERSIH project is working in three strategic areas:
Improving nutritional status through health and nutrition knowledge and practices
The BERSIH program is helping families improve the nutritional status in several key ways:
First, the program is collaborating with local and national programs to revitalize the village health posts. CII trains the health volunteers in the skills needed to run and manage the health posts. These skills include weighing and recording children, providing good information on diet, referring severely malnourished to the community health centre, reporting to health authorities, and self monitoring. In addition, CII provides scales and growth cards to the health posts.
Second, BERSIH works with health volunteers to establish Nutrition Posts for moderately malnourished children. Health Volunteers are trained in the Positive Deviance approach in which the volunteers identify mothers in their neighbourhood who use good nutritional practices and have well nourished children and then teach those practices to other neighbourhood mothers whose children are underweight. In this way, the program is able to ensure that it is extending practical advice which can be adopted by the families of the children in the nutrition post.
Third, the health volunteers along with BERSIH staff are establishing Centres of Mother Education (COME). Again, based on the positive deviance approach, these centres will teach and support pregnant women practice good antenatal care programs by supporting them to take iron supplements and get routine ANC checkups. The program will support lactating mothers to practice early initiation of breast feeding, exclusive breast feeding for children under 6 months old and then good complementary and weaning practices - in order to prevent children from becoming undernourished during that critical 6 to 18 month age period.
CARE supports the community level implementation of these programs by providing technical and managerial training as well as small stipends of Food for Peace commodities.
Improving quality and accessibility of primary health care services
The project facilitates assessment by clients of the local health service department and community health centres using Client Oriented Provided Efficient (COPE) tools. This tool is designed to help the community health centres measure their level of service to the local community and implement improvement plans. In addition, CARE is working to improve the collaboration between the community health centres and the local communities by facilitating routine meetings between the health centres and village leaders. These meetings review the health programs being implemented in the villages and develop plans that share responsibility for ensuring that they are implemented. Finally, as CARE and the community health centres complete their assessments, CARE will help develop quality guidelines for health services; train health workers in public health surveillance and information systems; and facilitate the development of health centre action plans for improved services and community outreach through the community health posts.
Reducing the incidence of diarrhoea
The BERSIH project initiates its efforts to reduce diarrhoea by facilitating communities to assess and diagnose the health and environment situations in their villages. After the participatory assessment, the program facilitates the formation of a Health Committee that works with the project to plan and design all aspects of the program that are implemented in that village. The environmental health program focuses on developing and/or repairing public infrastructure that affects diarrhoea and also training beneficiaries in healthy practices, such as hand washing, that prevent diarrhoea. Program staff and health committees plan both infrastructure projects and trainings. Infrastructure projects include building public and private toilets, rehabilitating and constructing protected wells, improving village drainage systems, and improving village solid waste (garbage) disposal systems. Each project is planned together; CARE supports the programs by providing materials, trainers, and an incentive “payment” in the form of the Food For Peace commodities dried green peas and fortified cooking oil. The community contributes by providing expertise (when available), construction labour, and long term management of the infrastructure.
Sector : Health and Nutrition
Location : 20 villages in Tangerang Districts and Cities, Banten
Donor : USAID/ FFP/ Local Mission
Project Period : October 2004 – September 2008
Page last updated : October 22, 2008
