The ChallengeWhen the tsunami struck Aceh Dec. 26, 2004, it devastated a health system that was already under strain due to a 30-year civil war. Even before the tsunami, access to health facilities was lower than in other parts of Indonesia, malnutrition was a serious problem, and vaccine-coverage rates lagged behind the rest of the country. Lack of access to health-care services means nearly three out of 100 women will die during childbirth, and four per cent of newborns will not survive delivery (Indonesia Ministry of Health, 2005).
When the tsunami hit, it destroyed more than 400 health facilities, and killed many of the doctors, nurses and midwives that would be needed to rebuild the health sector post-disaster. The tsunami also took a terrible toll on the most vulnerable: women and children. Rates of acute malnutrition for children under five after the tsunami were as high as 12 per cent, which has serious long-term consequences for a child’s development.
CARE’s response
In response to these health challenges, CARE’s Integrated Health and Nutrition Program’s goal is to reduce mortality and morbidity from health and nutrition problems amongst children under five and pregnant and lactating women in the target communities of Banda Aceh and Aceh Besar. INTHAN II aims to accomplish this goal by increasing access to health services and by encouraging people to adopt healthy behaviours.
The program has three major strategic objectives:
- to re-establish sustainable, high-quality reproductive and maternal health services for pregnant and lactating women;
- to reduce the prevalence of malnutrition among children under five and pregnant and lactating women;
- to improve surveillance and treatment of communicable diseases.
After the tsunami, revitalization of existing health infrastructure and systems was crucial to restoring the health and wellbeing of tsunami-affected populations. The posyandu (integrated health post), where community health workers monitor the health and development of children and pregnant and lactating women, is the cornerstone of the local health-care system. CARE believes that supporting posyandu is the most effective way to improve the health of children under five and pregnant and lactating women.
Improving maternal health care
To improve maternal and neonatal health services, CARE’s INTHAN-II team works with the local government and other health partners to conduct regular training and information sessions for pregnant women through the Desa Siaga Program (a community empowerment project started by the Ministry of Health) and the Centre for Mothers’ Education. Women learn about better nutrition, sanitation and hygiene practices, where to go for a safe delivery, and what to do in case of complications during pregnancy.
Reducing rates of malnutrition
Malnutrition is an acute and chronic problem in many parts of Aceh. In order to reduce the prevalence of malnutrition, CARE promotes breastfeeding as the best source of nutrition for infants, and micronutrient supplements for young children to ensure they have the extra nutrients they need. To encourage mothers and caregivers to feed their children a balanced diet, which is not always common in many parts of Aceh, CARE staff hold community-based feeding demonstrations and monitor child growth and development, as well as the nutritional status of pregnant and lactating women, to ensure children are developing properly.
Improve surveillance and treatment of communicable diseases
Common illnesses such as malaria or diarrhea can be fatal for children under five. They are one of the main causes of death during childbirth, cause complications during pregnancy, and often exacerbate any pre-existing health problems such as malnutrition. CARE’s health team provides education to mothers and caregivers about major communicable disease issues and what to do if a child or family member falls ill.
Throughout the program, INTHAN II staff collects and sorts data about health indicators to monitor trends in the prevalence of malnutrition, prenatal risk factors (which contribute to infant mortality and low birth weight), and infant-feeding practices. By looking at these trends, INTHAN can ascertain the success of its efforts, identify areas of need and prepare a response.
With the community, for the community
Capacity building for the local health-care system and new health-care workers is crucial if the people of Aceh are to rebuild and improve the local health-care system after the tsunami, which is why all CARE project activities are planned, implemented, and evaluated with local partners, especially the targeted communities and the government. Project responsibility will be gradually passed to local partners as the project progresses to ensure the improvements continue long after CARE’s project is complete. Working together with local communities, CARE is building better health care for the people of Aceh.
Sector: Emergency Response, Health and Nutrition
Location: Nanggroe Aceh Darussalam
Donor: Private donations
Project period : January 2006 - June 2008
Page last updated October 23, 2008
