The Challenge
After the tsunami of Dec. 26, 2004, the quick response from the international aid community and provision of essential, basic health services to tsunami-affected populations helped to prevent the feared outbreaks of disease and water-borne illness. The temporary living conditions for tsunami survivors that followed, however, were often built with quickly installed sanitation systems, shared latrines and poor access to safe water.
Surveys by the Provincial Health Office in February 2005 identified high rates of diarrheal diseases, with as many as one in five infants suffering from diarrhea; in only five of 16 surveyed camps did the quantity of latrines meet Sphere standards (international standards for emergency humanitarian response), and only in four of these were the latrines regularly cleaned. More comprehensive investigations in June 2005, in cooperation with the Centers for Disease Control and Prevention in the United States, showed that nearly half of all stored water samples tested positive for E. coli despite widespread reported boiling of stored water, and approximately 70 per cent of tankered water was not sufficiently treated.
CARE’s response
The GLEEH Project builds on the success of CARE’s post-tsunami health programs, which aimed to reduce diarrheal disease and improve nutritional status of tsunami survivors during the immediate emergency phase. GLEEH’s goal is to bring about expanded and sustained health improvements among target populations in the tsunami-affected areas, by increasing access to health and hygiene supplies and services and helping communities adopt healthy technologies and behaviours.
The project’s objectives are:
- the reduction of diarrheal disease;
- the reduction of intestinal worms.
GLEEH targets 15 temporary living centres (barracks) in Aceh Besar and Banda Aceh. The project team works closely with other health interventions, particularly the Transitional Water and Sanitation program, which improves, builds and maintains water and sanitation facilities in temporary living settlements for tsunami survivors.
Provision of supplies and equipment to reduce cases of diarrhea
One of the major causes of childhood morbidity in Aceh is water-related diseases, primarily diarrhea, through faecal-oral transmission routes. To prevent the spread of contamination, CARE, in coordination with the local health departments, USAID-ESP and USAID-HSP, provides soap and hand-washing stations at public places such as menasah, meeting places, public latrines, and schools, and works with other aid agencies and the local health department to encourage the practice of hand-washing with soap and clean water.
To improve access to safe water, CARE is providing water purification solution to tsunami survivors, along with jerry cans to keep the treated water free of further contamination. Families receive training on hygiene and how to use the simple solution, which you add to water to purify it. CARE staff then follow up to test water quality and ensure people are using Air Rahmat effectively. (Air means water and Rahmat stands for murah/Cheap, mudah /easy, sehat/healthy). GLEEH also provides cleaning supply kits to communities so they can clean and maintain the communal latrines in their temporary settlements.
Coordination of health services and health and hygiene promotion
CARE is coordinating with government health services to establish community-based health information resource centres to provide communities with health information on hygiene promotion and improved sanitation. The GLEEH program also conducts health surveillance activities to help local health workers detect health risks or diarrhea outbreaks.
Training for local health providers
CARE is training local health workers and families on how to properly manage diarrhea cases, from early detection methods, to the use of Oral Rehydration Solution. Together with other aid agencies, CARE provides training to the provincial and district health offices in order to increase coverage of routine immunizations for children. In order to ensure communities are using Air Rahmat effectively, CARE trains community health workers how to properly use it and to teach others as well.
To increase our coverage, GLEEH staff conduct bi-monthly home visits to monitor diarrheal disease in children under five in all target areas, and give health education and treatment when needed. During these visits, staff also test stored drinking water for quality and to ensure Air Rahmat is being used properly.
Educational messages on health and hygiene
CARE works closely with the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs to develop communication messages focused on health and hygiene behaviour. CARE produced television and radio spots to advertise hygiene and food safety messages. GLEEH also provides educational materials to community leaders, such as teachers and village heads, to encourage them to take the lead in creating healthier living environments, and uses innovative printed materials and dramas to reach out to schoolchildren.
Reducing intestinal worms
CARE worked with the Provincial Health Office, in collaboration with UNICEF and WHO, to pilot Albendazole as a de-worming treatment for school-age children. The results of this study were used to produce a recommendation on the use of Albendazole as the drug of choice for de-worming in Aceh. A mass de-worming campaign for children between the ages of two and five was held province-wide in August 2006 using Albendazole. CARE staff assisted the Provincial Health Office in monitoring distribution. The success of the same activity is then replicated in February 2007.
The GLEEH program supports the CARE Indonesia Health Strategy goal to improve the health of women and children, and their communities – particularly the poor majority that has little or no access to quality health care. Through GLEEH, CARE is working with communities to ensure their temporary living conditions are safe, clean and healthy until they can move into their new homes.
Sector : Health, Water and Sanitation, Emergency Response
Location : Nanggroe Aceh Darussalam, Aceh Besar, Banda Aceh
Donor : USAID
Project period : January 2006 to December 2007
Page last updated October 23, 2008
