(formerly IRIN News) Journalism from the heart of crises

Bid to revitalize community-based healthcare

Room that serves as village health clinic in eastern Indonesia's Kupang province
Phuong Tran/IRIN

Efforts in Indonesia to save a volunteer-led community health initiative are working, but more is needed to boost the programme, shown to improve child and maternal health, say health officials.

Pos Pelayanan Terpadu (integrated service post in Indonesian), known by its acronym Posyandu, is a monthly clinic for children and pregnant women, providing vaccinations and nutritional supplements.

There are more than 260,000 Posyandu posts nationwide, but lack of funding, political support and volunteers has rendered half of them inactive, said the head of the Demographic Institute at the Jakarta-based University of Indonesia, Sonny Harmadi.

"Times have changed. People no longer take pride in being Posyandu volunteers," he said. "People also prefer to go to clinics [more] than Posyandu."

Volunteers trained by local health departments have typically organized the monthly check-ups.

And even though more health clinics serve rural patients now than when Posyandu posts were launched in the 1980s, there is still a need for the community gatherings, Sugiri Syarief, head of the government's Agency for Population and Family Planning, told IRIN.

"We cannot afford to let them die because we will lose an important vehicle for early detection of malnutrition."


According to the Health Ministry's 2010 Basic Health Survey, 17.9 percent of children under five are underweight nationwide (weight-to-age ratio), a decrease from 31 percent in 1989.

Posyandu monthly check-ups are partly responsible for the drop, said Minarto, who, like most Indonesians, goes by one name, the Health Ministry's director for nutrition promotion.

"Recent data shows that about 70 percent of mothers visit a Posyandu at least once every six months."

Chronic malnutrition (as measured by stunting, or height-to-age ratio) among under-five children stood at 35.7 percent, while acute malnutrition (weight-to-height ratio, also known as acute malnutrition) was 13.3 percent.

Fifteen percent is the widely recognized indication of a nutrition emergency.

In addition, in 2007, the maternal mortality rate was 228 deaths per 100,000 live births, far short of the Millennium Development Goal target of 102 per 100,000 live births for 2015.

Boosting interest

To boost attendance, officials and NGOs are expanding Posyandu services to include early childhood education and elderly care, Minarto said.

Since 2009, the international NGO Save the Children, with Kraft Foods, has worked with Posyandu posts in 54 villages in West Java Province through its Future Resilience and Stronger Households (FRESH) programme.

"West Java is a food basket... but why does malnutrition still exist?" posited Evi Yulianti, a programme manager at Save the Children.

"Our observation shows that the biggest problems are parents' lack of knowledge about nutrition and hygiene," she said.

Nutrient-deficient diets coupled with water-borne diseases from unsafe drinking water have led to persistently high levels of malnutrition even during bountiful harvests.


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