Polio exposes health care weaknesses<\/p>\n
Michael Casey, Associated Press\/Jakarta<\/p>\n
A polio outbreak that spread rapidly through the country after a
\ndecade-long absence, crippling hundreds of children, has exposed
\nweaknesses in the sprawling archipelago's long-neglected health
\ncare system, experts said on Tuesday.<\/p>\n
Hampered by chronic funding shortages and chaotic
\ndecentralization efforts, local health clinics in the poorest
\nparts of the country have been forced to scale back their
\noperations, limiting the amount of time and money they spend on
\ncommunity outreach, health education and routine immunization
\nprograms.<\/p>\n
As a result, experts say, about 239 children under 5 have been
\ninfected by polio since March and cases of measles have increased
\ntenfold since 2000.<\/p>\n
The country also saw its worst-ever dengue fever outbreak last
\nyear and there are fears bird flu could mutate into a form that
\nspreads easily among humans, possibly triggering a global
\npandemic.<\/p>\n
\"The context for these events is a primary health care system
\nthat has suffered from a decrease in resources and is struggling
\nto manage the expectations placed on it by the newly
\ndecentralized health systems,\" UNICEF's David Hipgrave said.<\/p>\n
\"What we're seeing is major inconsistencies between the rich
\nand poor provinces,\" he said.<\/p>\n
It was not always this way. During the 32-year dictatorship of
\nSoeharto, the health system was highly centralized and services
\nreached all the way down to the village level. Polio was
\neradicated in 1995 and key indicators like child malnutrition and
\npoverty rates fell.<\/p>\n
A key component was volunteer outreach efforts like the Family
\nEducation Program, where the wives of government officials would
\nmake the rounds to talk to mothers about nutrition and
\nsanitation, while reminding them about national immunization
\ndays. That program was abandoned after his ouster in 1998.<\/p>\n
A radical decentralization program that was introduced in 2001
\nhas added to the country's health care woes. Almost overnight,
\nthe government handed control of public services to regional and
\nlocal authorities. But their roles were often unclear, experts
\nsay, funding was inadequate and priorities left to the whims of
\ninexperienced governments, mayors and village heads.<\/p>\n
The result, WHO and Ministry of Health officials say, is that
\nimmunization rates dropped in certain poor communities and
\nservices -- like monitoring the weight of babies -- all but
\ndisappeared.<\/p>\n
\"We'd provide the needles and vaccines for immunization but
\nsome districts wouldn't have enough money for operations,\" said
\nDr. Jane Soepardi, who oversees immunizations at the Ministry of
\nHealth. \"They could reach nearby areas but left out remote areas.
\nSo you'd find mothers who don't even know about immunization.\"<\/p>\n
And so when polio re-emerged, it took hold in overly poor,
\nrural communities where entire villages were vulnerable having
\nmissed out on immunizations.<\/p>\n
However, the government has begun to address the problem,
\nwinning praise for a nationwide polio vaccination campaign in
\nAugust.<\/p>\n
Despite having only a few weeks to prepare, about 95 percent
\nof the 24 million children under 5 were vaccinated.<\/p>\n
\"There was realization with health officials at the central
\nlevel and provinces that there was much more to dealing with this
\noutbreak than what they were used to in the past,\" Thapa said, as
\nthe second round of the campaign got under way Tuesday. \"It made
\nthem realize that business as usual was not good enough.\"<\/p>",
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