Polio exposes health care weaknesses

Polio exposes health care weaknesses

Michael Casey, Associated Press/Jakarta

A polio outbreak that spread rapidly through the country after a decade-long absence, crippling hundreds of children, has exposed weaknesses in the sprawling archipelago's long-neglected health care system, experts said on Tuesday.

Hampered by chronic funding shortages and chaotic decentralization efforts, local health clinics in the poorest parts of the country have been forced to scale back their operations, limiting the amount of time and money they spend on community outreach, health education and routine immunization programs.

As a result, experts say, about 239 children under 5 have been infected by polio since March and cases of measles have increased tenfold since 2000.

The country also saw its worst-ever dengue fever outbreak last year and there are fears bird flu could mutate into a form that spreads easily among humans, possibly triggering a global pandemic.

"The context for these events is a primary health care system that has suffered from a decrease in resources and is struggling to manage the expectations placed on it by the newly decentralized health systems," UNICEF's David Hipgrave said.

"What we're seeing is major inconsistencies between the rich and poor provinces," he said.

It was not always this way. During the 32-year dictatorship of Soeharto, the health system was highly centralized and services reached all the way down to the village level. Polio was eradicated in 1995 and key indicators like child malnutrition and poverty rates fell.

A key component was volunteer outreach efforts like the Family Education Program, where the wives of government officials would make the rounds to talk to mothers about nutrition and sanitation, while reminding them about national immunization days. That program was abandoned after his ouster in 1998.

A radical decentralization program that was introduced in 2001 has added to the country's health care woes. Almost overnight, the government handed control of public services to regional and local authorities. But their roles were often unclear, experts say, funding was inadequate and priorities left to the whims of inexperienced governments, mayors and village heads.

The result, WHO and Ministry of Health officials say, is that immunization rates dropped in certain poor communities and services -- like monitoring the weight of babies -- all but disappeared.

"We'd provide the needles and vaccines for immunization but some districts wouldn't have enough money for operations," said Dr. Jane Soepardi, who oversees immunizations at the Ministry of Health. "They could reach nearby areas but left out remote areas. So you'd find mothers who don't even know about immunization."

And so when polio re-emerged, it took hold in overly poor, rural communities where entire villages were vulnerable having missed out on immunizations.

However, the government has begun to address the problem, winning praise for a nationwide polio vaccination campaign in August.

Despite having only a few weeks to prepare, about 95 percent of the 24 million children under 5 were vaccinated.

"There was realization with health officials at the central level and provinces that there was much more to dealing with this outbreak than what they were used to in the past," Thapa said, as the second round of the campaign got under way Tuesday. "It made them realize that business as usual was not good enough."