'Posyandu' lacks volunteers, fails to enhance health services
The Jakarta Post, Jakarta
It was a Tuesday morning when a group of women gathered to chat on a narrow veranda of the house of a subdistrict head in Pangkalan Jati Baru, Depok. One might think that they were there for an arisan (monthly social gathering) to catch up with the local gossip.
The topic of discussion was a little more weighty than that. The housewives were discussing efforts to make sure that around 200 children under five years of age in the area received the polio vaccination scheduled for later that day.
These volunteers, with the help of a worker from a nearby community health center, are running community health activities at an integrated health service post known as Posyandu.
Such a program was part of a community-based health concept developed in 1975, three years ahead of its international declaration.
Sadly, little is heard about it nowadays, which may be the reason for the emergence of acute and chronic community health problems such as polio and malnutrition, even in financially stable areas like Jakarta and West Nusa Tenggara.
Posyandu, which was made a national health program in 1984, aimed to promote maternal and child health through the monitoring of children's growth, breast-feeding, immunization, women's education, family planning and provision of food supplements.
The posts multiplied from only 25,000 in 1986 to over 230,000 in 2003. However, a growth in number does not necessarily mean an improvement in quality.
According to a 2003 survey, only 4.82 percent of Posyandu were fully operational, while 37.7 percent still lacked human resources and had no regular activities.
Following the outbreak of polio in West Java and malnutrition cases in some provinces, the government is pushing for the revival of Posyandu.
"It is very hard to find new volunteers to take care of the Posyandu," 37-year old Martati who succeeded her mother as head of the Pangkalan Jati Baru Posyandu. "I was reluctant when people asked me to replace my late mother."
Middle-aged Evi Arifin, a fellow volunteer who headed a post for 10 years before finally finding a replacement, admitted that if it were not for the national vaccination campaign, not many people would like to participate in the community service.
"Mothers have been busy trying to find additional income since the (monetary) crisis that they do not have time to volunteer for such things," she said.
"Regeneration is a serious problem. These (women) have been working for the last eight years," Evi said. A new volunteer, a nursing academy graduate who is in early 20s, has been assisting them for quite some time.
Martati said the monthly activities focused more on providing food supplements for toddlers and assisting in immunization.
"With less than five people active and with a stipend of only Rp 25,000 (US$2.6) per month, this is all that we can do," she said.
She added that there were fewer and fewer mothers taking their children to the post. "Except for mass vaccinations like today, we see up to 50 visitors every month," she said, while in fact a Posyandu is expected to serve between 100 and 150 mothers and children per month.
A study conducted recently by Padang-based Andalas University, Makassar-based Hasanuddin University and Surabaya-based Food and Nutrition Institute revealed that the lack of (trained) human resources prompted Posyandu volunteers to rely on local community health center officers.
At the same time, community health centers could not perform well due to insufficient funding and attention from local authorities.
The study also showed that more than 50 percent of the Posyandu surveyed occupied any vacant shelter available, including house verandas, garages or lofts, lacked the required equipment and did not set targets.
"Creating more innovative programs such as adding a simple children's playground or opening an exercise class for pregnant women could help revive the role of Posyandu," Ministry of Health's director general of community health Azrul Azwar told The Jakarta Post recently.
He mulled offering incentives to attract new young volunteers who could come up with ideas for interesting activities while carrying out the main duties.
Azrul highlighted the need for communities to form a health council in every district consisting of local leaders to motivate and supervise the role of the community-based health posts.
Reviving the old concept of community health, Azrul added, needs attention from both the central government and local administrations.
"These concepts may be old, but they are not passe," he said. (003)