Safety net fails to catch starving children

Safety net fails to catch starving children

By Rita A. Widiadana

JAKARTA (JP): Hundreds of children across the country die of
hunger every day. And an early death looms for thousands of
others because their parents are too poor to feed them
adequately.

In community health centers and public hospitals, many
children are in critical condition, their tiny bodies reduced to
skin and bone. Wrinkled skin and distended bellies are the
telltale signs of severe malnutrition and marasmic kwashiorkor.

Almost daily TV and newspaper reports on widespread
malnutrition, even in cosmopolitan Jakarta, have shocked many
Indonesians and embarrassed government officials who have done
their best to keep the problem hidden.

In the past, the cases were rarely exposed. Provincial
governments falsified facts about the extent of the problem,
presenting sugar-coated reports to the central government.

Experts warn that the reports on the discovery of malnourished
children are only the tip of the iceberg of health problems
affecting infants and children due to the impact of the economic
crisis.

The problem is now, but also for the future; experts say
there will be a diminished quality of human resources because of
a drop in intelligence quotient levels.

Scars from malnutrition in early childhood are permanent; more
illness, a 15-point lowering of IQ, lower productivity, higher
risk of death, more generative diseases.

Malnutrition kills 450 Indonesian pre-school age children per
day, 170,000 children per year.

The most recent statistics show 39 percent of Indonesia's 202
million population are estimated to be living below the poverty
line. Millions among them cannot afford more than one meal a day.

Dr. Muhilal, head of the Ministry of Health's Nutrition
Research Center in Bogor, West Java, said malnutrition was long
one of the country's most serious health problems, yet it
received little attention.

"It is not solely caused by the economic crisis -- millions of
Indonesian children and women were malnourished before the crisis
broke out two years ago," he said.

Nutrition and health status of the vast majority of children
and women in Indonesia were poor, one of the country's poverty
indicators.

He counted himself among the many experts who predicted the
crisis would have little impact on the health and nutritional
status of the population.

"We made a mistake. The crisis has caused tremendous
nutritional and health problems. There must be something very
wrong in our public health care system," he admitted.

Despite the economic miracles of the past 20 years, the social
and health conditions of most Indonesians remained fragile.

Director General for Public Health Affairs Dr. Azrul Azwar
said the country's public health care system needed reviewing.

"It hasn't been changed since 25 years ago," said Azwar.

Indonesia has thousands of community health centers scattered
around the country's 27 provinces, but their facilities and human
resources are severely limited.

Subsidy

The government provides a health subsidy of Rp 10,000
(US$1.40) per family to receive treatment at community health
centers.

In reality, the amount often means little, even to the poor.

"Many health centers can no longer provide services because of
the lack of medicine and equipment, particularly during the
crisis," he said.

Some doctors, nurses and paramedics have left community health
centers to work at better jobs in other institutions.

There are about 24,000 village-level health service posts
(Posyandu) established for community self-reliance, growth
monitoring of children under five, immunization, provision of
vitamin A capsules and orientation.

Stephen J. Woodhouse, the United Nations Children's Fund
(Unicef) representative for Indonesia and Malaysia, commented
that cases of malnourished children could be early detected if
Posyandu worked properly.

"Posyandu is actually the frontline defense mechanism and
driving force for preventing malnutrition because every month all
children in a village must have their health checked in that
place, " Woodhouse said.

During the crisis, most of the posts have been inactive and
unable to provide children with health care. Services at Posyandu
are provided by volunteers and under a community-based financing
system.

"When most people do not have money and meals and can hardly
survive in this crisis, how can they think of other things, let
alone joining Posyandu as volunteers?" he said.

Despite all the shortcomings, efforts to tackle the
malnutrition problem are under way.

The government has set up a special committee to alleviate the
malnutrition problem, which is chaired by Azrul Azwar.

Among the strategy is revitalization of the food procurement
system, family nutrition program and Posyandu.

The government has set aside Rp 1.7 trillion in its social
safety net program for health, including the problem of
malnutrition.

Under the program, the government provides a daily allowance
of Rp 750 per baby and Rp 1,000 for pregnant and nursing mothers
to help improve their nutritional status.

The amount of money is insignificant in helping society's most
vulnerable members.

Nuraini, a midwife in Bekasi, has to think hard about how to
get the most out of the allowance. "The price of an egg is
already Rp 550, how can we give them nutritious food for just Rp
750?"

It costs at leasts Rp 3,500 to provide meals consisting of two
glasses of milk, a bowl of green beans and an egg to aid the
recovery of a malnourished baby.

Help from international agencies is available, including the
World Food Program, Unicef, WHO and foreign government
representatives.

In 1999, Unicef will allocate $5.5 million to provide nine
million sachets of fortified food for 325,000 children in seven
provinces.

"We have been working very hard to look for additional
donations from domestic sources and overseas countries,"
explained Woodhouse.

He said Unicef was concerned by the poor condition of millions
of Indonesian children, pregnant women and nursing mothers.

It will require integrated coordination among local government
agencies and overseas bodies to deal with the malnutrition
problem, he added.

"It will be very difficult to solve malnutrition without
strong political will from the government and related parties,"
Woodhouse said.