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.