Children, the 'Hunger Games' and Posyandu
The Jakarta Post
It's said that children are the future of the nation but in the Hollywood blockbuster Hunger Games, they are killed in cruel, violent and excruciatingly painful ways for the entertainment of the Capitol (the government) ' and moviegoers like you and me.
In Indonesia, sad to say, we have our own, live version of hunger games and they kill children too, or stunt their growth and chances for a decent and dignified life.
They don't do it for entertainment but through neglect and ignorance. Widespread poverty, corruption
and confused government priorities also help.
When I returned from my sociology studies in London in 1979, I became involved with Posyandu (integrated health services posts) while working for the Yayasan Indonesia Sejahtera (YIS, Prosperous Indonesia Foundation), an NGO dealing with community development. At the height of the New Order, Posyandu provided core health services for mothers and children, especially in remote areas.
Child health was always a major part of the YIS health program ' for good reason. According to Stephen Woodhouse, former representative of UNICEF in Jakarta (1995-2000), 30 to 35 percent of children were severely stunted and wasted back then, mainly due to malnutrition. Once stunted, the damage is permanent, leading to premature death because their vital organs are never fully developed during childhood.
Others died in infancy of easily preventable diseases ' diarrhea, dehydration, diseases that could be immunized against, acute respiratory infections and so on. 'You had about 280,000 infants dying every year then,' Woodhouse says. That is approximately the equivalent of 600 Boeing 747 (average passenger capacity 470) crashes with no survivors.
I remember observing the five steps that mothers and their children had to go through at the Posyandu: registration; infant weighing; filling in the 'Road to Health Cards' (KMS, Kartu Menuju Sehat), a chart to monitor an infant's weight (a simple but reliable indicator of health); health counseling (which often included family planning), and last but not least, nutritional counseling, which sometimes included supplementation.
I only worked for a year with YIS, but those field visits made a deep impression on me, making me understand the fundamental importance of Posyandu for mother and child welfare.
In the mid-1980s, I encountered Posyandu again through my study of the Family Welfare Guidance (PKK), then the only vehicle at the village level for the mobilization of women allowed by the government. My interest in PKK was ideological. I wanted to understand how it was used to impose 'state ibuism', the notion that women existed not in their own right, but to serve the family, the community and the state. The state, in this case, was the authoritarian military New Order state, led for 32 years by Gen. Soeharto, so it was all pretty fascistic.
PKK had 10 programs, health being the seventh, and it was called upon to 'make a success' of all government health programs, including Family Nutrition Improvement Program (UPGK). This was also done through Posyandu, which became very much linked to PKK.
Posyandu were also where immunization was conducted. According to Woodhouse, 'By the mid-1990s, there were about 250,000 Posyandus throughout Indonesia. In 1996 when I was UNICEF representative in Jakarta, we were able to immunize 23 million under-five children against polio in three days thanks to the Posyandu system.'
Well, I have to concede, some good things can come from authoritarian states, and Posyandu was certainly one of them. With full government support behind them, Posyandu were guaranteed success.
But when the New Order era ended in 1998, the support ended as well. In fact, the prolonged economic crisis that began in 1997 ultimately forced 70 percent of Posyandu to close, and ' as usual ' women and children suffered the most. I joined the activist movement struggling to help shape Indonesia's nascent democracy, reemerging after more than three decades. While still fighting for women and children's rights, Posyandu ceased to be the specific focus of my attention.
That's why I was glad to be given the opportunity to see how Posyandu were doing 15 years on, when Kartika Soekarno asked me to go and visit one in Bali that her philanthropic foundation supports.
From the onset of Reformasi, local governments had stepped in to fill the void left by the central government, but it was very patchy. NGOs like the Kartika Soekarno Foundation (KSF) and companies like NestlÃ© provided vital support, but it was only in 2000 that the then-Health and Social Welfare Ministry started a nationwide campaign to revive Posyandu.
So are things much better now? Yes, the infant mortality rate has gone down to between 12-15 percent. According to Woodhouse, it is about 100,000 deaths now, so ' umm ' only 215 Boeing 747 crashes per year.
But guess what? The underlying cause of 60 percent of those deaths is still malnutrition, and survivors often suffer impaired brain development and learning capacity that weaken a child's immunity and increase the risk of diabetes, obesity, heart disease and stroke.
Today, Indonesia is among the 15 countries making the fastest gains in cutting child malnutrition. But with population growth since 1998, the proportion of under-fives in the population is also probably greater than 20 years ago. According to Nuraini Razak, a communications specialist at UNICEF, stunting, wasting or acute malnutrition still affects a 'significant' proportion of children in Indonesia.
'The New Order got it right.' I never thought I'd say that, but when it comes to children's health, it's certainly true. So let us prove that democracies can look after kids too, by speeding up the revitalization of Posyandu, which are so vital for the future of our nation. Let's keep the hunger games in the cinemas.
The writer is the author of State Ibuism.
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