EAST JAVA: MALNUTRITION COMPLICATED BY INADEQUATE GOVERNMENT

UNCLAS SECTION 01 OF 02 SURABAYA 000096 SIPDIS DEPT FOR EAP/MTS E.O. 12958: N/A TAGS: ECON SENV EAID PGOV ID SUBJECT: EAST JAVA: MALNUTRITION COMPLICATED BY INADEQUATE GOVERNMENT SUPPORT REF: JAKARTA 1498 SURABAYA 00000096 001.2 OF 002 This message is sensitive but unclassified. Please protect accordingly. ¶1. (SBU) SUMMARY: Malnutrition in children is an enduring problem in Indonesia, not only for rural provinces with weak economies such as East Nusa Tenggara (NTT),but also for more developed provinces such as East Java. Although poverty makes malnutrition worse, ill-prepared local healthcare staff, poor family planning, and a general lack of information are also strong contributors to a problem that is not limited to the poor. Conversations with local women's issues advocates and visits to a free local clinic (Posyandu) and a community women's group (PKK) suggest that a lack of support from the government is at the core of growing malnutrition in East Java. End Summary. Competing Definitions of Malnutrition Skew Reporting ¶2. (SBU) Negative though inconsistent malnutrition statistics in East Java imply that existing efforts to combat malnutrition have been ineffective. East Java's Department of Health claimed to handle 4,445 cases of malnutrition during 2007. So far this year, the Department of Health is quoting a figure of 5,461 malnourished children. However, according to press reports, the Surabaya Health Department has announced that as of March 2008, there were 10,071 malnourished children in the provincial capital of Surabaya alone. These inconsistent statistics are often based on inconsistent definitions of malnutrition. Lack of progress spurred the creation of a malnutrition task force in April 2008 by the Surabaya city government. The city Health Department also launched a program with PKK groups to provide healthy food for malnourished children. Conquering malnutrition in Surabaya is estimated to cost Rp. 6 billion (USD 659 thousand). The East Java Health Department has reportedly requested a budget of Rp. 15.6 billion (USD 1.7 million) to combat malnutrition throughout the province, but given wide disparities in the number of malnutrition cases, this figure is likely to be insufficient. Local Clinics Understaffed ¶3. (SBU) According to local experts, the progress of local clinics (Posyandus) in Surabaya in tackling malnutrition has been impeded by a lack of training, support, and personnel. The Posyandus are set up by the government-run hospitals (Puskesmas) in poor neighborhoods to provide free health services and combat malnutrition by weighing children and giving out information and vitamins. Malnutrition cases are then reported to the local Puskesmas. The 30 Posyandus that each Puskesmas must supervise strain understaffed operations. In addition, Posyandu staff are usually untrained members of the local PKK and cannot provide the nutritional counseling required. To remedy this problem, the Surabaya Health Council is giving nutritional training to 2,000 would-be Posyandu workers. ¶4. (SBU) Complicating efforts, the 3,000 Posyandus in Surabaya are also often short of the five people considered necessary to carry out the monthly check-ups, because volunteers are hard to come by. As an incentive, the city government recently offered a Rp. 75,000 (USD 8.00) monthly stipend. Current Posyandu workers feel this is still inadequate. In addition, parents are often reluctant to bring their children to be weighed at the Posyandus, as a diagnosis of malnutrition is seen as a failure of parenting. One of the Posyandus in the Tambaksari district of Surabaya visited by Pol/Econ staff is considered one of the best-run clinics in the city, supported by materials from USAID and World Vision. However this model Posyandu still reported a weight gain of below 50% for children under five for its neighborhood, and not all families were participating in the program. So far in 2008, 17 cases of malnutrition have been found in the Tambaksari district, 10 of which have since recovered. Family Planning ¶5. (SBU) One of the main contributors to malnutrition, a lack of family planning, is frequently blamed on the government. Previously successful national family planning programs were abandoned after the fall of the New Order and have not been reinvigorated. Malnourished children are often the youngest in a family of four or five children, whose parents can no longer provide adequate food for each child. This problem is compounded by poverty, but health workers and NGOs blame a lack of government support for family planning. For example, a nutritional expert working at the Posyandu visited by Pol/Econ SURABAYA 00000096 002.2 OF 002 staff praised the Suhartoist policy of subsidizing contraceptives. Under the current government, such incentives to have fewer children are gone, and public awareness of contraceptive options is also dropping. Not Restricted to the Poor ¶6. (SBU) While poverty is a significant factor, malnutrition is not restricted to the poor. All 31 districts of Surabaya have seen malnutrition cases. As factories increase lay-offs, more people have turned to the unreliable informal sector to support their families. Only 20 percent of Surabaya residents can afford a doctor visit according to a representative of the Surabaya PKK. The Posyandu nutritional expert pointed to the recent fatal malnutrition cases of two children in the Tambaksari district who were not from poor families as indication that the incidence of malnutrition among the wealthy is also increasing. This is commonly attributed to neglect, especially on the part of working mothers, and ignorance on the part of both the children's babysitters and absent parents. MCCLELLAND