NTT: LONG-TERM CONDITIONS GENERATE HIGH INFANT/MATERNAL

UNCLAS SECTION 01 OF 02 SURABAYA 000093 SENSITIVE SIPDIS DEPT FOR EAP/MTS, EAP/RSP JAKARTA FOR ODC, ECON, AND AID (NORTH AND BALDWIN) E.O. 12958: N/A TAGS: ECON EAID PGOV ID SUBJECT: NTT: LONG-TERM CONDITIONS GENERATE HIGH INFANT/MATERNAL MORTALITY RATES AND MALNUTRITION REF: A. 08 Surabaya 109 (NTT: Where Children Starve, a Famine of Solutions Too) ¶B. 07 Surabaya 55 (West Timor's Perfect Storm) SURABAYA 00000093 001.2 OF 002 This Message is Sensitive But Unclassified. Please Protect Accordingly. ¶1. (SBU) SUMMARY: East Nusa Tenggara (NTT) province, one of the poorest in Indonesia, faces serious health challenges, especially high maternal and infant mortality rates and child malnutrition. Experts blame problems with access, a lack of medical personnel, a lack of education and information, and cultural factors for the disturbingly high mortality rates. The provincial Health Department is focusing its efforts on reducing the mortality rates by seeking to expand availability of health facilities throughout the province. These efforts are hampered by a lack of resources. Malnutrition rates have fallen following serious attention from the government and civil society, but remain unacceptably high. Health Department officials argue the long-term solution lies in economic development, outside the department's mandate. End Summary. Lagging behind the National Average -------------- -- ¶2. (SBU) During a September 29-October 1 visit to Flores and West Timor, two of the major islands which comprise the NTT province, Surabaya Pol/Econ Officer discussed NTT's dismal health statistics with local officials, academics, and NGOs. According to official government statistics from 2004, the most recent numbers available, the maternal and infant mortality rates in NTT were significantly higher than the national average. The NTT maternal mortality rate was 554 per 100,000, women as compared to the national rate of 307 per 100,000, and the NTT infant mortality rate was 62 per 100,000 infants, as compared to the national rate of 45 per 100,000. Experts blame difficult access to health facilities, lack of medical personnel, lack of education and information, and cultural factors. According to the head of the Provincial Health Department, Stefanus Bris Seran, there are 300 community health centers (Puskesmas) and 33 public/private hospitals throughout the province, but only 20% of the Puskesmas and 50% of the hospitals meet the national standards considered necessary to help pregnant women deliver babies safely. ¶3. (SBU) The lack of qualified medical personnel is another problem. By national standards, Puskesmas at the district level should have at least seven medical specialists. However, many of NTT's Puskesmas have no medical specialists at all. Representatives of an NGO in Flores told Pol/Econ Officer that when people in remote areas come to the closest Puskesmas to deliver a baby or to get any medical treatment, there is often no medical personnel available. Another difficulty faced by women seeking to deliver their babies at a Puskesmas is a lack of transportation. This is especially problematic for those who live on NTT's many small islands. The NGO representative added that, for cultural reasons, many women in NTT prefer to deliver their babies at home and do not understand the risks inherent in this custom. Mother's and Children's Health Revolution Program -------------- -------------- ¶4. (SBU) Seran explained that the NTT Health Department recently launched a program called "Mother-Child Health (KIA) Revolution" to reduce the Maternal and Infant Mortality Rates in the province. The program seeks to develop sufficient health facilities and infrastructure by providing an adequate number of qualified medical personnel, health centers, and medical equipment; to build a good health service system; and to secure sufficient operating budget to meet the obstetric needs of women in the province. The KIA Revolution program also encourages women to deliver their babies in a hospital or health center and educates them about the dangers of delivery at home. The Health Department has contracted with two local newspapers to build awareness. As a result, one major local newspaper is running two pages, and another runs half a page, every week about the KIA program and related health issues. The department has also hired an independent institution to gather feedback on KIA's effectiveness. ¶5. (SBU). Seran added that KIA would mean nothing if the province does not have adequate resources. Nedi of the Human Rights Protection Coalition, an NGO in Flores, said that the local government, NGOs, and churches in Flores are working together to find solutions to health problems in NTT, but they SURABAYA 00000093 002.2 OF 002 have been hampered by a lack of funding. According to Seran, only 10% of the provincial budget is allocated for the health sector and 76% of that is used to finance the province's flagship public hospital in the capital city of Kupang. The provincial government has requested that the hospital's status be changed from a provincial to a national hospital, thus shifting funding obligations to the central government. According to Seran, the current Minister of Health has already agreed with this status change. However, there is no guarantee that the new Minister of Health will go through with the status change after the new cabinet is formed after October 23. Malnutrition: Still High But Improving -------------- -- ¶6. (SBU). Seran in Kupang and NGO contacts in Flores agreed that malnutrition is still a serious problem for the province. The number of malnourished children under the age of five in NTT during the January - August 2009 period was 56,972 children, or 11.3% of the total population. This is an improvement over the 15% rate during the same period last year. The number of malnutrition cases fell after garnering serious attention from the local government and parliament and stimulating good cooperation between government and civil society organizations. For example, the Bishop of Ende said that the Ende Diocese recently held a workshop on food sustainability in cooperation with the local government. Likewise, Community Women's Groups (PKK) and NGOs continue to educate people about nutrition and encourage the introduction of healthy foods to augment the staple food: rice. ¶7. (SBU) Despite recent improvement, Seran stated that he does not think that the Health Department has a long-term role in fighting child malnutrition. He pointed out that in order to provide the standard 90-day emergency food supplement for these 56,972 malnourished children, the NTT Health Department would need to spend at least $ 5.4 million. At the end of the 90-day treatment, the children would return to the impoverished circumstances that lead to their malnutrition in the first place. He suggested that spending this money on strengthening other sectors such as agriculture and fisheries would be a more effective way to combat malnutrition, since that would reduce poverty and create food sustainability. Recent American Assistance -------------- ¶8. (SBU) In July 2009, the USAF and TNI conducted the joint Pacific Angel Exercise in the Kupang area, providing much needed medical and dental care to thousands of disadvantaged people in West Timor and building/repairing water storage and drainage infrastructure in local villages. Seran expressed gratitude for that assistance, and hope that the U.S. may be able to provide further assistance to the province in the future. MCCLELLAND