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)

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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
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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
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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

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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
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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
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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