Battling stunting in East Nusa Tenggara: Healthcare and knowledge access
The prevalence of childhood stunting in East Nusa Tenggara (NTT) has been ascribed to low public awareness, especially among caregivers and health workers. But the shortage in local food supplies, insufficient sanitation and insufficient healthcare are also contributing factors.
A public health emergency, stunting underlines the truth that our health isn't entirely inside our own hands and is influenced by societal, environmental and cultural factors. More crucially, the success (or failure) of the authorities in providing adequate public healthcare for all citizens can be an indispensable contributor to maintaining health.
The puskesmas (community health center) is a cornerstone of the national health system, but according to a Databoks article on medical Ministry’s 2015 Puskemas Basic Data report, a single puskesmas was serving medical needs of 26,000 people that year. This indicates the disproportionate number of registered health facilities that serve the naitonal population.
Albertus Hadat, a 69-year-old grandfather, recalls the long journey it once took to acquire a check-up at a public healthcare facility. Decades ago, traveling from his house in Liang Ndara village to the nearest puskesmas in Labuan Bajo took a whole day, although it is significantly less than 28 kilometers from the village to the administrative centre of West Manggarai regency, NTT.
"If we left early each morning, we would reach Puskesmas Labuan Bajo in the evening. The road was bumpy and muddy, not forgetting it could be a little too dark, as we had a need to cut through some forests to finally arrive at Labuan Bajo," Albertus told The Jakarta Post in May.
But things are looking up, as a puskemas pembantu (auxiliary health center) now stands just 500 meters from Albertus' house. While the option of local healthcare facilities is no more a concern for the residents of West Manggarai, their reluctance to help make the trip still is.
A visit over two days in Liang Ndara plus the villages of Tondong Belang and Lengkong Cepang on Flores Island, respectively located around 45 minutes and 2.5 hours by car from Labuan Bajo, discovered that the road that linked them passed over very rocky terrain.
Irma, a 27-year-old mother of one who lives in Munting village near Lengkong Cepang. told the Post that most of the people still traveled by walking. The only available road to the neighborhood puskesmas passed through the hills, she explained, which means this only weakened peoples’ drive and sense of urgency in visiting the puskesmas whenever they had a ailment.
As midwife Yosephina Kurnia told the Post, "Some [people] prefer home births as a result of the distance from their residence to healthcare facilities. This may be dangerous for [both] the baby and the mother. Plus, they wouldn't get the postnatal care and education that they need. This could also bring about a higher threat of stunting."
While healthcare facilities were growing in number and access was improving, the gap in local knowledge still needs to be filled in. This is where the 1000 Days Fund will come in, a Jakarta-based NGO pushing toward attaining zero childhood stunting in Indonesia by 2030.
Health employees Yosefina Berti and Emiliana Manul at Puskesmas Lengkong Cepang told the Post that they did not have proper onboarding training.
"If you are a mother in a village in eastern Indonesia, it’s likely that you are taking your son or daughter to a posyandu (integrated health post) operated by kader [volunteer health workers] who've never really had any training, which is something that keeps [my] team and me up during the night. This is unacceptable, and we are doing everything to change that," stressed Zack Petersen, lead strategist at 1000 Days Fund.
Equipping frontline health workers with the correct training goes a long way, as they hold one-on-one consultations with mothers within their own homes, a two-way conversation that helps build trust.
The NGO also makes and distributes “Smart Charts” in easy-to-understand language that's tailored for health workers, mothers and families. It really is designed to be hung on walls as a daily reminder to measure a child’s height and determine their nutritional needs. According to its website, the NGO has distributed 43,000 Smart Charts across 28 islands to date.
However, delivering factual, science-based information to persons with different education levels remains a challenge. Senior program manager Sisi Arawinda of 1000 Days Fund says that the main obstacle is simplifying the information for easy comprehension.
"It is extremely natural for individuals to forget the information they have heard only once, so we need to keep repeating the same information until it sticks within their mind," she said.
The business does this alongside regular monitoring, since it believes that frequent small campaigns will have more far-reaching, long-term impacts than major one-off campaigns. Regardless of the challenges, 1000 Days Fund finds fulfillment in the measurable results of their work.
"My reward originates from every 'Ah, I see!' that I have received as time passes. Knowing that you can give persons information that they haven't recognized before, it really is worth more than money," Petersen said.
In the same vein, finance and project officer Velo Theresia said what was most rewarding was when mothers and health workers engaged in the conversation by asking questions, showing that they were paying attention.
Still, targeting Indonesia to be no cost from stunting appears an ambitious goal. According to Petersen, however, desire to is not to eradicate stunting, as other factors will often stand in the manner.
"Here's my finish line: Ninety percent of most women that are pregnant in Indonesia is examined six times throughout their pregnancy, and 90 percent of most kids below five years old are measured," he said.
As the word goes, “What gets measured gets managed.”
Based on the World Bank, stunting prevalence contributes losses amounting to 2-3 percent of Indonesia’s GDP, but for families, protecting against stunting is a lot more than just statistics.
"My granddaughter Septi isn't only the hope of us, but also the hope of our neighbors, the hope of [our] kampung, the hope of [the island] and ultimately, the hope of Indonesia," said Albertus.