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Cablegate: Poor Health Results From 2007 Demographic Health Survey

VZCZCXRO5222
PP RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #0889/01 1261003
ZNR UUUUU ZZH
P 051003Z MAY 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 8917
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS

UNCLAS SECTION 01 OF 02 JAKARTA 000889

SIPDIS


SIPDIS
SENSITIVE

DEPT FOR EAP/MTS, G/AIAG AND OES/IHA
USAID FOR ANE/COOK AND GH/PHR/PEC/STEWART


E.O. 12958: N/A
TAGS: TBIO KLFU AMGT PGOV ID
SUBJECT: POOR HEALTH RESULTS FROM 2007 DEMOGRAPHIC HEALTH SURVEY


1. (SBU) Summary. Preliminary Demographic Health Survey (DHS)
results provide evidence of poor performance of the recently
decentralized health system in Indonesia and slowed progress toward
Millennium Development Goals (MDG). There is no evidence of
continued reduction of child death risk over the past five years,
despite a 53% decline from 1994 to 2002. New data document poor
performance on critical indicators of child survival such as
breastfeeding and oral rehydration therapy for managing diarrhea.
Contraceptive prevalence, crude birth rate and total fertility rate
are stagnant since 2002. These are preliminary data only, not yet
officially released by Government. End summary.


SURVEY METHODOLOLGY PRODUCES ACCURATE ESTIMATES
--------------------------------------------- --

2. (SBU) The Government's Bureau of Statistics conducts a
Demographic Health Survey every five years adhering to an
international standard survey design that incorporates quality
control measures in data collection and management. USAID has
supported the development of this survey methodology over the past
several decades. Over 200 surveys in 75 countries have been
completed. DHS data provide internationally comparable, valid and
representative estimates over time describing primary health care
services, health outcomes, reproductive health, fertility and
nutrition. USAID now supports minimal technical assistance costs,
while the Government of Indonesia covers all operational costs of
data collection, analysis and results publication. The recent
survey data were collected in 2007-8 from all provinces in Indonesia
and provide nationally representative estimates. All DHS datasets
worldwide are made publicly available for secondary analysis but
these Indonesia data are preliminary only and not yet officially
released by the Government. Preliminary results should not be
shared with the press.


HEALTH SERVICE DECENTRALIZATION, LOW SECTOR INVESTMENT
--------------------------------------------- ---------

3. (SBU) More than 400 district governments have taken over
responsibility from the central government for budgeting and
managing primary health services since XX?. Decentralization of
health services has led to a lack of consistency in budget support,
human resource planning and quality control measures across the
country's public health facilities. The private sector has
proliferated, now providing more than two-thirds of all out-patient
visits. Government supports only one-third of total health
expenditures (1% of GDP), far below recommended levels of
investment. There is a high unmet need for health financing schemes
that reach the poor and near-poor. USG support to improved maternal
and child health services Indonesia has been slashed nearly 30% in
FY2008.

NO DECLINE IN CHILD DEATHS
---------------------------

4. (SBU) Child mortality is a sensitive indicator of health system
performance overall, equity of access and quality of services.
Momentum from consistent declines in neonatal, infant and child
mortality indicators from 1994-2002 is now lost. Under-5 mortality
rate for 2007 is estimated at 45/1000 live births (2002 estimate
46). The MDG-4 goal for 2015 is 33. The vast majority of other
countries worldwide that have documented child mortality rates below
50 have demonstrated continued declines in recent years.


DRASTIC EROSION OF BREASTFEEDING BEST PRACTICES
--------------------------------------------- --

5. (SBU) Exclusive breastfeeding according to the WHO recommendation
declined 20% since 2002. Fewer than one in three infants are
exclusively breastfed for six months. Formula milk use has more
than doubled among infants below six months. Local and
multinational subsidiary companies aggressively market breast milk
substitutes to mothers and health providers in direct violation of
the International Code of Marketing Breast Milk Substitutes. No
legal sanctions are in place to curb such violations. Civil society
oversight mechanisms are weak. Health providers benefit financially
from their affiliation with formula companies. Declining
breastfeeding increases risk of infant death and child
malnutrition.


LIFE-SAVING TREATMENT OF DIARRHEA UNDER THREAT

JAKARTA 00000889 002 OF 002


--------------------------------------------- --

6. (SBU) The rate of children reporting diarrhea illness increased
since 2002 and higher proportions of children with diarrhea are
being taken to health providers for treatment. But the rate of
using life-saving and inexpensive oral rehydration therapy is
stagnant. This suggests lack of appropriate training and oversight
of health providers. Irrational use of antibiotics and other
ineffective medicines are over-prescribed at substantial out of
pocket expense to customers. Diarrhea causes about one-fifth of all
child deaths.


FERTILITY CONTROL INDICATORS STAGNATE
--------------------------------------

7. (SBU) The crude birth rate has decreased slightly overall
(21/1000 population), but the decrease is accounted for by urban
populations only; rural birth rates have not declined.
Contraceptive prevalence has remained the same since 2002 at 61%.
Method mix is changing, with increasing reliance on traditional and
short term methods. There is significant regional variation in
contraceptive use.

SMALL INCREASES IMMUNIZATION, SKILLED BIRTH ATTENDANCE
--------------------------------------------- ---------

8. (SBU) Full immunization coverage increased from 51% in 2002 to
58% in 2007. Skilled attendance at birth and rates of delivery in
health facilities also increased. Still more than 50% of women
deliver at home and access to emergency obstetric care is severely
limited. The maternal mortality ratio (MMR) is high, estimated to
be 307 / 100,000 live births in the 2002 DHS. MMR estimates from
the 2007 DHS are not expected until the final report later this
year. Maternal health indicators show the greatest variation by
region, and MMR reduction efforts are especially sensitive to the
weaknesses in the health care system: Equity of access, financial
protection against catastrophic spending on health care, referral
systems, and accountability of providers.

HUME

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