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Cablegate: East Java: Malnutrition Complicated by Inadequate Government

VZCZCXRO5400
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJS #0096/01 2200951
ZNR UUUUU ZZH
R 070951Z AUG 08
FM AMCONSUL SURABAYA
TO RUEHC/SECSTATE WASHDC 0272
RUEHJA/AMEMBASSY JAKARTA 0258
INFO RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHWL/AMEMBASSY WELLINGTON 0143
RUEHBY/AMEMBASSY CANBERRA 0143
RHHMUNA/HQ USPACOM HONOLULU HI
RUEHJS/AMCONSUL SURABAYA 0277

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


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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

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