Child Survival Revolution Some Illustrations from Indonesia

The Development Context Continuing interest in problems of poverty and inequitable income distribution Continuing interest in problems of poverty and inequitable income distribution Clearly absolute poverty is closely linked to ill-health and premature mortality Clearly absolute poverty is closely linked to ill-health and premature mortality Persistent problem in the Third World is high infant and child mortality Persistent problem in the Third World is high infant and child mortality Indonesian IMR in 1960 was 120 and in 2004 stands at 46 per 1,000 live births Indonesian IMR in 1960 was 120 and in 2004 stands at 46 per 1,000 live births How has this been accomplished? How has this been accomplished? Yet striking contrast with Malaysia’s IMR of 11/1,000 live births Yet striking contrast with Malaysia’s IMR of 11/1,000 live births

Indonesian Infant Mortality Rates

Population Density in Indonesia

Roots of the Problem Survival and development of children in Indonesia and elsewhere dominated by two major problem areas Survival and development of children in Indonesia and elsewhere dominated by two major problem areas Nutritional deficiency- especially protein energy malnutrition (PEM) Nutritional deficiency- especially protein energy malnutrition (PEM) Infectious diseases: acute respiratory (influenza and pneumonia), diarrhea and measles Infectious diseases: acute respiratory (influenza and pneumonia), diarrhea and measles Major causes of deaths is dehydration due to diarrhea and neo-natal tetanus Major causes of deaths is dehydration due to diarrhea and neo-natal tetanus

Child Survival Revolution Attempt by United Nations to address the growing concern worldwide for infant and child mortality levels Attempt by United Nations to address the growing concern worldwide for infant and child mortality levels Aid has focused on a set of four factors defined by GOBI: Aid has focused on a set of four factors defined by GOBI: 1. Growth monitoring- weighing children regularly to detect weight loss 1. Growth monitoring- weighing children regularly to detect weight loss 2. Oral rehydration- replenishing body fluids 2. Oral rehydration- replenishing body fluids 3. Breast feeding- more nutritious and important where water is non-potable 3. Breast feeding- more nutritious and important where water is non-potable 4. Immunization- immunizing against preventable diseases through four vaccines (measles, polio, diphtheria, tetanus) 4. Immunization- immunizing against preventable diseases through four vaccines (measles, polio, diphtheria, tetanus)

Child Health in Rural Indonesia Growth monitoring is done in ‘posyandu’ – ‘one-stop’ small health posts in rural areas Growth monitoring is done in ‘posyandu’ – ‘one-stop’ small health posts in rural areas Goal: all children have access to health center no more than 5 kilometers away Goal: all children have access to health center no more than 5 kilometers away Goal: Immunization regime to cover major diseases Goal: Immunization regime to cover major diseases Health care system deepened through use of midwives Health care system deepened through use of midwives

Breast feeding; birthing room rural Java; Sarmani, 65-years- old, has been a Dukun (traditional birth attendant) for 50 years. She is bathing a one-day-old baby girl from the village of Deket Kulon; posyandu. Breast feeding; birthing room rural Java; Sarmani, 65-years- old, has been a Dukun (traditional birth attendant) for 50 years. She is bathing a one-day-old baby girl from the village of Deket Kulon; posyandu.

Family Planning in Indonesia Natural increase rate currently 1.6 (22/6) Natural increase rate currently 1.6 (22/6) But Indonesian family planning program very successful But Indonesian family planning program very successful 60 percent of women use some form of contraception 60 percent of women use some form of contraception Health care practices emphasized as part of the family planning program Health care practices emphasized as part of the family planning program