Health Service Condition in East Aceh

    Untitled Document

    East Aceh, as was Nangroe Aceh Darussalam (NAD) propinsi, was affected by the Tsunami on the 26 December 2004, although the impacts was much less here, in terms of human lives and properties including houses and public facilities, but particularly firm farms and rice fields. In this context, East Aceh is in a transition period from post-Tsunami emergency into rehabilitation and reconstruction.

    In terms of public health, Tsunami did not cause much physical damage to the health insfratructure. Health service delivery in East Aceh resumed quickly after the Tsunami, although it had limited reach. Damages to health infrastructure and limited capacities ocurred most importantly during the armed conflict between TNI and GAM. During armed conflict, TNI often took over abandoned health facilities as military posts, which made them prime target of attacks by GAM.Armed conflict also limited the movements of health service providers due to iuncreased security risk associated with war although in many cases GAM allowed health service delivery in areas under its control.

    The Helsinki MoU between GAM and the Indonesian Government opened the way for a normalisation of life in East Aceh. The MoU also paved the way for a special autonomy in NAD, particularly after the Indonesian Government signed the Law on Aceh Governance. SHEEP needs to develop a strategy to respond effectively to the socio-political dynamics emerging in East Aceh during this political transition, and to the impacts of the prolonged armed conflict on the socio-political, cultural, economic, as well as demographic life of people in East Aceh.

    Within this socio-political context and within the transition from eergency into rehabilitation and reconstruction, SHEEP is commissioning this study into the health service delivery in East Aceh. SHEEP expects that this study will sharpen its comprehensive health service in East Aceh.

    Some health problem idntified in East Aceh, especially in four sub-district where SHEEP worked in were: people did not care about sanitation as well as the government. Available health service was not optimum yet, and people awareness on the value of health was very weak.

    Illnesses associated with armed conflict exist, such as malaria or gunshots amongst former combatants, but these cases are isolated. GAM leadership, in many instances, have provided information to former combatants to seek help at local community Health Centres/Hospitals. One issue which escapes this research is the problem associated with disabilities as a result of armed conflict. The number of people with permanent disabilities associated with the conflict, whether civilians or combatants, is not known.

    One of the most significant impact of the armed conflict is in people’s lifestyle and awareness of health (‘flying toilets, clean water, and so on) and people’s ability to manage their own health independently (poverty, high level of Posyandu dependence on government health providers, fragile village institutions, conflicts between communities). SHEEP should respond to these issues directly. In addition, the political dynamics at the District level (i.e. Pilkada) will have great indirect influence on people’s health, i.e. emergence of new conflicts, security problems or development priorities.

    Below is the condition of health service in nine partner villages of SHEEP:

    Village Name

    Basis of Program Intervention

    Health Service Condition facilitated by SHEEP

    Seulemak Muda, Sinebok Tuha 1 and  Sinebok Tuha 2

    Those villages were considered as the combatant basis (GAM)

    • Health service was going for six months then stopped after health service by Government Health Center in sub-district was accessible.
    • Health program activity then was more focusing on awareness discussion on health and health life style through CBOs penyadaran kesehatan melalui kelompok2 masy; ( there was a need of training for Village Health Volunteer (done for 2 months); Seulemak Muda villages started refunction their Villahe Health Post which facilitated by Village Health Volunteers.
    • SHEEP also facilitated the training and organized women group to develop family nutrition garden which at the end became women economic group.

    Village Name

    Basis of Program Intervention

    Health Service Condition facilitated by SHEEP

    Kuala Geulumpang, Teupin Pukat, Matang Neuhen

    These villaged were directly affected by the tsunami, which destroyed hundred hectars of aqua-culture and irrigation facility.

    • Health service done by Sub-district Government Health Center was refunctioning.
    • Health program activity then was more focusing on awareness discussion on health and health life throug 2 CBOs à which at the end became women economic group

    Melidi, Tampor Bor, Tampor Paloh

    Additional villages that accmodated into rehabilitation program post Tamiang flood striked them in December 2006.

    • Setting up People/Village Integrated Health Post in Melidi, TB treatment in three villages, Health Service in cooperation with East Aceh Health Department.
    • The existence of SHEEP in Simpang Jernih was aiming at increasing government’s attention toward more qualified health service.
    • Village Health Volunteer training in Tampor Paloh village.
    • Assessment on people’s health condition in Simpang Jernih Sub-district.

     

    Below was Focused Group Discussion with Village Health Volunteer, community leaders of SHEEP’s partner villages. There were 29 people participated to the discussion which most of them were women. Four from nine community leaders who came to the discussion were village leader.
     


    Demography – demographic transition

    Most people find employment elsewhere, due to limited opportunities and conflict

    The District Government provides job opportunities, thus reducing temporary migration

    Nutritional Status (effects of politics, disaster) 

    Most under-five year old babies suffer malnutrition, due to weak economy (Note: some participants own mobile phones)

    There ought to be supplmenetary food and routine monitoring (by puskesmas, District Health Office), health promotion, i.e. nutritional food.

    Health Indicators
    Mortality
    Morbidity

    There is no records of deaths, at the village office, there is no data management system and reporting of deaths. Malaria, Rheumatism are common. Health services are not optimal, and services by private providers are deemed better than Puskesmas.
    During office hours, Puskesmas staff (nurses, doctors) are available but when patients demand better drugs, they are only available at private practice. 

    There ought to be a data management system and reporting of exeptional cases of deaths. There ought to be staff and drugs available at Puskesmas during office hours

     

    Health and Clean lifestyles

     

    Communities have little awareness of environmental health (flying toilets)

    Water is difficult to get, water from a local river has not yet been treated or optimalised

    Communities do not understand the importance of nutritious food

     

    There ought to be awareness raising

    The ’flying toilet’ habit must end through health education and by making available proper toilets (with water)

    Treatment of river water or other sources

    There ought to be attemtps to increase people’s appreciation of nutritious food.

    Social-economic development, community education, demands for health services

    Limited job opportunities, low levels of skills/ ability to create jobs.

    The quality of available health services is low (drugs)

    Solidarity is low amongst people to help each other improve their health

    Lack of monitoring by District Health Office on its Puskesmas

    There are only auxilliary Health Centres (Pustu) and Polindes buildings, but no permanent staff.

    There ought to be skills trainings to prepare people for new employment. Also training in farming techniques to make use of vacant land.

    Health fund needs to develop with intensive consultation by consultants

    The District Health Office must improve its human resources development particularly for Puskesmas staff

    Pustu and Polindes must operate as prescribed

    Politics, democracy, community participation

    Lack of appreciation by the government towards health volunteers

    Formulating conducive roles for health volunteers. (better incentives)

     

    Strategy

    Based on people’s health condition above and available health services, SHEEP strategic roles must focus on strengthening local (community) organisations (i.e. Posyandu) and village administration (Village and Mukim) and improving the capacities of these local organisations in the management of basic health problems. SHEEP may adopt the national health plan of developing self-relant villages Desa Mandiri) by facilitating the development of Posyandu Pratama (basic level Posyandu) into Posyandu Purnama and Posyandu Mandiri (self-reliant Posyandu). For this to happen, intensive capacity building and personal development of Posyandu and health volunteers are necessary, whether targeting skills, knowledge and individual capacity and programming. Additionally, the political’ status of Posyandu within the village/mukim and Puskesmas needs to improve, not merely as ideas to program implementation.

    Steps taken for supporting people’s health empowerment were:

    -
    Coordination and consolidation with East Aceh Health Department about the existence of SHEEP Health Program reached an agreement on each strategic role between government and SHEEP in order to form self-reliant village or Desa Siaga.
    -
    SHEEP, for example, can focus on community empowerment, i.e. enhancing communities’ capacity to manage basic health problems independently (be it at the community level, village and mukim), to manage community organisations, to conduct health promotion and awareness raising. The District Health Office (re: Puskesmas) can at the same time concentrate itself on consolidating its own health services within the Puskesmas, Pustu or Polindes. The benefit for District Health Office is that it allows better focus of its limited budget on improving its overall services. Another benefit is that communities may be more prepared to interact with the District Health Office (re: Puskesmas) and accept their programs.
    -
    In terms of health planning, SHEEP and Puskesmas may sit together and work out a framework for sub-district strategic health planning together with the communities and local (village and mukim administrators). The benefit of this exercise is that sub-district (Puskesmas) health programs/services will reflect real needs within the communities, and consider the prevailing local social,  cultural and political dynamics. Another advantage is that health development will integrate local resources (social capital). The third advantage is that this exercise will lead to a two-way dialogue between Puskesmas (District Health Office), the communities and the village/mukim administrators.
    -
    Cooperation between SHEEP and East Aceh District Health Office is highly important not only on pragmatic but also strategic grounds for both parties. On a pragmatic ground, SHEEP health service must aim to strengthen people’s capacity to manage their own basic health independently (see Point 2). Strategically, SHEEP may assume an advocacy role at the District and Provincial levels. Both levels of government, particularly the new governments, certainly needs to pay more attention to the health sector. The health budget at both levels needs to increase, but more importantly the budget allocation for development and more particularly for health programs (rather than routine program) need significant increase

     

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