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Viewing cable 08SURABAYA96, EAST JAVA: MALNUTRITION COMPLICATED BY INADEQUATE GOVERNMENT

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Reference ID Created Released Classification Origin
08SURABAYA96 2008-08-07 09:51 2011-08-24 01:00 UNCLASSIFIED Consulate Surabaya
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 
 
 
This message is sensitive but unclassified.  Please protect 
accordingly. 
 
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