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