VZCZCXRO6384
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJS #0093/01 2820837
ZNR UUUUU ZZH
R 090837Z OCT 09
FM AMCONSUL SURABAYA
TO RUEHC/SECSTATE WASHDC 0470
RUEHJA/AMEMBASSY JAKARTA 0459
INFO RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RHHMUNA/HQ USPACOM HONOLULU HI
RUEHWL/AMEMBASSY WELLINGTON 0176
RUEHBY/AMEMBASSY CANBERRA 0209
RUEHJS/AMCONSUL SURABAYA 0482

UNCLAS SECTION 01 OF 02 SURABAYA 000093 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EAP/MTS, EAP/RSP 
JAKARTA FOR ODC, ECON, AND AID (NORTH AND BALDWIN) 
 
E.O. 12958: N/A 
TAGS: ECON EAID PGOV ID
SUBJECT: NTT: LONG-TERM CONDITIONS GENERATE HIGH INFANT/MATERNAL 
MORTALITY RATES AND MALNUTRITION 
 
REF: A. 08 Surabaya 109 (NTT: Where Children Starve, a Famine of Solutions Too) 
     ¶B. 07 Surabaya 55 (West Timor's Perfect Storm) 
 
SURABAYA 00000093  001.2 OF 002 
 
 
This Message is Sensitive But Unclassified.  Please Protect 
Accordingly. 
 
¶1. (SBU)  SUMMARY: East Nusa Tenggara (NTT) province, one of the 
poorest in Indonesia, faces serious health challenges, 
especially high maternal and infant mortality rates and child 
malnutrition.  Experts blame problems with access, a lack of 
medical personnel, a lack of education and information, and 
cultural factors for the disturbingly high mortality rates.  The 
provincial Health Department is focusing its efforts on reducing 
the mortality rates by seeking to expand availability of health 
facilities throughout the province.  These efforts are hampered 
by a lack of resources.  Malnutrition rates have fallen 
following serious attention from the government and civil 
society, but remain unacceptably high.  Health Department 
officials argue the long-term solution lies in economic 
development, outside the department's mandate. End Summary. 
 
Lagging behind the National Average 
--------------------------------------------- -- 
 
¶2. (SBU) During a September 29-October 1 visit to Flores and 
West Timor, two of the major islands which comprise the NTT 
province, Surabaya Pol/Econ Officer discussed NTT's dismal 
health statistics with local officials, academics, and NGOs. 
According to official government statistics from 2004, the most 
recent numbers available, the maternal and infant mortality 
rates in NTT were significantly higher than the national 
average. The NTT maternal mortality rate was 554 per 100,000, 
women as compared to the national rate of 307 per 100,000, and 
the NTT infant mortality rate was 62 per 100,000 infants, as 
compared to the national rate of 45 per 100,000.  Experts blame 
difficult access to health facilities, lack of medical 
personnel, lack of education and information, and cultural 
factors.  According to the head of the Provincial Health 
Department, Stefanus Bris Seran, there are 300 community health 
centers (Puskesmas) and 33 public/private hospitals throughout 
the province, but only 20% of the Puskesmas and 50% of the 
hospitals meet the national standards considered necessary to 
help pregnant women deliver babies safely. 
 
¶3. (SBU) The lack of qualified medical personnel is another 
problem. By national standards, Puskesmas at the district level 
should have at least seven medical specialists.  However, many 
of NTT's Puskesmas have no medical specialists at all. 
Representatives of an NGO in Flores told Pol/Econ Officer that 
when people in remote areas come to the closest Puskesmas to 
deliver a baby or to get any medical treatment, there is often 
no medical personnel available. Another difficulty faced by 
women seeking to deliver their babies at a Puskesmas is a lack 
of transportation. This is especially problematic for those who 
live on NTT's many small islands. The NGO representative added 
that, for cultural reasons, many women in NTT prefer to deliver 
their babies at home and do not understand the risks inherent in 
this custom. 
 
Mother's and Children's Health Revolution Program 
--------------------------------------------- ------------------- 
 
¶4. (SBU) Seran explained that the NTT Health Department recently 
launched a program called "Mother-Child Health (KIA) Revolution" 
to reduce the Maternal and Infant Mortality Rates in the 
province. The program seeks to develop sufficient health 
facilities and infrastructure by providing an adequate number of 
qualified medical personnel, health centers, and medical 
equipment; to build a good health service system; and to secure 
sufficient operating budget to meet the obstetric needs of women 
in the province. The KIA Revolution program also encourages 
women to deliver their babies in a hospital or health center and 
educates them about the dangers of delivery at home. The Health 
Department has contracted with two local newspapers to build 
awareness. As a result, one major local newspaper is running two 
pages, and another runs half a page, every week about the KIA 
program and related health issues.  The department has also 
hired an independent institution to gather feedback on KIA's 
effectiveness. 
 
¶5. (SBU). Seran added that KIA would mean nothing if the 
province does not have adequate resources.  Nedi of the Human 
Rights Protection Coalition, an NGO in Flores, said that the 
local government, NGOs, and churches in Flores are working 
together to find solutions to health problems in NTT, but they 
 
SURABAYA 00000093  002.2 OF 002 
 
 
have been hampered by a lack of funding.  According to Seran, 
only 10% of the provincial budget is allocated for the health 
sector and 76% of that is used to finance the province's 
flagship public hospital in the capital city of Kupang. The 
provincial government has requested that the hospital's status 
be changed from a provincial to a national hospital, thus 
shifting funding obligations to the central government. 
According to Seran, the current Minister of Health has already 
agreed with this status change.  However, there is no guarantee 
that the new Minister of Health will go through with the status 
change after the new cabinet is formed after October 23. 
 
Malnutrition: Still High But Improving 
--------------------------------------------- -- 
 
¶6. (SBU). Seran in Kupang and NGO contacts in Flores agreed that 
malnutrition is still a serious problem for the province. The 
number of malnourished children under the age of five in NTT 
during the January - August 2009 period was 56,972 children, or 
11.3% of the total population.  This is an improvement over the 
15% rate during the same period last year.  The number of 
malnutrition cases fell after garnering serious attention from 
the local government and parliament and stimulating good 
cooperation between government and civil society organizations. 
For example, the Bishop of Ende said that the Ende Diocese 
recently held a workshop on food sustainability in cooperation 
with the local government. Likewise, Community Women's Groups 
(PKK) and NGOs continue to educate people about nutrition and 
encourage the introduction of healthy foods to augment the 
staple food: rice. 
 
¶7. (SBU) Despite recent improvement, Seran stated that he does 
not think that the Health Department has a long-term role in 
fighting child malnutrition.  He pointed out that in order to 
provide the standard 90-day emergency food supplement for these 
56,972 malnourished children, the NTT Health Department would 
need to spend at least $ 5.4 million.  At the end of the 90-day 
treatment, the children would return to the impoverished 
circumstances that lead to their malnutrition in the first 
place.  He suggested that spending this money on strengthening 
other sectors such as agriculture and fisheries would be a more 
effective way to combat malnutrition, since that would reduce 
poverty and create food sustainability. 
 
Recent American Assistance 
----------------------------------- 
 
¶8. (SBU) In July 2009, the USAF and TNI conducted the joint 
Pacific Angel Exercise in the Kupang area, providing much needed 
medical and dental care to thousands of disadvantaged people in 
West Timor and building/repairing water storage and drainage 
infrastructure in local villages.  Seran expressed gratitude for 
that assistance, and hope that the U.S. may be able to provide 
further assistance to the province in the future. 
MCCLELLAND