 |
| Galton Institute Home Page | December 1998 Newsletter Contents | Newsletter Index |
In 1995 the Institute made a grant of £70,000, payable over three years, to Marie Stopes International, for a scheme of practical birth control provision in Indonesia. Reports on the first and second year's progress of the scheme appeared in the December 1996 and December 1997 issues of the Newsletter. The following is the third and final report received from MSI.
The Galton Institute's grant was applied to the expansion of a three clinics project in the densely populated urban areas of Bogor, Bandung and Tangerang in Indonesia. Additional funding of £205,679 for this project was leveraged from the European Union, using the grant from the Galton Institute. The project has evolved over the past three years and today the three clinics provide a full range of reproductive health care services. The third and final tranche of funding has enabled YMSI (Yayasan Marie Stopes International - the name of our local NGO partner) to strengthen and expand its widely acclaimed outreach services and to fund Information, Education and Communication activities. These will generate awareness and promote the uptake of family planning and reproductive health care in these communities. This report covers the period of 1 July 1997 to 30 June 1998, which represents the final year of this project.
|
Although the population of Indonesia is the fourth most populous in the world, its inhabitants are unevenly distributed. Java has one of the highest population densities in the world with 640 inhabitants per sq km, while neighbouring Borneo has fewer than 10.
Under the sl
ogan "TWO CHILDREN IS ENOUGH" the Indonesian Government has adopted a family planning policy that has led to a reduction in the growth rate of its population. Even so, demographic pressure, combined with rapid industrialisation has led to environmental degradation and a depletion of agricultural land. Due to high fertility rates in the past there is an unusually large proportion of the population that is within reproductive age. With such a vast and growing population, health services for the low income women and men are virtually non-existent. This is highlighted by the fact that…maternal mortality is over 72 times higher in Indonesia than in Denmark or in UK countries.
This demonstrates the high unmet demand for reproductive health services particularly amongst low income women.
The three areas have a total population of approximately four million and are predominantly industrial with fast growing slums, partly due to continuing immigration from Sumatra. Additionally, Bogor and Bandung are university towns housing a high number of young people in the reproductive age group.
The overall project objectives were:
To reduce maternal mortality and morbidity due to repeated pregnancies through the introduction of reproductive health clinics into three under-served urban areas of Indonesia.
To generate awareness of family planning and sound reproductive health practices amongst low-income women and their families.
To reduce poverty and environmental degradation.
The final year objectives were:
Expansion of the existing range of services
Expansion of outreach components
Achieve sustainability
Since last year, all three clinics have been fully operational. They are providing an extensive range of reproductive health services including:
Family planning counselling and services, including male voluntary surgical contraception, IUDs, injectables, implants (Norplant), condoms, spermacides and oral pills
Ante natal and post natal care
Diagnostic tests (pregnancy, blood, urine and pap-smears)
STD testing and referral for HIV/AIDS treatment
Infertility counselling
Circumcision
The number of clients that the project serves has gradually increased. A total of approximately 17,175 people visited the project during the final year including 2,983 voluntary surgical contraception (VSC) clients. This represents an increase of approximately 115 per cent over the previous year.
Tangerang and Bandung clinics are now equipped with vehicles for use by mobile teams to take voluntary surgical contraception services to under-served peri-urban and rural districts and municipalities within West Java province.
They provide the following services:
Vasectomy
Tubal ligation
FP education
HIV/AIDS education
Distribution of condoms and oral contraception
Treatment of moderate complications of VSC clients who had previous treatment by other service providers
In addition to providing a full range of reproductive health care services, the clinic team also carried out a significant number of training and educational initiatives, working with a variety of community groups such as sex workers, traditional birth attendants, midwives, women's groups etc.
To achieve full sustainability, YMSI recognises the importance of promoting sound reproductive health services and generating awareness of family planning methods. For this purpose, various IEC activities have been carried out during the final year including the following:
a total of 28 reproductive health education workshops and seminars were held, attended by 5000 people.
reproductive health seminars were held for high school students.
a total of 206 radio sessions reached an estimated 900 000 people.
thousands of leaflets and booklets describing the range of services provided have been distributed during these events and seminars.
38 house wives were trained as volunteer health educators in Bandung to educate local women on reproductive health and refer clients to the Bandung clinic.
196 midwives were trained in reproductive health and HIV/AIDs awareness and have become the main referral source for clinic clients.
To assist the project to become sustainable, Marie Stopes International strongly believes in developing the professional capacity of its staff. All team members received ongoing training as appropriate to their job description. In the final year of the project, four clinic teams undertook English Language training, one nurse was given a scholarship for midwifery education and all doctors attended training in the use of implantable contraception. The project manager attended a number of workshops including a training programme on Orientation and Management Strategy in London.
The Galton Institute has greatly contributed to the success of this project. In the final year, YMSI was able to implement various IEC activities which in turn lead to the increase in client referrals. The purchasing and equipping of a new vehicle meant that team members were able to reach very remote areas of Indonesia and carried out vasectomy sessions and other methods of family planning.
This is how the final instalment of the grant was allocated:
Despite the recent economic and political upheaval in Indonesia the project has achieved its objectives of introducing sound reproductive health and family planning services in these regions and will continue to expand its range of services. The success of the project is reflected in the increasing numbers of clients utilising the project services and in the quality of services they are receiving. Government health and family planning officials at all levels have expressed significant appreciation of the mobile services provided by YMSI. With their assistance, mobile sites were established in government as well as non government facilities. The programme has undergone a process of evolution since the beginning and it is now fully sustainable. This achievement was made possible through the generous assistance of the Galton Institute to which we the staff of Marie Stopes International and the clients of Yayasan Marie Stopes International would like to express our gratitude.