Some people work as integrated service post cadres, who are the spearhead of the health program in the village, only to carry out their duties. In work, they are relatively passive. This condition causes the Supplemental Food Program to suppress malnutrition in children under the age of five handled by cadres can be said to be “staying in place”.

The communication between integrated service post (posyandu) cadres and technical agencies related to the program was deadlocked, resulting in a lack of transparency in the use of the Supplemental Food Program (PMT) budget. As a result, posyandu cadres seem to only do what is “ordered” by the authorities.

However, this did not apply to Rosita Chandra Komala (46 years), a Posyandu cadre, resident of Kota Baru Hamlet, Rato Village, Bolo District, Bima Regency, Sumbawa Island, West Nusa Tenggara (NTB), was able to open the deadlock. Chandra, as he is called, succeeded in encouraging the enthusiasm of other posyandu cadres to work actively.

Other posyandu cadres heard not only his words about working actively, but also Chandra’s ideas for health development planning. He is also entrusted with managing PMT funds in a number of villages.

It started when Chandra, as a Posyandu cadre, questioned the PMT budget to one of the Posyandi advisory technical agencies in the Bima Regency Government. At that time, he also requested that the management of budget funds for PMT be handed over to the cadres who were directly in the field. His attitude made some of the ranks of the Bima Regency Government look like they were “on fire”.

“I was accused of various kinds, but I do not care. I let it go. After all, my goal is for the PMT to run effectively and the work of cadres to be excited. The results will surely be felt by the community more clearly,” said Chandra, the 6th child of nine children of Baso Yusuf and Hj Rusmini.

Chandra feels confident because his steps are aimed at improving the performance of the cadres who only carry out standard tasks at the posyandu, namely registering, weighing and recording the condition of babies.

While counseling to mothers they rarely do. For example, cadres should have information from mothers whose toddlers’ weight (under five years of age) is constant or decreasing, as well as asking whether their toddlers have ever had coughs and colds.

All this was not done by cadres. This resulted in weak problem identification and inaccurate data on the causes of malnutrition and malnutrition in children under five in that area. In fact, this information needs to be recorded on the health card.

Mother is reluctant to come

Another excess is mothers whose children under five suffer from malnutrition are reluctant to come to the posyandu for fear of being scolded by cadres. Some other mothers feel embarrassed because their toddlers are not healthy.

In fact, if the identification of the problem goes well, cases of under-five malnutrition can be immediately referred to the puskesmas to get adequate medical services.

This condition is exacerbated by the lack of transparency in the PMT budget. In fact, the puskesmas has set a standard for nutritional intake in the form of mung bean porridge, even though it is known that the village is rich in potential vegetables, fish and other agricultural products that can be used as nutritional intake.

Procurement of materials for PMT was also supplied by the puskesmas. While the posnyandu cadres are in charge of processing it into ready-to-eat food. Unfortunately, it is not uncommon for green beans to be unfit for consumption, such as lice and worms.

Chandra was trying to find out why it happened. He also received the Bima Health Office’s 2011 Budget Use Document (DPA). It was from that DPA that he learned that for PMT there is Rp. 100,000 per month for each posyandu. In Bolo District there are 54 posyandu with a PMT target of 60-70 people.

He then invited the cadres to calculate the allotted funds for each posyandu using PMT raw materials in the form of heads, sugar and green beans received. The result is a figure of Rp. 60,000-Rp. 64,000 so that there is a difference of at least Rp. 36,000.

This difference can actually be used to optimize the fulfillment of toddler nutrition. That’s what makes the ranks of the authorities as if “burning beards”. What’s more, this information is also circulating among the West Nusa Tenggara Provincial Government Work Unit and members of the DPR.

Get attention

What Chandra did was solely to make posyandu cadres more confident, awaken their critical abilities, and take responsibility for their work.

His efforts have attracted the attention of a number of non-governmental organizations. They also received training in processing various local food ingredients. In 2012, the NTB Provincial Government also helped them by allocating Rp. 3 million per posyandu. All of this is intended to make the program successful in reducing maternal mortality to zero.

In the same year, through the Village Care Women’s Movement and the Posyandu Cadre Communication Forum, the cadres were also entrusted with managing PMT funds. The double effect is felt by housewives. They are increasingly able to choose healthy, more varied, balanced and nutritious food for their families.

“In the Posyandu where I work, there are no more malnourished toddlers. Meanwhile in Rato village, out of seven posyandu, only one or two children are malnourished,” said Chandra about the development of toddler health which was much better than in 2003. At that time, in Bima District, around 30 percent of toddler health was at the “red line” ” aka suffering from malnutrition.

However, this development did not make Chandra satisfied. This is because there are only a few posyandu cadres who receive training, only two people per village out of around 30 posyandu cadres in each village. PMT funds are also not sufficient to reduce the number of severely malnourished children under five quickly.

“I mentioned the issue of funding when I was a guest speaker at the 2012 Millennium Development Goals Seminar in Jakarta. With just a glass of mung bean porridge per month, it’s impossible to improve toddler nutrition instantly,” said Chandra.

His assertive style of speech seems to have enabled Chandra to transmit active work enthusiasm and new energy to his fellow posyandu cadres.

Source:

KOMPAS Daily, 14 August 2013 edition