Quarterly Updates March 09

Program Kesehatan Berbasis Masyarakat

Intro to SurfAid in NiasOrganizational Interventions One the first Aid orgs to provide health emergency

health clinics after 2005 earthquake Rehabilitated water supply to Hinako islanders

2006 Launched CBHP 2006 Launched Siaga Bencana 2007 Conducted extensive KAP Survey 2OO7 Delivered 103 water facilities with UNICEF 2008 Community lead Posyandu and PD Hearth process

in 33 Village 2008 – 2009 Malaria Pilot areas Alasa and Afulu Feb 2009 Commence CL WATSAN April 09

Qtly Milestones1. Completion of hearth in Phase I

communities. 2. Commence of hearth in phase II

communities3. MSC Stories – shared with stakeholders

through Kese Kese and websites (both english and indo blogs)

4. Implementation of Malaria in priority areas

5. Coordination and evaluations for Project Design for CBHP II

Milestone 1. Completion of hearth in Phase I communities.

Heath Phase I

Completion of 20 directly supervised hearth posts with 232 children in Phase I communities.

For the remaining 105 children who have not yet attained normal status SurfAid will continue to provide reduced support in Pos Gizi Mandiri

Results from Phase I

8

107

164

8562

20

226

105

-

50

100

150

200

250

Normal Moderate Severe Malnurished

Overall change in Nurtrition Status

Session I Session III

Milestone 2. Commence of hearth in phase II communities

In Phase II - Planned

323 Children in 36 hearth sessions.

Afulu - 9 Alasa – 2 Sirombu – 4 Teluk Dalam - 18

Milestone 3. MSC Stories

shared with stakeholders through Kese Kese and

websites (both english and indo blogs)

three new stories – giving our community a voice! A second Chance The fruits of our

labour Bothers join the

fight against Malnutrition

Milestone 4. Implementation of Malaria in priority areas

Malaria Outputs two target villages of the Alasa districts

have been fully covered. Within the two villages (6 dusun) a

population 2779 have received and total of 1491 nets (approx. 1 net for every 2 people).

Since the slides are still being analyzed in the lab.

Team has now moved on to Afulu. Hinako island will also be covered

Milestone 4. Coordination and evaluations for Designing CBHP II

CoordinationThe point of the meeting included: The Head of District Health Office presented the

DHO Strategic Plan concerning Health Programs in Nias.

presentation of progress CBHP activities, including Devian-Positive Strategy

presentation of Malaria Program implementation for Alasa and Afulu,

A brief presentation regarding the planed extension for next 3-years was also delivered. The plan would be prepared for and proposed to donors, and it would call for meetings with and follow-ups from District Health Office to ensure continued strong partnership between SurfAid and DHO.

CBHP Evaluationsevaluations are part of the end of program assessments in

which a range of approaches are adopted to designed to meaningfully involve communities in quantitative and qualitative method to gathering, analyzing and interpreting data. These approaches include:

community led Posyandu health hearth Pos Gizi growth monitoring results Direct observation monitoring surveys Community evaluation workshops Care Group FGDs and Most Significant Change stories

The community evaluations, DOMS and staff FGDs will be reported in this quartely report

Community evaluations

Form the community evaluations it is seen the communities have a strong sense of ownership of the CBHP program.

They saw that “CBHP is from themselves, by themselves and for themselves.”

community prioritisations The community prioritisations highlighted some

concerns i.e. the continued persistence in desires for infrastructural improvements.

It was however hearting to see that unhealthy behaviours was their number one concern. And threat under 5 malnutrition rates & Open defection were all highlighted in their top five concerns.

Although the fact the under 5 maln. Was number five on the list highlights the challenges to retain community focus on the key health issues

FGD on Analysis of Barriers to household visits

Care Group Volunteer don’t do household visit

There is no gift or incentive as acknowledgement from SAI

There is jealousy with Hearth Cadre

There is problem with household

Volunteer is not trusted by household

Volunteer is not confidence

Volunteer is not welcome by household

Household have prejudice that volunteer

get incentive from program

Weather

Volunteer are busy

Working on their garden or plantation

No household in their house

Harvest season

Volunteer feel bored deliver similar health messages all the time

Feel hurt by household comments such as boring listen similar health messages which they already heard before and no real action after asking their health condition and measuring their MUAC

Barriers for Care Group Volunteer to do Household Visits:

Sample DOMs resultsThe behaviour changes reported in the community

evaluation correlate with the results from DOMs surveys.

Hygiene and nutrition behaviours both highlighted

by communities demonstrated strong improvements in DOMs Surveys and

the lack of mentioning respiratory inflections in the community evaluations correlates with the poor results in DOMs for same behaviours.

DOMS sample size 106 households. Note these were targeted at high risk households and not randomly selected. This means random select of Household would include PD household which would be like to reflect more positive results in all areas.

9.3

76

13

0

10

20

30

40

50

60

70

80

KAP Baseline % Current % Target %

Mother who are aware of good weaning habits [EO 3.5.]

Sample results

40.5

85

66.4

0

20

40

60

80

100

KAP Baseline % Current % Target %

Hand washing by mothers (EO 2.2.)

Jembatan menuju perubahan perilaku masyarakat

KKnowledgenowledge... ... AAttitudesttitudes...... PPracticeractice

KPK

Dasa Wisma

Cader

caregiver

Lembaga Adat

Kades

Puskesmas

TKD

Pertanian

Bupati & Ibu

KesehatanPertanian

PKK/ BPM

KKnowledgenowledge... ... AAttitudesttitudes...... PPracticeractice

Leadership & Reinforce actions

Field learning

HH Visit

Creating Suppoting

Evironments

Improved Improved HHealthealth, Wellbeing and Self , Wellbeing and Self RelianceReliance in in the the CommunityCommunity

ongoing challenges The community evaluation is strong on

opinions from community and on their needs and how they value the current CBHP. Further evaluation into community perception and barriers are required at a more focused level.

Hearth is still demand much of staff time to drive down malnutrition levels but its still seen as our best intervention for building widespread community support for the programs

Terima Kasih

Growth Applying to NZAID for 3 years

extension Will work to to deliver a greater level

of sustainability through: Deeper collaboration with government

health service providers (Desa SIAGA)

development of a greater level of self-awareness and

self-sufficiency at community level.

Strategic Action Areas

1. Strengthening Community action2. Developing personal Skills3. Creating Supportive Environments4. Building Healthy Public Policy5. Reorienting Health Services

Framework will follow Indonesia DOH,WHO and Ottawa Charter

Timeline

Community Evaluation ongoing Draft proposal by end of March Present back to DHO April?

Now we seek to learn of opportunities for greater collaboration with DOH for

a better more sustainable initiative for vulnerable Nias Communities