Advance Health In Indonesian Rurals Through 'Local Heroes'

Photo: Special

JAKARTA - Still in commemoration of the World Immunization Week recently, Indonesia highlighted an inspiring story about the health transformation driven by the people in the interior. Providing health education in areas like this has always been a challenge 'finite access to information and cultural beliefs that have long been embraced often hinders progress. However, there is something that changes when the message comes from someone you believe in-like a friendly neighbor and also acts as a health cadre in Posyandu.

Like the story of Herawati, a mother in the interior of Bogor, who shared her experience after joining the GISAP program.

"After joining this program, we found out that immunization is not as scary as we thought. Some parents are worried about fever, but after we receive education, it's not too scary. If a child has a fever, the fever is mild and will usually disappear the next day. They will soon return cheerful. That's why my husband and I feel confident that completing our child's immunization will provide the best protection for him," he said, quoted on Saturday, May 10.

Like Herawati, many other parents initially hesitate to bring their toddlers to get immunization, or only immunize the first dose without further immunization. By equipping local health cadres with the right tools and knowledge, this program undermines fears and misunderstandings about vaccines, making immunization not only as a public health goal, but also as a joint effort that is easily approached, easily understood, and accessible to each family.

This community-based approach is at the heart of the SIGAP Family, a partnership initiative that is in line with the World's Immunization Week's goal of promoting fair access to vaccines and protecting each child. By focusing on three simple but strong behaviors, namely washing hands with soap, immunizing children on time and complete, and improving nutrition, including providing exclusive breastfeeding for the first six months. The SIGAP family equips local health cadres to lead to continuous behavioral changes in their environment.

The impact is very real. At pilot locations such as Bogor Regency (West Java) and Banjar Regency (South Kalimantan), vaccine coverage and health behavior showed a significant increase. PCV1 vaccine coverage, which is important to prevent pneumonia, increased from 28% to 64%, while washing hands with soap before feeding children increased from 50 percent to 81 percent.

Nutrition practices have also increased: the proportion of children receiving food with more than five food groups increasing by 11 percent, indicating a better food diversity. In addition, approval of recommendations for exclusive breastfeeding during the first six months without water also increased from 90 percent to 94 percent, reflecting stronger compliance with optimal baby feeding practices.

Intan Widayati, Head of Public Health at the Bogor Health Office, highlighted the positive impact.

"Learning from the GISAP program is also felt at the village level. Several villages have even started allocating village funds for the sustainability of this program until 2025," said Intan.

The SIGAP family is more than just a Health initiative, but also a movement that empowers families, strengthens communities, and demonstrates the strength of multi-sector collaboration. Initiated by Gavi, Unilever Lifebuoy, and The Power of Nutrition, this program empowers local cadres to ensure that no Indonesian children are left behind.

The success of the SIGAP Family has sparked important discussions on sustainability. In a forum held earlier this year- which presented representatives from various positive ministries and institutions and the potential expansion of this program in the spotlight. One of the important things that can be taken from the discussion is the strategic role of village funds in maintaining and expanding the SIGAP initiative at the local level.

Sappe MP Sirait, an Analyst of the Intermediate Expert Policy at the Ministry of Villages, emphasized that the current regulations allow village funds to be used to support basic health services on a village scale including stunting.

"Village cadres can be trained for basic health services using these funds. Permendesa PDT No. 2/2024 is focused, among others, on handling extreme poverty and food security. In addition, it can also be used for community empowerment initiatives, such as cadre training and replicating educational materials used in the SIGAP Family Program," he explained.

Eppy Lugiarti, Intermediate Expert Policy Analyst/Head of Health Service Working Group, Directorate of Socio-Cultural and Environmental Development of Villages and Rural Areas, stated that guidance from local governments is very important.

"The direction of village development is in line with the principles of sustainable development, so that the SIGAP Family program is basically in line with health programs and targets to be achieved as part of the sustainable development goals (SDGs), as outlined in the Regulation of the Minister of Villages Number 21 of 2020 concerning Guidelines for Development and Empowerment of the Village Community. With proper supervision and integration into regional regulations, SIGAP can be a long-term solution, not only for stunting but also for wider health challenges," he explained.

Following the success of the pilot program, the SIGAP Family initiative is now preparing to expand the program. Based on a series of criteria and consultations with the central and regional governments, three districts have been selected for the expansion phase: Banjar (South Kalimantan), Brebes (Central Java), and Sukabumi mm (West Java). This expanded program aims to protect more than 1 million children from preventable disease, with the initial target of reaching at least 100,000 children during the expansion phase.

Talking about the expansion strategy, Andri Mursita, a Functional Officer of Health Administrator from the Primary Health Governance Directorate at the Ministry of Health, emphasized the importance of aligning this program with the existing framework.

"Despite the methods used or the significance level achieved, our hope is that during the expansion, this program is not seen as something completely new or separate from existing initiatives. Approaches and materials used in the Family SIGAP program can be aligned with existing initiatives, so as to strengthen existing systems," he explained.

Ardi Prastowo, Head of the SIGAP Family Program Team, also conveyed the same thing, outlining the two main pillars to ensure the sustainability of the program.

"First, we aim to enable local governments at the district and sub-district levels to allocate their resources to continue this program. Second, we are trying to integrate this program into a primary health consortium, especially through initiatives such as home visits. Finally, we plan to strengthen the reach and sustainability of the program by utilizing digital channels, including WhatsApp bots and media campaigns, to raise awareness and involve rural communities more effectively," he explained.

Inke Maris & Associates, which is responsible for communicating and implementing multi-sectoral collaboration for the SIGAP Family program, stressed the need to map out problems and opportunities across related ministries.

"The SIGAP family is a program that uses a communication-based approach by community cadres through visits to homes and also digital campaigns to encourage behavioral changes towards healthy living habits. The sustainability of this program is very important to ensure long-term impacts, thus requiring cross-ministerial support and integration into existing government programs. With strong collaboration, the Sigap Family can become an integral part of a national strategy to improve public health in a sustainable manner," concluded Widyaretna Buenastuti, Director & Senior Consultant of Inke Maris & Associates.

Through this collaborative and multi-sectoral effort, Gavi and his partners are committed to ensuring that no child is left behind, contributing not only to Indonesia's immunization goals but also to wider health and development achievements.