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Report on Study Tour

India-Indonesia Knowledge Exchange on Community Action for

Health and Nutrition by representatives of health departments

from NorthEast India


Study tour conducted by:
Dr. Vizolie Zakieneile Suokhrie, Nagaland.
Dr. Kuputha Atoshe Sema, Nagaland.
Dr. Thomas Keppen, Nagaland.
Ms. Regina Hongray, Manipur.
Dr. Zothankuma Chhak Chhuak, Mizoram.
Dr.Pranab Chatterjee, Tripura.

Report Prepared by
Dr.Thomas Keppen
Monitoring & Evaluation Officer
Nagaland Health Project
Directorate of Health & Family Welfare, Nagaland

Prepared for:
The Nagaland Health Project and the World Bank

November 2016

Report on the Study Tour

TITLE: India-Indonesia Knowledge Exchange on Community Action for Health and Nutrition, November 7-11, 2016.

INTRODUCTION:  On November 7-11, 2016, a delegation of health officials from North-East India visited Indonesia to get a better understanding of the Generasi Program, the visit was organised by the World Bank.

Generasi is an innovative Community Conditional Cash Transfer (CCT) launched by the Government of Indonesia in 2007. It is a multi-sector program that involves the Ministry of Village, Development Disadvantage Areas and Transmigration (MoV) with support from both the Ministry of Health (MoH) and Ministry of Education (MoE). The Generasi program is supported by the World Bank, the Australia Development of Foreign Affairs and Trade (DFAT) and the Millennium Challenge Account Indonesia (MCA-1).

Generasi addresses Government of Indonesia’s priority to accelerate achievement of Indonesia’s lagging Millennium Development Goals in maternal and child health, universal primary education, and poverty reduction. The Villages with assistance from trained facilitators and service providers use a participatory planning process to identify problems and challenges in the community. The Community then uses Block Grants (BGs) to create local solutions to meet 12 health and education indicators.

Target beneficiaries are pregnant mothers, children under 5 years of age, and children from 7-15 years of age. Current coverage areas are 11 provinces, 64 districts, 499 sub-districts and 5700 villages.

FOCUS OF THE STUDY: The Nagaland Health Project, which is funded by the World Bank, is implemented by the department of Health & Family Welfare, Nagaland. The Project has two components: 1) Community Action for Health & Nutrition and 2) Health System Development.

The component on Community Action for Health & Nutrition is to support community engagement and community implemented investments intended to impact on Health, Nutrition and Population. The component will support capacity building of various health committees and provide results-based financial resources for the community. The project will not duplicate existing activities of health system. Basing on this concept the main focus of the visit, including its objectives and activities in Indonesia are:

Objectives:

  • Obtain an understanding of the planning and implementation and procedures of the PNPM Generasi Program from government officials at the central, local and village government levels.
  •  Learn from the experiences and challenges faced in early stages of planning and implementation of the PNPM Generasi program from government officials and village communities.
  •  Learn from lessons shared by village communities and village governments in planning and implementation of Generasi financed projects.

Activities:

  • Drawing up of a schedule for meetings and discussions.
  • Meetings at the Ministry of Village office, Jakarta with officers and specialist from the Ministry of Village, Ministry of Health, World Bank and Generasi Team.
  • Meeting with District officials, Project officers of Province, Generasi Team of Province & District.
  • Field visit to observe how participatory planning process is used in the villages to identify problems and challenges.

OVERALL OVERVIEW: The beginning of this memorable trip was promising as the Final negotiation of the Nagaland Health Project between the Government of India and the World Bank had just been signed two days earlier. On the 6th Of November as we landed In Jakarta, Visa on Arrival was obtained without any difficulty. And as we made our way out Mr. E. Jan Surya Rama, the Event Organiser received us at the arrival gate and from this time on until we went back to the same airport, the most significant thing about the whole tour was effective management of time. Though we had a very busy schedule, to make sure that we benefit from the tour, short time-off for sightseeing and leisure time were according to the schedule which was impressive.

The study tour to Indonesia was held in two main parts of Indonesia: the city of Jakarta and the Malang district, which is located in the East Java Province.

On November 7, we had a workshop at the MoV Office Jakarta with the ministry officials, the World Bank and the Generasi team, in the course of the meeting a group of media personals interviewed their Director General Health and also Dr. Vizolie Suokhrie about the visit, which was publish in the paper1 the next day, after an initial discussion and information sharing session in Jakarta, the tour continued in Malang on November 8, where we had an interaction with the head of the district and program managers, this meeting with the district head was also highlighted in the Malang Voice2, Lunch was prepared for us at the office of the head of the District of Malang.

November 9-10, we observed some of the Generasi Sehat dan Cerdas (Generasi) program sites in several villages. On the 9th of November we visited a village health post, a community health post and a village hall where a demonstration of food preparation for underweight child was demonstrated, the sub-district head of office and the police chief of the sub-district also accompanied us in all this visits.

On the fourth day the 10th of November, we visited Pait village where we observed an FGD in progress by the house-wives forum, we also got to observe a pregnant mother class in session. Thereafter we visited another Village health post, where we observed health education class for ANC and another class on nutrition which was under way, earlier in the day, a group of house-wife club members presented a choreography on hand-washing with a catchy Hindi song.

The wrap up of the tour was held at the conference hall of Kartika Wijaya Batu Heritage Hotel on November 11 with the Generasi team and the World Bank. The World Bank was led by Mr. Derrick Maximillian Pfeffer and Ms. Patricia Astiani, World Bank Indonesia and Ms. Neesha Harnam, Health Specialist, World Bank DC. Mohamad Ikhwan Maulana Consultant Generasi, knowledgeably facilitated all our visits. Ms. Handewi Pramesti was the official translator for the entire tour.

CULTURE: Indonesia consists of hundreds of distinct native ethnic and linguistic groups. A shared identity has developed, defined by a national language, ethnic diversity, religious pluralism within a Muslim-majority population, despite its diversity, One cannot help noticing the harmony between the modern buildings and the historical ones, preserving the province’s historical identity. As much as preserving a national identity seems to be a priority respecting individual variances and religious, political, and personal liberties is cherished as well. Work time is very well planned and applied. Equality in rights and duties between men and women is strictly applied to the extent that no consideration of gender is put in mind when job tasks and nature are decided.

HUMAN RELATIONS: The hospitality and warm welcome we received starting from the officials in the Ministry to the people in the villages was heart warming and reflecting of the simple cheerful image. The sense of humour and how everyone was encouraged to interact in an informal manner was characteristic. Their humility and mutual respect for each other is worth emulating. All the people we interacted exhibit a sense of responsibility in their assigned works and other walks of life which was remarkable.

HEALTH SCENARIO: The effective presence of the House Wives Forum in all the villages we visited beside the dynamic health cadres reflects the belief in the integrated role of community participation and the practical application in the field of Public Health. It is very impressive that there is a strong inter-sectoral cooperation between various departments like Ministry of Village, Ministry of Health and Ministry of Education, this cooperation has trickled down to the grassroots level and the fruit of which can be witnessed in the success of the Generasi program.

POINTS OF INTEREST: What interested us most in this visit are three points:

  • House-wives playing a key role in the planning and execution of health action plans in the village and adding to that is the enthusiasm and awareness of the people of the project and accepting the challenges.
  •  The village chiefs playing an instrumental role in providing the logistic and budgetary requirement of the health action plans, when it cannot be managed by the GSC.
  • Health cadres and volunteers at all levels are highly motivated and knowledgeable about their job responsibilities besides the fact that they are not paid.

SIGNIFICANT LEARNING:

  • We learned from the visit that all the health problem identification in the village starts from the 10-15 household neighbourhood forum in the hamlets which is then brought to the village level where the house-wives club members along with the village and health cadres plan and prioritize their needs and challenges.
  •  The implementation of the program and services are systematic and well executed, for eg: a child is identified as underweight in a village health post by the midwifes through constant monitoring, this child is then taken over by the house-wives forum who are trained to prepared food as per required calories, and provided to the child at regular intervals.
  •  The Village chiefs who are instrumental source of resource generation for the plans and projects of the villages are giving their full cooperation for the success of the program.
  •  The project funding pattern in the villages are “open-menu”, so once a problem/challenges is identified and prioritised, the village chief along with other members helps in getting the fund from various other sources.
  • There is no penalty for low achievements of targets; instead if there is a low achievement of certain targets in a village, this target becomes the reference for achievement while planning for the following year.

CONCLUSION AND RECOMMENDATIONS:

This well organized and memorable tour came just in time for us to enhance our professional skills as health managers, our conceptual skills as a person, and gain an indepth understanding of the skills and lifestyles and also live experience of day-to-day life of a diverse foreign country such as Indonesia, just when the World Bank funded Nagaland Health Project is about to be scaled up. This is mainly why another study tour is strongly recommended in the early mid-phase of the NHP. As we will be able, not only to receive as in the first tour but also to participate and apply what we have learned. It is suggested that large scale dissemination workshop on participatory planning and community engagement basing on the Communitization act of Nagaland and inter-sectoral cooperation especially with the departments of Rural Development, Social Welfare and School Education be carried at all levels of government hierarchy as well as in the village level. Strategy workshop should take place and we could participate in a workshop with health managers and perhaps share experiences with them which maybe professional, conceptual or academic.

 

 

Bibliography /Reference

  1. Poskotanews, November 7, 2016 ,
  2.  Malangvoice.com, November 15, 2016

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