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Karin Hulshof wipes a tear away from a child who will soon
receive a health checkup at a local health post in West Jakarta. © Cory Rogers
/ UNICEF / 2017
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The line curls out of the door and into the alley, where dozens of mothers stand patiently, cradling newborns under an early morning drizzle.
“I’ll wait for the line to thin out and
take my baby in later,” Eka* told UNICEF East Asia and the Pacific (EAPRO)
Regional Director Karin Hulshof in her doorstep during Karin’s visit to
Indonesia last week, her first as EAPRO Regional Director.
Like other young mothers in this West
Jakarta slum, Eka looks forward to the opening of the posyandu (community-level health post) each month. “The difference
is I’m not so eager to get wet,” she laughed.
“At the posyandu I get my baby checked and vaccinated for free,” Eka said motioning
for Karin to come inside her house. Six people sleep cheek-by-jowl in the
one-room home each night.
Eka lives in one of hundreds of
informal settlements that have sprouted up due to accelerating rural-urban
migration rates in Jakarta. While these slums
can be vibrant zones of community life, they are typically poor, densely
populated, and located near riverbanks, where flooding is common and sanitation
is poor.
Combined with the fact that urban
migrants often lack the residency papers for accessing essential health
services like immunizations, these shantytowns are climates par excellence for outbreaks of vaccine-
preventable disease.
“It’s in the slums were the risk of
outbreak is highest, and the rate of immunization is lowest, said
UNICEF Child Survival and Development Chief Paul
Pronyk, who accompanied the Regional Director during her field visit.
“That makes it the most important site
for intervention efforts to protect children,” he added.
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Eka waits at the local health post in
Cengkareng, West Jakarta to take her youngest daughter for a health check- up.
© Cory Rogers / UNICEF / 2017
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Since
2015, UNICEF has been piloting a mobile health solution for boosting vaccine coverage for children between 12 and
23 months of age in several Jakarta shantytowns.
The initiative leverages Indonesia’s high levels of
mobile connectivity and the digital platform RapidPro
to introduce a number of key interventions.
During the first stage, local health
workers go door-to-door to register newborns. Then, over a series of months,
automated reminders are sent to parents and guardians about upcoming
vaccinations at local health posts (posyandu). A separate feature allows health
workers to record when vaccine stocks dip, permitting real-time monitoring of
coverage by Government officials.
Two years after
the intervention’s launch, progress has been strong: nearly 3000 infants have been reached, and the
programme has spread from Jakarta into dozens of urban districts in the
neighbouring provinces of East and Central Java. All enrolled health facilities, meanwhile, have
provided monthly updates on the stock levels of each of the six vaccines
monitored in the intervention.
The Regional
Director stressed the need to ensure that UNICEF continues to work with the
Ministry of Health to ensure the platform is “complementary and integrates with
national data systems”. Interoperability remains a prime aim of the
intervention.
“Given hthe igh degree of mobile
penetration in Indonesia, where there are more SIM cards than people, the time
is ripe to explore the potential of mobile health,” Pronyk said. “There’s
promising potential here for scale-up by our Government partners across a range
of initiatives,” he added.
Ibu Helvina, the head of the posyandu, reckons the mobile health
pilot is a big reason why the clinic is, as Eka pointed out, buzzing of late–
even on days when it rains.
“For mothers who have a tendency to forget
the [immunization] schedule, it really helps them,” she said. “And once we know
who they are and where they live, we go out and get them if they’re not here by
10am,” she said.
Such dedication and synergy between
community members and local health workers is indispensable to boosting low
immunization coverage, or indeed to addressing any health challenge, Karin
Hulshof said.
“The level of engagement here between
mothers, health workers and government officials was marvelous,” she added.
“It is hard not to feel like if all children
living in informal settlements [shantytowns] in Jakarta had access to the kind
of services here, the indicator [on low rates of immunization] will start to
come up,” she said.
Though grinding poverty and social
exclusion leave indelible marks, “there was a lot of heart on display here, a
lot dedication to improving the community,” she added.
“In the end, it’s the ‘human touch’
that makes the difference.”
