Surfaid Nias

Field Monitoring EPREP

2009-08-28T19:19:00.000-07:00

Community movement for total sanitation

2009-06-11T03:39:00.000-07:00

Updates Jan - march 09

2009-06-11T01:23:00.000-07:00

Nias CBHP updates

View more OpenOffice presentations from declanhearne.

Malaria team deliver nets in the Hinako Islands

2009-05-16T19:39:00.000-07:00

A Second Chance

2009-05-07T03:08:00.000-07:00

Priska lost her mother two years ago because of serious illness. Her mother died leaving Priska and her sister in the care of their father who unfortunate hasn’t provided much care for the children. Priska is the youngest and since the death of their mother the lack of god parent has left her withdrawn and of poor health. Ina Eni is Priska’s grandmother and up to recently she hadn’t taken a lead role in looking after the 2 children. When Ina Eni hear about the SurfAid Pos Gisi a change began. Ina Eni told us how the Pos Gizi has played a formative role in changing how she cares for Priska of her second chance as she see it….

A second chance at parenting

“ My name is Ina Eni. I’m so glad with all that SurfAid has helped in our village.. Why am I so happy? It is because of SurfAid that I realize that I did not really know how to care for my grandchildren. But since SurfAid came, they thought me from how to maintain cleanliness, how to give a balance meal to a child and how to treat the child in a caring and supportive manner. What I have learnt from SurfAid has really changed how I care for my grandchild Priska.”

“Previously her meals schedule was not arranged, when she was hungry she would come looking for food and she could it what ever was left over from the last meal, but now I begun to be arrange her food first, then we eat after her. Her meal schedule is arranged carefully. In the morning around 6 am and again at 10 am she eats egg or porridge, then at 12 pm she having complete lunch with some vegetables and meat if we have it. Then before get dinner she is given a snack like sweet potatoes or bananas. With the increased focus on regular meals her appetite has also steadily increased.”

“The changes in her behavior since we joined the pos gizi are very real. Like washing hands, before she never washed hands at all, but now she is so used to wash hands before meals, that it is not only me who feels unhappy about unwashed hands. Priska demands that we wash hands before every meal and she also now brushes her teeth after eating.”

“After learning about the importance of good hygiene and keeping a clean home, we try to keep our home more clean and neat. In my kitchen for my whole life there have always been plenty of insects and spider webs but now it is all been cleaned. I clean to make sure, my grandchild can have the best chance to become more healthy and more cheerful and Priska responding. Through the Pos Gizi she has developed her health first and now her sing voice. She loves to sing the health songs like the hand washing song taught by the SurfAid staff in the pos gizi. To ensure Priska’s stay healthy I will try as good as I can to apply all health message which I learnt in Pos gizi.”

“Thank you to SurfAid for serving us well. My hope is the pos gizi could be continued in our village and also that SurfAid don't get tired to educate us and giving even an old lady like me a second chance”

Listen to the Pos Gizi song on the Nias blog. This is an amateur staff video from a recent training in Teluk Dalam. While the picture quality is not great the sounds capture the sprit of the volunteers who through song are leading behavior change across Nias. Songs are key in traditional Nias culture for passing on learning and enforcing cultural norms. The Nias pos gizi was composed during a care group training. It focuses on telling mothers to bring their children to pos gizi to gain their strength.

Come on re-strengthen your arms,

and your tired knees

then look at the straight road to go

so that would be still stable what have been tired…

Footnotes

Ina Eni was interviewed by Mawar, CF for Sirombu and Hepi admin Officer for Nias. The Community Based Health Program in Nias is funded by NZAID. Story was edited by Declan hearne. All photos by Declan Hearne

In the Hearth approach, community volunteers and caregivers of malnourished children practice new cooking, feeding, hygiene and caring behaviors shown to be successful for rehabilitating malnourished children. Volunteers actively involve the mother and child in rehabilitation and learning in a comfortable home situation and work to enable the families to sustain the child’s enhanced nutritional status at home. The Hearth session (Pos Gizi) consists of nutritional rehabilitation and education over a twelve-day period followed by home visits to the caregivers by volunteers. After two weeks of being fed additional high-calorie foods, children become more energetic and their appetites increase. Visible changes in the child, coupled with the “learning by doing” method, results in improved caregiver confidence and skills in feeding, child care, hygiene and health-seeking practices.

NZAID monitoring visit to Nias

2009-04-22T04:45:00.000-07:00

NZAID conducted an end of program monitoring visit to Nias CBHP at the start of April for 3 days. The monitoring visit was lead by Merinda-Lee Hassell from the Wellington head office and Gloriani Panjaitan of NZAID Jakarta. Andew Judge SurfAid’s Chief Operating Officer also joined the visit.

The visited focused on high level meetings with key stakeholders and decision makers in both the districts of Nias and Nias Selatan along with visits to Puskesmas and villages to see Pos Gizi Session and the completed WATSAN facilities.

Meetings in Nias were held with Bappeda, Dinas Kesahtan , UNORC & BRR, ACTED & World Relief. An evening meeting was also held with the Bupati at his personal residence. Meetings in Nias Selatan were held with UNORC, SRC & PMI health along with a lunch meeting with heads of government Nias Selatan focused health coordination.

The village visited to Hilamaetaluo was the highlight of the visit with NZAID being able to spot check on four pos gizi sessions across the village. Each session was being managed by the community cader and each was model for transparency, accountability and community lead actions. After visiting the Pos Gizi Session and Watsan facilities the donors met with the village leaders, elders and stakeholders who were all delighted to host the visit and continued to demonstrate their great support for the health activities in their village.

Feedback from the donor was all extremely positive and is seen as validation of the results now evident from the Pos Gizi sessions, the Nias team spirit and great collaboration with local communities.

Merinda-Lee reported that “It was super to see first hand the Community Based Health Programms and the implementation of the PD Hearth approach. It is a very dynamic programme and great to see the commitment of the villages in educating and improving the health of their children.”

The NZAID team were really appreciative for all the effort and enthusiasm that went into making the visit happen and enjoyed meeting the SurfAid team and learning about our challenges and successes. On behave of the Nias team the only disappoint was that the donors could not visit more villages – but the team remains hopeful that other visitors from within the SurfAid community and beyond will visit to see their efforts and success over the coming months as CBHP I draws to a close.

Brothers join the fight against Malnutrition

2009-03-15T22:14:00.000-07:00

In Nias, current malnutrition rates are 39% over twice the national average for Indonesia. One of the biggest challenges facing these communities is understanding basic health care practices and ensuring good nutrition for children under five years. Segera Wa’u (Sege), tells us his story.

My family

“My name is Segera Wa’u (Sege) and i am 17 years ol. I am the one and only male teenager cadre from Hilisalo’o, Botohilitano village, Nias Selatan.”

“Since my father has recently passed away I have started to look after my youngest brothers Lakhemi, is 44 months and Sultan, 32 months. They are the ninth and tenth children my mother Ina Mardi has given birth too. When the SurfAid facilitators Mutiara Sihombing and Yustisia Wa’u approached my mother to join the Hearth rehabilitation session she could not see any point and refused to participate. But to me there was something unique and unusual in the Hearth sessions facilitated by SurfAid International. I had never seen NGOs work directly with poor mothers like that before in our village.”

Looking in from the outside

“After a few days of the Hearth session, I observed that the Hearth session was good for the weaker children like my younger brothers, Sultan and Lakhemi. On the sixth day of the Hearth, while my mother was out, I brought my two brothers and two cans of rice (approx ½ kg) as our contribution to participate in the Hearth with the other mothers.”

“The other caregivers and Hearth cadres (formal volunteers) welcomed us to join the Hearth session. They all know my families condition and thankfully asked me to only bring firewood next time so I didn’t have to bring rice, which I didn’t have anyway! Everyday I brought firewood and coconut which I collected from our coconut trees. After the second week Mutiara and Ina Anugrah the head cadre asked me be a Hearth cadre, this was a real honour for me.”

Family Impacts

“When my father passed away I knew my mother would not have the heart to look after all of us. What I saw SurfAid doing was good and I wanted to join in. I have now learnt how to cook healthy meals from local ingredients which cost nothing extra to our family. It was difficult to mange Lakhemi and Sultan at the being but seeing the care and additional food they got kept me motivated. At home too it is having positive impacts. We now know and understand the importance of hygiene and hand washing and we are keeping our home cleaner than before.”

"But best of all my two little brothers have both gained weight, Sultan gained 800 grams and Lakhemi 900 grams over the last two months. They both are no longer several malnourished and they are both cleaner, more energetic and friendly with other kids. If SurfAid did not help us, I don’t know what would be of them now. Thank you SurfAid!"

Segera Wa’u was interviewed by Herry Napitupulu is the Senior Community Facilitator for Nias Selatan. Muturia and Yustisa are two of 6 Community Facilitators working with SurfAid to rehabilitate 50% of the 419 malnourished children in the SurfAid partner villages of Nias Selatan by June 2009. The Community Based Health Program in Nias is funded by NZAID. Story was edited by Declan hearne.

Pos Gizi Song

2009-03-10T01:33:00.000-07:00

This is an amateur staff video from a recent training in Teluk Dalam. While the picture quality is not great the sounds capture the sprit of the volunteers who are leading behavior change across Nias. Songs are key in traditional Nias culture for passing on learning and enforcing cultural norms. The Nias pos gizi was composed during a care group training. It focuses on telling mothers to bring their children to pos gizi to gain their strength.

Come on re-strengthen your arms,

and your tired knees

then look at the straight road to go

so that would be still stable what have been tired…

The United Nations Solution Exchange platform

2009-03-09T21:08:00.001-07:00

Based on an initiative by the United Nations, the Solution Exchange platform has garnered praise from around the world as an innovative way of harnessing global and in-country expertise, practice and institutional memory. By creating multi-stakeholder Communities of Practices (COPs) through a virtual network, this expertise and memory fosters learning and real-time “solutions” to a vast range of problems and challenges as identified by government, partners and others in each COP. This process, in turn, accelerates the pace and quality of targeted advice, analysis and prescriptions that otherwise depend on physical committee meetings or field assessment missions.

SurfAid is an active particpant in the Health and Nutrition community. Below is a extract from one recent contibution from SurfAid throught Solution Exchange platform. It focuses on our integrated approach towards Dasa Wisma and Posyandu using the Care Group Model.

SurfAid have been implementing the Care Group Model in Nias for over two years. The program is entitled Community Base Health Program (CBHP) and is funded by NZAID. The Care Group Model is very similar to the Dasa Wisma structure under PKK. At the village level we integrate both with Dasa Wisma and Posyandu. WATSAN is also integrated with the CBHP.

Lessons Learnt

In the process of delivering the program SurfAid has absorbed some valuable lessons which can be informative to future program designs. Key lesson to caders and household visits include:

Up to six months, before the beginning of the program, should be invested in the initial socialisation and community organizing processes to create a supportive environment that is embraced across the community by all stakeholders and households. This time frame can help to secure better active cadre participation and to overcome barriers that inhibit volunteers from confidently making household visits from the outset of the program. A community-wide approach is required, and should not be focused solely on the election of care group volunteers, but should include the identification of roles and responsibilities of other key stakeholders and of individual household members.

The practice of household visits lies at the core of successful care group programs in other parts of the world. In Nias, making house visits is sometimes culturally difficult. Consequently it is necessary, to firstly understand the local culture with regard to household visits and secondly to find ways of making these visits easier. In CBHP the focus is on nutrition, and the introduction of PDI-Hearth has especially been successful in this regard and has helped build strong relationships between volunteers and the mothers who form the target group. Future project design should include PDI-Hearth as early in project activity as is feasible. Posyandu revitalization is critical prior to the implementation of PDI-Hearth to ensure other treatable illnesses do not inhibit rehabilitation of malnourished children.

· Incentive systems are challenging generally, and in the Nias they have been particularly challenging. Most villagers receive handouts or payments for the work they do from government reconstruction projects, and often from other NGOs. SurfAid does not promote incentives but focus on rewards for achievement of community goals. There is a need to agree upon types of rewards early in the project and ensure their agreement is in writing and with multiple levels within communities. Rewards should be for group achievement of community agreed targets, and not given out simply for being elected as a volunteer or for attending care group meetings.

For sustainability we focused on developing relationships with a wide range of key stakeholders. This has been achieved through:

· Establishing a series of formal stakeholder meetings, including representatives from the Bupati’s office, health departments and other official groups;

· Placing specific emphasis on developing relationships with the health departments;

· Working with local health department staff at Puskesmas and community level, focusing on revitalization of Posyandu services and up-skilling of key staff and volunteers.

The sustainability of CBHP inputs relies on care groups continuing to be active, and also on support from their communities, particularly from key stakeholders. SurfAid has focused on Posyandu for the process of delivering sustainability, at the same time as community health services centres. Communities generally support Posyandu, as they can see the benefits to their children (and themselves, in the case of pregnant women or new mothers). The focus on nutrition has demonstrated that there remain problems of malnutrition in almost every community. And the implementation of the hearth rehabilitation program, together with the establishment of a database for individual children, provides an invaluable opportunity for communities to see the practical benefits of their commitment from participation in CBHP.

Delivering an improved, high quality Posyandu service has already had the effect of galvanising communities through shared health-related objectives. Increasing the commitment and participation of health department staff, and improving the level of support throughout targeted communities, will be key objectives for the remainder of the current CBHP, and for any future programs.

Integrating Water and Health

2009-01-11T23:26:00.000-08:00

Improving access to water or sanitation can be worthless if community health practices remain unchanged. Our water components have empowered and strengthened local capacities through the introduction of sustainable, replicable techniques for well rehabilitation, water supply improvement and household toilet prototypes. Meanwhile health behaviour change is enabled through Care Group volunteers, drama shows and other interactive activities held across the communities. SurfAid has also piloted community-led total sanitation (CLTS), a process to inspire and empower rural communities to stop open defecation and to build and use latrines, without being offered external subsidies. SurfAid looks to make donor funds work harder, with communities required to address open defecation in return for improvements in drinking water facilities.

For an overview of our work in water and saniation pls download our Watsan Report Card for 2008.

Island spirit prevails as vaccinations finally arrive

2008-12-02T19:34:00.000-08:00

Can you imagine your child without any immunizations? They would be even more vulnerable to a range of preventable diseases such as measles, rubella, polio, tetanus, diphtheria, viral diarrhea and more? Early this year, across the Hinako Islands, there was outbreak of measles and it spread rapidly from Bawa to Asu. Children had not been immunised. Indeed until June of this year the children of Hinako Islands had not received any vaccinations since the March 2005 earthquake.

Since the 2005 earthquake the communities of the Hinako suffered more than most. The earthquake lifted the islands by up to 3 meters, raising the majority of wells above the water table, while saline intrusion of sea water contaminated other wells. This not only severally disrupted access to fresh water but also badly affected coconut production, the only livelihood on the islands apart from fishing. This led to caused a collapse of the local economy and, with offers of reconstructed houses from aid agencies on the main land of Nias, many islanders choose to forgo their island ways and try a new life on Nias. For those that remained life has slowly found a rhythm again but basic services have remained in a very poor state.

The Care Groups established under the Community Based Health Program have started to fill two gaps; providing basic health skills and rebuilding the social fabric of the communities. Firstly the provision of knowledge and skills to practice healthy lifestyles is helping ensuring their children don’t succumb to preventable illnesses. The reduction of open defecation, proper hand washing, better cooking practices and exclusive breastfeeding are all leading to reduced occurrences of diarrhea infection in children. Nutrition gardens are boosting children’s nutrition levels by ensuring basic vegetables are available at the doorstep of homes. But despite these advances, vaccinations remained a two hour boat ride away in the health centre in Sirombu, on mainland Nias.

In May SurfAid commenced a Posyandu revitalization drive across Nias and the Hinako Islands. SurfAid staff educated the Care Group, Pustu (health post) officer and community stakeholders on the Posyandu service provided by the government. It was shocking to reveal the lack of understanding of their rights, but also the lack of understanding of their responsibilities to organize and call for Posyandu.

Staff explained how Posyandu must be for the people, from the people, by the people and that revitalization started with the community taking ownership and leadership in managing Posyandu. SurfAid shared experiences from across Nias and encouraged the community to go and make an official request for immunization from the Puskesmas.

Surf Aid worked with the community to prepare request letters for Puskesmas and helped compile the data of all children under five from the islands. SurfAid also helped build relationships between health staff and stakeholders at village level, and a few weeks later the Puskesmas agreed to provide immunizations, but required the islanders to collect the vaccination and transport themselves. The time came and a day before the Posyandu was to be held on the island, Amapira, the islands’ Health Post officer set of with the SurfAid staff to collect the vaccinations. As all good stories go, there was a twist. When they arrived at the Health Centre they found that the head had left the area and the vaccination chest was locked and no one else had a key. When word got back to the islands there was dreadful disappointment and frustration as many mothers had traveled from the other islands to the Posyandu location. In true island spirit they rallied on and the following month every thing was prepared again, and this time vaccinations were delivered. For the first time in three years the islands’ children received their due vaccinations.

Hinako archipelago consists of 8 islands. SurfAid is supporting Care Groups on the 4 main islands; Hinako, Bawasawa, Simana and Asu. Logistical and budgetary challenges to ensure regular vaccinations to the islands remain and SurfAid is continuing to work with Health staff and communities to try find ways to sustainable overcome the these challenges.

Care Group Sutainability: funding the future

2008-11-24T01:45:00.000-08:00

It all began after Care Group ACC won an oven in the village celebrations for Indonesian Independence Day. The following week in their Care Group meeting they discussed what to do with the oven. The Care Group volunteers decided to use the oven to fund raise through the baking of coconut and rice cakes to sell to the community. The money collected was then used for social activities such as visiting vulnerable households and providing condolences to families. Through the cake selling they eventually collected Rp 750,000,(US$75) and started to use this as a revolving capital for sharing short term loans to Care Group members.

Care Group volunteers often have to walk long distances to reach their group meeting and so SurfAid had also agreed a policy to provide Rp 30,000 (US$3) to cover the costs of small snacks and water for each Care Group meeting. The ACC Care Group members negotiated with the SurfAid staff to put this small resource to better use. It was agreed that the Care Group would provide snacks from local resources, such as cooked banana or taro, and the SurfAid contribution would be used to increase their capital.

One year later the capital stands at Rp 1,350,000 (US$135) and thirty members are now benefiting from a revolving loan system which is funded from this capital. The Care Group have agreed to charge 3% interest every 3 months. Every Care Group member has the right to borrow a loan and loans are prioritised for urgent needs such as for medical treatment or educational needs for their children.

The ACC-Care Group dream of forming a Care Group Cooperative and through their activities, they wish to continue meeting, learning and discussing health messages and to carry on promoting these health practices in their communities long after Surf Aid moves on.

Care Group ACC is in the remote village of Bitaya, Alasa in the interior of Nias Island. It is a two hour walk through mosquito infested swamps and forest to the nearest road. To dat,e across the Island of Nias, there are 13 Care Groups who have established similar revolving loans schemes. These are examples of some of the indirect benefits being achieved under this Community Based Health Program.

Hearth Session's start in Nias

2008-11-13T23:32:00.000-08:00

In the Hearth approach, community volunteers and caregivers of malnourished children practice new cooking, feeding, hygiene and caring behaviors shown to be successful for rehabilitating malnourished children. Volunteers actively involve the mother and child in rehabilitation and learning in a comfortable home situation and work to enable the families to sustain the child’s enhanced nutritional status at home. The Hearth session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits to the caregivers by volunteers. After two weeks of being fed additional high-calorie foods, children become more energetic and their appetites increase. Visible changes in the child, coupled with the “learning by doing” method, results in improved caregiver confidence and skills in feeding, child care, hygiene and health-seeking practices.

Selection of Photos from CBHP

2008-11-09T19:01:00.000-08:00

CBHP Photos

Watsan progress

2008-08-30T20:19:00.000-07:00

Positive Deviance Hearth Approach kicks off in Southern Nias

2008-08-08T18:47:00.000-07:00

The Positive Deviance/ Hearth Approach is a proven community based nutrition rehabilitation program that sustainably addresses childhood malnutrition in resource poor settings. The approach identifies and shares solutions (practices) already being used by community members with well nourished children who have no access to special resources (positive deviants). Through identifying and using demonstrably successful local practices and resources and promoting behavior change by doing, caregivers and communities are empowered to take responsibility for nutritionally rehabilitating and maintaining good growth and health in their children. The PD/Hearth Approach can be implemented as a stand alone program but benefits greatly from established relationships and strengthened community and health structures when integrated into ongoing child survival or multi-sectoral development initiatives.

the "Most Significant Changes"

2008-08-05T20:13:00.000-07:00

Translations of the "Most Significant Changes" Guide

This blog is maintained by Rick Davies, and is part of the MandE NEWS website. The purpose of this blog is:
1. To make available translations of the MSC Guide in languages other than English.
2. To solicit and share comments on the quality of these translations, so they can be improved.

The original English version can be found here The ‘Most Significant Change’ (MSC) Technique: A Guide to Its Use

Nias Local Drama Road Show is ‘the chic way’ of Sanitation Promotion

2008-06-10T18:51:00.000-07:00

Watsan UNICEF Drama Shows

The drama was playing by PUSAKA-SURFAID drama team, it is simply sending the messages to keep the environment and body clean, wash the hand with soap, not the defecate in open area and prevention activities from worm sickness and diarrhea which was attracted by many people including children. More than a hundred people consist of youth and children in each village were watching, observing and enjoying the drama playing. The word sanitation is spreading and improving people awareness. It is very chic way of sanitation promotion. ‘aine ono sonikhe, aine ai bale’ (hand washing song in Nias language ended the show)

Source: Unicef