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4.1.2 BUDGET ALLOCATION
The main provision of Law No. 322004 on local government is to delegate fiscal responsibility to the district level sectoral offices Article 11. The budget allocation for district government is
stipulated by Law No. 332004 on the Fiscal Balance between the Central Governments and the Regional Governments.
Following the implementation of Laws No. 32 and 332004, which revise the original decentralisation laws, provincial and districtmunicipal revenues are derived from:
• The central government general allocation fund DAU, dana alokasi umum is a block grant to
local governments forming the basis for payments for civil servants and the general provision of services. It is designed to partially equalise the fiscal capacity among districts. Twenty-six
per cent of net central government revenue should, according to the law, be allocated to the DAU Article 27. The amount of DAU allocated to provinces and districts is calculated based
on the number of local civil servants Article 27, and on the discrepancy between the size of the population and geographic size, gross regional domestic product per capita and the
construction cost index, the human development index, and the levels of income and natural resource endowments at the local level Article 28.
• The central government special allocation fund DAK, dana alokasi khusus, is earmarked for specific purposes in particular regions Article 39. It is often allocated for development of
infrastructure needs. The DAK is allocated based on general criteria i.e., fiscal capacity of the local budget, specific criteria i.e., related laws and local socio-demographic characteristics,
and technical characteristic i.e., determined by related ministriesdepartment Article 40.
• Local government revenues PAD, pendapatan asli daerah such as taxes, revenues, levies, profits from properties, etc. Article 6.
• Natural resources and tax revenue sharing from the central government. These are called revenue sharing funds DBH, dana bagi hasil. Between 15-80 per cent of natural resource
revenues, such as from forestry, mining, fishery, and gas and oil, are now distributed to regional governments Article 11. Districtsprovinces rich in oil and gas such as Aceh and
Papua have especially gained from this reform.
• Grants hibah from foreign countries made through the central government Article 44. • Emergency funds dana darurat from the national budget are allocated in emergency
situations created by natural disasters or extraordinary events that cannot be handled by local budgets Article 45.
• Deconcentration funds dana dekonsentrasi are provided from the central government to the governor for functions associated with delegated deconcentrated authority from the central
government to the governor Article 87. • Co-administered task funds Dana tugas Perbantuan are funds for jointly implemented
activities between the central and local governments Article 94. Special Autonomy regions also have a Special Autonomy Budget Allocation Dana Otsus for a
defined time period from the central government, based on the Special Autonomy Laws enacted in Papua and Aceh.
Most local budgets at the districtmunicipal level comprise general and special budget allocations, and local revenues. Most provincial budgets comprise general and special budget allocations, and
deconcentrated funds. Local level budgets are jointly approved by the executive and legislative branches of local government and are enacted through local regulations according to Law No.
332004.
4.1.3 OFFICES RESPONSIBLE FOR DIFFERENT ASPECTS OF CHILD WELFARE
Under decentralisation, a number of different offices of government Dinas are responsible for improving particular aspects of child welfare.
The Ofice of Health Dinas Kesehatan at the provincial and districtmunicipal level handles most aspects of maternal care, child nutrition, disease and sanitation.
The Office of Education Dinas Pendidikan is responsible for ensuring children complete nine years of compulsory education, as well as improving graduation rates, continuation rates, and
improving quality of education.
The Office of Social Affairs Dinas Sosial is tasked with improving the welfare of abandoned children and protecting children from serious social welfare problems. This includes child labour,
children living on the street, children in orphanages, disaster victims and children with special needs. Children who suffer from domestic abuse are also the responsibility of the Office of Social
Affairs.
Alongside the Office of Social Affairs, the Office of Manpower Dinas Ketenagakerjaan is also responsible for dealing with child labour. This Office is authorised to monitor and ensure that
companies and factories do not employ children.
Children who are in conflict with the law are the responsibility of the police department Polda, Kepolisian Daerah, the prosecutions office and the courts.
Birth registration is the responsibility of the Bureau of Population and Civil Registration. In most provinces and districtsmunicipalities, such as in Yogyakarta, this bureau is structurally
responsible to the district and municipal Secretariats Sekda and does not fall under a technical implementing unitoffice. The bureau must ensure that every child born is registered.
In each provinces and districtmunicipality with a functioning Bureau of Women’s Empowerment, Child Protection and Family Planning BP3AKB, BadanBiro Pemberdayaan Perempuan dan
Perlindungan Anak dan Keluarga Berencana, child victims of human trafficking are the responsibility of that Bureau. The Bureau is responsible to the districtmunicipalprovincial
secretariat and coordinates with the Office of Social Affairs to run an integrated services centre PPT, Pusat Pelayanan Terpadu to deal with cases, such as child trafficking and early marriages.
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4.2 TACKLING MALNUTRITION IN EAST NUSA TENGGARA NTT:
A LARGE, DISPARATE AND POOR PROVINCE
4.2.1 INTRODUCTION
Section 4.1 discussed the regulation of the processes of development planning and policymaking under decentralisation. This case study focuses on malnutrition in East Nusa Tenggara NTT
within the decentralised context. The impacts of malnutrition are enormous and have broad effects on the health and social welfare, both of individuals and of society as a whole. The case
study examines the current status of malnutrition in NTT and endeavours to understand some of the contributing factors in context, as well as policy responses to the problem. This is not an
exhaustive sectoral review, but rather the discussion endeavours to highlight the challenges and space for innovation in the decentralised context.
Malnutrition is a particular problem in NTT, exacerbated by the geography and climate, particularly the unreliable agricultural yields, the difficulty in accessing health care in remote
areas, and local behaviours and cultural practices relating to the use of health facilities and consumption of nutrients. Examining the case study of malnutrition and health in NTT highlights
other contributing factors such as poor economic status, low education levels, customary nutrition practices and poor access to health services, which are all prevalent in the province. In
relation to the Millennium Development Goals MDGs on health and nutrition, NTT is well behind the national average, particularly in terms of underweight and wasting in children and, related to
this, child mortality. Not only are these indicators worse than at the national level but they have also seen little or no improvement in recent years. Disparity is key when studying the issue of
malnutrition in NTT, not only the disparity of the region as a whole compared to the national level but also the disparities between rural and urban areas, among districts and across social strata.
Secondary data sources were used for quantitative analysis
17
see annex 4.2, supplemented by qualitative data from focus group discussions FGDs and in-depth interviews with children
and their parents, medical practitioners and those working on the administrative side of health- care provision including civil servants and development agency employees. Two districts
were chosen for in-depth study to provide insight into the issues of malnutrition in NTT: more urbanised Kupang municipality and more rural Belu district. This allowed for comparison
between an urbanised and a remote community, as well as one in transition from conflict. In the discussion, in-depth interview and FGD data are useful for further elaborating on the relationship
between direct and underlying causes of death and malnutrition in the province in terms of diet, disease, household practices and living environment, as well as institutional service delivery
as it relates to the UNICEF conceptual framework for understanding malnutrition and mortality problems, as discussed in Section 3.1.
17 Most notably data from: Badan Pusat Statistik BPS - Indonesia 2008 National Socio-Economic Survey SUSENAS, Survei Sosial Ekonomi Nasional 2008; BPS - Statistics Indonesia 2007 Indonesia Demographic and Health Survey IDHS 2007; and Ministry of
Health, National Institute of Health Research and Development 2008 Basic Health Research Riskesdas, Riset Kesehatan Dasar 2007.
4.2.2 BACKGROUND
4.2.2.1 Geography and livelihoods Figure 4.2.1: East Nusa Tenggara NTT location map
Source: Center for Population and Policy Studies, Gajah Mada University, 2010
The province of NTT covers an area of approximately 2.49 per cent 47,349.90 km2 of the whole of Indonesia, and the landscape is comprised almost entirely of limestone mountains and hills.
18
The province consists of more than 550 islands, including the larger islands of Flores and Sumba, and the western portion of the island of Timor West Timor. Kupang municipality is the provincial
capital, which is located in West Timor. NTT has a dry, semi arid climate that is affected by the monsoon. The dry season is longer than in most other parts of Indonesia, lasting seven months of
the year May-November. The topography of NTT is hilly and mountainous, with very few flat or sloped areas appropriate for farming. These conditions make the region less fertile and drier than
other parts of the country, which impacts on agriculture and in turn on diet and nutrition levels, as well as economic output of the region.
The regional topography also shapes the customs and life choices of the population, including settlement patterns. People tend to build houses high on the rocky mountains, above the erosion
prone soils, but far from water and food sources. This in turn presents development challenges, since the difficult geographical terrains are an obstacle to providing accessible public services,
such as schools, sub-district community health centres puskesmas and hospitals, and lack of
18 BPS - Statistics Indonesia 2009 NTT Province in figures 2008, BPS NTT: Kupang
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THE SITUATION OF CHILDREN AND WOMEN IN INDONESIA 2000-2010 185
access to these facilities directly impacts on health and nutrition. This is reflected, for example, in low attendance by health professionals during delivery see Figure 4.2.13 later in this subsection
for the proportion of institution-based deliveries, and see also the detailed examination of this issue nationwide in Section 3 of this document.
NTT’s economy is dominated by agriculture, which accounts for 35 per cent of GDP and is based almost entirely on smallholders.
19
The vast majority 89 per cent of NTT’s population are farmers; 79 per cent of them are dryland farmers who cultivate corn as their main crop. These
farmers are vulnerable since their income generating activities rely on infertile soil, which is susceptible to draught, placing the entire province at high risk of food insecurity.
20
Agriculture in NTT is largely based on subsistence farming and ground crops, with the majority of farmers
cultivating maize, followed by wetland rice, cassava, and dryland rice. Other food crops include dry season vegetables, which grow well in much of NTT. Tree crops are largely grown as cash
crops. These consist primarily of coconut, cashew nut, candlenut and coffee. Forests in NTT occupy an extensive 1,800,000 hectares, but this is mainly for conservation purposes, with sparse
growth in the dry climate.
21
The average yields per hectare of all food and tree crops are low, and there is great potential for enhanced production
22
. This should certainly be addressed in long- term development projects, and represents a promising opportunity for economic and nutritional
improvement.
Subsistence agriculture is highly susceptible to the frequent price increases for staple foods and for oil that occur in Indonesia, following national and global market trends. This has had a
substantial impact on transportation costs and non-staple food prices during the last decade, deepening the state of poverty of rural people who live in the more remote districts, such as
Sumba Barat, Timor Tengah Selatan, Timor Tengah Utara, Lembata and Manggarai.
Livestock are also a significant source of income and food, with widespread farming of cattle, pigs, goats and poultry. Cattle are largely farmed for cash and other livestock are kept partly for
domestic purposes, partly for income generation.
23
Here too, production eficiency is low, and there is major potential for improvement with obvious implications for improving nutrition in the
region, both directly and via economic means.
All crops and livestock are sold for cash once domestic needs are met, and key cash crops each have specialised marketing facilities. Not recognised by those living in NTT as nutritious, foods
like beans, eggs, fruits and vegetables are often sold, the money being used primarily to purchase rice, adding little nutritional value to the usual existing food stocks of corn and cassava.
24
Programmes to educate communities about the nutritionional value of such products could prove a valuable means of boosting nutrition using existing resources. Crops and livestock are sold in
local periodic markets, which are often hard to access. Barter is also common and farmers may, for instance, exchange corn for chickens or vice versa. While competitive pricing often prevails,
the potential for raising producers’ market returns are a concern for economic development.
19 Muslimatun, S. and Fanggidae, S. 2009 A brief review on the persistence of food insecurity and malnutrition problems in East Nusa Tenggara province, Indonesia
, Oxfam Working Paper No. 12: Kupang, NTT 20 Ibid.
21 Kana Hau, D. et al. 2007 Pengkajian pengembangan teknologi konservasi lahan untuk peningkatan halis usaha tani di lahan kering Kabupaten Ende: Laporan akhir,
Balai Besar Pengkajian Dan Penengembangan Teknologi Pertanian, Badan Penelitian dan Pengembangan Pertanian, Departemen Pertanian: Kupang, NTT
22 Barlow, C. and Gondowarsiot, R. 2007 Economic development and poverty alleviation in Nusa Tenggara Timur, Working Paper, Department of Political and Social Change, RSPAS, Australian National University, Canberra and Nusa Tenggara Association: Canberra
and Kupang 23 Ibid.
24 Stuttard, J. 2008 Nutrition assessment report: NTT Province, TTS District, Action Contre le Faim Indonesia: Timor Tengah Selatan, NTT
4.2.2.2 Demography The population of NTT province is estimated to be 4,534,319, with the vast majority living in rural
areas 83 per cent.
25
As shown in Figure 4.2.2, the population is characterised by a relatively large proportion of people under the age of 30, and in particular is skewed towards the under-15
age group, reflective of the high birth rate in this region, clearly a region in a phase of population growth. For NTT, having a large ‘productive population’ aged between 15 and 50 years to
support a relatively small older population is economically beneicial. However, to counter this, the particularly large group of children under age 15 years does put a high burden of care and
support on this productive segment of the population. Lots of mouths to feed mean that the limited food stocks are spread thin, often limiting calorie and nutritional intake to such an extent
that there are serious health implications, particularly for young, growing bodies.
Figure 4.2.2: Population pyramid, NTT 2005
Source: Badan Pusat Statistik BPS - Statistics Indonesia, Intercensal survey 2005
The population of NTT continues to grow year on year. The rate of growth, however, has been decreasing slightly over the past five years, from 1.97 per cent in 2005 to 1.84 per cent in 2009.
26
Related to this, the total fertility rate
27
TFR is also high and has being steadily decreasing, albeit slowly, from 2.99 in 2005 to 2.8 in 2009.
28
These are above the national TFR levels for those years, which were 2.2 and 2.16, respectively.
29
The religious make up of NTT is atypical of Indonesia, with a predominance of Christians living in the province. There are about 56 per cent Catholics, 35 per cent Protestants, 8 per cent Muslim,
0.6 per cent Hindu and Buddhist, and the rest still follow their traditional systems of belief, most notably Marupu.
30
Customary systems and practices strongly influence the way of life of those living in NTT, including customs surrounding nutrition and food, which will be outlined more in
the subsection on the contributing factors to malnutrition Section 4.2.3.2.
25 BPS - Statistics Indonesia 2009 Report based on the Intercensal Survey SUPAS 2005: Jakarta 26 Ibid.
27 Children born on average to one woman over the course of her reproductive life 28 BPS - Statistics Indonesia 2009 Intercensal survey 2005
29 Ibid. 30 Ibid.
Male Female
Age Groups
75+
0.3 0.2
0.1 0.0
0.1 0.2
0.3 70-74
65-69 60-64
55-59 50-54
45-49 40-44
35-39 30-34
70-74 25-29
20-24 15-19
10-14
5-9 0-4
Population ’000,000
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