PERCEPTION OF MOTHERS AND CHILDREN’S PARTICIPATION IN THE NUTRITIONAL PROGRAMS
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
PERCEPTION OF MOTHERS AND CHILDREN’ S PARTICIPATION
IN THE NUTRITIONAL PROGRAMS
( Persepsi Ibu dan Part isipasi Anak dal am Program Gizi )
Dadang Sukandar 1 and Ali Khomsan1
ABST RAK
Penel it ian ini bert uj uan unt uk menget ahui persepsi masyar akat t erhadap pel ayanan
pr ogram gizi ser t a menganal isis par t isipasinya dal am pr ogram posyandu. Disain penel it ian
ini menggunakan cross-sect ional dengan sampel rumah t angga yang memil iki anak bal it a.
Sampel yang diambil sebanyak 300. Pemil ihan sampel dil akukan secara acak berl apis
(st rat if ied random sampl ing). Penel it ian ini dil akukan di dua kecamat an di Kabupat en
Cianj ur yang dil akukan pada t ahun 2006-2007. Dat a yang dikumpul kan meliput i j enis pel ayanan gizi, persepsi t erhadap program gizi dan part isipasi dal am pr ogram gizi. Dat a
diperol eh mel al ui wawancara. Dat a hasil wawancara dient ri menggunakan sof t ware excel .
Dat a dianal isis dengan SAS (St at ist ical Anal ysis Syst em). Hasil penel it ian ini menunj ukkan
bahwa para ibu berpendapat bahwa pr ogram PMT dan penyul uhan gizi harus l ebih diperbaiki. Juml ah dan ket erampil an kader cukup memadai, namun kahadiran bidan di
posyandu kurang mencukupi. Program imunisasi bagi bal it a diikut i dengan baik ol eh para
ibu bal it a. Terkait pel ayanan di puskesmas, sebagian besar ibu mengel uhkan wakt u ant ri
yang l ama dan f rekuensi kehadiran dokt er yang kurang. Part isipasi bal it a dalam mengunj ungi posyandu rel at if baik (92.4%). Lebih dari 90% bal it a, baik yang sering maupun j arang
mengunj ungi posyandu t el ah menerima kapsul vit amin A. Pel ayanan posyandu yang sangat
dirasakan ol eh masyarakat adal ah penimbangan bal it a dan imunisasi.
Keywords : persepsi, part isipasi, program gizi
INTRODUCTION1
Background
Nat ional ef f ort s in improving nut rit ion in
Indonesia have been running f or t hirt y years
and are st ill f ocused on t he maj or problems of
nut rit ion, namely, prot ein energy malnut rit ion
(PEM), vit amin A def iciency (VAD), iron anemia
and iodine def iciency disorders (IDD). Nut rit ional improvement has succeeded in reducing
t he f our maj or nut rit ional problems, but is
considered as inef f icient because it is closely
relat ed t o t he ef f iciency of cross-sect or ef f ort s
such as povert y elevat ion. Hart oyo, Ast ut i,
Briawan, and Set iawan (2000) st at e t hat nut rit ion programs need support s by making ef f ort s
in improving mot ivat ion, knowledge and skills
of cadres, part icipat ion of f amilies and public
f igures so t hat f acilit ies and inf rast ruct ure of
nut rit ion programs provided by t he government can bring out opt imal result s.
One goal of t he nut rit ion program is t o
improve t he st at us of communit y nut rit ion
geared t o t he improvement of int elligence and
1
Lect urer on Depart ment of Communit y Nut rit ion,
Facult y of Human Ecology, Bogor Agricult ural
Universit y (IPB).
26
work perf ormance t o support t he improvement
of human resource qualit y. Anot her obj ect ive
is t o reduce t he rat e of nut rit ional diseases
(PEM, VAD, iron anemia, and IDD), which are
in general experienced by a low income societ y (poor household) in rural and urban areas
especially children under f ive and pregnant
women. The obj ect ive support s at t empt s in
reducing t he inf ant mort alit y rat e, children
under f ive, and mot hers. The program also
support s t he improvement of t he st at us of
communit y nut rit ion in general by improving
t he pat t erns of f ood consumpt ions t o become
more diverse, balanced and nut rit ionally qualif ied. Such improvement of consumpt ion pat t ern is also required f or a group of people wit h
t he high risk of some degenerat ive diseases,
who t end t o increase in number (At marit a &
Fallah, 2004).
The nut rit ion program at dist rict level is
a part of nat ional nut rit ion program. The nat ional policy of nut rit ion program consist s of 4
sub programs: program on prot ein–calorie malnut rit ion, program on iron-anemia, program on
vit amin A def iciency, and program on iodine
def iciency.
There are some variat ions in achieving
t he program obj ect ives at dist rict level. Our
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
discussion wit h st af f of Healt h Of f ice in Cianj ur Dist rict (February 10, 2006) showed t hat
even all programs have been implement ed;
t he communit y st ill has problems relat ed t o
nut rit ion. Implement at ion of nut rit ion program
at communit y level is t hrough Posyandu.
Posyandu has f unct ioned as t he spearhead f or all t he nut rit ion and primary healt h
care services provided by healt h cent res and
sub-cent res now present in every sub-dist rict
and village (Jus’ at , 1992). Thus, Posyandu
f unct ions as an inf ormal-ref erral syst em of
communit y part icipat ion t o rural healt h cent res and sub-cent res. Posyandu makes t he "unreachable" children and mot hers "reachable".
The occurrence of malnut rit ion is of t en
overlooked f rom our common observat ion, but
a closer look will indicat e high deat h rat es of
mot hers, babies, children under f ive, and a
low lif e expect ancy. Alt hough nut rit ion programs have long been in operat ion, t he problems of malnut rit ion st ill happen everywhere.
Goals and Obj ectives
1.
2.
The obj ect ives of t his research were :
To f ind out t he mot hers’ s percept ion of
nut rit ion program services.
To analyze children’ s part icipat ion in
Posyandu program (Healt h and Nut rit ion
Int egrat ed Service Cent er).
METHODS
Design
This research used a cross-sect ional design. The research was carried out in t wo subdist rict of Cianj ur, t he Province of West Java.
The research was conduct ed in 2006.
Sampling
The populat ions st udied in t his research
are having children under f ive years old and
300 of t hem were t aken. The populat ions were
select ed in t wo subdist rict s of Cianj ur Dist rict ,
West Java. Those subdist rict s are t he areas
wit h a high port ion of poor populat ion and
many of t hem ut ilized t he nut rit ion programs
of f ered by t he government .
Samples were t aken t hrough st rat if ied
random sampling wit h proport ional allocat ion
where high and low f requency visit st and as
st rat um. Sample size was also proport ional
wit h respect t o posyandu size.
Cianj ur Dist rict was select ed since t here
were variat ions in nut rit ion program implement ed and variat ions in achieving t he program obj ect ives (Personal Communicat ion wit h
St af f of Healt h Services, Cianj ur, February 10,
2006). The t wo subdist rict s were chosen t o
increase het erogeneit y of samples, so t hat t he
perf ormance of nut rit ion program was t ruly
represent ed by t he select ed samples.
Data collection
Dat a collect ion consist ed of ut ilizat ion of
nut rit ional program, nut rit ion service and acces t o services of nut rit ion pograms. The
secondary dat a involved coverage of nut rit ion
programs. The primary dat a were collect ed
t hrough quest ionnaires, while t he secondary
dat a by means of a complet ion f orm. To be
more operat ional, quest ionnaires and complet ion f orm t ried out bef ore use. Then t he revised quest ionnaires and complet ion f orm
were use t o collect dat a.
Data Analysis and Management
Dat a
processing
involves
edit ing
quest ionnaires, coding, arrangement of f ile
st ruct ure, dat a ent ry, edit ing f iles, generat ing
variables, merger creat ing and split t ing f iles.
The sof t ware used in dat a processing is Excel
and St at ist ical Analysis Syst em.
The est imat ions of means, st andard
deviat ion, minimum and maximum values
made f or all quant it at ive variables. The est imat ion of proport ion has been conduct ed f or
all cat egorized qualit at ive and quant it at ive
variables. All paramet er predict ions have been
made f or t he respondent s who ut ilize nut rit ion
programs great ly (high f requency visit s) and
t he respondent s wit h a low ut ilizat ion (low
f requency visit s) in each dist rict . The est imat e
result s have been present ed in t he f orms of
t ables and diagrams.
RESULTS
Perception of Mothers towards Nutritional
Program
The dist ribut ion of mot hers’ percept ion
t hat t he nut rit ional program must be improved
can be seen in Table 1. As many as 33. 6%
mot hers of children under f ive in t he low part icipat ion group and 37. 6% in t he high part icipat ion group st at e t hat t he weighing services
f or children must be improved. This indicat es
some dissat isf act ion among mot hers wit h t he
weighing program. Weighing is a rout ine maj or
27
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
act ivit y of posyandu. Theref ore, an improved
service is much needed, which can be done by
increasing t he number of weighing scales so
t hat posyandu’ s part icipant s do not have t o
queue f or a long t ime f or weighing t heir children. Commonly, at posyandu t here is only one
weighing scale t o serve around 50 children.
Table 1. Dist ribut ion of Mot hers based on Percept ion about Act ivit y t hat should be
Improved at Posyandu
Kinds of Activity
Supplement al Feeding
Program
Nut rit ional ext ension
Iron t ablet dist ribut ion
Immunizat ion
Growt h chart
availabilit y
Weighing of children
Vit amin A dist ribut ion
Participation
at Posyandu
Low
High
Low
High
Low
High
Low
High
Low
High
Low
High
Low
High
n
%
166
111
152
107
90
63
66
51
71
43
68
40
51
30
91. 7
93. 2
83. 9
89. 9
49. 7
52. 9
36. 5
42. 7
39. 2
36. 1
37. 6
33. 6
28. 2
25. 2
As many as 39. 2% of mot hers in t he low
part icipat ion group and 36. 1% in t he high part icipat ion group say t hat t he availabilit y of
growt h chart cards should be increased. Besides a growt h chart result ed f rom t he weighing records of children, t he card cont ains immunizat ion records. Such card has an import ant f unct ion; f rom t he card, a mot her can
look at her child’ s growt h. The f act t hat some
mot hers want an increased availabilit y of t he
cards indicat es t hat number of cards available
may be not enough f or t he number of children
part icipat ing at posyandu.
Improvement in immunizat ion service is
expect ed by 36. 5% mot hers of children under
f ive years in t he low part icipat ion group and
42. 7% in t he high part icipat ion group. It indicat es a dissat isf act ion of some mot hers wit h
t he immunizat ion act ivit ies so f ar carried out
at posyandu. Immunizat ion is given according
t o t he dif f erent ages of children and f ree or at
a very low cost . This indicat es t he seriousness
of t he Indonesian Government t o increase t he
healt h level of under-f ive-year children.
ered t o be bet t er by respondent s because t he
government has int roduced cert ain mont hs,
namely February and August as t he mont hs of
vit amin A. In bot h mont hs, children are t aken
t o get vit amin A.
Supplement ary f eeding program and
nut rit ional ext ension at posyandu might be
seen as t he weakest point . Over 90% mot hers
in t he low and high part icipat ion group expect
an improvement in t he service of f ood supplement s and more t han 80% hope f or an improvement in ext ension. They view t hat t he
supply of f ood supplement is not good enough.
The dist ribut ion of mot hers’ percept ion
t hat some aspect s of ext ension must be improved can be seen in Table 2. The mat erial of
ext ension is t he most import ant t o improve.
More t han half of mot hers in t he low part icipat ion group (61. 8%) and in t he high part icipat ion group (53. 9%) say t hat t he mat erial of
ext ension should be improved. The ext ension
mat erials relat ed t o f ood, nut rit ion, healt h are
essent ial f or t he mot her of children under f ive
year because wit h such mat erials t hey can
prepare a healt hy and nut rit ious menu f or
t heir children. As long as t here is no economic
const raint , t he applicat ion of nut rit ional
knowledge can be easily done in each household.
Anot her aspect of ext ension needing improvement is t he use of visual aids. This is expressed by 70. 6% mot hers in t he low part icipat ion group and 65. 4% in t he high part icipat ion
group. A visual aid has an import ant role in
allowing mot hers t o underst and t he ext ension
mat erial easily. However, because of a lack of
f und, such visual aids are rarely available at
posyandu t o support t he ext ension act ivit ies.
Table 2. Dist ribut ion of Mot hers based on Percept ion about Nut rit ional Educat ion
Variable t hat should be Improved
Nutritional
Education Variable
at Posyandu
Mat erials
Cadres
Visual aids
There are st ill many mot hers who f eel
unsat isf ied wit h t he supply of iron t ablet s.
Approximat ely half of respondent s admit t hat
it should be improved. Wit h t he dist ribut ion of
vit amin-A capsules, about a quart er of respondent s say t hat t hey are not sat isf ied, and
t heref ore t he service must be improved. The
supply of vit amin A in high might be consid-
28
Participation
at Posyandu
Low
High
Low
High
Low
High
n
42
28
30
19
48
34
%
61. 8
53. 9
44. 1
36. 5
70. 6
65. 4
The qualit y of cadres in giving ext ension
also requires improvement . As can be seen at
Table 2, more t han 40% mot hers in t he low
part icipat ion group and over 35% in t he high
part icipat ion group expect an improved qualit y
of t he cadres. The posyandu’ s cadres in rural
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
areas are volunt eers working wit hout a salary.
There are no specif ic requirement s t o be a
cadre; anyone having t he t ime and willing t o
work volunt arily can become a posyandu’ s
cadre. Because women of rural areas have
commonly a low educat ion, t hose who become
cadres are also of t he low educat ional level.
Thus it is not an easy t ask t o upgrade t he
qualit y of cadres. However, it is st ill possible
t o improve t he cadres, f or example, by giving
some t raining on nut rit ion and healt h so t hat
t hey can do t heir j obs at posyandu. In t his
cont ext , it is import ant t hat t he Healt h Services launch a regular program of t raining or
capacit y building f or cadres t o upgrade t heir
knowledge.
The respondent s’ percept ion of cadres
and midwif e at posyandu can be seen in Table
3. More t han 80% mot hers of children under
f if e years in t he low and high part icipat ion
groups view t hat t he number of cadres is already adequat e. A posyandu in t he village is
commonly served by 2 - 4 cadres, which is
relat ively suf f icient and proport ional t o t he
number of children visit ing posyandu.
As f or t he skill of cadres, more t han 70%
mot hers in t he low part icipat ion group st at e
t hat t he cadre’ s skill is adequat ely good, while
around 65% in t he high part icipat ion group
t hink t hat it is already good. Mot hers’ percept ion of cadres is cert ainly pleasing, but t heir
hope f or an improved qualit y of cadres (in ext ension) is really an indicat ion t hat a more
skillf ul cadre is very much expect ed. As t he
f ront line in giving nut rit ional service t o t he
public, posyandu wit h it s cadres have an import ant role in maint aining t he nut rit ional
st at us of children under f ive years.
Table 3. Dist ribut ion of Mot hers based on Percept ion about Cadres and Midwives at
Posyandu
Variable
Participation
at Posyandu
n
%
Suf f iciency of cadres
number
Low
151
83. 4
High
97
81. 5
Adequat ely skills of
cadres
Low
129
71. 3
High
77
64. 7
Presence of midwives
at posyandu
Low
104
57. 5
High
76
63. 9
Table 3 indicat es t hat around 57. 5% 63. 9% of mot hers in bot h low and high part icipat ion groups expect t he presence of a midwif e f or each act ivit y at posyandu. This, however, has not been met . In every village, t here
are generally 8 - 10 posyandus, meaning t hat a
midwif e must allocat e her t ime of 8 t o 10 days
in a mont h t o be act ive at posyandu.
The percept ion of mot hers t owards
immunizat ion at posyandu can be seen in Table 4. In general (80% - 90%) mot hers of children under f ive years old admit t hat all t ypes
of immunizat ion are available at posyandu.
Immunizat ion has become an import ant part of
nut rit ional programs Indonesia. Through immunizat ion (BCG, DPT, measles, TT, Polio, and
Hepat it is), t he Indonesian government would
be able t o reduce t he deat h rat e of children.
The immunizat ion programs become a
mot ivat ing f act or f or mot hers t o come t o
posyandu every mont h. The government subsidy has enabled mot hers of children under
f ive t o get an opt imum service of immunizat ion at a very low cost or f ree of charge. The
success of immunizat ion programs by t he government has so f ar cut down t he children mort alit y rat e t o less t han 50/ 1000 birt hs.
Table 4. Dist ribut ion of Mot hers based on Percept ion t owards Immunizat ion Availabilit y at Posyandu
Kinds of
Immunization
BCG
DPT
Measles
TT
Polio
Hepat it is
Participation
at Posyandu
n
%
Low
161
90. 5
High
107
90. 9
Low
166
92. 7
High
108
91. 5
Low
158
88. 3
High
104
88. 1
Low
155
86. 6
High
105
89. 0
Low
159
88. 8
High
109
92. 4
Low
31
83. 8
High
13
72. 2
Immunizat ion is an init ial st ep t o improve t he nut rit ional st at us of children. The
result ed prot ect ion of children f rom inf ect ious
diseases means t hat one cause of malnut rit ion
problems can be solved. Inf ect ion and malnut rit ion are synergic or st rengt hen each ot her.
An inf ect ion will worsen t he nut rit ional st at us,
and vise versa – malnut rit ion will make it easier f or a child t o get inf ect ed by a cert ain disease.
The percept ion of mot hers having children under f ive years on t he healt h services at
puskesmas is present ed in Table 5. There are
35. 0% mot hers in t he low part icipat ion group
and 40. 0% in t he high part icipat ion group who
t hink t hat t he medical workers at puskesmas
29
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
are not f riendly. This indicat es t hat improved
services are required so t hat t he complaint s
about t he unf riendly medical workers can be
reduced.
The daily working hours of puskesmas
are 8. 00 – 14. 00. This is suf f icient because
most mot hers wit h children under f ive years
old st at e t hat t he service hours have already
met t heir expect at ions. Only a small number
(13. 7%) of t hem in t he low part icipat ion group
and (21. 3%) in t he high part icipat ion group
admit t hat t here should be longer working
hours.
Given t he large number of pat ient s at
puskesmas, one must queue f or quit e a long
t ime t o get a healt h service. This is t he complaint of many respondent s in t his research.
There are 57. 3% mot hers (of children under
f ive year) of t he low part icipat ion group and
64. 6% of t he high part icipat ion group view t hat
t he queuing is quit e long.
Table 5. Dist ribut ion of Mot hers based on Percept ion t owards Services at Puskesmas (Communit y Healt h Cent re)
Services at
Puskesmas
Long t ime queue
Rarely present of
doct or
Unf riendly services
Expensive t icket
Short working hours
Participation
at Posyandu
n
%
Low
67
57. 3
High
48
64. 0
Low
54
46. 2
High
32
42. 7
Low
41
35. 0
High
30
40. 0
Low
19
16. 2
High
12
16. 0
Low
10
13. 7
High
16
21. 3
The doct or puskesmas, besides a medical
worker, is also responsible f or t he daily administ rat ive work at puskesmas and at t ends
meet ings at t he Healt h Services in t he Regency. This condit ion has caused t he presence
of a doct or at puskesmas t o give public healt h
service is considered t o be less. This percept ion is expressed by 46. 2% of mot her in t he low
part icipat ion group and 42. 7% in t he high part icipat ion group. Alt hough t he doct or is seldom
present at puskesmas, t he healt h services cont inue t o operat e because t here are ot her
medical st af f s. For t he people, t he presence of
a doct or is import ant because t hey will f eel
more sat isf ied wit h a doct or’ service t han a
nurse’ .
30
Children’ s Participation in and Access to Nutritional Programs
Vit amin A Capsule Program for Children
The f irst f ive years is an individual
developing phase f or children. Based on it s
charact erist ic af t er t he inf ant hood (0 – 1
year), it is necessary t o dist inguish it f rom
ot her developing phases because t he children
have t o begin t o learn t o live in an ext ernal
and new environment (Hurlock, 1999).
Table 6 indicat es t hat mot hers are in
general aware of t he vit amin A program f or
t heir children. Every August and February
Posyandus dist ribut e high-dosage capsules of
vit amin A t o children f or f ree. Usually many
mot hers wit h t heir children visit posyandus f or
such capsules. Posyandu has been operat ional
in Indonesia f or decades, so generally mot hers
already know t he programs of posyandu. And
t hus, despit e being t he low part icipat ion
group, most mot hers (97. 2%) know t he vit amin
A program. The percent age is not much dif f erent f rom t hat of t he high part icipat ion group
(98. 3%).
Table 6. Dist ribut ion of Mot hers based on Having Knowledge about Vit amin A Capsule Program f or Children
Level of Participation
Knowledge of Mother
Having knowledge about
Vit amin A Capsule
Program f or Children
Low
High
n
%
n
%
176
97. 2
117
98. 3
70
43
7
5
59. 3
24. 3
5. 9
2. 8
154
30
87
2
87. 0
25. 4
49. 1
1. 7
Inf ormat ion Sources of
Vit amin A Capsule
Program f or Children :
1.
2.
3.
4.
Healt h Workers
Television
Friends/ Neighbors
Radio
Mot hers’ access t o inf ormat ion can become an indicat or of t heir abilit y t o t ake a
bet t er care of t heir children. Inf ormat ion can
be obt ained f rom newspapers, radios, or t elevisions f or underst anding (Engle, Manon, &
Hadad, 1997). The inf ormat ion about t he presence of vit amin A program can be t aken f rom
ot her sources: healt h workers, f riends or
neighbors.
Table 6 shows t hat t he high part icipat ion
group get s more inf ormat ion about vit amin
program f rom healt h workers t han t he low
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
part icipat ion group (87. 0% compared t o
59. 3%). Approximat ely a quart er of respondent s receive such inf ormat ion f rom t elevisions and only around 2-3% know it f rom radios. This indicat es t hat t elevision is more inf luent ial and can become a bet t er media of
inf ormat ion t han radios f or nut rit ional programs.
More t han 90% of t he samples (children
under f ive years) admit obt aining vit amin A
capsules, bot h in low and high part icipat ion
groups (see Table 7). It shows t hat t he vit amin
A dist ribut ion program has been successf ul.
Children under f ive years old are very
suscept ible t o inf ect ious diseases (Sat ot o,
1990). According t o t he Minist ry of Healt h of
t he Republic of Indonesia (1995), vit amin A is
import ant not only f or t he eye healt h and t he
prevent ion of blindness, but also f or an improved immunit y of t he body. The condit ion
of children wit h adequat e vit amin A, when
developing diarrhea, smallpox, or ot her inf ect ious diseases, would not get worse or endanger t heir lives.
Table 7 shows t hat many mot hers know
t hat vit amin A are good only f or eye healt h. In
t he low and high part icipat ion groups, almost
Table 7.
60% mot hers realize t he benef it of vit amin A
f or eyes; whereas only 5 – 10 % of t hem know
it s benef it f or t he body’ s immunit y, and 8 – 11
% underst and it s benef it f or children growt h.
Children’ s Part icipat ion at Posyandu
Regular visit s of children t o posyandu
are highly recommended. At posyandu every
child is monit ored f or it s body weight by
weighing. In t his way, t he body weight changes
can be obt ained f rom one mont h t o anot her. In
case of a decreased t rend of body weight or
below t he red line, posyandus are expect ed t o
give nut rit ional advice or f ood supplement s so
t hat a declining body weight can be prevent ed.
Table 8 indicat es t he suit abilit y of t he
crit eria det ermined by t he researchers, i. e.
t hose ent ering t he low part icipat ion group in
t he last six mont hs are indeed irregular t o visit
posyandus. As many as 71. 7% children of t he
low part icipat ion group are not regularly t aken
t o posyandus, while in t he high group t here
are only 7. 6% children who do not regularly
visit posyandus.
Dist ribut ion of Children based on Vit amin A Capsule Supply
Supply, Kind, and Benefit of
Vitamin A Capsule
for Children
Level of Participation
Low
High
n
%
n
%
Dist ribut ion of Vit amin A Capsule f or Children
167
92. 3
113
95. 0
Kind of Vit amin A Capsule f or Children :
1. Red
2. Blue
3. Forget
140
15
26
77. 3
8. 3
14. 4
85
15
19
71. 4
12. 6
16. 0
Benef it of Vit amin A :
1. Eye healt h
2. Children growt h
3. Body’ s immunit y
99
14
9
58. 2
8. 2
5. 3
68
13
12
59. 1
11. 3
10. 4
Table 8. Dist ribut ion of Children according t o Mot her’ s Regular Visit t o Posyandu
Level of Participation
Visiting
Low
High
n
%
n
%
101
71. 7
9
7. 6
1. Mot hers are busy
51
60. 7
3
37. 5
2. Children are st ill asleep
33
39. 3
5
62. 5
3. Complet eness of children immunizat ion
17
12. 9
1
12. 5
Mot her Who’ s not Regularly Visit ing Posyandu
Various Reasons of Inf requent Visit ing :
31
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
Such irregular visit s t o posyandus have
various reasons (see Table 8). The reason
most ly given by t he mot hers in t he high part icipat ion is t hat t heir children are st ill asleep
(62. 5%). On t he ot her hand, t hose of low part icipat ion say t hat t hey are busy (60. 7%),
t heref ore, unable t o t ake t heir children t o
posyandu. Only a small number of mot hers
(around 12 – 13 %) have t he reason t hat t heir
children have already had a complet e immunizat ion, t hus t hey do not need t o come t o
posyandu regularly.
In one village t here are usually 6 – 18
unit s of posyandus. The many posyandus are t o
f acilit at e mot hers t o get access t o nut rit ional
and healt h services. Theref ore, t here is no
reason f or mot hers not t o come t o posyandus
because of a long dist ance t o posyandu. A
Posyandu as t he f ront line of nut rit ional service in villages is commonly open once a
mont h, t heref ore mot hers having children under f ive years old should be able t o t ake t heir
children t o t he posyandu on t he day scheduled
t o open.
KMS (Growt h Chart Card) is a simple and
inexpensive t echnique t o monit or t he healt h
and growt h of children. According t o Sukarni
(1994), KMS allows an appropriat e and pract ical monit oring of children healt h in all aspect s. Theref ore, such a card could be very
usef ul f or mot hers and f amilies t o observe
t heir children growt h so t hat no mist akes or
imbalance would occur in f eeding t heir children.
Every child should have t he card dist ribut ed f ree at posyandus. The percent age of
t hose holding t he cards varied f rom 65. 3% 97. 8% f rom 2001 – 2005. The biggest percent age of card ownership was in 2001 (97. 8%) and
t he lowest was in 2005 (65. 3%). The decreased
car ownership in 2005 was indeed a problem
because children wit hout such cards mean t hat
t hey do not visit posyandus; or if t hey do
come, t he services provided are less opt imal.
Wit h t he regular weighing of children once a
mont h, t he ownership of t he cards would be
very usef ul f or underst anding t he growt h of a
child.
The percent age of children having t he
cards t o reach 100% is rat her dif f icult t o at t ain. The children of bet t er-of f f amilies seldom go t o posyandus f or healt h examinat ion,
but t o privat e doct ors f or children. Theref ore,
if t he percent age of card ownership can reach
90%, t his would seem t o be a good achievement and must become t he t arget .
32
Weighing part icipat ion ref ers t o t he
number of children visit ing posyandus in a cert ain mont h (August ) compared t o t he t ot al
populat ion of children. Bet ween 2001 and 2005
t he weighing part icipat ion was bet ween 57. 1%
and 76. 8%. In 2005, it was t he lowest (57. 1%).
This indicat es t hat it is necessary f or
posyandus t o make great er ef f ort s t o remind
mot hers t o t ake t heir children t o posyandus
f or weighing.
Those who do not weigh t heir children
might have st opped visit ing posyandus or are
t oo busy t o come t o posyandu on t he day of
weighing. It is much bet t er if posyandus can
set a t arget of part icipat ion expect ed. Wit h
such t arget , t he degree of success in at t aining
t he t arget can be evaluat ed. From t he f igures
present ed in t he t able, t he part icipat ion t arget s ranging f rom 80% - 85% may be regarded
t o be realist ic t o reach. The poor perf ormance
in 2005 wit h t he weighing part icipat ion of only
57. 1% must be analyzed f or possible causes so
t hat solut ions can be made immediat ely. In
t he coming years it is expect ed t hat t he degree of part icipat ion will improve.
Children’ s Access t o Nut rit ional Programs
The dist ance f rom home t o t he locat ions
of healt h/ nut rit ional services can be seen in
Table 10. A Posyandu locat ed in every
neighborhood (RW) is t he closest locat ion of
nut rit ional/ healt h services (84 m) f rom t he
homes of mot hers having children under f ive
years old. The government ’ s policy t o short en
t he dist ance t o t he nut rit ional/ healt h services
is considered t o be very appropriat e and will
allow people t o access such services easily.
Ot her places f or such services which are relat ively close in dist ance are healt h clinics (122
m) and Pust u/ Pol indes (459 m), which are
commonly privat ely managed wit h relat ively
more expensive t arif f compared t o t he public
healt h cent ers. As can be seen f rom Table 9,
t he dist ance t o t he locat ion of nut rit ional/ healt h service, which is relat ively f ar
away, is t o t he doct ors who provide privat e
services (1510 m), puskesmas (1938 m), and
hospit als (5293 m).
Table 11 shows t he means of t ransport at ion t aken by mot hers t o get t o t he locat ions
of nut rit ional/ healt h services. To arrive at posyandus, most respondent s (99. 3%) walk because of t he relat ively short dist ance. Only
About 0. 7% of respondent s ride mot orcycles t o
go t o posyandus. Meanwhile, t o go t o a village/ privat e midwif e, 44. 6% of t he respondent s walk. A village midwif e is one who is
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
assigned by t he government t o open pract ices
in every village so t hat t he rural people can
get healt h services more easily. Some respon-
dent s visit a village midwif e by a public t ransport (29. 5%) and mot orcycles (25. 5%).
Table 9. Growt h Chart Card Ownership of Children in Cianj ur Regency in 2001-2005
Variable of Growth Chart Card Ownership
Year
2001
2002
2003
2004
2005
Tot al of children under f ive
157 782
171 472
171 696
171 919
198 446
Children under f ive who owned growt h chart card
154 312
129 623
157 960
129 621
129 511
Children under f ive who had been weighed
121 220
104 065
120 874
107 634
113 292
Coverage of growt h chart card ownership (%)
97. 8
75. 6
92. 0
75. 4
65. 3
Part icipat ion of weighing (%)
76. 8
60. 7
70. 4
62. 6
57. 1
Tabel 10. Dist ance of Nut rit ional/ Healt h Service Locat ion f rom Children Homes
Location of Nutritional/ Health Service
n
Distance
(m)
Category of
Distance
300
84
Close
Healt h Clinics
300
122
Close
Pust u/ Polindes (Auxiliary Public Healt h Cent re)
300
459
Close
Local/ Privat e Midwif e
300
802
Medium
Doct or
300
1510
Far away
Puskesmas (Public Healt h Cent re)
300
1938
Far away
Hospit al
300
5293
Far away
Posyandu (Int egrat ed Healt h Service Cent re)
Not e : Close
= < 500 m
Medium = 500 – 1500 m
Far away = > 1500 m
Table 11. Dist ribut ion of Children based on The Transport at ion t aken by Mot hers t o Nut rit ional/
Healt h Service Locat ion
Location of Nutritional/ Health Service
Posyandu (Int egrat ed Healt h Service Cent re)
Local/ Privat e Midwif e
Pust u/ Polindes (Auxiliary Public Healt h Cent re)
Puskesmas (Public Healt h Cent re)
Kind of Vehicle
Walking
Hospit al
%
297
99. 3
2
0. 7
Walking
112
44. 6
Riding mot orcycles
64
25. 5
Public t ransport
74
29. 5
Walking
40
31. 5
Riding mot orcycles
Riding mot orcycles
37
29. 1
Public t ransport
34
39. 4
Walking
24
10. 5
Riding mot orcycles
45
30. 7
Public t ransport
132
57. 9
1
7. 7
Walking
Healt h Clinics
n
Riding mot orcycles
2
15. 4
Public t ransport
8
61. 5
Privat e car
Walking
2
15. 4
6
2. 8
Riding mot orcycles
52
23. 9
Public t ransport
159
72. 9
33
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
To go t o puskesmas, most respondent s
t ake public vehicles (57. 9%). A puskesmas is
locat ed in t he capit al of Dist rict , which rat her
f ar away f rom t he respondent ’ home. Only a
small number (10. 5%) of respondent s t ake a
walk t o get t o puskesmas.
There is a relat ively small number of
respondent s who go t o healt h clinics. The privat ely owned healt h clinics charges higher
medical cost s t han puskesmas. Those going t o
healt h clinics commonly t ake public vehicles
(61. 5%). Similarly t hose going t o t he hospit al
locat ed in t he t own use public vehicles
(72. 9%).
CONCLUSION AND RECOMENDATION
t he nut rit ion knowledge of cadres and
midwives who are in charge at posyandus
t hrough t rainings. Furt her, t he ext ension
act ivit y has t o be an inseparable part of
t he nut rit ional program services at
posyandus.
2.
The supplement al f ood program at posyandus has not been opt imally managed because of a limit ed budget of posyandus.
Theref ore, t he bet t er-of f communit y or
corporat ions around posyandu must be encouraged t o give volunt ary donat ion or f inancial aid so t hat t he operat ion of supplement al f ood program can be more ef f ect ive. In addit ion, t he Healt h Services
should also be able t o allocat e a bigger
budget of posyandus t o carry out t he supplement al f ood program.
Conclusion
Mot hers having children under f ive years
old t hink t hat t he supplement al f ood program
and nut rit ion ext ension at posyandus should be
improved. The number and skills of t he cadres
are already considered quit e good, t he presence of midwives at posyandus is inadequat e.
The immunizat ion program f or children is
viewed as very good by mot hers having children under f ive years old. As f or t he services
at puskesmas, t he maj orit y of mot hers wit h
children under f ive years old complaint about
t he long queuing t ime and t he inf requent
presence of doct ors when t hey visit f or medical t reat ment .
The part icipat ion of children (under f ive
years old) in visit ing posyandus is relat ively
good, namely, 92. 4% (f or t he high part icipat ion group). However, f or t he low part icipat ion group, t he number of part icipat ing children is relat ively low (28. 3%). The absences
f rom posyandus are due t o t heir mot hers being
busy or children being st ill asleep. More t han
90% of children, bot h of t hose who of t en and
seldom visit posyandus, have received vit amin
A capsules. This means t hat t here is an adequat e dist ribut ion of vit amin A capsules. A
posyandu’ s services most ly f elt by t he public
are t he weighing of children and immunizat ion. The access f rom t he homes of mot hers
having children under f ive years old t o t he
nearest places of nut rit ional services (i. e.
posyandu) is < 500 m and t he dist ance is covered by walking.
Recommendation
1.
34
Because t he nut rit ional ext ension is a
weak aspect of t he act ivit ies at posyandus,
it is necessary t o make ef f ort s in improving
ACKNOWLEDGEMENT
Thank you very much t o t he Neys-van
Hoogst rat en Foundat ion (NHF), t he Net herlands f or f unding t his proj ect . It is a good opport unit y t o collaborat e wit h t he NHF. Thank
you and appreciat ion t o ot her research t eam
Hadi Riyadi, Faisal Anwar, and Eddy S. Mudj aj ant o who part icipat ed in t his proj ect .
BIBLIOGRAPHY
At marit a & Tat ang SF. 2004. An Analysis of
Nut rit ional Sit uat ion and Public Healt h.
Paper of Nat ional Workshop on Food and
Nut rit ion 2004. LIPI. Jakart a.
Engle, PLP Menon, & L Hadad. 1997. Care and
Nut rit ion. Int ernat ional Food Policy
Research Inst it ut e, Washingt on DC, USA.
Hart oyo, D Ast ut i, D Briawan & B Set iawan.
2000. Addit ional Food t o Children Under
Five Years Old and Empowerment of
Families/ Communit y in Bogor Municipalit y. Depart ment of Communit y Nut rit ion
and Family Resources, IPB, Bogor.
Hurlock
EB.
1999.
Child
Development
(Tj andrasa,
t ranslat or).
Erlangga,
Jakart a.
Jus'at I. 1992. Review on Mat ernal and Child
Nut rit ional St at us and Feeding Pract ice.
Draf t , Report t o UNICEF.
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Sat ot o. 1990. Growt h and Development of
Children on Age 0-18 Mont hs in Mlonggo
Sub-dist rict , Jepara Regency, Cent ral
Java Province. Doct oral Dissert at ion
(unpublished). Post graduat e Program,
Universit y of
Cent ral Java.
Diponegoro,
Semarang,
Sukarni M. 1994.
Healt h,
Family
Environment . Kanisius, Yogyakart a.
and
35
PERCEPTION OF MOTHERS AND CHILDREN’ S PARTICIPATION
IN THE NUTRITIONAL PROGRAMS
( Persepsi Ibu dan Part isipasi Anak dal am Program Gizi )
Dadang Sukandar 1 and Ali Khomsan1
ABST RAK
Penel it ian ini bert uj uan unt uk menget ahui persepsi masyar akat t erhadap pel ayanan
pr ogram gizi ser t a menganal isis par t isipasinya dal am pr ogram posyandu. Disain penel it ian
ini menggunakan cross-sect ional dengan sampel rumah t angga yang memil iki anak bal it a.
Sampel yang diambil sebanyak 300. Pemil ihan sampel dil akukan secara acak berl apis
(st rat if ied random sampl ing). Penel it ian ini dil akukan di dua kecamat an di Kabupat en
Cianj ur yang dil akukan pada t ahun 2006-2007. Dat a yang dikumpul kan meliput i j enis pel ayanan gizi, persepsi t erhadap program gizi dan part isipasi dal am pr ogram gizi. Dat a
diperol eh mel al ui wawancara. Dat a hasil wawancara dient ri menggunakan sof t ware excel .
Dat a dianal isis dengan SAS (St at ist ical Anal ysis Syst em). Hasil penel it ian ini menunj ukkan
bahwa para ibu berpendapat bahwa pr ogram PMT dan penyul uhan gizi harus l ebih diperbaiki. Juml ah dan ket erampil an kader cukup memadai, namun kahadiran bidan di
posyandu kurang mencukupi. Program imunisasi bagi bal it a diikut i dengan baik ol eh para
ibu bal it a. Terkait pel ayanan di puskesmas, sebagian besar ibu mengel uhkan wakt u ant ri
yang l ama dan f rekuensi kehadiran dokt er yang kurang. Part isipasi bal it a dalam mengunj ungi posyandu rel at if baik (92.4%). Lebih dari 90% bal it a, baik yang sering maupun j arang
mengunj ungi posyandu t el ah menerima kapsul vit amin A. Pel ayanan posyandu yang sangat
dirasakan ol eh masyarakat adal ah penimbangan bal it a dan imunisasi.
Keywords : persepsi, part isipasi, program gizi
INTRODUCTION1
Background
Nat ional ef f ort s in improving nut rit ion in
Indonesia have been running f or t hirt y years
and are st ill f ocused on t he maj or problems of
nut rit ion, namely, prot ein energy malnut rit ion
(PEM), vit amin A def iciency (VAD), iron anemia
and iodine def iciency disorders (IDD). Nut rit ional improvement has succeeded in reducing
t he f our maj or nut rit ional problems, but is
considered as inef f icient because it is closely
relat ed t o t he ef f iciency of cross-sect or ef f ort s
such as povert y elevat ion. Hart oyo, Ast ut i,
Briawan, and Set iawan (2000) st at e t hat nut rit ion programs need support s by making ef f ort s
in improving mot ivat ion, knowledge and skills
of cadres, part icipat ion of f amilies and public
f igures so t hat f acilit ies and inf rast ruct ure of
nut rit ion programs provided by t he government can bring out opt imal result s.
One goal of t he nut rit ion program is t o
improve t he st at us of communit y nut rit ion
geared t o t he improvement of int elligence and
1
Lect urer on Depart ment of Communit y Nut rit ion,
Facult y of Human Ecology, Bogor Agricult ural
Universit y (IPB).
26
work perf ormance t o support t he improvement
of human resource qualit y. Anot her obj ect ive
is t o reduce t he rat e of nut rit ional diseases
(PEM, VAD, iron anemia, and IDD), which are
in general experienced by a low income societ y (poor household) in rural and urban areas
especially children under f ive and pregnant
women. The obj ect ive support s at t empt s in
reducing t he inf ant mort alit y rat e, children
under f ive, and mot hers. The program also
support s t he improvement of t he st at us of
communit y nut rit ion in general by improving
t he pat t erns of f ood consumpt ions t o become
more diverse, balanced and nut rit ionally qualif ied. Such improvement of consumpt ion pat t ern is also required f or a group of people wit h
t he high risk of some degenerat ive diseases,
who t end t o increase in number (At marit a &
Fallah, 2004).
The nut rit ion program at dist rict level is
a part of nat ional nut rit ion program. The nat ional policy of nut rit ion program consist s of 4
sub programs: program on prot ein–calorie malnut rit ion, program on iron-anemia, program on
vit amin A def iciency, and program on iodine
def iciency.
There are some variat ions in achieving
t he program obj ect ives at dist rict level. Our
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
discussion wit h st af f of Healt h Of f ice in Cianj ur Dist rict (February 10, 2006) showed t hat
even all programs have been implement ed;
t he communit y st ill has problems relat ed t o
nut rit ion. Implement at ion of nut rit ion program
at communit y level is t hrough Posyandu.
Posyandu has f unct ioned as t he spearhead f or all t he nut rit ion and primary healt h
care services provided by healt h cent res and
sub-cent res now present in every sub-dist rict
and village (Jus’ at , 1992). Thus, Posyandu
f unct ions as an inf ormal-ref erral syst em of
communit y part icipat ion t o rural healt h cent res and sub-cent res. Posyandu makes t he "unreachable" children and mot hers "reachable".
The occurrence of malnut rit ion is of t en
overlooked f rom our common observat ion, but
a closer look will indicat e high deat h rat es of
mot hers, babies, children under f ive, and a
low lif e expect ancy. Alt hough nut rit ion programs have long been in operat ion, t he problems of malnut rit ion st ill happen everywhere.
Goals and Obj ectives
1.
2.
The obj ect ives of t his research were :
To f ind out t he mot hers’ s percept ion of
nut rit ion program services.
To analyze children’ s part icipat ion in
Posyandu program (Healt h and Nut rit ion
Int egrat ed Service Cent er).
METHODS
Design
This research used a cross-sect ional design. The research was carried out in t wo subdist rict of Cianj ur, t he Province of West Java.
The research was conduct ed in 2006.
Sampling
The populat ions st udied in t his research
are having children under f ive years old and
300 of t hem were t aken. The populat ions were
select ed in t wo subdist rict s of Cianj ur Dist rict ,
West Java. Those subdist rict s are t he areas
wit h a high port ion of poor populat ion and
many of t hem ut ilized t he nut rit ion programs
of f ered by t he government .
Samples were t aken t hrough st rat if ied
random sampling wit h proport ional allocat ion
where high and low f requency visit st and as
st rat um. Sample size was also proport ional
wit h respect t o posyandu size.
Cianj ur Dist rict was select ed since t here
were variat ions in nut rit ion program implement ed and variat ions in achieving t he program obj ect ives (Personal Communicat ion wit h
St af f of Healt h Services, Cianj ur, February 10,
2006). The t wo subdist rict s were chosen t o
increase het erogeneit y of samples, so t hat t he
perf ormance of nut rit ion program was t ruly
represent ed by t he select ed samples.
Data collection
Dat a collect ion consist ed of ut ilizat ion of
nut rit ional program, nut rit ion service and acces t o services of nut rit ion pograms. The
secondary dat a involved coverage of nut rit ion
programs. The primary dat a were collect ed
t hrough quest ionnaires, while t he secondary
dat a by means of a complet ion f orm. To be
more operat ional, quest ionnaires and complet ion f orm t ried out bef ore use. Then t he revised quest ionnaires and complet ion f orm
were use t o collect dat a.
Data Analysis and Management
Dat a
processing
involves
edit ing
quest ionnaires, coding, arrangement of f ile
st ruct ure, dat a ent ry, edit ing f iles, generat ing
variables, merger creat ing and split t ing f iles.
The sof t ware used in dat a processing is Excel
and St at ist ical Analysis Syst em.
The est imat ions of means, st andard
deviat ion, minimum and maximum values
made f or all quant it at ive variables. The est imat ion of proport ion has been conduct ed f or
all cat egorized qualit at ive and quant it at ive
variables. All paramet er predict ions have been
made f or t he respondent s who ut ilize nut rit ion
programs great ly (high f requency visit s) and
t he respondent s wit h a low ut ilizat ion (low
f requency visit s) in each dist rict . The est imat e
result s have been present ed in t he f orms of
t ables and diagrams.
RESULTS
Perception of Mothers towards Nutritional
Program
The dist ribut ion of mot hers’ percept ion
t hat t he nut rit ional program must be improved
can be seen in Table 1. As many as 33. 6%
mot hers of children under f ive in t he low part icipat ion group and 37. 6% in t he high part icipat ion group st at e t hat t he weighing services
f or children must be improved. This indicat es
some dissat isf act ion among mot hers wit h t he
weighing program. Weighing is a rout ine maj or
27
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
act ivit y of posyandu. Theref ore, an improved
service is much needed, which can be done by
increasing t he number of weighing scales so
t hat posyandu’ s part icipant s do not have t o
queue f or a long t ime f or weighing t heir children. Commonly, at posyandu t here is only one
weighing scale t o serve around 50 children.
Table 1. Dist ribut ion of Mot hers based on Percept ion about Act ivit y t hat should be
Improved at Posyandu
Kinds of Activity
Supplement al Feeding
Program
Nut rit ional ext ension
Iron t ablet dist ribut ion
Immunizat ion
Growt h chart
availabilit y
Weighing of children
Vit amin A dist ribut ion
Participation
at Posyandu
Low
High
Low
High
Low
High
Low
High
Low
High
Low
High
Low
High
n
%
166
111
152
107
90
63
66
51
71
43
68
40
51
30
91. 7
93. 2
83. 9
89. 9
49. 7
52. 9
36. 5
42. 7
39. 2
36. 1
37. 6
33. 6
28. 2
25. 2
As many as 39. 2% of mot hers in t he low
part icipat ion group and 36. 1% in t he high part icipat ion group say t hat t he availabilit y of
growt h chart cards should be increased. Besides a growt h chart result ed f rom t he weighing records of children, t he card cont ains immunizat ion records. Such card has an import ant f unct ion; f rom t he card, a mot her can
look at her child’ s growt h. The f act t hat some
mot hers want an increased availabilit y of t he
cards indicat es t hat number of cards available
may be not enough f or t he number of children
part icipat ing at posyandu.
Improvement in immunizat ion service is
expect ed by 36. 5% mot hers of children under
f ive years in t he low part icipat ion group and
42. 7% in t he high part icipat ion group. It indicat es a dissat isf act ion of some mot hers wit h
t he immunizat ion act ivit ies so f ar carried out
at posyandu. Immunizat ion is given according
t o t he dif f erent ages of children and f ree or at
a very low cost . This indicat es t he seriousness
of t he Indonesian Government t o increase t he
healt h level of under-f ive-year children.
ered t o be bet t er by respondent s because t he
government has int roduced cert ain mont hs,
namely February and August as t he mont hs of
vit amin A. In bot h mont hs, children are t aken
t o get vit amin A.
Supplement ary f eeding program and
nut rit ional ext ension at posyandu might be
seen as t he weakest point . Over 90% mot hers
in t he low and high part icipat ion group expect
an improvement in t he service of f ood supplement s and more t han 80% hope f or an improvement in ext ension. They view t hat t he
supply of f ood supplement is not good enough.
The dist ribut ion of mot hers’ percept ion
t hat some aspect s of ext ension must be improved can be seen in Table 2. The mat erial of
ext ension is t he most import ant t o improve.
More t han half of mot hers in t he low part icipat ion group (61. 8%) and in t he high part icipat ion group (53. 9%) say t hat t he mat erial of
ext ension should be improved. The ext ension
mat erials relat ed t o f ood, nut rit ion, healt h are
essent ial f or t he mot her of children under f ive
year because wit h such mat erials t hey can
prepare a healt hy and nut rit ious menu f or
t heir children. As long as t here is no economic
const raint , t he applicat ion of nut rit ional
knowledge can be easily done in each household.
Anot her aspect of ext ension needing improvement is t he use of visual aids. This is expressed by 70. 6% mot hers in t he low part icipat ion group and 65. 4% in t he high part icipat ion
group. A visual aid has an import ant role in
allowing mot hers t o underst and t he ext ension
mat erial easily. However, because of a lack of
f und, such visual aids are rarely available at
posyandu t o support t he ext ension act ivit ies.
Table 2. Dist ribut ion of Mot hers based on Percept ion about Nut rit ional Educat ion
Variable t hat should be Improved
Nutritional
Education Variable
at Posyandu
Mat erials
Cadres
Visual aids
There are st ill many mot hers who f eel
unsat isf ied wit h t he supply of iron t ablet s.
Approximat ely half of respondent s admit t hat
it should be improved. Wit h t he dist ribut ion of
vit amin-A capsules, about a quart er of respondent s say t hat t hey are not sat isf ied, and
t heref ore t he service must be improved. The
supply of vit amin A in high might be consid-
28
Participation
at Posyandu
Low
High
Low
High
Low
High
n
42
28
30
19
48
34
%
61. 8
53. 9
44. 1
36. 5
70. 6
65. 4
The qualit y of cadres in giving ext ension
also requires improvement . As can be seen at
Table 2, more t han 40% mot hers in t he low
part icipat ion group and over 35% in t he high
part icipat ion group expect an improved qualit y
of t he cadres. The posyandu’ s cadres in rural
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
areas are volunt eers working wit hout a salary.
There are no specif ic requirement s t o be a
cadre; anyone having t he t ime and willing t o
work volunt arily can become a posyandu’ s
cadre. Because women of rural areas have
commonly a low educat ion, t hose who become
cadres are also of t he low educat ional level.
Thus it is not an easy t ask t o upgrade t he
qualit y of cadres. However, it is st ill possible
t o improve t he cadres, f or example, by giving
some t raining on nut rit ion and healt h so t hat
t hey can do t heir j obs at posyandu. In t his
cont ext , it is import ant t hat t he Healt h Services launch a regular program of t raining or
capacit y building f or cadres t o upgrade t heir
knowledge.
The respondent s’ percept ion of cadres
and midwif e at posyandu can be seen in Table
3. More t han 80% mot hers of children under
f if e years in t he low and high part icipat ion
groups view t hat t he number of cadres is already adequat e. A posyandu in t he village is
commonly served by 2 - 4 cadres, which is
relat ively suf f icient and proport ional t o t he
number of children visit ing posyandu.
As f or t he skill of cadres, more t han 70%
mot hers in t he low part icipat ion group st at e
t hat t he cadre’ s skill is adequat ely good, while
around 65% in t he high part icipat ion group
t hink t hat it is already good. Mot hers’ percept ion of cadres is cert ainly pleasing, but t heir
hope f or an improved qualit y of cadres (in ext ension) is really an indicat ion t hat a more
skillf ul cadre is very much expect ed. As t he
f ront line in giving nut rit ional service t o t he
public, posyandu wit h it s cadres have an import ant role in maint aining t he nut rit ional
st at us of children under f ive years.
Table 3. Dist ribut ion of Mot hers based on Percept ion about Cadres and Midwives at
Posyandu
Variable
Participation
at Posyandu
n
%
Suf f iciency of cadres
number
Low
151
83. 4
High
97
81. 5
Adequat ely skills of
cadres
Low
129
71. 3
High
77
64. 7
Presence of midwives
at posyandu
Low
104
57. 5
High
76
63. 9
Table 3 indicat es t hat around 57. 5% 63. 9% of mot hers in bot h low and high part icipat ion groups expect t he presence of a midwif e f or each act ivit y at posyandu. This, however, has not been met . In every village, t here
are generally 8 - 10 posyandus, meaning t hat a
midwif e must allocat e her t ime of 8 t o 10 days
in a mont h t o be act ive at posyandu.
The percept ion of mot hers t owards
immunizat ion at posyandu can be seen in Table 4. In general (80% - 90%) mot hers of children under f ive years old admit t hat all t ypes
of immunizat ion are available at posyandu.
Immunizat ion has become an import ant part of
nut rit ional programs Indonesia. Through immunizat ion (BCG, DPT, measles, TT, Polio, and
Hepat it is), t he Indonesian government would
be able t o reduce t he deat h rat e of children.
The immunizat ion programs become a
mot ivat ing f act or f or mot hers t o come t o
posyandu every mont h. The government subsidy has enabled mot hers of children under
f ive t o get an opt imum service of immunizat ion at a very low cost or f ree of charge. The
success of immunizat ion programs by t he government has so f ar cut down t he children mort alit y rat e t o less t han 50/ 1000 birt hs.
Table 4. Dist ribut ion of Mot hers based on Percept ion t owards Immunizat ion Availabilit y at Posyandu
Kinds of
Immunization
BCG
DPT
Measles
TT
Polio
Hepat it is
Participation
at Posyandu
n
%
Low
161
90. 5
High
107
90. 9
Low
166
92. 7
High
108
91. 5
Low
158
88. 3
High
104
88. 1
Low
155
86. 6
High
105
89. 0
Low
159
88. 8
High
109
92. 4
Low
31
83. 8
High
13
72. 2
Immunizat ion is an init ial st ep t o improve t he nut rit ional st at us of children. The
result ed prot ect ion of children f rom inf ect ious
diseases means t hat one cause of malnut rit ion
problems can be solved. Inf ect ion and malnut rit ion are synergic or st rengt hen each ot her.
An inf ect ion will worsen t he nut rit ional st at us,
and vise versa – malnut rit ion will make it easier f or a child t o get inf ect ed by a cert ain disease.
The percept ion of mot hers having children under f ive years on t he healt h services at
puskesmas is present ed in Table 5. There are
35. 0% mot hers in t he low part icipat ion group
and 40. 0% in t he high part icipat ion group who
t hink t hat t he medical workers at puskesmas
29
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
are not f riendly. This indicat es t hat improved
services are required so t hat t he complaint s
about t he unf riendly medical workers can be
reduced.
The daily working hours of puskesmas
are 8. 00 – 14. 00. This is suf f icient because
most mot hers wit h children under f ive years
old st at e t hat t he service hours have already
met t heir expect at ions. Only a small number
(13. 7%) of t hem in t he low part icipat ion group
and (21. 3%) in t he high part icipat ion group
admit t hat t here should be longer working
hours.
Given t he large number of pat ient s at
puskesmas, one must queue f or quit e a long
t ime t o get a healt h service. This is t he complaint of many respondent s in t his research.
There are 57. 3% mot hers (of children under
f ive year) of t he low part icipat ion group and
64. 6% of t he high part icipat ion group view t hat
t he queuing is quit e long.
Table 5. Dist ribut ion of Mot hers based on Percept ion t owards Services at Puskesmas (Communit y Healt h Cent re)
Services at
Puskesmas
Long t ime queue
Rarely present of
doct or
Unf riendly services
Expensive t icket
Short working hours
Participation
at Posyandu
n
%
Low
67
57. 3
High
48
64. 0
Low
54
46. 2
High
32
42. 7
Low
41
35. 0
High
30
40. 0
Low
19
16. 2
High
12
16. 0
Low
10
13. 7
High
16
21. 3
The doct or puskesmas, besides a medical
worker, is also responsible f or t he daily administ rat ive work at puskesmas and at t ends
meet ings at t he Healt h Services in t he Regency. This condit ion has caused t he presence
of a doct or at puskesmas t o give public healt h
service is considered t o be less. This percept ion is expressed by 46. 2% of mot her in t he low
part icipat ion group and 42. 7% in t he high part icipat ion group. Alt hough t he doct or is seldom
present at puskesmas, t he healt h services cont inue t o operat e because t here are ot her
medical st af f s. For t he people, t he presence of
a doct or is import ant because t hey will f eel
more sat isf ied wit h a doct or’ service t han a
nurse’ .
30
Children’ s Participation in and Access to Nutritional Programs
Vit amin A Capsule Program for Children
The f irst f ive years is an individual
developing phase f or children. Based on it s
charact erist ic af t er t he inf ant hood (0 – 1
year), it is necessary t o dist inguish it f rom
ot her developing phases because t he children
have t o begin t o learn t o live in an ext ernal
and new environment (Hurlock, 1999).
Table 6 indicat es t hat mot hers are in
general aware of t he vit amin A program f or
t heir children. Every August and February
Posyandus dist ribut e high-dosage capsules of
vit amin A t o children f or f ree. Usually many
mot hers wit h t heir children visit posyandus f or
such capsules. Posyandu has been operat ional
in Indonesia f or decades, so generally mot hers
already know t he programs of posyandu. And
t hus, despit e being t he low part icipat ion
group, most mot hers (97. 2%) know t he vit amin
A program. The percent age is not much dif f erent f rom t hat of t he high part icipat ion group
(98. 3%).
Table 6. Dist ribut ion of Mot hers based on Having Knowledge about Vit amin A Capsule Program f or Children
Level of Participation
Knowledge of Mother
Having knowledge about
Vit amin A Capsule
Program f or Children
Low
High
n
%
n
%
176
97. 2
117
98. 3
70
43
7
5
59. 3
24. 3
5. 9
2. 8
154
30
87
2
87. 0
25. 4
49. 1
1. 7
Inf ormat ion Sources of
Vit amin A Capsule
Program f or Children :
1.
2.
3.
4.
Healt h Workers
Television
Friends/ Neighbors
Radio
Mot hers’ access t o inf ormat ion can become an indicat or of t heir abilit y t o t ake a
bet t er care of t heir children. Inf ormat ion can
be obt ained f rom newspapers, radios, or t elevisions f or underst anding (Engle, Manon, &
Hadad, 1997). The inf ormat ion about t he presence of vit amin A program can be t aken f rom
ot her sources: healt h workers, f riends or
neighbors.
Table 6 shows t hat t he high part icipat ion
group get s more inf ormat ion about vit amin
program f rom healt h workers t han t he low
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
part icipat ion group (87. 0% compared t o
59. 3%). Approximat ely a quart er of respondent s receive such inf ormat ion f rom t elevisions and only around 2-3% know it f rom radios. This indicat es t hat t elevision is more inf luent ial and can become a bet t er media of
inf ormat ion t han radios f or nut rit ional programs.
More t han 90% of t he samples (children
under f ive years) admit obt aining vit amin A
capsules, bot h in low and high part icipat ion
groups (see Table 7). It shows t hat t he vit amin
A dist ribut ion program has been successf ul.
Children under f ive years old are very
suscept ible t o inf ect ious diseases (Sat ot o,
1990). According t o t he Minist ry of Healt h of
t he Republic of Indonesia (1995), vit amin A is
import ant not only f or t he eye healt h and t he
prevent ion of blindness, but also f or an improved immunit y of t he body. The condit ion
of children wit h adequat e vit amin A, when
developing diarrhea, smallpox, or ot her inf ect ious diseases, would not get worse or endanger t heir lives.
Table 7 shows t hat many mot hers know
t hat vit amin A are good only f or eye healt h. In
t he low and high part icipat ion groups, almost
Table 7.
60% mot hers realize t he benef it of vit amin A
f or eyes; whereas only 5 – 10 % of t hem know
it s benef it f or t he body’ s immunit y, and 8 – 11
% underst and it s benef it f or children growt h.
Children’ s Part icipat ion at Posyandu
Regular visit s of children t o posyandu
are highly recommended. At posyandu every
child is monit ored f or it s body weight by
weighing. In t his way, t he body weight changes
can be obt ained f rom one mont h t o anot her. In
case of a decreased t rend of body weight or
below t he red line, posyandus are expect ed t o
give nut rit ional advice or f ood supplement s so
t hat a declining body weight can be prevent ed.
Table 8 indicat es t he suit abilit y of t he
crit eria det ermined by t he researchers, i. e.
t hose ent ering t he low part icipat ion group in
t he last six mont hs are indeed irregular t o visit
posyandus. As many as 71. 7% children of t he
low part icipat ion group are not regularly t aken
t o posyandus, while in t he high group t here
are only 7. 6% children who do not regularly
visit posyandus.
Dist ribut ion of Children based on Vit amin A Capsule Supply
Supply, Kind, and Benefit of
Vitamin A Capsule
for Children
Level of Participation
Low
High
n
%
n
%
Dist ribut ion of Vit amin A Capsule f or Children
167
92. 3
113
95. 0
Kind of Vit amin A Capsule f or Children :
1. Red
2. Blue
3. Forget
140
15
26
77. 3
8. 3
14. 4
85
15
19
71. 4
12. 6
16. 0
Benef it of Vit amin A :
1. Eye healt h
2. Children growt h
3. Body’ s immunit y
99
14
9
58. 2
8. 2
5. 3
68
13
12
59. 1
11. 3
10. 4
Table 8. Dist ribut ion of Children according t o Mot her’ s Regular Visit t o Posyandu
Level of Participation
Visiting
Low
High
n
%
n
%
101
71. 7
9
7. 6
1. Mot hers are busy
51
60. 7
3
37. 5
2. Children are st ill asleep
33
39. 3
5
62. 5
3. Complet eness of children immunizat ion
17
12. 9
1
12. 5
Mot her Who’ s not Regularly Visit ing Posyandu
Various Reasons of Inf requent Visit ing :
31
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
Such irregular visit s t o posyandus have
various reasons (see Table 8). The reason
most ly given by t he mot hers in t he high part icipat ion is t hat t heir children are st ill asleep
(62. 5%). On t he ot her hand, t hose of low part icipat ion say t hat t hey are busy (60. 7%),
t heref ore, unable t o t ake t heir children t o
posyandu. Only a small number of mot hers
(around 12 – 13 %) have t he reason t hat t heir
children have already had a complet e immunizat ion, t hus t hey do not need t o come t o
posyandu regularly.
In one village t here are usually 6 – 18
unit s of posyandus. The many posyandus are t o
f acilit at e mot hers t o get access t o nut rit ional
and healt h services. Theref ore, t here is no
reason f or mot hers not t o come t o posyandus
because of a long dist ance t o posyandu. A
Posyandu as t he f ront line of nut rit ional service in villages is commonly open once a
mont h, t heref ore mot hers having children under f ive years old should be able t o t ake t heir
children t o t he posyandu on t he day scheduled
t o open.
KMS (Growt h Chart Card) is a simple and
inexpensive t echnique t o monit or t he healt h
and growt h of children. According t o Sukarni
(1994), KMS allows an appropriat e and pract ical monit oring of children healt h in all aspect s. Theref ore, such a card could be very
usef ul f or mot hers and f amilies t o observe
t heir children growt h so t hat no mist akes or
imbalance would occur in f eeding t heir children.
Every child should have t he card dist ribut ed f ree at posyandus. The percent age of
t hose holding t he cards varied f rom 65. 3% 97. 8% f rom 2001 – 2005. The biggest percent age of card ownership was in 2001 (97. 8%) and
t he lowest was in 2005 (65. 3%). The decreased
car ownership in 2005 was indeed a problem
because children wit hout such cards mean t hat
t hey do not visit posyandus; or if t hey do
come, t he services provided are less opt imal.
Wit h t he regular weighing of children once a
mont h, t he ownership of t he cards would be
very usef ul f or underst anding t he growt h of a
child.
The percent age of children having t he
cards t o reach 100% is rat her dif f icult t o at t ain. The children of bet t er-of f f amilies seldom go t o posyandus f or healt h examinat ion,
but t o privat e doct ors f or children. Theref ore,
if t he percent age of card ownership can reach
90%, t his would seem t o be a good achievement and must become t he t arget .
32
Weighing part icipat ion ref ers t o t he
number of children visit ing posyandus in a cert ain mont h (August ) compared t o t he t ot al
populat ion of children. Bet ween 2001 and 2005
t he weighing part icipat ion was bet ween 57. 1%
and 76. 8%. In 2005, it was t he lowest (57. 1%).
This indicat es t hat it is necessary f or
posyandus t o make great er ef f ort s t o remind
mot hers t o t ake t heir children t o posyandus
f or weighing.
Those who do not weigh t heir children
might have st opped visit ing posyandus or are
t oo busy t o come t o posyandu on t he day of
weighing. It is much bet t er if posyandus can
set a t arget of part icipat ion expect ed. Wit h
such t arget , t he degree of success in at t aining
t he t arget can be evaluat ed. From t he f igures
present ed in t he t able, t he part icipat ion t arget s ranging f rom 80% - 85% may be regarded
t o be realist ic t o reach. The poor perf ormance
in 2005 wit h t he weighing part icipat ion of only
57. 1% must be analyzed f or possible causes so
t hat solut ions can be made immediat ely. In
t he coming years it is expect ed t hat t he degree of part icipat ion will improve.
Children’ s Access t o Nut rit ional Programs
The dist ance f rom home t o t he locat ions
of healt h/ nut rit ional services can be seen in
Table 10. A Posyandu locat ed in every
neighborhood (RW) is t he closest locat ion of
nut rit ional/ healt h services (84 m) f rom t he
homes of mot hers having children under f ive
years old. The government ’ s policy t o short en
t he dist ance t o t he nut rit ional/ healt h services
is considered t o be very appropriat e and will
allow people t o access such services easily.
Ot her places f or such services which are relat ively close in dist ance are healt h clinics (122
m) and Pust u/ Pol indes (459 m), which are
commonly privat ely managed wit h relat ively
more expensive t arif f compared t o t he public
healt h cent ers. As can be seen f rom Table 9,
t he dist ance t o t he locat ion of nut rit ional/ healt h service, which is relat ively f ar
away, is t o t he doct ors who provide privat e
services (1510 m), puskesmas (1938 m), and
hospit als (5293 m).
Table 11 shows t he means of t ransport at ion t aken by mot hers t o get t o t he locat ions
of nut rit ional/ healt h services. To arrive at posyandus, most respondent s (99. 3%) walk because of t he relat ively short dist ance. Only
About 0. 7% of respondent s ride mot orcycles t o
go t o posyandus. Meanwhile, t o go t o a village/ privat e midwif e, 44. 6% of t he respondent s walk. A village midwif e is one who is
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
assigned by t he government t o open pract ices
in every village so t hat t he rural people can
get healt h services more easily. Some respon-
dent s visit a village midwif e by a public t ransport (29. 5%) and mot orcycles (25. 5%).
Table 9. Growt h Chart Card Ownership of Children in Cianj ur Regency in 2001-2005
Variable of Growth Chart Card Ownership
Year
2001
2002
2003
2004
2005
Tot al of children under f ive
157 782
171 472
171 696
171 919
198 446
Children under f ive who owned growt h chart card
154 312
129 623
157 960
129 621
129 511
Children under f ive who had been weighed
121 220
104 065
120 874
107 634
113 292
Coverage of growt h chart card ownership (%)
97. 8
75. 6
92. 0
75. 4
65. 3
Part icipat ion of weighing (%)
76. 8
60. 7
70. 4
62. 6
57. 1
Tabel 10. Dist ance of Nut rit ional/ Healt h Service Locat ion f rom Children Homes
Location of Nutritional/ Health Service
n
Distance
(m)
Category of
Distance
300
84
Close
Healt h Clinics
300
122
Close
Pust u/ Polindes (Auxiliary Public Healt h Cent re)
300
459
Close
Local/ Privat e Midwif e
300
802
Medium
Doct or
300
1510
Far away
Puskesmas (Public Healt h Cent re)
300
1938
Far away
Hospit al
300
5293
Far away
Posyandu (Int egrat ed Healt h Service Cent re)
Not e : Close
= < 500 m
Medium = 500 – 1500 m
Far away = > 1500 m
Table 11. Dist ribut ion of Children based on The Transport at ion t aken by Mot hers t o Nut rit ional/
Healt h Service Locat ion
Location of Nutritional/ Health Service
Posyandu (Int egrat ed Healt h Service Cent re)
Local/ Privat e Midwif e
Pust u/ Polindes (Auxiliary Public Healt h Cent re)
Puskesmas (Public Healt h Cent re)
Kind of Vehicle
Walking
Hospit al
%
297
99. 3
2
0. 7
Walking
112
44. 6
Riding mot orcycles
64
25. 5
Public t ransport
74
29. 5
Walking
40
31. 5
Riding mot orcycles
Riding mot orcycles
37
29. 1
Public t ransport
34
39. 4
Walking
24
10. 5
Riding mot orcycles
45
30. 7
Public t ransport
132
57. 9
1
7. 7
Walking
Healt h Clinics
n
Riding mot orcycles
2
15. 4
Public t ransport
8
61. 5
Privat e car
Walking
2
15. 4
6
2. 8
Riding mot orcycles
52
23. 9
Public t ransport
159
72. 9
33
Jurnal Gizi dan Pangan, Juli 2007 2(2): 26 - 35
To go t o puskesmas, most respondent s
t ake public vehicles (57. 9%). A puskesmas is
locat ed in t he capit al of Dist rict , which rat her
f ar away f rom t he respondent ’ home. Only a
small number (10. 5%) of respondent s t ake a
walk t o get t o puskesmas.
There is a relat ively small number of
respondent s who go t o healt h clinics. The privat ely owned healt h clinics charges higher
medical cost s t han puskesmas. Those going t o
healt h clinics commonly t ake public vehicles
(61. 5%). Similarly t hose going t o t he hospit al
locat ed in t he t own use public vehicles
(72. 9%).
CONCLUSION AND RECOMENDATION
t he nut rit ion knowledge of cadres and
midwives who are in charge at posyandus
t hrough t rainings. Furt her, t he ext ension
act ivit y has t o be an inseparable part of
t he nut rit ional program services at
posyandus.
2.
The supplement al f ood program at posyandus has not been opt imally managed because of a limit ed budget of posyandus.
Theref ore, t he bet t er-of f communit y or
corporat ions around posyandu must be encouraged t o give volunt ary donat ion or f inancial aid so t hat t he operat ion of supplement al f ood program can be more ef f ect ive. In addit ion, t he Healt h Services
should also be able t o allocat e a bigger
budget of posyandus t o carry out t he supplement al f ood program.
Conclusion
Mot hers having children under f ive years
old t hink t hat t he supplement al f ood program
and nut rit ion ext ension at posyandus should be
improved. The number and skills of t he cadres
are already considered quit e good, t he presence of midwives at posyandus is inadequat e.
The immunizat ion program f or children is
viewed as very good by mot hers having children under f ive years old. As f or t he services
at puskesmas, t he maj orit y of mot hers wit h
children under f ive years old complaint about
t he long queuing t ime and t he inf requent
presence of doct ors when t hey visit f or medical t reat ment .
The part icipat ion of children (under f ive
years old) in visit ing posyandus is relat ively
good, namely, 92. 4% (f or t he high part icipat ion group). However, f or t he low part icipat ion group, t he number of part icipat ing children is relat ively low (28. 3%). The absences
f rom posyandus are due t o t heir mot hers being
busy or children being st ill asleep. More t han
90% of children, bot h of t hose who of t en and
seldom visit posyandus, have received vit amin
A capsules. This means t hat t here is an adequat e dist ribut ion of vit amin A capsules. A
posyandu’ s services most ly f elt by t he public
are t he weighing of children and immunizat ion. The access f rom t he homes of mot hers
having children under f ive years old t o t he
nearest places of nut rit ional services (i. e.
posyandu) is < 500 m and t he dist ance is covered by walking.
Recommendation
1.
34
Because t he nut rit ional ext ension is a
weak aspect of t he act ivit ies at posyandus,
it is necessary t o make ef f ort s in improving
ACKNOWLEDGEMENT
Thank you very much t o t he Neys-van
Hoogst rat en Foundat ion (NHF), t he Net herlands f or f unding t his proj ect . It is a good opport unit y t o collaborat e wit h t he NHF. Thank
you and appreciat ion t o ot her research t eam
Hadi Riyadi, Faisal Anwar, and Eddy S. Mudj aj ant o who part icipat ed in t his proj ect .
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