Aceh, Indonesia: Children's Participation in the Successful Reconstruction of the Community-Based Primary Health Network

Indonesia was the hardest hit by tsunami in December 2004. In the districts of Aceh Besar and Aceh Jaya, health infrastructure collapsed as a result. In the immediate aftermath of the tsunami, it was estimated that one-third of health centres were destroyed and that another one-third required renovation. Children suffered enormously, both due to physical suffering (e.g. trauma, disease) but also due to psychological stress.

Plan Indonesia, an international, child-centered humanitarian organization, received a 3-year grant (2006-9) from the American Red Cross to re-build the primary health services in both districts.

Participatory methods were applied in the design of the project activities and included children, families, community leaders and government officials. Village mapping and open discussions were applied. In these discussions, children voiced their needs for psychological support from health providers, and for recreational and social areas and activities. Children also expressed their hopes to participate more actively in the project activities.

Based on these contributions, major project components included: (a) Rebuilding and re-equipping of 39 Posyandus(village health post) and 24 Polindes (village birth delivery post) with child friendly spaces for early stimulation, social and recreational activities and programming. (b) Training for 40 midwives and 139 community health volunteers on psychological counseling and support in addition to disease prevention and control; (c) Development of a service network with District Health Office managing both disease and emotional distress; and (d) Community mobilization and education activities using radio, and group/individual education. Children organized and participated in these activities.

Nine months before the scheduled end of the project, it achieved all its planned outputs, e.g. number of facilities rehabilitated and people trained. Both moderate child malnutrition and anemia in pregnancy have experienced significant decreases (15% vs 3%, and 42% to 39% respectively). The child immunization coverage has been kept high, at 70%'s levels. Most importantly, the emotional and social standing of these children have improved by both taking into account their needs and also making them participants of the project.

This experience shows that the participation of the disaster-affected population (and especially children) led to quality improvements of the health services after the disaster.