INDONESIA: Building a bridge to eliminate malaria

IRIN,  (UN Office for the Coordination of Humanitarian Affairs)

NGRECO, 8 February 2009 (IRIN) - Like most remote villages in Indonesia, Ngreco, tucked away in the mountains of Pacitan District in East Java Province, suffers from a high incidence of malaria.

 

A new bridge in Ngreco village, East Java Province, has helped reduce incidences of malaria

The village’s remote location means residents are inaccessible to district health workers, and have little access to health care services. In eastern Indonesia, where malaria is endemic, malaria rates are usually 20-30 percent, but at one point in Ngreco it reached 80 percent. 

In 2006, a US$25,000 grant from the local government allowed the 5,400 inhabitants to build a much-needed concrete bridge to replace the precarious, hanging bridge that they had been forced to use until then. The money was not enough, but the villagers knew they needed the bridge, and so they decided to contribute their time and resources to make up the difference. 

"Villagers worked in shifts,” said Wasi Prayitno, head of the task force that carried out the project in Pacitan. "Thirty people worked each day for three months until the bridge was completed." They were paid 50-70 percent of their normal wages. 

Bridge allows access by health workers 

Haryono, the village head, enumerated the benefits they have reaped from the bridge: cheaper prices for the goods they purchase, higher selling prices for their produce, easier access to schools and hospitals, and, he emphasised, a drastically reduced malaria incidence of just 20 percent. 

Before, health extension workers could not get in. The sick had to be carried out by villagers on stretchers.

In a country where, according to the World Health Organization, nearly half the population or more than 90 million people live in malaria endemic areas, Ngreco's experience shows that the government's goal of eliminating the mosquito-borne disease by 2030 is not impossible. Both government and private malaria experts told IRIN that reducing isolation is a critical factor in achieving this goal. 

Dave Jenkins, director of SurfAid International in Indonesia, which runs an anti-malaria programme covering more than 200 villages in Mentawai Islands, eastern Indonesia, said that while incidents of malaria fluctuate based on a number of variables, such as weather, "access [by health workers] is one of the critical success factors". 

"Isolation is a huge issue," he told IRIN. "It's the reason there's a high incidence in remote areas." 

The Ministry of Health agrees. "Indonesia has a strong health infrastructure. We have specific malaria control units in districts. We recruit women volunteers and train them in malaria control," said Rita Kusriastuti, the ministry's director of vector-borne diseases. "But our volunteers can't conduct spraying and distribute bed nets if they can't access the villages." 

“Behaviour change is key” 

She added that Indonesia was currently on track to meet the Millennium Development Goals of halting and beginning to reverse the incidence of malaria by 2015. "In Java and Bali, the incidence is now just 0.2 percent," she said. 

Jenkins warns, though, that not too much credit should be given to any single factor, and that an effective malaria control programme should have a mix of interventions. "In Mentawai, we have seen very significant reductions and very strong downward trends, but not all this is due to our interventions. There are natural fluctuations in malaria incidence. Behavior change is key," he said. "You can't just go into a village and dump bed nets. You have to educate people in using them." 

WHO said that in 2000, only about 0.2 percent of children slept under an insecticide-treated bed net. "Once people use bed nets, that's definitely an indicator of success," Jenkins said.