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Sumbawa is a remote island located in the east of Indonesia and is notorious for its high level of maternal and infant mortality and malnutrition.
In the sub-district of Parado, childhood malnutrition was found to be at unacceptably high levels. Child malnutrition is the single biggest contributor to under-five mortality due to greater susceptibility to infections and slow recovery from illness. The lack of household food availability, personal health, and ineffective health services put the children in Parado at risk.
Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. The diarrhea rate amongst children below five is very high , with a clear link to unhygienic practices such as open defecation keeping livestock in/under the house and a lack of access to clean water and sanitation.
E-coli is a type of bacteria that causes diarrhoeal disease. The diarrhoea rate among children under-five in Parado used to be 35% (SurfAid baseline, 2014). Hygienic practices were needed to bring this rate down, alongside improvements to the water sources and properly designed toilets to stop waste water from contaminating the drinking water. The short-term solution was an intensive health promotion campaign to boil all water before using it. Then, using the Community-Led Total Sanitation (CLTS) approach, community members were encouraged to build their own family latrines. Communities were trained on health and sanitation issues, and learned how to create simple, safe and low-cost squat toilets. By October of 2016, the local government officially declared the villages as Open Defecation Free (ODF) villages. This would not have been possible without the construction and renovation of 46 hand-dug water wells, leading to clean water close to the houses of the communities of Kuta and Paradowane.
SurfAid provided the technical expertise and knowledge, but the community members of Paradowane and Kuta villages built the water facilities themselves. Based on experience, SurfAid has found that water facilities will only be, sustained if the following is in place: there is genuine demand from the community, the community participates in every key decision, and the community understands and agrees that the maintenance of the water facilities is their own responsibility. We have trained and coached a Water and Sanitation Committee (WSC) for each community. The WSCs play an important part in planning, managing, maintaining and coordinating the labour for the water facilities. The communities have provided local materials, such as 46 m3 stones, and 5,520 hours of labour in the process of construction.
With water in place closer to the homes, we were able to work on the next element to improve the health of mothers and children in Parado. Together with an expert in permaculture, SurfAid trained 55 community member in topics such as compost making, seed saving, garden design, and organic pest control. All of the training participants now have their own nutrition gardens, and they spread the word! They succeeded in coaching their neighbours to create permaculture nutrition gardens themselves. In total 98 households in Paradowane (11% out of total population) and 52 households (15% of population) in Kuta now have their own nutrition gardens with vegetables and herbs including tomato, spinach, bok choy, chilli, cucumber and basil. These are mainly used for their own consumption and have helped to increase the nutrition status of the children under five.
The support from Footprints has contributed towards the implementation of clean water facilities and the training of community members on the importance of nutrition and sanitation in Parado, Bima on the island of Sumbawa. As a result, the rate of diarrhoea among children under five has reduced from 34% to 0.4%!
This in turn contributed to a reduction in the rate of children under five who are underweight in the last year from to 27.4% to 20%. That is truly amazing. We still have a long way to go, but changing behaviour is an evolution, not a revolution. With most of the healthy behaviours now in place, we are looking forward to even more positive changes for the Parado communities.
Clean water is a scarce commodity in the remote area of Parado. People depend on hand-dug wells and periodically on the government’s old piping system. When SurfAid initially tested the water, 75% of the water from the traditional hand-dug wells and 65% of the water from the piping system were contaminated by e-coli.
Rahmani Amin (Ani) lives in Fo’oKompo hamlet of Paradowane village. She is a mother of 8 children, 2 of which are still under five years of age. She was inspired by a community health volunteer from her hamlet, who provided coaching in permaculture techniques for nutrition gardens. When Ani decided to start her own nutrition garden, the health volunteer shared some vegetable seeds with her. After she learned how to manage her own nutrition garden, Ani learned how to make her garden sustainable by producing her own organic seeds from her harvest.
“I am really grateful to have this little nutrition garden…I don’t need to spend any money for buying vegetables anymore. We have what we need for our daily consumption. We have tomatoes, bok choy, eggplant and chilies. This has also reduced our daily expenditures for food. I can feed my children more varieties of food to make them healthier.” - Rahmani Amin, 2016.
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