Indonesia is a middle income country, with annual growth rates around 6%. However, there are inequalities between certain regions and populations. In terms of medical care access, despite the efforts made to increase the number of sanitary infrastructures, the average national access to health services is still low (52,5%) and the allocation of health services and human resources is not homogeneous: there is a good coverage on Java Island but a low one on Eastern provinces. The public health system particularly suffers from a lack of qualified staff and/or a staff insufficiencies and/or a lack of infrastructures in remote regions.

The same disparities exist between provinces in terms of under-nutrition. Most of the cases are concentrated in rural areas in Eastern provinces of Indonesia. Generally, under-nutrition comes from poverty (the NTT is one of the 6 less developed provinces: the insufficient weight rate is about 29,4% and the delayed development is about 58,4%). The principal factors responsible of this situation are the food insecurity, insufficient food supply, uncertain weather and the poor access to water, sanitation and health services.

A new analysis of the underlying causes of malnutrition (NCA)(1) led by ACF in the NTT in 2010 has confirmed the fact that the principal factors of under-nutrition are structural and include the lack of knowledge in babies and children food practices, the weak health and nutritional state of mothers, those two factors leading to a high disease risks for both mothers and children.

Since the 1990’s, the country has been affected by a global agricultural productivity decrease because of the research and development decrease, the reduction of the agricultural infrastructures budget and the reduction of public subventions to agricultural inputs, to industrialization and urbanization leading to a land competition and a small farm holding model. In NTT, 80% of the population lives in rural areas and needs agriculture to eat. In this region, 44,9% of households suffers from food insecurity. The recent NCA analysis made by ACF shows that food insecurity is also linked to under-nutrition, more because of the food use than because of its access and its availability.

Natural disasters in Indonesia have strong impacts on the population vulnerability, especially in terms of food insecurity and under-nutrition. Climatic change can worsened the situation because the consequences of those events have an influence on under-nutrition rates, are harmful on health, increase poverty and tensions on resources use.

ACF in Indonesia

Since the opening of the mission ACF in Indonesia in 1998, ACF as implemented emergency help projects, rebuilt and development programs in 10 provinces provinces (Papua, Maluku, North Maluku, Aceh, North Sumatra, West Sumatra, Yogyakarta, Central Java, Jakarta and NTT). Following an exploration mission led in the NTT province in 2006, a first intervention was launched in the Timor Tengah Selatan (TTS) district including a water, sanitation and hygiene program, a food security project and evaluations in order to eventually launch a nutritional program.

At national level, ACF cooperates with the Health Minister through an agreement protocol about a common effort to improve the nutritional situation of the population in the regions where under-nutrition is widespread. At province/district/under-district level, ACF is working with local authorities, competent agencies and institutions, with for example the Secretariat of Agriculture and Livestock, the Secretary of Public Work, the socio-medical centres, National Disaster Management Agency.