Child survival in Indonesia

The program has also strengthened the country's primary health care system by rapidly expanding services outside the physical and administrative confines of the existing public health facilities. Principal achievements include: a rapid expansion of community-level health posts (posyandus), which deliver child survival interventions nationwide; high rates of child immunization (65% for DPT3 and 50% for measles); successful education of mothers in oral rehydration therapy; and nationwide expansion of growth monitoring and nutrition education through the posyandus. Much of the program's success can be attributed to the incremental growth of highly focused and vertical efforts to deliver key services, beginning with family planning and nutrition in the 1970's and later adding immunization and diarrheal disease control. By 1985, the country began large- scale efforts to integrate these services at the community level. A.I.D. has played a critical role in stimulating and shaping the program, providing $60 million (over and above support for family planning) and supporting more than 25 bilateral, private voluntary organization, and central projects over the last decade. Key elements of A.I.D.'s contribution include: sustained commitment and support for highly focused programs (family planning, immunization), effective policy dialogue coupled with research, provision of some operational costs for major activities, provision of supplemental support from centrally funded A.I.D. programs, collaboration with other donors, and investment in training and education. Despite the child survival program's achievements, however, sustainability is still in question. Additional efforts are needed to ensure the long-term financial basis, consolidate activities, and solidify political support and popular demand.