Making health a primary concern: the Jayawijaya WATCH project
Case Study
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| Teacher's Notes | Student Activities |
| Background |
From the air it may appear like a scenic paradise but the people of Jayawijaya in the highlands of Irian Jaya [now renamed Papua*] have too often seen their babies and children die of illness and malnutrition. Diarrhoea, tuberculosis and pneumonia are common; even malaria has spread to the highlands. Many women are anaemic and the poor health of pregnant women, as well as a shortage of trained birth attendants, contributes to a high maternal mortality rate.
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| Jayawijaya extends through the rugged highlands of Irian Jaya (Papua). |
Reliable health data is difficult to obtain from isolated villages where many people cannot read and write. The table below compares development indicators for the Jayawijaya area with Indonesia's national figures and Australia.
| Indicator | Jayawijaya | Indonesia | Australia |
| Infant mortality rate (deaths under 1 year) | 98 per 1000 live births (1) | 40 per 1000 live births (3) | 5 per 1000 live births (3) |
| Maternal mortality rate | > 450 per 100,000 (1) | 450 per 100,000 (3) | 3 per 100,000 (4) |
| Literacy rate (latest available data) |
44% women, 58% men Irian Jaya (2) | 58% women, 78% men (5) 78% women, 90% men (6) |
99% (estimate) |
Jayawijaya had critical gaps in its health system. In 1990, 400,000 people relied on one hospital in Wamena (the district administrative centre) with 13 health centres and 51 sub-health centres concentrated around Wamena and smaller urban centres. For most villagers getting to a health centre meant a long walk due to a lack of roads and no public transport. For women it was especially difficult due to a heavy workload, preparing and tending food gardens, as well as feeding the pigs, cooking and caring for children. Many of the health centres also lacked trained staff, as well as supplies of medicines, vaccines and basic equipment. In villages with an unsafe water supply, limited health knowledge, and a small cash income, it was hard for families to prevent illness or to follow through on appropriate treatment.
| The Jayawijaya WATCH project |
The Jayawijaya WATCH project set out to develop a primary health care strategy appropriate to remote areas of Irian Jaya [Papua], with a particular focus on women and their children's health (WATCH). The project aimed to strengthen and develop the formal health sector by working closely with the local authorities.
The project, which began in 1991, is funded through the Australian Government's overseas aid program, and implemented by World Vision Australia and World Vision Indonesia in collaboration with the district health office.
| Training health workers and volunteers |
Local health workers, traditional birth attendants and volunteers were trained to weigh children, provide ante-natal checks, ensure safe delivery of babies, and conduct basic treatment when needed. Teaching materials were developed to help workers learn how to recognise and treat common illnesses. A new health information system was designed to increase the efficiency of collecting basic information about illnesses and treatments. Solar refrigerators and back-pack vaccine carriers were provided in key locations to assist the health office's immunisation campaigns. The project also funded new classrooms and a dormitory at the nurses' training school in Wamena.
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| Learning about ante-natal care reduces the risk to both mothers and babies. |
| Understanding factors contributing to poor health |
Various environmental and social factors affecting health, particularly the roles of women and men were addressed. Communities discussed ways tasks could be shared and some of the men became involved with crops, rabbits, goats and bees, which increased food variety and provided income. Communities constructed several cable bridges to improve access to markets and health services.
Another problem was the smoke from fires within people's homes that contributed to respiratory problems. The fires were used not only for warmth but also to repel malaria-carrying mosquitoes. While villagers are reluctant to replace their traditional housing, the problem may gradually be resolved through other avenues such as increased income which enables people to afford blankets and bed-nets.
| Health education |
An important part of primary health care is health education. Communities discussed the importance of good nutrition and personal hygiene. Mothers were encouraged to continue breastfeeding their babies and pay special attention to small children who risk becoming malnourished if breastmilk is not supplemented by other foods. The sweet potato is the staple item of the local diet and health workers experimented with sweet potato flour called "power powder" as a useful weaning food. Mothers were also encouraged to add a spoonful of cooking oil when preparing children's meals, to increase their energy intake.
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| Ensuring that young children's diet includes sufficient energy and protein is a key to healthy development. |
A local oral rehydration solution (Superoralit) made from sweet potato flour was developed to replace fluids and nutrients lost during illness from diahorrea.
Early teaching materials were produced to encourage key health messages. The materials used lots of pictures with text in the national and administrative language, Indonesian. Since many local languages are spoken, bilingual teaching materials are being developed. The chart below lists some of the key messages that are being encouraged.
Selected health messages
Medical treatment
Nutrition
Ante-natal care
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The WATCH project in collaboration with local communities and health authorities has taken important steps towards increasing access to primary health and development in Jayawijaya.
*On 1 January 2000, the official name of this province of Indonesia, occupying the western half of the island of New Guinea, was changed to Papua. Both names are used throughout this case study, for the sake of clarity.
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