Gender and Development News

Volume 10, Issue 1

Southeast Asia Regional Department

July 2015

Welcome to the first 2015 issue of SeaGen Waves a newsletter highlighting

the gender and development initiatives and activities of the Southeast Asia
Regional Department (SERD).
This special issue on Health and Education showcases SERDs efforts to advance
womens well-being and capability, to enable them to live healthy and productive
lives.
Poor health disproportionately affects women because of their specific health needs
during the reproductive years and their traditional role as family health care
providers. Women face challenges in meeting their health needs due to a lack of
access to quality health and maternal care services and limited knowledge of health
and nutrition. The articles on health showcase how ADB-supported projects have
addressed the financial, geographic and cultural barriers to maternal and child
health by building capacity of and providing more resources to frontline service
providers, linking them to back-up and referral services at the district and
provincial levels, and by mobilizing community to be informed and accountable.
The case studies on education highlight how our projects have addressed access
and equity issues to increase girls and ethnic minorities participation in lower
secondary education, who are currently disadvantaged by poverty, ethnicity and
geography. The story on upper secondary and professional secondary education
emphasizes our efforts to improve the quality of teacher education in Viet Nam and
to make it more accessible for ethnic minorities and women.
We hope that you find these stories inspiring. Please feel free to provide us with
ideas and stories for the next issue.
Uzma Hoque
Senior Social Development Specialist (Gender and Development)
Office of the Director General
Southeast Asia Department

Special thanks to Leavides Cabarrubias and Ien Lee Villanueva for their invaluable support in
putting together this issue of SEAGEN Waves.

Table of Contents
1. Bringing Good Health to Villages: Supporting Decentralized Maternal and Child
Health Services in Indonesia
2. Breaking Barriers: Helping Girls Access Quality Secondary Education in Lao
PDR
3. Fostering Healthier Communities: Improving Health and Disease Prevention in
Viet Nam
4. Educating the Educators: Expanding Access to Better Quality Teachers
Training in Viet Nam
5. On the Way to Better Health: Advancing Women and Childrens Health and
Nutrition Status in Indonesia.
6. News and Events

Bringing Good Health to Villages:

Supporting Decentralized Maternal and Child Health Services in Indonesia
The Second Decentralized Health Services Project
tackled the alarming rates of maternal and infant
mortality in Indonesia. Maternal and child health care
services were brought closer to the villages by
constructing new health facilities, training midwives to
provide quality service to villagers, and implementing
village-level programs to address maternal and child
health issues. Read more

Breaking Barriers:
Helping Girls Access Quality Secondary Education in Lao PDR
More and more girls and ethnic minorities are enrolling in
lower secondary schools in Lao PDR. The Basic
Education Sector Development Program (BESDP)
addressed some of the barriers to girls entry in LSE by
offering scholarship support and constructing new
schools in underserved areas. Read more

Fostering Healthier Communities:

Improving Health and Disease Prevention in Viet Nam
Through the Preventive Health System Support
Project, communities have been empowered to prevent
the occurrence and spread of infectious diseases within
their villages. The project strengthened the health
surveillance system and the capacity of health staff to
detect, prevent, and control diseases. Read more

Educating the Educators:

Expanding Access to Better Quality Teachers Training in Viet Nam
Interventions under the Upper Secondary and
Professional Teacher Development Project opened
opportunities for more ethnic minorities to become
teachers. The quality of teachers training was enhanced
through new methodologies that encourage creativity and
analytical thinking among students. Read more

On the Way to Better Health:

Advancing Women and Childrens Health and Nutrition Status in Indonesia
The Nutrition Improvement through Community
Empowerment Project has enabled women to improve
their health as well as that of their families by increasing
their knowledge and skills on food, nutrition, and health
care. The project made it possible for community people
to access health and nutrition services within their
villages. Read more

Bringing Good Health to Villages:

Supporting Decentralized Maternal and Child Health Services in Indonesia
A large number of women in Indonesia die during childbirth. Especially in the
poorest provinces and among the poorest households, women give birth at home
without the assistance of qualified health professional. Many infants die or are born
underweight, and continue to suffer from malnutrition. Limited access to quality
health
services
and
lack
of
information on nutritional and
health care needs during and after
pregnancy are critical
factors
severely affecting the health of
women and children.
Improving
the
health
and
nutritional status of women and
children was a key objective of the
Second Decentralized Health
Services Project. To ensure this,
it focused on improving the quality
of health services at the district
and village level; increasing access
Feeding sessions for mothers and
to health facilities and services;
children. Photo by Barbara Lochmann.
and mobilizing communities to
address maternal and child health issues.

underweight

Building capacity of health workers

In the villages, midwives are the first contact and the primary health service
providers for the rural population. However, they often lack the capacity to provide
maternal and child health care due to limited training. To address this, the project
provided training to 6,375 village and district-level midwives on maternal and
newborn care, including management of low birth weight. Scholarships were
offered to 2,147 midwives, doctors, and maternal and child health workers for
further training in regional health colleges. The training of midwives benefitted a
large proportion of women who comprised about 80% of the staff in village health
posts (poskesdes).
Constructing health facilities in underserved areas
Health facilities are sometimes beyond the reach of the poor especially in remote
areas due to distance and transport costs, or the services are inadequate because
of lack of equipment. The project supported the establishment of 449 poskesdes in
communities where there are no health posts. Trained nurses and midwives were
placed in most rural villages, with 85% of the midwives residing in the poskesdes.
Twenty one health centers and 2 district hospitals were constructed in districts
where there were none, bringing the services closer to underserved populations. A
total of 40 existing health centers and district and provincial hospitals were
upgraded and 273 health centers were provided with equipment. The design of
these facilities ensured the availability of delivery rooms and post-delivery rooms
which ensure womens privacy, and provided separate toilets and bathrooms for
men and women. In addition, medical equipment and ambulances were provided to
district hospitals, which ensured that people who need immediate medical
attention, especially those living in remote areas, can be brought to hospitals
immediately.

Mobilizing communities to address health issues

Limited awareness by local communities of health
issues and how to address these, and of the range of
services available for them, also contribute to the low
utilization of public health services. The project
supported the governments desa siaga (alert village)
program which uses a community mobilization
approach to promote safe pregnancies and deliveries
at the village level. Village forums were established to
increase awareness on maternal and child health.
Facilitators were recruited from the villages, with
women comprising 60% of 90 facilitators. They were
trained to help villages prepare their action plans to
address maternal and child health issues.

Desa Siaga is defined as a

village that has resources,
capability, and readiness to
overcome health problems. It
is a strategy introduced by the
Department of Health for health
investment at the grass roots
level.
The Desa Siaga aims to ensure
that each childbirth is attended
by skilled midwife at an
adequate
facility
through
increasing
community
awareness and preparedness.

Based on the village action plans, the project funded 732 activities (one for each
project village), which were mostly allocated for: construction of poskesdes;
support for activities of health forums (health education, feeding sessions for
mothers and underweight children); and training village midwives in maternal and
newborn care, breastfeeding, and timely referral to appropriate hospitals.
Making family planning work for villagers
Access to family planning services allows women and their families to make
informed decisions on childbearing and spacing of children. Availability of
contraceptives averts unplanned pregnancies that sometimes lead to unsafe
abortion, which is a major contributing factor in maternal deaths in Indonesia. To
bring the program closer to the communities, poskesdes were registered as family
planning clinics to serve the villages. Services included distribution of
contraceptives, targeting poor and vulnerable groups. About 2,197,781 poor and
urban slum dwellers received contraceptive services. By 2012, the use of modern
contraceptives in the project provinces increased to 55.2% from 49.6% in 2003.
Trainings were provided to 38,650 family planning field workers to ensure that they
provide quality services including counseling and information dissemination.
Women comprised 50% of the trainees. To raise awareness on the importance of
family planning and the available services, as well as to reach a wide range of
people in the localities, the project: (i) distributed 4,783 information, education,
and communication materials; and established (ii) 3,022 information and
counseling centers for adolescent reproductive health; (iii) 90 family planning
district offices; and (iv) 3,970 private family planning clinics.
The project significantly contributed in increasing the utilization of
maternal and child health services by 30%. Obstetric deliveries attended by
skilled medical staff increased remarkably from 56.5% in 2003 to 74.9% in 2012.
The percentage of births in hospitals was higher in project villages (28%) than in
non-project villages (17%) and the percentage of births at home was lower in
project villages (33.7%) than non-project villages (49%). The number of children
weighed at the health posts increased from 60% in 2007 to 67.5% in 2010. These
achievements can be attributed to increased access to health facilities with better
equipment that cater to womens needs; improved quality of services provided by
trained health professionals; and increased awareness and capacity of community
members to address maternal and child health issues within their villages.
For more information, please contact Barbara Lochmann, Senior Social Sector Specialist, SERD,
blochmann@adb.org

Breaking Barriers:
Helping Girls Access Quality Secondary Education in Lao PDR
For many girls and ethnic minorities in remote rural villages, the prospect of
entering lower secondary education is low. Poverty and distance to schools are key
barriers that are hindering them from enrolling in secondary schools even if they
have completed primary education. The Basic Education Sector Development
Program (BESDP) aimed to address these by constructing schools in areas where
there are no lower secondary schools, and providing scholarships targeted at poor
students, girls, and ethnic minorities.
By project end, girls transition rate from primary to secondary school increased to
87.2% from 75.9% in 2004, outpacing the increase for boys and narrowing the
gender gap in lower secondary education (LSE). The enrollment rate for both girls
and boys rose from 54% in 2004 to 69% in 2012.
The construction of new schools in underserved areas encouraged more
girls, who previously had to drop out due to distance, to continue their
secondary education. A total of 28 new lower secondary schools were
constructed and equipped, which included 112 standard classrooms. In addition,
144 classrooms were constructed in existing schools. These were intended to
address lack of schools or inadequate classrooms in 20 districts in six poor
provinces where female students, especially ethnic girls, have high dropout rates.
The facilities were designed to meet girls
need for sanitation and privacy by
providing separate toilets for boys and
girls, with access to water provided by the
project and/or the community. Lighting
and electricity were also installed to
ensure greater security for girls.
Scholarship programs targeted poor
students, girls, and ethnic minorities.
Launched in 2009, the Lower Secondary
Student Grant Program (LSSGP) provided
scholarships to 1,638 poor students,
including 841 girls (comprising 51.3%).
The scholarships were intended to cover
all four years of the extended LSE cycle,
with priority given to girls and children
from poor families and ethnic groups. The
program has reduced dropout among
targeted poor children, with 1,556
recipients including 797 girls (51%) and
1,168 children from
ethnic groups
(75.1%)successfully completing grade 9.
Project monitoring visits revealed that
many of the scholars excelled as high
performers in their classes.

Pheng Bounma of Nongkhet District,

Xiengkhuang Province, is one of the
beneficiaries of the BESDP scholarship
program. A 17-year old Laotai girl, she was
overage in completing primary school, and
had low prospects of entering secondary
education.
If I had not received scholarship support, I
would likely have dropped out already, like
most girls my age in our village, she shares.

The project significantly contributed in improving girls and boys access to

and completion of LSE. The national gross enrollment rate rose from 54% in
2004 to 69% in 2012. Dropout rates for females fell from roughly 11% to 8%, and

from 13% to 10% for males. The number of

LSE graduates rose from 58,200 to 69,219.
Girls outpaced boys in terms of the number of
graduates: between 2006 and 2011, female
LSE graduates rose by more than 11%, more
than double the increase in male graduates.
The increase in girls participation in LSE has
been noted in some villages. In Khangvieng
Primary and Secondary School in Mok District,
the school principal remarked that in her
village, it is typical to expect that by age 13 or
14, girls are already married and are no
longer in school. Now, more girls are entering
and staying in lower secondary school.

Waomona, 15 years old, is one of

very few girls in Khangvieng Primary
and Secondary School in Mok
District. Through project-supported
scholarship, she enrolled in LSE and
is now in Grade 8. She is determined
to finish her studies and become a
teacher
someday.
Her
family
supports her, allowing her to help
with farming and chores during
weekends.

The project ensured the quality of LSE

through curriculum reforms and training
of teachers. The project supported the
development of new national curriculum,
particularly for extending the secondary
education cycle to 7 years while strengthening
the quality of LSE. Womens organizations
participated in national curriculum workshops
to provide inputs related to gender and to ensure that all materials are free of
gender and ethnic biases. For instance, the new textbooks and teacher guides
include graphics that portray girls and boys performing the same tasks.

Khonsavanh
Souvannachoumkham
is
an
English teacher in Ban Seuth Lower Secondary
School
in
Kong
District,
Champassack
province. She attended the projects 2011 inservice teacher training. She says that in
addition to preparing her to deliver lessons
under the new curriculum and textbooks, she
now has better skills in lesson planning, and
in applying learner-centered approaches to
develop her students thinking skills.

Teachers were trained to teach under

the new curriculum, to use new
textbooks and teacher guides. Women
comprised 46% of the 4,030 grade 6
teachers and 51% of the 4,215 grade 7
teachers trained. The Project trained
more than half of all grade 67
teachers nationwide. An assessment
conducted after the trainings revealed
remarkable increase in the trainees
ability to teach the new curriculum
using more modern, student- centered
methodology.

The project succeeded not only in

improving
male
and
female
enrollment in and completion of
LSE but also in enhancing students
learning outcomes. The project
completion report noted that in recent
years, both girls and boys performance had improved in both scores on the
national examinations at the end of LSE and olympiad competitions, with particular
increases for girls in science and math.
For more information, please contact Christopher Spohr, Principal Social Sector Specialist (SERD),
csphor@adb.org

Fostering Healthier Communities:

Improving Health and Disease Prevention in Viet Nam
We no longer have stomach ache or diarrhea
so often, says Ms. Ha Thi Phong of Son La
province. She shares that through health
information campaigns under the Preventive
Health System Support Project, she and her
fellow community members learned how to
prevent common diseases. For instance, they
now boil their drinking water.
Just 3- 4 years ago, we still drank water from
the stream while we went to work in the field.
Now, we boil our water. When we go to the
fields, we bring boiled water with us, she says.

Ms. Ca Thi Hoa (left) and Ms. Ha Thi

Phong, from Chieng Mung commune,
Mai Son district, Son La province.

Ms. Ca Thi Hoa, her neighbor, also shares, I

now wash my hands with soap before feeding
my child. Before, I did not know that I had to
do this.

The project aimed to improve disease prevention in 46 provinces and prioritized

the poorest 17 provinces with a high burden of infectious diseases. High prevalence
of diseases disproportionately affects women, who are traditionally responsible for
family health care including taking care of sick family members.
At the village level, combating diseases entailed a change in behavior
related to health and hygiene among community members. Information
campaigns on causes, symptoms, and prevention of
common diseases such as malaria and dengue, and
promotion of positive behavior on health, sanitation,
and
hygiene,
were
crucial
in
empowering
communities to prevent and control diseases within
their localities.
Communities were reached through leaflets,
posters, CDs/VCDs/DVDs, radio and TV spots. These
were developed taking into account specific health
needs of women, men, and children (including
materials on diseases common to women and
children; breastfeeding; proper nutrition, etc.).
Thirteen provinces produced materials in ethnic
minority languages to ensure that these were easily
understood by villagers.
Before the project, we had to conduct outreach to
community people, but we did not have many
materials for information dissemination. After
attending project trainings, we received these
materials and learned how to use them. We
conducted
outreach
events,
disseminating
information on avian influenza, diarrhea, hygiene
and environment protection, etc. We found that the

We moved animals (pigs,

buffalos, chicken, ducks.) far
from
our
house
-on-stills
ground floor just 4- 5 years
ago. Thanks to knowledge
introduced by the project, we
now have cleaner and less
smelly
surroundings,
says
Tong Thi Chinh, 24-year old
mother of 2, from Chieng Mung
commune, Mai Son district, Son
La Province.

materials are easy to use, and community people also found these easy to
understand, shared village health workers Ca Thi Hoc, Hoang Thi A, and Ha Van
Tieng, of Mai son district, Son La province.
Community members have begun taking actions to prevent diseases, such as
moving their animals away from their homes, boiling their drinking water, and
washing their hands before eating. The project end-survey showed that 91%-100%
of female members of ethnic minority households, and 93% - 100% of male
members, demonstrated average to good knowledge on disease symptoms and
prevention for the diseases assessed (e.g. malaria, dengue fever).
Health staff were trained to provide better
services on detection, prevention and
control of diseases. A range of trainings
were provided to improve capacity of health
workers at provincial, district, commune and
village levels, including specialized courses on
public health, preventive medicine, and
laboratory testing/technique. Preventive care
for women and children and family disease
control were among the trainings given to
district and commune health staff.

I especially appreciate that the

project had organized the specialized
training program in Son La city, which
enabled me to attend. If the training
was delivered in Hanoi, I would not
have been able to attend, says Ms. Vi
Thi Mi Son, a Medical Doctor and Head
of Health Occupational Division at
Preventive Health Center in Son La
province. She attended a 3 year
Specialization program on preventive
health, a
2-month training on
environment supervision, and a 2month training on occupational health
examination.
I benefited greatly from all the
training. They helped me gain
confidence in my work, she says.

Women accounted for 62% (8,933 out of

14,443) of health workers trained, with 7,090
(49%) belonging to ethnic minority groups. Of
the total trainees, women comprised 49% in
post-graduate training; 65% in technical
trainings of all kind; 68% community health
training; and 53% of about 4,925 village
health workers (VHWs) trained.
The project conducted the trainings in
locations convenient for women who are
unable to travel to distant venues due to
family responsibilities. Long-term trainings
at the provincial level, in venues close to the
work station and homes, created opportunities
for female staff to benefit from the project and
to advance their career.

Interviews with participants revealed that the trainings resulted in improved

knowledge, skills, confidence, and independence in doing their work and/or leading
their departments. Female participants in the training on food safety testing and
biochemistry water testing, reported that they improved their skills in taking,
conserving, carrying samples from the sample-taking spot to the lab based on
standards introduced in the training.
Improving the surveillance system, the primary tool in collecting the patterns,
causes, and effects of diseases, was a crucial step in ensuring better tracking and
monitoring of public health threats. The development of software for electronic
communicable disease surveillance (e-CDS) ensured a more efficient data
collection. Among the 3,000 staff from central, provincial and district levels who
were trained on e-CDS software utilization, female staff who were interviewed

shared that by using the e-CDS software and the skills they learned, they have
saved about one day and a half in recording and preparing monthly report for
epidemic surveillance, and in responding to epidemics. The quality of their
reporting also improved.
The project also provided equipment for improved detection of communicable and
non-communicable diseases, and laboratory equipment for provincial preventive
health centers.
By project end, remarkable reductions in the incidence of certain diseases
were noted. Malaria cases per 100,000 people decreased by 59% nationally
between 2005 and 2012, and by more than 85% in the project areas. The number
of cases of tuberculosis (TB) fell by 64% between 2005 and 2012 in the target
regions, due partly to significant improvements in the case detection rate. In
addition, the Project has made significant contributions in strengthening the
capacity for case detection and confirmation in the areas of non-communicable
diseases, food safety, and occupational health.
The improvements in disease control and prevention alleviated womens burden in
their role as family health care providers. Further, the project innovation in
bringing training closer to female health staffs work stations and home created
new opportunities for the advancement of womens learning and career
development.
For more information, please contact Barbara Lochmann, Senior Social Sector Specialist, SERD,
blochmann@adb.org

Educating the Educators:

Expanding Access to Better Quality Teachers Training in Viet Nam
For Thach Thi Phat, an ethnic minority
girl from Tra Vinh province, becoming
a teacher is a dream come true. Her 3
older siblings were not able to go to
school due to poverty. With sheer
determination to achieve her dream of
becoming a teacher someday, she
finished primary and secondary school,
and took the entrance examination for
Can Tho University, Department of
Teacher Training. When she passed the
exam, her family was very proud, but
they were worried that they will not be
able to support her.
Phat is very thankful that she received
scholarship support from the Upper
Secondary
and
Professional
Teacher
Development
Project,
which enabled her to finish her studies.
She is now a teacher of literature at
the Ethnic Minority Boarding School in
Tra Vinh province.
The key objectives of the project were
to expand access to teacher training
for
ethnic
minority
students,
particularly women; and to improve
the quality of upper and professional
secondary teacher training.

My dream of becoming a teacher has come

true. Now that my parents are old and can no
longer work, I can afford to take care of them,
says Thach Thi Phat.
She shares that before receiving the
scholarship grant, her parents found it hard to
come up with enough money to send to her
every week, and they would sometimes borrow
from relatives or neighbors so they could send
to her. She worried about food, school
supplies, and other necessities all the time.
She had to take part-time job to support
herself.
The scholarship meant a lot to me. It helped
me overcome the hard life in the university
period and gave me the feeling of being cared
for. I hope the new poor ethnic minority
students will be as lucky as I was.

To address the underrepresentation of ethnic minority groups among

teacher trainees, the project provided targeted support to ethnic minority
students, particularly women. Scholarships were awarded to 5,044 ethnic
minority upper secondary (US) and professional secondary (PS) students in 17
teacher training institutes (TTIs), out of which 63% were awarded to women.
Based on a project tracer study, the majority of scholars completed the scholarship
program.
The project constructed and upgraded facilities and provided equipment in six TTIs
located in predominantly ethnic minority areas, to meet the increasing enrolment
of ethnic minority students. Improvements included new multi-function buildings,
lecture halls, libraries, running and gymnastic grounds.
Bridging courses were provided for ethnic minority students to fill the gap
between the skills they acquired in lower secondary schools and the entry
requirements of the TTIs. The project supported the development of
instructional materials aimed at improving the quality of bridging courses to help
ethnic minorities keep abreast of the improvements in TTI curriculum, and facilitate
their smooth transition to a more challenging academic environment. Trainings on

using the bridging materials were conducted for 476 ethnic minority students, of
whom 81% were women.

Now, everything is so different. I am most

impressed with the students enthusiasm
and progress in their studies, shares Dang
Vu Kim Chi, an English teacher at Can Tho
Universitys
Department
of
Teacher
Training. She received a scholarship from
the project in 2012 to take her Masters
Degree in Australia. She was trained on a
new pedagogy that encourages students
curiosity, creativity and problem-solving
skills, to explore complex ideas, and to
actively participate in class. Her knowledge,
skills, and teaching methods improved
significantly.
Before I participated in the MA program,
my teaching method was quite traditional,
she recalls. I felt my lessons were quite
boring. I also noticed that the students
were very passive, always waiting for my
instructions to do the exercises. I realized
that but did not know how to improve it. I
just followed the same teaching method
that I was taught, Chi says.
Now, she knows how to encourage
students active participation in class. She
has also gained more confidence in teaching
her classes. Chi has become a respected
teacher in the university. She is actively
involved in doing research on teaching
methodologies, developing new curriculum
or improving the current curriculum, and
participating in teacher training activities for
the Mekong River Delta region.

Improving the quality of teacher

training is crucial in enabling
teachers to produce a skilled
workforce
that
can
meet
the
demands of a growing economy. This
includes developing methodologies that
foster creativity, analytical and problemsolving skills among students. The
project supported the development of
curriculum and teaching methodology
that shifts from passive to active
learning, through more creative and
student-centered teaching, including the
use of information technology.
Women comprised 55% of the 14,954
teachers who participated in teacher
training and workshops on developing
new TTI pre-service courses and training
materials that are aligned with new
school curriculum, improving content
and methodology of training programs,
and use of information technology in
teaching.
TTI
lecturers
and
teachers
were
supported to obtain in-service training,
through
scholarships
for
Masters
Degrees in reputable TTIs. Priority was
given to female teachers, who comprised
65% of the 551 scholarship recipients. A
total of 2,539 (62% women) teachers
were
also
trained
on
developing
instructional materials, and improving
relevance of content and methods in all
US and PS in-service training.

The project also supported training of

about 9,326 (40% women) managers of
education centers and secondary ethnic boarding schools, key teachers and staff
from all 63 provinces, to strengthen their capacity for education planning and
management. Gender and ethnic minority issues were integrated in training
materials and sessions. Training on culture and customs of ethnic minorities for
teachers and managers of universities and pre-university colleges were also
conducted. A framework was developed for management of the teaching
workforce. Support was also provided to 12 TTIs including 6 TTIs in ethnic
minority regions - for improving classrooms, laboratories, and workshops, and
upgrading equipment. The project provided a short-term training course on proper
O&M to 129 TTI staff (67 females, or about 52% of total trainees).

More than forty thousand upper secondary and professional secondary

teachers, education managers, and heads of boarding schools, benefitted
from capacity building trainings, including pre-service and in-service
training programs, use of information technology, education planning and
management. More than half of the participants were women, and a large
proportion belonged to ethnic minority groups. Improvements in the curriculum
and teaching methodology, including training materials that integrate gender and
ethnic minority issues, are expected to be institutionalized and benefit training
institutes, teachers and students in the coming years.
For more information,
eizawa@adb.org

please

contact

Eiko

Izawa,

Senior

Education

Specialist,

SERD,

On the Way to Better Health:

Advancing Women and Childrens Health and Nutrition Status in Indonesia
Improving the nutrition status of children under 5 years and pregnant and lactating
women was the goal of the Nutrition Improvement through Community
Empowerment Project. It sought to address the high prevalence of malnutrition
among children and pregnant women, especially in the eastern part of the country
such as in the provinces of East and West Nusa Tenggara.
Malnutrition, usually caused by insufficient intake of nutritious foods and micronutrients, can lead to serious health problems such as stunting, impaired mental
development, and vulnerability to illness. Malnutrition in pregnant women has been
associated with low birth weight and maternal deaths. Unfortunately, women are
often powerless to prevent this due to lack of access to adequate sources of
nutrition, and limited knowledge of nutritional needs and related information
necessary to improve their health.
To help nutritionally at-risk women and children access nutrition supplements, the
project distributed micronutrients (iron tablets or syrup), paying particular
attention to poor women who had limited resources to purchase adequate food for
themselves or their children.
By 2013, the number of women receiving
micronutrients at sub-district health centers (puskesmas) increased to 33% from
29% in 2007. About 450,000 children under 5 years received micronutrients
named Taburia each year from 2011 and 2012. More than 95% of the
mothers claimed that their children had become more active and cheerful
after taking Taburia.
Womens awareness and practical
knowledge on food and nutrition was
enhanced through monthly meetings in
posyandus (integrated health posts).
About 49,225 pregnant women
who attended monthly meetings
gained increased awareness and
practical
knowledge
on
food,
nutrition, and health care for
pregnant women and infants.
Women
who
were
interviewed
remarked that they learned how to
prepare and select nutritious foods that
meet the nutritional needs of pregnant
women, young children, and other
family members; feeding techniques
and practices relating to infants and
young children; and the importance of
breast-feeding. Some posyandus ran
exercise classes for pregnant women.

Ibu Aminah from lingkungan Talamangape

Kelurahan Raya, South Sulawesi, could not be
happier about her babys health and growth
rate. She is thankful that she attended
monthly posyandu meetings to learn about
proper food, nutrition, and health care for
pregnant women. She also learned the
importance of pre-natal check-ups, and made
it a point to regularly consult midwives or
doctors at puskesmas (subdistrict health
centers). She gave birth to a healthy baby
girl.

Village-level
health
and
nutrition
services were established or upgraded
to cater to women and childrens
needs.
Posyandus
services
were
expanded to include classes for
mothers and pregnant women, cooking demonstrations, feeding of infants and

young children, and nutrition counseling. These were financed through the
community nutrition packages (CNPs). CNPs were village-level grants provided to
1,800 villages and urban neighborhoods to improve nutrition status of women and
children within their communities. Through the CNPs, facilities of 8,028 posyandus
were upgraded. More than 1,800 primary schools received small-scale water and
sanitation infrastructure, ensuring access to safe water and better sanitation, thus
helping prevent illness among school children.
Innovative activities such as the construction of fishponds, training on food
processing, and collective poultry ensured sustainability of posyandu operations
after project completion. Ibu Murni from West Nusa Tenggara shared that her
village was able to construct a fishpond from the grant. Fish from the pond has
been used as complementary food provided monthly by the posyandu. Even after
project completion, they could finance posyandu operations through proceeds from
selling fish.
Ibu Murni also benefitted from training on how to reuse used plastic as handicraft
material. She shared her knowledge and skills with her fellow villagers, especially
women.
Now we are able to transform plastic garbage into plates, wallets, and bags, she
says. They sell their products widely, even to Jakarta. This has helped them
increase their incomes, ultimately improving their ability to provide nutritious food
to their families.
Communities actively participated in selecting activities based on their
needs. Community facilitators were recruited from the villages to help raise
awareness on nutrition, hygiene, and sanitation; and train community members in
preparing community nutrition plans. Women comprised 67% of the 900
facilitators, and 70% out of 18,000 community nutrition committee members who
were mobilized to help implement the CNPs.
The capacity of health centers in providing services to address
malnutrition was also enhanced. By project completion, all nutrition staff at the
494 project-supported puskesmas had been trained on health and hygiene,
nutrition surveillance, and community involvement in nutrition and breastfeeding
promotion programs. Women comprised 77% (1,894 out of 2,460) of the staff
trained. Posyandu staff were also trained, with women comprising more than 95%
of the 16,000 trainees. Nutrition guidelines, counseling tools, and nutrition
information, education, and communication materials were distributed to guide
posyandus in providing services and outreaching their constituents.
Therapeutic feeding centers (facilities designed to treat severely malnourished
children) at 48 puskemas were refurbished and equipped with food processing
equipment. The project also strengthened the referral system (e.g. referring cases
of severe malnutrition to appropriate health facilities) between feeding centers,
posyandus, puskesmas, and district hospitals. Nutrition kits which included basic
growth monitoring kits, source-of-nutrition dummies (for nutritional counseling),
and food processing kits, were provided to the 494 puskesmas.
By project completion, the prevalence of underweight children under 5 years old
fell to 19.6%, from 28% in 2005. The prevalence of anemia fell from 48% to 28%
for children aged 1-4 years, and to 21.7% for babies (less than one year). The
number of children under 6 months exclusively breast-fed increased from 10% in

2005 to 41.5% in 2012. Women derived significant benefits as recipients of

micronutrients, participants in capacity building activities, and beneficiaries of
improved nutrition facilities and services.
It is envisaged that more long term positive impacts will become evident in the
years to come. It is crucial for the government, local authorities, communities and
other stakeholders to continue efforts to sustain or replicate project interventions
to ensure communities access to improved nutrition services.
For more information, please contact Rooswanti Soeharno, Social Sector Officer, IRM, SERD,
rsoeharno@adb.org

News and events

Myanmar Gender Situational Analysis (GSA) Consultation Workshop
16-17 January 2015
A 2-day consultation workshop was organized by the government of Myanmar with
support from ADB and UN Women, to validate the Gender Situational Analysis. ADB
has been a key partner in preparing the GSA, which assesses achievements and
remaining challenges in advancing gender equity in various areas. Representatives
from 28 government ministries, two large NGO networks, and 7 UN agencies,
attended the workshop.
Gender Training for Project Officers in Viet Nam
29-30 January 2015
The 2-day training was conducted in Hanoi for a range of government project
officers of ADB-supported projects in various sectors including transport,
agriculture and natural resources, and health. The training aimed to increase
awareness of provincial project management units (PPMU) staff on ADB gender
policy and requirements, and improve their skills on Gender Action Plan (GAP)
implementation, monitoring and reporting. A total of 30 participants consisting of
PPMU staff and relevant government officials at the provincial level attended the
training, which was facilitated by Nguyen Thanh Giang, VRM Social Development
Officer (Gender).
Knowledge Sharing Workshop on Mainstreaming Gender in Public Works
and Transport
20 February 2015
The workshop held in Vientiane, Lao PDR was undertaken under the ADB-supported
TA Strengthening the National Commission for the Advancement of Women
Network in the Ministry of Public Works and Transport. Over 60 participants from
the government or various government ministries attended the event to discuss
ways to mainstream gender into planning, monitoring, and evaluation of public
works and transport sector nationwide. LRM Country Director Sandra Nicoll gave
the opening remarks. Theonakhet Saphakdy, ADB-LRM Social Development Officer
(Gender), facilitated discussions on the importance of gender in the transport
sector, and gender entry points for transport subsectors.
Regional Seminar on Womens Employment, Entrepreneurship and
Empowerment
20-22 May 2015
The 3-day Regional Seminar held in Bangkok, Thailand was jointly organized by
RSGG and the Gender Equity Thematic Group. More than 100 participants from 21
countries, representing governments, private sector, civil society organizations,
academic institutions, and development partners, as well as gender staff from
headquarters and resident missions, attended the event. The seminar provided an
opportunity for participants to learn and discuss research findings on womens
employment and entrepreneurship, and share lessons and experiences from gender
inclusive projects.

Gender Specialists Annual Consultation Workshop

25-26 May 2015
Thirty ADB gender specialists and focal points participated in the annual
consultation workshop for gender specialists held in Bangkok, Thailand. The
workshop was divided into 2 parts: Day 1 discussed the 2015 priorities on the
Gender Equality and Womens Empowerment Operational Plan (Gender OP),
challenges and new approaches in project processing, and GAP implementation and
monitoring. Day 2 was dedicated to presentations and discussions on improving
monitoring and reporting on gender equality results; working with the private
sector and strengthening partnership with development agencies; and knowledge
sessions on gender and the law, and global debates on gender equity. The
workshop ended with a tribute to Ms. Shireen Lateef, Senior Gender Advisor to the
Vice President for Knowledge Management and Sustainable Development. Ms.
Lateef retired in June.
Training Workshop on Gender Mainstreaming in Construction Sector in
Cambodia
29 May 2015
The training held in Phnom Penh aimed to increase participants awareness on
gender mainstreaming in construction sector, and to discuss the gender action plan
(GAP) designed for Flood Damage Emergency Reconstruction Project (FDERP). A
total of 55 participants consisting of project staff, government officials at the
national and provincial levels, and contractors, attended the workshop. Ms. Chandy
Chea, ADB-CARM Gender Specialist, facilitated discussions on FDERP project GAP,
and strategies to ensure that women are employed in construction works.
DG Nugent meets with EFG members
5 June 2015
SERD Director General James Nugent met with members of the External Forum on
Gender and Development (EFG) on 5 June 2015 to discuss key gender issues in the
Southeast Asia Region and how loans, grants, and TAs are used to address them.
The EFG held meetings with VP Lohani, DG Nugent and other senior ADB staff to
conclude its 15th session held on 3-5 June 2015 at ADB Headquarters, Manila. The
EFG was established as a forum for dialogue between ADB and external experts on
gender equality and womens empowerment issues and concerns in the region.

Finally, SERD Countdown!

In 2014, 62% of our portfolio had gender mainstreamed projects
that is 16 out of a total of 26 projects.
Hurray! This is higher than our achievement in 2013 when
we had reached 50%.
Lets keep on working together to ensure quality design and
implementation of GEN and EGM projects in SERD!