Facing Reality (or getting smacked in the face by it)

I found this Paul Farmer quote a while ago but only recently has its truth really impacted the way I see my position in Jambi.

On the limits of NGOs: If you're interested in rights -- things like the right to health care, to clean water, to education, or even a job -- which institutions confer those rights, especially rights to poor people? It's the government. So while celebrating the NGO movement is a really important thing to do, we really need to find ways to strengthen public-sector capacity.    -Paul Farmer

The other day I attended a meeting on HIV/AIDS at the provincial health department that was held between the National AIDS Commission and a number of local NGOs that are active in HIV/AIDS advocacy and prevention efforts.  I was struck by the seeming ineptness displayed by the government in its lack of preparedness and managerial capability. 

This sense of government ineptness soared through the roof when afterwards I used the opportunity to ask the relative health office for their statistical data on maternal mortality during the past year.  After an hour of searching- most records here are not computerized and those that are, are not well organized- the health official wrote down the statistics for me so I could take them home; it listed a total of three maternal deaths and 11 neonatal deaths.  In reality the number is closer to 300 maternal deaths!  How could the government’s health department not have data on such an important health topic, or at least admit to me that it was incomplete?  Because the woman of course confidently reassured me when I asked if her numbers were for all of Jambi, unfortunately similar to the way students give their loudest affirmative response when you ask them “do you understand?”  They do not. 

This experience only underscored the importance of the subject of the day’s meeting: coordination between the provincial government and NGOs to collect accurate and comprehensive data on the number of HIV/AIDS cases and the profile of those people so as to better understand the situation in Jambi.  Surprisingly, or not so surprisingly, this seems to have not yet been done and the current statistics I am told change with each source.  Nevertheless, it is absolutely necessary before the planned HIV/AIDS program is begun for the entire province in 2011.  The Global Fund previously provided a massive grant to Indonesia to carry out comprehensive HIV/AIDS programs in each province, the current Round 8 of the program is being implemented in the top 12 worst effected provinces in Indonesia.  Jambi ranks number 15 out of 33 provinces for the percent of its population infected and thus falls into the next round. 

I remember when I was in Thailand before coming to Indonesia and while searching for information to learn about the health situation in Jambi, I found a news article from 2009 that said HIV/AIDS cases had grown by 200% in one year!  My immediate feeling was shock about the AIDS epidemic it implied, but in reality data collection for this has only just very recently begun and is thus skyrocketing as they realize how many cases there are.

This lack of accurate data poses challenges most importantly to the government that cannot effectively implement programs that will target those social issues which are most pressing.  For my own work here it challenges my ability to do such things as just apply for program funding when I can not illustrate the seriousness of the problems we wish to address through statistics.  What an impossible situation! 

I don’t wish to be a pessimist about NGO efforts, but their frequently touted metaphor of teaching a man to fish so that he can eat for his life rather than just giving him a fish to eat that day, can be extrapolated to an even wider scale.  Why not teach the man’s village leaders how to effectively provide fishing materials and instructions so that this knowledge is institutionalized and can be provided to the village for generations?  Government capacity building is where efforts should focused for maximal results.  NGOs like PKBI should not have to be providing basic health care and information, they should be there to fill in the cracks, conduct public advocacy, and press the government where it falls short.