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Community Based Health and First Aid Project

Kapuas District, Central Kalimantan 2012-2014


Report on the Analysis of Baseline and Endline Survey









Bangun Indonesia Foundation
www.watershedpress.com
April 28, 2014
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

Community Based Health and First Aid Project
Kapuas District, Central Kalimantan 2012-2014
Report on
the Analysis of Baseline and Endline Survey










Submitted to:
Palang Merah Indonesia Cabang Kapuas
Jl. Untung Surapati No. 5, Kuala Kapuas,
Central Kalimantan 73513
Indonesia
+62 513 22400










Prepared by:
Sumengen Sutomo, Agustina Lubis, Nurmansyah Surya Adisaputra and Rossana Solen
Bangun Indonesia Foundation
Jl.H.Rasuna Said Apt.Taman Rasuna
Tower 12/12C
Jakarta 12920










The Community Based Health and First Aid Project in Kapuas, Central Kalimantan was conducted from
2012 through 2014 by Palang Merah Indonesia partnership with Spanish Red Cross. For more
information about the project contact PMI Kapuas, This analysis was conducted by BIF under the contract
from PMI Kapuas 2014
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey


Table of Contents

Table of Contents iv
Preface. vi
Executive Summary............................................................................................................................ vii
List of Tables.. xii
List of Figures. xiii
Abbreviations...................................................................................................................................... xiv

1. INTRODUCTION.................................................................................................................... 1

1.1 Background .............................................................................................................................. 1
1.2 Projet description ..................................................................................................................... 1
1.3 Project location......................................................................................................................... 2
1.4 Baseline and endline survey..................................................................................................... 4

2. METHODS............................................................................................................................... 4

2.1 Review documen. .................................................................................................................... 4
2.2 Analysis of baseline and enline survey ....................................................................... ............. 5
2.2.1 Selected diseases....................................................................................................................... 5
2.2.2 Number of respondents ............................................................................................................ 5
2.2.3 Performance measurement........................................................................................................ 6
2.3 In-depth interview..................................................................................................................... 7
2.4 Focus Group Discussion........................................................................................................... 7
2.5 Analysis in-depth interview and FGD...................................................................................... 8

3. RESULTS .................................................................... 9

3.1 Baseline survey............................................................. 9
3.1.1 Respondent characteristics........................................................................................................ 9
3.1.2 Knowledge, attitude, and practices on diseases........................................................................ 9
3.1.3 Knowledge, attitude, and practices on accidents......................................................... ............. 10
3.1.4 Interview and discussion........................................................................................................... 11
3.2 Endline survey............................................. ............. 12
3.2.1 Respondent characteristics....................................................................................................... 12
3.2.2 Knowledge, attitude, and practices on diseases........................................................................ 13
3.2.3 Knowledge, attitude, and practices on accidents...................................................................... 14
3.3 Analysis of baseline and endline data....................................................................................... 15
3.3.1 Respondent characteristics........................................................................................................ 15
3.3.2 Knowledge, attitude, and practices on diseases........................................................................ 16
3.3.3 Knowledge, attitude, and practices on accidents......................................................... ............. 18
3.3.4 Ceramic filter............................................................................................................................ 20





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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

3.3.5 In-depth interview ............................................................................................................... 20
3.3.5.1 Terusan Raya....................................................................................................................... 20
3.3.5.2 Pulau Kupang...................................................................................................................... 21
3.3.5.3 Handiwong ......................................................................................................................... 22
3.3.5.4 Teluk Pelinget...................................................................................................................... 23
3.3.5.5 District Health Office and PMI........................................................................................... 23
3.3.6 FGD with women and men ................................................................................................. 25
3.3.6.1 Terusan Raya....................................................................................................................... 25
3.3.6.2 Pulau Kupang....................................................................................................................... 27
3.3.6.3 Handiwong .......................................................................................................................... 28
3.3.6.4 Teluk Pelinget...................................................................................................................... 30

4. CONCLUSION......................................................................................................................... 33
4.1 Achievement of the objectives...................................... 33
4.2 Lessons..................................................................................................................................... 34
4.3 Recommendations ........................ 35

REFERENCES................................................................................................................................... 35

Annex 1: In-depth interview guides.................................................................................................... 3-6
Annex 2: FGD guides............................. ........................................................................................... 7-9
Annex 3: Summary of analysis, baseline and endline survey............................................................ 10-20
Annex 4: Transcipt of In-depth interview........................................................................................... 21-89
Annex 5: Transcript of FGD............................................................................................................... 90-151














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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

Preface


This report provides information on the results and performance of the Project for Community
Based Health and First Aids in Kapuas, Central Kalimantan, implemented by Palang Merah Indonesia
and Spanish Red Cross in 2012-2014. The results of analysis on baseline survey, endline survey, and
qualitative survey in 4 villages in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget. PMI
with the assisstant of a consultant was responsible for the baseline survey and endline survey. The
baseline survey was conducted in September 2012 using a Rapid Mobile Phone Based Survey. The
endline survey was conducted in January 2014 using a similar method of the baseline survey.
Bangun Indonesia Foundation was responsible for analysis of the baseline survey, endline survey,
and additional qualitative survey which was carried out in February 2014. The qualitative survey
included in-depth interview with those responsible for the project management at all levels and focus
group discussion with women and men in the targeted community.
The report briefly describes in four sections including introduction, methods, results, and
conclusion. In conclusion includes the project achievement and performance in each village and overall
villages, lessons and recomendations for developing future program.
We would like to express our thanks to:
Eka Wulan Cahyasari - Public Health Sub-Div I Health Division - Palang Merah Indonesia in
providing overall information on the national policy, strategy and program for CBHFA including
project planning, implementation, and other related information.
Farah Sr. Health Officer - International Federation of Red Cross and Red Crescent Societies for
providing information related to the SRC in the operational partnership with PMI Branch.
Silvia Crespo Country Representative Spanish Red Cross for providing information on the SRC
policy, strategy, and program for partnership with PMI related to CBHFA project in Kapuas.
Irma Normaulidah PMI Kapuas Health Staff in arranging the preparation, data collection, and
supporting resources for the both qualitative survey.
Jumatil Fajar MD PMI Kapuas Head Office in providing overall information on the baseline
survey, endline survey, resources for making the qualitative survey effectively carried out at all level
of project implementation.
PMI Branch staff in supporting the logistic including personel, administration, which made the survey
effetively completed.
PMI Field Coordinator in providing information on their roles and performance in the village, and
their recomendations for incorporate in the project report.

BIF Team







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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

Executive Summary

1. Background

Palang Merah Indonesia partnership with Spanish Red Cross has implemented Community Based
Health First Aid project in Kapuas, Central Kalimantan. The project aimed at empowering people with
the ability to respond to daily emergencies where health professionals are absent or overworked. It not
only brings first aid to the community about common injuries but also effectively addresses community
health priorities through prevention, health promotion and control of common diseases in preparing
and responding to disaster. It also helps the recruitment and retention of effective volunteers of the
CBHFA program in Indonesia.
The goals of the project were i) PMI has increased its capacity, performance and image in Central
Kalimantan Province in order to serve the communities; and ii) Kapuas communities have the capacity to
reduce their vulnerability related to specific diseases and injuries in non-emergency and emergency
situations. The objectives included: 1) PMI Central Kalimantan is able to serve community through
community based health, first aid, and social services activities; 2) Pulau Kupang, Terusan Raya and
Handiwong communities are able to organize themselves and to establish means of dialogue among the
members of the community with other stakeholders; 3) Community knowledge on health issues, basic
first aid and blood donation has improved; and 4) Terusan Raya, Pulau Kupang, and Handiwong
communities are able to take action related to diseases prevention and risk reduction.
The CBHFA project main activities included training for branch and village volunteers; home
visits for health prevention, promotion, and simple treatment; integrating a message of health promotion
into a regular meetings, quran reading group, social gathering, women welfare organization, and youth
activities; help, support and being Posyandu cadres; mobilization of community in cleaning the
environment; integrating the message into socio drama, traditional music and songs, integrating the
message into global and national birth days ;developing information center in the villages, bulletin board,
promotion of basic first aid and injury, simulation, provision of ceramic filter, education and promotion of
hand washing to the communities and school children. The project was implemented for 3 years from
2012-2014.
PMI NHQ with SRC required assessing the project performance and achievements by the project
closing date in March, 2014. PMI Branch with the assistant of external consultant has completed a
baseline and endline survey. Further analysis and qualitative survey were required to provide more
information for the project performance assessment. Bangun Indonesia Foundation was responsible for
further analysis of the baseline and endline survey focused on the CBHFA project. This report provides
results on the analysis including its lessons and recommendations.

2. Methods

The methods of analysis included a review document, analysis of baseline survey, endline survey,
in-depth interview and focus group discussion. The review document provided various information on the
CBHFA project planning, implementation, and reporting carried out by PMI and SRC. The analysis of
the baseline survey involving a total sample of 459 households, selected by systematic random sampling;
data were collected by interview with the respondents representing of the households; using structures
questionnaires of RAMP method; reported data on the spread sheets; transferred data into SPSS data
view, recorded the category of each correct answers; and developed frequency distribution table . The
tables includes table of respondents by characteristics, knowledge, attitude, and practices on selected
diseases, accident, and distribution of ceramic filter. As well as the baseline survey, the endline survey
involved 457 households; data were processed and analyzed using similar methods for developed
frequency distribution tables.
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

The interviews involved in-depth interview with key officer of the project management and FGD
with women and men of the households representing of targeted community. In-depth interview involved
key officer of the PMI NHQ, SRC, PMI Branch, DHO, HC, and other related personnel. A total of 8
FGDs was carried out involving 90 participants consisted of 40 men in 4 FGDs; and 50 women in 4
FGDs in the village. Each FGD involved 8-12 participants represented of households in the village:
Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget.Data records on the FGDs and in-depth
interviews were transcribed into written document, organized, categorized, and summary the results. The
results provided more information and clarification on the sample surveys. The overall results provided
information on knowledge, attitude, and practices on diseases, accidents, water, sanitation, and IEC. The
project performance and achievement were measured by project effectiveness of training for Branch
volunteers and village volunteers; comparison of the baseline with endline results; measurement results
by effective percentage changes; and incorporated the results of in-depth interviews and FGDs.

3. Results

The baseline survey reported the community targeted by the CBHFA project, its geographical and
social economic condition of the villages are not much differences. Life of people in Terusan Raya, Pulau
Kupang, and Handiwong depends on river trasportation, and in Teluk Pelinget on road transportation.
People in Teluk Pelinget may have better sosial economic condition compare with other villages. Most of
respondents in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget were females, productive
age, primary school graduates or less, and farmers.
In Terusan Raya, Pulau Kupang, and Handiwong, respondents knowledge on identification,
prevention, and treatment of diarrhea, TB, malaria, ARI, malnutrition and hypertension was 22.9%,
attitude 30.9%, and practices 18.4%. The respondents knowledge on accidents, first aid, and injury was
7.8%, attitude 6.2% and practices 23.9%. In Teluk Pelinget, respondents knowledge on identification,
prevention, and treatment of diarrhea, TB, malaria, ARI, malnutrition and hypertension was 23.1%,
attitude 54.7%, and practices 25.7%. The respondents knowledge on accidents was 9.4%, attitude 8.8%
and practices 24%.
The respondents knowledge, attitude, and practices on diseases in Teluk Pelinget were relatively
better compared with the respondents knowledge in Terusan Raya, Pulau Kupang, and Handiwong. Most
of the community in all villages do not have access to adequate water and apropriate sanitation facilties.
Most people collected water for domestic purposes from river; do not have access to sanitary latrines,
sanitary waste water discharges, and garbage collection and disposal system. The consultant
recommended that the CBHFA project should addresss issues on community knowledge, attitude, and
practice on prevention of seleted diseases including diarrhea, TB, malaria, ARI, malnutrition, and
hypertension.
The endline survey as well as the baseline survey indicates that most of the respondents in Terusan
Raya, Pulau Kupang, Handiwong, and Teluk Pelinget were females, productive age, primary school
graduates or less and farmers.
The project has successfully strengthened PMI Branch including its organization, personnel,
professional leader and staff, branch volunteers, and village volunteers. PMI Branch has served
community based health, first aid, and social services by 214 village volunteers under the coordination of
PMI Branch. PMI Branch may sustain in carrying out community based activities partnerhsip with local
stakeholders.
At the beginning of the project, the community knowledge on symptoms, causes, risk factors, and
prevention of diseases including diarrhea, TB, malaria, ARI, malnutrition, and hypertension was 22.9%;
and accidents, first aid, and injury was 7.8%. By the project termination, the effective percentage change
of the community knowledge on symptoms, causes, risk factors, and prevention of diseases was 9; and
accidents, first aid, and injury was 1.2. The project has increased the community knowledge on diseases
including diarrhea, TB, malaria, ARI, malnutrition, hypertension; accidents, first aid, and injury.
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

At the beginning of the project, the community attitude on seeking treatments including get
information related to diseases was 30.9% and accidents, first aid, and injury was 6.2%. By the project
termination, the effective percentage change of the community attitude on seeking treatment of diseases
was 19.2 and accidents, first aid, and injury was 1.8. The project has increased the attitude of the
community on seeking treatment of diseases and accident, first aid, and injury.
At the beginning of the project, the community practices on prevention of diseases including
diarrhea, TB, malaria, ARI, malnutrition, and hypertension was 18.4%; accidents on river, road, field
work, first aid, and injury was 23.9%. By the project termination, the effective percentage change of the
community practices on prevention of diseases was 3.8; accidents, first aid, and injury was 4.8. The
project has increased the community practices on the prevention of diseases including diarrhea, TB,
malaria, ARI, malnutrition, hypertension; accidents, first aid, and injury.
The project planned to disribute more than 2500 units of ceramic filters. In February 2014, PMI
has distributed 180 units to the village volunteers. Of the total 31 units sample, 45% of the units were
broken outlets and leakages after 2 months uses. The village volunteer repaired the broken parts, and
finally 87% units were in used. Longer use of the ceramic filters by the community may provide
different information due lack of capacity for reparing the units.
Improving community personal hygiene and environmental sanitation are challenging. The success
of this effort would indicate better community practices on prevention of diarrhea. At the beginning of
the project, the community practices on preventing diarrhea was 19.9%. By the project termination, the
effective percentage change of community practices on prevention for diseases including diarrhea was 6.
The project has increased the practices on prevention diseases including diarrhea.

4. Conclusion

The CBHFA project was relevance to the needs of the local community in addressing important diseases
issues including diarrhea, malaria, and hypertension; access to safe water; and emergency first aid of
accident on the river and field work. It was also in line with the priority of the District Health Office
including Health Centers in providing primary health care services.

4.1 Achievement of the objectives

1. The project has successfully strengthened PMI Branch including its organization, personnel and
resources. As of the project end, PMI may sustain as the branch and continue carrying out community
based health activities partnership with local stakeholders.
2. The project has successfully trained more than 30 branch volunteers in basic principal of first aid,
communication methods, health promotion.They were able to trained and transferred their knowlege
and skills to more than 214 village volunteers in Pulau Kupang, Terusan Raya and Handiwong.
3. The village volunteers have conducted home visits to increase community knowledge, attitude, and
practices on basic health, first aid, and social issues; however, the results have limited because of
lack ability of community in receiving too much health and diseases information, limited technical
capacity of volunteers in accepting and delivering the messages, and short duration of the project
implementation.
4. The community knowledge on diseases prevention 22.9%, and accident prevention 7.8%. The
effective percentage change on diseases prevention was 9.4 and accident prevention was 1.2. The
project has increased the knowledge, however, it has not reached to the expected target of 75%.
5. The community attitude on seeking treatment of disease was 30.9% ; and accidents was 6.2%. The
effective percentage change of attitude on seeking treatment of diseases was 18.3 and accidents was
1.8. The project has inreased the attitude on seeking treatment, however, it has not reached to the
expected target of 75%.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

6. The community practices on prevention of disease was 18.4%, and accidents was 23.9% .The
effective percentage changes of the community knowledge was 5.3 and accidens 4.8 . The project has
increased the community practices on prevention of diseases, accident and injuries , however, it has
not reached the expected target of 70%.
7. A total 180 ceramic filter has been distributed to the village volunteers. Of the 31 units sample of
ceramic filters, after 2 months utilization, 45% of the units were broken outlets and leakages. After
the village volunteer repaired the broken parts, finally 87% units were in used.
8. Improving community personal hygiene and environmental sanitation are best described by
community practies on prevention of diarrhea. At the beginning of the project, the community
practices on preventing diarrhea was 19.9% .The effective percentage change of the community
practices on prevention of diseases was 6 . The project has increased the practices on prevention for
diarrhea, however, it has not reached to the expected target of 65%.

4.2 Lessons

1. The CBHFA project was not focused on addressing community knowledge, attitude, and practices on
specific diseases but covering several diseases including diarrhea, TB, malaria, ARI, malnutrition,
and hypertension which have so many different causes and effects may dificult to relate to each other.
2. The logical framework is an exellence tool for project management, however the application was
limited to the higher level of management through several meetings and workshops which resulted
in unfocus objectives. The higher management level is responsible for developing project strategy
and the grass root level management is responsible for operational project activities involving local
stakeholders who face the problems.
3. Many trainings were conducted by PMI through the field coordinator. Of the total village volunteers
participated in the training, about 50% participants were able to understand and practice on the
knowledge and skills, however it was no training report informing its effectiveness of the training.
4. Many volunteers expressed their benefits but the other volunteers discontinued their participation
due to finding another job, having married, moving to other village, sick, and looking for better job,
do not have time and busy with their bussiness. Provision of refreshed traininng and other activities
may help reducing drop out of the volunteers.
5. The CBHFA project has provided IEC materials, but its may not spesific and applicable for the local
community, so the coordinator tried to develop more local spesific materials integrating the messages
of diarrhea, malaria, hypertension into the fasting months. The field coordinator developed
additional IEC materials, however, no information on the effectiveness of the new IEC marerials, and
no information on how many persons informed by new IEC materials.
6. Selection of ceramic filter for addressing issues on water supply services may effective temporarily,
however, it may not effective in the future due to need regular maintenance, repaired, cost, labour,
and communiy habits for regular cleaning.

4.3 Recommendations

1. Project for addressing community based health and behavior change should be developed by
participatory approaches involving local stakeholders with realistic goal and objective considering the
available resources. The central and provincial management should involve and help in developing
project strategy, while the local management reponsible for operational management.
2. Logical framework including its evaluation methods should be trained to the operational staf
involving local stakehodler and community to produce effective management document.
3. Report on the training for village volunteers should include the results of pre-post test for measuring
effectiveness of the training.
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

4. Several activities for reducing drop out of village volunteers include conducting: regular refresher
courses, having specific identity, regular seminar, workshop, discussion, sport, website, competition,
journal, and other social gathering.
5. The Branch staff and volunteers who are responsible for developing local spesific IEC intervention
should be trained in P-Process.
6. Cost benefit analysis should be done to demonstrate the effectiveness and efficiency on the use of
ceramic filters for the benefits of the producer and users. In addition, further comparison with the
provision of bored deep well by DHO and CWS may provide more and better alternatives.
7. Community behavior change is a long process, and the project has just reached to the community. It is
therefore, suggested that the CBHFA project should be continued, having a focused on addressing
water and sanitation related issues. Developing MCK and training in CLTS may provide effective
health promotion and community mobilization for improving sanitation services.




































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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

List of Tables


No Table Page
1. Number of respondents in baseline and endline survey 6
2. Number of participants of in-depth interview and FGDs 8
3. Respondent characteristics by village-baseline 9
4. Respondent knowledge, attitude, and practices on diseases-baseline 10
5. Respondent knowledge, attitude, and practices on accidents -baseline 11
6. Respondent characteristics by village-endline 13
7. Respondent knowledge, attitude, and practices on disease-endline 14
8. Respondent knowledge, attitude, and practices on accidents-endline 15
9. Respondent characteristics in both surveys 15
10. Respondent knowledge, attitude, and practices on disease both surveys 17
11. Respondent knowledge, attitude, and practices on accidents-both surveys 19
12. Observation of ceramic filter distributed to village volunteer 20

































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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

List of Figures


No. Figure Page

1. Project location: Bataguh (A) and Pulau Petak(B), sub-districts,
Kapuas district (A), Central Kalimantan 2
2. Terusan Raya, Pulau Kupang, Handiwong , and Teluk Pelinget 3
3. Respondents characteristics in Terusan Raya, Pulau Kupang, Handiwong,
and Teluk Pelinget in the baseline and endline survey 16
4. The effective percentage change of respondents knowledge, attitude,
and practices on diseases in endline survey 18
5. The effective percentage change of respondents knowledge,attitude,
and practices on accidents in endline survey 19




































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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Report on the Baseline and Endline Survey

Abbreviations


ARI Acute respiratory infection
Ave Average
BIF Bangun Indonesia Foundation
BKKBN National Family Planning Coordination Board
CBHFA Community based health and first aid in action
CLTS Community Lead Total Sanitation
CWS Community Water Supply Project
DHF Dengue Haemorrhagic Fever
DHO District Health Office
DO Drop out
EPC Effective Percentage Change
FA First Aid
FGD Focus Group Discussion
HC Health Center
HH Household
HP Handphone/Mobile phone
Ir Interviewer
IEC Information, Education, and Communication
In-depth In-depth Interview
KAP Knowledge Attitude and Practice
Km Kilometer
Log frame Logical Framework
LLIN Long Lasting Insecticides Nets
MCK Mandi Cuci Kakus (Access water, and sanitary latrines)
MDG Millennium Development Goals
MOH Ministry of Health
NHQ National Head Quarter
ODCB Organization Development and Capacity Building
PDAM Water Supply Enterprises
PKK Women Welfare Association
PHBS Perilaku Hidup Bersih dan Sehat (Sanitation and Health Behavior)
PMI Palang Merah Indonesia
PHC Primary Health Care
Polindes Village Family Planning Services
Posyandu Integrated Health Services in village level
Pustu Sub Health Center
RAMP Rapid Assessment Mobile Phone
RFP Request for Proposal
RT Rukun Tangga (neighbourhood)
SPSS Statistical Package for Social Sciences
SODIS Solar Desinfection
SRC Spanish Red Cross
TB Tuberculosis
TOR Terms of Reference
TOT Training of the Trainer


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

1. INTRODUCTION

1.1 Background

Palang Merah Indonesia (PMI), the National Red Cross is a non-governmental organization
operating in emergency situations and also involved in assistance to vulnerable population groups. PMI
has responsible for various programs including first aid training, disaster response, disaster
preparedness, blood banks, health and social programs, health promotion activities targeting vulnerable
population groups. In the Strategic Plan 2010-2014, PMI has emphasized a community based health
programs to ensure that activities are of maximum benefit to the most needy. The program mainly
covered eight components including primary health care, health education, nutrition, water and
sanitation, mother and child health care, immunizations, prevention, monitoring of endemic disease and
provision of basic medicines. PMI and Spanish Red Cross (SRC) are humanitarian organizations that
have been long involved together to respond to the December 26, 2004 tsunami in Aceh. It has been
engaged in recovery activities targeting tsunami affected communities. The vision of PMI and SRCs
intervention is to support quality health services and prepare for future disasters. The mission is to
build on the strengths of communities, the International Red Cross and Red Crescent Movement, and
other partners to restore better life of the target communities. The mission and vision of movements are
further informed by its organizational values, derived from the seven fundamental principles of the
International Red Cross and Red Crescent Movement: humanity, impartiality, neutrality, independence,
voluntary service, unity, and universality.
In September, 2009, PMI with SRC have developed a project, Community Based Health and First
Aid (CBHFA) through Organizational Development and Capacity Building (ODCB). The project
focused on delivering a quality services to the most vulnerable communities in several selected villages
in Central Kalimantan for 3 years, December 2010 - November 2013. However the project has been
delay and the intervention at community level was late as it starts in Q3 - 2012. The reason is because
the first year of the project was focused on the capacity building to PMI as institution both in chapter
and branch level. The project was delivered by PMI partnership with SRC in Terusan Raya, Pulau
Kupang, Handiwong and Teluk Pelinget as a control village in Kapuas district, Central Kalimantan
province. PMI Branch with the assistant of external consultant has completed a baseline survey using
rapid mobile phone based surveys (RAMP) in September 2012 and the endline survey using similar
methods in January 2014.
By the project termination, PMI and SRC required to assess the project achievement and
performance focusing on the CBHFA in the community level. In addition, a qualitative survey should
be done to provide more information for further analysis. The purposes of the baseline survey, endline
survey, and qualitative survey were to assess the results of the project performance in the targeted
communities and its lessons for further project development. For this purpose, PMI and SRC have
assigned Bangun Indonesia Foundation as the consultant for carrying out further analysis on the finding
of the surveys. This report provides information on the results of the analysis of the baseline survey,
endline survey, and qualitative survey which focused on the CBHFA project in Terusan Raya, Pulau
Kupang, Handiwong, and Teluk Pelinget. The report includes introduction, methods, project results
in each village and overall villages, conclusion, lessons, and recommendations for the program
development in the future.

1.2 Project description

The project aimed at empowering people with the ability to respond to daily emergencies
where health professionals are absent or overworked. It not only brings first aid to the community
about common injuries but also effectively addresses community health priorities through prevention,
health promotion and control of common diseases in preparing and responding to disaster. It also
helps the recruitment and retention of effective volunteers of the CBHFA program in Indonesia.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The CBHFA action contributes to achieving all four goals of the International Federations Global
Agenda that is aimed at providing a framework of integrated approach in building safer and healthier
communities.
The goals of the project were: i) PMI has increased its capacity, performance and image in Central
Kalimantan Province in order to serve the communities; and ii) Kapuas communities have the capacity
to reduce their vulnerability related to specific diseases and injuries in non-emergency and emergency
situations. The objectives included: 1) PMI Central Kalimantan is able to serve community through
community based health, first aid, and social services activities; 2) Pulau Kupang, Terusan Raya and
Handiwong communities are able to organize themselves and to establish means of dialogue among the
members of the community with other stakeholders; 3) Community knowledge on health issues, basic
first aid and blood donation has improved; and 4) Terusan Raya, Pulau Kupang, and Handiwong
communities are able to take action related to diseases prevention and risk reduction.
The CBHFA project main activities included recruitment of the PMI Branch staf, procurement of
equipment for the project operation; training for Branch volunteer and village volunteers; regular home
visits of health promotion for diseases prevention, control, treatment, and first aid; integrating a
message of health promotion into a regular meetings such as quran reading groups, social gathering,
women welfare organization, and youth activities; helping and supporting Posyandu cadres;
mobilizing community in cleaning the environment; integrating the message into socio drama,
traditional music and songs, message into global and national birth days; developing information center
in the villages, bulletin board, promotion of basic first aid and injury; simulation; providing drinking
water instrument, ceramic filter; educating and promoting hand washing to the communities and
elementary school children.
The principal stakeholders involved in the project management including PMI NHQ, SRC
PMI Chapter, PMI Branch, Kapuas District Government, Sub-District Government, District Health
Office, Health Center, and Private Health Services. At the village l e ve l included Sub-Health Center,
community and religious leaders, village volunteers, a n d general community. Their role was depended
on their own function and responsibility integrated into CBHFA.

1.3 Project location


Figure 1
Project location in Bataguh (A) and Pulau Petak (B) sub-districts,
Kapuas district (A-Red), Central Kalimantan

Central Kalimantan is one of
the provinces in Indonesia which
includes 1 city and 13 districts, with
a total 130 sub-districts comprising
1,528 villages. The population is
approximately 2,249,146 in 2013.
Palangkaraya is a capital city of
Central Kalimantan comprising 5
sub-districts including 30 villages
with a total population of 191,014,
and the average density of the
population is 71 persons per square
km. Kapuas is one of the districts in
Central Kalimantan (A). PMI
partnership with SRC has
implemented CBHFA project in 3
villages, including Terusan Raya
and Pulau Kupang in Bataguh;
Handiwong and Teluk Pelinget in
Pulau Petak (Figure 1).

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Terusan Raya is a village in Bataguh sub-district which location along the Kapuas River,
bordered by Pulau Kupang on the north, Bamban Raya and Sei Jangkit on the east part, and Terusan
Bagutan Raya on the north part. The village has a total of 12 neighborhoods (RT), more than 543
households with a total 2,427 population. The family sizes 5-6 persons and many children per family.
Most of the households work as farmers. In addition, the family farm, women groups also make
mats to support their daily needs. Culturally, most population in Terusan Raya village comes from
Banjar, Dayak and mixed. The population religion is principally Islam and the remaining is Christian
Pulau Kupang is another village in Bataguh sub-district located in the other edge of Kapuas
River. The village boundaries are Sei Lunuk, north part; Sei Jangkit, south; Tahan, west part; and Anjir
Serapat, east part. The village has a total of 32 neighborhoods, more than 1,700 households with about
8,000 populations. Most of the population work as farmer and labor. Most population of Pulau Kupang
is Banjar and mixed and their religion is principally Islam and the remaining is Christian.
Handiwong is one of the villages in Pulau Petak bordering with Anjir Palambang, north part; Sei
Tatas, west part; Palangkai east part. The village has a total of 10 RTs, more than 645 households with
a total 2,581 population. Most of the households work as farmers, business and labor. The family also
makes mats to support their daily needs. Culturally, most population of Handiwong is Islam and the
other small part is Christian.
Teluk Pelinget, the village boundaries are Bunga Mawar in north part; Kelurahan Selat Hulu,
south part; Sei Kayu village, west part; and Bakungin in east part. The village consists of swamp with
a slope between 0-5 meters of sea water surface elevation. Administratively, Teluk Pelinget is under
Pulau Petak sub-district divided in 7 neighborhoods. It has about 868 households with a total
population of 3,294. Most of the population work as farmers and daily workers in plantations. To
support their daily needs, the community also works as fisherman and women groups makes mats from
Purun (local plant similar to bamboo). Most population in Teluk Pelinget is Banjarnese, Dayaknese and
Javanese. They are mostly Islam and the remaining about 5% Christian (Figure 2).


Figure 2
Terusan Raya, Pulau Kupang, Handiwong , and Teluk Pelinget
Source: Map of Kementerian Pekerjaan Umum, 2012

4
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

1.4 Baseline and endline survey

The overall purpose of the survey was to know the knowledge, attitude, and practices of the target
communitys health related issues. The baseline survey objective was to provide information for the
bases of the project performance assessment. PMI Branch Kapuas completed this survey with the
assistant of the previous consultant in September 2012. The endline survey main objectives were: to
assess pre and post operation exposure conditions of the targeted communities; to compare endline with
baseline to assess the change and project achievements which focused on the objective of CBHFA
project results; to establish lessons to influence future PMI community based work; and to provide
lessons and recommendations for the targeted communities. PMI Branch Kapuas completed this
survey in January 2014.
The indicators for measuring the results: By the project finalization:75% of target communities
able to identify at least 3 ways to prevent specific disease (based on priority); 75% of target
communities know where to get information related to specific topics (based on priority); 70% of target
communities active in basic first aid and injury prevention (based on priority). 65% households in
targeted communities able to use basic water treatment methods; by the project finalization: 65%
households in targeted communities implementing personal hygiene and environmental sanitation.
This survey examined both negative and positive changes and progress. Based on the available
project document, the summary of the project describes the project goal, objectives, outputs, verifiable
indicators, means of verification, and assumption as shown in Logical Framework of Project. The
Instrument was referred to the RAMP as well as the baseline survey.


2. METHODS

The main references of this analysis were project document of the CBHFA through ODCB
Project Proposal Kapuas, Central Kalimantan; CBHFA through ODCB Log Frame including its
modification; CBHFA through ODCB Detail Activities; CBHFA through ODCB Annual
Implementation Plan; Baseline Survey Results, Behavior Change Communication Framework;
WatSan Piloting; Endlinde Survey results; and other related documents at the PMI NHQ and PMI
Branch Kapuas.
The assessment process included review of project documents, analysis finding of the baseline
survey and endline survey carried out by PMI Branch on the targeted community of the CBHFA
project. In addition, the consultant conducted in-depth interview and FGD to provide further
information for the analysis. The project performance was measured according to the
implementation status, achievement of the project objectives as well as targeted community
knowledge, attitude and behavior change on specific diseases.

2.1 Review document

The purpose of review document was to provide more information for understanding the
project performance and achievement of the project objectives. The project documents were
collected from PMIs NHQ, PMI Branch and internet. Literature on the program for prevention and
control of diseases including diarrhea, tuberculosis, acute respiratory infection, malaria,
malnutrition, and hypertension is well established. In general many programs for addressing issues
on primary health care through health promotion, information, education, and communication
(IEC), and community behavior change have been reported anywhere, however, a specific program
for a specific community as well as CBHFA project in Kapuas is limited. The reviews included
studies on the assessment of effectiveness and efficiency of the program for primary health care
including first aid, water and sanitation, and health promotion in small rural community. In
addition, project documents such as RAMP questionnaires, behavior change communication
frameworks of water and sanitation, TORs of the assignment, raw data of quantitative survey,


5
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

monitoring report, annual report, training guidelines, IEC materials produced by PMI and by branch
volunteers, monitoring and evaluation instruments, meeting minutes, training reports, and other
document.

2.2 Analysis of baseline and endline survey

Community health status in the villages is determined by many factors including social behavior
changes. Community knowledge, attitude, and practices are the key factors of the community
behavior change. The CBHFA project has been implemented to increase community knowledge,
attitude, and practices focused on selected diseases, accidents, first aid, and water supply
services. The diseases included diarrheal diseases, tuberculosis, malaria, acute respiratory
infection, malnutrition, and hypertension.

2.2.1 Selected diseases

Diarrhea is defined as the passage of three or more loose or liquid stools per day or more
frequent passage than is normal for the individual. It is the second leading cause of death in
children under five years. Most children die from diarrhea due to severe dehydration and fluid loss.
Tuberculosis (TB) is the greatest killer diseases due to single infectious bacteria. It is
spread from person to person through the air. When people with lung TB cough, sneeze or spit
they propel the bacteria into the air. A person needs to inhale only few of these bacteria to
become infected.
Malaria is a life-threatening disease caused by parasites that are transmitted to people
through the bites of infected mosquitoes. Malaria is preventable and curable.
Acute respiratory infection (ARI) is a serious infection that prevents normal breathing
function. It usually begins as a viral infection in the nose, trachea or lungs. If the infection is not
treated, it can spread to the entire respiratory system and prevents the body from getting oxygen
and can result in death.
Malnutrition is an insufficient, excessive or imbalanced consumption of nutrients. Several
different nutrition disorders may develop depending on which nutrient lacking or in excess.
People suffer from under nutrition if their diet does not provide with adequate calories and
protein for maintenance and growth, or they cannot utilize the food they eat due to illness.
Hypertension or high blood pressure has no specific symptoms and increases the risk of
stroke, heart attack, heart and kidney failure. The cause isn't known; but high blood pressure is
easily detected by measuring blood pressure regularly and can be treated with lifestyle
modification.

2.2.2 Number of respondents

The baseline survey reported a total sample of 459 respondents representing of the households
selected by a systematic random sampling in Terusan Raya, Pulau Kupang, Handiwong, and Teluk
Pelinget. The respondents were interviewed using structured and open ended questionnaires. A
total of 66 questions consisted of 7 questions on respondents profile and characteristics, 44
questions of knowledge, attitude, and practices about diseases including diarrhea, TB, malaria,
ARI, malnutrition, and hypertension; 15 questions on special topics; and 5 questions on accidents
and safety on the river, road, and working in the field. All the questions were uploaded on the
cellular phone of 13 PMI Branch volunteers who were responsible for data collection using RAMP
methods. The results were documented in spread sheet and narrative report. The spread sheet
described a number and location of respondents, GPS, name of enumerator, and response of each
question according to its category. The baseline report described respondents characteristics,
proportion of individual responds of each category of the questions, conclusion and
recommendations.


6
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The endline survey involved a total sample of 457 respondents, representing of households
which were selected by systematic random sampling in Terusan Raya, Pulau Kupang, Handiwong,
and Teluk Pelinget. PMI Branch employed 13 branch volunteers to collect data and information
using a similar structured questionnaires as well as used in the baseline survey. Basically PMI
Branch repeated a similar survey as well as the baseline survey. The endline survey results were
documented in spread sheets without narrative report. The spread sheet described number of
respondents, location of respondents, GPS, name of enumerator, and response category of each
question.The number of respondents by villages is shown in Table1.

Table 1
Number of respondents in the baseline and endline survey




Data collected by the sample survey were reviewed, organized, and transferred into SPSS data
view and then processed. Data were cleaned, and recorded its category. A category of others was
recoded and integrated into variable categorization. As of the recording completed, analyzed the
baseline and endline data to produce a frequency distribution of each variable by village for
measuring the project performance.

2.2.3 Performance measurement

The project performance was measured by several criteria including project relevance,
implementation outputs, and achievement of the project objectives. The project relevance in
relation to the community needs, local health services, and District Health Office. The Project
implementation outputs limited on volunteer recruitment, training, home visits for health
promotion. The project achievement was measured by the effective percentage change (EPC) of
knowledge, attitude, and practices of the households on diseases, accidents and first aid.
The knowledge of respondents on diseases based on a combination responses of several
questions including symptoms, causes, transmission, and prevention (composite variables). In this
analysis, the knowledge of respondents is recorded into 3 Likert scales: the respondents with the
correct answer , if they know more than 50% correct responses (above the median value); the
respondents with partly correct if their responses are less than 50% of the correct responses; and
do not know. If they did not select any responses. The attitude and practices of the respondents on
diseases and accidents based on questions and responses as well as listed in the RAMP
questionnaires. In addition, observation was completed to identify the use of ceramic filters,
distributed to the village volunteers.
The correct answers of baseline data frequency distribution was compared with the correct
answers of endline data frequency distribution, and expressed in Effective Percentage Change (EPC)
of the correct answers. The EPC is calculated according to the formula: the proportion of endline
data (p2) of each variable minus the proportion of baseline data (p1) a similar variable are divided
by 100 minus the proportion of the baseline data times a hundred percent:

RT HH Pop* no RT HH Pop* no
Bataguh Terusan Raya 12 554 2,427 67 12 543 2,427 77
Pulau Kupang 24 1,692 7,079 215 32 1,692 7,074 208
Pulau Petak Handiwong 10 661 2,581 72 10 661 2,581 70
Teluk Pelinget 7 632 2,845 105 12 868 3,294 102
Sub-district:2 Village:4 53 3,539 14,932 459 54 3,764 15,376 457
Sub-district Village
Baseline 2012 Endline 2014
7
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The Effective Percentage Change indicates the changes of the knowledge, attitude, and practices as
the results of the CBHFA project implementation. A positive percentage change indicates an
increased effectiveness of the project intervention; on the other hand a negative percentage change
does not indicate the effect of the project intervention.

2.3 In-depth interview

The purpose of in-depth interview was to explore the respondents point of view, the feelings
and perspective. The interview involved asking questions, recording, reporting and documenting of
responses in line with probing for deeper meaning and understanding of the response. The
respondents were key personnel of the CBHFA project management including PMIN HQ, SRC,
PMI Chapter, PMI Branch, District Health Office, Health Center, sub- Health Center, branch
volunteer, village committee members, and village volunteers.
Interview guide was developed for in-depth interview. The actual interview guides included
introduction, establish a good communications with the respondents, listen and observe until the
important issues explored. The questions vary from one respondent to the other depending on their
roles and responsibilities in the project. Basically the questions included their role in the project
planning, implementation, followed up, partnership with other sector, progress of the project, problem
and their suggestions.The in-depth interview guide for the key personnel was mainly concerning
their roles and responsibilities for the CBHFA project management. The guide for the PMI Branch,
branch coordinator and volunteer included their roles and responsibilites for the project
implementation, monitoring and supervision, and results. The guide for the other stakeholder
including representative of District Health Office, Health Center, sub-Health Center, Polindes, and
Posyandu about community health status and program activities in the area of responsibility such as
morbidity and mortality of diseases occurrence, and primary health care activities.
The steps of in-depth interview included introduction on the purpose of the interview, asking
several questions on knowledge and awareness about diseases, health education materials, project
implementation, diseases prevention and control, and other related questions according to need of the
project objectives. In the introduction, the interviewer informed the purposes of the interview,
expectation of the correct answers, and permission for recording the conversation. As of the interview
completed, the team transcribed to written texts of the interviews using audio-taped and side notes.
Data were organized, verified, themalizing, and summarized. This method was a complement of the
quantitative survey to provide further information on the project performance.

2.4 Focus Group Discussion

The FGD provided qualitative information on community knowledge, attitude, and practices
toward community characteristics, diseases; accidents, first aid, and other related information. It
conducted through several steps including selection a FGD team, recruitment the participants,
preparation the discussion guides, conducted interview and analyzed results. The FGD participants
were selected to include a group of women and men in each village.
The participants of the FGD were the highest risk community including head of the households
and his/her spouse representing a community at the project area. Each group was selected by the
community representing of them on the same ages under the coordination of field coordinator. The
FGD spent the average time about 1-1.5 hours, and conducted at a location with enough privacy to
facilitate effective discussion group. Each village representated by 8-10 men in one FGD and 8-10
women in another seperated FGD. The FGD team consisted of one facilitator and one branch
volunteer in each village. The facilitator and branch volunteer were responsible for FGD
preparation, process, and report. The facilitator was responsible for leading the discussion,
recording, reporting; the volunteer was responsible for assisting the discussion and taking an
important notes. The field coordinator was responsible for overall preparation, including
recruitment of the participants, coordination, and implementation to make FGD process
effectively completed.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The FGD guides both for women and men basically were similar including list of question
discussion on the profile of the community, inform consent, question of diseases symptoms,
prevention and control for diarrhea, TB, malaria, ARI, malnutrition, hypertension; accidents on
river, field work, road, and other related information. Each question included its probing whenever
the discussion out of topics. The questions on water included source of water for domestic use
during rainy and dry seasons; on sanitation included site of defecation and cleaning, and its health
effects. The questions on IEC included source of information, frequency of the IEC intervention by
the local HC, and type of IEC materials. Each question included its probing whenever the discussion
out of the discussion topics. Interview and FGD activities were carried out from February 4-9, 2014;
the first day was a courtesy call with the PMI Branch Leader and staff; discussion on the agenda of
data collection and PMI Branch volunteer participations. In-depth interview of the village committee,
representative of DHO, FGD women and men in Terusan Raya was completed on day 2; Pulau
Kupang on day 3; Handiwong on day 4; and Teluk Pelinget on day 5. The FGD knowledge, attitude,
and practice about diarrhea, TB, malaria, ARI, malnutrition, hypertension; accidents and first aid,
water and basic sanitation. In addition, direct observation on distribution of ceramic filters to selected
village volunteers. The number of participants in of in-depth interview, FGDs and ceramic filter
observation is shown in Table 2.

Table 2
Number of participants of in-depth interview and FGDs




2.5 Analysis of in-depth interview and FGD

During in-depth interview and FGD all information were recorded in the Sony tape recorder.
The information from the key personnel of CBHFA project management of the central, branch,
field coordinator, village committee, village volunteers, men and women of FGD participant.
The BIF team transcribed all the recorded data into the written narrative texts. The information
included community knowledge, attitude, and practices about various aspects of diseases prevention
and control. The analysis included determination of the information in term of the objective of the
assessment, checking the credibility and validity of the information through triangulation, and
writing report for each individual interview.
The results of each in-depth interview were reported in a summary of each response on the
questions according to the interview. The FGD results were transcribed, identified and categorized
into key words and phrases, coded according to the central theme, issues, suggestions, and
interpreted the findings. The results summarized on the community knowledge, attitude and
behavior practices on diseases, accidents, and other related information.


Terusan Pulau Teluk Hadi
Raya Kupang Pelinget wong
Observation 0 0 0 10 11 0 10 31
In-depth I'r 2 0 5 1 2 2 2 14
PMI HQ 1 0 0 0 0 0 0 1
SRC 1 0 0 0 0 0 1 2
PMI Branch 0 0 1 0 0 0 0 1
Field coordinator 0 0 3 0 0 0 0 3
Village committee 0 0 0 1 1 1 1 4
District Health Office 0 0 1 0 0 0 0 1
Health Center 0 0 0 0 1 1 0 2
FGD 0 0 0 2 2 2 2 8
Women 0 0 0 1 1 1 1 4
Men 0 0 0 1 1 1 1 4
Methods Central Chapter Branch Total
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

3. RESULTS

This section presents the findings and challenges identified by the baseline and endline survey.
The findings of both surveys are described according to respondent characteristics; knowledge, attitude,
and practices on diseases and accidents, including identification, prevention, and treatment on diarrhea,
TB, malaria, ARI, malnutrition, and hypertension; summary of interview with key personnel; and FGD
with women and men of the targeted community. The diseases priority include diarrhea, malaria, and
hypertension, other selected diseases of interest are TB, ARI, and malnutrition.

3.1 Baseline survey

3.1.1 Respondent characteristics

The respondents in Terusan Raya, Pulau Kupang, and Handiwong were mostly females, with the
average of 70%, range from 66.3-76.6%; productive age 35-44 years 69.6%, range from 61.1-82.1%;
primary graduates school or less 78.3%, range from 70.7-83.6%; and farmers 79%, range 70.2-83.5%.
The respondents in Teluk Pelinget were mostly females 79.4%, productive age 35-44 years 72.4%,
primary school graduates or less 72.4%, and farmers 62.9%.
The respondents in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget were mostly
females, productive age, primary school graduates or less, and farmers. The proportion of respondents
females, productive age, primary school graduates or less, and farmers in Teluk Pelinget was higher
than the proportion of respondents females, productive age, primary school graduates of less, and
farmers in other villages. There was no significantly different of the characteristics of respondents in
each village from the characteristics of respondents in Teluk Pelinget ( p>0.05). (Table 3)

Table 3
Respondent characteristics by village



3.1.2 Knowledge, attitude, and practices on diseases

The respondents in Terusan Raya, Pulau Kupang, and Handiwong, who correctly answered the
questions of symptoms, causes, infection, prevention, and treatment on diarrhea, TB, malaria, ARI,
malnutrition and hypertension were 22.9%, range from 20.2 26.4%; who positively responded to the
Charact erist ics Baseline Ave T.Pelinget
Cat egory T. Raya P.Kupang Hadiwong 3 villages (cont rol)
Sex Male 23.4 33.7 32.9 30.0 20.6
Female 76.6 66.3 67.1 70.0 79.4
Age <35 47.8 37.7 38.9 41.5 48.6
35-44 34.3 27.9 22.2 28.1 23.8
45-54 17.9 34.4 38.9 30.4 27.6
No School 6.0 7.0 9.7 7.6 7.2
Educat ion DO 34.3 22.8 20.8 26.0 22.9
Primary 43.3 40.9 50.0 44.7 42.3
Secondary> 16.4 28.7 19.5 21.5 28.2
Occupat ion Farmer 83.5 70.2 83.3 79.0 62.9
Busniss 12.0 13.1 9.7 11.6 12.4
Other 4.5 13.0 4.2 7.2 14.3
Most Female 76.6 66.3 67.1 70.0 79.4
35-44 82.1 65.6 61.1 69.6 72.4
Primary+less 83.6 70.7 80.5 78.3 72.4
Farmer 83.5 70.2 83.3 79.0 62.9
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

questions of seeking treatment 30.9%, range from 29.9- 36.4%; who practiced on the prevention of
these diseases 18.4%, range from 14.8% -23.6%.
The respondents in Teluk Pelinget,who correctly answered the questions of symptoms, causes,
infection, prevention, and treatment on diarrhea, TB, malaria, ARI, malnutrition and hypertension were
23.1%, attitude 54.7%, and practices 25.7%. The respondents in Teluk Pelinget were relatively better
knowledge, attitude, and practices of identification, prevention and seeking treatment on diseases
(Table 4)

Table 4
Respondents knowledge, attitude, and practices on diseases




3.1.3 Knowledge, attitude, and practices on accidents

The respondents in Terusan Raya, Pulau Kupang, and Handiwong, who correctly answered the
questions of accidents on river, road, and field work were 7.8%, range from 8.2 10.3%; who
positively responded to the questions of accidents on river, road, and field work 6.2%, range from 3.0 -
7.7%; who practiced of the prevention of accidents on river, road, field work 23.9%,range from 20.5-
31.9%. The respondents in Teluk Pelinget, who correctly answered the questions of accidents on river,
road, and field work were 9.4%, who positively responded the questions of accidents on river, road,
and field work 8.8%, and who practiced on river, road, and fieldwork accidents prevention 24%.
The respondents in Teluk Pelinget was relatively better knowledge, attitude, and practices of
accidents on river, road, and field work compared with the respondentsw in Terusan Raya, Pulau
Kupang, and Handiwong.
Diseases Correct Baseline survey Ave T.Pelinget
answers T.Raya P.KupangHandiwong3 villages (control)
Diarrhea Knowledge 19.4 18.1
26.4
21.3 28.6
At t it ude 46.3 36.3
36.1
39.6 47.6
Pract ice 10.4 22.8
26.4
19.9 27.6
TB Knowledge 14.9 11.6 14.9 13.8 14.3
At t it ude 3.0 4.2 3.0 3.0 49.5
Pract ice 0.0 5.1 6.0 3.0 26.7
Malaria Knowledge 21.4 18.5 18.5 19.5 1.0
At t it ude 67.5 63.9 78.6 70.0 58.2
Pract ice 35.1 47.1 60.0 47.4 40.8
ARI Knowledge
26.9 19.5 20.8
22.4 21.0
At t it ude
3.0 2.3 0.0
1.8 2.9
Pract ice
4.5 2.3 0.0
2.3 1.0
Malnut rit ion Knowledge
9.0 14.4 13.9
12.4 13.3
At t it ude
16.4 33.0 31.9
27.1 40.0
Pract ice
19.4 11.6 5.6
12.2 9.5
Hypert ension Knowledge
40.3 19.1
15.3 24.9 37.1
At t it ude 13.4 10.2 15.3 13.0 75.2
Pract ice 4.5 10.7 6.9 7.4 22.9
All Knowledge 26.4 20.2 22.0 22.9 23.1
At t it ude 29.9 36.4 33.0 30.9 54.7
Pract ice 14.8 23.6 21.0 18.4 25.7
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The reasons of better knowledge, attitude, and practices on accidents of river, road, and field work
might be people in Teluk Pelinget have more access to primary health care services such as HC, sub
HC, Posyandu, Polindes, and easily access to road transportation facilities (Table 5)

Table 5
Respondent knowledge, attitude, and practices on accidents




3.1.4 Interview and discussion

The interview and FGD were carried out with local stakeholders including PMI Branch staff,
Village Secretary, Posyandu cadres, representative of several sub-villages, informal community
leaders, and representatives of the village community. Most of the participants identified several issues
including social economic, health, diseases, accidents, injuries, water and basic sanitation.
People in Teluk Pelinget have better living conditions compare with people in Terusan Raya,
Pulau Kupang, and Handiwong. The transportation facilities in T.Pelinget much depend on the road
pass through the village; while in the other villages depend on the river and its tributaries. People in
T.Pelinget have better social and economic conditions than people in other villages. Most people in
T.Pelinget have permanent buildings, cars, and motorbikes as the transportation facilities. They are less
depending on river compare with the other villages, due to have access to main road to Banjarmasin.
The population health status in each village is relatively similar, with high morbidity and
mortality of both communicable and non-communicable diseases. The communicable diseases are
diarrhea, TB. ARI and malaria; while non-communicable diseases are malnutrition and hypertension.
Diarrhea is the main causes of morbidity and mortality in all villages. People believe that diarrhea
is caused by drinking un-boiled river water. It is seasonally diseases and occurred during the transition
of the seasons.
Tuberculosis has indicated many cases in the villages. There is a medical treatment for 6 months,
however, people did do not follow the regular treatment, and resulted in TB has not cured and infected
other person by air.
Malaria is not an endemic disease in the villages. People believe that is an imported cases from
young people who worked at the gold and coal mining out of town in forest areas. When they come
home, malaria will be transmitted by mosquitoes to other people and they can get sick. If the sick
people are not well treated they may result in death.
ARI is a disease of respiratory infection due to smoke, dust, and other air pollution. Many people
in the village believe that the main causes of ARI are air pollution.

Accident s
Correct Average T.Pelinget
answers
T.Raya P.Kupang Handiwong
3 villages (cont rol)
River Knowledge 8.9 6.9 15.1 10.3 6.6
At t it ude 1.5 3.2 2.7 2.5 13.3
Pract ice 19.4 25.1 9.7 18.1 4.8
Road Knowledge 7.4 12.1 15.3 11.6 18.1
At t it ude 4.5 5.2 9.7 6.5 2.9
Pract ice 44.4 45.3 46.2 45.3 62.5
Field work Knowledge 8.9 0.5 1.4 3.6 6.6
At t it ude 8.9 10.6 9.7 10.2 7.6
Pract ice 0.0 5.6 8.3 4.6 1.9
All Knowledge 8.2 9.3 10.3 7.8 9.4
accident s At t it ude 3.0 5.8 7.7 6.2 8.8
Pract ice 31.9 23.5 20.5 23.9 24.0
Baseline survey
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Malnutrition cases were not known by people in the village. Posyandu services are limited,
however, the cadres observed several cases visiting for treatment at the Posyandu. Posyandu provided
basic health services, immunization, family planning, health promotion, and provision of food
sumplement to the children.
Hypertension is not communicable disease, but many people get strokes which affected to people
death and handicapped. People do not know what are the causes of strokes and they treated by their
own drugs bought from the local market.
People in the villages are at risk of accidents and injuries due to river transportation, working in
the field, and road accidents. River accidents due to boat accident, sinking boats, hit each other and
high wave of water during the season. Field work accident such as cut by knives, fall down due to
slippery road, and snake bites. Road accidents due to high speed of riding motorbikes without wearing
helmet and slippery road.
People obtain water from rivers and streams for domestic purposes such as drinking, cooking,
washing and cleaning household equipment. Rivers are considered as the main transportation facilities
where people working and doing their life business. The Government though the DHO and CWS has
provided deep well pump in almost every neighbourhood, however people did not use its. People
believe that river water look clean after mixed with tawas (Aluminum potassium sulfat) and taste
better than other source of water.
In conclusion, the findings indicate that communities in Terusan Raya, Pulau Kupang, Handiwong
and Teluk Pelinget have similar characteristics: more females population, high proportion of people in
productive age, low educational background, and most of their occupation are farmer and labor. Life
of the community in Terusan Raya, Pulau Kupang, and Handiwong depends on rivers and streams
passing through their villages. Health status of the population in each village relatively similar, with
high morbidity and mortality due to both communicable and non-communicable diseases.
The communicable diseases included diarrhea, TB. ARI and malaria; while non-communicable
diseases included malnutrition and hypertension. Accidents are frequently occured on the river, field
work and road. Most people familiar with some of the diseases and accidents, but they have limited
knowledge, attitude, and practices on diseases preventions and treatment.
Most population in all the villages does not have access to safe water, and they use water for
domestic purposes from river water, streams, and bored deep well provided by government and CWS.
People preferred using river water compare with water of deep well because they believe that river
water taste better. People also do not access to basic sanitation facilities including sanitary latrines,
waste water discharges, and garbage disposal system. Most people defecate on the river and streams;
collect garbage and dispose on the river, and discharge waste water on the river.
The findings of the baseline survey recommended that the CBHFA project should involve Terusan
Raya, Pulau Kupang, Handiwong, and Teluk Pelinget as the control village. The project should
address primary health care issues including diseases, accidents, water and basic sanitation. The key
intervention mainly provides information, education, and communication (IEC) for addressing
community limited knowledge, attitude, and practices on diseases. The consultant and stakeholders
identified diseases issues such as diarrhea, TB, ARI, malaria, malnutrition, and hypertension.
Community knowledge on diseases including symptoms, causes, prevention, and treatment.Community
attitudes on seeking treatment when they have a member of the family were sick and community daily
practices on diseases prevention. First aid and accidents due to travelling by transportation, working in
the field work, and travelling by road. Finally the project should also address issues on water and basic
sanitation since most people in need.

3.2 Endline survey

3.2.1 Respondent characteristics

The respondents in Terusan Raya, Pulau Kupang, and Handiwong were mostly females, with the
average 67.6%, range from 62.5 -71.6%; productive age 35-44 years 62%, range from 57.2-65.1%;
13
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

primary school graduates or less 77.4%, range from 62.9-88.4%; and farmers 62.6%, range 57.1-
72.7%. The respondents in Teluk Pelinget were mostly females 73.3%; productive age 35-44 years
69.9 %; primary school graduates or less 67.6%; and farmers 57.1%.
The respondents in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget were mostly
females, productive age, primary school graduates or less, and farmers. The proportion of respondent
females, productive age, primary school graduates, and farmers in Teluk Pelinget was higher than the
proportion of females, productive age, but not on education level, and occupation compared with the
other villages. There was no significantly different characteristics of respondents in each village from
the characteristics of respondents in Teluk Pelinget (Table 6)

Table 6
Respondent characteristics by village




3.2.2 Knowledge, attitude, and practices on diseases

The respondents knowledge in Terusan Raya, Pulau Kupang, and Handiwong , who correctly
answered the questions of symptoms, causes, infection, prevention, and treatment on diarhea, TB,
malaria, ARI, malnutrition and hypertension were 29.8%, range from 27.9 31.1%; who positively
responded to the question of seeking treatment 44.4% ,range from 41.8-48.4%; who practiced on
prevention of these diseases 29.5% , range from 17.4% -27.7%.
The respondents in Teluk Pelinget ,who correctly answered the questions of symptoms, causes,
infection, prevention, and treatment on diarhea, TB, malaria, ARI, malnutrition and hypertension were
33.1%; who positively responded to the question of seeking treatment 54.2%, and practiced for
prevention on diseases 26.3%.
The respondents in Teluk Pelinget were relatively better knowledge, attitude, and practices on the
identification, seeking treatment, and prevention diseases priority including diarrhea, TB, and malaria,
and other diseases such as ARI, malnutrition, and hypertension.(Table 7)

Charact erist ics Cat egory Endline survey Average T.Pelinget
respondet ns T. Raya P.Kupang Hadiwong 3 villages (cont rol)
Sex Male 28.4 31.2 37.5 32.4 26.7
Female 71.6 68.8 62.5 67.6 73.3
Age < 25 11.7 10.1 13.0 11.6 13.7
25-34 20.8 24.6 15.9 20.4 36.3
35-44 24.7 30.4 34.8 30.0 19.6
45-54 26.0 19.8 18.8 21.5 20.6
55+ 16.9 15.0 17.4 16.4 9.8
No School 11.7 9.1 14,.3 10.4 7.8
Educat ion DO 32.5 30.3 24.3 29.0 19.6
Primary 44.2 38.0 38.6 38.0 40.2
Secondary> 11.7 22.2 22.8 18.9 29.4
Occupat ion Business 20.8 29.4 28.5 26.2 28.5
Farmer 72.7 58.1 57.1 62.6 57.1
Ot her 7.8 11.5 18.5 12.6 18.5
Most
Female 71.6 68.8 62.5 67.6 73.3
respondent s 35-44 57.2 65.1 63.7 62.0 69.6
Primary+less 88.4 77.4 62.9 77.4 67.6
Farmer 72.7 58.1 57.1 62.6 57.1
14
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Table 7
Respondent knowledge, attitude, and practices on diseases




3.2.3 Knowledge, attitude, and practices on accidents

The respondents in Terusan Raya, Pulau Kupang, and Handiwong , who correctly answered the
questions on accidents of river, road, and field work were 8.8%, range from 8.1 12%; who positively
responded to the questions on accidents of river, road, and field work 7.9% , range from 2.6 -12.5%;
who practiced for the prevention of accidents on river, road, first aid, and injuries 27.6%, range from
25.4-30.6%.
The respondents in Teluk Pelinget , who correctly answered the questions of accidents on river,
road, and field work were 11.8%, who positively responded to the questions of accidents on river,
road, and field work 10.5% , and who practiced for the prevention of accidents on river, road, first
aid, and injuries 27.6%.
The respondents in Teluk Pelinget were relatively better knowledge and attitude on accidents on
river, road, and fieldwork than respondents in the other villages; however, indicated similar practices
on accidents of river, road, and field work. (Table 8)








Diseases Correct Endline survey Ave TPelinget
answers T.Raya P.Kupang Handiwong 3 villages (cont rol)
Diarrhea Knowledge 24.7 24.6
28.6
26.0 36.3
At t it ude 55.9 54.8
58.6
56.4 53.9
Pract ice 29.6 28.8
18.8
25.7 33.3
TB Knowledge 19.5 20.7 15.7 18.6 25.5
At t it ude 29.2 28.1 15.7 24.3 24.2
Pract ice 4.3 48.6 12.8 21.9 0.0
Malaria Knowledge 25.4 24.2 24.2 24.6 8.6
At t it ude 74.6 81.9 83.3 79.9 71.4
Pract ice 37.3 47.4 59.7 48.1 20.0
ARI Knowledge
28.6 31.4 37.1
32.4 18.6
At t it ude
1.3 42.3 0.0
14.5 2.0
Pract ice
0.0 0.5 2.9
1.1 0.0
Malnut rit ion Knowledge
10.4 9.1 12.9
10.8 29.4
At t it ude
40.3 28.8 41.4
36.8 39.2
Pract ice
9.1 7.2 14.3
10.2 12.7
Hypert ension Knowledge
44.2 29.3
37.1 36.9 47.1
At t it ude 7.8 6.3 15.7 9.9 80.4
Pract ice 6.5 5.8 17.1 9.8 65.7
All Knowledge 30.6 27.9 31.1 29.8 33.1
diseases At t it ude 41.8 48.4 42.9 44.4 54.2
Pract ice 17.4 27.7 25.1 29.5 26.3
15
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Table 8
Respondent knowledge, attitude, and practices on accidents



3.3 Analysis of baseline and endline data

3.3.1 Respondent characteristics

In the baseline survey, the respondents in Terusan Raya, Pulau Kupang, and Handiwong were
mostly females, with the average of 70%, productive age 69.6%, primary school graduates or less
78.3%, and farmers 79%. The respondents in Teluk Pelinget were mostly females 79.4%, productive
age 72.4%, primary school graduates or less 72.4%, and farmers 62.9%.
In the endline survey, the respondents in Terusan Raya, Pulau Kupang, and Handiwong were
mostly females, with the average of 67.6%, productive age 62%, primary school graduates or less
77.4%, and farmers 62.6%. The respondents in Teluk Pelinget were mostly females 73.3%,
productive age 69.6%, primary school graduates or less 67.6%, and farmers 57.1%. (Table 9)

Table 9
Respondents characteristics in both surveys*


* Ave baseline-endline; p<0.05; and Teluk Pelinget p<0.05
Accident s Correct
Ave TPelinget
answer TRaya PKupang Handiwong
3 villages (control)
River Knowledge 8.5 13.4 17.1 13.0 13.6
At t it ude 0.0 10.1 15.6 8.6 8.6
Pract ice 40.3 21.2 18.6 26.7 2.9
Road Knowledge 7.7 10.4 9.9 9.3 16.5
At t it ude 5.1 14.8 18.5 12.8 21.4
Pract ice 20.8 30.3 35.7 28.9 51.0
Field work Knowledge 2.6 9.1 4.2 5.3 6.8
At t it ude 1.3 0.9 2.3 1.5 0.9
Pract ice 24.7 35.1 27.1 29.0 39.2
All Knowledge 8.1 11.9 12.0 8.8 11.8
accident s At t it ude 2.6 12.5 11.7 7.9 10.5
Pract ice 30.6 25.4 29.8 27.6 27.6
Endline survey
Charact erist ics Cat egory Baseline survey Endline survey
Ave T.Pelinget Ave T.Pelinget
Sex Male 30.0 20.6 32.4 26.7
Female 70.0 79.4 67.6 73.3
Age <35 41.5 48.6 32.0 50.0
35-44 28.1 23.8 30.0 19.6
45-54 30.4 27.6 38.0 30.4
No School 7.6 7.2 10.4 7.8
Educat ion DO 26.0 22.9 29.0 19.6
Primary 44.7 42.3 38.0 40.2
Secondary> 21.5 28.2 18.9 29.4
Occupat ion Farmer 79.0 62.9 62.6 57.1
Busniss 11.6 12.4 27.3 29.9
Ot her 7.2 14.3 8.7 11.4
Most Female 70.0 79.4 67.6 73.3
35-44 69.6 72.4 62.0 69.6
Primaary+less 78.3 72.4 77.4 67.6
Farmer 79.0 62.9 62.6 57.1
16
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

In both surveys, the average characteristics of respondents in Terusan Raya, Pulau Kupang, and
Handiwong were mostly females, productive age, primary school graduates, and farmers. In the endline
survey, the average proportion of respondents characteristics in Terusan Raya, Pulau Kupang, and
Handiwong were less compared with the average proportion of females, productive age, primary school
graduates, and farmers in the baseline survey. The characteristics of respondents in Terusan Raya,
Pulau Kupang, and Handiwong in the endline survey were significantly different from the baseline
survey (p<0.05); might be caused by chance of sampling process.
In both surveys, the characteristics of respondents in Teluk Pelinget as well as in Terusan Raya,
Pulau Kupang, and Handiwong were mostly females, productive age, primary school graduates, and
farmers. In the endline survey, the average characteristics of respondents in Teluk Pelinget were less:
females, productive age, primary school graduates, and farmers compared with the the characteristics
of respondents inhe baseline survey. The respondents characteristics in the endline survey were
significantly different from the baseline survey (p<0.05) might be caused by chance of the sampling
processs (Figure 3).


Figure 3
Respondents characteristics in Terusan Raya, Pulau Kupang, Handiwong,
and Teluk Pelinget in the baseline and endline survey


3.3.2 Knowledge, attitude, and practices on diseases

In the baseline survey, the average knowledge of respondents in Terusan Raya, Pulau Kupang,
and Handiwong, who correctly answered the questions on diseases symptoms, causes, prevention, and
treatment was 22.9%; attitude on seeking treatment including get information on spesific topics 30.9%,
and practices on diseases prevention 18.4% . In Teluk Pelinget, the knowledge of respondents who
correctly answered the questions on diseases symptoms, causes, prevention, and treatment was 23.1%;
attitude on seeking treatment including get information on the specific topics 54.7% , and practices on
the diseases prevention 25.7% .
In the endline survey, the average knowledge of respondents in Terusan Raya, Pulau Kupang, and
Handiwong, who correctly answered the questions on diseases symptoms, causes, prevention, and
treatment was 29.8%; attitude on seeking treatment including get information on specific topics
44.4% , and practices on diseases prevention 29.5% . In Teluk Pelinget, the knowledge of respondents
who correctly answered the questions on diseases symptoms, causes, prevention, and treatment was
33.1%; attitude on seeking treatment including get information on the specific topics 54.2% , and
practices on the diseases prevention 26.3% .
The effective percentage change of respondents knowledge in Terusan Raya, Pulau Kupang, and
Handiwong was 9.0, attitude 19.2 and practices 3.8. The effective percentage change of respondents
in Teluk Pelinget who correctly answered the questions on diseases symptoms, causes, prevention, and
17
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

treatment was 12.6; attitude on seeking treatment including get information on specifc topic 2.5 , and
practices on the diseases prevention -1.1 (Table 10)

Table 10
Respondent knowledge, attitude, and practices on diseases, in both surveys



In Terusan Raya, Pulau Kupang, and Handiwong the respondents knowledge, attitude, and
practices have increased on diseases prevention for diarrhea, malaria, TB, ARI, and hypertesion.The
increased might be a contribution of HC, sub-HC, Posyandu, and Polindes. Under the coordination of
HC, sub-HC, Posyandu, and Polindes provided primary health care services incuding immunization,
family planning, promotion of personal hygiene, environmental sanitation, and various diseases
prevention. However, their activities were limited because HC, sub-HC Posyandu and Polindes more
concern in-patient services. Posyandu is community based health services with the assisstant of HC and
regularly opens once per month.
During the project implementation, PMI volunteers conducted more home visits and activities for
promoting basic health, first aid, diseases prevention, and social activities. PMI may contribute to the
largest part of community awareness and behavior changes but it is very difficult to proof. However,
the community FGD reported that during the project implementation, PMI volunteers conducted more
regular home visit for promoting basic health, first aid, and social activities. Although there was an
increase on the community knowledge, attitude, and practices on diseases prevention, however it has
not reached the expected project targets.
The effective percentage change of the knowledge,attitude, and practices on diseases prevention
was very low. The reasons may include limited ability of community in receiving so many information
on health and diseases promotion, limited ability of village volunteers in receiving the training
Diseases Correct Baseline survey Endline survey Effective%Change
answers Ave* T.Pelinget Ave* T.Pelinget Ave* T.Pelinget
Diarrhea Knowledge 21.3 28.6 26.0 36.3 5.8 10.8
Attitude 39.6 47.6 56.4 53.9 27.4 12.0
Practice 19.9 27.6 25.7 33.3 14.8 7.9
TB Knowledge 13.8 14.3 18.6 25.5 7.9 13.1
Attitude 3.0 49.5 24.3 24.2 20.1 -50.1
Practice 3.0 26.7 21.9 0.0 2.2 -36.4
Malaria Knowledge 19.5 1.0 24.6 8.6 5.7 7.7
Attitude 70.0 58.2 79.9 71.4 22.0 31.7
Practice 47.4 40.8 48.1 20.0 0.6 -35.2
ARI Knowledge 22.4 21.0 32.4 18.6 12.6 -3.0
Attitude 1.8 2.9 14.5 2.0 14.0 -0.9
Practice 2.3 1.0 1.1 0.0 -2.3 -1.0
Malnutrition Knowledge 12.4 13.3 10.8 29.4 -1.9 18.6
Attitude 27.1 40.0 36.8 39.2 12.1 -1.3
Practice 12.2 9.5 10.2 12.7 -2.9 3.5
Hypertension Knowledge 24.9 37.1 36.9 47.1 15.0 15.9
Attitude 13.0 75.2 9.9 80.4 0.5 21.0
Practice 7.4 22.9 9.8 65.7 6.6 55.5
All Knowledge 22.9 23.1 29.8 33.1 9.0 12.6
diseases Attitude 30.9 54.7 44.4 54.2 19.2 2.5
Practice 18.4 25.7 29.5 26.3 3.8 -1.1
* Ave: T.Raya, P.Kupang, and Handiwong
18
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

materials and delivering their knowledge and skills, ineffective of training village volunteers,
ineffective of IEC materials, and limited duration of the project implementation at the community
level.
The proportion of respondents inTeluk Pelinget, the knowledge and attitude of the respondents on
diseases has increased such as in the other villages. As well as in Terusan Raya, Pulau Kupang, and
Handiwong the effective percentage change of knowledge, attitude, and practices on diseases was very
low. The increased may not caused by PMI but other services including HC, sub-HC, Posyandu and
other services; and the effective percentage change of knowledge, attitude, and practices on diseases
was low since no intervention in the village. In addition, the data can not be compared with the other
villages because respondents were not selected in simple random sampling method (Figure 4).




Figure 4
The effective percentage change of respondents knowledge, attitude,
and practices on diseases in endline survey

3.3.3 Knowledge, attitude, and practices on accidents

In the baseline survey the average knowledge of respondents in Terusan Raya, Pulau Kupang, and
Handiwong, who correctly answered the questions on accidents of river, road, and field work was
7.8%, attitude including get information on accidents was 6,2%, and practices on accidents
prevention 23.9%. In Teluk Pelinget, the knowledge of respondents who correctly answered the
questions of accidents was 9.4%, attitude on accidents was 8.8%, and practices on accidents
prevention 24%.
In the endline survey the average knowledge of respondents in Terusan Raya, Pulau Kupang, and
Handiwong, who correctly answered the questions on accidents on river, road, and field work was
8.8%; attitude on seeking treatment including get information on accident prevention 7.9% , and
practices on accidents prevention 27.6%. In Teluk Pelinget, the knowledge of respondents who
correctly answered the questions on accidents was 11.8 % %; attitude on seeking treatment on
accidents 10.5% , and practices on accidents prevention 27.6% .
The effective percentage change of respondents knowledge on accidents prevetion in Terusan
Raya, Pulau Kupang, and Handiwong on was 1.2 , attitude including get information on accidents 1.8,
and practices on accidents prvention 4.8. The effective percentage change of respondents in Teluk
Pelinget who correctly answered the questions on accidents 2.6, attitude on seeking treatment
including get information on accidents 1.9 , and practices on accidents prevention 4.8 (Table 11)





19
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report



Table 11.
Respondents knowledge, attitude, and practices on accidents, in both surveys



In Terusan Raya, Pulau Kupang, and Handiwong the respondents knowledge, attitude, and
practices on the prevention of accidents have increased.The increased might be a contribution of HC,
sub-HC, Posyandu, and Polindes. The HC, sub-HC, Posyandu, and Polindes provided primary health
care services incuding promotion of personal hygiene, environmental sanitation, and various accident
prevention. However, their activities were limited because HC, sub-HC and Polindes more concerned
in-patient services.
During the project implementation, PMI volunteers conducted more home visits and activities for
promoting basic health, first aid, accidents prevention and social activities. PMI may contribute to the
largest part of community awareness but it is very difficult to proof. PMI may increase community
knowledge, attitude, and practices since during the project implementation. PMI volunteers conducted
more regular home visit for promoting basic health, first aid, and social activities. Although there was
an increase on the community knowledge, attitude, and practices on diseases prevention, however it has
not reached the expected target.


Figure 5
The effective percentage change of respondents knowledge, attitude,
and practices on accidents in endline survey


Accident s
Correct Baseline survey Endline survey Effective%Change
answers Ave* T.Pelinget Ave* T.Pelinget Ave* T.Pelinget
River Knowledge 10.3 6.6 13.0 13.6 3.0 7.5
At t it ude 2.5 13.3 8.6 8.6 6.3 -5.4
Pract ice 18.1 4.8 26.7 2.9 10.5 -2.0
Road Knowledge 11.6 18.1 9.3 16.5 -2.6 -2.0
At t it ude 6.5 2.9 12.8 21.4 6.7 19.1
Pract ice 45.3 62.5 28.9 51.0 -30.0 -30.7
Field work Knowledge 3.6 6.6 5.3 6.8 1.8 0.2
At t it ude 10.2 7.6 1.5 0.9 -9.7 -7.3
Pract ice 4.6 1.9 29.0 39.2 25.6 38.0
All Knowledge 7.8 9.4 8.8 11.8 1.2 2.6
accident s At t it ude 6.2 8.8 7.9 10.5 1.8 1.9
Pract ice 23.9 24.0 27.6 27.6 4.8 4.8
* Ave: T.Raya, P.Kupang, and Handiwong
As the control village,
without PMI intervention, the
knowledge, attitude, and
practices on accidents
prevention and first aid in
Teluk Pelinget has increased
as well as in the other villages.
The increased may not caused
by PMI but it can not be
compared with the other
villages because the
respondents of the project
villages and control village
were not selected in simple
random sampling methods
(Figure 5).

20
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

3.3.4 Ceramic filter

PMI through the village volunteers introduced several methods for improving access to safe
drinking water for the community. The methods included biosand filter, ceramic filter, solar
disinfectant (SODIS), air rahmat, and boiling water. The volunteers and the community were trained
how to use the methods and its maintenance. Of these methods, the community selected a ceramic
filter as the method of choice. Provision of ceramic filter is selected as an alternative method for
improving access to safe water. PMI Branch through the field coordinators firstly distributed to the
village volunteers and then to households in Terusan Raya, Pulau Kupang, Handiwong, but not in
Teluk Pelinget.
In the endline survey, the consultant directly observed to assess the use of ceramic filter by village
volunteers. A total of 31 units sample was randomly selected from 180 units distributed to village
volunteers, and then directly observed to 11 units in Terusan Raya (10 volunteer), 10 units in Pulau
Kupang(10 volunteers), and 10 units in Handiwong (10 volunteer). After the village volunteers used
the units for about two months, the findings indicate that: In Terusan Raya, 36% units were not well
function due to leakage and broken outlet. The volunteers repaired 18% of the broken units and finally
82% units in used; In Pulau Kupang, 30% units were not well function due to leakage and broken
outlet. The village volunteers repaired 18% the broken units and finally 90% units in use. In
Handiwong, 60% units were not well function due to leakage and broken outlet. The village
volunteers repaired 50% of broken units and finally 82% of the units in used. Of the total 31 units,
45% were not well function due to leakage and broken outlet. The village volunteers repaired 32% of
the broken units, and finally 87% of the units in used (Table 12).

Table 12
Observation of ceramic filter distributed to village volunteer

Village Ceramic Condition
Outlet
broken
filter Good Broken Repaired Use
T.Raya 11 7 (64) 4 (36) 2 (18) 9 (82)
P.Kupang 10 6 (60) 4 (40) 3 (30) 9(90)
Handiwong 10 4(40) 6(60) 5(50) 9(90)
Total 31 17(55) 14(45) 10 (32) 27(87)

3.3.5 In-depth interview

This section describes summary information provided during in-depth interview with key
personnel involved in the CBHFA project implementation, and FGD of women and men
representing of the targeted communities in Terusan Raya, Pulau Kupang, Handiwong, and Teluk
Pelinget.

3.3.5.1 Terusan Raya

Field Coordinator T.Raya (2/4/1014). Formerly I was a branch volunteer who received training
in Module 1-7, a general knowledge on Red Cross, first aid, health promotion, and community
behavior. After training in March 2011, I was appointed as the field coordinator who was responsible
for implementing CBHFA in Terusan Raya. I and a team of field coordinator prepared IEC materials of
diseases promotion focused on diarrhea, malaria and TB. Under the coordination of PMI Branch, I
recruited a total of 78 volunteers, transferred my knowledge and skills, through training practices for
village volunteers. I coordinated and facilitated the village volunteers working in the community for
basic health and first aid promotion. The project expected that the community knowledge increased
75% and action 65% on 3 diseases priority including diarrhea, malaria, and hypertension.

21
Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

I have to address issues on provision of drinking water services based on the results of the pilot project
for testing 5 alternative methods including air rahmat, SODIS, ceramic filter, biosand filter, and boiling
water.The PMI decision was provision of ceramic filter for every household depending on its number
of the families. Of the total village volunteers, 33.3% dropped out due to several reasons including
moving to other village, married, and finding a job. Due to so many targeted activities and limited time
of village volunteer on home visits for health and first aid promotion, it was not possible to achieve the
target. My targets only increasing knowledge, attitude, and practices on the village volunteers by the
end of the project. To achieve the targets, we need at least 2 years more to make community behavior
change
The Village Committee (2/5/2014) I am a member of village committee and lived on the village,
responsible for coordination, facilitation, and helping field coordinator and village volunteers in the
implementation of the project activities: including socialization, health education, transferring
knowledge and skills in health and first aid for the benefits of community I worked through formal
and informal meetings with people at any places whenever met with them in the village. I met with
people at least 1-3 times a week, help people in taking care of accident, meetings, talk at the coffee
shops, and may carry out formal or not formal discussions. Although, the village volunteers have
provided information on diseases prevention and first aid. I provided information to community with
several differences responsibilities for home visits to increase community awareness and practices on
prevention of diseases and accidents. The village committee has 5 members, but not all members
actively participated in the project activities.
The village volunteer (2/5/2014).The village volunteers were responsible for delivering health
promotion, prevention of accidents, and addressing other social issues. They were females and males
age of 18-50 years. They have to visit at least one family per month. They received training in
knowledge and skills for addressing community health and social issues, including prevention on
diseases priority such as diarrhea, TB, malaria, and understanding basic health services. They received
benefits including teaching their own children, in the same time transferring to other children. About
accident on river, road, and field work, they were able to take first aid before going to the health
facilities such as HC and hospital. People believed that education is not important, even illiterate is
enough, since farming does not need high educational background. This community believed and
perception make the project intervention faced more challenges to improve behavior on health and
diseases prevention.

3.3.5.2 Pulau Kupang

Field coordinator (4/2/2014), I was responsible for coordinating, facilitating, and working with
community under the guidance and supervision of PMI Branch. I have to communicate with
community leaders, religious leaders as the village committee member. I received training in Module 1-
7, first aid, simulation and 3 diseases priorities: diarrhea, malaria, and hypertension. As of completed
the training , partnership with other field coordinator developed additional IEC materials for the
diseases priority based on our knowledge, internet browsing, discussion with colleges, medical doctor
and Branch staff management. Then, I recruited a total of 99 village volunteers, transferred my
knowledge and skills to the village volunteers. After the village volunteers have been trained,
Dec.2011-March 2012, they started to visit home for socialization on general red cross, diseases
prevention, first aid, accidents and injuries to increase people knowledge, attitude, and practices. Of
the total village volunteers, 37.4% dropped out and the remaing 62 continued working on home visits.
Ideally each field coordinator was responsible for 15 village volunteers; each village volunteer
responsible for 15 households. Each volunteer at least visited one household per month. The total visits
in each village would be completed for about 15 months. Up to the end of the project, the total visit
would not be completed. Regular and frequency home visit should be done to increase community
behavior changes. He said that village volunteers and people were very difficult to manage and
educated them. First, we made the village volunteers having better knowledge, attitude, and practices
on basic health;

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Second, the village volunteers should be able to deliver the correct messages to the community on
diseases prevention, first aid and other social messages; Third, the community should convince and
accept the correct messages and then practice the messages. It estimated about 50% of the village
volunteers understood our knowledge; the community accepted and practiced our knowledge and
messages. People firstly did not accept our visits, however after more than one year they accepted our
visits. Talking about project, it meant than was money. They were interested in obtaining a gift such as
food or whatever since they involved in the project. After they could understand our objectives for their
benefits, they welcome us as the team of PMI. It means that the promotion on health, diseases, first aid
and other messages reached to the community about 25%
Most people in the village preferred to use water from river. They collectted water in the
containers, added with tawas (Aluminum Potasium Sulfat) for 12-24 hours, and resulted clean water.
They use water either directly drink or boil before drinking. Of the population in the village, 60-70%
directly drink water without boiling, because of having original taste and smell; while 30-40% like to
boil water because of safer. This may be effect of the health personnel education including by PMI
volunteer. The project objectives of community behavior change may not completed up to the end of
the project, so regular activities should be continued

3.3.5.3 Handiwong

Field coordinator (7/2/2014): I was one of the Branch volunteers selected as the field
coordinator. I received training in module 1-7; and having TOT in Palangkarya. Teluk Pelinget first
was selected as the project intervention, however, the head of the village rejected due to a long waiting
time for the project implementation and Handiwong replaced it. The project formerly included six
diseases, and then selected to three diseases priority including diarrhea, malaria, and hypertension. I
participated in the refreshed training, on the diseases knowledge, prevention, and control. Handiwong
focused on accident in the workplace as well as in Terusan Raya. Pulau Kupang focused on the river
accidents such as sinking kelotok. Workplace, rice field accidents such as snake bites, backache,
fractures, and cut by sharp knives. Pulau Kupang, such as strong wind and large wave effect on small
boat and kelotok free moving around, and then sinking. But that was rarely happened in Handiwong. I
recruited a total of 37 village volunteers, and each volunteer responsible for 10-20 households. I said
that of the total 35 village volunteers, 5.4% dropped out; during the training 50% could understand the
messages and the remaining could not understand. The reasons might include limited capacity and
educational background of the volunteers, not interested in the volunteer job, and have to work for
another job. I believed that the preliminary visit for delivery of basic health and first aid messages
would not much impact on the families, because most of them needed medicines for treating diseases
or solving their problems. On the other hand, we were not providing medicines but knowledge. We
have monitored on the results of delivery the messages on hypertension but most of the family did not
get the messages. It might be caused by ineffective training of the village volunteers and ineffective
volunteer in delivering the health messages. It was estimated that the training results increased about
50% volunteers knowledge; their delivery information on the diseases and first aid promotion
increased 50% community knowledge. It meant that the project intervention would not reach more than
25% percent of the expected target. An effective training and effective delivery health and first aid
messages should be improved .
Water and sanitation. Handiwong as well as Terusan Raya were not served by PDAM, and most
people do not have access to safe water, and they obtained water from river. In Kupang and Terusan
Raya people have access to bored deep well, but in Handiwong only very few deep wells. River water
from Handiwong different from Terusan Raya and Pulau Kupang where water might salty during dry
season since sea water currents flows into the river, but not in Handiwong river that was no sea water
connection.
PMI Branch has tested 5 methods of water system including SODIS, air rahmat, boiled water,
biosand filter, and ceramic filter. People selected that the best quality of water is a ceramic filter. So
PMI planned to distribute a total more than 2,500 ceramic filter to the households. Water from several
different sources filters about several hours for producing 12 liter drinking water, for 6 persons /day.
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The maintenance of the units includes cleaning the filter every 3-7 days depending on quality of water
sources, regular repaired when it is broken, and cost for the replacement materials and labor. Each
ceramic filter costs about Rp 150,000- 250,000 per unit. Cost benefits analysis should be done in order
to help community in improving access to adequate water services. People preferred to use water from
river and treated with tawas and either drinks directly or boiled before drinking. As well as the
coordinator of other village, they use similar IEC materials for health education to the community on
diarrhea, malaria and hypertension. They developed their own IEC materials based on the reference of
books, internet, and consultation with physician (medical doctor) and PMI Branch staff.

3.3.5.4 Teluk Pelinget

Village committee member (2/8/2014). Formerly Teluk Pelinget was included as the project
intervention, however it was canceled due to the village rejected as of the project began because of so
many other activities should be done in the village. Teluk Pelingat includes 12 neighborhoods, with a
total population approximately 2,346. The main occupation of the population was farmer and local
business. The diseases frequently occurred in the village including diarrhea, heart attack, hypertension,
and respiratory infection. During weather changes, there were many hens died, and people treated to
throw all the dead stuff dumped and burnt.
Teluk Pelinget has one sub-health center, and 3 Posyandu. The sub-health center every day
provides basic health services including immunization, basic treatment of diseases such as diarrhea,
TB, malaria, and other diseases, health education, hygiene and sanitation services. The Posyandu
actively carried out monthly community services including immunization, weighing infant and
children, add nutrition supplement for children, family planning services, and health education such as
personal hygiene and basic sanitation. Each Posyandu was led by a village midwife. The midwife
recorded all their services and reported to sub-health center and HC of their supervisors.
People in Teluk Pelinget have not accessed to PDAM. They obtained water from river, deep well,
rain water, and bottle water. Most people use river water for their domestic purposes including
drinking, cooking, and washing. People do not like other water source since taste different, and they
preferred river water. People who live rather distance from the river, pumping water by Hitachi
machine water pump up to their containers. Water in the containers added with tawas and waited until
water was cleaned and then used it.
People defecate on simple latrines that build at her nearest home on the river, and they also clean
using river water. People living far from a river, may use latrines on the water handil (small stream) as
well as source of water. Most people do not have waste water discharge system.They discharge their
waste water on the yard, or directly to the river. Garbage and refuse were collected, and then dump on
the river or burnt on the collection sites.

3.3.5.5 District Health Office and PMI

The District Health Office (2/5/2014). The Head of the Environmental Health Division,
represented of the District Health Officer explained: A public health problem in Kapuas district is a
high morbidity and mortality caused by diseases related to environment such as diarrhea, malaria,
acute respiratory infection, dengue haemorrhagic fever (DHF), and other water related diseases.
Every year there is an outbreak of DHF causing high morbidity and risk of mortality. In line with
the national policy and commitment on MDGs, our program focuses on controlling malaria, water and
basic sanitation related diseases such as diarrhea and DHF. Our priority is increasing people access to
adequate water and basic sanitation services to control water borne and water related diseases including
malaria and diarrhea. We have lessons in implementing project for Community Water Supply (CWS)
funded by the central government for 4 years, and the main problem is mobilizing people to use the
facilities and developing its sustainability. In addition, the DHO included a primary health care as the
priority services at the Health Center and sub Health Center. The services including maternal and child
health, family planning, malnutrition, communicable diseases control, immunization, water and
sanitation, and health promotion.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Most people in Terusan Raya, Pulau Kupang, and Handiwong do not have access to safe water
and basic sanitation services. They use river water and rain water for domestic purposes including
drinking, cooking, washing clothes, utilities, and other household equipment. The DHO provided
freshwater water supply services, by bored deep well about more than 100 m from the ground, pumped,
collected in the storage tank, aerated, and produced better quality of water than river water. However,
this service needs more socialization; information, education, and communication to increase
community use the water. The DHO is formerly interested in partnership with PMI to increase
community access to adequate water and sanitation services. The physical construction under the
responsibility of the government and DHO, and socialization, IEC intervention under the responsibility
of PMI integrated into its first aid program. However, the partnership was not happened since they
have so many operational activities at the same time, their own scheduled which can not be canceled
targets should be completed according to their schedules. The DHO through the Division of
Environmental Health continued with its own program for water and basic sanitation since funded by
the local goverment budget. PMI selected provision of ceramic filter for addressing issues on water
supply services, and the DHO continued its program for increasing water and basic sanitation services.
Provision of ceramic filter may temporarily provide safe water and reduce water related diseases such
as diarrhea, but it may not sustain due to its limited capacity producing safe water, need regular
maintenance and cost for repaired of broken part. Since, there is available refilling water gallon in the
market; people may select this offer in the future
PMI Branch Manager (2/6/2014): As the medical professional, he has so many lessons in
implementing community health and nutrition project through the health center. He informed that his
first question was on project sustainability, he worried about its sustainability. He observed that lack
of participation of the local people in developing detail project planning since more roles of the central
than in local. In addition, during the project development there was lack of other sector participation
including education sector, local government, and health sector institution at the local level such as HC
and sub HC and local profit and non profit organization. The weakness of the program, included: 1)
having so ambitious objectives such as reducing morbidity of selected diseases while its resources were
very limited; 2) lack of participation other sector development such as education, health, local
government, and community; 3) limited local stakeholder (Poskesdas, Polindes, Posyandu, Pustu, and
HC) in the project planning, implementation, monitoring and evaluation. A logical framework planning
is an excellent method for project planning involving local community, by the community, and for the
community. By their participation, they would responsible for contribution and mobilization
community resources and empower community participation. The project has not involved local
community in identifying their own problem, and then mobilization and empowering its resources for
addressing the problem. Late in financial dropping made the project implementation activities which
need financial payment for human resources and equipment. The project was implemented effectively
by the branch only one year, effectively began in March 2013. It was too early to evaluate the
community behavior change since limited duration of the project implementation in the villages for
addressing community behavior issues. We were thought the program should consider its sustainability
and empowering local community in planning, implementation, and controlling. It was recommended
that not taking so big problems but should be focused. We have to start with a small and focus but we
can see the impact on community.
About the baseline survey and endline survey, PMI provided cellular phone, developed and
uploaded the questions using RAMP methods. PMI volunteers collected a number of households
sample selected by systematic random sampling method; Endline survey was carried out in February
2014, repeating baseline survey in Sepetember 2012
The project has two components, ODCB and CBHFA. The ODCB has indicated significantly
changes. Formerly, we did not have any office of PMI, we started from zero. But now we have trained
branch volunteers, village volunteers, and starting to deliver the information to the community.
Formerly people did not know what PMI was; people in Kapuas only knew pak Agung as the
director, for blood donation activities. However, to date people has known that PMI business was not
only in blood donor, but also many basic health and sosial services

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The Head of Health Center (6/2/2014) informed: The HC provided primary health care
including in-patient and outpatient services. In-patient services included simple treatment, maternal and
child health, immunization, dental services, nutrition, health education, health insurance, birth delivery,
and referral patients. Outpatient services include immunization, health promotion integrated into
Mobile HC and Village Health Post (Posyandu). The HC staff includes one physician, two midwives,
five nurses, one nutritionist, and one dental nurse. Basically community have access to primary health
care services, however there are still various health issues have not been completed. There were
frequently outbreaks of diarrheal disease which resulted in high morbidity and mortality among
children for many years; however since 2006-2014, the diseases have significantly reduced. One of the
risk factor of diarrhea is that so many people do not have access to adequate water and sanitation
services.
There were several cases of malaria, however, they were imported from other areas such as from
gold and coal mining in the areas of Palangkaraya. The cases visited and asked for malaria treatment at
the HC. The DHO through HC has distributed long lasting insecticide nets (LLIN) , permanet nets
particularly for pregnant women and children under five. Tuberculosis and hypertension are considered
as the 10 leading causes of high morbidity and mortality in Pulau Kupang. The HC provided mainly
primary health care services including health education, prevention measures, and simple treatment.
Most people use water from river, bored deep well, bottle water, and rain water. Since there was
bottled water available in the market, people who use river water has reduced compare with several
years ago. Most people do not have access to basic sanitation and they are considered not important.
The HC has provided health education on personal hygiene and basic sanitation through school health.
The HC has carried out mobile PHC services integrating its personal hygiene and health education on
cleaning behavior and healthy life (PHBS) as well as guided by the MOH through DHO. Referring to
the ceramic filter, he has familiar with it, and he commented on problem of its maintenance. People
may interest in it when it is new, however, they usually lazy in regular cleaning, fixing, and
maintaining after it is broken and leakages. They finally just give up and let the ceramic filter put aside
and not using anymore. There is a need more effective socialization, health education, and training to
repair.

3.3.6 FGD with woment and men

3.3.6.1 Terusan Raya

FGD women (2/05/2014). A total 12 women involved the FGD in Terusan Raya . Their
kowledge, attitude, and practices on diseases, accidents, water and basic sanitation were very limited
and mixed with their traditional and cultural perception. The summary of their believes is described as
follows.
Diseases. Most participants have heard about diarrhea, TB, malaria, malnutrition, and
hypertension; but they were not familiar with ARI. All the participants did not know the causes of
these diseases.
Diarrhea was thought as a disease with more than 5 times diarrhea a day with vomiting. The
cases of diarrhea were many children. They believed the main causes of diarrhea included eating
unhealthy food, not washing hand, eat cold food, and drinking river water. They did not know
dehydration, but most of them knew oralit and how to make an oralit solution for treating diarrhea.
TB was a dry cought which caused by drinking coffee too much and smoking, while the
prevention method just go to the hospital.
ARI. People did not know what ARI, and they thought the signed was cought with blood, sound
breathing, drink too much coffee, and drink too much sweet. Its prevention included drink a water of
extracted root of alan kuyu trees, and drink 3 times a day, used traditional medicines, and go to hospital
Malaria was a imported disease due to anopheles mosquitoes.The prevention included use
mosquito nets, repellent, mosquito coils, cleaning water containers, management solid waste, use
traditional medicie such as kecapi leaves, rattan leaves, and practicing spa to avoid the diseases.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Malnutritioan was considered as lack of food consumption, prevention included drink milk,
vitamin,and immunization. They said that no cases of malnutrition in the village. The prevention and
treatment methods were just eating enough food.
Hypertension was believed caused by eat too much fat, coconut milk, salty fish, vegetables green,
hot food, too much meet, and drink much cofee. The prevention should reduce these including sweet
food and salty fish.
Accidents.Most participants have familiar with the accidents on river, road, and field work. River
accidents included a high wave of water hitting small boat, the smoke made a water taxi difficult in
moving foward, etc. In the rice field the accidents included cut by long knives, slippery way to the
field. Although they knew the prevention measures, people did not practices since they believed that
people should be taken carefully by themseves.
Water and sanitation. The source of water for domestic purposes was taken from a river. People
collected water in the container, added with tawas, waited for 12 hours, and then they can drink water
directly since it was cleaned already. People defecated on the latrines built outside home or inside but
above the river. They also did not have garbages disposal system and waste water discharges system.
People collected garbages, storage in one place, and then burnt or threw away on the river.
Health education. Peole receive health education services from village health volunteers,
Posyandu, HC, sub-HC, and hospital and PMI. When people get sick, first they go to traditional
healers. If they failed to treat, then people go find HC or hospital for treatment. People access to
information from medical doctor and hospsital. PMI village volunteer made more visits for health
promotion compare with the health center staff.

FGD men (2/05/2014). A total of 12 persons involved in the FGD in Terusan Raya. Their
kowledge, attitude, and practices on diseases, accidents, water and basic sanitation as well as the
women were summarized as follows.
Diseases. Most participants thought diarrhea was a seasonal diseases due to sea water flows to the
river. Diarrhea can bee treated by traditional healers and Health Center. The first aid should be by
oralit solution and some cases went to hospital.
TB is a communicable disease. Its symptoms included cought because of dust.The causes included
dust from rice processing small factory, bad weather, and heritage of the parent. Farmers and youth
used to get TB due to drink alcohol, heritage, asthma. Method of tretment by drinking milk, and go to
Health Center.
Malaria was imported cases from gold mining, Pujun. Malaria was caused by a toxin as well as a
toxin of snakes, thausand leqs, and mosquitoes. Malaria can be transmitted by wind, water, and
sleeping in the morning. It can be treated by traditional healers including boiled water mixed with root
of a particular wood leaves to make smokes which were able to treat the toxin out of the body as well
as spa (timung). People belived that going to doctor spent money but does not help, went to the
traditional healer can treat the diseases and cheaper.
Malnutrition was caused by children do not eat; they eat so much snacks, eat too much salted
fishes, and their parents were low economic stastus. There was no malnutrition cases in the village.
Actually, we have enough food, since vegetables can be planted by ourselves and fishes can be
obtained easily.
Hypertension was caused by eat too much salty fishes, fatty food, green vegetables and can be
complicated. The results included gout disease, high cholesterol, and high blood pressures. People
believed that medical doctor can not treat the disease.
Accidents. Main transportation facilities of people in the village by boat and kelotok running
regular every day from and out of the villages. The risk of accidents included the boat hit rocks,
kelotok hits each other, larger boat passing high water wave and hits small boat and a kelotok sink.
People who wounded with blood should be treated by traditional medicines such as watery leaves of
banana. People aware on the accidents, such as wearing life jackets but they did not practices due to
everybody is able to swim.



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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Water and sanitation. The source of water is river and bored deep well. People believed that
bored deep well water tasted salty and river water tasted better. People did not use water from bored
deep well although every neighborhood has been built by the government porject and DHO. Everyday
people collect river water in the container, adds with tawas (aluminum sulfat) for a night, and then
they can drink direclty. People defecate on the river; did not have waste water discharge system, and
garbgage disposal system.
Health education. The HC provided health services including children immunization, maternal
and child health, family planning, promotion, food suplement, school children education, promotion of
personal hygiene, ennvironmental sanitation, and provision of adequate water and sanitation services.
PMI conducted home visit for health promotion, diseases prevention, seeking treatment, and
simulation in prevention of accidents and injuries.

3.3.6.2 Pulau Kupang

FGD women (2/05/2014). A total 12 persons involved in the FGD in Pulau Kupang . Summary of
their believe are as follows.
Diseases. Most participants heard on diarrhea, TB, malaria, and hypertension; however, not on
ARI, and malnutrition.
They believed that diarrhea was caused by drinking not boiled water, personal hygiene, sanitation,
climate change, salty water. They did not know the causes and symptoms. The treatments included take
traditional medicine, oralit, and clean environment, physical messages, drink extracted kecapi leaves,
and cengkeh leaves 3 time perday.
TB. There were less than 10 cases in the village. They believe the causes were eating dried food,
drinking ice, heritages of the parents, smoking , lung diseases, blooding, and thin. They have not yet
been informed by PMI volunteers on the diseases. They did not know how to treat the diseases but they
thought just go to the doctor.
ARI was a disease with coughing, inflamation of the throats that caused by smoke and dust. A baby
might sick due to absorp of water placenta. The treatment included giving medicines, messaging body,
and bring to health center.
Malaria was caused by mosquitoes, raining, tired, Aedes aegyti, poor environment, persons
working at the gold mining. Prevention of malaria by using mosquito coil, use insecticide nets, more
cleaning environment, spa with warm water plus flower as wellas particular leaves.
Malnutrition. They believed that no cases in the village. The diseases caused by not having
immunization, low economic conditions, poor nutrition status, and no vitamin. The symptoms included
eye balls convert, pales, and less eating. Treatment with traditional medicines such as temu lawak, and
bee oils, and other traditional medicines.
Hypertension was caused by too much think, food pattern, not regular eating, salty fishes and less
rest. It can be treated by drink coconut oil, eat star fruit, pickels, and drink enough water to prevent
cramps, and go to the doctor for further treatment when blood pressure up to 200 or go to the hospital.
Accidents. Most respondents though that to prevent river accidents should be carefully watched,
screaming and asking for help. People travelling by kelotok without floating jackets since everybody
was able to swim. Accidents in the field work included cut by long knives resulted in lost of fingers and
thumb. Prevention the accidents by carefully work, not wearing sarong, and wear long shoes. First aid
included wrap with mixed of vegetables banana leaves, casava leaves, and other leaves.
Water and sanitation. People who living far from the river pumped water by Hitatchi pumping
machine from river. Nobody wanted to use rain water for drinking water. Some people collected water
at the first flow of the river, treated, cleaned, and bottled, then bring to the other side of the river and
sold to those who in need. We never treated salty water with tawas because make smell and sour water.
People most defecate on the river, clean on the river. Some people living far from the river use handil
or stream as source of water for drinking and cooking. People do not have garbage and refuse
collection system, they collect on the yard, dump, burn, and dischargd into the river.


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Health education. HC and PMI provided health education on various topics according to the needs
of the community. PMI village volunteers visit households every week for health promotion on
prevention of diseases, accidents and first aid.

FGD men (2/6/2014). A total 9 men involved in the FGD in Pulau Kupang Most participants heard
on diarrhea, TB, malaria, and hypertension; however not on ARI, and malnutrition.
Diseases. They thought diarrhea was frequently occurred and it was a normal. They thought that
diarrhea was caused by salty water, and can be treated by oralit solution, which can be bought, made,
from the HC, and hospital. They considered that dengue hemorrhagic fever was more important.
TB was a disease with coughing and blood vomiting. There was cases, however after treated by
doctor for 6 months they were better
ARI was a respiratory disease due to dust of the rice processing home industry. There are 8 rice
processing home industries in the village. When people got sick, they would faced difficult in
breathing, coughing, and can be problems. The causes of the diseases included climate change, long
dry season. People can be treated by a local medicines of three wheels branded, that can be bought at
the neares local small shops. .
Malaria was infected by mosquitoes from imported cases of the persons working in the gold
mining. When there was cases went to the HC and if not better then referred to the hospital for futher
treatment. However, they believed that malaria can be treated traditionally by injection, spa for treating
the toxin as the causes of malaria.
Malnutrition effected the children have a skinny body, only skin and bone, no meat. They can be
treated by traditional medicines, praying, showered, and drink milk for 2 years.
Hypertension, disease caused by economic depression, food, thinking too much, stress, eat salty
fishes, and high cholesterol. It can be treated by eating pineapple, coconut milk to prevent weakness,
and eat enough eggs.
Accidents. Our village has small road of 4 m wide, but not cemented, muddy, soil, and very
difficult to pass the road particularly during rainy season. The accidents frequently due to slippery,
muddy, and difficult passing the road. Most respondents have familiar with the accident on the river
and accident can be caused by high wave of water, kelotok hit rock, and another kelotok make them
damage and sink. The first aid for the wounded persons just use any traditional medicines made of
roots or leaves of plants for treatment.
Water and sanitation. The source of water included river and bored deep well. Some people
pumped water from river by Hitachi pumping machine; collected in the containes and added with
tawas, about spoon per a drum of container. Tawas can be bought at any stores locally. Too much
tawas made water taste sour. Water of the deep bored well tasted not good, smell, not for drinking but
only for washing and cleaning.
Health education. Health education provided by PMI, DHO, HC, sub HC, and Posyandu. PMI
just recently regularly visits every household for health promotion including first aid, prevention on
diseases, accidents, and injuries. DHO and HC has many years did not come. They usually come when
there was an outbreak of diseases in the village.

3.3.6.3 Handiwong

FGD women (2/8/2014). A total of 18 women participated in the FGD in Handiwong. The
participants knowlegde, attitude, and practices on diseases identification, prevention, and treatment
were very limited as well as the other village. Summary of their believes is described as follows.
Diseases. Most participants heard on diarrhea, TB, malaria, malnutrition, and hypertension; but
not on ARI. They believed that diarrhea was caused by stomach ache, not boiled water; eat too much
shrimps, to much sour food, too much rice, food not cooked, not washing hand, and uncovered food.
They believed that diarrhea prevention could be done by washing hand, drink boiled water, discharge
refuses and garbages, eat covered food, and drink boiled water. Treatment of diarrhea can be done by
eating fruit, jambu leaves, drinking oralit solution, and drink juices made of root plant. To prevent
dehydration, the patient should drink much water to replace loosing water from the body.
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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

TB is a disease caused by smoking too much, and people did not know to prevent and treat the
disease because there was no person sick of TB at home.
ARI is a flu like disease and heart disease due to eat too much rambutan, raining season, dry and
hot season, climate change, dust, cool weather, and smoke. To prevent the disease people need to use a
masker. When there is a case of ARI, the family should firstly bring and treat by traditional healers,
midwives, and buy medicines from the local stores, such as mixagrips, kunyit, kapur, and tooth paste.
Malaria was transmitted by mosquitoes bites, sleeping without nets, without mosquitoes coil,
without long sleeves clothes, not burning refuse and garbage,water container not cleaned, clothes
hanging, come back from rice field, collection of dietary foods. Prevention measures included sleeping
under the nets, and use mosquitoes coil. Malaria was not due to mosquitoes bites but because of not
cleaning the larvae habitat, man get infection from people who were from the gold mining areas.
Malnutrition was not found in the village. The causes of malnutrition included lack of vitamin,
lack of nutritious food. The treatment of the cases just by giving milk regularly.
Hypertension was known by every body. They believed that the causes of hypertension included
eat too much salt, too much vegetables, coconut milk, less sport, too much smoking, eat too much
eggs, food to much colors, eat kuini manggo, eat too much meat of cow and lamb. The prevention was
by not eating all the foods that believed causes hypertension.
Accidents. On the river, the small boat or kelotok hit the dead trees, and then boat sink in the
river. People accidents because they can not swim. The prevention method included be carefull in
travelling by kelotok, small boat, make sure people able to swim, and when it is happened ask for help.
People who have wounded and blooded due to accidents should receive first aid and treated by local
traditional healers by drinking juices of plant leaves.
Water and sanitation. People obtained water from river water and bored deep well. Water from
river was collected by small container and stored in larger plastic container or drum. Water added with
tawas (Aluminum Pottasium Sulfat) and stored for 1-2 days. About tea spoon tawas added to one
container. When water has already clear and then boiled for drinking water. People defecate on the
latrines built above the river, and the other people as well as them on the handil. There were no garbage
disposal system. Garbage was collected and burnt or threw away on the river. People do not have waste
water disposal system. People who live far from river, pumping water from river by Hitachi pumping
machines and then collected in the containers and added tawas according its measurement of the
containers.
Health education. PMI, DHO, HC. Community leaders, and health personnel provide health
education to the community on prevention of diseases, accidents, and injuries. PMI regulary conducts
house to house visit for health promotion once a month, and HC may less and uncertain. They used to
come to the village when it is an outbreak of particular diseases such as diarrhea.

FGD men (2/8/2014).A total of 11 men participated in the FGD in Handiwong. Most of them
have heard diarrhea, TB, malaria and hypertension; however, rarely on ARI and malnutrition. They
believed that their knowledge, attitude, and practices on symptoms, causes, prevention, and seeking
treatment were mixed with their believed and traditional perceptions as follows.
Diseases. Diarrhea was the requently occured in small children. They thought that diarrhea was
caused by eat and drink unhealthy food and water during the dry season. When there was case of
diarrhea, they went to HC, and before they went to the HC, they gave solution of salt and sugar made
by themself.
TB is though a city disease, not rural disease. However, there were cases in the village. Since this
was a heritage of parents more than half people have the diseases. The cases should go to the local
hospital for treatment.
ARI is a respiratory infection, mainly old people. This is an old people disease.
Malaria is a disease brough by people from the field, it is callled wisa, with the sign of fever, cool,
chilly, dizy and wanted to sleep during the day, night, and morning.The cause of infection is during
people working in the field, get rain, wet, cold, and then sick.

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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

People believed that going to HC for treatment made the disease getting worst, and not
better.Treatment by traditional medicines, shower 3 times a day, gave the mantra from the taditional
healer and spa like treatment would treat the toxin out of the body.
Malnutrition was not present in the village. The symptom was believed that children with low
weight, thin, and having yellow skin. The treatment first by traditional healers. Children with low
weight should be showered to treat the disease.
Hypertension was known by everybody. People believed that the causes of hypertension included
eat too much salt, too much vegetables, coconut milk, less sport, too much smoking, eat too much
eggs, food to much color, eat kuini manggo, eat too much meat of cow and lamb. The prevention
method includes carefully eating foods.
Accidents. Farmer frequently faced accidents such as cut their fingers, wounded their legs by long
and sharp knives. When it was not serious people need to go back home, and treated by traditional
medicines incuding drinking banana leaves juices, covered on the wound by liquid made of particular
root or leaves to stop bleeding. They did not practices on using boots due to slipery during the raining.
A river accident included a taxi sinking due to over pasengers, coming a very high wave of water, and
these made people at risk of sinking. During the dry season also smokes, made the boat can not see far
to drive the direction. There were so many accidents on the river during children swimming and
training to swim.
Water and sanitation. Of the people in the village, 70% access to river water for domestic uses.
However, during the dry season river water becoming salty due to the sea water go inside river water.
In addition, they also access to bored deep wells provided by the local government, but they prefered
river water for drinking and cooking. People defecated mostly on the river, and those far from the river
on small river or handil. Garbage was collected and dumped any where including on the river, on the
yard, and burnt. There was no waste water discharge system, as well as garbage disposal system in the
village.
Health education. People have limited access to information on health promotion and diseases
prevention. Very limited information available on the radio and TV which people can listen and
understand. DHO and HC rarely carried out community education regularly. During the project
implementation, PMI village voluteers at least visiting each household per month. They conducted
home visit for health promotion on prevention of diseases, accidents, and injuries; first aid, and social
activities.

3.3.6.4 Teluk Pelinget

FGD women (2/8/2014). A total of 12 women involved in the FGD in Teluk Pelinget.Most
participants have heard on diarrhea and malaria, but not other disease. Their knowledge, attitude, and
practices on diseases and accidents, first aid, and injuries are very limited and confussing as follows.
Diseases. They believed that diarrhea was caused by animal diseases, eat sour food, eat fatty food,
hot, and cook not clean, river water, and buy food. The prevention of diarrhea by taking medicine,
traditional healer, dried rice, treated water for drinking, and keep healthy food. Cases of diarrhea are
usually children. The practiced on prevention of diarrhea should keep the food clean. If the family has
a diarrhea first they have to give oralit solution, diatep medicine, and drink a juice of jambu leaves.
They familiar with the term of dehydration that was less of water in the body and the treatment method
was using oralit solution.
TB is a disease with cough and blood. There were many cases in the village. And the Health
Center is able to treat in 6 months. The disease transmission by blood, smoking, and heritages from
their parents. The prevention with healthy life, not using similar cups. Several cases in the village have
died due to not well treated.
ARI is a disease with difficulty in breathing, due to smoke, dry season; cool air, as well as asthma.
The prevention method by avoiding dust, drinking soda, and ingredients such as noodle. When there
was a case of ARI, people are able to treat by traditional medicines, jahe, red sugar, tangerine, and go
to the doctor. The disease can be prevent by wearing masker.


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Malaria caused by Aedes aegypti, imported cases from gold mining area and with main symptoms
was fever and chilly. The prevention methods by eating leaves of fruits, boiled and drinking 3 times a
day. There were 5-6 deaths per year. The disease can be treated at home by traditional medicines. If the
family can not treated and the sick person getting seriously ill, they would bring to doctor at the
hospital. The prevention methods included cleaning with clean water, clean sanitation, and sleep
under insecticides nets.
Malnutrition. There were no cases of malnutrition in the village, because people have met the
standar of eating of complete food, as well as a national slogan recommended by health personnel.
Most people have practiced on drinking milk, vitamin, vegetables, meat, enough sleep and taken rest.
When there was a sick person, people can take care by Posyandu. Having additional menu, including
vitamin, chicken, and green beans. Posyandu regularly opens and provides primary health care services
at least once a month.
Hypertension. People believed that hypertension occurred at the old people age of more than 40
years. However, there was several young people about 30 years have strokes. The causes might be
including eating style, food too much fat, so many meat, too much thinking, and cassava leaves. People
should not less sleep, less rest, and eat pakis, durian, and hot coffee, eat lamb, salty fishes.
The prevention of hypertension by eat fruit ,vegetables, Dutchs manggo, lemon, coconut milk,
pickles, juice of stars fruit and mengkudu. People should be able to keep their life style and relaxes,
reduce stress, and walk regularly.
Accidents. Most people familiar with information on river accidents such as sign of body weaks no
energy, fell down from the boat, sinking, and the first aid use wood, board, and life floating jacket. The
accidents in the field included cut by knife or sword, hit by fallen trees, wet of raining, and lighting.
The prevention of the accidents including wearing boot shoes, avoid from snake bites, fall down from
a tree, clean and wrap up the wound and drink coffee and they will dry and better. The accidents on the
road such as hit by motorbikes, and the first aid should waiting untill people coming.
Water and sanitation. People have access to river water, dug well, bored deep well 90-100 m, salty
water, dug well 3-4 m, and they use for showering and cleaning. Water collected from river, added with
tawas, and waited for a night and then use for domestic purposes. People defecated on the river and use
latrines without septic tank. They do not have access waste water and solid waste disposal system.
Health education. BKKBN, HC, and PMI provide health education services. BKKBN provides
one-two times per year on family planning. HC provides primary health care services including
immunization, promotion of hygiene and sanitation, diseases prevention. PMI conducts home visits for
improving people knowledge, attitude, and practices on diseases prevention, blood donor once a month
per family.

FGD men (2/8/2014). A total 8 men involved in the FGD in Teluk Pelinget. Most participants
heard on diarrhea, TB, malaria, and hypertention; however, rarely on the ARI and malnutrition.
Diseases. Diarrhea was prevalence on children age of 7 years and less, and there was a case of 6
months died due to diarrhea. The causes of diarrhea included drinking unclean water. The treatment of
disease by going to HC and doctors. People also gave oralit solution for treating diarrhea. Oralit
solution is available on the local stores, and people can make by themselves.
TB. There were several cases of TB in the village and treatment is available at the HC for free. The
cause of TB is an old person and late in having treatment.
ARI is a respiratory disease with sign of difficult breating, cough, as well asthma, better and sick.
The causes ARI included dust from the small home rice industrial processing, pesticide spraying,
bloody vomiting, did not use maskers, and without drink milk after spraying in the field.
Malaria. Many cases of tropical malaria, and most cases were imported from those works in the
gold mining out of town in the forest. It was called wisa. In the forest there were wisa wood, maratus
wood, and its dirt went into the river, and infected workers. The cases were treated by traditional
medicines including spa or timung. Root of rumbia tree and soil worms were boiled drink for
preventing and treating wisa.


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Hypertension cases were many in the village. They believed that hypertension was caused by
people think too much and did not have money. The treatment can be by traditional healers or mantra.
Accidents. There is a road pass through the village to Banjarmasin as the main transportation
facilities. Road accidents mainly people driving motor bikes on the road very fast, over limit, and did
not wear helmet . Therefore, they were at risk of road accidents and injuries. River accidents mainly
caused by kelotok without floating jacket for passengers. People believed that the prevention of river
accidents by having ability to swim that is enough. There were rarely accident in the rice field work.
Water and sanitation. Source of water included river, bored deep well, and refill water gallon.
People who live far from the river, pumped water from the river by Hitatchi pumping machine,
collected into the containers, added with tawas, and waited for one night , and then used for domestic
purposes. PDAM has not yet served in Teluk Pelinget. Dug well or bored well 3-4 m, and they thought
water from river taste better. Waste water discharges to the river and garbage collected in the holes,
dumped, and burnt.
Health education. Frequently health education was carried out by DHO, HC, and sub-HC about
primary health care services including immunization, maternal and chilld health, family planning, and
diseases prevention on diarrhea and water related diseases including DHF. In addition, there are three
Posyandu provide basic health services including immunization, family planning , personal hygiene
and environmental sanitation.
In summary of FGD with 90 participants, involving 50 women in 4 FGDs and 40 men in 4
FGDs in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget indicates that their limited
knowledge, attitude, and practice on diseases, first aid, water and sanitation. Most respondents in 4
villages were familiar with diarrhea, malaria, and hypertension, but less familiar with TB, ARI, and
malnutrition. They did not know the causes of diseases priority, and limited knowledge on the
symptom of the diseases; risk faktor of infection, prevention and seeking treatment. Their
understanding on risk of infection of all diseases mixed with their believes, traditional values,
perception and social cultures. For example, they believed that most diseases can be treated by water
extracted from leaves of cassava, banana, papaya and other leaves that taste bit. Their attitude partly
positive when they have family member sick, firstly they treated by traditional healers or by them self
with available medicines bought in the shops. When the sick person were not better, they were
looking for HC, health personnel, and health facilities for further treatment. It seems, that they have
been informed by the village volunteers on the risk and prevention of hypertension, and they could
remember and mention some of the correct answers but combining with incorrect answers such as
going to the health facilities when they have stroke already. Most people were lack of knowledge,
partly have positive attitude, and lack of practices on the disease prevention and treatment. People
belived that malaria caused by a toxin as well as snake bites, and it can be treated by having spa.
Malaria is considered as an imported cases, because young men working out town, in the forest, of gold
mining and coal mining and then have infected malaria. When he got back home sick and felt fever and
chilly. His wife prepared traditional medicines, and boiled ingredients with water made of plan roots
and leaves, and then used for timung as well as spa. They believed that the toxin can be taken out by
smoke of spa. They also believed that malaria is transmitted by Aedes aegypti and other mosquitoes.
Most partipants in Terusan Raya and Pulau Kupang were familiar with river accidents and
fieldwork accidents such as boat hit the rock and wood, high wave due to larger boat passing the small
boat, and many accidents in the rice field. On the other hand, most participants in Handiwong were
familiar with accident in the self plantation and river accidents. Most of them knew the causes,
prevention, and control based on their experience in facing such accident in the villages. When people
get an accident, the first aid, people have to treat by themself or go to a local traditional healer for
treatment. Later they should go to the health facilities such as Health Center, sub-Health Center, and
hospital for further treament. Most people still believed that the traditional healer is able to treat any
types of accidents and cost cheaper. In practices, when people travelling by boat carefully look at the
availability of floating jacket. People wear long shoes to prevent dirt and slippery; and wearing helmet
when people driving a motor bikes.


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Most of the households in Terusan Raya, Pulau Kupang, Handiwong and Teluk Pelinget do not
have access to adequate water and sanitation services. People obtained water from several sources
including river, handil, rain water, bored deep well, and bottled water. Most people preferred to collect
water from river because it easy, cheap and taste better compare with other sources of water. The
government through District Health Office and Community Water Supply project has provided a bored
deep well with public reservoir and hydrants in several neighborhoods in Terusan Raya, Pulau Kupang,
and Handiwong many units but people did not use it. Most people preferred to use river water because
they believed that taste better than deep well water.
People do not have access to basic sanitation facilities. Most people defecate and discharge their
feces on the river. Those do not live along the river, they may use latrines but discharge their feces into
handil. People living on the edge of the river, discharge waste water into the river, and the other
discharge around the yard. People use to discharge garbage around the yard, throw into the river, burnt,
and dig into the ground. These might results in a regular occurrence of water related diseases including
diarrhea.
People in the villages obtained information on health and diseases from several sources including
PMI volunteers, HC, Sub HC, Polindes, and Posyandu.Though CBHFA project PMI volunteer have
frequently conducted home visits. In addition, PMI has many agendas for health promotion. HC
through their networking including sub-Health Center, Posyandu and Polindes provide health education
in various topis depends on the recent issues.Personal hygiene and environmental sanitation are topics
usually deliver through health promotion activities.


4. CONCLUSION

The CBHFA project was relevance to the needs of the community, local health services, and
District Health Office. The DHO through Health Centers and Sub-Health Centers provides primary
health care including provision of basic health services, prevention of infectious diseases, accidents,
and basic treatment, improving community nutritional status, health education through community
participation, and improving access to adequate water and sanitation services. The project has to
increase community knowledge, attitude, and prevention practices on diseases: diarrhea, TB, malaria,
ARI, malnutrition, hypertension; first aid, accidents, and social activites.
Most people in Terusan Raya, Pulau Kupang, Handiwong, and Teluk Pelinget are at risk of
infection of diseases including diarrhea, TB, ARI, malaria, malnutrition and hypertension. They have
very limited knowledge on diseases symptoms, causes, risk factors, attitude on seeking treatment and
get information to specific diseases; and practices on diseases prevention, accidents, and injuries.
Moreover, they do not have access to adequate water and basic sanitation facilities such as sanitary
latrines, waste water discharges, and garbage disposal system.

4.1 Achievement of the Objectives

The CBHFA Project in Kapuas has successfully strengthened PMI Branch including organization,
personnel, a professional leader, branch volunteers, and village volunteers. PMI Branch has served
community based health, first aid, and social services by 214 village volunteers under the coordination
of branch volunteers and PMI Branch. As of the project termination, PMI Branch may sustain in
carrying out community based activities partnerhsip with local stakeholders including District Heath
Office and Heath Center.
The characteristics of the population in Pulau Kupang, Terusan Raya,Handiwong, and Teluk
Pelinget are mostly females, productive age 35-44 years, graduates primary school or less, and farmers.
People in all villages started to accept and welcome to the visit of village volunteers for delivering
various health promotion activites including prevention of diseases, accidents, injuries, first aid, and
social services.


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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

The community knowledge on diseases including identification of symptoms, causes, risk factors,
and prevention was 22.9% and accidents, first aid, injuries was 7.8% at the beginning of the project.
The effective percentage change of the community knowledge was 9.0 and accidents, first aid, injuries
1.2 by the project termination.The project has increased the effective percentage change of community
knowledge on diseases and accidents, however, it has not reached to the expected target of 75%.
The community attitude on diseases including to get information related to specific diseases was
30.9% and accidents, first aid, injuries was 6.2% at the beginning of the project. The effective
percentage change of community attitude on diseases including to get information related to specific
diseases 19.2 and accidents, first aid, and injuries was 1.8 by the project termination. The project has
increased the effective percentage change of community attitude on diseases and accidents, however, it
has not reached to the expected target of 75%.
The community practices on prevention of diseases was 18.4% and accidents, first aid and
injuries was 23.9% at the beginning of the project. The effective percentage change of prevention
practices on diseases 3.8 and accidents, first aid, and injuries 4.8 by the project termination. The
project has increased the effective percentage change of practices on diseases and accidents, first aid,
and injuries, however, it has not reached to the expected target of 70%
The CBHFA project planned to disribute more than 2500 units of ceramic filters. In February
2014, PMI has distributed 180 units to the village volunteers. Assessment of 31 units sample of
ceramic filters indicated that after 2 months used, 45% of the units broken outlets and leakages. After
the village volunteer repaired the broken parts, finally 87% of the units in used. Longer use of the
ceramic filtes by the community may provide different information due to lack of capacity to repair the
units.
Improving community personal hygiene and environmental sanitation are not easy. The succes of
this effort could be measured by outcome indicator on the occurence of diarrhea.. At the beginning of
the project, the community practices on prevention for diarrhea was 19.9% and the effective
percentage change of community practices on prevention for diarrhea 14.8. The project has increased
the practices on prevention for diarrhea, however, it has not reached to the expected target of 65%.

4.2 Lessons

The CBHFA project has an ambitious objectives for increasing community knowlege, attitude,
and practices on various diseases including diarrhea, TB, malaria, ARI, malnutrition, and
hypertension; first aid, injuries and sosial services. On the other hand, the project has so many causes
and effects on the problem of each disease which are very diffcult to analyse and determine activities
for achieving the objectives with limited resources.
The logical framework is an exellence tool for project management, however the application
was limited to the higher level of management by several meetings and workshops which resulted in
unrealistic objectives.The higher management level is responsible for developing project strategy and
the grass root level of management is responsible for operational project activities. In the project
planning is required actively involve local stakeholders such as community leader, religious leader,
health center, sub health center, private sector, and related institution.
Many trainings were conducted by PMI through the field coordinator in transferring their
knowledge and skills to the village volunteers. The topics of the training included delivering health,
first aid, and social messages to the community. Of the total village volunteers participated in the
training, 50% participants able to understand the materialas, however, it was no report on the training
results including pre-post results. By having the training results the trainers and project management
may have information for improving further training.
The CBHFA project in Kapuas involved many volunteers including branch volunteers and village
volunteers. Many volunteers expressed their benefits such as understanding various health promotion,
prevention, and control; meeting with many people, and working more experiences.



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Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.
Baseline and Endline Report

Some volunteers discontinued their participation due to several reasons including finding another job,
having married, moving to other village, sick, and looking for better job, do not have time and busy
with their bussiness. Giving a transportation fee and refreshed training may help reducing drop out of
village volunteers.
The field coordinator as well as the branch volunteer developed IEC materials based on their
general knowledge and skills received from PMI NHQ , PMI Branch, and other references from the
internet, consultation with the professional and staff, however, there was no report on the effectiveness
of the IEC materials and no information on how many persons informed by using the IEC materials.
Although the CBHFA has provided IEC materials which were developed according to a general
needs and issues, but might not applicable and need more spesific materials especially in diarrhea,
malaria, hypertension related to the fasting months. The field coordinator might observe a specific
issues that can not be met by the existing materials. It is therefore, they created their own materials
which meeting the local needs, cultures, and habits.
Selection of ceramic filter for addressing issues on water supply services may effective
temporarily, however, it may not effetive in the future due to need regula maintenance, repaired, cost,
labour, and communiy habits for regular cleaning.

4.3 Recommendations

1) Project for addressing community based health and behavior change should be developed by
participatory approaches involving local stakeholders including community leader, religious leader,
other sector key personnel with realistic goal, objectives and considering the available resources.
The central and provincial key officer involve in the strategic management; while the local
management is reponsible for operational management.
2) Logical framework including it evaluation design, should be trained to the operational staf
involving local stakehodler and community to make effective project implementation.
3) Report on the training for village volunteers should include the results of pre-post test for
measuring the effectiveness of the training. In addition, this may help for increasing effectiveness
of the volunteers in delivering basic health and and first aid messages to the community.
4) Several activities for reducing drop out of village volunteers include conducting: regular refresher
courses, having specific identity, regular seminar, workshop, discussion, sport, website,
competition, journal, and other social gathering.
5) The Branch staff and volunteers who are responsible for developing local spesific IEC
intervention should be trained in P-Process.
6) Cost benefit analysis should be done to demonstrate the effectiveness and efficiency of the use of
ceramic filters compare with the provision of bored deep well by DHO and CWS. In addition, for
those prefer to use ceramic filters should easily acces to the part,techology, and technical assistant
for replacing and repairing the units.
7) Community behavior change is a long process, and the project has just reached to the community.
It is therefore, suggested that the CBHFA project should be continued, focused on addressing water
related diseases issues, partnership with DHO, HC, sub-HC, local government, and other donor
agencies. Developing MCK and training in CLTS may provide effective health promotion and
community mobilizatio in improving sanitation services.

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