Laporan Analisis Hasil CBHFA Kabupaten Kapuas

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

http://www.watershedpress.com/

iii 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

iv Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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


3.2.3 Knowledge, attitude, and practices on accidents...................................................................... 14

3.3 Analysis of baseline and endline data....................................................................................... 15

3.3.1 Respondent characteristics........................................................................................................ 15


3.3.3 Knowledge, attitude, and practices on accidents......................................................... ............. 18

3.3.4 Ceramic filter............................................................................................................................ 20

v Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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

vi Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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.

Jum’atil 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

vii Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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, qur’an 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.

viii Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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.

ix Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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%.

x Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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 it’s 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.

xi Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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.

xii Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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

xiii Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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

xiv Community Based Health and First Aid Project, Kapuas, Central Kalimanatan.


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

I’r 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

1 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 SRC’s

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.



The CBHFA action contributes to achieving all four goals of the International Federation’s 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 qur’an 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 v e 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).



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



1.4 Baseline and endline survey

The overall purpose of the survey was to know the knowledge, attitude, and practices of the target

community’s 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 PMI’s 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,



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 respondent’s characteristics,

proportion of individual responds of each category of the questions, conclusion and

recommendations.

http://www.healthline.com/human-body-maps/lung



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 VillageBaseline 2012 Endline 2014



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 respondent’s 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.



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



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

Characteristics Baseline Ave T.Pelinget

Category T. Raya P.Kupang Hadiwong 3 villages (control)

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

Education 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

Occupation 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



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

Attitude 46.3 36.3 36.1 39.6 47.6

Practice 10.4 22.8 26.4 19.9 27.6

TB Knowledge 14.9 11.6 14.9 13.8 14.3

Attitude 3.0 4.2 3.0 3.0 49.5

Practice 0.0 5.1 6.0 3.0 26.7

Malaria Knowledge 21.4 18.5 18.5 19.5 1.0

Attitude 67.5 63.9 78.6 70.0 58.2

Practice 35.1 47.1 60.0 47.4 40.8

ARI Knowledge 26.9 19.5 20.8 22.4 21.0

Attitude 3.0 2.3 0.0 1.8 2.9

Practice 4.5 2.3 0.0 2.3 1.0

Malnutrition Knowledge 9.0 14.4 13.9 12.4 13.3

Attitude 16.4 33.0 31.9 27.1 40.0

Practice 19.4 11.6 5.6 12.2 9.5

Hypertension Knowledge 40.3 19.1 15.3 24.9 37.1

Attitude 13.4 10.2 15.3 13.0 75.2

Practice 4.5 10.7 6.9 7.4 22.9

All Knowledge 26.4 20.2 22.0 22.9 23.1

Attitude 29.9 36.4 33.0 30.9 54.7

Practice 14.8 23.6 21.0 18.4 25.7



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.

Accidents Correct Average T.Pelinget

answers T .Raya P.Kupang Handiwong 3 villages (control)

River Knowledge 8.9 6.9 15.1 10.3 6.6

Attitude 1.5 3.2 2.7 2.5 13.3

Practice 19.4 25.1 9.7 18.1 4.8

Road Knowledge 7.4 12.1 15.3 11.6 18.1

Attitude 4.5 5.2 9.7 6.5 2.9

Practice 44.4 45.3 46.2 45.3 62.5

Field work Knowledge 8.9 0.5 1.4 3.6 6.6

Attitude 8.9 10.6 9.7 10.2 7.6

Practice 0.0 5.6 8.3 4.6 1.9

All Knowledge 8.2 9.3 10.3 7.8 9.4

accidents Attitude 3.0 5.8 7.7 6.2 8.8

Practice 31.9 23.5 20.5 23.9 24.0

Baseline survey



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


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%;



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


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)

Characteristics Category Endline survey Average T.Pelinget

respondetns T . Raya P.Kupang Hadiwong 3 villages (control)

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

Education 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

Occupation Business 20.8 29.4 28.5 26.2 28.5

Farmer 72.7 58.1 57.1 62.6 57.1

Other 7.8 11.5 18.5 12.6 18.5

Most Female 71.6 68.8 62.5 67.6 73.3

respondents 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



Table 7

Respondent knowledge, attitude, and practices on diseases


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 (control)

Diarrhea Knowledge 24.7 24.6 28.6 26.0 36.3

Attitude 55.9 54.8 58.6 56.4 53.9

Practice 29.6 28.8 18.8 25.7 33.3

TB Knowledge 19.5 20.7 15.7 18.6 25.5

Attitude 29.2 28.1 15.7 24.3 24.2

Practice 4.3 48.6 12.8 21.9 0.0

Malaria Knowledge 25.4 24.2 24.2 24.6 8.6

Attitude 74.6 81.9 83.3 79.9 71.4

Practice 37.3 47.4 59.7 48.1 20.0

ARI Knowledge 28.6 31.4 37.1 32.4 18.6

Attitude 1.3 42.3 0.0 14.5 2.0

Practice 0.0 0.5 2.9 1.1 0.0

Malnutrition Knowledge 10.4 9.1 12.9 10.8 29.4

Attitude 40.3 28.8 41.4 36.8 39.2

Practice 9.1 7.2 14.3 10.2 12.7

Hypertension Knowledge 44.2 29.3 37.1 36.9 47.1

Attitude 7.8 6.3 15.7 9.9 80.4

Practice 6.5 5.8 17.1 9.8 65.7

All Knowledge 30.6 27.9 31.1 29.8 33.1

diseases Attitude 41.8 48.4 42.9 44.4 54.2

Practice 17.4 27.7 25.1 29.5 26.3



Table 8

Respondent knowledge, attitude, and practices on accidents

3.3 Analysis of baseline and endline data


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

Accidents Correct Ave TPelinget

answer TRaya PKupang Handiwong 3 villages (control)

River Knowledge 8.5 13.4 17.1 13.0 13.6

Attitude 0.0 10.1 15.6 8.6 8.6

Practice 40.3 21.2 18.6 26.7 2.9

Road Knowledge 7.7 10.4 9.9 9.3 16.5

Attitude 5.1 14.8 18.5 12.8 21.4

Practice 20.8 30.3 35.7 28.9 51.0

Field work Knowledge 2.6 9.1 4.2 5.3 6.8

Attitude 1.3 0.9 2.3 1.5 0.9

Practice 24.7 35.1 27.1 29.0 39.2

All Knowledge 8.1 11.9 12.0 8.8 11.8

accidents Attitude 2.6 12.5 11.7 7.9 10.5

Practice 30.6 25.4 29.8 27.6 27.6

Endline survey

Characteristics Category 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

Education 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

Occupation Farmer 79.0 62.9 62.6 57.1

Busniss 11.6 12.4 27.3 29.9

Other 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



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


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



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



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 respondent’s 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


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)



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

Accidents 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

Attitude 2.5 13.3 8.6 8.6 6.3 -5.4

Practice 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

Attitude 6.5 2.9 12.8 21.4 6.7 19.1

Practice 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

Attitude 10.2 7.6 1.5 0.9 -9.7 -7.3

Practice 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

accidents Attitude 6.2 8.8 7.9 10.5 1.8 1.9

Practice 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).



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.



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;



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% volunteer’s 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.



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”.



“ 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 “



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.



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.



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.



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 person’s 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 ½ 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.



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 ½ 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.



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.



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, Dutch’s 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.



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 we’re 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.



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.



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.



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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Documents

Laporan Analisis Hasil CBHFA Kabupaten Kapuas