Oyos Saroso H.N., Bandarlampung – Officials' maneuvers to maintain a good political image ahead of a direct election are believed to have contributed to widespread malnutrition in Bandarlampung, Lampung province, say health institutions.

A number of integrated health services (posyandu) were reportedly intimidated by officials to not reveal malnutrition cases to media that could taint the mayor's image.

As the local health office did not get reports of malnutrition cases, some children, mainly those below the age of five, were left untreated.

Lampung Maarif Institute program officer Nur Rakhman Yusuf said his institution has received many reports from posyandu members being threatened by officials from community health centers (puskesmas).

These posyandu are mostly located in Panjang, Sukarame and South Telukbetung districts. "These three districts are prone to malnutrition because many residents are poor and live in unclean homes," Yusuf said.

"A number of posyandu members do not receive operational funds and often subject to intimidation from puskesmas if they report cases of malnutrition."

Bandarlampung Health Office, does not set aside special funds for posyandu volunteers. Their operational allowances are derived from the main puskesmas, but some do not receive any funds.

Bandarlampung has 609 posyandu, each manned by five volunteers who each receive Rp 3,000 (30 US cents) in monthly allowance.

"The allowance does not reflect their responsibilities," Yusuf said. "The Bandarlampung municipality actually depends on them to handle malnutrition as they are the ones at the frontline in detecting malnutrition cases."

Coordinator of Coalition for a Healthy Lampung (KULS) Herdimahsyah said the intimidation against posyandu volunteers was ironic.

"They should be appreciated. They receive a small allowance and are willing to work hard to make people healthy. Don't sacrifice children just for the sake of maintaining a good image ahead of the election."

Herdimahsyah said malnutrition took place in every city and regency in Lampung.

"Malnutrition is like the tip of the iceberg. The detected cases are just a small part of those exposed." Data at the Policy and Strategic Studies Center showed that in 2009, 36 cases of acute malnutrition were recorded in Bandarlampung, 10 of which resulted in deaths.

In 2008, it recorded 33 cases, with nine deaths, and in 2007 it listed 33 cases, with six deaths.

The center's director Aryanto said most malnutrition cases were detected in areas where the surroundings were unclean and densely populated, poor sanitation, lack of clean water supplies and prone to diseases.

Aryanto added poverty made it more difficult for residents to access healthcare. "[The situation] has been aggravated by their lack of awareness to apply for the Jamkesda health insurance for the poor."

Bandarlampung Health Office head Reihana said her office was currently handling three malnutrition cases. She said the cases were challenging because the patients were suffering from complex illnesses, not only from malnutrition.

"The rampant cases of malnutrition were due to lack of support from related agencies and public awareness on the disease itself."

Bandarlampung Mayor Eddy Sutrisno said from 2008 and 2006, the administration had conducted various interventions to mitigate malnutrition, including at posyandu, as well as investigating and validating acute malnutrition found.

He denied there had been efforts to polish his politiical image ahead of the election, especially intimidations against posyandu volunteers, saying he was very grateful for the work done by posyandu volunteers.