The use of RAP in the assessment of growth monitoring and promotion in North Sulawesi: Indonesia.

Growth monitoring by means of monthly weighing of children under the age of 5 at a Posyandu (integrated health service post) has been conducted for more than 20 years in Indonesia. The objective was to improve the quality of growth monitoring and that of the Posyandus services by conducting an assessment in three villages in North Sulawesi (Lemoh Sukur and Walian). The team consisted of one coordinator nutritionist and four provincial nutritionists who were trained to use RAP methods for data collection. An average of 42% target children gained weight in each session. Weighing sessions were conducted once a month at Posyandus including interpreting results nutrition counseling and immunization. Focus group discussions were also conducted with groups of mothers with children under the age of 3 groups of cadres and a group of key persons (PKK women from the family welfare movement and LKMD or village community welfare movement members) in each village. Home visits were paid to mothers; and the head physician of the community health center and the head of the health district office were also interviewed. It was found that motivation of the physician in charge of the Puskesmas (community health center) was instrumental in improving services. Contraceptive use was over 80% in these villages. Trained cadres also performed far superior to untrained ones in weighing and interpreting results. Lemoh village performed best in North Sulawesi province in 1989 thanks to the cooperation of Puskesmas leader village leader and PKK leader. In all villages the child was given priority in receiving food in the family. The Posyandus mothers were also trained in registration weighing recording weights and interpreting results and immunization. In Lemoh 74.0% of mothers brought their children more than four times to the Posyandu versus 62.0% of mothers in Sukur which scored a good mark and 48.3% of mothers in Walian with a fair mark. The family welfare movement was essential in the functioning of Posyandus.