The Role of Faith-Based NGOs in Combating Pandemic Threats

Muhammadiyah Experience in Combating Avian Influenza in Indonesia.

By Sudibyo Markus[1]

Chairman, National Board of Muhammadiyah[2],

Jakarta, Indonesia

I. INTRODUCTION

1. Currently, we are facing a global health crisis, characterized by growing inequalities within and between the countries[3]. New threats to health such as SARS, HIV/AIDS, and avian flu threats are continuing emerging. Within the health sector, failure to implement the principles of Primary Health Care as set out in the Alma Ata Declaration, has significantly aggravated the global health crisis. It was apparent that the Alma Ata declarators could not foreseen the rapidly changing world events such as the global financial recession, the climate change and the subsequent crisis affected every country which end up to the downgrading of their commitment to the Declaration.

2. Alma Ata Declaration was a very strategic road map in coping with the emerging diseases at community levels, in building up our self reliance capacity in combating all different kind of diseases. The failure in pursuing the Alma Ata declaration which created the new global health crisis was mainly characterized by growing inequalities within and between the countries. This is compounded by negative forces of globalization which prevent the equitable distribution of resources, particularly for the poor. There had been a simplification of approaches to the Alma Ata spirit, especially by simply “medicalizing” the spirit into medical technical interventions such as in growth chart, breast feeding, oral re-hydration and immunization. at the same time disregarding the non-health determinant factors. Meanwhile, the predominant role of the neo-liberalism spirit and practices has been widening the inequalities between the rich and the poor countries.

3. Indonesia was shocked by the first avian flu human victim in 2005, after its wide spread in Viet Nam and China since 2004. The first victim was a family, comprised of a father and his two sons. The first attack was shocking, because we have not even finished our rehabilitation and recovery measures for the Aceh and Nias island which was devastated by the tsunami on 26 December 2004. In fact, Indonesia is the most severely affected by the avian flu. As per November 2008, there were 137 positive avian flu cases with 112 deaths. Most of the cases occurred among the Third and Fourth Sectors, where bio-security is not well taken care.

4. However, despite the fact that Indonesia was the most severely affected country by avian flu virus, WHO still continue with its unfair practices in developing vaccine using the Indonesia H5N1 virus strain, but unwilling to share it with Indonesia, where the virus strain comes from. The WHO Collaborating Centers developed the Indonesian virus strain into a commercial commodity for the develop countries. Therefore, the Indonesian Ministry of Health, Dr Siti Fadilah Supari, made a tough appeal to the World Health Assembly on 20 November 2007[4]. The tough appeal got positive supports, not only from most countries experienced the same deadly avian flu attacks, but also from international media and Research Institute.

The Economist[5], August 10, 2006 wrote:

“With those words, spoken on August 3^rd, Siti Fadilah Supari started a revolution that could save the world from the ravages of a pandemic disease. That is becaused Indonesia’s Ministry of Health has chosen a weapon that may proof more useful than today’s best vaccines in tackling such emerging threats as avian flu: transparancy”

While Lancet editorial, February 17^th, 2007 wrote[6]:

“Indonesia’s move to secure an affordable vaccine supply for its population is understandable… the country has made an controversial decision not to share its H5N1 virus sample with WHO.”

5. Indonesia is the fourth largest country by population, with its 223 million people, scattered in 15.000 islands. 40 million out of which are classified as poor people. This number could even be doubled, if we apply the World Bank poverty criteria, which those earn less two US dollar per day, are classified as poor people. The government and people of Indonesia have to encounter the complexity of health problems. We have not been able to counter our “regular” health problems such as the high maternal mortality, malnutrition and infectious diseases such as tuberculosis and malaria, when immediately we have to cope with the new emerging viral diseases like HIV/AIDS, SARS and avian influenza.

II. Faith-Based NGOs and the National Health System

1. Indonesia is neither an Islamic state nor a secular state either. However, religious-based or faith-based NGOs like Muhammadiyah, has very fundamental and strategic roles in coping with people’s daily livelihoods at the macro, meso and micro levels. The faith-based NGOs, could support the National Health system in two ways. First, by socializing the religious values and tenets for having clean and healthy livelihoods. Second, by promoting direct health services to the community. Along side with the nation wide organizational structure of faith-based NGO like Muhammadiyah, will enable all faith-based Muslim NGOs and all different kinds of denominations to play their role at different levels.

2. The Australian Strategic Policy Institute (ASPI)[7] launched its strategic study on Indonesian democratization process on May 27, 2008. The study on “Seeing Indonesia as a Normal Country” which was conducted jointly by Prof. Andrew Macintyre (Australian National University) and Douglas E. Ramage (The Asian Foundation, Indonesia) concluded that democratization process in Indonesia has been regarded as final. Accordingly, Indonesia could now be considered as equal with India and Brasilia. The study reported that the two largest Islamic organizations, namely Muhammadiyah and Nahdlatul Ulama (NU), which are regarded as the mainstream of moderate Muslim movements, are the main pillars of the democratization process. Earlier study on Civil Islami had been also conducted by Robert W. Hefner[8], where he concluded that the globalization brought about two trends in Indonesia, first is the spirit on democratization, and second is on the awakening of ethno-religious groups.

3. However, the successful achievement in the making of democracy is only benefited by small group of politician elites, but not yet by all people. It is still along way to go, since democracy could be considered as development output, but at the same time also as a mean, a stepping stone for striving forward for the fulfillment of the basic human rights of the people. Both, Muhammadiyah along with Nahdlatul Ulama (NU), are also the core pillars of civil society organization (CSOs). Both Islamic organizations have their lowest organizational structures at the community levels. The success consolidation and coordination between these two largest Islamic NGOs will be at the same time the success of consolidating the Islamic civil society movement at the community levels.

4. Muhammadiyah national machineries at the national, regional and district levels are but part of the National Health System. Muhammadiyah could play its role in three ways:

(i) Running our health provider institutions in support to the National Health System machineries,

(ii) In support to the social determinant of health,

(iii) Building up a healthy living behavior.

In short, Muhammadiyah has the capacity in promoting the community resilience to combat all different kind of physical and social illnesses of the community at the different levels.

5. Internal & external preventive and promotional measures

Community resilience is very important, not only for preventing any threats or hazards coming from outsides, for instance for coping with insurgency, natural disasters or pandemic threats, but also by itself, is a strong preventive measures for preventing to internal threat, such as vertical and horizontal conflicts. And the most important thing is that community resilience is a very strong fundamental for promoting the welfare and sustainable livelihoods of all the people, who are residing in those very localities.

6. Grassroots citizen groups

For hundred years and decades, people from all over the world lived in two-sector world, the government or state, and the market or the capitalistic economy. The last decades of former millennium indicated, that democratization processes in some part of the world, including in Central and Eastern Europe, was marking the awakening of civil society. Therefore, Lester Solmon[9] indicated, that

“Grassroots citizens group awakening, a global association revolution that may prove to be as significant as the rise of the nation state”.

The awakening of the civil society as the third sector at the end of the second millennium was indeed the awakening of a new sector, CSO sector, which undoubtedly will play more important role in the future in promoting community resilience, at macro, meso, and moreover at the micro community levels.

III. Muhammadiyah, combating the threat the avian flu pandemic.

1. “Phantom symptom”.

In her doctorate promotion dissertation on “Phantom Symptom in Rehabilitation of the Disabled”[10], Dr. Wirda, a medical rehabilitation specialist at Dr. Cipto Mangunkusumo hospital in Jakarta, indicated that in some significant cases, amputated persons may immediately feels pain or itching somewhere on his finger tips or any other parts of his or her amputated arm or leg. The amputee thought that their arms or legs were still normally there, so that in responding to any situation affecting them, they may immediately make a gesture or movement as if their arms or legs were there. This is what Dr. Wirda meant with “Phantom symptom”.

2. Triangle Partnership: government, the market and civil society.

We believe that there are so many similar examples of good cases of grassroots community resilience or local wisdom in many other countries. We noted that every country has different setting of local wisdom, as part of the grassroots community resilience system. The community-based local wisdom has similar advantages in promoting prevention and coping mechanism towards all kinds of hazards and threats to the community. The absence of this local wisdom as part of the community resilience at the locality levels will create the Phantom symptom. In broader sense, the absence of the community participation and mechanism in coping with the internal and external threats will create a defect in the macro, meso and micro coping mechanism.

3. Muhammadiyah experience in combating avian flu pandemic.

Muhammadiyah launched its program in combating avian flu, along with the establishment of the “Muhammadiyah Committee against Avian Flu” in 7 June 2006. Then five months later, we embarked to a partnership with USAID in implementing a project named: Community-Based Avian Influenza Control or CBAIC. The project which is being implemented in 9 prone provinces, 55 districts, trained 40 Trainer of facilitator and 12 646 Village Avian Influenza Cadre (VAIC). The facilitators and VAICs, under close supervision and coordination with the local health and veterinarian district officers, conducting the community education and participatory disease surveillance and participatory disease response (PDS and PDR). Not many Indonesian NGOs interested in moving to this direction. They thought that the avian flu virus causes only a small amount of death, as compared to 230.000 victims caused by the Aceh tsunami, or 6 000 caused by Yogyakarta earthquake

4. The CBAIC aims to (i) increase community capacity, knowledge and awareness on avian flu threat, (ii) strengthen community response, coordination and networking, and (iii)increase community surveillance and reporting at village and sub-district levels. We started the project by training the Master Trainer and the Facilitators, and then followed by district level training of the VAICs. The VAICs are the front liners of the CBAIC, the ones who are responsible for delivering the services at the village level. The VAICs are conducting the rural rapid appraisal and participatory rural appraisal (RRA and PRA), and then continue with awareness campaign and surveillance in partnership with the local veterinary officer. The awareness campaign through communication, information and education, and the development of local networking with local stake holders and the other faith-based Civil Society Organization (CSO) are the primary key initial organizational development for a successful CBAIC mission.

IV. CONCLUSSION

1. People from all over the world are now encountering a global health crisis characterized by growing inequalities within and between the countries. New threats to health are continuing emerging. The medicalization of the Alma Ata spirit, by focusing the strategic efforts into medical technical interventions only, such as in growth chart, breast feeding, oral re-hydration and immunization, at the same time disregarding the non-health determinant factors, were the underlying factors of the failure

2. The current awakening of etnoreligious groups in Indonesia has brought about new dimension on the awakening of civil society organization in Indonesia. The vibrant interaction among the religious group, especially in humanitarian fields, undoubtedly will give a new opening in coping with so many humanitarian problems, also in combating the avian flu pandemic threats.

3. Indonesia with its 223 million populations has been worstly affected by the avian flu. Muhammadiyah, the largest Islamic humanitarian movement in Indonesia, even according James L Peacock also the largest in the world, hand-in-hand with the other religious denominations, and under the supervision of the district health and veterinarian officers, has taken active part in combating the avian flu pandemic threat, by utilizing its existing internal and external networks of humanitarian services at the national or macro, regional or meso and locality micro levels.

4. The Social determinant of health factors have to be adequately addressed in the combating the avian flu pandemic threats, otherwise we will create and be trapped in the so called “Phantom symptom”.

---

[1] Presented at the “International Conference on Pandemic”, S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University, Singapore, 12-13 January 2009.

[2] Muhammadiyah is the oldest and largest modernist Islamic movement in Indonesia, established in 1912, with about 30 millions members and supporters, currently running 15 000 schools, 200 Universities and academics, 450 hospitals and clinics, 350 orphanages, thousand of mosques and grassroots community development and welfare movements. The movement, which is supported by its ladies and young ladies wings, youth movement, student movement, university student association, boys scout and girl guide movement, cultural movement, sports and martial-art groups. Its organization spreads over the country, from national office, down to provincial, district, sub-district and villages levels. Therefore, Prof. James L. Peacock, North Carolina University concluded, that outside the Christian world, Muhammadiyah is the largest Islamic humanitarian movement in the world.

[3] People’s Charter for Health 2000.

[4] Fadilah Supari, “It’s Time for the World to Change, In the Spirit of Dignity, Equity and Transparancy”, Lentera, March 2008, pp 262-268

[5] Ibid, cover and back pages.

[6] Ibid, back page.

[7] http://www.aspi.org.au/publiucations/publication_detail.aspx

[8] Robert W. Hefner, “Civil Islami, Muslim and Democratization in Indonesia”, Princeton University Press, 2000.

[9] Lester Salmon, John Hopkinds University, Center for Civil Society Study, Christian Science Monitor, 3 February 2000.

[10] Dr. Wirda Wijoyonitisastro, University of Indonesia, Jakarta, 7 October 2004