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Indonesia country office Household and health Household and health facility surveys in facility surveys in Indonesia Indonesia Indonesia country team Jakarta, Indonesia

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Page 1: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Household and health facility Household and health facility

surveys in Indonesiasurveys in Indonesia

Indonesia country teamJakarta, Indonesia

Page 2: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

MNCH-Household Survey

• Builds on CDD/ARI household surveys

• Provides information of direct programmatic relevance on the coverage of key interventions for maternal, newborn, and child health

• Identifies problems with intervention delivery and/or reasons for delivery failure that should be addressed by programme managers

• (Provides information on adolescent sexual and reproductive health)

• Provides some information on expenditures for child health

Page 3: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

MNCH-HHS: Characteristics (1)

• Sub-national, focus on outputs and outcomes (no impact)

• Coverage measures and information on:

- delivery channels (how and where interventions are delivered)

and/or

- reasons for coverage failures

• Limited to few interventions with high potential for impact

• Modular format for adaptation based on interventions with high potential for impact that are actually being scaled up locally

Page 4: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

MNCH-HHS: Characteristics (2)

• Program focus: locally planned and analyzed, results rapidly fed back into programming cycle

• Developed jointly by WHO/CAH and WHO/MPS with input from UNICEF and from countries where the survey has been tested

• Complementary to and consistent with existing household survey tools (DHS, MICS)

• Limited cost and short duration

Page 5: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Sampling methodology and sample size

• Cluster sampling• Using a sampling strategy where all individuals have the

same probability of being selected and where the size of the population in each village/community is taken into account

• Usual sample between 1000 to 1,200 households (larger sample are difficult to manage and are likely to require more than 2 weeks of data collection)

• Maximum of 120 clusters• Between 10 to 15 households selected in each cluster• In each household, children <2 or <5years of age are the

entry points

Page 6: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Process in Indonesia

• Introduced in workshop June 2010• Adapted by University of Indonesia• Use by UNICEF as baseline for intervention

project• Use by SCF and MCHIP in project areas• Intention to be socialized to district health offices

for their surveys on intervention coverage

Page 7: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

19/04/236th Asia-Pacific Conference of

Reproductive and Sexual Health Rights

STUDY LOCATIONSTUDY LOCATION

4470 km

Page 8: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

19/04/236th Asia-Pacific Conference of

Reproductive and Sexual Health Rights

QUESTIONNAIRES MODULESQUESTIONNAIRES MODULES

Module HH Household

Module AN Antenatal Care

Module DN Delivery and Newborn

Module BN Breastfeeding & Nutrition

Module IM Immunization

Module MA Prevention of Malaria

Module CO Fever and Cough

Module DI Diarrhea

Module VA Vitamin A

Module HF Health Facility

Page 9: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Ownership of MCH Book among mothers in 4 districts

19/04/236th Asia-Pacific Conference of

Reproductive and Sexual Health Rights

Page 10: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

19/04/236th Asia-Pacific Conference of

Reproductive and Sexual Health Rights

BREASTFEEDING (n= 799)

In all districts, exclusive breastfeeding were low and there was significant advice on using formula milk

Page 11: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Evaluation Survey of IMCI Implementation in 8 Districts in

IndonesiaCenter for Health Research

University of Indonesia

Page 12: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Objectives

• The objectives of this study were to determine:

– Current level of quality of care delivered to sick children at outpatient health facilities

– Current quality of counseling given at outpatient health facilities and caretakers’ understanding of home treatment of sick children

– Current availability of key health system supports that are required for the implementation of sick children services, such as drugs and vaccines, equipments and supervision

– Principal barriers to effective integrated case management of sick children

Page 13: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Study area

Page 14: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Methods

• Design:– Cross sectional survey of 15 puskesmas/district

• Population:– Sick children who come to puskemas in the six districts

• Sample size– Using sample size formula for estimation of a population

proportion– Proportion of sick children who are appropriately managed

using IMCI = 50%, error of estimation=15%, confidence level= 95%, design effect=2

– Minimal sample size: 86 sick children/district

Page 15: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Proportion of sick children managed by IMCI trained providers

Page 16: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Checking of signs, symptoms and immunization status by IMCI trained & untrained providers

Note: all heath providers in Rote Ndao are not trained in IMCISource: IMCI Evaluation Survey in 8 Districts in Indonesia, 2008.

Page 17: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Proportion of sick children who did not need antibiotic/antimalaria but received those drugs

Note: all heath providers in Rote Ndao are not trained in IMCISource: IMCI Evaluation Survey in 8 Districts in Indonesia, 2008.

Page 18: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Health facility received at least 1 supervisory visit that include observation of case management during the previous 6 months

Page 19: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Conclusions Health Facility Survey• Assessment of sick children by IMCI trained providers was

more comprehensive than by untrained providers• Nevertheless, about half of sick children who were

assessed by IMCI trained providers were not comprehensively assessed according to IMCI standard procedure

• Missed opportunities for immunization occurred in all sick children who were managed by IMCI trained & untrained providers

• The use of antibiotics & antimalarials was more rational in IMCI trained providers compared to untrained providers

Page 20: Indonesia country office Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

Indonesia country office

Summary

• Health facility surveys allow the assessment of the effectiveness of IMCI training

• Household surveys allow to determine coverage and effectiveness of interventions at the household level

• WHO generic tools can be easily adapted fro use in countries

• Both surveys can be used by programme planners to determine next steps, or for operations research