maternal and child nutrition program : 1000 days of...
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Maternal and Child Nutrition Program : 1000 days of Life
Directorate of Public Health Nutrition
Ministry Of Health Republic Indonesia
Magnitude of Problem
Coverage of Program in Indonesia
Causes and Implication
Policy Direction and National Strategy
Conclusion
OUTLINE
Health and Nutrition Problems
3Sumber: Global Nutrition Report, 2018
Each country has his own nutrition problems
single burden double burden triple burden
22,2% Children under
5 years in the World
(150,8 M)
Stunting
7,5%
(50,5 M)
Wasting
5,6%
(38,3 M)
Overweight
Indonesia is one of the countries successful in
reducing malnutrition among children, but facing
increasing obesity problem among adults
Stunting, Wasting and Overweight among Children under 5
2013-2018
Sumber: Riskesdas, 2013 dan 2018
2013 2018
14.8% 21.8%
2013; Stunting; 37,2
2013; Wasting; 12,1
2013; Overweight;
11,9
2018; Stunting; 30,8
2018; Wasting; 10,2
2018; Overweight; 8
2013 2018
Obesity among Adults18+ years
Nutritional Problems of Maternal in Indonesia
Half of pregnant women are
DEFICIT OF ENERGY AND PROTEIN
Proportion of Protein Intake < 80% AKP of Pregnant Women 49,5% & Proportion of Energy Intake < 70% AKE of Pregnant Women is 44,8% (Riskesdas, 2010)
SDT, 2014 SDT, 2014
Maternal Mortality Rate and Cause of Death
MMR/100.000 LB
2010 SP 2015 SUPAS 2019 TARGET
305346 306
CAUSE OF MATERNAL DEATH
(Source : SRS 2016)
Infant Mortality Rate, Cause of Death, and Fetal Undernutrition
PROPORTION OF BIRTH WEIGHT
IMR/1.0000 LB
2432 24IDHS 2012 IDHS 2017 2019 TARGET
(Source : Basic Health Survey 2007-2018)
CAUSE OF INFANT DEATH
Under-nutrition foetal and adolescent nutrition status linkage
Coverage of Micronutrient supplementation, IFA, compliance 38,1% (Basic Health Survey, 2018)
Pregnant women get IFA
Supplementation
Get < 90 Tablet
Get >= 90 Tablet
9
Multidimensional causes of nutrition problem
Source: UNICEF 1990 (adjusted with Indonesia’s condition)
1Indonesia: Study on The Cost of Diet, WFP (2017)2Basic Health Research Ministry of Health Republic of Indonesia (2018)3Indonesia Statistics Bureau (2016)
Sociocultural, economic and
political context
Poverty, Food Security and
Nutrition, Education
Purchasing Power,
Access to Food, Information
and Services
Food
Consumption
Infection Status
Nutrition
Status
Root
CausesIndirect Causes Direct Causes
• 62% population can afford nutritious
food1
• 95.5% have inadequate consump-
tion of fruit & vegetables2
Availability and Food
Consumption Patterns
• 37.3% exclusive breastfeeding2
• 46.6% U5 children consumed
diverse diet2
Parenting & Feeding Practices
Environmental Health &
Health-care Services
• 57.9% immunization rate2
• 71.14% household access
to improved water sources3
Outcome
10
IMPROVING ACCESS TO THE UNIVERSAL HEALTH SERVICES
STRATEGY INTERVENTION
IMPROVING QUALITY OF HEALTH SERVICES
STRENGTHENING GOVERNANCE
COMMUNITY EMPOWERMENT
1
2 3
4
IMPROVING ACCESS TO THE UNIVERSAL HEALTH SERVICES
Adolescent Reproductive agePregnant women
& MaternityNewborns
62.2% of PHC conducting adolescent health
services/PKPR
76.2% of young women got Fe Tablets
54% of PHC provide reproductive health services to pre-married couples
57.2% active FP attendees modern Way
13.3% wearing MKJP10.6% Unmet need KB
98% got quality ANC
79% mothers giving birth in
healthcare facilities
Neonatal visit 1x : 84,1 % Neonatal visit 3x : 43,5%
MOH Regulation No 4/2019 on Minimum Standard of Services/SPM responsibility of Head of Local Government
448 Companies implement Productive Women Workers
Movement (GP2SP)
READY to
pregnant
Health Services for School Age Children
Health Services for Productive Age
Health Services forPregnant Mother
Health Services forLabouring Mother
Health Services for Newborn
Source : Basic Heallth Survey 2018, Data routine 2018
1
9.993 PHC
DTPK
IMPROVING QUALITY OF HEALTH SERVICES2
• PHC
• Clinic
• Private Practice
• Midwife Private
Practice
Integrated Referral System
• Local Public
Hospital
• Private Hospital
• Mother and Child
Hospital
• Quality ANC and
PNC includes
early detection
• BEmONC 24/7
• Accreditation of
First Level Health
Facilities(FKTP)
• CEmONC 24/7
• Mother Baby
Love Hospital
• Accreditation of
Advanced Health
Facilities
(FKRTL)• Evidence based planning
• Human Resource
management
• Medicine and medical
devices compliance
• Audit Maternal Neonatal
• Partnership
• Development of Integrated
Referral System
EMPOWERING THE COMMUNITY3
MCH Handbook
Mother class Village budget fund Active
Alert Village(DESA SIAGA)
Birth Preparedness
and Complication
Prevention
STRENGTHENING THE GOVERNANCE4
Community Empowerment(Mother Baby Friendly Hospital, MCH HB, Mother
Class, P4K, MMD/SMD, Adolencents Posyandu,
Active Alert Village)
Referral network(Referral Manual, Integrated Referral
System)
Access and quality of
services(ANC, neonatal essential services,
Nutrition Counselling,
micronutrient
supplementation compliance,
emergency response)
Regulation(Law 36/2009, MoH Regulation 75/2014, MoH
Regulation 97/2014, MoH Act Nutrition
Supplementation 51/ 2016, MoH Act IFA
88/2014, MoH Act Vitamin A 21/ 2015,
Nutrition Balance Diet 41/ 2014)
Human Resouces(amount, distribution, competence)
Facilities and Infrastructure(medicine, medical devices,
Nutrition Supplementation)
01
0405
06
07
08
02
03 Information systems(MDN, Local Health Information
System, Hospital Information
System, SiJARI EMAS)
Budget and Funding(State Budget, Local Budget,
Special Allocation Fund, National
Health Coverage/JKN, Delivery
Safety Net/Jampersal, Village
Budget, utilization of Waiting
Home)
CONCUSION :
HEALTH DEVELOPMENT FOCUS
HEALTH DEVELOPMENT PRIORITY
FAMILY
APPROACH
Nutrition
Improvement
especially
stunting
MMR, IMR,
Immunization
Management of non
communicable diseases
Management of communicable
diseases
Health Sector in central and district, related cross sector, professional
organizations, academics, social institutions, mass media, business,
development partners and community participation
Improvement of Maternal and Child Health, Family Planning, and Reproduction Health
Priority Project: 1. Decreasing of
Maternal and Infant Mortality
2. Improvement of Family Planning (KeluargaBerencana/KB) and Reproduction Health
Acceleration of Community Nutrition Improvement
Priority Project:Decreasing of Stunting
Strengthening Disease Control
Strengthening the Healthy Life Community Movement (GerakanMasyarakat HidupSehat/GERMAS)
Priority Project: 1. Development of
Healthy Environment2. Strengthening
promotion of GERMAS
Improvement of Health Services and
Drug-Food Control
1
3
4 2
5
IMPROVING ACCESS AND QUALITY OF
HEALTH SERVICES
(STRATEGY OF RPJMN 2020-2024)
Thank you
HEALTHY REGARDS