Meeting of South-East Asia Regional Programme Managers on Child Health,

Kathmandu, 15 – 18 Nov 2011

Progress in Implementation of Child Health Programme

15 Nov 2011 Regional CH Meeting, Kathmandu 1

Country: Indonesia

TREND OF CHILD, INFANT AND NEONATAL MORTALITY RATES,

1991 -2015

The Prevalance of under weight decrease

Prediction in 2011, 1 million severe malnutrition

Low Birth Weight - in 2007: 11.5% (Basic Health Research 2007) - in 2010: 11.1% (Basic Health Research 2010)

18.8 17.9

18.0 17.9

0

5

10

15

20

25

30

35

40

Tahun 2007 Tahun 2010

PendekSangat pendek

The Prevalance of Stunting in 2007 & 2010

%

Basic Health Research in 2007 & 2010

stunting

Severe stunting

Epidemiology / burden of childhood diseases

Main causes of Neonatal Mortality:1. Asphyxia2. Low Birth Weight3. Neonatal infections

Main causes of Child Mortality:1. Neonatal problems2. Diarrhoea3. Pneumonia4. Meningitis

15 Nov 2011 Regional CH Meeting, Kathmandu 5

Resource: Basic Health Research 2007

IMCI ImplementationIMCI implementation started (If yes, year) 1997Newborn Added (If yes, year) 1997Number and Proportion of districts implementing IMCI No data

Number and proportion of MOs trained No dataNumber and proportion of Nurses/other workers trained 12.556?

Proportion of districts (out of IMCI districts) with 60 % or more health providers trained

No data

IMCI supervisory checklists introduced 1998, 20052010 rev

Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during previous year

No data

Proportion of districts (out of IMCI districts) covered with Follow-up IMCI training

No data

IMCI implementation IMCI implementation review conducted (If yes, year; National or sub-national)

20022009

IMCI Health Facility Survey conducted (If yes, year; National or sub-national)

2008(8 districts), 2010 in 3 District in Aceh

Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI

4.118 ?

Pre-Service IMCI teaching/training:Number and proportion of Medical Schools teaching IMCI No data

Number and proportion of Nursing Schools teaching IMCI No data

ICATT introduced (If yes, year and scale) 2009 – 2012

15 Nov 2011 Regional CH Meeting, Kathmandu 8

15 Nov 2011 Regional CH Meeting, Kathmandu 9

PHC implementing IMCI compared to total of PHC in 3 districts in Aceh 2010

0

10

20

30

40

50

60

Aceh Besar Aceh Jaya Aceh Timur Total

All puskesmas Implementing IMCI

IMCI ImplementationKey factors that helped scaling up1. Part of national strategy to decrease underfive

mortality 2. Budgeting (deconcentration budget, donors,

some from local government)3. Included in the curiculum of medical

education and midwife academy education

Key challenges to scaling up:1. Decentralization and flow of funding2. inadequate program coordination in MOH, PHO

& DHO 3. High turnover of program managers in PHO &

DHO4. Lack of supervision & monitoring5. Scaling up to large number of PHC and midwives

& nurses a big problem

.

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Newborn Health No single training for Essential Newborn Care

included in Normal delivery training (but lack of time for neonates)

Management Asphyksia, Management of Low Birth Weight (including KMC) Integrated with maternal: BEONC and CEONC Pocket Book for Essential Newborn Care

Guidelines (including ENC, Manage Asphyxia, Manage LBW, Neonate Visit guidelines)

MCH HB, C-IMCI component neonate (pilot project)

Child Health Guideline for Kaders (village health volunteers)

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In-Patient (Hospital) care of sick newborns and children

Adaptation of WHO Pocket Book in 2006 – 2009, printing 50000 copies, DVD No training course for Hospital care What was done a. Distribution the pocket book through - Indonesia Pedriatric Association for Pediatrician - District Health Office for Primary Health Center with bed and Hospital (especially Gov Hospital) b. Socialization of Pocket book c. Collaboration with IMA introduce TOT and training for general doctor on Child Health in 2 Provinces (2011) the pocket book as major component of training material. 15 Nov 2011 Regional CH Meeting, Kathmandu 12

In-Patient (Hospital) care of sick newborns and children

Proportion of hospitals providing pediatric care having oxygen: (18 Hospital)

- 100% cylinders - 77 % Oxygen Concentrator -waiting for the result of national health

facility research by National Health Research Institute

Hospital assessment using WHO tools carried out: In 2009 18 hospital and 6 PHC with

bed in 6 provinces In 2010 12 PHC with bed in 6

Provinces15 Nov 2011 Regional CH Meeting, Kathmandu 13

0,00

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40,00

50,00

60,00

70,00

80,00

90,00

100,00

0 1 2 3 4 5 6 7 8 9 10JAMBI SULAWESI TENGGARA JAWA TIMUR

NTT MALUKU UTARA KALIMANTAN TENGAH

PERLU PENINGKATAN

BAIK

SANGATPERLUPENINGKATAN

1. Pelayanan Penunjang

2. Pelayanan Gawat darurat

3. R.Rawat Inap Anak

4. Tatalaksana di R.Rawat Inap Anak

5. Pelayanan neonatus

6. Pemantauan Pasien

7. Pelayanan sayang ibu dan anak

8. Dukungan PKM9. Keluar PKM

dan perawatan lanjutan

10. Akses ke PKM

Persentase Pencapaian Standar Pelayanan Kesehatan Anakdi Puskesmas Perawatan di 6 Provinsi, 2009

5/17/2009

The precentage of services in line with Standards in

6 PHC with bed in 6 Provinces1. Supporting HS2. Emergency HS3. Child health care

In patient4. Manajemen child

health care in patient

5. Neonate HS6. Patient

monitoring7. Mother & baby

friendly health services

8. Supporting PHC9. Follow up HS10.Access to PHC

GOOD

Needsimprovement

Strong Need for

improve

ment

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

0 1 2 3 4 5 6 7 8 9 10JAMBI SULAWESI TENGGARA JAWA TIMUR NTT MALUKU UTARA KALIMANTAN TENGAH

BAIK

PERLU PENINGKATAN

SANGATPERLUPENINGKATAN

1. Penunjang2. Pelayanan

GD3. R.Rawat

Inap Anak4. Tatalaksana

Rawat Inap5. Pelayanan

neonatus6. Pemantauan

pasien7. Pelayanan

sayang ibudan anak

8. DukunganRS

9. Keluar RS danperawatanlanjutan

10. Akses ke RS

Persentase Pencapaian Standar Pelayanan Kesehatan Anakdi rumah sakit 6 provinsi

The precentage of services in line with Standards in

18 Hospital in 6 ProvincesGOOD

Needimprovment

Strong

Need for

improve

ment

1. Supporting HS2. Emergency

HS3. Child health

care In patient4. Manajemen

child health care in patient

5. Neonate HS6. Patient

monitoring7. Mother & baby

friendly health services

8. Supporting PHC

9. Follow up HS10. Access to

PHC

CHW Village midwife or nurse “Kader (village volunteer” for promotive

and preventive Adaptation C-IMCI - in 3 districts in Aceh (Save the Children) 2007-2009 at the end of 2010 continue in pilot project : a. MCHIP in Bireun Aceh & Sangata East Kalimantan (for neonate component )

Neonatal visit b. UNICEF (TTS district in NTT , Jayawijaya district in Papua, Buru Island in Maluku) diarrhoea and pneumonia Introduced C-IMCI (promotive , preventive and early

detection in one subdistrict in Cianjer and Sukabumi district in west Java15 Nov 2011 Regional CH Meeting, Kathmandu 16

CHW approach for care of sick newborns and children

Availability of midwife at village level

CCMCCM

CCM

CCM

CCM

Programme Review and Management CH Short Programme Review introduced,

if yes : Year: 2010, after Nepal participation National or sub-national: socialize in national

meeting & Programme Management Course

introduced, if yes: Year: 2010 in India National or sub-national: socialization for

some provinces, no decision yet on further use

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Health Management Information Systems (HMIS) and DHS/MICS

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List the key indicators for newborn and child health included in HMIS and DHS/MICS?

- The % of Neonate Visit (1x, 3x complete neonate visit; 6-24 hour, 3-7 days, 8-28 days) - The % of neonate with complication that get services - The coverage of villages with universal Child imunization - The % of U5 get growth monitoring - The % of U5 with severe malnutrition get treatment in hospital - The % of Infant visit (should be completed for: complete imunization, Early Stimulation Detection and Intervention on Growth Development 4 times, Vit A 1 x and counseling for care giver) - The % of Under five Visits ( Growth Monitoring 8X , ESDIGD 2 times, Vit A 2 x)

2020

PHC

DHO

PHO

MOH- Data

- Field observed- analyzed

HMIS ONLINE (REPORT SP2TP/SP3 )

HOW AND AT WHAT LEVEL ARE THE DATA FOR THESE KEY PROGRAMME INDICATORS ANALYSED AND USED BY THE PROGRAMMES?

National Planning

Province Health Planning

District Health Planning

PHC Planning

Future PlansStrengthening and scale-up plans for next

2 years IMCI - to strengthen IMCI implementation in the midwife and nursing academic curiculum in the Aus-HSS and GAVI project, other project national - Accelerated expansion of the PHC facilities - Improve integrate supervison and monitoring ICATT - facilitation ICATT as a methode of teaching IMCI in medical education, midwife and nursing academies - Study of effectiveness of ICATT compared to traditional IMCI in west Java, AI project area - Facilitation of implementation of ICATT in AI project area & deconcentration budget

15 Nov 2011 Regional CH Meeting, Kathmandu 21

Future PlansStrengthening and scale-up plans for next 2 years CHW Packages:• Strengthening of early detection and prompt treatment

(community case management ~ 10-15% of villages)• Capacity building in component “Infant Young Child

feeding” for midwife & nurse and also “kader”• Improving community behaviour change• Strengthening the integration between Posyandu

(Integrated Post) with Early Child Education Post and Family with U5 Children Program (program from Family Planning Board ) for Early Stimulation, Dectection and Intervention Growth Development

15 Nov 2011 Regional CH Meeting, Kathmandu 22

Future PlansStrengthening and scale-up plans for Next 2 years Hospital Facilitate TOT and Training for doctor in child health

component using central, decontration budget and their own budget

Part of quality improvement approach in AI area project Detection of Hypoxemia and O2 Delivery Pediatric standard on Hospital Accreditation Tools

Strengthening and scale-up plans for Next 5 yearsNeonate Strengtening neonatal services for maternal and neonate in

150 Hospitals (Gov & private) and 300 PHC with bed in 6 Provinces through EMAS project

Using IT as one of model to increase the quality and accesibility and improvement of knowledge of community in MCH

15 Nov 2011 Regional CH Meeting, Kathmandu 23

Future PlansINDOOR AIR POLUTION Based on National Socio-economic Survey in 2005,

45% of household using kerosene, 42% using Fuelwood, in rural area 64% using biomass (three stone, mud stove, fired clay stove, cement stove, stone stove, metal stoves) and only 10% of all sample using LPG for cooking

Any tradition in some districts (Papua and NTT), living in small house without ventilation and doing”SEI” for mother and baby 40 days post partum intervention

MOH regulation regarding Indoor Air Polution Quality, Healthy House

The implementation Management of Indoor Air Polution conversion from Biomass, kerosene and fuelwood to

LPG

15 Nov 2011 Regional CH Meeting, Kathmandu 24

Future PlansStrengthening and scale-up plans for

Next 2 years Programme Review and Management:

CH Short Programme Review how integrate with DTPS Programme Managers Course: - need detailed orientation (especially for

related programmes in MOH, Bureau Planning & Human Resources Development)

- orientation on costing tools

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C-IMCI

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..\..\..\MTBS\C-MTBS\Lembar MTBS(New Revisi Final)LR.pdf

15 Nov 2011 Regional CH Meeting, Kathmandu 28

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