District Team Problem Solving

Dr. Lukman Hendro L

Maternal Health Directorate Ministry of Health

Background

• Decentralization era District Health Office (DHO) obtain more authority and responsibility to manage the health program.

• DHO staff require a planning and budgeting capacity, that is appropriate to local context, regulation and based on evidence (Data and Information).

• To maintain and improve the quality of health services a practical, simple, sistematic and comprehensive planning and budgeting tool is needed.

What is DTPS -2007 ?

A sistematic, practical and comprehensive MNCH planning tool, that is based on data and evidence

Objectives:• Improve the quality of MNCH planning

through District Team problem Solving approach

• Build the capacity of district health staff in MNCH planning and budgeting.

3 – Phases of DTPS 2007

1. Orientation ( 1- 2 days )2. Planning process ( 5 days )3. Follow-up phase (post workshop –

Advocation, until issues of RKA-SKPD /Perda).

DTPS-2007 should align with local government Planning cycle as guided in Permendagri No.13/2006

Orientation phase(1 day)

Objectives:1) Create awarenss of district

stakeholders about national, local MNCH issues and obtain support at once.

2) Identify role and responsibility of each stakeholders at district.

3) Form a “DTPS team“.4) Inform DHO on data needed for

planning purposes.

Participant of orientation ( Phase I)

Province and District stakeholders, represented by:- Local government- DPRD- PHO and DHO staff- Hospital- Profesional organization- BKKBN, PMI- NGO, Media

Planning Workshop (Phase II ) 5 days

Objectives:- Develop an evidence based planning

and budgeting document through sistematic session such as:

Data validation, situation analysis,problem analysis, solution and activities, setting target, budget calculation, Monitoring and evaluation, Follow-up action.

Participant of planning workshop

• District planning team ( DTPS team ) consisted of 10-12 persons from:

- DHO staff ( MNCH, nutrition, Immunization, Pharmacy, Puskesmas)

- Bappeda- Hospital, Prof. organization- BKKBN - NGO, PKK, etc

Follow-up ( Phase III)Post workshop until RKA-SKPD approved by DPRD

Goals:- Finalize planning document- Calculate budget needed- Prepare advocacy material- Convince decision maker through Advocacy- Incorporate MNCH budget into health sector

budget- Ensure that activities and budget will be

approved in APBD or other sources.

Challenges • Availability and Quality of collected data.

• Difficulty to obtain data from hospital and private services, particularly in big cities.

• In new district a Health Information System (HIS) is not yet established.

• Time limitation for collecting data ( DTPS should be carried out between January and March before Musrenbang)

• DTPS should accommodate service point’s ( Puskesmas ) need.

• Lack of collaboration with other sectors and institution( BKKBN, hospital, PKK, Media )

Challenges• Certain activities proposed by DTPS

process can not be carried out by health sector since it is a task and responsibility of other sector ( for example: community empowerment ).

• Lack of DHO’s capacity to convince DTPS result to decision maker.

• Often political issues ( Bupati election ) are more important than MNCH issues

Recommendation• Data should be collected and validated

before planning process.• A data analysis capacity for DTPS team

is required.• To strengthen planning capacity at

Puskesmas level, DTPS approach could be used

• Other sectors or institution should be involved in planning and implementation process as well

• DTPS process should be followed by advocacy process.

• Media / journalist could be a strong alliance to raise public and decision maker’s awareness on MNCH issues.

Benefit

• Team Building Among Stakeholder (Inter-program and Inter-sector) – Share Responsibility and Budget

• Capacity Building – Data Analyze – Problem Identification – Problem Solving

• Utilizing Data and Information – Build Awareness on the Importance of data validity – Data Improvement

• Proposed activities based on the real problem

• Routine data can not be collected on time, validity???

• Too many forms in the field• There is no person who responsible

for data collection in the district and sub-district

• Team member do not have authority for decision and high turn over

• Team member do not have enough capability to analyze data

Recommendations

• Reduce the number of data collection form

• Training: Data Analysis DTPS and Advocacy

• Local Area Monitoring (MCH LAM): Monthly MCH data collection Analyze problem on coverage of MCH

program Problem identification and Problem

Solving• Audit Maternal Perinatal/Neonatal:

Regular meeting to discuss the cause and underlying cause of maternal and child mortality and morbidity

Utilizing morbidity, mortality and other related data

• Input for Monitoring and Evaluation Activity

Utilizing Data Is The Importance Key Utilizing Data Is The Importance Key For Improving The Availability And For Improving The Availability And

Data Validity Data Validity