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Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011. Progress in Implementation of Child Health Programme. Country: Indonesia. TREND OF CHILD, INFANT AND NEONATAL MORTALITY RATES, 1991 -2015. Low Birth Weight - PowerPoint PPT Presentation
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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
.
15 Nov 2011 Regional CH Meeting, Kathmandu 10
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)
15 Nov 2011 Regional CH Meeting, Kathmandu 11
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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50,00
60,00
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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
15 Nov 2011 Regional CH Meeting, Kathmandu 18
Health Management Information Systems (HMIS) and DHS/MICS
15 Nov 2011 Regional CH Meeting, Kathmandu 19
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
15 Nov 2011 Regional CH Meeting, Kathmandu 25
15 Nov 2011 Regional CH Meeting, Kathmandu 26
C-IMCI
15 Nov 2011 Regional CH Meeting, Kathmandu 27
..\..\..\MTBS\C-MTBS\Lembar MTBS(New Revisi Final)LR.pdf
15 Nov 2011 Regional CH Meeting, Kathmandu 28
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