CURRENT STATUS OF HEALTH INFORMATION SYSTEM: INDONESIA*

1. Presented at the 6th Meeting of the Asia Pacific Network of the WHO IFC, Bangkok, Thailand, 18-19 July 2013 Soewarta Kosen National Institute of Health Research & Development Center for Community Empowerment, Health Policy and Humanities Jakarta, Indonesia CURRENT STATUS OF HEALTH INFORMATION SYSTEM: INDONESIA*

2. Law No 36/2009 on Health states that to manage effective and efficient health efforts, health information is needed and should be implemented through the health information system and include information from other sectors • To be optimum, the Health Information System needs cooperation and support of various sectors and cover integrated information from health sector and all other health related sectors for policy formulation • Law No 23/2006 on Population Administration stated that Vital Registration is implemented through Population Administration Information System from village/kelurahan up to district, city, province and national BACKGROUND

3. Sources of Health Information System and basic demographic statistics in Indonesia include: population administration information system (Civil Registration), Population Census, National Socioeconomic Survey, Demographic Health Survey, National Health Survey, Baseline Health Research (RisKesDas), regular recording-reporting system of Puskesmas (Community Health Center) and Hospitals, surveillance data, sentinel data: Nutrition, MCH, Family Planning, Mortality Data with Multiple Causes of Death (ICD – 10) • The benefits of a well-developed information system include the ability to monitor impact of health programs, better quality information, and more efficient delivery of health care services. • With sound data sources and proper data collection, transforming data and information (evidence) into policy becomes best practices BACKGROUND

4. Health Information Data Sources Integrated Health Information System Sources of Data Monit-Evaluation:reports, event inquiries & warning Fact & evidence from HIS, used for decision making • MoH • Other gov’t ministries • Local health offices (prov/ district/city) • International agencies • Universities • Researchers • etc. Census ResourceRecords POLICY, RESOURCES AND PROCESS Processing & Integrating data Saving of Integrated data Civil Registra-tion Service Records Population SurveysCommunity Individual Records Population based Facility based Standardized Data Collection Source: HMN, 2008

5. The HIS includes data of health sector & other related development sectors (FP, Social Welfare, Agriculture) • The HIS integrates routine facility based data and non-routine community based data (survey, census): Baseline Health Research, Facility Based Survey, Demographic Health Survey, National Socio-economic Survey • Used for advocacy, program planning, monitoring and management; as well as for evaluation • Emphasize: availability, quality, value & utilization of timely and accurate information CHARACTERISTICS OF THE INDONESIAN HEALTH INFORMATION SYSTEM

6. Health status (morbidity, disability and mortality) • Health efforts (public goods & private goods) • Health care financing • Health man-power • Drugs and supplies • Community empowerment in health • Health resources: building/physical infrastructure, medical equipment and non-medical (vehicles, furnitures) • Local specific data TYPE OF COLLECTED DATA IN HIS

7. Self reliance • Data & information are processed and analyzed mainly at and for local use (operational level) • Applying conventional (paper based) as well as ICT/computer based procedures: maximize efficiency (personnel time) and effectiveness (relevance & usefulness) • Proper selection of essential indicators: Obligatory Public Health Functions/Minimum Service Standard; to serve the need of data and information at various levels, including local level (city, district, prov.) • Development of a network of data-bank • Comprehensive & relevant for health development Characteristics of Improved Indonesian HIS

9. Identified weakness of Indonesian HIS: • Irrelevance of the collected information • Fragmented & poor quality of data • Duplication among parallel information • Lack of timely reporting and feedback • Minimal analysis and use of data & information at local level (district and city) for advocacy, program planning, monitoring and management; as well as for obtaining needed resources SITUATIONAL ANALYSIS

10. Provide basic information to formulate policies, priorities and development of intervention programs (health and non health) as well as a guidance in allocating resources • As a base to monitor and evaluate program effectiveness of basic services/obligatory public health functions, their achievements and trends • To determine research priorities, e.g. relationship of tobacco and certain diseases, causes of high incidence of stroke, determine risk factors, relationship with socioeconomic level, demography and behavior Statistics based on WHO - FIC

11. Indonesian SRS sites cover 128 Sub-Districts in 89 districts and 25 cities (7 regions and 30 provinces) that represent Indonesia • Total population covered about 4 % of Total Population (240 millions): about 9 millions to represent Indonesia • Stratified into Development Area (7) and Urban - Rural • Joint Decree of the Minister of Home Affairs and the Minister of Health (January 2010) on Reporting of Death and Cause of Death facilitates the recording of events and cooperation between the two sectors at the grass-root level INDONESIAN SAMPLE REGISTRATION SYSTEM (SRS)

12. Questionnaire for interview with family members and/or caregivers • Standard questionnaires permit reasonably accurate ascertainment of causes of death based on responses to a well-administered questionnaire. • Responses to questionnaire analysed for classification and coding in line with ICD-10 • Application of ICD-10 to verbal autopsy interviews • Certification by medically trained personnel • Professionalised coding Components of the WHO verbal autopsy guidelines

13. Collected thru Baseline Health Research 2007 and 2013 for situational analysis of disabilities Applied in Disability Weight Survey for Global Burden of Disease 2010 (3 provinces of Indonesia) Indonesia Statistical Office incorporates the ICF Concept for Handicapped Survey (together with the Ministry of Social Affairs) ICF (International Classification of Functioning, Disability and Health), WHO 2001

14. Need to emphasize the Medical Certification of Cause of Death (MCCD) as a confidential part of the formal death certificate • Need to refresh medical communities (physicians) in all health facilities (hospitals and community health centers)onthe writing of multiple causes of death based on ICD – 10 • Need to enforce compulsory mortality registration based on current national law & regulations and support the formulation of local regulations • Since the majority of deaths occur outside the hospital, verbal autopsy method to obtain causes of death has to be disseminated and carried out for deaths occurring in the community • Accelerate development of ICT to assure more reliable, timely and complete Health Information System CONCLUSIONS

15. The improved Indonesian Health Information System based on WHO - Family International Classification: • Be adaptive to the information need of the health sector, relevant and produce better quality of data to support planning and management at various levels of administration • Permit development of integrated and comprehensive HIS to support the national and local health systems • Be locally sustainable • Be able to monitor achievement in health development, including Medium Term National Health Dev’t Plan, MDGs, WSC , etc. ULTIMATE TARGET: Disseminate information culture: “no reasons to make decisions without information and evidence based support” Conclusions

16. Terima kasih