Progress in Implementation of Child Health Programme

1. 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 Regional CH Meeting, Kathmandu

2. TREND OF CHILD, INFANT AND NEONATAL MORTALITY RATES, 1991 -2015

3. Low Birth Weight - in 2007: 11.5% (Basic Health Research 2007) - in 2010: 11.1% (Basic Health Research 2010) The Prevalance of under weight decrease Prediction in 2011, 1 million severe malnutrition

4. The Prevalance of Stunting in 2007 & 2010 % stunting Severe stunting BasicHealth Research in 2007 & 2010

5. Epidemiology / burden of childhood diseases • Main causes of Neonatal Mortality: • Asphyxia • Low Birth Weight • Neonatal infections • Main causes of Child Mortality: • Neonatal problems • Diarrhoea • Pneumonia • Meningitis Resource: Basic Health Research 2007 Regional CH Meeting, Kathmandu

6. IMCI Implementation

7. IMCI implementation

8. Regional CH Meeting, Kathmandu

9. 60 50 40 30 20 10 0 Aceh Besar Aceh Jaya Aceh Timur Total All puskesmas Implementing IMCI PHC implementing IMCI compared to total of PHC in 3 districts in Aceh 2010 Regional CH Meeting, Kathmandu

10. IMCI Implementation Key factors that helped scaling up 1. 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: • Decentralization and flow of funding • inadequate program coordination in MOH, PHO & DHO • High turnover of program managers in PHO & DHO • Lack of supervision & monitoring • Scaling up to large number of PHC and midwives & nurses a big problem . Regional CH Meeting, Kathmandu

11. 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) Regional CH Meeting, Kathmandu

12. 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. Regional CH Meeting, Kathmandu

13. 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 Provinces Regional CH Meeting, Kathmandu

14. The precentage of services in line with Standards in 6 PHC with bed in 6 Provinces GOOD • Supporting HS • Emergency HS • Child health care In patient • Manajemen child health care in patient • Neonate HS • Patient monitoring • Mother & baby friendly health services • Supporting PHC • Follow up HS • Access to PHC Needs improvement Strong Need for improve ment

15. The precentage of services in line with Standards in 18 Hospital in 6 Provinces • Supporting HS • Emergency HS • Child health care In patient • Manajemen child health care in patient • Neonate HS • Patient monitoring • Mother & baby friendly health services • Supporting PHC • Follow up HS • Access to PHC GOOD Need improvment Strong Need for improve ment

16. CHW approach for care of sick newbornsand children • 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 Java Regional CH Meeting, Kathmandu

17. Availability of midwife at village level CCM CCM CCM CCM CCM

18. 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 Regional CH Meeting, Kathmandu

19. Health Management Information Systems (HMIS) and DHS/MICS • 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) Regional CH Meeting, Kathmandu

20. HOW AND AT WHAT LEVEL ARE THE DATA FOR THESE KEY PROGRAMME INDICATORS ANALYSED AND USED BY THE PROGRAMMES? • MOH • Data • Field observed • analyzed National Planning Province Health Planning PHO HMIS ONLINE (REPORT SP2TP/SP3 ) District Health Planning DHO PHC PHC Planning 20

21. Future Plans Strengthening 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 Regional CH Meeting, Kathmandu

22. Future Plans Strengthening 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 Regional CH Meeting, Kathmandu

23. Future Plans Strengthening 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 years Neonate • 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 Regional CH Meeting, Kathmandu

24. Future Plans INDOOR 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 Regional CH Meeting, Kathmandu

25. Future Plans Strengthening 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 Regional CH Meeting, Kathmandu

26. Regional CH Meeting, Kathmandu

27. C-IMCI ..\..\..\MTBS\C-MTBS\Lembar MTBS(New Revisi Final)LR.pdf Regional CH Meeting, Kathmandu

28. Terimakasih Regional CH Meeting, Kathmandu