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To Overcome IDD : Indonesian Experience

To Overcome IDD : Indonesian Experience. Triono Soendoro Ministry of Health. 1979: M.D. ( Airlangga Medical School, Indon ) 1985-1989 : M.Sc , M.Phil , Ph.D , Yale Univ , USA. 1991-2000: Director Health & Nutrition, Bappenas

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To Overcome IDD : Indonesian Experience

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  1. To Overcome IDD: Indonesian Experience Triono Soendoro Ministry of Health

  2. 1979: M.D. (AirlanggaMedical School, Indon) • 1985-1989: M.Sc, M.Phil, Ph.D, Yale Univ, USA. • 1991-2000: Director Health & Nutrition, Bappenas • 2000-2001: Leadership Fellow at the Gates Institute, University of Johns Hopkins, USA • 2001: Secretary of Decentralization Unit and Policy Advisory Group to MoH; • 2001-now: Senior Associate, Bill and Melinda Gates Institute, Johns Hopkins University, USA • 2006-2009: Director General of NIH-RD, MoH; • 2009 –now: Senior Advisor to MoH. • 1997-now: Faculty Member of O/G, Reproductive Endocrinology, Med SchUdayanaUniv, Bali. • 2001-now: Visitng lecturer at several universities. • 2012- : Assist Indon President to Post MDG 2015

  3. Outline • Setting the Objectives • Assessing IDD Progress • The Challenges • The Way forward

  4. Outline • Setting the Objectives • Assessing IDD Progress • The Challenges • The Way forward

  5. The Objectives • To increase the national coverage of adequate iodized salt consumption at household level • To sustain the coverage of adequate iodized salt consumption in all districts

  6. Outline • Setting the Objectives • Assessing IDD Progress* • The Challenges • The Way forward

  7. Assessing IDD Progress • IDD surveys: 93, 96/98, ‘03 (TGR, UIE) • HH’s Iodized Salt: • CBS (Susenas 1998-2003), • MOH (Riskesdas 2007 - 2013) • Urinary Iodine Excretion (UIE): • Riskesdas 2007 (sub-samples in 30 districts)

  8. IDD Survey: ‘93, ’96/’98, & ‘03

  9. Progress: IDD Elimination/TGR Note: Only sub-districts included within the 80/82 sample frame were included from the 96/98 sample for comparison

  10. Progress: IDD Elimination/TGR

  11. The Changes: District Endemicity

  12. Changes: 268 DistrictEndemicity

  13. Distribution of Province by Category of Endemicity in ’96/’98 and ‘03

  14. Trend of HH’s Iodized Salt Consumption: 1998-2007 Source: Susenas 1998-2003, Riskesdas 2007

  15. % HH Consume Iodized Salt: 2003-2007

  16. Association between UIE and Iodized Salt Coverage Source IDD Survey 2003

  17. HH’s Iodized Salt vs Iodine Urine (School Age Children) *) Excessive: Source: Riskesdas 2007 (30 Districts)

  18. Outline • Setting the Objectives • Assessing IDD Progress • The Challenges* • The Way forward

  19. The Challenges • Universal Salt Iodization (USI) targets have not been met nationally, but excessive iodine intake is beginning to manifest • Focus of USI should be directed to Provinces/Districts with HH’s consume Iodized salt <50% • Attention is also needed for areas where the UIE level >300 ug/L • Health disparities*: PHDI

  20. The Purpose: PHDI • Describe public health development progress for entire districts in Indonesia • Focused programs interventions (local specific) in each districts.

  21. PHDI Progress: ‘07-’10 (‘13) Composite PHDI (7 Indicator): Malnutr, Stunring, ImunizANC/MCH, Sanitation, Water

  22. The Benefits • A tool to evaluate the process of improving a certain area (district/municipality) on health status over time. • An advocacy for province and district government to increase their health status using focused resources and programs interventions priority. • As a criteria of health fund allocation from central to province and district government.

  23. District DBK: The Areas

  24. Aceh (14/21) NTB ( 6/9) NTT (11/16) Sulteng (7/10) Sultra (8/10) Gorontl (5/5) Sulbar (4/5) Maluku (5/8) Pap Bar (6/9) Papua (14/20) P-DBK: 10 Prov as of ‘11 • Prop DBK: # total : 28 prop 130kab/kot • Prop > 50% Kab DBK : 10 prop*80kab/kot • Prop < 50% Kab DBK : 18 prop 50kab/kot

  25. Sumber : Riskesdas 2007

  26. RDS RDS Translation The Challenges: Partnership Organizational Change End InternalSupportGroup Start Training Actions Actions Mentoring Learning History: Cohort of PDBK

  27. Comitment & Involvement

  28. District Gorontalo (2011) sejumlah

  29. The Way Forward • Increase knowledge and awareness of the population • Establish a proper surveillance system • Ensuring sustainability • Conduct national survey to track progress

  30. The Way Forward (2) • It tells us “WHAT • It tells us “PROBLEM” • But it does not tell us “HOW? • Left us with: ‘ISSUES , UNCERTAINTIES, and ‘HOPES’ Action Non Material Approach

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