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SUB NATIONAL HEALTH SYSTEM PERFORMANCE ASSESSMENT (Indonesia Experience)

SUB NATIONAL HEALTH SYSTEM PERFORMANCE ASSESSMENT (Indonesia Experience). National Institute of Health Research and Development In Collaboration with World Health Organization BPS Statistics Indonesia. Why Assess District Health System Performance in Indonesia?.

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SUB NATIONAL HEALTH SYSTEM PERFORMANCE ASSESSMENT (Indonesia Experience)

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  1. SUB NATIONAL HEALTH SYSTEM PERFORMANCE ASSESSMENT (Indonesia Experience) National Institute of Health Research and Development In Collaboration with World Health Organization BPS Statistics Indonesia

  2. Why Assess District Health System Performance in Indonesia? • Decentralization in 2001 redefined role of central MoH and districts: created new challenges vis-à-vis district-centre information flows. • National health goals, similar to those identified by WHO HSPA. • Variety of reforms in last 10 years: to improve staff distribution, insurance coverage, provider performance (quality), etc. • Interest in what existing data can say about district performance and what the implications would be for district benchmarking.

  3. WHO HSPA Framework Goals and functions of the health system GOALS / OUTCOMES FUNCTIONS Stewardship (Oversight) Responsive-ness HEALTH Resources Generation Service Proviision Financing (Collecting, Pooling and Purchasing) Fair Financial Contribution

  4. Adaptation of WHO HSPA for Indonesia WHO HSPA 2000 FrameworkIndonesia Application Scope International/National District-level Goals/Outcomes HALE Life expectancy Fairness in Financial Catastrophic expenditure contribution Responsiveness Responsiveness Risk Factors Smoking Access to safe water Intermediate Coverage indicators Coverage indicators Outputs Provider performance Utilization InputsHealth expenditure Human resources Education Facilities Income Female education

  5. Health Information System: Indonesian Data Sources Population based: • CENSUS 2000. • Household surveys (Susenas and other household surveys). Health service based: • MoH inventories: human resources; facilities. • National health accounts. • Public health expenditure review. Studies: • Indonesia Human Development Report 2001,04

  6. Indonesia Sub-National HSPA Report Part I: Intro/Background • II: Health and Health System Goal • Health conditions • Financial protection • Responsiveness of the health system • III: Risk Factors and Health Services Provision • Risk Factors • Coverage and health services utilization • IV: Health system resources • Human resources • Health facilities • V: Health system performance • Health system efficiency VI: Conclusions

  7. DISTRICT VARIATIONS IN LIFE EXPECTANCY AT BIRTH National Estimate: 66.2 Range: 57.5 – 73.7 Below National Estimate Above National Estimate

  8. DISTRICT VARIATION OF LIFE EXPECTANCY WITHIN PROVINCE There are significant differences in average life expectancy across provinces; 8 provinces exceed the Healthy Indonesia 2010 target of life expectancy of 67.9

  9. Catastrophic health payments and impoverishment National Average National Average

  10. District Variationin Catastropic Health Payment within Province

  11. Responsiveness Percentage of respondents rating a responsiveness domain to be most important Health system responsiveness by domain and type o care

  12. DISTRICT VARIATION IN BIRTHS ATTENDED BY TRAINED PERSONEEL WITHIN PROVINCE

  13. Human Resources and Coverage • A higher concentration of midwives increases the likelihood for a district to achieve greater than 80% skilled birth attendance (MDG target) • However, the relationship is not very clear for the highest category of midwives – the number of districts achieving more than 80% coverage is less for the highest category (52+) than for the second highest (31–51) • Though when we include physicians and nurses together with midwives the relationship between higher coverage and higher concentration of human resources is stronger

  14. DISTRICT VARIATION IN UTILIZATION OF AMBULATORY CARE WITHIN PROVINCE

  15. EFFICIENCY ANALYSIS

  16. Key Messages • HSPA framework can be applied at sub-national & can be used for setting benchmarks. • Benchmarks may include input, output, outcome, non health-related aspects of health system, quality of care • Input vs Output: Measure Efficiency • Indicators selection and target setting • Problems related to data availability and quality (HIS)

  17. Next steps • HIS assessment (HMN tool). • Advocacy: Common understanding on principles of HIS for all parties concerned • Strengthen data sources both population based and service based • Population based: • Surveys: strengthen the integration • Vital registration: Initiate IMRSSP

  18. NATIONAL HEALTH SURVEY (SURKESNAS) TOWARDS HEALTHY INDONESIA 2010 Integrated Approach Round 2007 2001 2004 2010 Community based IDHS Other surveys Baseline Evaluation Monitoring Monitoring NHHS/ BHR NSES (Process indicators) (Process indicators) (Outcome & process indicators) (Outcome & process indicators) SURKESNAS HFS Facility/service based Focus of survey Notes: NHHS/BHR: National Household Health Survey/Baseline Health Research; NSES (SUSENAS): National Social Economic Survey; IDHS (SDKI): Indonesia Demographic and Health Survey; HFS: Health Facilities Survey

  19. IMRSSP: Flow of COD reporting (Generic) DEATH EVENT HOME Health Facility CERT, 2 DeathReport DOA CERT, 1 POLICE CENTRAL RT/RW Death Report CODStat CERT, 1 CERT, 1 Death Report VA VILLAGE COD Stat Death Report CERT, 2 HEALTH CENTER District Health Office PROVINCE COD Stat SUB-DISTRICT COD Stat Death Report Vital Stat POP ADMN COD Notification System (Health Center  DHO)

  20. THANK YOU

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