MCHIP /INDONESIA Model of Integrated MNCH intervention Package : Accelerate the reduction of maternal and neonatal morbidity and mortality toward achievement of MDGs 4 &5

At a glance  Three-year program, $9.8 million  Original: January 2010-December 2011 with $4.8 million budget  In October 2010, MCHIP was extended until December 2012 with an additional $5 million  National and district level activities in Three component of intervention: Community intervention Clinical services Strengthen health system and District health planning. 2

At a glance  At the district level, integrated approach in “health problem areas”  Partners:  Jhpiego: Overall program management, clinical services, and Kutai Timur  Save the Children: Community, newborn, and Bireun district  JSI: Governance and health system planing and Serang 3

Intervention Package. Intervention / Area Community/ New born Clinical/ maternal Health system & District planning BireuenMSG, CCM, C-KMC, I-PNC, TBA –MW partnership, HW Newborn SBMR, partograph, PE/E, AMTSL, NB rhesus, BF ) DTPS, advocacy MNCH policy, AMP, surveillance. Kutai TimurMSG, CCM, C-KMC, I-PNC, TBA –MW partnership, HW newborn SBMR, partograph, PE/E, AMTSL, NB rhesus, BF ) DTPS, advocacy MNCH policy, AMP, surveillance SerangMSG, I-PNC, TBA – MW partnership, HW new born. SBMR, partograph, PE/E, AMTSL, NB rhesus, BF ) DTPS, advocacy MNCH policy, AMP, surveillance 4

Integration  Integration of maternal and newborn services  Integration of community, health facilities, and district health offices ( district health planning)  Integration of key practices and behaviors into ANC and PNC 5

Integrated MNCH Package from HH to HF are effective and efficient Increased service coverage Improve Clinical service quality Increase of community demand Improve Health behavior and practice at HH and Community Level Improve service demand Improve planning process and sustainability Integrated 3 component approach. Community Clinical District health system planning Case findings, referal Logistic, supply, supervision, monitoring Selected plan base on need

Overview of Workplan Submissions 7 Jan-Mar 2010, MCHIP WP draft Submitted to USAID ( ) Oct-Nov, 2010 Revised WP, extend program until2012 April 2011 Revised WP to include scale up strategy to other district within province.

Current Results Framework SO2: Improve Maternal and Newborn Care practices at the community Level SO3 Improve Quality of care services at all level of care SO4 Improve management of the district Health System S01 cross cutting): Effective implementation of MDG Roadmap for scaling up life-saving interventions to achieve MNCH impact at scale within three remote provinces. Program Goal Catalyze implementation of existing policies that promote key evidence based life saving interventions at scale in remote areas 8

DEMAND SUPPLY MANAGEMENT Inter- dependency Coordination 1.Mother suport Group 2.C-KMC 3.CCM 4.Integrated PNC 5.Midwife-TBA Partnership 6.Hand washing SBMR, OJT/OJM of PI, IMCI, KMC, partograph, PE/E, AMTSL, NB rhesus, BF Distric Planing and problem solving. Advocacy, AMP, Surveilence Component of Integrated MNCH Package Monitoring, Controlling, Evaluation Planing Movement implementation strengthen Health providers capacity and standart service in Primary health centre and Distric hospital Strengthen Program management and planning, Increase health budgeting and create supportive policy community mobilization/empowe rment

What would we like to see districts scaling up?  Community practices  Integrated mothers’ classes to promote good practices—8 key practices  Three integrated postnatal visits in the first month of life  Midwife-TBA partnerships to increase use of midwives and facilities 10

Community ( count..)  Community KMC to care for stable low birth weight babies at home with follow up from puskesmas  Kaders and Bidan di Desa identifying and initiating treatment for sick newborns 11

What would we like to see districts scaling up?  Improved clinical services  Use of performance standards, mentoring, recognition to change provider practices (partograph, PE/E, AMTSL, NB resus, IMD/ASI)  Puskesmas competently and confidently managing normal births and providing basic emergency care 12

What would we like to see districts scaling up?  Improved district health management  Maternal-perinatal audits for every death  The multi-level DTPS planning process to develop and advocate for MNCH budgets 13

What are we trying to achieve?  Scale up of key evidence based life saving interventions in remote areas  By providing catalytic inputs, document how to implement existing policies and programs  support our target districts to provide TA to other districts in each province in Coordination. DEMAND SUPPLY MANAGEMENT S1S1 S3S3 S2S2 S1=Planning S2=Movement and implementation S3=Monitoring, Countroling dan evaluation

Progress to Date  Sub-objective 1: Effective implementation of MDG Roadmap for scaling up life-saving interventions to achieve MNCH impact at scale within three remote provinces.  Scale up of Kelas Ibu in neighboring sub districts and districts  Scale up of MCHIP approaches to other districts with support from corporate partners 15

Progress to Date  Sub-objective 2: Improve Maternal and Newborn Care Practices at the Community Level  Kelas Ibu: MOH materials and methodology adopted to integrate key practices for ANC and PNC; kaders as facilitators  Midwife-TBA partnership: Scaling up example from Takalar District; development of village regulations underway  Integrated PNC: Consensus on single schedule achieved; development of job aid and updating of midwives underway 16

Progress to Date (cont)  Sub-objective 2: Improved maternal and newborn care practices at the community level  KMC and CCM: Materials developed and approved for use in Bireun and Kutai Timur; training for midwives and kaders conducted in Bireun  Handwashing with Soap: Collaboration with National Handwashing Alliance; agreed to make handwashing for newborn survival a key topic for 2011; formative research with Unilever/LSHTM completed 17

Progress to Date (cont)  Sub-objective 3: Improved quality of clinical services at all levels of care  Performance standards in use for hospital, puskesmas, and bidan di desa; steady improvement observed  On the job training and mentoring ongoing  Use of US midwives to accelerate progress  Current emphasis on PONED and PONEK  Maternal-perinatal audit teams being established in each district  Pre-eclampsia/eclampsia survey  Collaboration with HealthTech 18

Progress to Date  Sub-objective 4: Improved management of the district health system  Multi-level district team problem solving approach implemented for 2011; facilitators trained to implement in 2012  Referral assessment conducted  Local regulations and laws being developed 19

Contributions to Program Learning  Scale up in remote areas  Community KMC and CCM  Handwashing for newborn survival 20

21 Terimakasih….. Thank you…