1. Progress in Implementation of Child Health Programme 15 Nov 2011Regional CH Meeting, Kathmandu1 Country: Indonesia

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

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

5.  Main causes of Neonatal Mortality: 1. Asphyxia 2. Low Birth Weight 3. Neonatal infections  Main causes of Child Mortality: 1. Neonatal problems 2. Diarrhoea 3. Pneumonia 4. Meningitis 15 Nov 2011Regional CH Meeting, Kathmandu5 Resource: Basic Health Research 2007

6. IMCI implementation started (If yes, year)1997 Newborn Added (If yes, year)1997 Number and Proportion of districts implementing IMCINo data Number and proportion of MOs trainedNo data Number and proportion of Nurses/other workers trained12.556? Proportion of districts (out of IMCI districts) with 60 % or more health providers trained No data IMCI supervisory checklists introduced1998, 2005 2010 rev Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during previous year No data Proportion of districts (out of IMCI districts) covered with Follow-up IMCI training No data

7. IMCI implementation review conducted (If yes, year; National or sub-national) 2002 2009 IMCI Health Facility Survey conducted (If yes, year; National or sub-national) 2008 (8 districts), 2010 in 3 District in Aceh Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI 4.118 ? Pre-Service IMCI teaching/training: Number and proportion of Medical Schools teaching IMCINo data Number and proportion of Nursing Schools teaching IMCINo data ICATT introduced (If yes, year and scale)2009 – 2012

8. 15 Nov 2011Regional CH Meeting, Kathmandu8

9. 15 Nov 2011Regional CH Meeting, Kathmandu9 PHC implementing IMCI compared to total of PHC in 3 districts in Aceh 2010 0 10 20 30 40 50 60 Aceh BesarAceh JayaAceh TimurTotal All puskesmasImplementing IMCI

10. 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: 1. Decentralization and flow of funding 2. inadequate program coordination in MOH, PHO & DHO 3. High turnover of program managers in PHO & DHO 4. Lack of supervision & monitoring 5. Scaling up to large number of PHC and midwives & nurses a big problem. 15 Nov 2011Regional CH Meeting, Kathmandu10

11.  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) 15 Nov 2011Regional CH Meeting, Kathmandu11

12.  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. 15 Nov 2011Regional CH Meeting, Kathmandu12

13.  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 15 Nov 2011Regional CH Meeting, Kathmandu13

14. The precentage of services in line with Standards in 6 PHC with bed in 6 Provinces 1.Supporting HS 2.Emergency HS 3.Child health care In patient 4.Manajemen child health care in patient 5.Neonate HS 6.Patient monitoring 7.Mother & baby friendly health services 8.Supporting PHC 9.Follow up HS 10.Access to PHC GOOD Needs improv ement Strong Need for improv e ment

15. The precentage of services in line with Standards in 18 Hospital in 6 Provinces GOOD Need impro vment Strong Need for impro ve ment 1.Supporting HS 2.Emergency HS 3.Child health care In patient 4.Manajemen child health care in patient 5.Neonate HS 6.Patient monitoring 7.Mother & baby friendly health services 8.Supporting PHC 9.Follow up HS 10.Access to PHC

16.  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 15 Nov 2011Regional CH Meeting, Kathmandu16

17. CCM

18.  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 15 Nov 2011Regional CH Meeting, Kathmandu18

19. 15 Nov 2011Regional CH Meeting, Kathmandu19  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)

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

21. 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 15 Nov 2011Regional CH Meeting, Kathmandu21

22. 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 15 Nov 2011Regional CH Meeting, Kathmandu22

23. 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 15 Nov 2011Regional CH Meeting, Kathmandu23

24. 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 15 Nov 2011Regional CH Meeting, Kathmandu24

25. 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 15 Nov 2011Regional CH Meeting, Kathmandu25

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