Australia Indonesia Partnership for Maternal and Neonatal Health
(AIPMNH) June 2015
AIPMNH is managed by Coffey on behalf of the Australian Government
AIPMNH is a partnership between the Government of Australia and the Government of Indonesia, operating from January 2009 to December 2015 assisting governments and communities in Nusa Tenggara Timur (NTT) and has successfully reduced maternal mortality by 40%.
Purpose
Strategy
Provide technical assistance, management expertise and other resources to support Government of Indonesia, organisations and communities to reduce maternal and neonatal mortality. Total value of the Grant from the Australian Government to June 2015 is 76 million Australian dollars.
Identify factors contributing to maternal and neonatal mortality and morbidity and implement solutions that address deficiencies in health services and the constraints on communities accessing services.
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Results 14 Districts 2009 to 2014 40%
7%
reduction in maternal mortality
reduction in neonatal mortality
31%
30%
increase in Facility Deliveries
increase in management of maternal and neonatal complications
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11
District Hospitals capable of PONEK and improved referral system
District Hospitals accredited
licenced
and
AIPMNH Approach (Key Success Factors) Catalyse cross-sectoral collaboration to focus on MNH Work through, and strengthen government budgeting, planning and implementation systems Foster development of local initiatives and innovative solutions for local problems Improve monitoring and evaluation to provide feedback to inform decision making Remain flexible and responsive to emerging needs and promising interventions Provide multiple mechanisms for dissemination of learning and replication
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Intended Beneficiaries Women and their families in the 14 Districts of NTT with a population of 3.6 million in 2014, and approximately 96,000 births each year. Districts Ende Sikka Sumba Timur Kota Kupang Lembata Ngada Manggarai Manggarai Barat Sumba Barat Kab Kupang TTS TTU Belu Flotim
2009
2010
2011
2012
2013
2014
2015
Partners and Roles Government of Indonesia agencies at national, provincial and district levels; Bappeda, Health, Community Empowerment, Family Planning and Women’s Empowerment. Role: to develop strategies, plan and allocate resources, implement, monitor and evaluate. Academic institutions; University of Nusa Cendana NTT, University of Gadjah Mada, Yogyakarta. Role: to provide technical support, develop and manage studies, develop and deliver training programs, coordinate the Sister Hospital program. Professional organisations; IBI, IDI, POGI, IDAI, IAKMI, at both national and local levels. Role: to provide technical input to training, studies, strategy development. Hospitals; eleven district and nine national. Role: implementing partners and targets to improve referral services, improve management and achieve BLUD status. Other organisations at provincial and district levels; Religious, PKK, PMI. Role: implementing partners and to provide technical advice. Private sector. Role: provision of technical support, equipment and supplies, renovation and construction.
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12 Major Innovations and Initiatives 1. Partnership Management Unit All activities are planned and implemented through Provincial and District Bappeda using standardised unit costs thus aligning with local strategies and priorities, promoting ownership, avoiding duplication and preventing scheduling conflicts. 2. MNH Desa Siaga and Revitalisasi Posyandu Six community networks and a unique monitoring system were established in over 300 villages to support pregnant women to deliver in health facilities, coupled with improved management and use of Posyandu. 3. Puskesmas Reformasi Mechanisms and processes for bringing communities and health staff together to agree on expectations; introduction of transparency in health facility planning and budgeting and oversight by community boards in 61 Puskesmas.
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4. Sister Hospital Program Indonesian teaching hospitals in central cities were paired with 11 district hospitals for provision of specialist services and capacity building for both clinical services and management. District governments provided funding for specialist training of local doctors, with coordination and monitoring of the whole program by the University of Gajah Mada. 5. Clinical Skills for Health Centre (Puskesmas) Staff Clinical skills training was strengthened through development of clinical training centres in the district hospital, introduction of Clinical Instructor training for Puskesmas Midwife Coordinators, and development and implementation of hospital internship (on the job or magang) training for Puskesmas staff. 6. Performance Management and Leadership (PML) Puskesmas Development and implementation of the self-paced, learning by doing training program for Puskesmas and district health staff, combining web based distance learning, and periodic face to face meetings with local mentors. 7. SIKDA NTT The regional health information system (SIKDA) was revised and new templates for reporting developed to reduce facility reporting requirements and use a one-door approach for data. The system was then progressively introduced across all NTT districts, mostly paper based but with options for electronic systems where electricity and internet was available.
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8. Behaviour Change Communication (BCC) Development and implementation of an active learning curriculum for interpersonal communication for village and health centre staff. Production of the cinema standard film ‘Inerie’ filmed in Flores. Formation of District BCC teams able to produce locally appropriate programs and materials. 9. Planning and Budgeting Development and implementation of the Integrated Health Planning and Budgeting program – Gender Responsive improved the alignment of annual plans with identified problems. 10. Human Resource Information System (SIMK) Development and implementation of a web based system (aligns with GOI SIMPEG) for mapping, workload measurement and tracking of health personnel that is inclusive of trainings completed. 11. Audit Maternal Perinatal (AMP) All districts are now implementing routine AMP supported by a provincial coordinating team including relevant technical specialists from the professional organisations. Implementation of the new operational guidelines provides detailed evidence for planning and interventions. 12. Studies Risk factors associated with maternal health and neonatal mortality; Audit of MNH data; Knowledge and skills retention post training and staff transfers.
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Policies and Regulations Supported District and village level MNH regulations Health workforce regulations in Flores Timur, TTU and Sumba Timur In process as at June 2015 Bupati’s regulation on integrated data reporting from the DHO, the District Hospital, BKKBN and the private sector (Ngada District) Governor’s regulation on the AIPMNH introduced Integrated Health Planning and Budgeting (Gender Responsive) Provincial Regulations on SIKDA and PML Puskesmas Revision to Revolusi KIA and to become Provincial Regulation
Replication All Districts plus two non-AIPMNH districts are replicating initiatives with their own funding.
Information Go to www.aipmnh.org that has both Indonesian and English sites to access full contact details, a range of materials on specific AIPMNH innovations, studies, evaluations, reports, stories of change and reports. Videos and movies are available on YouTube by typing in AIPMNH in the search box; https://www.youtube.com/results?search_query=AIPMNH
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12 Inovasi dan Inisiatif Utama 1.Unit Pengelolaan Kemitraan Semua kegiatan direncanakan dan diimplementasikan melalui Bappeda Provinsi dan Kabupaten, menggunakan standar biaya lokal, sehingga selaras dengan strategi dan prioritas daerah, mendorong rasa kepemilikan, menghindari duplikasi dan mencegah terjadinya tumpang tindih jadwal perencanaan. 2. Desa Siaga KIBBLA dan Revitalisasi Posyandu Enam jejaring masyarakat dan sistem pemantauan yang unik berhasil dibentuk di lebih dari 300 desa guna membantu ibu hamil melahirkan di fasilitas kesehatan, dilengkapi dengan peningkatan pengelolaan dan pemanfaatan pelayanan posyandu. 3. Puskesmas Reformasi Berbagai mekanisme dan proses menyatukan masyarakat dan tenaga kesehatan dalam menyepakati hasil yang hendak dicapai; memperkenalkan perencanaan dan penganggaran secara transparan dan diawasi oleh badan penyantun di 61 Puskesmas.
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Penerima Manfaat Para ibu dan keluarganya di 14 dari 22 Kabupaten di NTT, dengan jumlah penduduk 3,76 juta pada tahun 2014, dan sekitar 96.000 persalinan setiap tahun. Kabupaten Ende Sikka Sumba Timur Kota Kupang Lembata Ngada Manggarai Manggarai Barat Sumba Barat Kab Kupang TTS TTU Belu Flotim
2009
2010
2011
2012
2013
2014
2015
Mitra dan Perannya Instansi-instansi Pemerintah Indonesia di tingkat pusat, provinsi dan kabupaten: Bappeda, Dinkes, Badan Pemberdayaan Masyarakat, BKKBN dan Badan Pemberdayaan Perempuan. Peran: menyusun strategi, perencanaan dan alokasi sumber daya, melaksanakan, memantau dan mengevaluasi. Lembaga akademik: Universitas Nusa Cendana, NTT; Universitas Gadjah Mada, Yogyakarta. Peran: memberi bantuan teknis, mengembangkan dan melaksanakan penelitian, mengembangkan dan menyajikan program-program pelatihan, dan koordinasi program Sister Hospital. Organisasi profesi: IBI, IDI, POGI, IDAI, IAKMI, di tingkat pusat dan regional. Peran: memberi masukan teknis untuk pelatihan, penelitian, dan penyusunan strategi. Rumah sakit: sebelas RSUD dan sembilan rumah sakit nasional. Peran: melaksanakan kemitraan dan mencapai target yaitu meningkatkan layanan rujukan, meningkatkan pengelolaan dan memperolah status Badan Layanan Umum Daerah (BLUD). Organisasi lainnya di tingkat provinsi dan kabupaten; organisasi keagamaan, PKK, PMI. Peran: melaksanakan kemitraan dan memberikan bantuan teknis. Sektor swasta. Peran: menyediakan bantuan teknis, suplai dan peralatan kesehatan, renovasi dan pekerjaan konstruksi.
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Hasil di 14 Kabupaten 2009 sampai 2014 Penurunan kematian ibu
40%
Penurunan kematian neonatus
7%
RSUD berizin operasi dan terakreditasi
RSUD mampu menyajikan pelayanan PONEK dan memperbaiki sistem rujukannya
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11
30%
31%
Peningkatan penanganan komplikasi ibu dan bayi
Peningkatan persalinan di faskes
Pendekatan AIPMNH (kunci keberhasilan) Menggerakan kerja sama lintas sektor agar berfokus pada KIBBLA Bekerja melalui dan memperkuat sistem penganggaran, perencanaan dan pelaksanaan kegiatan instansi pemerintah Indonesia Mendorong pengembangan inisiatif-inisiatif lokal dan solusi-solusi inovatif untuk berbagai persoalan lokal Meningkatkan sistem pemantauan dan evaluasi dalam rangka memberi umpan balik bagi pengambilan keputusan Tetap fleksibel dan responsif terhadap kebutuhan yang muncul dan intervensi yang bermanfaat Memberikan berbagai pilihan mekanisme dalam menyebarluaskan pembelajaran dan replikasi
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AIPMNH adalah kemitraan antara Pemerintah Australia dan Pemerintah Indonesia, berkarya sejak Januari 2009 hingga Desember 2015. Program ini membantu pemerintah dan masyarakat di Nusa Tenggara Timur (NTT), dan telah berhasil menurunkan kematian ibu sebanyak 40%.
Mengidentifikasi faktor-faktor yang berkontribusi terhadap kematian dan morbiditas ibu dan bayi baru lahir, serta menerapkan berbagai solusi untuk mengatasi kekurangan dalam pelayanan kesehatan dan berbagai persoalan yang menghambat masyarakat dalam mengakses pelayanan kesehatan.
Memberi bantuan teknis, manajemen, dan sumber daya lainnya untuk membantu Pemerintah Indonesia, lembaga dan masyarakat menurunkan kematian ibu dan bayi baru lahir. Total bantuan yang diberikan oleh Pemerintah Australia sampai dengan bulan Juni 2015 adalah 76 juta dolar Australia.
Strategi
Tujuan
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Australia Indonesia Partnership for Maternal and Neonatal Health
(AIPMNH) Juni 2015
AIPMNH is managed by Coffey on behalf of the Australian Government
