MONTHLY TECHNICAL REPORT
EVIDENCE SUMMIT REDUCING MATERNAL AND NEONATAL MORTALITY IN INDONESIA
NOVEMBER - DECEMBER 2016
Indonesian Academy of Science Jalan Hang Lekiu I no. 6A, Kel. Gunung, Jakarta Selatan DKI Jakarta, Indonesia 12120
This report was produced for review by the United States Agency for International Development. It was prepared by the Indonesian Academy of Sciences (AIPI). This report is made possible by the support of the American People through the Unites States Agency for International Development (USAID). The contents of this report are the sole responsibility of AIPI and do not necessarily reflect the views of USAID or the United States Government.
CONTENTS Contents .............................................................................................................................................................................. 2 Abbreviations ..................................................................................................................................................................... 3 Executive Summary ........................................................................................................................................................... 4 Objective & Expected Results Assessment ................................................................................................................. 4 Activities completed ......................................................................................................................................................... 4 Barriers and Challenges .................................................................................................................................................13 Conclusions and Recommendations ...........................................................................................................................13 Next steps .........................................................................................................................................................................13 Annexes .............................................................................................................................................................................14 Annex 1. Updates on Progress of Focal Questions from AER ....................................................................... 14 Annex II. Assignation of CTG to Focal Questions ............................................................................................ 16
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ABBREVIATIONS AER
Associate Evidence Reviewer
AIPI
Akademi Ilmu Pengetahuan Indonesia (Indonesian Academy of Sciences)
CTG
Core Technical Group
EC
Executive Committee
ERT
Evidence Review Team
FQ
Focal Question
IDAI
Ikatan Dokter Anak Indonesia / Indonesian Paediatric Society
IT
Information Technology
MCSP
Maternal Child Survival Program
POGI
Perkumpulan Obstertri & Ginekologi Indonesia / Indonesian Association of Obstetrics and Gynecology
TA
Topic Area
URC
University Research Co., LLC
USAID
United States Agency for International Development
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EXECUTIVE SUMMARY In overall, November was allocated for activities associated with finishing the progress set as objectives in October such as finalizing and approving all the protocols. As for December, the focus is to produce outputs to be presented at the pre-summit. The major accomplishments would be the focal group discussion with one of the stakeholders and the initiation of being subcontracted by MCSP (Maternal Child Survival Program) team from Jhpiego and Save the Children. The main challenge was to follow the progress in a timely manner (based on deadline and scheduled objectives) in order for everyone to be effective and actively contribute to the Evidence Summit.
OBJECTIVE & EXPECTED RESULTS ASSESSMENT Objective The finalized output of the Evidence Gathering stage (designing search strategy, choosing the resources, call for evidence)
Expectation All the protocols from existing focal questions are finalized and approved.
Results Compared to the progress in October, more protocols are finalized and the existing focal questions are all assigned to ERT (including the new focal questions from Topic Area 5 and 6).
The finalization of Selection stage (sorting the evidence, screening eligibility)
All the necessary evidences are collected and screened.
No additional evidence received through call of evidence (same results as of October). Except through contributions from the CTG or ERT, we have received additional ones and uploaded them to Dropbox. However, the AER has managed to obtain hundreds of journal articles in the internet.
ACTIVITIES COMPLETED 1. CTG MEETING IV (1ST- 2ND OF NOVEMBER) A. OBJECTIVES: •
Reviewing all the protocols based on focal questions (FQ) for Topic Area 1, 2 and 3 submitted by the ERT
B. RESULTS: • Protocol for FQ 1A is reviewed and its focal question is rephrased • Protocol for FQ 1B is approved with minor revisions • Protocol for FQ 1C is approved with minor revisions • Protocol for FQ 1D is reviewed and its focal question is rephrased • Protocol for FQ 1E is approved with no revisions • Protocol for FQ 1F is reviewed and its focal question is rephrased 4
• • • • • • • • • • • • • •
Protocol for FQ 1G is approved with no revisions Protocol for FQ 1H is approved with no revisions Protocol for FQ 1I is reviewed and its focal question is rephrased Protocol for FQ 1J is reviewed and its focal question is rephrased Focal question 1K combined with focal question 1F. The FQ of 1K is taken from FQ 2E which is no longer in Topic Area 2 Protocol for FQ 2A is reviewed and its focal question is rephrased Protocol for FQ 2B is approved with minor revisions Protocol for FQ 2C is reviewed and its focal question is rephrased Protocol for FQ 2D is approved with no revisions Focal question 2E is moved to Topic Area 1 into FQ 1K Focal question 2F Is combined with FQ 3A and FQ 3B and rephrased into one focal question of 3A Protocol for FQ 3C is renumbered into FQ 3B., its focal question is rephrased Focal question 3D is renumbered into FQ 3B, its protocol is approved with no revision Three focal questions are firmly formulated to be placed within Topic Area 0. 4. 5 or 6
C. CHALLENGES: •
The problem in October persist where finalization is still steps away since several focal questions are rephrased and only a few protocols are approved
D. PHOTOS:
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2. ERT – AER WORKSHOP IV (16TH OF NOVEMBER) A. OBJECTIVES: • • •
Reporting of finalized protocols and preliminary search results from ERT in Topic Area 1, 2 and 3 Technical discussion on Topic Area 0, 4, 5 and 6 regarding focal questions and data collection Priority objective is to finalized all the protocols to start searching
B. RESULTS: • • • •
• • • • • • •
Protocol for FQ 2B was discussed and amended Protocol for FQ 2C was discussed and amended Protocol for FQ 1D, its question is slightly rephrased again Protocol for FQ 1H is considered as not finished and cannot proceed to searching since the keywords are yet to be determined by all ERT (one of the ERT is absence) Protocol for FQ 1E can proceed to searching step Protocol for FQ 1F is being revised Protocol for FQ 1G can proceed to searching step Protocol for FQ 1I can proceed to searching step Protocol for FQ 1J is being revised on the spot Protocol for FQ 2A can proceed to searching step Protocol for FQ 2B can proceed to searching step 6
• • • • • • • • • •
Protocol for FQ 2C can proceed to searching step Protocol for FQ 2D can proceed to searching step The combined protocol of focal questions 2F and former FQ 3A and former FQ 3B is discussed further Protocol for FQ 3B can proceed to searching step Protocol for FQ 3C can proceed to searching step Protocol for FQ 1B is already in the midst of searching Protocol for FQ 1D is finalized Protocol for FQ 3A was revised based on feedback on the spot Additional FQs of 5A, 5B and 6A were assigned to pairs of ERT and AERs; as for details of data collection, a method is yet to be confirmed Specific updates on progress from AER (refer to Annex I)
C. CHALLENGES: Not all protocols were able to be presented on the spot and reviewed by the CTG with the attendance of ERT which is unfortunate. Since having the ERT sit together with CTG would actually be beneficial compared to when the review session is solely done by CTG since the ERT could hear and ask directly shall the revision inputs are deemed as unnecessary or unclear. For example, on the last reviewing session, the ERT was not invited to understand why three focal questions were combined into one protocol thus ERT needed more time to comprehend.
D. PHOTOS:
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3. CTG – STAKEHOLDER MEETING (23TH OF NOVEMBER) A. OBJECTIVES: • •
•
Introducing Evidence Summit on Reducing Maternal & Neonatal Mortality in Indonesia project to stakeholder (i.e. POGI) Presentation on background problems on maternal and child mortality/health including key questions regarding formulating alternative policy by Coordinator of CTG (Core Technical Group)
Consultation on eligible service for healthy and safe pregnant women and the fetus by Coordinator of CTG to respective stakeholders
B. RESULTS: •
• •
Agreed action plan of engaging other stakeholders through similar group discussions (i.e with Director Generals of the Ministry of Health and professional organization) There is a need for public outreach to both the public and the government before the Summit Agreed that the core problems of maternal and neonatal mortality are: 8
1. 2. 3. 4.
The lack of prioritization from the government The lack of awareness from the public The lack of access to reaching healthcare services The lack of highly-qualified healthcare services
C. CHALLENGES: Out of two stakeholder groups invited, only one group attended. The discussions were therefore lacking from the perspective of IDAI or known as Indonesian Paediatric Society.
D. PHOTOS:
4. ERT-AER WORKSHOP V (14 TH OF DECEMBER) A. OBJECTIVES: • •
Report on progress from every focal question including challenges and constrictions Introduction, sharing experience and inputs from MCSP (for 90 minutes)
B. RESULTS: all protocols are finally approved and it was decided that the CTG will be involved directly with the focal questions by being divided into 3 groups (see Annex II) C. CHALLENGES: There is yet to be clear timeline or schedule established for the upcoming months that would be specific to delivering the outputs (producing bibliography and/or reviews for policy recommendations). 9
D. PHOTOS:
5. CTG MEETING V (21ST OF DECEMBER) A. OBJECTIVES: 10
• • •
Evaluate the progress of review results based on workshop on the 14th of December Discuss the strategy to improve the performance of Evidence Summit in achieving desired outputs by the beginning of February 2017 Discuss the feedback or inputs from MCSP, including completing the work plan & time line
B. RESULTS: • CTG will actively participate with the ERT on several stages of selecting and reviewing the evidence. • The focus for the next two months until a national health meeting that is held annually by the Ministry of Health (i.e. RAKERKESNAS) will be to finish systematic review of the existing focal questions in Topic Area 1, 2, 3, 5 and 6 by producing a bibliographic reference. It is predicted that the RAKERKESNAS will be in March 2017. • The next workshop will be on the 11th of January 2016 of which the ERT is expected to have done quality assessment to the articles chosen based on their focal questions respectively. • On the 13th of February 2016, the ERT will submit the draft of systematic review report to the CTG for them to review. • ERT will be paid based on output (i.e. review), rather than receiving activity-based honorarium, which will have an effect on the budget realignment. • On the 17th of February, the ERT will present their results of the evidence quality assessment to the CTG. • On the 26th – 27th of February, the CTG will have a meeting to formulate the output of the Evidence Summit in the form of a policy brief or presentation to be delivered at the Rakerkesnas. C. CHALLENGES: The main challenge that emerged from this meeting is the lack of effective collaboration between the ERT and CTG to reach the set targets.
D. PHOTOS:
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BARRIERS AND CHALLENGES Specifically, in November, the biggest challenge was finalizing and approving all protocol determinants as a result of: •
•
Low Response Rate: When going offline/virtual/not in person, the AER, ERT and CTG are spread across Indonesia among their busy schedules. The ERT would not revise the protocols promptly between one another nor report to the AER. The AER would be offline or away from laptops since they are very mobile and do not have a stable physical working environment. The Secretariat would not reply to emails promptly nor collect all the information off working hours, and the CTG were often reminded via email and phone to review the protocols but still give no response within days or weeks. The most productive method of communication and collaboration is to conduct meetings in person, such as workshops, yet it is not financially effective. Effective Discussion: During workshops or meetings, plenty of minds and perspectives are combined and each have their own to say; this caused the protocols and the focal questions to be rephrased. Sometimes it becomes challenging to agree upon the same thing or to have the same perspective. The Executive Committee should be strict with how the conversation goes and summarize the agreement during the meeting so it can be confirmed by all the participants.
In December, the biggest challenge was to produce deliverables for the Pre-Summit since specific format or outlines of the product is yet to be finalized nor confirmed. However, the format/template will be prepared by the CTG.
CONCLUSIONS AND RECOMMENDATIONS In conclusion, the project team should accelerate the achievement of review targets with the support from Call for Evidence and additional journal subscriptions. The CTG are now also participating actively by being able to communicate directly across to ERT and AER within a Whatsapp group so any questions can be answered directly and progress is easily reported and observed.
NEXT STEPS The plan of action to be commenced next month is to proceed to making brief recommendations or bibliography per focal question. The progress of the quality assessment will be presented and approved at the upcoming workshop on the 11th of January. Hence the Pre-summit will need to be postponed from the 10th of January, and will be held closely before or after one day from RAKERKESNAS which is predicted to be held in March 2017.
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ANNEXES Annex 1. Updates on Progress of Focal Questions from AER This table below indicates the progress of focal questions based on updates from the AER.
SPECIFIC UPDATES FQ 1A
1B
1C 1D
FQ
Comments and Explanations Focal question 1A berubah bunyi focal question dari “Bagaiamanakah pengaruh/peran pelayanan kesehatan tradisional/traditional birth attendant (TBA) terhadap maternal neonatal mortality” menjadi “Does place of birth influence maternal and neonatal mortality? Protocol Evidence Summit sudah diperbaiki oleh dr. Pramita tetapi belum diperbaiki oleh pasangan ERT (dr. Indah Ita Kartika) dan belum dipresentasikan di depan CTGs. Yang menjadi catatan “Apakah Protocol ES ini sudah bisa dilanjutkan ke tahap pencarian?” Rencana tindak lanjut dengan bantuan sekretariat AIPI akan dikirimkan ke Cordinator Focal Question 1 A. Focal question 1B berubah menjadi seperti berikut. Kata “terhadap” diganti menjadi “dalam “Bagaimanakah peran serta masyarakat (Kader, kepala/perangkat desa, pemuka adat) dalam prevention, promotion, and early detection condition related maternal neonatal health? Rencana tindak lanjut sudah dilakukan pencarian sesuai dengan FQ dan abstrak hasil pencarian sudah dimasukkan ke covidence untuk di review. Dr. Ketut Arystami sudah melakukan pencarian dan info tentang hal ini sudah diberitahukan kepada dr. Indah Ika Kartika Belum sempat dipresentasikan Sumber2 funding yang lain apa saja? Butuh masukan Private sector bekerja sama dengan yayasan-yayasan seperti: organisasi keagamaan, dll Private sector: tidak terkait pemerintah Protocol approved, pencarian dapat dimulai
Comments and Explanation
1I Protokol sudah acc dan tidak ada revisi, bisa lanjut ke searching. Sudah mendapat beberapa jurnal tetapi belum dimasukkan ke Covidence. setelah review dari CTG update tanggal 8 Nov 2016, sudah tidak ada perubahan lagi dan lanjut ke searching. Hasil searching : - 0 jurnal di Pubmed - 12 jurnal di IPI Jurnal belum dimasukkan ke Covidence, sedang melengkapi abstrak 1J baru ketemu 78 jurnal dari Pubmed, Science direct, IPI, EBSCO, Cochrane. 1K Awalnya adalah focal question 2e dan sudah mengalami perubahan menjadi focal question 1 K dengan bunyi sebagai berikut: Bagaimanakah perbedaan utilisasi pelayanan kesehatan tradisional, private sectors, dan formal government health system? Focal question sudah dipresentasikan dan ada masukan dari Prof. Budi Utomo sebagai berikut: Perlu dalam Protocol Evidence Summit dibedakan antara pelayanan kesehatan traditional, private sector, formal goverment health system (Bidan praktik vs mandiri) dan dalam fasilitas kesehatan Antara ketiga tempat pelayanan ini harus ada indikator outcome pencapaian yang perlu dituliskan untuk membedakannya. 2A baru ketemu 30 jurnal dari Pubmed dan IPI. 2B baru ketemu 45 jurnal dari Pubmed dan IPI.
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FQ
Comments and Explanations
2C Protokol sudah acc, usul dari Prof. Endang untuk menambahkan search term yaitu hospital response time, selain itu sudah tidak ada revisi bisa lanjut ke searching. Hasil searching : 7 jurnal dari IPI sudah masuk Covidence dan ERT sudah di tahap review Title/Abstract. setelah review dari CTG update tanggal 15 Nov, revisi terakhir tanggal 16 Nov 2016 karena ada perubahan search term, lalu lanjut ke searching. Hasil searching : - 0 jurnal di Pubmed - 7 jurnal di IPI Jurnal sudah masuk ke Covidence, 7 jurnal sudah di review : 5 disetujui, 2 irrelevant 2D Seluruh ERT tidak hadir Protocol approved pada meeting CTG-AER 1-2 November, pencarian sudah dimulai 3A Have been approved verbally by CTGs on the workshop thus currently Searching for bibliographic databases 3B Protokol sudah acc dan tidak ada revisi, bisa lanjut ke searching. Sudah mendapat beberapa jurnal tetapi belum dimasukkan ke Covidence. setelah review dari CTG update tanggal 8 Nov 2016, sudah tidak ada perubahan lagi dan lanjut ke searching. Hasil searching : - 0 jurnal di Pubmed - 2 jurnal di IPI Jurnal belum dimasukkan ke Covidence, masih dalam proses searching 3D Protocol approved, ERT baru menyetor matrix. Pencarian akan segera dimulai. 5A Have been approved verbally by CTGs on the workshop thus currently Searching for bibliographic databases 6A Have been sent to CTGs and still waiting for the CTGs’ review
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Annex II. Assignation of CTG & AER to Focal Questions No.
Focal Question
1A
Does place of birth influence maternal and neonatal mortality
1B
1C
1D
1E
1F
1G
1H
1I
How do the public (Cadre, village officials, indigenous leaders) take part in prevention, promotion, and early detection condition related to maternal neonatal health? How is the provision of system determinant on urban, rural , remote, border and frontier settings? What is the contribution of the private sector to ensure the availability of continuum of care for maternal (pregnant ) & neonatal? The differences of maternal mortality and morbidity rate receiving care from various healthcare personnel/providers Is there difference on the quality of maternal healthcare across different health workforce/providers? The differences of neonatal mortality and morbidity rate receiving care from various healthcare personnel/providers How do professional associations affect the improvement of health workforce competency & performance? Is there difference on the quality of service across healthcare facilities implementing PONED/PONEK?
CTG 1
CTG 2 CTG Methods AER dr dr Rinawati dr. Detty Mindo Dwiana Rohsiswatmo Nurdiati Nainggolan Ocviyanti dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Mindo Nainggolan
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Amanda Yoga
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Amanda Yoga
dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Sarah Rasyid
dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Sarah Rasyid
dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Sarah Rasyid
dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Sarah Rasyid
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Adrita Nima Sari
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1J
1K
2A
2B
2C
2D
3A
3B
3C
Is there difference on the quality of service across healthcare facilities having received training, support program or accreditation? How do the utilisations differ across traditional health service, private sectors, and formal government health system? Is there any difference in the referral rate, morbidity, and maternal and neonatal mortality before and after the implementation of the National Health Insurance system (JKN) among the vulnerable and poorest population?) What are the referral pattern in urban, rural, remote, border and frontier areas? Apakah pelayanan kesehatan PONED/PONEK meningkatkan kualitas rujukan? Does PONED/PONEK healthcare service increase the quality of referral? How do provision of system determinants affect the timeliness and effectivenes of referral in urban, rural, remote, border and frontier settings? How is the effectiveness of JKN (National Health Insurance) in improving the service and status of health? Does the JKN (National Health Service) improve the services in PONED/PONEK accredited facilities? How do the system determinants in area covered by health insurance differ from the area not covered by health insurance?
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
dr dr Rinawati dr. Detty Dwiana Rohsiswatmo Nurdiati Ocviyanti
Korina Wulandari
Mindo Nainggolan
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Korina Wulandari
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Korina Wulandari
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Adrita Nima Sari
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Amanda Yoga
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Desy Natalia Sagala
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Adrita Nima Sari
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Amanda Yoga
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Does support from the local government affect maternal & 5A neonatal morbidity and mortality? How does maternal/mothersrelated government policy 5B impact maternal & neonatal morbidity and mortality? Does gender equity have impact 6A on maternal & neonatal morbidity and mortality?
Prof Budi Utomo
Prof Endang Achadi
Prof Siti Setiati
Korina Wulandari
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Desy Natalia Sagala
dr. Trihono
dr. Maisuri
Siti Rizny F. Saldi
Desy Natalia Sagala
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