Service Policy of Maternal and Perinatal in Indonesia
Vision, Mission and Values Department of Health Republic Indonesia (No. 331/MenKes/SK/V/2006 about Renstra DepKes 2005-2009)
V a l u e
For Community Doing Save and carry Teamwork High intellegence Transpancy and acountability
MISSION Community Healthty
VISSION : Independent community health
Prior Strategic
Community empowerment to life healhty Community access increase to quality of health services Increase of surveilance system, monitoring and health information Increase of health expenses
Prior Strategic 1
1. 2.
3.
Community empowerment to life healhty
All of village to be alertness in healty Behavioral of All community to health awareness Clean and Nutritive
Prior Strategic 2 1. 2.
3. 4.
5.
Community access increase to quality of health services
Poor people get a good quality of health service Neonate, child and highrisk community coverred from illness Competent human resource in villages are Essensial medicine and medical tools are completed in village Health services at every hospital, puskesmas and the other network in criteria.
Prior Strategic 4
1.
2.
3.
Increase of health expenses
Health development get a expenses priority from top government Government health budgeting priority for preventive and promotion Insurance healty for poor
Condition and Problem of Maternal and Neonate Mortality
a. The high of helthtyless and maternal mortality rate b. The high of helthtyless and neonate mortality rate c. Inadequate access to health facility especially at villages d. Low community awarenss in mother and child healthty
Ad.a. Maternal Rete In Indonesia SDKI 1994, 1997, 2002
500 450 400
390
350
334
300
307
250 200 150
125
100 50 0
1980
1985
1990 SDKI
1995 Target
2000
2005 Linear (SDKI)
2010
2015
Caused of Maternal Mortality Others 12% Puerpureum Copmlication 8%
Bleeding 30%
Embolic obstetric 3% Long labor 5%
Abortus 5% Infection 12% Eclampsia 25%
SKRT 2001
Ad.b. Neonatal Mortality Rate In Indonesia 40
28.2 26
20
20
0 87-92
Sumber: SDKI
93-97
98-02
Caused of Neonatal Mortality Infeksi 5% Tetanus 10%
Gangguan hematologik 6%
Mslh pemberian minum 10%
others 13%
lowbirth 29%
Sumber: SKRT 2001
Asfiksia 27%
Ad.c. Minimalize Access to service Health Facilities
1.
2. 3. 4.
75% RSU Kabupaten mempunyai Sp Obsgyne, melakukan PONEK tapi tidak 24 jam. 59 % Puskesmas melakukan PONED. 50% desa mempunyai Polindes. Sistem Pencatatan dan Pelaporan belum optimal.
Ad.d.Rendahnya kepedulian masy termasuk provider 1. 2. 3. 4.
66 % ibu hamil tahu fasilitas kesehatan Hanya 33% dari mereka mamanfaatkan untuk ante natal care 59,9 % kelahiran dengan tenaga kesehatan Organisasi Profesi belum mendukung program secara optimal ( perawat, bidan, Obgin, Dokter anak ) 5. Peran Dinkes belum optimal dalam mendukung program 6. Transfer skill & knowledge dari spesialis ke dokter umum, bidan perawat belum optimal 7. Delegasi wewenang kepada dokter , bidan ,perawat belum berjalan baik . 8. Management Development System of Clinical Performance for midwife & nurse in health center ( WHO) menyatakan bahwa bidan & perawat melakukan lebih banyak aktivitas non klinis dari pada klinis
Mengapa hanya terjadi sedikit kemajuan ? Padahal: • Pengetahuan tentang penyebab dan cara mengatasi penyebab kematian: tersedia • Sumberdaya walaupun kurang namun dengan realokasi dan peningkatan efisiensi: relatif cukup belum terfokus pada kegiatan yang efektif
MPS
Making Pregnancy Safer (MPS) • Strategi sektor kesehatan yang ditujukan untuk mengatasi masalah kesehatan akibat kematian dan kesakitan ibu dan bayi • Merupakan penekanan/fokus dari upaya Safe
Motherhood
Tiga Pesan Kunci MPS 1. Setiap persalinan ditolong tenaga kesehatan terampil 2. Setiap komplikasi obstetri dan neonatal ditangani secara adekuat 3. Setiap wanita usia subur mempunyai akses terhadap pencegahan kehamilan yang tidak diinginkan dan penanggulangan komplikasi keguguran tidak aman
Kebijakan Pelaksanaan Program DepKes dalam rangka penurunan AKI, AKB 1. Penempatan bidan di Desa Æ akhir 2010 minimal 80% desa terpenuhi. 2. Mengembangkan Pelayanan Obstetri Neonatal Emergensi Dasar (PONED) dan Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK). 3. Mengembangkan Rumah Sakit Sayang Ibu dan Sayang Bayi di seluruh Rumah Sakit Æ 10 langkah Menuju Perlindungan Ibu dan Bayi secara Paripurna dan terpadu. 4. Pemantapan Sistem Rujukan.
Puskesmas dengan Pelayanan Obstetri Neonatal Emergensi Dasar (PONED) 1. Merupakan Puskesmas yang mempunyai fasilitas atau kemampuan untuk melakukan penanganan kegawatdaruratan obstetri dan neonatal dasar 2. Puskesmas PONED mrpk Puskesmas yang siap 24 jam 3. Sebagai tempat rujukan atau rujukan antara kasus-kasus kegawat daruratan obstetri & neonatal dari Polindes dan Puskesmas 4. Apabila memerlukan penanganan seksio sesarea dan transfusi Æ dirujuk ke Rumah Sakit PONEK 5. Polindes & Puskesmas Non Perawatan disiapkan untuk melakukan Pertolongan Pertama Gawat Darurat Obstetri & Neonatal (PPGDON) dan tidak disiapkan untuk melakukan PONED.
Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK)
Dilaksanakan di Rumah Sakit kemampuan untuk memberikan pelayanan 24 jam thd Kasus kegawatdaruratan ibu/bayi, neonatal resiko tinggi, Pelayanan tranfusi darah, Tindakan operasi, Kesiapan di ruang kebidanan dengan fasilitas gawat darurat Meliputi pelayanan Seksio sesaria & Transfusi Darah
10 langkah Menuju Perlindungan Ibu dan Bayi secara Paripurna dan Terpadu dalam Program RSSIB 1. Membuat kebijakan tertulis tentang manajemen yang mendukung pelayanan kesehatan Ibu dan Bayi, termasuk kebijakan keberhasilan menyusui. 2. Pelayanan Obstetrik dan Neonatal Esensial Komprehensif (PONEK). 3. Menyelenggarakan pelayanan ANC (Ante Natal Care). 4. Pertolongan persalinan aman. 5. Pelayanan rawat gabung neonatus dan ibunya. 6. Pelayanan KB dan imunisasi yang bermutu. 7. Pelaksanan kegiatan audit material perinatal. 8. Meningkatkan mutu pelayanan kesehatan ibu dan bayi yang didukung oleh kemampuan masyarakat. 9. Membentuk tim ASI eksklusif di RS. 10.Melarang pemakaian Susu Formula pada bayi baru lahir kecuali atas indikasi medis yang ditetapkan oleh Dokter yang merawat.
PEMANTAPAN SISTEM RUJUKAN
BERBAGAI STRATEGI DAPAT DITEMPUH, DALAM MEMPERBAIKI SISTEM RUJUKAN IBU HAMIL DAN BAYI BERESIKO. SEDIKITNYA ADA 10 AGENDA STRATEGI YANG DAPAT DIKEMBANGKAN SESUAI DENGAN KEBUTUHAN KABUPATEN/ KOTA.
STRATEGI PEMANTAPAN RUJUKAN REORIENTASI DINKES DAN RS KAB / KOTA
PERBAIKAN MUTU PELAYANAN KLINIK & NON KLINIK
PENYUSUNAN KESEPAKATAN MANAJEMEN STRATEGIK
KESINAMBUNGAN & KELEMBAGAAN
PERBAIKAN KOORDINASI LINTAS SEKTOR
MOBILISASI SUMBER DAYA
PERBAIKAN SISTIM JARINGAN INFORMASI RUJUKAN MANAJEMEN STRATEGI PEMANTAPAN SISTEM RUJUKAN KAB/KOTA
MONITORING & EVALUASI PERBAIKAN
PERBAIKAN MANAJEMEN DINKES KAB/ KOTA & RS
PELATIHAN
MONITORING DAN EVALUASI
Untuk memonitor pelaksanaan kegiatan serta melakukan evaluasi program.
Terima kasih
INDONESIAN MIDWIFERY ASSOCIATION (IMA) ROLE IN MATERNAL AND CHILD CARE IN INDONESIA
Place of Delivery and Least Qualified Delivery Assistant
Home Private facility Public facility
Place of Delivery
Relative/other Doctor Midwife/Nurse TBA
Least Qualified Delivery Assistant
INDONESIAN MIDWIFERY ASSOCIATION (IMA – IBI)
Head office in Jakarta Has 31 Chapters – 349 district 85.000 registered members
PLACE OF WORK
Hospital Health Center Birthing Center Home Private Practice
A midwife has the authority:
To provide reproductive health services
To provide family planning and
Community health services
30
Midwife’s active role in RH and FP Health Statistic, 2002
66 % of deliveries 93 % of ante natal care 80 % of family planning services 53 % prevalence of contraceptive uses - 58 % in contraceptive injection - 25 % of pill user - 25 % IUD - 25 % of implant Provided by the private practice midwives
Provided by the private practice midwives
31
IMA IN IMPROVING MATERNAL AND CHILD CARE BIDAN
DELIMA
AN INOVATIVE APPROACH TO QUALITY CONTROL MIDWIVE’S CARE
COVERAGE 2004 : - 6 provinces, 145 districts 2005 : - 9 provinces, 173 district, 845 Bidan Delima 2006: - 10 provinces, 180 district, 1025 Bidan Delima 2007: - 15 provinces, 195 district, 10.000 Bidan Delima
33
BENEFIT 1. 2. 3. 4. 5. 6. 7. 8.
Professional statuse Quality of services improving Acceptance of professional organization Acceptance of the community Coverage increased Marketing and promotion Bidan Delima Award Other privileges
34
Bidan Delima is a strategic program involved : 1. 2. 3. 4. 5.
Monitor improvement of quality of services Trademark of the private practice midwife Standard of quality, superior, special, plus value, complete and has patent rights Carried out consistently & continuously, self development Net working
35
Minimum Requirement of Bidan Delima
Standard Knowledge Standard Skills Standard Facilities
STEPS TO BECOME BIDAN DELIMA
START
DISTRICT BRANCH: Registration & pre qualification
PASSED ALL MINIMUM REQUIRMENTS
BIDAN DELIMA CANDIDATE
YES
FAILED SELF ASSESMENT MANUAL
SELF ASSESSMENT MANUAL
ALL STANDARD OF SERVICES & STANDARD OF PROCEDURES COVERED
VALIDATION BY FACILITATOR
FAILED MENTORING & COACHING BY FACILITATOR
37
BIDAN DELIMA YES
The logogram of Bidan Delima
Maternal and Infant Health Care in Sangihe Regency NANCY MONNA LISSA MOHEDE, ST From:
Sangihe Regency North Sulawesi Province INDONESIA
The health development represents integral part of national development and its aim to provide an easy and cheap health service for public. Quality of human resource in national development increased along with increasing public health degree. Efforts to increase public health degree have conducted by government
Facility
Sangihe has only 1 unit hospital with capacity as much 153 beds. While the number of public health centre is 128 units, consist of 25 Primary Public Health Centre, 80 Subsidiary Public Health Centre, 18 Land Mobile Health Centre and 5 unit Sea Mobile Public Health Centre.
Medical Worker Total number of physician, pharmacy
bachelor of public health paramedics and non medics decreased from 282 personnel in 2004 to 265 personnel in 2005. Number of integrated health served posts, dispensaries and drugstore was 286 units, decreased by 4.76%.
Maternal and Infant in Sangihe Regency To pregnant and give birth a baby are the aims of every woman. And their desire is to have healthy baby and gets natural birth, but some of them can not reach them, because of many problem.
Geography
Sangihe regency as the archipelago regency while the island spread out along the archipelago distance to each other, easy to get natural disaster, as a boarding crossing area and less developing area/ backward area, they are influenced to medical service with the high cost. The nice climate is less than 3 (three) months. It influences for implementation the programs. The islands spread out along the archipelago with less population those are needed to build more health facilities and efficiency service
Demography The distribution and varieties residences who spread in every island most influences for public health and most people with low education degree and low economical sector impact the ability of independent participate in health sector.
Culture
Some people still believe traditional faith and mystics, that is will give healing recovery. Sometimes the traditional faith in line with the medical health healing But some times it can be coincide.
Nutrition
Some of the maternal women in our regency have not good nutrition, some of them have disease while they are pregnant and the other things are about the geography of Sangihe Regency
We still need medical worker
We less of medical worker, because not in all island could be served by public heath service or medical worker, as a specialist, general medical, nurse or midwife. That’s why in our regency we still have traditional midwife. The rate of the traditional midwife is 321 peoples.
Program To solve the problems, the government has programs; The Pregnant women have to check up minimal 4 (four) times The mother would should had 5 program is : Rate The Blood Pressure, Had the tablets for increase blood nutrition, Measure weigh and tall, Measure Pundus Uteri and Get TT (Tetanus Toxic) While pregnant, the mother is given medicine to add the blood, Tetanus Toxic, Vitamin A, Fe, and the other medicine needed. Measure LILA (Upper arm rim) To propose specialist medical worker to the province and central government. Open Medical and midwife school in Tahuna.
Baby and infant And Program for health care the baby is: Immunization for Baby, while Growth of immunization result for baby, child of fertile age woman and also the pregnant in Sangihe decrease from year to year Giving Month Vitamin A in February and August. Blue tablets for Baby, and Red tablet for children The Baby and Children had additional food
Family plan
National Family Planning (KB) program in Sangihe is showing excitement result. A number of fertile age couples (PUS) in 2005 are 32.267 couples, or decreased by 2.14% as compared to the previous year. Total number of new acceptors are 1.803 acceptors, decreased 20.47 %. Active competitor Family Planning in Sangihe was 27.099 or decreased by 1.75 %.
Thank You
For The Government of China for support developing country as we are Thank you for Our Government For Our Regent and First Lady Who support and struggle for develop our regency And also thank you for my family, for my husband and all my relative and friend
Maternal and Infant Training Course In China NANCY MONNA LISSA MOHEDE, ST From: Sangihe Regency North Sulawesi Province INDONESIA I’m very Thankful God to be in China May God Help Me and Guide me to follow all the Training Course in China
Maternal and Infant Health in Sangihe Regency Nancy Monna Lissa Mohede, ST
Foreword Indonesia Is My Nationality The Capital Of Indonesia is Jakarta
Consist of 33 Provinces … … … North Sulawesi is one of them
North Sulawesi It’s located on Eastern of Indonesia North Sulawesi has 2 Big Cities, Manado city as the Capital of the Province and Bitung city is Called Cakalang City or Industry City North Sulawesi consist of 9 Regency
BRIEF INFORMATION Regency of Sangihe represent as Integral part of North Sulawesi Province, with Tahuna as the capital city, situated 142 miles from Manado. Located between 4° 13’ 4’’ - 4° 40’ 22’’ North Latitude and 125° 9’ 28’’ - 125° 56’ 57’’ East Longitude. Sangihe reside between Sulawesi Island and Mindanao Island Republic of Philippines, posses of unique characteristic as border land.
Sangihe consist of 112 island in which 30 island (26,79 %) are populated and 82 island (73,21 %) are unpopulated & the number of population is 192.490 peoples The unpopulated island spread out along the archipelago distance to each other, where so required to be developed, constructed, maintenances and defended as National asset.
Sangihe is a maritime area. It has ocean area about 20.250,60 km² (80 %) and land area about 1.012,93 km² (20%). Land area divided into two of islands bunch. Great Sangihe island (72,76 %) which consist of 14 sub districts, Siau – Tagulandang island (27,24 %) consist of 10 sub districts. We also have 231 villages
Beside of that we have special region which known as Border Crossing Area with check point at Marore, in the northest. Border Crossing Agreement is one regulation to facilitate the people of Indonesian and Philippines who live in two side border line. This agreement give them legality for trading activity with maximum amount of US $ 250.-
Sangihe has 5 Volcanoes, which still
active and have been erupted, one of them is Awu Volcano Mount which is in Sangihe island. It will be erupted every 45 years.
Sangihe also has Volcano Under the Sea
is Mahangetang Volcano Mount, this is very interesting place for tourism.
Awu Volcano Mount
Commodities
Sangihe high competitive commodities such as : coconut, nutmegs, cloves, pineapple, sago, snake fruit, The potency of fishers are : Tuna, Skip jack (Cakalang) , Easter little (Tuna / Deho), Coral Fish(Ikan Karang), Sea Weed (Rumput Laut) View Of Tahuna Bay
Commodities
Multi various product in Sangihe :
Bamboo Music’s
Bamboo furniture, webbing & Music, Coconut trees crafts, Rotan’s handcrafts, Wood Furniture, Various of iron products, Kerawang embroidery, Melinjo,Coconut Trees Crafts Sago & Canary Cake & flour, Nutmegs Candy, Coconut oil produced by villagers Fish dry flour, Salty fish Kursi Bulu Nutmegs seed, Nutmegs flower, Nutmegs oil, Clove,Batik White copra, Smoke copra, Mineral water refill, and etc
Facilities
