country team action plan scaling-up management of neonatal sepsis in indonesia
TRANSCRIPT
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Country Team Action Plan
Scaling-Up Management of Neonatal Sepsis in
Indonesia
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Background
• NMR: 19/1000 (57% of IMR) ; Neonatal Infection is the 3rd major killer
• ~ 54% home delivery, low access of newborn care, cultural & geographical barrier
• Midwives are the front line health providers at community (55%)
• IMCI algorithm adopted & implemented,
• Health center with BEONC & hospital with CEONC implemented as referral services
• Completed Manual of Pediatric Service in Hospital
• Schedule for postnatal visit: NV1 (6-48 hours), NV2 (3-7 days) & NV3 (8-28 days)
• Decentralized health system at district (489 districts)
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Intervention
• Improving case management of neonatal sepsis at community level through home visits
– Midwives
– Nurses
– Community health cadre
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Evidence of effectiveness community based newborn
care•Global evidence in India, Nepal, Bangladesh,
and Pakistan of community based newborn care
•Joint statement WHO/UNICEF on community-based newborn care
•Management of birth asphyxia by community midwives in Cirebon, West Java (SNL)
• Indonesia IMCI (include diarrhea & pneumonia)
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Stakeholders involve in scaling up
• MoH, Provincial & District Health Office
• Professional organizations (Pediatrician, Obgyn, Medical, Perinatologist, Midwive, Nurse, Public Health, Nutritionist)
• Institutional academics
• National Family Planning Board, Ministry of Internal Affairs, Ministry of Women Empowerment & Children Protection, Ministry of Education, Ministry of Religion)
• Local NGOs
• International agencies (Unicef, USAID, WHO, World Bank, ADB, GTZ, AusAID, JHPIEGO, Mercy Corps, WVI, Save the Children, etc)
• Media
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Policy Implication
• Task shifting: review role of nurses & midwives, community health cadres, and TBAs to identify and manage neonatal sepsis
• Legal authority: delegation of authority from and among professional organizations
• Funding resources: to provide operational cost for home visits from central, provincial, & district/ municipalities budget
• Logistic issue of supply chain management of antibiotic
• Trainings: pre- & in-service for health providers
• Community mobilization to increase demand for newborn care
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Pilot Project Area
Suggested criteria of choosing pilot project area:• Public health development index, child health & nutrition
problem • Financial capacity• Geographical• Health workers availability: health staff -midwives, nurses-
or non-health staff/cadres, FP workers• Possible resources: budget, human resource in health,
supervisions. • Local government leadership• Urban/rural considerations
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Piloting Project AreasScenario for intervention, different areas:• Availability of midwives &/ nurses• No midwives but nurses available• No midwives and no nurses available, CHWs exist
Possible areas:• Serang – West Java (Java) • Bireun – Aceh (Sumatera)• Kutai Timur – East Kalimantan (Kalimantan)
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Monitoring & Evaluation
• Using MNCH local area monitoring system (LAMAT)
• Robust and regular M & E
• Good documentation
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Action StepsSteps and Actions PIC Timeline
1. Preparations• Cross-sector coordination MOH,
NGOs and professional organizations
• Form technical working group on child survival
• Preparation of pilot project areas• Discussion on policy implication• Developing manual of community-
based neonatal sepsis case management.
• Developing manual for FP-MNCH services integration
MoH
MoH
MoHTWGTWG
TWG
April 2010
May 2010
May 2010Aug 2010Aug 2010
Aug 2010
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Steps and actions PIC Timeline
2. Pilot project implementation• Dissemination and advocacy in pilot
areas• Cross-countries learning• System analysis to identify the existing
model to integrate the neonatal sepsis case management
• In-service trainings• Pre-service trainings (curriculum
development and integration)• Monev trainings• IEC development• Review possible new inovations &
diversifications
MoHDonorsTWG
PHO/DHOTWG
TWGTWGTWG
Aug 2010
Oct 2010
Oct 2010Feb 2011
Oct 2010Oct 2010Dec 2010
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Steps and actions PIC Timeline
3. Monitoring and Evaluation• Pilot project monitoring and
evaluation (competency, coverage, quality, access, logistic, community uptake)
• Refining the strategy program design adjustment based on evaluation findings
• Evaluation• Documentation for scaling-up
TWG
TWG
Start June 2011
June 2012
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Terima kasih