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)

For Community
V
a Doing Save and carry

MISSION
Teamwork
l Community VISSION :
Independent
High intellegence Healthty community health

u
Transpancy and
e acountability
 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 Community empowerment to
Strategic
1 life healhty

1. All of village to be alertness in healty

2. Behavioral of All community to health
awareness
3. Clean and Nutritive
 Prior Community access increase to
Strategic
2 quality of health services
1. Poor people get a good quality of health service
2. Neonate, child and highrisk community
coverred from illness
3. Competent human resource in villages are
4. Essensial medicine and medical tools are
completed in village
5. Health services at every hospital, puskesmas and
the other network in criteria.
 Prior Increase of health
Strategic
4 expenses
1. Health development get a expenses priority from
top government
2. Government health budgeting priority for
preventive and promotion
3. 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 1995 2000 2005 2010 2015

SDKI Target Linear (SDKI)

 Caused of Maternal Mortality

Others
12%
Bleeding
30%
Puerpureum
Copmlication
8%

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 93-97 98-02

Sumber: SDKI
 Caused of Neonatal Mortality

Gangguan
Infeksi hematologik
5% 6% Mslh pemberian
Tetanus minum
10% 10%

others
13%

lowbirth
29%

Asfiksia
Sumber: SKRT 2001 27%
 Ad.c. Minimalize Access to service Health
Facilities

1. 75% RSU Kabupaten mempunyai Sp Obsgyne,

melakukan PONEK tapi tidak 24 jam.
2. 59 % Puskesmas melakukan PONED.
3. 50% desa mempunyai Polindes.
4. Sistem Pencatatan dan Pelaporan belum optimal.
Ad.d.Rendahnya kepedulian masy termasuk provider

1. 66 % ibu hamil tahu fasilitas kesehatan

2. Hanya 33% dari mereka mamanfaatkan untuk ante natal care
3. 59,9 % kelahiran dengan tenaga kesehatan
4. 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 PERBAIKAN MUTU
KAB / KOTA PELAYANAN KLINIK
& NON KLINIK MOBILISASI
SUMBER DAYA

PENYUSUNAN
KESEPAKATAN MANAJEMEN
STRATEGIK PERBAIKAN SISTIM JARINGAN
INFORMASI RUJUKAN
MANAJEMEN
STRATEGI
KESINAMBUNGAN & PEMANTAPAN
KELEMBAGAAN SISTEM PERBAIKAN
RUJUKAN MANAJEMEN
KAB/KOTA DINKES KAB/ KOTA
& RS

PERBAIKAN
KOORDINASI
LINTAS MONITORING & PELATIHAN
SEKTOR EVALUASI
PERBAIKAN
 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 Provided by the
- 58 % in contraceptive injection private practice
- 25 % of pill user midwives
- 25 % IUD
- 25 % of implant
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. Professional statuse
2. Quality of services improving
3. Acceptance of professional organization
4. Acceptance of the community
5. Coverage increased
6. Marketing and promotion
7. Bidan Delima Award
8. Other privileges

34
Bidan Delima is a strategic program
involved :
1. Monitor improvement of quality of services
2. Trademark of the private practice midwife
3. Standard of quality, superior, special, plus value, complete
and has patent rights
4. Carried out consistently & continuously, self development
5. Net working

35
 Minimum Requirement of Bidan
Delima

„ Standard Knowledge
„ Standard Skills
„ Standard Facilities
STEPS TO BECOME BIDAN DELIMA

DISTRICT BRANCH: PASSED ALL

START Registration & pre - MINIMUM BIDAN DELIMA
qualification REQUIRMENTS YES CANDIDATE

FAILED

SELF ASSESMENT
MANUAL

ALL STANDARD OF
SELF VALIDATION BY BIDAN
SERVICES &
ASSESSMENT STANDARD OF DELIMA
MANUAL FACILITATOR YES
PROCEDURES
COVERED

FAILED

MENTORING &
COACHING BY
FACILITATOR

37
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
„ Bamboo furniture, webbing & Music, Coconut trees Music’s

crafts, Rotan’s handcrafts, Wood Furniture, Various

of iron products, Kerawang embroidery, Melinjo,Coconut Trees
Sago & Canary Cake & flour, Nutmegs Candy, Crafts

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