MCH Handbook

Implementation and
Utilization in Indonesia
Directorate of Family Health
Ministry of Health, Republic of Indonesia

OUTLINE
MCH HANDBOOK IN INDONESIA
Why MCH Handbook?
Development: From a City to a
National Policy
Current Situation
Implementation Results and
Challenges
Future Improvement

WHY MCH HANDBOOK?

WHY MCH
HANDBOOK ?
To increase health status of mother and child
Ensure quality of MCH services
Maintain continuum of care
To strengthen health system
Optimize roles of human resources in the field
Improve recording and reporting system
Create effective management
Encourage efficient budgeting
MCH HANDBOOK:
OUTLOOK
Covers color: PINK
Easy-to-understand contents
For all pregnant women; no other cards
Illiterate mothers should be assisted by
cadres or literate family members

DEVELOPMENT:
From a City to a National
Policy

Development of MCH Handbook in Indonesi

19
Pilot 93
project:

Salatiga
Muncipality
(pop. 150.000)

20
Expansion:
05 + all
of 35 distritcs in
Central Java
Province

20
EXPANSION:
06

ALL OF 34
PROVINCES IN
INDONESIA

19
95 + 8
Expansion:

districts (pop. 7.4

million)

20
01 + 22
Expansion:

district/municips.
(pop. 1.8 million)

19
Expansion:
10
96 +(pop.
districts/municip
7.3
million); Pilot in 4 prov: W
Sumatera, S Sulawesi,
Bengkulu, E Java

19
97 + 3
Expansion:

districts
(pop. 2.3 million)

TCTP Phase
1
2007 East

TCTP Phase
2
2014 Bali

Java
2015 N
2008 West
Sulawesi
Java
2016
2009 W
Yogyakarta
Sumatera
2010 NTB
Supported by JICA, World Bank, UNICEF Partners,
2011 Central
Professional Organizations, and private companies
Java

MCH Handbook in Indonesia:

National Policy
1.Minister of Health Decree No
284/Menkes/SK/III/2004 concerning MCH
Handbook Use in MCH Services strong
commitment of MOH RI
2. Being implemented in ALL of 34 provinces in
Indonesia
3. Collaboration with other programs and sectors,
professionals, and institutions to implement MCH
handbook at community and health facility level,
including hospital
4. Since 2009, provided by central government to
meet the need of all pregnant women in
Indonesia

Ministerial Decree No. 284/2004

on MCH Handbook
Minister of Health
Republic of Indonesia

The only recording tool for MCH services that

belongs to pregnant women and under-five children
Responsibilities:
Procurement and distribution: local government
Utilization: health workers
Care of the book: community/family
Professional organizations, NGOs, and private sector
should support the use of MCH handbook

Supported by professional
organizations and relevant sectors:

IDAI

PKK

POGI

PERSAG
I

IBI

PPN
I

PERS
I

IDI

ARSAD
A

MCH Handbook:
Integrated instrument for MCH services
Information/education and recording
Pregnancy
Adequate
antenatal care

Delivery

Postpartu
m

Baby (29 day 11

month)

Under five
Preschool

Delivery

Postnatal
care
(maternal &
neonatal),
breastfeedi
ng

Breastfeeding,
immunization,
growth and
development
monitoring,
supplementation
Post-delivery

Growth and
development
monitoring, IMCI

Mother record
Birth
certificate

family
planning

Imunization
record
Neonatal visit
record

Healthy
children

MCH

10

Growth
monitoring

MCH Handbook
Maternal Health

Child Health

During pregnancy

Child care:
neonatal U5

Infant feeding

During delivery

Daily care of
U5

Child stimulation:
baby preschool

During postpartum

Treatment
for common
childhood
illnesses

Complementary
feeding

Family planning
Records of maternal health services

Records of child health services

BPCR sticker

Implementation of MCH
Handbook: CURRENT
SITUATION

Current
Situation 1
1.Level of implementation: nation-wide
2. Target population:
Pregnant women: 5.29 million
annually
Children under 5 years: 24 million
annually
3.Distribution:
Health providers give MCH Handbook to
pregnant women coming for ANC
MCH Handbook stays with
mothers/families
4.Free of charge
5.Recording
By health professionals (midwifes,

Current
Situation 2
6. Services provided:
Community level (Poskesdes, Polindes,
Posyandu); primary care level (Puskesmas,
birthing clinic, private practice); and hospital
level
Public and private health facilities
7. Budget for MCH handbook provision:
. Central & local governments
. Private sectors (Midwifery organization,
Private company, etc.)
. Donor agencies (JICA, UNICEF, GAVI, PCI, etc.)

MCH Handbook is Everywhere!

Home
Hospital,
Private Clinic

Read it with all family

members

Referral
Counseling
ANC, Child welfare

Integrated
Service Post
(Posyandu)
Growth monitoring
Immunizations
Health Education

Mother Classes

PHC,
Polindes

Counseling
ANC
Child welfare
IMCI

Use of
MCH
Handboo
k

Community support
Physical activity

Integration of MCH
Handbook
into Health Services
MCH Handbook contents are relevant to
related programs addressing:

Maternal and neonatal health

Child health
Immunization
Diarrhea
Malaria
Nutrition
Family planning

Adopted in Training Modules:

Training for Midwives concerning Allert Village (Desa
Siaga) program
Training for Cadres and Community Leaders concerning
Allert Village program

Implementation of MCH
Handbook: ACHIEVEMENTS
AND CHALLENGES

Achievements
MCH
Handbook
Ownership
among
Pregnant
Women (%)

79.6

80.8

37.3
2007

53

28.7
2010

2013
Riskesdas 2007, 2010, 2013

Child health:
Measles
immunization
(%)

74.2

67

65
2003

Pregnant women
get informed
about signs of
complications
38.8
(%)

2007

2012
IDHS 2003, 2007, 2012

2003

2007

2012
IDHS 2003, 2007, 2012

Achievements
MOTHERS

M&E of MCH Handbook

94.7

96.9

93.3
75.1

64.9

64.9

62.2

60.0

63.6

89.8
81.4

Directorate of Family Health

and Universitas Indonesia
School of Public Health
9 districts/cities in Indonesia
April May 2016

MIDWIVES

85.3

75.1
65.3

Materials available: Basic tools

MCH Handbook

Manual of MCH
Handbook

Guideline on
Management of
MCH Handbook
Implementation

MCH Handbook package

for health providers

Materials available:
Orientation & Quality
Service
Mother Class
<Birth Preparedness>
NTB version (2008)

Mother Class
<Child Health>
W Sumatra version (2008)

National version(2009) National version(2009)

MCH Handbook package
for cadre & interest group

21

Model Activity: Mother

Classes

In-depth learning of MCH using MCH HB

Exercises for pregnant women

Practice for infant and under-5 daily care

22

Model Activity:
Active Participation of Village
Health Volunteers

Health educations delivered by village health

volunteers through:
- Home visits
- Posyandu (Villages Integrated Services Post)
23

Strengthening of MCH Handbook

Orientation

Trainings and orientations on MCH handbook for health workers and for health volunteers

24

Challenges
At health facility level
Incomplete recordings
Underutilization of MCH Handbook as a
counseling tool
Use of MCH Handbook is more common in
Puskesmas and its public networks;
underutilized in hospitals and private health
facilities
At community level
Lack of desire to read and discuss
Loss or broken MCH Handbook is common

Overcoming
Challenges
1) Capacity improvement of providers
&
stakeholders

a. Orientation of relevant program managers & providers

b. Orientation of community health volunteers
c. Advocacy to relevant stakeholders: international/in-country
training/seminar/workshop
d. Dissemination to stakeholders
e. Monitoring & Evaluation of MCH Handbook implementation

2) Relevant instrument development needed for

implementation

a. Technical guideline for providers and program

managers
b. Guideline for community health volunteers
c. Activities to elaborate MCH Handbook contents
(counseling and Mother Class)
d. Advocacy materials
e. MCH Handbook integration into pre-service curricula

MCH Handbook Utilization:

FUTURE IMPROVEMENT

Improving MCH Handbook

Utilization
1. Integration into birth certificate application
process (Ministry of Home Affairs, Civil
Registration Office)
2. Integration of MCH Handbook into National
Health Insurance program
3. MCH Handbook for cash transfer program (by
Ministry of Social Affairs)
4. Expansion of MCH Handbook use:
Bina Keluarga Balita (communitys under-five
playgroups)
Mother Classes & other MCH support groups
Early-childhood educations: day care, pre-school,
kindergarten, Sunday school

Keeping MCH Handbook

Updated 1
Four times updates since 2000
Periodical reviews: every five years
Last update: 2015

Keeping MCH Handbook

Updated 2
Updates in 2015:
1. Related to the roles of health workers at primary
and referral levels:
. To strengthen MCH Handbook as a tool for
counseling, information and education,
. To strengthen MCH Handbook as a tool for
recording and reporting
2. Related to the roles of health cadres:
. To take part in monitoring of child growth and
development

Keeping MCH Handbook

Updated 3
Updates in 2015:
3. Related programs updates
4. Extension of use: MCH Handbook is now
designated for children until 6 years of age
5. Addition of relevant information:
Parenting skill
Children with disabilities
Child protection

Terima Kasih
Thank you
32