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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?

no other cards  Illiterate mothers should be assisted by cadres or literate family members .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  Cover’s color: PINK  Easy-to-understand contents  For all pregnant women.

DEVELOPMENT: From a City to a National Policy .

4 million) 20 01 + 22 Expansion: district/municips. E Java 19 97 + 3 Expansion: districts (pop. (pop. 150. and private companies Java .Development of MCH Handbook in Indonesi 19 Pilot 93 project: Salatiga Muncipality (pop. 2011 Central Professional Organizations. 1. UNICEF Partners. Pilot in 4 prov: W Sumatera. 7. Bengkulu.8 million) 19 Expansion: 10 96 +(pop.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. S Sulawesi.3 million).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. districts/municip 7. 2.

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

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. and private sector should support the use of MCH handbook . NGOs.

Supported by professional organizations and relevant sectors: IDAI PKK POGI PERSAG I IBI PPN I PERS I IDI ARSAD A .

immunization. growth and development monitoring. breastfeedi ng Breastfeeding.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). 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 .

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

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

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.MCH Handbook is Everywhere! Home Hospital. 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 .

3 2007 53 28. 2007.6 80. 2012 .7 2010 2013 Riskesdas 2007. 2010. 2012 2003 2007 2012 IDHS 2003.Achievements MCH Handbook Ownership among Pregnant Women (%) 79.8 37. 2013 Child health: Measles immunization (%) 74.8 (%) 1 2007 2012 IDHS 2003. 2007.2 67 65 2003 Pregnant women get informed about signs of complications 38.

6 89.2 60.3 .9 2 62.8 81.9 64.Achievements MOTHERS M&E of MCH Handbook 94.7 96.9 93.0 63.4 • Directorate of Family Health and Universitas Indonesia School of Public Health • 9 districts/cities in Indonesia • April – May 2016 MIDWIVES 85.1 64.3 75.1 65.3 75.

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: .Posyandu (Village’s Integrated Services Post) 23 .Home visits .

Strengthening of MCH Handbook Orientation Trainings and orientations on MCH handbook for health workers and for health volunteers 24 .

underutilized in hospitals and private health facilities At community level • Lack of desire to read and discuss • Loss or broken MCH Handbook is common .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.

Activities to elaborate MCH Handbook contents (counseling and Mother Class) d. Technical guideline for providers and program managers b. Orientation of community health volunteers c. Orientation of relevant program managers & providers b. Advocacy materials e.Overcoming Challenges 1) Capacity improvement of providers & stakeholders a. MCH Handbook integration into pre-service curricula . Advocacy to relevant stakeholders: international/in-country training/seminar/workshop d. Dissemination to stakeholders e. Guideline for community health volunteers c. Monitoring & Evaluation of MCH Handbook implementation 2) Relevant instrument development needed for implementation a.

MCH Handbook Utilization: FUTURE IMPROVEMENT .

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

Keeping MCH Handbook Updated 1 • Four times updates since 2000 • Periodical reviews: every five years • Last update: 2015 .

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

Addition of relevant information: – Parenting skill – Children with disabilities – Child protection .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.

Terima Kasih Thank you 32 .