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EMAS Year 4

Rencana Kerja
Workplanning
Tahun 2014
4 Februari 2014

12 Juni 2014
Overall meeting objectives
• To review and identify new/refreshed
strategies for improved performance and “all
out consolidation” in key areas for Year 4
• To identify key provincial and national
workplan activities for Year 4
• To draft preliminary budget for national
activities
Key messages from Midterm
• Strategy has potential for impacting change—no major
changes moving forward
• Referral networks may be the most important positive
outcome thus far
• Good things happening at district/prov level need to be
better communicated at national level
• Not yet seeing changes in mortality--Need to
understand more about causes of death
• Need to apply the theory of change pathways—drop
components that are less critical/effective
• Need to determine our role with JKN and how best to
communicate challenges to Jakarta
Key messages from Midterm
• Need to strengthen relationships with central
MOH—include provincial staff often
• Although we are not yet seeing reductions in
mortality, selected EMAS approaches have
significant potential that should be taken to
scale
• Program learning agenda will help define what
to scale
Results to Date
Mortality
• Not yet seeing reductions in mortality in EMAS
facilities
– 2012: MMR of 356, NMR 15
– 2013: MMR of 352, NMR 17
• We now have the systems in place to track
service statistics
Cakupan Intervensi “Life-Saving”
Year 2, Q1-Year 3 Q2; 23 hospitals and 93 health centers

100% 95%
92% 90% 92%93%94%94%
88%
90% 85%87%
80%79%
80%
70%
YR2 Q1
60%
YR2 Q2
50%
YR2 Q3
40%
32% YR2 Q4
29%27%
30% 23%
22%21% YR3 Q1
20%
YR3 Q2
10%
0%
% of PE/E cases treated with % of referred PE/E cases % of deliveries that receive a
MgSO4 treated with MgSO4 before uterotonic in the 3rd stage of
referral (hospital only) labor
Cakupan Intervensi Neonatal
Year 2, Q1-Year 3 Q2; 23 hospitals and 93 health centers

100%
90%
80%
70%
70%
62%60% 60%
59%
60% 54% YR2 Q1
49% 51%
50% YR2 Q2
42% 42%41%
40% YR2 Q3

30% YR2 Q4
20% 22%
18% YR3 Q1
20% 13% 12%
9% 9% YR3 Q2
10%
0%
% of newborns breastfed within % of newborns delivered % of newborns referred with
1 hour of delivery between 24-36 weeks whose infection, given antibiotic
mothers received antenatal before referral (hospital only)
corticosteroids (hospital only)
Phase 2
% of deliveries that receive a uterotonic in the
92%
3rd stage of labor

% of referred PE/E cases treated with MgSO4


11%
before referral (hospital only)

% of PE/E cases treated with MgSO4 72%

YR3 Q2
% of newborns referred with infection, given
8%
antibiotic before referral (hospital only)

% of newborns delivered between 24-36 weeks


whose mothers received antenatal 61%

corticosteroids (hospital only)

% of newborns breastfed within 1 hour of


52%
delivery (among live births ≥ 2000 grams)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
KINERJA KLINIS—RUMAH SAKIT
Hospital achievement, by tool
Hospital Tool 1: Emergency response

achievement Tool 2: AMSTL

on Clinical Tool 3: PPH


Standards Tool 4: PE/E
disaggregated by Tool 5: Sepsis & infection
technical Tool 6: Obstructed labor
area and tool NEONATAL
(n=23) Tool 1: Emergency response
as of YR 3 Q2 Tool 2: Neonatal resusitation
(March 2014) Tool 3: Neonatal sepsis
As of March 2014
Baseline (Yr2Q1)
Tool 4: Antenatal steroid
Tool 5: Early and exclusive…
Tool 6: Kangaroo mother care
Tool 7: Neonatal BBLR
INFECTION PREVENTION
GOVERNANCE
Tool 1: Clinical performance…
Tool 2: Client satisfaction

0% 20% 40% 60% 80% 100%


KINERJA KLINIS—PUSKESMAS
Puskesmas achievement, by tool
Puskesmas achievement on clinical standards disaggregated by technical area (n=93) as of Y3
Q2 (Jan 2014)

66%
Tool 1: Emergency response
6%

75%
Tool 2: Skill assessment
12%
Average % of standards achieved (as of
71% March 2014)
Tool 3: Emergency referral
17% Average % of standards achieved
(baseline)

72%
Tool 4: Tools and equipment**
0%

74%
Tool 5: Infection prevention*
59%
Audit Kematian di RS
Percentage of neonatal and maternal deaths audited in EMAS-supported
hospitals compared with achievement on related performance standards
(governance, tool 1) (EMAS-supported hospitals, n=23) as of March 2014
100%

90%

80%

70%
Average % achievement of
governance standards (tool
60% #1) n=23
49% % of neonatal deaths audited
50% 45% in EMAS facilities (n=23)
41%
40%
% of maternal deaths audited
30% 27% in EMAS facilities (n=23)

20%
9%
10% 5%

0%
YR2 Q1 YR2 Q2 YR2 Q3 YR2 Q4 YR3 Q1 YR3 Q2
Kinerja Sistem Rujukan—Fase 1
100%

90%

80%

70%
Percentage of standards achieved

60%

50%

40%

30%

20%

10%

0%
Asahan Bandung Banyumas Cirebon Deli Serdang Malang Pinrang Serang Sidoarjo Tegal
1st Assessment 19% 20% 51% 35% 32% 9% 41% 20% 21% 26%
YR3Q2 63% 93% 89% 89% 79% 85% 77% 81% 90% 51%
Kinerja Sistem Rujukan—Fase 2
100%

90%

80%
Percentage of standards achieved

70%

60%

50%

40%

30%

20%

10%

0%
Labuhan Kota
Bandung 2 Blitar Bulukumba Cirebon 2 Gowa Jombang Karawang Langkat Cilacap Pasuruan
Batu Semarang
1st Assessment 20% 10% 7% 35% 7% 9% 22% 0% 4% 13% 21% 14%
2nd Assessment 28% 58% 22% 18% 8% 43%
Pengunaan Sijariemas
# of cases referred Total # of referral % of cases facilitated
District
using SijariEMAS cases with SijariEMAS
Phase 1
Asahan 30 180 17%
Bandung 146 977 15%
Banyumas 104 1130 9%
Cirebon 1009 1248 81%
Deli Serdang 22 514 4%
Malang 9 482 2%
Pinrang 82 305 27%
Sidoarjo 63 426 15%
Tegal 99 890 11%
Serang 136 543 25%
Phase 2
Bogor 355 1502 24%
Karawang 775 1161 24%
TOTAL 2830 9358 30%
AUDIT MATERNAL-PERINATAL

Maternal Perinatal Audits: Percentage of district-wide maternal and newborn deaths


reviewed by MPA process, January-March 2014
Maternal deaths not Newborn deaths not
reviewed by MPA process reviewed by MPA process
Maternal deaths Newborn deaths reviewed
reviewed by MPA process by MPA process
32%
23%

48% 68%
50% 50% 77%
52%

Phase 1 (N=35) Phase 2 (N=88) Phase 1 Phase 2


(N=273) (N=383)

Note:
These deaths represent cases reported across the 10 districts supported by EMAS and are not limited to
cases occurring in an EMAS-supported facility.
QR Tables
Group Discussions
Outputs
• Year 4 Workplan matrix for your objective
• Draft Year 4 Budget for your objective’s
national activities
Looking Forward to Maximize Impact
Group Discussions
• Identify strategies or modifications in approaches
that are needed to accelerate progress in the
areas described below for your objective—refer
to theory of change pathways
• Using Year 3 Workplan as a starting point,
modify/delete/edit activities for Year 4 workplan
• Identify both provincial and national activities
that need to be done in Year 4
• Develop draft budget for national activities
Component 1
• What new or different strategies do we need
to do to address lagging indicators?
– IMD
– antibiotics for newborns, newborn resuscitation
– MgSO4 before referral
– Use of dashboards, death reviews
• What can we do to ensure EMAS and facilities
are more focused on lagging death indicators?
– Email Death alerts?
Component 1 (cont)
• Do we need more concerted efforts in specific
technical areas? Newborn in general, KMC,
infection prevention (especially for newborn),
high c-section rates, or high rates of induction.
• How can we maximize existing mentor resources
(including vertical hospitals) to ensure mentoring
is happening in both hospitals and puskesmas?
– roster of provincial mentors?
– How do we ensure consistency with mentoring
• Do we continue with nutrition DST?
• Will we continue to use US Pediatricians?
Component 2
• What new or different strategies do we need to do to address
lagging indicators?
– AMP
– MOH approval for referral standards
• What can we do to ensure EMAS and districts are more focused
following up on deaths?
• How can we improve the effectiveness of key approaches?
– Civic forums—how to put them in the driver’s seat?
– Pokjas
• how do they become more effective advocating for changes in
facilities and referral systems
• How do we synergize Pokja, FMM, Muhammadiyah, EMAS
– AMP
Component 2 (cont)
• Do we need to extend to all PKM in Phase 1
districts?
• What does EMAS need to do to get full MOH
buy in for referral standards? How does this
synergize with Collaborative improvement?
• How do we help FMM to generate useful data,
without having to do service charters, surveys
• What must be done to improve the
functionality and use of SijariEMAS?
• What is EMAS’s strategy to support JKN?
Communications/Documentation
• What does EMAS need to document in Year 4 to
highlight key learning, experience or approaches?
This could be relevant to trends, best practices,
innovations, key program approaches, EMAS
strategies, etc
– Note that the MTE recommended EMAS document
the following: referral system strengthening, EMAS
experience with JKN, and obtaining buy-in a provincial
and district levels.
– Are there other key learning or experiences that need
to be documented?
Communications/Documentation
• What products should EMAS be developing to better
share successes and results? Please identify 1) what
needs to be shared, 2) to whom and 3) the type of
format that would be most useful for sharing (eg.
factsheet, brief, video, presentation, etc).
• Are there specific success stories that EMAS should
document? This can be a story of a life saved, strong
performance or commitment of a facility or district,
etc.
• Are there specific events that are needed to
disseminate EMAS results to date?
M&E—Data use
• (Note: “Data” refers to 1) EMAS PMP data as well as 2)
data generated within a facility)
• Which internal processes should EMAS put in place in
Year 4 to improve the internal use of data at national,
provincial or district levels?
• Which activities should EMAS do in Year 4 to improve
the use of data at national, provincial or district levels
among EMAS stakeholders (eg. facilities, districts,
MOH, pokja, civic forum, etc)?
– Examples could be: meetings/events, products, etc.
• How can we as EMAS and our stakeholders become
more focused on the lagging mortality indicators?
M&E—Program Learning
• What are our next steps for getting MOH
involved in finalizing program learning agenda
• What our the learning activities that we will
undertake:
– Monitoring
– Evaluation
– Learning to inform scale up and sustainability
• Q: Who are EMAS key stakeholders? (spheres of influence)
Learning to Inform • Q: What information are stakeholders interested in learning
from and about EMAS?

EMAS LEARNING AGENDA


• Q; Which interventions are under consideration for scale-up?
Scale-up and • Q: What evidence is needed by stakeholders to inform and
guide scale up activities for priority interventions?
Sustainability • Level of evidence and data collection design will be based on
prioritization

• Q: Are collective efforts having an impact on maternal and


newborn health?
• Impact evaluation (with comparison groups)
Evaluation • Q: Are specific activities having the intended effect (per
causal pathways and results framework)?
• Case studies + special studies

• Q: Are we implementing activities as planned?


• Quality assurance by technical and program
management teams
Monitoring • Q: What are we implementing?
• Work plan-related tracking, reporting, analysis
• PMP-related tracking, reporting, analysis
Cross cutting
• Increasing involvement of Muhammadiyah at
provincial and district levels (PWM/PWA and
PDM/PDA)
• Recognition of high performers
• Events/activities to spotlight progress at
provincial and national levels
Terima Kasih atas Kerjasamanya!