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)

V a l u e

For Community Doing Save and carry Teamwork High intellegence Transpancy and acountability

MISSION
Community Healthty
VISSION :
Independent community health

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

3. 2.Prior Strategic 1 Community empowerment to life healhty 1. All of village to be alertness in healty Behavioral of All community to health awareness Clean and Nutritive .

5. Community access increase to quality of health services 3. 4. 2. . child and highrisk community coverred from illness Competent human resource in villages are Essensial medicine and medical tools are completed in village Health services at every hospital. Poor people get a good quality of health service Neonate.Prior Strategic 2 1. puskesmas and the other network in criteria.

2. Health development get a expenses priority from top government Government health budgeting priority for preventive and promotion Insurance healty for poor .Prior Strategic 4 Increase of health expenses 1. 3.

Condition and Problem of Maternal and Neonate Mortality a. Low community awarenss in mother and child healthty . The high of helthtyless and maternal mortality rate b. Inadequate access to health facility especially at villages d. The high of helthtyless and neonate mortality rate c.

Ad.a. Maternal Rete In Indonesia
500 450 400 350 300 250 200 150 100 50 0 125 390 334 307

SDKI 1994, 1997, 2002

1980

1985

1990
SDKI

1995
Target

2000

2005
Linear (SDKI)

2010

2015

Caused of Maternal Mortality
Others 12% Puerpureum Copmlication 8% Embolic obstetric 3% Long labor 5% Bleeding 30%

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 Infeksi 5% Tetanus 10% Gangguan hematologik 6% Mslh pemberian minum 10% others 13% lowbirth 29% Sumber: SKRT 2001 Asfiksia 27% .

Minimalize Access to service Health Facilities 1. 2. Sistem Pencatatan dan Pelaporan belum optimal. 50% desa mempunyai Polindes. melakukan PONEK tapi tidak 24 jam. 59 % Puskesmas melakukan PONED. . 75% RSU Kabupaten mempunyai Sp Obsgyne.Ad. 3. 4.c.

Obgin. Peran Dinkes belum optimal dalam mendukung program 6.Ad.Rendahnya kepedulian masy termasuk provider 1. Transfer skill & knowledge dari spesialis ke dokter umum. bidan perawat belum optimal 7. 8.9 % kelahiran dengan tenaga kesehatan Organisasi Profesi belum mendukung program secara optimal ( perawat. Dokter anak ) 5.perawat belum berjalan baik .d. 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 . Delegasi wewenang kepada dokter . 66 % ibu hamil tahu fasilitas kesehatan Hanya 33% dari mereka mamanfaatkan untuk ante natal care 59. 2. 4. 3. bidan. bidan .

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 .

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 . Setiap persalinan ditolong tenaga kesehatan terampil 2.Tiga Pesan Kunci MPS 1.

Mengembangkan Pelayanan Obstetri Neonatal Emergensi Dasar (PONED) dan Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK). Pemantapan Sistem Rujukan.Kebijakan Pelaksanaan Program DepKes dalam rangka penurunan AKI. Mengembangkan Rumah Sakit Sayang Ibu dan Sayang Bayi di seluruh Rumah Sakit 10 langkah Menuju Perlindungan Ibu dan Bayi secara Paripurna dan terpadu. AKB 1. 2. Penempatan bidan di Desa akhir 2010 minimal 80% desa terpenuhi. 4. 3. .

Puskesmas PONED mrpk Puskesmas yang siap 24 jam 3. . Apabila memerlukan penanganan seksio sesarea dan transfusi dirujuk ke Rumah Sakit PONEK 5.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. Polindes & Puskesmas Non Perawatan disiapkan untuk melakukan Pertolongan Pertama Gawat Darurat Obstetri & Neonatal (PPGDON) dan tidak disiapkan untuk melakukan PONED. Sebagai tempat rujukan atau rujukan antara kasus-kasus kegawat daruratan obstetri & neonatal dari Polindes dan Puskesmas 4.

Kesiapan di ruang kebidanan dengan fasilitas gawat darurat Meliputi pelayanan Seksio sesaria & Transfusi Darah . neonatal resiko tinggi. Pelayanan tranfusi darah.Pelayanan Obstetri Neonatal Emergensi Komprehensif (PONEK) Dilaksanakan di Rumah Sakit kemampuan untuk memberikan pelayanan 24 jam thd Kasus kegawatdaruratan ibu/bayi. Tindakan operasi.

Pelayanan rawat gabung neonatus dan ibunya. 7. 5. 8. termasuk kebijakan keberhasilan menyusui. Menyelenggarakan pelayanan ANC (Ante Natal Care). Pelayanan KB dan imunisasi yang bermutu. Membentuk tim ASI eksklusif di RS. Meningkatkan mutu pelayanan kesehatan ibu dan bayi yang didukung oleh kemampuan masyarakat. Membuat kebijakan tertulis tentang manajemen yang mendukung pelayanan kesehatan Ibu dan Bayi. Pertolongan persalinan aman.10 langkah Menuju Perlindungan Ibu dan Bayi secara Paripurna dan Terpadu dalam Program RSSIB 1. . 3. 2. 9. 4. Pelayanan Obstetrik dan Neonatal Esensial Komprehensif (PONEK).Melarang pemakaian Susu Formula pada bayi baru lahir kecuali atas indikasi medis yang ditetapkan oleh Dokter yang merawat. 6. 10. Pelaksanan kegiatan audit material perinatal.

DALAM MEMPERBAIKI SISTEM RUJUKAN IBU HAMIL DAN BAYI BERESIKO. SEDIKITNYA ADA 10 AGENDA STRATEGI YANG DAPAT DIKEMBANGKAN SESUAI DENGAN KEBUTUHAN KABUPATEN/ KOTA. .PEMANTAPAN SISTEM RUJUKAN BERBAGAI STRATEGI DAPAT DITEMPUH.

STRATEGI PEMANTAPAN RUJUKAN REORIENTASI DINKES DAN RS KAB / KOTA PERBAIKAN MUTU PELAYANAN KLINIK & NON KLINIK MOBILISASI SUMBER DAYA PENYUSUNAN KESEPAKATAN MANAJEMEN STRATEGIK PERBAIKAN SISTIM JARINGAN INFORMASI RUJUKAN MANAJEMEN STRATEGI PEMANTAPAN SISTEM RUJUKAN KAB/KOTA KESINAMBUNGAN & KELEMBAGAAN PERBAIKAN MANAJEMEN DINKES KAB/ KOTA & RS PERBAIKAN KOORDINASI LINTAS SEKTOR MONITORING & EVALUASI PERBAIKAN PELATIHAN .

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 .

000 registered members .INDONESIAN MIDWIFERY ASSOCIATION (IMA – IBI) Head office in Jakarta Has 31 Chapters – 349 district 85.

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 .

2002 66 % of deliveries 93 % of ante natal care 80 % of family planning services 53 % prevalence of contraceptive uses .58 % in contraceptive injection .25 % of pill user .25 % IUD .Midwife’s active role in RH and FP Health Statistic.25 % of implant Provided by the private practice midwives 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 .

9 provinces.6 provinces. 1025 Bidan Delima 2007: .000 Bidan Delima 33 . 173 district. 10. 195 district.15 provinces.COVERAGE 2004 : . 845 Bidan Delima 2006: . 145 districts 2005 : . 180 district.10 provinces.

6. Professional statuse Quality of services improving Acceptance of professional organization Acceptance of the community Coverage increased Marketing and promotion Bidan Delima Award Other privileges 34 . 7. 4. 3. 2.BENEFIT 1. 5. 8.

self development Net working 35 .Bidan Delima is a strategic program involved : 1. Monitor improvement of quality of services Trademark of the private practice midwife Standard of quality. complete and has patent rights Carried out consistently & continuously. plus value. 3. 5. superior. special. 2. 4.

Minimum Requirement of Bidan Delima Standard Knowledge Standard Skills Standard Facilities .

STEPS TO BECOME BIDAN DELIMA DISTRICT BRANCH: Registration & pre qualification PASSED ALL MINIMUM REQUIRMENTS FAILED SELF ASSESMENT MANUAL START YES BIDAN DELIMA CANDIDATE SELF ASSESSMENT MANUAL VALIDATION BY FACILITATOR ALL STANDARD OF SERVICES & STANDARD OF PROCEDURES COVERED BIDAN DELIMA YES 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 .

Quality of human resource in national development increased along with increasing public health degree.The health development represents integral part of national development and its aim to provide an easy and cheap health service for public. Efforts to increase public health degree have conducted by government .

18 Land Mobile Health Centre and 5 unit Sea Mobile Public Health Centre. . consist of 25 Primary Public Health Centre.Facility Sangihe has only 1 unit hospital with capacity as much 153 beds. While the number of public health centre is 128 units. 80 Subsidiary Public Health Centre.

Number of integrated health served posts. .76%.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. decreased by 4. dispensaries and drugstore was 286 units.

but some of them can not reach them. . because of many problem. And their desire is to have healthy baby and gets natural birth.Maternal and Infant in Sangihe Regency To pregnant and give birth a baby are the aims of every woman.

The islands spread out along the archipelago with less population those are needed to build more health facilities and efficiency service .Geography Sangihe regency as the archipelago regency while the island spread out along the archipelago distance to each other. they are influenced to medical service with the high cost. It influences for implementation the programs. The nice climate is less than 3 (three) months. easy to get natural disaster. as a boarding crossing area and less developing area/ backward area.

.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.

some of them have disease while they are pregnant and the other things are about the geography of Sangihe Regency .Nutrition Some of the maternal women in our regency have not good nutrition.

because not in all island could be served by public heath service or medical worker. The rate of the traditional midwife is 321 peoples.We still need medical worker We less of medical worker. That’s why in our regency we still have traditional midwife. . nurse or midwife. as a specialist. general medical.

Measure Pundus Uteri and Get TT (Tetanus Toxic) While pregnant. Open Medical and midwife school in Tahuna.Program To solve the problems. Had the tablets for increase blood nutrition. the mother is given medicine to add the blood. Vitamin A. and the other medicine needed. Measure weigh and tall. Fe. The Pregnant women have to check up minimal 4 (four) times The mother would should had 5 program is : Rate The Blood Pressure. Measure LILA (Upper arm rim) To propose specialist medical worker to the province and central government. Tetanus Toxic. . the government has programs.

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. while Growth of immunization result for baby. and Red tablet for children The Baby and Children had additional food .Baby and infant And Program for health care the baby is: Immunization for Baby.

Family plan National Family Planning (KB) program in Sangihe is showing excitement result.75 %.14% as compared to the previous year. decreased 20. . Active competitor Family Planning in Sangihe was 27.267 couples.803 acceptors. Total number of new acceptors are 1.47 %. A number of fertile age couples (PUS) in 2005 are 32.099 or decreased by 1. or decreased by 2.

for my husband and all my relative and friend .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.

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 .

with Tahuna as the capital city.125° 56’ 57’’ East Longitude. situated 142 miles from Manado.BRIEF INFORMATION Regency of Sangihe represent as Integral part of North Sulawesi Province.4° 40’ 22’’ North Latitude and 125° 9’ 28’’ . Located between 4° 13’ 4’’ . . 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. . maintenances and defended as National asset.21 %) are unpopulated & the number of population is 192. where so required to be developed.490 peoples The unpopulated island spread out along the archipelago distance to each other. constructed.79 %) are populated and 82 island (73.

250. Siau – Tagulandang island (27.24 %) consist of 10 sub districts.Sangihe is a maritime area. We also have 231 villages .60 km² (80 %) and land area about 1. It has ocean area about 20. Land area divided into two of islands bunch.76 %) which consist of 14 sub districts.93 km² (20%). Great Sangihe island (72.012.

in the northest.- . Border Crossing Agreement is one regulation to facilitate the people of Indonesian and Philippines who live in two side border line.Beside of that we have special region which known as Border Crossing Area with check point at Marore. This agreement give them legality for trading activity with maximum amount of US $ 250.

one of them is Awu Volcano Mount which is in Sangihe island.Sangihe has 5 Volcanoes. Sangihe also has Volcano Under the Sea is Mahangetang Volcano Mount. It will be erupted every 45 years. this is very interesting place for tourism. which still active and have been erupted. Awu Volcano Mount .

pineapple. Easter little (Tuna / Deho). The potency of fishers are : Tuna.Commodities Sangihe high competitive commodities such as : coconut. sago. Sea Weed (Rumput Laut) View Of Tahuna Bay . cloves. Skip jack (Cakalang) . snake fruit. nutmegs. Coral Fish(Ikan Karang).

Salty fish Kursi Bulu Batik Nutmegs seed. Coconut trees crafts. Mineral water refill. Melinjo. Coconut oil produced by villagers Fish dry flour. webbing & Music. Various of iron products. Smoke copra. White copra. Wood Furniture.Coconut Trees Crafts Sago & Canary Cake & flour. Kerawang embroidery.Commodities Multi various product in Sangihe : Bamboo furniture. Nutmegs oil. Clove. and etc Bamboo Music’s . Rotan’s handcrafts. Nutmegs flower. Nutmegs Candy.

Facilities .