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PENGEMBANGAN “QUASI SAMPLE REGISTRATION SYSTEM” UNTUK
MEMONITOR PENCAPAIAN MDGs DI INDONESIA
Soewarta KosenBadan Penelitian dan Pengembangan Kesehatan
Departemen Kesehatan R.I.Jakarta
Latar Belakang
Statistik kejadian demografi dasar (kelahiran, kematian, pindah) yang akurat merupakan dasarpembuatan kebijakan kesehatan dan manajemenpemerintahan yang efektifStatistik kematian dan sebab medis kematian darifasilitas kesehatan (RS) tidak memadai, karenaterbatasnya jangkauan (Ind. : hanya 2 % daritotal yang mengeluh sakit memanfaatkan rawatinap RS dalam 12 bulan)Informasi kematian SUSENAS Kor: “under-reporting” sekitar 40 %
Latar BelakangMillennium Development Goals 4,5,6 menggariskanberbagai target bidang kesehatan (tingkat kematianbayi, anak balita, maternal); kematian karena Tb. dan MalariaInformasi kematian karena sebab tertentu, belumdicakup sistem yang adaInformasi COD didapat dari survei berkala berbasismasyarakat (SUSENAS/SKRT): metode autopsi verbalUU No. 23/2006 tentang Adm. Kepend.: pencatatanvital dilakukan melalui sistem informasi adm. Kepend. dari desa/kelurahan hingga kab/kota, prop. dannasional
Cause of Death Data Source
Vital Registration:g o o di n c o m p l e t ep o o r / n o n e x i s t a n t
Latar Belakang
Badan LitBang Kes. dengan kerja sama DitJenAdminDuk DepDaGri, bantuan tehnis & keuangan dari WHO Ind & AUSAID (melaluiUniv. of Queensland) sejak 2003 mengembangkan Sertifikasi Medis PenyebabKematian (ICD-10) di fasilitas kes (RS) dan dimasyarakat (autopsi verbal) == IMRSSP (Indonesia Mortality Registration System Strengthening Project)
IMRSSP: Flow of COD reporting (Generic)(Integrate existing mortality registration and health reporting system)
DEATH EVENT
HOME HealthFacility
RT/RWRT/RW
HEALTH CENTERHEALTH CENTER
VILLAGEVILLAGE
SUB-DISTRICTSUB-DISTRICT
POP ADMNPOP ADMN
HEALTH OFFHEALTH OFF PROVINCE
CERT, 2
CERT, 2
CERT, 1
CERT, 1
VA
Death Report
Death Report
DOA
Death Report
COD Stat
COD Stat
Vital Stat
CODStat
COD Stat
CERT, 1
POLICEPOLICECENTRAL
Death Report
Death Report
COD Notification System (Puskesmas Dinkes)?
JAVA ISLANDMAP OF INDONESIA
IMRSSP Project Sites2 Sub-districts
257. 770 Pop
557. 541 Pop252. 020 Pop
4 Sub-districts5 Sub-districts
DAERAH PENGEMBANGAN “Quasi Sample Registration System”
TB Notification Rate
0 - 2425 - 4950 - 99
100 – more*sm+ notif rate per 100,000 population
N
W
S
E
* Provinsi:1. LAMPUNG, 2. WEST KALIMANTAN3. GORONTALO 4. PAPUA
32
14
Pengembangan “Quasi Sample Registration System”
Lampung:Metro (city) 126,978Lampung Selatan (district) 80,861
West KalimantanPontianak city 510,927Sambas (district) 104,429
GorontaloGorontalo city 145,754Gorontalo (district) 345,771
PapuaJayapura city 216,192Jayapura (district) 61,145
Total 1,592,057
Bali: 2 districts
TOTAL POPULASI YANG DICAKUP TAHUN 2008: 3 Juta
Medical certificate of cause of death
Contoh:
Cardiac arrestVentricular fibrillationMyocardial infarction
Metastatic lung cancer
Mode of dyingIaIb
II
Underlying cause of death: Myocardial infarction
Sertifikat Medis Penyebab Kematian
Distribution of deaths by COD and project sites, IMRSSP 2006 (First Semester)
2.5222.928J45Asthma
2.5222.120J18Pneumonia
12.210711.9113I00-I09, I16-I19, I26-I63, I65-I99
Other diseases of circulatory system
15.313424.9237I64Stroke
4.8425.149I20-I25Ischemic heart diseases
8.57412.6120I10-I15Hypertensive diseases
0.110.00H00-H59Diseases of eye & adnexa
1.9170.55G00-G99Diseases of nervous system
0.760.11F00-F99Mental & behavioral disorders
0.981.716E00-E09, E15-E90
Other endocrine, nutritional & metabolic diseases
3.3297.571E10-E14DM
3.2285.653C00-C49, C51-C97,D00-D89Other Neoplasm
0.650.99C50Ca mamae
6.3551.716A00-A08, A10-A14, A20-B99
Other certain & parasitic diseases
5.7502.019A15-A19TBC
5.7503.029A09GE
%Number%Number
PekalonganSurakartaCause of death
Continued
Distribution of deaths by COD and project sites, IMRSSP 2006 (First Semester)
Other external causes of
1.7150.44V01-V99transport accident
2.4211.817S06Injury to the head
1.5131.413R00-R99Symptoms & abnormal clinical & lab findings, NOS
0.220.00Q00-Q99
Congenital malformations, deform & chromosomal abnormalities
0.760.00O00-O99Pregnancy, childbirth and the puerperium
3.4301.615N17-N19Renal failure
1.3110.88N00-N16, N20-N99Diseases of genitourinary system
0.110.33M00-M99Diseases of musculoskeletal system
0.330.22L00-L99Diseases of the skin and subcutaneous tissue
4.8425.350K70-K77Diseases of liver
2.3201.817K00-K67, K80-K93Other diseases of digestive system
4.7413.230J00-J17, J20-J44, J46-J99
Other diseases of the respiratory system
%Number%Number
PekalonganSurakarta
Cause of death - ICD 10 Code
8436.7 per 1000
8056.4 per 1000
Pekalongan:- Deaths (6 months)*- Estimated CDR
1,9356.9 per 1000
1,0543.8 per 1000
Surakarta:- Deaths (6 months)*- Estimated CDR
HH SurveyIMRSSP (registrasi)
Project sites
Hasil asesmen “Dual System”pengumpulan data kematian
Note: * From January to June 2006
DUAL SYSTEM: Vital Registration Completeness
Total
SurveyNot
recorded
SurveyRecorded
234
71
163
VRRecord
ed
111
34*
77
VRNot
recorded
345
105
240
Total
VR Completeness = 68%
SURAKARTA
Total
SurveyNot
recorded
Survey Recorded
137
22
115
VR Record
ed
35
6*
29
VR Not
Recorded
172
28
144
Total
VR Completeness = 80%
PEKALONGAN
Statistik Sebab Kematian
─ Informasi dasar yang dibutuhkan untukmenyusun kebijakan kesehatan danpengembangan program
─ Evaluasi efektivitas suatu program (imunisasi, Tb, dll)
─ Penelitian (hubungan tembakau danpenyakit tertentu)
─ Penetapan prioritas kesehatan
RINGKASAN HASIL KAB. PEKALONGAN
Total deaths: 1,728Total population: 252,020Completeness of registration: 80%Note: adjusted refers to data that have been corrected for incompleteness of registrationCrude death rate, males (unadjusted): 687 deaths per 100,000 peopleCrude death rate, males (adjusted): 858Crude death rate, females (unadjusted): 685Crude death rate, females (adjusted): 856Life expectancy at birth (e0), males (unadjusted): 68.05 yearsLife expectancy at birth (e0), males (adjusted): 64.38 yearsLife expectancy at birth (e0), females (unadjusted): 70.57 yearsLife expectancy at birth (e0), females (adjusted): 66.86 yearsUnder-five mortality rate (q5), males (unadjusted): 0.0203Under-five mortality rate (q5), males (adjusted): 0.0253Under-five mortality rate (q5), females (unadjusted): 0.0189Under-five mortality rate (q5), females (adjusted): 0.0235Adult mortality rate (45q15), males (unadjusted): 0.2315Adult mortality rate (45q15), males (adjusted): 0.2805Adult mortality rate (45q15), females (unadjusted): 0.1629Adult mortality rate (45q15), females (adjusted): 0.1993
Kematian Karena TuberkulosisDI Kab Pekalongan
Death Rate (per 100,000) Age Males Females Total0-14 - - -15-59 26 30 2860+ 440 185 298Total 46 34 40 Age-Standardised Death Rate Males Females TotalTotal 69 41 53
KESIMPULAN“Quasi Sample Registration System” denganmemasukkan sebab kematian, dapatmemonitor pencapaian MDGsMeningkatkan kualitas statistik kematianBahan konstruksi “Life Table”Sebagai laboratorium Kesehatan Masyarakatuntuk memonitor dampak berbagai upayapengembangan kesehatan, pengembanganmodel intervensi: mengurangi faktor risikopenyakit tidak menular, dll
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