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INTERNATIONAL CONFERENCE ON CSR AND COMBATING MALNUTRITION:
OBTAINING MILLENNIUM DEVELOPMENT GOALS (MDGs) IN INDONESIA
Grand Sahid Jaya Hotel, 13 – 14 December 2010
Session 1: Prevention & Intervention in Improving The National
Nutrition Status in Indonesia
Budi Iman Santoso, Sp. O.G., Head of Obstetrics & Gynecology,
Cipto Mangunkusumo Hospital
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EFFORTS OF OBSTETRIC CARE
ON REDUCING MATERNAL MORTALITY
RATE TO ACHIEVE MDG TARGETS
IN INDONESIA
Dr. Budi Iman Santoso, SpOG(K)
DEPARTMENT OF OBSTETRIC-GYNECOLOGY
CIPTO MANGUNKUSUMO HOSPITAL –
FACULTY OF MEDICINE UNIVERSITY OF INDONESIA -
JAKARTA
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OUTLINE
Introduction
Achievement of Reduced MMR
Comprehensive analysis
◦ Linear and Dynamic System
◦ Priority Strategy – 5W + 1 H
Role of Obstetric Care
SWOT Analysis
Conclusion
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INTRODUCTION
Millenium Development Goals (MDGs)
September, 2000 – the Millenium Summit of
189 UN Nations, the Millenium Declaration
Indonesia:
◦ The National Long-term Development Plan
RPJPN (2005-2025)
◦ Mid-term: RPJMN 2005-2009 & 2010-2014
◦ Annual: RKP
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INTRODUCTION… MDGs
Pro-growth, pro-jobs, pro-poor and pro-environment
8 targets:
5A. Reduce MMR by three-quarters
between 1990-2015
5B. Achieve universal access to
reproductive health
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THE CURRENT STATUS OF MDG TARGETS
3 categories of MDG achievement
A. Have already been achieved: 1,3,6
B. Significant progress has been achieved: 1,
2, 3, 4, 8
C. Still requires great efforts to be
achieved:
1,5,6,7
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REDUCED MATERNAL MORTALITY RATE
IN INDONESIA
1992: 425/100.000
2007: 228/100.000
RJMPN 2014: 118
MDG 2015: 102
Acceleration initiatives!
Global: MDG 5 slow progress
◦ Only China and Vietnam have been “on track”
◦ Separating MDG 5A and 5B (introduced 2007)
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Indicators of Achievement: MDG 5
Mostly, still need special
attention
Indonesia: We are not alone
– similar results in Asia
Pacific region
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COMPREHENSIVE ANALYSIS
LINEAR SYSTEM OF THINKING
DYNAMIC SYSTEM
PRIORITY STRATEGY – 5 W + 1 H
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LINEAR SYSTEM :
Gender, Nutrition, Safe Abortion
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Pre-Pregnancy, Pregnancy, Labor & Delivery,
Post-Partum
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Gender Issues- Reproductive Health:
Woman’s Basic Human Rights
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Safe mother – Safe child
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Mother’s nutrition - neglected
Dear man,
Do you really care for your woman & children??
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Family Planning – Safe Abortion,
Woman’s right
Woman’s right is not only in Education and Work
But most importantly is the right to decide what’s best for her
body
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DYNAMIC SYSTEM :
4 sub-systems:
◦ Demography, social and culture (blue)
◦ Family Planning (yellow)
◦ Quality of labor assistance (red)
◦ Environment and sanitation (grey)
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PRIORITY STRATEGY 5W
+1H WHAT – 4 Priority Strategies, 1 Vision:
“Making Pregnancy Safer”
◦ Quality of Effective Health Services
◦ Inter-program/sector/private partnership
◦ Family empowerment
◦ Public Mobilization
WHERE – Extreme extensive area in
Indonesia Map of Priority for Target
Area
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PRIORITY STRATEGY 5W
+1H WHO –
◦ Target: mother and couples of reproductive
age
◦ Executor: Health care professionals
Mutual responsibilities: government,
private & community
Need a Consultant Manager?
Role of general practitioner in assisting
labor (in service & pre-service)
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PRIORITY STRATEGY 5W
+1H WHEN – tight deadline 2015
◦ When is the best time for monitoring & evaluation
◦ Improvement on indicator – Official / Alternative
indicator
WHY – clearly stated in linear & dynamic
system
HOW – Start the Effective Strategy ASAP
◦ Guidelines
◦ Meetings & panel discussion
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Official or Alternative indicators?Asian-Pacific Resource &Research for Woman (ARROW)
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THE ROLE OF OBSTETRIC CARE
Most maternal death is due to obstetric
complication and emergency
Risk of maternal death – extremely high:
◦ 100 x on First day after labor
◦ 30 x on Second day postpartum
◦ 14.8% - 1 week before labor
◦ 43.5% during labor
◦ 23.7% in 1 week after labor
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Obstetric care has important role on Strategy 1
(Access and Quality Health Services)
Obstetric and neonatal emergency care
Preventive and promotive care:
◦ Pre-pregnancy (Family Planning, Pre-marital
counseling, Improved Nutrition, Immunization)
◦ During pregnancy (ANC, BPCR, Fe, Calcium (PE/E),
Immunization)
◦ During Labor (Labor assistance in Health Care
Facility, Safe and Clean Labor, CTG, Biophysical
profile, Partograf, MAK III, Initial breast feeding)
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ROLE OF OBSTETRIC CARE
JNPK (Jaringan Nasional Pelatihan Klinik) & MOH
Directorate General of Medical Services have conducted
training on Comprehensive Emergency Obstetrics and
Neonatal Care (CEONC) at Tangerang Hospital (2008-
2009)
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Training Results
20 hospital staff (3 obs-gyn, 2
pediatricians, 9 midwives, 6 nurses) are
certified in CEONC
4 Health Care units are certified in
BEONC
40 midwives are certified in LSS
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Training results
Midterm Maternal Death reduced from 32/2998 to
12/3503 live-birth
Annual Maternal Death reduced from 52/5002 (2008)
to 29/7018 live-birth (2009).
Reduced Annual Mortality*
Mortality 2008 2009
Maternal
per 100,000 live-births800 300
Perinatal
per 1000 live-births30 16
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Effective Obstetric Care
Cause of death Effective care % reduction
Bleeding AMTSL,Obstetric care,
transfusion
40%
Infection Preventing infection and
uses of antibiotics
13%
Eclampsia Magnesium Sulfate & anti
hypertension agents
7%
Delayed labor Partograf, Operator
competence
10%
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ROLE OF OBSTETRIC CARE
Health care professionals have less role in
Strategy 2 (Inter-Program & Sector Partnership)
Rigid bureaucracy & regulation
Turniani L, et al: Strategic policy has supported
the program of reducing MMR
Sugeng et al: not all sectors have realized the
importance of program to reduce MMR
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Program supported by local government policy
Province Supported Program
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North Sulawesi GSI, SPM, AMP
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ROLE OF OBSTETRIC CARE
Least role in Strategy 3 (Family
Empowerment)
In Strategy 4 (Public Mobilization) it
depends on government initiatives to
involve the health care professionals
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COULD WE ACHIEVE MDG 5 BY 2015??
SWOT analysis ON MDG 5 - 102/100,000 livebirth on 2015
STRENGTH
Fine human resource
Good strategy program
High commitment by the government,
private sectors (CSR)
Overseas fund: USAID for CEONC
Many programs have been conducted
Positive reduction on MMR, needs
acceleration
Weakness –
Different vision, not well-coordinated
Less concern on priority
Less awareness on woman’s right in
reproductive health
Geographical obstacles
Tight deadline
Problems in training of labor assistance
Opportunity –
Support by developed countries on MDG
program
Threat –
No concern on existing program
Egoism – fond of new program rather than
integrating with the existing program
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CONCLUSION
Positive reduction in MMR needs acceleration
Issues on discussion:
◦ Gender equality / woman’s right: family planning, nutrition, safe
abortion
◦ Alternative indicators
◦ Effective Strategy
◦ Consultant manager
◦ Using technology : www. kesehatan-ibuanak.net Launching: 30
Nov 2010
◦ Training of labor assitance (in service dan pre-service)
◦ Fund rising
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GREATEST THREAT:
WE DON’T CARE
I don’t care
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REDUCING MMR
= Treating Wound Healing
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At beginning… Everything looks terrible….
But … We Care !!(On courtesy of: Kompyang Rata, I Gusti Agung)
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First month… After exhausting efforts of daily care..
Nearly loss of hope
But.. We do care!!!
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Third month…. On Progress..
For the patient, it is still troublesome
But.. We still and do care !!
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Fourth month… and there is a smile
120 x we’ve tried to be still and do care..
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When it seems nothing…
Actually, there is everything…
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Every dark cloud has a silver lining
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Is it a road to DIE or to SMILE – We decide..
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