Household and health facility surveys in Indonesia

1. Household and health facility surveys in Indonesia Indonesia country team Jakarta, Indonesia

2. MNCH-Household Survey • Builds on CDD/ARI household surveys • Provides information of direct programmatic relevance on the coverage of key interventions for maternal, newborn, and child health • Identifies problems with intervention delivery and/or reasons for delivery failure that should be addressed by programme managers • (Provides information on adolescent sexual and reproductive health) • Provides some information on expenditures for child health

3. MNCH-HHS: Characteristics (1) • Sub-national, focus on outputs and outcomes (no impact) • Coverage measures and information on: • delivery channels (how and where interventions are delivered) and/or - reasons for coverage failures • Limited to few interventions with high potential for impact • Modular format for adaptation based on interventions with high potential for impact that are actually being scaled up locally

4. MNCH-HHS: Characteristics (2) • Program focus: locally planned and analyzed, results rapidly fed back into programming cycle • Developed jointly by WHO/CAH and WHO/MPS with input from UNICEF and from countries where the survey has been tested • Complementary to and consistent with existing household survey tools (DHS, MICS) • Limited cost and short duration

5. Sampling methodology and sample size Cluster sampling Using a sampling strategy where all individuals have the same probability of being selected and where the size of the population in each village/community is taken into account Usual sample between 1000 to 1,200 households (larger sample are difficult to manage and are likely to require more than 2 weeks of data collection) Maximum of 120 clusters Between 10 to 15 households selected in each cluster In each household, children <2 or <5years of age are the entry points

6. Process in Indonesia • Introduced in workshop June 2010 • Adapted by University of Indonesia • Use by UNICEF as baseline for intervention project • Use by SCF and MCHIP in project areas • Intention to be socialized to district health offices for their surveys on intervention coverage

7. STUDY LOCATION 4470 km 15/09/2014 6th Asia-Pacific Conference of Reproductive and Sexual Health Rights

8. QUESTIONNAIRES MODULES 15/09/2014 6th Asia-Pacific Conference of Reproductive and Sexual Health Rights

9. Ownership of MCH Book among mothers in 4 districts 15/09/2014 6th Asia-Pacific Conference of Reproductive and Sexual Health Rights

10. BREASTFEEDING (n= 799) In all districts, exclusive breastfeeding were low and there was significant advice on using formula milk 15/09/2014 6th Asia-Pacific Conference of Reproductive and Sexual Health Rights

11. Evaluation Survey of IMCI Implementation in 8 Districts in Indonesia Center for Health Research University of Indonesia

12. Objectives • The objectives of this study were to determine: • Current level of quality of care delivered to sick children at outpatient health facilities • Current quality of counseling given at outpatient health facilities and caretakers’ understanding of home treatment of sick children • Current availability of key health system supports that are required for the implementation of sick children services, such as drugs and vaccines, equipments and supervision • Principal barriers to effective integrated case management of sick children

13. Study area

14. Methods • Design: • Cross sectional survey of 15 puskesmas/district • Population: • Sick children who come to puskemas in the six districts • Sample size • Using sample size formula for estimation of a population proportion • Proportion of sick children who are appropriately managed using IMCI = 50%, error of estimation=15%, confidence level= 95%, design effect=2 • Minimal sample size: 86 sick children/district

15. Proportion of sick children managed by IMCI trained providers

16. Checking of signs, symptoms and immunization status by IMCI trained & untrained providers Note: all heath providers in Rote Ndao are not trained in IMCI Source: IMCI Evaluation Survey in 8 Districts in Indonesia, 2008.

17. Proportion of sick children who did not need antibiotic/antimalaria but received those drugs Note: all heath providers in Rote Ndao are not trained in IMCI Source: IMCI Evaluation Survey in 8 Districts in Indonesia, 2008.

18. Health facility received at least 1 supervisory visit that include observation of case management during the previous 6 months

19. Conclusions Health Facility Survey Assessment of sick children by IMCI trained providers was more comprehensive than by untrained providers Nevertheless, about half of sick children who were assessed by IMCI trained providers were not comprehensively assessed according to IMCI standard procedure Missed opportunities for immunization occurred in all sick children who were managed by IMCI trained & untrained providers The use of antibiotics & antimalarials was more rational in IMCI trained providers compared to untrained providers

20. Summary • Health facility surveys allow the assessment of the effectiveness of IMCI training • Household surveys allow to determine coverage and effectiveness of interventions at the household level • WHO generic tools can be easily adapted fro use in countries • Both surveys can be used by programme planners to determine next steps, or for operations research