Household and health facility
surveys in Indonesia
Indonesia country team
Jakarta, Indonesia
Indonesia country office
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
Indonesia country office
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
Indonesia country office
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
Indonesia country office
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
Indonesia country office
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
Indonesia country office
STUDY LOCATION
4470 km
13/04/2015
6th Asia-Pacific Conference of
Reproductive and Sexual Health Rights
Indonesia country office
QUESTIONNAIRES MODULES
13/04/2015
Module HH
Household
Module AN
Antenatal Care
Module DN
Delivery and Newborn
Module BN
Breastfeeding & Nutrition
Module IM
Immunization
Module MA
Prevention of Malaria
Module CO
Fever and Cough
Module DI
Diarrhea
Module VA
Vitamin A
Module HF
Health Facility
6th Asia-Pacific Conference of
Reproductive and Sexual Health Rights
Indonesia country office
Ownership of MCH Book among mothers in
4 districts
13/04/2015
6th Asia-Pacific Conference of
Reproductive and Sexual Health Rights
Indonesia country office
BREASTFEEDING (n= 799)
In all districts, exclusive breastfeeding were low and there was significant
advice on using formula milk
13/04/2015
6th Asia-Pacific Conference of
Reproductive and Sexual Health Rights
Indonesia country office
Evaluation Survey of IMCI
Implementation in 8 Districts in
Indonesia
Center for Health Research
University of Indonesia
Indonesia country office
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
Indonesia country office
Study area
Indonesia country office
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
Indonesia country office
Proportion of sick children managed by IMCI trained
providers
Indonesia country office
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.
Indonesia country office
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.
Indonesia country office
Health facility received at least 1 supervisory visit that include observation
of case management during the previous 6 months
Indonesia country office
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
Indonesia country office
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
Indonesia country office