CURRENT STATUS OF HEALTH
INFORMATION SYSTEM: INDONESIA*
Soewarta Kosen
National Institute of Health Research & Development
Center for Community Empowerment, Health Policy and Humanities
Jakarta, Indonesia
Presented at the 6th Meeting of the Asia
Pacific Network of the WHO IFC,
Bangkok, Thailand, 18-19 July 2013
BACKGROUND

Law No 36/2009 on Health states that to manage effective
and efficient health efforts, health information is needed
and should be implemented through the health information
system and include information from other sectors

To be optimum, the Health Information System needs
cooperation and support of various sectors and cover
integrated information from health sector and all other
health related sectors for policy formulation

Law No 23/2006 on Population Administration stated that
Vital Registration is implemented through Population
Administration Information System from village/kelurahan
up to district, city, province and national
BACKGROUND

Sources of Health Information System and basic demographic
statistics in Indonesia include: population administration
information system (Civil Registration), Population Census,
National Socioeconomic Survey, Demographic Health Survey,
National Health Survey, Baseline Health Research (RisKesDas),
regular recording-reporting system of Puskesmas (Community
Health Center) and Hospitals, surveillance data, sentinel data:
Nutrition, MCH, Family Planning, Mortality Data with Multiple
Causes of Death (ICD – 10)

The benefits of a well-developed information system include the
ability to monitor impact of health programs, better quality
information, and more efficient delivery of health care services.

With sound data sources and proper data collection, transforming
data and information (evidence) into policy becomes best
practices
Health Information Data Sources
Civil
Registration
Service
Records
Population
Surveys
Community
Individual
Records
Population
based
Facility
based
Processing & Integrating
data
Census
Resource
Records
Saving of Integrated data
Integrated Health Information System
Sources of Data
MonitEvaluation:
reports,
event
inquiries &
warning
Fact & evidence
from HIS, used for
decision making
• MoH
• Other gov’t
ministries
• Local health
offices (prov/
district/city)
• International
agencies
• Universities
• Researchers
• etc.
Standardized Data
Collection
POLICY, RESOURCES AND PROCESS
Source: HMN, 2008
CHARACTERISTICS OF THE INDONESIAN
HEALTH INFORMATION SYSTEM

The HIS includes data of health sector & other related
development sectors (FP, Social Welfare, Agriculture)

The HIS integrates routine facility based data and nonroutine community based data (survey, census):
Baseline Health Research, Facility Based Survey,
Demographic Health Survey, National Socio-economic
Survey

Used for advocacy, program planning, monitoring and
management; as well as for evaluation

Emphasize: availability, quality, value & utilization of
timely and accurate information
TYPE OF COLLECTED DATA IN HIS








Health status (morbidity, disability and mortality)
Health efforts (public goods & private goods)
Health care financing
Health man-power
Drugs and supplies
Community empowerment in health
Health resources: building/physical infrastructure,
medical equipment and non-medical (vehicles,
furnitures)
Local specific data
CHARACTERISTICS OF IMPROVED INDONESIAN
HIS






Self reliance
Data & information are processed and analyzed mainly at and
for local use (operational level)
Applying conventional (paper based) as well as ICT/computer
based procedures: maximize efficiency (personnel time) and
effectiveness (relevance & usefulness)
Proper selection of essential indicators: Obligatory Public Health
Functions/Minimum Service Standard; to serve the need of data
and information at various levels, including local level (city,
district, prov.)
Development of a network of data-bank
Comprehensive & relevant for health development
N
CURRENT ACHIEVEMENT OF INDONESIAN CRVS
W
E
S
Uses of e-ID & unique population number in all over Indonesia: accelerate better
civil registration (births, deaths) and causes of death
Several cities & districts have allocated special budget for CRVS activities
Joined efforts (MoH & MoHA) to improve Civil Registration and certification of
causes of death based on existing law and regulations, use the information for
national and local planning and policy formulation
Collection of real-time of vital statistics data and causes of death, through Sample
Registration System
SITUATIONAL ANALYSIS

Identified weakness of Indonesian HIS:
◦
◦
◦
◦
◦
Irrelevance of the collected information
Fragmented & poor quality of data
Duplication among parallel information
Lack of timely reporting and feedback
Minimal analysis and use of data & information at
local level (district and city) for advocacy, program
planning, monitoring and management; as well as
for obtaining needed resources
STATISTICS BASED ON WHO - FIC

Provide basic information to formulate policies,
priorities and development of intervention
programs (health and non health) as well as a
guidance in allocating resources

As a base to monitor and evaluate program
effectiveness of basic services/obligatory public
health functions, their achievements and trends

To determine research priorities, e.g. relationship
of tobacco and certain diseases, causes of high
incidence of stroke, determine risk factors,
relationship with socioeconomic level,
demography and behavior
INDONESIAN SAMPLE REGISTRATION SYSTEM
(SRS)

Indonesian SRS sites cover 128 Sub-Districts in 89
districts and 25 cities (7 regions and 30 provinces) that
represent Indonesia

Total population covered about 4 % of Total Population
(240 millions): about 9 millions to represent Indonesia

Stratified into Development Area (7) and Urban - Rural

Joint Decree of the Minister of Home Affairs and the
Minister of Health (January 2010) on Reporting of Death
and Cause of Death facilitates the recording of events and
cooperation between the two sectors at the grass-root
level
COMPONENTS OF THE
WHO VERBAL AUTOPSY GUIDELINES
I.
Questionnaire for interview with family members and/or
caregivers

Standard questionnaires permit reasonably accurate
ascertainment of causes of death based on responses
to a well-administered questionnaire.

Responses to questionnaire analysed for
classification and coding in line with ICD-10
II.
Application of ICD-10 to verbal autopsy interviews

Certification by medically trained personnel

Professionalised coding
ICF (INTERNATIONAL CLASSIFICATION OF
FUNCTIONING, DISABILITY AND HEALTH),
WHO 2001
Collected thru Baseline Health Research
2007 and 2013 for situational analysis of
disabilities
 Applied in Disability Weight Survey for Global
Burden of Disease 2010 (3 provinces of
Indonesia)
 Indonesia Statistical Office incorporates the
ICF Concept for Handicapped Survey
(together with the Ministry of Social Affairs)

CONCLUSIONS





Need to emphasize the Medical Certification of Cause of Death
(MCCD) as a confidential part of the formal death certificate
Need to refresh medical communities (physicians) in all health
facilities (hospitals and community health centers) on the
writing of multiple causes of death based on ICD – 10
Need to enforce compulsory mortality registration based on
current national law & regulations and support the formulation
of local regulations
Since the majority of deaths occur outside the hospital, verbal
autopsy method to obtain causes of death has to be
disseminated and carried out for deaths occurring in the
community
Accelerate development of ICT to assure more reliable, timely
and complete Health Information System
CONCLUSIONS

The improved Indonesian Health Information System based on
WHO - Family International Classification:




Be adaptive to the information need of the health sector,
relevant and produce better quality of data to support
planning and management at various levels of administration
Permit development of integrated and comprehensive HIS to
support the national and local health systems
Be locally sustainable
Be able to monitor achievement in health development,
including Medium Term National Health Dev’t Plan, MDGs,
WSC , etc.
ULTIMATE TARGET:
Disseminate information culture: “no reasons to make
decisions without information and evidence based support”
TERIMA KASIH