Country Team Action Plan

Scaling-Up Management of Neonatal Sepsis in

Indonesia

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Background

• NMR: 19/1000 (57% of IMR) ; Neonatal Infection is the 3rd major killer

• ~ 54% home delivery, low access of newborn care, cultural & geographical barrier

• Midwives are the front line health providers at community (55%)

• IMCI algorithm adopted & implemented,

• Health center with BEONC & hospital with CEONC implemented as referral services

• Completed Manual of Pediatric Service in Hospital

• Schedule for postnatal visit: NV1 (6-48 hours), NV2 (3-7 days) & NV3 (8-28 days)

• Decentralized health system at district (489 districts)

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Intervention

• Improving case management of neonatal sepsis at community level through home visits

– Midwives

– Nurses

– Community health cadre

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Evidence of effectiveness community based newborn

care•Global evidence in India, Nepal, Bangladesh,

and Pakistan of community based newborn care

•Joint statement WHO/UNICEF on community-based newborn care

•Management of birth asphyxia by community midwives in Cirebon, West Java (SNL)

• Indonesia IMCI (include diarrhea & pneumonia)

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Stakeholders involve in scaling up

• MoH, Provincial & District Health Office

• Professional organizations (Pediatrician, Obgyn, Medical, Perinatologist, Midwive, Nurse, Public Health, Nutritionist)

• Institutional academics

• National Family Planning Board, Ministry of Internal Affairs, Ministry of Women Empowerment & Children Protection, Ministry of Education, Ministry of Religion)

• Local NGOs

• International agencies (Unicef, USAID, WHO, World Bank, ADB, GTZ, AusAID, JHPIEGO, Mercy Corps, WVI, Save the Children, etc)

• Media

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Policy Implication

• Task shifting: review role of nurses & midwives, community health cadres, and TBAs to identify and manage neonatal sepsis

• Legal authority: delegation of authority from and among professional organizations

• Funding resources: to provide operational cost for home visits from central, provincial, & district/ municipalities budget

• Logistic issue of supply chain management of antibiotic

• Trainings: pre- & in-service for health providers

• Community mobilization to increase demand for newborn care

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Pilot Project Area

Suggested criteria of choosing pilot project area:• Public health development index, child health & nutrition

problem • Financial capacity• Geographical• Health workers availability: health staff -midwives, nurses-

or non-health staff/cadres, FP workers• Possible resources: budget, human resource in health,

supervisions. • Local government leadership• Urban/rural considerations

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Piloting Project AreasScenario for intervention, different areas:• Availability of midwives &/ nurses• No midwives but nurses available• No midwives and no nurses available, CHWs exist

Possible areas:• Serang – West Java (Java) • Bireun – Aceh (Sumatera)• Kutai Timur – East Kalimantan (Kalimantan)

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Monitoring & Evaluation

• Using MNCH local area monitoring system (LAMAT)

• Robust and regular M & E

• Good documentation

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Action StepsSteps and Actions PIC Timeline

1. Preparations• Cross-sector coordination MOH,

NGOs and professional organizations

• Form technical working group on child survival

• Preparation of pilot project areas• Discussion on policy implication• Developing manual of community-

based neonatal sepsis case management.

• Developing manual for FP-MNCH services integration

MoH

MoH

MoHTWGTWG

TWG

April 2010

May 2010

May 2010Aug 2010Aug 2010

Aug 2010

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Steps and actions PIC Timeline

2. Pilot project implementation• Dissemination and advocacy in pilot

areas• Cross-countries learning• System analysis to identify the existing

model to integrate the neonatal sepsis case management

• In-service trainings• Pre-service trainings (curriculum

development and integration)• Monev trainings• IEC development• Review possible new inovations &

diversifications

MoHDonorsTWG

PHO/DHOTWG

TWGTWGTWG

Aug 2010

Oct 2010

Oct 2010Feb 2011

Oct 2010Oct 2010Dec 2010

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Steps and actions PIC Timeline

3. Monitoring and Evaluation• Pilot project monitoring and

evaluation (competency, coverage, quality, access, logistic, community uptake)

• Refining the strategy program design adjustment based on evaluation findings

• Evaluation• Documentation for scaling-up

TWG

TWG

Start June 2011

June 2012

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