Maternal and Child Nutrition Program : 1000 days of Life

Directorate of Public Health Nutrition

Ministry Of Health Republic Indonesia

Magnitude of Problem

Coverage of Program in Indonesia

Causes and Implication

Policy Direction and National Strategy

Conclusion

OUTLINE

Health and Nutrition Problems

3Sumber: Global Nutrition Report, 2018

Each country has his own nutrition problems

single burden double burden triple burden

22,2% Children under

5 years in the World

(150,8 M)

Stunting

7,5%

(50,5 M)

Wasting

5,6%

(38,3 M)

Overweight

Indonesia is one of the countries successful in

reducing malnutrition among children, but facing

increasing obesity problem among adults

Stunting, Wasting and Overweight among Children under 5

2013-2018

Sumber: Riskesdas, 2013 dan 2018

2013 2018

14.8% 21.8%

2013; Stunting; 37,2

2013; Wasting; 12,1

2013; Overweight;

11,9

2018; Stunting; 30,8

2018; Wasting; 10,2

2018; Overweight; 8

2013 2018

Obesity among Adults18+ years

Nutritional Problems of Maternal in Indonesia

Half of pregnant women are

DEFICIT OF ENERGY AND PROTEIN

Proportion of Protein Intake < 80% AKP of Pregnant Women 49,5% & Proportion of Energy Intake < 70% AKE of Pregnant Women is 44,8% (Riskesdas, 2010)

SDT, 2014 SDT, 2014

Maternal Mortality Rate and Cause of Death

MMR/100.000 LB

2010 SP 2015 SUPAS 2019 TARGET

305346 306

CAUSE OF MATERNAL DEATH

(Source : SRS 2016)

Infant Mortality Rate, Cause of Death, and Fetal Undernutrition

PROPORTION OF BIRTH WEIGHT

IMR/1.0000 LB

2432 24IDHS 2012 IDHS 2017 2019 TARGET

(Source : Basic Health Survey 2007-2018)

CAUSE OF INFANT DEATH

Under-nutrition foetal and adolescent nutrition status linkage

Coverage of Micronutrient supplementation, IFA, compliance 38,1% (Basic Health Survey, 2018)

Pregnant women get IFA

Supplementation

Get < 90 Tablet

Get >= 90 Tablet

9

Multidimensional causes of nutrition problem

Source: UNICEF 1990 (adjusted with Indonesia’s condition)

1Indonesia: Study on The Cost of Diet, WFP (2017)2Basic Health Research Ministry of Health Republic of Indonesia (2018)3Indonesia Statistics Bureau (2016)

Sociocultural, economic and

political context

Poverty, Food Security and

Nutrition, Education

Purchasing Power,

Access to Food, Information

and Services

Food

Consumption

Infection Status

Nutrition

Status

Root

CausesIndirect Causes Direct Causes

• 62% population can afford nutritious

food1

• 95.5% have inadequate consump-

tion of fruit & vegetables2

Availability and Food

Consumption Patterns

• 37.3% exclusive breastfeeding2

• 46.6% U5 children consumed

diverse diet2

Parenting & Feeding Practices

Environmental Health &

Health-care Services

• 57.9% immunization rate2

• 71.14% household access

to improved water sources3

Outcome

10

IMPROVING ACCESS TO THE UNIVERSAL HEALTH SERVICES

STRATEGY INTERVENTION

IMPROVING QUALITY OF HEALTH SERVICES

STRENGTHENING GOVERNANCE

COMMUNITY EMPOWERMENT

1

2 3

4

IMPROVING ACCESS TO THE UNIVERSAL HEALTH SERVICES

Adolescent Reproductive agePregnant women

& MaternityNewborns

62.2% of PHC conducting adolescent health

services/PKPR

76.2% of young women got Fe Tablets

54% of PHC provide reproductive health services to pre-married couples

57.2% active FP attendees modern Way

13.3% wearing MKJP10.6% Unmet need KB

98% got quality ANC

79% mothers giving birth in

healthcare facilities

Neonatal visit 1x : 84,1 % Neonatal visit 3x : 43,5%

MOH Regulation No 4/2019 on Minimum Standard of Services/SPM responsibility of Head of Local Government

448 Companies implement Productive Women Workers

Movement (GP2SP)

READY to

pregnant

Health Services for School Age Children

Health Services for Productive Age

Health Services forPregnant Mother

Health Services forLabouring Mother

Health Services for Newborn

Source : Basic Heallth Survey 2018, Data routine 2018

1

9.993 PHC

DTPK

IMPROVING QUALITY OF HEALTH SERVICES2

• PHC

• Clinic

• Private Practice

• Midwife Private

Practice

Integrated Referral System

• Local Public

Hospital

• Private Hospital

• Mother and Child

Hospital

• Quality ANC and

PNC includes

early detection

• BEmONC 24/7

• Accreditation of

First Level Health

Facilities(FKTP)

• CEmONC 24/7

• Mother Baby

Love Hospital

• Accreditation of

Advanced Health

Facilities

(FKRTL)• Evidence based planning

• Human Resource

management

• Medicine and medical

devices compliance

• Audit Maternal Neonatal

• Partnership

• Development of Integrated

Referral System

EMPOWERING THE COMMUNITY3

MCH Handbook

Mother class Village budget fund Active

Alert Village(DESA SIAGA)

Birth Preparedness

and Complication

Prevention

STRENGTHENING THE GOVERNANCE4

Community Empowerment(Mother Baby Friendly Hospital, MCH HB, Mother

Class, P4K, MMD/SMD, Adolencents Posyandu,

Active Alert Village)

Referral network(Referral Manual, Integrated Referral

System)

Access and quality of

services(ANC, neonatal essential services,

Nutrition Counselling,

micronutrient

supplementation compliance,

emergency response)

Regulation(Law 36/2009, MoH Regulation 75/2014, MoH

Regulation 97/2014, MoH Act Nutrition

Supplementation 51/ 2016, MoH Act IFA

88/2014, MoH Act Vitamin A 21/ 2015,

Nutrition Balance Diet 41/ 2014)

Human Resouces(amount, distribution, competence)

Facilities and Infrastructure(medicine, medical devices,

Nutrition Supplementation)

01

0405

06

07

08

02

03 Information systems(MDN, Local Health Information

System, Hospital Information

System, SiJARI EMAS)

Budget and Funding(State Budget, Local Budget,

Special Allocation Fund, National

Health Coverage/JKN, Delivery

Safety Net/Jampersal, Village

Budget, utilization of Waiting

Home)

CONCUSION :

HEALTH DEVELOPMENT FOCUS

HEALTH DEVELOPMENT PRIORITY

FAMILY

APPROACH

Nutrition

Improvement

especially

stunting

MMR, IMR,

Immunization

Management of non

communicable diseases

Management of communicable

diseases

Health Sector in central and district, related cross sector, professional

organizations, academics, social institutions, mass media, business,

development partners and community participation

Improvement of Maternal and Child Health, Family Planning, and Reproduction Health

Priority Project: 1. Decreasing of

Maternal and Infant Mortality

2. Improvement of Family Planning (KeluargaBerencana/KB) and Reproduction Health

Acceleration of Community Nutrition Improvement

Priority Project:Decreasing of Stunting

Strengthening Disease Control

Strengthening the Healthy Life Community Movement (GerakanMasyarakat HidupSehat/GERMAS)

Priority Project: 1. Development of

Healthy Environment2. Strengthening

promotion of GERMAS

Improvement of Health Services and

Drug-Food Control

1

3

4 2

5

IMPROVING ACCESS AND QUALITY OF

HEALTH SERVICES

(STRATEGY OF RPJMN 2020-2024)

Thank you

HEALTHY REGARDS