1. Country Team Action Plan Scaling-Up Management of Neonatal Sepsis in Indonesia

2. 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)

3. Intervention
Improving case management of neonatal sepsis at community level through home visits
Midwives
Nurses
Community health cadre
Content of Slide:
Desired levels of accomplishment
Country Team Goal
Best Practice Chosen for Scale-Up and Its Components (TRACK 2)
TRACK 1: Flipchart Titles for Session 1 and 2:
“Desired Accomplishment”
“Country Team Goal”
TRACK 2:
“Country Team Goal” and “Final Selection of Best Practice for Scale-Up” – elaborate on the various components of the best practice package

4. 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)

5. 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

6. 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

7. 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

8. Piloting Project Areas
Scenario 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)

9. Monitoring & Evaluation
Using MNCH local area monitoring system (LAMAT)
Robust and regular M & E
Good documentation

10. Action Steps Steps and Actions PIC Timeline 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
TWG
April 2010
May 2010
Aug 2010

11. 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
MoH
Donors
TWG
PHO/DHO
Aug 2010
Oct 2010
Feb 2011
Dec 2010

12. 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
Start June 2011
June 2012

13. Terima kasih