Tuesday, January 31, 2012

Papers on: Health Concerns and Health Policy in Indonesia on Aggregate mother

Health Concerns and Health Policy in Indonesia on Aggregate mother
Papers on: Health Concerns and Health Policy in Indonesia on Aggregate mother 

Papers on: Health Concerns and Health Policy in Indonesia on Aggregate mother 
Health Concerns and Health Policy in Indonesia on Aggregate mother 

Health Issues and Health Policy in Indonesia, is a domestic issue that should be in Indonesia selesiakan. Health Issues and Health Policy in Indonesia is basically the responsibility of every individual in Indonesia. Health Issues and Health Policy in Indonesia, looking at the problem from this oneheath.blogspot.com Health and Health Policy in Indonesia try to give an explanation of the issue of Health and Health Policy in Indonesia.
The following overview of Health and Health Policy issues in Indonesia by oneheath.blogspot.com



1.1. Background

Currently in Indonesia there are some health problems of the population that still need attention in earnest from all parties include: anemia in pregnant women, lack of calories and protein in infants and children, especially in endemic areas, vitamin A deficiency in children , anemia in the group of students, school-age children, as well as how to maintain and increase immunization coverage. Those issues should be dealt with seriously because the impact will affect the quality of the raw materials of Indonesia's human resources in the future.

One measure to describe the achievement of development results, including the development of a country's health indicators are used Human Development Index (HDI). Some indicators of IPM is the health, education and economics. One indicator of health is life expectancy as a measure of the achievement of public health degree. HDI countries Indonesia is ranked 108 out of 177 countries in the world, lower than the ASEAN countries like Singapore, Malaysia, Brunei Darussalam and Thailand.

The composition of Indonesia's population by age group, showed that the population yag young (0-14 years) of 29.30%, of reproductive age (15-64 years) of 65.05% and elderly (> 65 years) for 5.65 %. With the burden of Dependant (Dependency Ratio) of Indonesia's population in 2007 amounted to 53.73%. This figure has increased compared to 2006 amounting to 49.90%.

Mortality rate of mother / maternal mortality rate along with Babies always be an indicator of the success of health development sector. MMR (Maternal Mortality Rate) refers to the number of maternal deaths related to pregnancy, childbirth and postpartum. The results of Indonesia Demographic and Health Survey of 2007 mentions that the maternal mortality rate in 2007 amounted to 228 per 100,000 live births. This figure compared to the 2002 maternal mortality rate was 307 per 100,000 live births.

Efforts to achieve MDG 4 to reduce child mortality and MDG 5 to improve maternal health in Indonesia is still heavy. Many obstacles in terms of both technical and program of the factors that affect the health financing efforts that have been and are being carried out. Decentralized system of health that has been applied for many years to give the area an opportunity to assert themselves in planning and implementing health programs, especially for maternal and child health, but in its implementation faces many obstacles.

When this has been done an analysis of barriers and blockages (bottleneck) in system planning and budgeting at national and local levels. Has also conducted various discussions and observations about maternal health funding from central government over the last few years. The result is that there are various obstacles and blockages in the regulation, distribution systems, and political aspects. As a result, central government funds are not able to effectively reach those in need.

To overcome the barriers and blockages that exist in the effort to achieve MDGs 4 and 5 in terms of both technical and financing programs, needed improvement budgeting and distribution system of government budgets. In the process of budgeting and disbursement budget for the current MCH, still not much the role of NGOs and universities. Actor actors more heavily on the Ministry (of Health and Finance), House of Representatives, and Bappenas. In concrete, yet there is such a Watch Group for the budgeting and disbursement of government funds for MCH.

1.2 Problem formulation

1. What is health policy?

2. Any problems that occur on the aggregate capital in Indonesia?

3. Policy - health policy any reply made to aggregate capital in Indonesia?

4. What factors are affecting the health problems?

5. Reproductive health policy efforts whatever you have in Indonesia?

1.3 Purpose of

The purpose of the writing of this paper is to:

1. Knowing the meaning of health policy.

2. Knowing the aggregate maternal health problems in Indonesia

3. Knowing the health policies on aggregate mother in Indonesia

4. Knowing the factors - factors that affect health problems

5. Knowing the health policy



2.1. Definition of Policy

Policy is a written rule that where a formal decision of the organization, which is binding, which govern the behavior with the aim of creating a new tatanilai in society. The policy will be the main reference of the members of the organization or members of the public to behave. Policies are generally problem solving and proactive. Unlike the Law (Law) and Regulations (Regulations), policies are more adaptive and intepratatif, although the policy also set the "what is allowed, and what not". The policy is also expected to be general but without eliminating the specific local characteristics. Policies should provide opportunities interpreted according to specific conditions that exist.

The practice of government policy is aimed at and geared to the interests of all social interactions such as national defense policy, environmental policy, economic policy, and policies in the health field. While public policy is a set of action plans that are intended to give effect to the improvement of social conditions and economic society in which the results of decisions taken by certain actors for public purposes or the final product every government in the sense of a final agreement between executive with the legislative (representative of the people) in which the results of executive decisions as a response to its environment and is believed to be beneficial in improving the socio-economical conditions of society as well as agreed upon or approved by the legislature.

Examples of policies include: (1) of the Act, (2) government regulation, (3) Decree, (4) Decree, (5) regulation, (6) Decision of the Regent, and (7) Decision of the Director. Each policy is exemplified here is binding and must be implemented by the object of policy. The above example also gives knowledge to us all that the scope of the policy may be macro, meso, and micro.

Policy analysis is an intellectual and practical activity aimed at creating, implementing, critically assess, and communicate the substance of policy. Policy analysis process consists of three main phases which are interrelated, which together form a complex cycle of activity and not linear.

2.2 Problems - Health problems On Mother Aggregate

The main issues currently facing related to maternal health in Indonesia is still high maternal mortality associated with childbirth. Faced with this problem then in May 1988 launched the Safe Motherhood program that has a priority on improving women's health services, especially during pregnancy, childbirth and postpartum.

Prenatal care is one of the factors that most need attention to prevent the occurrence of complications and death ketikapersalinan, besides that it is also to maintain growth and health of the fetus. Understanding the behavior of antenatal care (antenatal care) is important to know the health effects of the baby and the mother alone. Facts various circles of society in Indonesia, there are many mothers who consider pregnancy as a matter of course, natural and innate. They felt no need to check themselves regularly to the midwife or doctor.

Still the number of mothers who are less aware of the importance of prenatal care does not lead to detection of high risk factors that may be experienced by them. These new risks known at the time of delivery, often because the case was too late to bring the deadly consequences of death. This is probably caused by low levels of education and lack of information.

In studies conducted conducted at Hasan Sadikin Hospital, Bandung, and 132 mothers who died, 69 of which have never examined her pregnancy or recent pregnancy came the first time in 7 -9 months (Wibowo, 1993). Apart from the lack of knowledge of the importance of prenatal care, problems in pregnancy and childbirth is influenced also by factors of marriage at a young age are still often found in rural areas. In addition, the persistence of gender preference for children, especially in some tribes, which led to his wife suffered consecutive pregnancies in a relatively short period of time, causing the mother have a high risk during delivery.

Another issue which is quite large effects on pregnancy is a nutritional problem. This is because the existence of beliefs and taboos against some foods. Meanwhile, their daily activities is not reduced coupled with taboos against some foods that are actually needed by pregnant women will certainly have a negative impact on the health of mother and fetus. No wonder anemia and malnutrition in pregnant women is quite high, especially in rural areas. From the 1986 Household Health Survey data shows that the prevalence of anemia in pregnant women in Indonesia at 73.7%, and the numbers decreased in the presence of nutritional improvement programs to 33% in 1995. It says that the main cause of high rates of anemia in pregnant women due to lack of nutrients needed for blood formation.

In Central Java, there is the belief that pregnant women abstain from eating eggs because it would complicate labor and abstain from eating meat because it will cause a lot of bleeding. While in one area of ​​West Java, mother accidentally 8-9 months into her pregnancy should eat in order to reduce the baby was born small and easy. Restrictions apply in the Betawi people eat fish, marine fish, shrimp and crabs because it can cause the milk to be salty. Another example in Subang area, pregnant women abstain from eating by using a large plate for fear that her baby will be big so would complicate labor. And indeed, in addition to his mother's malnutrition, weight babies born too low. Obviously this greatly affect the durability and health of the baby. In addition, the prohibition to eat fruits like banana, pineapple, cucumber and others for pregnant women are still held by some people, especially people in rural areas. (Wibowo, 1993).

Entered a period of labor is a critical period for pregnant women because of all the possibilities can occur before the end with the survivors or by death. A number of factors memandirikan role in this process, ranging from the absence of maternal health risk factors, the selection of helper delivery, affordability and availability of health services, the ability of labor to rescue the family attitude in the face of grave circumstances.

In rural areas, many pregnant women still believe in traditional birth attendants to help labor that is usually done at home. Data of Household Health Survey in 1992 rnenunjukkan that 65% of births assisted by midwives. Several studies ever conducted revealed that there are still labor practices by a shaman who can harm the mother. Research Iskandar et al (1996) show some action / practice that carries risks of infection such as "ngolesi" (wet vagina with coconut rninyak to expedite delivery), "toad" (inserting the hand into the vagina and uterus to the placenta rnengeluarkan) or "Nyanda" ( after childbirth, the mother sitting with legs straightened position bersandardan forward for hours that can cause bleeding and swelling).

Selection of the TBA as a delivery helper is basically caused due to several reasons, among others known to be close, low cost, understand and can assist in the ceremonies relating to childbirth and caring for mothers and babies up to 40 days. Besides it is also still a limited range of existing health services. Although many TBAs have been trained, but certain traditional practices are still carried out. lnteraksi between health conditions of pregnant women with the ability of helper labor is labor that determines the outcome of death or survival. Medically, the classic cause of maternal deaths due to childbirth are bleeding, infection and eclampsia (pregnancy poisoning). These conditions if not handled properly and professionally can be fatal for the mother in labor. However, these fatalities often occur not only due to poor handling, but also because there are delays in decision-making factors in the family. Generally, especially in rural areas, decisions on what medical treatments will be selected subject to approval of an older relative, or a decision in the hands of a husband who is often a state of panic to see the crisis.

Panic and ignorance of certain symptoms during labor may inhibit the actions that should be done quickly. Not infrequently also the advice given by friends or neighbors influence the decisions taken. This situation is often compounded by geographical factors as well, where the distance of the mother's house with a place far enough health services, unavailability of transportation, or by a factor of economic constraints in which it was thought that bringing the mother to the hospital will cost expensive. Apart from delays in decision-making factors, geographic factors and economic constraints, delays in seeking help is also caused by the existence of a conviction and resignation from the public that everything that happens is an inevitable destiny.

In addition to pregnancy, taboos or recommendation still applied also in the postpartum period. Abstinence or recommendation is usually associated with physical conditions such as the recovery process, there are certain foods that should be consumed to increase milk production; there are also certain foods that are prohibited because they can affect infant health. Traditionally, there are practices that are conducted by traditional birth attendants to restore the physical condition and health of the mother. Eg abdominal massage which aims to restore the uterus to its original position; enter

Herbs such as leaves into the vagina in order to cleanse the blood and fluid that comes out because of the birth process, or to give certain herbs to strengthen the body (Iskandar et al., 1996).

Based on the above, some health issues with an aggregate terkatit mother in Indonesia, among others:

Maternal mortality is still high, due to childbirth bleeding
Lack of education and lack of information about pregnancy and childbirth
Economic factors, so there are many mothers who gave birth in the shaman, because of high labor costs in hospitals
Geographic factors, namely health care away, so that mothers and families too late to get the right snacks
Cultural factors, values ​​and beliefs, namely the belief in certain myths, such as a pregnant woman should not eat too much and postpartum mothers should not eat eggs, meat, etc..
Policy 2.3 - Health policy Mother In Aggregate

Policy in health is an action taken by the government to save and improve health and provide health services to the community. The policy that is given as follows:

1. RI Kepmenkes 450/MENKES/SK/IV 2004 on exclusive breastfeeding for infants in Indonesia from birth to age 6 months and is recommended until the child was 2 years old.

That is, with supplementary feeding and who according to all health workers who work disarana health in order to inform all mothers giving birth in order to give milk eklusive with reference to the 10 steps to successful breastfeeding.

2. MDG4 target is to reduce maternal mortality and infant becomes 2 / 3 in the period 1990 to 2015.

The main causes of infant and child mortality are diarrhea and pneumonia, and more than 50% of infant mortality based on the lack of nutrition. For exclusive breastfeeding for 6 months and continued until the age of 2 years in addition to provision of complementary feeding (MP ASI) adequately proven is one of the interventions can effectively reduce the IMR.

3. Law No.23 of 1992 on health, especially in Chapter V. Protection of reproductive health as a prevention of diseases transmitted infections in the mother and child.

Vision and Mission of the Ministry of Health is increasing public access to quality health services, to achieve these efforts are:

1. Basic Health Services consists of:

a. Maternal and child health services:

The policy on MCH specifically related to antenatal care, childbirth, postpartum and newborn care provided in all health facilities, from posyandu to government hospitals and private health facilities.

Antenatal care is a health services by health professionals (obstetrician and midwifery, general practitioners, midwives and nurses) as the measurement of body weight and blood pressure, high-fundus examination, immunization Tetanus Toxoid (TT) and the provision of iron tablets to pregnant women during pregnancy according to existing guidelines for antenatal care with an emphasis on promotive and preventive activities. The results of antenatal care can be seen from the coverage of pregnant women K1 and K4.

b. Aid deliveries by health personnel with midwifery competencies. Complications and maternal mortality and neonatal mostly occurred at around the time of delivery. This is partly due to help not conducted by health personnel who have midwifery competencies (professional). Scope of delivery assistance by health professionals at 70.62% - 77.21%.

c. Risk Detection, Referral and Treatment Complications Case Resti.

Activities of early detection and treatment of pregnant women at risk / obstetric complications should be improved both in MCH facilities and in the community. Detection of risk by health professionals in 2007 amounted to 46.17% while the risk of detection by the community (volunteers, community leaders, etc.) amounted to 22.08%.

Resti complication is deviation from the normal state that directly cause morbidity and mortality of mother and infant. Resti / complications include Hb content <> 140 mmHg, diastolic> 90 mmHg). Oedeme real, ekslampsia, vaginal bleeding, premature rupture of membranes, where the latitude at gestation> 32 weeks, where the breech in primigravida, severe infections / sepsis, preterm labor.

2. Family Planning Services (KB)

Fertile period of a woman to have an important role for the occurrence of pregnancy so that the chances a woman gave birth to become high enough. According to the research, a woman of childbearing age between 15-49 years of age. Therefore to set the number of births or spacing births, women / couples have priority to use the tools / ways KB.

Based on National Socio Economic Survey in 2007, the percentage of women aged 10 years or older ever married by the number of children born alive is the greatest 2 people (23.02%), 1orang (19.52%) and 3 people (17.11%) . While the average number of children born alive per woman aged 15-19 years is 1.79 to 1.98 in urban and rural areas.

3. Immunization Services

Activities include the provision of routine immunization for infants 0-1 years immunized (BCG, DPT, Measles, Polio, HB), immunizations for women of childbearing age / TT and immunization of pregnant women for elementary school children (grade 1; DT and grade 2-3; TT ), while an additional immunization activities conducted on the basis of the discovery of problems such as non-UCI villages, potential / Resti outbreaks, found / suspected presence of wild polio virus or other activities on the basis of technical policy.

UCI achievement is basically a proxy to complete the coverage of immunization of infants. If the UCI coverage limitations associated with a particular area, means eilayah the indescribable magnitude of the public or the baby's immunity level (herd immunity) against disease transmission can be prevented by immunization (PD31). In this case the government is targeting the achievement of UCI in the village and village administration. UCI achievement in 2007 amounted to 71.18% with 80% national target UCI.

The programs are government policies towards maternal and child health in Indonesia is in progress between the covers:

Integrated Treatment of Childhood Illness (IMCI)
National Adolescent Health Plan
policies and plans for preventing malaria in pregnancy and congenital malaria, vertical transmission of HIV and syphilis in pregnancy
Making Pregnancy Safer
Increased awareness of HIV / AIDS

2.4 Factors - factors that affect

Factors affecting the decline of the implementation of the policy:

Local Government, Health Office
Not all governments follow up on the concrete rules on exclusive breastfeeding through 10 steps to successful breastfeeding, for example in the regulations (including rewards and sanctions for those who carry it out), budgeting in the budget for example for training for health workers and promotions.

Health workers (midwives, nurses, doctors)
There are still many health workers who have not run this policy. Health workers was instrumental in the success of the process of breastfeeding, by providing counseling on breastfeeding since pregnancy, carrying out early initiation of breastfeeding (IMD) at the time of delivery and support of breastfeeding with 10 steps kebehasilan breastfeeding. Some barriers are less the role of health workers in carrying out its obligations in the context of exclusive breastfeeding more because less motivated officers to carry out their role of knowledge in addition to breastfeeding counseling are still lacking.

Promotion of infant formula manufacturers.
Despite existing regulations and codes of conduct on marketing infant formula, but the implementation still exist producers who do not perform correctly. The promotion of infant formula manufacturers for both the public and for healthcare workers (by providing assistance for scientific activities) hamper of exclusive breastfeeding.

Working mothers.
With the increased percentage of breastfeeding mothers who work will hinder the practice of exclusive breastfeeding. Although there has been together three ministerial decree on the rights of working mothers who breastfeed in practice not all workplaces support the practice of breastfeeding

HIV-positive mothers.
Breastfeeding in mothers with HIV-positive based calculation of losses and benefits of stopping or continuing breastfeeding, ie the probability of children infected / infected with the HIV virus from breast milk and losses due to children not breastfed syang result in increased risk of diarrhea, pneumonia, malnutrition and other infections . Previous WHO recommends one way in Preventive mother to child transmission (PMCT) is to stop feeding infant formula unless ineligible affordable, accessabel, safety, sustainable (AFASS). Recent research has shown that giving antiretroviral drugs in pregnant women during the early and continued breast-feeding is proven to prevent HIV transmission through breast milk, so the WHO (2009) recommends breastfeeding in mothers who have who have received ARV prophylaxis.

Emergency situations such as disasters.
In emergency conditions that breastfeeding becomes more important because of very limited facilities for preparation of infant formula, such as clean water, fuel availability and continuity of formula milk in sufficient quantities. Formula feeding increases the risk of diarrhea, malnutrition and infant mortality. When received donations of formula, then the distribution and its use should be monitored by staff who are trained, and should only be given in very limited circumstances, namely: has conducted an assessment of the status of breastfeeding mothers, and relactation not possible, given only to children who can not feeding, for example: the fatherless, the motherless babies and babies whose mothers are no longer able to breastfeed, infant formula supplies for infants need to be guaranteed, and should be given counseling to the mother about the preparation and provision of infant formula that is safe, and should not be using a pacifier. Learning from the experience of the tsunami in Aceh and the earthquake in Yogyakarta, a drop of formula aid achievement of exclusive breastfeeding.

2.5 Efforts National Policy and Strategy in Reproductive Health in Indonesia

In order to achieve reproductive health goals should be formulated policies and general strategies that can be an umbrella for the implementation efforts of all components of reproductive health in Indonesia. Efforts to address reproductive health should be undertaken with due regard to religious values ​​and cultural / social norms, and activities directed to improving the quality of human life.

2.5.1 Public Policy Efforts

1. Putting reproductive health efforts into one national development priorities.

2. Acceleration of efforts to implement reproductive health and reproductive rights compliance throughout Indonesia.

3. Implementing reproductive health efforts holistically and integrated through a life cycle approach.

4. Using the approach to justice and gender equality in all reproductive health efforts.

5. Providing quality reproductive health services for poor families.

2.5.2 General Strategy Effort

1. Placing and functioning of Reproductive Health Commission (TRC) at ministerial level and by establishing TRC Coordinator at provincial and district / city.

2. Promote the publication of legislation in the field of reproductive health.

3. Increase advocacy, socialization and political commitment at all levels.

4. Striving for budget adequacy funding implementation of reproductive health.

5. Each component responsible for developing reproductive health measures in accordance with the scope of partnerships with related sectors, professional organizations and NGOs.



3.1. Conclusion

Policies are generally problem solving and proactive. Unlike the Law (Law) and Regulations (Regulations), policies are more adaptive and intepratatif, although the policy also set the "what is allowed, and what not". The policy is also expected to be general but without eliminating the specific local characteristics. Policies should provide opportunities interpreted according to specific conditions that exist.

Policy analysis is an intellectual and practical activity aimed at creating, implementing, critically assess, and communicate the substance of policy. Policy analysis process consists of three main phases which are interrelated, which together form a complex cycle of activity and not linear.

Health Concerns and Health Policy in Indonesia on Aggregate mother

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