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A MATERNAL AND CHILD COMMUNITY-BASED HEALTH PROGRAM IN ENDE DISTRICT, INDONESIAMartha Mabiala
INDONESIA1,2•The world’s 4thmost populous country•17,000 islands ; 33 provinces•Lower middle-income country•1997 financial crisis•65.9% of the population can be categorized in the lowest wealth quintile•10.4% (8.0%) of women have no education; 21% only completed primary education
INDONESIA1-3•Indonesia at the bottom of several health indicators:•Maternal mortality rate: 126 per 100,000 births•U5M: 167 per 1,000; Infant mortality: 138 per 1,000; Neonatal deaths: 83 per 1,000•32% of infants exclusively breastfed for the first 6 months•Prevalence of anemia in under-fives: 36%•Shortage of health professionals and healthcare facilities:•Health post density: 9.2 per 100,000; health district density: 0.4 per 100,000•Hospital beds density: 6 beds per 100,000 (for 8 consecutive years)
MATERNAL AND CHILD HEALTH ASSESSMENT
ENDE, NUSA TENGGARA TIMUR4,5•Nusa Tenggara Timur (NTT)•One of the poorest provinces•Under-5 mortality: 80 per 1,000 live births•80% (59% for Indonesia) of women give birth at home•55% (32% for Indonesia) have birth assisted by a TBA•Ende, a rural, mountainous district in Nusa Tenggara Timur (NTT)•Population: 250,000; 214 villages•Lower life expectancy at birth for both sexes than NTT•95% of the population lives in rural areas•High prevalence of diarrhea, ARI, pneumonia and skin diseases among under-fives
THE ENDE CHILD MORTALITY SURVEY (ECMS)4,5•Cross-sectional household survey•Measured MCH service utilization, early age mortality, socioeconomic factors•Results: •Low utilization of skilled birth assistance and obstetric services•50% of deliveries attended by a SBA in a hospital•Higher infant mortality and risk of infant death associated with the use of TBAs compared to SBAs•Higher risk of child mortality in areas where health centers were more than 1 hour away
Community Health Worker program•CHWs can provide health services affordable even to the poorest members of the community•More likely to be well-received•Objectives•Improving provision of maternal, neonatal and child health services at household and community levels•Increasing knowledge of and practices related to maternal, neonatal and child health.
PROJECT IMPLEMENTATIONPHASE 1- Community engagement and community plan•Community engagement•Focus groups, key informant interviews, community dialogues•