BOVEN DIGOEL
MONITORING AND SOCIALIZATION REPORT

JUNE, 3rd and 4th 2013

Preface

The geographical characteristic (access), human resource, and local capacity (both side suppky and demand) are major factor for the difficulty in improving health status for the community in Boven Digul, especially for the community living in outreach area. The planning and budgeting process for health sector presently composed by the district health office (DHO) and district bureau of planning (Bappeda Kabupaten). The process of planning and budgeting are based on projections of the previous year. The investment case tries to improve the planning and budgeting method by using evidence to compose more integrated planning and budgeting based on the local situation.

The previous step on evidence planning and budgeting process includes health problem analyses using bottleneck analysis approach, strategy planning and budgeting. The next process will be monitoring and advocacy. The monitoring and advocacy process aim to guide the strategy input process to the DHO planning sheet and Musrenbang process. The other objectives are to gain local government support for this evidence-based planning and budgeting process and also to improve the use of government (central, provincial and district, include OTSUS) fund.

Process

1. The 3rd monitoring and advocacy dates
   The monitoring and advocacy were held on Tanah Merah, Boven Digul, June, 3rd-4th 2013.
2. Venue
   The 1st day: District Bureau of Planning and District Health Office, Tanah Merah, Boven Digul
   The 2nd day: District Health Office and District Government Office, Tanah Merah, Boven Digul
3. Attendees from local government partner (invited and be present)
   1. Secretary of Bureau of Planning and Development, Boven Digul
   2. Head of Economic, Social and Cultural Department, Bureau of Planning and Development, Boven Digul
   3. Head of Section Family Planning, DHO
   4. Head of Section Nutrition and Family Health, DHO
   5. Head of Environment Health and Externalities, DHO
   6. Head of CDC Program, DHO
   7. Head of Puskesmas
   8. Head of Farm and Plantation, District Boven Digul.
   9. Head of Social Welfare, District Boven Digul.
   10. Head of Women Empowerment, District Boven Digul
   11. Daily executive officer of Boven Digul Hospital
        
4. Attendees from Gadjah Mada University, Cenderawasih University and Papua Province Team
   1. Deni Harbianto (Gadjah Mada University)
   2. Melkior Tappy (Cenderawasih University)
   3. Samaun Salim (Provincial Bureau of Planning, Bappeda Papua)
   4. Enny Gutit (Poltekkes Jayapura)
       
5. Discussion process first day
   1. Opening speech by secretary of district bureau of planning (BAPPEDA) Boven Digul . He welcome to provincial teams and hoping to continue the program. This program is very good and accepted to improve the MCH planning and budgeting in Papua. For year 2014, MCH is still main priority concern of district development program.
   2. Starting opening by Samaun Salim introduce all member team to all participants
   3. Melkior presented overview of MCH Status, and MCH latest strategies for Boven Digul (what's done and didn't yet)
   4. Discussion, facilitate by Enny Gutit (Province team);
      For year 2013, most of strategy that adopted from EBP is mainly for improving human resource capacity (DHO, PHC and Hospital). Other strategies, such as improve capacity for BEOC facility (PONED), has approved and budgeted on district budget plan (RKA) 2013, also training for a resuscitation and Asphyxia.
      
      District of Social Welfare Department has mentioned that for year 2013, they have budgeted for building maternity waiting home near hospital. DHO has agreed to support for maintenance and operational cost (include food, and amenities). Other Maternity waiting homes near 4 BEOC-PHC (Puskesmas PONED) will be plan for next year 2014 – 2015, after they have evaluation of effectiveness/efficiency on Hospital's maternity waiting home this budget year.
      
      Diarrhea and Malaria training program such as, MTBS, MTBM, not yet budgeted on 2013. Possibility it will be budgeted for 2014.
      
      
      
      Related to improving CEOC at district hospital, the strategy is to upgrading the competency of general practitioner to do emergency obstetric care. CEOC device has complete and provided by provincial health office. Other major problem faced is limitation on infrastructure to do Sectio (Operation Room). Operation Room did not build on medical standard for operation room infrastructure requirement. Almost all operation room section cannot use. Need 900million IDR to 1billion to rehabilitate the operation room. Revised budget meeting will be conducted with consultation with Bappeda and BPK (Financial Audit Department) to avoid missed budget against government financial regulation. If this problem is clearly approved, will be budgeted for 2014 budget change (APBD-P)
      
      In order to meet the needs of midwife kits, district health office assisted by the district woman empowerment office to fulfil the lack of MW kits, but there is still shortages and will be budgeted for 2014.
      
      District of Social Welfare Office; from these meeting they indicate need more coordination for evidence-based action plan to anticipate the overlap program among district's government offices.
      
      District Regional Planning Board (Bappeda) said that Regional Development Plan 2014 should be seem to revised, because he saw the urgency to coordinate regarding cross-sectioned MCH program, and will tracing best-price strategy to be included on next year plan.   

1. Discussion process second day
   1. Opening Session by Enny Gutit.
   2. Discussion
      District Hospital is still under UPT Dinas but it has self-existing structural planning scheme. Although there's independency in planning, but still there is the hospital program that cannot be accommodated by DHO. MCH program for example, RS leading ahead than primary health care. For example, HIV testing of pregnant women, hospital has advance facility to screening. So every suspect pregnant woman goes to hospital. It could be prepared at PHC level. It shows that referral system is still didn't work well.
      
      Related on health education to community, the big question is how to it will be contributed to the health program strategies. Women Empowerment District office is the leading sector of the family planning program, while it should be working together with the DHO, through healthy lifestyle counseling.
      
      There should be at 2014 to improvement, there must be a clear pembukitan of society who really show what evidence-based and performance. Many underserved communities. Family planning program remains the same, but the details of the activities are not increased in accordance with the real needs of the public, such as the Healthy Family Planning.

At most crucial cases in the Boven Digoel Hospital; there were a potential health disasters in the future:

1. Increase in TB cases and multidrug resistant; the drugs are available but there is no support for the sustainability of program in taking medication. As it is known that in this case after 3 weeks of treatment patients to reduce the risk of transmission and after 6 months will be completely cured. In the case at Boven Digoel, this situation happens is the patient treatment, given a commitment for treatment, but within 2 years the patient will be returning home to the hospital, and the case becomes more severe due to drug withdrawal because there is no support for such basic needs as basic food. So it need for TB drugs officer and additional food for TB patient. There's should be supported from local government/provincial support the continuity of TB treatment.
2. Malnutrition Case. It will cross sectional responsibility. Head of Agricultural District Office mention to lead this collaboration. Head of Agricultural District Office has nutrition improvement program to household (Tanaman Gizi Keluarga). And they ready to elaborate Field Promotional Officer Unit (Petugas Penyuluh Lapangan) as health nutrition task force.
3. High risk maternal health on because of the low knowledge of community health lifestyle. Board of Village Community Empowerment (BPMK)through RESPEK program has decide to more funded in improving health services program in Posyandu (Integrated health post), with many limitation. Main program was improving health post infrastructure and increasing incentive for health's cadre.

DHO, District Bureau of Planning (Bappeda Kabupaten) and District Secretary were agreed with continuing the process of the evidence-based planning and budgeting. They accepted the strategies and put strategy, which one might need modification and how it could be implemented in their region. They were agreed to conduct capacity building, facilitated by the provincial team and universities partner. Each bureau gave their opinion on how to oversee each of the strategy during the Musrenbang process.

Main Results

Progress in Boven Digul is relatively similar with other districts. They have been responsive to requests and more involved/engaged with the process, particularly around coordinating with other bureaus and ensuring EBP strategies are well defined.

Penyebab Kematian Ibu dan Anak serta Intervensi Kesehatan Prioritas

Penyebab Kematian Neonatal serta Intervensi Kesehatan Prioritas

Penyebab Kematian Balita serta Intervensi Kesehatan Prioritas

Note

Provincial team should have re-positioning about their responsibilities, for example who will be technical leader, coordinator leader and advocating unit.

1. Uncen team (Melkior) has capacity on all section, but much leading in technical aspect
2. PHO team (Enny, from Poltekkes) has capacity to advocacy and technical
3. Bappeda (Samaun) has capacity in coordination.