Shela Putri Sundawa      April 16th, 2012      Essay Presentation
THE STATE OF MATERNAL ANDCHILD HEALTH TODAY
Maternal Mortality Rate                  Source: Trends in Maternal228 in 2007       Mortality 1990 to 2008. WHO,         ...
Child Mortality Rate                           44 in 2007Source: WHO 2008
MDGS INDONESIA PROGRESS ANDPROBLEM IDENTIFICATION
8 MILLENNIUM DEVELOPMENT GOALS          eradicate extreme    improve maternal                poverty and     health       ...
Goal 4 Reduce Child Mortality      • Target 4A: Reduce by two-thirds, between        1990 and 2015, the under-five mortali...
Disparity in Child Health“Disparities in neonatal, infant, and under five mortality rates by demography, as well as social...
Global Child Health and Disparity• Under 5 mortality rate by wealth quantile and  region of the world                     ...
Goal 5 Improve Maternal Health• Target 5A  – Reduce by three quarters, between 1990 and    2015, the maternal mortality ra...
Maternal Health and Maternal Death• Maternal Health is  – “Health of women during pregnancy, childbirth    and the postpar...
Trend of National Maternal Mortality 1991-2005Source: Report on the Achievement of the Millenium DevelopmentGoals Indonesi...
Cause of Maternal Mortality Direct                Haemorrhage           • resulting from obstetric                        ...
Birth Assisted by Skilled Provider                                   Wide gap of disparity      Total PHC       31.581    ...
• Age Specific Fertility Rate for aged 15-19 is 35  births per 1000 married women (2007)  declined from 67 births per 1000...
SOCIAL DETERMINANTS OF HEALTH
What is Social Determinants of Health?
SDH and Health InequitiesA toxic combination of bad policies, economics,and politics, is in large measure responsible for ...
CLOSER THE     GAP    Social                      Health Inequities andDeterminants                           disparities ...
Source: Ravi Narayan, SOCHARA, India
ACTION ON     MATERNAL AND                                                                                                ...
“If medicine is to fulfillher great task, then shemust enter the politicaland social life. Do we notalways find the diseas...
IDEAL HEALTH                             Alma Ata, 1978                                                           REFERRAL...
OUR HEALTH REFERALL SYSTEM          TERTIARY CARE                ?          SECONDARY CARE                ?          PRIMA...
“Too many, too close, too       early, and too late       pregnancies are a major       cause of maternal , infant,       ...
Ideas                                           Strenghten family                                               planning  ...
Train        Include them                Local              traditional       in health                                   ...
What good does it do to treat people’s Illnesses...only to send them back to the conditions          that made them sick?
HEALTH FOR ALL!
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  • This diagram show you many aspect in ones’ life that can determine their health status and access to health care. Health is not only determined by what you eat or do. Health is also determined with social factor like shown in the diagram – education, work environment, housing, etc. That is what it means with social determinants of health
  • So the idea of social determinants of health is to closer the gapMaternal and child health shows health inequitis and disparity
  • Presentasi esai mgims

    1. 1. Shela Putri Sundawa April 16th, 2012 Essay Presentation
    2. 2. THE STATE OF MATERNAL ANDCHILD HEALTH TODAY
    3. 3. Maternal Mortality Rate Source: Trends in Maternal228 in 2007 Mortality 1990 to 2008. WHO, UNICEF, UNFPA, The World Bank. 2010
    4. 4. Child Mortality Rate 44 in 2007Source: WHO 2008
    5. 5. MDGS INDONESIA PROGRESS ANDPROBLEM IDENTIFICATION
    6. 6. 8 MILLENNIUM DEVELOPMENT GOALS eradicate extreme improve maternal poverty and health hunger achieve universal combat HIV/AIDS, malaria primary and other diseases educationpromote gender equality and ensure environmental empower women sustainability reduce child mortality develop a global partnership for development
    7. 7. Goal 4 Reduce Child Mortality • Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate • Trend of National Child Mortality 1991-2015Source: Report on the Achievement of the Millenium Development Goals Indonesia 2010.Bappenas. 2010
    8. 8. Disparity in Child Health“Disparities in neonatal, infant, and under five mortality rates by demography, as well as social and economic status remain major problem” DI Yogyakarta Sulawesi Barat 22 96 Report on the Achievement of the Millenium Development Goals Indonesia 2010. Bappenas. 2010Factors influence disparity in child mortality rate:•Mother’s education level•Family income
    9. 9. Global Child Health and Disparity• Under 5 mortality rate by wealth quantile and region of the world Source: equity, social determinants, and public health programmes. WHO. 2010.
    10. 10. Goal 5 Improve Maternal Health• Target 5A – Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio• Target 5B – Achieve, by 2015, universal access to reproductive health
    11. 11. Maternal Health and Maternal Death• Maternal Health is – “Health of women during pregnancy, childbirth and the postpartum period• Maternal Death is – “Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of pregnancy, from any cause related to or aggravated or its management, but not from accidental causes” WHO. Maternal Health. http://www.who.int/topics/maternal_health/en/
    12. 12. Trend of National Maternal Mortality 1991-2005Source: Report on the Achievement of the Millenium DevelopmentGoals Indonesia 2010. Bappenas. 2010
    13. 13. Cause of Maternal Mortality Direct Haemorrhage • resulting from obstetric Eclampsia complications of pregnant Cause state Unsafe abortion Sepsis Health care facility • Resulting from previous AnemiaIndirect existing disease, or diseasesChronic energy that developed Birth attendant during pregnancy due to Cause deficiency physiological effects of pregnancy Infectious disease
    14. 14. Birth Assisted by Skilled Provider Wide gap of disparity Total PHC 31.581 18 GP in 30% PHC, every 1 No GP 1 primary health care as km2 1 primary health care only wide as 960 in every 2 km2 km2 12.000 GP Source: Report on the Achievement of the Millenium Development Goals Indonesia 2010. Bappenas. 2010
    15. 15. • Age Specific Fertility Rate for aged 15-19 is 35 births per 1000 married women (2007) declined from 67 births per 1000 married women (1991) Reflected: Disparity in knowledge• The dispariy among region still wide and – Lowest DI Yogtakarta ASFR : 7 Access of family planning – Highest Sulawesi Tengah ASFR : 92 – Higher in rural area and lower in urban areaSource: Report on the Achievement of the Millenium DevelopmentGoals Indonesia 2010. Bappenas. 2010
    16. 16. SOCIAL DETERMINANTS OF HEALTH
    17. 17. What is Social Determinants of Health?
    18. 18. SDH and Health InequitiesA toxic combination of bad policies, economics,and politics, is in large measure responsible for theinequalities in health that we see. - MICHAEL MARMOT, Head of WHO Commission of Social Determinants of Health
    19. 19. CLOSER THE GAP Social Health Inequities andDeterminants disparities of Health Maternal and child health problem
    20. 20. Source: Ravi Narayan, SOCHARA, India
    21. 21. ACTION ON MATERNAL AND Living and working CHILD HEALTH Traditional conditions may include: birth •Psychosocial factorsSocial-Ecological Models attendant Employment status and occupational factors Socioeconomic status (income, education, occupation) The natural and built c Over the life span environments Public health services Health care services Primary health care Health insurance Dotted lines denote Health referral system Family Planning interaction effects between and among the various levels of health determinants Political IOM model of multiple determinants of health used to develop Action Model for Healthy People 2020. Dahlgren, G. (1995) commitment: Political European Health Policy Conference: Opportunities for the Future. Vol. 11 – Intersectoral Action for Health. Copenhagen: WHO Regional Office for Europe regional commitment: national
    22. 22. “If medicine is to fulfillher great task, then shemust enter the politicaland social life. Do we notalways find the diseasesof the populacetraceable to defects insociety?” - Rudolf VIRCHOWFATHER OF SOCIAL MEDICINE
    23. 23. IDEAL HEALTH Alma Ata, 1978 REFERRAL Distance? Road? The International care Tertiary Conference on Primary Health SYSTEM consultant of Care calls for urgent action by all governments, Accesibility Obgyn, pediatric all health and development workers, and the Primary world community to protect and promote theHealth Care Obgyn health of all the people of the world by the year Availability specialist, 2000.Secondary Carepediatrician Health care provider? Political General Global National commitment practicioners, midwives Primary Care Regional Traditional birth Pre-primary care attendant
    24. 24. OUR HEALTH REFERALL SYSTEM TERTIARY CARE ? SECONDARY CARE ? PRIMARY CARE
    25. 25. “Too many, too close, too early, and too late pregnancies are a major cause of maternal , infant, and childhood mortality Solution: and morbidity”Strengthen family planning city Declaration on Population and Mexico Development, August 1984
    26. 26. Ideas Strenghten family planning Make it accesible National Ministry of Health Reform the health referral system Form a national health insurance system Regulate well Ministry of distributed health Transportation care provider flowProvide adequate and cheap public Build the road, bridge transportation
    27. 27. Train Include them Local traditional in health birth referral attendants system Educate young Empower women in them to be Send local maternal and health students to Educate men child health watcher instudy to be a about their matter communityfuture health rolecare provider Counseling about marital age and contraception
    28. 28. What good does it do to treat people’s Illnesses...only to send them back to the conditions that made them sick?
    29. 29. HEALTH FOR ALL!

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