Transcript Outline

To Overcome IDD:
Indonesian Experience
Triono Soendoro
Ministry of Health
1.
2.
3.
4.
1979: M.D. (Airlangga Medical School, Indon)
1985-1989: M.Sc, M.Phil, Ph.D, Yale Univ, USA.
1991-2000: Director Health & Nutrition, Bappenas
2000-2001: Leadership Fellow at the Gates
Institute, University of Johns Hopkins, USA
5. 2001: Secretary of Decentralization Unit and Policy
Advisory Group to MoH;
6. 2001-now: Senior Associate, Bill and Melinda Gates
Institute, Johns Hopkins University, USA
7. 2006-2009: Director General of NIH-RD, MoH;
8. 2009 –now: Senior Advisor to MoH.
9. 1997-now: Faculty Member of O/G, Reproductive
Endocrinology, Med Sch Udayana Univ, Bali.
10. 2001-now: Visitng lecturer at several universities.
11. 2012- : Assist Indon President to Post MDG 2015
Outline
1.
2.
3.
4.
Setting the Objectives
Assessing IDD Progress
The Challenges
The Way forward
Outline
1.
2.
3.
4.
Setting the Objectives
Assessing IDD Progress
The Challenges
The Way forward
The Objectives
1. To increase the national coverage
of adequate iodized salt
consumption at household level
2. To sustain the coverage of
adequate iodized salt consumption
in all districts
5
Outline
1.
2.
3.
4.
Setting the Objectives
Assessing IDD Progress*
The Challenges
The Way forward
Assessing IDD Progress
• IDD surveys: 93, 96/98, ‘03 (TGR, UIE)
• HH’s Iodized Salt:
– CBS (Susenas 1998-2003),
– MOH (Riskesdas 2007 - 2013)
• Urinary Iodine Excretion (UIE):
– Riskesdas 2007 (sub-samples in 30
districts)
IDD Survey: ‘93, ’96/’98, & ‘03
Design
‘93 survey
Baseline (96/98)
Evaluation (‘03)
5
25
170
27
276
3916
28
343
Primary school
Primary school
Primary school
60 in every province
3 in every sub-district
25 in every district
Palpation of
thyroid gland
enlargement
School children 6-10
School children 6-12
School children 8-10
Pregnant women <35
Pregnant women <35
School children
Pregnant women
School children
Urine sample
for urinary
iodine level
Analysis urine sample:
wet
acid
digestion
method using potassium
chlorate
Analysis urine sample:
wet acid digestion
method
using
potassium chlorate
Analysis urine sample:
wet acid digestion
method
using
ammonium persulfate
Pregnant women
Pregnant women (in 2
provinces)
-
Province
District/City
Sub-district
Cluster
-
Progress: IDD Elimination/TGR
PER CENTAGE OF SCHOOL CHILDREN
SAMPLED
50
40
30
III
II
20
IB
10
IA
0
80/82
96/98
YEAR OF SURVEY
Note: Only sub-districts included within the 80/82 sample frame
were included from the 96/98 sample for comparison
Progress: IDD Elimination/TGR
% TGR School Age Children
35.0
30.0
30.0
25.0
20.0
15.0
9.8
10.0
11.0
5.0
0.0
80/82
96/98
Year of Survey
2003
The Changes: District Endemicity
District/City
Endemicity
Category
96/98
03
TGR
N
%
N
%
Non-endemic
< 5.0%
123
44.7
148
43.3
Mild endemic
5.0 – 19.9%
106
38.6
122
35.7
Moderate
endemic
20.0 – 29.9%
30
10.9
42
12.2
>= 30%
16
5.8
30
8.8
275
100
342
100
Severe endemic
Total
Changes: 268 District Endemicity
Endemicity
District/City
1996/1998
2003
Category
TGR
N
%
N
%
Non-endemic
< 5.0%
122
45.5
115
42.9
Mild endemic
5.0 – 19.9%
104
38.9
96
35.8
Mod- endemic
20.0 – 29.9%
28
10.4
35
13.1
Sev- endemic
>= 30%
14
5.2
22
8.2
268
100
268
100
Tot al
Distribution of Province by Category of
Endemicity in ’96/’98 and ‘03
Province
Endemicity
Category
1996/1998
2003
TGR
N
%
N
%
Non-endemic
< 5.0%
9
34.6
7
25.0
Mild endemic
5.0 – 19.9%
13
50.0
17
60.8
Moderate endemic
20.0 – 29.9%
2
7.7
2
7.1
Severe endemic
>= 30%
2
7.7
2
7.1
26
100
28
100
Tot al
Trend of HH’s Iodized Salt
Consumption: 1998-2007
100%
80%
19.7
18.5
17.0
17.9
16.1
15.1
18.0
18.4
16.7
15.4
65.2
63.6
64.5
65.4
68.5
14.1
12.7
14.0
23.7
60%
40%
73.2
62.3
20%
0%
1998
1999
2000
Adequate
2001
Inadequate
2002
2003
None
Source: Susenas 1998-2003, Riskesdas 2007
2007
% HH Consume Iodized Salt:
2003-2007
% Household consumed adequate Iodized salt
100
90
80
70
60
50
40
30
20
10
0
2003
2007
Association between UIE and
Iodized Salt Coverage
Urinary Iodine and Iodized Salt Coverage - Provincial data
y = 1.6728x + 123.34
R2 = 0.4727
Urinary iodine (median)
400
300
200
100
0
0
20
Source IDD Survey 2003
40
60
Iodized salt coverage (%)
80
100
18
HH’s Iodized Salt vs Iodine Urine
(School Age Children)
Iodized Salt (ppm)
<5
7,8%
5-15
29,4%
15-20
12,6%
20-30
25,7%
30+
24,5%**
*) Excessive:
Source: Riskesdas 2007 (30 Districts)
UIE ug/L
<20
20-50
50-100
100-300
>300
0,4
3,2
9,3
65,1
21,9*)
Outline
1.
2.
3.
4.
Setting the Objectives
Assessing IDD Progress
The Challenges*
The Way forward
The Challenges
• Universal Salt Iodization (USI) targets have
not been met nationally, but excessive
iodine intake is beginning to manifest
• Focus of USI should be directed to
Provinces/Districts with HH’s consume
Iodized salt <50%
• Attention is also needed for areas where
the UIE level >300 ug/L
• Health disparities*: PHDI
The Purpose: PHDI
• Describe public health development
progress for entire districts in
Indonesia
• Focused programs interventions
(local specific) in each districts.
Maluku
Sulbar
NTT
Papua
0.7
Gorontalo
Malut
Pabar
Sulsel
NTB
Kalteng
Banten
Sultra
Kalbar
Sulteng
Jambi
Aceh
Sumsel
Lampung
Jabar
Kalsel
Sumbar
Babel
Sumut
Riau
Jatim
Jateng
Bengkulu
Sulut
Kepri
Kaltim
Bali
DKI
DIY
Indeks
PHDI Progress: ‘07-’10 (‘13)
0.8
indeks 2007
indeks 2010
0.6
0.5
0.4
0.3
0.2
0.1
0
Provinsi
Composite PHDI (7 Indicator): Malnutr, Stunring, Imuniz ANC/MCH,
Sanitation, Water
The Benefits
• A tool to evaluate the process of improving
a certain area (district/municipality) on
health status over time.
• An advocacy for province and district
government to increase their health status
using focused resources and programs
interventions priority.
• As a criteria of health fund allocation from
central to province and district
government.
District DBK: The Areas
Category
2007
2012
• District/Urban DBK
130
156
• District/Urban Non
DBK
310
341
440
497
Jumlah
P-DBK: 10 Prov as of ‘11





Aceh (14/21)
NTB
( 6/9)
NTT (11/16)
Sulteng(7/10)
Sultra (8/10)





Gorontl (5/5)
Sulbar (4/5)
Maluku (5/8)
Pap Bar (6/9)
Papua (14/20)
• Prop DBK: # total :
28 prop
• Prop > 50% Kab DBK : 10 prop*
• Prop < 50% Kab DBK : 18 prop
130 kab/kot
80 kab/kot
50 kab/kot
Sumber : Riskesdas 2007
27
The Challenges: Partnership
Organizational Change
Start
Training
Actions
Internal
Support
Group
Trans
RDS
RDS
lation
Mentoring
Actions
Learning History: Cohort of PDBK
End
Comitment & Involvement
District Gorontalo (2011)
32,363
32,045
28,458
23,300
sejumlah
9,187
969
3,286
Profil 2010 Densus Profil 2010 Densus Profil 2010 Densus
Jumlah
Ditimbang
Gizburkur
Gizburkur
IPKM 2007
The Way Forward
• Increase knowledge and
awareness of the population
• Establish a proper surveillance
system
• Ensuring sustainability
• Conduct national survey to track
progress
The Way Forward (2)
• It tells us “WHAT
• It tells us “PROBLEM”
• But it does not tell us “HOW?
• Left us with:
‘ISSUES , UNCERTAINTIES, and
‘HOPES’
Action Non Material Approach