PENGEMBANGAN “QUASI SAMPLE REGISTRATION SYSTEM” UNTUK

MEMONITOR PENCAPAIAN MDGs DI INDONESIA

Soewarta KosenBadan Penelitian dan Pengembangan Kesehatan

Departemen Kesehatan R.I.Jakarta

Latar Belakang

Statistik kejadian demografi dasar (kelahiran, kematian, pindah) yang akurat merupakan dasarpembuatan kebijakan kesehatan dan manajemenpemerintahan yang efektifStatistik kematian dan sebab medis kematian darifasilitas kesehatan (RS) tidak memadai, karenaterbatasnya jangkauan (Ind. : hanya 2 % daritotal yang mengeluh sakit memanfaatkan rawatinap RS dalam 12 bulan)Informasi kematian SUSENAS Kor: “under-reporting” sekitar 40 %

Latar BelakangMillennium Development Goals 4,5,6 menggariskanberbagai target bidang kesehatan (tingkat kematianbayi, anak balita, maternal); kematian karena Tb. dan MalariaInformasi kematian karena sebab tertentu, belumdicakup sistem yang adaInformasi COD didapat dari survei berkala berbasismasyarakat (SUSENAS/SKRT): metode autopsi verbalUU No. 23/2006 tentang Adm. Kepend.: pencatatanvital dilakukan melalui sistem informasi adm. Kepend. dari desa/kelurahan hingga kab/kota, prop. dannasional

Cause of Death Data Source

Vital Registration:g o o di n c o m p l e t ep o o r / n o n e x i s t a n t

Latar Belakang

Badan LitBang Kes. dengan kerja sama DitJenAdminDuk DepDaGri, bantuan tehnis & keuangan dari WHO Ind & AUSAID (melaluiUniv. of Queensland) sejak 2003 mengembangkan Sertifikasi Medis PenyebabKematian (ICD-10) di fasilitas kes (RS) dan dimasyarakat (autopsi verbal) == IMRSSP (Indonesia Mortality Registration System Strengthening Project)

IMRSSP: Flow of COD reporting (Generic)(Integrate existing mortality registration and health reporting system)

DEATH EVENT

HOME HealthFacility

RT/RWRT/RW

HEALTH CENTERHEALTH CENTER

VILLAGEVILLAGE

SUB-DISTRICTSUB-DISTRICT

POP ADMNPOP ADMN

HEALTH OFFHEALTH OFF PROVINCE

CERT, 2

CERT, 2

CERT, 1

CERT, 1

VA

Death Report

Death Report

DOA

Death Report

COD Stat

COD Stat

Vital Stat

CODStat

COD Stat

CERT, 1

POLICEPOLICECENTRAL

Death Report

Death Report

COD Notification System (Puskesmas Dinkes)?

JAVA ISLANDMAP OF INDONESIA

IMRSSP Project Sites2 Sub-districts

257. 770 Pop

557. 541 Pop252. 020 Pop

4 Sub-districts5 Sub-districts

DAERAH PENGEMBANGAN “Quasi Sample Registration System”

TB Notification Rate

0 - 2425 - 4950 - 99

100 – more*sm+ notif rate per 100,000 population

N

W

S

E

* Provinsi:1. LAMPUNG, 2. WEST KALIMANTAN3. GORONTALO 4. PAPUA

32

14

Pengembangan “Quasi Sample Registration System”

Lampung:Metro (city) 126,978Lampung Selatan (district) 80,861

West KalimantanPontianak city 510,927Sambas (district) 104,429

GorontaloGorontalo city 145,754Gorontalo (district) 345,771

PapuaJayapura city 216,192Jayapura (district) 61,145

Total 1,592,057

Bali: 2 districts

TOTAL POPULASI YANG DICAKUP TAHUN 2008: 3 Juta

Medical certificate of cause of death

Contoh:

Cardiac arrestVentricular fibrillationMyocardial infarction

Metastatic lung cancer

Mode of dyingIaIb

II

Underlying cause of death: Myocardial infarction

Sertifikat Medis Penyebab Kematian

Distribution of deaths by COD and project sites, IMRSSP 2006 (First Semester)

2.5222.928J45Asthma

2.5222.120J18Pneumonia

12.210711.9113I00-I09, I16-I19, I26-I63, I65-I99

Other diseases of circulatory system

15.313424.9237I64Stroke

4.8425.149I20-I25Ischemic heart diseases

8.57412.6120I10-I15Hypertensive diseases

0.110.00H00-H59Diseases of eye & adnexa

1.9170.55G00-G99Diseases of nervous system

0.760.11F00-F99Mental & behavioral disorders

0.981.716E00-E09, E15-E90

Other endocrine, nutritional & metabolic diseases

3.3297.571E10-E14DM

3.2285.653C00-C49, C51-C97,D00-D89Other Neoplasm

0.650.99C50Ca mamae

6.3551.716A00-A08, A10-A14, A20-B99

Other certain & parasitic diseases

5.7502.019A15-A19TBC

5.7503.029A09GE

%Number%Number

PekalonganSurakartaCause of death

Continued

Distribution of deaths by COD and project sites, IMRSSP 2006 (First Semester)

Other external causes of

1.7150.44V01-V99transport accident

2.4211.817S06Injury to the head

1.5131.413R00-R99Symptoms & abnormal clinical & lab findings, NOS

0.220.00Q00-Q99

Congenital malformations, deform & chromosomal abnormalities

0.760.00O00-O99Pregnancy, childbirth and the puerperium

3.4301.615N17-N19Renal failure

1.3110.88N00-N16, N20-N99Diseases of genitourinary system

0.110.33M00-M99Diseases of musculoskeletal system

0.330.22L00-L99Diseases of the skin and subcutaneous tissue

4.8425.350K70-K77Diseases of liver

2.3201.817K00-K67, K80-K93Other diseases of digestive system

4.7413.230J00-J17, J20-J44, J46-J99

Other diseases of the respiratory system

%Number%Number

PekalonganSurakarta

Cause of death - ICD 10 Code

8436.7 per 1000

8056.4 per 1000

Pekalongan:- Deaths (6 months)*- Estimated CDR

1,9356.9 per 1000

1,0543.8 per 1000

Surakarta:- Deaths (6 months)*- Estimated CDR

HH SurveyIMRSSP (registrasi)

Project sites

Hasil asesmen “Dual System”pengumpulan data kematian

Note: * From January to June 2006

DUAL SYSTEM: Vital Registration Completeness

Total

SurveyNot

recorded

SurveyRecorded

234

71

163

VRRecord

ed

111

34*

77

VRNot

recorded

345

105

240

Total

VR Completeness = 68%

SURAKARTA

Total

SurveyNot

recorded

Survey Recorded

137

22

115

VR Record

ed

35

6*

29

VR Not

Recorded

172

28

144

Total

VR Completeness = 80%

PEKALONGAN

Statistik Sebab Kematian

─ Informasi dasar yang dibutuhkan untukmenyusun kebijakan kesehatan danpengembangan program

─ Evaluasi efektivitas suatu program (imunisasi, Tb, dll)

─ Penelitian (hubungan tembakau danpenyakit tertentu)

─ Penetapan prioritas kesehatan

RINGKASAN HASIL KAB. PEKALONGAN

Total deaths: 1,728Total population: 252,020Completeness of registration: 80%Note: adjusted refers to data that have been corrected for incompleteness of registrationCrude death rate, males (unadjusted): 687 deaths per 100,000 peopleCrude death rate, males (adjusted): 858Crude death rate, females (unadjusted): 685Crude death rate, females (adjusted): 856Life expectancy at birth (e0), males (unadjusted): 68.05 yearsLife expectancy at birth (e0), males (adjusted): 64.38 yearsLife expectancy at birth (e0), females (unadjusted): 70.57 yearsLife expectancy at birth (e0), females (adjusted): 66.86 yearsUnder-five mortality rate (q5), males (unadjusted): 0.0203Under-five mortality rate (q5), males (adjusted): 0.0253Under-five mortality rate (q5), females (unadjusted): 0.0189Under-five mortality rate (q5), females (adjusted): 0.0235Adult mortality rate (45q15), males (unadjusted): 0.2315Adult mortality rate (45q15), males (adjusted): 0.2805Adult mortality rate (45q15), females (unadjusted): 0.1629Adult mortality rate (45q15), females (adjusted): 0.1993

Kematian Karena TuberkulosisDI Kab Pekalongan

Death Rate (per 100,000) Age Males Females Total0-14 - - -15-59 26 30 2860+ 440 185 298Total 46 34 40 Age-Standardised Death Rate Males Females TotalTotal 69 41 53

KESIMPULAN“Quasi Sample Registration System” denganmemasukkan sebab kematian, dapatmemonitor pencapaian MDGsMeningkatkan kualitas statistik kematianBahan konstruksi “Life Table”Sebagai laboratorium Kesehatan Masyarakatuntuk memonitor dampak berbagai upayapengembangan kesehatan, pengembanganmodel intervensi: mengurangi faktor risikopenyakit tidak menular, dll