6. 8 MILLENNIUM DEVELOPMENT GOALS
eradicate extreme improve maternal
poverty and health
hunger
achieve universal combat HIV/AIDS, malaria
primary and other diseases
education
promote gender equality and ensure environmental
empower women sustainability
reduce child mortality develop a global
partnership for
development
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 1991-2015
Source: Report on the Achievement of the Millenium Development Goals Indonesia 2010.
Bappenas. 2010
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. 2010
Factors influence disparity in child mortality rate:
•Mother’s education level
•Family income
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. 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. 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. Trend of National Maternal Mortality 1991-2005
Source: Report on the Achievement of the Millenium Development
Goals Indonesia 2010. Bappenas. 2010
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
Anemia
Indirect existing disease, or
diseasesChronic energy
that developed
Birth
attendant
during pregnancy due to
Cause deficiency
physiological effects of
pregnancy
Infectious disease
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. • 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 area
Source: Report on the Achievement of the Millenium Development
Goals Indonesia 2010. Bappenas. 2010
18. SDH and Health Inequities
A toxic combination of bad policies, economics,
and politics, is in large measure responsible for the
inequalities in health that we see.
- MICHAEL MARMOT,
Head of WHO Commission of Social Determinants
of Health
19. CLOSER THE
GAP
Social
Health Inequities and
Determinants
disparities
of Health
Maternal and
child health
problem
21. ACTION ON
MATERNAL AND
Living and working
CHILD HEALTH
Traditional conditions may include:
birth •Psychosocial factors
Social-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. “If medicine is to fulfill
her great task, then she
must enter the political
and social life. Do we not
always find the diseases
of the populace
traceable to defects in
society?”
- Rudolf VIRCHOW
FATHER OF SOCIAL MEDICINE
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 the
Health 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
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. 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 flow
Provide adequate and
cheap public Build the road, bridge
transportation
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 in
study to be a about their
matter community
future health role
care provider
Counseling
about marital
age and
contraception
28. What good does it do to treat people’s Illnesses...
only to send them back to the conditions
that made them sick?
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
