An epidemiological approach to health planning and problem-solving in Indonesia

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Abstract
Daerah Istimewa Aceh, with a population of 2.9 million, is located in northern Sumatra and is one of 27 provinces in Indonesia. Since 1982 a USAID-funded project (CHIPPS) has supported an experiment in Aceh involving decentralized health planning and problem-solving. Instead of following the usual Indonesian practice of rigidly adhering to strict health programme guidelines sent from Jakarta, Acehnese health officials tried to use an epidemiological approach in defining their most important health problems and in selecting the most appropriate interventions to solve those problems. The fundamental approaches of the project were to provide training in applied epidemiology for health officials at province, district and sub-district levels, to carry out province-wide or district-wide surveys designed to identify the major preventable causes of death and to develop a population-based information system concerning births, deaths and cause-of-death. Provincial health officials carried out several major surveys which demonstrated that the pattern of morbidity and mortality in Aceh differed markedly from national estimates and that the provincial health department needed to develop specific disease control strategies tailored to fit the situation in Aceh. For example, a province-wide neonatal tetanus mortality survey found that 2.1 per cent of all infants born in Aceh died of tetanus, that neonatal tetanus mortality rates in some districts were 10 times higher than in other districts and that babies delivered by trained village midwives were nearly as likely to die from tetanus as babies delivered by untrained village midwives. Surveys like this had major implications for health planning and priority-setting in Aceh. The CHIPPS project in Aceh has demonstrated that province-level health officers, with training in epidemiology and with limited financial resources, can develop a simple but sound information base, determine their own local priorities and implement effective interventions, even when these priorities and interventions differ markedly from national norms.

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