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ICT Development Programme for Supporting ICT Pilot Projects in Rural Areas 2013 (J3) PROJECT COMPLETION REPORT Digitalization of maternal and post-natal care system (DigiMAPS) Implementation in Bandung Barat District Reported by: Hadi Hariyanto/Chief Researcher On August 20, 2015 PT. Telekomunikasi Indonesia Tbk. 2015 ICT Development Programme for Supporting ICT Pilot Projects in Rural Areas 2013 (J3) PROJECT COMPLETION REPORT Digitalization of maternal and post-natal care system (DigiMAPS) Implementation in Bandung Barat District Executive Summary DigiMAPS is a system consist of electronic medical record for mother & children called “KIA Online” and tele-consultation facility called “Tele-Obgyn”. Under APT J2 Project Scheme (2013), the project focused on the development of KIA Online prototype and a cloud computing-based video conferencing as a basis of Tele-Obgyn platform. DigiMAPS system had been developed gradually following lean-innovation management concept which focused on customer- problem-solution matching with rapid prototyping and validation from idea to solution. There was significant effort to establish a close relationship and learning process with prospective users of DigiMAPS, hence in the broader perspective we used a participatory research approach. By using lean innovation management, several inputs were gathered from prospective users including health authority, head of primary health centres (PHCs), midwives, obgyn doctors, and public health staffs. In this project, the DigiMAPS system was further enhanced to achieve the pilot project objectives. This includes to leverage the original concept of DigiMAPS in Public Health Centre (PHC) in Gunung Halu sub-district, District Hospital in Cililin sub-district and Health Department of West Bandung District (WBD). The significant development of DigiMAPS Application covered a multi-screen user interface support, a decision support system, a mother alert system and an integration with medical device data. The second major development of DigiMAPS system is a tele-conference system which not only offers the tele-consultation service but also a tele-education program for midwives in the primary health centre. Furthermore we also introduced a Mobile CTG (cardiotocography) device and system to the midwives and obgyn doctors to see their comments and feedback to the system. There are more than 400 pregnant women and children health records which were entered by 10 midwives for the period of 4 months usage from March – June 2015. These records are more than enough to bring a meaningful report which is generated by the decision support system. In addition, as the result of 2 of 49 DigiMAPS J3 project, now the users can experience some new features namely a mother alert system using SMS service and an M2M medical data presentation as part of KIA Online. Six online training and conferences were done using a teleconference platform called UMeetMe. The pilot project has been disseminated to the key persons in the Health Department of West Java Province and the Indonesian Ministry of Health in order to generate a greater awareness and to confince that KIA Online can be considered as a next generation of the PWS-KIA health information system. By the end of July 2015, the project objectives were achieved and all activities were done (100 %). The project cost spent until July 31, 2015 was USD 129,143.90 or 86.54% of total budget approved by APT. West Bandung District commits to use the innovation resulted from the DigiMAPS project, so that WBD can be a considered for a living laboratory for KIA Online along with a primary health care information system managed by TELKOM Indonesia. 1. Project Information 1.1. Introduction This project awarded a grant by Asia-Pacific Telecommunity (APT) as an ICT Development Programme for Supporting ICT Pilot Projects in Rural Areas 2013 (J3) (supported by extra budgetary contribution by Japan). This project commenced on June 24, 2014 and completed by the end of June 2015. The total budget approved for the project is USD 129,143.90. DigiMAPS program aims to support midwives in performing mother and children health record as part of their daily task in the rural area. Based on the fact that all maternal and postnatal data are reported in paper-based formats, thus we developed a new way to capture the data then store them digitally. In addition that the data are also useful for area-based health surveillance reports, we developed new ways to aggregate the data into a management report format. Furthermore we leveraged a multimodal communication concept in order to allow prospective users such as midwives, general practitioners (GPs) and Obgyn specialists can access the application any where, any time from any devices. Multimodal communication basically refers to the use of public broadband access to reduce capex and human resource issues which are usually experienced by telemedicine initiatives. This research project was coordinated by, Innovation and Design Center (IDeC) of PT. Telekomunikasi Indonesia Tbk. (TELKOM), and fully supported by: a. Padjajaran University Faculty of Medicine / Hasan Sadikin Hospital (RSHS), Indonesia b. Health Office, West Bandung District, Government agency, Indonesia c. Basic Human Needs (BHN) Telecom Association, Japan. d. Kagawa University, Japan. 3 of 49 DigiMAPS concept and system has been disseminated to the local, provincial and national authorities including: a. Indonesian Primary Health Centres (PHCs) called Puskesmas in West Bandung District. b. Referral Hospital in West Bandung District. c. Department of Obstetric and Gynaecology Padjadjaran University Faculty of Medicine Hasan Sadikin Hospital Bandung d. Health Service Office of West Java Province e. The Centre of Data and Information of the Indonesian Ministry of Health, Jakarta West Bandung District (Kabupaten Bandung Barat) is a regency of West Java Province. It was established in 2007, formerly it was part of Bandung District. The capital of this new regency is Ngamprah, an industrial district on the west side of Bandung. It is part of the Bandung Metropolitan Area. West Bandung District is divided into fifteen sub-districts (kecamatan), two of them are Gunung Halu and Cililin. In the proposal, we used terminology regency, county to represent “Kabupaten” in DigiMAPS J2 and J3 Proposal, however after reading English literature (Mahendra et al. 2011; Rambu Ngana et al. 2012) in Indonesian health informatics context, the terminology of District is more common, therefore we use this “District” terminology to translate the word “Kabupaten” in Indonesian language. 1.2. Project Objectives The objectives of DigiMAPS implementation in West Bandung District as stated in the proposal are a. to leverage DigiMAPS concept (APT J2 Outcome) from prototypes into a pilot implementation project in two rural area of West Bandung County (West Bandung District). b. to enhance DigiMAPS application, platform and communication system so they can improve the user experience, handle larger scalability as a new decision support system. c. to introduce of a new use-case of telepresence system to support midwives professional education. d. to design, develop and implement a mother alert system (of KIA Online) to improve K1 and K4-mother-visit coverage. e. to introduce Machine-to-Machine (M2M) communication for Mother with hypertension (preeclampsia) home care service. f. to disseminate DigiMAPS concept to the national level through Indonesia MDG Office and Indonesian Ministry of Public Health. 4 of 49 1.3. Overview of DigiMAPS System DigiMAPS stands for Digitalization of Maternal and Post-natal care System. It is the first ICT project in Indonesia which initiated the digitalization of maternal-children health record called KIA Online which has medical M2M functionalities, SMS alert system and Decision Support System (DSS) features. By developing the electronics version of KIA, it will benefit to save, archive and trace the patient records. It also helps health staff (including midwives, doctors, public health officers) to make reporting faster, reducing data duplicity and re- entering data processes to generate a cohort report and an area-based health surveillance report (PWS-KIA). These three KIA features (M2M, SMS based alert system, DSS) & PWS KIA Online will strengthen the recording and reporting system effectively and efficiently especially in West Bandung District. It is expected that the local government can develop an intervention program more accurately, hence improving the effectiveness of the program. In the J3 pilot project context, the KIA Online has not only had three new features, but also been transformed into a new on-line system which is fit with multi-screen suitable for mobile devices as well as desktop terminal. Table 1. Digimaps Benefit Indicator Existing DigiMAPS Target Improving data record PWS-KIA and KIA Book Direct linkage between KIA accuracy (KIA, validation requires a lot of effort book and PWS-KIA, prevent COHORT) data mismatch Improving reporting 1-3 weeks delay in reporting Reporting can be generated speed (PWS) in real time Improving data Manually, requires at least 1 Automatically calculated by analysis process day or more to analyst data system (for selected (PWS) performance report) Obgyn Support No obgyn support for obgyn Virtually present to (Tele-Obgyn and Tele- emergency situation, unless the support midwives during presence) mother transferred to referral emergency situation and hospital during professional education programs for Mid-Wives M2M Home Care for None, the mother should be Mother can stay at home to mother with referred to hospital, to do receive medical care, reduce hypertension medical check up regularly manual input by midwives Mother alert system None, K4 is very low Improve K4 visits by mothers Tele-consultation under the J2-Project was called Tele-Obgyn, which allowed Obgyn specialist could support midwives in the rural area during an emergency situation. In the J3 context the video conference system was extended to support tele-education programs for midwives in Gunung Halu sub-district. A new feature called M2M for medical care was introduced in this project in order to reduce manual data input of KIA Online by midwives.
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    Authors: Rebecca Surtees, Thaufiek Zulbahary, Suarni Daeng Caya, Laura S. Johnson and Maria Antonia Di Maio Technical assistance and oversight: Stephen Warnath Layout and design: Laura S. Johnson Photos: Peter Biro Project team: Stephen Warnath, Rebecca Surtees, Thaufiek Zulbahary, Suarni Daeng Caya, Laura S. Johnson and Sheila Berman Publisher: NEXUS Institute 1440 G Street NW Washington, DC 20005 © 2018 NEXUS Institute The NEXUS Institute® is an independent international human rights research and policy center. NEXUS is dedicated to ending contemporary forms of slavery and human trafficking, as well as other abuses and offenses that intersect human rights and international criminal law and policy. NEXUS is a leader in research, analysis, evaluation and technical assistance and in developing innovative approaches to combating human trafficking and related issues. www.NEXUSInstitute.net @NEXUSInstitute In partnership with: Cover photo: Village life in rural West Java. Foreword from the Ministry of Social Affairs First of all, let us pray in the presence of God the Most Holy and Exalted because of His grace, the book: Identification and Referral for Trafficking Victims in Indonesia. Guidelines for Frontline Officers and Multi-Disciplinary Teams at the Village Level was successfully published by NEXUS Institute and is expected to be a reference for capacity building at the front line and village level in identifying trafficking victims and ensuring their access to referral services. Village and family are very important entities in preventing the exposure of trafficking victims from beginning to end. The publication of this book serves an important purpose as guidance for village-based multi-disciplinary teams to help identify and refer trafficking victims for access to services provided by relevant agencies and institutions.