MONITORING and EVALUATION of the INTEGRATED COMMUNITY-BASED INTERVATION for the PREVENTION of NONCUMMUNICABLE DISEASES in DEPOK, WEST JAVA, INDONESIA General contacts information for this study : Ekowati Rahajeng Phone : 6221 – 4244693 Email : ekowatir@ yahoo.com [email protected] [email protected] [email protected] i This Study was funded by : WHO Regional Office – APW No : SE/ICP/NCD/003/XK/02 WHO Headquarters – Priject NMH/NPH/BRS – 13 September 2002 WHO Country Office APW No : C2-AMP-05-004 18 August 2005 Who searo, HQ, WHO Kobe Centre Acknowledgements We wish to gratefully acknowledge many individuals and institutions who contributed and participated for the success of the study, among other things : Mayor of Depok Municipality West Java Indonesia Depok Municipality Health Office Healthy Depok City Forum Abadijaya Health Center PKK (Women Welfare Movement) in Abadijaya Village Center for Health Promotion – MOH Directorate Genderal of Medical Services – MOH Directorate Genderal of Health Community – MOH Center for Diabetes & Lipid Faculty and Division of Metabolic & Endocrinology Faculty of Medicine University of Indonesia/Tjipto Mangunkusumo Hospital Center for Healthy Heart Medicine University of Indonesia/Harapan Kita Hospital Indonesia Healthy Heart Association Indonesia Smoking Controlling and Stoping (LM3) ii Principal Investigator: Ekowati Rahjeng, PHD Co-Investigator: Nunik Kusumawardhani, MSc Consultant: Stephanus Indradjaja, MD. PHD Institutional Address : National Institute Health Research and Development Ministry of Health Indonesia Jalan Percetakan Negara 23 A Jakarta Pusat Indonesia Telpon/Fax : 6221 – 4244693 General contacts information for this intervention study: Ekowati Rahjeng Email: [email protected] [email protected] Nunik Kusumawardani Email : [email protected] [email protected] iii ABBREVIATION AC Air Conditioning BKKBN Family planning board BMI Body Mass Index Puskesmas (CHC) Community Health Center DM Diabetes Mellitus DPRD Local Peoples Representative Assembly HDL High Density Lipoprotein LDL Low Density Lipoprotein PSP (KAP) Knowledge Attitude and Practice MSG Mono Sodium Glutamate NGO Non Governmental Organization Kabupaten District Kelurahan City Block (in rural areas : Village) Kota City /Municipality PTM (NCD) Non Communicable diseases Posbindu Integrated Health Service and Promotions Post RT City neighborhood (under RW) RW Village Block (under kelurahan) SD Elementary School SLTP Junior High School SLTA Senior High School Tuak Traditional alcohol drink of Indonesia WHR Waist Hip Ratio Yandu PTM An integrated of health post for common risk factors NCD in community health center services iv List ofContent Page ABBREVIATION iv List of Content v List o Table vii List of Atachment ix ABSTRACT xi 1. INTRODUCTION 1 1.1 Background 1 1.2 The purpose of the study 2 3. The benefit of study 3 2. STUDY DESIGN 3 2.1 Goal and objectives 3 2.1.1 Goal 3 2.1.2 Objectives 3 2.2 Type of study design 3 2.2.1 The intervention area 4 2.2.2 Target population 4 2.2.3 Evaluation design 4 3. PLANNING 16 3.1 Situation analysis 16 3.1.1 Geographic aspect 16 3.1.2 Demographic aspect 17 3.1.3 Socioeconomic condition 18 3.1.4 Socio-cultural aspect 19 3.1.5 Health system development 20 3.1.6 Local health office program 21 3.1.7 Health seeking behaviour of the community 22 3.1.8 Health city forum of Depok 24 3.2. Community diagnosis 25 3.3. Intervention strategy. 25 3.3.1 Concept development of strategy 26 3.3.2 The main of strategy intervention 29 3.3.3 Frame work of CBI 31 4. IMPLEMENTATION 31 4.1 Program and activities 32 4.2 Monitoring programs and activities 44 5. EVALUATION 44 5.1 Result of process evaluation 44 5.1.1 NCD RF Surveillance in 2003 44 5.1.1.1 Sampling and Response Proportions of surveillance 45 5.1.1.2 Risk Factors of NCD in 2003 47 5.1.1.3 Utilization of surveillance risk factors NCD information. v 5.1.2 Policy Development and Coordination 48 5.1.2.1 Policy and program in surveillance 49 5.1.2.2 Policy and program in health promotion 49 5.1.2.3 Policy and program in health service management 49 5.1.2.4 Policy and program in industry sector 50 5.1.3 Strengthening individual skill 51 5.1.4 Enhancing social environment and enabling community actions 51 5.1.5 Reorienting Health Services 53 5.1.5.1 Posbindu PTM 53 5.1.5.2 Integrated ’Yandu PTM’ in PHC 57 5.1.6 Constraints in NCD control program implementation 60 5.2 Effect/Outcome Evaluation 61 5.2.1 Behavior Risk Factors 62 5.2.2 Physical Risk Factors 64 5.2.3 Biochemical Risk Factors 65 6. CONCLUSION 66 7. RECOMMENDATION 67 vi List of Table Table 1. Difference of mean score of knowledge test in pre and post training 2004 69 Table 2. Difference of mean score of knowledge test in pre and post training 2005 69 Table 3. Ratio of ‘Posbindu PTM’ at the selected Villages in Depok……………... 70 Table 4. Target achievement of Posbindu PTM by budgeting system applied ……… 70 Table 5 Target achievement of Posbindu PTM by Constraints which found in implementation…………………………………………………………… 71 Table 6. Target achievement of Posbindu PTM by Constraints which found in Counseling activity…………………………………………………………. 71 Table 7 Target achievement of Posbindu PTM by Knowledge and Skill of Health volunteers……………………………………………………………………… 72 Table 8. Achievement of Development Level of Integrated Health Post for NCD (‘Posbindu PTM’) by Indicator in Abadijaya in 2003 ………………… 73 Table 9. Achievement of Development Level of Integrated Health Post for NCD (‘Posbindu PTM’) by Indicator in Abadijaya in 2004 …………………. 74 Table 10. Achievement of Development Level of Integrated Health Post for NCD (‘Posbindu PTM’) by Indicator in Abadijaya in 2005 …………………. 75 Table 11 . Achievement of Development Level of Integrated Health Post for NCD (‘Posbindu PTM’) by Indicator in Abadijaya in 2006 …………………. 76 Table 12. Percentage who currently smoke tobacco daily ……………………… 77 Table 13. Average age started smoking (years) for those who smoke tobacco daily 77 Table 14. Average years of smoking ……………………………………………. 78 Table 15. Percentage smoking manufactured cigarettes ………………………… 78 Table 16. Mean number of Cloves manufactured cigarettes smoked per day ……. 79 Table 17. Mean number of Non-Cloves manufactured cigarettes smoked per day 79 Table 18. Percentage of Abstainers (who did not drink alcohol in the last year) … 80 Table 19. Mean number of servings 0f fruit consumed per day ………………….. 80 Table 20. Mean number of servings of vegetable consumed per day ……………. 81 Table 21. Percentage who ate 5 or more combined servings of fruit & vegetables per day ……………………………………………………………….. 81 Table 22. Percentage with low levels of activity (defined as <600 MET-minutes/ Week …………………………………………………………………. 82 Table 23. Median time spent in work-related physical activity per day (minutes) 82 Table 24. Median time spent in transport-related physical activity per day 83 (minutes) ……………………………………………………………… Table 25. Median time spent in recreation physical activity per day (minutes) 83 Table 26. Mean body mass index – BMI (kg/m2) ………………………………. 84 Table 27. Percentage who are overweight or obese (BMI ≥ 25 kg/m2) ………… 84 Table 28. Percentage who are obese (BMI ≥ 30 kg/m2) ……………………….. 85 Table 29. Average waist circumference (cm) ………………………………….. 85 Table 30. Mean systolic blood pressure - SBP (mmHg) ……………………….. 86 Table 31. Mean diastolic blood pressure - DBP (mmHg) ………………………. 86 Table 32. Percentage with raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg) ……. 87 Table 33.Percentage with raised BP (SBP ≥ 170 and/or DBP ≥ 100 mmHg) ……. 87 Table 34. Mean fasting blood glucose (mmol/L) ………………………………… 88 Table 35. Percentage with raised blood glucose (≥ 7.0 mmol/L) ………………… 88 vii Table 36. Mean fasting blood glucose (mmol/L) ………………………………… 89 Table 37. Percentage fasting blood glucose (≥11mmol/L) ………………………. 89 Table 38. Prevalence diabetes …………………………………………………… 90 Table 39. Mean total blood cholesterol (mmol/L) ……………………………….. 90 Table 40. Percentage with raised total cholesterol (≥ 5.2 mmol/L) …………….. 91 Table 41. Percentage with raised total cholesterol (≥ 6.5 mmol/L) ……………… 91 Table 42. Percentage with low risk (less then three of the risk factors *) ……….. 92 Table 43. Percentage with raised risk (three or more of the risk factors*) ……… 92 Table 44. Percentage of who Raised Risk of NCD by achievement of their “Posbindu PTM” ……………………………………………………… 93 viii List of Attachment Attachment 1: Figures and Graphs of General Description of Geographical and Demographic Aspects of Depok Figure 1.Map of Depok). Figure 2. Map of village and sub district in Depok, Graph 1. Number of Population per sub district Graph 1. Distribution of land use in Depok Graph 2. Population Size of 6 Sub District in Depok Graph 2a Development parameter progress Graph 3. Consumption per capita (in thousand) Graph 4. Income distributions Graph 5. Depok regional/district revenue expenditure budget- regional/district income Graph 6. Depok District revenue expenditure budget Graph. 7.National revenue expenditure budget for Depok Attachment 2 Steps Instrument Depok Indonesia Attachment 3 Operationl standard prosedure Attachment 4 Interview guidance and questionnaire guidance Attachment 5 Form consent Attachment 6 Consent information Attachment 7 Invitation letter Attachment 8 Posbindu PTM Attachment 9 Form evaluation of Posbindu PTM program Attachment 10. Courses topics/material for health volunteer and health workers Attachment 11 Fact sheet 2003 Attachment 12 Fact sheet 2006 Attachment 13 Data Book 2003 Attachment 14 Data Book 2006 ix ABSTRACT Background: