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GFMER Country Coordinators

Agus Fitriangga

GFMER Coordinator for Indonesia

Agus Fitriangga

Agus Fitriangga, MKM
Head of Department, Community Medicine, Faculty of Medicine, Tanjungpura University, Pontianak, Indonesia
afitriangga@yahoo.co.id

Agus Fitriangga was born on the 26th of August 1979. He is a researcher, lecturer and the head of department of Community Medicine in the Faculty of Medicine, Tanjungpura University in West Kalimantan Province, Indonesia. He graduated from the University of Indonesia with a Bachelor of Public Health, and a Master in Epidemiology degree. Currently, he is pursuing a PhD program in Epidemiology at the Faculty of Medicine, Unit Prince of Songkla University, Thailand. He was among the 15 top graduates/awardees at the intensive GFMER Workshop in Geneva for Sexual Reproductive Health Course; From Research to Practice in 2014.

He has been involved in GFMER training three times as a coach. The first was the Training Course in Adolescent Sexual and Reproductive Health 2020 “Lessons learned and experiences gained in improving the SRH of adolescents in the 25 years since the ICPD and Responding to the SRH needs of adolescents in the context of the COVID-19 crisis”, where he coached 12 participants from Indonesia. One of the participants, namely Diyah Herowati, was chosen as a representative from Indonesia to present her paper. The second course was "Family Planning": An Online Evidence-based Course 2021. He coached 15 participants of the course of whom five were from Indonesia and 10 from Myanmar. Currently, he is involved in the Training course in research methodology and research protocol development 2021, mentoring 9 participants from various countries.

As a lecturer and researcher, he is very concerned with issues related to family planning and reproductive health. He is a member of IPADI (Association of Indonesian Demographic Experts and Supporters) in collaboration with the BKKBN (the National Family Planning Coordinating Board) of West Kalimantan Province. He is focused on providing pre-service training to medical students and alumni of Faculty of Medicine Tanjungpura University in the West Kalimantan Province. He also focuses on efforts to reduce the TFR rate in the West Kalimantan Province through community service activities by providing education and training to the community.

Country Situation

Indonesia has been among the global leaders in family planning. The success of the national family planning program is evidenced by the sharp increase in the contraceptive prevalence rate (CPR) among married women from 8% in the early 1970s to 60% in 2002, while during the same time period the total fertility rate (TFR) was reduced by nearly one-half from 5.0 to 2.6 [1]. Although the rate of growth in contraceptive use has slowed since the early of 2000s, CPR reached 63% in 2017 and the TFR fell to 2.3. [2]

A major recent advance in provision of health services in Indonesia is the enactment of the National Health Insurance Scheme (Jaminan Kesehatan Nasional/JKN6) since 2014. The JKN aims to achieve universal health coverage for all by the end of 2019. At the end of the first year implementation of JKN, 133.4 million people were covered. By mid-2019, 222 million people were covered by JKN, equal to 84.1 per cent of the population. With JKN, the cost for health services, including SRHR such as family planning services, antenatal care, delivery, post-partum and treatment of sexually transmitted diseases, can be obtained free of charge or at a minimal cost. In the other words, implementation of JKN offers a great opportunity to address the continuing problem of high maternal mortality as it removes the user fee. Financial constraints are dominant factors causing maternal deaths in Indonesia. [3]

Maternal Mortality in Indonesia

Measurement of maternal mortality could not be easily done in Indonesia where vital statistics and civil registration are not fully in place. Therefore, the MMR measurement relies mostly on survey data where calculations of MMR are often based on a very small number of cases and the validity of the MMR levels were often questioned and debated. After 2000, the government of Indonesia has recommended using census or intercensal data for calculating MMR and special questions to investigate maternal deaths were added to the Census questionnaire. The Census of 2010 reported a maternal mortality ratio of 278 per 100,000 livebirths, although this number was not widely quoted. [4]

The maternal health program relies heavily on the community health centre (Pusat Kesehatan Masyarakat/Puskesmas), the cornerstone of the public health system in Indonesia, and remains one of the program priorities of Puskesmas since its inception. Early initiatives in maternal and child health focused on the provision of care. However, a significant change was Puskesmas substituting the extensive network of TBAs, Traditional Birth Attendants (dukun) with a ‘Community Midwives’ program. With a local area monitoring concept, a Puskesmas is responsible for various programs provided in its catchment area, usually at the sub-district level. The service of Puskesmas can be provided either at the Puskesmas facilities, by Puskesmas pembantu (sub-health centres), at a village maternity post by the midwives in the community, or through an outreach program. The community midwives’ program deployed midwives at village level as part of the effort to reduce maternal deaths. This was a strategic step to reduce the domination of traditional birth attendants close to the community in providing delivery assistance at the village level. The community midwives programme was dramatically successful in increasing the coverage of maternal health care, particularly antenatal care and skilled birth attendance. [5]

Contraceptive Usage in Indonesia

Deployment of midwives at village level is expected to increase family planning uptake, as there are more providers for contraceptives. However, the program only slightly affects overall prevalence of contraceptive use although it did affect method choice. In early 1990s when the community midwives’ program was introduced, the level of contraceptive use reached 50 per cent. The family planning agency was very strong then, with huge campaigns promoting ‘two children is enough’ and long-term contraceptives being encouraged through mobile clinics. In the decades afterward contraceptive use only slightly increased. The presence of midwives at community level was associated with increased use of injectable contraceptives and decreased use of IUDs and implants. The women’s “switching behaviour” indicates that the program succeeded in providing additional outlets for promoting the use of injectable contraceptives and data shows an increased uptake of short-term contraceptive methods. With deployment of midwives at village level, there are more providers for contraceptives. However, the midwives gain benefit from promoting injectables (with a regular need to retake the injectable, thus requiring payment of a fee for services) rather than the long-term methods. The contraceptive prevalence rate for all contraceptive methods was 63.6 per cent in 2017, with an increase in the use of traditional methods but a slight decrease in modern contraceptive methods in the previous five years, from 57.9 per cent to 57.2 per cent. Overall, most provinces experienced a decrease in the use of modern contraception. The disparity in the use of modern contraception between provinces is also considerable. The highest use is found in Central Kalimantan at 69.4 per cent while the lowest is in Papua at 35.9 per cent. [6]

HIV/AIDS in Indonesia

Although it tends to fluctuate, data on HIV AIDS cases in Indonesia continues to increase from year to year. During the last eleven years the number of HIV cases in Indonesia reached its peak in 2019, which was 50,282 cases. Based on WHO data in 2019, there are 78% of new HIV infections in the Asia Pacific region. For the highest AIDS cases for eleven years since in 2013, which was 12,214 cases7. The five provinces with the highest number of HIV cases are East Java, DKI Jakarta, West Java, Central Java, and Papua, where in 2017 the most HIV cases were recorded in these five provinces. The provinces with the highest number of AIDS cases were Central Java, Papua, East Java, DKI Jakarta, and Riau Islands7. The number of AIDS cases in Central Java was about 22% of the total cases in Indonesia. The trend in the highest HIV and AIDS cases from 2017 until 2019 is still the same, which is mostly on the Java Island. Based on SIHA (HIV/AIDS Information System) data on the number of reported HIV infections in 2010-2019 by group age, the age group of 25-49 years or productive age is the age with the number of people with most HIV infection every year. [7]

Reference

  1. Statistics Indonesia (Badan Pusat Statistik-BPS). Proyeksi Penduduk Indonesia 2010-2035. Jakarta: Badan Pusat Statistik; 2013.
  2. Statistics Indonesia (Badan Pusat Statistik-BPS), National Family Planning Coordinating Board, Ministry of Health and ICF. Survei Demografi and Kesehatan Indonesia 2017: Laporan Pendahuluan Indikator Utama. Jakarta: Statistics Indonesia; 2018.
  3. Ministry of Health. Indonesian Health Profile, 2020.
  4. Statistics Indonesia (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), and Kementerian Kesehatan (Kemenkes—MOH), and ICF International. 2013. Indonesia Demographic and Health Survey 2012. Jakarta, Indonesia: BPS, BKKBN, Kemenkes, and ICF International.
  5. Directorate of Public Health and Nutrition, Deputy for Human Development, Society and Culture, Ministry of National Development Planning/Bappenas. Strengthening basic health services in Primary Health Care (Puskesmas). 2018.
  6. Statistics Indonesia (Badan Pusat Statistik-BPS), National Family Planning Coordinating Board, Ministry of Health and ICF. Survei Demografi and Kesehatan Indonesia 2017: Laporan Pendahuluan Indikator Utama. Jakarta: Statistics Indonesia; 2018.
  7. Ministry of Health, Data and Information Center. HIV in Indonesia, 2020.

Publications

  1. Fitriangga A, Albilardo G, Pramulya M. Distribution and spatial pattern analysis on malnutrition cases: a case study in Pontianak City. Malaysian Journal of Public Health Medicine. 2020 Oct 1;20(2):56-64. ISSN 1675-0306.
  2. Fitriangga A, Adawiah AR, Rialita A. Factors affecting contact dermatitis on palm oil plantation workers of PT. X in Semitau sub-district. Malaysian Journal of Public Health Medicine. 2020 Oct 1;20(2):43-8. ISSN 1675-0306.
  3. Putri A, Natalia D, Fitriangga A. Hubungan personal hygiene terhadap kejadian Pityriasis capitis pada siswi di smk negeri 1 Mempawah Hilir [The relationship of personal hygiene with the incidence of Pityriasis capitis among female student of vocational and pre-professional high school 1 Mempawah Hilir]. Jurnal Nasional Ilmu Kesehatan. 2020 Feb 24;2(3):121-9. e-ISSN 2621-6507. Indonesian.
  4. Fitriangga A, Nasip M, Siswani AN, Surjana NT, Simon S, Riono P. The procedure of empowering former TBC patients to improve detection of presumptive TBC cases: case study in Kubu Raya District, West Kalimantan. Journal of Social Health. 2020;3(1):21-30. ISSN 2651-6837.
  5. Natalia D, Fitriangga A. Hubungan antara tingkat pengetahuan skabies dan personal hygiene dengan kejadian skabies di Puskesmas Selatan 1, Kecamatan Singkawang Selatan [Relationship between knowledge levels of scabies and personal hygiene for scabies in South Puskesmas 1, South Singkawang District]. Cermin Dunia Kedokteran. 2020 Mar 1;47(2):97-102. ISSN.2503-2720. Indonesian.
  6. Syauqiannur S, Fitriangga A, Pramulya M. Sebaran kasus dan faktor risiko kejadian DBD berbasis SIG Kabupaten Kubu Raya tahun 2016-2018 [The distribution of cases and risk factors of dengue haemorrhagic fever incidence using geographic information system in Kubu Raya district 2016-2018]. Majalah Kedokteran Andalas. 2019 Sep 11;42(3):108-20. e-ISSN 2442-5230. Indonesian.

Conference presentations

  1. Fitriangga A. Empowerment of former TB patient to improve TB suspect detection in Sungai Kakap Sub District, Kubu Raya District, West Kalimantan Province. Oral presentation at: The 4th Indonesia TB Research Parade; 2015.
  2. Fitriangga A. Empowerment of Former TB Patients to Improve TB Suspect Detection in Sungai Kakap Sub-District Kubu Raya District of West Kalimantan Province. Poster Presentation at: B49. TUBERCULOSIS EPIDEMIOLOGY. American Thoracic Society International Conference Abstracts. American Thoracic Society; 2015.

Books

  1. Fitriangga A, Wicaksono A. faktor-faktor yang berpengaruh terhadap fertilitas di Kecamatan Tangaran Kabupaten Sambas [Factors influencing fertility in Tangaran District, Sambas District, West Kalimantan Province]. Perwakilan BKKBN Provinsi Kalimantan Barat 2014; 2014. ISBN. 978-602-70015-7-2. Indonesian.
  2. Fitriangga A, Wicaksono A, Riza H. Kesenian wayang gantung sebagai media intervensi pengetahuan dan sikap pencegahan HIV/AIDS pada remaja di Singkawang [Art of hanging puppets for HIV/AIDS prevention among adolescents in Singkawang City]. IAIN Pontianak Press; 2019. ISBN. 978-623-7167-28-0. Indonesian.
  3. Fitriangga A, Alex, Rahardjo WA, Fahdi FK. Training module for health care worker in mental health facing pandemic Covid 19. IAIN Press; 2020.

Memberships

  1. The Indonesian Public Health Association, West Kalimantan Province, 2012-2016.
  2. The Indonesian Public Health Association, West Kalimantan Province, 2016-2020
  3. Association of Indonesian Demographic Experts and Supporters (IPADI), West Kalimantan Province, 2016-2020.
  4. Association of Indonesian Demographic Experts and Supporters (IPADI), West Kalimantan Province, 2020-2024.

Intelectual Property Right (IPR)

  1. Art of Hanging Puppets for HIV/AIDS Prevention Among Adolescents in Singkawang City. Number 000154921. Date 1st May, 2019.
  2. Fitriangga A, Alex, Rahardjo WA, Fahdi FK. Training Module for Health Care Worker in Mental Health Facing Pandemic Covid 19. Number. 000227254. Date 30 October 2020

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