Implementation of the MCH Handbook in The Family, and Health Protection for

Children with Special Needs during The Pandemic

The COVID-19 epidemic has had a negative impact on various public service sectors,
especially the health sector – more specifically nutrition and maternal and child health
(MCH) services. The COVID-19 pandemic has generally reduced the number of visits to
nutrition and maternal and child health (MCH) services, especially basic immunization and
weighing services for children under five years of age. Changes in the implementation of
nutrition and MCH services in the five regions have referred to the guidelines for nutrition
and MCH services during the COVID-19 pandemic from the Ministry of Health. Access to
technology and the internet supports the continued implementation of monitoring and
consultation on nutrition and MCH services during the COVID-19 pandemic. However,
digital inequality between regions in Indonesia could widen the gap in the health status of
mothers and children after the COVID-19 pandemic ends.

This is in line with the findings of several studies in various countries showing the
impact of the pandemic on health services. There was a 50% and 32% decrease in antenatal
visits and deliveries by health workers during the Ebola outbreak in Liberia (Shannon et al.,
2017) which trend did not even improve after the outbreak ended (Delamou et al., 2017).
Another study found indications of community reluctance in Sierra Leone to immunize and
weigh their children in health facilities for fear of contracting the virus during an Ebola
outbreak (Elston et al., 2016). In Indonesia, the COVID-19 pandemic has the potential to
hinder mothers and children's access to optimal health services. The decrease in the number
of visits to nutrition and MCH services also has the potential to create new nutrition and
health problems. To find out the impact of the COVID-19 pandemic on nutrition and MCH
services, The SMERU Research Institute conducted a case study in five regions in Indonesia,
namely East Jakarta City, Bekasi Regency, Maros Regency, Badung Regency, and Kupang
City in the May–June 2020 period. The difference in the number of COVID-19 cases in the
five districts/cities is expected to provide an overview of the varied nutrition and MCH
services. This study uses a combination of qualitative and quantitative methods (mixed
methods). In-depth interviews were conducted online and in stages, starting with the Ministry
of Health (Kemenkes), district/city Health Offices, community health centers (puskesmas), to
health cadres and mothers who are pregnant/breastfeeding/have children under five years old
( toddler). This study utilizes monthly visit data for the period January 2019 to March/April
2020 from puskesmas and the Health Office to analyze changes in the number of visits to
nutrition and MCH services.

Nutrition and MCH services in this essay are grouped into three types of services,
namely (i) services antenatal care, (ii) delivery services and postpartum, and (iii) services for
infants and toddlers. Impact the COVID-19 pandemic on these three types of services varies,
depending on the severity of the case and innovation in each region. In general, during the
COVID-19 pandemic, services nutrition and MCH in the five study areas remain available
and carried out in accordance with the health protocol of Ministry of Health. There is a
Variation of Decrease in Quantity Visit to Inspection Service Pregnancy During the COVID-
19 Pandemic There is a decrease in the number of first visits pregnancy checks in the first
trimester (K1), Fourth visit for prenatal check-up third trimester (K4), and giving additional
tablets blood supply (TBS) in the period February–April 2020.1 The sharpest decrease in the
number of pure K1 was experienced Maros Regency, from 666 visits to 438 visits (34.23%),
which were then followed East Jakarta City (30.62%) and Badung Regency (18.19%) (Figure
1). A decrease in the number of K4 occurs in East Jakarta City (31.65%), Bekasi Regency
(6.6%), and Badung District (3.89%), while the increase in the number of K4 only occurred
in the District Maros (9%). This shows that in Maros Regency, the COVID-19 pandemic has
no impact on this service. Meanwhile, in the other three districts, there was a decrease in the
number of administration of TBS, with the smallest decrease occurring in Badung regency.
Service method changes, such as delays integrated service post activities (posyandu) and
limitation of services at the puskesmas, is a factor which affects the decrease in the number of
visits pregnancy test. Since March 2020, in many regions in Indonesia, there is an appeal that
Posyandu implementation was postponed to prevent spread of COVID-19. Posyandu can stay
implemented in the green zone area or if there is a directive specifically from the regional
head. Of the five study areas, only the city of Kupang is still holding posyandu until mid-
April 2020 because COVID-19 cases have not been found in this area. In all study areas,
maternity services are centralized at the puskesmas and prioritized only for K1, K4, and visits
during emergency situations. Besides In addition, the components of pregnancy services too
reduced to shorten the visit time. In Maros Regency, triple elimination checks abolished,
while at one of the puskesmas in East Jakarta, dental check-ups are no longer served. Health
workers should also limit the number of daily visits, reduce service duration, and implement
the COVID-19 prevention protocol. In order to maintain service, in some areas home visits or
online services. In Bekasi Regency and Maros Regency, cadres and health workers make
visits to home, especially to monitor pregnant women with high risk (risk). Meanwhile, in the
District Badung, home visits by cadres are not done because there are ambulances around
every village and sub-health center midwives (pustu) who specifically monitors pregnant
women Risti. Monitoring also maximized by using phone or online applications, such as
WhatsApp. In Bekasi Regency and Maros Regency, WhatsApp is used as a medium of
consultation and to organize classes for pregnant women. Power health services in East
Jakarta City, Badung Regency, and Kupang City only use WhatsApp as a consulting medium.
By doing these two innovations, a decrease in the number of visits pregnancy check-up and
administration of TBS in Bekasi Regency and Badung Regency are smaller than in other
regions. Decrease in the number of antenatal care visits and the provision of sufficient TBS in
East Jakarta City large occurs along with the increase in the number of COVID-19 cases in
the region. Provincial government DKI Jakarta implements social distancing and social
distancing policies Large-Scale Social Restrictions (PSBB) from the start April 2020 which
led to service outage Integrated Healthcare Center. Besides, home visits are also not enacted
to prevent the spread of COVID-19 However, in Maros Regency, an increase in the number
of COVID-19 cases don't seem to affect number of antenatal care visits. Decrease the number
of K1 in Maros Regency is mainly influenced by a decrease in the number of pregnancies
during pandemic due to delays in weddings or economic problems (Wicaksana, 2020). K4
and service giving TBS is not affected because of energy health maximizes home visits using
existing cohort data. Policies from the Ministry of Health and local governments (local
government) to respond to the COVID-19 pandemic have a major effect on changes in
nutritional services and KIA. The Ministry of Health has developed various policies
contained in various guidelines, technical instructions, and directions. Policies This is
disseminated to all local governments through the Provincial Health Office, Health Office
districts/cities, and health centers.

Majority of services nutrition and MCH in the five study areas have been
implemented according to these guidelines. Uniform nutrition and MCH services can be
realized thanks to the systematic method of socialization and effective. Apart from webinars,
socialization is also carried out via WhatsApp. The Ministry of Health provides an
opportunity to health workers in the area with limited access to the internet or unable to
attend the webinar to still get it access presentation materials and ask questions directly when
there is confusion. All local governments in the study area also carry out modification of
services according to the socio-economic conditions of the community and the severity of the
case COVID-19 in the region. Health workers in the City East Jakarta is monitoring the
condition of mother and baby online because of increase in the number of COVID-19 cases
and the majority of the people have access to good for the internet. Meanwhile, the City
Government Kupang continues to hold posyandu until April 2020 because COVID-19 cases
have not occurred in his territory. Although online monitoring also carried out in Kupang
City, the number is more slightly due to the proportion of individuals who use internet is
smaller than in four regions other studies. This difference in access is important for
underlined considering the large role of the internet in maintaining nutrition and MCH
services during COVID-19 pandemic. It should also be ensured that the whole community
can get access towards equitable online health services during the COVID-19 pandemic.