Inside a Yogyakarta health centre that has kept its doors open to the community during the pandemic

Strict health protocols have allowed staff at the Tegalrejo puskesmas to continue providing essential services for children and pregnant mothers while minimising the risk of COVID-19 transmission

UNICEF
A mother waits for her child to be vaccinated
UNICEF/UNI350155/Ijazah
31 August 2020

As the COVID-19 pandemic weakens health systems and disrupts routine services around the world, millions of children are at risk of missing out on lifesaving vaccines and other critical health interventions. In Indonesia, physical distancing measures led to the temporary closures and suspension of services in puskesmas (health centres) and posyandu (village posts) – the backbone of routine maternal, newborn and child services – across much of the country. 

In response, the Government of Indonesia, with support from UNICEF and other partners, has provided guidelines and supplies for health workers to carry out their jobs safely and effectively during the pandemic. In Yogyakarta, the Tegalrejo puskesmas implemented new health measures in line with the guidelines and was able to keep its doors open to the community. 

Above, a mother holds her infant son during a routine check-up at the Tegalrejo puskesmas. 

Midwife Yuliani cleans her face shield
UNICEF/UNI350147/Ijazah
Midwife Yuliani cleans her face shield before seeing a patient.

At the beginning of the pandemic in March, many staff members at the health centre were afraid of becoming infected, which constrained their ability to deliver services.  

To reduce the risk of transmission, the centre mandated that all staff wear personal protective equipment (PPE) and masks, wash their hands with soap and maintain physical distancing. Moreover, air circulation inside the facility was improved and waiting times were shortened. 

A mother washes her hands
UNICEF/UNI350077/Ijazah
A mother holding her infant son washes her hands before entering the centre to register him for vaccination.
A mother registers her baby for vaccination
UNICEF/UNI350152/Ijazah
A mother registers her baby for vaccination at a Community Health Centre in Yogyakarta, Indonesia.

Visitors must also follow health measures when going to the facility, which include washing hands with soap, wearing a mask and having their body temperature checked.  

A mother waits for her child to be vaccinated
UNICEF/UNI350106/Ijazah
A mother waits in the hallway to have her child examined by Puskesmas staff.

To enforce physical distancing requirements, chairs inside the centre have been taped off to prevent people from sitting too close to each other. Patients must wait in the hallway before being called in one at a time. 

A child is checked by nutritionist before being vaccinated
UNICEF/UNI350165/Ijazah
A child is checked by nutritionist Reana Marliza before being vaccinated.

To better understand the effects of COVID-19 on immunization services, the Ministry of Health, with support from UNICEF, conducted a rapid assessment of the health system.  

The assessment found that in nearly 84 per cent of the reporting health facilities, immunization services were significantly disrupted due to the COVID-19 outbreak and physical distancing measures. More than 56 per cent of respondents reported that immunization services were affected at both the puskesmas and posyandu levels in their areas.  

Midwife Yuliani prepares a vaccine in a syringe for injection.
UNICEF/UNI350141/Ijazah
Midwife Yuliani prepares a vaccine in a syringe for injection.

Data from the Ministry of Health shows that the disruptions have already caused a steep drop in the number of child vaccinations this year. Between March and May 2020, the coverage rates of life-saving vaccines decreased by more than 35 per cent compared to last year during the same period. As a consequence, thousands of children could be left vulnerable to morbidity and mortality from vaccine-preventable diseases. 

Children are vaccinated by staff.
UNICEF/UNI350142/Ijazah
Children are vaccinated by staff.
UNICEF/UNI350133/Ijazah
Children are vaccinated by staff.

While vaccination rates have dropped, a recent survey of nearly 7,000 parents and caregivers shows that there is still high demand for safe and timely vaccination services.  

According to the survey, more than half of responding parents and caregivers brought their children for routine immunization over the past two months, with the other half not attending immunization sessions either due to the conditions created by the COVID-19 pandemic or because their children did not need a vaccine in the given timeframe. Respondents to the survey expressed strong support for government policy to continue immunization services with safety precautions. 

A doctor consults a mother after her child was vaccinated.
UNICEF/UNI350139/Ijazah
A doctor consults a mother after her child was vaccinated.

With many in the community still afraid of contracting the virus, the number of patients coming to the centre has decreased significantly. Since the new health measures were put in place, however, staff report that more families are slowly starting to come back.  

Yunida measures her daughter Sharon’s height at home
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Yunida measures her daughter Sharon’s height at home before sending the results with a mobile phone application to nutritionist Reana Marliza.
After receiving the results, Reana inputs them into an online database.
UNICEF/UNI350144/Ijazah
After receiving the results, Reana inputs them into an online database.

Mobile phones have also enabled staff to provide health services during the pandemic by having regular contact with patients for appointments and initial consultations while maintaining physical distancing. 

Pregnant mothers have their vital measurements
UNICEF/UNI350161/Ijazah
Pregnant mothers have their vital measurements
UNICEF/UNI350149/Ijazah
Pregnant mothers have their vital measurements, including their blood pressure, temperature and pregnancy status, checked by a nurse and midwife.

“It’s in the best interests of children and pregnant women to come to the Tegalrejo Puskesmas,” said Yuliani, a midwife at the centre. “Among other reasons, they should have their children vaccinated, while expecting mothers should have their pregnancies checked.” 

UNICEF Indonesia wishes to express its sincere gratitude to key donors, including the Governments of Australia, Canada and New Zealand.