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Civil Registration and Vital Statistics (CRVS) systems are the optimal source for data on births, deaths and causes of death for health policy, program evaluation, and research. In Indonesia, indicators such as life expectancy at birth, infant and maternal mortality rates, and cause-specific death rates need to be routinely monitored for national health policy. However, the CRVS system has not yet been fully established, which creates a challenge for evidence-based health action. In 2019, the Indonesian government released a national strategy for accelerating the CRVS system, with targets for improved coverage and data quality by 2024. This article describes findings from a program of formative and implementation research to guide the application of the national strategy. At first, a detailed CRVS assessment and gap analysis was undertaken using an international framework. The assessment findings were used to develop a revised business process model for reporting deaths and their causes at village, sub district and district level. In addition, a field instruction manual was also developed to guide personnel in implementation. Two field sites in Java – Malang District and Kudus Regency were selected for pilot testing the reporting procedures, and relevant site preparation and training was carried out. Data compilations for Malang in 2019 and Kudus in 2020 were analyzed to derive mortality indicators. High levels of death reporting completeness (83 to 89%) were reported from both districts, along with plausible cause-specific mortality profiles, although the latter need further validation. The study findings establish the feasibility of implementing revised death reporting procedures at the local level, as well as demonstrate sustainability through institutionalization and capacity building, and can be used to accelerate further development of the CRVS system in Indonesia.

Exclusive operations in health services remains a common practice on primary health services in Indonesia, particularly in the First Level Health Facility. This form of services was incapable of covering the need for people with disability (PwD) towards adequate health services. Prerequisite facilities were not available nor accessible for the disabled in need of health treatment. This research was aimed at depicting friendly health services for people with disability at the Puskesmas level. This research looked at several factors, including the need for PwD, assessment of facility provision, evaluating policy support, also support from family and Disabled People Organisation (DPO) to ensure adequate services for PwD. This study is qualitative research with in-depth interviews, observations, and literature reviews, data collection methods. Research sites were three Puskesmas in Sukoharjo, Central Java. The result shows that PwD’s needs on primary health services in Puskesmas include physical accessibility, health worker’s ability to understand them and proper health insurance. DPO in Sukoharjo had actively supported disability rights. DPO and local government had also been working together in the improvement of health services for PwD. However, the three Puskesmas were in the process of improving their supporting facilities. The refurbishment followed building accessibility guidelines from the Ministry of Public Works. This study was a pilot project on inclusive primary health services in Sukoharjo. Abstrak Pola-pola non inklusif masih sering ditemui pada pelayanan kesehatan dasar di Indonesia, khususnya pada fasilitas kesehatan tingkat pertama (FKTP). Bentuk layanan itu tidak dapat mengakomodir kebutuhan difabel terhadap pelayanan kesehatan yang memadai. Kebutuhan seperti aksesibilitas fisik masih belum tersedia dan dapat diakses oleh difabel yang membutuhkan pelayanan kesehatan. Penelitian ini bertujuan untuk mencari gambaran pelayanan kesehatan yang ramah bagi difabel pada tingkat Puskesmas. Penelitian ini melihat pada faktor kebutuhan difabel akan pelayanan kesehatan, mengevaluasi ketersediaan pelayanan kesehatan dan faktor dukungan kebijakan, serta melihat faktor dukungan dari keluarga dan organisasi difabel dalam memastikan kebutuhan difabel akan pelayanan kesehatan yang memadai. Metode yang digunakan dalam penelitian ini adalah metode kualitatif. Penelitian dilaksanakan di tiga Puskesmas di Kabupaten Sukoharjo, Jawa Tengah. Data dikumpulkan dengan melakukan wawancara mendalam, observasi dan penelusuran literatur terkait. Hasil dari penelitian ini menunjukkan bahwa kebutuhan difabel pada pelayanan kesehatan dasar di Puskesmas meliputi aksesibilitas fisik, kemampuan petugas dalam memahami dan jaminan kesehatan yang tepat. Organisasi Difabel di Sukoharjo secara aktif mengadvokasi hak difabel kepada pemerintah setempat. Sinergi yang baik terbangun di antara kedua belah pihak dalam meningkatkan pelayanan kesehatan untuk difabel. Sarana dan prasarana penunjang yang lebih aksesibel masih dalam proses peningkatan pada ketiga Puskesmas yang menjadi fokus dalam penelitian ini. Pembangunan tersebut dilakukan dengan mengikuti petunjuk teknis aksesibilitas gedung. Ini merupakan pilot project pembangunan Puskesmas ramah-difabel di Sukoharjo.