Epidemiological approach to health planning and problem solving in Indonesia

This paper describes the experience of health officials in Aceh in using an epidemiological approach to define their most important health problems and select the most appropriate interventions for those problems. The conduct and results, including lessons learned, of each of the project"s three fundamental elements are described: (1) training in applied epidemiology for province-, district-, and subdistrict-level health officials; (2) province-wide or district-wide surveys to identify major preventable causes of death, which revealed some very high rates for neonatal tetanus mortality and tuberculosis prevalence; and (3) the development of a population-based information system on births, deaths, and causes of death. Implications of the Aceh experience for training in community epidemiology are briefly discussed. While the project intended to demonstrate the feasibility of decentralizing health management, it proved epidemiology useful not so much as a technical tool as a means of generating self-confidence and a sense of control among local health officials.