A Maternal and Child Health(MCH)handbook was introduced in Indonesia in 1993 to improve the quality of MCH services. BolMong district in the North Sulawesi province, a pilot area for the Japan International Cooperation Agency, started a user-fee system for distributing the handbook. The purpose of this study was to describe the policy-making process, management system, implementation, and outcome of this system. In June 2000, the Local Government instituted a user-fee system; price was set at Rp. 3,500(40 yen). Through continuous efforts of district health officers, all the money collected was used only for reprinting. Midwives collected the money from mothers and turned it in to their health center on a monthly basis, who then sent it to the district office. District health officers monitored and supervised the distribution of the handbooks to maintain the integrity of the system. Payment rate was calculated by dividing the number of pregnant woman paying the book by the number of books distributed. Considering a non-payment rate of 31.8% and an increase in printing cost of 30%, only 47.7% of the initial order could be reprinted. The remaining cost was subsidized by local government. The following three factors were critical in sustaining a user-fee system: strong political commitment by local government, proper supervision of distribution and funds, and simple distribution and management methods.

Objective
To assess the effects of the utilization of Maternal and Child Health Handbook (MCHH) in West Sumatra on the utilization of maternal health services.
Methods
A repeated cross sectional study design was used. Three consecutive surveys were conducted in two districts, in 1999, 2001 and 2003, involving respectively 611, 621, and 630 mothers (pregnant and/or with one or more children under age three) as respondents. Respondents for each survey were selected from the same sub-districts and villages, using a multistage random sampling method. Data were collected primarily by using a pre-tested structured questionnaire. Multiple logistic regression analyses were carried out to estimate the net effects of the MCHH on mother's use of maternal health services.
Results
After controlling for other influencing factors, utilization of MCHH was found to be associated with better maternal knowledge regarding antenatal care (ANC), tetanus toxoid (TT) immunization and skilled birth attendance. MCHH utilization was also associated with higher likelihood of mothers' utilizing ANC, TT immunization and family planning services, and of use or planned use of skilled birth attendance. Simply owning the handbook did not affect maternal knowledge and was only associated with higher utilization of skilled birth attendance.
Discussion
The MCHH needs some modification, taking into account the educational level of the targeted mothers. Appropriate health care provider training is needed to promote the use of the MCHH as a tool for encouraging and focusing communication between mothers and health care providers, as well as to ensure that health care providers are able to use the handbook.
Conclusion
Utilization of the MCHH has the potential both to improve maternal knowledge and to increase the utilization of maternal health services. For maximum benefits, the handbook should be actively used by both mothers and health care providers.

Objectives
To analyze the professionalization process of medical interpreting in the United States. The findings are expected to provide suggestions for Japan, a nation primed to educate its future professional medical interpreters.
Method
Initial members of the world’s oldest medical interpreters association were interviewed. The transcripts were analyzed through thematic analysis.
Results
A group of staff interpreters met to share stories of difficult cases and dilemmas at work in the 1980s, later forming a professional organization in Boston, Massachusetts, in 1986. Later, they began to discuss common issues and developed some standards to clarify role definitions. They advocated for the profession with an aim to increase employment by collaborating with stakeholders to enact the first state law of medical interpreting. Out of eight participants, six worked as a professional interpreter and trainer simultaneously, thus educating newcomers to the profession. Conferences enabled professional medical interpreters and stakeholders to expand their network for local or joint initiatives to further develop the profession. The state government provided grants to medical interpreting education projects and issued guidance to hospitals for best practices.
Conclusion
To establish medical interpreting as a profession, organizational and advocacy activities were vital. Pioneering medical interpreters played an important role in the process of developing the profession by forming a professional organization, creating standards, approaching stakeholders, and becoming professional trainers to educate newcomers to be skillful enough. This network expanded through conferences enabling multiple stakeholders to take initiatives and accelerate the process. The participants pointed out the lack of training courses, difficulty in building relationships with physicians, and self-stress control. A survey conducted in Japan revealed that medical interpreters pointed out a lack of training courses, a lack of understanding by physicians and patients, and a lack of mental support. This study provides important lessons for burgeoning interpreters in Japan, with these commonalities in mind.

Since it first accepted 138 participants in 1954, the Japan International Cooperation Agency (JICA) has accepted approximately 270,000 participants from developing countries for training in Japan during the past 57 years.
In order to verify factors that contribute to the utilization of knowledge and techniques/skills after participants have returned to their countries, questionnaires were distributed through e-mail to 856 former participants, of whom 601 were Indonesian (total response rate: 24.4%), and 264 were Laotian (total response rate: 31.9%)
Interviews were conducted with 28 Indonesian and 15 Laotian ex-participants through snowball sampling.
In the questionnaire, most ex-participants stated that JICA training was valuable. The reasons they mentioned were that they could understand conditions in Japan through field trips/observation, gain up-to-date knowledge about Japan, and learn about the process of technological development in Japan.
About the usefulness of knowledge and techniques/skills gained in Japan for their work, knowledge was considered to be slightly more useful than techniques/skills.
On the other hand, the participants had some difficulties in utilizing knowledge and techniques/skills because of a lack of budget or facilities/equipment, and differences between conditions in Japan and their own countries’.
In the interview survey, the majority of ex-participants provided examples of good practices in which they actively utilized skills/techniques and knowledge they gained in Japan after returning to their countries. The three factors contributing to this result were (1) their needs matched Japanese resources used in training. (2) Ex-participants developed awareness and learned new things spontaneously during the training. (3) Ex-participants and Japanese instructors maintained a long-term relationship after the training.
This study suggests that in order to enable participants to apply knowledge and techniques/skills gained in Japan to their local circumstances, JICA needs to identify appropriate technology that developing countries wish to implement and to conduct follow-up related to adoption and diffusion in their countries through ongoing dialogue.

Introduction
  Sales of prescription-only drugs are not well regulated in developing countries. Self-medication with antibiotics is a major concern in global public health from the perspective of increased drug resistance. In addition to common self-medication with prescription-only drugs, distribution of dangerous counterfeit drugs is a social problem in Indonesia. This study aims to examine the factors relevant to self-medication with antibiotics by clarifying customers’ behavior requesting antibiotics at pharmacies and pharmacists’ response in the capital region of Indonesia.
Method
  Two hundreds customers who requested antibiotics were exit-interviewed at 6 community pharmacies in the Ciputat district of South Tangeran City. Structured questionnaire was used on general attribute including health insurance coverage and having/not-having prescription and instructions by pharmacists, etc. Eight informants of pharmacists and an owner from a pharmacy were interviewed by using semi-structured questionnaire. They were questioned on number of customers requesting antibiotics with/without prescriptions, pharmacists’ responses and experience of health damages. The investigation was conducted between late May and early July of 2012.
Results
  Of the customers requesting antibiotics, 48.5% (97/200) had no prescriptions. Neither consultation with doctor nor self-medication is statistically associated with health insurance coverage. Among customers without prescriptions, 51.9% (54/104) purchased antibiotics by showing drug samples they did not take. This was significantly more frequent than those following advice by family/friends or pharmacists. Pharmacists are cautious of dispensing antibiotics without prescriptions. They assess patients, being mindful of allergy and drug resistance. Pharmacists recognize the importance of patient education and intervention in the community.
Conclusion
  The results of exit-interview suggested that economic reason is not a dominant factor to promote self-medication. From the observations among self-medicated customers who are on over-confidence, purchase antibiotics using drug samples they left over, and having preference of advice by family/friends to advice by pharmacist, self-medication is considered based on heuristic selection as well as risk-management within their limited scope of options. The efficacy of antibiotics is manifested in a short duration so that it gives efficient feedback as well as successful experience to patients. The successful experience is considered to strengthen patients’ behavior of self-medication. Pharmacists are expected to challenge their new role to develop patient education to alter patient behaviors.

Background:
Maternal and child health handbook (MCHH) consists of records of pregnancy, delivery, child development and immunization, as well as child growth charts. MCHH has been utilized in Japan since 1947 and it is now introduced in more than 20 countries in the world.
Objectives:
The objectives of this study were to collect research documents and reports in the past studies of MCHH and to analysis the effect of MCHH on maternal and child health through systematic review.
Methods:
The systematic searches were conducted for the studies published between 1980 and October 2011. After the initial screening of titles and abstracts of the studies, we reviewed 57 documents which were studied for MCHH in maternal and child health (MCH) programs or activities. After the final selection, we identified only 5 documents with 43 question items in Indonesia (1999 and 2001), Bangladesh (2003), the Philippines (2009) and Cambodia (2010).
Results:
The relationship between MCHH and pregnancy care revealed that mothers who used MCHH during pregnancy had higher level of knowledge (OR 1.44, 95% CI: 1.22-1.70) than whose did not use MCHH during pregnancy. The strong significant effects of MCHH were observed in knowledge of antenatal care visit (OR 1.86, 95% CI: 1.59-2.18), and mother should consume more food during pregnancy (OR 1.97, 95% CI: 1.37-2.83). Mothers who got MCHH during pregnancy had safer practice by skilled birth attendants (OR 1.12, 95% CI: 0.95-1.32) and delivered in health facilities (OR 1.31, 95% CI: 1.12-1.53). MCHH showed the effect of knowledge of child health care (OR 1.22, 95% CI; 1.05-1.41).
Discussion:
This study utilizing meta-analyses showed MCHH had higher association with knowledge of mothers than practice in pregnancy and child health care, although the study has its limitation. The illumination of the relationship between knowledge and practice by the effect of MCHH needs more quantitative analysis in both community and hospital settings in many countries.