By Sagita Adesywi, ChildFund Indonesia
In Indonesia’s low-income communities, the expenses related to childbirth lead to difficult decisions. Mulyana, a trained health-care volunteer (locally known as cadres) in Pakan Sari, had a miscarriage when she was three months pregnant.
“The treatment at the hospital cost me about US$400,” she recalls. “We have enough money for food, but we couldn’t afford to pay the hospital. Thank the Lord, I received an allowance from the government and have a childbirth savings account as well. Otherwise, I don’t know how I would be able to pay.”
Many women in Mulyana’s region go to traditional birth attendants instead of the hospital, which is often better prepared if a mother or baby encounters complications during birth. Improper medical treatments have contributed to the high number of deaths of mothers and babies. Indonesia’s maternal mortality rate, 228 deaths per 100,000 births, is among the highest in Southeast Asia; its infant mortality rate is 28 deaths per 1,000 live births.
Traditional birth attendants charge much less than a hospital, but that advantage sometimes comes at the expense of current medical knowledge, properly maintained equipment and even good hygiene.
To reduce the number of maternal and infant mortalities, a government program called Desa Siaga (Alert Village) has been rolled out by the Indonesian Ministry of Health targeting rural and poor regions.
Desa Siaga programs aim to encourage self-reliant communities that actively address their own health challenges, such as maternal and infant mortality. Through this initiative, the government provides a childbirth allowance that pays all expenses incurred at a state hospital. Women must first go to their health post for prenatal appointments to receive the allowance.
In Pakan Sari, community members started a forum to discuss needs and healthy practices surrounding childbirth and pregnancy. Everyone in the community — husbands, neighbors, community leaders, midwives and health cadres — has a role to play in promoting birth preparedness. This participatory approach is aimed at raising awareness that pregnancy should not be a private concern affecting women only.
Supporting this initiative, ChildFund works with its local partner organization, Warga Upadaya, strengthening the health cadres’ capacity to assist midwives in the community. Health cadres attended training on monitoring of pregnant mothers, breast feeding, nutrition for children from birth to age 5, household economy management and community organization.
Each pregnant woman’s health status and due date is recorded, as well as who will assist with transportation or give blood if it’s needed. The record also shows the family’s financial resources, aside from the government allowance.
“We have endorsed the rollout of the Desa Siaga program in our neighborhood for the last year,” says Sigit Murjati, a community leader. “We have developed a community savings system to prepare for the costs of childbirth.”
These financial contributions are used to offset the costs of transportation and medical care during and after childbirth.
When a state hospital is full, and the mother is then referred to a private hospital, the savings play a critical role since the government pays only for a stay at a state facility.
With the community preparedness system in place and health cadres all trained, Pakan Sari can better meet the needs of mothers and newborns. At the launch of the Desa Siaga program on May 15, 99 health cadres from 22 health centers came to Pakan Sari, as well as the sub-district head.
“This launching of Desa Siaga by the sub-district head is recognition from the government to the health cadres and the entire community,” says Sri Dwi Lestari, a community leader who works for the local health department. “This makes the community feel that they own the program, since the health cadres are all community volunteers. If the community doesn’t feel like they own the program, the program would not run so well.”
By Dirce Sarmento
It was her first midwife training session in more than 10 years, but Maria de Fatima Moniz made it clear she was up for the challenge. She seized a valuable opportunity this past June and participated in a two-week midwife training facilitated by ChildFund Timor-Leste and Instituto Nacional de Saude (National Institute of Health) in the Covalima district.
During her first week, Maria, 38, learned the “55 Steps” — guidelines used by midwives to ensure the safe delivery of newborns and appropriate care for pregnant women. The second week of training, based in Dili’s National Hospital, gave the group of 17 midwives the opportunity to use their practical skills while under close supervision.
“During this training, I felt very fortunate to be able to learn new knowledge about the 55 steps and safe deliveries,” Maria says.
With more than 15 years of experience caring for mothers and newborns, Maria will use the information she learned to improve the delivery process she practices in her community. She is the only midwife for five sucos (villages) in Covalima — a community of approximately 7,500 people — and works at the Tilomar clinic. Tilomar has no running water, so she has to ask families to bring their own to use during and after delivery.
“The problem we have now in our community is that we don’t have any materials for delivery, like baby napkins, and no sterile delivery set,” Maria says. Despite these challenges, Maria has successfully delivered countless babies at the clinic. She hopes that conditions will improve.
As a mother of four children, Maria understands how important it is to support pregnant women at each stage of their delivery. “After this training, I hope what I learned will help local women have clean and safe deliveries and that [maternal and infant] mortality in Timor-Leste will be reduced.” Since she began working at the clinic in 2000, she says, eight women have been taken to Suai hospital for caesareans, and two babies have died.
In Maudemo suco, where Tilomar clinic is located, 48.7 percent of births from 2005 to 2010 were assisted by a skilled health provider. Comparing this to Timor-Leste’s countrywide average of 33.5 percent highlights how Maria’s hard work is making a real difference to women and children in her community.
With new skills and support through ChildFund Timor-Leste’s project, Improving Health Outcomes for Children in Covalima District, Maria can improve the level of care for pregnant women and newborns in Tilomar. “I am grateful for ChildFund helping us in Covalima. I hope we can improve the future of this cooperation, because we still confront problems implementing the safe delivery,” says Maria. “I hope next year ChildFund can support us to give us refresher training on safe motherhood and supervision.”