Paramitra staffmember interviews a Puskesmas visitor as part of a citizen perception survey to
improve the public healthcare service delivery in the region.
Malang is one of the largest districts in East Java and has a high prevalence of maternal and neonatal mortality, and stunting. In 2021, Malang ranked fifth highest among 38 districts and cities in East Java Province with 36 maternal and 68 neonatal mortalities. The major
causes of deaths were bleeding and eclampsia, but the high number of cases were further exacerbated by COVID-19 during the height of the
pandemic.
Ineffective patient referral systems, lengthy administrative processes, and the community’s lack of participation also contributed. The Malang District Government initiated a pilot program to address these issues back in 2015 in two villages, but the program has hardly shown any progress because of a lack of local ownership.
To address this issue, in 2020 Paramitra established the multi-stakeholder Learning Forum FORBAIK (Berbagi dan Peduli Kesehatan Ibu dan Bayi Baru Lahir, or “Share and Care for the Health of Mothers and Infants”). With MADANI support, the forum brought together district agencies, academia, the private sector, local CSO networks, and professional organizations, and set the goal of improving MCH by reducing the number of deaths in Malang to less than 10 cases per year. They would do so by better understating underlying causes and by collaborating more deeply with various stakeholders, building the capacity of CSOs, encouraging better public health service delivery, and improving community awareness.
Puskesmas in Turen, one of MADANI’s pilot locations in Malang district, has upgraded the entrance with a ramp to improve access for people with disabilities, among others, as a way to provide better health services for visitors by applying minimum service standards.
To address MCH and stunting, Paramitra and the FORBAIK Learning Forum started by revitalizing the Ministry of Health program Desa Siaga KIBBL (“Maternal and Child Health Alert Village”) in two pilot areas by increasing community participation and communication with Community Health Centers (Puskesmas).
In 2021, the governments of the two pilot areas, Talangsuko and Pegedangan, issued decrees (Surat Keputusan) to support the MADANI community-based initiative. This allowed Paramitra and FORBAIK to train Desa Siaga cadres on promoting good governance and train community members to participate in village development planning meetings. Since then, government support has continued to gain momentum with the two village governments covering parts of the cost for the Alert Village teams’ monthly meetings as part of the revitalization initiatives using the 2022 regional budget (APBD).
In 2022, Paramitra, together with Desa Siaga cadres and the Puskesmas, established MCH Forums (Forum Kesehatan Ibu dan Anak) in the two MADANI focus areas. The MCH Forums involved health and stunting prevention volunteers, Family Assistance Teams (TPK), and Community Empowerment Cadres (KPM) organized by the district agencies to help the villages reorganize and better coordinate the handling of their MCH and stunting initiatives.
In 2022, Paramitra and FORBAIK launched a Citizen Report Card….(CSC) survey, a community-based monitoring too (CRC) survey, a community-basedmonitoring tool to measure customers’ satisfaction, at each ofthe Puskesmas. The study showed Puskesmas were quite unpopular among patients, despite seemingly adequate services and facilities. Findings include the quality of healthcare professionals, travel time and costs associated with visiting the facilities, and cultural preference towards traditional midwives, among other reasons. The findings became the foundation of a policy brief drafted and disseminated by Paramitra, which served to encourage the Puskesmas to provide better health services by applying minimum service standards. They have for instance upgraded the entrance with a ramp and renovated the toilet to improve access for people with disabilities and launched a home service antenatal care. Other issues are also being addressed.
Paramitra and FORBAIK then targeted the revision of the district’s regulation on MCH (Perda KIBBL). In early 2023, they submitted a policy brief and carried out advocacy work to encourage the Malang District Government to improve the district’s enabling environment for civil society on MCH issues. As a result, the District Health Agency allocated IDR 200 million in their approved 2023 Budget Implementation Document (DPA) to ensure that the revised regulation is enacted and enhanced – to be focused not solely on MCH but also youth (Perda KIA dan Remaja).
Parallel to their advocacy work, Paramitra is supporting the USAID Momentum Private Healthcare Delivery (MPHD) project as part of its work to increase the quality of MCH services among private healthcare providers in Malang. Paramitra’s technical expertise inconducting the CRC attracted the attention of MPHD, which seeks to apply Paramitra’s skills to measure customers’ satisfaction at their three privately-owned hospital partners in the city. In October 2022, Paramitra and FORBAIK, in collaboration with the University of Muhammadiyah Malang and MPHD, launched the CRC survey, collecting patients’ feedback on MCH services, and presented the findings to each of the hospitals’ doctors and senior management, who responded positively to the highly anticipated results.
MPHD Policy and Advocacy Advisor, Nuwirman, commented on Paramitra’s professionalism: “They are highly recommended for such delicate work. They were very proactive, administratively sound, open to collaboration, and were involved in all phases of the survey and data collection.” Furthermore, the successful outcome has also inspired faith-based organization Muhammadiyah to apply the CRC monitoring tool at their own hospital in Malang, and potentially to others across the archipelago.
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