Members of the citizen forum participate in a MCH discussion and brainstorming session.
Their participatory approach to advocacy work on addressing maternal child health (MCH) has resulted in closer relations with the district government on improving regulations related to MCH and women’s empowerment. Citizens’ lack of access to health service facilities is one of the underlying factors that is the cause of the high maternal and child mortality rate in Bandung district, as in many other parts of Indonesia. With many low-income households, women in rural areas are mostly affected due to inhibiting transportation costs to reach Community Health Centers (Puskesmas). The distance to these facilities and the associated costs have become a barrier for women in conducting periodic pregnancy check-ups. Hence, they prefer visiting facilities closer to home despite inadequate facilities and sub-standard services.
In response, Yayasan Sapa focused on improving inclusive healthcare service delivery for pregnant women. In September 2020, with MADANI’s support, Yayasan Sapa established the multi- stakeholder Learning Forum Simpul Belajar Madani (SIMBAD). The SIMBAD Learning Forum brought together a dozen representatives from the government, civil society, youth, women, religious organizations, like-minded individuals, as well as various community-based forums that address relevant issues. Since then, they have targeted policy changes using an evidence-based and participatory approach that would increase funding for frontline health care services and expand the level of accessibility for patients from all backgrounds. One of Yayasan Sapa’s early groundbreaking advocacy successes was the adoption of new village-level regulations in December 2021 at their two pilot villages. The regulations revitalized the Ministry of Health program Desa Siaga KIBBL (“Maternal and Child Health Alert Village”) by integrating a collaborative “MCH Working Group” (Pokja KIBBL) into each of the village’s governance structures around the “Alert Village” initiative.
Dindin Syarifudin from Yayasan Sapa explained that they used the Community Score Card (CSC) − a citizen-driven monitoring and evaluation tool: “The [advocacy] achievement was the result of a multi-stakeholder effort to assess the quality of public services at Puskesmas in our pilot locations.”
Yayasan Sapa and SIMBAD host a discussion to identify challenges related to the draft regulation (raperda) on MCH in Bandung district.
Yayasan Sapa and SIMBAD invited the community, local government, and frontline agencies to take part in a problem mapping, which identified limited access to health services for poor families and a lack of budget allocation for MCH at the village level. Based on this, Yayasan Sapa and SIMBAD put their teams on the ground to organize the collaborative MCH Working Group to educate Puskesmas staff, midwives, and healthcare volunteers on MCH-related issues. They used a participatory approach to reduce maternal mortality by involving citizens within the communities to carry out early detection of women with high-risk pregnancies. Their team also worked with village government officials and facilitators from the Ministry of Villages in drafting the village budget to provide budget allocation for MCH.
About ten years ago, Sapa had established a community-based forum called Bale Istri (“Women’s Haven”) in a number of villages, serving as a community-based self-help center to empower women through education and aiding survivors of gender-based violence. With support from MADANI, Sapa has involved members of the Bale Istri forum in their MCH advocacy, and their monitoring of health expenditures and supporting access to health facilities for pregnant women and newborn children. Members of this forum have played an active and critical role in Sapa’s advocacy through their direct involvement of the communities.
In March 2023, Yayasan Sapa and SIMBAD replicated their success by establishing a collaborative MCH Working Group to the neighboring Sukamaju Village and integrating it into the village’s “Alert Village” governance structure. Yayasan Sapa then worked with Yayasan Rumah Inklusi Indonesia (RUMII) – a CSO and SIMBAD member focusing on people with disabilities – to train key individuals within Sukamaju Village’s MCH Alert Village program on providing better healthcare services for pregnant women with disabilities. The workshop briefed participants on various types of disabilities, health challenges pregnant women with disabilities may face, as well as assistance techniques and strategies to help deal with various situations.
At the district level, Yayasan Sapa and SIMBAD also pushed several recommendations to improve MCH and reduce stunting. The proposed policy recommendations on an outdated policy, District Regulation (Perda) No. 8/2009 on maternal and child health, introduced a collaborative governance approach to solve MCH and stunting by engaging all stakeholders (CSOs, academia, private sector), pushed for a more inclusive healthcare services that include people with disabilities, and pressed the creation of citizen forums from the district to the village government level. Through the development of a policy brief with evidence-based recommendations, Sapa aims to make MCH and quality of healthcare services a district priority – especially post-pandemic.
In January 2023, the Deputy Head of Bandung District accepted the policy brief and commended the multi-stakeholder Learning Forum’s contributions and partnerships with the government. The Head of the Community Health Empowerment Division of the District Health Office also responded positively and added: “The updated regulation will help form the basis for MCH improvements at the village level.” The success Sapa has had in bringing about service quality and policy improvements on this issue demonstrates the potential of MADANI’s collaborative governance approach to empower CSOs and government to work together to enhance local development outcomes.
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