The improvement of maternal and child health (MCH) remains a key priority for both government and civil society across Indonesia. The government is hoping to reduce the maternal and child death rate from 300 per 100,000 live births in 2020 to 183 in 2024. Furthermore, according to 2018 sampling data, approximately 62 percent of maternal deaths in Indonesia occur at health facilities. To improve the labour and delivery experience and avoid preventable deaths, public health care quality must be strengthened.
For Boyolali, a rural city in Central Java, maternal and child deaths is a pressing concern and top priority for the local government. Boyolali District has the third-highest maternal and child death rate in all Central Java, with 45 maternal deaths and 131 child deaths in 2021.* Records also show that 98 maternal deaths occurred during the period from 2015 to 2020.
USAID MADANI works with Lembaga Kajian untuk Transformasi Sosial (LKTS), a local civil society organization (CSO) in Boyolali, supporting the organization to strengthen its effectiveness, legitimacy, and sustainability. This partnership aims to improve civil society participation and government accountability in public health services delivery, as well as identify local solutions to improving community responses to access health services and information for pregnant women and children. Through MADANI, LKTS established a multi-sector learning forum, Forum Masyarakat Madani (FORMMAD, the Civil Society Forum), to further this agenda. FORMMAD consists of 16 local CSOs, universities, journalists, and professional organizations.
MADANI supports local CSOs to provide policy recommendations and try out local community- community-based solutions on service delivery improvements that will have a lasting impact on the community in their hometown. Specifically, in Boyolali, the local solution is about establishing a team of community facilitators (Tim Siaga) to assist pregnant women and children in selected villages.
In response to MADANI’s efforts, the local government of Boyolali has provided a supportive environment and collaborative workspace for multiple stakeholders. The Boyolali District Secretary believes in the importance of working with all actors – government, civil society, and the private sector – to find locally-driven solutions.
In February 2021, members of the FORMMAD forum shared their action plan with the local government. The plan targets improvements in the quality of health services and policies on nutrition for pregnant women and children that will have a lasting impact on the community. To develop this action plan, LKTS and FORMMAD launched a survey in three subdistricts to better understand public opinion. The results showed that improvement is needed, especially pertaining to speed of care, caregiver attitude, proper and adequate equipment, midwife response time, availability, and matching the supply and demand for health care services.
In July 2021, FORMMAD met with village governments and midwives in two sub-districts. The village governments will draft regulations to optimize the Village Health Forums (Forum Kesehatan Desa) to improve MCH issues and provide village funds in 2022.
**Boyolali District Health Office, 2022