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CHAPTER 3 OVERCOMING
CHALLENGES AND ACHIEVING SUCCESS
KINERJA ’s experience shows that there are several challenges that must be faced when
implementing maternal health programs.
At District Government Level:
• KINERJA
’s implementation required changes to be made to some district plans and policies. This was not easy to achieve, and meant that some program activities either
could not be carried out or were poorly implemented due to a lack of support from the districts.
•
Frequent senior staff changes in the health sector – such as district health
office heads or heads of health centers – were a major obstacle to
sustainability.
At District Health Office and Health Center Level:
•
Difficulty in synchronizing schedules between district health offices and health centers.
•
Personnel at decision-making levels in district health offices and health centers sometimes provided insufficient support.
•
Several health centers refused to or were unwilling to accept the results of the community complaint surveys, primarily because they were unfamiliar with complaints as tools for
improvement.
At MSF and Community Level:
•
Difficulty in ensuring the participation of MSF members in meetings and activities without expecting reimbursement for transport.
•
A tendency in some communities and amongst some women to distrust midwives.
At IO Level:
Ringkasan Tata Kelola Persalinan Aman, Inisiasi Menyusu Dini dan ASI Eksklusif
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•
Despite capacity building, limited knowledge of good governance, safe delivery, IEBF, and facilitation techniques restricted the assistance IOs could provide to district health offices, health
centers, and MSFs.
•
Isolated geography and long distances between health centers meant it was harder to schedule and carry out multiple activities over a short period of time.
Success Stories
1. Midwife and Traditional Birth Attendant TBA
Partnerships in Singkil Health Center, Aceh Singkil District, Aceh Province
• Partnership commenced in April 2012. During the first phase, partnership was
implemented in 2 villages, which later on expanded to a total of 31 villages. •
Childbirth assisted by TBAs decreased to 0 within two years at the first health centre to implement the program. In 2011, there were 18 deliveries assisted by TBAs, which
decreased to 8 childbirths in 2012, and 0 in 2013. The number remained at 0 in 2014. •
Some health centres now involve TBAs in promoting health in the community as Village Health Motivators.
• The District Health Office has committed to replicating the partnerships across the
whole district. •
Creation of Emergency Childbirth Assistance Card and Health Care Hotline in all health centers.
2. Immediate Breastfeeding in South Singkawang Health Center, Singkawang City, West Kalimantan
Province
• Patients now feel more comfortable in asking for the healthcare they are supposed to
receive. •
Families of patients now complain to midwives when mothers are not assisted in carrying out immediate breastfeeding after childbirth.
• Requests for breastfeeding counseling have increased.
• Exclusive breastfeeding rates in Singkawang City have increased. In 2011 when
KINERJA entered the region, the percentage of infants exclusively breastfed was only 22.2. The coverage increased to 38.1 after 1 year of assistance 2012, and rose
again to 48.7 in 2013. •
All childbirths assisted by health personnel are required to include immediate breastfeeding in the South Singkawang area.
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