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MSF capacity to begin motivating the community to support IEBF. The meetings aimed to increase MSF
members’ understanding of the importance breastfeeding for child nutrition. 3.
Sharing experiences and problem solving
MSF capacity building was done through holding periodic meetings to share experiences in the community and seek mutual solutions to problems identified in the field. This was continued with
the development of action plans on how to better support breastfeeding mothers. 4.
Advocacy
MSFs, assisted by IOs, advocated to the District Health Offices and the health centers to integrate MSF activity into their plans and budgets in order to ensure the MSF’s oversight role would
continue. The advocacy strategy included visiting health centers for discussions with center
management. With intensive assistance from the District Health Offices, the MSFs successfully advocated to the districts governments to develop regional laws on maternal and child health and
budgets that would support their implementation. 5.
Institutionalization of MSFs
Several districts chose to formalize their MSFs into legal entities. This makes the activities carried out by MSFs more powerful and sustainable.
3. Process of Change and Benefits
Changes in KINERJA’s partner districts were witnessed from multiple sides. 1.
From the district government side:
KINERJA’s partner district governments slowly began to see the benefit of increased public participation as the program progressed. The
community helped the government to identify areas for action, such as the need to establish District Head Regulations on safe delivery and IEBF and the necessity of
allocating part of the district budget for program replication to other health centers in the district. In general, government commitment to improving maternal health services was
notably higher after one year of assistance. 2.
From the supply side: Changes have been seen in how service providers think about
community participation, especially with regards to user complaints, which are now being increasingly heard and responded to. As a result, health results improved, meeting MSS
indicators. One example of the breastfeeding program ’s impact was the prohibition of formula
milk promotion and sales in all puskesmas of Probolinggo District and Makassar City; this caused a dramatic increase in the rates of exclusive breastfeeding.
3. From the demand side: The community in general but particularly members of the MSFs
became more aware of their role in monitoring health care. MSFs have brought many changes to health care, to the point that health centers now regularly take into account input from MSFs.
MSFs have also been included in the development of health care policies at sub-district and district levels. Community members in some districts also formed action groups such as the
Kelompok Peduli ASI Breastfeeding Concern Group and Ayah Peduli ASI Fathers who Support Breastfeeding to support their communities and encourage breastfeeding. Partnerships
between midwives and traditional birth attendants also run better due to MSF supervision.
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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:
